Pub Date : 2025-12-09DOI: 10.1016/j.clnu.2025.11.022
Rabia Topan , Shraya Pandya , Paula Chance , Natalia Zarate-Lopez , Qasim Aziz , Paul Bassett , Janet Kyle , Kevin Whelan , Asma Fikree
Background and aims
Hypermobile Ehlers Danlos Syndrome (hEDS) patients have a high prevalence of Disorders of Gut–Brain Interaction (DGBI) and can pose complex nutritional challenges, yet little is known about their dietary intake, adequacy or dietary patterns and how this relates to clinical presentation. We aimed to assess this.
Methods
In a cross-sectional study, patients with hEDS completed a food frequency questionnaire and questionnaires characterizing: DGBI, gastrointestinal (GI) symptoms, Avoidant Restrictive Food Intake Disorder (ARFID), and use of nutrition support. Principal component analysis and cluster analysis classified patients into dietary patterns.
Results
425 participants were included (mean: 41 years, 96 % female); 46.4 % were overweight/obese. Patients consumed high protein (77.2 g ± 37.8), high fat (79.1 g ± 36.9) diets that were low in calories, Vitamin B and D; only 24.7 % achieved fibre requirements. Four dietary patterns existed: (1) ‘low food intake’ (n = 149), with highest nutrient inadequacy, highest ARFID scores (p < 0.001), most likely to use nutrition support (24 %, p = 0.02); (2) ‘vegetarian/health conscious’ (n = 120), with highest fibre intake (p < 0.001); (3) ‘low residue’ (n = 35), mostly seen in tertiary clinics (46 %, p < 0.001) and (4) ‘refined/highly processed’, with highest BMI (27.3 kg/m2 p < 0.001) and presence of dyspepsia (p = 0.007) and least likely to have a dietetic consultation (p = 0.02).
Conclusion
This is the first study to measure nutrition intake, adequacy and dietary patterns in hEDS. Patients with either restrictive or highly processed food intake have more GI symptoms. Further research is needed to establish how these dietary patterns can best be managed in clinical practice, to optimize intake and minimize the use of artificial nutrition support.
{"title":"Nutrient intake, dietary patterns and relationship to symptoms and comorbidities in hypermobile Ehlers-Danlos syndrome","authors":"Rabia Topan , Shraya Pandya , Paula Chance , Natalia Zarate-Lopez , Qasim Aziz , Paul Bassett , Janet Kyle , Kevin Whelan , Asma Fikree","doi":"10.1016/j.clnu.2025.11.022","DOIUrl":"10.1016/j.clnu.2025.11.022","url":null,"abstract":"<div><h3>Background and aims</h3><div>Hypermobile Ehlers Danlos Syndrome (hEDS) patients have a high prevalence of Disorders of Gut–Brain Interaction (DGBI) and can pose complex nutritional challenges, yet little is known about their dietary intake, adequacy or dietary patterns and how this relates to clinical presentation. We aimed to assess this.</div></div><div><h3>Methods</h3><div>In a cross-sectional study, patients with hEDS completed a food frequency questionnaire and questionnaires characterizing: DGBI, gastrointestinal (GI) symptoms, Avoidant Restrictive Food Intake Disorder (ARFID), and use of nutrition support. Principal component analysis and cluster analysis classified patients into dietary patterns.</div></div><div><h3>Results</h3><div>425 participants were included (mean: 41 years, 96 % female); 46.4 % were overweight/obese. Patients consumed high protein (77.2 g ± 37.8), high fat (79.1 g ± 36.9) diets that were low in calories, Vitamin B and D; only 24.7 % achieved fibre requirements. Four dietary patterns existed: (1) ‘low food intake’ (n = 149), with highest nutrient inadequacy, highest ARFID scores (p < 0.001), most likely to use nutrition support (24 %, p = 0.02); (2) ‘vegetarian/health conscious’ (n = 120), with highest fibre intake (p < 0.001); (3) ‘low residue’ (n = 35), mostly seen in tertiary clinics (46 %, p < 0.001) and (4) ‘refined/highly processed’, with highest BMI (27.3 kg/m<sup>2</sup> p < 0.001) and presence of dyspepsia (p = 0.007) and least likely to have a dietetic consultation (p = 0.02).</div></div><div><h3>Conclusion</h3><div>This is the first study to measure nutrition intake, adequacy and dietary patterns in hEDS. Patients with either restrictive or highly processed food intake have more GI symptoms. Further research is needed to establish how these dietary patterns can best be managed in clinical practice, to optimize intake and minimize the use of artificial nutrition support.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106538"},"PeriodicalIF":7.4,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-08DOI: 10.1016/j.clnu.2025.12.003
Ningyi Zou , Peijuan Zhou , Qing Zhou , Jizheng Ma , Shuo Feng , Peijing Rong , Shaoyuan Li
Dysregulation of glucose and lipid metabolism is a systemic disorder involving intricate interactions between the central nervous system, which governs stress and emotional regulation, and peripheral organs such as the gastrointestinal tract, liver, and pancreas. As a key component of the autonomic nervous system, the vagus nerve plays a pivotal role in regulating metabolic homeostasis through its widespread distribution and bidirectional communication along the gut-brain axis. Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising non-pharmacological therapy for metabolic disorders, modulating autonomic function via brain-gut coordination to reduce food intake and enhance energy expenditure, thereby alleviating obesity, type 2 diabetes, and related conditions. However, the dynamic mechanisms by which taVNS maintains homeostatic balance through the gut-brain axis, as well as its novel targets, mediators, and pathways, remain elusive. Based on the concept of “brain-gut interaction for holistic regulation”, this review explores the potential mechanisms of taVNS in ameliorating glucose and lipid metabolic disorders, offering new perspectives and strategies for clinical intervention.
