Clinical nutrition最新文献

{"title":"Measuring diet intake in adolescents: Relative validation of an artificial intelligence enhanced, image assisted mobile application","authors":"Audrey Moyen ,&nbsp;Antonio Rossi ,&nbsp;Maurya Hart ,&nbsp;Elinor Simons ,&nbsp;Piushkumar J. Mandhane ,&nbsp;Theo J. Moraes ,&nbsp;Meghan B. Azad ,&nbsp;Stuart E. Turvey ,&nbsp;Padmaja Subbarao ,&nbsp;Anne-Julie Tessier ,&nbsp;Kozeta Miliku","doi":"10.1016/j.clnu.2025.106568","DOIUrl":"10.1016/j.clnu.2025.106568","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Puberty is a critical period of development during which nutritional exposures are known to shape long-term health and the risk of chronic diseases. Current dietary assessment methods have limitations for use in large cohorts of adolescent populations. We aimed to evaluate the relative validity of Keenoa (not an acronym), an artificial intelligence-enhanced image-assisted mobile application, against the validated Automated Self-Administered 24 h recall (ASA24)-Canada web-based platform, among adolescents in the CHILD Cohort Study.</div></div><div><h3>Methods</h3><div>Using a randomized crossover design, participants aged 11–15 years old completed three days (two weekdays and one weekend day) of both Keenoa food tracking and ASA24 food recalls. Differences in reported intakes were analyzed using paired t-tests or Wilcoxon signed-rank test and deattenuated correlations by Spearman's coefficient. Agreement and bias were determined using Bland–Altman's test, and inter-quartile cross-classification agreement was assessed using weighted Cohen kappa.</div></div><div><h3>Results</h3><div>This study included 141 participants with a mean age of 12.2 ± 0.8 years; of them 74 (52.5 %) males; and 88 (62.4 %) identified as Caucasian/White. Mean ± SD reported energy intakes (kcal/d) were 1976 ± 451 and 1978 ± 425, with ASA24 and Keenoa, respectively (P = 0.95). Mean reported macronutrient, iron, and potassium intakes did not significantly differ between tools. Reported fiber intake was higher, while sodium, calcium and vitamin D intakes were lower with Keenoa compared to ASA24 (P values &lt; 0.001–0.025). Deattenuated correlations between tools ranged from r = 0.77 to 1.00 (all p&lt; 0.01) and weighted Cohen κ scores ranged from 0.22 to 0.42 (all p &lt; 0.001). Among all participants, 121 (85.8 %) and 78 (55.3 %) completed all 3 requested days with Keenoa and ASA24, respectively (P&lt; 0.01).</div></div><div><h3>Conclusion</h3><div>The artificial intelligence-enhanced image-assisted Keenoa mobile application showed strong to moderate relative validity against ASA24 for energy, macronutrient, potassium and iron intakes. Vitamin D, calcium, fiber and sodium showed limited relative agreement based on mean differences. This novel tool may facilitate dietary assessment and reduce attrition bias in cohort studies. Future validation using objective biomarker measures will help establish true validity.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106568"},"PeriodicalIF":7.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923148","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":"Nocturnal enteral feeding and mechanical ventilation risk in intensive care unit patients: A deep Learning–Based causal inference study","authors":"Min Woo Kang ,&nbsp;Soojeong Yun ,&nbsp;Seung Min Song ,&nbsp;Ji Eun Kim ,&nbsp;Hyo Jin Kim ,&nbsp;Eun Jung Cho ,&nbsp;Young Joo Kwon ,&nbsp;Shin Young Ahn","doi":"10.1016/j.clnu.2025.106556","DOIUrl":"10.1016/j.clnu.2025.106556","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Continuous enteral nutrition is widely used in critically ill patients, but its clinical superiority over intermittent feeding remains uncertain. A particular concern is nocturnal feeding, a common component of continuous regimens, which may elevate the risk of aspiration due to diminished airway protective reflexes during sleep. This study investigated whether nocturnal enteral feeding is associated with a higher requirement for mechanical ventilation in intensive care unit (ICU) patients.