Clinical nutrition ESPEN最新文献

{"title":"The metabolic and molecular mechanisms linking fructose consumption to lipogenesis and metabolic disorders","authors":"Baharuddin Baharuddin","doi":"10.1016/j.clnesp.2025.06.042","DOIUrl":"10.1016/j.clnesp.2025.06.042","url":null,"abstract":"<div><div>The global rise in type 2 diabetes mellitus (<em>T2DM</em>) has been closely associated with excessive fructose consumption, particularly from processed foods and sugar-sweetened beverages. High fructose intake disrupts metabolic homeostasis, leading to hyperglycemia and lipid dysregulation. Yet, long-term investigations of fructose's effects are lacking, especially regarding gene expression mechanisms. This review examines the metabolic and molecular gene expression mechanisms linking fructose consumption to metabolic disorders, focusing on pathways that drive lipogenesis and insulin resistance. Fructose's insulin-independent (<em>FII</em>) nature allows its rapid hepatocyte uptake, bypassing key metabolic checkpoints. This unique pathway facilitates accelerated production of triglycerides and uric acid, contributing to insulin resistance, dyslipidemia, Metabolic Dysfunction-Associated Steatotic Liver Disease (<em>MASLD</em>, formerly <em>NAFLD</em>), potentially progressing to chronic liver disease. Key transcription factors mediate fructose-induced lipogenesis, notably sterol regulatory element-binding protein 1c (<em>SREBP1c</em>) and carbohydrate response element-binding protein (<em>ChREBP</em>). Elevated fructose levels stimulate the expression of lipogenic enzymes in hepatocytes, such as fatty acid synthase (<em>FAS</em>) and acetyl-CoA carboxylase (<em>ACC</em>). Fructose also enhances phosphofructokinase-2 (<em>PFK-2</em>) activity and suppresses pyruvate dehydrogenase kinase, promoting glycolytic flux and de novo lipogenesis. Based on these metabolic and gene expression profiles, this review highlights how fructose metabolism accelerates lipid accumulation, promotes insulin resistance, and triggers key lipogenic regulators, strengthening the biological and clinical plausibility of fructose's role in <em>T2DM</em>. Although fructose occurs naturally and is often perceived as harmless, excessive fructose intake poses significant metabolic risks, particularly when consumed in large amounts. This highlights the critical role of healthy dietary patterns and portion control in reducing these adverse effects. However, the long-term causal relationship between high fructose intake and the development of type 2 diabetes mellitus (<em>T2DM</em>) remains insufficiently understood. Therefore, there is a pressing need for well-designed prospective studies—especially in developing countries—to elucidate the long-term metabolic impact of fructose consumption. These findings reinforce the importance of dietary moderation and evidence-based policy interventions to curb the growing burden of fructose-related metabolic disorders.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Pages 63-68"},"PeriodicalIF":2.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individually Compounded Multi-Chamber vs. Standardized Parenteral Nutrition Bags in Solid Tumors - A randomized clinical trial (IKF-010).","authors":"Thorsten Oliver Goetze, Ralf-Dieter Hofheinz, Ingeborg Roetzer, Wolfgang Blau, Thomas Zander, Kim Barbara Luley, Philipp Ivanyi, Matthias Groschek, Janine Kreiss-Sender, Christina Baur, Thomas Wolff, Barbara Wenning, Dirk Behringer, Florian Weißinger, Annegret Kunitz, Barbara Tschechne, Christiane Decker-Baumann, Melanie Frank, Luisa Wohn, Johanna Riedel, Disorn Sookthai, Marina Schaaf, Salah-Eddin Al-Batran, Georg Martin Haag","doi":"10.1016/j.clnesp.2025.06.040","DOIUrl":"https://doi.org/10.1016/j.clnesp.2025.06.040","url":null,"abstract":"<p><strong>Purpose: </strong>Many cancer patients rely on home parenteral nutrition (HPN), requiring intensive nursing care and facing higher infection risks. Multi-chamber bags (MCB) for individualized HPN could reduce manipulation, enhance patient autonomy, and lower infection risks. This study (IKF-t01/PEKANNUSS) compares MCB-based HPN to traditional 2/3-chamber bags in improving patient safety and independence.