Diet plays a critical role in the development, progression and prognosis of inflammatory bowel disease (IBD) . Given that specific nutritional guidelines are limited, nutritional management for patients with IBD remains challenging and fraught with uncertainty. Although previous studies have demonstrated that artificial intelligence (AI) shows promising applications in the nutritional management of patients with chronic diseases, research specifically focused on its application in the nutritional management of patients with IBD remains limited.

To conduct a scoping review of studies on AI in nutrition management of patients with IBD.

Following the methodology of scoping reviews, the databases of PubMed, Web of Science, Embase, Cochrane Library, CINAHL, IEEE Xplore, Association for Computing Machinery Digital Library, SinoMed, CNKI, Wanfang Data, and VIP were systematically searched from inception to March 2024 for studies on the application of AI in the nutritional management of patients with IBD. According to the established inclusion and exclusion criteria, two investigators independently screened the literature, and the basic characteristics of the selected studies were extracted.

A total of 15 studies were included. The applications of AI in this field include exploring the relationship between diet and IBD, assisting in nutritional assessment, and aiding nutritional interventions. The majority of utilization AI technologies in the included studies are machine learning, with some also employing additional techniques such as natural language processing and deep neural networks.

AI is beneficial for exploring healthy dietary patterns for patients with IBD and providing personalized nutritional guidance. However, its application in the field of nutritional management in patients with IBD is still in its infancy. Future efforts should focus on strengthening multidisciplinary collaboration, emphasizing the integration of clinical guidelines, and assessing the effectiveness of AI applications in clinical settings to enhance the rigor and accuracy of the results.

Malnutrition has become one of the adverse complications in patients with cirrhosis, and early nutritional screening and early identification of patients with cirrhosis can effectively improve clinical outcomes, however, the types of nutritional screening tools for patients with cirrhosis are varied and not yet standardized, and further research is needed.

To evaluate the applicability of 4 nutritional screening tools for patients with cirrhosis.

CNKI, VIP, Wanfang Data, PubMed, Embase, Cochrane Library and Web of Science were searched for diagnostic studies related to nutritional screening tool screens for malnutrition in cirrhotic patients. The search time was limited to December 2023. Two researchers individually read and filtered the literatures, extracted data, and assessed the bias risk of the incorporated researches. RevMan 5.4.1, Meta-DiSc, and StataMP 17.0 were used to perform network meta-analysis. The sensitivity, specificity, positive predictive value and negative predictive value of different nutritional screening tools were ranked by the surface under the cumulative ranking curve (SUCRA) .

5 Chinese and 5 English literatures were incorporated, totaling 10, including 1 299 patients; and four nutritional screening tools were included: the Nutritional Risk Screening 2002 (NRS2002), the Royal Free Hospital-Nutritional Prioritization Tool (RFH-NPT), the Malnutrition Universal Screening Tool (MUST), and the Subjective Global Assessment (SGA). The findings of meta-analysis revealed that the combined sensitivity of the four nutritional screening tools was 0.65 (95%CI=0.56-0.73), 0.93 (95%CI=0.89-0.96), 0.77 (95%CI=0.72-0.82), respectively. The combination specificity was 0.87 (95%CI=0.83-0.91), 0.72 (95%CI=0.64-0.79), 0.81 (95%CI=0.68-0.90), and MUST only be studied separately, without the combination sensitivity and combination specificity. The results of network meta-analysis showed the sensitivity and negative predictive value of SGA were lower than that of RFH-NPT (OR=0.03, 95%CI=0-0.55; OR=0.08, 95%CI=0.01-0.81, P<0.05) ; and the sensitivity and negative predictive value of RFH-NPT were higher than that of NRS2002 (OR=44.33, 95%CI=3.94-498.52; OR=17.68, 95%CI=2.13-147.05, P<0.05). The results of the combined subject work characterization curve (SROC) showed that the area under the SROC curve (AUC) for screening for malnutrition in cirrhotic patients was 0.86 for NRS2002, 0.90 for RFH-NPT, and 0.85 for SGA. The SUCRA values of the tools ranked in terms of combined sensitivity from highest to lowest were RFH-NPT (SUCRA=99.5%) >MUST (SUCRA=43.0%) >SGA (SUCRA=39.0%) >NRS2002 (SUCRA=18.5%) ; the SUCRA values of these tools ranked in terms of combined specificity from highest to lowest were: MUST (SUCRA=91.4%) >NRS2002 (SUCRA=49.1%) >SGA (SUCRA=39.8%) >RFH-NPT (SUCRA=19.7%) ; the SUCRA values of these tools ranked in terms of positive predictive value from highest to lowest were MUST (SUCRA=95.2%) >RFH-NPT (SUCRA=37.4%) >NRS2002 (SUCRA=36.1%) >SGA (SUCRA=31.3%) ; the SUCRA values of these tools ranked in terms of negative predictive value from highest to lowest were RFH-NPT (SUCRA=99.1%) >MUST (SUCRA=44.9%) >SGA (SUCRA=39.4%) >NRS2002 (SUCRA=16.7%) .

The current evidence shows that RFH-NPT and MUST are suitable, but this conclusion still needs to be further confirmed by large samples and multiple high-quality studies.

With the increase of the aging population, age-related health problems have garnered increasing attention. Compared to physiologic diseases with significant clinical symptoms, the mental health issues of the elderly are often overlooked. The underlying depressive states and high incidence of chronic diseases collectively contribute to a decline in quality of life in old age. Moreover, metabolic diseases, more prevalent in the elderly, significantly impact brain health, potentially leading to neurological damage and cognitive decline.

This study aims to investigate the relationship between depression, cognitive status, and nutritional and metabolic status among elderly individuals in the community.

We selected 3 767 elderly individuals who participated in physical examinations at the Youyi Street Community Health Service Center in Baoshan District, Shanghai. The demographic data on sex, age, BMI and waist-to-hip ratio were collected. The evaluations included the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA), and Activities of Daily Living Scale (ADL). Metabolic syndrome-related diseases and the 10-year cardiovascular disease risk were assessed using clinical metabolic indicators, and Pearson correlation analysis was used to explore the correlations among these indicators.

This research showed that significant differences were found in age, MNA, MMSE scores, the proportion of people at high risk of cardiovascular disease and the 10-year cardiovascular disease risk grade among the different groups (P<0.05). Correlation analysis indicated that the GDS score was negatively correlated with the total MMSE score and its sub-item scores, except for the repetition ability score. MNA and ADL were positively correlated with the total MMSE score (P<0.05). Additionally, GLU and HbA_1c levels were negatively correlated with immediate recall ability in the MMSE (P<0.05) .

Our findings suggest that depression in the elderly is associated with cognitive decline, while better nutritional status is linked to improved cognitive performance. Focusing on and improving metabolic health in the elderly may enhance their mental state and overall mental health.

