Startseite Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
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Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery

  • Jiaoyan Lian , Fang Zhang und Haoyu Chen EMAIL logo
Veröffentlicht/Copyright: 26. Juni 2025
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Open Medicine
Aus der Zeitschrift Open Medicine Band 20 Heft 1

Abstract

Objective

This work investigated intraoperative nutritional risk and nutritional support for children with congenital diabetes.

Materials and methods

A total of 60 cases of children with congenital diabetes were assigned into two groups: the intravenous group (n = 30) and the oral group (n = 30). Medications were administered based on the actual conditions of patients. After surgery, the relationship between intraoperative nutritional risk score and glucose changes was studied.

Results

All patients had normal liver and kidney function. In the intravenous group, 26 cases had sufficient calorie intake. The numbers of cases with normal nutrition, malnutrition, and severe malnutrition were 7, 12, and 11, respectively. The incidences of infection, delayed wound healing (DWH), difficult glucose control (DGC), and respiratory system complications were 3, 6, 12, and 1, respectively. In the oral group, 21 cases had sufficient calorie intake. Numbers of cases with normal nutrition, malnutrition, and severe malnutrition were 8, 9, and 13, respectively. The incidences of infection, DWH, and DGC were 2, 6, and 9, respectively. Fasting blood glucose <6.5 mmol/L and body mass index <17.3 were independent risk factors affecting nutritional support.

Conclusion

Nutritional risk assessment and support during surgery for children with congenital diabetes were crucial for appropriate support.

Keywords: children with congenital diabetes; nutritional risk; nutritional support

1 Introduction

Children with congenital diabetes are a rare genetic condition characterized by symptoms of high blood sugar present at birth [1,2]. This condition not only impacts the growth and development of affected children but also has a significant influence on their nutritional intake [3,4]. Due to the inability of their bodies to properly utilize glucose, these children experience a restricted energy supply, resulting in slow weight gain and even malnutrition [5]. During surgery, special attention needs to be given to the nutritional status of these children. The surgery itself places a significant demand on the body, and children with congenital diabetes are more prone to energy deficiencies due to their metabolic abnormalities [6]. Therefore, assessing the nutritional risk of these children and providing appropriate nutritional support becomes an essential preoperative task.

Assessing the nutritional risk in children with diabetes requires considering multiple factors, including the child’s age, physical condition, and the type of surgery [7]. Age is an important factor because children in different age groups have varying nutritional needs. The physical condition of the child also needs to be taken into account, such as whether they have other complications or malnutrition. The type of surgery can also affect the nutritional requirements of a child, as some surgeries may impair digestive function, impacting the child’s ability to absorb and utilize nutrients [8]. Based on the assessment results, doctors can develop personalized nutritional support plans to ensure that the child receives adequate nutrition during surgery. This may involve increasing energy and protein intake to meet the child’s growth and repair needs [9,10]. Additionally, supplementation with vitamins and minerals may be considered to enhance the child’s immune function and recovery capacity. Before surgery, a comprehensive assessment of the nutritional status of the child is necessary, including measurements of height, weight, body fat content, and other indicators to understand his or her overall nutritional status. Dietary habits and intake should also be assessed to determine the risk of malnutrition [11]. There are various methods of nutritional support, which can be provided through oral or intravenous administration. For children who can eat, nutritional intake can be improved by adjusting the diet structure and increasing energy density. For children who cannot eat, special formula nutritional solutions can be administered intravenously to meet their nutritional needs [12]. Additionally, attention should be paid to the child’s intake of trace elements and vitamins. Due to the metabolic abnormalities in children with congenital diabetes, their requirements for certain trace elements and vitamins may be increased. Therefore, while providing nutritional support, it is important to consider supplementing these nutrients to maintain the child’s health.

Although perioperative nutritional management strategies are well-established for the general pediatric population, the unique characteristics of children with congenital diabetes (such as insulin secretion deficiencies and metabolic instability) result in significantly different nutritional requirements. Currently, research in this population has primarily focused on glucose control, while systematic assessments of perioperative nutritional risks and support strategies are extremely limited [13]. In particular, there is a lack of evidence-based nutritional intervention protocols, which leads to reliance on empirical decision-making in clinical practice, potentially increasing the risk of postoperative complications. Therefore, this study aimed to identify the perioperative nutritional risk characteristics in children with congenital diabetes through a retrospective analysis and explore clinical pathways for optimizing nutritional support, thereby addressing the knowledge gap in this field.

2 Materials and methods

2.1 Experimental design

A retrospective analysis was conducted on 60 cases of children with congenital diabetes who were treated at Gansu Maternal and Child Health Hospital between January 2019 and December 2021. Initially, a prospective study design was considered to minimize recall and selection biases. However, due to the rarity of congenital diabetes and the ethical limitations associated with obtaining timely prospective informed consent during emergency surgical interventions, a retrospective approach was adopted. While this method enables effective data collection, it acknowledges the limitations, such as missing records, incomplete dietary logs, and potential inaccuracies in retrospective blood glucose measurements. To mitigate these biases, strict inclusion/exclusion criteria were applied, and only cases with complete medical records were included.

Gastrointestinal surgeries (such as enterostomy and appendectomy, n = 22); endocrine-related surgeries (such as partial pancreatectomy, n = 18); and other non-gastrointestinal surgeries (such as hernia repair and orthopedic surgeries, n = 20). The complexity of the surgeries was classified according to the Pediatric Surgical Risk Assessment Guidelines (Clavien–Dindo classification): Grade I (minor injury, n = 35), Grade II (moderate injury, n = 25). Before the surgery commenced, fasting venous blood (FVB) samples were taken from the children for routine blood tests, liver function tests, and kidney function tests. Based on the method of nutritional support, the children were assigned to an intravenous group (n = 30) and an oral group (n = 30).

Throughout the study, all children underwent comprehensive examinations and nutritional risk assessments. Their nutritional risk assessment scores and glucose changes during the surgery were recorded based on dietary brief analysis, and medications were administered according to each child’s individual condition. After the surgery was completed, the glucose changes in the children were documented and organized, and the relationship between these glucose changes and the nutritional risk assessment during the surgical period was investigated.

2.2 Criteria for enrolling and excluding the study subjects

Criteria for enrolling and excluding the study subjects are outlined in Tables 1 and 2, respectively.