</p><p><strong>Patients and methods: </strong>Patients with metastatic or locally advanced tumors were randomized 2:1 to receive either individually compounded HPN via MCB (Arm A) or physician-choice HPN in 2/3-chamber bags (Arm B). The primary endpoint was the autonomy rate, defined as the proportion of patients self-administering ≥70% of HPN without home care or nursing assistance. Secondary endpoints included catheter-related infections (CRIs), safety, body weight, and serum albumin levels.</p><p><strong>Results: </strong>The study was prematurely terminated due to slow recruitment after enrolling 142 patients, with 131 evaluable in the intent-to-treat analysis. Patient autonomy was significantly improved in Arm A compared to Arm B (52% vs. 33%, p=0.04), with the difference being more pronounced in patients with ECOG ≤ 1 (68% vs. 42%). The number of required injections of additive supplements into HPN bags at home was considerably lower in Arm A (11% vs. 96%; p<0.01). The incidence of all-grade HPN-related adverse events (AEs) was significantly lower in Arm A (27% vs. 55%; p<0.01). CRI rates were numerically lower in Arm A (13% vs. 22%; p=0.22), with a more pronounced difference in patients with ECOG ≤ 1 (8% vs. 25%).</p><p><strong>Conclusion: </strong>Individually compounded parenteral nutrition using multi-chamber bags is a safe and effective treatment option that enhances patients' capacity to self-manage their treatment.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, identifier NCT04105777.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing weight loss with artificial intelligence: A randomized controlled trial of dietary-supplement prescriptions in adults with overweight and obesity","authors":"Evgeny Pokushalov ,&nbsp;Claire Garcia ,&nbsp;Andrey Ponomarenko ,&nbsp;Iuliia Samoilova ,&nbsp;John Smith ,&nbsp;Michael Johnson ,&nbsp;Inessa Pak ,&nbsp;Evgenya Shrainer ,&nbsp;Dmitry Kudlay ,&nbsp;Anastasia Romanova ,&nbsp;Richard Miller","doi":"10.1016/j.clnesp.2025.06.035","DOIUrl":"10.1016/j.clnesp.2025.06.035","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a complex, multifactorial chronic disease that poses significant health risks. Recent advancements in artificial intelligence (AI) offer the potential for more personalized and effective dietary-supplement (DS) regimens to promote weight loss. This randomized controlled trial evaluated the efficacy of AI-guided DS prescriptions compared with standard physician-guided DS prescriptions in adults with obesity.</div></div><div><h3>Methods</h3><div>This randomized, parallel-group pilot study enrolled 60 individuals aged 40–60 years with a body-mass index (BMI) ≥ 25 kg m⁻². Participants were randomized to receive either AI-guided DS prescriptions generated on the basis of each patient's individualized genetic, metabolic, and behavioral data (n = 30) or physician-guided DS prescriptions (n = 30) for 180 days. The primary endpoints were the percentage change in body weight and the proportion of participants achieving a ≥5 % weight reduction. Secondary endpoints included changes in BMI, fat mass, visceral-fat rating, systolic and diastolic blood pressure, lipid profiles, fasting plasma glucose, hsCRP levels, and postprandial appetite ratings. Adverse events were monitored throughout the study.</div></div><div><h3>Results</h3><div>Baseline characteristics were well balanced between groups. Mean weight loss was −12.3 % (95 % CI: −13.1 to −11.5) in the AI-guided group vs. −7.2 % (95 % CI: −8.1 to −6.3) in the physician-guided group, giving a treatment difference of −5.1 % (95 % CI: −6.4 to −3.8; p &lt; 0.01). At day 180, 25/30 (83.3 %) AI-guided participants achieved ≥5 % weight reduction compared with 16/30 (53.3 %) in the physician-guided arm (OR 4.4; 95 % CI: 1.3 to 14.5; p = 0.01). Significant improvements were also seen in BMI, fat mass and visceral-fat rating in the AI-guided group (p &lt; 0.01 for all).</div><div>Postprandial appetite suppression was greater in the AI-guided group, with significant reductions in hunger and prospective food consumption and increases in fullness and satiety (p &lt; 0.01 for all). Adverse events were generally mild to moderate, with higher incidences of gastrointestinal symptoms in the AI-guided group, but these were manageable and did not affect adherence.