Kristie Huirong Fan

Hepatocellular carcinoma (HCC) is the third leading cause of cancer‐related mortality worldwide. Malnutrition is highly prevalent among people living with HCC and has a substantial impact on morbidity and mortality. Nutrition influences the development of HCC and is also a consequence of chronic liver disease and liver cancer. Routine screening and nutritional assessment using validated tools, along with evaluation of muscle mass and functional status, are essential in the optimal care of patients with HCC. Nutritional interventions may change throughout the disease trajectory depending on the stage of HCC, the severity of liver cirrhosis, and the overall treatment options and intent. Evidence supports the use of oral nutritional supplements, branched‐chain amino acids, exercise interventions, and the preferential use of enteral over parenteral nutrition. Optimizing nutrition is integral to HCC management across all disease stages and is best accomplished with a multidisciplinary team to individualize the nutritional care across the disease continuum. In this review, we summarize current evidence on the impact and role of nutritional therapy in HCC and provide actionable recommendations for clinical practice. We highlight the current challenges and provide future directions for future HCC nutritional care pathways.

Objective: Intestinal failure in advanced malignancy is most commonly due to mechanical bowel obstruction. Palliative home parenteral nutrition (HPN) is an option for such patients to meet their nutritional needs. However, there are limited data on overall survival and predictive factors. This study aimed to evaluate the survival of patients receiving palliative HPN and the impact of patient factors on survival. Methods: This is a single-centre retrospective observational study of patients referred for palliative HPN from 1 January 2020 to 19 November 2024 at the Cambridge University Hospitals NHS Foundation Trust. Demographic, nutritional and medical data were analysed. Survival rates were compared using Kaplan-Meier curves and Cox regression. Results: 84 patients were referred and 77 were discharged with HPN (median age was 60.9 years (IQR: 51.3–70.4), female 77%). 78% of the underlying primary malignancies were gynaecological and gastrointestinal. Malignant bowel obstruction was the main indication for HPN (86%). Eastern Cooperative Oncology Group performance status (PS) scores were ≤2 in 82% of patients and 75% had an estimated prognosis of >3 months. Median survival was 58 days (IQR 31–108) with a 3-month mortality of 69%. There was no statistical difference in survival by PS, estimated prognosis, underlying malignancy or modified Glasgow Prognostic Score (mGPS). Conclusions: The overall survival in our study is modest. PS, prognosis, mGPS or tumour type did not show a significant impact on survival. This highlights the challenges in artificial nutrition and emphasises the role of a multidisciplinary team in the care of these patients.

Background and Aim: Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut brain interaction with a multifactorial etiology. Food trigger avoidance is common among individuals with IBS and exclusion diets are gaining popularity. However, recent guidelines on IBS management cautioned regarding the use of unsupervised dietary therapy with concerns of development of poor eating habits and even nutritional deficiencies. We aimed to review the available literature on the effect of habitual and exclusion diets on micronutrient status as well as the role of micronutrient supplementation in alleviating IBS symptoms.Methods: Four electronic databases (PubMed, Embase, Cochrane, Web of Science) were searched for articles that reported micronutrient data in patients with IBS. Serum micronutrient levels and dietary intake of micronutrients in patients with IBS were collected. The extracted data were tabulated and organized by micronutrient type to observe for trends.Results: Twenty‐six articles were included in this systematic review (12 interventional and 14 observational studies). Studies showed that generally IBS subjects had lower levels of vitamin B2, vitamin D, calcium, and iron at baseline compared with non‐IBS subjects. Studies also found that exclusion diets were associated with lower intake of micronutrients especially vitamin B1, B2, calcium, iron, and zinc. There was a lack of interventional studies on micronutrients.Conclusion: Irritable bowel syndrome patients are at risk of developing multiple micronutrient deficiencies that may have both localized gastrointestinal as well as systemic effects. Dietary management of IBS patients should include a proper dietitian review to ensure nutritional adequacy where possible.

Acute and chronic diarrheal illness secondary to gastrointestinal infection is a significant cause of morbidity and mortality around the world. A cornerstone of management includes prompt diagnosis and appropriate treatment of culprit pathogens. Timely diagnosis can improve patient care, assist in infection control, and prevent disease outbreaks. Historical methods of diagnosis include traditional culture methods and stool analysis. These are limited by long turnaround time and inability to simultaneously assess multiple pathogens. The advent of multiplexed nucleic acid amplification tests first began with the Food and Drug Administration‐approved respiratory virus multiplex polymerase chain reaction (PCR) panel in 2009, followed by gastrointestinal infections in 2013, and neurological infections in 2014. We conducted a review of current literature pertaining to the clinical utility of a gastrointestinal multiplex PCR in management of acute and chronic diarrhea in patients. To date, seven platforms approved by the US Food and Drug Administration are used in detection of various bacterial, viral, and parasitic causative organisms for diagnosis of gastrointestinal infections. The sensitivity and specificity of each assay vary depending on the tested organism. Interpretation of a positive result has to be tailored to the clinical context. Further studies are required to establish the utility of gastrointestinal multiplex PCR from a cost‐based perspective, whether specific enteropathogens such as Clostridioides difficile are better assessed with toxin gene detection and whether new parameters such as cycle threshold values can improve clinical application of test results.