Clinical nutrition最新文献

{"title":"Nutrition care in adults with spinal cord injuries and disorders with pressure injuries: A systematic review of clinical practice guidelines","authors":"Yiwen Wang ,&nbsp;Man Ching Lo ,&nbsp;Murray Fisher ,&nbsp;Katherine Desneves ,&nbsp;Amy Nevin ,&nbsp;Priya lyer","doi":"10.1016/j.clnu.2026.106580","DOIUrl":"10.1016/j.clnu.2026.106580","url":null,"abstract":"<div><div>Pressure injuries (PIs) are a common and costly complication in adults with spinal cord injuries and disorders (SCI/D), with a global prevalence of 32 % and a lifetime risk exceeding 85 % in Australia. Nutrition is a key factor in the prevention and management of PIs, supporting wound healing, immune function, and overall recovery. This systematic review evaluated the quality, scope, and methodological rigour of 17 international clinical practice guidelines (CPGs) published since 2010 that included nutrition recommendations for PIs in adults with SCI/D. Using the AGREE II and the AGREE-REX tools, this review assessed overall guideline quality and nutrition-specific recommendations mapped to the Nutrition Care Process domains. Seven CPGs were rated high quality with AGREE II, and three with AGREE-REX. While most guidelines focussed on nutrition interventions, limited detail was provided on assessment and monitoring. Considerable variation was found in the rigour and specificity of recommendations. These findings underscore a need for high-quality, SCI/D-specific guidelines that offer consistent, evidence-based, actionable nutrition guidance, particularly in the under-represented areas of assessment and monitoring, to better support PI prevention and treatment in this vulnerable population.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"58 ","pages":"Article 106580"},"PeriodicalIF":7.4,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077060","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}

{"title":"Prospective study of anamorelin in pancreatic cancer cachexia: Clinical and translational insights into response heterogeneity","authors":"Ryosuke Matsukane ,&nbsp;Haruna Minami ,&nbsp;Nao Fujimori ,&nbsp;Keijiro Ueda ,&nbsp;Yasuhiro Komori ,&nbsp;Yu Takamatsu ,&nbsp;Takahiro Ueda ,&nbsp;Minako Kimura ,&nbsp;Chitose Matsuzaki ,&nbsp;Takanori Tanaka ,&nbsp;Aimi Morito ,&nbsp;Saki Kuwahara ,&nbsp;Masako Hashimoto ,&nbsp;Satoshi Hirai ,&nbsp;Tomiko Yokoyama ,&nbsp;Shigeru Ishida ,&nbsp;Takeshi Hirota ,&nbsp;Yoshihiro Ogawa ,&nbsp;Mayako Uchida","doi":"10.1016/j.clnu.2026.106581","DOIUrl":"10.1016/j.clnu.2026.106581","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Clinical evidence for anamorelin in pancreatic cancer is extremely limited, despite its approval in Japan. This study provides the first prospective evaluation of anamorelin specifically in pancreatic cancer, aiming to assess real-world efficacy and safety and to identify factors contributing to treatment-response heterogeneity through integrated biomarker analyses.</div></div><div><h3>Methods</h3><div>This prospective, single-center, observational study enrolled 24 patients with unresectable or metastatic pancreatic cancer who developed cachexia. Efficacy was evaluated in patients who received anamorelin for &gt;1 month. The primary endpoint was change in LBM from baseline, and secondary endpoints included the LBM-based response rate. Responders were defined as those who maintained or increased LBM during treatment. Safety assessment focused on treatment-related adverse events, particularly hyperglycemia.</div></div><div><h3>Results</h3><div>Seventeen patients were included in the efficacy analysis (median age, 68 years; median weight loss, 8.3 %). The mean LBM increased by 0.9 and 1.4 kg at 1 and 2 months, respectively. Quality-of-life scores related to appetite, weight gain, and total scores improved significantly at 1 month. Ten patients (58.8 %) were classified as responders, showing significant LBM gains from baseline (+2.4 kg at 1 month, +3.4 kg at 2 months, p &lt; 0.001). Handgrip strength also improved in responders compared with non-responders at 2 months (+1.7 kg vs −2.0 kg, p &lt; 0.01). Serum levels of insulin-like growth factor-1, inflammatory cytokines, ghrelin, and leptin levels did not differ significantly between baseline and 1 month. However, lower baseline body mass index (BMI) was strongly associated with response (sensitivity 85.7 %, specificity 90.0 %, area under the curve [AUC] 0.886, cutoff 20.4 kg/m²; p = 0.008). In the safety analysis (n = 23), 34.8 % experienced hyperglycemia of any grade, and 26.1 % developed grade ≥2 hyperglycemia—higher than in NSCLC trials. Median time to onset was 4.5 days (range, 2–18). Baseline diabetes was significantly associated with grade ≥2 hyperglycemia. This event was highly predictable by low pre-treatment ΔC-peptide levels (6–0 min; sensitivity 100.0 %, specificity 91.7 %, cut-off 1.03 ng/mL, AUC 0.967; p = 0.0032).