{"title":"Brain-gut interaction for holistic regulation: Transcutaneous auricular vagus nerve stimulation in modulating glucose and lipid metabolic disorders","authors":"Ningyi Zou , Peijuan Zhou , Qing Zhou , Jizheng Ma , Shuo Feng , Peijing Rong , Shaoyuan Li","doi":"10.1016/j.clnu.2025.12.003","DOIUrl":"10.1016/j.clnu.2025.12.003","url":null,"abstract":"<div><div>Dysregulation of glucose and lipid metabolism is a systemic disorder involving intricate interactions between the central nervous system, which governs stress and emotional regulation, and peripheral organs such as the gastrointestinal tract, liver, and pancreas. As a key component of the autonomic nervous system, the vagus nerve plays a pivotal role in regulating metabolic homeostasis through its widespread distribution and bidirectional communication along the gut-brain axis. Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising non-pharmacological therapy for metabolic disorders, modulating autonomic function via brain-gut coordination to reduce food intake and enhance energy expenditure, thereby alleviating obesity, type 2 diabetes, and related conditions. However, the dynamic mechanisms by which taVNS maintains homeostatic balance through the gut-brain axis, as well as its novel targets, mediators, and pathways, remain elusive. Based on the concept of “brain-gut interaction for holistic regulation”, this review explores the potential mechanisms of taVNS in ameliorating glucose and lipid metabolic disorders, offering new perspectives and strategies for clinical intervention.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106544"},"PeriodicalIF":7.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-06DOI: 10.1016/j.clnu.2025.11.023
Elvira Marquez-Paradas , Gregorio Gil-Sanchez , Luna Barrera-Chamorro , Teresa Gonzalez-de la Rosa , Antonio D. Miguel-Albarreal , Alfredo Corell , Sergio Montserrat-de la Paz
Background and aims
Dietary fatty acids are central modulators of postprandial metabolism and inflammation, processes intimately linked to long-term cardiometabolic health. Circulating extracellular vesicles (EVs), particularly exosomes, have emerged as dynamic mediators of intercellular communication and may reflect acute physiological changes. However, the impact of distinct dietary fatty acids on EV phenotype during the postprandial period remains poorly understood. Our aim was to investigate the effect of isoenergetic meals enriched in saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs) or omega-3 long-chain polyunsaturated fatty acids (ω3-LCPUFAs) on classical immunometabolic markers and on the phenotypic profile and cellular origin of circulating EVs in healthy adults.
Methods
In a randomized crossover study, ten healthy participants (a total of 40 postprandial curves) received four test meals (SFA-, MUFA-, or ω3-LCPUFA-enriched emulsions, plus a fat-free control emulsion). Blood samples were collected at fasting, 2–3 h (postprandial peak), and 5–6 h (late postprandial phase). Clinical, biochemical, haematological, and immunological parameters were assessed. EVs were isolated from plasma, and 37 surface markers were analysed by multiplex flow cytometry to infer their cellular origin.
Results
Postprandial responses varied with fat quality. MUFA and ω3-LCPUFA meals induced broader immunometabolic activation than SFA. At the late postprandial phase, MUFA increased serum IgA, IgG, and IgM (p = 0.004, 0.013, and 0.020) and complement C1q and C3 (p = 0.008 and 0.004), whereas ω3-LCPUFA increased IgG and C3 (p = 0.027 and 0.046). Lymphocyte counts declined after all four meals (all p ≤ 0.007). EV concentration and mean diameter (∼100–150 nm) remained stable across interventions. Notably, MUFA intake enriched CD14+ (monocyte-derived) vesicles, ω3-LCPUFA enhanced EVs from endothelial and T-cell lineages in the late postprandial phase, and the SFA meal reduced expression of multiple lineage-specific markers.
Conclusions
Dietary fat composition modulates the postprandial phenotype and cellular origin of circulating EVs without altering their abundance or size. These findings support the use of EV phenotyping as a sensitive tool to monitor early immune-metabolic responses to nutritional interventions and may inform precision strategies for cardiometabolic disease prevention.
{"title":"Postprandial modulation of the surface profile and cellular origin of circulating extracellular vesicles by dietary fatty acid composition: A randomized crossover pilot study in young healthy adults","authors":"Elvira Marquez-Paradas , Gregorio Gil-Sanchez , Luna Barrera-Chamorro , Teresa Gonzalez-de la Rosa , Antonio D. Miguel-Albarreal , Alfredo Corell , Sergio Montserrat-de la Paz","doi":"10.1016/j.clnu.2025.11.023","DOIUrl":"10.1016/j.clnu.2025.11.023","url":null,"abstract":"<div><h3>Background and aims</h3><div>Dietary fatty acids are central modulators of postprandial metabolism and inflammation, processes intimately linked to long-term cardiometabolic health. Circulating extracellular vesicles (EVs), particularly exosomes, have emerged as dynamic mediators of intercellular communication and may reflect acute physiological changes. However, the impact of distinct dietary fatty acids on EV phenotype during the postprandial period remains poorly understood. Our aim was to investigate the effect of isoenergetic meals enriched in saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs) or omega-3 long-chain polyunsaturated fatty acids (ω3-LCPUFAs) on classical immunometabolic markers and on the phenotypic profile and cellular origin of circulating EVs in healthy adults.</div></div><div><h3>Methods</h3><div>In a randomized crossover study, ten healthy participants (a total of 40 postprandial curves) received four test meals (SFA-, MUFA-, or ω3-LCPUFA-enriched emulsions, plus a fat-free control emulsion). Blood samples were collected at fasting, 2–3 h (postprandial peak), and 5–6 h (late postprandial phase). Clinical, biochemical, haematological, and immunological parameters were assessed. EVs were isolated from plasma, and 37 surface markers were analysed by multiplex flow cytometry to infer their cellular origin.</div></div><div><h3>Results</h3><div>Postprandial responses varied with fat quality. MUFA and ω3-LCPUFA meals induced broader immunometabolic activation than SFA. At the late postprandial phase, MUFA increased serum IgA, IgG, and IgM (<em>p</em> = 0.004, 0.013, and 0.020) and complement C1q and C3 (<em>p</em> = 0.008 and 0.004), whereas ω3-LCPUFA increased IgG and C3 (<em>p</em> = 0.027 and 0.046). Lymphocyte counts declined after all four meals (all <em>p</em> ≤ 0.007). EV concentration and mean diameter (∼100–150 nm) remained stable across interventions. Notably, MUFA intake enriched CD14<sup>+</sup> (monocyte-derived) vesicles, ω3-LCPUFA enhanced EVs from endothelial and T-cell lineages in the late postprandial phase, and the SFA meal reduced expression of multiple lineage-specific markers.</div></div><div><h3>Conclusions</h3><div>Dietary fat composition modulates the postprandial phenotype and cellular origin of circulating EVs without altering their abundance or size. These findings support the use of EV phenotyping as a sensitive tool to monitor early immune-metabolic responses to nutritional interventions and may inform precision strategies for cardiometabolic disease prevention.</div></div><div><h3>Registration number of Clinical Trial</h3><div>NCT06051461.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106539"},"PeriodicalIF":7.4,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-06DOI: 10.1016/j.clnu.2025.11.026
Zhongyang Guan , Blossom CM. Stephan , Lorenzo M. Donini , Joshua R. Lewis , Carla M. Prado , Richard L. Prince , David Scott , Kun Zhu , Marc Sim , Mario Siervo
Background and aims
Longitudinal studies have explored the association between sarcopenic obesity (SO) and the risk of cognitive impairment, yet findings remain mixed. This study aimed to investigate the associations of SO with risk of incident dementia in older women, using two diagnostic models: the Sarcopenic Obesity Global Leadership Initiative (SOGLI) and the load-capacity model.
