Humans have a primitive defense mechanism called metabolic adaptation that slows voluntary weight loss. It works by downregulating hormones that reduce food intake and by lowering the metabolic rate. Second-generation GLP-1 receptor agonists, such as semaglutide or tirzepatide, promote weight loss by targeting this hormonal system to control appetite. Appetite can be divided into hunger, satiety, satiation, and reward eating. This review will examine how GLP-1 receptor agonists and newer satiety hormone agonists influence appetite and its components. Research indicates that these new satiety hormone agonists significantly reduce meal size and may decrease overall water intake. Additionally, the choice of highly palatable foods is affected and may extend to alcohol consumption. Clinicians need to understand how these new drugs affect food intake to counsel patients effectively. Most patients will experience gastrointestinal side effects, which can often be managed with dietary adjustments. Other clinical issues stemming from the substantial decrease in food intake will also need to be monitored. Loss of lean tissue, including bone and muscle, has been reported. Clinicians can adjust dosing of these medications but will need to make nutritional adjustments to help mitigate these effects. Now that these powerful weight-loss agents have been available for several years, vitamin deficiencies have been reported. Given the side effects of GLP-1 receptor agonists and their intended appetite suppression, clinicians' nutritional counseling and treatment become invaluable.

The administration of parenteral nutrition (PN) to neonates presents challenges related to the stability and incompatibility of both 2-in-1 and 3-in-1 admixtures when co-administered with drugs. Incompatibility data derived from adult patients cannot be applied to neonates because of distinct clinical conditions and differences in components of the admixture (e.g., neonatal amino acid formulation). This review presents an overview of the stability and influencing factors, along with the incompatibility of drug-PN mixtures in neonates within the neonatal intensive care unit setting. Various nutritional components and non-nutritional factors such as oxygen, light, pH, temperature, containers, and drugs affect the stability of PN. Patient conditions and the dosage of PN and drugs influence the stability and incompatibility of drug-PN admixtures, whether 2-in-1 or 3-in-1. Furthermore, assessing identification methods is crucial to ensure precise data regarding the stability and incompatibility of drug-PN. The standardization of PN formulas is essential for the safe administration of PN in neonates; however, individualized PN formulas offer more advantages in addressing specific nutritional requirements. Collaboration among healthcare professionals, including inter-institutional efforts, is essential to establish a consensus on the safe administration of PN to neonates.

Diabetes is commonly encountered in hospitalized adult patients. Blood glucose (BG) management in acutely ill hospitalized patients receiving nutrition support therapy with enteral nutrition (EN) or parenteral nutrition (PN) often varies from strategies utilized in stable patients with diabetes in the outpatient setting. Some degree of BG elevation is expected in hospitalized patients due to the acute stress response. However, hyperglycemia should be prevented, if possible, and treated if it occurs, as it has been shown to increase infections, length of stay, and mortality. While a variety of oral and injectable medications are utilized in outpatients who are fed orally, insulin is the primary therapy utilized in hospitalized patients receiving nutrition support therapy. The use of insulin, interruptions in nutrition support therapy, and abrupt changes in clinical status all increase the risk of hypoglycemia, which is associated with increased morbidity and mortality in acutely ill patients. The aim of this review is to discuss application of recent guideline recommendations and offer practical strategies for safe and effective management of hyperglycemia with nutrition support therapy in hospitalized patients with diabetes.

The increasing prevalence of obesity has transformed intensive care and nutritional therapy of patients with obesity from a specialized problem to standard care. The dilemma in providing nutrition to critically ill patients with obesity is that current and historical nutritional guideline recommendations are based on expert opinion, are divergent, and are sometimes contradictory. None has been evaluated in a clinical trial. All but one are based on body weight, which results in a sex difference in the protein dose per fat free mass (FFM). We propose a standardized body weight (SBW22) to determine energy delivery, but to measure FFM as the reference parameter for protein administration. In case FFM cannot be measured, we describe an estimation based on measurements of 1420 healthy humans. While energy delivery based on SBW22 will result in a progressive hypoalimentation (based on calories/kg body weight) with increasing body mass index (BMI), a protein dose based on FFM will ensure an equal protein delivery over a broad range of BMI for both sexes. We propose this simple and physiological approach that should be evaluated in a clinical trial.

Traditional nutritional assessments in pediatric oncology, such as weight and body mass index, often fail to accurately capture changes in body composition, frequently masking significant muscle depletion, or secondary sarcopenia. This retrospective case series evaluates the novel clinical application of muscle ultrasound (mUS) by a pediatric oncology dietitian to help objectively guide and monitor nutrition interventions. We report our observations regarding three pediatric patients with cancer (one school-aged child and two adolescents/young adults). Serial mUS measurements of the quadriceps femoris and rectus femoris were obtained alongside standard anthropometric data. Nutritional interventions, including appetite stimulants and enteral nutrition, were tailored based on these combined assessments. In all three cases, mUS findings were discordant with total body weight trends. One patient exhibited weight gain on appetite stimulants, but mUS revealed concurrent muscle loss, prompting a transition to enteral nutrition. Conversely, another patient experienced persistent weight loss, but mUS confirmed muscle preservation and growth and led to reduced healthcare utilization. These observations suggest mUS is a feasible, non-invasive tool with potential to complement conventional anthropometric measures by detecting subclinical muscle changes that may otherwise be missed. Given the small, heterogeneous sample and retrospective design, these findings should be considered as hypothesis-generating rather than conclusive and warrant further validation in larger, prospective studies before mUS can be recommended as a standard component of nutritional assessment in pediatric oncology.

This case series explores the feasibility and clinical considerations of implementing the ketogenic diet therapy (KDT) for epilepsy management in patients with ileostomies. Two pediatric patients with medication-resistant epilepsy and ileostomies continued KDT under clinical supervision. The first patient had an ileostomy placed while on KDT. Fluids and electrolytes were increased initially, although sodium (Na) levels remained within a normal range. The second patient had an ileostomy before starting KDT. Hyponatremia and acidosis occurred initially. With routine laboratory monitoring, and electrolyte and bicarbonate supplementation, normal laboratory values were achieved. Overall fluid needs did not change. Both patients maintained adequate hydration and electrolytes. Seizure control was not compromised in either case while having an ostomy. This study supports the feasibility of KDT in patients with ileostomies, while also highlighting the need for individualized monitoring of hydration status and electrolytes, specifically sodium levels.