</div></div><div><h3>Conclusions</h3><div>Anamorelin effectively improved LBM and appetite/QOL domains in pancreatic cancer, particularly in patients with low BMI. However, hyperglycemia—especially in those with impaired insulin secretion—requires careful monitoring. Baseline BMI and insulin secretion capacity should be evaluated before initiating therapy, and these findings provide preliminary insight into treatment response heterogeneity in pancreatic cancer cachexia.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"58 ","pages":"Article 106581"},"PeriodicalIF":7.4,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077063","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}

{"title":"Dietary flavonoid intake and psychological well-being – A bidirectional relationship","authors":"Alysha S. Thompson ,&nbsp;Nicola P. Bondonno ,&nbsp;Yan Lydia Liu ,&nbsp;Farah Qureshi ,&nbsp;Laura D. Kubzansky ,&nbsp;Claudia Trudel-Fitzgerald ,&nbsp;Julia K. Boehm ,&nbsp;Eric B. Rimm ,&nbsp;Aedín Cassidy","doi":"10.1016/j.clnu.2026.106579","DOIUrl":"10.1016/j.clnu.2026.106579","url":null,"abstract":"<div><h3>Background and aim</h3><div>Higher dietary flavonoid intake has been associated with lower risks of mortality and major chronic disease, yet its relationship with psychological well-being (PWB), a key contributor to health and quality of life, remains unclear. This study aimed to investigate bidirectional associations between dietary flavonoid intake and two PWB facets: happiness (positive emotional state) and optimism (generalized expectation of positive outcomes). Specifically, we examined whether (1) overall flavonoid-rich dietary patterns (flavodiet score), (2) intake of specific flavonoid-rich foods, and (3) total flavonoid and subclass intakes were each associated with happiness and optimism over time.</div></div><div><h3>Methods</h3><div>Data were drawn from the Nurses’ Health Study to form two analytical samples. Flavonoid intake measured in 1990 (n = 44,659) was examined in relation to sustained happiness (1992–2000) while intake in 2002 (n = 36,723) was analysed in relation to sustained optimism (2004–2012). Secondary analyses assessed whether higher baseline levels of each PWB facet were associated with sustained higher flavonoid intake, over up to 18 years. Associations were assessed using generalized estimating equations, adjusting for potential confounders.</div></div><div><h3>Results</h3><div>Higher flavodiet scores were associated with a 3–6 % higher likelihood of sustained happiness [RR_Q4vsQ1 (95 % CI): 1.03 (1.02–1.05)] and optimism [RR_Q4vsQ1 (95 % CI): 1.06 (1.01–1.11)]. Specific flavonoid-rich foods (strawberries, apples, oranges, grapefruit, blueberries) were associated with a 3–16 % greater likelihood of sustained PWB, across the two facets. Similarly, total flavonoid and subclass intakes were associated with a 2–18 % greater likelihood of sustained PWB. Women with higher baseline levels of happiness or optimism were also more likely to sustain a higher flavonoid intake.</div></div><div><h3>Conclusions</h3><div>Consuming ∼3 servings/day of flavonoid-rich foods is associated with sustained PWB, and higher baseline PWB is associated with sustained higher flavonoid intake over up to 18 years. This bidirectional relationship suggests that integrated interventions targeting both diet and well-being may help promote long-term health and reduce chronic disease risk.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"58 ","pages":"Article 106579"},"PeriodicalIF":7.4,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077176","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}

