Clinical nutrition最新文献

{"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 , Chi-Yun Wu , Wei-Ju Lee , Li-Ning Peng , Pi-Shan Hsu , Fei-Yuan Hsiao","doi":"10.1016/j.clnu.2025.11.011","DOIUrl":"10.1016/j.clnu.2025.11.011","url":null,"abstract":"<div><h3>Background and aims</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>p</em> < 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], <em>p</em> < 0.001; Step 2: aOR 15.89 [10.72–23.56], <em>p</em> < 0.001), cognition (Step 1: aOR 1.75 [1.17–2.62], <em>p</em> = 0.007), and psychological capacity (Step 2: aOR 2.56 [1.39–4.73], <em>p</em> = 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}

{"title":"Challenges of nutritional support in patients with diabetes: A position paper of the ESPEN special interest group","authors":"Laurence Genton ,&nbsp;Miguel Leon Sanz ,&nbsp;Marianna Arvanitakis ,&nbsp;María D. Ballesteros-Pomar ,&nbsp;Lia Bally ,&nbsp;Rocco Barazzoni ,&nbsp;Cécile Bétry ,&nbsp;Rosa Burgos ,&nbsp;Cristina Cuerda ,&nbsp;Alia Hadefi ,&nbsp;Stanislav Klek ,&nbsp;Meliha Mahmutovic ,&nbsp;Didier Quilliot ,&nbsp;Diana Rubin ,&nbsp;Stéphane M. Schneider ,&nbsp;Mireille J. Serlie ,&nbsp;Tinh-Hai Collet","doi":"10.1016/j.clnu.2025.106550","DOIUrl":"10.1016/j.clnu.2025.106550","url":null,"abstract":"<div><div>Malnutrition affects up to 30 % of the general population, and especially older people with polymorbid conditions. In parallel, the prevalence of diabetes increases with age affecting over 800 million adults worldwide. Healthcare providers are increasingly challenged to care for patients with diabetes that require nutritional support. To address this issue, the ESPEN Special Interest Group \"Nutrition and Diabetes\", aims to provide guidance for health care providers that treat these patients. This paper had three aims: 1) to summarise the guidelines and recommendations regarding nutritional support and diabetes or stress hyperglycaemia provided by scientific societies, 2) to review the associations of nutritional disorders with diabetes and its pharmacological treatments, and 3) to identify the challenges of optimal nutritional care for patients with diabetes and stress hyperglycaemia. To this end, we conducted a systematic search of guidelines and recommendations on nutritional support for patients with diabetes or stress hyperglycaemia, that have been published in English by national and international societies over the last 15 years. Our systematic search showed that published guidelines and recommendations rarely addressed the practical management of blood glucose control according to the modality of nutritional support. The literature on the association of malnutrition with diabetes and its pharmacological treatment is very limited. The identified challenges include the multidisciplinary and multiprofessional continuity of care between the hospital and ambulatory settings, the ideal pattern of hospital food, the choice of oral nutritional supplements, the adjustment of diabetes management to nutritional support, and diabetes technology to support nutritional care in these patients.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106550"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881577","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":"An observational study on the effect of l-ornithine-l-aspartate (LOLA) on the gut microbiome in liver cirrhosis. A single center phase 4 study","authors":"Daniel Habich ,&nbsp;Angela Horvath ,&nbsp;Nicole Feldbacher ,&nbsp;Lavra Rebol ,&nbsp;Maximilian Nepel ,&nbsp;Tobias Madl ,&nbsp;Hans-Jörg Habisch ,&nbsp;Franziska Baumann-Durchschein ,&nbsp;Stefan Fürst ,&nbsp;Johannes Plank ,&nbsp;Florian Rainer ,&nbsp;Walter Spindelböck ,&nbsp;Rudolf E. Stauber ,&nbsp;Elisabeth Tatscher ,&nbsp;Martin Wagner ,&nbsp;Gernot Zollner ,&nbsp;Vanessa Stadlbauer","doi":"10.1016/j.clnu.2025.11.007","DOIUrl":"10.1016/j.clnu.2025.11.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background &amp; Aims&lt;/h3&gt;&lt;div&gt;Liver cirrhosis is associated with gut microbiome dysbiosis, intestinal inflammation and gut barrier dysfunction, contributing to reduced quality of life and the development of complications. We showed in a retrospective study that &lt;span&gt;l&lt;/span&gt;-ornithine-&lt;span&gt;l&lt;/span&gt;-aspartate (LOLA) was associated with improvement in taxonomic composition of the microbiome. Here we prospectively studied the influence of LOLA on the gut microbiome, quality of life, sarcopenia and the gut barrier.