Clinical nutrition最新文献

{"title":"Adherence to the planetary health diet and healthy aging: A prospective analysis","authors":"Javier Maroto-Rodriguez ,&nbsp;Rosario Ortolá ,&nbsp;Esther García-Esquinas ,&nbsp;Fernando Rodríguez-Artalejo ,&nbsp;Mercedes Sotos-Prieto","doi":"10.1016/j.clnu.2025.106562","DOIUrl":"10.1016/j.clnu.2025.106562","url":null,"abstract":"<div><h3>Background and Aims</h3><div>The Planetary Health Diet Index (PHDI) was designed to align environmental objectives with human health. This is the first study to assess the relationship between the PHDI and healthy aging, measured by intrinsic capacity (IC) and physical frailty.</div></div><div><h3>Methods</h3><div>We analyzed data from 19,505 participants in the UK Biobank cohort. Dietary intake was assessed using two to five 24-h assessments, and the PHDI was constructed based on 15 food groups. IC was assessed according to the Integrated Care for Older People guidelines with a score between 0 and 10 points (higher score indicated higher IC); while frailty was assessed using Rockwood's frailty index (FI) and Fried's frailty phenotype (FP). Linear regression was used to examine the relationship between PHDI and IC, and logistic regression for associations with frailty.</div></div><div><h3>Results</h3><div>After a median follow-up of 6.25 years, higher adherence to the PHDI was associated with greater IC: the mean difference (95 % CI) for the 3rd vs. 1st tertile of PHDI was 0.46 (0.05, 0.86). Higher adherence to the PHDI was associated with lower frailty risk: the odds ratios comparing extreme tertiles of PHDI were 0.80 (0.71, 0.90) for FI and 0.62 (0.43, 0.88) for FP. Fish &amp; seafood was independently associated with higher IC and less frailty, while whole grains, fruits, vegetables, nuts &amp; seeds and limiting added sugars &amp; juices were linked to lower frailty risk..</div></div><div><h3>Conclusions</h3><div>In this cohort of British adults, greater adherence to the PHDI was associated with improved IC and lower frailty risk.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106562"},"PeriodicalIF":7.4,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145974162","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":"Serum mercury, lead, cadmium, and arsenic and incidence of type 2 diabetes among adults: A nested case–control study","authors":"Aoi Ito ,&nbsp;Shohei Yamamoto ,&nbsp;Miyuki Iwai-Shimada ,&nbsp;Yayoi Kobayashi ,&nbsp;Tomohiko Isobe ,&nbsp;Kenta Iwai ,&nbsp;Shoji F. Nakayama ,&nbsp;Maki Konishi ,&nbsp;Shuichiro Yamamoto ,&nbsp;Tohru Nakagawa ,&nbsp;Shin Yamazaki ,&nbsp;Tetsuya Mizoue","doi":"10.1016/j.clnu.2025.106563","DOIUrl":"10.1016/j.clnu.2025.106563","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>We aimed to prospectively examine the associations of serum mercury, lead, cadmium, and arsenic with type 2 diabetes.</div></div><div><h3>Methods</h3><div>This is a nested case–control study within a cohort of employees (<em>n</em> = 4754), who underwent comprehensive health checkups and provided blood samples, between 2008 and 2009. Serum cadmium, lead, mercury, and arsenic levels were measured using inductively coupled plasma mass spectrometry. During a 5-year follow-up period, type 2 diabetes was identified by plasma glucose, HbA_1c, or self-report. Using the incident density method, two controls were randomly matched to each case by age, sex, and health checkup date, resulting in 325 cases and 611 controls with measurements of serum metal(loid)s. A conditional logistic regression model was used to estimate the odds ratio and 95% CI of type 2 diabetes across the quartiles of these metal(loid)s.</div></div><div><h3>Results</h3><div>Higher serum mercury concentrations were associated with higher odds of type 2 diabetes after adjusting for job section, shift work, smoking, alcohol consumption, leisure-time physical activity, family history of diabetes, BMI, hypertension, and serum concentrations of long-chain omega-3 fatty acids, vitamin D, magnesium, selenium, lead, cadmium, and arsenic. The odds ratios (95% CIs) for the lowest to the highest quartiles of serum mercury were 1 (reference), 1.15 (0.70, 1.90), 1.41 (0.85, 2.36), and 1.98 (1.13, 3.47), respectively (<em>P</em>_trend = 0.01). There were no associations between serum cadmium, lead, and arsenic and type 2 diabetes.