Methods
We analysed data from 900 community-dwelling women (aged ≥70 years). SO was defined using two models: (1) the SOGLI criteria, based on low handgrip strength (HGS), low appendicular lean soft tissue to body weight (ALST/W) ratio, and high fat mass percentage (%FM); and (2) the load-capacity model, based on a high truncal fat mass to ALST (TrFM/ALST) ratio. Incident dementia events (hospitalisation and/or death) over 9.5 years were identified through linked health records using International Classification of Diseases (ICD) codes. Cox proportional hazards and Fine–Gray sub-distribution models were applied.
Results
Using the SOGLI criteria, SO was not significantly associated with the risk of overall dementia events compared with the non-sarcopenic, non-obesity group (hazard ratio [HR] 0.63, 95 % CI 0.39–1.03); however, SO was significantly associated with a reduced risk of dementia-related hospitalisation (HR 0.57, 95 % CI 0.33–0.98), mainly driven by the reduced risk observed with obesity. When defined by the load-capacity model, SO remained significantly associated with a reduced risk of overall dementia events (HR 0.54, 95 % CI 0.34–0.85). Restricted cubic spline (RCS) analyses demonstrated significant associations of lower HGS, lower %FM, higher ALST/W ratio, and lower TrFM/ALST ratio with increased risk of overall dementia events. Results remained consistent in sensitivity analyses excluding participants with BMI <21 kg/m2 (n = 67) or %FM below the 15th percentile (n = 135), and after further adjustment for age at highest education level..
Conclusion
This is the first longitudinal study to examine the association between SO and dementia using either the SOGLI or load-capacity models. In this cohort of older women, SO was associated with a lower risk of dementia-related hospitalisation. These findings suggest that the relationship between obesity and dementia risk in late life may differ from current evidence regarding midlife, indicating potential age-specific effects. Further research is needed to clarify the underlying mechanisms and generalisability of these observations to broader populations..
背景和目的纵向研究探讨了肌肉减少型肥胖（SO）与认知障碍风险之间的关系，但研究结果仍不一致。本研究旨在通过两种诊断模型：肌少性肥胖全球领导倡议（SOGLI）和负荷能力模型，探讨老年女性SO与痴呆发生风险的关系。方法对900名年龄≥70岁的社区妇女进行数据分析。SO的定义采用两个模型：(1)SOGLI标准，基于低握力（HGS）、低阑尾瘦软组织与体重（ALST/W）比和高脂肪质量百分比（%FM）；(2)基于较高的躯干脂肪质量与ALST （TrFM/ALST）比率的荷载-能力模型。通过使用国际疾病分类（ICD）代码的相关健康记录确定9.5年以上的偶发性痴呆事件（住院和/或死亡）。采用Cox比例风险模型和Fine-Gray子分布模型。结果使用SOGLI标准，与非肌肉减少、非肥胖组相比，SO与总体痴呆事件的风险无显著相关（风险比[HR] 0.63, 95% CI 0.39-1.03）；然而，SO与痴呆相关住院风险降低显著相关（HR 0.57, 95% CI 0.33-0.98），主要是由于肥胖导致的风险降低。当用负荷能力模型定义时，SO仍然与总体痴呆事件风险降低显著相关（HR 0.54, 95% CI 0.34-0.85）。限制性三次样条（RCS）分析显示，较低的HGS、较低的%FM、较高的ALST/W比率和较低的TrFM/ALST比率与总体痴呆事件的风险增加有显著关联。排除BMI = 21 kg/m2 （n = 67）或%FM低于第15个百分点（n = 135）的参与者，并进一步调整最高教育水平的年龄后，敏感性分析的结果保持一致。结论：这是第一个使用SOGLI或负荷能力模型检验SO与痴呆之间关系的纵向研究。在这个老年妇女队列中，SO与痴呆相关住院的风险较低有关。这些发现表明，肥胖和老年痴呆风险之间的关系可能与目前关于中年的证据不同，这表明了潜在的年龄特异性影响。需要进一步的研究来澄清潜在的机制和这些观察结果在更广泛人群中的普遍性。
{"title":"Association of sarcopenic obesity with dementia risk in a cohort of older women","authors":"Zhongyang Guan , Blossom CM. Stephan , Lorenzo M. Donini , Joshua R. Lewis , Carla M. Prado , Richard L. Prince , David Scott , Kun Zhu , Marc Sim , Mario Siervo","doi":"10.1016/j.clnu.2025.11.026","DOIUrl":"10.1016/j.clnu.2025.11.026","url":null,"abstract":"<div><h3>Background and aims</h3><div>Longitudinal studies have explored the association between sarcopenic obesity (SO) and the risk of cognitive impairment, yet findings remain mixed. This study aimed to investigate the associations of SO with risk of incident dementia in older women, using two diagnostic models: the Sarcopenic Obesity Global Leadership Initiative (SOGLI) and the load-capacity model.</div></div><div><h3>Methods</h3><div>We analysed data from 900 community-dwelling women (aged ≥70 years). SO was defined using two models: (1) the SOGLI criteria, based on low handgrip strength (HGS), low appendicular lean soft tissue to body weight (ALST/W) ratio, and high fat mass percentage (%FM); and (2) the load-capacity model, based on a high truncal fat mass to ALST (TrFM/ALST) ratio. Incident dementia events (hospitalisation and/or death) over 9.5 years were identified through linked health records using International Classification of Diseases (ICD) codes. Cox proportional hazards and Fine–Gray sub-distribution models were applied.</div></div><div><h3>Results</h3><div>Using the SOGLI criteria, SO was not significantly associated with the risk of overall dementia events compared with the non-sarcopenic, non-obesity group (hazard ratio [HR] 0.63, 95 % CI 0.39–1.03); however, SO was significantly associated with a reduced risk of dementia-related hospitalisation (HR 0.57, 95 % CI 0.33–0.98), mainly driven by the reduced risk observed with obesity. When defined by the load-capacity model, SO remained significantly associated with a reduced risk of overall dementia events (HR 0.54, 95 % CI 0.34–0.85). Restricted cubic spline (RCS) analyses demonstrated significant associations of lower HGS, lower %FM, higher ALST/W ratio, and lower TrFM/ALST ratio with increased risk of overall dementia events. Results remained consistent in sensitivity analyses excluding participants with BMI <21 kg/m<sup>2</sup> (n = 67) or %FM below the 15th percentile (n = 135), and after further adjustment for age at highest education level..