Clinical nutrition最新文献

{"title":"GLIM Criteria–defined malnutrition and short-term mortality in acute care hospitals: A nationwide claims-based historical cohort study","authors":"Akio Shimizu ,&nbsp;Yasutake Tomata ,&nbsp;Yoko Hasegawa ,&nbsp;Yoji Kokura ,&nbsp;Yoshinaga Okugawa ,&nbsp;Rei Kawamura ,&nbsp;Yoshino Ogasawara ,&nbsp;Ryo Momosaki","doi":"10.1016/j.clnu.2025.09.012","DOIUrl":"10.1016/j.clnu.2025.09.012","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Malnutrition is associated with adverse clinical outcomes in hospitalized patients. The Global Leadership Initiative on Malnutrition (GLIM) criteria have been proposed as an internationally standardized nutritional assessment; however, their adoption and prognostic value in real-world hospital settings remain underexplored. In June 2024, Japan's Diagnosis Procedure Combination (DPC) reimbursement system began encouraging routine GLIM-based assessments, creating a quasi-natural experiment to evaluate its implementation and prognostic utility at scale. This study evaluated the association between GLIM-defined malnutrition and mortality in routine clinical practice under Japan's DPC system.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized Japan's nationwide DPC database provided by JMDC, Inc., which includes patient data from approximately 1,700 hospitals. Adult patients (age ≥ 18 y) hospitalized between June 2024 and August 2024 were included. The primary outcomes were the 30-d and 60-d mortality rates. Cox proportional hazards models were used to estimate the multivariate-adjusted hazard ratios (HR) and 95 % confidence intervals (CI) for mortality.</div></div><div><h3>Results</h3><div>Of the 174,439 eligible patients, 3.9 % were classified as malnourished, 47.9 % as nonmalnourished, and 48.2 % had GLIM criteria assessments that were not performed or had missing data. GLIM-defined malnutrition was significantly associated with a higher risk of 30-d mortality (HR = 1.46; 95 % CI: 1.33–1.60) and 60-d mortality (HR = 1.46; 95 % CI: 1.34–1.59). Additionally, patients with incomplete GLIM assessment data had a higher mortality risk than those without malnutrition. Among the patients with completed GLIM criteria assessments (n = 90,321), the most frequently missing GLIM sub-items were “reduced food intake/absorption” (2.7 %) and “low muscle mass” (2.6 %).</div></div><div><h3>Conclusions</h3><div>In this nationwide cohort of 174,439 hospitalized adult patients, both GLIM-defined malnutrition and incomplete or missing GLIM assessment data were associated with substantially higher 30-d and 60-d mortality rates, highlighting the potential utility of the criteria for mortality risk stratification in routine clinical practice and identifying underassessment as a pragmatic risk indicator.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"54 ","pages":"Pages 83-90"},"PeriodicalIF":7.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145218857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early nutritional support enhances recovery after endovascular thrombectomy: A prospective study with institutional historical control","authors":"Kota Maekawa ,&nbsp;Nobuyuki Ohara ,&nbsp;Naoki Higashibeppu ,&nbsp;Michi Kawamoto ,&nbsp;Tsuyoshi Ohta","doi":"10.1016/j.clnu.2025.09.013","DOIUrl":"10.1016/j.clnu.2025.09.013","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>The efficacy of nutritional support in patients after successful endovascular thrombectomy (EVT) remains unclear. This study aimed to determine whether individualized nutritional support through a multidisciplinary team approach could improve the clinical outcomes of patients who underwent EVT.</div></div><div><h3>Methods</h3><div>This quasi-experimental study with a non-randomized controlled design compared a prospective cohort receiving individualized nutritional support with an institutional historical control cohort receiving standard care. Patients with acute ischemic stroke who underwent successful EVT (mTICI 2b-3) were included, and propensity score matching performed using age, sex, premorbid modified Rankin Scale (mRS) score, and initial National Institutes of Health Stroke Scale score, resulting in 42 matched pairs. The nutritional support group received individualized nutritional support by a multidisciplinary team targeting 30 kcal/kg/day of energy and 1.5 g/kg/day of protein within 7 days post-admission. Achievement was evaluated using two criteria: target achievement (≥70 % of goals of both energy and protein goals) and full target completion (100 % of both goals). The team monitored the swallowing function, metabolic parameters, and adjusted nutrition plans to safely achieve nutritional targets. The primary outcome was mRS score at 90 days.