{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:04:42Z","timestamp":1784005482130,"version":"3.55.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Enteral nutrition-associated diarrhea (ENAD) is a frequent gastrointestinal complication during enteral nutrition (EN) in critically ill patients. In ICU patients with ischemic stroke, neurological impairment, dysphagia, reduced consciousness, immobility, infection, and intensive care interventions may further impair gastrointestinal tolerance; however, disease-specific prediction tools are scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop and internally validate an interpretable machine-learning model for individualized ENAD prediction in ICU patients with ischemic stroke receiving EN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective cohort study included adult ICU patients with ischemic stroke who received EN at Yichang Central People\u2019s Hospital from January 2024 to December 2025. ENAD was defined as Bristol Stool Form Scale type \u22656 plus either \u22653 bowel movements\/day or stool output &amp;gt;500\u202fg\/24\u202fh after EN initiation. Candidate predictors covered demographic, neurological, nutritional, laboratory, EN-related, medication, and organ-support variables. Missing values were handled within five-fold cross-validation training folds. LASSO logistic regression was used for feature screening, and six algorithms were compared using five-fold cross-validated out-of-fold predictions. Performance was assessed using discrimination, precision-recall performance, calibration-related metrics, confusion-matrix indices, decision-curve analysis, and SHAP interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 374 patients, 105 developed ENAD (28.1%). Patients with ENAD had higher NRS-2002, APACHE II, NIHSS, and mRS scores; lower GCS scores; longer ICU stay and mechanical ventilation; higher EN infusion rates and CRP; and lower albumin. The random forest model showed the best overall internal performance, with AUC 0.969, AUPRC 0.921, sensitivity 0.943, specificity 0.888, negative predictive value 0.98, and F1 score 0.85 at a threshold of 0.45. SHAP identified EN infusion rate, CRP, NRS-2002 score, albumin, mRS score, APACHE II score, and NIHSS score as leading contributors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pending external validation, the interpretable random forest model can support an early ENAD risk pathway for ICU patients with ischemic stroke receiving EN. High-risk predictions should trigger structured stool monitoring, feeding-rate and delivered-versus-prescribed EN review, medication review, skin protection, fluid-electrolyte surveillance, and early nutrition-support consultation. Future work should prioritize multicenter validation, calibration updating, parsimonious model comparison, and prospective impact testing before routine clinical deployment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1890164","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:21:31Z","timestamp":1784002891000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of an interpretable machine-learning model for enteral nutrition-associated diarrhea in critically ill patients with ischemic stroke: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yang","family":"He","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, The First College of Clinical Medical Science, Yichang Central People's Hospital, China Three Gorges University","place":["Yichang, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First College of Clinical Medical Science, Yichang Central People's Hospital, China Three Gorges University","place":["Yichang, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The First College of Clinical Medical Science, Yichang Central People's Hospital, China Three Gorges University","place":["Yichang, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinglan","family":"Liu","sequence":"additional","affiliation":[{"name":"Yichang Central People's Hospital","place":["Yichang, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000513","article-title":"Guideline for the early management of patients with acute ischemic stroke: a guideline from the American Heart Association\/American Stroke Association","author":"Prabhakaran","year":"2026","journal-title":"Stroke"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1016\/S0140-6736(05)17983-5","article-title":"Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial","volume":"365","author":"Dennis","year":"2005","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1007\/s00134-016-4665-0","article-title":"Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines","volume":"43","author":"Reintam Blaser","year":"2017","journal-title":"Intensive Care Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1016\/j.clnu.2023.07.011","article-title":"ESPEN practical and partially revised guideline: clinical nutrition in the intensive care unit","volume":"42","author":"Singer","year":"2023","journal-title":"Clin Nutr"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1177\/0148607115621863","article-title":"Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition","volume":"40","author":"McClave","year":"2016","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.3760\/cma.j.cn121430-20230829-00710","article-title":"Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China","volume":"35","year":"2023","journal-title":"Zhonghua Wei Zhong Bing Ji Jiu Yi Xue"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2851","DOI":"10.3390\/nu13082851","article-title":"Nutrition in the intensive care unit-a narrative review","volume":"13","author":"Hill","year":"2021","journal-title":"Nutrients"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1007\/s00134-022-06663-8","article-title":"Diarrhea during critical illness: a multicenter cohort study","volume":"48","author":"Dionne","year":"2022","journal-title":"Intensive Care Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1097\/MCC.0000000000001024","article-title":"Diarrhea in the critically ill: definitions, epidemiology, risk factors and outcomes","volume":"29","author":"Dionne","year":"2023","journal-title":"Curr Opin Crit Care"},{"key":"ref10","volume-title":"Management of enteral feeding related diarrhoea: Decision Tree. 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