</div></div><div><h3>Methods</h3><div>We analyzed Medical Information Mart for Intensive Care (MIMIC)-IV (n = 1551) for model development and eICU Collaborative Research Database (eICU) (n = 3394) for external validation, including those who began enteral feeding within 72 h of ICU admission. The exposure was any enteral feeding between 10 PM and 6 AM in the first 72 h; outcomes were mechanical ventilation after 72 h. We used multivariable regression models. Subgroup analyses, including tests for interaction, were performed across patient characteristics, feeding volume, and comorbidities. A deep learning-based causal inference model was developed and estimated average treatment effects, and SHapley Additive exPlanations (SHAP) analysis identified influential predictors.</div></div><div><h3>Results</h3><div>Night-time enteral feeding was associated with higher odds of requiring mechanical ventilation, with an odds ratio (OR) of 1.88 (95 % confidence interval [CI] 1.17–3.01) in the MIMIC-IV cohort and an OR of 2.45 (95 % CI 1.01–5.95) in the eICU cohort. The deep learning–based causal inference model estimated that night-time feeding increased the probability of mechanical ventilation by 7.29 % (95 % CI 5.37–9.37) in MIMIC-IV and by 3.50 % (95 % CI 2.66–4.40) in eICU. SHAP analysis consistently identified total daily enteral feeding volume as the most influential predictor of ventilation risk. Subgroup analysis revealed that patients without cerebrovascular disease experienced higher ventilation risk with night-time feeding, whereas those with cerebrovascular disease did not.</div></div><div><h3>Conclusion</h3><div>Among non-intubated ICU patients, night-time enteral feeding may increase the risk of mechanical ventilation, particularly at very large feeding volumes. These findings suggest reconsidering overnight continuous feeding practices and support prospective trials of circadian-aligned nutrition to reduce respiratory complications.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106556"},"PeriodicalIF":7.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923142","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":"Nutritional care using oral nutritional supplements: 22 questions every clinician Asks—Answered by global experts in a Delphi consensus study","authors":"Gulistan Bahat ,&nbsp;Ezgi Pinar ,&nbsp;Osman Abbasoglu ,&nbsp;Mehmet Akif Karan ,&nbsp;Savas Ozturk ,&nbsp;Rocco Barazzoni ,&nbsp;Jürgen Bauer ,&nbsp;Stephan C. Bischoff ,&nbsp;Tommy Cederholm ,&nbsp;Liang-Kung Chen ,&nbsp;Antonio Cherubini ,&nbsp;Maria Isabel T.D. Correia ,&nbsp;Jerzy Gąsowski ,&nbsp;Maria Cristina Gonzalez ,&nbsp;Harriët Jager-Wittenaar ,&nbsp;Francesco Landi ,&nbsp;Nuno Mendonça ,&nbsp;Maurizio Muscaritoli ,&nbsp;Graziano Onder ,&nbsp;Karolina Piotrowicz ,&nbsp;Yusuf Ozogul","doi":"10.1016/j.clnu.2025.106552","DOIUrl":"10.1016/j.clnu.2025.106552","url":null,"abstract":"<div><h3>Background/aims</h3><div>Malnutrition is a common clinical problem causing poor outcomes, including longer hospital stays, complications, functional decline, and mortality. Oral nutritional supplements (ONS) are a key component of medical nutrition therapy for patients who cannot meet their nutritional needs through diet alone. Despite their proven effectiveness, ONS use in practice remains inconsistent due to the lack of comprehensive, practice-based, and internationally validated guidelines. In 2023, the Turkish Clinical Enteral and Parenteral Nutrition Society (KEPAN) developed a national consensus report to address this gap. To enhance international validity and applicability, this study aimed to validate and refine those recommendations through a global Delphi process involving multidisciplinary experts.</div></div><div><h3>Methods</h3><div>A two-round modified Delphi study was conducted between February 2023 and March 2024. Twenty-two experts from 13 countries and various disciplines (internal medicine, gastroenterology, geriatrics, surgery, family medicine, physiatry, clinical nutrition, dietetics, etc.) rated 22 predefined recommendations using a 5-point Likert scale. Consensus was defined as a median score ≥4 with a 25th percentile ≥4. Expert comments were reviewed and incorporated, and recent international guidelines were used to update the supporting commentaries as well.