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Consumption of ultra-processed foods is associated with dietary iron availability, anemia, and excess weight in socially vulnerable children 在社会弱势儿童中,食用超加工食品与膳食铁可得性、贫血和超重有关。
IF 2.9 Q3 NUTRITION & DIETETICS Pub Date : 2025-02-01 DOI: 10.1016/j.clnesp.2024.12.023
Jonatan Christian de Lima Santos Queiroz , Luis Carlos Rey , Terezinha da Rocha Ataide , Telma Maria de Menezes Toledo Florêncio , Luiz Gonzaga Ribeiro Silva-Neto

Background & aims

Eating habits during childhood have undergone significant changes, with a notable increase in the consumption of ultra-processed foods (UPF). This situation deserves attention, given the close relationship between UPF and adverse health outcomes. This is due to the nutritional composition of UPF, which has high levels of health-critical nutrients such as sugar, fat, and sodium, thus compromising the overall quality of the diet. An excess of these nutrients can increase the risk of developing excess weight, nutritional deficiencies, and chronic diseases during childhood. Among the nutritional deficiencies is iron. This is due to the fact that UPF are not good sources of iron. This, combined with the fact that UPF is low in nutrients that help make iron more available, such as vitamin C, increases the risk of developing anemia. Therefore, this study aimed to assess the availability of iron, as well as the presence of anemia and excess weight in children living in situations of social vulnerability, and to determine their association with the consumption of UPF.

Methods

This is a population-based cross-sectional study. Children aged between 6 and 59 months living in slums were included. The presence of excess weight was assessed by measuring weight and height, and the presence of anemia was determined by hemoglobin concentration, assessed using the HemoCue portable hemoglobinometer. A 24-h food recall was also used to assess the relative calorie intake of UFP and the dietary availability of iron using an algorithm. All statistical analyses were carried out using the statistical software Jamovi.

Results

In this study, 443 children were included; 19.2 % were classified as with excess weight, and 55.6 % were anemic; the average absorbable iron content was 0.54 (SD ± 0.42) mg, and 39.2 % of the calories consumed came from UPF. The association analysis showed that children with calorie share relative to UPF had a decrease of −0.12 mg of bioavailable iron (β: −0.12; 95 % CI: −0.23; −0.01). It was also possible to identify that the higher calorie share of UPF increased their chances of being classified as with excess weight and anemic by up to 116 % (OR: 2.16; 95 % CI 1.05; 4.46) and 145 % (OR: 2.45; 95 % CI: 1.26; 4.78), respectively.

