Current Opinion in Clinical Nutrition and Metabolic Care最新文献

{"title":"Iron deficiency during pregnancy and lactation.","authors":"Laura Wasserfallen, Diego Moretti","doi":"10.1097/MCO.0000000000001257","DOIUrl":"https://doi.org/10.1097/MCO.0000000000001257","url":null,"abstract":"<p><strong>Purpose of review: </strong>Iron deficiency persists as the most common nutritional deficiency worldwide and is highly prevalent among women of reproductive age. Pregnancy substantially raises iron requirements, increasing the risk of complications for mother and newborn particularly in low-income and middle-income countries. We summarize current evidence on the determinants, physiological adaptations, diagnostic thresholds, and management of iron deficiency during pregnancy and lactation, focusing on recent developments.</p><p><strong>Recent findings: </strong>Maternal iron regulation during pregnancy involves progressive hepcidin suppression to enhance absorption and fetal iron transfer, though regulatory mechanisms remain incompletely understood. Daily supplementation may maintain maternal iron status more effectively than an alternate-day regimen but is associated with more side effects; thus, the choice of regimen should be individualized and based on context. Multiple micronutrient supplements offer superior clinical outcomes compared to iron-folic supplements. For moderate-to-severe iron deficiency or late-pregnancy correction, intravenous iron has proven to be well tolerated and highly effective.</p><p><strong>Summary: </strong>Effective management requires early identification using ferritin-based diagnostic thresholds. Intravenous iron is an essential clinical tool for rapid correction or when oral iron is poorly tolerated. Sustainably improving maternal iron status globally would prevent iron deficiency in pregnancy but further necessitates integrated public health approaches - addressing dietary quality, low-dose supplementation, sanitation, and digital health interventions.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Micronutrients in adult critically ill patients: lessons learned and the path toward precision.","authors":"Christian Stoppe, Kursat Gundogan, Stefano Marelli","doi":"10.1097/MCO.0000000000001253","DOIUrl":"https://doi.org/10.1097/MCO.0000000000001253","url":null,"abstract":"<p><strong>Purpose of review: </strong>Despite strong biological plausibility, empiric high-dose micronutrient supplementation has failed to improve outcomes in critically ill patients. This review synthesizes evidence from the past 18 months and outlines the necessary transition toward biomarker-guided precision nutrition.</p><p><strong>Recent findings: </strong>Recent evidence has further challenged routine high-dose micronutrient therapy. High-dose intravenous vitamin C failed to improve outcomes and was associated with potential harm in patients with sepsis, COVID-19, severe burns, and post-cardiac arrest syndrome. In contrast, a 2025 meta-analysis reported reduced short-term mortality and shorter ICU stay with vitamin D supplementation in patients on mechanical ventilation. Thiamine may shorten the duration of shock without affecting mortality. Observational studies suggest that carnitine deficiency is common during critical illness, and both deficiency and excess may be associated with adverse outcomes in critically ill patients. Selenium supplementation continues to show no clinical benefits in multiple sepsis phenotypes and high-risk surgical populations. Novel evidence also links trace element dysregulation to critical illness-acquired weakness, implicating copper-dependent cuproptosis, zinc homeostasis, and iron metabolism in the pathogenesis of muscle dysfunction. Advances in biomarkers (e.g. hepcidin, soluble transferrin receptor, ferritin, and selenoprotein P) are enabling more accurate identification of true deficiency states and targeted replacement strategies.</p><p><strong>Summary: </strong>Current evidence does not support routine high-dose single-micronutrient therapy in critically ill patients and suggests potential harm with pharmacological doses of vitamin C. Clinicians should ensure that daily baseline requirements are met and reserve supplementation only for patients with biomarker-confirmed deficiency or biologically defined high-risk phenotypes. Future research should prioritize precision nutritional approaches based on validated biomarkers and individualized metabolic profiling.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seeing cachexia clearly: the evolution of body composition and radiological biomarkers in cancer wasting.","authors":"Maria Soupashi, Richard J E Skipworth, Leo R Brown","doi":"10.1097/MCO.0000000000001246","DOIUrl":"10.1097/MCO.0000000000001246","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cancer cachexia is a highly prevalent multifactorial syndrome with huge prognostic influence. It is primarily characterised by progressive tissue wasting and imaging can be a powerful tool for noninvasive, longitudinal assessment.</p><p><strong>Recent findings: </strong>Ongoing exploration and development of imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI), as well as emerging radiological biomarkers, will deepen our understanding of distinct cachexia phenotypes.</p><p><strong>Summary: </strong>Bioelectrical impedance (BIA) and dual-energy X-ray absorptiometry (DEXA) were amongst the earlier modalities used to assess body composition. They are accessible and easy to use; however, concerns remain regarding their accuracy, and a paucity of detail provided in their estimates. CT provides more granular muscle and adipose tissue measurements, and analyses can be augmented with the use of automated segregation systems and multislice volumetric analysis. This could be key for supporting its integration in clinical practice. Beyond conventional quantitative assessments, MRI may aid in characterising emerging, clinically important markers of cachexia such as muscle inflammation, fat infiltration or fibrosis. Positron emission tomography (PET) CT may also become important tools for exploring how specific tissue-level pathophysiology can be accurately detected.