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that individuals with higher concentrations of serum mercury were more likely to develop type 2 diabetes.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106563"},"PeriodicalIF":7.4,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008650","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":"Poly- and perfluoroalkyl substances (PFAS) associate with alterations in adipokine levels and eating behavior in the first 2 years of life","authors":"Inge A.L.P. van Beijsterveldt ,&nbsp;Demi J. Dorrepaal ,&nbsp;Bertrand D. van Zelst ,&nbsp;Leonie C. van Vark-van der Zee ,&nbsp;Monique T. Mulder ,&nbsp;Sjoerd A.A. van den Berg ,&nbsp;Anita C.S. Hokken-Koelega","doi":"10.1016/j.clnu.2025.106555","DOIUrl":"10.1016/j.clnu.2025.106555","url":null,"abstract":"<div><h3>Background and aims</h3><div>The non-degradable poly- and perfluoroalkyl substances (PFAS) are ‘Endocrine Disrupting Chemicals’ (EDCs), a group of chemicals that interfere with endocrine processes in the human body and potentially have adverse effects on several developmental domains in children. Particularly when PFAS exposure occurs during susceptive periods, including ‘the first 1000 days’ of life. Human milk is an important PFAS exposure pathway. In contrast to breastfeeding, PFAS have been thought to negatively influence growth, body composition development and metabolic health. However, exact mechanisms are not yet unraveled. Potential pathways might be via appetite regulating hormones (ARHs) and eating behavior. We, therefore, investigated the influence of feeding type (exclusive breastfeeding (EBF), exclusive formula feeding (EFF) or mixed feeding (mix)) on plasma ARHs and eating behavior and also the associations between plasma PFAS levels, ARHs and eating behavior, in infants during the first 2 years of life.</div></div><div><h3>Methods</h3><div>This study was embedded in the Sophia Pluto study. We conducted longitudinal follow-up in 371 healthy term-born infants (150 EBF, 97 EFF and 124 mix) during the first 2 years of life. At age 3 months and 2 years, we studied eating behavior via the Baby Eating Behavior Questionnaire (BEBQ) and Child Eating Behavior Questionnaire (CEBQ), respectively. At these timepoints, fasting blood samples were collected in which plasma levels of 5 individual PFAS and 9 ARHs were determined. The associations of plasma PFAS levels and feeding type with ARHs and eating behavior were studied using multiple regression models, corrected for known confounders, such as sex and fat mass SDS.</div></div><div><h3>Results</h3><div>At age 3 months plasma ARH levels differed between children that were EBF, EFF and mix. With EBF-infants having the highest levels of peptide YY (PYY) and the lowest of insulin, amylin and pancreatic polypeptide (PP). These differences disappeared at age 2 years. Higher plasma PFAS levels, corrected for feeding type, at age 3 months were associated with higher adiponectin and lower leptin levels and at age 2 years with lower leptin and insulin levels<strong>.</strong> When studying eating behavior, we did neither find any differences between EBF, EFF and mix infants at age 3 months nor at age 2 years. At age 3 months, plasma PFAS levels were inversely associated with “food responsiveness”, and positively with “slowness in eating”. At age 2 years, plasma PFAS levels, corrected for feeding type, were inversely associated with all “food approach” subscales.</div></div><div><h3>Conclusion</h3><div>Our findings could indicate that PFAS exposure does not compromise breastfeeding's health benefits on metabolic health and insulin sensitivity until age 2 years and that PFAS exposure probably effects eating behavior via other pathways than ARHs alone, which warrants further research.