The prevalence of diabetes and cardiovascular diseases in China has been increasing annually, and it has been demonstrated that diabetes can exacerbate the adverse effects of cardiovascular diseases through nutritional and inflammatory pathways. The prognostic nutritional index (PNI) is a marker of immunonutrition that reflects the inflammation, immune status and nutritional status of an individual. Due to its advantages of simplicity, rapidity, accessibility, and reliability, research on PNI has been increasing, yet its role in cardiovascular diseases has been less explored.

To investigate the relationship between PNI and major in-hospital adverse cardiovascular events (MACE) in patients with acute ST-elevation myocardial infarction (STEMI) complicated by type 2 diabetes mellitus (T2DM) following percutaneous coronary intervention (PCI) .

A retrospective analysis of 1 053 STEMI patients with T2DM who underwent PCI at the First Affiliated Hospital of Xinjiang Medical University from January 2015 to June 2023 was conducted. The patients were divided into the MACE (n=177) and non-MACE (n=876) groups according to the occurrence of MACE during hospitalization, and further categorized into the high PNI (n=686) and low PNI (n=367) groups according based on the cutoff value of PNI to predict the occurrence of in-hospital MACE after PCI in patients with STEMI and T2DM. Univariate and multivariate Logistic regression analyses identified factors influencing in-hospital MACE after PCI in patients with STEMI and T2DM. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of PNI for in-hospital MACE, and the area under the curve (AUC) was calculated. Pearson correlation analysis or Spearman rank correlation analysis was used to explore the correlation between PNI and cardiovascular disease risk factors.

The differences between the MACE and non-MACE groups in gender, age, history of hypertension, serum glucose, Killip classification, lactate dehydrogenase, heart rate, myoglobin, creatine kinase-MB isoenzyme (CK-MB), white blood cell count, brain natriuretic peptide (BNP), PNI, Global Registry of Acute Coronary Events (GRACE) score, hemoglobin, platelet count, lymphocyte count, albumin, total protein, creatinine, urea nitrogen and triacylglycerol were statistically significant (P<0.05). The results of multivariate Logistic regression analysis showed that elevated serum glucose (OR=1.055, 95%CI=1.002-1.112, P=0.044) and higher GRACE score (OR=1.034, 95%CI=0.876-0.939, P<0.001) were risk factors for in-hospital MACE, while increased PNI (OR=0.907, 95%CI=1.017-1.050, P<0.001) was a protective factor. The AUC of PNI for predicting in-hospital MACE was 0.734 (95%CI=0.694-0.773). A predictive model was constructed by Logistic regression analysis, and the model predicted an AUC of 0.791 (95%CI=0.753-0.858) for the occurrence of in-hospital MACE after PCI in patients with STEMI complicated by T2DM. The low PNI group showed higher incidence of MACE and proportion of intra-aortic balloon counterpulsation, longer hospitalization duration, higher levels of serum glucose, troponin T, CK-MB, myoglobin, BNP, C-reactive protein, creatinine, and urea nitrogen than those in the high PNI group; and lower optical coherence tomography ratio, total cholesterol, triacylglycerol, HDL-C, and hemoglobin levels than those in the high PNI group (P<0.05). The results of correlation analysis showed that PNI was positively correlated with hemoglobin, HDL-C, total cholesterol, and triacylglycerol (P<0.05) ; PNI was negatively correlated with serum glucose, creatinine, urea nitrogen, BNP, troponin T, CK-MB, myoglobin, and C-reactive protein (P<0.05) .

PNI is an independent predictive factor for in-hospital MACE in STEMI patients with T2DM after PCI, which can serve as an auxiliary indicator for monitoring patients' immunonutritional status and predicting their short-term prognosis.

The health and nutrition survey databases of China, the United States, and Korea are all focused on national health and nutrition surveillance, which have become important public resources for data mining in recent years. The construction status, brief histories, sampling methods, and survey contents of the three health and nutrition survey databases were compared and analyzed, it was found that the main difference lies in the types of study design, with cohort study used in China, cross-sectional survey used in both the United States and Korea. Then, the database-based publication volume and research hotspots were visually analyzed and found that the upward trend is more prominent in the United States, the research hotspots of the three databases were consistent with the themes of the health and nutrition survey. Finally, the construction and application of the databases were discussed and recommendations were made, which was expected to provide a path for relevant researches and better encourage the generation of scientific evidence.

Esophageal cancer is one of the most aggressive gastrointestinal tumors. Advanced esophageal carcinoma is mainly associated with dysphagia. Most elderly patients with severe obstruction esophageal carcinomacannot tolerate anesthesia and invasive treatment due to comorbidities, while the failure to improve dysphagia in the short term will seriously affect the nutritional status, life quality and prognosis of patients.

To explore the safety and efficacy of image-guided photodynamic therapy (IGPDT) under local anesthesia for short-term improvement of obstruction and nutritional status in elderly patients with severe obstruction esophageal carcinoma.

A total of 24 elderly patients with severe obstruction esophageal carcinoma admitted to Hebei General Hospital from March 2020 to December 2021 were selected for IGPDT in the prospective, single-arm, self-control study. The upper boundary of the lesion was located by endoscopy and marked with metal tissue clips, the lower boundary of the lesion was located by CT and esophagography before treatment. During the treatment, the fiber of laser treatment was delivered to the lesion site under the guidance of X-ray fluoroscopy during treatment. The Stooler dysphagia score was evaluated before, 1 week and 1 month after operation. The nutritional status of patients was evaluated by nutritional risk screening 2002 (NRS 2002) score, hemoglobin, BMI, albumin and prealbumin before and 2 months after operation. The swallowing quality of life scale (SWAL-QOL) was used to evaluate the quality of life in patients.

All patients achieved partial response (PR) at 1 month postoperative efficacy evaluation. The Stooler dysphagia scores at 1 week and 1 month after IGPDT were significantly lower than that before operation (P<0.001). BMI, albumin and prealbumin at 2 months after operation were significantly increased than that before operation (P<0.05). The total score and scores of different dimensions in SWAL-QOL at 2 months after operation were significantly higher than those before operation, including psychological burden, appetite, eating time, fear of eating and swallowing symptoms (P<0.05). 92% (22/24) of the patients presented with grade 1-2 mild fever, and most of them could be relieved on their own. 83% (20/24) of the patients presented with grade 1-2 pain at the site of operation at 1-2 days after surgery but could be relieved by themselves. No esophageal fistula occurred in all patients during the operation, and no serious adverse effects of grade 3 or above occurred.

IGPDT has the advantages of easy operation, excellent efficacy and safety, and short-term improvement of nutritional status in patients, which can be used as a novel photodynamic therapy for patients with severe obstruction esophageal carcinoma cannot be passed by endoscopy.

Malnutrition is a common complication in patients with esophageal cancer, which has been validated by domestic and international studies to seriously impact the recovery of patients. While the number of patients receiving home enteral nutrition (HEN) is increasing, the effectiveness and safety of HEN for patients with esophageal cancer remains unclear.

To systematically evaluate the effectiveness and safety of HEN by meta-analysis.