Conclusions

The relationship found between UPF consumption and the availability of iron in the diet, excess weight, and anemia calls for attention, especially in contexts of social vulnerability. These findings demonstrate the need for greater attention to nutrition in childhood to promote an adequate and healthy diet. This can help to change the nutritional and epidemiological panorama of the population, contributing to a better general state of health for future generations of adults.
背景与目的:儿童时期的饮食习惯发生了重大变化,超加工食品(UPF)的消费量显著增加。鉴于UPF与不良健康结果之间的密切关系,这种情况值得注意。这是由于UPF的营养成分,其中含有高水平的健康关键营养素,如糖、脂肪和钠,从而损害了饮食的整体质量。这些营养物质过量会增加儿童时期体重超重、营养缺乏和慢性疾病的风险。缺铁是其中之一。这是因为UPF不是铁的良好来源。这一点,再加上UPF缺乏维生素C等有助于铁的营养物质,增加了患贫血的风险。因此,本研究旨在评估生活在社会脆弱状况下的儿童铁的可用性,以及贫血和超重的存在,并确定它们与UPF消费的关系。方法:这是一项基于人群的横断面研究。其中包括生活在贫民窟的6至59个月大的儿童。通过测量体重和身高来评估超重的存在,通过血红蛋白浓度来确定贫血的存在,使用HemoCue便携式血红蛋白计进行评估。24小时的食物召回也被用来评估UFP的相对卡路里摄入量和铁的膳食可用性。所有统计分析均使用统计软件Jamovi进行。结果:本研究纳入443名儿童;19.2%为超重,55.6%为贫血;平均可吸收铁含量为0.54 (SD +/- 0.42) mg,所消耗热量的39.2%来自UPF。关联分析显示,相对于UPF的卡路里份额,儿童的生物可利用铁减少了-0.12 mg (β: -0.12;95% ci: -0.23;-0.01)。还可以确定,UPF中较高的卡路里份额使他们被归类为超重和贫血的可能性增加了116% (OR: 2.16;95% ci 1.05;4.46)和145% (OR: 2.45;95% ci: 1.26;分别为4.78)。结论:UPF消费与饮食中铁的可用性、超重和贫血之间的关系值得关注,特别是在社会弱势群体中。这些发现表明,需要更多地关注儿童营养,以促进适当和健康的饮食。这有助于改变人口的营养和流行病学状况,有助于改善后代成年人的总体健康状况。
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引用次数: 0
The relationship between probiotics and prebiotics, kidney dysfunction and mortality – Results from a longitudinal cohort study and Mendelian randomization 益生菌和益生元、肾功能障碍和死亡率之间的关系——来自纵向队列研究和孟德尔随机化的结果。
IF 2.9 Q3 NUTRITION & DIETETICS Pub Date : 2025-02-01 DOI: 10.1016/j.clnesp.2024.11.035
Ruiyan Xie , Sze Kit Yuen , Zoe Tsang , William C.S. Tai , Desmond Y.H. Yap

Introduction

The benefits of probiotics/prebiotics consumption on chronic kidney disease (CKD) and mortality remains controversial.

Objectives

This study investigates the association of probiotics/prebiotics consumption with chronic kidney disease (CKD) and mortality.

Methods

Clinical data were retrieved from the National Health and Nutrition Examination Survey (NHANES) 2005–2016 database. Weighted multivariable logistic and liner regression models, cox proportional hazards models and stratified analysis were used to analyse the relationships between consumption of probiotics/prebiotics, renal parameters, CKD and mortality. We also conducted a two-sample Mendelian randomization (MR) analysis of single nucleotide polymorphisms (SNPs) related to different genera of gut microbiota to assess their causal relationships with CKD and mortality.

Results

15,291 subjects were analysed (897 with consumption of probiotics/prebiotics and 14,394 without). The use of probiotics/prebiotics showed an inverse correlation with urinary albumin-to-creatinine ratio (UACR) (P < 0.05). Probiotics/prebiotics use was associated with lower risk of CKD in subjects with hypertension, hyperlipidaemia and diabetes mellitus. The consumption of probiotics/prebiotics was associated with a significantly lower risk of all-cause mortality in different regression models (P < 0.001, for all), but the lower risk of cardiovascular mortality did not reach statistical significance (P > 0.05, for all)]. MR analysis showed negative associations between the genetically predicted genus Flavonifractor and risk of CKD and diabetic kidney disease (DKD).

