Clinical nutrition ESPEN最新文献

Background: Although the primary impairment involved in Cerebral palsy (CP) is motor function, malnutrition is also common. However, there is a lack of tool recommendations for early malnutrition risk screening in children with CP, and the means of nutritional intervention for children with CP are also limited.

Methods: This study systematically searched the literature about clinical nutrition related content of cerebral palsy in Pubmed, MEDLINE, Embase, and the Cochrane Library in Jan 2024 and by hand searching, and we checked reference lists and citations to identify additional studies. Search terms include cerebral palsy, children, diagnosis, prediction, malnutrition, nutritional risk screening, nutritional assessment, nutritional support. Additions are marked in red in the modified version.

Results: The timing of diagnosis of CP has been moving forward, and some new diagnostic tools have been developed. Nutritional status is correlated with regional economic level, but there is still a malnutrition rate of nearly 30 % in developed countries. Severe restrictions in terms of gross motor function, swallowing dysfunction, feeding difficulties, cognitive impairment, and insufficient energy intake are common risk factors for malnutrition in children with CP. Z-score should be calculated in combination with measurement indicators in the assessment of physical development of children with CP. The nutritional outcomes of children with CP can be improved by various means, including diversified a Nutrition Support Team (NST) interventions.

Conclusions: The incidence of malnutrition in children with CP is high, which needs to be paid more attention. More effective malnutrition risk screening tools need to be developed for children with CP to guide the implementation of comprehensive and personalized nutritional interventions and improve malnutrient-related outcomes.

Background & aims: Vitamin D deficiency is defined by most experts as a level of less than 20 ng/ml. Studies have shown a relationship between musculoskeletal pain, muscle weakness, headache, and fatigue with low vitamin D level. The term Post-Corona Virus-19 Disease syndrome (PCS) describes new, returning or ongoing symptoms more than 12 weeks after Corona Virus Disease -19 (COVID-19) infection which cannot be explained by any other disorders or illnesses. The most prominent symptoms in PCS are fatigue, headache, and attention disorders. These similarities in PCS and vitamin D deficiency leads to the hypothesis of an association. The aim of this study was to find possible differences in vitamin D levels between PCS patients and a control group without PCS.

Methods: We measured vitamin D levels from April 2021 to December 2022 in 75 (2021) and 73 (2022) subjects (PCS) and compared these values with data from 2019 to 2022 in a non-PCS control group (non-PCS).

Results: We found significantly lower (p < 0,05) vitamin D levels in the PCS cohort (2021: 17,04 ± 8,0 ng/ml; 2022: 17,6 ± 6,6 ng/ml) compared to all years of the non-PCS group (2019: 23,7 ± 14,7 ng/ml; 2020:22,3 ± 13,7 ng/ml; 2021: 22,4 ± 12,3 ng/ml; 2022: 22,6 ± 11,0 ng/ml). There were no significant differences in vitamin D levels within the different years of the non-PCS group and when comparing the two PCS groups.

Conclusion: The results of the study recorded for the first-time decreased vitamin D values in a PCS cohort compared to a control group. This raises the question of whether vitamin D deficiency influences PCS symptoms or whether they are merely the consequences of the limitations of PCS.

Background & aims: Breastfeeding can be challenging in mothers with overweight or obesity-related chronic low-grade inflammation, resulting in negative consequences for the newborn. The pre-gestational body mass index is negatively associated with lactogenesis II, the onset of colostrum secretion. Herein, we evaluated mothers' inflammation, metabolic status, and components of breast milk after birth to associate these factors with their nutritional and breastfeeding status.

Methods: The study included volunteer mothers, categorized based on their nutritional status and anthropometric parameters, who gave birth in a tertiary maternity hospital. Serum and breast milk samples were collected 24 and 48 h after birth to determine inflammatory biomarkers (SAA, leptin, CRP, IL-1β, TNF-α, IL-8, IL-6, MCP-1, IL-10, and IFN-γ), reproductive hormones (prolactin and progesterone), as well as the breast milk composition (total protein, fatty acid, percentage of fat and Kcal). Furthermore, we conducted a six-month follow-up to assess breastfeeding outcomes. Interestingly, the composition of breast milk did not vary in the different situations analyzed, indicating the stability of the breast milk's composition in meeting infant needs, regardless of age, nutritional status, and type of birth.

