In vitro studies are critical for elucidating the mechanisms contributing to disease development, such as how diet-induced obesity leads to increased risk and incidence of breast cancer. However, they are often limited to short-term trials which fail to mimic the prolonged exposure to energy excess that contributes to obesity development. This project investigates how acute and chronic exposure to the saturated fatty acid, palmitic acid, affects the oxidative stress response in MCF-7 breast cancer cells. In excess, palmitic acid increases cellular lipid load and can lead to the production of reactive oxygen species (ROS), ultimately resulting in inflammation and cellular damage. However, chronic exposure to low doses of oxidative stressors have been shown to be protective against acute stress events via a biologic process termed hormesis. The study compares short-term and long-term treatments to determine whether continuous exposure amplifies oxidative stress or activates cellular defense mechanisms. To do this, I have already been culturing MCF-7 cells in a low dose of palmitic acid, and will continue to do so for 3 months. Once cells have been chronically exposed to a low dose (50 µM) of palmitic acid, they will be acutely treated with a high dose (250 µM) of palmitic acid for 24-48 hr. Basal ROS production (before high dose treatment) will be compared ROS production after the high dose treatment in cells that have been chronically exposed to palmitic acid. Cells that have not been chronically exposed will serve as our controls. These studies will help us understand how chronic exposure to saturated fats, as occurs with diet-induced obesity, alters oxidative balance in breast cancer cells and contribute to a better understanding of how diet influences cancer progression and cellular stress responses.

Chylothorax is the accumulation of chyle within the thoracic or pleural cavity resulting
from thoracic duct leakage. This condition can arise from thoracic duct injury, increased
systemic pressure in the superior vena cava, and following the Fontan procedure for hypoplastic
left heart syndrome. Clinical manifestations include respiratory distress (coughing, shortness of
breath, and chest pain), milky fluid accumulation in the pleural cavity, and elevated triglyceride
and lymphocyte cell counts. Medical Nutrition Therapy (MNT) from registered dietitians is
instrumental in chylothorax management and treatment. Diet initiation is dependent on the
patients' individualized chest tube output, and strict fat restriction is vital to reduce chyle output.
General recommendations for limiting fat include <10 grams per day or <30% of total daily
calories. To prevent essential fatty acid deficiency (EFAD), which can occur within three to four
weeks of restriction, patients need a medium chain triglyceride (MCT) enriched diet and to
maintain two to four percent of calories from essential fatty acids. Signs and symptoms of EFAD
include poor wound healing, dry skin and rash, poor growth, and hair loss. Additional nutrition
concerns include increased protein requirements due to fluid losses, and the monitoring of fat-
soluble vitamins (A, D, E, K) and minerals (Calcium, Zinc) that bind to albumin. The case report
explores the complex nutrition needs, feeding timelines, and goals of care for a postoperative
chylothorax in a pediatric patient with hypoplastic left heart syndrome.

Background: Chronic stress among older adults increases risk for depression, anxiety, cardiovascular disease, and cognitive decline. Nature-based interventions may improve psychosocial and physiological stress outcomes, though longitudinal evidence in aging populations remains limited.

Methods: A convenience sample of community-dwelling older adults (N = 21; M age = 74.14 ± 4.59 years; range 65–85) participated in a six-week Nature Rx intervention study conducted in partnership with the Fort Worth Botanic Garden and Texas Christian University. The program included three two-week modules meeting twice weekly: garden yoga, forest bathing, and vegetable gardening. Repeated measures for the Well-Being/Personal Health Index (WPHI), positive and negative affect, nature-relatedness, outdoor activity minutes were assessed at baseline and at three subsequent time points across the program. Measures for handgrip strength (HGS), and salivary cortisol were assessed at the beginning of the first and sixth weeks, respectively. Friedman tests with Bonferroni-adjusted post hoc comparisons evaluated changes in psychosocial outcomes. Paired t-tests and repeated-measures ANOVA assessed physiological outcomes. Analyses were conducted using available cases due to incomplete measurements across time points.

