Clinical nutrition最新文献

{"title":"Comparative performance of the nutritional risk index and modified 5-item frailty index in predicting surgical outcomes: A multi-institutional analysis of 9.7 million patients","authors":"Samuel Knoedler ,&nbsp;Sarah Friedrich ,&nbsp;Kevin Hu ,&nbsp;Leonard Knoedler ,&nbsp;Thomas Schaschinger ,&nbsp;Felix Klimitz ,&nbsp;Jasper Iske ,&nbsp;Gabriel Hundeshagen ,&nbsp;Adriana C. Panayi ,&nbsp;Bong-Sung Kim ,&nbsp;Martin Kauke-Navarro ,&nbsp;Fortunay Diatta ,&nbsp;Bohdan Pomahac","doi":"10.1016/j.clnu.2025.11.020","DOIUrl":"10.1016/j.clnu.2025.11.020","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Preoperative risk stratification is crucial for surgical decision-making and patient counseling. While the Modified 5-Item Frailty Index (mFI-5) is widely used, the Nutritional Risk Index (NRI) has emerged as a promising alternative due to its dynamic and continuous nature. However, their comparative effectiveness remains unclear.</div></div><div><h3>Objective</h3><div>To compare the predictive performance of the NRI versus the mFI-5 for predicting postoperative complications, readmissions, and mortality in a large, multi-institutional surgical cohort.</div></div><div><h3>Methods</h3><div>We analyzed 9,782,974 patients from the American College of Surgeons National Surgical Quality Improvement Program database. Three predictive models using NRI (dichotomous, spline, and adjusted) and two using mFI-5 (unadjusted and adjusted) were developed for six outcomes: overall complications, surgical complications, medical complications, readmission, unplanned reoperation, and mortality. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was evaluated using bootstrap-validated calibration plots.</div></div><div><h3>Results</h3><div>The overall complication rate was 14.7 % (n = 1,442,984). Both adjusted NRI and mFI-5 models showed excellent discrimination for mortality (AUC = 92.6 for both) and medical complications (AUC = 83.7 and 83.5, respectively). The NRI also demonstrated comparable or superior performance for surgical complications (AUC = 75.8 vs 75.4), readmission (AUC = 69.8 vs 71.3), and unplanned reoperation (AUC = 65.2 vs 65.0). Mortality discrimination was 92.6 for both models. Notably, NRI values were significantly lower in patients who experienced complications compared to those who did not (96.0 vs 103, <em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>The NRI demonstrates comparable, and in some cases, superior, predictive performance to mFI-5 across surgical outcomes. As a dynamic and continuous measure, NRI may offer advantages over mFI-5 for preoperative risk stratification. These findings support the integration of NRI into surgical risk assessment protocols.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106536"},"PeriodicalIF":7.4,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838350","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":"Eight strategic elements that support successful implementation of beneficial nutritional interventions in the perioperative setting: A systematic review","authors":"Eline S. de Klerk ,&nbsp;Benedikt Preckel ,&nbsp;Lucas W. van den Boomen ,&nbsp;Maarten R. Soeters ,&nbsp;Annelies Visser ,&nbsp;Faridi S. Jamaludin ,&nbsp;Markus W. Hollmann ,&nbsp;Jeroen Hermanides ,&nbsp;Mireille F.M. van Stijn","doi":"10.1016/j.clnu.2025.106548","DOIUrl":"10.1016/j.clnu.2025.106548","url":null,"abstract":"<div><h3>Background and aims</h3><div>Research findings are often difficult to implement into daily practice. This systematic review aimed to identify elements of implementation strategies for perioperative nutritional interventions supporting successful adoption in daily practice.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search in PubMed, Embase (Ovid), Cochrane Library and CINAHL (EBSCO) databases. The search entailed articles including adult patients and describing successful implementation strategies of beneficial nutritional interventions in the perioperative setting, published up to July 2024. Given the descriptive nature of the outcomes, a meta-analysis was not deemed feasible, thus we performed a qualitative data analysis.