Clinical nutrition ESPEN最新文献

Introduction: Graft dysfunction after liver transplantation is marked by elevated liver enzymes. Taurine, an antioxidant amino acid, may support graft function. This study evaluated taurine's effect on post-transplant liver biomarkers.

Methods: In this randomized, double-blind trial, adults undergoing liver transplantation (Sept 2020-June 2021) were enrolled. Exclusions were death within 72 h or multi-organ transplant. Patients received oral taurine or placebo (2 g/day) from transplant day to day 30. The primary outcomes were changes in liver enzymes and bilirubin. Secondary outcomes included mortality, intensive transplantation unit (ITU)/hospital stay, and ventilation duration.

Results: Of 225 patients, 56 were excluded (29 refusals, 27 early deaths). The 169 analyzed patients were evenly randomized. The taurine group had significantly greater reductions in aspartate aminotransferase (AST), total bilirubin, and international normalized ratio (INR). Taurine was also associated with significantly lower mortality (p < 0.05), shorter ITU stay (mean difference: -4.09 days), shorter hospital stay (mean difference: -3.49 days), and reduced mechanical ventilation duration (mean difference: -20.06 h) compared to placebo. All patients showed expected post-operative declines in alanine aminotransferase (ALT), AST, and bilirubin.

Conclusion: Supplementation with 2 g/day taurine for 30 days after transplantation was associated with improved graft function markers (AST, total bilirubin, INR) and better clinical recovery outcomes. These results suggest taurine may be a beneficial adjunct therapy to support early post-transplant recovery.

Background and aims: Sarcopenia is a critical problem in patients with chronic kidney disease (CKD). Longitudinal assessment of skeletal muscle mass is essential for early detection and intervention. However, conventional standard assessment methods for measuring skeletal muscle mass require specialized equipment, which might not be practical in routine care settings. The aim of this study was to construct a predictive model for skeletal muscle mass using readily available variables from the routine clinical care for patients with CKD.

Methods: This cross-sectional study included patients with CKD who underwent kidney biopsy and non-contrast abdominal computed tomography. Skeletal muscle mass was estimated by the skeletal muscle index, calculated as the cross-sectional area of muscle at the third lumbar vertebra level, normalized by height. The creatinine muscle index (CMI), calculated as the product of serum creatinine and cystatin C-based estimated glomerular filtration rate (eGFR), was included as a variable in the analysis. A predictive model was developed using Least Absolute Shrinkage and Selection Operator (LASSO) regression with 10-fold cross-validation to optimize the regularization parameter (λ). Variables selected by LASSO regression were used for constructing an ordinary least squares (OLS) regression model (Model 1), followed by a second model (Model 2) that included only variables with p < 0.05. Model performance was evaluated by adjusted R², mean absolute percentage error, root mean square error, and mean Winkler interval score with 90 % prediction coverage (PC). Bootstrap resampling was used to calculate 95 % confidence intervals (CIs).

Results: Between June 2018 and March 2024, 111 patients (56 female individuals) were enrolled. The median age and creatinine-based eGFR were 55 years and 56 mL/min/1.73 m², respectively. Model 1, derived from LASSO and OLS regressions, included log-transformed age, male sex, body mass index (BMI), CMI, serum albumin level, and log-transformed creatine kinase level. Model 2 included only male sex, BMI, and CMI. The adjusted R² and PC were 0.749 (95 % CI: 0.663-0.835) and 92.0 % for Model 1, and 0.739 (95 % CI: 0.652-0.825) and 92.24 % for Model 2, respectively. No significant differences were observed between the models across all metrics, despite the simplicity of the variables included in Model 2.

Conclusion: A simple and reasonable predictive model for skeletal muscle mass was developed. This model solely comprised parameters routinely obtained in the daily clinical care for patients with CKD, allowing for longitudinal monitoring and early detection of muscle loss.

Background: Malnutrition is a prevalent yet often under-recognized condition in oncology that could potentially compromise treatment outcomes. This study assessed its prevalence at cancer diagnosis and the prognostic implications within a large cohort of adult patients with cancer.

Methods: In this prospective study, 2501 adults with newly diagnosed, histologically confirmed cancer (2018-2022) underwent nutritional screening within seven days preceding the initiation of cancer therapy. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form and patients were classified as well-nourished (12-14), at-risk (8-11), or malnourished (<8) points. Overall survival was analyzed using Kaplan-Meier estimates and multivariable Cox models.