Conclusion

After multivariable regression, and cox proportional hazards analysis, we found that the use of probiotics/prebiotics was associated with improved kidney and mortality outcomes in the general population from NHANES database. The two-sample MR analysis provided further genetic evidence that a distinct genus of gut microbiota was associated with reduced risk of CKD, DKD and mortality.
益生菌/益生元对慢性肾脏疾病(CKD)和死亡率的益处仍然存在争议。目的:本研究探讨益生菌/益生元摄入与慢性肾脏疾病(CKD)和死亡率的关系。方法:从2005-2016年国家健康与营养检查调查(NHANES)数据库中检索临床资料。采用加权多变量logistic和线性回归模型、cox比例风险模型和分层分析分析益生菌/益生元摄入量、肾脏参数、CKD和死亡率之间的关系。我们还对与不同肠道菌群属相关的单核苷酸多态性(snp)进行了两样本孟德尔随机化(MR)分析,以评估其与CKD和死亡率的因果关系。结果:分析了15,291名受试者(897名食用益生菌/益生元,14,394名未食用)。益生菌/益生元的使用与尿白蛋白/肌酐比值(UACR)呈负相关(P < 0.05)。在高血压、高脂血症和糖尿病患者中,益生菌/益生元的使用与较低的慢性肾病风险相关。在不同的回归模型中,益生菌/益生元的摄入与全因死亡率的风险显著降低相关(P均为0.05)。MR分析显示,基因预测的黄酮因子属与CKD和糖尿病肾病(DKD)的风险呈负相关。结论:经过多变量回归和cox比例风险分析,我们发现益生菌/益生元的使用与NHANES数据库中普通人群肾脏和死亡率结果的改善有关。两样本MR分析提供了进一步的遗传证据,表明一种独特的肠道微生物群与降低CKD、DKD和死亡率的风险相关。
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引用次数: 0
An Exploratory Study Of Enhanced Recovery After Surgery(ERAS) Protocol In Children Undergoing Urologic Complex Procedure
IF 2.9 Q3 NUTRITION & DIETETICS Pub Date : 2025-02-01 DOI: 10.1016/j.clnesp.2024.10.035
Kaiyun Fang ∗ , Nini An , Xiong zhan , Weijing Zhang , Li Gui , Yi Ma , Shaopeng Gang
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引用次数: 0
An open-label, randomized, controlled trial on the benefit of β-hydroxy-β-methyl butyrate, l-arginine, l-glutamine combination beverages and locomotion training as supportive care for the treatment of unresectable hepatocellular carcinoma using lenvatinib: A pilot study (HELLO study) 一项开放标签、随机对照试验,研究β-羟基-β-丁酸甲酯、l-精氨酸、l-谷氨酰胺联合饮料和运动训练作为lenvatinib治疗不可切除肝癌的支持治疗的益处:一项试点研究(HELLO研究)。
IF 2.9 Q3 NUTRITION & DIETETICS Pub Date : 2025-02-01 DOI: 10.1016/j.clnesp.2024.12.005
Atsushi Naganuma , Fujio Makita , Rie Sugimoto , Masahiro Kikuchi , Kiyoshi Furuta , Satoru Iwamoto , Ryotaro Sakamori , Hirotaka Kouno , Keisuke Ario , Hiroshi Yatsuhashi

Introduction

Hand–foot-skin reaction (HFSR) is the most common side effect of multi-tyrosine kinase inhibitor therapy for unresectable hepatocellular carcinoma (uHCC). Sarcopenia has been reported to be a poor prognostic factor for HCC. Here, we performed a randomized controlled trial (RCT) of the efficacy of a β-hydroxy-β-methyl butyrate/l-arginine/l-glutamine (HMB/Arg/Gln) beverage and locomotion training as supportive care in the treatment of uHCC with lenvatinib.

Methods

A total of 20 patients were enrolled from the jRCTs031190252 trial in this pilot study. HFSR was the primary endpoint, and other adverse events and skeletal muscle index at the third lumbar level (L3-SMI) were secondary endpoints.

Results

Twelve patients had albumin-bilirubin grade 1, and eight had grade 2. No difference in HFSR was observed. Although interesting differences were observed in the secondary endpoints, a slight retention of L3-SMI values in the intervention group compared with that in the control group was observed (96.5 % vs. 89.9 %, p = 0.407).

