Clinical nutrition最新文献

{"title":"Association of sarcopenic obesity with dementia risk in a cohort of older women","authors":"Zhongyang Guan ,&nbsp;Blossom CM. Stephan ,&nbsp;Lorenzo M. Donini ,&nbsp;Joshua R. Lewis ,&nbsp;Carla M. Prado ,&nbsp;Richard L. Prince ,&nbsp;David Scott ,&nbsp;Kun Zhu ,&nbsp;Marc Sim ,&nbsp;Mario Siervo","doi":"10.1016/j.clnu.2025.11.026","DOIUrl":"10.1016/j.clnu.2025.11.026","url":null,"abstract":"<div><h3>Background and aims</h3><div>Longitudinal studies have explored the association between sarcopenic obesity (SO) and the risk of cognitive impairment, yet findings remain mixed. This study aimed to investigate the associations of SO with risk of incident dementia in older women, using two diagnostic models: the Sarcopenic Obesity Global Leadership Initiative (SOGLI) and the load-capacity model.</div></div><div><h3>Methods</h3><div>We analysed data from 900 community-dwelling women (aged ≥70 years). SO was defined using two models: (1) the SOGLI criteria, based on low handgrip strength (HGS), low appendicular lean soft tissue to body weight (ALST/W) ratio, and high fat mass percentage (%FM); and (2) the load-capacity model, based on a high truncal fat mass to ALST (TrFM/ALST) ratio. Incident dementia events (hospitalisation and/or death) over 9.5 years were identified through linked health records using International Classification of Diseases (ICD) codes. Cox proportional hazards and Fine–Gray sub-distribution models were applied.</div></div><div><h3>Results</h3><div>Using the SOGLI criteria, SO was not significantly associated with the risk of overall dementia events compared with the non-sarcopenic, non-obesity group (hazard ratio [HR] 0.63, 95 % CI 0.39–1.03); however, SO was significantly associated with a reduced risk of dementia-related hospitalisation (HR 0.57, 95 % CI 0.33–0.98), mainly driven by the reduced risk observed with obesity. When defined by the load-capacity model, SO remained significantly associated with a reduced risk of overall dementia events (HR 0.54, 95 % CI 0.34–0.85). Restricted cubic spline (RCS) analyses demonstrated significant associations of lower HGS, lower %FM, higher ALST/W ratio, and lower TrFM/ALST ratio with increased risk of overall dementia events. Results remained consistent in sensitivity analyses excluding participants with BMI &lt;21 kg/m² (n = 67) or %FM below the 15th percentile (n = 135), and after further adjustment for age at highest education level..</div></div><div><h3>Conclusion</h3><div>This is the first longitudinal study to examine the association between SO and dementia using either the SOGLI or load-capacity models. In this cohort of older women, SO was associated with a lower risk of dementia-related hospitalisation. These findings suggest that the relationship between obesity and dementia risk in late life may differ from current evidence regarding midlife, indicating potential age-specific effects. Further research is needed to clarify the underlying mechanisms and generalisability of these observations to broader populations..</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106542"},"PeriodicalIF":7.4,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789178","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":"Effects of 5:2 intermittent fasting meal replacement on body composition and abdominal fat distribution in overweight and obese adults with early type 2 diabetes","authors":"Dongni Yu ,&nbsp;Mingzhu Zou ,&nbsp;Bo cheng ,&nbsp;Peng Yang ,&nbsp;Dongni Huang ,&nbsp;Qi Pan ,&nbsp;Lixin Guo","doi":"10.1016/j.clnu.2025.11.025","DOIUrl":"10.1016/j.clnu.2025.11.025","url":null,"abstract":"<div><h3>Background and Aims</h3><div>The 5:2 intermittent fasting meal replacement (5:2 MR) improved glycemic control and weight loss in adults with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Objective</h3><div>This analysis further investigated the exploratory outcomes related to body composition and abdominal fat distribution.