Clinical nutrition最新文献_第2页

Proteins in artificial nutrition: toward an individualized and phase-specific prescription 人工营养中的蛋白质：走向个体化和阶段性处方

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2026-01-14 DOI: 10.1016/j.clnu.2026.106577

Philipp Schuetz , Frank Carrera-Gil , Carla Wunderle

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.

蛋白质是人工营养的核心成分，但其最佳剂量和时间仍然存在争议。蛋白质供应不足和过量都与不良后果有关。摄入不足会促进负氮平衡，肌肉萎缩，组织愈合和修复受损，并增加感染风险，而过量的蛋白质可能超过代谢能力，导致氮血症，肝脏或肾脏应变，并降低代谢灵活性-特别是在肾功能不全的患者中。新出现的证据表明，最佳蛋白质剂量受到患者特异性特征的强烈影响，并在整个疾病过程中不断发展，这支持个性化的、适应阶段的蛋白质供应策略，而不是固定的普遍目标。在早期危重疾病期间，分解代谢占主导地位，高蛋白剂量可能无法有效利用。相反，在恢复和稳定期间，较高的蛋白质目标似乎有利于恢复瘦体重和功能能力。这一动态轨迹强调了放弃普遍建议而采用个性化处方的必要性。虽然氮平衡、身体成分分析和间接量热等仪器可以提供蛋白质剂量的信息，但它们在临床实践中的常规应用有限，在急性疾病中的解释仍然困难。因此，需要实用的床边策略和使用生物标志物的患者表型，根据疾病分期、器官功能和合成代谢能力定制蛋白质供应。本文探讨了蛋白质补充的机理见解、临床试验证据和指南，探讨了生物标志物驱动的个性化，并强调了营养治疗中正在面临的挑战和未来的研究重点。

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引用次数: 0

The 2025 Sir David Cuthbertson Lecture: Energy metabolism: Beyond calories, feeding the mitochondria 2025年David Cuthbertson爵士讲座：能量代谢：超越卡路里，喂养线粒体

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2026-01-09 DOI: 10.1016/j.clnu.2026.106575

Eric Fontaine

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”.

在这篇文章中，我探讨了能量代谢如何依赖于适当的线粒体功能。三磷酸腺苷（ATP）是细胞的主要能量来源，主要在线粒体中产生，是营养物质与氧气分解产生的氢融合的结果。这个反应允许质子穿过线粒体内膜，产生一个梯度，为ATP合成提供动力。然而，ATP的产生并不是完全有效的。由于质子泄漏或其他利用梯度的过程，一些氧气被消耗而不产生ATP。饮食、激素和细胞信号可改变线粒体效率：例如，甲状腺功能亢进和多不饱和脂肪酸缺乏可导致偶联解除，而甲状腺功能减退和一氧化氮可增加偶联，但减少最大ATP产量。我还指出，ATP的使用取决于它的热力学值，这体现在三磷酸腺苷/二磷酸腺苷的比值（[ATP]/[ADP]比值）上。这一比例的降低可以选择性地减少某些atp消耗过程，二甲双胍和依米明的研究表明。在压力或营养缺乏的情况下，细胞可以消耗ATP而不进行有用的工作，导致效率低下，甚至当[ATP]/[ADP]比率崩溃时细胞死亡。知道这些概念相当复杂，我简化了它们，以清楚地表明线粒体不仅仅是被动的“细胞发电站”。

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引用次数: 0

Effectiveness of probiotic supplementation in managing depressive symptoms and inflammatory status in patients with depression: A systematic review and meta-analysis 补充益生菌对抑郁症患者控制抑郁症状和炎症状态的有效性：一项系统综述和荟萃分析

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2026-01-08 DOI: 10.1016/j.clnu.2025.106554

Hajar Nabeel Shakir Shakir , Antonio Javier Alias-Castillo , Daniel Bertini-Pérez , Lola Rueda-Ruzafa , Pablo Roman , Diana Cardona

Background and Aims

Depression is a multifactorial disorder influenced by genetic, biochemical, psychological, and environmental factors, and it significantly impacts quality of life. Probiotics, especially Lactobacillus and Bifidobacterium 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.