</div></div><div><h3>Results</h3><div>Seventeen recommendations achieved consensus in round 1, and the remaining five in round 2. The final internationally validated set of recommendations covers practical aspects of ONS use including: (1) indications for initiation, dose, timing, and product selection; (2) monitoring strategies, adherence, and management of taste, tolerance, and other common problems; and (3) condition-specific considerations across diabetes, chronic kidney disease, cirrhosis, congestive heart failure, chronic obstructive pulmonary disease, neurological diseases, pressure injuries, surgery, cancer, geriatrics and multimorbidity, as well as guidance on continuation and discontinuation of ONS. The refined recommendations emphasize the food-first principle, individualized decision-making, and multidisciplinary collaboration to optimize person-centered nutritional care.</div></div><div><h3>Conclusions</h3><div>This study delivers the first internationally validated, expert-informed recommendations on ONS use, providing a standardized and adaptable framework for global implementation. Familiarity with and application of these recommendations in clinical practice should lead to improved nutritional care, better adherence, enhanced patient outcomes, and more efficient, person-centered use of ONS across several healthcare settings.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106552"},"PeriodicalIF":7.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923146","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 chemotherapy delivery and outcomes in advanced pancreatic cancer: A prospective multicenter study","authors":"Maria Kiriukova ,&nbsp;Giulia Orsi ,&nbsp;Vasile Sandru ,&nbsp;Daniel de la Iglesia ,&nbsp;Nikola Panic ,&nbsp;Maryana Bozhychko ,&nbsp;Bartu Avci ,&nbsp;Alice Burini ,&nbsp;Sara Cardellini ,&nbsp;Valeria Loliva ,&nbsp;Livia Archibugi ,&nbsp;Marina Macchini ,&nbsp;Afrodita Panaitescu-Damian ,&nbsp;Dmitry Bordin ,&nbsp;Paolo Giorgio Arcidiacono ,&nbsp;Patrick Maisonneuve ,&nbsp;Enrique de-Madaria ,&nbsp;Michele Reni ,&nbsp;Gabriele Capurso","doi":"10.1016/j.clnu.2025.106573","DOIUrl":"10.1016/j.clnu.2025.106573","url":null,"abstract":"<div><h3>Background &amp; aim</h3><div>Malnutrition is common in pancreatic ductal adenocarcinoma (PDAC) and may compromise chemotherapy delivery. We investigated whether baseline nutritional status and quality of life (QoL) predict chemotherapy relative dose intensity (RDI) and survival in advanced PDAC.</div></div><div><h3>Methods</h3><div>In this multicenter prospective cohort, adults with locally advanced or metastatic PDAC planned for first-line chemotherapy underwent baseline nutritional and QoL assessments, including the Mini Nutritional Assessment (MNA), European Organisation for Research and Treatment of Cancer-Pancreas 26 (EORTC-PAN26), and Functional Assessment of Anorexia/Cachexia Therapy subscale (FAACT-A/CS). The primary outcome was chemotherapy delivery during the first 12 weeks, expressed as RDI. Secondary outcomes included overall survival (OS). Associations between baseline scores, RDI, and OS were analyzed using regression models adjusted for age, sex, disease stage, and center. Kaplan–Meier and Cox models assessed survival.</div></div><div><h3>Results</h3><div>Of 140 enrolled patients, 105 started chemotherapy. Malnutrition was frequent (55.7 % at risk, 33.6 % malnourished). Higher MNA and EORTC-PAN26 scores were associated with better RDI (r = 0.31, p = 0.001; r = 0.30, p = 0.002), whereas FAACT-A/CS showed no correlation. In multivariable analysis, higher MNA scores [odds ratio (OR) 0.55; 95 % confidence interval (CI) 0.32–0.96; p = 0.036] and metastatic disease (OR 0.36; 95 % CI 0.13–0.99; p = 0.048) independently predicted RDI ≥80 %. Reduced RDI (hazard ratio [HR] 2.05; 95 % CI 1.20–3.50; p = 0.009) and FAACT-A/CS &lt; 28 (HR 1.90; 95 % CI 1.04–3.49) were independently associated with shorter OS.</div></div><div><h3>Conclusions</h3><div>Baseline nutritional status and QoL, particularly assessed by MNA and EORTC-PAN26, predict chemotherapy delivery in advanced PDAC. Reduced RDI and anorexia/cachexia symptoms are linked to poorer survival, supporting systematic nutritional assessment and targeted interventions to optimize outcomes.