RCTs on the HEN in patients with esophageal cancer were retrieved in PubMed, Cochrane Library, Embase, Web of Science, CINAHL, Scopus, Wanfang Data, CNKI, VIP and CBM from inception to December 2021. Patients in the experimental group received HEN support〔both enteral tube feeding (ETF) and oral nutritional supplement (ONS) were both acceptable〕, while patients in the control group received conventional oral diet only. Two researchers independently screened the literature and extracted data. The RoB 2.0 recommended by the Cochrane Collaboration was used to evaluate the quality of the included studies, and the RevMan 5.4.1 software was used to perform the meta-analysis.

A total of 14 articles were included, involving 1 040 patients with esophageal cancer. Meta-analysis showed that the increase values of body mass, BMI, hemoglobin, serum total protein, serum prealbumin and serum transferrin in the experimental group were higher than those in the control group〔SMD=0.63, 95%CI (0.40, 0.85), P<0.000 01; SMD=0.60, 95%CI (0.44, 0.76), P<0.000 01; SMD=1.58, 95%CI (1.37, 1.79), P<0.000 01; SMD=1.19, 95%CI (0.79, 1.58), P<0.000 01; SMD=0.97, 95%CI (0.79, 1.14), P<0.000 01; SMD=1.12, 95%CI (0.45, 1.79), P=0.001〕. The increase value of serum albumin in the experimental group was higher than that in the control group in both ETF and ONS subgroups analysis〔SMD=1.25, 95%CI (0.82, 1.68), P<0.000 01; SMD=0.61, 95%CI (0.26, 0.97), P<0.000 01〕. The incidence of malnutrition was lower in the experimental group than in the control group〔OR=0.47, 95%CI (0.33, 0.67), P<0.000 1〕. There was no statistically significant differences in the incidence of gastrointestinal complications〔RR=1.33, 95%CI (1.00, 1.77), P=0.05〕and life quality score〔MD=4.97, 95%CI (0.06, 9.87), P=0.05〕 between the two groups. The physical function score of the experimental group was higher than that of the control group〔MD=6.67, 95%CI (2.86, 10.48), P=0.000 6〕, and the fatigue symptom score was lower than that of the control group〔MD=-7.31, 95%CI (-11.85, -2.77), P=0.002〕. Sensitivity analysis showed that the combined results were stable and reliable.

HEN can significantly improve the nutritional status and physical function, reduce fatigue symptoms of discharged patients after esophageal cancer surgery, and does not increase the incidence of gastrointestinal complications, however, it has not been found to improve the global overall quality of life.

The older adults are high risk population for malnutrition. Malnutrition is closely associated with numerous adverse clinical outcomes, which may seriously affect the physical health and life quality of the older adults, causing heavy burdens on families and society. Therefore, it is of great importance to take effective measures to improve malnutritionin the older adults, and non-pharmacological interventions have been proved to be important measures to improve nutritional status. However, there is no domestic clinical practice guideline for non-pharmacological interventions specifically for malnourished older adults. Therefore, nutrition experts from China Gerontological Nursing Alliance, National Center for Gerontology and National Clinical Research Center for Geriatric Disorders developed the guideline based on the Grading of Recommendation Assessment, Development and Evaluation (GRADE) including 9 recommendations of non-pharmacological intervention formal nourished older adults through a comprehensive search and analysis of the latest domestic and international literature on malnutrition in the elderly, in order to improve malnutrition and quality of life in the older adults. This guideline focuses on malnourished older adults who can be fed orally and enteral nutrition, parenteral nutrition is not covered by the scope of this guideline.

Maintaining brain health is an advanced goal of healthy ageing. Eating a diet with appropriate nutrients has been identified as a promising approach to reducing the risk of dementia, but community-dwelling residents have inadequate or no health guidance from medical workers since there is no detailed and comprehensive clinical dietary nutrients management program for brain health promotion for community-dwelling people .

To search, evaluate and summarize the evidence on dietary nutrients management for brain health promotion in community-dwelling people, providing an evidence-based basis for clinical implementation of such management for this group of population.

In March 2022, we searched UpToDate, BMJ Best Practice, JBI Model of Evidence-based Healthcare, National Institute on Aging, Registered Nurses' Association of Ontario, the Cochrane Library, PubMed, CNKI, Medlive and other databases to collect literature (involving clinical decisions, recommended practices, guidelines, evidence summaries, expert consensuses and systematic reviews) regarding dietary nutrients management for brain health promotion in community-dwelling people. The retrieval period was from January 1, 2017 to March 29, 2022. Two researchers systematically trained in evidence-based medicine independently screened literature, extracted data, and evaluated the quality of the included literature. Then evidence was extracted from the included literature, and its quality was graded, then the best evidence was summarized.

A total of 28 studies with an overall high methodological quality were included, including three clinical guidelines, five expert consensuses, one clinical decision and 19 systematic reviews. Finally, 23 pieces of best evidence were summarized, involving seven aspects of intervention timing, dietary nutrients assessment and screening, dietary patterns and components, specific nutrients, coffee intake, body weight management, health education and guidance.

Eating a diet with appropriate nutrients can promote brain health of residents. Community medical workers should develop an individualized dietary nutrients management program for brain health for them in accordance with the practical clinical situation, residents' current dietary nutrients status and preferences, and insights from the best evidence.

As an important modifiable factor that can be intervened, nutrition is closely related to the occurrence of frailty. Early identification of frailty through nutrition evaluation and reversal of its occurrence is of great significance for improving clinical outcomes. There are few available studies on the predictive value of nutrition-related parameters for frailty among older patients in the emergency department (ED) .

To evaluate the relationship between commonly used nutrition-related parameters and frailty among older adults in the ED.

Two hundred and ten people aged≥65 years were recruited from the Department of Emergency Medicine, China Rehabilitation Research Center (Beijing Bo'Ai Hospital) from January to October 2021. The demographic data were recorded. Fasting venous blood sample was collected within 24 hours after admission to measure routine indicators. The nutritional risk was assessed by Nutrition Risk Screening 2002 (NRS2002) . The basic activities of daily living were evaluated by Barthel Index (BI) . The Clinical Frailty Scale (CFS) was used to assess frailty, and individuals with CFS levels 1-4 (n=68) and those with CFS levels 5-9 (n=142) were assigned to non-frail group and frail group, respectively. Multivariable Logistic regression was used to analyze the factors associated with frailty in older patients in the ED. Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve were used to evaluate the predictive validity of nutrition-related parameters for frailty in older patients in the ED. Nonparametric DeLong test was used to compare the area under the ROC curve (AUC) of each parameter.

