The purpose of this scoping review by the American Society for Parenteral and Enteral Nutrition (ASPEN) COVID‐19 Nutrition Taskforce was to examine nutrition research applicable to the COVID‐19 pandemic. The rapid pace of emerging scientific information and need for expeditious translation into clinical nutritional care prompted this activity to discover research/knowledge gaps. This methodology adhered with recommendations from the Joanna Briggs Institute. There were 2301 citations imported, 439 articles fully abstracted, with 23 main topic areas identified across 24 article types, sourced across 61 countries and 51 specialties, in eight settings, and amongst 14 populations. Epidemiological/mechanistic relationships between nutrition and COVID‐19 were reviewed, important topics catalogued, and results mapped to “Population, Intervention, Comparator, Outcome, and Time” (PICO‐T) questions. The aggregated data was analyzed by clinical stage: pre‐COVID‐19, acute COVID‐19, and chronic/post‐COVID‐19. Research gaps were discovered for all PICO‐T questions. Important nutrition topics meriting urgent research included: food insecurity/societal infrastructure and transcultural factors (Pre‐COVID‐19); cardiometabolic‐based chronic disease, pediatrics, nutrition support, and hospital infrastructure (Acute COVID‐19); registered dietitian nutritionist counseling (Chronic/Post‐COVID‐19); and malnutrition and management (All Stages). The paucity of randomized, control trials (RCTs) was particularly glaring. Knowledge gaps were discovered for PICO‐T questions on pediatrics, micronutrients, bariatric surgery, and transcultural factors (Pre‐COVID‐19); enteral nutrition, protein‐energy requirements, and glycemic control with nutrition (Acute COVID‐19); and home enteral and parenteral nutrition support (Chronic/Post‐COVID‐19). In conclusion, this ASPEN scoping review has identified multiple critical areas for urgent nutrition research, particularly using RCT design, to improve nutritional care for patients before, during, and after COVID‐19. This article is protected by copyright. All rights reserved

The nutritional hallmark of chronic critical illness (CCI) after sepsis is persistent inflammation, immunosuppression, and catabolism syndrome (PICS), which results in global resistance to the anabolic effect of nutritional supplements. This ultimately leaves these patients in a downward phenotypic spiral characterized by cachexia with profound weakness, decreased capacity for rehabilitation, and immunosuppression with the propensity for sepsis recidivism. The persistent catabolism is driven by a pathologic low-grade inflammation with the inability to return to homeostasis and by ongoing increased energy expenditure. Better critical care support systems and advances in technology have led to increased intensive care unit (ICU) survival, but CCI due to PICS with poor long-term outcomes has emerged as a frequent phenotype among ICU sepsis survivors. Unfortunately, therapies to mitigate or reverse PICS-CCI are limited, and recent evidence supports that these patients fail to respond to early ICU evidence-based nutrition protocols. A lack of randomized controlled trials has limited strong recommendations for nutrition adjuncts in these patients. However, based on experience in other conditions characterized by a similar phenotype, immunonutrients aimed at counteracting inflammation, immunosuppression, and catabolism may be important for improving outcomes in PICS-CCI patients. This manuscript intends to review several immunonutrients as adjunctive therapies in treating PICS-CCI.

Accumulating scientific evidence supports the benefits of parenteral nutrition (PN) with fish oil (FO) containing intravenous lipid emulsions (ILEs) on clinical outcomes. Yet, the question of the most effective ILE remains controversial. We conducted a network meta-analysis (NMA) to compare and rank different types of ILEs in terms of their effects on infections, sepsis, ICU and hospital length of stay, and in-hospital mortality in adult patients. MEDLINE, EMBASE, and Web of Science databases were searched for randomized controlled trials (RCTs) published up to May 2022, investigating ILEs as a part of part of PN covering at least 70% of total energy provision. Lipid emulsions were classified in four categories: FO-ILEs, olive oil (OO)-ILEs, medium-chain triglyceride (MCT)/soybean oil (SO)-ILEs, and pure SO-ILEs. Data were statistically combined through Bayesian NMA and the Surface Under the Cumulative RAnking (SUCRA) was calculated for all outcomes. 1651 publications were retrieved in the original search, 47 RCTs were included in the NMA. For FO-ILEs, very highly credible reductions in infection risk versus SO-ILEs [odds ratio (OR) = 0.43 90% credibility interval (CrI) (0.29-0.63)], MCT/soybean oil-ILEs [0.59 (0.43-0.82)], and OO-ILEs [0.56 (0.33-0.91)], and in sepsis risk versus SO-ILEs [0.22 (0.08-0.59)], as well as substantial reductions in hospital length of stay versus SO-ILEs [mean difference (MD) = -2.31 (-3.14 to -1.59) days] and MCT/SO-ILEs (-2.01 (-2.82 to -1.22 days) were shown. According to SUCRA score, FO-ILEs were ranked first for all five outcomes. In hospitalized patients, FO-ILEs provide significant clinical benefits over all other types of ILEs, ranking first for all outcomes investigated. PROSPERO 2022 CRD42022328660.