</div></div><div><h3>Results</h3><div>The nutritional support group exhibited significantly improved 90-day mRS scores across multiple adjusted models (common odds ratio: 2.280–2.820, P &lt; 0.05) and eliminated 90-day mortality (0 % vs. 23.8 %, P = 0.001). Target achievement (66.7 % vs. 31.0 %, P = 0.002) and full target completion (16.7 % vs. 2.4 %, P = 0.057) tended to be higher in the nutritional support group than in the control group. The proportion of complications, including aspiration pneumonia, diarrhea, and hyperglycemia, was comparable to or lower in the nutritional support group than in the control group.</div></div><div><h3>Conclusions</h3><div>Early individualized nutritional support by a multidisciplinary team safely improves functional outcomes in patients with successful EVT. These findings support the implementation of team-based individualized nutritional support for patients following EVT.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"54 ","pages":"Pages 99-109"},"PeriodicalIF":7.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145218798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High “sarcopenia index” reduce all-cause mortality in patients with acute myocardial infarction","authors":"Hui Pan ,&nbsp;C. Yu Dong ,&nbsp;Z. Cheng Yang ,&nbsp;Y. Bin Xi ,&nbsp;He Lin ,&nbsp;J. Lu Zhu ,&nbsp;X. Wen Wang ,&nbsp;H. Jie Zhan ,&nbsp;Z. Hao Wang","doi":"10.1016/j.clnu.2025.09.009","DOIUrl":"10.1016/j.clnu.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>The product of serum creatinine and cystatin C-based estimated glomerular filtration rate (hereinafter referred to as “Cr × eGFRcys”), serving as the formula for the Sarcopenia Index (SI), could be regarded as a representative marker for sarcopenia. However, no studies have investigated whether Cr × eGFRcys can predict all-cause mortality in elderly patients with acute myocardial infraction (AMI).</div></div><div><h3>Aim</h3><div>To investigate the association between Cr × eGFRcys and all-cause mortality risk in elderly AMI patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort analysis of 500 elderly (≥65 years) AMI patients. Participants were stratified into high and low Cr × eGFRcys groups using the optimal cut-off determined by receiver operating characteristic (ROC) analysis, with all-cause mortality as the primary endpoint. Kaplan–Meier (hereinafter referred to as “K-M”) survival curves assessed survival differences (log-rank test). Multivariable Cox proportional hazards models evaluated the independent association of Cr × eGFRcys (as continuous, categorical, or per-standard deviation increase) with mortality. The added predictive value beyond conventional risk factors was assessed through C-statistics, continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI).</div></div><div><h3>Result</h3><div>Survival analysis revealed significantly better outcomes in the high Cr × eGFRcys group compared to the low group (log-rank p &lt; 0.0001). Inclusion of Cr × eGFRcys significantly enhanced the predictive accuracy of the baseline risk model for all-cause mortality: NRI = 0.43 (95 % CI: 0.17–0.61, p &lt; 0.01), IDI = 0.04 (95 % CI: 0.01–0.08, p = 0.02), and C-index = 0.93 (95 % CI: 0.90–0.96), all with <em>p</em> &lt; 0.05.</div></div><div><h3>Conclusion</h3><div>Cr × eGFRcys was significantly associated with all-cause mortality, and the optimal cut-off value for predicting all-cause mortality was 53.56, suggesting that Cr × eGFRcys may serve as a valid marker of all-cause mortality in elderly patients with AMI.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"54 ","pages":"Pages 91-98"},"PeriodicalIF":7.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145218797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a multiphase dietary intervention on metabolic profile and gut microbiota composition in metabolically healthy and unhealthy obese subjects","authors":"N. Bosch-Sierra ,&nbsp;B. Navajas-Porras ,&nbsp;C. Grau-del Valle ,&nbsp;C. Salom ,&nbsp;S. Pérez-Burillo ,&nbsp;G. D'Auria ,&nbsp;M.P. Francino ,&nbsp;C. Morillas ,&nbsp;C. Bañuls","doi":"10.1016/j.clnu.2025.09.010","DOIUrl":"10.1016/j.clnu.2025.09.010","url":null,"abstract":"<div><h3>Background and aims</h3><div>Gut microbiota influences obesity and its comorbidities by affecting metabolism and inflammation. The metabolic phenotype of obese individuals alters microbiota composition and metabolite production, impacting metabolic risk. This study examined the effects of a multiphase dietary intervention on metabolism, inflammation, and gut microbiota diversity in obese individuals with and without metabolic syndrome (MetS).