There were statistically significant differences between frail and non-frail patients in mean age, sex ratio, mean body mass index (BMI) , prevalence of coronary heart disease, mean levels of hemoglobin (HGB) , albumin (ALB) , prealbumin (PA) , high-sensitivity C-reactive protein (hs-CRP) and 25-hydroxyvitamin D〔25 (OH) D〕, and mean score of NRS2002, as well as mean BI and length of hospital stay (P<0.05) . Multivariable Logistic regression analysis showed that higher PA〔OR=0.943, 95%CI (0.891, 0.998) , P=0.041〕 and 25 (OH) D〔OR=0.909, 95%CI (0.844, 0.979) , P=0.012〕were protective factors of frailty in older patients in the ED. The risk of frailty decreased by 44.6% for every 100 mg/L increase in PA, and decreased by 61.7% for every 10 μg/L increase in 25 (OH) D. However, higher NRS2002 score〔OR=1.701, 95%CI (1.353, 2.138) , P<0.001〕was the risk factor of frailty in older patients in the ED, and the risk of frailty increased by 70.1% for every one score increase in NRS2002 score. Hosmer-Lemeshow test showed PA (χ²=6.120, P=0.634) , 25 (OH) D (χ²=5.386, P=0.716) and NRS2002 score (χ²=4.758, P=0.446) had good goodness of fit. ROC analysis demonstrated showed that the optimal cutoff values of PA, 25 (OH) D and NRS2002 score for predicting frailty in older patients in the ED were 211.9 mg/L, 7.06 μg/L and 3 points, respectively, and the AUCs of them were 0.749, 0.670 and 0.835, respectively. Nonparametric DeLong test showed that the AUC of NRS2002 score was greater than that of PA (Z=2.241, P=0.025) and 25 (OH) D (Z=3.400, P<0.001) .

As frail patients have poor nutritional status, nutritional assessment contributes to early identification of frailty. Among the nutrition-related parameters, PA, 25 (OH) D and NRS2002 score can effectively predict frailty in older patients in the ED, and NRS2002 score may have the strongest predictive ability.

Considerable evidence suggests that people with depressive disorder are at higher risk for somatic symptoms than normal people, but the mechanisms of susceptibility are unclear. Some studies suggest that the levels of precursor of brain-derived neurotrophic factor (ProBDNF) and inflammatory cytokines in depressive disorder patients are higher, but it is still unclear whether this is related to the accompanying somatic symptoms.

To explore the characteristics of somatic symptoms, and their correlations with BDNF and inflammatory cytokines in patients with major depressive disorder (MDD) .

A total of 59 MDD outpatients and inpatients from Mental Health Department, First Hospital of Shanxi Medical University and 32 healthy volunteers from the community were recruited from February 2019 to December 2020. Somatic symptoms were diagnosed using the Somatic Self-rating Scale (SSS, SSS score >36 and SSS score ≤36 were defined as with somatic symptoms or without, respectively) . Depression was assessed using the Hamilton Depression Rating Scale (HAMD-17) . Clinical data were collected, including gender, age, years of education, HAMD-17 score, SSS score, absorbance of ProBDNF and BDNF, and inflammatory cytokines (CRP, IL-4, IL-10, IL-18, IL-23a, HMGB1, IL-6, TNF-α, IFN-α) . Spearman's rank correlation analysis was used to investigate the correlation of somatic symptoms (including dizziness and headache, frequent and urgency of urination, cardiovascular symptoms, muscle soreness, gastrointestinal symptoms, tingling and twitching of hands and feet, choking and sighing, blurred vision, and discomfort of the throat) , SSS-S factor score and HAMD-17 score with ProBDNF and BDNF, and inflammatory cytokines.

MDD patients with somatic symptoms had higher total HAMD-17 score than those without (P<0.001) . Both MDD patients with and without somatic symptoms had higher total HAMD-17 score than healthy volunteers (P<0.001) . MDD patients with somatic symptoms had higher total SSS score and SSS-S factor score than those without (P<0.001) . And they also had higher total SSS score and SSS-S factor score than healthy volunteers (P<0.001) . MDD patients with somatic symptoms had higher BDNF than those without (P<0.05) . The IFN-α in healthy volunteers was lower than of MDD patients with or without somatic symptoms (P<0.001) . ProBDNF was negatively correlated with muscle soreness (r_s=-0.262, P<0.05) . CRP was negatively correlated with tingling and twitching of hands and feet (r_s=-0.386, P<0.01) . IL-4 had a negative correlation with gastrointestinal symptoms (r_s=-0.336, P<0.01) . IL-10 had a positivecorrelation with blurred vision (r_s=0.286, P<0.05) . BDNF was positively correlated with dizziness and headache (r=0.339, P<0.01) , cardiovascular symptoms (r_s=0.309, P<0.05) , gastrointestinal symptoms (r_s=0.278, P<0.05) , muscle soreness (r_s=0.419, P<0.01) , tingling and twitching of hands and feet (r_s=0.286, P<0.05) , choking and sighing (r_s=0.372, P<0.01) , discomfort of the throat (r_s=0.392, P<0.01) and SSS-S factor score (r_s=0.418, P<0.01) . IL-6 was positively correlated with cardiovascular symptoms (r_s=0.283, P<0.05) and choking and sighing (r_s=0.374, P<0.01) . TNF-α was negatively correlated with muscle soreness (r_s=-0.299, P<0.05) . IFN-α showed a negative correlation with blurred vision (r_s=-0.267, P<0.05) .

The peripheral blood IFN-α of MDD patients was lower than that of normal people. The severity of depression and BDNF level were higher in MDD patients with somatic symptoms than those without. The elevation of multiple inflammatory cytokines was correlated with the increase in the risk of somatic symptoms, suggesting that patients with MDD may be prone to somatic symptoms and adverse outcomes, requiring early intervention.

Protein-energy malnutrition (PEM) is a common nutritional deficiency. With the change of lifestyle and eating habits, people pay increasing attention to nutritional health problems, and PEM may have different effects on the health of different age groups.

To analyze the overall and age-specific trends of PEM incidence in 1990-2019 and to predict its incidence in 2020-2029 in China.

The data of this study were derived from the Global Burden of Disease Study 2019, involving mortality indicators, and incidence indicators in 18 age groups (ranged from 0 to over 85 years grouped by an interval of 5 years) of PEM in China from 1990 to 2019. The age-standardized rates were calculated using the world standard population. Joinpoint regression analysis was used to calculate the annual percentage change (APC) and annual average percentage change (AAPC) of the incidence rate and 95% confidence interval, and to describe the temporal trend. The autoregressive integrated moving average (ARIMA) model was used to predict the incidence of PEM in China from 2020 to 2029.