Methods

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.

Results

Probiotic supplementation was significantly associated with improvement in depressive symptoms (p < 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).

Conclusions

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..

背景与目的抑郁症是一种受遗传、生化、心理和环境因素影响的多因素疾病，对生活质量有显著影响。益生菌，特别是乳酸菌和双歧杆菌菌株，由于其调节肠道微生物群和肠脑轴的能力，已被提出作为辅助治疗。本系统综述和荟萃分析旨在评估补充益生菌对抑郁症患者抑郁症状和炎症状态的有效性。方法通过检索PubMed、Scopus、CINAHL和Zenodo等数据库，使用与抑郁症、微生物组和益生菌相关的术语对文章进行识别。这项研究于2025年1月至2月进行，共发现780篇文章。在排除重复项并应用资格标准后，13项研究被纳入系统评价，7项研究被纳入荟萃分析。结果补充益生菌与抑郁症状改善显著相关（p < 0.00001）。然而，炎症生物标志物，包括白细胞介素-6 （p = 0.45）和肿瘤坏死因子- α (p = 0.21)未发现显著变化。结论益生菌可能有助于缓解抑郁症状，但其对炎症的影响尚不确定。需要进一步的高质量研究来阐明潜在的机制，并确定益生菌作为抑郁症辅助治疗的临床相关性。

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引用次数: 0

Comparing bedside and CT-derived muscle mass assessment methodologies at intensive care unit admission: A critical step towards bedside detection of reduced muscle mass 比较重症监护病房入院时床边和ct得出的肌肉质量评估方法：床边检测肌肉质量减少的关键一步

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2026-01-07 DOI: 10.1016/j.clnu.2026.106574

Michelle C. Paulus , Max Melchers , Imre W.K. Kouw , Myrthe Vestering , Alain R. Viddeleer , Arthur R.H. van Zanten

Background and Aims

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.

Methods

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 (<48 h of ICU admission) included multifrequency BIA-derived skeletal muscle mass (BIA-SMM) and fat-free mass (BIA-FFM)), US-derived rectus femoris cross-sectional area (US-RFCSA) and quadriceps 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 <38 cm²/m²; males <50 cm²/m²) to determine cut-off values of bedside parameters using ROC analyses.

Results

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 < 0.05), while CT-SMA correlated moderately with BIA-FFM (r = 0.57) and BIA-SMM (r = 0.62, both p < 0.001) but not with US-RFCSA, US-QMLT, and CC (p > 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).

Conclusion

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.

背景和目的在重症监护病房（ICU）入院时骨骼肌量减少与死亡率增加相关。床边技术，包括生物电阻抗分析（BIA）、超声检查（US）和小腿围（CC），可以帮助估计危重病人的骨骼肌质量。本研究旨在探讨这些床边方法与腰椎3 (L3) ct衍生骨骼肌指数（CT-SMI）相比评估肌肉质量的准确性，并确定ICU入院时肌肉质量减少的临界值。方法一项于2023年5月至2025年4月进行的前瞻性、单中心、队列研究。纳入预期ICU住院≥3天的患者（≥18岁）。床边参数（入院前48小时）包括多频cia衍生的骨骼肌质量（BIA-SMM）和无脂质量（BIA-FFM）， cia衍生的股直肌横截面积（US-RFCSA）和股四头肌层厚度（US-QMLT），以及CC（经BMI调整）。这些数据与L3 CT-SMI和ct衍生骨骼肌面积（CT-SMA）在ICU入院前7天至24小时后进行比较。评估CT与床边检查方法的相关性。使用基于ct的SMI截断值（女性& 38 cm2/m2；男性& 50 cm2/m2）定义肌肉量减少，并使用ROC分析确定床边参数的截断值。结果纳入56例ICU患者（男性70%），其中64%骨骼肌减少。CT-SMI与BIA和US参数的相关性为弱至中度（r = 0.36-0.45，均p <； 0.05），而CT-SMA与BIA- ffm （r = 0.57）和BIA- smm （r = 0.62，均p <； 0.001）有中度相关性，但与US- rfcsa、US- qmlt和CC无相关性（p < 0.05）。骨骼肌减少的临界值为BIA-FFMI: 23.8 kg/m2和20.0 kg/m2；BIA-SMMI: 13.4 kg/m2和10.7 kg/m2；调整后的CC分别为36.8 cm和33.8 cm，男性和女性，US-RFCSA为4.3 cm2， US-QMLT为2.3 cm（两性）。结论在ICU入院时，床边方法与L3 ct衍生肌肉量的相关性为低至中等。得出截断值，以检测ICU入院时骨骼肌的减少。然而，在临床应用之前，需要进一步的验证。