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106573"},"PeriodicalIF":7.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923147","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":"Positive attitudes and beliefs drive the intention to adopt a more plant-derived diet in hospitals: Insights from patients and healthcare professionals","authors":"Maaike A. van Bree ,&nbsp;Hinke M. Kruizenga ,&nbsp;Rinaldo J. Kühne ,&nbsp;Barbara C. Schouten ,&nbsp;Maarten R. Soeters","doi":"10.1016/j.clnu.2025.106553","DOIUrl":"10.1016/j.clnu.2025.106553","url":null,"abstract":"<div><h3>Background and aims</h3><div>Public health and sustainability prompt hospitals to promote more plant-derived nutrition for patients. Yet, successful implementation remains limited. The extent to which patients intend to consume such nutrition and healthcare professionals intend to provide it to patients, is unexplored. To support more effective implementation strategies, this study examines factors that predict patients' intention to consume and healthcare professionals' intention to provide more plant-derived protein-rich nutrition during hospitalization..</div></div><div><h3>Methods</h3><div>A single-center cross-sectional study using two parallel surveys - one for patients and one for healthcare professionals - was conducted between September 2024 and January 2025. Both surveys incorporated constructs from the Theory of Planned Behavior and the Stages of Change, assessing dietary habits, attitudes, behavioral beliefs, perceived behavioral control, stages of change, and intention towards plant-derived food consumption and provision. Regression analyses using PROCESS v5.0 were performed to identify predictors of behavioral intention for both groups.</div></div><div><h3>Results</h3><div>In total, 603 participants were included comprising patients (n = 300) and healthcare professionals (n = 303). For both groups, intention was significantly predicted by a positive attitude towards consuming (β = 0.33, <em>p</em> &lt; 0.001) or providing (β = 0.29, <em>p</em> &lt; 0.001) more plant-derived nutrition and by a positive subjective norm towards consuming (β = 0.19, <em>p</em> &lt; 0.05) or providing (β = 0.14, <em>p</em> &lt; 0.05) more plant-derived nutrition. For both groups, the behavioral beliefs (resp. β = 0.75, <em>p</em> &lt; 0.001; β = 0.61, <em>p</em> &lt; 0.001) were the most influential determinant of attitude..</div></div><div><h3>Conclusion</h3><div>To increase behavioral intention among patients and healthcare professionals, interventions must strengthen positive attitudes by addressing specific underlying behavioral beliefs that are related to these attitudes. The behavioral beliefs regarding ‘<em>taste</em>’ and ‘<em>plant-derived nutrition</em> supports <em>recovery</em>’ offer the most potential for improvement in both groups. Future research should assess whether addressing these beliefs effectively enhances attitudes and promotes the intention to consume or provide more plant-derived protein rich nutrition in hospitals..</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106553"},"PeriodicalIF":7.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923141","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":"Effects of a novel synbiotic intervention on abdominal visceral fat reductions and gut microbiota in overweight and obese adults: A randomized, double-blind, placebo-controlled trial","authors":"Nengjuan Li ,&nbsp;Zhigang Zhu ,&nbsp;Shuang Wu ,&nbsp;Daochen Gong ,&nbsp;Richard Day ,&nbsp;Vineetha Vijayakumar ,&nbsp;Xiao Yu ,&nbsp;Qiuxia Chen ,&nbsp;Yuting Feng ,&nbsp;Qiong Wang ,&nbsp;Zhiming Hu ,&nbsp;Jinjun Li ,&nbsp;Jun Du ,&nbsp;Changyun Xu ,&nbsp;Wang Li ,&nbsp;Liang Chen ,&nbsp;Jiang Hu ,&nbsp;Xiaoqiong Li","doi":"10.1016/j.clnu.2025.106560","DOIUrl":"10.1016/j.clnu.2025.106560","url":null,"abstract":"<div><h3>Background and aims</h3><div>Emerging evidence highlight the gut microbiome as an important regulator of metabolic health, with probiotics and prebiotics demonstrating exciting potential for their role in health promotion. This study aims to investigate a novel synbiotic formulation comprising four probiotic strains (<em>Bifidobacterium animalis</em> subsp. <em>lactis</em> CECT 8145, and three <em>Lacticaseibacillus rhamnosus</em> strains), prebiotics (inulin, fructooligosaccharides), and <em>Chrysanthemum morifolium</em> extract. We hypothesized that this intervention would improve metabolic health parameters, particularly visceral adiposity.