Results: At baseline, 47.1 % of patients were at risk of malnutrition and 12.0 % were malnourished, together comprising 59.1 % of patients with compromised nutrition. The highest burden was observed in pancreatic (74.2 %), esophageal (72.8 %), and gastric (65.3 %) cancers. Malnourished patients more frequently presented with stage IV disease (62.7 % vs. 49.5 % in well-nourished patients; P < 0.001) and with poor performance status (ECOG ≥2: 20.0 % vs. 4.8 %, respectively; P < 0.001). Three-year overall survival was 69.8 % in well-nourished patients, 51.5 % in those at risk, and 37.2 % in malnourished patients (log-rank P < 0.001). Adjusted hazard ratios (HRs) for mortality were 1.79 (95 % confidence interval [CI], 1.51-2.13) in the at-risk group and 2.74 (95 % CI, 2.20-3.42) in the malnourished group. Exploratory site-specific analyses suggested heterogeneity in the association between nutritional status and survival across tumor types.

Conclusion: Pre-treatment MNA-SF screening identifies patients with cancer who are at high risk of mortality. Prospective trials are needed to determine whether nutritional interventions can improve survival outcomes, particularly in patients with gastrointestinal and head and neck cancers.

Background: The prevalence of obesity in adults over 60 is rising, presenting challenges for healthcare systems. Bariatric surgery (BS) is increasingly considered for older adults, but complex health risk such as sarcopenic obesity (SO) and osteosarcopenic obesity (OSO) need evaluation to optimize clinical outcomes and guide preoperative risk stratification.

Objectives: The aims was to describe the prevalence and severity of SO, OSO, and to examine the associated health consequences in BS candidates over 60 years.

Setting: This prospective cross-sectional study was conducted at a single tertiary care university hospital.

Methods: Cross-sectional study of 109 BS candidates over 60 years. The assessments included anthropometry, body composition (BC), muscle strength and function, bone mineral density (BMD), physical activity (PA) levels and metabolic pathologies associated with obesity. SO and OSO were defined using ESPEN/EASO (2022) consensus criteria.

Results: The mean age of the participants was 64.1 (2.9), and, 36 % were male. The prevalence of SO was 42 %, with no significant differences between sexes. This prevalence was primarily due to greater impairment in the 5-times sit-to-stand test (39.8 %). The prevalence of OSO was 26.8 %, largely attributed to a higher prevalence of osteopenia in females. Among obesity-related pathologies, only obstructive sleep apnea was more prevalent in males. Those with SO had a lower BMD and PA levels.

Conclusions: The high prevalence of SO and OSO in BS candidates over 60 highlights the importance of comprehensive preoperative assessment. Sex and age-specific differences in BC and sarcopenia severity underscore the need for tailored interventions.

Background and aims: Vitamin D deficiency is highly prevalent in older adults and has been linked to cancer-related fatigue through mechanisms involving muscle dysfunction and systemic inflammation. This study aimed to evaluate the association between serum 25-hydroxyvitamin D [25(OH)D] levels and fatigue in women aged ≥65 years with metastatic breast cancer (BC) receiving palliative and oncological care.

Methods: A single-center, cross-sectional study was performed at a tertiary-level cancer referral and teaching hospital in Mexico. A total of 177 women with metastatic BC undergoing active treatment were included. Fatigue was assessed using the Spanish-validated Brief Fatigue Inventory (BFI), frailty with the FRAIL scale, and sarcopenia risk with SARC-F. Serum 25(OH)D was measured and categorized as deficient (<20 ng/mL), insufficient (20-29.9 ng/mL), or sufficient (≥30 ng/mL). Associations were analyzed using Spearman correlation, Kruskal-Wallis, and multivariate linear regression.

Results: Median age was 72 years (IQR 68-78). Vitamin D deficiency was present in 51.4% of patients, insufficiency in 36.7 %, and only 11.9 % had sufficient levels. Patients with 25(OH)D deficiency exhibited significantly higher BFI scores compared to the sufficient group (median 2.40 vs. 1.20; p = 0.009). A significant negative correlation was observed between 25(OH)D levels and BFI scores (ρ= -0.19; p = 0.011). In the multivariate linear regression analysis, serum 25(OH)D levels were significantly associated with fatigue scores (beta -0.04; 95%CI -0.08, -0.01; p = 0.012).

Conclusion: Vitamin D deficiency is highly prevalent and independently associated with increased fatigue severity in older women with metastatic BC. These findings identify vitamin D status as a potentially modifiable contributor to one of the most distressing symptoms in advanced disease. Routine screening of 25(OH)D levels and targeted supplementation should be considered integral components of supportive and palliative care in this population. Prospective interventional trials are warranted to confirm clinical benefit.

Background & aims: Various dietary approaches, such as continuous calorie-restricted (CCR) diets and, more recent, intermittent calorie-restricted (ICR) diets have demonstrated success in weight management and glycaemic control in people with type 2 diabetes. However, there are concerns about disproportionate decrease in fat-free mass (FFM) and consequently in resting energy expenditure (REE), with inconsistent results to date. Therefore, the aim of the present study was to evaluate the effects of a 3-month CCR diet and ICR diet on body composition and REE in people with type 2 diabetes and overweight or obesity.