Conclusion

Although the HMB/Arg/Gln beverage and locomotion training did not reduce adverse events caused by lenvatinib, they might be useful in maintaining skeletal muscle mass. Further validation studies with a larger number of patients are warranted.
简介:手足皮肤反应(HFSR)是多酪氨酸激酶抑制剂治疗不可切除的肝细胞癌(uHCC)最常见的副作用。据报道,肌肉减少症是HCC预后不良的因素。在这里,我们进行了一项随机对照试验(RCT),研究β-羟基-β-丁酸甲酯/ l -精氨酸/ l -谷氨酰胺(HMB/Arg/Gln)饮料和运动训练作为支持护理对lenvatinib治疗uHCC的疗效。方法:从jRCTs031190252试验中共入组20例患者。HFSR是主要终点,其他不良事件和第三腰椎水平骨骼肌指数(L3-SMI)是次要终点。结果:白蛋白胆红素1级12例,2级8例。两组HFSR无显著差异。虽然在次要终点上观察到有趣的差异,但与对照组相比,干预组的L3-SMI值略有保留(96.5% vs 89.9%, p=0.407)。结论:虽然HMB/Arg/Gln饮料和运动训练不能减少lenvatinib引起的不良事件,但它们可能有助于维持骨骼肌质量。有必要对更多的患者进行进一步的验证研究。
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引用次数: 0
Impact of radiotherapy on body weight in head and neck cancer patients: A prospective study 放疗对头颈癌患者体重影响的前瞻性研究
IF 2.9 Q3 NUTRITION & DIETETICS Pub Date : 2025-02-01 DOI: 10.1016/j.clnesp.2024.12.019
Ingrid M. Fange Gjelstad , Christian Lyckander , Anne Høidalen , Åse Bratland , Rune Blomhoff , Ingvild Paur , Christine Henriksen

Background

Patients with head and neck cancer (HNC) undergoing radiotherapy or chemoradiotherapy often experience symptoms that affect their ability to eat. This study aimed to explore the impact of radiotherapy on body weight in HNC patients and compare the characteristics of patients receiving enteral tube feeding with those maintaining an oral diet.

Methods

In this prospective study, 52 patients with HNC were examined at diagnosis, at the start and end of radiotherapy, and six weeks after end of treatment. The nutritional assessment included measurements of body weight, food intake, and malnutrition using Patient-Generated Subjective Global Assessment (PG-SGA). Other variables were retrieved from the electronic patient record.

Results

Critical weight loss (defined as >5 % from start of radiotherapy) was present in 60 % of the patients at the end of radiotherapy, and only half of these patients received any enteral nutrition therapy. The mean weight loss was 5.8 % during radiotherapy, and an additional 2.1 % at follow-up (n = 48). A nasogastric feeding tube was used by 42 % at the end of radiotherapy, and 29 % at follow-up. The tube feeding users had a lower energy intake and higher weight loss than non-tube feeding users (22 vs 27 kcal/kg body weight, 7.8 vs 4.4 % weight loss) at the end of radiotherapy treatment. According to PG-SGA, 92 % of the patients were malnourished at the end of treatment and 71 % at follow-up (p < 0.001).