</div></div><div><h3>Methods</h3><div>In a 12-week, double-blind, randomized, placebo-controlled, parallel-group trial with a 6-week post-intervention follow-up, 112 participants (BMI: 24.0–34.9 kg/m²) received daily synbiotic or a matched placebo. Changes in visceral adipose tissue (VAT) area, serving as the primary endpoint, were quantified by dual-energy X-ray absorptiometry (DXA). Secondary outcomes included analysis of blood biochemical parameters, body composition, and fecal microbiota characterization.</div></div><div><h3>Results</h3><div>Compared with placebo, synbiotic supplementation significantly reduced VAT area from baseline to week 12 (p = 0.048). In subgroup analyses by gender and BMI, the effect was more pronounced in men than in women (p = 0.051) and was highly significant in individuals with 24 ≤ BMI &lt;28 (p = 0.003). However, subcutaneous adipose tissue (SAT) increased in the 24 ≤ BMI &lt;28 subgroup (p = 0.027). Although no significant changes occurred in blood biochemistry, BMI, or waist circumference, the synbiotic group showed a trend toward greater total body fat reduction between weeks 12–18 (p = 0.077). Microbiota analysis revealed transient enrichment of <em>B. animalis</em> subsp. <em>lactis</em> (ASV110) and <em>L. rhamnosus</em> (ASV473), which dissipated by week 18.</div></div><div><h3>Conclusions</h3><div>This synbiotic formulation reduced visceral fat, a key driver of metabolic dysfunction, and modulated adipose distribution, particularly in men and overweight (24 ≤ BMI &lt;28) individuals. These results support its use as a functional food for visceral adiposity management.</div></div><div><h3>Trial registration</h3><div>This study was registered on the website of <span><span>www.chictr.org.cn</span><svg><path></path></svg></span>, number ChiCTR2400088457.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106560"},"PeriodicalIF":7.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923144","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":"Vitamin D supplementation and incidence of major depressive disorder – A randomized clinical trial","authors":"Noora-Maria Ahl ,&nbsp;Sari Hantunen ,&nbsp;Tomi-Pekka Tuomainen ,&nbsp;Christel Lamberg-Allardt ,&nbsp;JoAnn E. Manson ,&nbsp;Tarja Nurmi ,&nbsp;Matti Uusitupa ,&nbsp;Ari Voutilainen ,&nbsp;Tommi Tolmunen ,&nbsp;Jyrki K. Virtanen","doi":"10.1016/j.clnu.2025.106570","DOIUrl":"10.1016/j.clnu.2025.106570","url":null,"abstract":"<div><h3>Background and aims</h3><div>Depression is a significant public health issue, but current prevention methods are limited. Vitamin D has shown some promise in treatment of depression, but evidence for primary prevention is inconclusive. We investigated the effects of long-term vitamin D₃ supplementation on the incidence of major depressive disorder (MDD).</div></div><div><h3>Methods</h3><div>The study was a randomized placebo-controlled clinical trial conducted in 2012–2018. Participants were randomized to receive either 1600 IU/day (n = 814) or 3200 IU/day (n = 817) of vitamin D₃ or placebo (n = 803) for 5 years. The primary endpoint of the current study was incident MDD, diagnosed by physician, during the 5-year supplementation period. The secondary endpoint was incident MDD during an extended follow-up until the end of 2021. A sub-cohort of 542 participants had more detailed in-person investigations.