Clinical nutrition ESPEN最新文献

Acute kidney injury (AKI) is a complex clinical syndrome characterized by a rapid decline in kidney function, often resulting in complex metabolic and hormonal derangements. A major concern in managing AKI patients is the development of protein energy wasting (PEW), a condition marked by loss of lean body mass and negative impact on overall health outcomes. Additionally, the need of Kidney Replacement Therapy (KRT) for the most severe forms of AKI may further increase the risk of PEW, with a substantial impact on fluid and metabolic balance. Adequate nutritional support is crucial in the management of AKI, as it plays a pivotal role in muscle mass preservation, morbidity reduction and recovery of renal function. This paper aims to evaluate the current evidence regarding nutritional strategies in AKI patients, focusing on energy and protein requirements, timing and route of nutritional intervention, and impact of individualized nutrition plans on PEW prevention and management.

Background & aims: Eating habits during childhood have undergone significant changes, with a notable increase in the consumption of ultra-processed foods (UPF). This situation deserves attention, given the close relationship between UPF and adverse health outcomes. This is due to the nutritional composition of UPF, which has high levels of health-critical nutrients such as sugar, fat, and sodium, thus compromising the overall quality of the diet. An excess of these nutrients can increase the risk of developing excess weight, nutritional deficiencies, and chronic diseases during childhood. Among the nutritional deficiencies is iron. This is due to the fact that UPF are not good sources of iron. This, combined with the fact that UPF is low in nutrients that help make iron more available, such as vitamin C, increases the risk of developing anemia. Therefore, this study aimed to assess the availability of iron, as well as the presence of anemia and excess weight in children living in situations of social vulnerability, and to determine their association with the consumption of UPF.

Methods: This is a population-based cross-sectional study. Children aged between 6 and 59 months living in slums were included. The presence of excess weight was assessed by measuring weight and height, and the presence of anemia was determined by hemoglobin concentration, assessed using the HemoCue portable hemoglobinometer. A 24-h food recall was also used to assess the relative calorie intake of UFP and the dietary availability of iron using an algorithm. All statistical analyses were carried out using the statistical software Jamovi.

Results: In this study, 443 children were included; 19.2 % were classified as with excess weight, and 55.6 % were anemic; the average absorbable iron content was 0.54 (SD ± 0.42) mg, and 39.2 % of the calories consumed came from UPF. The association analysis showed that children with calorie share relative to UPF had a decrease of -0.12 mg of bioavailable iron (β: -0.12; 95 % CI: -0.23; -0.01). It was also possible to identify that the higher calorie share of UPF increased their chances of being classified as with excess weight and anemic by up to 116 % (OR: 2.16; 95 % CI 1.05; 4.46) and 145 % (OR: 2.45; 95 % CI: 1.26; 4.78), respectively.

Conclusions: The relationship found between UPF consumption and the availability of iron in the diet, excess weight, and anemia calls for attention, especially in contexts of social vulnerability. These findings demonstrate the need for greater attention to nutrition in childhood to promote an adequate and healthy diet. This can help to change the nutritional and epidemiological panorama of the population, contributing to a better general state of health for future generations of adults.

Background: Undernutrition is purportedly highly prevalent in inflammatory bowel diseases (IBD). While several risk factors have been identified, the impact of widespread eating behaviors such as food exclusions and therapeutic fasting practices has not been evaluated. There are limited data on the prevalence of undernutrition diagnosed according to internationally recognized criteria in this population.

Objectives: To estimate the prevalence of undernutrition assessed with the Global Leadership Initiative on Undernutrition (GLIM) criteria and to analyze factors associated with the characteristics of the disease and factors related to undernutrition.

Methods: Patients attending our IBD nutrition clinic were screened between November 2021 and April 2022. The complete avoidance of a food category was defined as total exclusion while avoidance most of the time was defined as partial exclusion. Undernutrition was diagnosed according to GLIM criteria. Weight history, past maximal involuntary weight loss and minimal body mass index since diagnosis of IBD were also collected.

