During progression of chronic kidney disease (CKD), the requirements and utilization of different nutrients change significantly. These changes ultimately place patients with kidney disease at higher risk for nutritional and metabolic abnormalities. Understanding the applicable nutritional principles, the available methods for assessing nutritional status, establishing patient-specific dietary needs, and preventing or treating potential or ongoing nutritional deficiencies and derangements is therefore essential for optimal care of the patients with CKD.

Oral nutritional supplementation with Nepro®, as part of a structured, directly observed peridialytic therapy in chronic hemodialysis patients was well-accepted, and resulted in the maintenance of serum albumin levels and QOL, with respect to impact of physical health on daily activities

The International Society of Renal Nutrition and Metabolism set up a panel to define nomenclature for the wasting syndrome, as distinct from malnutrition and inflammation, associated with chronic kideny disease (CKD) and acute kideny injury (AKI)

In adults with CKD 3-5D or posttransplantation, it is reasonable that a registered dietitian nutritionist (RDN) or an international equivalent conduct a comprehensive nutrition assessment (including but not limited to appetite, history of dietary intake, body weight and body mass index, biochemical data, anthropometric measurements, and nutrition-focused physical findings) at least within the first 90 days of starting dialysis, annually, or when indicated by nutrition screening or provider referra

Hyperleptinemia reflects better nutritional status and rHuEPO response in long-term HD patients. Increasing energy intake through high-energy, high protein renal-specific supplements (Nepro®) improves erythropoiesis, which may be mediated in part by an increase in serum leptin levels.

Maintenance hemodialysis patients with albumin levels < 3.5 g/dL who received monitored intradialytic oral nutritional supplements showed survival significantly better than similar matched patient controls, with the as-treated analysis highlighting the potentially large effect of this strategy in clinical practice

HMB supplementation reduces post exercise muscle damage, and thuscaccelerates recovery. It also allows for increases in lean body mass, improved strength and aerobic capacity.

HMB (ß-hydroxy-ß-methylbutyrate): A scientific review New Perspective on Lean Body Mass

Video HMB mechanism of action Thai version

The Role of Amino Acids and Their Metabolites in Supporting Muscle Health in Aging and Illness

COVID-19 patients often suffered from malnutrition and sarcopenia. In addition, patients may have other complications of organs and gastrointestinal symptoms, resulting in the risk of malnutrition which can compromise their immune system and the severity of disease complications, leading to unfavorable clinical outcomes in both short- and long-terms.

Early nutrition intervention help support patients:

Improve nutrition intake, fast recovery and muscle strength.

Reduce the disease complications

In this infographic, see the role muscle plays in overall health, and why maintaining muscle matters

The important of nutrition in surgery and learn more on ESPEN’s complete guidelines on Clinical Nutrition in Surgery.

Maintain or improve muscle through good nutrition including oral nutrition supplements

The case study video

The lecture Video

Nutrition Matter_ Video Malnutrition in the Healthcare Setting from an Asian Perspective

HMB supplementation seems to be a feasible alternative for the maintenance of muscle mass in the population over 65 years, especially in bedridden or sedentary elderly, aiding in the reduction of muscle catabolism. Three grams of HMB seem to be the optimal dose to promote these benefits.

The effective amount of HMB (3 g/day) is extremely difficult to obtain from the normal diet, given the low quantities of HMB available in foods and the low conversion rate of leucine to HMB. Several studies have shown positive effects of HMB supplementation on body composition, muscle mass and strength, and physical function in older adults.

Enhanced Recovery After Surgery (ERAS) Programs Over the last decade, Enhanced Recovery After Surgery (ERAS) programs have been adopted as the standard of perioperative care across the world. 

Nutritional status is a strong predictor of postoperative outcomes

Clinical summary overview ONS Summary

The ESPEN poster: SECONDARY ANALYSIS OF THE EFFORT TRIAL

Nutrition Matter_TH Malnutriition infographic

Nutrition Therapy as Part of Multimodal Intervention for the Management of Frail Elderly Patients-case study 2

This systematic review shows that HMB can improve lean body mass and preserve muscle strength and function in older people with sarcopenia and frailty.

The Asian working group for sarcopenia (AWGS) is established and work with collaboration in Taiwan, Japan, Korea, Hongkong, China and Southeast Asian countries such as Thailand. The special interest groups of AWGS studied sarcopenia in the following categories: definition, epidemiology, diagnosis, and intervention. The AWGS consensus (AWGS 2014 and AWGS 2019) has been widely accepted and cited in many important medical journals about sarcopenia.

Exercise and nutrition can fight with sarcopenia

Sarcopenia often overlaps with malnutrition, especially in older patients.

Sarcopenia is defined as skeletal muscle disorders due to aging processes leading to decreased muscle strength, increased functional impairment and disability, raised mortality, and lessened quality of life.

Nutrition Matter_TH Simple pathway for nutrition care

Undernutrition and resultant muscle loss (muscle atrophy), as associated with aging and disease, can lead to adverse health and economic consequences. Nutrition and exercise are key to growth and maintenance of muscle promoting overall health, well-being, and recovery from disease.

Good nutrition is an integral component of patient care.

