Hyperammonemic encephalopathy is a rare but potentially fatal condition, that can occur after obesity surgery.
Case report
A 43-year-old Caucasian woman, with history of omega-loop gastric bypass, with hydrops, dyspnoea and severe malnutrition was referred for evaluation. After admission to medical department, she experienced three episodes of coma, and biochemical investigations showed hyperammonemia, hypoalbuminemia and hyperglutaminemia. Etiological investigations were not in favour of a urea cycle disorder, but rather a nutritional catastrophe with severe malnutrition secondary to the omega-loop gastric bypass.
Discussion
In patients with history of obesity surgery, encephalopathy symptoms should lead to look after hyperammonemia and malnutrition.
Conclusion
This report demonstrates the importance of ammonemia testing in case of neurological symptoms in patients with a history of obesity surgery.
{"title":"Hyperammonemic encephalopathy after omega-loop gastric bypass for obesity: A case report and discussion","authors":"Maurine Allard , Mylène Guiho , Audrey Le Ruyet-Le Henaff , Caroline Moreau , Ronan Thibault","doi":"10.1016/j.clnesp.2025.03.165","DOIUrl":"10.1016/j.clnesp.2025.03.165","url":null,"abstract":"<div><h3>Background</h3><div>Hyperammonemic encephalopathy is a rare but potentially fatal condition, that can occur after obesity surgery.</div></div><div><h3>Case report</h3><div>A 43-year-old Caucasian woman, with history of omega-loop gastric bypass, with hydrops, dyspnoea and severe malnutrition was referred for evaluation. After admission to medical department, she experienced three episodes of coma, and biochemical investigations showed hyperammonemia, hypoalbuminemia and hyperglutaminemia. Etiological investigations were not in favour of a urea cycle disorder, but rather a nutritional catastrophe with severe malnutrition secondary to the omega-loop gastric bypass.</div></div><div><h3>Discussion</h3><div>In patients with history of obesity surgery, encephalopathy symptoms should lead to look after hyperammonemia and malnutrition.</div></div><div><h3>Conclusion</h3><div>This report demonstrates the importance of ammonemia testing in case of neurological symptoms in patients with a history of obesity surgery.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 645-651"},"PeriodicalIF":2.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-09DOI: 10.1016/j.clnesp.2025.03.175
Yang Gao , Xinyi Tang , Bingjie Liu, Li Qiu
Background & aims
Obesity is a significant health concern associated with various diseases. Accurate measurement of body fat mass (BFM) and local fat thickness (FT) is crucial for health assessment. Ultrasound offers a non-invasive, portable, and cost-effective alternative for measuring FT, but its application for quantitative BFM estimation has not been fully explored. This study aimed to develop and validate a quantitative estimation algorithm for BFM based on local FT measured by ultrasound.
Methods
A total of 179 volunteers were randomly divided into modeling and verification groups. BFM was measured using bioelectrical impedance analysis (BIA), and FT was measured at 10 sites throughout the body using ultrasound. In the modeling group, the correlation between FT and BFM at different sites was analyzed, and a BFM estimation algorithm based on FT was developed using multiple linear regression. The accuracy of the estimation equation was validated in the verification group.
Results
Men had lower BFM than women (P < 0.05). At most sites, the FT of males was less than that of females (P < 0.001). Significant positive correlations were observed between FT at various sites (site 1 to 10) and BFM across all groups (P < 0.01). The estimation algorithm revealed that FT at 4 sites (intra-abdominal, posterior right perinephric, abdominal subcutaneous, and anterior upper arm) contributed to BFM estimation for men, while two additional sites (pre-peritoneal and posterior lower leg) were valuable for women. The R2 for the algorithms was 0.882 for men and 0.907 for women, with the standard error of estimate of 2.04 kg for both. The intraclass correlation coefficient between ultrasound-derived estimated BFM and the BFM measured by BIA in the verification group was 0.848 (P < 0.001).
Conclusions
BFM can be quantitatively estimated using a fitting algorithm based on ultrasound-derived local FT.
{"title":"Application of ultrasound for quantitative assessment of body fat mass","authors":"Yang Gao , Xinyi Tang , Bingjie Liu, Li Qiu","doi":"10.1016/j.clnesp.2025.03.175","DOIUrl":"10.1016/j.clnesp.2025.03.175","url":null,"abstract":"<div><h3>Background & aims</h3><div>Obesity is a significant health concern associated with various diseases. Accurate measurement of body fat mass (BFM) and local fat thickness (FT) is crucial for health assessment. Ultrasound offers a non-invasive, portable, and cost-effective alternative for measuring FT, but its application for quantitative BFM estimation has not been fully explored. This study aimed to develop and validate a quantitative estimation algorithm for BFM based on local FT measured by ultrasound.</div></div><div><h3>Methods</h3><div>A total of 179 volunteers were randomly divided into modeling and verification groups. BFM was measured using bioelectrical impedance analysis (BIA), and FT was measured at 10 sites throughout the body using ultrasound. In the modeling group, the correlation between FT and BFM at different sites was analyzed, and a BFM estimation algorithm based on FT was developed using multiple linear regression. The accuracy of the estimation equation was validated in the verification group.</div></div><div><h3>Results</h3><div>Men had lower BFM than women (<em>P</em> < 0.05). At most sites, the FT of males was less than that of females (<em>P</em> < 0.001). Significant positive correlations were observed between FT at various sites (site 1 to 10) and BFM across all groups (<em>P</em> < 0.01). The estimation algorithm revealed that FT at 4 sites (intra-abdominal, posterior right perinephric, abdominal subcutaneous, and anterior upper arm) contributed to BFM estimation for men, while two additional sites (pre-peritoneal and posterior lower leg) were valuable for women. The R<sup>2</sup> for the algorithms was 0.882 for men and 0.907 for women, with the standard error of estimate of 2.04 kg for both. The intraclass correlation coefficient between ultrasound-derived estimated BFM and the BFM measured by BIA in the verification group was 0.848 (<em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>BFM can be quantitatively estimated using a fitting algorithm based on ultrasound-derived local FT.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 635-644"},"PeriodicalIF":2.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-08DOI: 10.1016/j.clnesp.2025.03.052
Tehreema Ghaffar, Francesca Ubaldi, Federica Valeriani, Vincenzo Romano Spica
Background
Athletes in different sports may experience a change in the physical performance during Ramadan Intermittent Fasting (RIF). The impacts of fasting on performance, coping behaviour and fatigue in athletes have not been fully researched.
