Abstract Background Nutritional therapy is a key component of critical care management, yet optimal strategies remain debated due to the heterogeneity of ICU patients, dynamic metabolic alterations, a

The gap

Consensus across the literature

Supporting evidence — 6 representative gaps

• Prevalence of Nutritional Deficiencies Among Patients Attending a Nutrition Clinic at a Tertiary Care Hospital in Andhra Pradesh, South India: A Retrospective Cross-Sectional Study (2026) · doi

  This study has several strengths. First, the use of complete enumeration rather than probability sampling - every eligible patient seen at the center during the 30-month study period was included - eliminates sampling bias and yields narrow 95% CIs (margin of error ≤ ±4% for every major prevalence estimate), supporting the precision of the reported figures. Second, the large sample size, comprehensive multi- parameter nutritional assessment, application of standardized international deficiency criteria, and examination of gender- and age-stratified patterns, including multiple concurrent deficiencies, allow a granular description of the nutritional landscape in this clinical population. Third, the study characterizes nutritional status among patients actively seeking nutrition-focused healthcare, a population that is poorly represented in community-based surveys but increasingly relevant as nutrition clinics expand in tertiary care. Several limitations should also be acknowledged. Although the census approach removes sampling bias, the study population was restricted to patients self-referred or clinically referred to a specialized nutrition center at a tertiary institution; the prevalence estimates are therefore conditional on clinical presentation and are not directly generalizable to the source community (Berkson's bias). The subsamples tested for 25(OH)D and vitamin B12 were smaller than the full cohort because biochemical testing was performed on clinical indication rather than universally; post hoc precision nevertheless remained acceptable (±2.9% and ±4.0%, respectively, at 95% CI). The cross-sectional design with retrospective data acquisition precludes inference about temporal relationships or causality. On account of high patient load, difficulty in digitalizing, Twenty-four-hour dietary recall data were available for only a small convenience subset of participants; although gender comparisons using the Mann-Whitney U test showed no statistically significant differences, these analyses are severely underpowered, and the results should not be interpreted as evidence for the absence of a gender gap in dietary intake. Definitive inference will require a prospective study with universal dietary assessment. Detailed data on potential confounders - including socioeconomic status, education, occupation, and habitual dietary patterns - were not collected, limiting our ability to adjust for these variables in the multivariable analyses.

  Keywords: dietary sampling bias nutritional gender clinical population nutrition several rather every patient center prevalence precision
• Association of Nutritional Level with Remission and Nutritional Advice in Obesity Surgery (2026) · doi

  Conclusions regarding the long-term efficacy of BS in relation to the level of nutritional levels are limited. Analyzing follow-up remission with nutritional levels is a strength of the current study. Despite its efforts, our study did not achieve the complete personal follow-up needed to measure clinical and nutritional characteristics. This underlines that sustained efforts are needed to maximize retention and tracking, one of the major challenges of large, multi-center, observational clinical studies of BS. Another weakness is the under-reporting of nutrient categories in the data collection. To provide more effective nutritional advice, more nutrients should be covered and more data on vitamins and minerals should be included. DECLARATIONS Authors’ contributions Designed the research: Z.H., L.Y., and L.H; Supervised patient recruitment and data collection: L.Y., L.H; Performed the patient recruitment, the patient examination, the experimental work and data collection: S.Z., S.J., X.J., C.X., Y.L., X.Y; Analyzed and interpreted the data: S.L. and Z.H; Wrote the paper: Z.H.

  Keywords: nutritional collection patient levels follow efforts needed clinical recruitment conclusions regarding long term efficacy relation
• Comparative prognostic performance of nutritional, immune-inflammatory, and anthropometric indices for cardiovascular and all-cause mortality in older adults with cardiovascular disease (NHANES 2009–2018) (2026) · doi

  Strengths include a nationally representative NHANES sample with National Death Index linkage and a median follow-up exceeding a decade; survey-weighted analysis with multiple imputation; and restricted cubic-spline modeling of non-linear dose–response relationships. The within-cohort comparison of three index categories provides directly comparable evidence, and sensitivity analyses (landmark, complete-case, and dietary- adjusted) converged on the same conclusions. This study has limitations. First, the cohort is heterogeneous (congestive heart failure, coronary heart disease, angina, myocardial infarction, stroke), and NHANES lacks cardiac- specific characterization such as left ventricular ejection fraction or natriuretic peptides; the 20 findings should not be extrapolated to phenotype-specific decisions without validation in cohorts with detailed cardiac phenotyping. Second, the comparison between the nutritional indices and the SII is conceptually asymmetric: the former integrate a chronic exposure and the latter reflects an acute snapshot. Third, all indices were measured at a single visit, precluding evaluation of longitudinal trajectories. Finally, despite multivariable adjustment, multiple imputation, and sensitivity analyses, residual confounding cannot be excluded.