</div></div><div><h3>Results</h3><div>Out of 3070 articles screened, thirteen studies were included in our review. Several successful elements of implementation strategies were identified: I. providing team training for a new protocol, II. appointing a leader with clear responsibility, III. conducting audits of the process, IV. inclusion of pre-identified barriers, V. implementation guidance by a defined framework, VI. working with visual aids, VII. creating an order set in electronic medical records, and VIII. learning from peers with practical experience. Successful implementation of a beneficial perioperative nutritional intervention was seen when all or a part of these identified successful strategies were combined. All studies had at least one methodological weakness based on the risk of bias assessment. We observed that the studies which explicitly pre-defined barriers, often employed strategies to directly target those barriers.</div></div><div><h3>Conclusions</h3><div>This review revealed eight strategic elements that support successful implementation of beneficial nutritional interventions in the perioperative setting. Incorporating these strategic elements should be considered to enhance implementation into clinical practice.</div></div><div><h3>Prospero number</h3><div>CRD42023465224.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106548"},"PeriodicalIF":7.4,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838351","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":"Implementation strategies for integrating nutritional interventions into cancer care: A systematic literature review","authors":"Niamh C. Fanning ,&nbsp;Shuang Liang ,&nbsp;Amanda Landers ,&nbsp;Helen Brown ,&nbsp;Catriona Rother ,&nbsp;Natalie Taylor ,&nbsp;Fong Fu ,&nbsp;April Morrow","doi":"10.1016/j.clnu.2025.106546","DOIUrl":"10.1016/j.clnu.2025.106546","url":null,"abstract":"<div><h3>Background and Aim</h3><div>Nutritional conditions and malnutrition commonly affect people diagnosed with cancer, leading to worse outcomes and reduced quality of life. An implementation science approach may improve the delivery of evidence-based nutrition in cancer. The aim of this review is to systematically evaluate published literature for implementation strategies that have been applied to improve delivery of nutritional interventions in cancer.</div></div><div><h3>Methods</h3><div>A literature search of databases including MEDLINE, EMBASE, Global Health, APA PsychINFO, CINAHL, yielded 5164 articles, of which 37 were included, comprising 30 independent studies. Reported barriers were classified according to the updated Consolidated Framework for Implementation Research (CFIR 2.0). Implementation strategies were mapped to the Expert Recommendations for Implementing Change (ERIC). The CFIR-ERIC Implementation Matching Tool was used to evaluate the extent to which current implementation strategies align with existing evidence, and to identify future strategies.</div></div><div><h3>Results</h3><div>Lack of knowledge and awareness of nutritional guidelines among clinicians and available resources were the most frequently reported barriers. The implementation strategies “Audit and provide feedback” and “Conduct educational meetings” were the most widely used. Adoption and fidelity were the most frequently assessed (27/30, 90 % of studies) implementation outcomes, with 22 (81.5 %) studies reporting positive findings. Four out of five (80.0 %) studies measuring patient satisfaction reported improvements with implementation strategies.</div></div><div><h3>Conclusion</h3><div>Deficits in knowledge and available resources are key barriers to implementation of nutritional interventions in cancer. The use of implementation strategies is associated with improved implementation, service, and patient-level outcomes. Key strategies to effective implementation include education, audit and feedback, and assessment of barriers and facilitators.</div><div><em>Registry and registry number for systematic reviews and meta-analyses:</em> This review protocol is registered with the PROSPERO group (CRD42023454210).