Conclusion

Critical weight loss and malnutrition were common in HNC patients after radiotherapy, and enteral tube feeding was initiated in only half of the cases with critical weight loss. Patients receiving enteral tube feeding may need closer monitoring to ensure adequate energy intake, and other treatment options may be necessary. These results emphasize the need for improved nutritional intervention during and after radiotherapy.
背景:接受放疗或放化疗的头颈癌(HNC)患者经常会出现影响其进食能力的症状。本研究旨在探讨放疗对HNC患者体重的影响,并比较接受肠内管喂养与维持口服饮食的患者的特点。方法:在这项前瞻性研究中,52例HNC患者在诊断时、放疗开始和结束时以及治疗结束后6周进行检查。营养评估包括体重、食物摄入和营养不良的测量,采用患者主观整体评估(PG-SGA)。其他变量从电子病历中检索。结果:60%的患者在放疗结束时出现临界体重减轻(定义为放射治疗开始时体重减轻5%),其中只有一半的患者接受了任何肠内营养治疗。放疗期间平均体重减轻5.8%,随访时平均体重减轻2.1% (n=48)。放疗结束时使用鼻胃管的比例为42%,随访时为29%。在放疗结束时,管饲使用者比非管饲使用者的能量摄入更低,体重损失更高(22 kcal/kg体重vs 27 kcal/kg体重,7.8 kcal/kg体重损失4.4%)。根据PG-SGA, 92%的患者在治疗结束时营养不良,71%的患者在随访时营养不良(p < 0.001)。结论:重度体重减轻和营养不良在HNC患者放疗后较为常见,只有一半的患者出现重度体重减轻并开始肠内管喂养。接受肠内管喂养的患者可能需要更密切的监测以确保足够的能量摄入,并且可能需要其他治疗方案。这些结果强调了在放疗期间和放疗后改善营养干预的必要性。
{"title":"Impact of radiotherapy on body weight in head and neck cancer patients: A prospective study","authors":"Ingrid M. Fange Gjelstad ,&nbsp;Christian Lyckander ,&nbsp;Anne Høidalen ,&nbsp;Åse Bratland ,&nbsp;Rune Blomhoff ,&nbsp;Ingvild Paur ,&nbsp;Christine Henriksen","doi":"10.1016/j.clnesp.2024.12.019","DOIUrl":"10.1016/j.clnesp.2024.12.019","url":null,"abstract":"<div><h3>Background</h3><div>Patients with head and neck cancer (HNC) undergoing radiotherapy or chemoradiotherapy often experience symptoms that affect their ability to eat. This study aimed to explore the impact of radiotherapy on body weight in HNC patients and compare the characteristics of patients receiving enteral tube feeding with those maintaining an oral diet.</div></div><div><h3>Methods</h3><div>In this prospective study, 52 patients with HNC were examined at diagnosis, at the start and end of radiotherapy, and six weeks after end of treatment. The nutritional assessment included measurements of body weight, food intake, and malnutrition using Patient-Generated Subjective Global Assessment (PG-SGA). Other variables were retrieved from the electronic patient record.</div></div><div><h3>Results</h3><div>Critical weight loss (defined as &gt;5 % from start of radiotherapy) was present in 60 % of the patients at the end of radiotherapy, and only half of these patients received any enteral nutrition therapy. The mean weight loss was 5.8 % during radiotherapy, and an additional 2.1 % at follow-up (<em>n</em> = 48). A nasogastric feeding tube was used by 42 % at the end of radiotherapy, and 29 % at follow-up. The tube feeding users had a lower energy intake and higher weight loss than non-tube feeding users (22 vs 27 kcal/kg body weight, 7.8 vs 4.4 % weight loss) at the end of radiotherapy treatment. According to PG-SGA, 92 % of the patients were malnourished at the end of treatment and 71 % at follow-up (p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Critical weight loss and malnutrition were common in HNC patients after radiotherapy, and enteral tube feeding was initiated in only half of the cases with critical weight loss. Patients receiving enteral tube feeding may need closer monitoring to ensure adequate energy intake, and other treatment options may be necessary. These results emphasize the need for improved nutritional intervention during and after radiotherapy.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"65 ","pages":"Pages 390-399"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparing Home-based Training and Crossfit in Prehabilitation: Physical and Emotional Outcomes
IF 2.9 Q3 NUTRITION & DIETETICS Pub Date : 2025-02-01 DOI: 10.1016/j.clnesp.2024.10.031
Marta Corcoy ∗ , Marc Sadurni , Ester Vila , Cristina Rodriguez , Jesus Carazo , Ana Luque , Luis Aguilera
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引用次数: 0
Exclusion diet and fasting practices in patients with inflammatory bowel disease: Impact on nutritional status 炎性肠病患者的排他饮食和禁食:对营养状况的影响
IF 2.9 Q3 NUTRITION & DIETETICS Pub Date : 2025-02-01 DOI: 10.1016/j.clnesp.2024.12.010
Didier Quilliot , Olivier Bonsack , Meliha Mahmutovic , Laurent Peyrin-Biroulet , Benedicte Caron

Background

Undernutrition is purportedly highly prevalent in inflammatory bowel diseases (IBD). While several risk factors have been identified, the impact of widespread eating behaviors such as food exclusions and therapeutic fasting practices has not been evaluated. There are limited data on the prevalence of undernutrition diagnosed according to internationally recognized criteria in this population.

