Clinical nutrition ESPEN最新文献

Background and aims: Epidemiological studies have associated reduced bacterial diversity and abundance and food allergy. This mechanistic review investigated the link between gut dysbiosis and food allergy with a focus on the role of short-chain fatty acids (SCFAs) in modulating T-cells. T-cell differentiation poses an opportunity to direct the immune cells towards an anergic regulatory T cell (Treg) or allergic T helper 2 (Th2) response. Probiotic intervention to prevent and/or treat atopic disease symptoms through this mechanistic pathway was explored.

Methodology: A narrative review was conducted following a three-stage systematic literature search of EMBASE and Medline databases. Ninety-six of 571 papers were accepted and critically appraised using ARRIVE and SIGN50 forms. Thematic analysis identified key pathophysiological mechanisms within the narrative of included papers.

Results: Preclinical studies provided compelling evidence for SCFAs' modulation of T-cell differentiation, which may act through G-protein coupled receptors 41, 43 and 109a and histone deacetylase inhibition. Foxp3 transcription factor was implicated in the upregulation of Tregs. Human probiotic intervention studies aimed at increasing SCFAs and Tregs and preventing atopic disease showed inconclusive results. However, evidence for probiotic intervention in children with cow's milk protein allergy (CMPA) was more promising and warrants further investigation.

Conclusion: Preclinical evidence suggests that the mechanism of gut dysbiosis and reduced SCFAs may skew T-cell differentiation towards a Th2 response, thus inducing allergy symptoms. Probiotic trials were inconclusive: probiotics were predominantly unsuccessful in the prevention of allergic disease, however, may be able to modulate food allergy symptoms in infants with CMPA.

Background and aims: Although the phase angle (PhA), a measure of frailty and sarcopenia, determined by bioelectrical impedance analysis has been reported as a prognostic factor after cardiovascular surgery, few studies have reported the trajectory of the PhA after discharge. In this study, we examined the trajectory of the PhA along with conventional physical function measures and explored the factors associated with recovery for 6 months after hospital discharge in patients who had undergone cardiovascular surgery.

Methods: We included 116 patients who underwent elective cardiovascular surgery and cardiac rehabilitation after discharge. The PhA, physical function measures (grip strength, knee extension isometric muscle strength [KEIS], and usual gait speed), and Geriatric Nutritional Risk Index (GNRI) were assessed preoperatively, at discharge, and 3 and 6 months. Correlations between the PhA recovery rates and physical function and nutritional indices were assessed using Spearman's correlation analysis. Multivariate linear regression analysis was performed to examine the factors associated with recoveries of PhA and physical function indices (grip strength, KEIS, gait speed) after discharge.

Results: Mean values of the PhA and physical function measurements and the GNRI score at discharge were lower than the preoperative values (PhA, -8.0%; grip strength, -8.7%; KEIS, -6.9%; usual gait speed, -8.3%; GNRI, -11%). The grip strength, KEIS, and gait speed recovered to almost preoperative values 3 months after discharge. Values for the PhA and GNRI were still lower than preoperative values 3 months after discharge but had recovered to preoperative values at 6 months. The PhA was not significantly correlated with the recovery rates of the other indicators. Older age was negatively associated with PhA recovery rate, however, recovery rates decreased significantly with post-discharge physical activity.

Conclusions: In patients undergoing cardiovascular surgery, the PhA takes longer to recover than muscle strength or gait speed, requiring up to 6 months to recover to preoperative levels. Post-discharge interventions to increase daily physical activity may be an important method of speeding PhA recovery.

Background: Ketosis seems to attenuate, or prevent, the rise in both ghrelin concentrations and subjective hunger ratings that follow weight loss. However, most of the previous studies have employed very-low energy diets (VLED) and are therefore limited in terms of generalizability.

Objectives: To compare changes in ghrelin plasma concentrations after a low-carbohydrate (LCD) versus an isocaloric low-fat low energy diet (LED) in females with lipedema. Secondary objectives were to determine potential differences between diets in changes in satiety hormones, and subjective ratings of appetite.

Methods: Females with obesity and lipedema were randomized to either an LCD (75g carbohydrates) or low-fat diet (180g carbohydrates) for 8 weeks. Plasma concentrations of ghrelin, peptide YY, cholecystokinin (CCK), and glucagon-like peptide 1 (GLP-1), and subjective ratings of appetite were measured in the fasting and postprandial states, pre and post intervention.

