Clinical nutrition ESPEN最新文献

Background: Ultra-processed foods (UPFs) are a major component of the Western diet, and their consumption is increasing worldwide. Although there is compelling evidence for the effects of UPF on non-communicable diseases, data on their long-term effects on liver health are limited.

Methods: We systematically searched PubMed and Embase (from 2009 to September 5, 2025) for prospective cohort studies assessing the association between higher UPF consumption (defined by the NOVA 4 classification) and the risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD) and primary liver cancer outcomes. Meta-analysis was performed using a random-effects model with the restricted maximum likelihood estimator and Knapp-Hartung adjustment to obtain pooled adjusted hazard ratios (HR) with 95 % confidence intervals (CIs).

Results: We included 7 studies with a total of 1,272,317 participants. The highest UPF consumption was significantly associated with an increased long-term risk of MASLD (pooled HR 1.32, 95 % CI 1.11 to 1.58). Moreover, the available evidence suggests no statistically significant association of higher UPF consumption and the long-term risk of developing primary liver cancer (pooled HR 1.21, 95 % CI 0.52 to 2.79), including hepatocellular carcinoma (pooled HR 0.98, 95 % CI 0.66 to 1.45) and intrahepatic cholangiocarcinoma (HR 1.00, 95 % CI 0.50 to 2.03). Sensitivity analyses did not modify these results. When UPF consumption was analyzed as a continuous variable, we found three cohort studies demonstrating its significant association with increased risk of MASLD and three cohort studies reporting conflicting results for primary liver cancer.

Conclusions: These preliminary findings suggest that higher consumption of UPFs may contribute to an increased long-term risk of MASLD, highlighting the potential benefits of reducing UPF intake as part of preventive strategies.

Background: Rheumatic diseases, including rheumatoid arthritis (RA) and osteoarthritis (OA), are characterized by chronic inflammation and oxidative stress, leading to joint destruction and disability. Conventional treatments, while effective, often present residual disease activity and adverse effects, prompting interest in complementary interventions. Pomegranate (Punica granatum), rich in bioactive polyphenols such as punicalagins and ellagitannins, has demonstrated anti-inflammatory and antioxidant properties that may benefit patients with rheumatic diseases.

Objective: To systematically review clinical and preclinical evidence regarding the effects of pomegranate supplementation in the management of rheumatic diseases.

Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, Cochrane, SciELO, and gray literature up to December 2024 following PRISMA 2020 guidelines. Eligible studies included randomized controlled trials (RCTs), observational studies, and preclinical models assessing pomegranate in RA, OA, and other autoimmune rheumatic conditions. Study quality was assessed using RoB 2, NOS, AMSTAR 2, and GRADE tools.

Results: Seven studies met the inclusion criteria: five clinical trials (one pilot and four randomized controlled trials), one preclinical animal study, and one in vitro study. In RA, supplementation with pomegranate extract or juice resulted in significant reductions in DAS28 scores, ESR, and CRP, accompanied by enhanced antioxidant activity. In OA, four randomized trials demonstrated significant improvements in WOMAC, KOOS, and VAS scores, decreased inflammatory biomarkers (IL-6, TNF-α), and enhanced antioxidant capacity. Preclinical and in vitro models confirmed inhibition of key pro-inflammatory cytokines (TNF-α, IL-1β, IL-6), suppression of NF-κB and MAPK pathways, and preservation of cartilage integrity. No serious adverse events were reported across clinical trials, and pomegranate supplementation was generally well tolerated. The overall certainty of evidence was graded as low to very low, primarily due to small sample sizes, heterogeneous interventions, and short follow-up durations.

Conclusion: Pomegranate demonstrates promising anti-inflammatory and antioxidant effects that may complement conventional therapies in rheumatic diseases. However, due to the limited number of high-quality studies, findings should be interpreted with caution. Larger, well-designed, multicenter randomized controlled trials are warranted to confirm both efficacy and safety before clinical recommendation.

Background & aims: Malnutrition affects hospital care and disease treatment. The evaluation of food intake is essential for assessing the nutritional status of patients. We developed a meal tray photography device that can automatically capture pictures of leftover food and upload them to an artificial intelligence model for analysis to improve the usability of food intake estimation.

Methods: In this study, the usability of food intake estimation using the automatic meal tray photography device and the tablet device was evaluated using the System Usability Scale (SUS). The accuracies of the automatic meal tray photography device, tablet device, and visual estimation method were compared with that of the weighing method as the benchmark.

Results: The mean SUS score of the automatic meal tray photography device was 63.2 (out of 100), which was significantly higher than that of 56.0 for the tablet device and higher than that of the tablet device for all questions. However, the accuracy of the automatic meal tray photography device tended to be lower than that of the tablet device, and the visual estimation method had the highest accuracy.

Conclusion: This study is valuable as it can help reduce the pressure on staff in healthcare settings.

Background and aims: Sarcopenia is common in cirrhosis and associated with poor outcomes. Effective interventions remain uncertain. This study evaluated the efficacy of a 12-week supervised home-based exercise combined with branched-chain amino acids (BCAA)-enriched nutritional supplementation on muscle mass in cirrhotic patients with sarcopenia.