(1) In 2019, the standardized incidence ratio (SIR) of PEM in the whole population of China was 1 996.5/100 000, and that in males (2 444.7/100 000) was higher than that in females (1 536.0/100 000) . The SIR of PEM in the whole population in China was lower than that of the world standard population (2 099.4/100 000) , and that of PEM in Chinese males was higher than that in the world standard male population (2 304.0/100 000) . The incidence of PEM was highest in <5 years old group (4 402.5/100 000) , followed by 80-84 years old group (2 417.7/100 000) . After 5 years old, the incidence of PEM in both males and females increased with age, but that was still higher in males. (2) The SIR of PEM in China from 1999 to 2019 generally showed six inflection points, which were in 1995, 2006, 2010, 2014, 2017 and 2019, respectively. The SIR of PEM in China showed a downward trend in periods from 1990 to 1995 (APC=-1.3%) and from 2010 to 2014 (APC=-2.3%) (P<0.05) . But from 1995 to 2006 and 2006 to 2010, it showed an upward trend, with APC of 0.9% in 1995, and of 2.5% in 2010, respectively (P<0.05) . The growth trend of the SIR of PEM was the most obvious in 2017-2019, with an APC of 8.9% (P<0.05) . The SIR of PEM in China increased at an average annual rate of 0.7% from 1999 to 2019 (AAPC=0.7%, P<0.05) . (3) The age-specific incidence of PEM in China from 1999 to 2019 showed that the incidence of PEM decreased at an average annual rate of 2.1% in the population under 5 years old, but showed a steady upward trend in other 17 groups (P<0.05) . In age groups of 75-79 and 80-84, the incidence of PEM increased at each time interval from 1999 to 2019 (P<0.05) . (4) The ARIMA model-based prediction showed that the incidence of PEM in China might continue to rise from 2020 to 2029, reaching 7 280.06/100 000 in 2029.

In 2019, the SIR of PEM in the whole population in China (1 996.5/100 000) was lower than that in the world standard population (2 099.4/100 000) , but that of PEM in Chinese males was higher than that in the world standard male population (2 304.0/100 000) . The SIR of PEM in China increased at an average annual rate of 0.7% from 1999 to 2019, and it might continue to rise until 2029.

Malnutrition is frequently observed in stroke patients. Most of the previous studies focused on their nutritional status at the time of admission, but there is a lack of studies on the nutritional status in different periods of hospitalization.

To investigate the influencing factors of nutritional status in stroke patients at different time points (admission, the 7th day and discharge) .

The study comprised 177 patients with the diganosis stroke admitted to the Department of Rehabilitation Medicine of the First Affiliated Hospital of Zhengzhou University between January and December 2021. According to the nutritional status, the patients were divided into nutritional normal and malnutrition groups at different time points. General data of the patients were being collected, including gender, age, hypertension, diabetes, post-stroke pneumonia, post-stroke anxiety and depression, obstructive sleep apnea hypoventilation syndrome (OSAHS), history of smoking and alcohol consumption, and mode of nutritional support〔oral feeding only, nasogastric tube only (NGT), intermittent oral to esophageal tube feeding only (IOE), combined parenteral nutrition (PN) 〕. Assessment of patients′ swallowing function using the Water Swallow Test (WST), and the degree of neurological deficits can be evaluated by the National Institutes of Health Stroke Scale (NIHSS). Univariate and multifactorial Logistic regression analyses were used to determine the factors influencing the nutritional status of stroke inpatients at different time points.

The incidence of malnutrition in stroke patients at admission, the 7th day and discharge were 11.9%, 32.2% and 19.8%, respectively. The rate of malutrition on the 7th day of admission was higher than admission and discharge (P<0.05). At the time of admission, between the normal nutrition group (n=156) and the malnutrition group (n=21) in the age, smoking and drinking history, nutritional support mode, and WST score, there were significantly different (P<0.05). On the 7th day of hospitalization, the normal nutrition group (n=120) was significant differences in age, post-stroke pneumonia, nutritional support mode, WST score and NIHSS score compared with malnutrition group (n=57) (P<0.05). At the time of discharge, the differences were statistically significant in nutrition support mode, WST score and NIHSS score between the normal nutrition group (n=142) and malnutrition group (n=35) (P<0.05). At the time of admission, WST score〔OR=2.118, 95%CI (1.390, 3.226), P<0.001〕was the influencing factor of malnutrition. On the 7th day, age〔OR=1.035, 95%CI (1.001, 1.070), P=0.028〕, combined-PN〔OR=19.206, 95%CI (3.188, 115.707), P=0.001〕and NIHSS score〔OR=1.108, 95%CI (1.029, 1.194), P=0.007〕were influencing malnutrition. Only-NGT〔OR=13.518, 95%CI (1.783, 102.493), P=0.012〕and combined-PN〔OR=18.445, 95%CI (2.870, 118.531), P=0.002〕are the influencing factors at the time of discharge.

The incidence of malnutrition is higher in stroke patients at admission, the 7th day and discharge. WST score is an influential factor for malnutrition at the time of admission. On the 7th day, the age, PN, and NIHSS score are influencing factors relevant to malnutrition. At the time of discharge, only-NGT and combined-PN are meaningful factors for malnutrition.

High blood pressure can cause damages of target organs such as the heart, brain, kidneys and retina, while diabetes can cause a series of metabolic disorders, resulting in a variety of complications. Both are major risk factors for cardiovascular and cerebrovascular diseases. Eating a healthy diet may significantly contribute to the prevention and control of hypertension and diabetes.

To investigate the effects of a Chinese-style DASH diet in improving the nutritional status of community-living patients with type 2 diabetes and hypertension.

Sixty-one hypertensive patients with type 2 diabetes with medical records created in Chongqing Sihai Community Health Center were selected to undergo an eight-week Chinese-style DASH diet intervention, including dietary guidance (at 1 and 2 weeks) , eating the Chinese-style DASH diet provided using a group-based approach (at 3 and 4 weeks) , and home-based medical care (at 5 to 8 weeks) . Food frequency survey and 24-hour dietary recall were used to investigate the dietary structure and nutritional intake at baseline and after intervention. Anthropometric indicators (BMI and waist-to-hip ratio) , blood lipids (triacylglycerol, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol) , glycemic control and hypertension control status at baseline and after intervention were compared.

A total of 59 cases were included in the study. Regarding dietary structure after intervention, the average daily intake of soy, nuts, pickled products, fried foods and salt significantly decreased in subjects, while that of fresh fruit, milk and dairy products increased significantly (P<0.05) . Regarding nutritional status, the daily average intake of fat and sodium was significantly reduced, while that of dietary fiber, calcium, potassium and magnesium was significantly increased (P<0.05) . The number of participants eating a diet with a recommended ratio of fat increased significantly (P<0.05) . Health monitoring showed that total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure and 2-hour postprandial glucose were partially improved after intervention (P<0.05) . From the 4th week of the intervention, the control rate of 2-hour postprandial glucose at follow-up was significantly higher than the baseline level (P<0.05) , and it reached 69.5% at the end of the intervention. Except for the 2nd week of the intervention, the blood pressure control rate at follow-up was notably higher than the baseline level (P<0.05) , and it reached 67.8% at the end of the intervention.

Eating the Chinese-style DASH diet helps to promote the health in community-living hypertension patients with type 2 diabetes via effectively adjusting the inappropriate diet structure and improving the nutritional status.

The prevalence of heart failure (HF) is growing in a rapidly increased number of older adults (≥60 years) , which, together with older age, produces an impact on nutritional status of the HF cases. But there are relatively few studies on the impact of nutritional status on the prognosis in elderly patients with chronic HF.

