Pub Date : 2026-01-21DOI: 10.1016/j.clnesp.2026.102936
Ida M. Heerfordt , Katrine Linnet , Christian Svendsen Juhl , Anja Julie Huusom , Henrik Horwitz
Background
Alpha-lipoic acid (ALA) is a naturally occurring antioxidant and mitochondrial cofactor, widely marketed as an over-the-counter dietary supplement. In clinical studies, ALA has been safe and well-tolerated at doses around 600 mg daily. However, several case reports worldwide have documented that overdose can result in rapid and severe toxicity.
Case report
We describe an elderly woman who accidently ingested 6 g of ALA, mistaking it for her usual fiber supplement. Three hours later, she was in a confused state, with nausea, vomiting, and diaphoresis. On admission, she displayed an altered mental state with a Glasgow Coma Scale score of 6–9 and mild lactic acidosis. She soon developed seizure-like activity unresponsive to midazolam and levetiracetam. She required intubation, sedation with propofol, and mechanical ventilation. She was extubated on day 2 and discharged home on day 3 without sequelae.
Discussion
The therapeutic benefits of ALA are limited, and compared with other vitamin supplements, it has a relatively narrow therapeutic index. This case illustrates the potential for severe and life-threatening intoxication following ingestion of amounts that may easily be present in a household supply of ALA. The clinical picture is characterized by rapid onset of gastrointestinal symptoms, seizures, and circulatory instability. As no antidote exists, management is supportive.
Conclusion
ALA can be highly toxic in overdose. As treatment is only supportive, prevention is critical. Clear packaging and labeling, together with consumer education, may help reduce the risk of accidental ingestion.
{"title":"Alpha-lipoic acid: High risk, little reward. A case of severe intoxication","authors":"Ida M. Heerfordt , Katrine Linnet , Christian Svendsen Juhl , Anja Julie Huusom , Henrik Horwitz","doi":"10.1016/j.clnesp.2026.102936","DOIUrl":"10.1016/j.clnesp.2026.102936","url":null,"abstract":"<div><h3>Background</h3><div>Alpha-lipoic acid (ALA) is a naturally occurring antioxidant and mitochondrial cofactor, widely marketed as an over-the-counter dietary supplement. In clinical studies, ALA has been safe and well-tolerated at doses around 600 mg daily. However, several case reports worldwide have documented that overdose can result in rapid and severe toxicity.</div></div><div><h3>Case report</h3><div>We describe an elderly woman who accidently ingested 6 g of ALA, mistaking it for her usual fiber supplement. Three hours later, she was in a confused state, with nausea, vomiting, and diaphoresis. On admission, she displayed an altered mental state with a Glasgow Coma Scale score of 6–9 and mild lactic acidosis. She soon developed seizure-like activity unresponsive to midazolam and levetiracetam. She required intubation, sedation with propofol, and mechanical ventilation. She was extubated on day 2 and discharged home on day 3 without sequelae.</div></div><div><h3>Discussion</h3><div>The therapeutic benefits of ALA are limited, and compared with other vitamin supplements, it has a relatively narrow therapeutic index. This case illustrates the potential for severe and life-threatening intoxication following ingestion of amounts that may easily be present in a household supply of ALA. The clinical picture is characterized by rapid onset of gastrointestinal symptoms, seizures, and circulatory instability. As no antidote exists, management is supportive.</div></div><div><h3>Conclusion</h3><div>ALA can be highly toxic in overdose. As treatment is only supportive, prevention is critical. Clear packaging and labeling, together with consumer education, may help reduce the risk of accidental ingestion.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102936"},"PeriodicalIF":2.6,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146040452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20DOI: 10.1016/j.clnesp.2026.102934
S.M.M. Vaes , E.G. Peters , J. Nors , C.H. Back , W.K.G. Leclercq , T.S. de Vries Reilingh , M.D.P. Luyer , B.J.J. Smeets
Introduction
Despite advancements in perioperative care, patients undergoing colorectal surgery remain at significant risk of developing postoperative complications. Myopenia, myosteatosis and visceral obesity may impair postoperative recovery, however the exact effects are unclear. This substudy from a prospective, randomized controlled trial investigates the effects of myopenia, myosteatosis and visceral obesity on postoperative outcomes and inflammatory markers following colorectal surgery.