Objective
To examines the effects of Ramadan Intermittent Fasting (RIF) on the physical performance of athletes in different types of sports. The approaches used to assess effects of intermittent fasting among young athletes have not yet been systematically reviewed.
Method
Following PRISMA guidelines, 3 independent searches on different databases to identify all the articles describing effects of RIF on physical performance of athletes with all available articles from 2014 up to April 2024.
Results
Among 422 articles identified, 31 studies met eligibility criteria. Fourteen studies reported the effect of Ramadan fasting on individual sports, three studies on combat sports, and fourteen studies on team sports.
Conclusion
The RIF negatively effects the physical performance, players coping behavior, nutritional status and fatigue capacities in different sports, although, the negative effects are greater for Handball, Basketball, Volleyball, Football and Swimming although the impact is less negative for Tennis, Badminton, Martial arts and Endurance sports. The athletes who maintain their total energy and macronutrient intake, training load, body composition, sleep length and quality are unlikely to suffer any substantial decrements in performance during Ramadan. Adding other recovery methods could improve performance and reduce the fatigue and muscle soreness experienced with increased game frequency during RIF.
{"title":"A review of the impact of intermittent ramadan fasting on wellbeing, nutrition and physical performance in different sports","authors":"Tehreema Ghaffar, Francesca Ubaldi, Federica Valeriani, Vincenzo Romano Spica","doi":"10.1016/j.clnesp.2025.03.052","DOIUrl":"10.1016/j.clnesp.2025.03.052","url":null,"abstract":"<div><h3>Background</h3><div>Athletes in different sports may experience a change in the physical performance during Ramadan Intermittent Fasting (RIF). The impacts of fasting on performance, coping behaviour and fatigue in athletes have not been fully researched.</div></div><div><h3>Objective</h3><div>To examines the effects of Ramadan Intermittent Fasting (RIF) on the physical performance of athletes in different types of sports. The approaches used to assess effects of intermittent fasting among young athletes have not yet been systematically reviewed.</div></div><div><h3>Method</h3><div>Following PRISMA guidelines, 3 independent searches on different databases to identify all the articles describing effects of RIF on physical performance of athletes with all available articles from 2014 up to April 2024.</div></div><div><h3>Results</h3><div>Among 422 articles identified, 31 studies met eligibility criteria. Fourteen studies reported the effect of Ramadan fasting on individual sports, three studies on combat sports, and fourteen studies on team sports.</div></div><div><h3>Conclusion</h3><div>The RIF negatively effects the physical performance, players coping behavior, nutritional status and fatigue capacities in different sports, although, the negative effects are greater for Handball, Basketball, Volleyball, Football and Swimming although the impact is less negative for Tennis, Badminton, Martial arts and Endurance sports. The athletes who maintain their total energy and macronutrient intake, training load, body composition, sleep length and quality are unlikely to suffer any substantial decrements in performance during Ramadan. Adding other recovery methods could improve performance and reduce the fatigue and muscle soreness experienced with increased game frequency during RIF.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 585-598"},"PeriodicalIF":2.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-04DOI: 10.1016/j.clnesp.2025.03.172
Valerie K. Sullivan , Jingsha Chen , Lauren Bernard , Bing Yu , Erin D. Michos , Lawrence J. Appel , Alice H. Lichtenstein , Casey M. Rebholz
Background & aims
Vitamin D regulates calcium and phosphorus homeostasis, skeletal health, and potentially other aspects of health. There are limitations of existing vitamin D biomarkers. We aimed to discover novel vitamin D biomarkers by investigating serum and urine metabolites associated with vitamin D supplementation.
Methods
We examined cross-sectional associations between vitamin D supplementation and serum and urine metabolites in Atherosclerosis Risk in Communities Study participants at visit 5 (2011–2013). Untargeted metabolomic profiling of serum and spot urine samples was performed by Metabolon, Inc. We analyzed associations between vitamin D supplementation and log2-transformed metabolites using linear regression models adjusted for demographic, lifestyle, and health covariates.
Results
Of 5225 participants with serum metabolites analyzed (mean age 76 [SD 5] years, 57 % female, 20 % Black), 45 % reported taking vitamin D supplements. Eighty-two of 933 serum metabolites were associated with vitamin D supplementation (P < 0.05/933). Most were lipids (n = 36). Of 1565 participants with urine metabolites analyzed, one-third (37 %) used vitamin D. Nineteen of 946 urine metabolites were associated with vitamin D supplementation (P < 0.05/946). Most were cofactors and vitamins (n = 12). After adjusting for other supplement use (multivitamin/mineral, omega-3, B and C vitamins), 5 serum metabolites (pro-hydroxy-pro, pyroglutamine, sulfate, creatine, and 2-hydroxypalmitate) and no urine metabolites were significantly associated with vitamin D supplementation.
