Daniele Angelillo

Background/Objectives. Nutrition therapy for diseased patients should satisfy patients’ nutritional needs and address the specific disease-related requirements. This study evaluated the prevalence and appropriateness of artificial nutrition (AN) prescriptions at University Hospital. Methods. On a single day, a multidisciplinary team of physicians and dietitians with specialized training in clinical nutrition assessed patients receiving AN. Except for ICU patients, caloric requirements calculations were performed using BMI-specific predictive formulas adjusted with a metabolic stress factor ac-cording to clinical condition. Results. Among 578 hospitalized patients from 36 different wards, 9.7% (30/26 males/females; mean age 67.1 ± 11.6 years) were receiving AN (39 total parenteral nutrition [TPN], 16 enteral nutrition [EN], and 1 enteral plus supportive parenteral nutrition [SPN]). The most common primary diagnoses were cancer (21.4%) and respiratory failure (17.8%). Only four patients were hospitalized for primary malnutrition. The median time to initiate AN after the hospital admission was 3 days (IQR 0-13.5 days). Only 10 patients with a peripheral implanted central catheter (PICC) met the proper caloric intake, and only 5 of them received an adequate protein intake (≥1 g/kg body weight). Among patients receiving EN, 11 were allocated to ICU, and their caloric intake was 6-12 kcal/kg b.w., while protein intake was 0.44 ± 0.16 g/kg b.w. Conclu-sions. The findings highlight significant gaps in the clinical application of nutrition support, in-cluding delayed initiation, underdosing, and variability across patient groups. These issues demonstrate the necessity of improved nutritional screening, earlier intervention, and greater in-volvement of trained nutrition professionals in hospital care pathways.

Immunotherapy with immune checkpoint inhibitors (ICIs) nowadays has indications for several solid tumors. The current targets for ICIs are CTLA-4, PD-1, and PD-L1 receptors. Despite the clinical advantages derived from ICIs, a variety of side effects are linked to overstimulation of the immune system. Among these, ICI-related colitis is one of the most common, with a disabling impact on the patient. Diarrhea, abdominal pain, abdominal distension, cramping, and hematochezia are the most common ICI enterocolitis presenting symptoms. The most frequently used grading system for assessment of the severity of ICI enterocolitis is called the Common Terminology Criteria for Adverse Events (CTCAE) grading. With regard to the histological picture, there is no specific feature; however, microscopic damage can be classified into five types: (1) acute active colitis, (2) chronic active colitis, (3) microscopic colitis-like, (4) graft-versus-host disease-like, and (5) other types. Supportive therapy (oral hydration, a bland diet without lactose or caffeine, and anti-diarrheal agents) is indicated in mild colitis. Symptomatic treatment alone or with loperamide, a low-fiber diet, and spasmolytics are recommended for low-grade diarrhea. In more severe cases, corticosteroid treatment is mandatory. In refractory cases, off-label use of biological therapies (infliximab or vedolizumab) was proposed.