Results: Our findings revealed a higher concentration of pro-inflammatory biomarkers (SAA, CRP, TNF-α, IL-8, and IFN-γ) than anti-inflammatory, IL-10, in breast milk. Our study showed that mothers who were overweight after pregnancy had a newborn with a higher birth weight compared to healthy post-pregnancy weight. Our study elucidates the intricate dynamics between maternal weight, inflammation, and breastfeeding outcomes.

Conclusions: While maternal overweight or obesity-related inflammation may pose challenges to lactogenesis II and influence newborn birth weight, breast milk remains a stable and reliable source of essential nutrients for infant nourishment. However, the presence of pro-inflammatory biomarkers in breast milk warrants further investigation into its potential implications for infant health.

Aim and background: A growing body of evidence supports the impact of intermittent fasting (IF) on longevity and healthy aging via the modulation of autophagy genes. The activation of the catabolic autophagic machinery (LAMP2, LC3B, ATG5, and ATG4D) has protective effects against degenerative aging and chronic diseases. This research examined the changes in the expression of the aforementioned genes upon the observance of dawn-to-dusk IF among metabolically healthy participants with overweight and obesity.

Methods: Fifty-one (51) participants (36 males and 15 females, 38.84 ± 11.73 years) with overweight and obesity (BMI = 29.75 ± 5.04 kg/m²) were recruited and monitored before and at the end of the commencement of the four-week IF. Six healthy subjects with normal BMI (21.4 ± 2.20 kg/m²) were recruited only to standardize the reference for normal levels of gene expressions. At the two time points, anthropometric, biochemical, and dietary assessments were performed, and LAMP2, LC3B, ATG5, and ATG4D gene expressions were assessed using qRT-PCR on RNA extracted from whole blood samples.

Results: At the end of IF, and compared to the pre-fasting levels, the relative gene expressions among participants with overweight/obesity were significantly increased for the three autophagy genes LAMP2, LC3B, and ATG5, with increments of about 4.2 folds, 1.9-fold, and 1.4-fold, respectively. In contrast, the increase in the ATG4D gene was not significant. Concomitantly, significant decreases were found in body weight, BMI, fat mass, body fat percent, hip and waist circumferences, LDL, IL-6, and TNF-a (P < 0.05), While HDL, IL-10, and CD163 significantly increased (P < 0.05). Binary logistic regression analysis for genetic expressions showed no significant association between high-energy intake, waist circumference, or obesity and the four gene expressions.

Conclusions: Four consecutive weeks of dawn-to-dusk IF of Ramadan is associated with the upregulation of autophagy gene expressions in participants with overweight/obesity, and this may explain, at least in part, its favorable short-term temporal metabolic and health-improving effects on early aging-related markers. Hence, IF presumably may entail a protective impact against early markers of aging and metabolic diseases in participants with overweight/obesity.

Background & aims: Meal timing is an emerging branch of science that investigates the influence of eating patterns on the circadian rhythm and overall health. There are still discrepancies in the literature as to whether late distribution of food intake and sleep disorders could impact biochemical, anthropometric, and cardiovascular markers. The objectives of this study were firstly observe skipping breakfast and sleep disorders over 12 months. Secondarily, analyze the individual influence of these findings on changes biochemical, anthropometric, and cardiovascular markers during the same period.

Methods: This descriptive study is part of a tertiary analysis in a recently published study. This research recruited 84 participants with Type 2 Diabetes (T2D) who were divided: Control-40 participants received only medical care; Intervention-44 participants received the same medical care along with nutritional assessment. Consultations occurred quarterly over 12th months, and a follow-up was conducted after 3 months. For influence analysis, non-normal variables were compared using Mann-Whitney, while normal variables were compared using unpaired t-tests. In all instances, α = 0.05 and P < 0.05 were adopted.