Conclusions
Many serum and urine metabolites were associated with vitamin D supplementation. Five serum metabolites remained associated with vitamin D after adjustment for other dietary supplements, including metabolites of bone collagen degradation, glutathione metabolism, and sphingolipid metabolism. These metabolites may reflect physiological activities of vitamin D and, thus, improve assessment of vitamin D adequacy to achieve functional outcomes. These merit further investigation as potential vitamin D biomarkers.
{"title":"Serum and urine metabolite correlates of vitamin D supplementation in the Atherosclerosis Risk in Communities (ARIC) study","authors":"Valerie K. Sullivan , Jingsha Chen , Lauren Bernard , Bing Yu , Erin D. Michos , Lawrence J. Appel , Alice H. Lichtenstein , Casey M. Rebholz","doi":"10.1016/j.clnesp.2025.03.172","DOIUrl":"10.1016/j.clnesp.2025.03.172","url":null,"abstract":"<div><h3>Background & aims</h3><div>Vitamin D regulates calcium and phosphorus homeostasis, skeletal health, and potentially other aspects of health. There are limitations of existing vitamin D biomarkers. We aimed to discover novel vitamin D biomarkers by investigating serum and urine metabolites associated with vitamin D supplementation.</div></div><div><h3>Methods</h3><div>We examined cross-sectional associations between vitamin D supplementation and serum and urine metabolites in Atherosclerosis Risk in Communities Study participants at visit 5 (2011–2013). Untargeted metabolomic profiling of serum and spot urine samples was performed by Metabolon, Inc. We analyzed associations between vitamin D supplementation and log<sub>2</sub>-transformed metabolites using linear regression models adjusted for demographic, lifestyle, and health covariates.</div></div><div><h3>Results</h3><div>Of 5225 participants with serum metabolites analyzed (mean age 76 [SD 5] years, 57 % female, 20 % Black), 45 % reported taking vitamin D supplements. Eighty-two of 933 serum metabolites were associated with vitamin D supplementation (P < 0.05/933). Most were lipids (n = 36). Of 1565 participants with urine metabolites analyzed, one-third (37 %) used vitamin D. Nineteen of 946 urine metabolites were associated with vitamin D supplementation (P < 0.05/946). Most were cofactors and vitamins (n = 12). After adjusting for other supplement use (multivitamin/mineral, omega-3, B and C vitamins), 5 serum metabolites (pro-hydroxy-pro, pyroglutamine, sulfate, creatine, and 2-hydroxypalmitate) and no urine metabolites were significantly associated with vitamin D supplementation.</div></div><div><h3>Conclusions</h3><div>Many serum and urine metabolites were associated with vitamin D supplementation. Five serum metabolites remained associated with vitamin D after adjustment for other dietary supplements, including metabolites of bone collagen degradation, glutathione metabolism, and sphingolipid metabolism. These metabolites may reflect physiological activities of vitamin D and, thus, improve assessment of vitamin D adequacy to achieve functional outcomes. These merit further investigation as potential vitamin D biomarkers.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 523-532"},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The prevalence of undernutrition in hospitalized patients and its impact on their length of stay (LOS) varies considerably depending on the population studied, the diagnosis criteria or the screening tools used. Previous reports using controlled data have been done on small populations while large cohorts have been studied on unverified declarative data. This study aims at determining the prevalence of undernutrition in a large population using verified anthropometric data and assessing its impact on the LOS.
Methods
– For 10 years (2007–2017), a specialized nutritional assessment unit screened inpatients in a tertiary hospital for undernutrition, with the exception of those in emergency and intensive care, orthopedics, pediatrics and maternity wards. Within each unit, screening was carried out every two to three weeks. The diagnosis of undernutrition in adult inpatients was made using body mass index (BMI) (<18.5 kg/m2 for age <70 or < 21 kg/m2 for age ≥70) or weight loss (weight loss >5 % over a month or >10 % over 6 months). We retrospectively analyzed this database, looking at all adults (>18 years) hospitalized for at least one day. The analysis of the prevalence of undernutrition and its consequence on the LOS was performed on the entire population as well as by sex, age groups and diagnosis-related groups (DRGs). Statistics were performed using the chi-square test, T-test, ANOVA and mixed linear analysis. Age and gender were added as potential confounders, while DRG was included as a random effect.
Results
The analysis included data from 65,226 stays. Mean age 65 years (min 18, max 113), 58.2 % male patients. The overall prevalence of undernutrition was 29.77 %, lower in the 40 to 70-year-old group than in the younger and older population. Undernutrition was present in all of the 53 surveyed DRGs, with a prevalence ranging from 12 % to 57.89 %. In the overall population, undernourished patients had a longer LOS than well-nourished patients, with a median increase of 5 days. In 42 of the 53 DRGs, representing 97.57 % of the total population, undernutrition significantly increased the LOS.
Conclusions
This large study of the prevalence of undernutrition diagnosed from verified anthropometric data in hospitalized adults does not confirm recent findings obtained from unverified data in hospital databases.