Results: WPHI scores did not significantly change over time, χ²(3, n = 18) = 1.886, p = .596. Positive affect significantly increased, χ²(3, N = 18) = 13.437, p = .004, with higher final scores compared with baseline (padj = .012) and Post 2 (padj = .018). Negative affect also showed a significant overall time effect, χ²(3, N = 18) = 11.131, p = .011, though pairwise differences were not significant after adjustment. Nature-relatedness and outdoor minutes did not change (all p > .05). HGS remained stable, t(18) = −1.08, p = .294, and strength classification did not significantly change (Wilcoxon W = 3.00, p = .157). Salivary cortisol significantly decreased from pre- to post-intervention, t(21) = 7.653, p < .001 (d = 1.63); ANOVA confirmed a significant condition effect, F(1, 12) = 33.09, p < .001, ηp² = .734.

Conclusion: The intervention was associated with increased positive affect and statistically significant reductions in physiological stress, despite minimal changes in global well-being or muscular strength. These findings suggest short-term nature-based programs reduce stress burden in older adults. Larger controlled studies are needed to confirm these preliminary results.

Small bowel obstruction (SBO) is a partial or complete blockage of the small intestine preventing normal passage of gastrointestinal (GI) contents. Common causes of SBO include adhesions, hernias, tumors/malignancies, and inflammatory conditions. SBO leads to abdominal pain, distension, nausea, vomiting, malaise, dehydration, and lack of appetite. Persistent vomiting contributes to significant fluid, electrolyte, and nutrient loss, and catabolic stress. In the critical care setting, these effects have a greater significance in patients with underlying severe malnutrition. Reduced intake, nutrient malabsorption, and ongoing GI losses exacerbate energy and protein deficits leading to impaired immune function, delayed wound healing, increased morbidity and risk of excess complications, and increased length of stay. Early identification of nutrition risk and timely intervention are vital to mitigate complications including bowel ischemia, perforation, sepsis, and nutrient depletion. Evidence-based practice suggests parenteral nutrition (PN) as means of nutrition support when GI tract function is compromised or enteral nutrition (EN) is not tolerated or feasible due to excessive vomiting or required bowel rest. Cautious initiation and advancement of nutrition support and careful monitoring of electrolytes are critical to reduce the risk of refeeding syndrome in SBO patients with delayed nutrition support and underlying malnutrition. As the obstruction resolves, gradual reintroduction of oral intake is recommended through low-fiber and high-energy foods to support GI tolerance and nutritional status improvement. This case report explores the complex nutritional needs and goals of care in a patient with a SBO presenting with intractable nausea, vomiting, and pre-existing chronic severe protein-calorie malnutrition.

Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) is among the most metabolically complex conditions encountered in the intensive care unit (ICU). Medical nutrition therapy (MNT) plays a critical role in mitigating the consequences of AKI and CRRT, including hypercatabolism, electrolyte shifts, fluid overload, and amino acid losses, ultimately influencing morbidity and length of stay. Evidence-based guidelines support early enteral nutrition (EN) initiation within 24-48 hours of ICU admission in hemodynamically stable patients. Indirect calorimetry (IC) is the gold standard for energy assessment, however in practice, a weight-based predictive equation is commonly utilized due to limited availability of IC equipment. A standard polymeric formula is the first-line option for EN infusion and a renal-specific formula may be indicated when potassium, phosphorus, or magnesium levels are elevated. Protein requirements are substantially elevated in patients receiving CRRT, ranging from 1.5 to 2.5 g/kg/day, reflecting both continuous amino acid losses and the heightened catabolic state. Supplemental protein modulars may be utilized to meet these increased demands without contributing excess fluid or electrolytes. Ongoing monitoring is essential for safe and effective MNT and should include daily renal labs (creatinine, blood urea nitrogen, electrolytes), 24-hour intake, weight trends, and assessment of fluid accumulation. This case report demonstrates the application of evidence-based, individualized MNT emphasizing timely EN initiation, adequate protein delivery, careful electrolyte management, and interdisciplinary collaboration to optimize clinical outcomes in critically ill patients receiving CRRT.

