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.