Results: Analysis revealed a high percentage of patients in both groups who skipped breakfast, slept less than 6 h, and experienced nighttime awakenings during the 1st visit. By the 12th month, there was deterioration in all data in the control group and significant improvement in the intervention group. Those with sleep disturbances also had lower HDL-cholesterol (HDL-C) values (p = 0.0054). For the other analyzes no significant differences were found.

Conclusion: Participants who skipped breakfast and had more nocturnal awakenings possibly had worse glycemic and weight control, but this difference was not statistically significant and only trends were observed. Sleep disorders could affect HDL-C levels. However, the influence analysis does not establish a causal relationship and more clinical trials are needed to analyze this topic on T2D.

Introduction: Type 2 diabetes mellitus (DM), osteoporosis (OP) and sarcopenia are major public health problems related with higher fall/fracture risks, morbidity and mortality. Due to the lack of a comprehensive analysis among OP, sarcopenia and DM; we aimed to explore the relationships between DM and the aforementioned conditions in postmenopausal women.

Methods: This cross-sectional study included postmenopausal women who consecutively admitted to the Departments of Physical & Rehabilitation Medicine, and Endocrinology and Metabolism. Demographic data, nutrition/cognition status and frailty scores of the participants were recorded. Sarcopenia-related parameters including, anterior thigh muscle thickness, handgrip strength, chair stand test, gait speed, and one-leg stand test (OLST) were measured. ISarcoPRM algorithm was used for the diagnosis of sarcopenia.

Results: A total of 444 postmenopausal women were consecutively enrolled. DM patients (N = 158) had higher frequency of sarcopenia (23.4 % vs. 12.9 %), but lower frequency of OP (33.5 % vs. 50.7 %) than controls (both p < 0.01). As regards regression analyses; menopause duration was positively (OR: 1.054, 95 % CI 1.030-1.077), but weight (OR: 0.957, 95 % CI 0.940-0.975) and DM (OR: 0.477, 95 % CI 0.310-0.733) were negatively related with OP (all p < 0.001). On the other hand, age (OR: 1.094, 95 % CI 1.056-1.133), body mass index (OR: 1.131, 95 % CI 1.067-1.198), and DM (OR: 1.887, 95 % CI 1.107-3.218) were positively related with sarcopenia (all p < 0.05). In addition, age (β = -0.355, p < 0.001), body mass index (β = -0.108, p = 0.021) and DM (β = -0.209, p < 0.001) were negatively related with OLST values.

Conclusion: DM has paradoxical associations with bone mass and muscle mass/function. Although it has negative relationship with OP (about two times lower odds), it has positive relationship with sarcopenia (about two times higher odds).

Background and objectives: Surgical resection is a first-line treatment for patients with cancer, but preoperative malnutrition is a risk factor for postoperative complications. This study aimed to evaluate the association between preoperative administration of an immunonutrition regimen and postoperative clinical outcomes in patients with cancer undergoing major abdominal surgery.

Methods: The Surgical Prehabilitation Multimodal Oncology (SUPREMO) retrospective cohort study, conducted from January 2021 to December 2023, included patients with cancer undergoing major abdominal surgery. Patients were categorized based on whether they received a complete immunonutrition regimen or an incomplete or no regimen. Demographic and clinical data were extracted from electronic health records for descriptive analysis. Logistic regression was used to assess the impact of immunonutrition on the risk of infectious complications, with clinical and demographic variables as explanatory factors.

Results: A total of 620 patients were included, with 49 % receiving a complete preoperative immunonutrition regimen. Bivariate analysis indicated that complete regimen administration was associated with lower intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and vasopressor support requirements (p = 0.005, p = 0.019, and p = 0.032, respectively). The logistic regression model showed a significant reduction in in-hospital infectious complications (odds ratio 0.54, 95 % confidence interval 0.31-0.98; p = 0.044).

Conclusion: Administering a complete preoperative immunonutrition regimen may be associated with reduced infectious complications, ICU and IMV requirements, and vasopressor support use.

Background: Nutritional intervention during hospitalisation is vital in managing of children and adolescents in intensive care. In this context, body composition measurements, such as mid-upper arm circumference (MUAC), can help improve the accuracy of nutritional assessments. However, using MUAC has some limitations. Calf circumference (CC) is a straightforward, inexpensive, and easily obtainable measurement. However, no reference values currently exist for CC in paediatric patients.

