Clinical nutrition最新文献

{"title":"The effects of ketogenic diet on polycystic ovary syndrome: A systematic review and meta-analysis","authors":"Elisavet Arsenaki ,&nbsp;Dimitra Stathi ,&nbsp;Konstantinos Katsikas Triantafyllidis ,&nbsp;Yeshey Seldon ,&nbsp;Stergios Bobotis ,&nbsp;George Lockett ,&nbsp;Shaun Haran ,&nbsp;Maria Kyrgiou ,&nbsp;Srdjan Saso ,&nbsp;Konstantinos S. Kechagias","doi":"10.1016/j.clnu.2025.11.019","DOIUrl":"10.1016/j.clnu.2025.11.019","url":null,"abstract":"<div><h3>Background and aim</h3><div>Polycystic ovary syndrome (PCOS) is a common endocrine disorder linked to obesity, insulin resistance, and reproductive dysfunction. While dietary modification is central to management, the optimal approach remains unclear. This systematic review and meta-analysis evaluated the effects of the ketogenic diet on anthropometric, metabolic, and endocrinological outcomes in women with PCOS.</div></div><div><h3>Methods</h3><div>A systematic search of five databases (inception–February 2025) identified studies reporting outcomes in women with PCOS following a ketogenic diet. Meta-analyses compared pre- and post-ketogenic diet outcomes (primary analysis) and ketogenic diet versus other diets (secondary analysis). Summary mean differences (MDs) with 95 % confidence intervals (CIs) were calculated using a random-effects model. Risk of bias and evidence quality were assessed using validated tools and the GRADE approach.</div></div><div><h3>Results</h3><div>Fifteen studies were included in the review, of which ten met the criteria for inclusion in the meta-analysis. Most participants in the included studies had a BMI exceeding 25 kg/m². In the primary analysis, ketogenic diet led to significant reductions in BMI (MD: −3.38 kg/m², 95 % CI: 2.53 to 4.23, I² = 0 %), weight (MD: −10.77 kg, 95 % CI: 8.73 to 12.81, I² = 0 %), and waist circumference (MD: −8.93 cm, 95 % CI: 5.66 to 12.19; I² = 44 %). Reductions were also observed in luteinising hormone (LH) levels (MD: 4.07, 95 % CI: 3.36 to 4.79, I² = 0 %), menstrual cycle duration (MD: 26.06, 95 % CI: 2.28 to 49.85, I² = 68 %), and insulin resistance (MD: 2.43; 95 % CI: 1.16 to 3.69, I² = 95 %). In the secondary analysis, ketogenic diet showed superior effects on BMI (MD: −1.65, 95 % CI: −2.76 to −0.55, I² = 0 %) and weight loss (MD: −4.98, 95 % CI: −9.05 to −0.91, I² = 7 %) as well as LH levels (MD 1.68, 95 % CI: −3.18 to −0.19, I² = 30 %) and insulin resistance (MD: −1.71, 95 % CI: −2.98 to −0.43, I² = 90 %) compared to other diets, though results for androgen and lipid parameters were inconsistent. Heterogeneity was high for most of the studied outcomes.</div></div><div><h3>Conclusion</h3><div>The ketogenic diet appears to be a promising dietary intervention for improving weight, insulin sensitivity, and reproductive hormone profiles in women with PCOS and a BMI exceeding 25 kg/m². Nonetheless, the considerable heterogeneity among included studies and variations in study quality warrant cautious interpretation of these findings. Further high-quality, long-term randomized controlled trials are needed to more definitively establish the efficacy and safety of the ketogenic diet in women with PCOS.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106535"},"PeriodicalIF":7.4,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799552","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":"Associations of dietary and erythrocyte membrane fatty acids with overall survival in oral cancer: A prospective cohort study with mechanistic exploration","authors":"Baochang He ,&nbsp;Xixi Dong ,&nbsp;Yichen Lin ,&nbsp;Jianli Lin ,&nbsp;Yu Qiu ,&nbsp;Lisong Lin ,&nbsp;Bin Shi ,&nbsp;Jing Wang ,&nbsp;Fa Chen","doi":"10.1016/j.clnu.2025.12.001","DOIUrl":"10.1016/j.clnu.2025.12.001","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Evidence suggests fatty acid metabolism may influence cancer progression, yet their role in oral cancer prognosis remains unclear. This study investigated associations between dietary fatty acid intake, erythrocyte membrane fatty acid composition, and overall survival in patients with oral cancer, and explored potential underlying mechanisms through network pharmacology and molecular docking analyses.