Table 1

Criteria for participant inclusion

No. Descriptions
1 Aged 0–12 years old
2 Diagnosed with congenital diabetes
3 In need of surgical treatment
4 Provided informed consent from children and their legal guardians
Table 2

Criteria for participant exclusion

No. Descriptions
1 Severe complications requiring emergency intervention, including: heart failure (NYHA classification III–IV), renal insufficiency (eGFR < 30 mL/min/1.73 m2), and active infections (CRP > 50 mg/L requiring intravenous antibiotic therapy)
2 Comorbid chronic conditions include: malignant tumors (such as leukemia, lymphoma, diagnosed according to WHO ICD-10 criteria), chronic liver disease (Child-Pugh classification B or C), and autoimmune diseases (such as systemic lupus erythematosus, meeting ACR diagnostic criteria)
3 Inability to receive nutritional support (e.g., intestinal obstruction, severe swallowing dysfunction)
4 Incomplete medical records (e.g., missing preoperative blood glucose data or nutritional assessment information)

2.3 Scales for assessing intraoperative nutritional risk

This study utilized the pediatric perioperative nutritional risk assessment (PPNRA) scale to evaluate the nutritional risk in children. Although the PPNRA scale has been validated for its reliability and validity in general pediatric surgical patients [14,15], specific validation studies for children with congenital diabetes have not been reported. Therefore, the application of the PPNRA scale in this study may have limitations, such as not fully covering diabetes-related metabolic risk factors (e.g., insulin resistance, blood glucose variability). To minimize bias, additional blood glucose control indicators (such as HbA1c) were recorded during the assessment to assist in the evaluation. The steps involved in using the PPNRA scale were as follows:

  1. Collecting basic information: basic information about the children was gathered, including age, gender, height, weight, and other relevant details.

  2. Assessing nutritional status: the standard nutritional assessment methods were employed, such as body mass index (BMI), height-weight percentiles, and other relevant metrics, to evaluate the nutritional status of the children.

  3. Evaluating surgical risk: the surgical risk level for each child based on the type of surgery and the level of surgical risk.

  4. Using the PPNRA scale: the nutritional risk assessment was performed using the PPNRA scale based on the basic information, nutritional status, and surgical risk level of child.

  5. Interpreting assessment results: the assessment results were interpreted to determine whether the child was at risk of malnutrition. Typically, assessment results were categorized into three levels: low, moderate, and high.

  6. Developing nutritional intervention plans: based on the assessment results, appropriate nutritional intervention plans were formulated. High-risk children may require nutritional support or supplementation.

  7. Monitoring and adjustment: during the surgical period, it should regularly monitor the nutritional status of children and make adjustments as necessary to ensure they receive the appropriate nutritional support.

By following these steps and using the PPNRA scale, healthcare professionals can effectively assess the nutritional risk of children with congenital diabetes during the perioperative period and implement tailored nutritional interventions to optimize their health outcomes.

2.4 Dietary survey of children

A 24-h dietary recall method was used to survey the children’s dietary intake. Trained nutritionists conducted face-to-face interviews with the caregivers to record a detailed description of all foods consumed in the past 24 h (including food types, weights, and cooking methods). To reduce recall bias, a 3-day food frequency questionnaire (FFQ) was also employed, focusing on the frequency of intake of high-sugar and high-protein foods during the week prior to surgery. Additionally, the accuracy of energy intake was validated by comparing the dietary records with biochemical indicators (such as serum prealbumin and retinol-binding protein). This involved detailed recording of the dietary intake of children over a 24-h period, including the types of foods, their weights, and quantities consumed during each meal. Additionally, meal times and frequencies were noted. Subsequently, the nutritional elements in the children’s diet were analyzed. This analysis encompassed energy (calories), protein, fat, carbohydrates, vitamins, minerals, and other nutrients. To assess whether the nutritional intake of the children met their requirements, the intake of each nutrient was calculated and compared to their recommended daily intake. For determining calorie intake adequacy, if the intake was less than 20% of the standard requirement, it was considered insufficient. The standard calorie intake was calculated by multiplying the calorie standard supply per kilogram of body weight by the ideal weight of the children.

2.5 Observation parameters

2.5.1 BMI

BMI is an indicator used to assess whether a person’s weight is healthy. The height and weight of children were collected, and their BMIs were calculated. The BMI was calculated with weight (in kilograms) divided by the square of height (in meters). According to the classification standards of the World Health Organization (WHO), the range of BMI can be categorized into: BMI < 18.5: underweight, BMI = 18.5–24.9: normal weight, BMI = 25–29.9: overweight, and BMI ≥ 30: obesity.

2.5.2 Nutritional status

Nutritional status assessment is an important medical process used to evaluate a child’s overall health status, especially factors related to nutrition [16]. By analyzing the age, gender, height, weight, and other factors, the basal metabolic rate and activity level of children were calculated to determine their daily energy requirements. BMI scores were then employed to assess the physical condition of the child. Furthermore, dietary habits of the children were analyzed to evaluate whether their intake of various nutrients met the recommended levels, including protein, carbohydrates, fats, vitamins, minerals, and more. Based on the assessment information, an overall description of the nutritional status of the children was provided, and the appropriate nutritional support method during surgery was determined.

2.5.3 Liver function

Approximately 5 mL of FVB was collected, with 2 mL used for complete blood count testing and 3 mL for serum separation. The serum separation process involved allowing the blood sample to stand at room temperature for 30 min, followed by centrifugation at 3,000 rpm for 10 min to collect the upper serum layer. Serum samples were immediately frozen and stored at −80°C for subsequent testing. First, the liver function tests included the examination of markers such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, direct bilirubin, alkaline phosphatase (ALP), and other indicators. Second, the liver function enzyme profile comprised tests for markers such as ALT, AST, ALP, and gamma-glutamyl transferase. Prior to surgery, an ultrasound examination was conducted to assess the child’s liver. Using an ultrasound probe, the child’s abdominal area was examined, and ultrasound images were used to observe the morphology, size, structure, and blood flow of the liver. This examination provided initial insights into the functional status of the liver and the presence of any abnormalities such as tumors or stones. Postoperative blood glucose monitoring time points were based on the Pediatric Perioperative Glycemic Management Guidelines [17] and clinical practice standards: venous blood samples were collected to measure fasting blood glucose (FBG) and postprandial blood glucose (PBG) at 0 h (post-anesthesia recovery), 6, 12, 24, and 48 h after surgery. These time points were selected to encompass the metabolic changes during the acute stress phase (0–24 h) and recovery phase (24–48 h) post-surgery while minimizing additional trauma to the children from frequent blood sampling.

2.5.4 Kidney function

Midstream urine samples were collected from children, and urine creatinine (Ucr), blood urea nitrogen (BUN), and urine albumin-to-creatinine ratio (UACR) were measured using an automated biochemical analyzer (BS-240E, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., China). FVB was also collected to measure serum creatinine (Scr) and cystatin C (Cys-C). Kidney function was assessed according to the Pediatric Nephrology Diagnosis and Treatment Guidelines (2020 edition):

Normal ranges: Scr (<1 year: 10–30 μmol/L; 1–12 years: 20–50 μmol/L); BUN (1.8–6.4 mmol/L); and UACR (<30 mg/g).

Abnormal values were defined as: Scr or BUN exceeding the age-specific upper limit, or UACR ≥ 30 mg/g.

2.5.5 Biochemical testing

Biochemical testing is a common medical diagnostic method used primarily to assess the state of human health and diagnose diseases (19). The operational steps were as follows:

  1. Preprocessing of samples: Depending on the testing requirements, serum and urine samples from the child were subjected to preprocessing, which involved precipitating and washing the substances to be tested.

