Clinical nutrition最新文献

{"title":"Associations of dietary and erythrocyte membrane fatty acids with overall survival in oral cancer: A prospective cohort study with mechanistic exploration","authors":"Baochang He ,&nbsp;Xixi Dong ,&nbsp;Yichen Lin ,&nbsp;Jianli Lin ,&nbsp;Yu Qiu ,&nbsp;Lisong Lin ,&nbsp;Bin Shi ,&nbsp;Jing Wang ,&nbsp;Fa Chen","doi":"10.1016/j.clnu.2025.12.001","DOIUrl":"10.1016/j.clnu.2025.12.001","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Evidence suggests fatty acid metabolism may influence cancer progression, yet their role in oral cancer prognosis remains unclear. This study investigated associations between dietary fatty acid intake, erythrocyte membrane fatty acid composition, and overall survival in patients with oral cancer, and explored potential underlying mechanisms through network pharmacology and molecular docking analyses.</div></div><div><h3>Methods</h3><div>This prospective cohort study recruited 908 newly diagnosed oral cancer patients from October 2011 to June 2024. Dietary fatty acid intake was assessed using a validated food frequency questionnaire. Erythrocyte membrane fatty acid profiles were measured using gas chromatography. Patients were followed until February 2025, with overall survival as the primary outcome. Cox proportional hazards models were used to evaluate hazard ratios (HRs) and 95 % confidence intervals (CIs) for associations between fatty acid levels and overall survival in oral cancer. Composite indices (dietary fatty acid index [DFAI] and erythrocyte fatty acid index [EFAI]) were constructed using LASSO regression to assess combined effects. Network pharmacology and molecular docking were employed to investigate potential mechanisms.</div></div><div><h3>Results</h3><div>In multi-adjusted Cox regression models, higher dietary intake of linolenic acid (C18:3), eicosatrienoic acid (C20:3), and docosahexaenoic acid (C22:6) were associated with reduced mortality risk (highest vs. lowest tertile: HR = 0.54, 95 % CI: 0.36–0.82; HR = 0.65, 95 % CI: 0.44–0.95; HR = 0.62, 95 % CI: 0.42–0.91, respectively; all <em>P</em>-trend&lt;0.05). Among erythrocyte membrane fatty acids, significant protective associations were observed for very long-chain saturated fatty acids behenic acid (C22:0) and tricosanoic acid (C23:0), with 48 % and 56 % lower mortality risks in the highest tertile (all <em>P</em> for trend &lt;0.05). Similar protective effects were found for omega-3 polyunsaturated fatty acids including α-linolenic acid (C18:3 n-3), docosapentaenoic acid (C22:5 n-3), and docosahexaenoic acid (C22:6 n-3). Composite fatty acid indices showed that DFAI and EFAI were associated with 59 % and 85 % mortality reduction, respectively (both <em>P</em> &lt; 0.001). Network pharmacology identified interleukin-6 (IL-6) as a key target in the fatty acid-oral cancer survival pathway. Molecular docking revealed favorable binding affinities between all six significant fatty acids and IL-6 (binding energies: −1.83 to −5.08 kcal/mol).</div></div><div><h3>Conclusion</h3><div>Higher dietary intake and erythrocyte membrane levels of specific polyunsaturated fatty acids and very long-chain saturated fatty acids are significantly associated with improved overall survival in oral cancer patients. These protective effects may be mediated through IL-6-related inflammatory pathways.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106534"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760784","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":"Diet, body composition and metabolic and hormonal profile in women at high risk of breast cancer recurrence: A secondary mediation analysis of the DIANA-5 trial","authors":"Olivera Djuric ,&nbsp;Laura Bonvicini ,&nbsp;Massimo Pellegrini ,&nbsp;Eleonora Bruno ,&nbsp;Patrizia Pasanisi ,&nbsp;Giuliana Gargano ,&nbsp;Patrizia Curtosi ,&nbsp;Franco Berrino ,&nbsp;Paolo Giorgi Rossi ,&nbsp;Anna Villarini","doi":"10.1016/j.clnu.2025.11.021","DOIUrl":"10.1016/j.clnu.2025.11.021","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background &amp; Aims&lt;/h3&gt;&lt;div&gt;Breast cancer recurrence risk is strongly influenced by metabolic and hormonal factors linked to adiposity and diet. The DIet ANd Androgens-5 (DIANA-5) randomized controlled trial was primarily designed to test whether adherence to a Mediterranean/macrobiotic diet, combined with moderate physical activity, could reduce the risk of breast cancer recurrence. In the present secondary analysis of the DIANA-5 trial, we investigated associations between dietary intake, anthropometric, metabolic and hormonal profile testing the hypothesis that improvement in metabolic and hormonal parameters after one year of intervention are mediated by increased consumption of recommended foods (“recommended food score”) and changes of body composition measures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A total of 1542 women with early-stage breast cancer and presence of one or more endocrine/metabolic risk factors were randomized to receive either standard healthy lifestyle recommendations (n = 773) or intensive support including dietary counseling, cooking classes, and moderate physical activity reinforcement (n = 769). Anthropometric (BMI, waist circumference [WC], fat mass/fat-free mass ratio [FM/FFM]), metabolic (glycemia, insulin, HOMA index, total cholesterol, triglycerides, metabolic syndrome), and hormonal (testosterone) endpoints were assessed at baseline and after 12 months. Potential mediation effects of “recommended food score” and WC or FM/FFM on metabolic and hormonal changes were tested by using SPSS version 23 and the PROCESS macro v.4.0 for SPSS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;604 and 551 women were available for mediation analyses in intervention and control groups, respectively. The dietary intervention improved all anthropometric, metabolic and hormonal measures. “Recommended food score” together with WC mediated 73 % of the effect of the intervention on glycemia, 67 % on insulin, 70 % on HOMA index, 96 % on total cholesterol, and 86 % on metabolic syndrome. With “recommended food score” and FM/FFM as mediators, proportions mediated were 86 % for glycemia, 73 % for insulin, 78 % for HOMA index, 126 % for total cholesterol, and 66 % for metabolic syndrome. Mediation effects of WC and FM/FFM on triglyceride changes were much weaker (38 % and 37 %, respectively). For all outcomes and all mediators, at least one path had a p-value &lt;0.05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Most benefits of the DIANA-5 lifestyle intervention were mediated by dietary adherence and reductions in WC and FM/FFM. The proportion of effects mediated on metabolic syndrome, glucose and glycemic tolerance is high enough to suggest that these are the main effectors. The results on triglyceride blood levels suggest that further mechanism, possibly physical activity and energy intake should be investigated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Trial Registry number&lt;/h3&gt;&lt;div&gt;NCT05019989. Available at: &lt;span&gt;&lt;span&gt;https://clinicaltrials.gov/se","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106537"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789177","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":"Nutrient intake, dietary patterns and relationship to symptoms and comorbidities in hypermobile Ehlers-Danlos syndrome","authors":"Rabia Topan ,&nbsp;Shraya Pandya ,&nbsp;Paula Chance ,&nbsp;Natalia Zarate-Lopez ,&nbsp;Qasim Aziz ,&nbsp;Paul Bassett ,&nbsp;Janet Kyle ,&nbsp;Kevin Whelan ,&nbsp;Asma Fikree","doi":"10.1016/j.clnu.2025.11.022","DOIUrl":"10.1016/j.clnu.2025.11.022","url":null,"abstract":"<div><h3>Background and aims</h3><div>Hypermobile Ehlers Danlos Syndrome (hEDS) patients have a high prevalence of Disorders of Gut–Brain Interaction (DGBI) and can pose complex nutritional challenges, yet little is known about their dietary intake, adequacy or dietary patterns and how this relates to clinical presentation. We aimed to assess this.</div></div><div><h3>Methods</h3><div>In a cross-sectional study, patients with hEDS completed a food frequency questionnaire and questionnaires characterizing: DGBI, gastrointestinal (GI) symptoms, Avoidant Restrictive Food Intake Disorder (ARFID), and use of nutrition support. Principal component analysis and cluster analysis classified patients into dietary patterns.