</div></div><div><h3>Methods</h3><div>The current interventional study describes differences in faecal microbial composition and serum metabolite signatures between two obese phenotypes (with versus without MetS) after a 6-month multiphase dietary intervention (consisting of two six-week phases of very-low calorie diet, separated by a 3-month hypocaloric diet) in 109 participants (64 % women).</div></div><div><h3>Results</h3><div>We found that weight loss improved gut microbiota diversity and composition, and was more effective in participants with MetS. Furthermore, only the MetS group showed a significant improvement in serum levels of acetate and a decrease for trimethylamine. In addition, strong correlations were observed between gut microbiota and clinical parameters, including insulin resistance, blood pressure, and visceral fat.</div></div><div><h3>Conclusions</h3><div>These results demonstrate that populations with obesity can respond differently to the same dietary intervention according to their metabolic phenotype, a difference manifested in gut microbiota parameters. Furthermore, the positive impact of multiphase dietary intervention on microbiota serum metabolites and microbiota composition is more pronounced in obese individuals with MetS.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"54 ","pages":"Pages 62-70"},"PeriodicalIF":7.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Docosahexaenoic acid supplementation in pregnancy and early lactation: Impacts on breast milk docosahexaenoic acid and Maternal–Infant gut microbiota – A randomized controlled trial","authors":"Tingchao He ,&nbsp;Jian Zhang ,&nbsp;Ai Zhao ,&nbsp;Sha Luo ,&nbsp;Hua Jiang ,&nbsp;Minghua Tang ,&nbsp;Yumei Zhang","doi":"10.1016/j.clnu.2025.09.006","DOIUrl":"10.1016/j.clnu.2025.09.006","url":null,"abstract":"<div><h3>Aim</h3><div>This study aimed to evaluate whether docosahexaenoic acid (DHA) supplementation during pregnancy increases DHA concentrations in colostrum among Chinese women, and to determine whether continued postpartum supplementation is necessary to sustain DHA levels throughout lactation. Additionally, the study examined the impact of maternal DHA supplementation on the gut microbiota of both mothers and their infants.</div></div><div><h3>Methods</h3><div>79 pregnant women were enrolled in this multicenter, double-blinded, randomized, placebo-controlled, parallel trial and were randomized to three groups (CC, control group; FC, DHA supplementation in the third trimester; FF, DHA supplementation from the third trimester to 42 days postpartum). Participants in the FF and FC groups were administered 100 mg/day DHA via milk powder and those in the CC group were administered milk powder without DHA fortification. Breast milk was collected - on days 3 and 42 postpartum. Fatty acid composition in breast milk was measured with gas chromatography and expressed as percentage of total fatty acids by weight. Fecal samples from mothers (at gestational week 28, 38 and 42 days postpartum) and infants (at 3 and 42 days of age) were collected, then analyzed using 16S rRNA sequencing.</div></div><div><h3>Results</h3><div>The FF group had significantly higher levels of DHA in colostrum than the other two groups (FF: 1.49%, FC: 1.27%, CC: 1.11, P-ANCOVA = 0.018) but not in early mature milk (FF: 0.94%, FC: 0.82%, CC: 0.85%, P-ANCOVA = 0.646). At 42 days postpartum, both mothers and infants in the FF group exhibited a higher abundance of the genus <em>Lactobacillus</em> in the fecal microbiome.</div></div><div><h3>Conclusion</h3><div>In this cohort of Chinese women, maternal supplementation with 100 mg/day of DHA starting from the third trimester of pregnancy significantly increased DHA concentrations in colostrum. However, 100 mg/day may be insufficient to sustain DHA levels beyond colostrum. Additionally, maternal DHA supplementation was found to influence <em>Lactobacillus</em> abundance at 42 days postpartum of both mothers and their infants. Future studies should explore higher DHA doses for long-term lactation stability, and investigate dynamic changes in other gut microbiota taxa and microbiota-mediated health effects.</div></div><div><h3>Clinical trial registration</h3><div>ChinaClinicalTrial.gov (ChiCTR1800019461).</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"54 ","pages":"Pages 71-82"},"PeriodicalIF":7.