</div></div><div><h3>Methods</h3><div>This prospective cohort study recruited 908 newly diagnosed oral cancer patients from October 2011 to June 2024. Dietary fatty acid intake was assessed using a validated food frequency questionnaire. Erythrocyte membrane fatty acid profiles were measured using gas chromatography. Patients were followed until February 2025, with overall survival as the primary outcome. Cox proportional hazards models were used to evaluate hazard ratios (HRs) and 95 % confidence intervals (CIs) for associations between fatty acid levels and overall survival in oral cancer. Composite indices (dietary fatty acid index [DFAI] and erythrocyte fatty acid index [EFAI]) were constructed using LASSO regression to assess combined effects. Network pharmacology and molecular docking were employed to investigate potential mechanisms.</div></div><div><h3>Results</h3><div>In multi-adjusted Cox regression models, higher dietary intake of linolenic acid (C18:3), eicosatrienoic acid (C20:3), and docosahexaenoic acid (C22:6) were associated with reduced mortality risk (highest vs. lowest tertile: HR = 0.54, 95 % CI: 0.36–0.82; HR = 0.65, 95 % CI: 0.44–0.95; HR = 0.62, 95 % CI: 0.42–0.91, respectively; all <em>P</em>-trend&lt;0.05). Among erythrocyte membrane fatty acids, significant protective associations were observed for very long-chain saturated fatty acids behenic acid (C22:0) and tricosanoic acid (C23:0), with 48 % and 56 % lower mortality risks in the highest tertile (all <em>P</em> for trend &lt;0.05). Similar protective effects were found for omega-3 polyunsaturated fatty acids including α-linolenic acid (C18:3 n-3), docosapentaenoic acid (C22:5 n-3), and docosahexaenoic acid (C22:6 n-3). Composite fatty acid indices showed that DFAI and EFAI were associated with 59 % and 85 % mortality reduction, respectively (both <em>P</em> &lt; 0.001). Network pharmacology identified interleukin-6 (IL-6) as a key target in the fatty acid-oral cancer survival pathway. Molecular docking revealed favorable binding affinities between all six significant fatty acids and IL-6 (binding energies: −1.83 to −5.08 kcal/mol).</div></div><div><h3>Conclusion</h3><div>Higher dietary intake and erythrocyte membrane levels of specific polyunsaturated fatty acids and very long-chain saturated fatty acids are significantly associated with improved overall survival in oral cancer patients. These protective effects may be mediated through IL-6-related inflammatory pathways.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106534"},"PeriodicalIF":7.4,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760784","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":"Comment on “Effect of red meat consumption on cardiovascular risk factors: A systematic review and Bayesian network meta-analysis of randomized controlled trials”","authors":"Hamza Khan","doi":"10.1016/j.clnu.2025.11.003","DOIUrl":"10.1016/j.clnu.2025.11.003","url":null,"abstract":"","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"55 ","pages":"Page 222"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620831","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":"Both skeletal muscle index and muscle attenuation are associated with frailty in preoperative older patients with pancreatic cancer","authors":"Claudia J. Lucassen ,&nbsp;Yaren Zügül ,&nbsp;Anneke Droop ,&nbsp;Bert A. Bonsing ,&nbsp;Alexander L. Vahrmeijer ,&nbsp;Nynke Michiels ,&nbsp;Shirin Shahbazi Feshtali ,&nbsp;E.T. Daniël Souwer ,&nbsp;Johanneke E.A. Portielje ,&nbsp;J. Sven D. Mieog ,&nbsp;Frederiek van den Bos","doi":"10.1016/j.clnu.2025.11.004","DOIUrl":"10.1016/j.clnu.2025.11.004","url":null,"abstract":"<div><h3>Background and aims</h3><div>Frailty and sarcopenia are associated with morbidity and mortality in older patients with cancer. The aim of this study was to examine the association of frailty with skeletal muscle index (SMI) and muscle attenuation (MA) on preoperative CT-scans in older patients with pancreatic cancer.</div></div><div><h3>Methods</h3><div>A single-center retrospective study was performed in patients aged ≥70 years with pancreatic cancer. Frailty was assessed by an abbreviated GA screening. Preoperative SMI and MA were determined by computed tomography (CT) scan analysis. The association of frailty and individual frailty domains with SMI and MA was assessed using linear regression analyses.