</div></div><div><h3>Results</h3><div>425 participants were included (mean: 41 years, 96 % female); 46.4 % were overweight/obese. Patients consumed high protein (77.2 g ± 37.8), high fat (79.1 g ± 36.9) diets that were low in calories, Vitamin B and D; only 24.7 % achieved fibre requirements. Four dietary patterns existed: (1) ‘low food intake’ (n = 149), with highest nutrient inadequacy, highest ARFID scores (p &lt; 0.001), most likely to use nutrition support (24 %, p = 0.02); (2) ‘vegetarian/health conscious’ (n = 120), with highest fibre intake (p &lt; 0.001); (3) ‘low residue’ (n = 35), mostly seen in tertiary clinics (46 %, p &lt; 0.001) and (4) ‘refined/highly processed’, with highest BMI (27.3 kg/m² p &lt; 0.001) and presence of dyspepsia (p = 0.007) and least likely to have a dietetic consultation (p = 0.02).</div></div><div><h3>Conclusion</h3><div>This is the first study to measure nutrition intake, adequacy and dietary patterns in hEDS. Patients with either restrictive or highly processed food intake have more GI symptoms. Further research is needed to establish how these dietary patterns can best be managed in clinical practice, to optimize intake and minimize the use of artificial nutrition support.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106538"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789179","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":"Exploring potential predictors of low muscle mass and muscle loss in adults with cancer: A scoping review","authors":"Annie R. Curtis ,&nbsp;Carla M. Prado ,&nbsp;Liliana Orellana ,&nbsp;Robin M. Daly ,&nbsp;Judy Bauer ,&nbsp;Linda Denehy ,&nbsp;Lara Edbrooke ,&nbsp;Brenton J. Baguley ,&nbsp;Laura Alston ,&nbsp;Nicholas Hardcastle ,&nbsp;Jenelle Loeliger ,&nbsp;Louise Moodie ,&nbsp;Sharad Sharma ,&nbsp;Nicole Kiss","doi":"10.1016/j.clnu.2025.11.016","DOIUrl":"10.1016/j.clnu.2025.11.016","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Early identification of cancer-related muscle loss is essential to enable timely interventions and mitigate adverse outcomes, including mortality. This scoping review aimed to identify routinely assessed clinical measures associated with low muscle mass or muscle loss to inform future global screening and assessment.</div></div><div><h3>Methods</h3><div>Medline Complete, CINAHL Complete and Embase databases were screened from January 2000 to October 2024. Eligible studies investigated factors associated with cancer-related muscle loss, included adults undergoing or previously treated for cancer, and assessed or estimated muscle mass.</div></div><div><h3>Results</h3><div>The search identified 22,270 studies, of which 292 were included. Most involved patients with upper and/or lower gastrointestinal cancers (50 %), undergoing surgery (44 %) or chemotherapy (27 %). Two-thirds (65 %) assessed muscle mass using computed tomography (CT) at the third lumbar vertebra. Other methods included CT-defined muscle mass of single muscles (e.g., psoas) (15 %), bioelectrical impedance analysis or spectroscopy (12 %), dual-energy x-ray absorptiometry (DXA) (7 %) or other (3 %). As the benchmark for muscle mass assessment in oncology, results focused on CT-defined muscle mass, with comparison to other methods. Twenty factors were identified. Thirteen showed a consistent association in unadjusted and/or adjusted analysis: age, body mass index (BMI), performance status, muscle strength, physical function, arm and leg circumference, body weight, body fat, weight loss, fatigue, energy or protein intake, and physical inactivity.</div></div><div><h3>Conclusions</h3><div>This review identified 13 factors consistently associated with CT-defined muscle loss which may help identify patients with cancer who are at risk and require further assessment and timely referral for evidence-based nutrition and exercise interventions.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106531"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760781","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":"Cachexia phenotype in community-dwelling, middle-aged and older adults and its impacts on intrinsic capacity and mortality: A pooled analysis of three cohorts","authors":"Liang-Kung Chen ,&nbsp;Chi-Yun Wu ,&nbsp;Wei-Ju Lee ,&nbsp;Li-Ning Peng ,&nbsp;Pi-Shan Hsu ,&nbsp;Fei-Yuan Hsiao","doi":"10.1016/j.clnu.2025.11.011","DOIUrl":"10.1016/j.clnu.2025.11.