</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106546"},"PeriodicalIF":7.4,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917278","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":"Changes in body composition, muscle function, and muscle insulin sensitivity induced by obesity and bariatric surgery: Implications for sarcopenic obesity","authors":"Laura Orioli ,&nbsp;Jean-Paul Thissen ,&nbsp;Audrey Loumaye","doi":"10.1016/j.clnu.2025.106547","DOIUrl":"10.1016/j.clnu.2025.106547","url":null,"abstract":"<div><div>Sarcopenic obesity, defined by the coexistence of excess adiposity and sarcopenia, represents an emerging clinical concern. Bariatric surgery, an effective treatment option for obesity, induces muscle mass loss, raising concerns about the potential development or worsening of sarcopenia. However, bariatric surgery improves body composition, notably the muscle-to-fat ratio, and muscle function, suggesting that the overall risk of sarcopenic obesity may actually decrease after bariatric surgery. The mechanisms underlying this paradox are not well characterized. Obesity profoundly alters skeletal muscle homeostasis, leading to insulin and anabolic resistance that contribute to type 2 diabetes and sarcopenia well before old age. In contrast, bariatric surgery, despite inducing muscle mass loss, improves or even reverses obesity-related alterations in muscle phenotype and oxidative metabolism, while reducing myosteatosis, inflammation and insulin resistance, thereby promoting overall improved muscle metabolic and functional health. This review examines how obesity and bariatric surgery affect skeletal muscle mass, function and insulin sensitivity, and discusses the implications of these alterations for the development, worsening, or remission of sarcopenic obesity after bariatric surgery.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106547"},"PeriodicalIF":7.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838415","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":"Postoperative exclusive enteral nutrition as a bridging therapy to reduce endoscopic recurrence after intestinal resection in Crohn’s disease: A randomized controlled trial","authors":"Mengting Zhang ,&nbsp;Qianwen Tu ,&nbsp;Kangcheng Luo ,&nbsp;Daojiang Li ,&nbsp;Songlin Wan ,&nbsp;Zhaoyang Cai ,&nbsp;Xianghai Ren ,&nbsp;Yi Li ,&nbsp;Yi Liu ,&nbsp;Mei Ye ,&nbsp;Min Chen ,&nbsp;Zhao Ding","doi":"10.1016/j.clnu.2025.106545","DOIUrl":"10.1016/j.clnu.2025.106545","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Postoperative recurrence remains a significant challenge in Crohn’s disease (CD) despite surgical intervention. While exclusive enteral nutrition (EEN) has demonstrated anti-inflammatory effects, its role in preventing postoperative recurrence remains underexplored. This study aimed to evaluate whether postoperative EEN reduces endoscopic recurrence at 1 year in CD patients after bowel resection.</div></div><div><h3>Methods</h3><div>This was a single center, open-label and randomized controlled trial. Using fixed block randomization, 100 participants were randomly assigned (1:1) to the normal diet group (unrestricted food intake) or the EEN group (receiving exclusive enteral formula for ≥2 months). The primary endpoint was endoscopic recurrence at 1 year after surgery (Rutgeerts score ≥ i2). Secondary endpoints included biochemical markers, postoperative complications, and quality of life.</div></div><div><h3>Results</h3><div>Overall, 100 participants were assessed for eligibility and randomly assigned to receive a normal diet (<em>n</em> = 50) or EEN (<em>n</em> = 50). All randomized participants were included in the intention-to-treat analysis. Compared to the normal diet group, the EEN group demonstrated a significantly lower postoperative endoscopic recurrence rate at 1 year (38 % [19/50] vs 18 % [9/50]; RR, 0.474; 95 % CI, 0.238–0.944; <em>P</em> = 0.026) and lower postoperative C-reactive protein at 2 months (median [IQR]:3.5 [0,7.75] mg/L vs 1 [1,2] mg/L, <em>P</em> = 0.034). No significant differences were observed in quality of life and 30-day/late-term postoperative complication rates (<em>P</em> &gt; 0.05) and no adverse events occurred between groups.</div></div><div><h3>Conclusion</h3><div>Postoperative EEN (≥2 months) significantly reduces the risk of endoscopic recurrence at 1 year in CD patients after resection. Additionally, CD patients showed high adherence to the oral EEN regimen after surgery.</div></div><div><h3>Clinical trial registration</h3><div>ChinaClinicalTrial.gov (Number: ChiCTR2400081066).</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106545"},"PeriodicalIF":7.4,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838348","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":"Nutrient intake, dietary patterns and relationship to symptoms and comorbidities in hypermobile Ehlers-Danlos syndrome","authors":"Rabia Topan ,&nbsp;Shraya Pandya ,&nbsp;Paula Chance ,&nbsp;Natalia Zarate-Lopez ,&nbsp;Qasim Aziz ,&nbsp;Paul Bassett ,&nbsp;Janet Kyle ,&nbsp;Kevin Whelan ,&nbsp;Asma Fikree","doi":"10.1016/j.clnu.2025.11.022","DOIUrl":"10.1016/j.clnu.2025.11.022","url":null,"abstract":"<div><h3>Background and aims</h3><div>Hypermobile Ehlers Danlos Syndrome (hEDS) patients have a high prevalence of Disorders of Gut–Brain Interaction (DGBI) and can pose complex nutritional challenges, yet little is known about their dietary intake, adequacy or dietary patterns and how this relates to clinical presentation. We aimed to assess this.