The branched-chain amino acid (BCAA) leucine acts as both a ‘trigger’ for the initiation of protein synthesis, and as a substrate for newly synthesized protein.The observation that HMB enhances muscle protein anabolismmay partly (or wholly) underlie its pre-defined anabolic/anti-catabolic supplemental efficacy in humans

Disease-related malnutrition occurs when nutrient intake is insufficient to meet nutrient needs. It occurs in the presence or absence of inflammation and can be related to starvation, chronic illness, or acute illness or injury.

Structured lifestyle intervention through culturally adapted nutrition algorithm and motivational interviewing together with using Glucerna SR Tripple Care as meal replacment significantly improved diabetes control and body weight in primary care setting.

The use of Glucerna in ICU patients with T2D is correlated with significant reduction in mortality and improved health economic outcomes.

N-3 Polyunsaturated FAs may beneficially affect quality of life, performance status and physical activity in patients with NSCLC undergoing multimodality treatment

Administration of an EPA-enriched oral nutrition supplement seems effective in improving the nutritional status and quality of life of lung cancer patients undergoing chemotherapy

Intention to treat group comparisons indicated that at the mean dose taken, enrichment with n-3 fatty acids did not provide a therapeutic advantage and that both supplements were equally effective in arresting weight loss. Post hoc dose-response analysis suggests that if taken in sufficient quantity, only the n-3 fatty acid enriched energy and protein dense supplement results in net gain of weight, lean tissue, and improved quality of life. Further trials are required to examine the potential role of n-3 enriched supplements in the treatment of cancer cachexia

EPA supplemented early EN is associated with preservation of lean body mass post esophagectomy compared with a standard EN. These properties may merit longer-term study to address its impact on recovery of function and quality of life in models of complex surgery or multimodal cancer treatment regimens.

Patients with NSCLC receiving ONS-EPA significantly improves energy and protein intake, body composition. and decreased fatigue, loss of appetite and neuropathy.

ESPEN's evidence-based nutrition guidelines for adult patients with cancer raise awareness by drawing attention to the high prevalence of malnutrition and its adverse impacts on response to treatment, prognosis, and survival. The Academy of Nutrition and Dietetics (AND) has also developed guidelines on nutritional management for patients with cancer in acute care and ambulatory settings [48]. Such updates help clinicians keep pace with advances in the science behind cancer and nutrition, and advise them how to translate information into practice. Of similar importance are wellargued calls for action to effectively couple oncologic and nutritional approaches throughout the patients' journey [49]. As we will discuss in this paper, many strategies are available to update nutritional care in patients with cancer. For example, most patients with cancer experience some degree of metabolic stress, which can now be quantified by measures of inflammatory biomarkers. Also, today's patients with cancer may be either underweight or overweight, but both groups are at high risk for cachexia and sarcopenia and its adverse effects. Sensitive new methods facilitate early and accurate measures of body cell and muscle mass. Medical nutrition care strategies have been updated, including recommendations for energy and protein requirements and the use of immune modulators and specialized nutrients to lessen adverse inflammatory and catabolic effects.

Clinical trials have demonstrated that increasing dietary intake is not usually effective for treating cancer-induced weight loss..1,2 Since cancer-induced weight loss is the result of inadequate energy intake, increased REE, and the complex interaction of many metabolic mediators, treatment can succeed only when underlying metabolic changes are addressed.3 The inclusion of metabolically-active substrate eicosapentaenoic acid (EPA) in the diet is now recognized to be helpful in interfering with mechanisms underlying metabolic perturbations of cachexia.⁴

In patients with cancer, systemic inflammation inhibits nutrient utilization and promotes catabolism, thus leading to muscle breakdown. Calorie and protein fortification of regular foods, even with standard ONS, does not reduce systemic inflammation. Updated nutritional strategies now suggest considering nutrition with anti-catabolic and inflammation-suppressing ingredients.¹

Cancer causes morbidity and mortality by effects on sites which are involved by tumor, and by remote or systemic effects of the cancer. Weight loss anda decrease in activity are recognized systemic effects of cancer. A decrease in activity or decreased performance status has long been recognized as an important prognostic factor which affects response to chemotherapy and duration of survival . Weight loss has received less quantitative study but in a few studies has been noted to influence the response to chemotherapy or the duration of survival .

Cancer-related malnutrition is a multimodal process because many factors collude to impair food intake, increase energy and protein needs, decrease anabolic stimuli such as physical activity, and alter metabolism in different organs or tissues. The multimodal drivers of malnutrition form a rationale for use of multiple therapeutic strategies to prevent, delay, or treat malnutrition in people with cancer

Cachexia has been recognised for a long time as an adverse effect of cancer. It is associated with reduced physical function, reduced tolerance to anticancer therapy, and reduced survival. Weight loss in patients with cancer is rarely recognised, assessed, or managed actively. Thus, cachexia represents an important unmet need.

Nutrition Therapy as Part of Multimodal Intervention for the Management of Frail Elderly Patients-case study 1

HMB can prevent the development of sarcopenia in elderly subjects and that the optimal action of HMB on muscle growth and strength occurs when it is combined with exercise.

Initiating effective nutritional treatment of the patient with cancer depends on an estimation of total energy expenditure. (TEE), which is the sum of resting energy expenditure (REE) plus activity-associated energy expenditure

Oral nutrition support includes regular food or fortified foods as meals or snacks and oral nutritional supplements (ONS) to fill nutritional gaps when patients are at nutritional risk.