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.