Methods
Adult patients undergoing elective colorectal surgery were included from a previous randomized controlled trial (SANICS II; NCT02175979). Preoperative CT images were analyzed to determine skeletal muscle index (SMI), visceral adipose tissue index (VATI) and mean skeletal muscle attenuation. Clinical outcomes and systemic inflammatory markers (interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-alpha and C-reactive protein (CRP)) were prospectively registered. Univariate and multivariate linear regression analyses were performed to identify significant associations.
Results
This study included 219 patients. After adjusting for confounding factors, mean skeletal muscle attenuation (p = 0.038) and VATI (p = 0.003) were significantly associated with the occurrence of any complication. Also, VATI was significantly associated with the occurrence of minor (Clavien-Dindo <3) complications (p = 0.010). In addition, VATI was associated with elevated CRP concentrations on postoperative day 2 (p = 0.020). However, the effect size was small, and all other analyses were not significant.
Conclusion
Although myosteatosis and visceral obesity affected some postoperative outcomes, these effects were small and did not include major complications following colorectal surgery. The clinical relevance of myopenia, myosteatosis and visceral obesity in surgical convalescence appears to be limited.
{"title":"The effect of myopenia, myosteatosis and visceral obesity on postoperative complications and inflammation in colorectal surgery","authors":"S.M.M. Vaes , E.G. Peters , J. Nors , C.H. Back , W.K.G. Leclercq , T.S. de Vries Reilingh , M.D.P. Luyer , B.J.J. Smeets","doi":"10.1016/j.clnesp.2026.102934","DOIUrl":"10.1016/j.clnesp.2026.102934","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite advancements in perioperative care, patients undergoing colorectal surgery remain at significant risk of developing postoperative complications. Myopenia, myosteatosis and visceral obesity may impair postoperative recovery, however the exact effects are unclear. This substudy from a prospective, randomized controlled trial investigates the effects of myopenia, myosteatosis and visceral obesity on postoperative outcomes and inflammatory markers following colorectal surgery.</div></div><div><h3>Methods</h3><div>Adult patients undergoing elective colorectal surgery were included from a previous randomized controlled trial (SANICS II; NCT02175979). Preoperative CT images were analyzed to determine skeletal muscle index (SMI), visceral adipose tissue index (VATI) and mean skeletal muscle attenuation. Clinical outcomes and systemic inflammatory markers (interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-alpha and C-reactive protein (CRP)) were prospectively registered. Univariate and multivariate linear regression analyses were performed to identify significant associations.</div></div><div><h3>Results</h3><div>This study included 219 patients. After adjusting for confounding factors, mean skeletal muscle attenuation (p = 0.038) and VATI (p = 0.003) were significantly associated with the occurrence of any complication. Also, VATI was significantly associated with the occurrence of minor (Clavien-Dindo <3) complications (p = 0.010). In addition, VATI was associated with elevated CRP concentrations on postoperative day 2 (p = 0.020). However, the effect size was small, and all other analyses were not significant.</div></div><div><h3>Conclusion</h3><div>Although myosteatosis and visceral obesity affected some postoperative outcomes, these effects were small and did not include major complications following colorectal surgery. The clinical relevance of myopenia, myosteatosis and visceral obesity in surgical convalescence appears to be limited.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102934"},"PeriodicalIF":2.6,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to assess the effects of early supplemental parenteral nutrition (E-SPN) on clinical outcomes in older adults Intensive Care Unit (ICU) patients receiving mechanical ventilation who failed to meet their nutritional requirements through enteral feeding alone.
Methods
In this prospective randomized controlled trial (RCT), ICU patients aged ≥60 years who achieved <50 % of prescribed energy or protein targets from enteral nutrition (EN) by ICU day 3 were enrolled. EN was initiated within 24 h of ICU admission (prescribed energy target: up to 25 kcal/kg/day based on actual body weight (ABW); protein: 1.2–1.5 g/kg/day) and advanced progressively according to tolerance and metabolic monitoring. Eligible patients were randomized to either the E-SPN group (early supplemental parenteral nutrition, initiated on ICU day 3) or the L-SPN group (late supplemental parenteral nutrition, initiated on ICU day 7).
Results
Ninety-two patients completed the study (E-SPN: 45; L-SPN: 47). Baseline characteristics were comparable between groups. The E-SPN group achieved significantly higher energy and protein intake than the L-SPN group until day 7 (P < 0.05). By day 10, serum albumin and prealbumin levels and diaphragm thickness and phosphate levels were higher in the E-SPN group (P < 0.05). Early SPN significantly reduced the duration of mechanical ventilation (157.8 ± 54.6 vs. 183.6 ± 61.0 h, P = 0.035) and ICU stay (240 vs. 288 h, P = 0.015), without affecting mortality.
