Clinical nutrition ESPEN最新文献

{"title":"Dietary sodium and potassium intake and risk of diabetes in the Million Veteran Program","authors":"Xuan-Mai T. Nguyen ,&nbsp;Yanping Li ,&nbsp;April R. Williams ,&nbsp;Neha Panigrahy ,&nbsp;Mark S. Nyaeme ,&nbsp;Kerry L. Ivey ,&nbsp;Daniel D. Wang ,&nbsp;Serena Houghton ,&nbsp;Hasan Mahbub ,&nbsp;Walter C. Willett ,&nbsp;Frank B. Hu ,&nbsp;John Michael Gaziano ,&nbsp;Lawrence Phillips ,&nbsp;Peter WF. Wilson ,&nbsp;Kelly Cho ,&nbsp;Luc Djousse ,&nbsp;the VA Million Veteran Program","doi":"10.1016/j.clnesp.2025.102882","DOIUrl":"10.1016/j.clnesp.2025.102882","url":null,"abstract":"<div><h3>Background/objective</h3><div>Studies show an association between elevated blood pressure, obesity, and insulin resistance with a higher risk of developing diabetes. As sodium is closely linked to elevated blood pressure and hypertension, and potassium is a counterbalancing nutrient to sodium, this study examines the association between intake of sodium, potassium, and sodium: potassium (Na:K) ratio and the incidence of diabetes.</div></div><div><h3>Design setting and participants</h3><div>Retrospective data analysis of dietary intake measured by a validated food frequency questionnaire in a prospective cohort of veterans participating in the Million Veteran Program (MVP) between 2011 and 2020, who were free of diabetes at baseline.</div></div><div><h3>Main outcome measurement</h3><div>The main outcome is clinically diagnosed diabetes defined by phenotyping algorithms applied to electronic health records.</div></div><div><h3>Results</h3><div>In this study of 198,049 veterans (mean age: 63.8 ± 13.1 years, 89 % male), 7260 were diagnosed with diabetes over a mean follow-up of 4.3 years. The mean sodium intake was 1218 mg/day. A higher sodium intake was associated with an 11 % higher rate of developing diabetes (hazard ratio, HR) comparing extreme quintiles: 1.11, 95 % CI: 1.03–1.20). The average daily potassium intake was 2589 mg and the highest quintile of potassium intake was associated with a 13 % lower rate of diabetes (HR: 0.87, 95 % CI: 0.81, 0.94) compared to the lowest quintile of potassium. Highest quintile of Na:K ratio was associated with a 21 % higher rate for diabetes (HR: 1.21, 95% CI: 1.12, 1.30). The pattern of associations between Na:K ratio and diabetes closely followed the pattern of dietary sodium intake and diabetes associations.</div></div><div><h3>Conclusion</h3><div>A higher sodium intake and a higher Na:K ratio were associated with a higher risk of diabetes in this large cohort of veterans. These findings may be applied in future work to identify personalized lifestyle and dietary supports to prevent and treat T2DM.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102882"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899280","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":"Energy, carbohydrates and fats in clinical sports nutrition","authors":"Ana Karin Kozjek Schwietert ,&nbsp;Krištof Knap ,&nbsp;Gašper Tonin ,&nbsp;Nada Rotovnik Kozjek ,&nbsp;Michael Gleeson","doi":"10.1016/j.clnesp.2025.102900","DOIUrl":"10.1016/j.clnesp.2025.102900","url":null,"abstract":"<div><div>Energy metabolism plays a central role in supporting physical activity and athletic performance. In almost all forms of exercise different metabolic pathways and energy systems are used concurrently, with their relative contributions depending on exercise intensity, duration, fuel availability, environment, and physiological adaptations. Carbohydrates and fats both serve as the primary energy sources, with fat dominating during rest and low-intensity exercise, and carbohydrates becoming a preferential fuel at moderate to high exercise intensities. With longer duration of exercise, muscle energy stores become gradually depleted and blood glucose and adipose tissue derived fatty acids become increasingly important sources of energy. Prolonged exercise performance can be enhanced with exogenous carbohydrate supplementation in form of drinks, gels or snacks. Maintaining adequate energy and carbohydrate availability is crucial to support training and recovery and to prevent negative health consequences. While low-carbohydrate, high-fat diets may increase fat oxidation, they often impair performance at higher intensities. Individualised and periodised nutritional strategies that tailor energy and macronutrient intakes to meet the daily requirements of an active individual are essential to optimise health, support adaptations to exercise, and achieve training goals.