  2. Reagent preparation: Based on the testing method and sample characteristics, appropriate reagents were prepared. The samples were mixed with the reagents in the specified proportions to induce specific biochemical reactions.

  3. Reaction termination and analysis: A termination solution was added to stop the reaction, and the reaction products were analyzed using a spectrophotometer. The testing results were then derived based on the data obtained from the analysis.

2.6 Methods for statistical analysis

Data were statistically analyzed using SPSS 26.0. Continuous data were expressed as (x ± s), and intergroup comparisons were conducted using independent sample t-tests. Categorical data were analyzed using the chi-square test (χ 2) or Fisher’s exact test (when expected frequencies were <5). A multifactorial analysis of variance was conducted for all postoperative complications (infection, delayed wound healing [DWH], difficult glucose control [DGC], respiratory system complications [RSC]), with group (intravenous/oral) and surgery type as fixed factors, while controlling for covariates such as age and BMI. When multiple factors were involved, multivariable logistic regression analysis was performed. The initial variables included FBG, BMI, surgery duration (minutes), intraoperative blood loss (mL), and postoperative complications (infection/delayed healing). Independent influencing factors were selected using stepwise regression (forward method, α = 0.1). P < 0.05 indicated a statistically great difference.

  1. Informed consent: Informed consent was obtained from all individual participants included in the study.

  2. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki.

3 Results

3.1 Basic characteristics of children

The basic characteristics of enrolled children are outlined in Table 3. It suggested that the age, weight, and gender of children were not greatly different (P > 0.05).

Table 3

Basic characteristics of children

Group Age Gender Weight
Male Female
Intravenous group 9 ± 3.63 17 13 29.81 ± 8.34
Oral group 9 ± 4.01 16 14 31.42 ± 9.13

3.2 Dietary survey results of children in different groups

The 24-h calorie intake between children in different groups was compared in Table 4. In the intravenous group, 26 cases (86.67%) had sufficient calorie intake, while 4 cases (13.33%) had insufficient intake. In the oral group, 21 cases (70%) had sufficient calorie intake, while 9 cases (30%) had insufficient intake.

Table 4

Comparison on the 24-h calorie intake of children

Group Sufficient intake Insufficient intake
Intravenous group 26 (86.67%) 4 (13.33%)
Oral group 21 (70%) 9 (30%)*

*Suggested a statistically remarkable difference with P < 0.05.

3.3 The nutritional status of diabetic children

The nutritional status of diabetic children in distinct group was presented in Table 5. In the intravenous group, there were 7 cases (23.33%) with normal nutrition, 12 cases (40%) with malnutrition, and 11 cases (36.67%) with severe malnutrition. In contrast, there were 8 cases (26.67%) with normal nutrition, 9 cases (30%) with malnutrition, and 13 cases (43.33%) with severe malnutrition in the oral group. These data exhibited no great difference (P > 0.05).

Table 5

The nutritional status of diabetic children in distinct groups

Group Normal nutrition Malnutrition Severe malnutrition
Intravenous group 7 (23.33%) 12 (40%) 11 (36.67%)
Oral group 8 (26.67%) 9 (30%) 13 (43.33%)

3.4 Results of biochemical testing

Biochemical testing was conducted on all children in the intravenous and oral groups, as depicted in Figure 1. In Figure 1a, the normal nutrition group exhibited the highest TLC levels, followed by the malnutrition group, with the severe malnutrition group showing the lowest levels. The severe malnutrition group showed a significant difference compared to the normal nutrition group (P < 0.05), and the malnutrition group also showed a significant difference compared to the normal nutrition group (P < 0.05). In Figure 1b, the malnutrition group had the highest TG levels, followed by the normal nutrition group, with the severe malnutrition group showing the lowest levels. There was a significant difference between the malnutrition and normal nutrition groups (P < 0.05) and a significant difference between the severe malnutrition and normal nutrition groups (P < 0.05). In Figure 1c, the normal nutrition group had the highest TC levels, followed by the malnutrition group, with the severe malnutrition group showing the lowest levels. Significant differences were found between the malnutrition and normal nutrition groups (P < 0.05) and between the severe malnutrition and normal nutrition groups (P < 0.05). In Figure 1d, the normal nutrition group exhibited the highest ALB levels, followed by the malnutrition group, with the severe malnutrition group showing the lowest levels. There was a significant difference between the severe malnutrition and normal nutrition groups (P < 0.05), while no significant difference was observed between the malnutrition and normal nutrition groups (P > 0.05). In Figure 1e, the normal nutrition group had the highest ALB levels, with the severe malnutrition group showing the lowest levels. A significant difference was observed between the severe malnutrition and normal nutrition groups (P < 0.05).

Figure 1 Comparison of biochemical indicators in children with different nutritional statuses. Note: (a) TLC; (b) TG; (c) TC; (d) ALB; and (e) Hb. *A significant difference between the severe malnutrition group and the normal nutrition group (P < 0.05). #A significant difference between the malnutrition group and the normal nutrition group (P < 0.05).
Figure 1

Comparison of biochemical indicators in children with different nutritional statuses. Note: (a) TLC; (b) TG; (c) TC; (d) ALB; and (e) Hb. *A significant difference between the severe malnutrition group and the normal nutrition group (P < 0.05). #A significant difference between the malnutrition group and the normal nutrition group (P < 0.05).

3.5 Comparison of kidney function indicators

Figure 2 shows that in Figure 2a, the average Scr for the intravenous group was 38.2 ± 12.1 μmol/L, and for the oral group, it was 41.5 ± 14.3 μmol/L. There was no statistically significant difference between the two groups (P > 0.05). In Figure 2b, the average BUN for the intravenous group was 5.2 ± 1.8 mmol/L, and for the oral group, it was 5.6 ± 2.1 mmol/L, both within the normal range. There was no statistically significant difference between the two groups (P > 0.05).

Figure 2 Comparison of kidney function indicators. Note: (a) Scr and (b) BUN.
Figure 2

Comparison of kidney function indicators. Note: (a) Scr and (b) BUN.

3.6 Impact of different surgery types on postoperative complications

The incidence of DGC in the gastrointestinal surgery group was significantly higher than in the other groups (52.4% vs 28.6%, P = 0.03). The endocrine-related surgery group had a higher risk of infection (14.3% vs 4.8%, P = 0.08), but this difference did not reach statistical significance. Surgical complexity (Clavien–Dindo classification) was positively correlated with the degree of malnutrition (r = 0.34, P = 0.01).

3.7 Surgery conditions and postoperative outcomes

Both groups of children had good surgical outcomes, and the postoperative recovery and complication occurrences were presented in Table 6. In the intravenous group, the number of cases with infection, DWH, DGC, and RSC were 3 (10%), 6 (20%), 12 (40%), and 1 (3.33%), respectively. In the oral group, the number of cases of infection, DWH, and DGC was 2 (6.67%), 6 (20%), and 9 (30%), respectively.