Conclusion
In ICU patients aged ≥60 years at high nutritional risk requiring mechanical ventilation, initiating supplemental PN on ICU day 3 rather than day 7 improved energy and protein delivery, preserved diaphragm thickness, and shortened ventilation and ICU stay, without increasing mortality. These findings support a proactive, individualized nutrition strategy in older adults ICU patients with limited EN tolerance.
{"title":"Early supplemental parenteral nutrition shortens ventilation and intensive care unit stay in ICU patients aged ≥60 Years requiring mechanical ventilation: A randomized controlled trial","authors":"Feng Tang , Peng Guo , Wei Zhang , Huan Qin , Huan Xu","doi":"10.1016/j.clnesp.2026.102933","DOIUrl":"10.1016/j.clnesp.2026.102933","url":null,"abstract":"<div><h3>Background & aims</h3><div>This study aimed to assess the effects of early supplemental parenteral nutrition (E-SPN) on clinical outcomes in older adults Intensive Care Unit (ICU) patients receiving mechanical ventilation who failed to meet their nutritional requirements through enteral feeding alone.</div></div><div><h3>Methods</h3><div>In this prospective randomized controlled trial (RCT), ICU patients aged ≥60 years who achieved <50 % of prescribed energy or protein targets from enteral nutrition (EN) by ICU day 3 were enrolled. EN was initiated within 24 h of ICU admission (prescribed energy target: up to 25 kcal/kg/day based on actual body weight (ABW); protein: 1.2–1.5 g/kg/day) and advanced progressively according to tolerance and metabolic monitoring. Eligible patients were randomized to either the E-SPN group (early supplemental parenteral nutrition, initiated on ICU day 3) or the L-SPN group (late supplemental parenteral nutrition, initiated on ICU day 7).</div></div><div><h3>Results</h3><div>Ninety-two patients completed the study (E-SPN: 45; L-SPN: 47). Baseline characteristics were comparable between groups. The E-SPN group achieved significantly higher energy and protein intake than the L-SPN group until day 7 (P < 0.05). By day 10, serum albumin and prealbumin levels and diaphragm thickness and phosphate levels were higher in the E-SPN group (P < 0.05). Early SPN significantly reduced the duration of mechanical ventilation (157.8 ± 54.6 vs. 183.6 ± 61.0 h, P = 0.035) and ICU stay (240 vs. 288 h, P = 0.015), without affecting mortality.</div></div><div><h3>Conclusion</h3><div>In ICU patients aged ≥60 years at high nutritional risk requiring mechanical ventilation, initiating supplemental PN on ICU day 3 rather than day 7 improved energy and protein delivery, preserved diaphragm thickness, and shortened ventilation and ICU stay, without increasing mortality. These findings support a proactive, individualized nutrition strategy in older adults ICU patients with limited EN tolerance.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102933"},"PeriodicalIF":2.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.clnesp.2026.102922
Maria D. Ballesteros-Pomar , Rocco Barazzoni
Obesity is currently recognized as a complex, multifactorial chronic disease, marking a significant shift from the historical, simplistic view of mere voluntary behavior attributed solely to “excessive intake and lack of physical activity”. Formal declarations by organizations such as the American Medical Association (2013) and the European Commission (2021) formally established obesity as a non-communicable, chronic, relapsing disease, acknowledging its profound health and societal implications. This recognition is crucial, as it shifts the focus away from moral judgments and weight bias toward understanding and treating the underlying physiological dysregulation.
The pathogenesis of obesity is intricate and extends beyond the classical energy balance model. It involves complex neuroendocrine circuitries that regulate appetite, including homeostatic, hedonic, and emerging microbiota-driven hunger mechanisms. Adipose tissue functions as a vital endocrine organ, and its dysfunction—often involving inflammation, oxidative stress, and mitochondrial impairment—lead to ectopic lipid accumulation and chronic low-grade inflammation, driving associated metabolic comorbidities. Furthermore, the disease is shaped by multiple determinants integrated into the “exposome hypothesis,” including genetic susceptibility, circadian rhythm disruptions, chronic stress, and environmental exposures such as endocrine-disrupting chemicals.
Up-to-date diagnosis must reflect this complexity. Relying solely on Body Mass Index is insufficient due to its inability to differentiate between muscle and fat mass or account for crucial fat distribution. The European Association for the Study of Obesity (EASO) 2024 framework defines obesity as an adiposity-based chronic disease, emphasizing that accurate diagnosis must include both the anthropometric component (excess fat accumulation) and the clinical component, analyzing the present and potential health effects (medical, functional, and psychological impairments). Recognizing obesity as a chronic, progressive process is vital for developing targeted and effective prevention and treatment strategies.