{"title":"Undernutrition in adult hospitalized patients and its impact on the length of stay, a 10-year repeated cross-sectional study analyzing 65,226 stays","authors":"Thierry Chevalier , Josiane Arnaud , Jérôme Fauconnier , Eric Fontaine","doi":"10.1016/j.clnesp.2025.04.001","DOIUrl":"10.1016/j.clnesp.2025.04.001","url":null,"abstract":"<div><h3>Background & aims</h3><div>The prevalence of undernutrition in hospitalized patients and its impact on their length of stay (LOS) varies considerably depending on the population studied, the diagnosis criteria or the screening tools used. Previous reports using controlled data have been done on small populations while large cohorts have been studied on unverified declarative data. This study aims at determining the prevalence of undernutrition in a large population using verified anthropometric data and assessing its impact on the LOS.</div></div><div><h3>Methods</h3><div>– For 10 years (2007–2017), a specialized nutritional assessment unit screened inpatients in a tertiary hospital for undernutrition, with the exception of those in emergency and intensive care, orthopedics, pediatrics and maternity wards. Within each unit, screening was carried out every two to three weeks. The diagnosis of undernutrition in adult inpatients was made using body mass index (BMI) (<18.5 kg/m<sup>2</sup> for age <70 or < 21 kg/m<sup>2</sup> for age ≥70) or weight loss (weight loss >5 % over a month or >10 % over 6 months). We retrospectively analyzed this database, looking at all adults (>18 years) hospitalized for at least one day. The analysis of the prevalence of undernutrition and its consequence on the LOS was performed on the entire population as well as by sex, age groups and diagnosis-related groups (DRGs). Statistics were performed using the chi-square test, T-test, ANOVA and mixed linear analysis. Age and gender were added as potential confounders, while DRG was included as a random effect.</div></div><div><h3>Results</h3><div>The analysis included data from 65,226 stays. Mean age 65 years (min 18, max 113), 58.2 % male patients. The overall prevalence of undernutrition was 29.77 %, lower in the 40 to 70-year-old group than in the younger and older population. Undernutrition was present in all of the 53 surveyed DRGs, with a prevalence ranging from 12 % to 57.89 %. In the overall population, undernourished patients had a longer LOS than well-nourished patients, with a median increase of 5 days. In 42 of the 53 DRGs, representing 97.57 % of the total population, undernutrition significantly increased the LOS.</div></div><div><h3>Conclusions</h3><div>This large study of the prevalence of undernutrition diagnosed from verified anthropometric data in hospitalized adults does not confirm recent findings obtained from unverified data in hospital databases.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 533-540"},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Since malnutrition is a risk factor for postoperative complications, preoperative nutritional therapy is recommended to reduce postoperative complications. Few meta-analyses conducted exclusively in cancer patients have shown that perioperative standard nutritional therapy reduces postoperative complications. This study examined whether preoperative or combined preoperative and postoperative standard nutritional therapy reduced postoperative complications in patients with head and neck or gastrointestinal (GI) cancer.
Methods
We conducted randomized controlled trials in 1979–2021. Patients who received standard nutritional interventions were classified as the intervention group and those who did not receive any nutritional intervention as controls. The primary outcome was the total number of postoperative complications and infectious complications.
Results
In total, 19 studies were included (n = 2047). Of 19 studies, 5 were for upper GI cancer, 8 were for lower GI cancer, 5 were for upper and lower GI cancers, and 1 was for head and neck cancer. Total postoperative and infectious complications were reported in 15 (n = 1762) and 9 (n = 905) studies. The meta-analysis showed that standard nutritional interventions may reduce the total complication rates (RR: 0.78, 95 % CI: 0.65–0.94) and infectious complications (RR: 0.67, 95 % CI: 0.51–0.87). There were no significant differences in subgroup analyses, according to the nutritional therapy timing and nutritional status. The risk of bias was high for random sequence generation, allocation concealment, and participants' and data analysts’ blinding. COE for total postoperative and infectious complications was weak and inconsistent due to the high risk of bias and substantial heterogeneity.
Conclusion
Although the present study was inconclusive due to the small number of studies in head and neck cancer, preoperative or combined preoperative and postoperative standard nutrition therapy in patients with GI cancer may significantly reduce the incidence of postoperative complications. Further studies are needed to confirm these findings and to reduce the risk of bias.
{"title":"Perioperative or combined preoperative and postoperative standard nutrition therapy for patients with head and neck or gastrointestinal cancer: A systematic review and meta-analysis","authors":"Masano Sagawa , Ryota Matsui , Akihiko Sano , Makoto Sakai , Shinichiro Hiraoka , Isao Tabei , Takayuki Imai , Hideo Matsumoto , Seiji Onogawa , Norihiro Sonoi , Shigeyuki Nagata , Ryo Ogawa , Shigeki Wakiyama , Yasuhiro Miyazaki , Koshi Kumagai , Rie Tsutsumi , Takehiro Okabayashi , Yu Uneno , Naoki Higashibeppu , Joji Kotani","doi":"10.1016/j.clnesp.2025.03.170","DOIUrl":"10.1016/j.clnesp.2025.03.170","url":null,"abstract":"<div><h3>Background & aims</h3><div>Since malnutrition is a risk factor for postoperative complications, preoperative nutritional therapy is recommended to reduce postoperative complications. Few meta-analyses conducted exclusively in cancer patients have shown that perioperative standard nutritional therapy reduces postoperative complications. This study examined whether preoperative or combined preoperative and postoperative standard nutritional therapy reduced postoperative complications in patients with head and neck or gastrointestinal (GI) cancer.</div></div><div><h3>Methods</h3><div>We conducted randomized controlled trials in 1979–2021. Patients who received standard nutritional interventions were classified as the intervention group and those who did not receive any nutritional intervention as controls. The primary outcome was the total number of postoperative complications and infectious complications.</div></div><div><h3>Results</h3><div>In total, 19 studies were included (n = 2047). Of 19 studies, 5 were for upper GI cancer, 8 were for lower GI cancer, 5 were for upper and lower GI cancers, and 1 was for head and neck cancer. Total postoperative and infectious complications were reported in 15 (n = 1762) and 9 (n = 905) studies. The meta-analysis showed that standard nutritional interventions may reduce the total complication rates (RR: 0.78, 95 % CI: 0.65–0.94) and infectious complications (RR: 0.67, 95 % CI: 0.51–0.87). There were no significant differences in subgroup analyses, according to the nutritional therapy timing and nutritional status. The risk of bias was high for random sequence generation, allocation concealment, and participants' and data analysts’ blinding. COE for total postoperative and infectious complications was weak and inconsistent due to the high risk of bias and substantial heterogeneity.</div></div><div><h3>Conclusion</h3><div>Although the present study was inconclusive due to the small number of studies in head and neck cancer, preoperative or combined preoperative and postoperative standard nutrition therapy in patients with GI cancer may significantly reduce the incidence of postoperative complications. Further studies are needed to confirm these findings and to reduce the risk of bias.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 567-577"},"PeriodicalIF":2.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-03DOI: 10.1016/j.clnesp.2025.03.167
Celi Yang , Xiaona Na , Haibing Yang , Menglu Xi , Yucheng Yang , Yalu Yan , Sufang Duan , Ting Li , Ignatius Man-Yau Szeto , Ai Zhao
Background & aims
Postpartum sleep disorder and mental disorders are common unpleasant conditions faced by women after delivery, and they have many adverse effects on both mothers and infants. It is unclear whether breast milk composition is affected by maternal sleep, psychological state, diet and gut microbiome. This study aims to explore the effects of these key factors on the functional protein components of breast milk.
