Clinical nutrition ESPEN最新文献

Background and aim: The prevention of abnormal fetal growth can improve the health status of children during infancy and in the future. However, the effect of folic acid supplementation on fetal weight for gestational age is unclear.

Objective: To investigate the effect of folic acid supplementation during pregnancy on abnormal fetal growth.

Methods: This study was an observational study based on a baseline survey of the Jinan birth cohort. Multivariate logistic regression models were constructed to analyze the effects of folic acid supplementation on the risk of abnormal fetal growth and the stratified analyses were used to assess effects of folic acid supplementation in different subgroups.

Results: A total of 6501 pairs of mothers and single live births met inclusion and exclusion criteria in the 6640 pairs baseline population of a birth cohort. The proportion for appropriate-for-gestational-age (AGA), Small-for-gestational-age (SGA), and Large-for-gestational-age (LGA) were 73.0 %, 5.2 %, and 21.7 % (1413/6501) among the study population. For the delivery of SGA, cumulative folic acid supplementation for more than 4 months was a protective factor in the mothers who were <35 years of age (OR = 0.76, 95 % CI: 0.58-0.99) or primiparas (OR = 0.73, 95 % CI: 0.54-0.98). While, for the delivery of LGA, folic acid supplementation during pregnancy was also a protective factor among the mothers who had 13 years of educational time or more (OR = 0.69, 95 % CI: 0.51-0.94).

Conclusion: Cumulative supplementation of folic acid for more than 4 months may be appropriate to reduce the risk of SGA for mothers aged <35 years and primiparas. Continuing to take folic acid supplements after the first trimester may increase the risk of LGA for multiparas and women with lower education time.

Background & aims: The effectiveness of preoperative carbohydrate loading(PCL) on postoperative insulin resistance(IR) is controversial. In addition, the effect of different doses of carbohydrates on postoperative IR is also controversial. Therefore, this study aimed to investigate the efficiency of PCL on postoperative IR and the optimal regimen for the effect on postoperative IR.

Methods: A systematic search of clinical randomized controlled trials was performed to extract basic information about the included studies, specific regimens of PCL, and preoperative and postoperative IR. Network meta-analysis was performed using frequentist random effects. A total of 7 regimens were identified by categorizing them based on frequency, timing, control groups, and conducting subgroup analysis according to surgical procedure. High (>45 g) and low (≤45 g) doses were divided according to the standard definition of PCL. Dose analysis was performed on studies in the subgroups that met the optimal frequency and timing regimen. Reporting of results based on weighted mean differences(WMD), 95 % confidence intervals(95%CrI), and the surface under the cumulative ranking(SUCRA).

Results: Carbohydrate loading given only 3 h before surgery is more strongly associated with insulin resistance than fasting(WMD: -4.04,95%CrI: -5.67 to -2.40) and placebo(WMD: -4.00,95%CrI: -5.98 to -2.02). Single-dose preoperative 3 h regimen has the highest probability of being the optimal regimen(SUCRA = 90.9 %). This is also true in open(SUCRA = 93.7 %) and laparoscopic surgery(SUCRA = 99.9 %). Analyzed using a fixed-effects model in open and laparoscopic surgery. In open surgery, high-dose and low-dose carbohydrates are associated with postoperative IR compared with fasting(high-dose: WMD: -1.75,95%CrI: -1.95 to -1.54; low-dose: WMD: -2.46,95%CrI: -3.70 to -1.23) and placebo(high-dose: WMD: -5.37,95%CrI: -6.99 to -3.76; low-dose: WMD: -6.09,95%CrI: -7.29 to -4.90). Low-dose carbohydrates(SUCRA = 95.3 %) have the highest probability of being the best option. In laparoscopic surgery, high-dose and low-dose carbohydrates are also associated with postoperative IR compared with fasting(high-dose (WMD: -5.70,95 %, CrI: -7.63 to -3.77); low-dose (WMD: -3.69,95%CrI: -4.11 to -3.27))and placebo(high-dose (WMD: -5.73,95%CrI: -7.72 to -3.74); low-dose (WMD: -3.72,95%CrI: -4.14 to -3.30)). SUCRA for high-dose carbohydrates is 99.2 %.