{"title":"Why obesity is a disease - Pathogenesis and diagnosis","authors":"Maria D. Ballesteros-Pomar , Rocco Barazzoni","doi":"10.1016/j.clnesp.2026.102922","DOIUrl":"10.1016/j.clnesp.2026.102922","url":null,"abstract":"<div><div>Obesity is currently recognized as a complex, multifactorial chronic disease, marking a significant shift from the historical, simplistic view of mere voluntary behavior attributed solely to “excessive intake and lack of physical activity”. Formal declarations by organizations such as the American Medical Association (2013) and the European Commission (2021) formally established obesity as a non-communicable, chronic, relapsing disease, acknowledging its profound health and societal implications. This recognition is crucial, as it shifts the focus away from moral judgments and weight bias toward understanding and treating the underlying physiological dysregulation.</div><div>The pathogenesis of obesity is intricate and extends beyond the classical energy balance model. It involves complex neuroendocrine circuitries that regulate appetite, including homeostatic, hedonic, and emerging microbiota-driven hunger mechanisms. Adipose tissue functions as a vital endocrine organ, and its dysfunction—often involving inflammation, oxidative stress, and mitochondrial impairment—lead to ectopic lipid accumulation and chronic low-grade inflammation, driving associated metabolic comorbidities. Furthermore, the disease is shaped by multiple determinants integrated into the “exposome hypothesis,” including genetic susceptibility, circadian rhythm disruptions, chronic stress, and environmental exposures such as endocrine-disrupting chemicals.</div><div>Up-to-date diagnosis must reflect this complexity. Relying solely on Body Mass Index is insufficient due to its inability to differentiate between muscle and fat mass or account for crucial fat distribution. The European Association for the Study of Obesity (EASO) 2024 framework defines obesity as an adiposity-based chronic disease, emphasizing that accurate diagnosis must include both the anthropometric component (excess fat accumulation) and the clinical component, analyzing the present and potential health effects (medical, functional, and psychological impairments). Recognizing obesity as a chronic, progressive process is vital for developing targeted and effective prevention and treatment strategies.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102922"},"PeriodicalIF":2.6,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Water plays a vital role in muscle function, and its distribution between intracellular (ICW) and extracellular (ECW) compartments serves as a key indicator of muscle quality. Bioelectrical impedance analysis (BIA) quantifies body water (BW), while myotonometry measures muscle mechanical properties; however, the relationship between these measures remains underexplored. This study aimed to assess the association between BW compartments and the resting mechanical properties of lower limb muscles.
Methods
A total of 158 healthy adults (97 men, 61 women; mean age 20.8 years) participated. BW compartments, including total body water (TBW), ICW, and ECW, were measured using a multi-frequency body composition analyser (TANITA MC-780 MA). A MyotonPRO® device assessed the mechanical properties (e.g. tone, stiffness) in the tibialis anterior, peroneus longus, and gastrocnemius muscles. Spearman's rank correlation and multiple linear regression models were used to analyse the relationships between BIA and myotonometry.
Results
The analysis revealed a consistent bipolar pattern of associations. Absolute hydration volumes (TBW, ICW, ECW expressed in kilograms) were positively correlated with muscle tone and stiffness, with correlations ranging from weak to high (r ≈ 0.30–0.70, p < 0.001). ICW was the strongest determinant. In contrast, relative ECW (expressed as a percentage) showed moderate negative correlations with tone and stiffness. This pattern was consistent across all muscles and between limbs.
Conclusions
In healthy young adults, the resting mechanical properties of lower limb muscles are significantly associated not only with TBW but, more importantly, with its compartmental distribution. Higher ICW corresponds to greater muscle tone and stiffness, whereas a high ECW proportion is linked to lower values.
