Clinical nutrition最新文献

{"title":"The association between serum zonulin levels and sarcopenia in older adults: How does intestinal permeability affect sarcopenia?","authors":"Kübra Erdoğan ,&nbsp;Betül Gülsüm Yavuz Veizi ,&nbsp;Selim Demirci ,&nbsp;Semih Sezer ,&nbsp;Özgür Kara","doi":"10.1016/j.clnu.2025.06.017","DOIUrl":"10.1016/j.clnu.2025.06.017","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Sarcopenia, characterized by the progressive loss of muscle mass and function, significantly reduces the quality of life and increases mortality risk in older individuals. Recent evidence highlights the role of intestinal permeability and its associated biomarker, zonulin, in the development of sarcopenia via chronic inflammation pathways. However, the relationship between serum zonulin levels and sarcopenia remains unclear. This study aims to investigate the association between serum zonulin levels and sarcopenia in elderly individuals and to assess the potential of zonulin as a diagnostic biomarker for sarcopenia.</div></div><div><h3>Methods</h3><div>A total of 93 patients aged ≥60 years were prospectively included. Serum zonulin levels were measured using enzyme-linked immunosorbent assay (ELISA), and sarcopenia diagnosis was established using the International Society of Physical and Rehabilitation Medicine (ISPRM), experts in the special interest group on sarcopenia (ISarcoPRM) algorithm, incorporating handgrip strength, chair stand test (CST), and ultrasonographic measurements of anterior thigh muscle thickness adjusted for body mass index (BMI). Logistic regression and Receiver Operating Characteristic (ROC) curve analyses were conducted to evaluate predictors of sarcopenia and zonulin's diagnostic performance.</div></div><div><h3>Results</h3><div>Zonulin levels were significantly elevated in sarcopenic patients compared to non-sarcopenic counterparts (24.92 ng/ml [21.01–27.06] vs. 19.52 ng/ml [18.00–22.85]; p &lt; 0.001). Multivariate logistic regression identified zonulin (odds ratio (OR) = 1.204, 95 % confidence interval (CI): 1.043–1.391; p = 0.011) as an independent predictor of sarcopenia. ROC analysis revealed an area under the curve (AUC) of 0.745, with an optimal zonulin cutoff of 23.33 ng/ml (71 % sensitivity, 79 % specificity).</div></div><div><h3>Conclusions</h3><div>Elevated serum zonulin levels are associated with sarcopenia in elderly individuals, suggesting a potential role of intestinal barrier dysfunction in sarcopenia pathophysiology. Zonulin shows promise as a novel biomarker for sarcopenia diagnosis, warranting further investigation in longitudinal studies to clarify causality and clinical utility.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"51 ","pages":"Pages 206-211"},"PeriodicalIF":6.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524289","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":"Zinc supplementation among zinc-deficient vegetarians and vegans restores antiviral interferon-α response by upregulating interferon regulatory factor 3","authors":"Fynn Vallboehmer,&nbsp;Hannah Schoofs,&nbsp;Lothar Rink,&nbsp;Jana Jakobs","doi":"10.1016/j.clnu.2025.06.010","DOIUrl":"10.1016/j.clnu.2025.06.010","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Sufficient zinc status is crucial for undisturbed immune function. Further, dietary zinc requirements are mainly covered by animal products. Consequently, plant-based diets have been repeatedly linked to zinc deficiency. In the light of increasing popularity of plant-based diets, elucidating the impact of zinc deficiency on the innate immune system of vegetarians and vegans is of great interest. Although it has been previously shown that interferon (IFN) -α response towards viral stimuli can be enhanced by administering zinc <em>in vitro</em>, the underlying molecular process remains unknown. In this project, we investigate the effect of short-term, oral zinc supplementation <em>in vivo</em> on antiviral immune response and describe the potential molecular mechanism behind zinc-dependent interferon-α production.