</div></div><div><h3>Methods</h3><div>This was a single-center analysis of a randomized, active-controlled trial (EARLY), which enrolled overweight and obese patients with early T2DM. A total of 85 participants were randomly assigned to receive metformin (n = 28), empagliflozin (n = 28), or 5:2 MR (n = 29) for 16 weeks. Body composition was assessed using InBody device, and the energy spectrum CT was used to measure abdominal fat distribution. Spearman's correlation coefficient was used to evaluate the associations between change in body mass index (BMI) and change in the exploratory outcomes.</div></div><div><h3>Results</h3><div>Compared with the metformin and empagliflozin groups, the 5:2 MR group showed the most significant reductions in BMI (least-squares mean, −3.41 kg/m² [standard error, 0.31], P &lt; 0.001), waist circumference (−8.83 cm [1.07], P &lt; 0.001), waist-to-hip ratio (WHR) (−0.04 [0.01], P &lt; 0.05), waist-to-height ratio (WHtR) (−0.05 [0.01], P &lt; 0.001), body fat percentage (BF%) (−4.84 % [0.66], P &lt; 0.05), abdominal cross-sectional area (ACSA) (−66.05 cm² [9.46], P &lt; 0.01), subcutaneous fat area (−58.27 cm² [5.99], P &lt; 0.001), and an increase in the liver-to-spleen (L/S) ratio) (0.43 [0.04], P &lt; 0.01). In the 5:2 MR group, changes in BMI exhibited linear associations and significant positive correlations with changes in WHR (r = 0.411, P = 0.030), WHtR (r = 0.635, P &lt; 0.001), BF% (r = 0.528, P = 0.020) and ACSA (r = 0.562, P = 0.003).</div></div><div><h3>Conclusion</h3><div>The 5:2 MR regimen may be more effective than metformin and empagliflozin in improving body composition and abdominal fat distribution in early T2DM, and is proposed as a therapeutic option.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106541"},"PeriodicalIF":7.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891179","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":"Diet, body composition and metabolic and hormonal profile in women at high risk of breast cancer recurrence: A secondary mediation analysis of the DIANA-5 trial","authors":"Olivera Djuric ,&nbsp;Laura Bonvicini ,&nbsp;Massimo Pellegrini ,&nbsp;Eleonora Bruno ,&nbsp;Patrizia Pasanisi ,&nbsp;Giuliana Gargano ,&nbsp;Patrizia Curtosi ,&nbsp;Franco Berrino ,&nbsp;Paolo Giorgi Rossi ,&nbsp;Anna Villarini","doi":"10.1016/j.clnu.2025.11.021","DOIUrl":"10.1016/j.clnu.2025.11.021","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background &amp; Aims&lt;/h3&gt;&lt;div&gt;Breast cancer recurrence risk is strongly influenced by metabolic and hormonal factors linked to adiposity and diet. The DIet ANd Androgens-5 (DIANA-5) randomized controlled trial was primarily designed to test whether adherence to a Mediterranean/macrobiotic diet, combined with moderate physical activity, could reduce the risk of breast cancer recurrence. In the present secondary analysis of the DIANA-5 trial, we investigated associations between dietary intake, anthropometric, metabolic and hormonal profile testing the hypothesis that improvement in metabolic and hormonal parameters after one year of intervention are mediated by increased consumption of recommended foods (“recommended food score”) and changes of body composition measures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A total of 1542 women with early-stage breast cancer and presence of one or more endocrine/metabolic risk factors were randomized to receive either standard healthy lifestyle recommendations (n = 773) or intensive support including dietary counseling, cooking classes, and moderate physical activity reinforcement (n = 769). Anthropometric (BMI, waist circumference [WC], fat mass/fat-free mass ratio [FM/FFM]), metabolic (glycemia, insulin, HOMA index, total cholesterol, triglycerides, metabolic syndrome), and hormonal (testosterone) endpoints were assessed at baseline and after 12 months. Potential mediation effects of “recommended food score” and WC or FM/FFM on metabolic and hormonal changes were tested by using SPSS version 23 and the PROCESS macro v.4.0 for SPSS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;604 and 551 women were available for mediation analyses in intervention and control