</div></div><div><h3>Methods</h3><div>In a cross-sectional study, patients with hEDS completed a food frequency questionnaire and questionnaires characterizing: DGBI, gastrointestinal (GI) symptoms, Avoidant Restrictive Food Intake Disorder (ARFID), and use of nutrition support. Principal component analysis and cluster analysis classified patients into dietary patterns.</div></div><div><h3>Results</h3><div>425 participants were included (mean: 41 years, 96 % female); 46.4 % were overweight/obese. Patients consumed high protein (77.2 g ± 37.8), high fat (79.1 g ± 36.9) diets that were low in calories, Vitamin B and D; only 24.7 % achieved fibre requirements. Four dietary patterns existed: (1) ‘low food intake’ (n = 149), with highest nutrient inadequacy, highest ARFID scores (p &lt; 0.001), most likely to use nutrition support (24 %, p = 0.02); (2) ‘vegetarian/health conscious’ (n = 120), with highest fibre intake (p &lt; 0.001); (3) ‘low residue’ (n = 35), mostly seen in tertiary clinics (46 %, p &lt; 0.001) and (4) ‘refined/highly processed’, with highest BMI (27.3 kg/m² p &lt; 0.001) and presence of dyspepsia (p = 0.007) and least likely to have a dietetic consultation (p = 0.02).</div></div><div><h3>Conclusion</h3><div>This is the first study to measure nutrition intake, adequacy and dietary patterns in hEDS. Patients with either restrictive or highly processed food intake have more GI symptoms. Further research is needed to establish how these dietary patterns can best be managed in clinical practice, to optimize intake and minimize the use of artificial nutrition support.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106538"},"PeriodicalIF":7.4,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the metabolic perspective of orbital fat: Can arachidonic acid turn “bad fat” into “good fat”?","authors":"Yu Cheng ,&nbsp;Siyuan Chen ,&nbsp;Lei Du ,&nbsp;Shifeng Yan ,&nbsp;Guangpeng Liu","doi":"10.1016/j.clnu.2025.11.018","DOIUrl":"10.1016/j.clnu.2025.11.018","url":null,"abstract":"<div><h3>Background and aims</h3><div>Obesity-induced increase in fat cell size is associated with adipose dysfunctions, and the local metabolic environment is an important regulator of adipose health. Although several metabolically beneficial metabolites have been found in adipose tissue by comparing obese and non-obese individuals, the results remain questionable due to inevitable intrinsic biological variables. Relatively small adipocytes in orbital fat (OF) have been confirmed, combined with the known correlation between adipocyte size and adipose health, inspiring us to use OF as an adipose depot-specific study model to explore key metabolite regulators.</div></div><div><h3>Methods</h3><div>To identify beneficial metabolites and the related mechanisms, lipidome compositions of healthy individuals’ OF and abdominal subcutaneous fat (SF) were analyzed using combined untargeted and targeted lipidomics, and the results were integrated with transcriptomics and molecular docking analyses. To validate the anti-obesity effects of our identified key metabolite–arachidonic acid (AA), male C57BL/6J mice were fed a high-fat diet (HFD) or normal chow diet (NCD) for 8 weeks, followed by a 7-week intervention with AA or blank solvent via oral gavage. Body weight, fat mass, serum metabolic and inflammatory parameters, and histomorphology of adipose and liver tissues were assessed. qRT-PCR, Western blot, immunohistochemistry, and immunofluorescence were further performed to elucidate the underlying molecular mechanisms.</div></div><div><h3>Results</h3><div>Higher AA concentration and its upregulated receptor, G protein-coupled receptor 120 (GPR120), were observed in OF, suggesting a positive association between AA and a healthy adipose tissue phenotype. In HFD-induced obese mice, AA attenuated weight gain, reduced white adipose tissue (WAT) mass, and improved serum metabolic and inflammatory profiles. AA also promoted healthy WAT expansion (increased proliferation, reduced hypertrophy, and reduced inflammation) and mitigated hepatic steatosis, hypertrophy, and fibrosis. These anti-obesity effects were associated with GPR120 activation.