</div></div><div><h3>Methods</h3><div>Zinc status of omnivore, vegetarian and vegan subjects was determined by serum zinc measurement and a food frequency questionnaire (FFQ). Antiviral IFN-α response was measured in whole-blood and peripheral blood mononuclear cells upon viral stimulus. Furthermore, expression of interferon regulatory factor (IRF) 3, a positive regulator of IFNα, was quantified in each cohort. If zinc deficiency was detected, participants received oral zinc supplementation and tests were repeated afterwards.</div></div><div><h3>Results</h3><div>We observed a high prevalence of imminent or manifest zinc deficiency among vegetarians and vegans. Compared to omnivores, IFNα response and IRF3 levels were significantly reduced. Moreover, we were able to enhance zinc status, increase IRF3 expression and reconstitute IFNα response by oral zinc supplementation.</div></div><div><h3>Conclusion</h3><div>We identified zinc-dependent IRF3 expression as an essential cellular mechanism behind impaired IFNα response in zinc-deficient subjects. This may contribute to disturbed antiviral immunity and cause increased susceptibility to virus infections <em>in vivo</em>. Oral zinc supplementation effectively restored IRF3 and IFNα levels. Hence, nutritional interventions may become increasingly important in order to prevent health implications from micronutrient deficiencies among vegetarians and vegans.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"51 ","pages":"Pages 161-173"},"PeriodicalIF":6.6,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489932","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":"Osteosarcopenic obesity: A systematic review and a call for consensus on definitions and diagnostic criteria","authors":"Olivia Di Vincenzo ,&nbsp;Claudia Piciocchi ,&nbsp;Luca Muzzioli ,&nbsp;Eleonora Poggiogalle ,&nbsp;Francesco Frigerio ,&nbsp;Marianna Minnetti ,&nbsp;Rocco Barazzoni ,&nbsp;Maria Luisa Brandi ,&nbsp;Luca Busetto ,&nbsp;Giovanni Iolascon ,&nbsp;Antimo Moretti ,&nbsp;Luca Scalfi ,&nbsp;Lorenzo Maria Donini ,&nbsp;Silvia Migliaccio","doi":"10.1016/j.clnu.2025.06.009","DOIUrl":"10.1016/j.clnu.2025.06.009","url":null,"abstract":"<div><h3>Background &amp; aim</h3><div>Osteosarcopenic obesity (OSO) is a clinical and functional condition characterized by the coexistence of osteopenia/osteoporosis, sarcopenia, and obesity (excess adiposity). Currently, the lack of consensus on diagnostic criteria and cut-off values complicates prevalence estimates and limits its potential role as a predictor for various diseases. This systematic review aimed at examining current definitions and diagnostic criteria adopted in individuals with OSO.</div></div><div><h3>Methods</h3><div>A systematic search was conducted on PubMed, Scopus and Web of Science from inception until July 31st, 2024. Human studies involving all ages, sexes, and ethnicities were included, excluding those lacking well-specified definitions or cut-offs for osteopenia/osteoporosis, sarcopenia and obesity. Results were reported in accordance with the PRISMA 2020 guidelines, with methodological quality assessed using the Quality Assessment Tools of the National Institutes of Health.</div></div><div><h3>Results</h3><div>After removing duplicates and screening titles and abstracts, 64 potentially eligible studies were examined. Of these, 39 studies involving 118,791 participants met the inclusion criteria. Significant heterogeneity was observed in the diagnostic approaches, largely due to the variability in parameters and methods used to assess sarcopenia and obesity, and reference cut-offs. This may partly be explained by differences in the availability of body composition techniques across settings, investigators’ level of expertise and the study population involved.</div></div><div><h3>Conclusion</h3><div>These findings underscore the need for consensus guidelines that provide a standardized definition of OSO, diagnostic criteria with practical and clinically relevant cut-offs, and consistent methodologies. This will help identify the prevalence of OSO, define its clinical and functional significance, and develop effective prevention and treatment strategies.