</div></div><div><h3>Results</h3><div>101 patients were included of which 15 (14.9 %) were frail. Frailty was associated with lower SMI (adjusted β: −5.07 cm²/m²; 95 % CI: −8.77–1.36) and MA (adjusted β: −5.70 HU; 95 % CI: −9.63–1.77). Both impaired functionality and risk of delirium were associated with lower SMI (adjusted β: −7.01 cm²/m²; 95 % CI: −11.69–2.33 and adjusted β: −4.58 cm²/m²; 95 % CI: −8.22–0.95, respectively). Impaired functionality was also associated with lower MA (adjusted β: −6.88 HU; 95 % CI: −11.89–1.87).</div></div><div><h3>Conclusion</h3><div>Frailty and impaired functionality were associated with lower SMI and MA. Risk of delirium was independently associated with lower SMI in preoperative older patients with pancreatic cancer. These results suggests that SMI and MA should be included in standard GA screening to better identify high-risk patients and enable more targeted treatment selection.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"55 ","pages":"Pages 242-248"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620829","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":"Does parenteral Omega-3 fatty acid administration increase the risk of atrial fibrillation? An analysis of the current evidence","authors":"Wolfgang H. Hartl ,&nbsp;Patrick Meybohm ,&nbsp;Matthias Pirlich ,&nbsp;Konstantin Mayer ,&nbsp;Gunnar Elke ,&nbsp;Christian Stoppe ,&nbsp;Christian von Loeffelholz","doi":"10.1016/j.clnu.2025.11.013","DOIUrl":"10.1016/j.clnu.2025.11.013","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>In 2023, the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) issued new safety information on oral fish oil (FO) pharmacotherapy. This information indicated a dose-related increased risk of atrial fibrillation (AF) with FO in patients with established cardiovascular disease (CVD). The aim of this study is to analyse the existing evidence on this risk and establish whether it can be extrapolated to FO-enriched intravenous lipid emulsions (FO-ILEs) or to other patient groups, such as critically ill patients with organ dysfunction.</div></div><div><h3>Methods</h3><div>We searched for large (&gt;50,000 participants) systematic reviews analysing the effect of long-term (&gt;1 year) oral FO pharmacotherapy on the incidence of AF in non-critically ill patients with CVD. Reviews also had to include at least one large randomised study (&gt;1,000 participants) on this topic. We examined these reviews with regard to specific limitations. We also estimated on a theoretical basis the extent to which short-term use of FO-ILEs in critically ill patients might alter plasmatic EPA (eicosapentaenoic acid)/DHA (docosahexaenoic acid) concentrations or myocardial EPA/DHA content, and investigated how these changes might affect the cardiac conduction system. We identified six meta-analyses, which consistently showed an increased risk of AF (primary, secondary, exploratory or safety outcome). In these analyses, however, significant bias may arise from including studies that ignored informative censoring or competing risks, or that used highly variable methods to search for AF. The results of these meta-analyses also conflicted with those of controlled trials in which AF was the primary endpoint, investigating the effect of long-term oral FO pharmacotherapy on the frequency of AF recurrence in patients with paroxysmal or persistent AF. Based on our theoretical considerations, it is unlikely that short-term (&lt;4 weeks) use of FO-ILEs would increase EPA/DHA plasma concentrations or myocardial contents to levels that could induce AF in critically ill patients.</div></div><div><h3>Results and conclusions</h3><div>Short-term administration of FO-ILEs at the currently recommended dose (0.1–0.2 g/kg, corresponding to an average daily EPA/DHA intake of 4–6 g) can be considered safe from a critical care perspective in the setting of AF, especially when the duration of total parenteral nutrition is limited (&lt;4 weeks).