Current Opinion in Clinical Nutrition and Metabolic Care最新文献

{"title":"Short-chain fatty acids in clinical practice: where are we?","authors":"Robert G Martindale, Manpreet S Mundi, Ryan T Hurt, Stephen A McClave","doi":"10.1097/MCO.0000000000001101","DOIUrl":"https://doi.org/10.1097/MCO.0000000000001101","url":null,"abstract":"<p><strong>Purpose of review: </strong>Once considered to have only local influences on the gut mucosa, short-chain fatty acids (SCFAs) now appear to have a much wider anti-inflammatory, immune-modulating, systemic effect. This article reviews recent evidence to suggest a much wider clinical application of this valued dietary substrate.</p><p><strong>Recent findings: </strong>SCFAs act systemically through stimulation of G protein receptors (GPRs) and inhibition of histone deacetylases (HDACs). SCFAs cause appetite suppression, reduce systemic inflammation, improve insulin sensitivity, increase energy expenditure, promote mitochondrial function, stimulate satiety, reduce blood pressure, and improve cognitive function from various neurologic maladies.</p><p><strong>Summary: </strong>Dietary strategies should be implemented to provide this beneficial substrate across a wide spectrum of disease conditions. Use of prebiotic fiber or liquid supplements containing high SCFA-producing organisms should be considered as therapeutic targets for multiple metabolic, immunologic, and neurodegenerative diseases.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":"28 2","pages":"54-60"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255035","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 impact of n-3 polyunsaturated fatty acids in patients with cancer: emerging themes.","authors":"Barbara van der Meij, Sarah Parsons, Vera Mazurak","doi":"10.1097/MCO.0000000000001102","DOIUrl":"10.1097/MCO.0000000000001102","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes recent literature falling broadly under the topic of n-3 polyunsaturated fatty acids (PUFAs) in the oncology setting, highlighting emerging themes and emphasizing novel explorations.</p><p><strong>Recent findings: </strong>Meta-analyses continue to confirm safety and efficacy of n-3 PUFA supplementation on reducing inflammation and improving survival in people with cancer. Common themes in recent studies emphasize improving tumor-directed efficacy and reducing toxicities of common cancer therapies. New areas of interest include the impact of n-3 PUFA when combined with immunotherapies and applications in pediatric acute lymphoid leukemia. Novel assessments include specialized pro-resolving lipid mediators, the intestinal microbiome and psychological well being. A variety of clinically relevant outcomes including nutritional status, toxicities and survival are being explored in ongoing clinical studies.</p><p><strong>Summary: </strong>Evidence confirms the safety of n-3 PUFA for patients with cancers, as well as benefits in some, but not all areas of exploration. Larger, well designed trials with biological assessment of compliance compared to the prescribed n-3 PUFA dose would strengthen the evidence needed to integrate n-3 PUFA recommendations into clinical practice for patients with cancer.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"75-85"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920949","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":"Missing data and long-term outcomes from nutrition research in the critically ill.","authors":"Eline Schouteden, Julia L M Bels, Marcel C G van de Poll, Jeffrey Presneill","doi":"10.1097/MCO.0000000000001098","DOIUrl":"10.1097/MCO.0000000000001098","url":null,"abstract":"<p><strong>Purpose of review: </strong>The use of functional outcomes in critical care nutrition research is increasingly advocated; however, this inevitably gives rise to missing data. Consequently there is a need to adopt modern approaches to the foreseeable problem of missing functional and survival outcomes in research trials.</p><p><strong>Recent findings: </strong>Analyses that ignore unobserved or missing data will often return biased effect estimates. An improved approach is to routinely anticipate the types and extent of missing data, and consider the likely mechanisms of that missingness. The researcher and their statistical advisor may then choose from a number of modern strategies to assess the sensitivity of the research conclusions to the patterns of missingness contained in these research data. Methods widely employed include multiple imputation of missing observations, mixed regression models, use of composite outcome variables with patients who die being attributed a value reflecting the lack of ability to function, and selected Bayesian methodology.</p><p><strong>Summary: </strong>Conclusions from clinical research in critical care nutrition will become more clinically interpretable and generalizable with the adoption of modern methods for the statistical handling of missing data.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"160-166"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921021","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":"Feeding interruptions for extubation and other procedures.","authors":"Mickael Landais, Stephan Ehrmann, Christophe Guitton","doi":"10.1097/MCO.0000000000001105","DOIUrl":"10.1097/MCO.0000000000001105","url":null,"abstract":"<p><strong>Purpose of review: </strong>The objective of this review is to examine the available evidence concerning feeding interruptions before extubation and other medical procedures in ICUs. We will analyze the physiological mechanisms involved, the potential risks associated with feeding interruptions, as well as the results of recent clinical studies. Additionally, we will explore current practices and recommendations from major professional societies, as well as recent innovations aimed at minimizing feeding interruptions.