{"title":"The association between body water compartments and muscle mechanical properties: A correlational study using bioimpedance and myotonometry","authors":"Martyna Sochor, Marcelina Mrowiec, Dawid Bączkowicz","doi":"10.1016/j.clnesp.2026.102927","DOIUrl":"10.1016/j.clnesp.2026.102927","url":null,"abstract":"<div><h3>Background and aims</h3><div>Water plays a vital role in muscle function, and its distribution between intracellular (ICW) and extracellular (ECW) compartments serves as a key indicator of muscle quality. Bioelectrical impedance analysis (BIA) quantifies body water (BW), while myotonometry measures muscle mechanical properties; however, the relationship between these measures remains underexplored. This study aimed to assess the association between BW compartments and the resting mechanical properties of lower limb muscles.</div></div><div><h3>Methods</h3><div>A total of 158 healthy adults (97 men, 61 women; mean age 20.8 years) participated. BW compartments, including total body water (TBW), ICW, and ECW, were measured using a multi-frequency body composition analyser (TANITA MC-780 MA). A MyotonPRO® device assessed the mechanical properties (e.g. tone, stiffness) in the tibialis anterior, peroneus longus, and gastrocnemius muscles. Spearman's rank correlation and multiple linear regression models were used to analyse the relationships between BIA and myotonometry.</div></div><div><h3>Results</h3><div>The analysis revealed a consistent bipolar pattern of associations. Absolute hydration volumes (TBW, ICW, ECW expressed in kilograms) were positively correlated with muscle tone and stiffness, with correlations ranging from weak to high (r ≈ 0.30–0.70, p < 0.001). ICW was the strongest determinant. In contrast, relative ECW (expressed as a percentage) showed moderate negative correlations with tone and stiffness. This pattern was consistent across all muscles and between limbs.</div></div><div><h3>Conclusions</h3><div>In healthy young adults, the resting mechanical properties of lower limb muscles are significantly associated not only with TBW but, more importantly, with its compartmental distribution. Higher ICW corresponds to greater muscle tone and stiffness, whereas a high ECW proportion is linked to lower values.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102927"},"PeriodicalIF":2.6,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Phase angle (PhA) reflects cellular health and nutritional status. Although PhA has been linked to mortality in various populations, its prognostic value for heart failure (HF), especially rehospitalization, remains unclear. This study investigated the association between PhA and the composite outcome of HF rehospitalization and all-cause mortality after discharge in patients hospitalized for acute HF.
Methods
Patients hospitalized with HF who underwent rehabilitation during hospitalization. The primary outcome was a composite of HF rehospitalization and all-cause mortality within one year. Associations were evaluated with multivariate Cox proportional hazards models. Receiver operating characteristic analysis determined the optimal PhA cut-off. The cumulative incidence of the composite outcome and all-cause mortality were estimated using Kaplan–Meier analysis with log-rank tests. For HF rehospitalization, the cumulative incidence was calculated using Gray's test, with death as a competing risk.
Results
The one-year incidence of the composite outcome was 23.3 % (n = 97) among the 417 patients. In multivariate models, PhA independently predicted the composite outcome (hazard ratio: 0.74; 95 % confidence interval: 0.55–0.99, p = 0.048). The optimal PhA cut-off was 3.8. Patients with PhA <3.8 had significantly higher rates of HF rehospitalization (p = 0.033), composite outcomes (p = 0.001), and all-cause mortality (p = 0.002).
Conclusions
In patients with HF, PhA assessed during hospitalization was significantly associated with HF rehospitalization and all-cause mortality within one year. These findings support PhA as a useful biomarker for prognostic assessment in clinical practice.
{"title":"Association between phase angle and one-year heart failure rehospitalization and all-cause mortality in patients with heart failure","authors":"Masaya Hori , Koya Takino , Takuji Adachi , Yoji Kuze , Takashi Nagai , Nao Ichiba , Kenya Usui , Tsuyoshi Tanabe , Misuzu Ide , Masayasu Nakagawa , Hitoshi Matsuo","doi":"10.1016/j.clnesp.2026.102928","DOIUrl":"10.1016/j.clnesp.2026.102928","url":null,"abstract":"<div><h3>Background & aims</h3><div>Phase angle (PhA) reflects cellular health and nutritional status. Although PhA has been linked to mortality in various populations, its prognostic value for heart failure (HF), especially rehospitalization, remains unclear. This study investigated the association between PhA and the composite outcome of HF rehospitalization and all-cause mortality after discharge in patients hospitalized for acute HF.