</div></div><div><h3>Conclusion</h3><div>This is the first longitudinal study to examine the association between SO and dementia using either the SOGLI or load-capacity models. In this cohort of older women, SO was associated with a lower risk of dementia-related hospitalisation. These findings suggest that the relationship between obesity and dementia risk in late life may differ from current evidence regarding midlife, indicating potential age-specific effects. Further research is needed to clarify the underlying mechanisms and generalisability of these observations to broader populations..</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106542"},"PeriodicalIF":7.4,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1016/j.clnu.2025.11.021
Olivera Djuric , Laura Bonvicini , Massimo Pellegrini , Eleonora Bruno , Patrizia Pasanisi , Giuliana Gargano , Patrizia Curtosi , Franco Berrino , Paolo Giorgi Rossi , Anna Villarini
<div><h3>Background & Aims</h3><div>Breast cancer recurrence risk is strongly influenced by metabolic and hormonal factors linked to adiposity and diet. The DIet ANd Androgens-5 (DIANA-5) randomized controlled trial was primarily designed to test whether adherence to a Mediterranean/macrobiotic diet, combined with moderate physical activity, could reduce the risk of breast cancer recurrence. In the present secondary analysis of the DIANA-5 trial, we investigated associations between dietary intake, anthropometric, metabolic and hormonal profile testing the hypothesis that improvement in metabolic and hormonal parameters after one year of intervention are mediated by increased consumption of recommended foods (“recommended food score”) and changes of body composition measures.</div></div><div><h3>Methods</h3><div>A total of 1542 women with early-stage breast cancer and presence of one or more endocrine/metabolic risk factors were randomized to receive either standard healthy lifestyle recommendations (n = 773) or intensive support including dietary counseling, cooking classes, and moderate physical activity reinforcement (n = 769). Anthropometric (BMI, waist circumference [WC], fat mass/fat-free mass ratio [FM/FFM]), metabolic (glycemia, insulin, HOMA index, total cholesterol, triglycerides, metabolic syndrome), and hormonal (testosterone) endpoints were assessed at baseline and after 12 months. Potential mediation effects of “recommended food score” and WC or FM/FFM on metabolic and hormonal changes were tested by using SPSS version 23 and the PROCESS macro v.4.0 for SPSS.</div></div><div><h3>Results</h3><div>604 and 551 women were available for mediation analyses in intervention and control groups, respectively. The dietary intervention improved all anthropometric, metabolic and hormonal measures. “Recommended food score” together with WC mediated 73 % of the effect of the intervention on glycemia, 67 % on insulin, 70 % on HOMA index, 96 % on total cholesterol, and 86 % on metabolic syndrome. With “recommended food score” and FM/FFM as mediators, proportions mediated were 86 % for glycemia, 73 % for insulin, 78 % for HOMA index, 126 % for total cholesterol, and 66 % for metabolic syndrome. Mediation effects of WC and FM/FFM on triglyceride changes were much weaker (38 % and 37 %, respectively). For all outcomes and all mediators, at least one path had a p-value <0.05.</div></div><div><h3>Conclusions</h3><div>Most benefits of the DIANA-5 lifestyle intervention were mediated by dietary adherence and reductions in WC and FM/FFM. The proportion of effects mediated on metabolic syndrome, glucose and glycemic tolerance is high enough to suggest that these are the main effectors. The results on triglyceride blood levels suggest that further mechanism, possibly physical activity and energy intake should be investigated.</div></div><div><h3>Clinical Trial Registry number</h3><div>NCT05019989. Available at: <span><span>https://clinicaltrials.gov/se
背景和目的乳腺癌复发风险受与肥胖和饮食相关的代谢和激素因素的强烈影响。饮食和雄激素-5 （DIANA-5）随机对照试验的主要目的是测试是否坚持地中海/长寿饮食，并结合适度的体育活动，可以降低乳腺癌复发的风险。在目前对DIANA-5试验的二次分析中，我们调查了饮食摄入、人体测量、代谢和激素特征之间的关系，验证了干预一年后代谢和激素参数的改善是通过增加推荐食物的摄入（“推荐食物评分”）和身体成分测量的变化来调节的假设。方法共纳入1542例存在一种或多种内分泌/代谢危险因素的早期乳腺癌患者，随机分为两组，一组接受标准健康生活方式建议（n = 773），另一组接受强化支持，包括饮食咨询、烹饪课程和适度体育锻炼（n = 769）。在基线和12个月后评估人体测量（BMI、腰围[WC]、脂肪质量/无脂肪质量比[FM/FFM]）、代谢（血糖、胰岛素、HOMA指数、总胆固醇、甘油三酯、代谢综合征）和激素（睾酮）终点。“推荐食物评分”和WC或FM/FFM对代谢和激素变化的潜在中介作用通过SPSS version 23和PROCESS macro v.4.0进行检验。结果干预组604例，对照组551例。饮食干预改善了所有人体测量、代谢和激素测量。“推荐食物评分”和WC共同介导干预对血糖影响的73%，对胰岛素影响的67%，对HOMA指数影响的70%，对总胆固醇影响的96%，对代谢综合征影响的86%。以“推荐食物评分”和FM/FFM作为媒介，血糖的介导比例为86%，胰岛素的介导比例为73%，HOMA指数的介导比例为78%，总胆固醇的介导比例为126%，代谢综合征的介导比例为66%。WC和FM/FFM对甘油三酯变化的中介作用要弱得多（分别为38%和37%）。对于所有结局和所有中介，至少有一条路径的p值为<；0.05。结论DIANA-5生活方式干预的大部分益处是通过饮食依从性和WC和FM/FFM的降低介导的。对代谢综合征、葡萄糖和糖耐量介导的影响比例足够高，表明这些是主要的影响因素。血液中甘油三酯水平的结果表明，进一步的机制，可能是体力活动和能量摄入应该进行调查。临床试验注册号：bernct05019989。可在：https://clinicaltrials.gov/search?cond=NCT05019989。