{"title":"Proteins in artificial nutrition: toward an individualized and phase-specific prescription","authors":"Philipp Schuetz ,&nbsp;Frank Carrera-Gil ,&nbsp;Carla Wunderle","doi":"10.1016/j.clnu.2026.106577","DOIUrl":"10.1016/j.clnu.2026.106577","url":null,"abstract":"<div><div>Protein is a central component of artificial nutrition, yet its optimal dose and timing remain controversial. Provision of both insufficient and excessive protein is associated with adverse outcomes. Inadequate intake promotes negative nitrogen balance, muscle wasting, impaired tissue healing and repair, and increased risk of infection, whereas excessive protein may exceed metabolic capacity, causing azotemia, hepatic or renal strain, and reduced metabolic flexibility — particularly in patients with renal dysfunction. Emerging evidence indicates that the optimal protein dose is strongly influenced by patient-specific characteristics and evolves throughout the course of illness, supporting an individualized, phase-adapted strategy for protein provision rather than a fixed universal target. During early critical illness, catabolism predominates and high protein doses may not be effectively utilized. In contrast, during recovery and stabilization, higher protein targets appear beneficial for restoring lean body mass and functional capacity. This dynamic trajectory underscores the need to abandon universal recommendations in favor of personalized prescriptions. Although instruments such as nitrogen balance, body composition analysis, and indirect calorimetry can provide information about protein dosage, their routine use in clinical practice is limited and interpretation in acute illnesses remains difficult. Pragmatic, bedside strategies and the phenotyping of patients using biomarkers are, therefore, needed to tailor protein provision according to disease stage, organ function, and anabolic capacity. This opinion paper explores mechanistic insights, evidence from clinical trials, and guidelines on protein supplementation, explores biomarker-driven personalization, and highlights ongoing challenges and future research priorities in nutritional therapy.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"58 ","pages":"Article 106577"},"PeriodicalIF":7.4,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146049112","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}

{"title":"The 2025 Sir David Cuthbertson Lecture: Energy metabolism: Beyond calories, feeding the mitochondria","authors":"Eric Fontaine","doi":"10.1016/j.clnu.2026.106575","DOIUrl":"10.1016/j.clnu.2026.106575","url":null,"abstract":"<div><div>In this article, I explore how energy metabolism depends on proper mitochondrial function. Adenosine triphosphate (ATP), the main source of energy for cells, is mainly produced in the mitochondria as a result of the fusion of hydrogen produced by the breakdown of nutrients with oxygen. This reaction allows protons to be pumped across the inner mitochondrial membrane, creating a gradient that powers ATP synthesis. However, ATP production is not perfectly efficient. Some oxygen is consumed without generating ATP due to proton leaks or other processes that utilize the gradient. Diet, hormones, and cellular signals can alter mitochondrial efficiency: for example, hyperthyroidism and polyunsaturated fatty acid deficiency cause uncoupling, while hypothyroidism and nitric oxide increase coupling but reduce maximum ATP production. I also point out that the use of ATP depends on its thermodynamic value, which is reflected in the Adenosine triphosphate/Adenosine diphosphate ratio ([ATP]/[ADP] ratio). A decrease in this ratio can selectively reduce certain ATP-consuming processes, as shown in studies on metformin and imeglimin. In cases of stress or nutritional deficiency, cells can consume ATP without performing useful work, leading to inefficiency or even cell death when the [ATP]/[ADP] ratio collapses. Knowing that these concepts are quite complex, I have simplified them to make clear that mitochondria are more than just passive “powerhouses of cells”.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106575"},"PeriodicalIF":7.4,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145974240","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}