Diverticulosis is the formation of several small pouches, called diverticula, within the intestinal lumen. Diverticulitis occurs when these pouches become inflamed. Risk factors for diverticular diseases include a chronically low-fiber diet, genetic predisposition, hypertension, type 2 diabetes, and obesity. Uncomplicated diverticulitis is typically managed through bowel rest and pain management. However, complicated diverticulitis, such as cases involving an abscess or fistula, often require surgical intervention, which can significantly impact nutritional status through subsequent complications during a hospital stay. Patients often experience inadequate oral intake due to prolonged diet restrictions, abdominal pain, nausea, vomiting, and fever. As a result, these patients are at increased risk for malnutrition and unintended weight loss, all of which may negatively impact recovery. The diet recommendations typically begin with complete bowel rest during inflammatory periods, with the eventual goal of gradually progressing to a high-fiber diet to prevent future recurrence. However, in patients with complications, diet progression may be delayed, requiring the initiation of enteral or parenteral nutrition to meet calorie and protein needs. Early nutrition intervention is critical to prevent further weight loss. This case report examines the diet progression following a diverticulitis flare-up with placement of colostomy in a patient who presented with severe, chronic malnutrition.

The transcription factor, Nuclear factor erythroid 2-related factor 2 (NRF2), functions by activating genes that help protect the body against oxidative stress, inflammation, and various toxins. Thus, identification of small molecules that can increase NRF2 activity could be helpful to increase the body’s natural defense system against chronic disease. The goal of this interdisciplinary project is to use cell lines generated by the Montgomery lab (Nutrition) that express a fluorescent NRF2 reporter to test a small library of novel compounds generated by the Green lab (Chemistry) for their NRF2 activation capacity. First, our reporter system will be validated with known NRF2 activators. We will then use a luciferase reporter assay to screen 15 novel compounds for their capacity to activate NRF2 compared to the known standards. These data can then be used to inform both labs about their antioxidant capacity and help optimize their furthered development and utility.

Malnutrition is a prevalent concern in older adults with dementia, due to disease progression causing oral feeding difficulties such as lessened interest in food, forgetting how to eat, food hiding behaviors, and dysphagia. Decreased oral intake is part of the natural progression for dementia, but this can be difficult for families to understand, and they often seek more aggressive forms of nutritional intervention, such as enteral nutrition feedings (EN). Although EN is frequently indicated for malnutrition, it has controversial ethical concerns within dementia patients, with little to no clinical benefit shown, and risk of complications. Current guidelines for dementia nutritional care emphasize comfort feedings, removing barriers to eating difficulties when able, and respecting patients’ desires and autonomy. Recognizing that dementia is a progressive, terminal illness that will not improve even with nutrition interventions is vital when making nutritional considerations in care. Educating the patient and family members on comfort centered care, providing favorite foods, and the natural progression of nutritional decline in dementia is essential to guide decisions surrounding whether or not to use EN. This case report explores a clinical dietitian's care plan for a 90-year-old malnourished female with dementia and food hiding behaviors, and the ethical care considerations discussed with her family to promote quality of life.

Dementia-related dysphagia is a progressive complication of advanced neurocognitive decline characterized by impaired swallowing coordination. As swallowing function deteriorates, individuals are at increased risk for aspiration pneumonia, dehydration, inadequate oral intake, and malnutrition.
Aspiration occurs when food, liquid, or gastric contents enter the airway and lungs, increasing the risk of pneumonia and other respiratory complications. Medical nutrition therapy (MNT) interventions include modification of food and fluid consistencies in accordance with the International Dysphagia Diet Standardization Initiative (IDDSI) framework, in combination with postural and behavioral strategies to reduce aspiration risk. Individuals with dysphagia, are at risk for malnutrition due to difficulties meeting estimated energy and protein requirements, due to feeding difficulties, reduced appetite, and decreased acceptance of texture-modified diets. Percutaneous endoscopic gastrostomy (PEG) placement is generally not recommended in advanced dementia, as current guidelines emphasize comfort-focused feeding and quality-of-life-centered care. However, when oral intake becomes insufficient to maintain hydration and nutritional status, PEG feeding may be considered on an individual basis following careful discussion of prognosis, risks, benefits, and patient-centered goals of care. PEG placement does not alter the progression of dementia or demonstrate improved survival in advanced dementia, however it provides a route for nutrition support and medication delivery when appropriate. A comprehensive nutrition assessment, including anthropometric trends, laboratory data, nutritional needs, fluid balance, and functional status, is essential for formula selection and ongoing monitoring. This case report highlights the complexity of nutritional clinical decision-making and ethical considerations of nutrition interventions, and interdisciplinary collaboration for individuals with dysphagia and dementia.