{"title":"Diet, body composition and metabolic and hormonal profile in women at high risk of breast cancer recurrence: A secondary mediation analysis of the DIANA-5 trial","authors":"Olivera Djuric , Laura Bonvicini , Massimo Pellegrini , Eleonora Bruno , Patrizia Pasanisi , Giuliana Gargano , Patrizia Curtosi , Franco Berrino , Paolo Giorgi Rossi , Anna Villarini","doi":"10.1016/j.clnu.2025.11.021","DOIUrl":"10.1016/j.clnu.2025.11.021","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Breast cancer recurrence risk is strongly influenced by metabolic and hormonal factors linked to adiposity and diet. The DIet ANd Androgens-5 (DIANA-5) randomized controlled trial was primarily designed to test whether adherence to a Mediterranean/macrobiotic diet, combined with moderate physical activity, could reduce the risk of breast cancer recurrence. In the present secondary analysis of the DIANA-5 trial, we investigated associations between dietary intake, anthropometric, metabolic and hormonal profile testing the hypothesis that improvement in metabolic and hormonal parameters after one year of intervention are mediated by increased consumption of recommended foods (“recommended food score”) and changes of body composition measures.</div></div><div><h3>Methods</h3><div>A total of 1542 women with early-stage breast cancer and presence of one or more endocrine/metabolic risk factors were randomized to receive either standard healthy lifestyle recommendations (n = 773) or intensive support including dietary counseling, cooking classes, and moderate physical activity reinforcement (n = 769). Anthropometric (BMI, waist circumference [WC], fat mass/fat-free mass ratio [FM/FFM]), metabolic (glycemia, insulin, HOMA index, total cholesterol, triglycerides, metabolic syndrome), and hormonal (testosterone) endpoints were assessed at baseline and after 12 months. Potential mediation effects of “recommended food score” and WC or FM/FFM on metabolic and hormonal changes were tested by using SPSS version 23 and the PROCESS macro v.4.0 for SPSS.</div></div><div><h3>Results</h3><div>604 and 551 women were available for mediation analyses in intervention and control groups, respectively. The dietary intervention improved all anthropometric, metabolic and hormonal measures. “Recommended food score” together with WC mediated 73 % of the effect of the intervention on glycemia, 67 % on insulin, 70 % on HOMA index, 96 % on total cholesterol, and 86 % on metabolic syndrome. With “recommended food score” and FM/FFM as mediators, proportions mediated were 86 % for glycemia, 73 % for insulin, 78 % for HOMA index, 126 % for total cholesterol, and 66 % for metabolic syndrome. Mediation effects of WC and FM/FFM on triglyceride changes were much weaker (38 % and 37 %, respectively). For all outcomes and all mediators, at least one path had a p-value <0.05.</div></div><div><h3>Conclusions</h3><div>Most benefits of the DIANA-5 lifestyle intervention were mediated by dietary adherence and reductions in WC and FM/FFM. The proportion of effects mediated on metabolic syndrome, glucose and glycemic tolerance is high enough to suggest that these are the main effectors. The results on triglyceride blood levels suggest that further mechanism, possibly physical activity and energy intake should be investigated.</div></div><div><h3>Clinical Trial Registry number</h3><div>NCT05019989. Available at: <span><span>https://clinicaltrials.gov/se","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106537"},"PeriodicalIF":7.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Polycystic ovary syndrome (PCOS) is a common endocrine disorder linked to obesity, insulin resistance, and reproductive dysfunction. While dietary modification is central to management, the optimal approach remains unclear. This systematic review and meta-analysis evaluated the effects of the ketogenic diet on anthropometric, metabolic, and endocrinological outcomes in women with PCOS.
Methods
A systematic search of five databases (inception–February 2025) identified studies reporting outcomes in women with PCOS following a ketogenic diet. Meta-analyses compared pre- and post-ketogenic diet outcomes (primary analysis) and ketogenic diet versus other diets (secondary analysis). Summary mean differences (MDs) with 95 % confidence intervals (CIs) were calculated using a random-effects model. Risk of bias and evidence quality were assessed using validated tools and the GRADE approach.