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引用次数: 0

Measuring diet intake in adolescents: Relative validation of an artificial intelligence enhanced, image assisted mobile application 测量青少年饮食摄入量：人工智能增强、图像辅助移动应用程序的相对验证

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2026-01-03 DOI: 10.1016/j.clnu.2025.106568

Audrey Moyen , Antonio Rossi , Maurya Hart , Elinor Simons , Piushkumar J. Mandhane , Theo J. Moraes , Meghan B. Azad , Stuart E. Turvey , Padmaja Subbarao , Anne-Julie Tessier , Kozeta Miliku

Background & Aims

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.

Methods

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.

Results

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 < 0.001–0.025). Deattenuated correlations between tools ranged from r = 0.77 to 1.00 (all p< 0.01) and weighted Cohen κ scores ranged from 0.22 to 0.42 (all p < 0.001). Among all participants, 121 (85.8 %) and 78 (55.3 %) completed all 3 requested days with Keenoa and ASA24, respectively (P< 0.01).

Conclusion

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.

背景和目的青春期是发育的关键时期，在此期间，营养暴露会影响长期健康和慢性疾病的风险。目前的饮食评估方法在大量青少年人群中使用有局限性。我们旨在评估Keenoa（不是首字母缩写），一个人工智能增强的图像辅助移动应用程序，与经过验证的自动自我管理24小时召回(ASA24)-加拿大网络平台，在儿童队列研究中的青少年中的相对有效性。方法采用随机交叉设计，11-15岁的参与者完成了为期3天（两个工作日和一个周末）的Keenoa食品跟踪和ASA24食品召回。使用配对t检验或Wilcoxon符号秩检验和Spearman系数去衰减相关性来分析报告摄入量的差异。使用Bland-Altman检验确定一致性和偏倚，使用加权Cohen kappa评估四分位数间交叉分类一致性。结果本研究纳入141名参与者，平均年龄12.2±0.8岁；其中男性74例（52.5%）；88人（62.4%）为高加索/白人。平均±SD报告能量摄入（kcal/d）分别为1976±451和1978±425，分别为ASA24和Keenoa （P = 0.95）。平均报告的常量营养素、铁和钾的摄入量在不同的工具之间没有显著差异。与ASA24相比，Keenoa报告的纤维摄入量较高，而钠、钙和维生素D摄入量较低（P值<； 0.001-0.025）。工具之间的去衰减相关性范围为r = 0.77至1.00（均p<； 0.01），加权Cohen κ评分范围为0.22至0.42（均p<； 0.001）。在所有参与者中，分别有121（85.8%）和78（55.3%）完成了Keenoa和ASA24的所有3天要求（P< 0.01）。结论人工智能增强图像辅助Keenoa移动应用程序在能量、常量营养素、钾和铁摄入量方面对ASA24具有较强至中等的相对效度。基于平均差异，维生素D、钙、纤维和钠显示出有限的相对一致性。这种新工具可以促进饮食评估，减少队列研究中的消耗偏倚。使用客观生物标志物测量的未来验证将有助于建立真正的有效性。