{"title":"Effectiveness of probiotic supplementation in managing depressive symptoms and inflammatory status in patients with depression: A systematic review and meta-analysis","authors":"Hajar Nabeel Shakir Shakir ,&nbsp;Antonio Javier Alias-Castillo ,&nbsp;Daniel Bertini-Pérez ,&nbsp;Lola Rueda-Ruzafa ,&nbsp;Pablo Roman ,&nbsp;Diana Cardona","doi":"10.1016/j.clnu.2025.106554","DOIUrl":"10.1016/j.clnu.2025.106554","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Depression is a multifactorial disorder influenced by genetic, biochemical, psychological, and environmental factors, and it significantly impacts quality of life. Probiotics, especially <em>Lactobacillus</em> and <em>Bifidobacterium</em> strains, have been proposed as adjunct therapies due to their capacity to modulate gut microbiota and the gut–brain axis. This systematic review and meta-analysis aimed to evaluate the effectiveness of probiotic supplementation on depressive symptoms and inflammatory status in individuals with depression.</div></div><div><h3>Methods</h3><div>Articles were identified through searches in databases including PubMed, Scopus, CINAHL, and Zenodo, using terms related to depression, microbiome, and probiotics. The search, conducted between January and February 2025, yielded 780 articles. After removing duplicates and applying eligibility criteria, 13 studies were included in the systematic review and 7 in the meta-analysis.</div></div><div><h3>Results</h3><div>Probiotic supplementation was significantly associated with improvement in depressive symptoms (p &lt; 0.00001). However, no significant changes were found in inflammatory biomarkers, including interleukin-6 (p = 0.45) and tumor necrosis factor-alpha (p = 0.21).</div></div><div><h3>Conclusions</h3><div>These results suggest that probiotics may help alleviate depressive symptoms, although their effect on inflammation remains uncertain. Further high-quality studies are necessary to clarify underlying mechanisms and determine the clinical relevance of probiotics as adjunctive therapy in depression..</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"58 ","pages":"Article 106554"},"PeriodicalIF":7.4,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146049111","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}

{"title":"Comparing bedside and CT-derived muscle mass assessment methodologies at intensive care unit admission: A critical step towards bedside detection of reduced muscle mass","authors":"Michelle C. Paulus ,&nbsp;Max Melchers ,&nbsp;Imre W.K. Kouw ,&nbsp;Myrthe Vestering ,&nbsp;Alain R. Viddeleer ,&nbsp;Arthur R.H. van Zanten","doi":"10.1016/j.clnu.2026.106574","DOIUrl":"10.1016/j.clnu.2026.106574","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Reduced skeletal muscle mass at Intensive Care Unit (ICU) admission is associated with increased mortality. Bedside techniques, including bioelectrical impedance analysis (BIA), ultrasonography (US), and calf circumference (CC), may help to estimate skeletal muscle mass in critically ill patients. This study aimed to investigate the accuracy of these bedside methods in assessing muscle mass compared to lumbar 3 (L3) CT-derived skeletal muscle index (CT-SMI) and determine cut-offs for reduced muscle mass upon ICU admission.</div></div><div><h3>Methods</h3><div>A prospective, single-centre, cohort study conducted between May 2023 and April 2025. Patients (≥18 years) with an expected ICU stay ≥3 days were included. Bedside parameters (&lt;48 h of ICU admission) included multifrequency BIA-derived skeletal muscle mass (BIA-SMM) and fat-free mass (BIA-FFM)), US-derived <em>rectus femoris</em> cross-sectional area (US-RFCSA) and <em>quadriceps</em> muscle layer thickness (US-QMLT), and CC (adjusted for BMI). These were compared to L3 CT-SMI and CT-derived skeletal muscle area (CT-SMA) retrieved 7 days before to 24 h after ICU admission. Correlations between CT and bedside methods were assessed. Reduced muscle mass was defined using CT-based SMI cut-offs (females &lt;38 cm²/m²; males &lt;50 cm²/m²) to determine cut-off values of bedside parameters using ROC analyses.</div></div><div><h3>Results</h3><div>Fifty-six ICU patients (70 % male) were included, showing 64 % having reduced skeletal muscle mass. Correlations of CT-SMI with BIA and US parameters were weak to moderate (r = 0.36–0.45, all p &lt; 0.05), while CT-SMA correlated moderately with BIA-FFM (r = 0.57) and BIA-SMM (r = 0.62, both p &lt; 0.001) but not with US-RFCSA, US-QMLT, and CC (p &gt; 0.05). Cut-offs for reduced skeletal muscle mass were BIA-FFMI: 23.8 kg/m² and 20.0 kg/m²; BIA-SMMI: 13.4 kg/m² and 10.7 kg/m²; adjusted CC: 36.8 cm and 33.8 cm, in males and females, respectively, and US-RFCSA: 4.3 cm² and US-QMLT: 2.3 cm (both sexes).</div></div><div><h3>Conclusion</h3><div>At ICU admission, correlations between bedside methods and L3 CT-derived muscle mass were low to moderate. Cut-off values were derived to detect reduced skeletal muscle upon ICU admission. However, further validation is required before clinical implementation.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106574"},"PeriodicalIF":7.4,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145974164","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}