Background: Glucagon-like peptide 1 (GLP-1) is a key gut hormone regulating glucose homeostasis and satiety. This triple-blind, crossover, placebo-controlled randomized study investigated the effect of an L-Arginine-based supplement on active GLP-1 secretion, appetite, and food intake.

Methods: Sixteen participants (N=16) completed three conditions: a placebo and two doses of the supplement (Low-Dose, 5g; High-Dose, 10g). Supplements were consumed at time 0, and an ad libitum meal was consumed at 60 minutes. Serum samples were collected at eight time points over 120 minutes to assess circulating active GLP-1 levels.

Results: Supplementation with L-Arginine significantly augmented circulating GLP-1 levels compared to the control condition. Both doses triggered an immediate, transient rise in GLP-1, followed by a robust and significantly enhanced post-meal response relative to placebo. Analysis of the Area Under the Curve (AUC) confirmed this finding: total GLP-1 exposure was 607% greater in the High-Dose group (~ 340n pg/ml/min, p < 0.0001) and 544% greater in the Low-Dose group (~130 pg/ml/min, p = 0.0076) compared to placebo (~ 50 pg/ml/min). No significant differences in GLP-1 concentrations were observed between the two supplement doses. Secondary analyses found no differences in subsequent food intake or subjective hunger ratings between conditions, a result likely limited by the study’s power for these secondary variables (eta ~ 0.023).

Conclusions: L-Arginine is a potent secretagogue for GLP-1. These findings demonstrate that supplementation significantly increases the body's overall exposure to this crucial gut hormone, suggesting a potential role for L-Arginine in supporting metabolic health.

Gastrointestinal (GI) surgical procedures are common interventions to alleviate complications, including obstructions, hernias, and tumor formation. Recovery from these procedures may include total GI tract rest, which affects a patient’s ability to meet their nutrient needs. Post-operative complications, such as a non-healing surgical site can result in the development of a wound, further complicating the nutritional needs of the patient. Unhealed, open wounds remain susceptible to surgical site infection (SSI) and impede a patient’s quality of life. Risk factors associated with impaired wound healing include comorbidities, infection, aging, malnutrition, and immunosuppressive therapy. The wound healing process requires the production and utilization of body proteins to repair damaged tissues, placing the body into a catabolic state. As a result, protein demands increase alongside the needs for micronutrients like vitamin A and C, selenium, zinc, and iron. High nutrient needs in conjunction with contraindications for utilizing the GI tract emphasize the need for non-oral nutrition support through intravenous nutrition, known as parenteral nutrition (PN). A timely, individualized nutrition plan of care with considerations of comorbidities that emphasizes increased protein, micronutrients, and PN is vital for GI surgical patients with wounds to promote healing and decrease the risk of SSI. This case report describes the medical nutrition therapy guidelines to care for a post-operative, non-healing surgical wound for a patient with cancer and obesity.

Cirrhosis is the advanced stage of chronic liver injury marked by progressive fibrosis and hepatic dysfunction resulting from alcohol-associated liver disease, chronic viral hepatitis, or metabolic dysfunction. It may ultimately progress to decompensation with complications such as portal hypertension, ascites, variceal bleeding, and hepatic encephalopathy. Malnutrition and sarcopenia are highly prevalent in cirrhosis and are associated with increased hospitalization, infection risk, and mortality. Medical nutrition therapy (MNT) is a cornerstone of cirrhosis management that includes alcohol cessation, adequate energy intake, increased protein intake, sodium restriction, and avoidance of prolonged fasting. Despite clear guidelines, adherence is often limited by the practical ability to translate clinical recommendations into sustainable daily eating patterns. This case report explores culinary medicine as a preventative, skill-based intervention to reduce progression from compensated to decompensated cirrhosis by improving nutrition-related behavior change. Based on established cirrhosis guidelines, three culinary medicine targets are proposed: structured meal timing to support alcohol cessation, flavor-forward low-sodium techniques using herbs and spices, and intentional protein distribution to reduce catabolic stress. This framework demonstrates how integrating clinical nutrition with culinary skills may help patients apply nutrition recommendations through everyday meals and represents a feasible approach for incorporating culinary medicine into chronic disease management.

