Current Opinion in Clinical Nutrition and Metabolic Care最新文献

{"title":"Are probiotics effective for preventing chemotherapy-induced diarrhea? Conditional benefits and remaining evidence gaps.","authors":"Yun Tian, Yanwen Ran, Jixia Wang, Ran Yang","doi":"10.1097/MCO.0000000000001234","DOIUrl":"10.1097/MCO.0000000000001234","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chemotherapy-induced diarrhea (CID) is a clinically significant toxicity that may impair nutritional status, quality of life, treatment continuity, and dose intensity. As CID is increasingly linked to gut dysbiosis, epithelial barrier dysfunction, inflammatory activation, and altered microbiota-host interactions, probiotics have been proposed as a potential preventive strategy. This review evaluates recent clinical and translational evidence on whether probiotics can prevent CID and in which settings benefit appears most plausible.</p><p><strong>Recent findings: </strong>Evidence published over the past 18 months has refined rather than fundamentally changed previous conclusions. Most recent data come from systematic reviews and meta-analyses, whereas newly published randomized or prospective clinical studies remain limited. Pooled analyses suggest that probiotic supplementation is associated with a lower risk of diarrhea, particularly in fluoropyrimidine- or irinotecan-based chemotherapy and in gastrointestinal malignancies, including colorectal cancer. Similar signals have also been reported in selected leukemia chemotherapy populations. However, these estimates remain limited by heterogeneity in treatment setting, probiotic formulation, dose, timing, duration, and outcome definition, and many still depend on earlier trials. Translational studies further support a strain-specific and context-dependent model involving microbial metabolites, epithelial barrier protection, inflammatory regulation, and drug-microbiota interactions.</p><p><strong>Summary: </strong>Current evidence does not support routine probiotic prophylaxis for all patients receiving chemotherapy. A more appropriate interpretation is that probiotics may represent candidate adjunctive preventive strategies in selected high-risk CID settings, particularly when the chemotherapy regimen, patient risk profile, probiotic intervention, and clinical endpoints are clearly defined. Future studies should move from broad probiotic supplementation toward regimen-specific, strain-defined, and risk-stratified trials, with standardized CID outcomes, rigorous safety monitoring, and assessment of treatment continuity, dose intensity, and antitumor efficacy.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"475-481"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980737","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":"Criteria to start home parenteral nutrition in advanced cancer.","authors":"Jennifer McCracken, Paolo Cotogni, Matthew Maddocks, Simon Lal","doi":"10.1097/MCO.0000000000001250","DOIUrl":"10.1097/MCO.0000000000001250","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review will present current practice and criteria for considering and commencing home parenteral nutrition (HPN) among people with advanced cancer.</p><p><strong>Recent findings: </strong>Despite the use of HPN in advanced cancer historically being considered controversial, there has been an increase in the number of people with advanced cancer receiving HPN in recent years in many countries. Clinical guidelines are highlighted throughout this review which outline key factors that should be considered when commencing HPN. Decisions should align with the ethical concepts of medical decision-making. Quality of life is a key outcome measure for people with advanced cancer; several studies have indicated an improvement in quality of life on HPN.</p><p><strong>Summary: </strong>International guidelines provide evidence-based recommendations around clinical parameters that should be considered when deciding about suitability for HPN, including performance status, prognosis and patient wishes. Patient-centred care is of the utmost importance, taking account of each patient's views and preferences, with an individualized approach. To provide coordinated care and facilitate timely discharge from hospital, all members of the multidisciplinary team must work together, ensuring effective communication.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"462-468"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410662","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":"Ethical imperatives in global nutrition care: reducing inequities in gastroenterology.","authors":"Rosa Burgos, Diana Cárdenas","doi":"10.1097/MCO.0000000000001231","DOIUrl":"10.1097/MCO.0000000000001231","url":null,"abstract":"<p><strong>Purpose of review: </strong>Malnutrition is a major concern in patients with digestive disorders. This review examines the ethical imperatives for addressing inequities in nutritional care, specifically focusing on disease-related malnutrition (DRM). It explores the implementation of a human rights-based approach to clinical practice to bridge the gaps between duty-bearers and rights-holders in the management of malnutrition.