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"453-459"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition in cirrhosis: bridging guidelines and practice in hepatic disease.","authors":"Jennifer Jin, Puneeta Tandon, Leah Gramlich","doi":"10.1097/MCO.0000000000001242","DOIUrl":"10.1097/MCO.0000000000001242","url":null,"abstract":"<p><strong>Purpose of review: </strong>Undernutrition and sarcopenia are common in patients with cirrhosis and independently predict increased morbidity and mortality. Despite recent guidelines emphasizing nutritional intervention, implementation in clinical practice remains inconsistent. This review is informed by key guidelines including the 2025 ACG guidelines on malnutrition and perioperative management in cirrhosis and the 2024 AASLD practice guidance on acute-on-chronic liver failure, and supplemented by newer meta-analyses and reviews, linking evidence-based recommendations to practical patient care strategies.</p><p><strong>Recent findings: </strong>The Royal Free Hospital Nutritional Prioritizing Tool is recommended for screening, with high sensitivity. Current recommendations for dietary intake include 35 kcal/kg/day and 1.2-1.5 g/kg/day of protein, with protein restriction contraindicated even in hepatic encephalopathy. Late evening snacks and micronutrient repletion (particularly vitamin D, zinc, and thiamine) show clinical benefit. Combined exercise and nutritional interventions demonstrate the greatest efficacy for improving sarcopenia.</p><p><strong>Summary: </strong>While recent guidelines have clarified optimal nutritional strategies in cirrhosis, significant implementation gaps persist. Addressing barriers including clinician awareness, resource constraints, and access to specialized nutrition services is essential to improve outcomes in this high-risk population.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"494-499"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148326975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The updated recommendations for medical nutrition in the perioperative period: a focus on early oral intake.","authors":"Rahel Maria Strobel, Tim Vilz, Arved Weimann, Maria Wobith","doi":"10.1097/MCO.0000000000001243","DOIUrl":"10.1097/MCO.0000000000001243","url":null,"abstract":"<p><strong>Purpose of review: </strong>Early oral feeding after gastrointestinal surgery is safe, promotes recovery, preserves gut integrity and aligns with enhanced recovery after surgery (ERAS) pathways. However, individualization and adaption of the pathway may be necessary postoperatively particularly after upper gastrointestinal procedures, where energy and protein requirements often remain unmet. The 2025 ESPEN guideline update advocates early oral/tube feeding while addressing supplementation strategies. The purpose of this review is to discuss the updated recommendations regarding the very recent literature.</p><p><strong>Recent findings: </strong>Early oral intake within 24 h is safe across gastrointestinal surgeries, shortening hospital stay, bowel recovery time and infectious complications without increasing the risk for anastomotic leaks. The choice of oral diet should be individualized and adapted to the performed surgery. Yet, the energy intake remains often inadequate, in particular after upper gastrointestinal surgery, necessitating monitoring and supplementation with enteral or parenteral nutrition if needed. Enteral nutrition via intraoperatively placed feeding jejunostomy should be considered in malnourished or high-risk patients in esophagectomy, total gastrectomy and pancreatoduodenectomy, to improve nutritional status and support weight maintenance, particularly in the postdischarge phase and during adjuvant therapy.</p><p><strong>Summary: </strong>Early oral feeding is feasible and preferred after gastrointestinal surgery, with enteral supplementation provided as needed in high-risk patients. Parenteral nutrition should be administered when patients cannot cover at least 50% of energy needs within 3-4 days. Guideline implementation gaps persist and standardized protocols, screening and nutrition support teams are essential for optimal postoperative nutritional support. More studies are required to evaluate the efficacy and indication of supplementing enteral and parenteral nutrition specifically in the context of ERAS protocols.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"482-488"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148327177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric and adolescent nutritional and metabolic assessment in the precision era.","authors":"Jose Manuel Jurado-Castro, Belen Pastor-Villaescusa, Francisco Jesus Llorente-Cantarero, Mercedes Gil-Campos","doi":"10.1097/MCO.0000000000001244","DOIUrl":"10.1097/MCO.0000000000001244","url":null,"abstract":"<p><strong>Purpose of review: </strong>To summarize recent methodological and technological advances in assessing nutritional and metabolic status among pediatric and adolescent populations, with emphasis on their translational value within precision and personalized nutrition. This review highlights how integrative, multi-omics, and digital approaches may complement the evaluation of body composition, dietary intake, metabolic profiling, and behavioral monitoring in youth.