</div></div><div><h3>Conclusion</h3><div>The AI-guided dietary-supplement regimen was more effective in promoting weight loss, improving body composition, and suppressing appetite than the physician-guided regimen. These findings suggest that AI-guided, personalized supplement prescriptions—grounded in genetic, metabolic, and behavioral profiling—could provide a more effective approach to obesity management. Larger studies are warranted to confirm these results and further refine AI-based interventions for weight loss.</div></div><div><h3>Trial Registration</h3><div>ClinicalTrials.gov NCT06458296.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Pages 75-86"},"PeriodicalIF":2.9,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the association between Triglyceride-glucose index and risk of chronic kidney disease: A systematic review and meta-analysis.","authors":"Mohammad Sharifi, Fatemeh Maleki Sedgi, Ensiye Soleimani, Houri Heshmatipoor, Mahsa Shirani, Gholamreza Askari","doi":"10.1016/j.clnesp.2025.06.028","DOIUrl":"https://doi.org/10.1016/j.clnesp.2025.06.028","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) has emerged as a critical public health issue, with its global prevalence steadily rising. Insulin resistance has been recognized as a significant contributor to the progression of CKD. The triglyceride-glucose (TyG) index, an established surrogate marker of insulin resistance, has been suggested as a potential predictor for CKD risk. However, the relationship between the TyG index and CKD remains inconsistent across various studies.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate the association between the TyG index and risk of developing CKD across diverse populations.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in the PubMed, ISI Web of Science, and Scopus databases through December 2024. Eligible studies examining the association between the TyG index and CKD risk were included. The pooled effect size (ES) was calculated using a random-effects model. Subgroup analyses were conducted based on study design, population characteristics, and methodological quality.</p><p><strong>Results: </strong>A total of 33 observational studies, encompassing 322,394 participants, were included. The meta-analysis revealed a significant association between a higher TyG index and an increased risk of CKD (pooled ES: 1.67; 95% CI: 1.51-1.86, P < 0.001) when analyzed as a categorical variable. A similar significant association was observed when the TyG index was assessed as a continuous variable (pooled ES: 1.44; 95% CI: 1.28-1.62, P < 0.001). Subgroup analyses indicated that this association was consistent across various study designs, geographic regions, and population characteristics.</p><p><strong>Conclusion: </strong>The findings suggest that the TyG index is a reliable predictor of CKD risk and may serve as a valuable tool for the early identification of individuals at high risk. Future research should focus on exploring the underlying mechanisms and evaluating the clinical utility of the TyG index in CKD screening and prevention strategies.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pre-post study of multidisciplinary ward-based conferences on nutrition care for hospital patients","authors":"Naoki Hashizume ,&nbsp;Natsumi Maruyama ,&nbsp;Ayu Nagamatsu ,&nbsp;Mayumi Ikeda ,&nbsp;Risa Takayanagai ,&nbsp;Hanae Kita ,&nbsp;Naruki Higashidate ,&nbsp;Saki Sakamoto ,&nbsp;Hirotomo Nakahara ,&nbsp;Daisuke Masui ,&nbsp;Nobuya Ishibashi ,&nbsp;Takumi Kawaguchi ,&nbsp;Tatsuru Kaji","doi":"10.1016/j.clnesp.2025.06.033","DOIUrl":"10.1016/j.clnesp.2025.06.033","url":null,"abstract":"<div><h3>Background</h3><div>Malnutrition is a significant concern among hospitalized patients, contributing to increased complication rates and prolonged hospital stays. To improve nutritional management, our institution implemented weekly multidisciplinary ward-based nutrition conferences involving physicians, nurses, pharmacists, and a dedicated dietitian. When necessary, a specialized nutritional support team (NST) provided additional interventions. This study aimed to evaluate the impact of this multidisciplinary approach, with the primary outcome being the length of hospital stay.