Conclusion: Preoperative implementation of carbohydrate loading is more beneficial in alleviating postoperative insulin resistance than fasting and placebo. Conducting PCL on the morning of surgery is more effective in relieving postoperative IR. For both open and laparoscopic surgeries, administering carbohydrate loading 3 h before the surgery may represent the optimal regimen. Further studies are needed to investigate the effect of different doses on postoperative IR.

Background & aims: Optimal nutritional intake is essential to support nutritional status and improve recovery in hospital patients. To monitor adequate food intake in patients, reliable and accessible methods to quantify patient food intake accurately are needed. The present study aims to compare the accuracy of two methods, Food Record Charts (FRCs) and Digital Photography (DP), in estimating food intake with the gold standard of Weighed Food Records (WFRs).

Methods: Thirty nurses, healthcare assistants, and researchers participated in a single-blind, prospective study to estimate food consumption using both FRCs and DP for 27 different hospital meals (6 breakfasts, 6 lunches, 6 dinners, and 9 snacks) consisting of 108 different food items. FRCs and DP estimates were compared to WFRs using the average estimations of all participants. Bland-Altman plots were used to identify any discrepancies in the accuracy of food intake estimation.

Results: FRCs overestimated food consumption by 3.2 ± 14.7 % and DP by 4.7 ± 15.8 % compared to WFRs. The Bland-Altman plots showed limited variation. Similar results were found when analyzing energy and protein content subcategories, the consumed amount, food categories, and food consistency. The inter-rater agreement was W = 0.733 (P = 0.000) and W = 0.682 (P = 0.000) for FRCs and DP, respectively.

Conclusions: FRCs and DP are accurate methods for quantifying food consumption in hospital meals compared to WFRs, with an overestimation of food consumption by less than 5 %.

Background and aims: Current prehabilitation programs are often limited by poor recruitment and attrition rates. Remote delivery of prehabilitation may reduce barriers to participation and maximize program retention. We aimed to assess the feasibility (uptake, retention, fidelity), preliminary effectiveness, and acceptability of delivering a technology-supported prehabilitation program remotely to oncologic surgical candidates.

Methods: This was a one-arm pragmatic feasibility study aiming to follow patients for 4-6 weeks preoperatively and 8 weeks postoperatively. All patients received a home-based aerobic and resistance exercise program, with psychosocial counselling as needed. Those at risk of malnutrition received nutritional counselling and supplements to meet personalized energy and protein targets. Adherence was assessed using an exercise watch and a mobile application for dietary assessment. In addition, we assessed physical effects, with change in 6-min walking distance of 20m defined as clinically meaningful recovery, and post-operative complications. Acceptability was assessed using a convergence mixed-methods approach.

Results: A total of 28 participants were included (median 69, IQR 9.5 years; 12/28, 43 % males). Rate of recruitment was 47 %, retention was 78 %, and attendance was 86-93 %. Participants walked an average of 8168 (SD: 4685) steps per day preoperatively and 6809 (SD: 4819) steps per day postoperatively. They consumed on average 21.6 kcal/kg of ideal body weight (IBW) and 1.1 g protein/kg IBW during the first week of the intervention. Participants demonstrated significant improvements in remote physical tests before surgery (arm strength: +9.7 [5.7, 13.6] repetitions in arm curl, p < 0.001; leg strength: +3.2 [1.4, 4.9] sit-to-stand repetitions in 30 s, p = 0.001; endurance: +19.4 [12.7, 26.1] repetitions in the 2-min step test, p < 0.001). The majority (16/22, 73 %) achieved clinically meaningful recovery at 8 weeks postoperatively. All participants attested to the acceptability of exercising with remote supervision.

Conclusion: A technology-assisted prehabilitation program delivered remotely is feasible and could lead to physical benefits for a surgical cancer population.

The immune system, sports injuries, physical activity and clinical sports nutrition are closely linked. Inadequate nutrition and intense stress in athletes increase the risk of immune dysfunction, injury and disease, while injury reduces the positive effects of physical activity, creating a vicious cycle affecting health and performance. Nutritional support is key to reducing the risk of injury, speeding up recovery and shortening rehabilitation. The intake of energy, protein, carbohydrates, fats and micronutrients should be adapted to the needs following injury. Quality nutrition is preferred over the use of dietary supplements, which are limited to cases of identified deficiencies (e.g. vitamin D or iron deficiencies). Health professionals with knowledge of clinical nutrition have a key role to play in injury prevention, treatment and rehabilitation, and nutritional interventions are an indispensable part of a holistic approach to athletes' health.