Table 6

Comparison of poor prognosis of children after surgery

Group Items
Infection DWH DGC RSC
Intravenous group 3 (10%) 6 (20%) 12 (40%) 1 (3.33%)
Oral group 2 (6.67%) 6 (20%) 9 (30%)* 0

*Suggested a statistical remarkable difference with P < 0.05.

Variance analysis in Table 7 indicated that there were no significant differences in the incidence of all complications between the two groups (P > 0.05), although the incidence of DGC showed an increasing trend in the intravenous group (40% vs 30%). Further subgroup analysis revealed that the risk of DGC in children undergoing gastrointestinal surgery was significantly higher than in those undergoing other types of surgery (P = 0.03).

Table 7

Results of between-group variance analysis for postoperative complications

Complication Intravenous group (n = 30) Oral group (n = 30) F P
Infection 3 (10%) 2 (6.67%) 0.21 0.65
DWH 6 (20%) 6 (20%) 0.00 1.00
DGC 12 (40%) 9 (30%) 0.67 0.41
RSC 1 (3.33%) 0 1.02 0.31

3.8 Changes in glucose of children before and after surgery

As depicted in Figure 3, it was evident that after the surgery, all children experienced varying degrees of reductions in FBG levels and post-meal blood glucose levels. These reductions may be attributed to the metabolic demands of surgery and the healing process of the surgical wounds. In Figure 3a, the FBG levels after treatment were significantly lower than before treatment (P < 0.05). The blood sugar levels 2 h after meals were also significantly lower after treatment compared to before treatment (P < 0.05). In Figure 3b, the FBG levels after treatment were significantly lower than before treatment (P < 0.05). The blood sugar levels 2 h after meals were significantly lower after treatment compared to before treatment (P < 0.05). Clearly, postoperatively, all children exhibited varying degrees of reduction in both FBG and PBG levels. These reductions may be attributed to the metabolic demands of surgery and the wound-healing process.

Figure 3 Changes in glucose of children before and after surgery. Note: (a) intravenous group; (b) oral group. *Suggested a significant difference with P < 0.05 based on the preoperative level.
Figure 3

Changes in glucose of children before and after surgery. Note: (a) intravenous group; (b) oral group. *Suggested a significant difference with P < 0.05 based on the preoperative level.

3.9 Multivariate logistic regression analysis results

Through the analysis of all the data in conjunction with the duration and outcomes of the children’s surgeries, some important findings have emerged. First, it was found that the FBG levels below 6.5 mmol/L (odds ratio [OR] = 2.4, 95% confidence interval [CI]: 1.4–5.1) and BMI below 17.3 (OR = 2.7, 95% CI: 1.6–5.72) were independent risk factors affecting nutritional support. A surgery duration of ≥120 min (OR = 1.8, 95% CI: 1.1–3.0) was also identified as an independent risk factor for the effectiveness of nutritional support. Postoperative complications (such as infection) did not reach statistical significance due to insufficient sample size (P = 0.08). These findings suggested that excessively low glucose levels and BMI may lead to suboptimal effectiveness of nutritional support.

4 Discussion

Through a comprehensive assessment of the nutritional status of children with congenital diabetes before, during, and after surgery, this work identified a significant nutritional risk in this specific patient population during the surgical period. First, the preoperative nutritional status exerted a crucial role in the recovery and rehabilitation after surgery. This work observed that many children with congenital diabetes patients had malnutrition before surgery, such as low body weight and insufficient protein intake. These factors may hinder the postoperative recovery process and increase the risk of infection and complications. Second, nutritional support during surgery also significantly influenced the surgical outcomes. During surgery, children with congenital diabetes patients underwent anesthesia and surgical trauma, leading to an increased metabolic rate and greater nutritional demands. Therefore, an appropriate nutritional support strategy was essential for maintaining metabolic balance and ensuring the success of the surgery. Finally, postoperative nutritional support was of paramount importance for the recovery and growth of children with congenital diabetes patients.

The reduction in postoperative blood glucose levels is the result of multiple factors acting in concert. In addition to the metabolic demands associated with surgical trauma and wound healing, the following factors may influence blood glucose fluctuations. Some children may experience exacerbated insulin resistance due to the use of glucocorticoids or β-receptor blockers for pain management [18]. Anesthetics used during surgery (such as propofol) may transiently lower blood glucose by inhibiting hepatic gluconeogenesis. Surgical stress leads to elevated cortisol and catecholamine levels, which temporarily increase glycogenolysis, but prolonged stress may deplete liver glycogen stores, resulting in delayed postoperative hypoglycemia [16,19]. In this study, the infection rate in the intravenous group was 10%, and infection-related inflammatory factors (such as IL-6) could interfere with insulin signaling pathways, exacerbating blood glucose fluctuations. The intravenous group’s reliance on glucose infusion may mask the true metabolic demands, whereas the oral group experienced insufficient energy intake due to postoperative fasting or impaired digestive function. Future studies should comprehensively analyze blood glucose regulation mechanisms through dynamic continuous glucose monitoring combined with blood biochemical markers (such as cortisol and inflammatory factors). It is important to note that although the PPNRA scale can reflect the common characteristics of perioperative nutritional risk, its applicability in children with congenital diabetes still requires further validation. For example, the scale does not include diabetes-specific metabolic indicators (such as glucose variability coefficient and insulin requirements), which may lead to an underestimation of the nutritional risk in these patients. Future studies should focus on optimizing the existing assessment system by incorporating diabetes-specific parameters.

In recent years, several studies explored the challenges of perioperative management in children with diabetes. For instance, a prospective cohort study by Wang et al. [20] found that the preoperative HbA1C > 7.850% is associated with an increased incidence of surgical site infections, thereby providing some support for the notion that higher preoperative HbA1c levels are correlated with an elevated risk of postoperative infections. In contrast, in this study, FBG < 6.5 mmol/L was identified as an independent risk factor, suggesting that different dimensions of glucose control (acute vs chronic) may have differential effects on outcomes. Rossing et al. [21] indicated that chronic kidney disease is a common complication of type 2 diabetes (T2D). Glucagon-like peptide-1 receptor agonists can improve blood glucose control and reduce weight in T2D patients, with some of them reducing the risk of cardiovascular (CV) events in patients with high CV risk. Nelson and Sumpter [22] noted that both surgery and anesthesia trigger stress responses, leading to significant metabolic changes in patients, thereby increasing blood glucose variability. Close monitoring of glucose levels and a clear insulin administration protocol can help mitigate these characteristic responses. Martin et al. [23] reported that in the United States, approximately 1 in every 300 children is affected by T1D. In the perioperative period, careful attention should be given to appropriate insulin administration, as well as the management of hypoglycemia and hypertension following anesthesia and surgery. However, compared to the aforementioned studies, the strength of this research lies in its systematic analysis of the nutritional risk characteristics of children with congenital diabetes, a unique subgroup, particularly the high incidence of severe malnutrition (36.67%), providing clinical evidence for targeted interventions. Future studies should integrate metabolic indicators (such as ketone levels) and dynamic glucose monitoring data to more comprehensively assess risk. This study, based solely on a grouping strategy for nutritional support methods, may overly simplify the interaction between surgical stress, metabolic demands, and nutritional status. For example, children undergoing major gastrointestinal surgery may inherently require extended intravenous support, while minor surgeries may be more suited to oral intake. Subsequent research should stratify participants based on surgical complexity and disease severity to refine nutritional support strategies.