Methods: In this post-hoc analysis of two ongoing trials (E-DIET and TIMED) in the Netherlands, we included people with type 2 diabetes and overweight or obesity that underwent a 3-month CCR diet (750 kcal per day) or ICR diet (eating window between 8AM and 6PM and 1300-1500 kcal per day). We measured differences in body composition, REE and glycaemic control over time within and (exploratively) between the groups.

Results: Sixty-seven participants (mean age 60 years; 56 % female; CCR: n = 41; ICR: n = 26) were included in the study. After three months, both interventions resulted in significant improvements in body composition, with a decrease in weight (CCR: 102.8 ± 17.1 kg to 97.7 ± 16.3 kg, p < 0.001; ICR: 107.3 ± 17.5 kg to 100.5 ± 15.2 kg, p < 0.001) and fat mass (CCR: 39.7 ± 7.7 % to 36.2 ± 7.8 %, p < 0.001; ICR: 38.5 ± 9.0 % to 35.8 ± 8.6 %, p < 0.001) while FFM increased (CCR: 59.6 ± 8.1 % to 64.9 ± 9.9 %, p = 0.001; ICR: 61.5 ± 9.1 % to 64.1 ± 8.7 %, p = 0.002). REE decreased significantly only in the CCR group (2006 ± 377 kcal to 1820 ± 348 kcal, p < 0.001). HbA1c decreased significantly from 61.0 [52.0-74.0] mmol/mol to 54.0 [43.0-66.0] mmol/mol, p = 0.028) in the CCR group, whereas a significant reduction in diabetes medication use (Medication Effect Score, MES) was seen in both groups (CCR: 2.41 [1.11-3.25] to 1.62 [0.62-2.36], p = 0.007; ICR: 0.38 [0.0-1.35] to 0.25 [0.0-0.67], p = 0.036), indicating improved diabetes control in both groups. No significant differences were observed between the two groups in all parameters except for dropout rate, which was 19 % for CCR and 0 % for ICR (p = 0.016).

Conclusions: Both CCR and ICR improved body composition after three months in individuals with type 2 diabetes and overweight or obesity, without excessive fat-free mass loss. While direct comparison is limited by the post-hoc design, both diets appear promising, with a lower dropout rate in ICR suggesting greater feasibility. Further research should assess long-term effects and underlying mechanisms.

Background and aims: Frailty is common in later life and chronic conditions. It is associated with reduced quality of life, and increased disability and mortality. The large overlap with malnutrition means that dietitians can play a key role in frailty identification and management, however, few studies have explored their experiences of this. We aimed to explore the perceptions of dietitians on the identification and management of frailty in older people.

Methods: We carried out virtual interviews and focus groups with 13 United Kingdom registered dietitians working with older people in a range of acute and community settings. Data were analysed using reflexive thematic analysis.

Results: Dietitians felt they had an important role in managing the nutritional aspects of frailty and were confident in this. They reported a need to engage and educate patients and carers to overcome misconceptions about later life nutrition and weight loss. Dietitians were often part of a multidisciplinary team, which was considered a holistic approach that facilitated interprofessional learning. However, they reported that other healthcare professionals had variable understanding of their frailty role. Dietitians were unsure regarding their role in frailty identification and lacked confidence and experience in using assessment tools. They felt there were few formal frailty training opportunities available and that they needed to actively seek these out.

Conclusion: Guidance needs to be developed to strengthen dietitians' role in frailty care and provide clarity regarding frailty identification. More formal training opportunities need to be provided by key regulating organisations.

Background & aims: The rapid expansion of digital platforms has transformed access to health information, but has simultaneously accelerated the spread of nutritional misinformation. Misleading dietary claims can influence people's behavior, erode confidence in evidence-based guidelines, and pose potential health risks. This study examines nutritional misconceptions, mechanisms underlying their dissemination, and strategies to mitigate their impact.

Methods: A narrative review of scientific literature, institutional reports, and public health guidelines was conducted to identify common dietary misconceptions. Specific cases were critically assessed for scientific validity. Psychological, social, commercial, media-related factors and other interacting and contextual drivers contributing to the propagation of misinformation were also evaluated, together with potential countermeasures.

Results: Most nutritional myths were found to lack robust scientific support and may promote ineffective or potentially harmful dietary practices. Detox diets do not enhance physiological detoxification, colored salts confer no meaningful nutritional advantage, and gluten-free or lactose-free products are often consumed without medical necessity. The persistence of these behaviours and misconceptions is reinforced by confirmation bias, emotional appeal, media oversimplification, and commercial exploitation. All these processes are amplified by social media, which fosters echo chambers and rapid dissemination.

Conclusions: Nutritional misinformation represents a significant challenge for public health, influencing food choices and undermining trust in scientific recommendations. Addressing this issue requires coordinated action by health professionals, educators, and institutions to promote accessible and scientifically supported communication. Strengthened educational strategies and enhanced professional training are essential to support informed decision-making and counter the pervasive influence of misinformation in nutrition.