{"title":"Measuring diet intake in adolescents: Relative validation of an artificial intelligence enhanced, image assisted mobile application","authors":"Audrey Moyen , Antonio Rossi , Maurya Hart , Elinor Simons , Piushkumar J. Mandhane , Theo J. Moraes , Meghan B. Azad , Stuart E. Turvey , Padmaja Subbarao , Anne-Julie Tessier , Kozeta Miliku","doi":"10.1016/j.clnu.2025.106568","DOIUrl":"10.1016/j.clnu.2025.106568","url":null,"abstract":"<div><h3>Background & 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 < 0.001–0.025). Deattenuated correlations between tools ranged from r = 0.77 to 1.00 (all p< 0.01) and weighted Cohen κ scores ranged from 0.22 to 0.42 (all p < 0.001). Among all participants, 121 (85.8 %) and 78 (55.3 %) completed all 3 requested days with Keenoa and ASA24, respectively (P< 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}

引用次数: 0

Impact of nutritional status on chemotherapy delivery and outcomes in advanced pancreatic cancer: A prospective multicenter study 营养状况对晚期胰腺癌化疗递送和结局的影响：一项前瞻性多中心研究

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2026-01-02 DOI: 10.1016/j.clnu.2025.106573

Maria Kiriukova , Giulia Orsi , Vasile Sandru , Daniel de la Iglesia , Nikola Panic , Maryana Bozhychko , Bartu Avci , Alice Burini , Sara Cardellini , Valeria Loliva , Livia Archibugi , Marina Macchini , Afrodita Panaitescu-Damian , Dmitry Bordin , Paolo Giorgio Arcidiacono , Patrick Maisonneuve , Enrique de-Madaria , Michele Reni , Gabriele Capurso

Background & aim

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.

Methods

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.

Results

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 < 28 (HR 1.90; 95 % CI 1.04–3.49) were independently associated with shorter OS.

Conclusions

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.

背景：营养不良在胰腺导管腺癌（PDAC）中很常见，并可能影响化疗的递送。我们研究了基线营养状况和生活质量（QoL）是否能预测晚期PDAC患者的化疗相对剂量强度（RDI）和生存期。方法在这个多中心前瞻性队列研究中，计划一线化疗的局部晚期或转移性PDAC患者接受了基线营养和生活质量评估，包括Mini营养评估（MNA）、欧洲癌症研究与治疗组织胰腺26 （EORTC-PAN26）和厌食症/恶病质治疗功能评估量表（FAACT-A/CS）。主要终点是前12周的化疗递送量，以RDI表示。次要结局包括总生存期（OS）。使用年龄、性别、疾病分期和中心校正的回归模型分析基线评分、RDI和OS之间的关联。Kaplan-Meier和Cox模型评估生存率。结果140例入组患者中，105例开始化疗。营养不良很常见（55.7%有危险，33.6%营养不良）。较高的MNA和EORTC-PAN26评分与较好的RDI相关（r = 0.31, p = 0.001; r = 0.30, p = 0.002），而FAACT-A/CS无相关性。在多变量分析中，较高的MNA评分[比值比（OR） 0.55；95%置信区间（CI） 0.32-0.96；p = 0.036]和转移性疾病（OR 0.36; 95% CI 0.13-0.99; p = 0.048）独立预测RDI≥80%。RDI降低（风险比[HR] 2.05; 95% CI 1.20-3.50; p = 0.009）和FAACT-A/CS <； 28（风险比[HR] 1.90; 95% CI 1.04-3.49）与较短的OS独立相关。结论基线营养状况和生活质量，特别是通过MNA和EORTC-PAN26评估，预测晚期PDAC的化疗递送。RDI降低和厌食/恶病质症状与较差的生存有关，支持系统的营养评估和有针对性的干预以优化结果。

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引用次数: 0

Glucagon-like peptide-1 receptor agonists and Wernicke encephalopathy: A pharmacovigilance study and literature review 胰高血糖素样肽-1受体激动剂与韦尼克脑病：一项药物警戒研究和文献综述

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2026-01-02 DOI: 10.1016/j.clnu.2025.106571

Dana Lev , Avshalom Leibowitz , Alon Lang , Gadi Shlomai , Gilad Twig , Yehudit Eden-Friedman , Tal Engel , Tali Cukierman-Yaffe , Rachel Dankner , Hertzel C. Gerstein , Adam Goldman

Background & aims

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).