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106555"},"PeriodicalIF":7.4,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917349","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":"Gut microbiota composition and derived enterotypes are associated with ponderal status in preschool children. Childhood obesity risk assessment longitudinal study (CORALS) cohort","authors":"Natalia Vázquez-Bolea ,&nbsp;Carlos Mora-Martínez ,&nbsp;Marta Cuervo ,&nbsp;J. Alfredo Martinez ,&nbsp;Mercedes Gil-Campos ,&nbsp;Rosaura Leis ,&nbsp;Nancy Babio ,&nbsp;Luis A. Moreno ,&nbsp;Dolores Corella ,&nbsp;Ana Moreira Echeverria ,&nbsp;Concepcion M. Aguilera ,&nbsp;Cristina Castro-Collado ,&nbsp;Rosaura Picáns-Leis ,&nbsp;Adrián Hernández-Cacho ,&nbsp;Maria L. Miguel-Berges ,&nbsp;Paula Martin-Climent ,&nbsp;Jose Manuel Jurado-Castro ,&nbsp;Rocío Vázquez-Cobela ,&nbsp;Julio Plaza-Diaz ,&nbsp;Isabel Rueda-De Torre ,&nbsp;Santiago Navas-Carretero","doi":"10.1016/j.clnu.2025.106558","DOIUrl":"10.1016/j.clnu.2025.106558","url":null,"abstract":"<div><h3>Background and aims</h3><div>Childhood obesity is a growing public health concern increasingly linked to gut microbiota. We analysed associations between microbiota composition, functionality, and weight status in 1134 children aged 3–6 years from the CORALS cohort.</div></div><div><h3>Methods</h3><div>The baseline cross-sectional study stratified participants by weight status (underweight, normal weight, overweight, obesity) and performed shotgun metagenomic sequencing of stool samples. Analyses in R assessed alpha/beta diversity, taxonomic composition, enterotypes, and microbial pathways.</div></div><div><h3>Results</h3><div>Alpha diversity decreased with increasing BMI, particularly in obesity (Shannon adj.P = 0.00301; Simpson adj.P = 0.00158). Beta diversity revealed distinct microbial structures across groups (p = 0.001). Four enterotypes were identified: obesity was associated with Enterotype 3 (Segatella-dominated, p = 0.023), while Enterotype 1 (Alistipes, Akkermansia, Coprococcus) was enriched in underweight/normal weight. Species linked to obesity included higher <em>Phocaeicola dorei</em> (adj.P = 0.003) and <em>Segatella hominis</em> (adj.P = 0.001), and lower <em>Longicatena caecimuris</em> (adj.P = 0.03) and <em>Blautia parvula</em> (adj.P = 0.003). Functional analyses showed downregulation of vitamin and nucleotide biosynthesis pathways and reduced carbohydrate metabolism in overweight/obesity.</div></div><div><h3>Conclusions</h3><div>Gut microbiota composition and functionality are strongly associated with weight status in early childhood, suggesting microbial biomarkers and metabolic pathways relevant to understand early obesity development.</div><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> ID <span><span>NCT06317883</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106558"},"PeriodicalIF":7.4,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917277","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":"Blood omega-3 is inversely related to risk of early-onset dementia","authors":"Aleix Sala-Vila ,&nbsp;Nathan L. Tintle ,&nbsp;Jason Westra ,&nbsp;William S. Harris","doi":"10.1016/j.clnu.2025.106559","DOIUrl":"10.1016/j.clnu.2025.106559","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Early-onset dementia (EOD, defined as diagnosis &lt; age 65) imposes a high socio-economic burden. It is less prevalent and less investigated than late-onset dementia (LOD). Observational data indicate that many EOD cases are associated with potentially modifiable risk factors, yet the relationship between diet and EOD has been under-explored. Omega-3 fatty acids are promising dietary factors for dementia prevention; however, existing research has primarily focused on cohorts aged &gt;65. We examined the associations between omega-3 blood levels (which objectively reflect dietary intake) and incident EOD by leveraging data from the UK Biobank cohort.</div></div><div><h3>Methods</h3><div>We included participants aged 40–64, free of dementia at baseline and for whom plasma omega-3 levels and relevant covariates were available. We modeled the relationships between the three omega-3 exposures (total omega-3, DHA, and non-DHA omega-3) and incident EOD with quintiles (Q) and continuous linear relationships. We constructed Cox proportional hazards adjusting for sex, age at baseline and <em>APOE-ε4</em> allele load, besides other lifestyle variables reported to relate to incident EOD. We also assessed the interaction between each exposure of interest and <em>APOE-ε4</em> allele load.