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145218799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal changes in muscle mass after ICU discharge: A prospective observational cohort study","authors":"Martin Sundström Rehal ,&nbsp;Cechael Sebghati Sparrfelt ,&nbsp;Nicole Lajewska ,&nbsp;Arabella Fischer ,&nbsp;Kristina Kilsand ,&nbsp;Johan Helleberg ,&nbsp;Henrike Häbel ,&nbsp;Olav Rooyackers","doi":"10.1016/j.clnu.2025.09.004","DOIUrl":"10.1016/j.clnu.2025.09.004","url":null,"abstract":"<div><h3>Background</h3><div>There is limited published data describing patterns of muscle wasting after critical illness. Muscle ultrasound is a practical method to monitor changes in muscle mass after Intensive Care Unit (ICU) discharge. The aim of this study was to investigate longitudinal changes in muscle mass after ICU discharge in a group of mixed medical-surgical ICU patients.</div></div><div><h3>Methods</h3><div>Adult ICU patients (n = 42) with a minimum length of stay in ICU of 3 days were prospectively enrolled. Baseline measurements of quadriceps muscle layer thickness, Medical Research Council sum score, hand grip strength and indirect calorimetry were performed in conjunction with ICU discharge and repeated every 3–5 days until hospital discharge or up to 28 days. The primary outcome was change in muscle thickness over time. Secondary outcomes were changes in physical function. Outcomes were assessed using best-fit generalized linear mixed models according to the Akaike information criteria. Interactions between outcomes and relevant covariates were investigated for hypothesis-generating purposes.</div></div><div><h3>Results</h3><div>In the best-fit crude analysis model, a small but statistically significant change in muscle thickness over time (p = 0.0475) was observed. In exploratory covariate analysis, there was a strong interaction between body weight, female sex, low nutritional intake and increased loss of muscle thickness. Assessments of physical function improved over time. Female sex and ICU length of stay were identified as potential predictors of impaired physical recovery.</div></div><div><h3>Conclusions</h3><div>In this cohort of adult ICU patients, we did not find a relevant group-level change in muscle mass after ICU discharge. However, patients with poor nutritional intake and female sex may be at greater risk of muscle wasting after intensive care. Further studies are warranted to investigate the relevance of post-ICU nutrition and gender on recovery of muscle mass after critical illness.</div></div><div><h3>Trial registration</h3><div>This study was prospectively registered at ClinicalTrials.gov on 2022-09-02 (NCT05531305).</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"54 ","pages":"Pages 53-61"},"PeriodicalIF":7.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of clinical outcomes after an intervention in malnourished hospitalized patients","authors":"Yolanda Garcia ,&nbsp;Nere Larrea ,&nbsp;Josune Martin ,&nbsp;Inmaculada Bolinaga ,&nbsp;Cristina Sarasqueta ,&nbsp;Amaia Perales ,&nbsp;Natalia-Covadonga Iglesias ,&nbsp;Alfredo Yoldi ,&nbsp;Jose M. Quintana","doi":"10.1016/j.clnu.2025.04.034","DOIUrl":"10.1016/j.clnu.2025.04.034","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Malnutrition is associated with higher mortality, lower functional capacity, and longer hospital stays. The goal of this study was to evaluate the effectiveness of a nutritional intervention in patients admitted to a hospital with disease-related malnutrition (DRM).</div></div><div><h3>Methods</h3><div>Pragmatic effectiveness study of patients recruited at three university hospitals with esophageal, gastric, pancreatic, colon, and rectal cancers, acute pancreatitis, or inflammatory bowel diseases (IBDs), with three groups: patients without DRM with no explicit nutritional intervention; patients with moderate to severe DRM on whom a nutritional intervention was performed; and patients with moderate to severe DRM who received standard care. DRM was diagnosed using the MUST and GLIM criteria. Depending on the outcome variable, survival, logistic regression, or generalized multilevel linear multivariable models were used.</div></div><div><h3>Results</h3><div>1051 patients were included in the study. Multivariate multilevel analysis showed no difference in 30-day mortality or readmission at 90 days between the DRM groups and those without DRM. For death at 90 days, DRM patients without intervention had a higher risk but those with intervention did not. Length of hospital stay was greater in both of the DRM groups, but there were no differences in the rate of infectious complications. We found no differences in the change in the three nutritional parameters evaluated (weight, calf circumference, and hand-grip strength) between admission and discharge.