Methods

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.

Results

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).

Conclusions

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.

背景和目的胰高血糖素样肽-1受体激动剂（GLP-1 RAs）近年来彻底改变了2型糖尿病和肥胖症的治疗。虽然胃肠道不良事件很常见，但它们与营养缺乏（包括硫胺素）的关系尚未得到全面调查。本研究旨在评估GLP-1 RAs治疗是否与韦尼克脑病（WE）的发生有关。方法采用FDA不良事件报告系统（FAERS）和叙述性文献综述进行药物警戒研究。歧化分析使用报告优势比（ROR）和信息成分（IC） 95%可信区间的下界评估GLP-1 RA治疗后WE报告。结果我们确定了15例GLP-1 ra相关WE: 13例来自FAERS， 1例来自已发表文献，1例来自我们的医疗中心。大多数病例发生在西马鲁肽（n = 8/15）或替西帕肽（6/15），报告时间为2023-2024年（14/15）。大多数患者（13/15）报告胃肠道表现为体重减轻、呕吐、食欲不振或营养不良。11例患者报告了典型WE症状，2例患者报告了完整的临床三联征。随访资料显示，11例患者中有7例存在长期神经系统后遗症。歧化分析显示，与其他药物相比，GLP-1 RAs的WE报告增加（ROR = 2.35 [95%CI, 1.38-4.01]; IC025 = 0.29）。结论在GLP-1类RA治疗中，we是一种潜在的罕见但严重的不良事件，主要以西马鲁肽或替西帕肽为主。由于早期发现可以预防神经系统后遗症，因此有必要提高临床意识，特别是在出现严重胃肠道症状的个体中。

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引用次数: 0

Daily oral iron supplementation produced greater improvements in hematological parameters than alternate day doses – A pilot double-blind randomized control trial in iron-deficient young women 每日口服补铁比隔天补铁对血液参数有更大的改善——一项针对缺铁年轻女性的先导双盲随机对照试验。

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2026-01-01 DOI: 10.1016/j.clnu.2025.11.005

Nikhitha M. John , Bhargavi Ashok , Obed John , Kanagalakshmi V , Dilip Abraham , Prasanna Samuel , Yesudas Sudhakar , Surjit K.S. Srai , Molly Jacob

Background and aims

There is little universal consensus on the optimal regime for oral iron supplementation to treat iron deficiency (ID) and iron-deficiency anemia (IDA) in women of reproductive age (WRA). A few studies in a high-income country have reported higher fractional absorption from oral iron supplements (OIS) given on alternate days than daily doses; however, there were no significant improvements in hematological indices in the women in these studies who received the alternate-day doses. There are also concerns about adverse gastrointestinal effects resulting from daily OIS. Data on these aspects from low and middle-income countries (LMIC), where the burden of IDA is high, are limited.

Methods

We conducted a double-blinded, parallel-arm, non-inferiority, randomized controlled trial in non-pregnant WRA aged 18–45 years with ID (serum ferritin <20 μg/L) (CTRI/2020/03/024144). They were randomized to receive either 60 mg elemental iron daily (n = 30) or 120 mg elemental iron on alternate days (n = 30) for 14 days. The primary outcome was to determine the comparative effectiveness of daily versus alternate-day OIS in improving hematological and iron-related parameters in blood, at the end of the intervention. Secondary outcomes included extent of adherence to intervention, adverse events experienced, and changes in fecal calprotectin concentrations (a marker of gut inflammation) and the gut microbiome profile.