</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"55 ","pages":"Pages 223-230"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621260","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":"Exploring potential predictors of low muscle mass and muscle loss in adults with cancer: A scoping review","authors":"Annie R. Curtis ,&nbsp;Carla M. Prado ,&nbsp;Liliana Orellana ,&nbsp;Robin M. Daly ,&nbsp;Judy Bauer ,&nbsp;Linda Denehy ,&nbsp;Lara Edbrooke ,&nbsp;Brenton J. Baguley ,&nbsp;Laura Alston ,&nbsp;Nicholas Hardcastle ,&nbsp;Jenelle Loeliger ,&nbsp;Louise Moodie ,&nbsp;Sharad Sharma ,&nbsp;Nicole Kiss","doi":"10.1016/j.clnu.2025.11.016","DOIUrl":"10.1016/j.clnu.2025.11.016","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Early identification of cancer-related muscle loss is essential to enable timely interventions and mitigate adverse outcomes, including mortality. This scoping review aimed to identify routinely assessed clinical measures associated with low muscle mass or muscle loss to inform future global screening and assessment.</div></div><div><h3>Methods</h3><div>Medline Complete, CINAHL Complete and Embase databases were screened from January 2000 to October 2024. Eligible studies investigated factors associated with cancer-related muscle loss, included adults undergoing or previously treated for cancer, and assessed or estimated muscle mass.</div></div><div><h3>Results</h3><div>The search identified 22,270 studies, of which 292 were included. Most involved patients with upper and/or lower gastrointestinal cancers (50 %), undergoing surgery (44 %) or chemotherapy (27 %). Two-thirds (65 %) assessed muscle mass using computed tomography (CT) at the third lumbar vertebra. Other methods included CT-defined muscle mass of single muscles (e.g., psoas) (15 %), bioelectrical impedance analysis or spectroscopy (12 %), dual-energy x-ray absorptiometry (DXA) (7 %) or other (3 %). As the benchmark for muscle mass assessment in oncology, results focused on CT-defined muscle mass, with comparison to other methods. Twenty factors were identified. Thirteen showed a consistent association in unadjusted and/or adjusted analysis: age, body mass index (BMI), performance status, muscle strength, physical function, arm and leg circumference, body weight, body fat, weight loss, fatigue, energy or protein intake, and physical inactivity.</div></div><div><h3>Conclusions</h3><div>This review identified 13 factors consistently associated with CT-defined muscle loss which may help identify patients with cancer who are at risk and require further assessment and timely referral for evidence-based nutrition and exercise interventions.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106531"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760781","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":"Risk factors for complications associated with peripherally inserted central venous catheters for parenteral nutrition: Machine learning and survival analysis based on deep learning","authors":"Seon Min Lee ,&nbsp;Jeongyun Park","doi":"10.1016/j.clnu.2025.11.008","DOIUrl":"10.1016/j.clnu.2025.11.008","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Peripherally inserted central catheters (PICCs) are widely used in patients receiving total parenteral nutrition (TPN), and identifying risk factors for PICC-related complications is essential to improve patient outcomes. This study aims to develop artificial intelligence (AI)-based survival analysis and machine learning models to predict PICC complications and identify significant risk factors.</div></div><div><h3>Methods</h3><div>This study was designed as a retrospective medical record analysis. Data were collected from 218 patients who underwent PICC insertion. Logistic regression, support vector machine, random forest, and extreme gradient boosting were used to develop discrete complication prediction models, whereas survival analysis models, including random survival forest, DeepSurv, and DeepHit, were used to create time-varying complication prediction models. Model performance was evaluated using accuracy for complication occurrence and the concordance index (C-index) and integrated Brier score (IBS) for catheter use.</div></div><div><h3>Results</h3><div>Complication prediction achieved a mean accuracy of 0.92. Among the survival models, DeepSurv exhibited the best C-index (0.61) but a relatively higher IBS (0.170). Significant complication risk factors included the catheter insertion site, catheter diameter, gender, cancer diagnosis, and timing of the PICC insertion decision. Left-arm insertion and larger catheter diameters were associated with higher complication risks.