The postoperative recovery period is a critical time for children’s growth and development, and malnutrition can lead to growth retardation and weakened immune function. Compared to nutritionally normal patients, children with diabetes exhibit a significant decrease in total lymphocyte count, which serves as a representative marker of their immune status, raising significant concerns. Over time, this may increase the risk of complications and other infections. Therefore, it is crucial to develop a reasonable nutritional support plan to meet the energy and nutritional needs of children with congenital diabetes, promoting their recovery and growth [24,25]. Recommendations for implementing individualized nutritional support strategies: according to the WHO energy requirements formula for children, the recommended perioperative intake is resting energy expenditure (REE) × 1.3–1.5, where REE (kcal/day) = 22 × body weight (kg) + 500 (for children aged 6–12 years). Postoperative protein requirements in children with congenital diabetes are increased, with a recommended daily intake of 1.5–2.0 g/kg, prioritizing high-biological-value proteins (such as whey protein and casein). Carbohydrates should account for 45–50% of total energy intake, with a focus on low glycemic index (<55) foods (such as whole wheat bread and oats), provided in 5–6 meals to avoid significant blood glucose fluctuations. Fat should constitute 30–35% of total energy, with an emphasis on monounsaturated fatty acids (such as olive oil) and limiting saturated fats (<10%). Capillary blood glucose should be monitored every 4 h, with adjustments made based on the readings. If FBG > 10 mmol/L, the glucose infusion rate should be reduced (e.g., from 5 to 3 mg/kg/min), and insulin dosages should be adjusted accordingly. For children with infections or DWH, additional supplementation with vitamin C (200 mg/day) and zinc (10 mg/day) is recommended to promote wound healing. Between 24 and 48 h postoperatively, a gradual transition from intravenous nutrition to enteral nutrition should be made, starting with elemental formulas (e.g., Peptamen Junior), and transitioning to polymeric formulas once well-tolerated [26,27].

Although the sample size of 60 children in this study is sufficient for an initial understanding, it limits the statistical power to detect subtle associations and restricts the generalizability to a broader population. Small sample sizes increase the risk of Type II errors, particularly in subgroup analyses (e.g., severe malnutrition vs normal nutrition). To address this limitation, future plans include a larger, multicenter cohort study aimed at recruiting at least 200 participants. This expansion will enhance the robustness of risk factor identification (e.g., BMI < 17.3 as an independent predictor) and allow for stratified analyses based on surgical type and disease severity. Due to the specificity of children with congenital diabetes during the surgical period, there are inherent challenges, including potential ethical and operational limitations. Additionally, the retrospective nature of this study introduces inherent limitations, including potential biases from incomplete records or unmeasured confounding factors (e.g., variations in preoperative care). For instance, dietary intake data relied on 24-h recalls from medical charts, which may not fully capture habitual nutritional patterns. Although the 24-h dietary recall is a commonly used clinical nutritional assessment tool, its reliance on caregivers’ recollection may either underestimate or overestimate actual intake. This study partially addressed this limitation by combining the FFQ with biochemical indicators, but future studies should incorporate more objective methods (e.g., doubly labeled water or smart dietary tracking devices) to improve data reliability. The development and implementation of nutritional support plans need to consider various factors, such as the type of surgery, the nutritional status of the children, surgical risks, and more. Therefore, further research and exploration are required to determine the optimal nutritional support strategies.

5 Conclusion

This study highlights the importance of PPNRA and support in children with congenital diabetes. However, there are several limitations to the study: first, the small sample size (n = 60) and the single-center retrospective design may limit the generalizability of the conclusions; second, the PPNRA scale has not been optimized for the metabolic characteristics of diabetes, which may result in an underestimation of risk. Therefore, clinical implementation should be approached with caution, and it is recommended to verify the findings using specialized assessment tools. Future research should expand the sample size through multicenter collaboration and adopt a prospective design to monitor blood glucose and nutritional indicators in real time. In addition, exploring personalized nutritional support strategies (such as dynamic adjustments based on continuous glucose monitoring) and the application of metabolomics in nutritional interventions will help optimize perioperative management for these children.

Acknowledgments

Not applicable.

  1. Funding information: The authors state no funding involved.

  2. Author contributions: All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Haoyu Chen and Fang Zhang. The first draft of the manuscript was written by Jiaoyan Lian. All authors read and approved the final manuscript.

  3. Conflict of interest: The authors state no conflict of interest.

  4. Data availability statement: The data are included in the manuscript.

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Received: 2025-02-13
Revised: 2025-04-02
Accepted: 2025-04-24
Published Online: 2025-06-26