Methods
With a prospective design, this pilot study included a total of 41 postpartum women. Breast milk and maternal faecal samples collected at 42 days and 3 months postpartum were tested by liquid chromatography-mass spectrometry and 16S RNA sequencing, respectively. Sleep state, psychological state and dietary intake data were also collected from the mothers with validated questionnaires.
Results
In the early postpartum period, sleep disorders and depression were associated with a decrease in the functional proteins in breast milk. Disordered sleep was significantly negatively correlated with α-lactalbumin (cor = −0.578, p < 0.001), osteopontin (cor = −0.522, p < 0.01) and κ-casein (cor = −0.451, p < 0.01). Depression was negatively correlated with αs1-casein (cor = −0.422, p < 0.01), β-casein (cor = −0.317, p < 0.05) and casein (cor = −0.318, p < 0.05). In 3 months postpartum, most associations were disappeared. But a positive correlation was observed between β-casein (cor = 0.414, p < 0.01), casein (cor = 0.372, p < 0.05), total protein (cor = 0.376, p < 0.05) and depression, while a positive correlation was found between total protein (cor = 0.357, p < 0.05) and disordered sleep at 3 months postpartum. Faecal microbiome data illustrated that changes in the gut microbiome at early postpartum were associated with sleep disorders/depression, but not with the diet. Furthermore, functional pathway analysis revealed metabolic regulation in the amino acid synthesis and metabolic pathways associated with specific microbes was involved in the reduction of breast milk protein.
Conclusion
Sleep disorders/depression could lead to significant changes in breast milk profiles at 42 days postpartum. Maternal gut microbiome might affect breast milk protein composition through regulating amino acid synthesis and metabolic pathways.
{"title":"Maternal sleep and psychological status in the postpartum period are associated with functional protein alterations in breast milk:a mother-infant cohort study","authors":"Celi Yang , Xiaona Na , Haibing Yang , Menglu Xi , Yucheng Yang , Yalu Yan , Sufang Duan , Ting Li , Ignatius Man-Yau Szeto , Ai Zhao","doi":"10.1016/j.clnesp.2025.03.167","DOIUrl":"10.1016/j.clnesp.2025.03.167","url":null,"abstract":"<div><h3>Background & aims</h3><div>Postpartum sleep disorder and mental disorders are common unpleasant conditions faced by women after delivery, and they have many adverse effects on both mothers and infants. It is unclear whether breast milk composition is affected by maternal sleep, psychological state, diet and gut microbiome. This study aims to explore the effects of these key factors on the functional protein components of breast milk.</div></div><div><h3>Methods</h3><div>With a prospective design, this pilot study included a total of 41 postpartum women. Breast milk and maternal faecal samples collected at 42 days and 3 months postpartum were tested by liquid chromatography-mass spectrometry and 16S RNA sequencing, respectively. Sleep state, psychological state and dietary intake data were also collected from the mothers with validated questionnaires.</div></div><div><h3>Results</h3><div>In the early postpartum period, sleep disorders and depression were associated with a decrease in the functional proteins in breast milk. Disordered sleep was significantly negatively correlated with α-lactalbumin (cor = −0.578, p < 0.001), osteopontin (cor = −0.522, p < 0.01) and κ-casein (cor = −0.451, p < 0.01). Depression was negatively correlated with αs1-casein (cor = −0.422, p < 0.01), β-casein (cor = −0.317, p < 0.05) and casein (cor = −0.318, p < 0.05). In 3 months postpartum, most associations were disappeared. But a positive correlation was observed between β-casein (cor = 0.414, p < 0.01), casein (cor = 0.372, p < 0.05), total protein (cor = 0.376, p < 0.05) and depression, while a positive correlation was found between total protein (cor = 0.357, p < 0.05) and disordered sleep at 3 months postpartum. Faecal microbiome data illustrated that changes in the gut microbiome at early postpartum were associated with sleep disorders/depression, but not with the diet. Furthermore, functional pathway analysis revealed metabolic regulation in the amino acid synthesis and metabolic pathways associated with specific microbes was involved in the reduction of breast milk protein.</div></div><div><h3>Conclusion</h3><div>Sleep disorders/depression could lead to significant changes in breast milk profiles at 42 days postpartum. Maternal gut microbiome might affect breast milk protein composition through regulating amino acid synthesis and metabolic pathways.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 510-522"},"PeriodicalIF":2.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-03DOI: 10.1016/j.clnesp.2025.03.168
Jinxiong Zhang , Shuoling Zhou , Yurong Jiang , Wei Zhao , Weiguo Xu , Jiawei Zhang , Taixue An , Jianfeng Yan , Chongyang Duan , Xiaojun Wang , Sihui Yang , Tao Wang , Dandan Dong , Yuan Chen , Feixiang Zou , Xiangrong Yu , Meiyan Huang , Sirui Fu
Background
Changes in protein and lipid metabolism could provide additional prognostic information for hepatocellular carcinoma (HCC).This study aimed to explore whether 3D automatic assessment of skeletal muscle and adipose tissue can contribute to the precise prognosis for HCC.