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"51 ","pages":"Pages 146-160"},"PeriodicalIF":6.6,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480323","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 anti-tumour role of ketogenic diet based on energy metabolism","authors":"Jiasheng Wu ,&nbsp;Xinyu Sun ,&nbsp;Hanmou Luo ,&nbsp;Xiaoqi Luo ,&nbsp;Suxia Sun","doi":"10.1016/j.clnu.2025.06.006","DOIUrl":"10.1016/j.clnu.2025.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Unlike the energy metabolism of normal cells, tumour cells favor aerobic glycolysis to meet their unique energy demands, while disrupting normal mitochondrial metabolism. This specialized energy metabolic pathway promotes tumour growth, proliferation, and metastasis. The ketogenic diet (KD) is a high-fat diet inducing ketone bodies (KBs) for energy metabolism by restricting carbohydrate intake and promoting fatty acid breakdown. Due to the unique energy metabolism of tumours, KD has the potential to counteract tumour energy metabolism.</div></div><div><h3>Methods</h3><div>The current literature was reviewed for potential anti-tumour mechanisms of KD based on energy metabolism and the clinical evidence suggested for KD roles in tumours.</div></div><div><h3>Results</h3><div>KD exerts anti-tumour effects by inhibiting tumour aerobic glycolysis, inducing KBs, activating AMP-activated protein kinase (AMPK), and regulating reactive oxygen species (ROS) levels.</div></div><div><h3>Conclusion</h3><div>This review groundbreakingly concludes that KD manifests the potential of anti-tumour effects based on energy metabolism. Furthermore, this study establishes a theoretical foundation for exploring the anti-cancer properties of KD and its potential as a adjunctive therapy for cancer.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"51 ","pages":"Pages 174-186"},"PeriodicalIF":6.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502090","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":"Functional food lycopene mitigates obesity-related cognitive decline via lipid metabolism regulation and neuroprotection via taurine and glutathione pathway","authors":"Yuqing Wu ,&nbsp;Jingfang Liu","doi":"10.1016/j.clnu.2025.06.005","DOIUrl":"10.1016/j.clnu.2025.06.005","url":null,"abstract":"<div><div>Obesity has emerged as a critical global public health challenge, contributing not only to metabolic disorders but also to neurological complications, including cognitive decline. Lycopene, a carotenoid found abundantly in tomatoes, has gained attention as a functional food due to its potent antioxidant and anti-inflammatory properties. This study explores the neuroprotective effects of lycopene against obesity-related cognitive impairment in male C57BL/6 mice. Mice were fed a high-fat diet (HFD) for four months to induce obesity, followed by supplementation with lycopene (50 mg/kg). Cognitive performance was assessed through Y-maze, Morris water maze, and novel object recognition tests. We also examined systemic and hippocampal inflammatory markers, along with lipidomic and proteomic profiles. Lycopene supplementation significantly improved cognitive function, restored neuronal density, and enhanced levels of key neuroprotective proteins, including BDNF and NeuN. Lipidomic analysis revealed a reduction in pro-inflammatory lipids (e.g., lysophosphatidylcholine, triglycerides) and an increase in neuroprotective lipids (e.g., phosphatidylserine, fatty acids). Additionally, proteomic data showed a decrease in lipid-induced neurotoxic proteins and an upregulation of pathways associated with taurine and glutathione metabolism, promoting neuronal stability and plasticity. These results suggest that lycopene exerts neuroprotective effects by restoring lipid balance and modulating amino acid signaling pathways, thereby alleviating cognitive decline in obese mice. This study highlights lycopene's potential as a functional dietary ingredient to combat obesity-related neurological disorders and provides novel insights into the development of food-based strategies to improve both metabolic health and cognitive function.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"51 ","pages":"Pages 136-145"},"PeriodicalIF":6.