To investigate the association of nutritional status with prognosis in elderly patients with HF with preserved ejection fraction (HFpEF) and coronary heart disease.

A retrospective cohort study was conducted. Inpatients with HFpEF and coronary heart disease (≥60 years old, NYHA gradeⅡ-Ⅳ) treated in Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University between 2017 and 2019 were enrolled. Clinical and laboratory data were collected. HF-related readmission and all-cause mortality within one year after discharge were followed up. Nutritional status was evaluated by controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI) . Patients were divided into non-malnutrition group (CONUT score 0-1, n=42) , low malnutrition risk group (CONUT score 2-4, n=181) and medium-high malnutrition risk group (CONUT score 5-12, n=156) . The differences in clinical data and prognosis among the three groups were compared. Univariate and multivariate logistic regression analyses were used to explore the influencing factors of readmission due to HF and all-cause mortality within one year after discharge. ROC analysis was used to analyze the prognostic value of CONUT score, GNRI and PNI for readmission due to HF and all-cause mortality within 1 year after discharge.

Age, proportion of elderly patients, sex, BMI, bed rest, length of hospital stay, NYHA grade, hemoglobin, lymphocytes, urea nitrogen, creatinine, total protein, albumin, triacylglycerol, total cholesterol, low density lipoprotein cholesterol, B-type brain natriuretic peptide (BNP) , all-cause death within 1 year were compared among the three groups, and there were statistically significant differences (P<0.05) ; among them, age, proportion of elderly patients, bed rest, length of hospital stay, NYHA grade, old myocardial infarction, urea nitrogen, creatinine, BNP, and all-cause death within 1 year in the no-malnutrition risk group and the low-malnutrition risk group were significantly lower than those in the medium-high malnutrition risk group (P<0.05) , and BMI, hemoglobin, lymphocytes, total protein, albumin, triacylglycerol, total cholesterol and low-density lipoprotein cholesterol were significantly higher than those in the medium-high malnutrition risk group (P<0.05) . Univariate logistic regression analysis showed that age, bed rest, length of stay, NYHA grade, hemoglobin, albumin, BNP, left ventricular ejection fraction, CONUT score, GNRI and PNI are the influencing factors of readmission due to HF and all-cause death within 1 year (P<0.05) . Multivariate logistic regression analysis showed that CONUT score〔OR=1.567, 95%CI (1.302, 1.885) , P<0.05〕 is an influence factor of all-cause death within 1 year (P<0.05) . ROC analysis estimating the performance in predicting all-cause mortality within one year after discharge showed that the AUC of CONUT score was 0.780〔95%CI (0.714, 0.845) 〕 with 0.723 sensitivity and 0.722 specificity when the optimal cut-off value was determined as 7.5, the AUC of GNRI was 0.695〔95%CI (0.604, 0.786) 〕with 0.532 sensitivity and 0.833 specificity when the optimal cut-off value was determined as 89, and the AUC of PNI was 0.722〔95%CI (0.643, 0.800) 〕 with 0.723 sensitivity and 0.654 specificity when the optimal cut-off value was determined as 41.

CONUT score can be used as the preferred nutritional evaluation tool for mortality risk assessment in elderly patients with HFpEF and coronary heart disease, and nutritional intervention may become one of the therapeutic targets for reducing mortality in the future.

Patients with diabetic foot undergoing endovascular therapy for lower extremity arterial disease exhibit poor outcomes and a high mortality rate. It is unclear whether malnutrition assessed by geriatric nutritional risk index (GNRI) is associated with clinical outcomes in these patients.

To investigate the association of baseline malnutrition assessed by GNRI and clinical outcomes of endovascular therapy for lower extremity arterial disease in patients with diabetic foot.

Ninety-five patients who were admitted in Department of Endocrinology, Sun Yat-sen Memorial Hospital due to diabetic foot and lower extremity arterial disease were included from January 2011 to December 2016. All of them received endovascular therapy and followed up for two years. Baseline GNRI was assessed, and divided into three levels: normal nutrition (43 cases) , mild malnutrition (31 cases) and moderate to severe malnutrition (21 cases) . Clinical characteristics were collected, including sex, age, diabetes duration, smoking, body mass index, prevalence of cardiovascular and cerebrovascular diseases, diabetic foot classification, systolic and diastolic blood pressure, and blood test results containing white blood cell count, platelet count, lymphocyte count, neutrophil count, neutrophil-to-lymphocyte ratio, hemoglobin, fasting blood glucose, glycosylated hemoglobin, total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, albumin, creatinine, and estimated glomerular filtration rate. The primary endpoint was all-cause mortality, and the secondary endpoint was major lower extremity amputation. The Kaplan-Meier curve was used for survival analysis. Univariate and multivariate Cox proportional hazards regression analysis were analyzed to evaluate the risk factors of all-cause mortality.

Fifty-two cases (54.7%) were assessed with malnutrition (GNRI≤98) . Normal nutrition, mild malnutrition, and moderate to severe malnutrition patients had significant differences in average body mass index, leukocyte count, neutrophil count, neutrophil-to-lymphocyte ratio, hemoglobin, triglyceride and albumin (P<0.05) . During the follow-up, 16 patients died, 10 of whom were due to cardiovascular or cerebrovascular diseases; five patients underwent major lower extremity amputation. The two-year survival rate was 92.1%, 75.6% and 50.1% in normal nutrition, mild malnutrition, and moderate to severe malnutrition patients, respectively, showing statistically significant difference (Log-rank test: χ²=10.812, P=0.004) . GNRI≤98〔HR=3.937, 95%CI (1.070, 13.942) , P=0.037〕 was an independent risk factor for all-cause mortality.

The two-year survival rate of patients in normal nutrition group (GNRI>98) was higher than that in malnutrition group (GNRI≤98) . Baseline GNRI-assessed malnutrition may be an independent risk factor for all-cause mortality in diabetic foot patients with lower extremity arterial disease treated by endovascular therapy, so assessing and improving the nutritional status may better improve the clinical outcome of these patients.

Chronic heart failure is a syndrome occurring at the end-stage of multiple cardiovascular diseases. In the condition, nutritional and metabolic problems such as loss of appetite, diarrhea, abdominal distension, and constipation are highly prevalent, which in turn affect the prognosis of heart failure. The relationship of nutritional assessment results with prognosis in chronic heart failure has been studied extensively, while nutritional assessment for older adults with chronic heart failure has been rarely studied, and there is no clinically recognized assessment method.

To perform a comparative analysis of four nutritional assessment methods in terms of clinical prognosis prediction in elderly patients with chronic heart failure.