</div></div><div><h3>Methods</h3><div>In an advanced treatment hospital functioning as both an acute care and long-term care hospital, as well as a designated tertiary care center under Japan's national medical system by the Ministry of Health, Labour, and Welfare, we conducted a retrospective analysis from April 2011 to March 2020, dividing the study period into two eras: Era 1 (pre-conferences, April 2011–March 2016) and Era 2 (post-conferences, April 2016–March 2020). Key metrics included the length of hospital stay and the proportion of patients receiving NST interventions. The NST has been the main organizer of nutrition-related seminars. These seminars have been held six times a year and were designed to provide training opportunities for multidisciplinary ward personnel, including nurses, physicians, and dietitians.</div></div><div><h3>Results</h3><div>The average length of hospital stay was significantly shorter in Era 2 (15.5 ± 0.1 days) compared to Era 1 (18.2 ± 1.1 days) (p = 0.0016). The proportion of patients requiring NST interventions decreased significantly from 3.36 ± 0.29 % in Era 1 to 2.06 ± 0.47 % in Era 2 (p = 0.0013).</div></div><div><h3>Conclusions</h3><div>The introduction of a multidisciplinary ward-based nutrition conferences significantly reduced the length of hospital stay and decreased the number of patients requiring NST interventions. These findings highlight the value of structured, collaborative nutritional care with training opportunities in improving hospital efficiency and patient outcomes.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 785-789"},"PeriodicalIF":2.9,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-designed, personalised protein supplementation with whole-food dairy products in a randomised controlled trial: An investigation of success and acceptability in ≥80 years old community-dwelling adults","authors":"Sussi Friis Buhl ,&nbsp;Ilaria Marcella Piccinini ,&nbsp;Anne Marie Beck ,&nbsp;Anja Serena ,&nbsp;Werner Vach ,&nbsp;Paolo Caserotti","doi":"10.1016/j.clnesp.2025.06.037","DOIUrl":"10.1016/j.clnesp.2025.06.037","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Protein malnutrition is associated with loss of muscle mass and physical function in older adults, and specific tailored nutritional interventions may be required. This two-phased randomised controlled trial aimed at evaluating the success of 16-week co-designed personalised protein supplementation intervention with whole-food dairy products in community-dwelling adults 80+ years.</div></div><div><h3>Methods</h3><div>Participants, recruited through a nationally regulated preventive service, were screened for protein malnutrition, with personalised guidance provided if below the cut-point of 1.0 g/kg/day (phase 1: 1-month optimization period). All eligible participants (≥1.0 g/kg/day) were randomly assigned to i) protein supplementation + power training, ii) protein supplementation-only, or iii) control. Protein supplementation included co-design of a supplementation plan with whole-food dairy products to supplement habitual diet (phase 2). Success was evaluated from changes in protein intake (mean (10; 90 percentiles) and ≥1.35 g/kg/day cut-point.</div></div><div><h3>Results</h3><div>Of the 92 participants entering the study, 55.4 % were protein malnourished with 56,9 % reaching eligibility following personal guidance. A total of 38 participants were randomised to phase 2. All receiving protein supplementation increased protein intake (0.24 (0.01; 0.63) g/kg/day) compared to 16.7 % in the control group (−0.19 (−0.35;-0.07)). However, only 47 % of participants in the supplementation groups reached cut-point success criteria (1.35 g/kg/day).</div></div><div><h3>Conclusion</h3><div>Co-designed personalised protein supplementation with whole-food dairy products was successful to increase protein intake in adults 80+ year. Nevertheless, reaching high intake was challenging. Individual nutritional guidance by a nutritional specialist may result in higher level of protein intake among most older adults with habitual low levels of protein intake.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 774-784"},"PeriodicalIF":2.