</div></div><div><h3>Results</h3><div>Among 2434 participants (mean age 68.2 years; 42.5 % women), 1786 completed the 5-year intervention. During the mean 4.2-year follow-up, there were 14, 11 and 8 MDD events in the placebo, 1600 IU/day (hazard ratio (HR), 0.78; 95 % CI 0.35–1.71; <em>P</em> = 0.53), and 3200 IU/day (HR, 0.57; 95 % CI 0.24–1.35; <em>P</em> = 0.20) arms. During the extended mean 7.8-year follow-up, there were in total 29, 18 and 16 MDD events in the placebo, 1600 IU/day (HR, 0.61; 95 % CI 0.34–1.10; <em>P</em> = 0.10) and 3200 IU/day (HR 0.54; 95 % CI 0.30–1.00; <em>P</em> = 0.05) arms. In the sub-cohort, the mean ± SD baseline serum 25-hydroxyvitamin D concentration was 75 ± 18 nmol/L. After 12 months, the concentrations were 73 ± 18 nmol/L, 100 ± 21 nmol/L, and 120 ± 22 nmol/L in the placebo, 1600 IU/day, and 3200 IU/day arms, respectively.</div></div><div><h3>Conclusions</h3><div>Vitamin D₃ supplementation did not lower the incidence of MDD during the 5-year supplementation period among largely vitamin D sufficient aging adults. However, there was a borderline indication of benefit during a longer follow-up, possibly suggesting a delayed effect of supplementation.</div></div><div><h3>Clinical Trial Registry number</h3><div>ClinicalTrials.gov: <span><span>NCT01463813</span><svg><path></path></svg></span>, <span><span>https://clinicaltrials.gov/ct2/show/NCT01463813</span><svg><path></path></svg></span> (date of registration Nov 1, 2011).</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106570"},"PeriodicalIF":7.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923138","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":"Nutritional and inflammatory status in the obesity paradox of coronary artery disease","authors":"Yuichiro Shirahama ,&nbsp;Noriaki Tabata ,&nbsp;Masanobu Ishi ,&nbsp;Hiroaki Kusaka ,&nbsp;Shinsuke Hanatani ,&nbsp;Hiroki Usuku ,&nbsp;Eiichiro Yamamoto ,&nbsp;Yasuhiro Izumiya ,&nbsp;Kenichi Tsujita","doi":"10.1016/j.clnu.2025.11.024","DOIUrl":"10.1016/j.clnu.2025.11.024","url":null,"abstract":"<div><h3>Background and aims</h3><div>The “obesity paradox,” where higher body mass index (BMI) is linked to lower mortality, has been observed in coronary artery disease (CAD) patients. One hypothesis is that weight loss in cancer patients may confound this association. This study examined the obesity paradox in CAD patients without cancer and investigated the roles of nutritional and inflammatory status.</div></div><div><h3>Methods</h3><div>We analysed 1,252 CAD patients without a history of cancer who underwent percutaneous coronary intervention. Patients were categorized into BMI &lt;25 kg/m² (n = 843) and BMI ≥25 kg/m² (n = 409). The primary outcome was 5-year all-cause mortality. Nutritional status was evaluated using the prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI), while inflammation was assessed by neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR).</div></div><div><h3>Results</h3><div>During the follow-up period, 73 deaths occurred (56 in BMI &lt;25 kg/m² vs. 17 in BMI ≥25 kg/m²). Patients with low BMI had significantly lower PNI and GNRI (both P &lt; 0.001), but no significant differences in NLR or PLR. Kaplan–Meier analysis showed poorer survival in people without obesity (P &lt; 0.001). In multivariable analysis, higher BMI remained an independent protective factor (HR 0.87, 95 % CI 0.81–0.94, P &lt; 0.001). However, PNI and GNRI had superior prognostic discrimination compared to BMI. The predictive model's C-statistic improved significantly when PNI and NLR were added to conventional risk factors, with notable gains in net reclassification and discrimination indices (both P &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The obesity paradox in non-cancer CAD patients remains evident and appears more closely related to nutritional status than BMI alone. Lower BMI was associated with malnutrition, not increased inflammation. Simple markers such as PNI and NLR offer additional prognostic value and may aid in better risk stratification of CAD patients.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106540"},"PeriodicalIF":7.