Richard Parker, Juan P. Arab, Jeffrey V. Lazarus, Ramon Bataller, Ashwani K. Singal
{"title":"Public health policies to prevent alcohol-related liver disease","authors":"Richard Parker, Juan P. Arab, Jeffrey V. Lazarus, Ramon Bataller, Ashwani K. Singal","doi":"10.1038/s41575-025-01084-6","DOIUrl":"10.1038/s41575-025-01084-6","url":null,"abstract":"Alcohol-related liver disease (ALD) is a major cause of morbidity and premature mortality around the world, with a substantial cost to individuals and to health-care systems. The incidence of ALD is closely associated with alcohol intake, and it is a preventable disease. There is clear evidence that public health measures to reduce alcohol consumption are effective, which in turn can have a positive effect on ALD. Effective policy includes controlling the price of alcohol, limiting or banning alcohol advertising and restricting the availability of alcohol. The strength of public health policy depends on the political willingness to develop robust strategies. However, effective lobbying of policy-makers by the alcohol industry and lack of political will are barriers to the implementation of these measures, resulting in suboptimal national alcohol control policies. Clinicians are well-placed to campaign for effective public health policy regarding alcohol to reduce the prevalence of ALD for the benefit of patients, their families and wider society. In this Perspective, we summarize the evidence for public health policies that affect alcohol consumption and the prevalence of ALD. There is clear evidence that public health measures to reduce alcohol consumption are effective, which can have a positive effect on alcohol-related liver disease. In this Perspective, Parker and colleagues discuss public health policies that affect alcohol consumption and alcohol-related liver disease.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"22 8","pages":"587-594"},"PeriodicalIF":51.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144211012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yolanda Sanz, John F. Cryan, Mélanie Deschasaux-Tanguy, Eran Elinav, Rebekka Lambrecht, Patrick Veiga
{"title":"The gut microbiome connects nutrition and human health","authors":"Yolanda Sanz, John F. Cryan, Mélanie Deschasaux-Tanguy, Eran Elinav, Rebekka Lambrecht, Patrick Veiga","doi":"10.1038/s41575-025-01077-5","DOIUrl":"10.1038/s41575-025-01077-5","url":null,"abstract":"The gut microbiome has an undeniable role in mediating the health effects of the diet, given its ability to co-digest nutrients and influence nutrient signalling to multiple organ systems. As a suboptimal diet is a major risk factor for and contributor to disease, understanding the multidirectional interactions between the food we eat, the gut microbiome and the different body organ systems is crucial from a public health perspective. Indeed, this research area is leading to the refinement of nutritional concepts and strategies to optimize health through diet. In this Review, we provide an update on how dietary patterns and food intake shape gut microbiome features, the mode of action of diet–microorganism interactions on the immune, nervous and cardiometabolic systems and how this knowledge could explain the heterogeneity of dietary responses, and support food-based dietary guidelines and medical and precision nutrition. Finally, we discuss the knowledge gaps and research efforts needed to progress towards the integration of microbiome science with more precise dietary advice to leverage the role of nutrition in human health. In this Review, Sanz and colleagues discuss how diet shapes the gut microbiome, the role of diet–microbiome interactions on the immune, nervous and cardiometabolic systems, and implications for dietary guidelines and precision nutrition.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"22 8","pages":"534-555"},"PeriodicalIF":51.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144211011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prioritizing inflammatory bowel disease","authors":"","doi":"10.1038/s41575-025-01078-4","DOIUrl":"10.1038/s41575-025-01078-4","url":null,"abstract":"Inflammatory bowel disease remains a global health challenge, despite advances in treatment and understanding of disease biology. In this issue, we focus on the most pressing priorities in inflammatory bowel disease research and care.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"22 6","pages":"361-361"},"PeriodicalIF":51.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41575-025-01078-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rashid Lui (, ), Renu Dhanasekaran, Yu Bin Tan (, ), Claudia Wing-Kwan Wu, Jan Bornschein, Daniel Q. Huang (, ), Arndt Vogel, Shilpa Grover
{"title":"Redefining cancer care: the case for an onco-gastroenterology subspecialty","authors":"Rashid Lui \u0000 (, ), Renu Dhanasekaran, Yu Bin Tan \u0000 (, ), Claudia Wing-Kwan Wu, Jan Bornschein, Daniel Q. Huang \u0000 (, ), Arndt Vogel, Shilpa Grover","doi":"10.1038/s41575-025-01076-6","DOIUrl":"10.1038/s41575-025-01076-6","url":null,"abstract":"Onco-gastroenterology is defined as a collaborative subspecialty of Gastroenterology that is dedicated to the unique needs of individuals with or at risk of cancer, with a focus on maintaining and managing their digestive and liver health throughout their clinical course.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"22 7","pages":"459-461"},"PeriodicalIF":51.