</div></div><div><h3>Results</h3><div>The study included 217,122 participants. During the mean follow-up of 8.3 years, 325 incident EOD cases were ascertained. Compared to participants at Q1 of total omega-3, those at Q4 and Q5 showed a statistically significantly lower risk of EOD (Q4, hazard ratio [95 % confidence interval] = 0.62 [0.43, 0.89]; Q5, 0.60 [0.42, 0.86]). A statistically significant inverse association was also observed for total omega-3 as a continuous variable. Compared to participants at Q1 of DHA, those at Q5 of non-DHA showed a significant lower risk of EOD. A statistically significant lower risk was observed in Q3, Q4 and Q5 of non-DHA omega-3. Finally, we observed no evidence of interaction omega-3 × <em>APOE-ε4</em> allele load.</div></div><div><h3>Conclusions</h3><div>This study expands the evidence of a beneficial association of omega-3 and LOD to EOD as well. These findings suggest that an increased intake of omega-3 fatty acids earlier in life may slow the development of EOD. Additional research is needed to confirm our findings, particularly in more diverse populations.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106559"},"PeriodicalIF":7.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923149","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":"Human milk oligosaccharides modulate inflammatory responses and lipid metabolism in a human intestinal organoid model","authors":"Ellie Slater ,&nbsp;Jaesub Park ,&nbsp;Thomas Dennison ,&nbsp;Tim Mak ,&nbsp;Igor Bendik ,&nbsp;Ateequr Rehman ,&nbsp;Bernd Mussler ,&nbsp;Frank Wiens ,&nbsp;Komal Nayak ,&nbsp;Matthias Zilbauer","doi":"10.1016/j.clnu.2025.106557","DOIUrl":"10.1016/j.clnu.2025.106557","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Human milk oligosaccharides (HMOs) are a major component of human breast milk and have significant protective effects on infant gut health. HMOs are also present in the amniotic fluid, exposing the fetal gut epithelium from 10 weeks of gestational age. Prior studies often relied on animal models or cell lines, which limited their relevance to human biology. In this study, we aimed to investigate the direct effect of a blend of HMOs, including 2′-fucosyllactose (2′FL), 3′-sialyllactose (3′SL), and difucosyllactose (DFL), on intestinal epithelial cells, exploring their role under steady-state conditions and during inflammation.</div></div><div><h3>Methods</h3><div>We utilized advanced human intestinal epithelial organoid (IEO) models from three fetal and three pediatric donors. Organoid viability and barrier function were assessed using functional assays. Bulk RNA sequencing was performed on a total of 76 samples to investigate transcriptomic responses to HMOs and interferon gamma (IFN-γ)-induced inflammation.</div></div><div><h3>Results</h3><div>HMO treatment was safe and well-tolerated in both fetal and pediatric IEOs. The HMO blend reduced baseline BAX expression (p-value = 0.027) and attenuated the IFN-γ-induced increase in BAX expression (p-value = 0.002). HMOs induced distinct, developmental-stage-specific transcriptional responses. Only in pediatric IEOs, HMOs significantly upregulated 536 genes and downregulated 270 genes (adjusted p-value &lt;0.05). Notably, lipid metabolic pathways were significantly activated (adjusted p-value &lt;1.0x10-3). Under IFN-γ-induced inflammation, HMOs mitigated the transcriptomic changes in 83.3 % (5 out of 6) of the identified differentially expressed genes in pediatric IEOs. HMOs also attenuated the expression of key inflammation-related genes, reducing PTGES (p-value &lt;0.05) and significantly upregulating SOCS5 (p-value &lt;0.001).</div></div><div><h3>Conclusion</h3><div>By utilizing advanced IEOs derived from fetal and pediatric patients, we reveal that this HMO blend elicits developmental-stage-specific responses. Our study highlights the potential of HMOs to support gut health, demonstrating their ability to enhance lipid metabolism and mitigate inflammatory damage. These findings offer important insights into the role of HMOs in early-life nutrition, lending compelling evidence to support their inclusion as key components in innovative and tailored infant nutrition strategies.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106557"},"PeriodicalIF":7.