Background & aims: To identify predictors of enteral autonomy and survival in pediatric intestinal failure patients followed up at three pediatric intestinal rehabilitation centers from a middle-income country.

Methods: This retrospective multicenter cohort study evaluated patients with intestinal failure from three high-volume intestinal rehabilitation centers on long-term parenteral nutrition between 2014 and 2023. The primary outcome was status at the end of the follow-up: parenteral nutrition dependence, enteral autonomy, transplantation, or death. Secondary outcomes were complications resulting from treatment and current parenteral nutrition dependency index. Competing risk analysis, Cox regression, and a decision tree model were employed.

Results: The cohort comprised 207 patients with a median (interquartile range) age at admission of 6.2 (3.1; 12.9) months and a median follow-up of 29.4 (10.2; 49.6) months. Short bowel (85 %) and motility disorders (10.6 %) were the primary causes of intestinal failure. Cumulative incidence of 5-year for enteral autonomy and survival rates were 37 % and 88 %, respectively. Intestinal failure-associated liver disease was present in 24 % of patients on admission. Enteral autonomy was associated with remnant intestine length >40 cm (hazard ratio: 2.0; 95 % confidence interval: 1.7; 3.6); age at admission <6.2 months (hazard ratio: 1.8; 95 % confidence interval: 1.0; 3.3); and preserved ileocecal valve (hazard ratio: 3.4; 95 % confidence interval: 1.9; 6.0). The overall mortality rate was 7.7 %.

Conclusion: The overall survival rate was 92.3 % and the 5-year cumulative incidence of enteral autonomy was 37 %. The probability of achieving enteral autonomy was associated with early arrival at the intestinal rehabilitation center and favorable bowel anatomy.

Background: Pediatric hypertension (HTN) is increasing over time. Worldwide, the blood pressure (BP) trend has been poorly studied. The aim of our study is to evaluate the recent trend in BP in a school-aged children sample, and to search for factors that might influence BP variability.

Materials and methods: This is a retrospective longitudinal analysis studying the BP of school-aged children covering the classes of 2013-2021. From medical records of the children, sex, date of birth, date of medical visit which takes place every two years (in the 6th, 8th, and 10th grade), height (in cm), weight (in kg), systolic blood pressure (SBP), and diastolic blood pressure (DBP), were collected for each child.

Results: The sample consisted of 2164 children. SBP and DBP were significantly lower in girls than in boys and were significantly correlated with body mass index (BMI) (p-value <0.001 for all comparisons). A significant increase in SBP and DBP was observed from the 6th to the 10th grade, as well as a significant decrease of BP during a nine-year follow-up (p-values <0.001 for all comparisons).

Conclusion: Our results confirmed a sex difference in BP, an increase in BP with age and a positive association between BMI and BP. Finally, a negative secular trend for BP was found. Further studies are needed to determine if this decrease in BP with time will persist after the coronavirus disease 19 pandemic.

Background: Esophagojejunal anastomotic fistula (EJF) following radical total gastrectomy is a severe perioperative complication in patients with gastric cancer, particularly as delayed fistula healing increases hospitalization costs and leads to poor prognosis. Numerous factors influence the occurrence and progression of EJF, with inflammation and nutritional status being significant contributors to perioperative complications. Therefore, this study aims to investigate the prediction of delayed EJF healing based on postoperative clinical and imaging-related inflammation-nutrition status.

Methods: We retrospectively collected data on 315 cases of EJF following radical total gastrectomy for gastric cancer from two centers between 2015 and 2023 (training group: center one with 194 cases, validation group: center two with 121 cases). EJF was diagnosed based on clinical presentation, gastrointestinal imaging, or endoscopic findings. The healing time for EJF was defined as the period from diagnosis to the removal of the abdominal drainage tube, and patients were categorized into early healing and delayed healing groups based on the median healing time. Postoperative abdominal computed tomography(CT) scans and clinical characteristics at the time of EJF diagnosis were collected. Univariate and multivariable logistic regression analyses were performed on the training group data to construct a predictive model (nomogram). The model's performance in both the training and validation groups was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curves, and decision curve analysis (DCA).