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338846","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":"Therapeutic advances in sarcopenia management: From traditional interventions to personalized medicine","authors":"Xiangliang Liu ,&nbsp;Xinqiao Chen ,&nbsp;Jiuwei Cui","doi":"10.1016/j.clnu.2025.06.007","DOIUrl":"10.1016/j.clnu.2025.06.007","url":null,"abstract":"<div><div>Sarcopenia, a progressive decline in skeletal muscle mass and function, has emerged as a critical geriatric syndrome affecting 10–40% of older adults, contributing to increased disability and mortality. This comprehensive review evaluates evidence-based strategies for sarcopenia management, from established interventions to emerging personalized approaches. Pathophysiological insights reveal multifactorial mechanisms involving anabolic resistance, chronic inflammation (elevated IL-6, TNF-α), hormonal imbalances (e.g., testosterone/IGF-1 decline), neuromuscular junction dysfunction, mitochondrial impairment, and novel mediators like GDF-15, which drive proteolysis and appetite suppression. Non-pharmacological interventions demonstrate robust efficacy: combined resistance-aerobic exercise regimens (2–3 sessions/week) improve muscle strength by 20–35%, while optimized protein intake (1.0–1.5 g/kg/day) with leucine or vitamin D supplementation enhances muscle synthesis and functional capacity. Pharmacological trials highlight selective androgen receptor modulators (SARMs) and myostatin inhibitors (e.g., bimagrumab) increasing lean mass by 3–5% in phase II studies, with GDF-15-neutralizing antibodies emerging as promising anti-catabolic agents. Advanced therapies, including stem cell transplantation and AAV-mediated gene editing targeting myostatin/IGF-1 pathways, show preclinical regenerative potential. However, clinical translation requires validation through large-scale trials. Personalized strategies integrating biomarkers, comorbidities, and digital monitoring tools optimize intervention efficacy, particularly in complex populations like diabetic or cachectic patients. This synthesis underscores the paradigm shift toward precision medicine but identifies critical knowledge gaps, including long-term safety of biologics and cost-effectiveness of regenerative approaches. Future research should prioritize multimodal therapies, validated biomarkers, and AI-driven algorithms to individualize sarcopenia management in aging populations.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"51 ","pages":"Pages 187-197"},"PeriodicalIF":6.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502091","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":"Activating nuclear receptor subfamily 2 group F member 2 in adipocyte stem cells rescues beige adipocyte metabolism impaired by excess early-life omega-6 fatty acids","authors":"Snehasis Das ,&nbsp;Rohan R. Varshney ,&nbsp;Jacob W. Farriester ,&nbsp;Gertrude Kyere-Davies ,&nbsp;Alexandrea E. Martinez ,&nbsp;Kaitlyn B. Hill ,&nbsp;Michael Kinter ,&nbsp;Gregory P. Mullen ,&nbsp;Prabhakara R. Nagareddy ,&nbsp;Michael C. Rudolph","doi":"10.1016/j.clnu.2025.06.003","DOIUrl":"10.1016/j.clnu.2025.06.003","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and aims&lt;/h3&gt;&lt;div&gt;Developmental exposure to an elevated ratio of omega-6 (n6) to omega-3 (n3) fatty acids (FA) is linked to increased infant body fat and risk of future childhood obesity. We demonstrated in mice that the high n6/n3 developmental exposure reduced nuclear receptor subfamily 2 group F member 2 (NR2F2) in Adipocyte Stem Cells (ASCs), coincident with an altered ASC mitochondrial expression profile and increased white adipose accumulation in pups. This suggested that NR2F2-low ASCs might adopt a nutrient-storage phenotype. Here, we tested the hypothesis that NR2F2 is required in ASCs to undergo beige adipogenesis and metabolism needed during postnatal life for energy and thermogenesis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;C57BL/6J dams were randomized to either n6-rich or balanced n6/n3 control diets at the time of mating and underwent normal gestation and parturition. On postnatal day 12 (PND12), whole-body offspring metabolism was quantified by indirect calorimetry in conjunction with &lt;sup&gt;13&lt;/sup&gt;C-palmitate and &lt;sup&gt;13&lt;/sup&gt;C-glucose tracing. Inguinal fat pad ASCs were isolated by flow cytometry to assess adipocyte differentiation potential, global gene expression and proteomics, and mitochondrial oxidation. NR2F2 was transiently re-activated &lt;em&gt;in vitro&lt;/em&gt; in ASCs with its ligand, 1-deoxysphingosine (1-DSO), and NR2F2 was ablated in ASCs &lt;em&gt;ex vivo&lt;/em&gt; using homozygous floxed Nr2f2 pups to determine loss of function, ensure specificity of 1-DSO treatment during gain of function.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Excess developmental n6-FA exposure reduced whole-body &lt;sup&gt;13&lt;/sup&gt;C-palmitate and &lt;sup&gt;13&lt;/sup&gt;C-glucose oxidation, diminished PND12 pup energy expenditure, and increased triacylglyceride accumulation in inguinal adipose. In ASCs isolated from n6-FA exposed pups, NR2F2 was decreased. These NR2F2-low ASCs formed downstream adipocytes with decreased beige metabolic regulators peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α), peroxisome proliferator-activated receptor gamma (PPARγ), PR domain containing 16 (PRDM16), and uncoupling protein 1 (UCP1), had lower glycolysis and lipid metabolism enzymes, oxidized lipid and glucose at lower rates, and had increased lipogenic enzymes. &lt;em&gt;Ex vivo&lt;/em&gt; deletion of Nr2f2 from ASCs recapitulated the metabolic deficits observed in the adipocytes derived from NR2F2-low ASCs isolated from n6-FA exposed pups. NR2F2 loss disrupted beige regulator induction, reduced adipocyte FAO, and promoted lipogenesis pathways, mirroring the n6-FA phenotype. Transient NR2F2 activation of ASCs from n6-FA pups using 1-DSO restored induction of beige regulators, increased mitochondrial oxidative phosphorylation enzymes, reduced lipogenic/storage pathways, ultimately enhancing nutrient oxidation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;These findings demonstrate that excess n6-FA developmental exposure disrupts NR2F2-mediated ASC fate determination, l","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"51 ","pages":"Pages 63-80"},"PeriodicalIF":6.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297908","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":"Standard continuous feeding versus intermittent feeding among mechanically ventilated patients in intensive care: A systematic review and meta-analysis of randomized controlled trials","authors":"Rakshit Panwar ,&nbsp;Nikhil Kumar ,&nbsp;Harshel Parikh ,&nbsp;Sananta Dash ,&nbsp;Sumeet Rai","doi":"10.1016/j.clnu.2025.05.024","DOIUrl":"10.1016/j.clnu.2025.05.024","url":null,"abstract":"<div><h3>Background</h3><div>Previous meta-analyses on the mode of enteral nutrition in intensive care unit (ICU) have not explored whether the standard practice of continuous enteral feeding is superior to intermittent or bolus feeding among mechanically ventilated patients. Large feed volumes maybe one of the barriers for the use of intermittent feeding. However, intermittent feeding when routinely paired with right lateral tilt positioning may be better tolerated. Aligning feeding-fasting periods with circadian patterns may also be beneficial during critical illness in relation to important patient-centered clinical outcomes.</div></div><div><h3>Objectives</h3><div>This systematic review and meta-analysis will summarize the current state of evidence from all randomized controlled trials (RCTs) comparing standard continuous gastric feeding and intermittent gastric feeding (with or without right lateral tilt positioning) among critically ill adult patients receiving mechanical ventilation in ICU.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in MEDLINE, EMBASE and CENTRAL for relevant RCTs published in the English language until September 2024. The primary outcome was all cause hospital mortality, expressed as pooled risk ratio (RR) for the standard continuous feeding relative to intermittent feeding. Key secondary outcomes were ICU length of stay, gut intolerance (vomiting and diarrhoea) and pneumonia.