Mechanick, Jeffrey I.

Abstract Disclosure: A. Nasir: None. F. Dehghani: None. F. Saeidifard: None. M. Ghannam: None. A. Almakadma: None. I. Idries: None. A. Esteghamat: None. R. Nieto- Martinez: None. J.I. Mechanick: None. Background: The Dysglycemia-Based Chronic Disease (DBCD) multi-morbidity care model was developed by American Association of Clinical Endocrinology to address the requirement for preventive care measures to reduce the impact of type two diabetes (T2D ) and its complications. The DBCD model consists of four distinct stages including: insulin resistance, prediabetes, T2D and vascular complication spectrum. This study assesses the prevalence and associated risk factors for each of the four DBCD stages in Iranian adults. Methods: From February 2002 to March 2020, 10,087 participants who attended clinic of Vali-Asr Hospital, Tehran, Iran, were evaluated. In total, 3,465 (34.3%) men with median age of 54.47 years and 6,629 (65.67%) women with median age of 50.2 years were included. A 10 ml blood sample was collected after an overnight fast, centrifuged, and stored at -70°C for lab evaluation to measure fasting blood sugar (FBS). Hemoglobin A1c was measured using high-performance liquid chromatography, while fasting and post-prandial glucose were assessed using enzymatic colorimetric methods. Results: Stage 1 was found in 19.7% of the population (23.2% in women and 13.1% in men), stage 2 in 17.8% of the population (19.3% in women and 14.8% in men), stage 3 in 31.4% of the population (28.2% in women and 37.5% in men), and stage 4 in 21.3% of the population (16.2% in women and 30.9% in men). DBCD stages increased significantly with age (stage 1=43.12, stage 2=51.24, stage 3=54.89, stage 4=61.51, P-value <0.01). All DBCD stages were associated with hypertension (stage 1: OR=3.07, stage 2: OR=5.08 ,stage 3: OR=7.87 and stage 4: OR=17.17) dyslipidemia (stage 1: OR=2.85, stage 2: OR=2.68, stage 3: OR=8.32, and stage 4: OR=7.66)and metabolic syndrome (stage 1: OR=14.04, stage 2: OR=21.95, stage 3: OR=32.50, and stage 4: OR=42.54). Conclusion: The findings of the current study further support the importance of the DBCD model in early detection and prevention of dysglycemia and their associated complications. Presentation: Sunday, July 13, 2025

AbstractThe dual burden of undernutrition and overnutrition requires a greater understanding and commitment to physician training and specialization in nutrition support. Despite the significant healthcare need and existence of organizations focused on nutrition support such as the American Society for Parenteral and Enteral Nutrition (ASPEN), physician involvement in the nutrition care of high‐risk patients remains low. In an ASPEN survey of members, inadequate training among physicians was reported along with significant barriers to involvement in nutrition support, such as insufficient protected time, reduced reimbursement and financial support, inadequate support from administrators or supervisors, as well as a nationwide reduction in number of nutrition support teams. These changes in the healthcare landscape prompted the ASPEN Physician Engagement Committee to develop a critical review focused on domains of nutrition risk assessment, enteral and parenteral access and support, scholarly activities, board certification, administrative responsibilities, education and training opportunities, coding, and reimbursement. The aim of this critical review is to capacitate physicians to engage in nutrition support and enhance their acumen in clinical nutrition to improve patient care and enrich personal and professional development.

AbstractThere is evidence that significant quality problems arise as patients transitions in care from one setting to another. Attention to nutrition during transitions of care is important to avoid complication. During the American Society for Parenteral and Enteral Nutrition 2022 preconference course, nutrition during transition of care from pediatric to adult care, from the intensive care unit to the hospital floors and from the hospital to home was addressed.