Result: The mean healing time for EJF was 16 ± 7 days (median time: 12 days, range: 4-43 days). Postoperative systemic immune-inflammation index (SII) > 521×10ˆ9/L, controlling nutritional status score (CONUT) > 4, nutritional support method, visceral fat index (VFI) < 74.42 cm²/m², and skeletal muscle index (SMI) < 41.25 cm²/m² were associated with delayed EJF healing times. A comprehensive model was developed, in the validation group, the model demonstrated an AUC of 0.838 (95% confidence interval (95% CI): 0.763-0.912). The DCA and calibration curves indicated a strong predictive consistency and clinical utility of the model.

Background & aims: Cardiometabolic traits are complex interrelated traits that result from a combination of genetic and lifestyle factors. This study aimed to assess the interaction between genetic variants and dietary macronutrient intake on cardiometabolic traits [body mass index, waist circumference, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, triacylglycerol, systolic blood pressure, diastolic blood pressure, fasting serum glucose, fasting serum insulin, and glycated haemoglobin].

Methods: This cross-sectional study consisted of 468 urban young adults aged 20 ± 1 years, and it was conducted as part of the Study of Obesity, Nutrition, Genes and Social factors (SONGS) project, a sub-study of the Young Lives study. Thirty-nine single nucleotide polymorphisms (SNPs) known to be associated with cardiometabolic traits at a genome-wide significance level (P < 5 × 10^-8) were used to construct a genetic risk score (GRS).

Results: There were no significant associations between the GRS and any of the cardiometabolic traits. However, a significant interaction was observed between the GRS and carbohydrate intake on HDL-C concentration (P_interaction = 0.0007). In the first tertile of carbohydrate intake (≤327 g/day), participants with a high GRS (>37 risk alleles) had a higher concentration of HDL-C than those with a low GRS (≤37 risk alleles) [Beta = 0.06 mmol/L, 95 % confidence interval (CI), 0.01-0.10; P = 0.018]. In the third tertile of carbohydrate intake (>452 g/day), participants with a high GRS had a lower concentration of HDL-C than those with a low GRS (Beta = -0.04 mmol/L, 95 % CI -0.01 to -0.09; P = 0.027). A significant interaction was also observed between the GRS and glycaemic load (GL) on the concentration of HDL-C (P_interaction = 0.002). For participants with a high GRS, there were lower concentrations of HDL-C across tertiles of GL (P_trend = 0.017). There was no significant interaction between the GRS and glycaemic index on the concentration of HDL-C, and none of the other GRS∗macronutrient interactions were significant.

Conclusions: Our results suggest that young adults who consume a higher carbohydrate diet and have a higher GRS have a lower HDL-C concentration, which in turn is linked to cardiovascular diseases, and indicate that personalised nutrition strategies targeting a reduction in carbohydrate intake might be beneficial for these individuals.

Background: Dyslipidaemia is among the major causes of severe diseases and, despite being well-established, the hypocholesterolaemic therapies still face significant concerns about potential side effects (such as myopathy, myalgia, liver injury digestive problems, or mental fuzziness in some people taking statins), interaction with other drugs or specific foods. Accordingly, this review describes the latest developments in the most effective therapies to control and regulate dyslipidaemia.

Scope and approach: Herein, the metabolic dynamics of cholesterol and their integration with the current therapies: statins, bile acid sequestrants, fibrates, niacin, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, reconstituted high-density lipoprotein (rHDL), or anti-inflammatory and immune-modulating therapies), were compared focusing their effectiveness, patients' adhesion and typical side-effects. Likewise, the interaction of these therapies with recommended dietary habits, focusing functional foods and nutraceuticals uptake were also considered.

Key findings and conclusions: Since none of the current therapeutic alternatives represent an ideal solution (mainly due to side-effects or patients' tolerance), the potential adjuvant action of selected diets (and other healthy habits) was proposed as a way to improve the cholesterol-lowering effectiveness, while reducing the adverse effects caused by dose-increase or continuous uptake of alternating therapeutic agents. In general, the relevance of well-adapted diets must be acknowledged and their potential effects must be exhorted among patients, who need to be aware of the associated multifactorial advantages.