Results
Fifteen studies were included in the review, of which ten met the criteria for inclusion in the meta-analysis. Most participants in the included studies had a BMI exceeding 25 kg/m2. In the primary analysis, ketogenic diet led to significant reductions in BMI (MD: −3.38 kg/m2, 95 % CI: 2.53 to 4.23, I2 = 0 %), weight (MD: −10.77 kg, 95 % CI: 8.73 to 12.81, I2 = 0 %), and waist circumference (MD: −8.93 cm, 95 % CI: 5.66 to 12.19; I2 = 44 %). Reductions were also observed in luteinising hormone (LH) levels (MD: 4.07, 95 % CI: 3.36 to 4.79, I2 = 0 %), menstrual cycle duration (MD: 26.06, 95 % CI: 2.28 to 49.85, I2 = 68 %), and insulin resistance (MD: 2.43; 95 % CI: 1.16 to 3.69, I2 = 95 %). In the secondary analysis, ketogenic diet showed superior effects on BMI (MD: −1.65, 95 % CI: −2.76 to −0.55, I2 = 0 %) and weight loss (MD: −4.98, 95 % CI: −9.05 to −0.91, I2 = 7 %) as well as LH levels (MD 1.68, 95 % CI: −3.18 to −0.19, I2 = 30 %) and insulin resistance (MD: −1.71, 95 % CI: −2.98 to −0.43, I2 = 90 %) compared to other diets, though results for androgen and lipid parameters were inconsistent. Heterogeneity was high for most of the studied outcomes.
Conclusion
The ketogenic diet appears to be a promising dietary intervention for improving weight, insulin sensitivity, and reproductive hormone profiles in women with PCOS and a BMI exceeding 25 kg/m2. Nonetheless, the considerable heterogeneity among included studies and variations in study quality warrant cautious interpretation of these findings. Further high-quality, long-term randomized controlled trials are needed to more definitively establish the efficacy and safety of the ketogenic diet in women with PCOS.
{"title":"The effects of ketogenic diet on polycystic ovary syndrome: A systematic review and meta-analysis","authors":"Elisavet Arsenaki , Dimitra Stathi , Konstantinos Katsikas Triantafyllidis , Yeshey Seldon , Stergios Bobotis , George Lockett , Shaun Haran , Maria Kyrgiou , Srdjan Saso , Konstantinos S. Kechagias","doi":"10.1016/j.clnu.2025.11.019","DOIUrl":"10.1016/j.clnu.2025.11.019","url":null,"abstract":"<div><h3>Background and aim</h3><div>Polycystic ovary syndrome (PCOS) is a common endocrine disorder linked to obesity, insulin resistance, and reproductive dysfunction. While dietary modification is central to management, the optimal approach remains unclear. This systematic review and meta-analysis evaluated the effects of the ketogenic diet on anthropometric, metabolic, and endocrinological outcomes in women with PCOS.</div></div><div><h3>Methods</h3><div>A systematic search of five databases (inception–February 2025) identified studies reporting outcomes in women with PCOS following a ketogenic diet. Meta-analyses compared pre- and post-ketogenic diet outcomes (primary analysis) and ketogenic diet versus other diets (secondary analysis). Summary mean differences (MDs) with 95 % confidence intervals (CIs) were calculated using a random-effects model. Risk of bias and evidence quality were assessed using validated tools and the GRADE approach.</div></div><div><h3>Results</h3><div>Fifteen studies were included in the review, of which ten met the criteria for inclusion in the meta-analysis. Most participants in the included studies had a BMI exceeding 25 kg/m<sup>2</sup>. In the primary analysis, ketogenic diet led to significant reductions in BMI (MD: −3.38 kg/m<sup>2</sup>, 95 % CI: 2.53 to 4.23, I<sup>2</sup> = 0 %), weight (MD: −10.77 kg, 95 % CI: 8.73 to 12.81, I<sup>2</sup> = 0 %), and waist circumference (MD: −8.93 cm, 95 % CI: 5.66 to 12.19; I<sup>2</sup> = 44 %). Reductions were also observed in luteinising hormone (LH) levels (MD: 4.07, 95 % CI: 3.36 to 4.79, I<sup>2</sup> = 0 %), menstrual cycle duration (MD: 26.06, 95 % CI: 2.28 to 49.85, I<sup>2</sup> = 68 %), and insulin resistance (MD: 2.43; 95 % CI: 1.16 to 3.69, I<sup>2</sup> = 95 %). In the secondary analysis, ketogenic diet showed superior effects on BMI (MD: −1.65, 95 % CI: −2.76 to −0.55, I<sup>2</sup> = 0 %) and weight loss (MD: −4.98, 95 % CI: −9.05 to −0.91, I<sup>2</sup> = 7 %) as well as LH levels (MD 1.68, 95 % CI: −3.18 to −0.19, I<sup>2</sup> = 30 %) and insulin resistance (MD: −1.71, 95 % CI: −2.98 to −0.43, I<sup>2</sup> = 90 %) compared to other diets, though results for androgen and lipid parameters were inconsistent. Heterogeneity was high for most of the studied outcomes.</div></div><div><h3>Conclusion</h3><div>The ketogenic diet appears to be a promising dietary intervention for improving weight, insulin sensitivity, and reproductive hormone profiles in women with PCOS and a BMI exceeding 25 kg/m<sup>2</sup>. Nonetheless, the considerable heterogeneity among included studies and variations in study quality warrant cautious interpretation of these findings. Further high-quality, long-term randomized controlled trials are needed to more definitively establish the efficacy and safety of the ketogenic diet in women with PCOS.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106535"},"PeriodicalIF":7.4,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.clnu.2025.12.001
Baochang He , Xixi Dong , Yichen Lin , Jianli Lin , Yu Qiu , Lisong Lin , Bin Shi , Jing Wang , Fa Chen
Background & Aims
Evidence suggests fatty acid metabolism may influence cancer progression, yet their role in oral cancer prognosis remains unclear. This study investigated associations between dietary fatty acid intake, erythrocyte membrane fatty acid composition, and overall survival in patients with oral cancer, and explored potential underlying mechanisms through network pharmacology and molecular docking analyses.