Results

Adherence to the regimes was excellent (≥90 %) in both arms. Both regimes significantly improved hematological and iron-related parameters in blood at the end of 14 days. Daily OIS resulted in greater increases in mean corpuscular volume (fL) [1.25 (0.25, 2.32) vs. 0.50 (−0.35, 1.42); p = 0.043], mean corpuscular hemoglobin (pg/cell) [0.52 (0.54) vs. 0.17 (0.56); p = 0.019], and reticulocyte counts (%) [0.32 (0.13, 0.75) vs. 0.27 (0.02, 0.45); p = 0.055] than alternate-day doses. There were no significant differences between the groups in extent of improvements in iron-related parameters, incidence of adverse effects, and effects on gut inflammation and microbiome profile.

Conclusion

In iron-deficient WRA in an LMIC setting, daily OIS (60 mg) for 14 days was more effective than equivalent amounts on alternate days in improving hematological parameters.

背景和目的：对于口服补铁治疗育龄妇女缺铁（ID）和缺铁性贫血（IDA）的最佳方案，目前还没有普遍的共识。在高收入国家进行的一些研究报告，隔日口服铁补充剂（OIS）的部分吸收率高于每日服用；然而，在这些研究中接受隔天剂量的妇女的血液学指标没有明显改善。还有人担心每天服用OIS会对胃肠道产生不良影响。来自低收入和中等收入国家（LMIC）的这些方面的数据有限，这些国家的IDA负担很高。方法：我们进行了一项双盲，平行组，非效性，随机对照试验，在18-45岁未怀孕的WRA（血清铁蛋白）中进行。结果：两组患者对方案的依从性都很好（≥90%）。在14天结束时，两种方案都显著改善了血液中的血液学和铁相关参数。每日OIS导致平均红细胞体积（fL）增加更大[1.25 (0.25,2.32)vs. 0.50 (-0.35, 1.42)；P = 0.043]，平均红细胞血红蛋白（pg/cell） [0.52 (0.54) vs. 0.17 (0.56)]；P = 0.019]，网织红细胞计数（%）[0.32 (0.13,0.75)vs. 0.27 (0.02, 0.45)；P = 0.055]。两组之间在铁相关参数的改善程度、不良反应发生率以及对肠道炎症和微生物群的影响方面没有显著差异。结论：在LMIC环境下缺铁的WRA中，每天服用OIS (60 mg) 14天比隔天服用同等剂量OIS更有效地改善血液学参数。

{"title":"Daily oral iron supplementation produced greater improvements in hematological parameters than alternate day doses – A pilot double-blind randomized control trial in iron-deficient young women","authors":"Nikhitha M. John , Bhargavi Ashok , Obed John , Kanagalakshmi V , Dilip Abraham , Prasanna Samuel , Yesudas Sudhakar , Surjit K.S. Srai , Molly Jacob","doi":"10.1016/j.clnu.2025.11.005","DOIUrl":"10.1016/j.clnu.2025.11.005","url":null,"abstract":"<div><h3>Background and aims</h3><div>There is little universal consensus on the optimal regime for oral iron supplementation to treat iron deficiency (ID) and iron-deficiency anemia (IDA) in women of reproductive age (WRA). A few studies in a high-income country have reported higher fractional absorption from oral iron supplements (OIS) given on alternate days than daily doses; however, there were no significant improvements in hematological indices in the women in these studies who received the alternate-day doses. There are also concerns about adverse gastrointestinal effects resulting from daily OIS. Data on these aspects from low and middle-income countries (LMIC), where the burden of IDA is high, are limited.</div></div><div><h3>Methods</h3><div>We conducted a double-blinded, parallel-arm, non-inferiority, randomized controlled trial in non-pregnant WRA aged 18–45 years with ID (serum ferritin <20 μg/L) (CTRI/2020/03/024144). They were randomized to receive either 60 mg elemental iron daily (n = 30) or 120 mg elemental iron on alternate days (n = 30) for 14 days. The primary outcome was to determine the comparative effectiveness of daily versus alternate-day OIS in improving hematological and iron-related parameters in blood, at the end of the intervention. Secondary outcomes included extent of adherence to intervention, adverse events experienced, and changes in fecal calprotectin concentrations (a marker of gut inflammation) and the gut microbiome profile.</div></div><div><h3>Results</h3><div>Adherence to the regimes was excellent (≥90 %) in both arms. Both regimes significantly improved hematological and iron-related parameters in blood at the end of 14 days. Daily OIS resulted in greater increases in mean corpuscular volume (fL) [1.25 (0.25, 2.32) vs. 0.50 (−0.35, 1.42); <em>p</em> = 0.043], mean corpuscular hemoglobin (pg/cell) [0.52 (0.54) vs. 0.17 (0.56); <em>p</em> = 0.019], and reticulocyte counts (%) [0.32 (0.13, 0.75) vs. 0.27 (0.02, 0.45); <em>p</em> = 0.055] than alternate-day doses. There were no significant differences between the groups in extent of improvements in iron-related parameters, incidence of adverse effects, and effects on gut inflammation and microbiome profile.</div></div><div><h3>Conclusion</h3><div>In iron-deficient WRA in an LMIC setting, daily OIS (60 mg) for 14 days was more effective than equivalent amounts on alternate days in improving hematological parameters.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106520"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699937","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}