</p><p><strong>Recent findings: </strong>Fasting before extubation is a common yet heterogeneous practice, varying across ICUs. Although dysphagia is a frequent complication after extubation, its prevalence decreases over time. However, physiologically, fasting before extubation appears ineffective in reducing gastric content or preventing aspiration. The Ambroisie study demonstrated that continuing enteral nutrition up to extubation is not inferior to a 6 h fasting strategy in terms of extubation failure at 7 days. The management of perioperative nutrition in intubated patients is debated. A retrospective study found no significant difference in postoperative respiratory events between patients fasting for at least 6 h and those fasting less or not at all but further prospective randomized studies are needed for definitive conclusions. For abdominal and digestive surgeries, fasting remains necessary to simplify procedures and reduce contamination risks. For invasive ICU procedures, such as catheter placement, the continuation of enteral nutrition appears reasonable. However, for percutaneous tracheotomy, limited evidence suggests no clear benefit from fasting, though the risk of large-volume aspiration during the procedure raises concerns. The approach to nutrition in this context requires further investigation.</p><p><strong>Summary: </strong>Fasting before extubation in ICUs is a common practice inherited from anesthesia, aiming to reduce the risk of aspiration. The Ambroisie study demonstrates that continuing enteral nutrition until extubation is not inferior to a 6 h fasting strategy regarding extubation failure at 7 days.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":"129-133"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001825","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":"Concurrent nutrition and physical rehabilitation interventions for patients with critical illness.","authors":"Felipe González-Seguel, Kirby P Mayer, Renee D Stapleton","doi":"10.1097/MCO.0000000000001099","DOIUrl":"10.1097/MCO.0000000000001099","url":null,"abstract":"<p><strong>Purpose of review: </strong>The effects of either physical rehabilitation or nutrition on outcomes in patients with critical illness are variable and remain unclear. The potential for the combination of exercise and nutritional delivered concurrently to provide benefit is provocative, but data are only emerging. Herein, we provide a summary of evidence from 2023 and 2024 on combined physical rehabilitation and nutrition during and following critical illness.</p><p><strong>Recent findings: </strong>While latest trials on physical rehabilitation alone reported conflicting findings, recent nutrition trials found no difference between higher and lower protein delivery and even suggested harm in patients with acute kidney injury. In 2023 and 2024, we identified four studies (one randomized controlled trial) combining physical rehabilitation and nutrition (mainly protein supplementation) within the ICU setting. Overall, these suggested benefits, including reduction of muscle size loss, ICU acquired weakness, delirium, and improved mobility levels, although these benefits did not extend to mortality and hospital length of stay. No recent trials combining physical rehabilitation and nutrition for patients after ICU were identified.</p><p><strong>Summary: </strong>Current insights on combined physical rehabilitation and nutrition suggest improved clinically relevant outcomes, but further investigations across the continuum of care of patients with critical illness are warranted.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":"28 2","pages":"140-147"},"PeriodicalIF":3.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254962","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":"The potential of creatine monohydrate supplementation in the management of osteosarcopenia.","authors":"Darren G Candow, Ben Kirk, Philip D Chilibeck, Gustavo Duque","doi":"10.1097/MCO.0000000000001118","DOIUrl":"https://doi.org/10.1097/MCO.0000000000001118","url":null,"abstract":"<p><strong>Purpose of review: </strong>Osteosarcopenia is an age-related condition characterized by reductions in bone mineral, muscle/lean mass, strength and functional ability which increases the risk of falls, fractures, frailty and premature mortality. One main contributing factor to osteosarcopenia is malnutrition. The purpose was to review recent evidence of creatine monohydrate (CrM) supplementation in older adults and to discuss the potential to manage osteosarcopenia.</p><p><strong>Recent findings: </strong>Accumulating research shows that CrM supplementation, primarily when combined with exercise training, has the potential to serve as a viable intervention in the management of osteosarcopenia. Collectively, CrM supplementation during exercise training in older adults led to greater improvements in whole-body lean mass, lower-limb muscle density and bone geometry and muscle strength (primarily upper-body) compared to exercise training alone. However, no study has investigated the effects of CrM, with and without exercise training, in older adults with osteosarcopenia.</p><p><strong>Summary: </strong>Given the positive findings of CrM on measures of muscle and bone in healthy older adults, there is potential for CrM to be added as an adjunct to exercise training in the management of osteosarcopenia. However, randomized clinical trials are needed to confirm the safety and efficacy of this nutrient in this clinical population.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514985","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":"Improving the quality of donor human milk to take advantage of more of the health benefits of mother's own milk composition.","authors":"Megan R Beggs, Sharon Unger, Deborah L O'Connor","doi":"10.1097/MCO.0000000000001116","DOIUrl":"https://doi.org/10.1097/MCO.0000000000001116","url":null,"abstract":"<p><strong>Purpose of review: </strong>Pasteurized donor human milk (PDHM) is the recommended supplement when there is inadequate volume of mother's own milk (MOM) for very low birth weight (<1500 g, VLBW) infants. Differences in the composition of these milks may impact growth, morbidities or long-term development of infants. The aim of this review is to highlight current trends in understanding compositional differences between MOM and PDHM, technological advances in processing PDHM, and infant outcomes when VLBW infants are fed these milks.