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102900"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905619","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":"Survival of patients after a hip fracture: Influence of previous nutritional status on outcomes","authors":"M.C. Cervera-Díaz ,&nbsp;J.J. López-Gómez ,&nbsp;H.J. Aguado-Hernández ,&nbsp;V. García-Virto ,&nbsp;D. Rico-Bargues ,&nbsp;D.A. De Luis-Román","doi":"10.1016/j.clnesp.2025.102897","DOIUrl":"10.1016/j.clnesp.2025.102897","url":null,"abstract":"<div><h3>Background</h3><div>Sarcopenia is a highly prevalent condition in patients with hip fracture; this condition can be related with prognosis. The main aim of this study was to investigate the survival rate of hip fracture inpatients and factors associated with mortality after six months and five years of the fracture event.</div></div><div><h3>Methods</h3><div>A real-world prospective study was carried out on 186 patients aged 75 years and older admitted after hip fracture, which were assessed within 48 h previous to surgical intervention. Hospitalized patients were able to walk before the fracture and showed no signs of cognitive impairment or chronic degenerative pathologies that posed a high risk of mortality. Integral Geriatric Assessment (IGA) was carried out at admission, at discharge, and after one, three and six months. Handgrip strength (HGS) was tested and lean tissue estimated through Bioelectrical Impedanciometry Analysis (BIA). Follow-up of all patients was carried out in order to record survival status or decease date. Mini-Nutritional Assessment (MNA) and European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were recorded to assess disease-related malnutrition (DRM) and sarcopenia.</div></div><div><h3>Results</h3><div>Age was 86.2 (75–104) years, with 81.7 % of women. Sarcopenia prevalence was of 59,1 % (with 76.9 % of patients showing low HGS and 73,7 % low estimated lean soft tissue. DRM was established in 81.2 % of patients, with 48,9 % of them showing both malnutrition and sarcopenia. Mortality within the first six months was 12.3 % increasing to 14,5 % and 51,6 % after one- and five-years follow-up respectively.The multivariate analyses identified the following significant factors associated with mortality across all subgroups: low handgrip (OR 3.61, 95 % CI (1.55–8.44; <em>p</em> &lt; 0.01), age &gt;85 years (OR 2.44; CI 1.24–4.81; <em>p</em> = 0.01), Barthel index at admission &lt;60 (OR 0.47, 95%CI 0.22–0.99; <em>p</em> = 0.049, and BMI &lt;22 kg/m² (OR 0.26; 95 % CI: 0.12–0.59; <em>p</em> &lt; 0.01))</div></div><div><h3>Conclusions</h3><div>Over half of hip fracture patients exhibit sarcopenia, with 81 % experiencing DRM, and nearly 50 % presenting both conditions simultaneously. Mortality at six months and five years is associated with sarcopenia, poorer nutritional status at the time of hospitalization, and a lower prefracture functional status.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102897"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899286","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":"Association of nutrition impact symptoms with dietary intake among patients with advanced cancer referred to palliative care","authors":"Koji Amano ,&nbsp;Vickie E. Baracos ,&nbsp;Saori Koshimoto ,&nbsp;Tatsuma Sakaguchi ,&nbsp;Sayaka Arakawa ,&nbsp;Naoharu Mori","doi":"10.1016/j.clnesp.2025.102894","DOIUrl":"10.1016/j.clnesp.2025.102894","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Considering that cachexia-related symptoms interfere with dietary intake and compromise nutritional status in advanced cancer patients, these symptoms are classified as nutrition impact symptoms (NISs). However, the extent to which each NIS interferes with dietary intake remains unclear. Therefore, we examined the association between each NIS and dietary intake, considering the impact of an NIS cluster, and investigated the ability of each NIS to predict reduced dietary intake.