A colostomy is a procedure in which a portion of the colon is removed, the new end is externalized as a stoma, and an ostomy bag is worn to collect stool. Patients that have undergone a colostomy procedure face heightened risk of dehydration and electrolyte imbalances due to loss of colonic length. Additionally, fear of adverse symptoms can contribute to reduced oral intake and exacerbation of malnutrition. Post-operative ostomy nutrition education with a registered dietitian is beneficial to prevent complications, support recovery, and improve long-term nutritional status. Traditional post operative diet progression involves advancing to clear liquids once stoma output is established, typically on postoperative day (POD) two or later. However, evidence from enhanced recovery after surgery (ERAS) protocols and randomized trials supportsearly diet progression on POD zero or one can safely accelerate return to normal gastrointestinal function and reduce hospital length of stay. Diet tolerance should be monitored by lack of abdominal discomfort, passing of flatulence, and stoma output. Hydration status should also be closely monitored including serum sodium, blood urea nitrogen, and electrolytes. Nutrition education includes counseling on small, frequent meals; a low-fiber diet for approximately six weeks followed by gradual reintroduction to 25-30g of fiber/day; and individualized fluid recommendations with an additional 500-750mL/day to reduce dehydration risk. This case report describes post-operative nutrition management of a colostomy procedure with underlying malnutrition, emphasizing interventions of early diet advancement, nutrition support, and education to mitigate malnutrition exacerbation.

End-stage renal disease (ESRD) represents the final stage of chronic kidney disease and is characterized by progressive loss of renal function, metabolic instability, inflammation, and increased risk of protein-energy wasting. Although kidney transplantation improves survival, the early post-transplant period remains clinically complex due to surgical stress, immunosuppressive therapy, and fluctuating renal function. These factors significantly increase energy expenditure, promote protein catabolism, and predispose patients to electrolyte abnormalities, underscoring the critical role of evidence-based medical nutrition therapy (MNT). Current standards of care recommend comprehensive nutrition assessment by a registered dietitian (RD) within the first 90 days post-transplant and routine monitoring of anthropometrics, intake adequacy, and biochemical markers. For metabolically stable post-transplant patients, energy needs are estimated at 25–35 kcal/kg/day, with higher targets of 30–35 kcal/kg/day in the early post-operative period. Protein recommendations increase to 1.2–2.0 g/kg/day initially to counter negative nitrogen balance and support wound healing. Sodium intake is generally limited to <2.3 g/day for blood pressure and volume control, while potassium and phosphorus are adjusted based on laboratory trends. If oral intake is inadequate beyond several days, enteral nutrition (EN) is recommended when gastrointestinal function permits, with parenteral nutrition (PN) reserved for cases where oral and EN routes cannot meet needs. This case report illustrates the application of evidence-based MNT standards in a post–kidney transplant patient during inpatient rehabilitation and highlights the integral role of RD-led care in supporting metabolic stabilization and clinical recovery.

Acute pancreatitis (AP) is an inflammatory condition characterized by premature pancreatic enzyme activation leading to autodigestion, local tissue injury, and systemic inflammation. AP commonly causes abdominal pain, nausea, vomiting, and ileus, which can decrease oral intake and increase the risk of malnutrition. In clinical practice, patients with AP often present with comorbid conditions that further complicate feeding tolerance. Historically, bowel rest and delayed feeding were standard management strategies. However, growing evidence demonstrates that early nutrition intervention improves outcomes, including reduced infectious complications, shorter hospital length of stay, and preservation of gut mucosal integrity. Medical nutrition therapy in AP requires careful assessment of feeding tolerance, disease severity, and metabolic demands. Current evidence-based guidelines recommend early oral feeding in mild pancreatitis and initiation of enteral nutrition within 24–48 hours in moderate to severe cases, with parenteral nutrition reserved for patients unable to tolerate enteral intake or meet requirements. Recommended diet progression involves advancement to low-fat or regular diets as tolerated rather than routine use of restrictive liquid diets. Key interventions include early diet advancement, appropriate diet or formula selection based on tolerance, provision of approximately 25–35 kcal/kg/day and 1.2–1.5 g/kg/day protein, and close monitoring of fluid status and biochemical markers, with adjustments individualized to clinical status. This case report reviews current nutrition guidelines for AP and highlights the importance of implementing evidence-based nutrition strategies in a patient with complex clinical presentations and increased nutrition risk.