© 2025 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

Artikel in diesem Heft

  1. Research Articles
  2. Network pharmacological analysis and in vitro testing of the rutin effects on triple-negative breast cancer
  3. Impact of diabetes on long-term survival in elderly liver cancer patients: A retrospective study
  4. Knockdown of CCNB1 alleviates high glucose-triggered trophoblast dysfunction during gestational diabetes via Wnt/β-catenin signaling pathway
  5. Risk factors for severe adverse drug reactions in hospitalized patients
  6. Analysis of the effect of ALA-PDT on macrophages in footpad model of mice infected with Fonsecaea monophora based on single-cell sequencing
  7. Development and validation of headspace gas chromatography with a flame ionization detector method for the determination of ethanol in the vitreous humor
  8. CMSP exerts anti-tumor effects on small cell lung cancer cells by inducing mitochondrial dysfunction and ferroptosis
  9. Predictive value of plasma sB7-H3 and YKL-40 in pediatric refractory Mycoplasma pneumoniae pneumonia
  10. Antiangiogenic potential of Elaeagnus umbellata extracts and molecular docking study by targeting VEGFR-2 pathway
  11. Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer
  12. Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis
  13. Adhered macrophages as an additional marker of cardiomyocyte injury in biopsies of patients with dilated cardiomyopathy
  14. Association between statin administration and outcome in patients with sepsis: A retrospective study
  15. Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018
  16. A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
  17. Lysophosphatidic acid 2 alleviates deep vein thrombosis via protective endothelial barrier function
  18. Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
  19. Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
  20. Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
  21. Vitamin D replacement therapy may regulate sleep habits in patients with restless leg syndrome
  22. The first-line antihypertensive nitrendipine potentiated the therapeutic effect of oxaliplatin by downregulating CACNA1D in colorectal cancer
  23. Health literacy and health-related quality of life: The mediating role of irrational happiness
  24. Modulatory effects of Lycium barbarum polysaccharide on bone cell dynamics in osteoporosis
  25. Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
  26. Examination of the causal role of immune cells in non-alcoholic fatty liver disease by a bidirectional Mendelian randomization study
  27. Clinical analysis of ten cases of HIV infection combined with acute leukemia
  28. Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
  29. Clinical observation of probiotics combined with mesalazine and Yiyi Baitouweng Decoction retention enema in treating mild-to-moderate ulcerative colitis
  30. Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection
  31. Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
  32. Core muscle strength and stability-oriented breathing training reduces inter-recti distance in postpartum women
  33. The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial
  34. The serum IL-17A levels in patients with traumatic bowel rupture post-surgery and its predictive value for patient prognosis
  35. Impact of Kolb’s experiential learning theory-based nursing on caregiver burden and psychological state of caregivers of dementia patients
  36. Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
  37. Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
  38. The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
  39. Tetrahydropalmatine improves mitochondrial function in vascular smooth muscle cells of atherosclerosis in vitro by inhibiting Ras homolog gene family A/Rho-associated protein kinase-1 signaling pathway
  40. A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
  41. A comparative analysis of the impact of repeated administration of flavan 3-ol on brown, subcutaneous, and visceral adipose tissue
  42. Identifying early screening factors for depression in middle-aged and older adults: A cohort study
  43. Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
  44. Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
  45. High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
  46. RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
  47. Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
  48. Clinical efficacy of azacitidine in the treatment of middle- and high-risk myelodysplastic syndrome in middle-aged and elderly patients: A retrospective study
  49. The effect of ambulatory blood pressure load on mitral regurgitation in continuous ambulatory peritoneal dialysis patients
  50. Expression and clinical significance of ITGA3 in breast cancer
  51. Single-nucleus RNA sequencing reveals ARHGAP28 expression of podocytes as a biomarker in human diabetic nephropathy
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  58. Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
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  60. Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
  61. Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
  62. GATA1: A key biomarker for predicting the prognosis of patients with diffuse large B-cell lymphoma
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  74. Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
  75. Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
  76. Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
  77. Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
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  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
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  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
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  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
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  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
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  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
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  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
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  117. Lateral transperitoneal laparoscopic adrenalectomy: A single-centre experience of 21 procedures
  118. Petunidin attenuates lipopolysaccharide-induced retinal microglia inflammatory response in diabetic retinopathy by targeting OGT/NF-κB/LCN2 axis
  119. Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
  120. Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients
  121. Development of a nomogram for predicting cancer-specific survival in patients with renal pelvic cancer following surgery
  122. Inhibition of ATG7 promotes orthodontic tooth movement by regulating the RANKL/OPG ratio under compression force
  123. A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
  124. Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
  125. Review Articles
  126. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  127. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  128. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  129. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  130. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  131. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  132. The application of augmented reality in robotic general surgery: A mini-review
  133. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  134. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
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  136. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  137. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  138. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
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  140. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  141. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
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  145. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  146. Case Reports
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  148. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
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  152. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  153. Rapid Communication
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  155. Letter to the Editor
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  157. Expression of Concern
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  159. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
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  161. Corrigendum
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  163. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  164. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  165. Retraction
  166. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  167. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  168. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  169. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  170. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  171. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
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  173. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  174. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  175. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  176. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  177. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  178. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  179. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  180. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  181. Special Issue Diabetes
  182. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  183. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  184. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  185. A review of brain research on T2DM-related cognitive dysfunction
  186. Special Issue Biomarker Discovery and Precision Medicine
  187. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
https://doi.org/10.1515/med-2025-1204
Schlagwörter für diesen Artikel
children with congenital diabetes; nutritional risk; nutritional support
Creative Commons
BY 4.0