</div></div><div><h3>Methods</h3><div>This is a secondary analysis using two datasets obtained from two surveys using a self-reported questionnaire conducted among advanced cancer patients referred to palliative care in multiple cancer hospitals. Participants evaluated 19 NISs (e.g., lack of appetite, early satiety, nausea, abnormal taste, and fatigue) and their dietary intake using a numerical rating scale (NRS) and the Ingesta-Verbal/Visual Analog Scale (IVVAS), respectively. To assess associations between each NIS and dietary intake, multivariate logistic regression analysis was performed adjusting for potential confounders, including four or more NISs with an NRS score of 4 or more as an NIS cluster. Values of the area under the curve (AUC) were also calculated for predicting a median IVVAS score or lower.</div></div><div><h3>Results</h3><div>Data were obtained from 328 participants in Survey 1 and 220 participants in Survey 2. Lack of appetite, early satiety, nausea, vomiting, abnormal taste, and fatigue were significantly associated with poor dietary intake (odds ratio [OR] 0.73, 95 % confidence interval [CI] 0.66–0.81; OR 0.84, 95 % CI 0.77–0.92; OR 0.80, 95 % CI 0.72–0.89; OR 0.80, 95 % CI 0.71–0.91; OR 0.91, 95 % CI 0.84–1.00; OR 0.90, 95 % CI 0.81–0.99, respectively). However, no significant association was observed for the other 13 NISs. All AUC values were greater than 0.750 for the 19 NISs. The highest AUC values were observed for lack of appetite, early satiety, and nausea (0.831, 95 % CI 0.797–0.866; 0.810, 95 % CI 0.773–0.848; 0.801, 95 % CI 0.764–0.838, respectively).</div></div><div><h3>Conclusions</h3><div>Lack of appetite, early satiety, nausea, vomiting, abnormal taste, and fatigue were significantly associated with dietary intake independently of the influence of other symptoms and other confounders. Furthermore, lack of appetite, early satiety, and nausea were good predictors for reduced dietary intake.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102894"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892199","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 single-centre retrospective study investigating changes in nutritional status and use of dietetic interventions in children receiving chimeric antigen receptor T-cell therapy","authors":"Anisah Chowdhury ,&nbsp;James Evans","doi":"10.1016/j.clnesp.2025.11.016","DOIUrl":"10.1016/j.clnesp.2025.11.016","url":null,"abstract":"<div><h3>Background and aims</h3><div>Chimeric antigen receptor T-cell therapy (CAR-T) is a novel treatment for children with relapsed or refractory acute lymphoblastic leukaemia. Preferential outcomes have been shown when children maintain their nutritional status during cancer treatment. Few studies have investigated the impact of CAR-T on the nutritional status of children. This study aimed to examine the nutritional status and use of dietetic interventions in children having CAR-T.</div></div><div><h3>Methods</h3><div>Electronic records of all children who had CAR-T between June 2015–June 2024 at Great Ormond Street Hospital in London were retrospectively reviewed. Nutritional outcomes were examined during the child's admission for CAR-T, including weight change and dietetic interventions used including oral nutritional supplements, enteral tube feeding and parenteral nutrition. Impact of different interventions on children's weight change and length of stay were analysed.</div></div><div><h3>Results</h3><div>CAR-T was provided to 132 children, 65 % male, mean age eight years. Weight change from CAR T-cell infusion to discharge was a mean loss of −1.8 %. Sixty two percent required a dietetic intervention and of these 45 % received oral nutritional supplements, 56 % enteral tube feeding (of these 87 % had a nasogastric tube, 13 % a gastrostomy), 34 % parenteral nutrition. The latter was initiated primarily for intolerance to tube feeding and provided for a mean 23 days. Children who received any dietetic intervention gained more weight than those who received none (+0.7 % v −1.6 %, p = 0.020), as did those who initiated oral nutritional supplements proactively (before day three post-CAR T-cell infusion) versus reactively (on or after day three) (+0.4 % v −3.3 %, p = 0.030), and those who started tube feeding proactively versus reactively (+2.4 % v −3.6 %, p = 0.027). Length of stay was shorter for children who did not receive any dietetic intervention than those who did (19 days v 30, p &lt; 0.001), and those who did not receive tube feeding versus those who did (22 v 32 days, p = 0.001).