Methods: This open-label, within-patient comparison pilot study enrolled compensated cirrhotic patients (Child-Pugh≤8) with sarcopenia, defined by CT-based L3 skeletal muscle index (SMI). Participants followed a supervised structured exercise program consisting of progressive resistance training using body weight and resistance bands (30 min/day, ≥5 sessions/week) and aerobic training (increase daily steps to 5000-10,000/day). Patients also received dietary counseling with daily BCAA supplementation (210 kcal, protein 13.5 g). Primary outcome was the change in SMI at 12 weeks. Secondary outcomes included changes in psoas muscle index (PMI), Liver Frailty Index (LFI), aerobic fitness (6-minute walk test [6MWT], cardiopulmonary exercise test), and quality of life (QoL).

Results: Twelve patients completed the study (age 63.3 ± 7.2 years, 58.3 % female). SMI significantly increased from 37.6 ± 2.2 to 44.5 ± 3.0 cm²/m² (p < 0.001), with sarcopenia resolution in 91.7 %. PMI also improved (4.6 ± 1.7 to 6.1 ± 1.8 cm²/m², p = 0.002). LFI decreased (4.2 ± 0.4 to 3.7 ± 0.4, p = 0.01), and 6MWT improved (372.5 ± 58.2 to 442.5 ± 78.7 m, p = 0.003). Physical component domain of QoL significantly increased (p < 0.001). No major adverse events occurred.

Conclusion: A home-based exercise program combined with nutritional supplementation improved muscle mass, frailty, functional capacity, and QoL in cirrhotic patients with sarcopenia. Larger trials are needed to confirm these findings.

Background and aims: Chimeric antigen receptor T-cell therapy (CAR-T) is a novel treatment for children with relapsed or refractory acute lymphoblastic leukaemia. Preferential outcomes have been shown when children maintain their nutritional status during cancer treatment. Few studies have investigated the impact of CAR-T on the nutritional status of children. This study aimed to examine the nutritional status and use of dietetic interventions in children having CAR-T.

Methods: Electronic records of all children who had CAR-T between June 2015-June 2024 from a single centre in London were retrospectively reviewed. Nutritional outcomes were examined during the child's admission for CAR-T, including weight change and dietetic interventions used including oral nutritional supplements, enteral tube feeding and parenteral nutrition. Impact of different interventions on children's weight change and length of stay were analysed.

Results: CAR-T was provided to 132 children, 65% male, mean age eight years. Weight change from CAR T-cell infusion to discharge was a mean loss of -1.8%. Sixty two percent required a dietetic intervention and of these 45% received oral nutritional supplements, 56% enteral tube feeding (of these 87% had a nasogastric tube, 13% a gastrostomy), 34% parenteral nutrition. The latter was initiated primarily for intolerance to tube feeding and provided for a mean 23 days. Children who received any dietetic intervention gained more weight than those who received none (+0.7% v -1.6%, p=0.020), as did those who initiated oral nutritional supplements proactively (before day three post-CAR T-cell infusion) versus reactively (on or after day three) (+0.4% v -3.3%, p=0.030), and those who started tube feeding proactively versus reactively (+2.4% v -3.6%, p=0.027). Length of stay was shorter for children who did not receive any dietetic intervention than those who did (19 days v 30, p<0.001), and those who did not receive tube feeding versus those who did (22 v 32 days, p=0.001).

Conclusion: Although children experienced a modest weight loss the majority required a dietetic intervention to support this, most commonly oral nutritional supplements and tube feeding. Proactive preparation of families for tube feeding is essential to facilitate acceptance. Children who did not receive a dietetic intervention may have benefitted from dietetic input. With growing evidence of changes in nutritional status and impact on outcomes, dietetic input is key to develop nutritional support algorithms that guide the use of screening, assessment and interventions in children having CAR-T.

Background & aims: Food intolerance/malabsorption, including fructose malabsorption (FM), histamine intolerance (HIT), lactose intolerance (LIT), and Helicobacter pylori (H. pylori), may present with symptoms similar to symptoms of the irritable bowel syndrome (IBS) spectrum. We aimed to investigate whether extra food intolerances/malabsorption and H. pylori infection affect the results of hydrogen breath tests in FM patients.

Methods: A hydrogen (H₂) breath test was conducted for evaluating FM and LIT. A serum diamine oxidase value determination, a search for H. pylori and antibodies to tissue transglutaminase were made. A retrospective analysis of 318 patients with FM identified 50 with FM-only, 50 FM patients with HIT and 50 FM patients with additional LIT, 50 FM and HIT patients also had LIT. Thirty-one FM patients had H. pylori, 26 FM patients had HIT and H. pylori and 40 FM patients had LIT and H. pylori, and 21 had FM, HIT, LIT and H. pylori.

Results: With the Kruskal-Wallis test we compared the area under the curve (AUC) and demonstrated that H₂ was significantly elevated in FM with LIT and FM and H. pylori patients compared to those with FM-only (p = 0.039, respectively). The comparison of the AUCs of FM-only to FM, LIT, and HIT (p = 0.006) and to FM, LIT, and HIT with H. pylori revealed a significant elevation (p = 0.026) in H₂ values.

Conclusion: In patients diagnosed with FM, the presence of additional food intolerance/malabsorption and H. pylori infection has been demonstrated to significantly increase expiratory H₂ values during fructose H₂ breath tests.