Methods
This prospective cohort study recruited 908 newly diagnosed oral cancer patients from October 2011 to June 2024. Dietary fatty acid intake was assessed using a validated food frequency questionnaire. Erythrocyte membrane fatty acid profiles were measured using gas chromatography. Patients were followed until February 2025, with overall survival as the primary outcome. Cox proportional hazards models were used to evaluate hazard ratios (HRs) and 95 % confidence intervals (CIs) for associations between fatty acid levels and overall survival in oral cancer. Composite indices (dietary fatty acid index [DFAI] and erythrocyte fatty acid index [EFAI]) were constructed using LASSO regression to assess combined effects. Network pharmacology and molecular docking were employed to investigate potential mechanisms.
Results
In multi-adjusted Cox regression models, higher dietary intake of linolenic acid (C18:3), eicosatrienoic acid (C20:3), and docosahexaenoic acid (C22:6) were associated with reduced mortality risk (highest vs. lowest tertile: HR = 0.54, 95 % CI: 0.36–0.82; HR = 0.65, 95 % CI: 0.44–0.95; HR = 0.62, 95 % CI: 0.42–0.91, respectively; all P-trend<0.05). Among erythrocyte membrane fatty acids, significant protective associations were observed for very long-chain saturated fatty acids behenic acid (C22:0) and tricosanoic acid (C23:0), with 48 % and 56 % lower mortality risks in the highest tertile (all P for trend <0.05). Similar protective effects were found for omega-3 polyunsaturated fatty acids including α-linolenic acid (C18:3 n-3), docosapentaenoic acid (C22:5 n-3), and docosahexaenoic acid (C22:6 n-3). Composite fatty acid indices showed that DFAI and EFAI were associated with 59 % and 85 % mortality reduction, respectively (both P < 0.001). Network pharmacology identified interleukin-6 (IL-6) as a key target in the fatty acid-oral cancer survival pathway. Molecular docking revealed favorable binding affinities between all six significant fatty acids and IL-6 (binding energies: −1.83 to −5.08 kcal/mol).
Conclusion
Higher dietary intake and erythrocyte membrane levels of specific polyunsaturated fatty acids and very long-chain saturated fatty acids are significantly associated with improved overall survival in oral cancer patients. These protective effects may be mediated through IL-6-related inflammatory pathways.
{"title":"Associations of dietary and erythrocyte membrane fatty acids with overall survival in oral cancer: A prospective cohort study with mechanistic exploration","authors":"Baochang He , Xixi Dong , Yichen Lin , Jianli Lin , Yu Qiu , Lisong Lin , Bin Shi , Jing Wang , Fa Chen","doi":"10.1016/j.clnu.2025.12.001","DOIUrl":"10.1016/j.clnu.2025.12.001","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Evidence suggests fatty acid metabolism may influence cancer progression, yet their role in oral cancer prognosis remains unclear. This study investigated associations between dietary fatty acid intake, erythrocyte membrane fatty acid composition, and overall survival in patients with oral cancer, and explored potential underlying mechanisms through network pharmacology and molecular docking analyses.</div></div><div><h3>Methods</h3><div>This prospective cohort study recruited 908 newly diagnosed oral cancer patients from October 2011 to June 2024. Dietary fatty acid intake was assessed using a validated food frequency questionnaire. Erythrocyte membrane fatty acid profiles were measured using gas chromatography. Patients were followed until February 2025, with overall survival as the primary outcome. Cox proportional hazards models were used to evaluate hazard ratios (HRs) and 95 % confidence intervals (CIs) for associations between fatty acid levels and overall survival in oral cancer. Composite indices (dietary fatty acid index [DFAI] and erythrocyte fatty acid index [EFAI]) were constructed using LASSO regression to assess combined effects. Network pharmacology and molecular docking were employed to investigate potential mechanisms.</div></div><div><h3>Results</h3><div>In multi-adjusted Cox regression models, higher dietary intake of linolenic acid (C18:3), eicosatrienoic acid (C20:3), and docosahexaenoic acid (C22:6) were associated with reduced mortality risk (highest vs. lowest tertile: HR = 0.54, 95 % CI: 0.36–0.82; HR = 0.65, 95 % CI: 0.44–0.95; HR = 0.62, 95 % CI: 0.42–0.91, respectively; all <em>P</em>-trend<0.05). Among erythrocyte membrane fatty acids, significant protective associations were observed for very long-chain saturated fatty acids behenic acid (C22:0) and tricosanoic acid (C23:0), with 48 % and 56 % lower mortality risks in the highest tertile (all <em>P</em> for trend <0.05). Similar protective effects were found for omega-3 polyunsaturated fatty acids including α-linolenic acid (C18:3 n-3), docosapentaenoic acid (C22:5 n-3), and docosahexaenoic acid (C22:6 n-3). Composite fatty acid indices showed that DFAI and EFAI were associated with 59 % and 85 % mortality reduction, respectively (both <em>P</em> < 0.001). Network pharmacology identified interleukin-6 (IL-6) as a key target in the fatty acid-oral cancer survival pathway. Molecular docking revealed favorable binding affinities between all six significant fatty acids and IL-6 (binding energies: −1.83 to −5.08 kcal/mol).</div></div><div><h3>Conclusion</h3><div>Higher dietary intake and erythrocyte membrane levels of specific polyunsaturated fatty acids and very long-chain saturated fatty acids are significantly associated with improved overall survival in oral cancer patients. These protective effects may be mediated through IL-6-related inflammatory pathways.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106534"},"PeriodicalIF":7.4,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.clnu.2025.11.003
Hamza Khan
{"title":"Comment on “Effect of red meat consumption on cardiovascular risk factors: A systematic review and Bayesian network meta-analysis of randomized controlled trials”","authors":"Hamza Khan","doi":"10.1016/j.clnu.2025.11.003","DOIUrl":"10.1016/j.clnu.2025.11.003","url":null,"abstract":"","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"55 ","pages":"Page 222"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.clnu.2025.11.004
Claudia J. Lucassen , Yaren Zügül , Anneke Droop , Bert A. Bonsing , Alexander L. Vahrmeijer , Nynke Michiels , Shirin Shahbazi Feshtali , E.T. Daniël Souwer , Johanneke E.A. Portielje , J. Sven D. Mieog , Frederiek van den Bos
Background and aims
Frailty and sarcopenia are associated with morbidity and mortality in older patients with cancer. The aim of this study was to examine the association of frailty with skeletal muscle index (SMI) and muscle attenuation (MA) on preoperative CT-scans in older patients with pancreatic cancer.