</div></div><div><h3>Conclusion</h3><div>Although children experienced a modest weight loss the majority required a dietetic intervention to support this, most commonly oral nutritional supplements and tube feeding. Proactive preparation of families for tube feeding is essential to facilitate acceptance. Children who did not receive a dietetic intervention may have benefitted from dietetic input. With growing evidence of changes in nutritional status and impact on outcomes, dietetic input is key to develop nutritional support algorithms that guide the use of screening, assessment and interventions in children having CAR-T.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102808"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534290","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":"Modulation of ceramides through nutrition: A new target in obesity and insulin resistance (Narrative Review)","authors":"Ana T. Arias-Marroquín ,&nbsp;Ivan Torre-Villalvazo ,&nbsp;Omar Granados Portillo ,&nbsp;Mariana Villegas-Romero ,&nbsp;Alberto Camacho-Morales ,&nbsp;Armando R. Tovar ,&nbsp;Carlos A. Aguilar Salinas ,&nbsp;Daniel Illescas-Zárate ,&nbsp;Natalia Vázquez-Manjarrez","doi":"10.1016/j.clnesp.2025.11.156","DOIUrl":"10.1016/j.clnesp.2025.11.156","url":null,"abstract":"<div><h3>Background</h3><div>Ceramides (Cer) are signaling sphingolipids that participate in insulin signaling, mitochondrial integrity, and inflammation. In obesity and insulin resistance (IR), Cer biosynthesis is exacerbated, leading to metabolic dysfunction and chronic diseases.</div></div><div><h3>Objective</h3><div>This narrative review synthesizes current evidence on how Cer metabolism can be modulated through dietary components and dietary patterns, with emphasis on lipidomic analyses.</div></div><div><h3>Key findings</h3><div>The synthesis and accumulation of Cer are influenced by dietary abundance and quality, such as carbohydrates, fat and phenolic compounds. High-fructose corn syrup and saturated fatty acids promote Cer accumulation and IR, while monounsaturated and polyunsaturated fatty acids—abundant in the Mediterranean and Nordic diets—attenuate these effects. Polyphenol-rich foods and caloric restriction may also reduce Cer concentrations and improve metabolic markers. The emerging evidence from lipidomic analyses is expanding our knowledge on the role of diet in Cer modulation.</div></div><div><h3>Conclusion</h3><div>Nutritional strategies targeting ceramide metabolism represent a promising approach to improve metabolic health. Beyond their therapeutic potential, ceramides also emerge as dynamic lipidomic biomarkers capable of reflecting early metabolic changes and monitoring the efficacy of nutritional interventions.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102836"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676727","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":"Positive clinical outcomes associated with use of glucagon-like peptide-2 (GLP-2) analogues in patients with intestinal failure: A systematic review and meta-analysis","authors":"Alysia Bastas ,&nbsp;Kyle Williams ,&nbsp;Darren Wong","doi":"10.1016/j.clnesp.2025.11.132","DOIUrl":"10.1016/j.clnesp.2025.11.132","url":null,"abstract":"<div><h3>Aim</h3><div>Glucagon-like peptide-2 analogues are part of the treatment algorithm for chronic intestinal failure to improve enteral nutrient absorption and reduce reliance on parenteral support. The purpose of this review is to update, consolidate and comprehensively evaluate the existing body of evidence, highlighting the breadth of positive clinical outcomes associated with glucagon-like peptide-2 analogue treatment.</div></div><div><h3>Methods</h3><div>A systematic review was conducted using OVID Medline, Embase, Cochrane Library, CINAHL, and Web of Science. Studies reporting on glucagon-like peptide-2 analogue use in adults focusing on any change in clinical outcomes were included, while studies reporting solely biochemical outcomes were excluded. Meta-analyses and meta-regressions were conducted using R software. Where insufficient data was present, results were pooled and weighted by sample size or presented as a narrative synthesis.