Non-occlusive mesenteric ischemia (NOMI) is a rare but highly fatal form of acute mesenteric ischemia, which is defined by a sudden interruption of blood supply to the intestines. NOMI occurs most commonly in critically ill, mechanically ventilated patients with hemodynamic instability presenting with low cardiac output and vasoconstriction. Mortality remains high due to diagnostic delays, rapid progression to bowel necrosis, and multisystem organ failure. While nutrition therapy is not a primary treatment for NOMI, it becomes essential following diagnosis due to repeated surgical interventions, sepsis, and increased metabolic demand, and the frequent interruption of feeding caused by hemodynamic instability. In critically ill patients, particularly with obesity, medical nutrition therapy (MNT) must balance the risks of underfeeding with the potential risks of enteral nutrition (EN) intolerance and bowel ischemia. Current evidence supports early nutrition intervention, prioritizing EN when hemodynamically stable, while initiating parenteral nutrition (PN) when EN is contraindicated or not feasible. Guidelines recommend hypocaloric, high protein feeding in obese critically ill patients to preserve lean mass and reduce the risks of complications of overfeeding. This case report highlights complexities of implementing evidence-based nutrition support in NOMI, and emphasizes the importance of individualized nutrition strategies, close monitoring, and interdisciplinary coordination to preserve nutritional status and support clinical outcomes.

Prebiotic sodas are marketed as healthy alternatives to traditional soda, but these claims have not yet been substantiated by research. This study evaluated the effects of fasted consumption of the prebiotic sodas Olipop and Poppi, compared with Diet Coke and Coca-Cola Original, on blood glucose, insulin, glucagon-like-peptide-1 (GLP-1), satiety, gastrointestinal symptoms, and beverage preference. A single-blind, repeated-measures design was employed with 10 participants. Participants completed four randomly assigned trials with a one-week washout period between each. During each visit, blood samples and satiety questionnaires were collected at baseline and throughout a two-hour trial. Beverage preference was assessed post-consumption, and gastrointestinal symptoms were evaluated using a follow-up questionnaire 24h post-intervention. The results from this study are expected to be completed by mid-April (by SRS).

The overall goal of our study is to understand how excess adiposity in women with and without
confounding cardiometabolic risk factors influences breast cancer cell growth and oxidative stress
signaling. I have already collected preliminary data indicating that activity of the antioxidant response
gene, NRF2, and expression of NRF2 targets are decreased in serum from obese subject, regardless of
phenotype. We investigated the functional consequences of these responses
by measuring and quantifying differences in reactive oxygen species (ROS) production. We also
investigated if these changes could lead to changes in breast cancer cell growth. To
investigate this, MCF7 breast cancer cells was grown in 6 distinct treatment groups reflecting varied
human metabolic health: CON (healthy control), NWO (normal weight obese), MUO (metabolically
unhealthy obese), and MHO (metabolically healthy obese), alongside the standard fetal bovine serum-
containing media a negative control. Reactive oxygen species production was assessed using a reagent
that fluoresces when it becomes oxidized by ROS. We expect cells grown in serum from obese subjects
will have higher levels of ROS production and increased invasive capacity. However, the results have yet
to be processed as of Mar 6. This research could demonstrate how total systemic metabolic health
influences oxidative stress responses and invasive potential, linking gene expression to real functional
outcomes. These insights could heavily inform medical assessments.

Congestive heart failure (CHF) is a highly prevalent form of heart disease in which the heart is unable to pump an adequate amount of blood to meet the body’s needs, with characteristic symptoms such as fluid overload, respiratory distress, and fatigue on exertion. Nutrition is an integral part of care for CHF with significant implications on health outcomes such as patient survival and quality of life. The primary goals of medical nutrition therapy (MNT) include preventing malnutrition, meeting patients’ nutritional needs, and managing signs and symptoms. CHF increases the risk of malnutrition. Evidence-based guidelines developed by the Heart Failure Society of America and the American College of Cardiology recommend weight loss for patients with overweight or obesity and weight gain for those with unintentional weight loss or cardiac cachexia, a condition involving fat loss and muscle wasting. The registered dietitian (RD), a key member of the interdisciplinary team, assesses patients’ nutritional needs and provides individualized nutrition care, including appropriate calorie recommendations and potential restrictions on sodium, fluid, and fat. Excessive sodium and fluid can contribute to volume overload, while the recommendations for fat intake address both the type and amount of fat to consume to control cholesterol levels. Despite established guidelines, implementing appropriate nutrition interventions can be complex, particularly in patients with numerous clinical needs. This case report discusses the challenges of balancing nutrition interventions with patient goals of care in a patient with CHF and malnutrition.