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relation between resting energy expenditure and amino acid metabolism in the post-acute phase of catabolic critically ill patients","authors":"Itai Bendavid ,&nbsp;Ilana BenAri ,&nbsp;Benjamin Zribi ,&nbsp;Raven A. Wierzchowska-McNew ,&nbsp;Mariëlle P.K.J. Engelen ,&nbsp;Nicolaas E.P. Deutz ,&nbsp;Pierre Singer","doi":"10.1016/j.clnesp.2025.06.031","DOIUrl":"10.1016/j.clnesp.2025.06.031","url":null,"abstract":"<div><h3>Introduction</h3><div>Post Intensive Care Unit (ICU) acquired weakness is characterized by a massive loss of muscle mass and is generally considered to be multifactorial, secondary to bedridden condition, ubiquitination, increased catabolism, and moderately increased anabolism, and a lack of protein administration. We attended to explore the metabolism of amino acids of long-stayer patients hospitalized for more than 7 days in the ICU, using a stable isotopes technique and correlate the changes observed in the amino acid metabolism to the resting energy expenditure obtained by indirect calorimetry measurement.</div></div><div><h3>Methods</h3><div>Chronically critically ventilated patients were included in the study and matched to healthy volunteers according to age, sex, and BMI. Labeled amino acids were injected, and samples were collected for tracer enrichment and amino acid concentration measurements. Compartment measurement was obtained. In addition, resting energy expenditure was measured by indirect calorimetry, and body composition was measured by bioimpedance. The results were compared to those from normal volunteers.</div></div><div><h3>Results</h3><div>Fourteen ICU patients were matched to 14 normal volunteers and were very comparable. A high catabolism was observed in these long stayers. Most of the plasma levels of amino acids were decreased in the ICU post-acute phase patients compared to healthy volunteers. Only aspartate, taurine, and hydro methyl butyrate significantly increased. The extracellular pool size of amino acids and whole-body amino acid production was significantly increased compared to normal volunteers. Phase angle was lower and REE was correlated to BMI but inversely correlated to citrulline.</div></div><div><h3>Conclusion</h3><div>In chronically critically ill patients, catabolism persists. Resting energy expenditure is in a decrease and is inversely correlated to citrulline. Most of plasma amino acid concentrations are decreased, but whole-body amino acid production is increased.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Pages 20-28"},"PeriodicalIF":2.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive role of the geriatric nutritional risk index and modified creatinine index in patients undergoing hemodialysis","authors":"Takahiro Yajima","doi":"10.1016/j.clnesp.2025.06.038","DOIUrl":"10.1016/j.clnesp.2025.06.038","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"69 ","pages":"Pages 29-30"},"PeriodicalIF":2.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serial measurement of energy expenditure in critically ill patients – Feasibility and impact on nutrition provision","authors":"Niklas Prange,&nbsp;Lorenz Weidhase,&nbsp;Bastian Pasieka,&nbsp;Sirak Petros","doi":"10.1016/j.clnesp.2025.06.036","DOIUrl":"10.1016/j.clnesp.2025.06.036","url":null,"abstract":"<div><h3>Background</h3><div>Serial indirect calorimetry instead of prediction of energy expenditure is recommended in critically ill patients. However, the feasibility and the challenges associated with it are not systematically investigated. This prospective study was aimed to investigate the course of measured resting energy expenditure in critically ill adult medical patients, the challenges associated with it and factors that significantly impact variations in energy expenditure.</div></div><div><h3>Method</h3><div>Indirect calorimetry was serially performed on critically ill adult medical patients on invasive mechanical ventilation. Data on disease severity, body temperature, vasopressor support and sedation depth as well as nutrition therapy were also recorded.