Methods
The data of 458 HCC patients from 6 hospitals were divided into training and external validation datasets. Preoperative CT Images were used for this study. First, we tested the stability of the 2D factors. Second, we tested whether standardization for volume assessment was necessary. Third, we compared the clinical (ModelC), skeletal muscle and adipose tissue (ModelNSA), and combined (ModelC−NSA) models by discrimination and calibration to identify the optimal model. Subgroup analysis was performed for the optimal model.
Results
For the 16 2D factors, 13 factors were statistically different among the three 2D slices. Standardization of the volume factors was necessary. Among the three models, ModelC−NSA had a higher area under the curve [AUC] than ModelC and ModelNSA, both in the training dataset (0.809 vs. 0.649 vs. 0.797) and the validation dataset (0.770 vs. 0.718 vs. 0.719). For calibration, the performance of ModelC−NSA was similar to those of ModelC and ModelNSA. The performance of ModelC−NSA was not influenced by age (P = 0.753), sex (P = 0.781), treatments (P = 0.504), Barcelona Clinic Liver Cancer stage (P = 0.913), or Child-Pugh class (P = 0.580).
Conclusions
Compared to 2D evaluation, 3D assessment is more stable. 3D automatic assessment of skeletal muscle and adipose tissue can accurately predict progression in patients with HCC.
{"title":"3D assessment of skeletal muscle and adipose tissue for prognosis of hepatocellular carcinoma: A multicenter cohort study","authors":"Jinxiong Zhang , Shuoling Zhou , Yurong Jiang , Wei Zhao , Weiguo Xu , Jiawei Zhang , Taixue An , Jianfeng Yan , Chongyang Duan , Xiaojun Wang , Sihui Yang , Tao Wang , Dandan Dong , Yuan Chen , Feixiang Zou , Xiangrong Yu , Meiyan Huang , Sirui Fu","doi":"10.1016/j.clnesp.2025.03.168","DOIUrl":"10.1016/j.clnesp.2025.03.168","url":null,"abstract":"<div><h3>Background</h3><div>Changes in protein and lipid metabolism could provide additional prognostic information for hepatocellular carcinoma (HCC).This study aimed to explore whether 3D automatic assessment of skeletal muscle and adipose tissue can contribute to the precise prognosis for HCC.</div></div><div><h3>Methods</h3><div>The data of 458 HCC patients from 6 hospitals were divided into training and external validation datasets. Preoperative CT Images were used for this study. First, we tested the stability of the 2D factors. Second, we tested whether standardization for volume assessment was necessary. Third, we compared the clinical (Model<sup>C</sup>), skeletal muscle and adipose tissue (Model<sup>NSA</sup>), and combined (Model<sup>C−NSA</sup>) models by discrimination and calibration to identify the optimal model. Subgroup analysis was performed for the optimal model.</div></div><div><h3>Results</h3><div>For the 16 2D factors, 13 factors were statistically different among the three 2D slices. Standardization of the volume factors was necessary. Among the three models, Model<sup>C−NSA</sup> had a higher area under the curve [AUC] than Model<sup>C</sup> and Model<sup>NSA</sup>, both in the training dataset (0.809 vs. 0.649 vs. 0.797) and the validation dataset (0.770 vs. 0.718 vs. 0.719). For calibration, the performance of Model<sup>C−NSA</sup> was similar to those of Model<sup>C</sup> and Model<sup>NSA</sup>. The performance of Model<sup>C−NSA</sup> was not influenced by age (<em>P</em> = 0.753), sex (<em>P</em> = 0.781), treatments (<em>P</em> = 0.504), Barcelona Clinic Liver Cancer stage (<em>P</em> = 0.913), or Child-Pugh class (<em>P</em> = 0.580).</div></div><div><h3>Conclusions</h3><div>Compared to 2D evaluation, 3D assessment is more stable. 3D automatic assessment of skeletal muscle and adipose tissue can accurately predict progression in patients with HCC.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 626-634"},"PeriodicalIF":2.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-03DOI: 10.1016/j.clnesp.2025.03.173
Jia-Yi Tuo , Qiu-Ming Shen , Zhuo-Ying Li , Dan-Ni Yang , Yi-Xin Zou , Yu-Ting Tan , Hong-Lan Li , Yong-Bing Xiang
Background and aims
Although dietary factors have been extensively investigated as potential risk factors for liver cancer, the evidence is inconclusive. Our study systematically assessed the associations between ten dietary guidelines compliance scores and liver cancer risk among adult people, and found out the dietary patterns for liver cancer prevention.