Patients with cancer who undergo ileostomy creation are at high risk for dehydration, electrolyte imbalance, malnutrition, and reduced quality of life due to increased gastrointestinal (GI) losses, impaired nutrient absorption, and the complex self-management and physiological demands associated with ostomy care. An ileostomy is an opening in the abdomen where the GI tract is brought to the surface, formed from the ileum. Evidence-based medical nutrition therapy (MNT) guidelines for ileostomy management emphasize a fiber-restricted diet in the early postoperative period (6-8 weeks), small, frequent meals, limitation of hypertonic and excessive hypotonic fluids, use of oral rehydration solutions, close monitoring of ostomy output, and sufficient protein intake to support wound healing. In contrast, evidence-based guidelines for severe chronic disease-related malnutrition prioritize adequate energy and protein provision, oral nutrition supplementation, weight stabilization or gain, correction of micronutrient deficiencies, and consideration of advanced nutrition support when oral intake remains inadequate. However, implementation of these standards becomes complex in the context of advanced malignancy, significant symptom burden, and evolving goals of care. This case report examines the application of evidence-based guidelines in an older adult with metastatic endometrial cancer, severe chronic disease-related malnutrition, and recent ileostomy following small bowel obstruction (SBO), illustrating the importance of individualizing MNT to the patient’s clinical trajectory and goals of care.

Oral health is an essential part of overall well-being, yet many children in underserved communities lack access to dental education and basic hygiene resources. Although cavities are completely preventable, they remain one of the most common chronic diseases affecting both children and adults. Early education is crucial for building lifelong habits and preventing future dental issues. The New Smiles initiative is a student-led outreach program focused on improving oral hygiene awareness and access to care among elementary students in the Fort Worth community.

Through interactive elementary school presentations, the program teaches proper brushing and flossing, healthy eating habits, and the importance of routine dental visits to kids. To reinforce these lessons, hygiene kits containing toothbrushes, toothpaste, floss, and educational materials were assembled in collaboration with Cook Children’s and distributed to participating students. Additionally, a brief survey was administered to assess students’ baseline knowledge of oral hygiene and evaluate the effectiveness of the educational presentation.

By combining hands-on education, community partnerships, and the distribution of essential hygiene supplies, the New Smiles program aims to promote preventive oral health practices at an early age. This initiative seeks to reduce oral health disparities while empowering children with the knowledge and resources needed to maintain lifelong dental health.

Women who are obese have a much higher risk of being diagnosed with breast cancer than women who maintain a healthy body weight. However, excess body fat, even in the absence of excess body weight, a condition referred to as normal weight obesity also increases breast cancer risk. The goal of our study is to determine how serum from human subjects with three distinct obesity phenotypes, metabolically healthy obese, metabolically unhealthy obese, and normal-weight obese, influences breast cancer cell growth and proliferation. We have already collected preliminary data indicating differences in cell viability via NADH measurement, yet metabolic activity alone does not definitively demonstrate growth or vitality because cells may be metabolically active without entering S-phase or replicating. To conclusively show DNA replication (and thus true proliferation/vitality), our plan is to quantitatively measure differences in DNA synthesis using the Click-iT EdU DNA-synthesis assay, which uses a thymidine analog incorporated into newly synthesized DNA which can be detected by the appearance of fluorescent conjugates. Based on our preliminary findings, we expect that the lower rates of metabolic activity in cells grown in serum from obese subjects are not due to reduced rates of cellular proliferation. These findings could be used to inform improved, targeted nutritional and chemotherapeutic strategies for individuals with distinct obesity phenotypes.