Results: A total of 434 patients with IBD were included. Undernutrition was observed in 25.8 % of the whole population at inclusion (15 % with moderate undernutrition and 10.8 % with severe undernutrition). Mean involuntary maximal weight loss since illness onset was -14.5 % ± 11.0. Previous undernutrition since IBD diagnosis was reported in 81.1 % of the population, 63.6 % for severe and 17.5 % for moderate undernutrition. In multivariate analysis, undernutrition at inclusion was independently associated with total exclusion of at least one food category (OR = 1.11 95 % CI, 1.01-1.22; p = 0.031) as well as active disease (OR = 1.16 95 % CI, 1.05-1.27; p = 0.002), and negatively with the duration of IBD (OR = 0.88 95 % CI, 0.78-0.99, p = 0.031). Exclusion diet was also the main variable significantly associated with episodes of undernutrition in the past (OR = 1.11 95 % CI, 1.01-1.22; p = 0.035) as well as previous surgery (OR = 1.11 95 % CI, 1.00-1.23; p = 0.048). In these analyses, fasting practices were not independently associated with a risk of undernutrition.

Conclusion: Total exclusion of at least one food category was one of the main factors associated with undernutrition independently of disease activity and duration, both at the time of inclusion and in the past, and should be avoided, whereas fasting practices were not associated with a risk of undernutrition.

Introduction: The benefits of probiotics/prebiotics consumption on chronic kidney disease (CKD) and mortality remains controversial.

Objectives: This study investigates the association of probiotics/prebiotics consumption with chronic kidney disease (CKD) and mortality.

Methods: Clinical data were retrieved from the National Health and Nutrition Examination Survey (NHANES) 2005-2016 database. Weighted multivariable logistic and liner regression models, cox proportional hazards models and stratified analysis were used to analyse the relationships between consumption of probiotics/prebiotics, renal parameters, CKD and mortality. We also conducted a two-sample Mendelian randomization (MR) analysis of single nucleotide polymorphisms (SNPs) related to different genera of gut microbiota to assess their causal relationships with CKD and mortality.

Results: 15,291 subjects were analysed (897 with consumption of probiotics/prebiotics and 14,394 without). The use of probiotics/prebiotics showed an inverse correlation with urinary albumin-to-creatinine ratio (UACR) (P < 0.05). Probiotics/prebiotics use was associated with lower risk of CKD in subjects with hypertension, hyperlipidaemia and diabetes mellitus. The consumption of probiotics/prebiotics was associated with a significantly lower risk of all-cause mortality in different regression models (P < 0.001, for all), but the lower risk of cardiovascular mortality did not reach statistical significance (P > 0.05, for all)]. MR analysis showed negative associations between the genetically predicted genus Flavonifractor and risk of CKD and diabetic kidney disease (DKD).

Conclusion: After multivariable regression, and cox proportional hazards analysis, we found that the use of probiotics/prebiotics was associated with improved kidney and mortality outcomes in the general population from NHANES database. The two-sample MR analysis provided further genetic evidence that a distinct genus of gut microbiota was associated with reduced risk of CKD, DKD and mortality.

Introduction: Hand-foot-skin reaction (HFSR) is the most common side effect of multi-tyrosine kinase inhibitor therapy for unresectable hepatocellular carcinoma (uHCC). Sarcopenia has been reported to be a poor prognostic factor for HCC. Here, we performed a randomized controlled trial (RCT) of the efficacy of a β-hydroxy-β-methyl butyrate/l-arginine/l-glutamine (HMB/Arg/Gln) beverage and locomotion training as supportive care in the treatment of uHCC with lenvatinib.

Methods: A total of 20 patients were enrolled from the jRCTs031190252 trial in this pilot study. HFSR was the primary endpoint, and other adverse events and skeletal muscle index at the third lumbar level (L3-SMI) were secondary endpoints.

Results: Twelve patients had albumin-bilirubin grade 1, and eight had grade 2. No difference in HFSR was observed. Although interesting differences were observed in the secondary endpoints, a slight retention of L3-SMI values in the intervention group compared with that in the control group was observed (96.5 % vs. 89.9 %, p = 0.407).

Conclusion: Although the HMB/Arg/Gln beverage and locomotion training did not reduce adverse events caused by lenvatinib, they might be useful in maintaining skeletal muscle mass. Further validation studies with a larger number of patients are warranted.

Background: Patients with head and neck cancer (HNC) undergoing radiotherapy or chemoradiotherapy often experience symptoms that affect their ability to eat. This study aimed to explore the impact of radiotherapy on body weight in HNC patients and compare the characteristics of patients receiving enteral tube feeding with those maintaining an oral diet.

