Trends at ASPEN 2021

The rising interest in the role of nutrition in patient treatment, augmented by the last year’s pandemic, is resulting in a breadth of new nutrition insights. Exciting developments were showcased at the latest virtual ASPEN conference, and we bring a selection of those highlights to you today. 

1. Intensive Care Nutrition and COVID-19

Nutrition in critical care patients has always been of great interest as the physiological changes in these patients are tremendous, with sudden inactivity, low intake, and insulin resistance as topics at the forefront. 

Since the beginning of 2020 this interest has risen exponentially with the rise and ongoing presence of the SARS-CoV-2 (COVID-19) pandemic which has put a huge strain on health care and Intensive Care (ICU) specifically.

Lessons learned in general ICU have shown to not be easily transferrable to patients suffering the novel COVID-19 virus, with larger trials required to find clear answers on how best to optimise care. 

Similarly, there is a lot of room for more research on how to improve immune status to reduce the risk of, and severity of infection as well as optimal care for chronic COVID-19, or long COVID-19 sufferers.

2. Timing of nutrition

Another promoted concept at ASPEN congress was an introduction to the circadian rhythm and how it impacts aspects of health and well-being. The body and each cell has an internal clock which is impacted by external cues, including light and food intake.

Health-care workers and other shift workers must adapt and re-adapt to different working hours, and this is also an important element in optimising patient care.

Regular food intake within a 24-hour schedule has been shown to impact physiological outcomes. Specifically, this schedule may help pre-diabetic patients to lose weight and improve blood glucose levels, even without an altered dietary composition.

Timing of nutrition often is less controlled in ICU care, where resting energy expenditure can vary widely with injury and illness, and often patients cannot meet their dietary goals without interventions such as nasogastric feeding or parenteral nutrition. 

Despite the lack of clarity on ideal nutrition approaches in the ICU, high protein intake from the beginning is recognised as gold standard to support recovery.

Further investigation is required to determine in detail of the sensitivity of the body to specific nutrients during the day and within sub-populations, like diabetics and elderly. This then can potentially provide an opportunity to develop more personalized nutrition care for patients.

3. Address frailty at multiple levels

With age, but also with disease, frailty has shown to be a key risk factor. Low muscle mass and function have shown an association with higher mortality in all types of patient groups, with considerable data presented on ICU patients, cancer patients as well as liver disease patients.

The combined approach of protein intake and exercise remains the primary approach, which continues to be embedded in healthcare.

Pre-habilitation focusses on an active multidisciplinary team to support the patient to increase physical activity as well as energy and protein intake in the period running up to invasive treatment such as surgery, to promote better healing, recovery, and general health outcomes.

A new area noted is the interest in mitochondrial function and its impact on frailty and sarcopenia. Mitochondrial function is shown to relate to self-reported fatigue. It is correlated most with high physical fitness and to a lesser extent with BMI and increasing age.

We expect an increasing amount of in-depth research in the future on the impact of nutrients on mitochondrial function.  Some initial results have been found already, for example, in the amino acid Glutathione.

4. Complexity of nutritional support

Nutrition management is a combination of many aspects and is seldomly a single-nutrient solution. Long term nutrition solutions work best when based on the right combination and amount of nutrients, alignment into the diet, and patient acceptance. 

Often disease results in low appetite and reduced intake. Further gastrointestinal challenges can appear during illness too, such as early satiety, which gives a feeling of fullness only after eating a small amount of food, or delayed gastric emptying, which causes feelings of discomfort and reluctance to eat. 

In these cases, small frequent meals of high nutrient density can help to achieve nutrition targets. The right nutrients that support digestion such as medium chain triglycerides or fast absorbing proteins like whey protein can also support comfort in meeting dietary goals. Finally, product format is important to reduce taste fatigue and hurdles to consumption, by providing interesting applications such as fortified shots, gels, and jellies.