{"title":"Measuring diet intake in adolescents: Relative validation of an artificial intelligence enhanced, image assisted mobile application","authors":"Audrey Moyen ,&nbsp;Antonio Rossi ,&nbsp;Maurya Hart ,&nbsp;Elinor Simons ,&nbsp;Piushkumar J. Mandhane ,&nbsp;Theo J. Moraes ,&nbsp;Meghan B. Azad ,&nbsp;Stuart E. Turvey ,&nbsp;Padmaja Subbarao ,&nbsp;Anne-Julie Tessier ,&nbsp;Kozeta Miliku","doi":"10.1016/j.clnu.2025.106568","DOIUrl":"10.1016/j.clnu.2025.106568","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Puberty is a critical period of development during which nutritional exposures are known to shape long-term health and the risk of chronic diseases. Current dietary assessment methods have limitations for use in large cohorts of adolescent populations. We aimed to evaluate the relative validity of Keenoa (not an acronym), an artificial intelligence-enhanced image-assisted mobile application, against the validated Automated Self-Administered 24 h recall (ASA24)-Canada web-based platform, among adolescents in the CHILD Cohort Study.</div></div><div><h3>Methods</h3><div>Using a randomized crossover design, participants aged 11–15 years old completed three days (two weekdays and one weekend day) of both Keenoa food tracking and ASA24 food recalls. Differences in reported intakes were analyzed using paired t-tests or Wilcoxon signed-rank test and deattenuated correlations by Spearman's coefficient. Agreement and bias were determined using Bland–Altman's test, and inter-quartile cross-classification agreement was assessed using weighted Cohen kappa.</div></div><div><h3>Results</h3><div>This study included 141 participants with a mean age of 12.2 ± 0.8 years; of them 74 (52.5 %) males; and 88 (62.4 %) identified as Caucasian/White. Mean ± SD reported energy intakes (kcal/d) were 1976 ± 451 and 1978 ± 425, with ASA24 and Keenoa, respectively (P = 0.95). Mean reported macronutrient, iron, and potassium intakes did not significantly differ between tools. Reported fiber intake was higher, while sodium, calcium and vitamin D intakes were lower with Keenoa compared to ASA24 (P values &lt; 0.001–0.025). Deattenuated correlations between tools ranged from r = 0.77 to 1.00 (all p&lt; 0.01) and weighted Cohen κ scores ranged from 0.22 to 0.42 (all p &lt; 0.001). Among all participants, 121 (85.8 %) and 78 (55.3 %) completed all 3 requested days with Keenoa and ASA24, respectively (P&lt; 0.01).</div></div><div><h3>Conclusion</h3><div>The artificial intelligence-enhanced image-assisted Keenoa mobile application showed strong to moderate relative validity against ASA24 for energy, macronutrient, potassium and iron intakes. Vitamin D, calcium, fiber and sodium showed limited relative agreement based on mean differences. This novel tool may facilitate dietary assessment and reduce attrition bias in cohort studies. Future validation using objective biomarker measures will help establish true validity.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106568"},"PeriodicalIF":7.4,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923148","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}

{"title":"Impact of nutritional status on chemotherapy delivery and outcomes in advanced pancreatic cancer: A prospective multicenter study","authors":"Maria Kiriukova ,&nbsp;Giulia Orsi ,&nbsp;Vasile Sandru ,&nbsp;Daniel de la Iglesia ,&nbsp;Nikola Panic ,&nbsp;Maryana Bozhychko ,&nbsp;Bartu Avci ,&nbsp;Alice Burini ,&nbsp;Sara Cardellini ,&nbsp;Valeria Loliva ,&nbsp;Livia Archibugi ,&nbsp;Marina Macchini ,&nbsp;Afrodita Panaitescu-Damian ,&nbsp;Dmitry Bordin ,&nbsp;Paolo Giorgio Arcidiacono ,&nbsp;Patrick Maisonneuve ,&nbsp;Enrique de-Madaria ,&nbsp;Michele Reni ,&nbsp;Gabriele Capurso","doi":"10.1016/j.clnu.2025.106573","DOIUrl":"10.1016/j.clnu.2025.106573","url":null,"abstract":"<div><h3>Background &amp; aim</h3><div>Malnutrition is common in pancreatic ductal adenocarcinoma (PDAC) and may compromise chemotherapy delivery. We investigated whether baseline nutritional status and quality of life (QoL) predict chemotherapy relative dose intensity (RDI) and survival in advanced PDAC.