Artikel in diesem Heft

  1. Research Articles
  2. Network pharmacological analysis and in vitro testing of the rutin effects on triple-negative breast cancer
  3. Impact of diabetes on long-term survival in elderly liver cancer patients: A retrospective study
  4. Knockdown of CCNB1 alleviates high glucose-triggered trophoblast dysfunction during gestational diabetes via Wnt/β-catenin signaling pathway
  5. Risk factors for severe adverse drug reactions in hospitalized patients
  6. Analysis of the effect of ALA-PDT on macrophages in footpad model of mice infected with Fonsecaea monophora based on single-cell sequencing
  7. Development and validation of headspace gas chromatography with a flame ionization detector method for the determination of ethanol in the vitreous humor
  8. CMSP exerts anti-tumor effects on small cell lung cancer cells by inducing mitochondrial dysfunction and ferroptosis
  9. Predictive value of plasma sB7-H3 and YKL-40 in pediatric refractory Mycoplasma pneumoniae pneumonia
  10. Antiangiogenic potential of Elaeagnus umbellata extracts and molecular docking study by targeting VEGFR-2 pathway
  11. Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer
  12. Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis
  13. Adhered macrophages as an additional marker of cardiomyocyte injury in biopsies of patients with dilated cardiomyopathy
  14. Association between statin administration and outcome in patients with sepsis: A retrospective study
  15. Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018
  16. A comparative analysis of the binary and multiclass classified chest X-ray images of pneumonia and COVID-19 with ML and DL models
  17. Lysophosphatidic acid 2 alleviates deep vein thrombosis via protective endothelial barrier function
  18. Transcription factor A, mitochondrial promotes lymph node metastasis and lymphangiogenesis in epithelial ovarian carcinoma
  19. Serum PM20D1 levels are associated with nutritional status and inflammatory factors in gastric cancer patients undergoing early enteral nutrition
  20. Hydromorphone reduced the incidence of emergence agitation after adenotonsillectomy in children with obstructive sleep apnea: A randomized, double-blind study
  21. Vitamin D replacement therapy may regulate sleep habits in patients with restless leg syndrome
  22. The first-line antihypertensive nitrendipine potentiated the therapeutic effect of oxaliplatin by downregulating CACNA1D in colorectal cancer
  23. Health literacy and health-related quality of life: The mediating role of irrational happiness
  24. Modulatory effects of Lycium barbarum polysaccharide on bone cell dynamics in osteoporosis
  25. Mechanism research on inhibition of gastric cancer in vitro by the extract of Pinellia ternata based on network pharmacology and cellular metabolomics
  26. Examination of the causal role of immune cells in non-alcoholic fatty liver disease by a bidirectional Mendelian randomization study
  27. Clinical analysis of ten cases of HIV infection combined with acute leukemia
  28. Investigating the cardioprotective potential of quercetin against tacrolimus-induced cardiotoxicity in Wistar rats: A mechanistic insights
  29. Clinical observation of probiotics combined with mesalazine and Yiyi Baitouweng Decoction retention enema in treating mild-to-moderate ulcerative colitis
  30. Diagnostic value of ratio of blood inflammation to coagulation markers in periprosthetic joint infection
  31. Sex-specific associations of sex hormone binding globulin and risk of bladder cancer
  32. Core muscle strength and stability-oriented breathing training reduces inter-recti distance in postpartum women
  33. The ERAS nursing care strategy for patients undergoing transsphenoidal endoscopic pituitary tumor resection: A randomized blinded controlled trial
  34. The serum IL-17A levels in patients with traumatic bowel rupture post-surgery and its predictive value for patient prognosis
  35. Impact of Kolb’s experiential learning theory-based nursing on caregiver burden and psychological state of caregivers of dementia patients
  36. Analysis of serum NLR combined with intraoperative margin condition to predict the prognosis of cervical HSIL patients undergoing LEEP surgery
  37. Commiphora gileadensis ameliorate infertility and erectile dysfunction in diabetic male mice
  38. The correlation between epithelial–mesenchymal transition classification and MMP2 expression of circulating tumor cells and prognosis of advanced or metastatic nasopharyngeal carcinoma
  39. Tetrahydropalmatine improves mitochondrial function in vascular smooth muscle cells of atherosclerosis in vitro by inhibiting Ras homolog gene family A/Rho-associated protein kinase-1 signaling pathway
  40. A cross-sectional study: Relationship between serum oxidative stress levels and arteriovenous fistula maturation in maintenance dialysis patients
  41. A comparative analysis of the impact of repeated administration of flavan 3-ol on brown, subcutaneous, and visceral adipose tissue
  42. Identifying early screening factors for depression in middle-aged and older adults: A cohort study
  43. Perform tumor-specific survival analysis for Merkel cell carcinoma patients undergoing surgical resection based on the SEER database by constructing a nomogram chart
  44. Unveiling the role of CXCL10 in pancreatic cancer progression: A novel prognostic indicator
  45. High-dose preoperative intraperitoneal erythropoietin and intravenous methylprednisolone in acute traumatic spinal cord injuries following decompression surgeries
  46. RAB39B: A novel biomarker for acute myeloid leukemia identified via multi-omics and functional validation
  47. Impact of peripheral conditioning on reperfusion injury following primary percutaneous coronary intervention in diabetic and non-diabetic STEMI patients
  48. Clinical efficacy of azacitidine in the treatment of middle- and high-risk myelodysplastic syndrome in middle-aged and elderly patients: A retrospective study
  49. The effect of ambulatory blood pressure load on mitral regurgitation in continuous ambulatory peritoneal dialysis patients
  50. Expression and clinical significance of ITGA3 in breast cancer
  51. Single-nucleus RNA sequencing reveals ARHGAP28 expression of podocytes as a biomarker in human diabetic nephropathy
  52. rSIG combined with NLR in the prognostic assessment of patients with multiple injuries
  53. Toxic metals and metalloids in collagen supplements of fish and jellyfish origin: Risk assessment for daily intake
  54. Exploring causal relationship between 41 inflammatory cytokines and marginal zone lymphoma: A bidirectional Mendelian randomization study
  55. Gender beliefs and legitimization of dating violence in adolescents
  56. Effect of serum IL-6, CRP, and MMP-9 levels on the efficacy of modified preperitoneal Kugel repair in patients with inguinal hernia
  57. Effect of smoking and smoking cessation on hematological parameters in polycythemic patients
  58. Pathogen surveillance and risk factors for pulmonary infection in patients with lung cancer: A retrospective single-center study
  59. Necroptosis of hippocampal neurons in paclitaxel chemotherapy-induced cognitive impairment mediates microglial activation via TLR4/MyD88 signaling pathway
  60. Celastrol suppresses neovascularization in rat aortic vascular endothelial cells stimulated by inflammatory tenocytes via modulating the NLRP3 pathway
  61. Cord-lamina angle and foraminal diameter as key predictors of C5 palsy after anterior cervical decompression and fusion surgery
  62. GATA1: A key biomarker for predicting the prognosis of patients with diffuse large B-cell lymphoma
  63. Influencing factors of false lumen thrombosis in type B aortic dissection: A single-center retrospective study
  64. MZB1 regulates the immune microenvironment and inhibits ovarian cancer cell migration
  65. Integrating experimental and network pharmacology to explore the pharmacological mechanisms of Dioscin against glioblastoma
  66. Trends in research on preterm birth in twin pregnancy based on bibliometrics
  67. Four-week IgE/baseline IgE ratio combined with tryptase predicts clinical outcome in omalizumab-treated children with moderate-to-severe asthma
  68. Single-cell transcriptomic analysis identifies a stress response Schwann cell subtype
  69. Acute pancreatitis risk in the diagnosis and management of inflammatory bowel disease: A critical focus
  70. Effect of subclinical esketamine on NLRP3 and cognitive dysfunction in elderly ischemic stroke patients
  71. Interleukin-37 mediates the anti-oral tumor activity in oral cancer through STAT3
  72. CA199 and CEA expression levels, and minimally invasive postoperative prognosis analysis in esophageal squamous carcinoma patients
  73. Efficacy of a novel drainage catheter in the treatment of CSF leak after posterior spine surgery: A retrospective cohort study
  74. Comprehensive biomedicine assessment of Apteranthes tuberculata extracts: Phytochemical analysis and multifaceted pharmacological evaluation in animal models
  75. Relation of time in range to severity of coronary artery disease in patients with type 2 diabetes: A cross-sectional study
  76. Dopamine attenuates ethanol-induced neuronal apoptosis by stimulating electrical activity in the developing rat retina
  77. Correlation between albumin levels during the third trimester and the risk of postpartum levator ani muscle rupture
  78. Factors associated with maternal attention and distraction during breastfeeding and childcare: A cross-sectional study in the west of Iran
  79. Mechanisms of hesperetin in treating metabolic dysfunction-associated steatosis liver disease via network pharmacology and in vitro experiments
  80. The law on oncological oblivion in the Italian and European context: How to best uphold the cancer patients’ rights to privacy and self-determination?
  81. The prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index for survival in patients with colorectal cancer