引用次数: 0

Individualised growth charts for preterm infants based on a cohort with healthy neurodevelopment 基于健康神经发育队列的早产儿个体化生长图表

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2026-01-01 DOI: 10.1016/j.clnu.2025.106551

Aneurin Young , Tim J. Cole , James Ashton , R Mark Beattie , Mark J. Johnson

Background & Aims

Early growth of very preterm infants is associated with later neurodevelopmental outcome. Current growth charts are based on in utero growth rather than a growth pattern associated with good outcomes. This study aimed to generate growth standards using infants who were developing normally.

Methods

Data were obtained from the National Neonatal Research Database. Logistic regression identified associations of in-hospital and post-discharge weight gain and head circumference growth with the chance of healthy development at two years. The LMS method was used to construct centile curves reflecting the growth of very preterm infants with a positive developmental outcome. Infants with surgical necrotising enterocolitis or a significant brain injury were excluded from the cohort used to generate growth charts.

Results

Growth data were available for 37700 infants, of whom 14120 had a documented developmental assessment. Healthy development was positively associated with three factors: In-hospital weight gain (adjusted OR 1·09 per unit z-score change, 95 % CI: 1·02–1·17), weight gain from discharge to two-year assessment (aOR 1·08, 1·04–1·12) and in-hospital head growth (aOR 1·12, 1.04–1·21). A web app is available (www.bit.ly/preterm-plotter) to generate individualised growth charts for preterm infants, conditioned on their weight and head circumference at birth, to plot their growth and indicate whether their growth was expected to align with that of healthily developing infants.

Conclusion

This study presents a novel method of forming individualised growth charts. It can be implemented using a web app or by integration with clinical information systems to allow an infant's growth to be compared to a cohort of infants with a favourable developmental outcome.

背景和目的极早产儿的早期生长与后期的神经发育结果有关。目前的生长图表是基于子宫内的生长，而不是与良好结果相关的生长模式。这项研究的目的是利用正常发育的婴儿得出生长标准。方法数据来源于国家新生儿研究数据库。Logistic回归发现住院和出院后体重增加和头围增长与两岁时健康发育的机会相关。采用LMS方法构建百分位曲线，反映了具有积极发育结局的极早产儿的生长情况。患有外科坏死性小肠结肠炎或严重脑损伤的婴儿被排除在用于生成生长图表的队列之外。结果有37700名婴儿的生长数据，其中14120名有发育评估记录。健康发育与三个因素呈正相关：住院体重增加（单位z分数变化调整OR为1.09,95% CI为1.02 - 1.17）、出院至两年评估体重增加（aOR为1.08,1.04-1·12）和住院头部生长（aOR为1.12,1.04-1·21）。有一个网络应用程序（www.bit.ly/preterm-plotter）可以根据早产儿出生时的体重和头围，为他们生成个性化的生长图表，绘制出他们的生长曲线，并表明他们的生长是否与健康发育的婴儿相一致。结论本研究提出了一种形成个性化生长图的新方法。它可以通过网络应用程序或与临床信息系统集成来实现，从而将婴儿的生长情况与具有良好发育结果的一组婴儿进行比较。