</p><p><strong>Recent findings: </strong>Recent findings suggest that combining compositional imaging (DXA, 3D optical, ultrasound) with bioelectrical and omic biomarkers may improve multidimensional nutritional profiling. Digital dietary assessment, biosensors, and continuous glucose monitoring may enhance real-time dietary and metabolic characterization in selected research or clinical contexts. Moreover, machine-learning models and multi-omic integration show promise individualized risk prediction and adaptive feedback, although their clinical utility requires further validation. However, standardization of protocols and pediatric reference datasets remains a key challenge.</p><p><strong>Summary: </strong>Nutritional and metabolic assessment in children and adolescents is progressively moving toward integrative frameworks that combine imaging, omics, and digital monitoring. These approaches may support more individualized and developmentally sensitive evaluations, but harmonization of protocols, ethical governance, accessibility, and pediatric reference datasets remain essential before broad clinical implementation.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"441-447"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148327221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition in gastroenterology: advancing evidence, bridging practice.","authors":"Kelly A Tappenden, André M Van Gossum","doi":"10.1097/MCO.0000000000001245","DOIUrl":"10.1097/MCO.0000000000001245","url":null,"abstract":"","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":"29 5","pages":"460-461"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in nutritional assessment and decision making.","authors":"Pierre Singer, Michal Slavin Kish, Orit Raphaeli","doi":"10.1097/MCO.0000000000001229","DOIUrl":"10.1097/MCO.0000000000001229","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Artificial intelligence (AI) has become an non contourable tool in clinical nutrition practice. This review proposes to discuss the most recent advances that can support the physician in nutritional assessment and mainly physician decision support systems trying to predict and prevent nutritional related complications.</p><p><strong>Recent findings: </strong>Advanced data storage systems improve screening and assessment tools using large database analysis. Medical CT images analysis can determine patients suffering from sarcopenia and suggest outcome predictions accordingly. Decision making of the type of parenteral nutrition formula according to cluster obtained by machine of large databases has been shown to be superior to the prescription of neonatologists in preterm children. Machine learning can help to anticipate enteral feeding intolerance and predict enteral nutrition feeding success. Numerous digital technologies support analysis of the meal, allows for the passive monitoring of eating behaviors, including acoustic sensors for swallowing detection and motion sensors for tracking hand-to-mouth gestures.</p><p><strong>Summary: </strong>Each step in clinical nutrition, from screening to clinical decision-making, can be improved using AI. However, large data sources, the participation of data scientists, and advanced technologies are required. These improvements have the potential to transform clinical nutrition toward personalized nutrition, but AI integration should be carefully monitored to ensure patient benefit and safety.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"434-440"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk, management and future directions for refeeding syndrome and enteral nutrition, an adult and paediatric perspective.","authors":"Kylie Matthews-Rensch, Julie Leake","doi":"10.1097/MCO.0000000000001236","DOIUrl":"10.1097/MCO.0000000000001236","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review was to summarise recent relevant studies examining refeeding syndrome risk and related outcomes in patients provided with enteral nutrition and discuss considerations for clinical practice and future research.</p><p><strong>Recent findings: </strong>Recent studies investigating enteral nutrition and refeeding syndrome were heterogeneous. With the exception of physical indicators of nutritional status, there was no agreement across studies regarding commonly agreed upon risk factors including periods of fasting, feeding rates, or specific medical conditions. Comparisons of three different recommended risk criteria had highly variable results in one study. Confounding factors were evident across studies. Management of refeeding syndrome risk is becoming increasingly debated. Recent research has questioned the need for prolonged high thiamin dosages in adult patients with eating disorders. Conservative feeding practices are also called into question when serum electrolyte levels can be monitored and replaced assertively.</p><p><strong>Summary: </strong>Clinical practice and research in refeeding syndrome is slowly changing, with a focus on preventing unnecessary and prolonged underfeeding in malnourished patients and in children during critical stages of growth. Future research should ensure risk criteria is specific to the clinical conditions and/or age groups being investigated. Refeeding syndrome and its subsequent management should also be considered along a spectrum, rather than as an all or nothing event. By incorporating these recommendations, research in the field will evolve to advance knowledge and enhance clinical practice.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":"29 5","pages":"469-474"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional assessment in the era of precision nutrition: from measurement to meaning.","authors":"Kianoush Kashani, Jann Arends","doi":"10.1097/MCO.0000000000001251","DOIUrl":"10.1097/MCO.0000000000001251","url":null,"abstract":"","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":"29 5","pages":"431-433"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}