</div></div><div><h3>Methods</h3><div>Patients hospitalized with HF who underwent rehabilitation during hospitalization. The primary outcome was a composite of HF rehospitalization and all-cause mortality within one year. Associations were evaluated with multivariate Cox proportional hazards models. Receiver operating characteristic analysis determined the optimal PhA cut-off. The cumulative incidence of the composite outcome and all-cause mortality were estimated using Kaplan–Meier analysis with log-rank tests. For HF rehospitalization, the cumulative incidence was calculated using Gray's test, with death as a competing risk.</div></div><div><h3>Results</h3><div>The one-year incidence of the composite outcome was 23.3 % (n = 97) among the 417 patients. In multivariate models, PhA independently predicted the composite outcome (hazard ratio: 0.74; 95 % confidence interval: 0.55–0.99, <em>p</em> = 0.048). The optimal PhA cut-off was 3.8. Patients with PhA <3.8 had significantly higher rates of HF rehospitalization (<em>p</em> = 0.033), composite outcomes (<em>p</em> = 0.001), and all-cause mortality (<em>p</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>In patients with HF, PhA assessed during hospitalization was significantly associated with HF rehospitalization and all-cause mortality within one year. These findings support PhA as a useful biomarker for prognostic assessment in clinical practice.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102928"},"PeriodicalIF":2.6,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.clnesp.2026.102926
Bochen Li , Ruotong Zhang , Rachel Gibson , Rebecca A. Hillier , Thivi Maruthappu , Alex Dregan , Christopher E.M. Griffiths , Wendy L. Hall
Background & aim
Chronic inflammatory skin disorders (CISDs)—including acne, psoriasis, and atopic dermatitis—are linked to substantial psychological distress and social stigma, often resulting in comorbid mental health conditions and contributing to the global disease burden. Diet, as a modifiable factor, has drawn growing attention for its potential impact on both CISDs and mental health. This systematic scoping review aimed to evaluate the current evidence on the interrelationships among dietary factors, CISDs, and mental health conditions.
Methods
A comprehensive literature search was performed across six databases (from inception to April 2024): MEDLINE, CINAHL, Embase, Scopus, Cochrane CENTRAL, and PROSPERO. After duplicate removal, 1739 unique records were identified. Titles, abstracts, and full texts were screened using predefined eligibility criteria. 22 studies met inclusion criteria and were included in the final synthesis. Data were extracted and synthesized according to study design, population characteristics, dietary factors, CISDs, and mental health conditions.
Results
Of the 22 included studies, 11 were cross-sectional. Among the three focal domains, acne (n = 12) was the most frequently studied CISD; food consumption and frequency (n = 8) were the most common dietary exposures; and depression (n = 13) was the most frequently assessed mental health condition. Across studies, consistent associations were observed: beneficial dietary factors, including guideline-aligned dietary patterns, components, and behaviours characterised by nutrient-dense and health-promoting profiles, were positively linked to reduced risk or severity of both CISDs and mental health conditions. A strong positive correlation between CISDs and mental health outcomes was also evident. Two major gaps were identified in the current literature. First, the overall strength of evidence remains limited, with only three cohort studies and two randomized controlled trials among the 22 included. Second, few studies concurrently examined the interrelationships among diet, CISDs, and mental health. The most promising conceptual framework for future mediation analysis appears to be the pathway: Diet → CISDs (mediator) → Mental health outcomes.
Conclusions
Diet represents a modifiable and potentially cost-effective factor within the interconnected system linking dietary factors, CISDs, and mental health conditions. Current evidence supports associations across all three domains, highlighting the need for integrated research and intervention strategies that simultaneously address diet, skin health, and mental health. Future studies using large-scale and integrated data sources are needed to clarify these complex interrelationships.
{"title":"Diet, inflammatory skin disorders, and mental health: A scoping review of current evidence","authors":"Bochen Li , Ruotong Zhang , Rachel Gibson , Rebecca A. Hillier , Thivi Maruthappu , Alex Dregan , Christopher E.M. Griffiths , Wendy L. Hall","doi":"10.1016/j.clnesp.2026.102926","DOIUrl":"10.1016/j.clnesp.2026.102926","url":null,"abstract":"<div><h3>Background & aim</h3><div>Chronic inflammatory skin disorders (CISDs)—including acne, psoriasis, and atopic dermatitis—are linked to substantial psychological distress and social stigma, often resulting in comorbid mental health conditions and contributing to the global disease burden. Diet, as a modifiable factor, has drawn growing attention for its potential impact on both CISDs and mental health. This systematic scoping review aimed to evaluate the current evidence on the interrelationships among dietary factors, CISDs, and mental health conditions.