Objectives

To estimate the prevalence of undernutrition assessed with the Global Leadership Initiative on Undernutrition (GLIM) criteria and to analyze factors associated with the characteristics of the disease and factors related to undernutrition.

Methods

Patients attending our IBD nutrition clinic were screened between November 2021 and April 2022. The complete avoidance of a food category was defined as total exclusion while avoidance most of the time was defined as partial exclusion. Undernutrition was diagnosed according to GLIM criteria. Weight history, past maximal involuntary weight loss and minimal body mass index since diagnosis of IBD were also collected.

Results

A total of 434 patients with IBD were included. Undernutrition was observed in 25.8 % of the whole population at inclusion (15 % with moderate undernutrition and 10.8 % with severe undernutrition). Mean involuntary maximal weight loss since illness onset was −14.5 % ± 11.0. Previous undernutrition since IBD diagnosis was reported in 81.1 % of the population, 63.6 % for severe and 17.5 % for moderate undernutrition. In multivariate analysis, undernutrition at inclusion was independently associated with total exclusion of at least one food category (OR = 1.11 95 % CI, 1.01–1.22; p = 0.031) as well as active disease (OR = 1.16 95 % CI, 1.05–1.27; p = 0.002), and negatively with the duration of IBD (OR = 0.88 95 % CI, 0.78–0.99, p = 0.031). Exclusion diet was also the main variable significantly associated with episodes of undernutrition in the past (OR = 1.11 95 % CI, 1.01–1.22; p = 0.035) as well as previous surgery (OR = 1.11 95 % CI, 1.00–1.23; p = 0.048). In these analyses, fasting practices were not independently associated with a risk of undernutrition.

Conclusion

Total exclusion of at least one food category was one of the main factors associated with undernutrition independently of disease activity and duration, both at the time of inclusion and in the past, and should be avoided, whereas fasting practices were not associated with a risk of undernutrition.
背景:营养不良据称在炎症性肠病(IBD)中非常普遍。虽然已经确定了几个风险因素,但广泛的饮食行为(如食物排除和治疗性禁食做法)的影响尚未得到评估。在这一人群中,根据国际公认的标准诊断出的营养不良患病率数据有限。目的:估计根据全球营养不良领导倡议(GLIM)标准评估的营养不良患病率,并分析与疾病特征和营养不良相关的因素。方法:对2021年11月至2022年4月期间在IBD营养诊所就诊的患者进行筛查。完全不吃某一类食物被定义为完全不吃,而大部分时间不吃被定义为部分不吃。根据GLIM标准诊断为营养不良。同时收集自诊断为IBD以来的体重史、过去最大非自愿体重减轻和最小体重指数。结果:共纳入434例IBD患者。纳入研究时,25.8%的人群营养不良(15%为中度营养不良,10.8%为严重营养不良)。自发病以来,平均非自愿最大体重减轻为-14.5%±11.0。自IBD诊断以来,81.1%的人群报告有营养不良史,其中63.6%为重度营养不良,17.5%为中度营养不良。在多变量分析中,纳入时的营养不良与至少一种食物类别的完全排除独立相关(OR= 1.11 95% CI, 1.01- 1.22;p=0.031)和活动性疾病(OR= 1.16 95% CI, 1.05-1.27;p=0.002),与IBD病程呈负相关(OR= 0.88 95% CI, 0.78-0.99, p=0.031)。排除饮食也是与过去营养不良事件显著相关的主要变量(OR= 1.11 95% CI, 1.01-1.22;p=0.035)和既往手术(OR= 1.11 95% CI, 1.00-1.23;p = 0.048)。在这些分析中,禁食与营养不良的风险并不是独立相关的。结论:完全排除至少一种食物类别是与营养不良相关的主要因素之一,独立于疾病活动和持续时间,无论是在纳入时还是过去,都应该避免,而禁食做法与营养不良的风险无关。
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引用次数: 0
Course of measured energy expenditure over the first 10 days of critical illness: A nested prospective study in an adult surgical ICU 危重病人最初 10 天的能量消耗测量结果:一项在成人外科重症监护室进行的巢式前瞻性研究。
IF 2.9 Q3 NUTRITION & DIETETICS Pub Date : 2025-02-01 DOI: 10.1016/j.clnesp.2024.11.009
Lizl Veldsman , Guy A. Richards , Carl Lombard , Renée Blaauw