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923143","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":"Positive attitudes and beliefs drive the intention to adopt a more plant-derived diet in hospitals: Insights from patients and healthcare professionals","authors":"Maaike A. van Bree ,&nbsp;Hinke M. Kruizenga ,&nbsp;Rinaldo J. Kühne ,&nbsp;Barbara C. Schouten ,&nbsp;Maarten R. Soeters","doi":"10.1016/j.clnu.2025.106553","DOIUrl":"10.1016/j.clnu.2025.106553","url":null,"abstract":"<div><h3>Background and aims</h3><div>Public health and sustainability prompt hospitals to promote more plant-derived nutrition for patients. Yet, successful implementation remains limited. The extent to which patients intend to consume such nutrition and healthcare professionals intend to provide it to patients, is unexplored. To support more effective implementation strategies, this study examines factors that predict patients' intention to consume and healthcare professionals' intention to provide more plant-derived protein-rich nutrition during hospitalization..</div></div><div><h3>Methods</h3><div>A single-center cross-sectional study using two parallel surveys - one for patients and one for healthcare professionals - was conducted between September 2024 and January 2025. Both surveys incorporated constructs from the Theory of Planned Behavior and the Stages of Change, assessing dietary habits, attitudes, behavioral beliefs, perceived behavioral control, stages of change, and intention towards plant-derived food consumption and provision. Regression analyses using PROCESS v5.0 were performed to identify predictors of behavioral intention for both groups.</div></div><div><h3>Results</h3><div>In total, 603 participants were included comprising patients (n = 300) and healthcare professionals (n = 303). For both groups, intention was significantly predicted by a positive attitude towards consuming (β = 0.33, <em>p</em> &lt; 0.001) or providing (β = 0.29, <em>p</em> &lt; 0.001) more plant-derived nutrition and by a positive subjective norm towards consuming (β = 0.19, <em>p</em> &lt; 0.05) or providing (β = 0.14, <em>p</em> &lt; 0.05) more plant-derived nutrition. For both groups, the behavioral beliefs (resp. β = 0.75, <em>p</em> &lt; 0.001; β = 0.61, <em>p</em> &lt; 0.001) were the most influential determinant of attitude..</div></div><div><h3>Conclusion</h3><div>To increase behavioral intention among patients and healthcare professionals, interventions must strengthen positive attitudes by addressing specific underlying behavioral beliefs that are related to these attitudes. The behavioral beliefs regarding ‘<em>taste</em>’ and ‘<em>plant-derived nutrition</em> supports <em>recovery</em>’ offer the most potential for improvement in both groups. Future research should assess whether addressing these beliefs effectively enhances attitudes and promotes the intention to consume or provide more plant-derived protein rich nutrition in hospitals..</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106553"},"PeriodicalIF":7.4,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923141","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":"Nocturnal enteral feeding and mechanical ventilation risk in intensive care unit patients: A deep Learning–Based causal inference study","authors":"Min Woo Kang ,&nbsp;Soojeong Yun ,&nbsp;Seung Min Song ,&nbsp;Ji Eun Kim ,&nbsp;Hyo Jin Kim ,&nbsp;Eun Jung Cho ,&nbsp;Young Joo Kwon ,&nbsp;Shin Young Ahn","doi":"10.1016/j.clnu.2025.106556","DOIUrl":"10.1016/j.clnu.2025.106556","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Continuous enteral nutrition is widely used in critically ill patients, but its clinical superiority over intermittent feeding remains uncertain. A particular concern is nocturnal feeding, a common component of continuous regimens, which may elevate the risk of aspiration due to diminished airway protective reflexes during sleep. This study investigated whether nocturnal enteral feeding is associated with a higher requirement for mechanical ventilation in intensive care unit (ICU) patients.