Results: 55 females (30 in LCD) were included (age 47.9±11.3 years, BMI 36.8±5.1 kg/m²). Both LCD and low-fat groups lost weight (10.3%, P<0.001 and 7.3%, P<0.001, respectively), but the LCD lost significantly more. No within or between groups differences were found for ghrelin in the fasting state. A reduction in postprandial (tAUC) ghrelin was seen only in the LCD group (P=0.002), and this change was significantly different from the low-fat group (P=0.046). The LCD group also reported an increase in postprandial (both iAUC and tAUC) fullness ratings (P=0.035 and P=0.005, respectively), but this was not significantly different from the low-fat group (P=0.703 and P=0.365, respectively), despite the latter experiencing no change (P=0.127 and P=0.152, respectively). Conversely, only the low-fat group reported increased hunger in fasting (P=0.046), but changes were not significantly different from the LCD group (P=0.711). A decrease in postprandial (both tAUC and iAUC) CCK was observed in both LCD and low-fat diet groups (P≤0.005 for all).

Conclusion: Despite no changes in fasting ghrelin concentrations in either of the diet groups, a reduction in postprandial ghrelin and increased fullness was seen in the LCD group. These favorable changes in appetite in the LCD group might have contributed to the greater weight loss observed in this group.

Clinical trial registration: NCT04632810, Effect of Ketosis on Pain and Quality of Life in Patients With Lipedema (Lipodiet).

Background & aims: In the Asian Working Group for Sarcopenia 2019 guidelines, SARC-F is used to screen for sarcopenia. SARC-F is measured based on five components: strength, assistance with walking, rising from a chair, climbing stairs, and falling. However, it has been reported that SARC-F has high specificity but low sensitivity for sarcopenia screening. Considering that SARC-F is currently recommended for sarcopenia screening, indicating the utility of SARC-F not only in sarcopenia screening but also in other aspects is pivotal. This cross-sectional study aimed to clarify the relationship between the SARC-F score and the extracellular water-to-total body water ratio (ECW/TBW) in community-dwelling older people.

Methods: This study included 167 community-dwelling older people (aged ≥ 65) who were able to walk independently and used the SARC-F as a screening test for sarcopenia diagnosis. ECW/TBW and the skeletal muscle mass index (SMI) were measured using bioelectrical impedance analysis. The associations among the SARC-F score, ECW/TBW, and SMI were assessed using Spearman's correlation coefficient. Multiple linear regression analyses of the SARC-F score were conducted. Age, sex, number of medications, pain, medical history, ECW/TBW, and SMI were considered independent variables in multiple linear regression analysis.

Results: The analyses revealed a significant positive correlation between the SARC-F score and ECW/TBW (ρ = 0.473, p < 0.001). SMI was significantly and negatively correlated with the SARC-F score (ρ = -0.233, p = 0.002). In the multiple linear regression analysis, ECW/TBW (β = 0.311, p < 0.001) and prevalence of pain (β = 0.169, p = 0.023) were significantly and independently associated with the SARC-F score (R² = 0.260). SMI was not significantly associated with the SARC-F score (β = 0.002, p = 0.986).

Conclusion: This study revealed a positive correlation between SARC-F score and ECW/TBW in community-dwelling older people, and this relationship persisted even after adjusting for confounding factors. However, there was no correlation between the SARC-F score and SMI. Our study indicated that the SARC-F score may be considered an indirect indicator of ECW/TBW. The score might also be useful for discriminating high and low ECW/TBW. These findings highlight a new use for SARC-F.

Background & aims: Despite ongoing research, the optimal nutritional support strategy in the first week of intensive care unit (ICU) stay remains unclear, given the complex interplay of the dynamic metabolic change and evolving nutritional requirements. In this study, we assessed the impact of calorie deficiency during this period on the nutritional care of critically ill patients.

Methods: In this retrospective study, we examined ICU admissions from January 2018 to September 2021, focusing on patients whose ICU stay exceeded 7 days. Data were collected from days 2 to 7 of ICU admission. The "average caloric intake (%)" was calculated as the actual calorie intake divided by the calculated calorie requirement over 6 days. Cox proportional hazard models were employed for analyzing the 28-day mortality, supplemented by sensitivity and subgroup analyses.

Results: The analysis of 3,544 patients revealed that those receiving less than 60% of their target calories in the first ICU week experienced higher 28-day mortality (hazard ratio (HR): 1.41, 95% confidence interval (CI): 1.19-1.67, p < 0.0001). Daily caloric intake below 30% of the goal from day 5 onward was associated with a gradual increase in mortality risk. Conversely, a significant reduction in 28-day mortality was noted in patients with a daily intake of >80% starting from day 6.