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Menopause and gastrointestinal health and disease","authors":"Dana Ley, Sumona Saha","doi":"10.1038/s41575-025-01075-7","DOIUrl":"10.1038/s41575-025-01075-7","url":null,"abstract":"Menopause has far-reaching effects on human physiology, including the gastrointestinal tract, and can negatively influence the quality of life of women who are affected. Menopause can have multiple effects on gastrointestinal function, including altering gut motility and changing the composition of the gut microbiota. As a result, some gastrointestinal and hepatic conditions are more common among individuals in peri- and postmenopause, and people with these conditions before menopause might also experience greater symptom severity and worse health-related quality of life during this time. The use of hormone replacement therapy to treat menopausal symptoms might also affect gastrointestinal health and well-being. Individuals in postmenopause are at risk for bone remodelling and osteoporosis due to ageing and loss of sex hormones. However, secondary osteoporosis can also occur due to medications used to treat gastrointestinal conditions (for example, glucocorticoids and other immunosuppressive medications) and the conditions themselves (for example, autoimmune disease or coeliac disease). Although all people who menstruate will eventually transition to menopause, there are relatively few studies evaluating the effect of menopause on gastrointestinal symptoms and quality of life. This Review aims to summarize available evidence and highlight areas where research is needed. Menopause affects human health and quality of life. This Review focuses on the effects of menopause and hormonal replacement therapy on gastrointestinal and liver disease, discusses osteoporosis in this context and identifies gaps in clinical research.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"22 8","pages":"556-569"},"PeriodicalIF":51.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"SSRIs and depression: role of gut–brain communication","authors":"Lin Y. Hung","doi":"10.1038/s41575-025-01082-8","DOIUrl":"10.1038/s41575-025-01082-8","url":null,"abstract":"","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"22 8","pages":"530-530"},"PeriodicalIF":51.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Bridging the gap: increasing MENA representation in MASLD clinical trials","authors":"Mohamed El-Kassas","doi":"10.1038/s41575-025-01081-9","DOIUrl":"10.1038/s41575-025-01081-9","url":null,"abstract":"Despite the Middle East and North Africa having the highest global burden of metabolic dysfunction-associated steatotic liver disease, patients from this region remain markedly under-represented in the disease clinical drug trials. Addressing this gap is essential for ensuring equitable access to novel therapies and enhancing global liver health.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"22 7","pages":"457-458"},"PeriodicalIF":51.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hepatic stellate cells: balancing homeostasis, hepatoprotection and fibrogenesis in health and disease","authors":"Robert F. Schwabe, David A. Brenner","doi":"10.1038/s41575-025-01068-6","DOIUrl":"10.1038/s41575-025-01068-6","url":null,"abstract":"In the past decades, the pathogenic role of hepatic stellate cells (HSCs) in the development of liver fibrosis and its complications has been deeply characterized, rendering HSCs a primary target for antifibrotic therapies. By contrast, the beneficial roles of HSCs in liver homeostasis and liver disease are only beginning to emerge, revealing critical regulatory and fibrosis-independent functions in hepatic zonation, metabolism, injury, regeneration and non-parenchymal cell identity. Here, we review how HSC mediators, such as R-spondin 3, hepatocyte growth factor and bone morphogenetic proteins, regulate critical and homeostatic liver functions in health and disease via cognate receptors in hepatocytes, Kupffer cells and endothelial cells. We highlight how the balance shifts from protective towards fibropathogenic HSC mediators during the progression of chronic liver disease (CLD) and the impact of this shifted balance on patient outcomes. Notably, the protective roles of HSCs are not accounted for in current therapeutic concepts for CLD. We discuss the concept that reverting the HSC balance from fibrogenesis towards hepatoprotection might represent a novel holistic treatment approach to inhibit fibrogenesis and restore epithelial health in CLD simultaneously. Hepatic stellate cells (HSCs) are best known as the primary fibrogenic liver cell type. This Review provides a comprehensive overview of protective and pathogenic HSC functions in health and disease and discusses novel therapeutic concepts derived from this dual role.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"22 7","pages":"481-499"},"PeriodicalIF":51.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deiziane V. S. Costa, Beatriz Thomasi, Gerly A. C. Brito, Brian D. Gulbransen, Cirle A. Warren
{"title":"The role of the enteric nervous system in the pathogenesis of Clostridioides difficile infection","authors":"Deiziane V. S. Costa, Beatriz Thomasi, Gerly A. C. Brito, Brian D. Gulbransen, Cirle A. Warren","doi":"10.1038/s41575-025-01071-x","DOIUrl":"10.1038/s41575-025-01071-x","url":null,"abstract":"Clostridioides difficile is the leading cause of antibiotic-associated diarrhoea worldwide. In the USA, C. difficile infection (CDI) is the eighth leading cause for hospital readmission and seventh for mortality among all gastrointestinal disorders. Gastrointestinal dysmotility and/or diarrhoea occurs after the acute phase of CDI, but persistent gastrointestinal dysfunction post-infection supports contributions of neuroplasticity in the enteric nervous system (ENS), which has a key role in regulating intestinal motility and secretion, in the natural course of CDI. Here, our goal is to provide an up-to-date summary of how the ENS and extrinsic innervation of the gut are affected by CDI and how ENS responses contribute to CDI pathogenesis and outcomes. Enteric neurons and glia are targets of C. difficile toxins in humans and in preclinical model, and changes to the ENS and extrinsic innervation contribute to intestinal inflammation, damage and secretory diarrhoea. These findings suggest possible bidirectional interaction between CDI and the ENS. More studies focusing on understanding how various neurotransmitters and mediators released by the ENS and extrinsic neurons modulate immune responses to CDI could provide insight into novel pharmacological approaches to balance the host response, improve the management of CDI and prevent gastrointestinal dysfunction post-infection. This Perspective highlights emerging evidence of an interaction between Clostridiodes difficile and the enteric nervous system (ENS) during infection, discussing underlying mechanisms and how the ENS and extrinsic innervation are affected by C. difficile infection and toxins and how ENS responses contribute to pathogenesis and disease outcomes.","PeriodicalId":18793,"journal":{"name":"Nature Reviews Gastroenterology &Hepatology","volume":"22 8","pages":"570-586"},"PeriodicalIF":51.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}