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was performed across six databases (from inception to April 2024): MEDLINE, CINAHL, Embase, Scopus, Cochrane CENTRAL, and PROSPERO. After duplicate removal, 1739 unique records were identified. Titles, abstracts, and full texts were screened using predefined eligibility criteria. 22 studies met inclusion criteria and were included in the final synthesis. Data were extracted and synthesized according to study design, population characteristics, dietary factors, CISDs, and mental health conditions.</div></div><div><h3>Results</h3><div>Of the 22 included studies, 11 were cross-sectional. Among the three focal domains, acne (n = 12) was the most frequently studied CISD; food consumption and frequency (n = 8) were the most common dietary exposures; and depression (n = 13) was the most frequently assessed mental health condition. Across studies, consistent associations were observed: beneficial dietary factors, including guideline-aligned dietary patterns, components, and behaviours characterised by nutrient-dense and health-promoting profiles, were positively linked to reduced risk or severity of both CISDs and mental health conditions. A strong positive correlation between CISDs and mental health outcomes was also evident. Two major gaps were identified in the current literature. First, the overall strength of evidence remains limited, with only three cohort studies and two randomized controlled trials among the 22 included. Second, few studies concurrently examined the interrelationships among diet, CISDs, and mental health. The most promising conceptual framework for future mediation analysis appears to be the pathway: Diet → CISDs (mediator) → Mental health outcomes.</div></div><div><h3>Conclusions</h3><div>Diet represents a modifiable and potentially cost-effective factor within the interconnected system linking dietary factors, CISDs, and mental health conditions. Current evidence supports associations across all three domains, highlighting the need for integrated research and intervention strategies that simultaneously address diet, skin health, and mental health. Future studies using large-scale and integrated data sources are needed to clarify these complex interrelationships.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102926"},"PeriodicalIF":2.6,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.clnesp.2026.102929
Grandhi Surendra, Monika Srivastav, Ajay Guru
{"title":"Letter to the editor: Association of diabetes with sarcopenia in patients on hemodialysis: A nationwide cross-sectional study in Portugal.","authors":"Grandhi Surendra, Monika Srivastav, Ajay Guru","doi":"10.1016/j.clnesp.2026.102929","DOIUrl":"https://doi.org/10.1016/j.clnesp.2026.102929","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":"102929"},"PeriodicalIF":2.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comment on \"Impact of fish oil-enriched high protein peptide-based formula on free fatty acid profiles and metabolomic changes in home enterally fed patients: A pilot study\".","authors":"Prashant Ramdas Kokiwar, Ranjana Roy, Archana Dhyani","doi":"10.1016/j.clnesp.2026.102924","DOIUrl":"10.1016/j.clnesp.2026.102924","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":"102924"},"PeriodicalIF":2.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The effectiveness of beta-hydroxy-beta-methylbutyrate (HMB) for sarcopenia in decompensated cirrhosis patients remains unclear. This pilot trial investigated the effect of HMB-containing oral nutritional supplement (ONS) on muscle mass as the primary outcome. Secondary outcomes included changes in muscle strength, quality, and physical performance.
Methods
This randomized controlled trial included 21 patients with stable decompensated cirrhosis and sarcopenia (April 2022–January 2024). Participants received either an HMB-containing ONS (daily total of 1.48 g Calcium HMB, 21 g protein, 524 kcal) (HMB group, n = 12) or maltodextrin (control group, n = 9) for 12 weeks. The primary outcome was the 12-week change in muscle mass measured by bioelectrical impedance analysis. Secondary outcomes included handgrip strength, anthropometry, and physical performance.
Results
At 12 weeks, there were no significant between-group differences in muscle mass parameters (e.g., appendicular skeletal muscle mass index [ASMI], fat-free mass index [FFMI]) or handgrip strength. However, the HMB group demonstrated significant within-group improvements from baseline in phase angle (4.6°–5.0°, p = 0.015), mid-arm muscle circumference [MAMC] (23.3–24.4 cm, p = 0.008), and 5-time chair stand test performance (18.6–16.5 s, p = 0.047). The supplement was well-tolerated with no significant adverse events.
Conclusion
In patients with stable decompensated cirrhosis and sarcopenia, 12-week HMB-containing ONS was well-tolerated. While it did not significantly increase muscle mass or handgrip strength compared to the control group, HMB-containing ONS showed promise for improving key sarcopenia-related parameters—phase angle, mid-arm muscle circumference, and chair stand test performance when compared to baseline. Larger adequately powered randomized controlled trials are needed to confirm these findings. (Trial Registration: Thai Clinical Trials Registry on April 22, 2024, No. TCTR20240422012. The registration can be accessed at: https://thaiclinicaltrials.org/).