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 ± 4.0 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.
背景与目的:各种因素都可能导致危重病人体内和之间的能量消耗出现明显的日差异。这项巢式前瞻性研究(ClinicalTrials.gov Identifier:NCT04099108)在以创伤外科为主的重症监护病房进行,旨在确定危重病人头10天的能量消耗测量结果,并找出导致能量消耗的因素:从重症监护室第3±1天到第10±1天,隔天进行间接热量测定。 使用线性混合回归法对每日测量的平均能量消耗、呼吸商数和总能量输出占测量能量消耗的百分比进行建模,其中包含两个分数多项式项,以适应随时间变化的非线性响应:共纳入 50 名 ICU 患者(平均年龄 36.9+-11.8 岁,急性生理学和慢性健康评估(APACHE II)13.5±6.6,序贯器官衰竭评估(SOFA)4.5±3.2)。平均体重指数(BMI)为 24.8±4.00 kg/m2,平均通气时间为 7.7±2.7 天。每天测量的平均能量消耗显示出显著的非线性反应(p=0.006),在最初 4 天内增加,在第 5 天达到峰值,然后趋于平稳。平均每日呼吸商在前 7 天有所增加,此后趋于平稳,从第 8 天开始略有下降趋势,尽管总能量输出占测量能量消耗的百分比在逐步增加。急性期早期的平均每日测量能量消耗显著低于急性期晚期(p=0.024),而急性期晚期和急性期后的平均每日测量能量消耗相似。年龄、性别和体重指数对测量的能量消耗有明显影响:在重症监护室的前 10 天,测量的能量消耗呈现出明显的非线性反应,在前 4 天增加,第 5 天达到峰值,随后趋于平稳。观察到的变化突显了重症患者管理的复杂性和个性化营养治疗的重要性。此外,观察到的能量消耗在第五天左右达到峰值的趋势可以为该患者群的营养干预时机和策略提供参考。
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引用次数: 0
Dietary inflammatory potential and metabolic (dysfunction)-associated steatotic liver disease and its complications: A comprehensive review 饮食炎症潜能和代谢(功能障碍)相关的脂肪变性肝病及其并发症:全面综述
IF 2.9 Q3 NUTRITION & DIETETICS Pub Date : 2025-02-01 DOI: 10.1016/j.clnesp.2024.11.032
Matin Sepehrinia , Shaghayegh Khanmohammadi , Nima Rezaei , Mohammad Shafi Kuchay
Metabolic (dysfunction)-associated steatotic liver disease (MASLD) represents a spectrum of liver pathologies linked to metabolic syndrome components. Inflammation emerges as a pivotal player in MASLD pathogenesis, initiating and perpetuating hepatic injury. Diet, a modifiable risk factor, influences inflammation levels and MASLD progression. This review synthesizes existing evidence on the association between pro-inflammatory diets, assessed via the Dietary Inflammatory Index (DII) and Empirical Dietary Inflammatory Potential (EDIP), and MASLD. Evidence suggests a significant association between higher DII/EDIP scores and MASLD risk, with studies revealing a positive correlation between inflammatory diet intake and MASLD occurrence, particularly in males. However, inconsistencies exist regarding the influence of body mass index (BMI) on this association and criticisms regarding adjustment for BMI and reliance on surrogate markers necessitate cautious interpretation. Limited data suggest a potential link between dietary inflammatory potential and advanced liver fibrosis and heightened risk of hepatocellular carcinoma (HCC) with increased DII/EDIP scores, albeit requiring further confirmation through gold-standard assessment methods. Dietary-induced inflammation exacerbates MASLD pathogenesis through multiple pathways, including insulin resistance, adipose tissue dysfunction, gut microbiota alterations, and oxidative stress, culminating in hepatic steatosis, inflammation, and fibrosis. Further research utilizing robust methodologies is imperative to confirm these findings and elucidate underlying mechanisms, thus informing targeted dietary interventions for MASLD management.
代谢(功能障碍)相关脂肪性肝病(MASLD),以前称为非酒精性脂肪性肝病(NAFLD),代表了与代谢综合征成分相关的一系列肝脏病理。炎症在MASLD发病机制中起关键作用,引发并持续肝损伤。饮食是一个可改变的危险因素,影响炎症水平和MASLD的进展。本综述综合了通过膳食炎症指数(DII)和经验膳食炎症潜力(EDIP)评估的促炎饮食与MASLD之间关联的现有证据。有证据表明,较高的DII/EDIP评分与MASLD风险之间存在显著关联,研究显示炎症性饮食摄入与MASLD发生呈正相关,尤其是在男性中。然而,关于身体质量指数(BMI)对这种关联的影响存在不一致的意见,关于BMI调整和依赖替代标志物的批评需要谨慎解释。有限的数据表明,饮食炎症潜力与晚期肝纤维化和肝细胞癌(HCC)风险增加之间存在潜在联系,但需要通过金标准评估方法进一步证实。饮食诱导的炎症通过多种途径加剧了MASLD的发病机制,包括胰岛素抵抗、脂肪组织功能障碍、肠道微生物群改变和氧化应激,最终导致肝脏脂肪变性、炎症和纤维化。利用可靠的方法进行进一步的研究是必要的,以证实这些发现并阐明潜在的机制,从而为MASLD管理提供有针对性的饮食干预措施。
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引用次数: 0
Nutritional risk screening and nutritional assessment for children with cerebral palsy: A review of the current research status and future directions 脑瘫儿童营养风险筛查与营养评估:研究现状与展望
IF 2.9 Q3 NUTRITION & DIETETICS Pub Date : 2025-02-01 DOI: 10.1016/j.clnesp.2024.12.018
Jixun Zhao , Yuyang Qiu , Huiqun Wang