Eligible older inpatients with chronic heart failure (n=199) were recruited from Department of Cardiology, ICU, and Department of Geriatrics, Linyi People's Hospital from June 2018 to June 2020. Data were collected via reviewing the medical records and telephone-based follow-ups, including sex, age, height, weight, serum albumin (ALB) level, BMI, Geriatric Nutritional Risk Index (GNRI) , and result of Nutrition Risk Screening 2002 (NRS2002) , as well as prognosis〔containing three classifications: in-hospital deaths (n=43) and in-hospital survivors (n=156) ; one-year deaths (n=51) and one-year survivors (n=148) ; readmission within half a year (n=69) and readmission after half a year (n=130) 〕. Multivariate Logistic regression analysis was used to explore the prognostic factors of chronic heart failure. The analysis of ROC curve with AUC value was carried out to comparatively estimate prognosis predictive values of the nutritional assessment methods.

There were significant differences in mean age, serum ALB, GNRI and NRS2002 score between in-hospital deaths and survivors (P<0.05) . The mean age, height, serum ALB, GNRI and NRS2002 score were also significantly different between one-year deaths and survivors (P<0.05) . Those with readmission within half a year had significantly different mean BMI, serum ALB, GNRI and NRS2002 score compared with those with readmission after half a year (P<0.05) . For predicting in-hospital death, the AUC of serum ALB was 0.76〔95%CI (0.68, 0.84) , P<0.001〕, and that of NRS2002 score was 0.80〔95%CI (0.73, 0.86) , P<0.001〕. In predicting one-year death, the AUC of serum ALB was 0.75〔95%CI (0.67, 0.82) , P<0.001〕, and that of NRS2002 score was 0.82〔95%CI (0.76, 0.88) , P<0.001〕. The AUC of NRS2002 score in predicting readmission within half a year was 0.73〔95%CI (0.65, 0.80) , P<0.001〕.

On the whole, NRS2002 score could be the first choice for prognostic assessment in elderly patients with chronic heart failure, for it was more effective in predicting the risks of in-hospital death, one-year death and readmission within half a year than serum ALB level, GNRI and BMI.

The prevalence of hip fractures is increasing due to increased number of aging people and availability of modern transportation. Elderly patients with hip fracture tend to have many basic diseases and poor prognosis, with 1-year postoperative mortality as high as 15%-25%. Timely screening of those at high risk of hip fractures with predictive tools and providing them with interventions can improve the prognosis. But there are rare studies and no appropriate objective indicators regarding predicted 1-year postoperative mortality in older hip fracture patients.

To assess the predictive association of Controlling Nutritional Status (CONUT) score and other possible associated factors for 1-year postoperative mortality in elderly patients with hip fracture.

A total of 399 patients with unilateral hip fracture (including femoral neck and intertrochanteric fractures) hospitalized in Xuanwu Hospital Capital Medical University from January 2013 to March 2016 were selected. General data, routine blood test results, biochemical and coagulation indices, and calculated CONUT score, geriatric nutritional risk index (GNRI) and neutrophil-to-lymphocyte ratio (NLR) were collected. All the patients received internal fixation or femoral head replacement procedure, and 1-year postoperative clinic- and telephone-based follow-up with death as an endpoint. Multivariate Logistic regression was used to identify influencing factors of 1-year postoperative mortality. Receiver operating characteristic (ROC) curve analysis was used to analyze the predictive value of CONUT score for 1-year postoperative mortality.

Among the 399 patients, 47 died and 352 survived at the end of follow-up. Multivariate Logistic regression analysis found that age〔OR=1.093, 95%CI (1.040, 1.148) 〕, old cerebral infarction〔OR=0.353, 95%CI (0.169, 0.737) 〕, serum creatinine〔OR=1.006, 95%CI (1.002, 1.010) 〕, CONUT score〔OR=1.261, 95%CI (1.005, 1.583) 〕 and NLR〔OR=1.049, 95%CI (1.003, 1.098) 〕 were associated with 1-year postoperative mortality (P<0.05). In predicting 1-year postoperative mortality, the area under the curve of CONUT score was 0.681〔95%CI (0.590, 0.771) 〕 with 4.5 as the optimal cutoff point, 48.9% sensitivity and 83.5% specificity. The area under the curve of NLR was 0.611〔95%CI (0.523, 0.699) 〕, with 7.055 μg/L as the optimal cutoff point, and 47.8% sensitivity and 75.9% specificity.

Age, old cerebral infarction, serum creatinine, CONUT score and NLR were associated with 1-year postoperative mortality in elderly patients with hip fracture. Preoperative CONUT score greater than 5 may be associated with worse postoperative nutritional status and higher risk of death. The CONUT score could be used for postoperative risk assessment in these patients.

Enteral nutrition (EN) is one important clinical treatment for severe acute pancreatitis (SAP) , but the optimal timing of initiation remains controversial.

To evaluate the efficacy of EN within 24 hours of admission in the treatment of SAP by applying a Meta-analysis.

Databases of PubMed, EMBase, the Cochrane Library, Web of Science, CNKI, VIP, Wanfang Data and SinoMed were searched to identify randomized controlled trials (RCTs) about efficacies of usual care and EN within 24 hours of admission (experimental group) versus usual care in combination with EN or oral eating after 24 hours of admission or parenteral nutrition immediately after admission (control group) in SAP patients included from inception to July 2021. Meta-analysis was performed using RevMan 5.4 software.

A total of 13 RCTs involving 1 193 patients were included. Meta-analysis results revealed that, compared to usual care with control interventions, usual care with EN within 24 hours of admission had better effects on reducing the mortality〔RR=0.61, 95%CI (0.39, 0.95) , P=0.03〕, incidence of multiple organ dysfunction syndrome (MODS) 〔RR=0.56, 95%CI (0.36, 0.86) , P=0.009〕and incidence of pancreatic infections〔RR=0.55, 95%CI (0.33, 0.91) , P=0.02〕, and post-treatment APACHE Ⅱ score〔MD=-2.18, 95%CI (-2.55, -1.80) , P<0.000 01〕. Further subgroup analysis indicated that, usual care with EN within 24 hours of admission was superior to usual care with parenteral nutrition immediately after admission in decreasing the mortality〔RR=0.28, 95%CI (0.11, 0.73) , P=0.009〕, incidence of MODS〔RR=0.40, 95%CI (0.20, 0.79) , P=0.009〕and pancreatic infections〔RR=0.50, 95%CI (0.25, 0.98) , P=0.04〕.

Available evidence showed that, EN within 24 hours of admission had better efficacy for SAP, and initiating EN within 24 hours of admission may be beneficial to the treatment of SAP.

Cirrhosis is a chronic consumption disease, whose impact on patients' physical function and nutritional status has been increasingly valued by the academic community. It is helpful to promote the innovation and development in nutrition for cirrhosis in China by reviewing the hotspots in global research on nutrition for cirrhosis periodically.

To perform a bibliometric and visualized review of the development, hotspots, and trends of studies on nutrition for cirrhosis published from 1991 to 2021, providing a reference for future studies related to nutrition in cirrhosis.