Methods
Participants of 59,844 men and 72,680 women, aged 40–74 years and living in urban Shanghai, were included in two prospective cohort studies conducted between 2002–2006 and 1996–2000, respectively. Dietary intakes were assessed during baseline in-person interviews using validated food-frequency questionnaires, and dietary guideline compliance scores were calculated by adjusting for total energy intake and adapting existing dietary recommendations. Hazards ratios (HRs) with 95 % confidence intervals (CIs) were evaluated by both tertile categories and per standard deviation (SD) increment using Cox proportional hazard regression models to assess the associations between ten dietary guideline compliance scores and liver cancer risk.
Results
In the two cohorts, 431 male and 256 female incident liver cancer cases were identified during a mean follow-up of 11.90 and 17.44 years, respectively. There were no statistically significant associations between these ten dietary guidelines and male liver cancer risk (P > 0.05). In contrast, only the modified reversed Empirical Dietary Inflammation Pattern (rEDIP) tended to be associated with the low risk of female liver cancer (HR T3 vs. T1 = 0.67, 95 % CI: 0.48–0.92, Ptrend = 0.016, HR per SD = 0.94, 95 % CI: 0.85–1.03). The inverse associations appeared stronger between rEDIP and liver cancer risk at younger ages (<55 years) in women (HR per SD = 0.91, 95 % CI: 0.84–0.99) compared to the older women (≥55 years). There were suggestive but non-significant inverse associations between the modified Diabetes Risk Reduction Diet (mDRRD) (men: HR per SD = 0.92, 95 % CI: 0.84–1.02; women: HR per SD = 0.97, 95 % CI: 0.84–1.02) and the modified World Cancer Research Fund/American Institute for Cancer Research (mWCRF/AICR) (men: HR per SD = 0.93, 95 % CI: 0.84–1.02; women: HR per SD = 0.91, 95 % CI: 0.80–1.03) and liver cancer incidence. The associations of mDRRD (HR per SD = 0.82, 95 % CI: 0.75–0.98) and mWCRF/AICR (HR per SD = 0.83, 95 % CI: 0.74–0.99) on liver cancer risk were significant in men who ever smoked.
Conclusions
Our findings confirm that greater adherence to some healthy dietary patterns (i.e. rEDIP, mDRRD and mWCRF/AICR) is inversely associated with liver cancer risk, especially in certain populations. Future studies are required to confirm these findings and elucidate potential mechanisms.
{"title":"Adherence to dietary guidelines and liver cancer risk: Results from two prospective cohort studies","authors":"Jia-Yi Tuo , Qiu-Ming Shen , Zhuo-Ying Li , Dan-Ni Yang , Yi-Xin Zou , Yu-Ting Tan , Hong-Lan Li , Yong-Bing Xiang","doi":"10.1016/j.clnesp.2025.03.173","DOIUrl":"10.1016/j.clnesp.2025.03.173","url":null,"abstract":"<div><h3>Background and aims</h3><div>Although dietary factors have been extensively investigated as potential risk factors for liver cancer, the evidence is inconclusive. Our study systematically assessed the associations between ten dietary guidelines compliance scores and liver cancer risk among adult people, and found out the dietary patterns for liver cancer prevention.</div></div><div><h3>Methods</h3><div>Participants of 59,844 men and 72,680 women, aged 40–74 years and living in urban Shanghai, were included in two prospective cohort studies conducted between 2002–2006 and 1996–2000, respectively. Dietary intakes were assessed during baseline in-person interviews using validated food-frequency questionnaires, and dietary guideline compliance scores were calculated by adjusting for total energy intake and adapting existing dietary recommendations. Hazards ratios (HRs) with 95 % confidence intervals (CIs) were evaluated by both tertile categories and per standard deviation (SD) increment using Cox proportional hazard regression models to assess the associations between ten dietary guideline compliance scores and liver cancer risk.</div></div><div><h3>Results</h3><div>In the two cohorts, 431 male and 256 female incident liver cancer cases were identified during a mean follow-up of 11.90 and 17.44 years, respectively. There were no statistically significant associations between these ten dietary guidelines and male liver cancer risk (<em>P</em> > 0.05). In contrast, only the modified reversed Empirical Dietary Inflammation Pattern (rEDIP) tended to be associated with the low risk of female liver cancer (HR <sub>T3 vs. T1</sub> = 0.67, 95 % CI: 0.48–0.92, <em>P</em> <sub><em>trend</em></sub> = 0.016, HR per SD = 0.94, 95 % CI: 0.85–1.03). The inverse associations appeared stronger between rEDIP and liver cancer risk at younger ages (<55 years) in women (HR per SD = 0.91, 95 % CI: 0.84–0.99) compared to the older women (≥55 years). There were suggestive but non-significant inverse associations between the modified Diabetes Risk Reduction Diet (mDRRD) (men: HR per SD = 0.92, 95 % CI: 0.84–1.02; women: HR per SD = 0.97, 95 % CI: 0.84–1.02) and the modified World Cancer Research Fund/American Institute for Cancer Research (mWCRF/AICR) (men: HR per SD = 0.93, 95 % CI: 0.84–1.02; women: HR per SD = 0.91, 95 % CI: 0.80–1.03) and liver cancer incidence. The associations of mDRRD (HR per SD = 0.82, 95 % CI: 0.75–0.98) and mWCRF/AICR (HR per SD = 0.83, 95 % CI: 0.74–0.99) on liver cancer risk were significant in men who ever smoked.</div></div><div><h3>Conclusions</h3><div>Our findings confirm that greater adherence to some healthy dietary patterns (i.e. rEDIP, mDRRD and mWCRF/AICR) is inversely associated with liver cancer risk, especially in certain populations. Future studies are required to confirm these findings and elucidate potential mechanisms.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 599-611"},"PeriodicalIF":2.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-03DOI: 10.1016/j.clnesp.2025.03.174
You Sun , Yong Zhang , Xiaokang Niu , Yan Liu , Lingling Xu , Yifan Wang , Qi Zhang , Jingjing He , Yinghua Liu , Kaishuai Zhang , Ran Wang , Jian He , Jie Guo
Background & aims
Lactose-hydrolyzed milk is widely used to address lactose intolerance. However, its monosaccharide content may rapidly increase postprandial blood glucose levels and heighten glycemic variability. We aimed to explore the effects of mulberry leaf and corn silk extracts (medicinal and edible homologous materials) and their supplementation in lactose-hydrolyzed milk on postprandial glycemic control in adults with type 2 diabetes.