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In this phase 4 study, patients with liver cirrhosis and hepatic encephalopathy grade 0–2 received LOLA 18 g/day orally for 3 months. We studied faecal microbiome composition (primary endpoint abundance of the genus &lt;em&gt;Flavonifractor)&lt;/em&gt;, microbiome function, quality of life, serum ammonia levels, sarcopenia and frailty, biomarkers of the gut liver axis and the stool, serum and urine metabolome.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We screened 258 patients with liver cirrhosis, included 65, of whom 52 patients (40 % female, age 62 (58; 65)) completed the study. LOLA intake decreased the abundance of the genus &lt;em&gt;Romboutsia&lt;/em&gt;, increased the abundance of the genus &lt;em&gt;Enterococcus,&lt;/em&gt; but did not alter other microbiome parameters. LOLA improved one out of 8 dimension of quality of life (vitality) and decreased serum ammonia concentrations. The subgroup of patients with improved ammonia concentrations responded with a halt in further muscle mass declined over the study period. Diamine oxidase, a marker of intestinal mucosal condition, decreased and LPS binding protein increased. Metabolomic analysis indicated an increase in alanine concentration.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;LOLA improved one quality of life dimension (vitality) and biomarker of the gut–liver axis, altered innate immune response, faecal microbiome and metabolome. LOLA prevented muscle loss only in patients with elevated ammonia concentrations at baseline. LOLA may therefore be a useful adjunct treatment to improve quality of life in cirrhosis and a promising intervention for muscle loss prevention in hyperammonemic patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Trials Registration number&lt;/h3&gt;&lt;div&gt;clinicaltrials.gov NCT05737030.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Impact and implication&lt;/h3&gt;&lt;div&gt;We conducted a 12-week prospective cohort study to test the effect of the ammonia lowering drug &lt;span&gt;l&lt;/span&gt;-ornithine-&lt;span&gt;l&lt;/span&gt;-aspartate (LOLA) on the gut microbiome, biomarkers along the gut-liver-axis, muscle health and quality of life in patients with liver cirrhosis and hepatic encephalopathy. Although our primary endpoint was not reached, LOLA slightly altered microbiome composition and function and improved vitality, a clinically relevant patient reported outcome parameter. LOLA also improved biomarkers for the gut-liver-axis, innate immune response and prevented muscle loss in patients with elevated ammonia levels at baselin","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106522"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760785","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":"Tolerability and efficacy of an enteral formula containing partially hydrolyzed guar gum in patients following gastrointestinal surgery: A prospective, multicenter, open-label, randomized controlled study","authors":"Ting Han ,&nbsp;Jialu Zhuo ,&nbsp;Xiaoting Wu ,&nbsp;Qiang Chi ,&nbsp;Bo Chen ,&nbsp;Junqiang Chen ,&nbsp;Wei Chen ,&nbsp;Zhenyi Jia ,&nbsp;Rui Zhao ,&nbsp;Xinyu Zhang ,&nbsp;Peng Zhang ,&nbsp;Yuantian Mao ,&nbsp;Xuan Xu ,&nbsp;Qi Gao ,&nbsp;Xiaoding Shen ,&nbsp;Boshi Sun ,&nbsp;Peiang Guo ,&nbsp;Zhen Wang ,&nbsp;Jun Yang ,&nbsp;Huanlong Qin","doi":"10.1016/j.clnu.2025.12.002","DOIUrl":"10.1016/j.clnu.2025.12.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Malnourished patients, who undergo gastrointestinal (GI) surgery, have a higher risk of postoperative complications, including higher rates of morbidity and mortality. Generally, a low-fiber diet is recommended after GI surgery. This study investigated the tolerance and clinical outcomes of an enteral formula supplemented with partially hydrolyzed guar gum (PHGG)—a soluble, prebiotic dietary fiber known to benefit gastrointestinal health—in Chinese patients following GI surgery, using a standard fiber-free formula as the control..</div></div><div><h3>Methods</h3><div>This study enrolled 631 patients requiring enteral nutrition following GI surgery. Participants were subsequently randomized to receive either a fiber-enriched formula containing 15 g/L PHGG (experimental group, n = 313) or a standard fiber-free formula (control group, n = 318) for 5 days. Data on feeding effectiveness, tolerability, and clinical outcomes were subsequently collected.