The studies about nutrition in cirrhosis published during 1991-2021 were searched from the database of Web of Science. Collaboration and co-occurrence network analyses supported by CiteSpace were used for data mining and visualization analysis of countries, institutions, authors, keywords, and burst keywords relevant to studies of nutrition in cirrhosis .

A total of 1 520 studies were finally included, the yearly number of these studies demonstrated a wave-like growth during the period of 1991-2021, in particular, it exceeded 100 in 2020 and 2021. The U.S. ranked first in terms of the number of published studies (424) and intermediary centrality value (0.32). As for institutions, Mayo Clinic (the U.S.) ranked first in terms of the number of published studies (25) and intermediary centrality value (0.08), followed by Gifu University (Japan), Cleveland Clinic (the U.S.), and Aarhus University Hospital (Denmark). Inter-institutional collaborative networks were formed in the U.S., with Mayo Clinic and Cleveland Clinic, as the core, and in Europe, with Charite (Germany) and Karolinska Institute (Sweden) as the core. A total of 891 authors were included in the collaborative network, represented by TANDON P and KAWAGUCHI T. High-frequency keywords included nutritional status, liver transplantation, and body composition. Sarcopenia was the keyword with the strongest citation bursts (strength 26.170 9) .

Nutritional assessment, liver transplantation and body composition may be hot topics in research on nutrition in cirrhosis. And the pathophysiological mechanisms of malnutrition and nutritional management in patients with cirrhosis and sarcopenia may be foci of future research.

In China, elderly patients with non-small cell lung cancer (NSCLC) accounts for the highest percentage of lung cancer patients, and most of them are found to have no surgical possibilities at the time of diagnosis. Moreover, these patients are increasing as aging advances. Increasing their survival rate will help to reduce the overall mortality of lung cancer patients. So identifying effective prognostic indicators in NSCLC patients with non-surgical treatment is of great significance in prognostic stratification, which also contributes to clinical studies aiming at improving the survival rate of such patients via prognostic stratification-based treatments.

To investigate the relationship between systemic immune-inflammatory-nutritional index (SIINI) and survival in non-surgically treated elderly patients with NSCLC.

Patients (n=231, ≥65 years old) with first treatment for NSCLC were retrospectively recruited from Hebei General Hospital from January 1, 2014 to June 30, 2018. Clinical characteristics were collected, mainly including age, sex, prevalence of smoking, baseline diseases, BMI, pathology, differentiation, and clinical stage of NSCLC. Some calculated data based on baseline routine blood test parameters, and/or serum albumin, and/or BMI using different approaches were also collected, including neutrophil to lymphocyte ratio (NLR) , derived NLR (dNLR) , platelet to lymphocyte ratio (PLR) , prognostic nutrition index (PNI) , systemic immune-inflammation index (SII) , advanced lung cancer inflammatory index (ALI) and SIINI 〔using a formula proposed in clinical retrospective studies, in which all variables are measured before treatment: (neutrophil count×platelet count×hemoglobin level) / (lymphocyte count×BMI×serum albumin level) 〕. Post-treatment follow-up was conducted till February 1, 2020 through outpatient reexamination, telephone or text messages with death as the endpoint. For assessing prognostic values of NLR, dNLR, PLR, PNI, SII, ALI and SIINI, ROC analysis was performed with defined optimal cut-off value and the area under the curve (AUC) for each indicator (if the AUC value is less than 0.5, then the optimal cut-off value is defined using the median value, by which the AUC value is defined as large or small when it is greater or less than the value) . The survival curves were comparatively analyzed by different patient characteristics. Cox regression analysis was applied to identify the influencing factors of survival. The survival rate curve was visualized using GraphPad Prism 8.0.2.

The optimal cut-off values using NLR, dNLR, PLR, PNI, SII, ALI and SIINI in assessing the prognosis were 3.30, 2.51, 179.99, 273.65, 736.54, 46.05 and 102.89, respectively. The survival curves varied significantly by age, sex, prevalence of smoking, pathology, differentiation, and clinical stage of NSCLC, NLR, dNLR, PLR, ALI, SII, PNI and SIINI (P<0.05) . Further analysis indicated that the difference between the survival curves of 65-70-year-olds and 76-and-over-year-olds was statistically significant (P<0.05) . The survival curves between those with low or moderate differentiation and those with high differentiation were significantly different (P<0.05) . The survival curves of patients with stageⅠ NSCLC were different from those of patients with stage Ⅱ, Ⅲ or Ⅳ NSCLC (P<0.05) . Cox regression analysis revealed that ≥76 years old (P<0.001) , highly differentiated NSCLC (P<0.001) , stage Ⅲ NSCLC (P=0.012) and Ⅳ NSCLC (P<0.001) and SIINI (P=0.001) were prognostic factors of patients. Moreover, there existed significant differences in survival curves by NLR, dNLR, PLR, ALI, SII, PNI, and SIINI (P<0.05) .

We found that SIINI, a new indictor calculated based on immunity, inflammation and nutrition factors, is effective in predicting the overall survival in non-surgically treated elderly patients with NSCLC, and it may be superior to NLR, dNLR, PLR, PNI, SII, ALI in terms of survival prediction-related application and in-depth research.

Enteral nutrition support can effectively improve the nutritional status of patients with severe brain injury, which is beneficial to the prognosis of patients. However, the relevant literature in China and abroad lacks a systematic nutritional management plan for such patients, and there is rare summary of the best evidence for enteral nutrition support.

To retrieve and summarize the best evidence of enteral nutrition support in adult patients with severe brain injury, and provide evidence-based evidence for the clinical nutrition management of such patients.

All evidence on enteral nutrition in adult patients with severe brain injury was retrieved from databases and websites including BMJ Best Practice, Up To Date, GIN, NICE, NGC, RNAO, Yimaitong, ESPEN, ASPEN, SCCM, ESICM, JBI Library, Cochrane Library, PubMed, EMBase, CINAHL, CBM, CNKI, Wanfang Data, VIP. The retrieved evidence included guidelines, evidence summaries, best practices, expert consensus, systematic reviews and meta-analysis. The retrieval period was from April 2011 to April 2021. Corresponding quality evaluation criteria were used to evaluate the quality of the included literature, and the evidence was described and summarized using the JBI Evidence-based Health Care Center Evidence Pre-grading System (2014 edition) and JBI Evidence Recommendation Rating System (2014 edition) .

A total of 18 articles were included, including 5 clinical guidelines, 3 evidence summaries, 3 expert consensus, 2 systematic reviews, and 5 meta-analysis. Their methodological qualities were rated high overall. Finally 25 pieces of best evidence involving 8 aspects were nutrition screening, nutrition assessment, timing of initiating enteral nutrition, energy and protein requirements, enteral nutrition composition, feeding route, infusion method and complication management.

When giving enteral nutrition to adult patients with severe brain injury, medical staff need to implement it based on the best evidence. At the same time, an individualized enteral nutrition support program should be formulated in combination with the current medical status and specific treatment goals in China to improve the effect of nutritional support, thereby improving the clinical outcome of patients.