</div></div><div><h3>Methods</h3><div>In this multicenter prospective cohort, adults with locally advanced or metastatic PDAC planned for first-line chemotherapy underwent baseline nutritional and QoL assessments, including the Mini Nutritional Assessment (MNA), European Organisation for Research and Treatment of Cancer-Pancreas 26 (EORTC-PAN26), and Functional Assessment of Anorexia/Cachexia Therapy subscale (FAACT-A/CS). The primary outcome was chemotherapy delivery during the first 12 weeks, expressed as RDI. Secondary outcomes included overall survival (OS). Associations between baseline scores, RDI, and OS were analyzed using regression models adjusted for age, sex, disease stage, and center. Kaplan–Meier and Cox models assessed survival.</div></div><div><h3>Results</h3><div>Of 140 enrolled patients, 105 started chemotherapy. Malnutrition was frequent (55.7 % at risk, 33.6 % malnourished). Higher MNA and EORTC-PAN26 scores were associated with better RDI (r = 0.31, p = 0.001; r = 0.30, p = 0.002), whereas FAACT-A/CS showed no correlation. In multivariable analysis, higher MNA scores [odds ratio (OR) 0.55; 95 % confidence interval (CI) 0.32–0.96; p = 0.036] and metastatic disease (OR 0.36; 95 % CI 0.13–0.99; p = 0.048) independently predicted RDI ≥80 %. Reduced RDI (hazard ratio [HR] 2.05; 95 % CI 1.20–3.50; p = 0.009) and FAACT-A/CS &lt; 28 (HR 1.90; 95 % CI 1.04–3.49) were independently associated with shorter OS.</div></div><div><h3>Conclusions</h3><div>Baseline nutritional status and QoL, particularly assessed by MNA and EORTC-PAN26, predict chemotherapy delivery in advanced PDAC. Reduced RDI and anorexia/cachexia symptoms are linked to poorer survival, supporting systematic nutritional assessment and targeted interventions to optimize outcomes.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106573"},"PeriodicalIF":7.4,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923147","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}

{"title":"Glucagon-like peptide-1 receptor agonists and Wernicke encephalopathy: A pharmacovigilance study and literature review","authors":"Dana Lev ,&nbsp;Avshalom Leibowitz ,&nbsp;Alon Lang ,&nbsp;Gadi Shlomai ,&nbsp;Gilad Twig ,&nbsp;Yehudit Eden-Friedman ,&nbsp;Tal Engel ,&nbsp;Tali Cukierman-Yaffe ,&nbsp;Rachel Dankner ,&nbsp;Hertzel C. Gerstein ,&nbsp;Adam Goldman","doi":"10.1016/j.clnu.2025.106571","DOIUrl":"10.1016/j.clnu.2025.106571","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have revolutionized the treatment of type 2 diabetes mellitus and obesity in recent years. While gastrointestinal adverse events are common, their association with nutritional deficiencies, including thiamine, has not been comprehensively investigated. This study aimed to evaluate whether treatment with GLP-1 RAs is associated with the occurrence of Wernicke encephalopathy (WE).</div></div><div><h3>Methods</h3><div>We conducted a pharmacovigilance study using the FDA Adverse Event Reporting System (FAERS) and a narrative literature review. Disproportionality analysis assessed WE reporting following GLP-1 RA treatment using the reporting odds ratio (ROR) and the lower bound of the information component (IC) 95 % credibility interval.</div></div><div><h3>Results</h3><div>We identified 15 cases of GLP-1 RA-associated WE: 13 from FAERS, 1 from published literature, and 1 from our medical center. Most cases occurred with semaglutide (n = 8/15) or tirzepatide (6/15), and were reported in 2023–2024 (14/15). Most patients (13/15) reported gastrointestinal manifestations of either weight loss, vomiting, loss of appetite, or malnutrition. Classic WE symptoms were reported in 11 patients, and the full clinical triad in 2 patients. Long-term neurological sequelae were noted in 7 of 11 patients with follow-up data. Disproportionality analysis showed increased reporting of WE with GLP-1 RAs compared with other medications (ROR = 2.35 [95%CI, 1.38–4.01]; IC₀₂₅ = 0.29).</div></div><div><h3>Conclusions</h3><div>WE is a potentially rare but severe adverse event of GLP-1 RA treatment, mainly with semaglutide or tirzepatide. As early detection may prevent neurological sequelae, increased clinical awareness is warranted, especially in individuals experiencing severe gastrointestinal symptoms.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106571"},"PeriodicalIF":7.4,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145974163","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}