Aims: To describe the nutritional monitoring of critically ill children and adolescents in the Paediatric Intensive Care Unit (PICU) using CC.

Methods: Patients aged 6 months to 18 years old who were admitted to the PICUs participated in the study. Two MUAC and CC measurements were performed: one in the first 48 h of admission to the PICU and another after 7 days. The percentage change between the two measurements was compared. Information was also evaluated about demographic and outcome data. Analyses were conducted with all patients included in the sample collectively and subdivided by age (<10 years and ≥10 years).

Results: Two hundred and eleven patients underwent anthropometric assessment on admission, and the sample for comparative analyses consisted of 103 patients (after discharges and deaths). MUAC and CC significantly decreased in the first week of hospitalisation. A positive weak correlation was found between the percentage change in the MUAC and CC only for individuals under 10 years old and for the total sample, but not for adolescents. The all age group and children under 10 years old showed a greater reduction in CC than in MUAC. The same did not occur for adolescents.

Conclusions: Calf circumference may be a promising method for nutritional monitoring of critically ill children in Paediatric Intensive Care Units because it can indicate signs of depletion earlier than mid-upper arm circumference. These results are more meaningful for children than for adolescents.

The relationship between sarcopenic obesity and hypovitaminosis D in individuals with chronic kidney disease is complex and has significant impacts on muscle and bone health. An observational, cross-sectional, and analytical study was conducted to analyze possible associations between serum vitamin D levels and sarcopenic obesity in patients with chronic kidney disease stages 3 and 4 in a cohort of patients under nephrology care. The presence of sarcopenic obesity was assessed using bioimpedance criteria, and vitamin D levels were measured and recorded for each patient. Statistically significant associations were found between sarcopenic obesity and suboptimal vitamin D levels (p < 0.005) as well as between severe sarcopenia and hypovitaminosis D (p < 0.05) in patients with chronic kidney disease stages 3 and 4. Patients with optimal levels of vitamin D showed better muscle quality and a lower prevalence of sarcopenia and severe sarcopenia. The findings suggest that vitamin D levels play a crucial role in muscle quality in patients with CKD stages 3 and 4. Maintaining optimal levels of vitamin D may help reduce the prevalence of sarcopenic obesity and improve quality of life in these patients.

Background & aims: Primary ovarian insufficiency (POI) is a significant clinical syndrome that leads to female infertility, and its incidence continues to increase. We used metabolome-specific Mendelian randomization (MR) to identify causally associated metabolites and explore the relationship between candidate metabolites and upstream genetic variations.

Methods: The primary MR analysis utilized the inverse variance weighted (IVW) method as the primary approach to assess the causal relationship between exposure and POI. Multiple sensitivity analyses included MR-Egger, weighted median, and weighted mode methods.

Results: After using genetic variants as probes, we identified 27 metabolites of 278 that are associated with the risk of POI, including dodecanedioate (OR 0.052, 95 % CI 0.010-0.265; P < 0.001), adrenate (OR 0.113, 95 % CI 0.016-0.822; P = 0.031), indolepropionate (OR 0.174, 95 % CI 0.051-0.593; P = 0.005), homocitrulline (OR 0.194, 95 % CI 0.051-0.741; P = 0.016), and 3-methylhistidine (OR 0.404, 95 % CI 0.193-0.848; P = 0.017). Our study indicated the presence of heterogeneity; therefore, we employed the IVW random-effects model as the primary approach. KEGG pathway enrichment analysis identified six significant metabolic pathways, primarily including biosynthesis of unsaturated fatty acids, phenylalanine, tyrosine and tryptophan biosynthesis, aminoacyl-tRNA biosynthesis, linoleic acid metabolism, valine, leucine and isoleucine biosynthesis, ubiquinone and other terpenoid-quinone biosynthesis.

Conclusions: By integrating genomics and metabolomics, this study provides novel insights into the causal relationship linking circulating metabolites and the onset of POI.