  82. Factors affecting the measurements of peripheral oxygen saturation values in healthy young adults
  83. Comparison and correlations between findings of hysteroscopy and vaginal color Doppler ultrasonography for detection of uterine abnormalities in patients with recurrent implantation failure
  84. The effects of different types of RAGT on balance function in stroke patients with low levels of independent walking in a convalescent rehabilitation hospital
  85. Causal relationship between asthma and ankylosing spondylitis: A bidirectional two-sample univariable and multivariable Mendelian randomization study
  86. Correlations of health literacy with individuals’ understanding and use of medications in Southern Taiwan
  87. Correlation of serum calprotectin with outcome of acute cerebral infarction
  88. Comparison of computed tomography and guided bronchoscopy in the diagnosis of pulmonary nodules: A systematic review and meta-analysis
  89. Curdione protects vascular endothelial cells and atherosclerosis via the regulation of DNMT1-mediated ERBB4 promoter methylation
  90. The identification of novel missense variant in ChAT gene in a patient with gestational diabetes denotes plausible genetic association
  91. Molecular genotyping of multi-system rare blood types in foreign blood donors based on DNA sequencing and its clinical significance
  92. Exploring the role of succinyl carnitine in the association between CD39⁺ CD4⁺ T cell and ulcerative colitis: A Mendelian randomization study
  93. Dexmedetomidine suppresses microglial activation in postoperative cognitive dysfunction via the mmu-miRNA-125/TRAF6 signaling axis
  94. Analysis of serum metabolomics in patients with different types of chronic heart failure
  95. Diagnostic value of hematological parameters in the early diagnosis of acute cholecystitis
  96. Pachymaran alleviates fat accumulation, hepatocyte degeneration, and injury in mice with nonalcoholic fatty liver disease
  97. Decrease in CD4 and CD8 lymphocytes are predictors of severe clinical picture and unfavorable outcome of the disease in patients with COVID-19
  98. METTL3 blocked the progression of diabetic retinopathy through m6A-modified SOX2
  99. The predictive significance of anti-RO-52 antibody in patients with interstitial pneumonia after treatment of malignant tumors
  100. Exploring cerebrospinal fluid metabolites, cognitive function, and brain atrophy: Insights from Mendelian randomization
  101. Development and validation of potential molecular subtypes and signatures of ocular sarcoidosis based on autophagy-related gene analysis
  102. Widespread venous thrombosis: Unveiling a complex case of Behçet’s disease with a literature perspective
  103. Uterine fibroid embolization: An analysis of clinical outcomes and impact on patients’ quality of life
  104. Discovery of lipid metabolism-related diagnostic biomarkers and construction of diagnostic model in steroid-induced osteonecrosis of femoral head
  105. Serum-derived exomiR-188-3p is a promising novel biomarker for early-stage ovarian cancer
  106. Enhancing chronic back pain management: A comparative study of ultrasound–MRI fusion guidance for paravertebral nerve block
  107. Peptide CCAT1-70aa promotes hepatocellular carcinoma proliferation and invasion via the MAPK/ERK pathway
  108. Electroacupuncture-induced reduction of myocardial ischemia–reperfusion injury via FTO-dependent m6A methylation modulation
  109. Hemorrhoids and cardiovascular disease: A bidirectional Mendelian randomization study
  110. Cell-free adipose extract inhibits hypertrophic scar formation through collagen remodeling and antiangiogenesis
  111. HALP score in Demodex blepharitis: A case–control study
  112. Assessment of SOX2 performance as a marker for circulating cancer stem-like cells (CCSCs) identification in advanced breast cancer patients using CytoTrack system
  113. Risk and prognosis for brain metastasis in primary metastatic cervical cancer patients: A population-based study
  114. Comparison of the two intestinal anastomosis methods in pediatric patients
  115. Factors influencing hematological toxicity and adverse effects of perioperative hyperthermic intraperitoneal vs intraperitoneal chemotherapy in gastrointestinal cancer
  116. Endotoxin tolerance inhibits NLRP3 inflammasome activation in macrophages of septic mice by restoring autophagic flux through TRIM26
  117. Lateral transperitoneal laparoscopic adrenalectomy: A single-centre experience of 21 procedures
  118. Petunidin attenuates lipopolysaccharide-induced retinal microglia inflammatory response in diabetic retinopathy by targeting OGT/NF-κB/LCN2 axis
  119. Procalcitonin and C-reactive protein as biomarkers for diagnosing and assessing the severity of acute cholecystitis
  120. Factors determining the number of sessions in successful extracorporeal shock wave lithotripsy patients
  121. Development of a nomogram for predicting cancer-specific survival in patients with renal pelvic cancer following surgery
  122. Inhibition of ATG7 promotes orthodontic tooth movement by regulating the RANKL/OPG ratio under compression force
  123. A machine learning-based prognostic model integrating mRNA stemness index, hypoxia, and glycolysis‑related biomarkers for colorectal cancer
  124. Glutathione attenuates sepsis-associated encephalopathy via dual modulation of NF-κB and PKA/CREB pathways
  125. Review Articles
  126. The effects of enhanced external counter-pulsation on post-acute sequelae of COVID-19: A narrative review
  127. Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
  128. Microscopic changes and gross morphology of placenta in women affected by gestational diabetes mellitus in dietary treatment: A systematic review
  129. Review of mechanisms and frontier applications in IL-17A-induced hypertension
  130. Research progress on the correlation between islet amyloid peptides and type 2 diabetes mellitus
  131. The safety and efficacy of BCG combined with mitomycin C compared with BCG monotherapy in patients with non-muscle-invasive bladder cancer: A systematic review and meta-analysis
  132. The application of augmented reality in robotic general surgery: A mini-review
  133. The effect of Greek mountain tea extract and wheat germ extract on peripheral blood flow and eicosanoid metabolism in mammals
  134. Neurogasobiology of migraine: Carbon monoxide, hydrogen sulfide, and nitric oxide as emerging pathophysiological trinacrium relevant to nociception regulation
  135. Plant polyphenols, terpenes, and terpenoids in oral health
  136. Laboratory medicine between technological innovation, rights safeguarding, and patient safety: A bioethical perspective
  137. End-of-life in cancer patients: Medicolegal implications and ethical challenges in Europe
  138. The maternal factors during pregnancy for intrauterine growth retardation: An umbrella review
  139. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings
  140. PI3K/Akt pathway and neuroinflammation in sepsis-associated encephalopathy
  141. Screening of Group B Streptococcus in pregnancy: A systematic review for the laboratory detection
  142. Giant borderline ovarian tumours – review of the literature
  143. Leveraging artificial intelligence for collaborative care planning: Innovations and impacts in shared decision-making – A systematic review
  144. Cholera epidemiology analysis through the experience of the 1973 Naples epidemic
  145. Risk factors of frailty/sarcopenia in community older adults: Meta-analysis
  146. Case Reports
  147. Delayed graft function after renal transplantation
  148. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  149. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  150. Giant right atrial hemangioma presenting with ascites: A case report
  151. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  152. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  153. Rapid Communication
  154. Biological properties of valve materials using RGD and EC
  155. Letter to the Editor
  156. Role of enhanced external counterpulsation in long COVID
  157. Expression of Concern
  158. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  159. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  160. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  161. Corrigendum
  162. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  163. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  164. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  165. Retraction
  166. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  167. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  168. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  169. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  170. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  171. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  172. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  173. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  174. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  175. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  176. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  177. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  178. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  179. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  180. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  181. Special Issue Diabetes
  182. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  183. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  184. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  185. A review of brain research on T2DM-related cognitive dysfunction
  186. Special Issue Biomarker Discovery and Precision Medicine
  187. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
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Heruntergeladen am 22.9.2025 von https://www.degruyterbrill.com/document/doi/10.1515/med-2025-1204/html
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