</div></div><div><h3>Methods</h3><div>We analyzed Medical Information Mart for Intensive Care (MIMIC)-IV (n = 1551) for model development and eICU Collaborative Research Database (eICU) (n = 3394) for external validation, including those who began enteral feeding within 72 h of ICU admission. The exposure was any enteral feeding between 10 PM and 6 AM in the first 72 h; outcomes were mechanical ventilation after 72 h. We used multivariable regression models. Subgroup analyses, including tests for interaction, were performed across patient characteristics, feeding volume, and comorbidities. A deep learning-based causal inference model was developed and estimated average treatment effects, and SHapley Additive exPlanations (SHAP) analysis identified influential predictors.</div></div><div><h3>Results</h3><div>Night-time enteral feeding was associated with higher odds of requiring mechanical ventilation, with an odds ratio (OR) of 1.88 (95 % confidence interval [CI] 1.17–3.01) in the MIMIC-IV cohort and an OR of 2.45 (95 % CI 1.01–5.95) in the eICU cohort. The deep learning–based causal inference model estimated that night-time feeding increased the probability of mechanical ventilation by 7.29 % (95 % CI 5.37–9.37) in MIMIC-IV and by 3.50 % (95 % CI 2.66–4.40) in eICU. SHAP analysis consistently identified total daily enteral feeding volume as the most influential predictor of ventilation risk. Subgroup analysis revealed that patients without cerebrovascular disease experienced higher ventilation risk with night-time feeding, whereas those with cerebrovascular disease did not.</div></div><div><h3>Conclusion</h3><div>Among non-intubated ICU patients, night-time enteral feeding may increase the risk of mechanical ventilation, particularly at very large feeding volumes. These findings suggest reconsidering overnight continuous feeding practices and support prospective trials of circadian-aligned nutrition to reduce respiratory complications.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106556"},"PeriodicalIF":7.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923142","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":"Nutritional care using oral nutritional supplements: 22 questions every clinician Asks—Answered by global experts in a Delphi consensus study","authors":"Gulistan Bahat ,&nbsp;Ezgi Pinar ,&nbsp;Osman Abbasoglu ,&nbsp;Mehmet Akif Karan ,&nbsp;Savas Ozturk ,&nbsp;Rocco Barazzoni ,&nbsp;Jürgen Bauer ,&nbsp;Stephan C. Bischoff ,&nbsp;Tommy Cederholm ,&nbsp;Liang-Kung Chen ,&nbsp;Antonio Cherubini ,&nbsp;Maria Isabel T.D. Correia ,&nbsp;Jerzy Gąsowski ,&nbsp;Maria Cristina Gonzalez ,&nbsp;Harriët Jager-Wittenaar ,&nbsp;Francesco Landi ,&nbsp;Nuno Mendonça ,&nbsp;Maurizio Muscaritoli ,&nbsp;Graziano Onder ,&nbsp;Karolina Piotrowicz ,&nbsp;Yusuf Ozogul","doi":"10.1016/j.clnu.2025.106552","DOIUrl":"10.1016/j.clnu.2025.106552","url":null,"abstract":"<div><h3>Background/aims</h3><div>Malnutrition is a common clinical problem causing poor outcomes, including longer hospital stays, complications, functional decline, and mortality. Oral nutritional supplements (ONS) are a key component of medical nutrition therapy for patients who cannot meet their nutritional needs through diet alone. Despite their proven effectiveness, ONS use in practice remains inconsistent due to the lack of comprehensive, practice-based, and internationally validated guidelines. In 2023, the Turkish Clinical Enteral and Parenteral Nutrition Society (KEPAN) developed a national consensus report to address this gap. To enhance international validity and applicability, this study aimed to validate and refine those recommendations through a global Delphi process involving multidisciplinary experts.</div></div><div><h3>Methods</h3><div>A two-round modified Delphi study was conducted between February 2023 and March 2024. Twenty-two experts from 13 countries and various disciplines (internal medicine, gastroenterology, geriatrics, surgery, family medicine, physiatry, clinical nutrition, dietetics, etc.) rated 22 predefined recommendations using a 5-point Likert scale. Consensus was defined as a median score ≥4 with a 25th percentile ≥4. Expert comments were reviewed and incorporated, and recent international guidelines were used to update the supporting commentaries as well.