</p><p><strong>Recent findings: </strong>Reported differences in the composition between MOM and PDHM are due to several factors including when and how milk is collected, sampled for analysis, and processed. Systematic reviews and primary research studies demonstrate that PDHM reduces the risk of necrotizing enterocolitis in VLBW infants but is also associated with slower postnatal growth. Work is ongoing to determine if alternative approaches to processing PDHM can improve milk composition and thereby infant growth and neurodevelopment and reduce morbidity.</p><p><strong>Summary: </strong>PDHM is a key component of feeding VLBW infants when there is inadequate volume of MOM. Recent developments aim to optimize this source of nutrition and bioactive compounds for VLBW infants while further understanding limitations of its use.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440119","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":"Disease associated malnutrition in pediatrics - what is new?","authors":"Koen Huysentruyt, Jessie M Hulst, Konstantinos Gerasimidis, Koen F Joosten","doi":"10.1097/MCO.0000000000001115","DOIUrl":"https://doi.org/10.1097/MCO.0000000000001115","url":null,"abstract":"<p><strong>Purpose of review: </strong>Disease associated malnutrition (DAM) remains an important concern in the care of hospitalized children and children with a chronic disease. This review focused on pediatric literature published since 2023 on the prevalence, assessment and treatment of DAM in different settings.</p><p><strong>Recent findings: </strong>The prevalence of DAM depends on a variety of factors. Studies focused on the relationship between different assessment methods of DAM and sarcopenia in hospitalized children and children with an underlying disease and clinical outcomes. Several papers focused on exploring the interplay between nutritional management and the evolving metabolic phases of critically ill children. Some studies explored feeding intolerance and barriers to administering enteral nutrition, micronutrient assessment and whether continuous versus intermittent feeding was superior in pediatric intensive care.</p><p><strong>Summary: </strong>In hospitalized children and chronically ill children, nutritional assessment and assessment of frailty and/or sarcopenia is best done using a comprehensive approach integrating anthropometrics, nutrition focused history and physical examination. Adequate nutritional support for critically ill children is challenging and needs to be tailored to the specific phases of critical illness. Intermittent feeding may offer potential advantages in inducing ketosis and circadian rhythm alignment but requires careful management to prevent nutritional deficits.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440116","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":"Bioactive compounds in human milk.","authors":"Ariadna Witte Castro, Maria Sanchez-Holgado, Miguel Saenz de Pipaon","doi":"10.1097/MCO.0000000000001114","DOIUrl":"https://doi.org/10.1097/MCO.0000000000001114","url":null,"abstract":"<p><strong>Purpose of review: </strong>Human milk is the optimal food choice for infants. Reviewing the latest advances in research about human milk compounds and their effect on health helps understand the benefits of breastfeeding and improves knowledge of key bioactive nutrients that can be used to improve feeding during infancy, with short and long-time effects on health.</p><p><strong>Recent findings: </strong>In the last years, it has been described how bioactive compounds such as Human milk oligosaccharides, hormones, lipids, cellular components and microbes play an important role in the infants' health, reducing the risk of infectious, metabolic and autoimmune diseases. The mechanisms of transmission from the mother to the infant of these bioactive compounds are not always well described, but there are several lines of research to understand the biological mechanisms of these beneficial effects.</p><p><strong>Summary: </strong>These findings may help improve research in maternal and infant interventions, the modifiable factors that are able to modulate human milk composition. They may help to improve the development of infant formulas and enhance nutritional plans. Also, human milk bioactive compounds identification and isolation may describe new ways of supplementation.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440112","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":"Prehabilitation in surgery - an update with a focus on nutrition.","authors":"Chelsia Gillis, Arved Weimann","doi":"10.1097/MCO.0000000000001112","DOIUrl":"https://doi.org/10.1097/MCO.0000000000001112","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Since the introduction of the prehabilitation concept for optimizing functional capacity before surgery 20 years ago, evidence and interest has grown considerably. This review summarizes the recent evidence and proposes questions for prehabilitation with special regard to the nutritional component.</p><p><strong>Recent findings: </strong>Several meta-analyses of multimodal prehabilitation (exercise, nutrition, and psychological support) have been published recently. These reviews suggest that preoperative conditioning can improve functional capacity and reduce the complication rate for many patient groups (risk of bias: moderate to low). A prerequisite is the identification of high-risk patients using suitable screening and assessment tools. Additionally, there are currently no standardized, clear recommendations for the organization and implementation of prehabilitation programs. The programs vary greatly in duration, content, and outcome measurement. Although the preoperative nutrition interventions enhanced outcomes consistently, there was no clear evidence for which nutritional intervention should be applied to whom over consistent time frame four to six weeks (timeframe consistent with most prehabilitation programs).</p><p><strong>Summary: </strong>To advance our understanding of which prehabilitation interventions work best, how they work, and for whom they work best, additional low risk of bias and adequately powered trials are required. Nevertheless, our review presents evidence that prehabilitation should be offered before major surgery on a risk-stratified basis.</p>","PeriodicalId":10962,"journal":{"name":"Current Opinion in Clinical Nutrition and Metabolic Care","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188526","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}