The aim of the present study was to evaluate the association between television viewing/physical activity (TVV/PA) interactions and cardiometabolic risk in an adult European population. A total of 2155 subjects (25–64 years) (45.2% males), a random population-based sample were evaluated in Brno, Czechia. TVV was classified as low (<2 h/day), moderate (2–4), and high (≥4). PA was classified as insufficient, moderate, and high. To assess the independent association of TVV/PA categories with cardiometabolic variables, multiple linear regression was used. After adjustments, significant associations were: High TVV/insufficient PA with body mass index (BMI) (β = 2.61, SE = 0.63), waist circumference (WC) (β = 7.52, SE = 1.58), body fat percent (%BF) (β = 6.24, SE = 1.02), glucose (β = 0.25, SE = 0.12), triglycerides (β = 0.18, SE = 0.05), and high density lipoprotein (HDL-c) (β = −0.10, SE = 0.04); high TVV/moderate PA with BMI (β = 1.98, SE = 0.45), WC (β = 5.43, SE = 1.12), %BF (β = 5.15, SE = 0.72), triglycerides (β = 0.08, SE = 0.04), total cholesterol (β = 0.21, SE = 0.10), low density protein (LDL-c) (β = 0.19, SE = 0.08), and HDL-c (β = −0.07, SE = 0.03); and moderate TVV/insufficient PA with WC (β = 2.68, SE = 1.25), %BF (β = 3.80, SE = 0.81), LDL-c (β = 0.18, SE = 0.09), and HDL-c (β = −0.07, SE = 0.03). Independent of PA levels, a higher TVV was associated with higher amounts of adipose tissue. Higher blood glucose and triglycerides were present in subjects with high TVV and insufficient PA, but not in those with high PA alone. These results affirm the independent cardiometabolic risk of sedentary routines even in subjects with high-levels of PA.

AbstractBackgroundMalnutrition is underrecognized and underdiagnosed, despite high prevalence rates and associated poor clinical outcomes. The involvement of clinical nutrition experts, especially physicians, in the care of high‐risk patients with malnutrition remains low despite evidence demonstrating lower complication rates with nutrition support team (NST) management. To facilitate solutions, a survey was designed to elucidate the nature of NSTs and physician involvement and identify needs for novel nutrition support care models.MethodsThis survey assessed demographics of NSTs, factors contributing to the success of NSTs, elements of nutrition education, and other barriers to professional growth.ResultsOf 255 respondents, 235 complete surveys were analyzed. The geographic distribution of respondents correlated with population concentrations of the United States (r = 90.8%, p < .0001). Most responding physicians (46/57; 80.7%) reported being a member of NSTs, compared with 56.5% (88/156) of dietitians. Of those not practicing in NSTs (N = 81/235, 34.4%), 12.3% (10/81) reported an NST was previously present at their institution but had been disbanded. Regarding NSTs, financial concerns were common (115/235; 48.9%), followed by leadership (72/235; 30.6%), and healthcare professional (HCP) interest (55/235; 23.4%). A majority (173/235; 73.6%) of all respondents wanted additional training in nutrition but reported insufficient protected time, ability to travel, or support from administrators or other HCPs.ConclusionCore actions resulting from this survey focused on formalizing physician roles, increasing interdisciplinary nutrition support expertise, utilizing cost‐effective screening for malnutrition, and implementing intervention protocols. Additional actions included increasing funding for clinical practice, education, and research, all within an expanded portfolio of pragmatic nutrition support care models.

Abstract Advances in treatment of malignancy including novel pharmacologic therapies and surgical interventions has led to significant improvement in survival. As cancer becomes a chronic disease, nutrition interventions play an increasingly important role in short‐ and long‐term outcomes. The current manuscript presents a case of a 66‐year‐old male with new diagnosis of pancreatic cancer diagnosed incidentally in the setting of COVID‐19. Expert panelists in the field of nutrition discuss optimal strategies for diagnosis of malnutrition along with preoperative, perioperative, and postoperative optimization of nutrition. This discussion focuses on the use of probiotics, immune‐modulating nutrition, fish oil, specialized proresolving mediators, and use of enteral and parenteral nutrition support.

AbstractThe worldwide increase in the prevalence of obesity and adiposity‐related comorbidities has required a novel approach to cardiometabolic risk mitigation focused on the key mechanistic drivers of disease. The current manuscript presents the case of a 74‐year‐old male with obesity complicated by coronary artery disease, hypertriglyceridemia, hypertension, nonalcoholic fatty liver disease, obstructive sleep apnea, and type 2 diabetes. Expert panelists discuss optimal diagnostic and treatment strategies focused on lifestyle modifications including dietary interventions such as the Mediterranean dietary pattern, medications that target multiple drivers of disease, as well as procedural options.

AbstractDespite a mounting evidentiary base, controversies surrounding critical care nutrition support persist. Anchored by a case of a 60‐year‐old male with esophageal cancer who develops acute hypoxemic respiratory failure and septic shock, five panelists from the American Society of Parenteral and Enteral Nutrition (ASPEN) 2021 Pre‐Conference discuss key clinical dilemmas in critical care nutrition, including hierarchy of evidence, bedside evaluation of malnutrition, optimal protein dose, use of fiber, and therapies targeting gut function and gut microbiota .