</div></div><div><h3>Results</h3><div>Seventeen recommendations achieved consensus in round 1, and the remaining five in round 2. The final internationally validated set of recommendations covers practical aspects of ONS use including: (1) indications for initiation, dose, timing, and product selection; (2) monitoring strategies, adherence, and management of taste, tolerance, and other common problems; and (3) condition-specific considerations across diabetes, chronic kidney disease, cirrhosis, congestive heart failure, chronic obstructive pulmonary disease, neurological diseases, pressure injuries, surgery, cancer, geriatrics and multimorbidity, as well as guidance on continuation and discontinuation of ONS. The refined recommendations emphasize the food-first principle, individualized decision-making, and multidisciplinary collaboration to optimize person-centered nutritional care.</div></div><div><h3>Conclusions</h3><div>This study delivers the first internationally validated, expert-informed recommendations on ONS use, providing a standardized and adaptable framework for global implementation. Familiarity with and application of these recommendations in clinical practice should lead to improved nutritional care, better adherence, enhanced patient outcomes, and more efficient, person-centered use of ONS across several healthcare settings.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106552"},"PeriodicalIF":7.4,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145923146","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":"A reverse J-shaped association between carbohydrate intake and mortality among populations with high carbohydrate diets","authors":"Hyun Jeong Cho ,&nbsp;Woo-Kyoung Shin ,&nbsp;YoonJu Song ,&nbsp;Jong-Koo Lee ,&nbsp;Daehee Kang ,&nbsp;Jung Eun Lee","doi":"10.1016/j.clnu.2025.106549","DOIUrl":"10.1016/j.clnu.2025.106549","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Limited evidence exists on the associations of carbohydrate intake, both in quantity and quality, with mortality in high-carbohydrate populations, particularly in relation to the type of fat replacing carbohydrates. We investigated these associations in relation to all-cause, cancer-specific, and cardiovascular disease (CVD) mortality in a large Korean cohort.</div></div><div><h3>Methods</h3><div>A total of 113,043 participants aged 40–69 years were included from the Health Examinees-Gem (HEXA-G) cohort of the Korean Genome and Epidemiology Study (KoGES). Dietary intake was assessed using a validated food frequency questionnaire (FFQ). Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for all-cause, cancer-specific, and CVD mortality.</div></div><div><h3>Results</h3><div>During a mean follow-up of 9.2 years, 2,009 deaths were documented, including 1035 from cancer and 304 from CVD. When considering isocaloric substitution of fat with carbohydrates, a reverse J-shaped association was observed between carbohydrate intake and mortality from all causes and CVD. Compared with 55-&lt;65 % of energy from carbohydrates, the HRs (95 % CIs) for all-cause mortality were 1.50 (1.09–2.06) for &lt;55 %, 0.90 (0.74–1.08) for 65-&lt;70 %, 0.96 (0.78–1.18) for 70-&lt;75 %, 0.96 (0.76–1.21) for 75-&lt;80 %, and 0.94 (0.71–1.24) for ≥80 % (<em>P</em> for trend = 0.16). Similarly, CVD mortality risk was significantly higher among participants with &lt;55 % of energy intake from carbohydrates (HR: 3.04; 95 % CI: 1.44–6.43), compared with those with 55–&lt;65 %. These findings were consistent across fat subtypes when carbohydrates replaced saturated, monounsaturated, or polyunsaturated fatty acids. No significant associations were observed between carbohydrate intake and cancer mortality. Regarding carbohydrate quality, no clear associations were found between dietary glycemic index or glycemic load and all-cause, cancer, and CVD mortality.</div></div><div><h3>Conclusions</h3><div>In a population with a predominantly high-carbohydrate diet, replacing fat with &lt;55 % of energy from carbohydrates was suggestive of increased risks of all-cause and CVD mortality, and these associations were consistent regardless of the type of fat replaced.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106549"},"PeriodicalIF":7.4,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917282","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}