背景与目的：β -羟基- β -甲基丁酸酯（HMB）治疗失代偿期肝硬化患者肌肉减少症的有效性尚不清楚。本试验以含hmb的口服营养补充剂（ONS）对肌肉质量的影响为主要观察指标。次要结果包括肌肉力量、质量和身体表现的变化。方法：该随机对照试验纳入了21例稳定失代偿性肝硬化和肌肉减少症患者（2022年4月- 2024年1月）。参与者接受含有HMB的ONS（每天总共1.48 g钙HMB， 21 g蛋白质，524千卡）（HMB组，n=12）或麦芽糊精（对照组，n=9），为期12周。主要结果是通过生物电阻抗分析测量肌肉质量的12周变化。次要结果包括握力、人体测量和身体表现。结果：在12周时，肌肉质量参数（如阑尾骨骼肌质量指数[ASMI]，无脂肪质量指数[FFMI]）或握力在组间无显著差异。然而，与基线相比，HMB组在相位角（4.6°至5.0°，p=0.015）、手臂中肌围[MAMC]（23.3至24.4 cm, p=0.008）和5次椅子站立测试性能（18.6至16.5秒，p=0.047）方面表现出显著的组内改善。该补充剂耐受性良好，无明显不良事件。结论：在稳定失代偿性肝硬化和肌肉减少症患者中，12周含hmb的ONS耐受性良好。虽然与对照组相比，它没有显著增加肌肉质量或握力，但与基线相比，含有hmb的ONS显示出改善肌少症相关的关键参数-相位角，手臂中部肌肉周长和椅子站立测试性能的希望。需要更大规模的充分有力的随机对照试验来证实这些发现。(试验注册：泰国临床试验注册中心，2024年4月22日；TCTR20240422012。注册可以访问：https://thaiclinicaltrials.org/)。
{"title":"The effects of beta-hydroxy-beta-methylbutyrate on sarcopenia in stable decompensated cirrhosis: A pilot randomized controlled trial","authors":"Witsarut Manasirisuk , Jittirat Jinchai , Jaruta Inthanon , Tanita Suttichaimongkol , Kookwan Sawadpanich , Wattana Sukeepaisarnjaroen , Chitchai Rattananukrom , Apichart Sangchan , Pisaln Mairiang , Veeradej Pisprasert , Sornwichate Rattanachaiwong , Pranithi Hongsprabhas , Thunchanok Kuichanuan","doi":"10.1016/j.clnesp.2026.102915","DOIUrl":"10.1016/j.clnesp.2026.102915","url":null,"abstract":"<div><h3>Background and objective</h3><div>The effectiveness of beta-hydroxy-beta-methylbutyrate (HMB) for sarcopenia in decompensated cirrhosis patients remains unclear. This pilot trial investigated the effect of HMB-containing oral nutritional supplement (ONS) on muscle mass as the primary outcome. Secondary outcomes included changes in muscle strength, quality, and physical performance.</div></div><div><h3>Methods</h3><div>This randomized controlled trial included 21 patients with stable decompensated cirrhosis and sarcopenia (April 2022–January 2024). Participants received either an HMB-containing ONS (daily total of 1.48 g Calcium HMB, 21 g protein, 524 kcal) (HMB group, <em>n</em> = 12) or maltodextrin (control group, <em>n</em> = 9) for 12 weeks. The primary outcome was the 12-week change in muscle mass measured by bioelectrical impedance analysis. Secondary outcomes included handgrip strength, anthropometry, and physical performance.</div></div><div><h3>Results</h3><div>At 12 weeks, there were no significant between-group differences in muscle mass parameters (e.g., appendicular skeletal muscle mass index [ASMI], fat-free mass index [FFMI]) or handgrip strength. However, the HMB group demonstrated significant within-group improvements from baseline in phase angle (4.6°–5.0°, <em>p</em> = 0.015), mid-arm muscle circumference [MAMC] (23.3–24.4 cm, <em>p</em> = 0.008), and 5-time chair stand test performance (18.6–16.5 s, <em>p</em> = 0.047). The supplement was well-tolerated with no significant adverse events.</div></div><div><h3>Conclusion</h3><div>In patients with stable decompensated cirrhosis and sarcopenia, 12-week HMB-containing ONS was well-tolerated. While it did not significantly increase muscle mass or handgrip strength compared to the control group, HMB-containing ONS showed promise for improving key sarcopenia-related parameters—phase angle, mid-arm muscle circumference, and chair stand test performance when compared to baseline. Larger adequately powered randomized controlled trials are needed to confirm these findings. (Trial Registration: Thai Clinical Trials Registry on April 22, 2024, No. TCTR20240422012. The registration can be accessed at: <span><span>https://thaiclinicaltrials.org/</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102915"},"PeriodicalIF":2.6,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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