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and aims&lt;/h3&gt;&lt;div&gt;Cachexia, which is a complex metabolic disorder that is characterized by weight loss, muscle atrophy, and inflammation, is commonly associated with chronic diseases. However, the occurrence of cachexia among community-dwelling, middle-aged and older adults remains underexplored. This study aimed to assess the associations among cachexia, intrinsic capacity (IC) impairment, and mortality in adults aged 50 years and older.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We pooled data from three longitudinal cohort studies, which included 3112 individuals aged 50 years and older. The cachexia phenotype was defined using two algorithms suggested by the Asian Working Group for Cachexia (AWGC), even in the absence of specific index diseases. For Algorithm 1, patients were identified as having cachexia when they presented with weight loss or low body mass index (BMI) combined with one of the following: anorexia, decreased grip strength, or elevated C-reactive protein (CRP) levels. For Algorithm 2, the identification of cachexia required elevated CRP levels, along with weight loss or low BMI, combined with either anorexia or decreased grip strength. Importantly, the presence of a specific index disease was not necessary to define the cachexia phenotype using these criteria. Instead, we screened for the following index diseases as comorbid conditions: malignancy, congestive heart failure, chronic pulmonary disease, chronic kidney disease, severe liver disease, rheumatic or immune diseases, and acquired immunodeficiency syndrome (AIDS). IC was evaluated using the World Health Organization’s ICOPE framework (Step 1 screening; Step 2 in-depth assessment), which includes six domains: locomotor, vitality, vision, hearing, cognition, and psychological capacity. Logistic regression was used to assess the association between cachexia and IC impairment, and Cox proportional hazard models were used to examine the effect of cachexia on all-cause mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 3112 participants (median age 68.8 years, 43.7 % male) in the three cohorts, 5.4 % of participants were identified as having the cachexia phenotype using Algorithm 1, whereas only 0.4 % met the criteria for Algorithm 2. Notably, only 22 % of the participants with the cachexia phenotype (Algorithm 1) had at least one of the screened index diseases compared with 12 % in the non-cachexia group (&lt;em&gt;p&lt;/em&gt; &lt; 0.001). These findings demonstrate that the cachexia phenotype can be identified even in the absence of specific index diseases. The cachexia phenotype was significantly associated with impairments in multiple IC domains, including vitality (Step 1: aOR 8.44 [95 % CI 5.15–13.83], &lt;em&gt;p&lt;/em&gt; &lt; 0.001; Step 2: aOR 15.89 [10.72–23.56], &lt;em&gt;p&lt;/em&gt; &lt; 0.001), cognition (Step 1: aOR 1.75 [1.17–2.62], &lt;em&gt;p&lt;/em&gt; = 0.007), and psychological capacity (Step 2: aOR 2.56 [1.39–4.73], &lt;em&gt;p&lt;/em&gt; = 0.003). Individuals with the cachexia phenotype had a","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106526"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838345","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":"Brain-gut interaction for holistic regulation: Transcutaneous auricular vagus nerve stimulation in modulating glucose and lipid metabolic disorders","authors":"Ningyi Zou ,&nbsp;Peijuan Zhou ,&nbsp;Qing Zhou ,&nbsp;Jizheng Ma ,&nbsp;Shuo Feng ,&nbsp;Peijing Rong ,&nbsp;Shaoyuan Li","doi":"10.1016/j.clnu.2025.12.003","DOIUrl":"10.1016/j.clnu.2025.12.003","url":null,"abstract":"<div><div>Dysregulation of glucose and lipid metabolism is a systemic disorder involving intricate interactions between the central nervous system, which governs stress and emotional regulation, and peripheral organs such as the gastrointestinal tract, liver, and pancreas. As a key component of the autonomic nervous system, the vagus nerve plays a pivotal role in regulating metabolic homeostasis through its widespread distribution and bidirectional communication along the gut-brain axis. Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising non-pharmacological therapy for metabolic disorders, modulating autonomic function via brain-gut coordination to reduce food intake and enhance energy expenditure, thereby alleviating obesity, type 2 diabetes, and related conditions. However, the dynamic mechanisms by which taVNS maintains homeostatic balance through the gut-brain axis, as well as its novel targets, mediators, and pathways, remain elusive. Based on the concept of “brain-gut interaction for holistic regulation”, this review explores the potential mechanisms of taVNS in ameliorating glucose and lipid metabolic disorders, offering new perspectives and strategies for clinical intervention.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106544"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789176","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":"Integrating downstream mediators of Omega-3 fatty acids into enteral nutrition for improved patient care: An expert panel consensus","authors":"Robert Martindale ,&nbsp;Manpreet S. Mundi ,&nbsp;Dan Waitzberg ,&nbsp;Elisabeth De Waele ,&nbsp;Marialaura Scarcella ,&nbsp;Michele Umbrello ,&nbsp;Philip C. Calder ,&nbsp;Jesmond Dalli ,&nbsp;Zudin Puthucheary ,&nbsp;Arthur R.H. van Zanten","doi":"10.1016/j.clnu.2025.11.014","DOIUrl":"10.1016/j.clnu.2025.11.014","url":null,"abstract":"<div><div>Acute inflammation is a crucial biological response necessary for host defense and tissue repair, but unresolved inflammation can contribute to adverse outcomes across critical illness, cardiovascular disease, neurodegeneration, and cancer. Emerging evidence emphasizes that the resolution of inflammation is an active biosynthetic process mediated in part by specialized pro-resolving mediators (SPMs), lipid-derived molecules generated from omega-3 polyunsaturated fatty acids (PUFAs) such as eicosapentaenoic acid (C20:5n-3, EPA) and docosahexaenoic acid (C22:6n-3, DHA). These mediators—including resolvins, protectins, and maresins—exert potent immunomodulatory actions that restore tissue homeostasis and attenuate inflammation without immunosuppression. Despite the established role of SPMs, clinical and preclinical studies demonstrate that SPM biosynthesis is often impaired in disease states, limiting the efficacy of omega-3 PUFA-based nutritional interventions. To explore the potential of standardized SPM enrichment in enteral nutrition (EN), a multidisciplinary panel of experts conducted a Delphi-based consensus process. Consensus statements were developed supporting the rationale for enriching EN with preformed SPMs or their stable precursors to overcome compromised endogenous biosynthesis and enhance clinical benefits. Preliminary human studies suggest that such enrichment may reduce inflammation, improve immune function, and contribute to better outcomes in conditions such as obesity, atherosclerosis, infections, and chronic pain. The panel emphasized the need for rigorously designed clinical trials to determine whether enteral SPMs have measurable clinical effects and, if so, to define effective dosing strategies. Overall, SPM-enriched EN represents a potential advancement in the nutritional modulation of inflammation, warranting further investigation to guide evidence-based clinical application.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106529"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760803","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 effects of ketogenic diet on polycystic ovary syndrome: A systematic review and meta-analysis","authors":"Elisavet Arsenaki ,&nbsp;Dimitra Stathi ,&nbsp;Konstantinos Katsikas Triantafyllidis ,&nbsp;Yeshey Seldon ,&nbsp;Stergios Bobotis ,&nbsp;George Lockett ,&nbsp;Shaun Haran ,&nbsp;Maria Kyrgiou ,&nbsp;Srdjan Saso ,&nbsp;Konstantinos S. Kechagias","doi":"10.1016/j.clnu.2025.11.019","DOIUrl":"10.1016/j.clnu.2025.11.019","url":null,"abstract":"<div><h3>Background and aim</h3><div>Polycystic ovary syndrome (PCOS) is a common endocrine disorder linked to obesity, insulin resistance, and reproductive dysfunction. While dietary modification is central to management, the optimal approach remains unclear. This systematic review and meta-analysis evaluated the effects of the ketogenic diet on anthropometric, metabolic, and endocrinological outcomes in women with PCOS.