While overnight cyclic infusions are considered standard clinical practice for home nutrition support therapy, particularly for parenteral nutrition, there is growing recognition that the optimal timing of infusion may vary among patients. A key clinical dilemma is determining the optimal timing of infusion schedules, which vary based on modality, tolerance, metabolic needs, and patient preference. Guidance from the American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) offers flexibility in selecting between daytime and nighttime infusion schedules. Overnight infusions largely reflect hospital-based cyclic regimens and offer advantages such as improved daytime independence and mobility, discretion, and potentially enhanced adherence and better tolerance with longer infusion cycles. However, advances in portable technology and a growing understanding of the role of the circadian system in governing metabolism, appetite, immune and inflammatory function, and aging have increased consideration of daytime infusions, which may better align with circadian rhythms and improve sleep quality by reducing nighttime disruptions. Selecting an optimal infusion schedule requires a patient-centered approach that balances clinical goals with quality of life, psychosocial factors, sleep, daily routines, and safety. Infusion schedule changes should be carefully monitored for tolerance, nutrition adequacy, and safety. Infusion timing should be tailored through ongoing collaboration between patients and interdisciplinary teams, with regular reassessment to ensure safety, effectiveness, and alignment with evolving patient needs.

Protein-energy malnutrition is a common complication in Crohn's disease (CD). In addition to weight loss, patients may develop significant alterations in body composition, including skeletal muscle depletion, which can negatively affect clinical outcomes and quality of life. Herein, we report on a patient with newly diagnosed CD who presented with severe malnutrition and myopenia, which persisted despite improvements in nutritional intake and body weight. A 27-year-old woman was admitted with abdominal pain, decreased appetite, nausea, vomiting, and progressive weight loss (10 kg, 22% of her usual body weight). Based on clinical presentation, family history, and magnetic resonance enterography findings, stricturing CD was diagnosed. Nutritional assessment revealed severe malnutrition (body weight, 31 kg; body mass index, 12.26 kg/m[2]; phase angle, 4.4°, intracellular-to-extracellular mass ratio, 0.75). Computed tomography-based body composition analysis demonstrated marked skeletal muscle depletion (skeletal muscle index, 27.5 cm[2]/m[2]), confirming myopenia. The patient was treated with corticosteroids, infliximab, azathioprine, and multidisciplinary nutritional management. After 12 months of follow-up, she achieved clinical remission and gained approximately 25% of her initial body weight. Despite significant weight recovery and improved dietary intake, computed tomography (CT) revealed low skeletal muscle mass and increased visceral and subcutaneous adipose tissue, indicating persistent myopenia. This case highlights the importance of comprehensive body composition assessments in CD. Clinical remission and weight gain may not accurately reflect recovery of skeletal muscle mass. Early nutritional evaluation and longitudinal body composition monitoring may be helpful in the management of patients with CD to identify persistent muscle depletion and optimize long-term outcomes.

Anthropometric characteristics and muscle strength remain insufficiently characterized in adults with congenital heart disease (CHD). The aim of the study was to characterize anthropometric indicators and muscle strength in hospitalized adults with CHD and examine differences according to cardiac lesion complexity. Exploratory comparisons with adults without CHD were performed as secondary analyses. This cross-sectional study included 109 hospitalized adults with CHD and an external convenience group of 115 adults without CHD. Body mass index (BMI), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), arm muscle area (AMA), corrected arm muscle area (cAMA), and handgrip strength (HGS) were assessed. Cardiac defects were classified as mild, moderate, or complex. Associations of lesion complexity and previous cardiac surgery with anthropometric indicators and HGS were examined using multivariable linear regression. Comparisons with adults without CHD were conducted as exploratory analyses using the same approach. Among adults with CHD, 57.8% had mild, 24.8% moderate, and 17.4% complex defects. Lesion complexity was associated with MAMC (P = 0.032); participants with complex defects had lower MAMC than those with mild defects (B = -2.44 cm; 95% CI: -4.26 to -0.63). Previous cardiac surgery was associated with higher BMI, MUAC, MAMC, and AMA. In adjusted exploratory comparisons, adults with CHD had lower weight, height, BMI, MUAC, MAMC, AMA, and HGS than adults without CHD, whereas TSF was similar. Values below reference ranges for BMI, MUAC, MAMC, cAMA, and HGS were more frequent in CHD. Greater lesion complexity was associated with lower MAMC, whereas previous cardiac surgery was associated with higher BMI, MUAC, MAMC, and AMA. Muscle-related anthropometric measures and HGS may provide complementary information beyond body size and adiposity in adults with CHD.

Perioperative hyperglycemia occurs in up to 40% of noncardiac and 80% of cardiac surgery patients, frequently independent of a diabetes diagnosis; it is driven by the neuroendocrine stress response, inflammatory cytokine release, and postoperative insulin resistance. Elevated glucose promotes protein glycosylation, which impairs wound healing and immune function, and it has been consistently associated with surgical site infection, anastomotic leak, prolonged length of stay, and increased mortality across surgical subspecialties. This narrative review examines biochemical aspects of glycogen metabolism and stress-induced insulin resistance, synthesizes evidence linking hemoglobin A1c (HbA1c) thresholds to surgical outcomes, and summarizes contemporary guidelines from the American Diabetes Association, Endocrine Society, European Society of Cardiology, Society of Critical Care Medicine, and Surviving Sepsis Campaign. Current consensus favors moderate, protocolized glucose targets (generally 100-180 mg/dL) while avoiding iatrogenic hypoglycemia. Preoperative optimization toward an HbA1c near 7%, judicious carbohydrate loading, and avoidance of glycemic extremes offer meaningful, modifiable strategies to improve outcomes in surgical and critically ill surgical patients.

Enhanced Recovery After Surgery (ERAS), as the plan A and standard for perioperative management, has shifted the focus from routine nutritional support toward the early identification and targeted management of high-risk patients. The new ICD-11 code for undernutrition offers an opportunity to better identify and characterize surgical patients at nutritional risk, while also potentially improving clinical recognition, acceptance of nutritional risk as a relevant perioperative condition, and reimbursement for targeted nutritional interventions. Early preoperative interventions should be considered. While short-term nutritional conditioning over 10-14 days primarily aims to correct nutritional and metabolic deficits, multimodal prehabilitation ideally requires 3-6 weeks to achieve meaningful improvements in physical fitness, functional capacity, and physiological reserve, particularly in patients undergoing major surgery after neoadjuvant therapy. Perioperative targeted strategies include carbohydrate loading (CHO drinks), immunomodulation, omega-3-fatty acids, hydroxymethylbutyrate, and probiotics or synbiotics. While parenteral nutrition is generally not required in low-risk patients with an uncomplicated recovery, the indication for supplemental (peripheral) parenteral nutrition should not be missed in high-risk patients with inadequate oral or enteral intake. Structured postoperative, post-discharge nutritional monitoring and rehabilitation should be integrated more consistently, especially in patients with eventful and complicated clinical courses.