</div></div><div><h3>Conclusions</h3><div>AA activated GPR120 and its downstream molecules to exert beneficial effects in obesity, indicating AA as a potential therapeutic agent for obesity via adipose GPR120.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106533"},"PeriodicalIF":7.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838346","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":"Brain-gut interaction for holistic regulation: Transcutaneous auricular vagus nerve stimulation in modulating glucose and lipid metabolic disorders","authors":"Ningyi Zou ,&nbsp;Peijuan Zhou ,&nbsp;Qing Zhou ,&nbsp;Jizheng Ma ,&nbsp;Shuo Feng ,&nbsp;Peijing Rong ,&nbsp;Shaoyuan Li","doi":"10.1016/j.clnu.2025.12.003","DOIUrl":"10.1016/j.clnu.2025.12.003","url":null,"abstract":"<div><div>Dysregulation of glucose and lipid metabolism is a systemic disorder involving intricate interactions between the central nervous system, which governs stress and emotional regulation, and peripheral organs such as the gastrointestinal tract, liver, and pancreas. As a key component of the autonomic nervous system, the vagus nerve plays a pivotal role in regulating metabolic homeostasis through its widespread distribution and bidirectional communication along the gut-brain axis. Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising non-pharmacological therapy for metabolic disorders, modulating autonomic function via brain-gut coordination to reduce food intake and enhance energy expenditure, thereby alleviating obesity, type 2 diabetes, and related conditions. However, the dynamic mechanisms by which taVNS maintains homeostatic balance through the gut-brain axis, as well as its novel targets, mediators, and pathways, remain elusive. Based on the concept of “brain-gut interaction for holistic regulation”, this review explores the potential mechanisms of taVNS in ameliorating glucose and lipid metabolic disorders, offering new perspectives and strategies for clinical intervention.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106544"},"PeriodicalIF":7.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tolerability and efficacy of an enteral formula containing partially hydrolyzed guar gum in patients following gastrointestinal surgery: A prospective, multicenter, open-label, randomized controlled study","authors":"Ting Han ,&nbsp;Jialu Zhuo ,&nbsp;Xiaoting Wu ,&nbsp;Qiang Chi ,&nbsp;Bo Chen ,&nbsp;Junqiang Chen ,&nbsp;Wei Chen ,&nbsp;Zhenyi Jia ,&nbsp;Rui Zhao ,&nbsp;Xinyu Zhang ,&nbsp;Peng Zhang ,&nbsp;Yuantian Mao ,&nbsp;Xuan Xu ,&nbsp;Qi Gao ,&nbsp;Xiaoding Shen ,&nbsp;Boshi Sun ,&nbsp;Peiang Guo ,&nbsp;Zhen Wang ,&nbsp;Jun Yang ,&nbsp;Huanlong Qin","doi":"10.1016/j.clnu.2025.12.002","DOIUrl":"10.1016/j.clnu.2025.12.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Malnourished patients, who undergo gastrointestinal (GI) surgery, have a higher risk of postoperative complications, including higher rates of morbidity and mortality. Generally, a low-fiber diet is recommended after GI surgery. This study investigated the tolerance and clinical outcomes of an enteral formula supplemented with partially hydrolyzed guar gum (PHGG)—a soluble, prebiotic dietary fiber known to benefit gastrointestinal health—in Chinese patients following GI surgery, using a standard fiber-free formula as the control..</div></div><div><h3>Methods</h3><div>This study enrolled 631 patients requiring enteral nutrition following GI surgery. Participants were subsequently randomized to receive either a fiber-enriched formula containing 15 g/L PHGG (experimental group, n = 313) or a standard fiber-free formula (control group, n = 318) for 5 days. Data on feeding effectiveness, tolerability, and clinical outcomes were subsequently collected.</div></div><div><h3>Results</h3><div>The incidence of diarrhea was 9.6 % (95 % confidence interval [CI]: 6.3 to 12.8) in the experimental group and 10.1 % (95 % CI: 6.8 to 13.4) in the control group, with an absolute difference of −0.5 (95 % CI: −5.1 to 4.2) confirming non-inferiority (<em>P</em> &lt; 0.001). In patients who consumed ≥4500 kcal over 5 days (averaging 900 kcal/day), the experimental group showed significantly improved feeding tolerance, with a reduced prevalence of diarrhea and abdominal distension (10.4 % vs 24.7 %, <em>P</em> = 0.045; 19.4 % vs 38.4 %, <em>P</em> = 0.016). Patients with gastric cancer in the experimental group had significantly less abdominal distension (22.7 % vs 48.8 %; <em>P</em> = 0.014). Regarding weight preservation, the experimental group demonstrated benefits in weight preservation at discharge (%weight change: −1.39 vs −2.33, <em>P</em> = 0.049). Thirty days after surgery, the experimental group had better EQ-5D scores, especially in E4 pain/discomfort and E5 anxiety.