</p><p><strong>Recent findings: </strong>DRM persists as a neglected crisis affecting 30-50% of hospitalized patients, particularly those with gastrointestinal and oncological conditions. Recent research identifies educational attainment as a super-determinant of diet quality, exerting a more powerful influence than income alone. Systemic barriers remain significant: mandatory screening is frequently unavailable across care settings, and a widespread knowledge gap persists among healthcare professionals. However, the emergence of the Cartagena and Vienna Declarations has established nutritional care as a human right, providing a new legal and ethical paradigm to tackle these disparities.</p><p><strong>Summary: </strong>Reducing inequities requires integrating nutritional care into Universal Health Coverage and mandating standardized screening and diagnosis using Global Leadership Initiative on Malnutrition (GLIM) criteria. Strategic alternatives include educational reform, interdisciplinary support teams, and patient empowerment. Ensuring equitable access to medical nutrition is essential to uphold human dignity and fulfill the right to health.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"489-493"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834842","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":"Scores to monitor inflammatory effects of a diet: a useful concept?","authors":"Stephan Bischoff","doi":"10.1097/MCO.0000000000001247","DOIUrl":"10.1097/MCO.0000000000001247","url":null,"abstract":"<p><strong>Purpose of review: </strong>The Dietary Inflammatory Index (DII) was developed to quantify the inflammatory potential of dietary patterns based on their effects on inflammatory biomarkers. Growing evidence links low-grade inflammation to chronic diseases such as obesity, cardiovascular disease, diabetes, and cancer. This review summarizes current evidence regarding the clinical and epidemiological relevance of the DII and evaluates its potential as a tool for nutritional assessment and disease prevention.</p><p><strong>Recent findings: </strong>Recent studies demonstrate consistent associations between higher DII scores and adverse cardiometabolic outcomes, including atherosclerosis, metabolic liver disease, obesity, and increased cardiovascular mortality. Anti-inflammatory dietary patterns, particularly the Mediterranean diet, are associated with lower DII scores, reduced inflammatory markers, and improvements in metabolic parameters and quality of life. Emerging evidence also suggests benefits in cancer survivors, patients with depression, and individuals with chronic inflammatory conditions. Methodological advances, including the energy-adjusted DII (E-DII) and the pediatric C-DII, have improved the applicability and predictive value of the index.</p><p><strong>Summary: </strong>The DII provides a useful framework for assessing the relationship between diet and inflammation across populations and clinical settings. Current evidence supports its value in identifying dietary patterns associated with chronic inflammation and related diseases. Although causal relationships remain to be fully established, the DII may contribute to personalized nutrition strategies and support prevention and management approaches for inflammation-related disorders. Further long-term interventional studies are needed to strengthen its clinical utility and prognostic significance.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":"29 5","pages":"448-452"},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677513","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":"Choline and metabolic health, a missing link in a critical chain.","authors":"Evan M Paules","doi":"10.1097/MCO.0000000000001252","DOIUrl":"https://doi.org/10.1097/MCO.0000000000001252","url":null,"abstract":"<p><strong>Purpose of review: </strong>Emerging evidence suggests that choline plays a significant role in mediating metabolic disease beyond the regulation of hepatic triglycerides. The aim of this article is to present a current, brief synthesis focused on the impact of choline intake on metabolic health and to identify future directions in this research space.</p><p><strong>Recent findings: </strong>Recent work has linked low choline intake to obesity, metabolic dysfunction-associated steatotic liver disease (MASLD), type 2 diabetes, and obesity-associated cognitive decline. A new methodology now enables more precise discrimination of choline intake in clinical populations. Emerging evidence reframes circulating trimethylamine N-oxide (TMAO) as a marker of metabolic dysfunction driven by obesity and a high-fat diet, rather than a direct consequence of dietary choline intake. Preclinical and clinical studies further suggest that adequate choline intake may be protective against obesity-related disease progression, particularly when established early in life.