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.