Sepsis-induced acute kidney injury (S-AKI) is a critical illness that causes decreased kidney function due to infection. With a prevalence of 40-50% of patients in the intensive care unit developing S-AKI, the illness is strongly associated with a higher risk of mortality, longer hospital stays, and increased risk of kidney failure relapse. S-AKI complicates medical nutrition therapy due to altered protein metabolism, increased metabolic demands, fluid imbalances, increased malnutrition risk, and electrolyte imbalances. Goals of nutrition care include close monitoring and evaluation of fluid, meeting estimated protein needs, maintaining electrolyte and vitamin status, and achieving supplemental nutrition tolerance to optimize kidney recovery and prevent malnutrition. Various nutrition interventions, such as individualized protein needs and enteral nutrition (EN), play a role in managing this illness. Evidence-based guidelines for protein recommendations vary based on the type of renal replacement therapy (RRT) and range from 1.2-2.5 g/kg/day. Patients with declining renal function prior to RRT and at risk for chronic kidney disease have a range of 0.8-1.0 g/kg/day to preserve long-term kidney function. Literature indicates initiation of EN within 24 hours is preferred over parenteral nutrition (PN) if oral intake is not feasible to prevent malnutrition. While there are no standardized fluid intake guidelines for S-AKI, continuous multidisciplinary assessment and adjustment to fluid intake are necessary to prevent volume overload. This case report reviews the importance of proactive individualized nutrition interventions to aid in patient recovery including improved nutritional status and AKI resolution.

Background: Research in animals and humans indicate that the gut microbiome plays a significant role in modulating insulin resistance1,2, while animal studies have demonstrated the gut microbiome's direct involvement in regulating body weight3,4. Furthermore, antibiotic use may impair insulin sensitivity and glucose tolerance in individuals with overweight and obesity5-9. However, no studies to date have evaluated the potential factors influencing this metabolic response.

Methods: This is a randomized clinical trial with a within- and between-subjects comparison. Seventy-five individuals aged 18-50 years (BMI 25.0-40.0 kg/m2), with no Diabetes Mellitus diagnosis, and no recent probiotic or antibiotic intake (3 months) were recruited. Participants were allocated to a synbiotic or placebo group for 12 weeks following a 3-day Vancomycin antibiotic intervention (500 mg every 8 hours). Body weight and fasting blood samples (glucose, insulin, HbA1c) were taken at the first (baseline), second (after antibiotic administration), and third visit (after synbiotic/placebo intervention). HOMA-IR was calculated from fasting insulin and glucose levels. Due to lack of normal distribution of independent variables, Mann-Whitney U tests were performed to evaluate within- and between-group changes over time.

Results: Compiled results for all participants were analyzed, although only 60 completed the study. It is important to highlight that the placebo group was significantly heavier at baseline (91.8 ± 18.1 kg) than the synbiotic group (82.8 ± 14.3 kg) (p=0.046), while the latter had a modest weight gain over time (~0.80 kg, p=.056). Neither fasting glucose nor HbA1C changed significantly between groups over time. HbA1c, insulin, and HOMA-IR slightly increased from baseline in all participants (p<.001 each), which could indicate a decreased insulin sensitivity over time, with no significant differences between groups.

Conclusion: Our unadjusted analysis demonstrates that providing a 12-week next-generation synbiotic supplementation posterior to a 3-day antibiotic intervention did not correct the commonly observed detrimental effect of antibiotics on insulin resistance. Furthermore, it seemed to lead to significant weight gain (~0.80 kg, p=.056).

Implications for future research: We are planning on re-running all our statistical analyses controlling for baseline sex and we are also planning on running an independent third group with synbiotic only for comparison purposes.

Funding Source: Pendulum® and TCU Dean’s Opportunity Grant

References
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Medical nutrition therapy is necessary for individuals at risk of impaired wound healing, such as those with malnutrition, poor circulation, or advanced age. During the acute inflammatory response from wounds, the body enters a catabolic state, increasing energy and protein needs. For those with malnutrition or at risk for malnutrition, calories should be provided at 30-35 kcal/kg body weight and protein at 1.25-1.5 g/kg body weight. Along with increased energy needs, the assessment and management of vitamins and minerals such as vitamins A, vitamin C, vitamin K, and zinc enhance the synthesis of fibroblasts needed for tissue formation. Early diagnosis and intervention for malnourished patients with chronic wounds are critical steps in providing effective patient care. Oral intake is monitored to ensure calorie and protein intake is adequate and oral nutrition supplements may be provided if indicated. For those unable to tolerate oral feeds, enteral nutrition is the next preferred method. If enteral nutrition is contraindicated then parenteral nutrition can be initiated to provide adequate calories and protein. This case report analyzes the care of a 74-year-old female with a non-healing surgical wound with a history of bariatric surgery who has been diagnosed with malnutrition.