</div></div><div><h3>Results</h3><div>Sixteen studies were identified for full text review out of a total of 678 records screened. Eight RCTs enrolling a total of 993 patients were included in this meta-analysis. There was a substantial heterogeneity in outcomes selection, definitions, and reporting among these RCTs. Aggregate effect size for the primary outcome was RR 0.97 (95 % confidence interval 0.72–1.32, I² = 9 %) for standard continuous feeding versus intermittent feeding. There were no between-group differences for any of the other secondary outcomes. Of all the included RCTs, the point estimate for all-cause mortality was least favourable (RR 1.55, 95 % CI 0.82 to 2.93) for the standard continuous feeding in the RCT that compared it against intermittent postural feeding.</div></div><div><h3>Conclusions</h3><div>Overall, our meta-analysis did not detect any clinically relevant differences in important clinical outcomes between the two groups. Future RCTs should prioritise clinically meaningful, patient-centred outcomes such as mortality or ventilator-free days as primary endpoints.</div></div><div><h3>PROSPERO registration number</h3><div>CRD42024591074.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"51 ","pages":"Pages 40-49"},"PeriodicalIF":6.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288982","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":"Prognostic impact of segmental extracellular water to total body water ratio in cardiovascular surgery patients","authors":"Kenichi Shibata ,&nbsp;Takuji Adachi ,&nbsp;Masataka Kameshima ,&nbsp;Hisako Kito ,&nbsp;Chikako Tanaka ,&nbsp;Taisei Sano ,&nbsp;Mizuki Tanaka ,&nbsp;Masayuki Ida ,&nbsp;Haruna Jinno ,&nbsp;Hideki Kitamura","doi":"10.1016/j.clnu.2025.06.004","DOIUrl":"10.1016/j.clnu.2025.06.004","url":null,"abstract":"<div><h3>Background and aims</h3><div>Perioperative fluid management is a key component of care for patients undergoing cardiovascular surgery. The ratio of extracellular water to total body water (ECW/TBW) has been recognized as a valuable biomarker for perioperative assessment, as it integrates information regarding fluid retention, muscle wasting, and nutritional status. However, evidence regarding the clinical utility of ECW/TBW and its association with long-term postoperative outcomes in cardiovascular surgery remains limited. This study aimed to investigate the prognostic value of ECW/TBW for long-term mortality in patients undergoing cardiovascular surgery.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included consecutive patients who underwent elective cardiovascular surgery between October 2016 and March 2021 at Nagoya Heart Center, Japan. ECW/TBW was assessed using bioelectrical impedance analysis before surgery and measured for the whole body, as well as each segment of the extremities. The association between ECW/TBW and all-cause mortality after discharge was assessed using Kaplan–Meier and multivariate Cox regression analyses. The cut-off value for all-cause mortality at each segmental ECW/TBW was calculated using the receiver operating characteristic curve.</div></div><div><h3>Results</h3><div>In total, 859 patients were included in this study (mean age = 68.4 ± 11.9 years, 67.6 % male). Whole-body ECW/TBW showed a significant positive correlation with log NT-proBNP (ρ = 0.51, p &lt; 0.001) and age (ρ = 0.58, p &lt; 0.001) and negative correlation with skeletal muscle mass index (ρ = −0.33, p &lt; 0.001), body mass index (ρ = −0.22, p &lt; 0.001), peak grip strength (ρ = −0.60, p &lt; 0.001), knee extension isometric muscle strength (ρ = −0.51, p &lt; 0.001), and Geriatric Nutritional Risk Index (ρ = −0.51, p &lt; 0.001). The mean follow-up period was 907.6 ± 500.8 days, during which 46 patients (5.4 %) died. Kaplan–Meier survival curves based on ECW/TBW tertiles showed that higher ECW/TBW was associated with worse prognosis (log-rank test, p &lt; 0.001). Cox regression analysis showed an independent association between ECW/TBW and mortality risk, even after adjusting for multiple confounding factors. The cut-off values for all-cause mortality, derived from the receiver operating characteristic curve, were 0.396 (area under the curve [AUC], 0.768) for whole-body ECW/TBW, 0.390 (AUC, 0.764) for upper-extremity ECW/TBW, and 0.398 (AUC, 0.764) for lower-extremity ECW/TBW.