Clinical nutrition ESPEN最新文献

Background: Endometriosis is a chronic estrogen-dependent inflammatory disease frequently associated with gastrointestinal symptoms, metabolic comorbidities, and impaired quality of life. Growing interest in nutrition has led to the widespread dissemination of restrictive dietary recommendations, often unsupported by robust clinical evidence and potentially associated with nutritional and psychological risks.

Methods: This article presents an evidence-based clinical position paper based on a critical narrative review of the scientific literature addressing nutritional interventions in endometriosis. Data were identified through systematic searches of PubMed/MEDLINE, Embase, and the Cochrane Library, focusing on observational studies, randomized controlled trials, systematic reviews, and meta-analyses. Dietary patterns, restrictive diets, targeted nutritional interventions for digestive symptoms, and their clinical implications were analyzed.

Results: Current evidence does not support any specific dietary strategy as an effective treatment for endometriosis. Restrictive diets, such as gluten-free, dairy-free, or so-called "anti-inflammatory" diets, are insufficiently supported by high-quality clinical trials and may expose patients to avoidable nutritional deficiencies and psychological burden. In contrast, global dietary patterns such as the Mediterranean diet or the DASH diet are supported by robust public health evidence and may offer indirect benefits on systemic inflammation, cardiometabolic health, and overall well-being, although disease-specific data remain limited. Targeted interventions, particularly low-FODMAP diets, may be considered in selected patients presenting with symptoms compatible with irritable bowel syndrome, provided they are time-limited and professionally supervised.

Conclusion: At present, nutrition should not be considered a specific therapeutic treatment for endometriosis. However, evidence-based global dietary models may serve as a safe nutritional foundation within a multidisciplinary care approach. Individualized, cautious, and professionally guided nutritional management is essential to prevent dietary excesses and support long-term health and quality of life in women with endometriosis. Further high-quality interventional studies are required to clarify the role of nutrition and identify subgroups most likely to benefit from targeted interventions.

Background & aims: Malnutrition is common in hospitalised patients and contributes to poor clinical outcomes. To support adequate nutritional intake in patients, accurate assessment of dietary food intake is critical, but it remains challenging and time-consuming. The present study aims to assess how accurate patients and family members estimate food intake using food record charts (FRCs) compared with weighed food records (WFRs).

Methods: In a cross-sectional study, 30 patients (≥18 y, Dutch-speaking, no delirium and no isolation restrictions) and 30 family members (≥18 y, Dutch-speaking, non-healthcare professionals) estimated simulated food consumption of nine different hospital meals (three breakfasts, three lunches, and three dinners) consisting of 79 different food items with FRCs, and these estimates were compared to WFRs. Subgroup analyses were performed for food consumption estimations by food item, including energy and protein content, food consistency, consumed amount, and food groups. Bland-Altman plots and inter-rater agreement were used to identify the accuracy of food intake estimation. Values are presented as mean ± SD.

Results: Food consumption estimated by patients using FRCs was comparable to food consumption measured by WFRs with a mean overestimation of 1.2 ± 8.1 % (p = 0.178), whereas family members overestimated intake by 2.2 ± 7.5 % with FRCs compared to WFRs (p = 0.012). Protein-dense products (>10 g/100 g) were underestimated by ∼2 %, while products with lower consumption (<25 % consumption) were overestimated by ∼8 % by patients and family members. The inter-rater agreement was W = 0.71 for patient FRCs (p < 0.001) and W = 0.74 for family members' FRCs (p < 0.001).

Conclusions: FRCs provide comparable estimates to WFRs for patients. Although family members slightly overestimated food intake (∼2 %), the deviation remained within acceptable limits. Therefore, FRCs present an accurate assessment tool to quantify food consumption of hospital meals by both patients and family members. The engagement of patients and families in assessing food consumption forms an important opportunity to monitor nutritional intake during hospitalisation, rehabilitation, and at home.

Objective: This study aimed to investigate the association of abdominal obesity indicators (Waist circumference (WC), lipid accumulation product (LAP), a body shape index (ABSI), body roundness index (BRI), weight-adjusted waist index (WWI), and visceral adiposity index (VAI)) with the risk of all-cause mortality in familial hypercholesterolemia (FH) and to compare their prognostic performance.

Methods: A cohort of 1,188 FH patients from the National Health and Nutrition Examination Survey (1999-2018) was analyzed. Mortality outcomes through 2019 were identified via linkage to the National Death Index. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95 % confidence intervals (CIs) for mortality. The incremental predictive value of each indicator beyond a base model was assessed using the C-statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI).

Results: During a median follow-up of 8.4 years, 215 patients (18.1 %) died. After full multivariable adjustment, individuals in the highest tertile of ABSI exhibited a significantly elevated mortality risk compared to the lowest tertile (HR = 1.97, 95 % CI: 1.31-2.95). Similarly, the highest WWI tertile was associated with increased mortality (HR = 1.49, 95 % CI: 1.01-2.22). No significant associations were observed for WC, LAP, BRI, or VAI. Among all evaluated indicators, ABSI conferred the most substantial incremental predictive value when added to the base model, significantly improving discrimination (C-statistic: 0.809, 95 % CI: 0.781-0.838), integrated discrimination (IDI: 0.033, 95 % CI: 0.011-0.063), and risk reclassification (NRI: 0.256, 95 % CI: 0.138-0.347).

Conclusions: Elevated ABSI and WWI independently predicted increased all-cause mortality in familial hypercholesterolemia patients. Crucially, ABSI demonstrated superior prognostic performance, significantly enhancing mortality risk stratification beyond established factors, and its incorporation into clinical models may improve prognostication and guide tailored management.

Background: Trauma survivors often develop early muscle wasting and long-term frailty, but still maintain ambiguous relationships among them. Herein, we aimed to determine a correlation among changes in skeletal muscle index (ΔSMI) during intensive care unit (ICU) stay, the development of frailty 1-year post-discharge, and the metabolic profiles in patients with trauma with varying ΔSMI.

Methods: In this single-center, prospective, observational study, the SMI in the third lumbar vertebra (L3SMI) and ΔSMI were evaluated on day 1 and day 7 after ICU admission in trauma patients. Based on the cut-off value of ΔSMI, the patients were grouped into high (HSMW) and low acute skeletal muscle wasting (HSMW VS LSMW) groups. We assessed the correlation between ΔSMI and frailty 1-year post-discharge and the metabolic profiles with untargeted metabolomics.

Results: A total of 99 eligible patients with trauma completed follow-up. ΔSMI using the cut-off value of 3.022 cm²/m² was significantly associated with frailty 1-year post-discharge. The metabolic profiles between the HSMW and LSMW groups were distinct, primarily involving amino acid and carbohydrate metabolism, with a potential link to muscle mass. Among the differential metabolites, glycine showed the most significant change and strong potential to distinguish between groups, suggesting an involvement of the serine-glycine metabolism pathway in muscle wasting.

Conclusions: In patients with trauma, an ΔSMI >3.022 cm²/m² during the first 7 days of ICU admission predicts frailty 1-year post-discharge. Metabolic analyses may help identify new therapeutic targets for reducing acute skeletal muscle wasting and ultimately improving clinical outcomes.

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.