Methods
A single-center retrospective study was performed in patients aged ≥70 years with pancreatic cancer. Frailty was assessed by an abbreviated GA screening. Preoperative SMI and MA were determined by computed tomography (CT) scan analysis. The association of frailty and individual frailty domains with SMI and MA was assessed using linear regression analyses.
Results
101 patients were included of which 15 (14.9 %) were frail. Frailty was associated with lower SMI (adjusted β: −5.07 cm2/m2; 95 % CI: −8.77–1.36) and MA (adjusted β: −5.70 HU; 95 % CI: −9.63–1.77). Both impaired functionality and risk of delirium were associated with lower SMI (adjusted β: −7.01 cm2/m2; 95 % CI: −11.69–2.33 and adjusted β: −4.58 cm2/m2; 95 % CI: −8.22–0.95, respectively). Impaired functionality was also associated with lower MA (adjusted β: −6.88 HU; 95 % CI: −11.89–1.87).
Conclusion
Frailty and impaired functionality were associated with lower SMI and MA. Risk of delirium was independently associated with lower SMI in preoperative older patients with pancreatic cancer. These results suggests that SMI and MA should be included in standard GA screening to better identify high-risk patients and enable more targeted treatment selection.
{"title":"Both skeletal muscle index and muscle attenuation are associated with frailty in preoperative older patients with pancreatic cancer","authors":"Claudia J. Lucassen , Yaren Zügül , Anneke Droop , Bert A. Bonsing , Alexander L. Vahrmeijer , Nynke Michiels , Shirin Shahbazi Feshtali , E.T. Daniël Souwer , Johanneke E.A. Portielje , J. Sven D. Mieog , Frederiek van den Bos","doi":"10.1016/j.clnu.2025.11.004","DOIUrl":"10.1016/j.clnu.2025.11.004","url":null,"abstract":"<div><h3>Background and aims</h3><div>Frailty and sarcopenia are associated with morbidity and mortality in older patients with cancer. The aim of this study was to examine the association of frailty with skeletal muscle index (SMI) and muscle attenuation (MA) on preoperative CT-scans in older patients with pancreatic cancer.</div></div><div><h3>Methods</h3><div>A single-center retrospective study was performed in patients aged ≥70 years with pancreatic cancer. Frailty was assessed by an abbreviated GA screening. Preoperative SMI and MA were determined by computed tomography (CT) scan analysis. The association of frailty and individual frailty domains with SMI and MA was assessed using linear regression analyses.</div></div><div><h3>Results</h3><div>101 patients were included of which 15 (14.9 %) were frail. Frailty was associated with lower SMI (adjusted β: −5.07 cm<sup>2</sup>/m<sup>2</sup>; 95 % CI: −8.77–1.36) and MA (adjusted β: −5.70 HU; 95 % CI: −9.63–1.77). Both impaired functionality and risk of delirium were associated with lower SMI (adjusted β: −7.01 cm<sup>2</sup>/m<sup>2</sup>; 95 % CI: −11.69–2.33 and adjusted β: −4.58 cm<sup>2</sup>/m<sup>2</sup>; 95 % CI: −8.22–0.95, respectively). Impaired functionality was also associated with lower MA (adjusted β: −6.88 HU; 95 % CI: −11.89–1.87).</div></div><div><h3>Conclusion</h3><div>Frailty and impaired functionality were associated with lower SMI and MA. Risk of delirium was independently associated with lower SMI in preoperative older patients with pancreatic cancer. These results suggests that SMI and MA should be included in standard GA screening to better identify high-risk patients and enable more targeted treatment selection.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"55 ","pages":"Pages 242-248"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.clnu.2025.11.013
Wolfgang H. Hartl , Patrick Meybohm , Matthias Pirlich , Konstantin Mayer , Gunnar Elke , Christian Stoppe , Christian von Loeffelholz
Background & aims
In 2023, the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) issued new safety information on oral fish oil (FO) pharmacotherapy. This information indicated a dose-related increased risk of atrial fibrillation (AF) with FO in patients with established cardiovascular disease (CVD). The aim of this study is to analyse the existing evidence on this risk and establish whether it can be extrapolated to FO-enriched intravenous lipid emulsions (FO-ILEs) or to other patient groups, such as critically ill patients with organ dysfunction.
Methods
We searched for large (>50,000 participants) systematic reviews analysing the effect of long-term (>1 year) oral FO pharmacotherapy on the incidence of AF in non-critically ill patients with CVD. Reviews also had to include at least one large randomised study (>1,000 participants) on this topic. We examined these reviews with regard to specific limitations. We also estimated on a theoretical basis the extent to which short-term use of FO-ILEs in critically ill patients might alter plasmatic EPA (eicosapentaenoic acid)/DHA (docosahexaenoic acid) concentrations or myocardial EPA/DHA content, and investigated how these changes might affect the cardiac conduction system. We identified six meta-analyses, which consistently showed an increased risk of AF (primary, secondary, exploratory or safety outcome). In these analyses, however, significant bias may arise from including studies that ignored informative censoring or competing risks, or that used highly variable methods to search for AF. The results of these meta-analyses also conflicted with those of controlled trials in which AF was the primary endpoint, investigating the effect of long-term oral FO pharmacotherapy on the frequency of AF recurrence in patients with paroxysmal or persistent AF. Based on our theoretical considerations, it is unlikely that short-term (<4 weeks) use of FO-ILEs would increase EPA/DHA plasma concentrations or myocardial contents to levels that could induce AF in critically ill patients.
Results and conclusions
Short-term administration of FO-ILEs at the currently recommended dose (0.1–0.2 g/kg, corresponding to an average daily EPA/DHA intake of 4–6 g) can be considered safe from a critical care perspective in the setting of AF, especially when the duration of total parenteral nutrition is limited (<4 weeks).
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