</div></div><div><h3>Conclusions</h3><div>Nutritional intervention in hospitalized patients has been shown to be beneficial for post-discharge mortality; however, in order to achieve greater benefits, it should be maintained after discharge.</div><div>Registered in ClinicalTrials.gov with ID NCT04188990.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"54 ","pages":"Pages 42-52"},"PeriodicalIF":7.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbohydrate-restricted diet types and macronutrient replacements for metabolic health in adults: A meta-analysis of randomized trials","authors":"Shuo Feng ,&nbsp;Renming Liu ,&nbsp;Brian Colwell ,&nbsp;Sunghyun Chung ,&nbsp;Adam Barry ,&nbsp;Huishan Wang","doi":"10.1016/j.clnu.2025.09.005","DOIUrl":"10.1016/j.clnu.2025.09.005","url":null,"abstract":"<div><h3>Background and aims</h3><div>Carbohydrate-restricted diets (CRDs) are increasingly used in managing metabolic disorders, yet evidence remains mixed regarding their effectiveness beyond glycemic control and across diverse populations. To systematically evaluate the effects of CRDs, ketogenic (KD), low-carbohydrate (LCD), and moderate-carbohydrate diets (MCD), and different macronutrient replacements (fat, protein, or both) on metabolic health-related biomarkers, including glycemic, hepatic, renal, adipokine, and lipid metabolism indices.</div></div><div><h3>Methods</h3><div>Five electronic databases, PubMed, MEDLINE, Embase, ERIC, and Web of Science, were used to identify relevant randomized trials. Outcomes analyzed included glucose, HbA1c, insulin, HOMA-IR, liver/kidney function markers, leptin, and beta-hydroxybutyrate (BHB). Subgroup analyses evaluated the effects of CRD type, macronutrient replacement, sex, diabetes status, weight status, study design (parallel vs. crossover), delivery mode (consultation vs. food provision), and calorie intakes (isocaloric vs. non-isocaloric).</div></div><div><h3>Results</h3><div>149 randomized controlled trials comprising 9104 adults across 28 countries were included. CRDs significantly improved glycemic control (including glucose: SMD = −2.94 mg/dL, 95 % CI: −4.19, −1.68; insulin: SMD = −8.19 pmol/L, 95 % CI: −11.04, −5.43; HOMA-IR = −0.54, 95 % CI: −0.75, −0.33), hepatic stress (GGT: SMD = −6.08 U/L, 95 % CI: −9.97, −2.20), renal function (UACR: SMD = −0.19, 95 % CI: −0.28, −0.10), and adipokine concentration (leptin: SMD = −3.25 ng/mL, 95 % CI: −4.91, −1.59), particularly in females, individuals with overweight/obesity, and people with T2DM. LCDs and MCDs showed the most consistent metabolic benefits. Combined fat and protein replacement yielded greater improvements. Isocaloric vs. non-isocaloric comparisons showed similar patterns, suggesting macronutrient composition alone may engender beneficial metabolic effects.</div></div><div><h3>Conclusions</h3><div>CRDs, particularly LCDs and MCDs with mixed macronutrient replacements, confer significant metabolic benefits independent of energy intake. These findings support CRDs as a potential nutritional strategy in metabolic disease prevention and management. Clinical supervision is recommended.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"54 ","pages":"Pages 27-41"},"PeriodicalIF":7.4,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between protein intake and body composition after bariatric surgery: Influence of sex and type of surgery","authors":"Maite Aguas-Ayesa ,&nbsp;Patricia Yárnoz-Esquíroz ,&nbsp;Laura Olazarán ,&nbsp;Ainhoa Garde-Aizpún ,&nbsp;Rocío Marugán-Pinos ,&nbsp;Víctor Valentí ,&nbsp;Manuel F. Landecho ,&nbsp;Rafael Moncada ,&nbsp;Carolina M. Perdomo ,&nbsp;Camilo Silva ,&nbsp;Marta García-Goñi ,&nbsp;Patricia Andrada ,&nbsp;Javier Escalada ,&nbsp;Javier Gómez-Ambrosi ,&nbsp;Gema Frühbeck","doi":"10.1016/j.clnu.2025.09.003","DOIUrl":"10.1016/j.clnu.2025.09.003","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Achieving the recommended protein intake (PI) is one of the main challenges of dietary monitoring in order to minimize fat-free mass (FFM) loss after bariatric surgery (BS). Protein supplementation is recommended to achieve this goal. However, the most appropriate PI recommendation scheme as regards amount and timing, as well as the relationship between PI and body composition after surgery, still needs to be studied. The aim of this study was to analyze PI and protein supplementation as well as their relationship with body composition during the first year after BS.