Conclusion: Our study underscores the correlation between caloric deficit (< 60%) in the initial ICU week and heightened mortality risk. It suggests the potential benefits of aggressive nutritional intervention toward the end of the week. These insights offer valuable guidance for clinicians in critical care settings.

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±4.00 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.

Background & aims: Glycogenosis type III is a rare autosomal recessive disease caused by a mutation in the AGL gene that results in a deficiency of the glycogen debranching enzyme. This deficiency impairs fasting tolerance and leads to hypoglycemia. While the symptomatology tends to improve with age, pregnancy can trigger a recurrence of hypoglycemia due to increased carbohydrate requirements. Since the late 1990s, continuous glucose monitoring (CGM) has been used in insulin-dependent diabetes to aid in the prevention of hypoglycemia. It has also been employed in type I glycogenosis for the same purpose. However, it has never been evaluated for the prevention of hypoglycemia in pregnant women with type III glycogenosis.

Case: report: We present the case of a 32-year-old pregnant woman with type IIIa glycogenosis diagnosed at the age of 2 years old. The resurgence of nocturnal hypoglycemia initially led to the reinstatement of continuous nocturnal nutrition. We established remote glucose monitoring via CGM, facilitating medical and dietary teleconsultations until delivery. These teleconsultations enabled dietary adjustment according to the patient's needs, based on the CGM data. This subsequently led to a reduction in the frequency and duration of nocturnal hypoglycemia, even after discontinuing continuous nutrition. No severe hypoglycemia was observed.

Discussion: Our results suggest that CGM combined with telemonitoring can provide effective support for individuals living with glycogenosis during pregnancy and may eliminate the need for resuming continuous nocturnal enteral nutrition. However, these results need to be confirmed with additional patient cases.

Conclusion: CGM is a safe tool to limit the risk of hypoglycemia and to improve the quality of life of pregnant patients with type III glycogenosis.

Background and aims: In patients with heart failure (HF), differences in the association between estimated protein intake (PI) and prognosis in those with and without chronic kidney disease (CKD) remain to be clarified. This study aimed to investigate whether the prognostic effects of the estimated PI differ between patients with HF with and without CKD.

Methods: We included patients who required hospitalisation owing to worsening HF between 2015 and 2019 and assessed the estimated PI based on the adjusted Maroni formula using the body mass index and urinary urea nitrogen level. Patients were stratified into the higher and lower estimated PI groups according to the median value of the estimated PI at the time of admission. The primary outcome was all-cause mortality.

Results: Among the 694 enrolled patients, 286 had CKD. A lower estimated PI was independently associated with a worse nutritional status. During a median follow-up period of 17.2 months, 175 all-cause deaths occurred, including 99 and 76 in the lower and higher estimated PI groups, respectively. In the Kaplan-Meier curves, the lower estimated PI group was associated with higher overall mortality. However, lower estimated PI was significantly associated with all-cause mortality in patients without CKD, but not in those with CKD, after adjustment for covariates. A significant interaction in terms of prognostic effect was observed between the presence or absence of CKD and estimated PI.

Conclusions: Among patients with HF, prognostic effect of the estimated PI may differ between patients with and without CKD.

Objective: This systematic review aimed to assess the effects of caffeine supplements on sleep parameters among professional athletes.

Methods: A systematic search of randomized controlled trials (PROSPERO: CRD42024505377) was performed from 1980 to December 2023 through Web of Science (ISI), Cinahl, Embase, CENTRAL, PubMed/MEDLINE, Scopus, and Scienceopen. The effect of caffeine supplement on all sleep parameters (e.g. duration, quality, insomnia), assessed through objective and subjective methods, was investigated among the athletic community.

Results: Of 1469 records, nine trials were eligible for the current review. The studies showed varying results concerning sleep quality, quantity, efficiency, number of awakenings, sleep onset latency, and other sleep-related variables. These differences in findings may be attributable to factors such as the timing of caffeine consumption in relation to sleep time and the time of exercise, habitual caffeine use, and the dose of caffeine prescribed. Given the nature of caffeine, insomnia following ingestion is likely to occur.

Conclusions: This review explores the mechanisms by which caffeine influences sleep in athletes. While caffeine supplementation may enhance athletic performance, it could have a detrimental effect on sleep and therefore recovery. It is important that supplementation considers individual responses to caffeine so that it does not adversely affect sleep in this population.

Prospero registration number: CRD42024505377.