</div></div><div><h3>Conclusions</h3><div>The PHGG-enriched enteral nutrition formulation is well-tolerated and non-inferior to a fiber-free formula among patients following GI surgery. To maximize its benefits on GI tolerance and body weight preservation, a daily intake of 800–900 kcal is suggested, though this warrants further validation. The trial protocol was registered at <span><span>www.chictr.org.cn</span><svg><path></path></svg></span> (Identifier: ChiCTR2000038429).</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106543"},"PeriodicalIF":7.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838347","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":"Postprandial modulation of the surface profile and cellular origin of circulating extracellular vesicles by dietary fatty acid composition: A randomized crossover pilot study in young healthy adults","authors":"Elvira Marquez-Paradas ,&nbsp;Gregorio Gil-Sanchez ,&nbsp;Luna Barrera-Chamorro ,&nbsp;Teresa Gonzalez-de la Rosa ,&nbsp;Antonio D. Miguel-Albarreal ,&nbsp;Alfredo Corell ,&nbsp;Sergio Montserrat-de la Paz","doi":"10.1016/j.clnu.2025.11.023","DOIUrl":"10.1016/j.clnu.2025.11.023","url":null,"abstract":"<div><h3>Background and aims</h3><div>Dietary fatty acids are central modulators of postprandial metabolism and inflammation, processes intimately linked to long-term cardiometabolic health. Circulating extracellular vesicles (EVs), particularly exosomes, have emerged as dynamic mediators of intercellular communication and may reflect acute physiological changes. However, the impact of distinct dietary fatty acids on EV phenotype during the postprandial period remains poorly understood. Our aim was to investigate the effect of isoenergetic meals enriched in saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs) or omega-3 long-chain polyunsaturated fatty acids (ω3-LCPUFAs) on classical immunometabolic markers and on the phenotypic profile and cellular origin of circulating EVs in healthy adults.</div></div><div><h3>Methods</h3><div>In a randomized crossover study, ten healthy participants (a total of 40 postprandial curves) received four test meals (SFA-, MUFA-, or ω3-LCPUFA-enriched emulsions, plus a fat-free control emulsion). Blood samples were collected at fasting, 2–3 h (postprandial peak), and 5–6 h (late postprandial phase). Clinical, biochemical, haematological, and immunological parameters were assessed. EVs were isolated from plasma, and 37 surface markers were analysed by multiplex flow cytometry to infer their cellular origin.</div></div><div><h3>Results</h3><div>Postprandial responses varied with fat quality. MUFA and ω3-LCPUFA meals induced broader immunometabolic activation than SFA. At the late postprandial phase, MUFA increased serum IgA, IgG, and IgM (<em>p</em> = 0.004, 0.013, and 0.020) and complement C1q and C3 (<em>p</em> = 0.008 and 0.004), whereas ω3-LCPUFA increased IgG and C3 (<em>p</em> = 0.027 and 0.046). Lymphocyte counts declined after all four meals (all <em>p</em> ≤ 0.007). EV concentration and mean diameter (∼100–150 nm) remained stable across interventions. Notably, MUFA intake enriched CD14⁺ (monocyte-derived) vesicles, ω3-LCPUFA enhanced EVs from endothelial and T-cell lineages in the late postprandial phase, and the SFA meal reduced expression of multiple lineage-specific markers.</div></div><div><h3>Conclusions</h3><div>Dietary fat composition modulates the postprandial phenotype and cellular origin of circulating EVs without altering their abundance or size. These findings support the use of EV phenotyping as a sensitive tool to monitor early immune-metabolic responses to nutritional interventions and may inform precision strategies for cardiometabolic disease prevention.</div></div><div><h3>Registration number of Clinical Trial</h3><div>NCT06051461.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106539"},"PeriodicalIF":7.4,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}