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.
背景:虽然脑瘫(CP)的主要损害是运动功能,但营养不良也很常见。然而,缺乏对CP儿童早期营养不良风险筛查的工具建议,对CP儿童的营养干预手段也有限。方法:系统检索2024年1月Pubmed、MEDLINE、Embase、Cochrane图书馆中有关脑瘫临床营养相关内容的文献,并采用人工检索的方法,通过查阅参考文献和被引文献,确定其他研究。搜索词包括脑瘫、儿童、诊断、预测、营养不良、营养风险筛查、营养评估、营养支持。修改后的版本中添加的内容用红色标注。结果:CP的诊断时机不断向前推进,并开发了一些新的诊断工具。营养状况与区域经济水平相关,但发达国家仍有近30%的营养不良率。大运动功能、吞咽功能障碍、进食困难、认知障碍、能量摄入不足是CP儿童营养不良的常见危险因素。在评估CP儿童身体发育时,应结合测量指标计算Z-score。通过多种方式改善CP儿童的营养结局,包括多样化的营养支持团队(NST)干预。结论:CP患儿营养不良发生率高,应引起重视。需要为CP儿童开发更有效的营养不良风险筛查工具,以指导实施全面和个性化的营养干预措施,并改善营养不良相关的结果。
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Clinical nutrition ESPEN
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