Current Opinion in Clinical Nutrition and Metabolic Care最新文献

{"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}

{"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}