groups, respectively. The dietary intervention improved all anthropometric, metabolic and hormonal measures. “Recommended food score” together with WC mediated 73 % of the effect of the intervention on glycemia, 67 % on insulin, 70 % on HOMA index, 96 % on total cholesterol, and 86 % on metabolic syndrome. With “recommended food score” and FM/FFM as mediators, proportions mediated were 86 % for glycemia, 73 % for insulin, 78 % for HOMA index, 126 % for total cholesterol, and 66 % for metabolic syndrome. Mediation effects of WC and FM/FFM on triglyceride changes were much weaker (38 % and 37 %, respectively). For all outcomes and all mediators, at least one path had a p-value &lt;0.05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Most benefits of the DIANA-5 lifestyle intervention were mediated by dietary adherence and reductions in WC and FM/FFM. The proportion of effects mediated on metabolic syndrome, glucose and glycemic tolerance is high enough to suggest that these are the main effectors. The results on triglyceride blood levels suggest that further mechanism, possibly physical activity and energy intake should be investigated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Trial Registry number&lt;/h3&gt;&lt;div&gt;NCT05019989. Available at: &lt;span&gt;&lt;span&gt;https://clinicaltrials.gov/se","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106537"},"PeriodicalIF":7.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789177","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 and inflammatory status in the obesity paradox of coronary artery disease","authors":"Yuichiro Shirahama ,&nbsp;Noriaki Tabata ,&nbsp;Masanobu Ishi ,&nbsp;Hiroaki Kusaka ,&nbsp;Shinsuke Hanatani ,&nbsp;Hiroki Usuku ,&nbsp;Eiichiro Yamamoto ,&nbsp;Yasuhiro Izumiya ,&nbsp;Kenichi Tsujita","doi":"10.1016/j.clnu.2025.11.024","DOIUrl":"10.1016/j.clnu.2025.11.024","url":null,"abstract":"<div><h3>Background and aims</h3><div>The “obesity paradox,” where higher body mass index (BMI) is linked to lower mortality, has been observed in coronary artery disease (CAD) patients. One hypothesis is that weight loss in cancer patients may confound this association. This study examined the obesity paradox in CAD patients without cancer and investigated the roles of nutritional and inflammatory status.</div></div><div><h3>Methods</h3><div>We analysed 1,252 CAD patients without a history of cancer who underwent percutaneous coronary intervention. Patients were categorized into BMI &lt;25 kg/m² (n = 843) and BMI ≥25 kg/m² (n = 409). The primary outcome was 5-year all-cause mortality. Nutritional status was evaluated using the prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI), while inflammation was assessed by neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR).</div></div><div><h3>Results</h3><div>During the follow-up period, 73 deaths occurred (56 in BMI &lt;25 kg/m² vs. 17 in BMI ≥25 kg/m²). Patients with low BMI had significantly lower PNI and GNRI (both P &lt; 0.001), but no significant differences in NLR or PLR. Kaplan–Meier analysis showed poorer survival in people without obesity (P &lt; 0.001). In multivariable analysis, higher BMI remained an independent protective factor (HR 0.87, 95 % CI 0.81–0.94, P &lt; 0.001). However, PNI and GNRI had superior prognostic discrimination compared to BMI. The predictive model's C-statistic improved significantly when PNI and NLR were added to conventional risk factors, with notable gains in net reclassification and discrimination indices (both P &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The obesity paradox in non-cancer CAD patients remains evident and appears more closely related to nutritional status than BMI alone. Lower BMI was associated with malnutrition, not increased inflammation. Simple markers such as PNI and NLR offer additional prognostic value and may aid in better risk stratification of CAD patients.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106540"},"PeriodicalIF":7.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 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}