</div></div><div><h3>Conclusions</h3><div>The segmental ECW/TBW is a useful predictor of long-term mortality in patients undergoing cardiovascular surgery. Although ECW/TBW strongly correlates with muscle mass and physical function, this correlation weakens at higher ECW/TBW levels, affecting measurement accuracy. Therefore, combining these measures may achieve more accurate postoperative risk stratification.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"51 ","pages":"Pages 81-89"},"PeriodicalIF":6.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307155","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":"Impact of nutritional status on the mortality and clinical outcomes of children admitted to the pediatric intensive care unit: A systematic review and meta-analysis","authors":"Amit Agrawal ,&nbsp;Shweta Sharma ,&nbsp;Dalwinder Janjua ,&nbsp;Gaurav Jadon ,&nbsp;Roshan Chanchlani ,&nbsp;Viola Dsouza","doi":"10.1016/j.clnu.2025.06.002","DOIUrl":"10.1016/j.clnu.2025.06.002","url":null,"abstract":"<div><h3>Background and aims</h3><div>Malnutrition has been associated with poor outcomes in hospitalized patients; however, previous studies reported variable results due to different periods, height and weight standards, interventions, and possible confounding factors. We aimed to evaluate the association of nutritional status with the clinical outcomes in children admitted to the Pediatric Intensive Care Unit (PICU).</div></div><div><h3>Methods</h3><div>We searched PubMed, Scopus, Web of Science, and Cochrane Library from inception to May 2024 using keywords and MeSH related to critically ill children, outcome, and nutritional status or malnutrition in different combinations. Studies reporting the association of undernutrition (UN), over-nutrition (ON), or both with outcomes of patients admitted to PICU aged 1 month to 18 years were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used to collect studies and extract relevant data. After removing duplicates, title, and abstract screening was done for 6560 studies, 121 full-text studies were reviewed, and 52 studies were finally included. The outcome measures were to assess risk difference (RD) and standardized mean difference (SMD) among UN, ON, and normal nutrition groups for mortality (primary), PICU length of stay (LOS), hospital LOS, duration, or need of mechanical ventilation (MV), and hospital-acquired infections (secondary). The protocol of this study is registered with the Open Science Framework (<span><span>https://osf.io/ywmvz</span><svg><path></path></svg></span>).</div></div><div><h3>Results</h3><div>We included 52 studies comprising 34,795 patients (4843 undernourished, 18,373 normally nourished, and 6552 overnourished). The male-to-female ratio was 1.13, with a mean age of 3.66 years. Meta-analysis showed a significantly increased risk of mortality in the UN group (RD = 0.02; 95%CI = 0.01–0.04, P &lt; 0.0001) but not in the ON group (RD = 0.00; 95%CI = −0.01–0.01, P = 0.78). The need for MV (RD = 0.04; P = 0.0004) and duration of MV (SMD = 0.23; P &lt; 0.00001) were significantly greater in the UN children but not in the ON group (P = 0.13, P = 0.43, respectively). UN significantly prolonged hospital LOS (SMD = 0.26; P &lt; 0.00001) and PICU LOS (SMD = 0.27; P &lt; 0.00001).</div></div><div><h3>Conclusion</h3><div>Undernutrition is independently associated with poor outcomes, including a higher risk of mortality, need for MV, longer MV duration, PICU, and hospital LOS. However, overnutrition did not show such associations with poor outcomes in critically ill children. Timely recognition of malnutrition is important for enhancing pediatric critical care and optimizing outcomes through planned nutritional interventions.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"51 ","pages":"Pages 28-39"},"PeriodicalIF":6.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288981","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}