Methods: In this prospective study, 52 patients with HNC were examined at diagnosis, at the start and end of radiotherapy, and six weeks after end of treatment. The nutritional assessment included measurements of body weight, food intake, and malnutrition using Patient-Generated Subjective Global Assessment (PG-SGA). Other variables were retrieved from the electronic patient record.

Results: Critical weight loss (defined as >5 % from start of radiotherapy) was present in 60 % of the patients at the end of radiotherapy, and only half of these patients received any enteral nutrition therapy. The mean weight loss was 5.8 % during radiotherapy, and an additional 2.1 % at follow-up (n = 48). A nasogastric feeding tube was used by 42 % at the end of radiotherapy, and 29 % at follow-up. The tube feeding users had a lower energy intake and higher weight loss than non-tube feeding users (22 vs 27 kcal/kg body weight, 7.8 vs 4.4 % weight loss) at the end of radiotherapy treatment. According to PG-SGA, 92 % of the patients were malnourished at the end of treatment and 71 % at follow-up (p < 0.001).

Conclusion: Critical weight loss and malnutrition were common in HNC patients after radiotherapy, and enteral tube feeding was initiated in only half of the cases with critical weight loss. Patients receiving enteral tube feeding may need closer monitoring to ensure adequate energy intake, and other treatment options may be necessary. These results emphasize the need for improved nutritional intervention during and after radiotherapy.

Background & aims: Various factors may cause significant daily variations in energy expenditure in and between critically patients. This nested, prospective study (ClinicalTrials.gov Identifier: NCT04099108) in a predominantly trauma surgical ICU, aimed to determine the course of measured energy expenditure over the first 10 days of critical illness, and to identify factors contributing to energy expenditure.

Methods: Indirect calorimetry was performed on alternate days from ICU Day 3 ± 1 until Day 10 ± 1. The mean daily measured energy expenditure, respiratory quotient and total energy delivery as a percentage of measured energy expenditure were modelled using linear mixed regression with two fractional polynomial terms to accommodate non-linear responses over time.

Results: Fifty ICU patients (mean age 36.9 ± 11.8 years, Acute Physiology and Chronic Health Evaluation (APACHE II) 13.5 ± 6.6, Sequential Organ Failure Assessment (SOFA) 4.5 ± 3.2) were included. Mean body mass index (BMI) was 24.8 ± 4.0 kg/m² and mean ventilation duration 7.7 ± 2.7 days. Mean daily measured energy expenditure showed a significant non-linear response (p = 0.006) increasing over the first 4 days peaking on day 5 and then plateauing. Mean daily respiratory quotient increased over the first 7 days, thereafter plateauing with a slight downward trend from day 8 despite a progressive increase in total energy delivery as a percentage of measured energy expenditure. Mean daily measured energy expenditure was significantly lower in the early than in the late acute phases (p = 0.024), whereas the late- and post-acute phases were similar. Age, sex and BMI significantly influenced measured energy expenditure.

Conclusion: Measured energy expenditure showed a significant non-linear response over the first 10 days in ICU, increasing over the first 4 days peaking on day 5 then plateauing. The observed variability highlights the complexity of managing critically ill patients and the importance of personalised nutrition therapy. Additionally, the observed trend with a peak in measured energy expenditure around day five could inform timing and strategies for nutritional intervention in this patient cohort.

Metabolic (dysfunction)-associated steatotic liver disease (MASLD) represents a spectrum of liver pathologies linked to metabolic syndrome components. Inflammation emerges as a pivotal player in MASLD pathogenesis, initiating and perpetuating hepatic injury. Diet, a modifiable risk factor, influences inflammation levels and MASLD progression. This review synthesizes existing evidence on the association between pro-inflammatory diets, assessed via the Dietary Inflammatory Index (DII) and Empirical Dietary Inflammatory Potential (EDIP), and MASLD. Evidence suggests a significant association between higher DII/EDIP scores and MASLD risk, with studies revealing a positive correlation between inflammatory diet intake and MASLD occurrence, particularly in males. However, inconsistencies exist regarding the influence of body mass index (BMI) on this association and criticisms regarding adjustment for BMI and reliance on surrogate markers necessitate cautious interpretation. Limited data suggest a potential link between dietary inflammatory potential and advanced liver fibrosis and heightened risk of hepatocellular carcinoma (HCC) with increased DII/EDIP scores, albeit requiring further confirmation through gold-standard assessment methods. Dietary-induced inflammation exacerbates MASLD pathogenesis through multiple pathways, including insulin resistance, adipose tissue dysfunction, gut microbiota alterations, and oxidative stress, culminating in hepatic steatosis, inflammation, and fibrosis. Further research utilizing robust methodologies is imperative to confirm these findings and elucidate underlying mechanisms, thus informing targeted dietary interventions for MASLD management.

