Clinical nutrition最新文献

Background & aims: Early-life nutrition shapes host-microbe interactions with lasting consequences for health. While dietary patterns are known to influence the infant gut microbiome, the impact of solid food source (homemade, commercial, or mixed) has not been examined. Our aims were to determine how solid food source at 6 months relates to infant gut microbiome diversity and composition at 1 year, and whether relationships differ by milk feeding type..

Methods: We conducted a secondary analysis within the Canadian Healthy Infant Longitudinal Development (CHILD) cohort. Solid food source was assessed at 6 months, and stool samples at 1 year were profiled using 16S rRNA sequencing. Generalized linear models were used to assess alpha-diversity; permutational multivariate analysis of variance (PERMANOVA) was used to evaluate beta-diversity based on OTU-level Bray-Curtis dissimilarities; and Microbiome Multivariate Association with Linear Models 2 (MaAsLin2), using centered log-ratio normalization, was used to examine taxa-level associations, adjusting for relevant perinatal and dietary covariates. Effect modification by milk feeding type (human milk, formula, combination, or weaned) at 6 months and 1 year was examined. Benjamini-Hochberg correction was applied (p < 0.05; q < 0.25).

Results: A total of 368 infants were included. At 6 months, most were mixed-fed (n = 154; 41.8 %), followed by homemade-fed (n = 143; 38.9 %) and commercially-fed (n = 71; 19.3 %). Solid food source explained only 0.53 % of gut microbiota variability. Differences were most pronounced in formula-fed infants: at 6 months, those given homemade or mixed foods showed higher abundances of Firmicutes, Turicibacteraceae, and Turicibacter compared with commercially fed infants. Within this group, mixed feeding was further linked to higher Eubacteriaceae and Lachnospiraceae (all q < 0.25). At 1 year, formula-fed infants who received homemade foods had higher microbial diversity (p = 0.028) but lower Shannon diversity (p = 0.041) than those receiving commercial foods, suggesting shifts in both community richness and evenness. No significant differences in gut microbiome diversity and composition were observed in the overall cohort or among infants receiving human milk or fully weaned (q > 0.25).

Conclusions: Solid food source is a previously under-investigated driver of infant microbiome variability, with effects contingent on milk feeding. Human milk may buffer against dietary choices, whereas formula-fed infants show heightened sensitivity to complementary food source, informing precision nutrition in early life.

Background & aims: Copper is a trace element essential for enzymatic reactions, but excessive accumulation can cause toxicity. Accurate interpretation of serum copper concentrations is crucial for diagnosing conditions such as Wilson's disease, liver dysfunction, and nutritional deficiencies. Current reference intervals often ignore the effect of inflammation and are typically established using discrete age groups rather than modelling age as a continuous variable. This study aimed to establish continuous, age-adjusted reference intervals for serum copper and to develop a method for correcting inflammation-related variability.

Methods: We retrospectively analyzed serum copper concentrations in a pediatric cohort of 4,368 unique samples. Inflammatory status was assessed using erythrocyte sedimentation rate (ESR), fibrinogen, and C-reactive protein (CRP). Samples without inflammation were used to generate age-continuous reference intervals through polynomial regression. To quantify and adjust for inflammation effects, we developed a composite inflammation score using partial least squares regression on standardized values of the three acute-phase markers and applied it to correct copper concentrations in samples exhibiting inflammation.

Results: Serum copper showed a nonlinear relationship with age. Inflammation elevated copper concentrations by approximately 24 %. The composite inflammation score independently predicted this variability in copper concentrations, and adjustment using the score restored copper concentrations within reference limits, reducing the risk of data misinterpretation.

Conclusion: Our findings underscore the necessity of considering both age and inflammation variables when interpreting pediatric serum copper concentrations. We provide continuous, age-adjusted reference intervals and a method to correct for inflammation-related variability, enhancing data interpretation. We propose a proof-of-concept potentially applicable to other biomarkers related with metabolic and nutritional disturbances in chronic and acute diseases.

Background & aims: Hypofibrinolysis is prevalent in obesity and type 2 diabetes mellitus (T2D) and may be involved in their pathophysiology. Metabolic bariatric surgery (MBS) markedly improves both obesity and T2D, but whether these improvements are related to fibrinolysis is not known. In this study, biomarkers of fibrinolysis were assessed before and after MBS in patients with and without T2D.

Methods: A single center prospective cohort study with 2-year follow-up. The participants were adults with obesity with (n = 28) or without T2D (n = 33) undergoing MBS preceded by 2 weeks of a low-calorie diet (LCD). The plasma concentrations of plasminogen activator inhibitor 1 activity (PAI-1_act), tissue plasminogen activator activity (tPA_act) and antigen (tPA_ag), plasmin-antiplasmin complexes (PAP) and fibrinogen were determined at baseline, after LCD and at 6 weeks, 1 and 2 years after MBS.