</p><p><strong>Summary: </strong>Choline is emerging as an important mediator of metabolic health and disease progression. A deeper understanding of the mechanisms regulating choline metabolism is critical to tailor nutritional therapies and mitigate metabolic disease progression. The impact of new antiobesity medications, including GLP-1 receptor agonists, on choline requirements also warrants investigation.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701007","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":"Metabolic health in a changing world: widening the lens to climate, cities, and place.","authors":"Erica Hinckson","doi":"10.1097/MCO.0000000000001239","DOIUrl":"10.1097/MCO.0000000000001239","url":null,"abstract":"<p><strong>Purpose of review: </strong>Individual-level interventions emphasizing diet, clinical management, and structured exercise have been the typical approach to addressing metabolic health. Growing evidence suggests that broader environmental factors that shape metabolic risk have been overlooked. In this opinion paper, metabolic health is reframed within the context of climate change, urbanization, physical activity, and local knowledge, highlighting them as interconnected determinants of metabolic wellbeing.</p><p><strong>Recent findings: </strong>Physical activity and metabolic processes are greatly influenced by neighbourhood urban design, transport infrastructure, and climate effects such as extreme heat. Evidence shows that greener neighbourhoods that support walking, cycling, and public transport are associated with more favourable cardiometabolic outcomes. Critical to the integration of such approaches for embedding physical activity into everyday life are insights from Indigenous and local communities that take a relational, place-based approach to movement and wellbeing.</p><p><strong>Summary: </strong>Addressing modern metabolic health may require a paradigm shift from an individual to a systems-level approach. It is proposed that, to achieve this, physical activity, climate resilience, urban design, and Indigenous/local knowledge should be considered together to create more equitable, sustainable, and metabolically supportive environments. This framing, therefore, has important implications for research, clinical practice, policy, and next steps.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":"29 4","pages":"391-394"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155718","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":"Reframing obesity through the gut microbiota: functional dysbiosis and metabolic disease.","authors":"Alaa Hamdan, Ziad Al Nabhani","doi":"10.1097/MCO.0000000000001230","DOIUrl":"10.1097/MCO.0000000000001230","url":null,"abstract":"<p><strong>Purpose of review: </strong>Obesity and its metabolic complications remain major global health challenges. Beyond excess caloric intake, emerging evidence implicates diet-induced gut microbiota dysfunction as a modulator of metabolic homeostasis. This review examines recent advances in understanding how functional alterations of the gut microbiota contribute to obesity pathogenesis.</p><p><strong>Recent findings: </strong>Current data indicate that obesity is characterized less by specific microbial taxa and more by disruption of key microbial functions. Diet-induced dysbiosis alters short-chain fatty acid production, bile acid metabolism, tryptophan-derived signaling, and intestinal barrier integrity. These changes promote metabolic endotoxemia, impair enteroendocrine hormone secretion, and disrupt gut-brain and gut-liver communication, contributing to adipose tissue inflammation, hepatic steatosis, and insulin resistance. Experimental and clinical studies further suggest that microbiota-targeted interventions, including dietary fiber enrichment, prebiotics, synbiotics, and fecal microbiota transplantation, can partially restore microbial metabolic function and improve selected metabolic outcomes.</p><p><strong>Summary: </strong>Obesity is increasingly conceptualized as a state of diet-driven functional gut microbiota disruption. Targeting microbial metabolic pathways rather than individual taxa may offer a promising adjunctive strategy to complement established therapies for obesity-related metabolic disease.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"377-384"},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13258111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A viewpoint review of recent policy changes and public health initiatives to combat obesity.","authors":"Yih-Kai Chan, Nerolie Stickland","doi":"10.1097/MCO.0000000000001228","DOIUrl":"10.1097/MCO.0000000000001228","url":null,"abstract":"<p><strong>Purpose of review: </strong>Obesity is a growing public health issue worldwide affecting one in three adults in Australia and two in five adults in the United States. Globally, the prevalence of obesity has doubled or even tripled in many countries over the past two decades, predominately driven by urbanization, sedentary lifestyles and increased consumption of high-calorie processed foods. The aim of this viewpoint article is to highlight recent policy changes and public health Initiatives to curb this obesity epidemic.