Clinical nutrition ESPEN最新文献

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.

Aim: This study aimed to understand how modifiable behavioural health determinants (HD), such as the quality of sleep, oral health, nutritional risk, and loneliness, affect the association between activity and functional status in community-dwelling older adults.

Methods: Physical activity (PA) and sedentary behaviour (SB) were measured using seven days of accelerometry data from 53 community-dwelling older adults (79.8 ± 6.1 yrs, 71.7 % females). Volume, pattern and variability of walking, upright, sitting and lying bouts were extracted. Measures include Nottingham Extended Activities of Daily Living (NEADL) for functional status (FS), Pittsburgh Sleep Quality Index (PSQI) for sleep, Oral-health-related quality of life and self-reported oral health (OHIP-14) for oral health, Seniors in the community: risk evaluation for eating and nutrition, Version II (SCREENII) for nutritional risk and the University of California, Los Angeles (UCLA) 3-item scale for loneliness. Linear regression models investigated the direct association between FS and activity. The impact of HD on the direct relationship between FS and activity was investigated by entering each HD as a covariate and an interaction term.

Results: FS was high for this sample (median [IQR]: 20 [19.0, 21.0]). PSQI was 6.0 [3.0, 8.0], OHIP-14 was 1.0 [0.0, 3.0], SCREENII was 48.5 [44.0, 52.0] and UCLA-3-item was 3.0 [3.0, 6.5]. FS was associated with daily total walk duration (p = 0.008), number of daily walking bouts (p = 0.010), number of daily steps (p = 0.007) and pattern of upright bouts [Alpha _Upright] (p = 0.010). FS was not associated (p > 0.05) with any of the sedentary behaviour measures. The quality of oral health significantly (p = 0.037) improved the strength of association between FS and Alpha _Upright. Those who reported greater nutritional risk (SCREENII <50) reported higher FS when they accumulated bouts that consisted of more uninterrupted time on their feet [Alpha _Upright] (p = 0.046). Those who reported less loneliness (UCLA <5) reported higher FS with greater number of daily walking bouts (p = 0.025). Neither the quality of sleep nor oral health moderated the association between FS and activity.

Conclusion: Nutritional risk and loneliness affect the relationship between activity and functional status. Older adults, particularly those with higher nutritional risk or lower loneliness, may benefit from more walking or upright activities.

Background & aims: Malnutrition can have serious effects on patient outcomes in children with cancer, including a decreased chance of survival, increased risk of treatment-related toxicities and an impaired quality of life. However, it remains insufficiently understood which factors are key determinants in the development of malnutrition in children with cancer. Given that resting energy expenditure (REE) is an important component of energy balance, we aimed to investigate whether REE is altered in children with cancer by reviewing and summarizing current literature comparing measured REE (mREE) in children with cancer to that of healthy peers or predicted REE (pREE).

Methods: A systematic search was conducted on Pubmed and Embase up to February 2025. All study designs were eligible for inclusion when they met the following criteria: (1) original studies including children (0-18 years) diagnosed with cancer, that (2) measured REE using indirect calorimetry, and (3) compared mREE with healthy controls or pREE derived from an established prediction equation. Results were reported in accordance with the PRISMA 2020 guidelines. Methodological quality of the included studies was assessed using an adapted version of the Critical Appraisal Skills Program Cohort Study Checklist.

Results: In total, 1673 unique publications were identified, of which 12 publications involving 212 patients met the inclusion criteria. The included studies were all of relative low quality with small samples sizes (range 7-40 patients). Considerable heterogeneity was observed across the studies with respect to age, diagnosis and treatment phase. Only 3 studies reported significant differences between mREE and healthy controls or pREE. One study performed in 13 children with newly diagnosed solid tumors reported a higher mREE compared to pREE derived from the Schofield equation, whereas another study performed in 40 children with various tumor types reported a lower mREE compared to pREE derived from the WHO equation. Additionally, 1 study performed in 20 children with leukemia during or after treatment reported a lower mREE compared to healthy controls. The remaining 9 studies included showed no significant difference between mREE and healthy controls or pREE.

Conclusions: There is inconclusive evidence to conclude that REE is altered in children with cancer. Larger longitudinal studies are needed to fully understand whether changes in REE contribute to the development of malnutrition in this population, and to explore differences across tumor types and treatment phases.