</div></div><div><h3>Results</h3><div>A total of 98 patients (65.3 % males) with a mean age of 66.9 ± 13.5 years were included. Their mean Acute Physiology And Chronic Health Evaluation-II score was 31.4 ± 8.4. There was a total of 600 potential measurement days, out of which indirect calorimetry could be carried out on 452 days (75.3 %). There was a stepwise increase in resting energy expenditure during the first 7 days with a quasi-plateau on day 8 and beyond, amounting to an increase in resting energy expenditure by 19.0 ± 28.7 %. Daily changes in body temperature and the Richmond Agitation and Sedation Scale showed a significant effect on variations in energy expenditure. The study patients received beginning from day 4 onwards 93.6 ± 34.7 % (95 % confidence interval 86.1–101.1 %) of their measured energy expenditure.</div></div><div><h3>Conclusion</h3><div>There is a stepwise increase in resting energy expenditure during the first week of critical care among critically ill adult medical patients. Patient-related factors and logistic challenges should be considered regarding indirect calorimetry. Body temperature and the degree of sedation have a significant impact on variations in energy expenditure.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 761-766"},"PeriodicalIF":2.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between homocysteine levels and bone quality in healthy adults - A systematic review and meta-analysis","authors":"Deepti K. Sharma ,&nbsp;Tim Soon Cheok ,&nbsp;Manuela Rogers ,&nbsp;Victor Yan Zhe Lu ,&nbsp;Lucian B. Solomon ,&nbsp;Boopalan Ramasamy ,&nbsp;Peter M. Clifton ,&nbsp;Stuart A. Callary","doi":"10.1016/j.clnesp.2025.06.034","DOIUrl":"10.1016/j.clnesp.2025.06.034","url":null,"abstract":"<div><h3>Background and aims</h3><div>Patients with elevated homocysteine (Hcy) levels are associated with an increased risk of fracture. B-vitamin supplementation studies have consistently shown an ability to reduce Hcy levels but have had no or marginal effect on bone mineral density (BMD), which led us to hypothesize that hyperhomocysteinemia may increase fracture risk by altering bone quality outcome measures beyond BMD. The aim of our systematic review was to investigate the association between Hcy and bone quality outcome measures, i.e. bone turnover, bone microarchitecture, collagen crosslinks and micro damage accumulation, in healthy adults.</div></div><div><h3>Methods</h3><div>A systematic search was performed on Pubmed, Embase, and Scopus from the date of inception to 30th of September^, 2024. Studies were included that had sufficient data to identify the pooled relationship between plasma Hcy and at least one domain of bone quality, such as bone microarchitecture, bone turnover, advanced glycation product (AGE) pentosidine levels, collagen crosslinks, or micro damage accumulation. Studies involving patients who were on medications or had conditions affecting plasma Hcy or bone health were excluded. Osteoporotic patients were included only if they had not been treated.</div></div><div><h3>Results</h3><div>Twenty-seven studies were included in our systematic review. Our meta-analysis found a significant positive correlation between Hcy and osteocalcin [Pearson's coefficient of correlation (r) = 0.39, significance value (p) = 0.023, 95 % Confidence Interval (CI) = 0.36–0.42]. No significant correlation was observed between Hcy and Procollagen type-1 N propeptide (P1NP), C-terminal telopeptide of type 1 collagen (CTX-1), or Bone-specific alkaline phosphatase (Bone ALP). Additionally, we found a strong positive correlation between Hcy and the AGE serum pentosidine [r = 0.72; 95 % CI: 0.67–0.76; p = 0.020], a molecule linked to increased non-enzymatic collagen cross-linkage. Further, two studies measured collagen-crosslinking in the bone, and both reported elevated Hcy to be associated with higher non-enzymatic crosslinks and reduced enzymatic crosslinks.</div></div><div><h3>Conclusion</h3><div>Our results suggest that elevated Hcy impacts bone quality outcome measures. The effect is possibly mediated via increased bone turnover and accumulation of non-enzymatic collagen crosslinking, resulting in decreased bone strength.</div></div><div><h3>PROSPERO Registration No</h3><div>CRD42024595870.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 790-805"},"PeriodicalIF":2.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}