</div></div><div><h3>Conclusions</h3><div>This study is significant in developing a PICC complication prediction model to support clinical decision-making and explaining the model's functioning using explainable AI (XAI) techniques.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"55 ","pages":"Pages 249-256"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145620832","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":"Utility of phase angle from bioelectrical impedance analysis as a disease-related clinical marker in people with dementia: A systematic review and meta-analysis","authors":"Keita Nakagawa,&nbsp;Junpei Tanabe,&nbsp;Yuji Iwamoto","doi":"10.1016/j.clnu.2025.11.015","DOIUrl":"10.1016/j.clnu.2025.11.015","url":null,"abstract":"<div><h3>Background and aims</h3><div>Dementia, a growing global health challenge, is frequently associated with malnutrition. The phase angle (PhA), derived from bioelectrical impedance analysis, is often clinically associated with composite changes related to the nutritional status. As a reduction in PhA shares common underlying mechanisms with the characteristic pathophysiological changes in dementia, its clinical utility as a surrogate marker for dementia has been proposed; however, this role remains uncertain. We aimed to systematically review and meta-analyze the evidence for PhA as a disease-related clinical marker in people with dementia (PwD).</div></div><div><h3>Methods</h3><div>This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis was PROSPERO-registered (registration number: CRD420251000592). We searched four major databases for clinical studies reporting PhA in PwD up to March 2025. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Primary meta-analyses compared whole-body PhA between PwD and healthy controls (HC), and PwD and people with mild cognitive impairment (PwMCI), using the weighted mean difference (WMD). Heterogeneity (<em>I</em>^<em>2</em>), publication bias, and evidence certainty assessments, as well as sensitivity and subgroup analyses, were performed.</div></div><div><h3>Results</h3><div>Of 1941 records identified, 12 studies were included, with 8 eligible for meta-analysis. Whole-body PhA was significantly lower in PwD than in HC (5 studies; 422 PwD, 1296 HC; WMD = −0.90°, 95 % confidence interval [CI]: −1.00 to −0.80; <em>I</em>^<em>2</em> = 0 %). No significant difference was found between PwD and PwMCI (2 studies; 130 PwD, 116 PwMCI; <em>I</em>^<em>2</em> = 82 %), but subgroup analysis by sex showed a significantly lower PhA in males with dementia than those with MCI (WMD = −0.44°, 95 % CI: −0.72 to −0.16). A meta-analysis of upper limb segmental PhA (2 studies) showed no significant difference, with high heterogeneity (<em>I</em>^<em>2</em> = 91 %).</div></div><div><h3>Conclusion</h3><div>PhA may be a useful clinical surrogate marker for PwD, as it is potentially associated with composite changes related to nutritional status. Its noninvasive and easy-to-measure nature makes it practical for PwD. Nevertheless, this evidence is primarily based on cross-sectional studies. Further high-quality prospective and interventional studies are crucial to establish its clinical significance and utility in the nutritional management of PwD.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"55 ","pages":"Pages 257-272"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621261","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":"Growth differentiation factor-15 is associated with adverse outcome, malnutrition risk and health deficit in decompensated cirrhosis","authors":"Binbin Peng ,&nbsp;Jia Li ,&nbsp;Ziyi Yang ,&nbsp;Mingxin Zhang ,&nbsp;Wei Zhao ,&nbsp;Chao Sun","doi":"10.1016/j.clnu.2025.11.009","DOIUrl":"10.1016/j.clnu.2025.11.009","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Growth differentiation factor (GDF)-15 plays pivotal roles in pathophysiology and is linked to anorexia, wasting conditions, and adverse outcomes. However, its clinical implementation as a biomarker among cirrhosis remains enigmatic; thus, we explored the relationships between serum GDF-15 and diverse endpoints, including nutritional status, all-cause mortality, and health deficit.