</div></div><div><h3>Results</h3><div>23 studies were included in the final review and analysis. Teduglutide demonstrated a positive and incremental effect on the proportion of short bowel syndrome-associated intestinal failure patients achieving a ≥20 % reduction in PS requirements, with response rates increasing from 64 % (95 % CI: 51 %–75 %) at 6 months to 73 % (95 % CI: 65 %–80 %) after ≥2 years of therapy. A similar trend was observed in patients achieving enteral autonomy, which rose from 13 % (95 % CI: 6 %–25 %) at 6 months to 31 % (95 % CI: 23 %–40 %) after ≥2 years of treatment. Moreover, early data shows teduglutide to have a positive effect on quality of life and stool characteristics of patients. Teduglutide appears to be an acceptable therapy, with a discontinuation rate of 14 %. Early reports suggest similar benefits for emerging GLP-2 including glepaglutide and apraglutide.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102817"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676758","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":"Impact of fish oil-enriched high protein peptide-based formula on free fatty acid profiles and metabolomic changes in home enterally fed patients: A pilot study","authors":"Osman Mohamed Elfadil ,&nbsp;Danelle A. Johnson ,&nbsp;Adele K. Pattinson ,&nbsp;Ryan T. Hurt ,&nbsp;Manpreet S. Mundi","doi":"10.1016/j.clnesp.2025.11.155","DOIUrl":"10.1016/j.clnesp.2025.11.155","url":null,"abstract":"<div><h3>Background</h3><div>Peptide-based formulas (PBFs) are safe and effective and are commonly used for home enteral nutrition (HEN) therapy, especially in patients with EN intolerance. There is a lack of data regarding biomolecular changes with EN, particularly concerning PBFs. This pilot study examines tolerance and changes in metabolic panels, including fatty acids and metabolomics, during the transition to a high-protein (100 % whey), fish oil-fortified, peptide-based formula (HP/FO w-PBF).</div></div><div><h3>Methods</h3><div>A pilot single-center prospective cohort study was conducted at a quaternary care center. Adult HEN-dependent participants switched from a standard polymeric formula (SPF) to HP/FO w-PBF for 14 days during their outpatient HEN follow-up routine visits. Participants completed a daily consumption and tolerance diary and collection of plasma at enrollment and the end of the study.</div></div><div><h3>Results</h3><div>Twenty-five participants (72 % female) with a mean age of 60.3 ± 16.3 years completed the study, with 18 completing baseline and end-of-study blood tests for metabolomics and 17 for metabolic panel and fatty acid profile. Compared to baseline, C-peptide and insulin levels increased by a median of 36 % and 13 %, respectively, possibly reflecting an insulinotropic effect of whey protein. Omega-3 fatty acids, EPA and DHA, plasma levels increased significantly by a median of 469 % and 143 %, respectively. Metabolomics analyses noted essential amino acid enrichment. A significant rise in arginine metabolites, such as ornithine, was observed, indicating possible utilization by cells such as enterocytes.</div></div><div><h3>Conclusions</h3><div>A high-protein (100 % whey), fish-oil-enriched, peptide-based formula was tolerated by participants and demonstrated increased levels of essential amino acids, as well as a boost in ω-3 fatty acids. However, further research is necessary to determine the long-term clinical impact given the short duration of this pilot study.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102835"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647589","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":"Understanding cross-contamination in a gluten-free diet: A scoping review","authors":"Diana Studerus ,&nbsp;Anne Roland Lee ,&nbsp;Tabea Hugo ,&nbsp;Philippe Heim ,&nbsp;Jacqueline Jossen ,&nbsp;Michael Scharl ,&nbsp;Jonas Zeitz","doi":"10.1016/j.clnesp.2025.102847","DOIUrl":"10.1016/j.clnesp.2025.102847","url":null,"abstract":"<div><h3>Introduction</h3><div>Maintaining a gluten-free diet (GFD) requires avoiding gluten containing grains, and preventing cross-contact with gluten-containing foods. Concerns about cross-contaminations can restrict food choices and may lead to behaviors resembling disordered eating. While guidelines state that gluten cross-contamination should be avoided, previous reviews and meta-analyses focused on whether contamination occurs, rather than its extent. Understanding contamination levels is crucial for risk assessment, resulting in a balanced approach that supports GFD adherence without hypervigilance or maladaptive eating behaviors.