Background: Helicobacter pylori (H. pylori) infection increases the risks of chronic gastritis, peptic ulcer diseases, and the incidence of gastric cancer. However, antibiotic resistance and adverse effects led to the emergence of alternative treatments such as probiotics supplementation. This systematic review and network meta-analysis aims to assess the efficacy and safety of incorporating probiotics into the various eradication regimens for H. pylori.

Methods: We searched PubMed, Embase, Scopus, Cochrane, and Web of Science from inception to May 2023, for randomized controlled trials (RCTs) comparing standard therapy (triple or quadrable therapy). for H. pylori with or without probiotic supplementation. Dichotomous data was reported using an odds ratio (OR) for intention-to-treat (ITT) and risk ratios (RR) for side effects with a 95 % confidence interval (CI).

Results: We included 91 RCTs involving 13,680 patients. Adding probiotics to standard treatment was associated with a higher H. pylori eradication rate in the ITT analysis (78.75 % vs 62.43 %, OR = 1.62, 95 % CI: 1.41 to 1.87, P < 0.0001), and per-protocol (PP) analysis (80.33 % vs 72.63 %, OR = 1.60, 95 % CI: 1.34 to 1.91, P < 0.0001). Meanwhile, dyspepsia, gastric ulcer, and peptic ulcer were comparable in both groups. The probiotics group was associated with significantly fewer side effects including, abdominal pain (RR = 0.68, 95 % CI: 0.54 to 0.86), bad taste (RR = 0.64, 95 % CI: 0.53 to 0.78), diarrhea (RR = 0.49, 95 % CI: 0.40 to 0.61), epigastric pain/bloating (RR = 0.76, 95 % CI: 0.65 to 0.88), headache/dizziness (RR = 0.46, 95 % CI: 0.29 to 0.74), (RR = 0.65, 95 % CI: 0.55 to 0.77), or nausea/vomiting (RR = 0.69, 95 % CI: 0.56 to 0.83). The network meta-analysis showed that, compared to the placebo, Bifidobacterium longum had the highest efficacy in eradicating H. pylori (ITT: 81.06 % vs 64.88 %, PP: 88 % vs 75.71 %) (OR = 2.52, 95 % CI: 1.18 to 5.49).

Conclusion: Adding probiotics to standard H. pylori therapy not only increased the rate of eradication but also reduced some of the adverse reactions throughout therapy, particularly nausea, vomiting, diarrhea, abdominal pain, epigastric pain/bloating, and taste issues.

Background: For a comprehensive evaluation and due to the inconsistent results of previous studies, we performed this meta-analysis with the aim of vitamin C effect on breast cancer and prostate cancer and colorectal cancer.

Methods: PubMed, Scopus and Web of Science were searched to identify studies on the association between vitamin C and breast cancer, prostate cancer and colorectal cancer through September 11, 2023. The pooled RR and the 95 % confidence intervals were used to measure the association between vitamin C and breast cancer, prostate cancer and colorectal cancer by assuming a random effects meta-analytic model. Newcastle-Ottawa scale was used for quality appraisal.

Results: A total of 69 studies were included. The pooled RR for the association between vitamin C (dietary) and breast cancer in the cohort study was 0.99 [95 % CI: 0.95, 1.03], but the pooled RR in the case-control study was 0.72 [95 % CI: 0.60, 0.85]. No association was found between vitamin E (supplemental, total intake) and breast cancer in studies. The pooled RR for the association between vitamin C (dietary) and prostate cancer was 0.88 [95 % CI: 0.77, 1.00], which represents a decrease in prostate cancer. No association was found between vitamin C (supplemental) and prostate cancer in studies. The pooled RR for the association between vitamin C (dietary) and colorectal cancer was 0.55 [95 % CI: 0.42, 0.73], which represents a decrease in colorectal cancer.

Conclusion: Our analysis shows an inverse significant relationship between vitamin C (dietary) and breast cancer in the case-control study. Also between vitamin C (dietary) and prostate cancer and colorectal cancer in studies, which represents a decrease in cancers.