Methods
Eligible participants in this crossover trial were randomized to four interventions, separated by a 7 d washout. Intervention foods were whole-grain bread (50 g carbohydrates) together with water, mulberry leaf and corn silk extracts (MCE), lactose-hydrolyzed milk (LHM), or lactose-hydrolyzed milk supplemented with mulberry leaf and corn silk extracts (LHM-MCE). Continuous glucose monitoring systems were used to collect fasting and postprandial interstitial glucose over 2 h after interventions and to calculate the incremental area under the curve (iAUC). Paired Wilcoxon signed-rank test was used to compare the difference in iAUC, 1-h postprandial glycemic (1h PG), 2h PG, maximum glycemic, and maximum glucose excursion from baseline across interventions.
Results
Twenty-eight adults with type 2 diabetes (55 ± 10 years old, fasting blood glucose: 6.93 ± 1.22 mmol/L) completed the trial. MCE was associated with lower levels of maximum glycemic (median of difference [interquartile range]: (−0.9 [−1.9, 0.4], P = 0.025) and maximum glucose excursion from baseline (−0.9 [−1.5, −0.03], P = 0.005) compared to water. LHM-MCE was associated with lower levels of 1h PG (−0.7 [−1.9, 0.4], P = 0.04), maximum glycemic (−0.9 [−2.2, 0.4], P = 0.014), and maximum glucose excursion from baseline (−1.0 [−2.3, −0.4], P = 0.003) compared to LHM.
Conclusions
Mulberry leaf and corn silk extracts may benefit postprandial glycemic control and their incorporation into lactose-hydrolyzed milk could be a promising dietary intervention for patients with type 2 diabetes.
{"title":"Postprandial glycemic effects of lactose-hydrolyzed milk supplemented with mulberry leaf and corn silk extracts in adults with type 2 diabetes: A randomized crossover trial","authors":"You Sun , Yong Zhang , Xiaokang Niu , Yan Liu , Lingling Xu , Yifan Wang , Qi Zhang , Jingjing He , Yinghua Liu , Kaishuai Zhang , Ran Wang , Jian He , Jie Guo","doi":"10.1016/j.clnesp.2025.03.174","DOIUrl":"10.1016/j.clnesp.2025.03.174","url":null,"abstract":"<div><h3>Background & aims</h3><div>Lactose-hydrolyzed milk is widely used to address lactose intolerance. However, its monosaccharide content may rapidly increase postprandial blood glucose levels and heighten glycemic variability. We aimed to explore the effects of mulberry leaf and corn silk extracts (medicinal and edible homologous materials) and their supplementation in lactose-hydrolyzed milk on postprandial glycemic control in adults with type 2 diabetes.</div></div><div><h3>Methods</h3><div>Eligible participants in this crossover trial were randomized to four interventions, separated by a 7 d washout. Intervention foods were whole-grain bread (50 g carbohydrates) together with water, mulberry leaf and corn silk extracts (MCE), lactose-hydrolyzed milk (LHM), or lactose-hydrolyzed milk supplemented with mulberry leaf and corn silk extracts (LHM-MCE). Continuous glucose monitoring systems were used to collect fasting and postprandial interstitial glucose over 2 h after interventions and to calculate the incremental area under the curve (iAUC). Paired Wilcoxon signed-rank test was used to compare the difference in iAUC, 1-h postprandial glycemic (1h PG), 2h PG, maximum glycemic, and maximum glucose excursion from baseline across interventions.</div></div><div><h3>Results</h3><div>Twenty-eight adults with type 2 diabetes (55 ± 10 years old, fasting blood glucose: 6.93 ± 1.22 mmol/L) completed the trial. MCE was associated with lower levels of maximum glycemic (median of difference [interquartile range]: (−0.9 [−1.9, 0.4], <em>P = 0.025</em>) and maximum glucose excursion from baseline (−0.9 [−1.5, −0.03], <em>P = 0.005</em>) compared to water. LHM-MCE was associated with lower levels of 1h PG (−0.7 [−1.9, 0.4], <em>P = 0.04</em>), maximum glycemic (−0.9 [−2.2, 0.4], <em>P = 0.014</em>), and maximum glucose excursion from baseline (−1.0 [−2.3, −0.4], <em>P = 0.003</em>) compared to LHM.</div></div><div><h3>Conclusions</h3><div>Mulberry leaf and corn silk extracts may benefit postprandial glycemic control and their incorporation into lactose-hydrolyzed milk could be a promising dietary intervention for patients with type 2 diabetes.</div></div><div><h3>Registration number of clinical trial</h3><div>ChiCTR2400086442.</div></div><div><h3>Website</h3><div><span><span>https://www.chictr.org.cn/showproj.html?proj=235132</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 549-554"},"PeriodicalIF":2.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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