</div></div><div><h3>Methods</h3><div>A scoping review methodology was conducted across databases including MEDLINE, EMBASE, Scopus and Web of Science databases. Studies with real-life gluten contamination data were included. The protocol was registered on the Open Science Framework (<span><span>https://osf.io/nhq84</span><svg><path></path></svg></span>) and follows PRISMA-ScR guidelines.</div></div><div><h3>Results</h3><div>From 4044 screened studies, 59 met the inclusion criteria (1993–2024, 28 countries). The analysis identified 27,806 food samples, predominantly analyzed by sandwich ELISA R5. Of these, 3100 (11 %) had a gluten content exceeding 20 mg/kg, 359 samples (1.3 %) contained &gt;80 mg/kg, and 142 samples (0.51 %) &gt; 200 mg/kg. After excluding two potentially biased studies, conservative descriptive analysis of 15,467 samples revealed that 20 % of analyzed samples showed contamination &gt;20 mg/kg (crude pooling). Oats showed the highest average cross-contamination and variability, while restaurant meals demonstrated the greatest inconsistency. We identified research gaps and inconsistent terminology use, leading us to propose a standardized definition of “cross-contamination.”</div></div><div><h3>Discussion</h3><div>Cross-contact occurs in approximately 20 % of samples, but clinically relevant levels (&gt;200 mg/kg) are rare (0.9 %). Regular portions (100–300 g) of foods &gt;200 mg/kg could exceed the 10 mg/day safety threshold. Our findings suggest strict avoidance of all cross-contact could be reconsidered. A nuanced approach discussing relevant sources while identifying clinically irrelevant ones could prevent maladaptive eating behaviors without compromising safety.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102847"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741357","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":"Development of an instantly reconstitutable powdered broth as a clear fluid to shorten preoperative fasting","authors":"Alana Smaniotto Biolo ,&nbsp;Rafael Vinícius Patzer ,&nbsp;Rosicler Colet ,&nbsp;Ana Luiza Lira ,&nbsp;Geciane Toniazzo Backes ,&nbsp;Jamile Zeni ,&nbsp;André Keng Wei Hsu","doi":"10.1016/j.clnesp.2025.11.164","DOIUrl":"10.1016/j.clnesp.2025.11.164","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to develop and validate an instant powdered broth, reconstitutable as a clear liquid, to shorten preoperative fasting, in accordance with ERAS and ACERTO protocols. Prolonged fasting is associated with discomfort, increased insulin resistance, and delayed recovery, while carbohydrate-rich clear liquids consumed up to 2 h before anesthesia are considered safe and beneficial.</div></div><div><h3>Methods</h3><div>Three formulations were prepared using maltodextrin, glucose, sodium chloride, and chicken flavoring, all fat-free and with high caloric value. After microbiological and sensory analyses with 30 evaluators, the most accepted formulation was selected for physicochemical characterization and clinical evaluation. Gastric emptying was assessed in 29 healthy volunteers (18–65 years) after consumption of 200 mL of the broth 2 h before elective surgery. Gastric ultrasound was performed in 28 participants using standardized qualitative assessment of the gastric antrum, while one participant underwent abdominal computed tomography (CT) solely as an illustrative and confirmatory imaging method. Subjective perceptions of satiety, thirst, palatability, and satisfaction were collected through questionnaires.</div></div><div><h3>Results</h3><div>The product showed pH 5.17, low water activity, clear appearance, and microbiological safety. Imaging demonstrated adequate gastric emptying in all participants 2 h after consumption. Subjectively, 60 % reported complete satiety, 75 % absence of thirst, 71 % approved palatability, and 92 % expressed overall satisfaction.</div></div><div><h3>Conclusion</h3><div>The developed broth proved to be a safe, palatable, and effective clear fluid alternative to reduce preoperative fasting, offering an innovative, low-cost option with potential application in hospital settings and personalized nutritional therapy.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102844"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676594","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}