</div></div><div><h3>Results</h3><div>The incidence of diarrhea was 9.6 % (95 % confidence interval [CI]: 6.3 to 12.8) in the experimental group and 10.1 % (95 % CI: 6.8 to 13.4) in the control group, with an absolute difference of −0.5 (95 % CI: −5.1 to 4.2) confirming non-inferiority (<em>P</em> &lt; 0.001). In patients who consumed ≥4500 kcal over 5 days (averaging 900 kcal/day), the experimental group showed significantly improved feeding tolerance, with a reduced prevalence of diarrhea and abdominal distension (10.4 % vs 24.7 %, <em>P</em> = 0.045; 19.4 % vs 38.4 %, <em>P</em> = 0.016). Patients with gastric cancer in the experimental group had significantly less abdominal distension (22.7 % vs 48.8 %; <em>P</em> = 0.014). Regarding weight preservation, the experimental group demonstrated benefits in weight preservation at discharge (%weight change: −1.39 vs −2.33, <em>P</em> = 0.049). Thirty days after surgery, the experimental group had better EQ-5D scores, especially in E4 pain/discomfort and E5 anxiety.</div></div><div><h3>Conclusions</h3><div>The PHGG-enriched enteral nutrition formulation is well-tolerated and non-inferior to a fiber-free formula among patients following GI surgery. To maximize its benefits on GI tolerance and body weight preservation, a daily intake of 800–900 kcal is suggested, though this warrants further validation. The trial protocol was registered at <span><span>www.chictr.org.cn</span><svg><path></path></svg></span> (Identifier: ChiCTR2000038429).</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106543"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838347","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":"Postoperative exclusive enteral nutrition as a bridging therapy to reduce endoscopic recurrence after intestinal resection in Crohn’s disease: A randomized controlled trial","authors":"Mengting Zhang ,&nbsp;Qianwen Tu ,&nbsp;Kangcheng Luo ,&nbsp;Daojiang Li ,&nbsp;Songlin Wan ,&nbsp;Zhaoyang Cai ,&nbsp;Xianghai Ren ,&nbsp;Yi Li ,&nbsp;Yi Liu ,&nbsp;Mei Ye ,&nbsp;Min Chen ,&nbsp;Zhao Ding","doi":"10.1016/j.clnu.2025.106545","DOIUrl":"10.1016/j.clnu.2025.106545","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Postoperative recurrence remains a significant challenge in Crohn’s disease (CD) despite surgical intervention. While exclusive enteral nutrition (EEN) has demonstrated anti-inflammatory effects, its role in preventing postoperative recurrence remains underexplored. This study aimed to evaluate whether postoperative EEN reduces endoscopic recurrence at 1 year in CD patients after bowel resection.</div></div><div><h3>Methods</h3><div>This was a single center, open-label and randomized controlled trial. Using fixed block randomization, 100 participants were randomly assigned (1:1) to the normal diet group (unrestricted food intake) or the EEN group (receiving exclusive enteral formula for ≥2 months). The primary endpoint was endoscopic recurrence at 1 year after surgery (Rutgeerts score ≥ i2). Secondary endpoints included biochemical markers, postoperative complications, and quality of life.</div></div><div><h3>Results</h3><div>Overall, 100 participants were assessed for eligibility and randomly assigned to receive a normal diet (<em>n</em> = 50) or EEN (<em>n</em> = 50). All randomized participants were included in the intention-to-treat analysis. Compared to the normal diet group, the EEN group demonstrated a significantly lower postoperative endoscopic recurrence rate at 1 year (38 % [19/50] vs 18 % [9/50]; RR, 0.474; 95 % CI, 0.238–0.944; <em>P</em> = 0.026) and lower postoperative C-reactive protein at 2 months (median [IQR]:3.5 [0,7.75] mg/L vs 1 [1,2] mg/L, <em>P</em> = 0.034). No significant differences were observed in quality of life and 30-day/late-term postoperative complication rates (<em>P</em> &gt; 0.05) and no adverse events occurred between groups.</div></div><div><h3>Conclusion</h3><div>Postoperative EEN (≥2 months) significantly reduces the risk of endoscopic recurrence at 1 year in CD patients after resection. Additionally, CD patients showed high adherence to the oral EEN regimen after surgery.</div></div><div><h3>Clinical trial registration</h3><div>ChinaClinicalTrial.gov (Number: ChiCTR2400081066).</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106545"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838348","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}