</div></div><div><h3>Methods</h3><div>A systematic search of five databases (inception–February 2025) identified studies reporting outcomes in women with PCOS following a ketogenic diet. Meta-analyses compared pre- and post-ketogenic diet outcomes (primary analysis) and ketogenic diet versus other diets (secondary analysis). Summary mean differences (MDs) with 95 % confidence intervals (CIs) were calculated using a random-effects model. Risk of bias and evidence quality were assessed using validated tools and the GRADE approach.</div></div><div><h3>Results</h3><div>Fifteen studies were included in the review, of which ten met the criteria for inclusion in the meta-analysis. Most participants in the included studies had a BMI exceeding 25 kg/m². In the primary analysis, ketogenic diet led to significant reductions in BMI (MD: −3.38 kg/m², 95 % CI: 2.53 to 4.23, I² = 0 %), weight (MD: −10.77 kg, 95 % CI: 8.73 to 12.81, I² = 0 %), and waist circumference (MD: −8.93 cm, 95 % CI: 5.66 to 12.19; I² = 44 %). Reductions were also observed in luteinising hormone (LH) levels (MD: 4.07, 95 % CI: 3.36 to 4.79, I² = 0 %), menstrual cycle duration (MD: 26.06, 95 % CI: 2.28 to 49.85, I² = 68 %), and insulin resistance (MD: 2.43; 95 % CI: 1.16 to 3.69, I² = 95 %). In the secondary analysis, ketogenic diet showed superior effects on BMI (MD: −1.65, 95 % CI: −2.76 to −0.55, I² = 0 %) and weight loss (MD: −4.98, 95 % CI: −9.05 to −0.91, I² = 7 %) as well as LH levels (MD 1.68, 95 % CI: −3.18 to −0.19, I² = 30 %) and insulin resistance (MD: −1.71, 95 % CI: −2.98 to −0.43, I² = 90 %) compared to other diets, though results for androgen and lipid parameters were inconsistent. Heterogeneity was high for most of the studied outcomes.</div></div><div><h3>Conclusion</h3><div>The ketogenic diet appears to be a promising dietary intervention for improving weight, insulin sensitivity, and reproductive hormone profiles in women with PCOS and a BMI exceeding 25 kg/m². Nonetheless, the considerable heterogeneity among included studies and variations in study quality warrant cautious interpretation of these findings. Further high-quality, long-term randomized controlled trials are needed to more definitively establish the efficacy and safety of the ketogenic diet in women with PCOS.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106535"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799552","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":"Systematic high-calorie, high-protein oral nutritional support in hospitalized, moderately hypophagic patients at nutritional risk: A randomized-controlled trial","authors":"Emanuele Cereda ,&nbsp;Valeria Borioli ,&nbsp;Marilisa Caraccia ,&nbsp;Anna Uggè ,&nbsp;Francesca De Simeis ,&nbsp;Raffaele Bruno ,&nbsp;Angelo Guido Corsico ,&nbsp;Antonio Di Sabatino ,&nbsp;Paolo Pedrazzoli ,&nbsp;Riccardo Caccialanza","doi":"10.1016/j.clnu.2025.11.017","DOIUrl":"10.1016/j.clnu.2025.11.017","url":null,"abstract":"<div><h3>Background</h3><div>Acute diseases responsible for hospitalization negatively affect protein-calorie balance, as well as the capacity of patients to cope with it. In those who still retain spontaneous feeding, oral nutritional supplements (ONSs) administration is an effective support strategy, but evidence on the timing they should be provided along with nutritional counseling during hospitalization is lacking. Hence, we evaluated the efficacy of the systematic use of ONSs since hospital admission.</div></div><div><h3>Methods</h3><div>In a single-site, open-label, randomized, controlled trial (NCT02763904; July 2016–July 2024), acutely hospitalized adults (N = 220) at nutritional risk (NRS-2002 ≥ 3), without severe hypophagia (defined as food intake &lt;50 % of estimated calorie requirements) and with an expected length of stay (LOS) ≥7 days were randomized to receive, along with nutritional counseling, high-protein ONSs systematically since admission or on-demand since day 8. The primary endpoint was the change in phase angle (PhA) on day 8. Secondary outcomes were the change in PhA at discharge and in muscle strength, body weight and protein-calorie intake over the hospital stay. LOS and the rate of acquired infections were also evaluated.