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917265","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":"Glucagon-like peptide-1 receptor agonists and Wernicke encephalopathy: A pharmacovigilance study and literature review","authors":"Dana Lev ,&nbsp;Avshalom Leibowitz ,&nbsp;Alon Lang ,&nbsp;Gadi Shlomai ,&nbsp;Gilad Twig ,&nbsp;Yehudit Eden-Friedman ,&nbsp;Tal Engel ,&nbsp;Tali Cukierman-Yaffe ,&nbsp;Rachel Dankner ,&nbsp;Hertzel C. Gerstein ,&nbsp;Adam Goldman","doi":"10.1016/j.clnu.2025.106571","DOIUrl":"10.1016/j.clnu.2025.106571","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have revolutionized the treatment of type 2 diabetes mellitus and obesity in recent years. While gastrointestinal adverse events are common, their association with nutritional deficiencies, including thiamine, has not been comprehensively investigated. This study aimed to evaluate whether treatment with GLP-1 RAs is associated with the occurrence of Wernicke encephalopathy (WE).</div></div><div><h3>Methods</h3><div>We conducted a pharmacovigilance study using the FDA Adverse Event Reporting System (FAERS) and a narrative literature review. Disproportionality analysis assessed WE reporting following GLP-1 RA treatment using the reporting odds ratio (ROR) and the lower bound of the information component (IC) 95 % credibility interval.</div></div><div><h3>Results</h3><div>We identified 15 cases of GLP-1 RA-associated WE: 13 from FAERS, 1 from published literature, and 1 from our medical center. Most cases occurred with semaglutide (n = 8/15) or tirzepatide (6/15), and were reported in 2023–2024 (14/15). Most patients (13/15) reported gastrointestinal manifestations of either weight loss, vomiting, loss of appetite, or malnutrition. Classic WE symptoms were reported in 11 patients, and the full clinical triad in 2 patients. Long-term neurological sequelae were noted in 7 of 11 patients with follow-up data. Disproportionality analysis showed increased reporting of WE with GLP-1 RAs compared with other medications (ROR = 2.35 [95%CI, 1.38–4.01]; IC₀₂₅ = 0.29).</div></div><div><h3>Conclusions</h3><div>WE is a potentially rare but severe adverse event of GLP-1 RA treatment, mainly with semaglutide or tirzepatide. As early detection may prevent neurological sequelae, increased clinical awareness is warranted, especially in individuals experiencing severe gastrointestinal symptoms.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106571"},"PeriodicalIF":7.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145974163","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 2025 Sir David Cuthbertson Lecture: Energy metabolism: Beyond calories, feeding the mitochondria","authors":"Eric Fontaine","doi":"10.1016/j.clnu.2026.106575","DOIUrl":"10.1016/j.clnu.2026.106575","url":null,"abstract":"<div><div>In this article, I explore how energy metabolism depends on proper mitochondrial function. Adenosine triphosphate (ATP), the main source of energy for cells, is mainly produced in the mitochondria as a result of the fusion of hydrogen produced by the breakdown of nutrients with oxygen. This reaction allows protons to be pumped across the inner mitochondrial membrane, creating a gradient that powers ATP synthesis. However, ATP production is not perfectly efficient. Some oxygen is consumed without generating ATP due to proton leaks or other processes that utilize the gradient. Diet, hormones, and cellular signals can alter mitochondrial efficiency: for example, hyperthyroidism and polyunsaturated fatty acid deficiency cause uncoupling, while hypothyroidism and nitric oxide increase coupling but reduce maximum ATP production. I also point out that the use of ATP depends on its thermodynamic value, which is reflected in the Adenosine triphosphate/Adenosine diphosphate ratio ([ATP]/[ADP] ratio). A decrease in this ratio can selectively reduce certain ATP-consuming processes, as shown in studies on metformin and imeglimin. In cases of stress or nutritional deficiency, cells can consume ATP without performing useful work, leading to inefficiency or even cell death when the [ATP]/[ADP] ratio collapses. Knowing that these concepts are quite complex, I have simplified them to make clear that mitochondria are more than just passive “powerhouses of cells”.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106575"},"PeriodicalIF":7.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145974240","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}