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引用次数: 0

Challenges of nutritional support in patients with diabetes: A position paper of the ESPEN special interest group 糖尿病患者营养支持的挑战：ESPEN特别兴趣小组的立场文件

IF 7.4 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2026-01-01 DOI: 10.1016/j.clnu.2025.106550

Laurence Genton , Miguel Leon Sanz , Marianna Arvanitakis , María D. Ballesteros-Pomar , Lia Bally , Rocco Barazzoni , Cécile Bétry , Rosa Burgos , Cristina Cuerda , Alia Hadefi , Stanislav Klek , Meliha Mahmutovic , Didier Quilliot , Diana Rubin , Stéphane M. Schneider , Mireille J. Serlie , Tinh-Hai Collet

Malnutrition affects up to 30 % of the general population, and especially older people with polymorbid conditions. In parallel, the prevalence of diabetes increases with age affecting over 800 million adults worldwide. Healthcare providers are increasingly challenged to care for patients with diabetes that require nutritional support. To address this issue, the ESPEN Special Interest Group "Nutrition and Diabetes", aims to provide guidance for health care providers that treat these patients. This paper had three aims: 1) to summarise the guidelines and recommendations regarding nutritional support and diabetes or stress hyperglycaemia provided by scientific societies, 2) to review the associations of nutritional disorders with diabetes and its pharmacological treatments, and 3) to identify the challenges of optimal nutritional care for patients with diabetes and stress hyperglycaemia. To this end, we conducted a systematic search of guidelines and recommendations on nutritional support for patients with diabetes or stress hyperglycaemia, that have been published in English by national and international societies over the last 15 years. Our systematic search showed that published guidelines and recommendations rarely addressed the practical management of blood glucose control according to the modality of nutritional support. The literature on the association of malnutrition with diabetes and its pharmacological treatment is very limited. The identified challenges include the multidisciplinary and multiprofessional continuity of care between the hospital and ambulatory settings, the ideal pattern of hospital food, the choice of oral nutritional supplements, the adjustment of diabetes management to nutritional support, and diabetes technology to support nutritional care in these patients.

营养不良影响着高达30%的普通人口，特别是患有多种疾病的老年人。与此同时，糖尿病的患病率随着年龄的增长而增加，影响到全世界8亿多成年人。医疗保健提供者在照顾需要营养支持的糖尿病患者方面面临越来越大的挑战。为解决这一问题，ESPEN “营养与糖尿病”特别兴趣小组旨在为治疗这些患者的保健提供者提供指导。本文的目的有三个：1)总结科学学会提供的关于营养支持和糖尿病或应激性高血糖的指南和建议；2)回顾营养失调与糖尿病及其药物治疗的关系；3)确定糖尿病和应激性高血糖患者最佳营养护理的挑战。为此，我们对过去15年来由国家和国际学会以英文出版的关于糖尿病或应激性高血糖患者营养支持的指南和建议进行了系统的搜索。我们的系统搜索显示，已发表的指南和建议很少涉及根据营养支持方式控制血糖的实际管理。关于营养不良与糖尿病的关系及其药物治疗的文献非常有限。确定的挑战包括医院和门诊环境之间多学科和多专业护理的连续性，医院食品的理想模式，口服营养补充剂的选择，糖尿病管理对营养支持的调整，以及糖尿病技术支持这些患者的营养护理。

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引用次数: 0