</div></div><div><h3>Methods</h3><div>We studied a sample of 621 patients (195 males/426 females) who underwent BS (205 sleeve gastrectomy/416 Roux-en-Y gastric bypass). Preoperative and first-year follow-up data of body composition, dietary intake and physical activity level were analyzed.</div></div><div><h3>Results</h3><div>Average PI was higher than 60 g/d but lower than 80 g/d at all time-points. Less than 10 % of patients achieved the target of 1.5 g/kg of ideal body weight (IBW)/d. Women presented a higher PI expressed in g/kg of IBW/d in the first and three months after BS (<em>P</em> &lt; 0.05) and in g/kg of FFM/d at all follow-up times (<em>P</em> &lt; 0.001). Adherence to protein supplementation decreased over the first post-operative year. Supplementation was essential for women to achieve the minimum PI of 60 g/d 1 month after surgery. Men with a higher PI than 60 g/d during the first year exhibited a lower fat mass (FM)% and higher FFM% than those who did not achieve this target during all the follow-up points. This effect was not observed in women. The average physical activity increased significantly after BS (<em>P</em> = 0.01), observing a positive correlation between FFM% and PAL at months 1, 6 and 12 of the follow-up (<em>P</em> = 0.05).</div></div><div><h3>Conclusions</h3><div>Protein supplementation helps to achieve the minimum PI threshold indication of 60 g/d, but patients did not achieve the recommended intake of 1.5 g/kg of IBW/d. PI and its relationship with the evolution of body composition after BS is different depending on sex. More research is needed to increase knowledge about the most appropriate PI, supplementation scheme and its impact on body composition, taking into account factors such as sex and physical activity to personalize protein recommendations.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"54 ","pages":"Pages 1-11"},"PeriodicalIF":7.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of dietary fibre with type 2 diabetes risk is modified by transcription factor 7 like 2 genotype in men with impaired fasting glucose: The T2D-GENE study","authors":"Ulla K. Tolonen ,&nbsp;Maria A. Lankinen ,&nbsp;Markku Laakso ,&nbsp;Ursula S. Schwab","doi":"10.1016/j.clnu.2025.09.002","DOIUrl":"10.1016/j.clnu.2025.09.002","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Dietary fibre helps prevent type 2 diabetes (T2D), but the effect could be affected by a risk allele T of the transcription factor 7 like 2 (<em>TCF7L2</em>) gene. We investigated the effects of a group-based, 3-year T2D-GENE diet and exercise intervention on dietary fibre intake and if fibre intake was associated with T2D risk and plasma glucose parameters. We also investigated if the <em>TCF7L2</em> rs7903146 genotype modified the effects of fibre.</div></div><div><h3>Methods</h3><div>A 3-year lifestyle intervention with Finnish men having impaired fasting glucose, aged 50–75 years. We measured fibre intake with 4-day food records (FR) and used plasma alkylresorcinol measurements for fibre intake validation. The participants (n = 558) were categorised into low (&lt;3 g/MJ) and high (≥3 g/MJ) fibre intake group. We measured glucose parameters with a 2-h oral glucose tolerance test and stratified participants by the <em>TCF7L2</em> genotype.</div></div><div><h3>Results</h3><div>The intervention increased the proportion of participants with fibre intake ≥3 g/MJ (45 % at baseline vs. 64 % at the end of the intervention, p &lt; 0.001). Higher fibre intake associated with lower risk for T2D in all participants (hazard ratio [HR] 0.46 (95 % confidence interval [CI] 0.23; 0.94), adjusted with age, body mass index, exercise, smoking, alcohol consumption, saturated fatty acid, monounsaturated fatty acid, and polyunsaturated fatty acid intake), especially in the <em>TCF7L2</em> rs7903146 risk allele carriers (HR 0.06 (95 % CI 0.01; 0.36), the adjusted model). The increase of fasting plasma glucose and glucose area under the curve and the decrease of disposition index were attenuated in the T allele carriers with fibre intake of ≥3 g/MJ as compared to the participants not reaching the fibre target (p = 0.01, p = 0.012, p = 0.013, respectively).</div></div><div><h3>Conclusion</h3><div>Group-based lifestyle intervention increased dietary fibre intake. Higher fibre intake benefited especially the risk allele carriers in <em>TCF7L2</em> rs7903146 gene. T2D-GENE study was registered at clinicaltrials.gov as NCT02709057.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"53 ","pages":"Pages 262-269"},"PeriodicalIF":7.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}