Results: After LCD and prior to MBS, PAI-1_act decreased and PAP increased significantly. Two years after MBS, PAI-1_act decreased from baseline 29.8 (63) to 3.8 (121) while tPA_act increased (0.08 (390) to 0.23 (150) IU), and PAP increased (544 (54) to 814 (60) ng/mL). tPA_ag and fibrinogen decreased (16.4 (29) to 9.7 (51) ng/mL and 4.15 (23) to 3.82 (20) g/L, respectively); p < 0.001 for all; (geometric means, except tPA_act which is arithmetic mean, coefficient of variation (%CV)). There were no differences in fibrinolysis between groups at baseline or after surgery. Multivariate analysis showed that reduction in body weight and fat mass had the most important influence on fibrinolysis.

Conclusion: Fibrinolysis is significantly improved two years after MBS, as also indicated earlier after the two-week LCD. The lack of differences between patients with vs. without T2D suggests that fat mass reduction rather than improvement of glucose control is most important for improved fibrinolysis after MBS. In summary, our results support hypofibrinolysis as a mechanism in the pathophysiology in obesity.

Malnutrition is a multifactorial and complex condition with significant consequences for recovery, functional outcomes, and healthcare systems. Research in malnutrition is often limited by single-component interventions, heterogeneous study designs, and variable outcome measures. This perspective paper introduces a practical guiding framework for clinical nutrition research, emphasizing interdisciplinary, multifactorial approaches, co-designed interventions, and pragmatic, adaptive study designs. Evidence from several trials demonstrates that individualized nutritional support delivered by multidisciplinary teams improves clinical outcomes, yet challenges remain in recruitment, adherence, and balancing intervention intensity with patient burden. The framework provides a structured approach to intervention development, outcome selection, and implementation, while remaining flexible to accommodate innovation, context-specific adaptation, and emerging outcome measures. By integrating lessons from prior trials, globally, and promoting systematic reporting and feasibility assessment, this framework aims to enhance the design, comparability, and translational impact of future research in clinical nutrition in older and other clinically vulnerable populations. Adoption of such a framework can guide research prioritization, optimize intervention delivery, and ultimately improve patient recovery and quality of life.

This article has been retracted: please see Elsevier policy on article withdrawal (https://www.elsevier.com/about/policies-and-standards/article-withdrawal). This article is retracted at the request of the authors. During post-publication data re-analyses, the authors found four additional hemoglobin datapoints at the endpoint of the trial reported in the above-named article that move the p-value for the primary outcome - the impact of intervention on the change in hemoglobin concentrations across the duration of the trial - from 0.053 to 0.044. Furthermore, the WHO has recently released a revised set of cutoffs for anemia [WHO 2024], and the anemia cutoff for the age group of interest in this article, 12-23 months, was lowered from a hemoglobin concentration of 11 g/dL to 10.5 g/dL. As such, the authors wish to report these revised estimates of anemia based on the revised WHO cutoffs to keep the findings as updated as possible and useful for guidelines. The Editors considered this request and agreed to the retraction of the article. The authors were invited to submit a revised version of the article, which has been peer-reviewed and accepted for publication in the journal. This retraction notice will be updated with a link to the revised paper when it is published.

Background and aims: This study aimed to systematically evaluate the genomic safety of Limosilactobacillus reuteri LR08 and to assess its effects on metabolic health, immune function, and gut microbiota composition in healthy adults..

Methods: Whole-genome sequencing and bioinformatics analyses were conducted to assess the presence of genes related to pathogenicity, antibiotic resistance, and biogenic amine synthesis. In vitro assays and animal studies evaluated hemolytic activity, cytotoxicity, and overall biosafety. A randomized, double-blind, placebo-controlled trial was performed in 48 healthy adults, who received either LR08 (30 billion CFU/day) or placebo for 8 weeks. Clinical, biochemical, and immune parameters were measured, and 16S rRNA sequencing was used to assess gut microbiota changes.

Results: Genomic analysis confirmed the absence of pathogenicity-related, antibiotic resistance, or biogenic amine synthesis genes. In vitro and animal tests demonstrated non-hemolytic, non-cytotoxic characteristics and overall safety. Clinically, LR08 significantly reduced serum uric acid (p < 0.001) and LDL-C levels (p = 0.007) compared with baseline. Compared with placebo, LR08 supplementation significantly increased salivary IgA (p = 0.039), IgM (p = 0.029), and calprotectin levels (p < 0.05). Gut microbiota analysis revealed increased α-diversity, enrichment of beneficial genera including Blautia and Romboutsia, and upregulation of pathways related to carbohydrate metabolism and genetic information processing..

Conclusions: L. reuteri LR08 demonstrates robust genomic safety and favorable effects on metabolic, immune, and gut microbiota profiles in healthy adults. These findings support its potential application as a safe probiotic for metabolic regulation, immune enhancement, and microbiota modulation..

Trial registration number: NCT06875362 (ClinicalTrials.gov).