</div></div><div><h3>Results</h3><div>A total of 201 patients were re-assessed at day 8 and at discharge. Systematic ONSs (n = 100) resulted in improved PhA at day 8 (mean difference, 0.47 [95%CI, 0.31–0.62]; P &lt; 0.001) and at discharge (mean difference, 0.49 [95%CI, 0.33–0.64]; P &lt; 0.001). A significant effect was also found for body weight and protein-calorie intake at all time-points (P &lt; 0.001) and for muscle strength at discharge (P = 0.042). LOS was also reduced (−2 days; P = 0.044).</div></div><div><h3>Conclusions</h3><div>In acutely hospitalized adult patients at nutritional risk and without severe hypophagia, the systematic use of ONSs since admission improved body composition, muscle function, and protein-calorie intake, and reduced LOS.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106532"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760782","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 sarcopenic obesity with dementia risk in a cohort of older women","authors":"Zhongyang Guan ,&nbsp;Blossom CM. Stephan ,&nbsp;Lorenzo M. Donini ,&nbsp;Joshua R. Lewis ,&nbsp;Carla M. Prado ,&nbsp;Richard L. Prince ,&nbsp;David Scott ,&nbsp;Kun Zhu ,&nbsp;Marc Sim ,&nbsp;Mario Siervo","doi":"10.1016/j.clnu.2025.11.026","DOIUrl":"10.1016/j.clnu.2025.11.026","url":null,"abstract":"<div><h3>Background and aims</h3><div>Longitudinal studies have explored the association between sarcopenic obesity (SO) and the risk of cognitive impairment, yet findings remain mixed. This study aimed to investigate the associations of SO with risk of incident dementia in older women, using two diagnostic models: the Sarcopenic Obesity Global Leadership Initiative (SOGLI) and the load-capacity model.</div></div><div><h3>Methods</h3><div>We analysed data from 900 community-dwelling women (aged ≥70 years). SO was defined using two models: (1) the SOGLI criteria, based on low handgrip strength (HGS), low appendicular lean soft tissue to body weight (ALST/W) ratio, and high fat mass percentage (%FM); and (2) the load-capacity model, based on a high truncal fat mass to ALST (TrFM/ALST) ratio. Incident dementia events (hospitalisation and/or death) over 9.5 years were identified through linked health records using International Classification of Diseases (ICD) codes. Cox proportional hazards and Fine–Gray sub-distribution models were applied.</div></div><div><h3>Results</h3><div>Using the SOGLI criteria, SO was not significantly associated with the risk of overall dementia events compared with the non-sarcopenic, non-obesity group (hazard ratio [HR] 0.63, 95 % CI 0.39–1.03); however, SO was significantly associated with a reduced risk of dementia-related hospitalisation (HR 0.57, 95 % CI 0.33–0.98), mainly driven by the reduced risk observed with obesity. When defined by the load-capacity model, SO remained significantly associated with a reduced risk of overall dementia events (HR 0.54, 95 % CI 0.34–0.85). Restricted cubic spline (RCS) analyses demonstrated significant associations of lower HGS, lower %FM, higher ALST/W ratio, and lower TrFM/ALST ratio with increased risk of overall dementia events. Results remained consistent in sensitivity analyses excluding participants with BMI &lt;21 kg/m² (n = 67) or %FM below the 15th percentile (n = 135), and after further adjustment for age at highest education level..</div></div><div><h3>Conclusion</h3><div>This is the first longitudinal study to examine the association between SO and dementia using either the SOGLI or load-capacity models. In this cohort of older women, SO was associated with a lower risk of dementia-related hospitalisation. These findings suggest that the relationship between obesity and dementia risk in late life may differ from current evidence regarding midlife, indicating potential age-specific effects. Further research is needed to clarify the underlying mechanisms and generalisability of these observations to broader populations..</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106542"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789178","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}