  Keywords: nhanes index multiple imputation cohort comparison sensitivity analyses heart cardiac specific indices strengths include nationally
• Predictive Ability of Malnutrition Screening Tools in Enterally Fed, Mechanically Ventilated Patients with Phase Angle Inference: A Prospective Observational Study (2026) · doi

  Possible single-nation sample bias is acknowledged. Variations in EN practices between hospitals from different sectors were reported. For example, using intermittent versus continuous feeding methods, and using hospital-prepared versus pre-packed formulas. The study had not articulated the actual caloric deliv- ery into patients’ observation to be assessed later for its correlation with BIA values. Potential device variability in BIA measurements is also recognized. For instance, controlling the effect of altered hydration on PhA vales would have provided more valid inferences. „Conclusions Early detection of malnutrition in the critically ill is still challenging for ICU professionals. Nutritional screening tools are key to rapid and early determina- tion of malnutrition risk and should be coupled with proper nutritional assessment. Drawing attention to the significance of objective methods for nutritional assessment such as BIA, some subjective tools such as MUST and NRS-2002 showed their precision in pre- dicting subsequent malnutrition risk for ICU patients from admission. „Acknowledgment The authors are indebted to all intensive care staff who participated in the study, especially those who facili- tated data collection, and the intensivist and dieticians for counselling support. The efforts and commitments made by research assistants were highly acknowledged. The role of Dr. Rami Al-Kawaldeh, who provided sta- tistical consultation for ML modelling, was also appre- ciated. „Authors’ contribution M. Al-Kalaldeh, M. Abu Sabra, and O. Al-Kalaldeh equally contributed to conceptualization; including ideas; formulation or evolution of overarching research goals and aims. M. Al-Kalaldeh and M. Abu Sabra con- tributed to the methodology; including development or design of methodology, and creation of models. M. Al-Kalaldeh, M. Abu Sabra, and O. Al-Kalaldeh con- tributed to the formal analysis; including application of statistical, and other formal techniques to analyze or synthesize study data. M. Al-Kalaldeh and M. Abu Available online at: www.jccm.roSabra, contributed to data curation; including man- agement activities to annotate, scrub data and main- tain research data, and the interpretation of the data. M. Al-Kalaldeh and M. Abu Sabra and O. Al-Kalaldeh contributed to visualization; including preparation, creation and/or presentation of the published work. M. Al-Kalaldeh was responsible for project admin- istration; including management and coordination responsibility for the research activity planning and execution. Funding acquisition was attempted by M. Al-Kalaldeh. M. Al-Kalaldeh, M. Abu Sabra, and O. Al-Kalaldeh contributed to writing – original draft; including preparation, creation and/or presentation of

  Keywords: kalaldeh including sabra contributed malnutrition nutritional creation acknowledged using versus patients provided early tools risk
• Current concepts on feeding the critically ill patient: a narrative review (2026) · doi

  Abstract Background Nutritional therapy is a key component of critical care management, yet optimal strategies remain debated due to the heterogeneity of ICU patients, dynamic metabolic alterations, and the profound influence of inflammation on nutrient utilisation.

  Keywords: abstract background nutritional therapy component critical care management optimal strategies remain debated heterogeneity patients dynamic
• Food insecurity, caloric intake and nutritional status among children under 5 years old: a predictive modelling analysis of the MAL-ED multi-country cohort (2026) · doi

  While the MAL-ED study undertook painstaking data collection based on standardised protocols, predictor and outcome data included in this analysis are likely to suffer from varying levels of measurement error. In particular, infectious disease occurrence relied on caregiver report and syndromic case definitions; anthropometric measurements are error-prone, especially length in young children; the 24-hour recall method for measuring caloric intake is complicated to administer, relies on local and approximate measurements of food quantities, and is generally known to yield inaccuracy; the FIES questionnaire also relies on accurate responses by households and, despite the method replicated here to standardise food insecurity variables across different countries, may feature unaccounted-for biases, e.g. due to perceptions of desirable responses by households. Moreover, its conversion to household-level probabilities of food insecurity rests on several assumptions, and the probabilities themselves, while treated deterministically in our model, feature Food insecurity, caloric intake and anthropometry prediction Page 12 of 17 medRxiv preprint preprint (which was not certified by peer review) doi: https://doi.org/10.64898/2026.06.22.26355679

  Keywords: food insecurity error measurements caloric intake relies responses households feature probabilities preprint undertook painstaking collection