</div></div><div><h3>Methods</h3><div>This observational study analyzed 287 patients hospitalized due to acute decompensating episodes (median age 64 years, 55.8 % male). Malnutrition risk, various body composition, health deficit, and underlying disease severity were assessed by the RFH-NPT scale, CT scans, handgrip strength/frailty index, and CTP/MELD-Na score, respectively.</div></div><div><h3>Results</h3><div>The median concentrations of GDF-15 were 4.75 (Q1, Q3: 3.25, 7.54) ng/mL. Higher GDF-15 levels were related to a more prevalent malnutrition risk and more detrimental disease severity. Patients with increased GDF-15 had more impairment of renal/hepatic function, lower zinc levels, and marked hypoalbuminemia, addressing metabolic imbalance. Moreover, participants with higher GDF-15 also exhibited more significant health deficit like multidimensional frailty. Multivariate Cox analysis indicated that increased GDF-15 independently predicted 1-year mortality after adjustment for coexisting nutritional status and underpinning disease burden (CTP: HR: 1.07, 95%CI: 1.01, 1.13, P = 0.013; MELD-Na: HR: 1.06, 95%CI: 1.01, 1.12, P = 0.044).</div></div><div><h3>Conclusions</h3><div>Serum GDF-15 concentrations were higher in patients with decompensated cirrhosis at risk of malnutrition. Furthermore, this biomarker was closely linked to an increased risk of adverse outcomes and health deficit. It has potential as a complementary biomarker for assessing the prognosis in the context of cirrhosis.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"55 ","pages":"Pages 273-281"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653802","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":"Development and validation of a risk prediction model for refeeding syndrome in adults with critical illness: A prospective observational study","authors":"Chan Jing ,&nbsp;Linlin Hou ,&nbsp;Liming Li ,&nbsp;Qiuhuan Jiang ,&nbsp;Lin Tao ,&nbsp;Yinping Yi ,&nbsp;Ruijie Qu ,&nbsp;Yutong Gao","doi":"10.1016/j.clnu.2025.11.006","DOIUrl":"10.1016/j.clnu.2025.11.006","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Early screening and identification of high-risk factors for refeeding syndrome (RFS) and targeted nursing measures are important to ensure the safety of patients admitted to the intensive care unit (ICU). This study aimed to develop and validate a reliable and effective nomogram for identifying adults with critical illness at high risk for RFS.</div></div><div><h3>Methods</h3><div>This study was conducted in the ICU of a general hospital, enrolling 400 adults with critical illness between July 2023 and March 2024. Predictive factors were selected through univariate analysis and least absolute shrinkage and selection operator regression; the nomogram was developed using R. The receiver operating characteristic curve, calibration curve analysis, clinical decision curve analysis, sensitivity, specificity, and accuracy were used to evaluate the performance of the model.</div></div><div><h3>Results</h3><div>The overall incidence of RFS was 39.25 %. In the training and validation cohorts, these proportions were 38.57 % and 40.83 %, respectively. The prediction model comprised eight variables—APACHE Ⅱ (Acute Physiology and Chronic Health Evaluation Ⅱ, APACHE Ⅱ)score, vomiting, history of surgery, energy intake level, intravenous glucose infusion before refeeding, albumin level, pre-albumin level, and lactate level—and demonstrated strong predictive capacity with an area under the curve of 0.945 and 0.908 in the training and validation cohorts, respectively. Calibration curves indicated good model calibration for the external validation, and the decision curve analysis indicated a significant net clinical benefit across a wide range of decision thresholds.</div></div><div><h3>Conclusions</h3><div>The nomogram showed high performance in predicting the occurrence of RFS in adults with critical illness, indicating good predictive value and clinical utility. Healthcare providers in the ICU can use the model to evaluate RFS risk in such patients, thereby facilitating timely intervention to reduce its incidence, shortening the length of hospital stay, and improving patient prognosis and quality of life.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"55 ","pages":"Pages 282-292"},"PeriodicalIF":7.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653823","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}