</p><p><strong>Recent findings: </strong>Traditional strategies that focus on individual behaviour have proven insufficient and broader public health policy models to address both societal and environmental contributors to obesity have emerged. Recent public health initiatives directed their focus on promoting healthier lifestyles through policies, family-based interventions, dietary education and sustained community support. Effective obesity prevention requires collaborative efforts across policy, healthcare and community sectors to mitigate its far-reaching physical, psychological and economic impacts from individual to population levels.</p><p><strong>Summary: </strong>Policy and public health efforts against obesity are evolving into comprehensive systems-oriented models. They combine regulation, fiscal tools, healthcare integration, education campaigns, measurement systems and equity-focused approaches. Together, they form a layered strategy aimed at preventing obesity, supporting individuals living with it and ensuring accountability across sectors.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"385-390"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765172","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":"Metabolic rebound and weight cycling following incretin mimetic drug withdrawal: a cause for concern?","authors":"Sarah E Alexander, Erin J Howden","doi":"10.1097/MCO.0000000000001232","DOIUrl":"10.1097/MCO.0000000000001232","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Incretin mimetic drugs (IMDs) induce rapid weight loss and improve cardiometabolic health. However, over 50% of users discontinue and then reinitiate therapy within two years. This drug cycling drives weight loss-regain cycling, which adversely affects body composition and metabolic health.</p><p><strong>Recent findings: </strong>Cessation of IMD therapy leads to a rapid and near-complete reversal of weight loss and cardiometabolic improvement within one year and early IMD discontinuation is associated with increased cardiometabolic risk. Concerningly, up to 40% of the weight lost on these therapies is attributed to lean mass loss. Weight cycling compounds these effects and may worsen body composition and metabolic profiles beyond baseline. Supervised exercise programmes attenuate weight regain and may have a lasting 'legacy' effect on metabolic markers.</p><p><strong>Summary: </strong>The benefits of IMDs are short-lived following drug cessation and the loss of lean mass that occurs with IMDs may increase the risk of sarcopenia. Incorporating supervised exercise programmes during and after therapy may preserve lean mass, promote healthier body composition and attenuate some of the observed metabolic rebound. Clinicians should weigh the risks and benefits of short-term, or cyclical use of IMDs, particularly in those with low initial muscle mass reserves or metabolically vulnerable cohorts.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"395-402"},"PeriodicalIF":3.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927435","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":"Proteomics for precision nutrition: current evidence and future directions.","authors":"Mirko Marino, Cristian Del Bo', Patrizia Riso","doi":"10.1097/MCO.0000000000001226","DOIUrl":"10.1097/MCO.0000000000001226","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review critically evaluates proteomics research applied to clinical nutrition and metabolism published between mid-2024 and early-2026, examining whether recent advances have moved the field closer to clinically actionable precision nutrition applications.</p><p><strong>Recent findings: </strong>Large prospective cohort studies show that circulating proteomic signatures reflect dietary patterns and are associated with incident cardiometabolic, hepatic, and neurodegenerative outcomes. In most analyses, these signatures capture plausible biological pathways, but their incremental predictive value beyond established risk models appears modest. Interventional studies confirm that circulating proteins respond to dietary modification, but these trials are considerably smaller than epidemiological cohorts and proteomic-guided randomized allocation has rarely been implemented to date. Although multiomics integration and machine-learning approaches have expanded discovery and improved pathway modeling, independent validation, cross-platform consistency, and clinically meaningful risk reclassification remain inconsistently demonstrated across studies.</p><p><strong>Summary: </strong>Diet-proteome associations are biologically coherent and reproducible at the population level. Nevertheless, translation into individualized dietary prescription remains to be demonstrated at scale. Robust evidence of cross-platform consistency, formal clinical utility, and outcome-driven trials incorporating proteomic-guided interventions will be key to enabling circulating proteomics to support routine precision nutrition practice.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"361-367"},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13258099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}