Clinical nutrition最新文献

{"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":"2026-02-01","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":"Gut microbiota composition and derived enterotypes are associated with ponderal status in preschool children. Childhood obesity risk assessment longitudinal study (CORALS) cohort","authors":"Natalia Vázquez-Bolea ,&nbsp;Carlos Mora-Martínez ,&nbsp;Marta Cuervo ,&nbsp;J. Alfredo Martinez ,&nbsp;Mercedes Gil-Campos ,&nbsp;Rosaura Leis ,&nbsp;Nancy Babio ,&nbsp;Luis A. Moreno ,&nbsp;Dolores Corella ,&nbsp;Ana Moreira Echeverria ,&nbsp;Concepcion M. Aguilera ,&nbsp;Cristina Castro-Collado ,&nbsp;Rosaura Picáns-Leis ,&nbsp;Adrián Hernández-Cacho ,&nbsp;Maria L. Miguel-Berges ,&nbsp;Paula Martin-Climent ,&nbsp;Jose Manuel Jurado-Castro ,&nbsp;Rocío Vázquez-Cobela ,&nbsp;Julio Plaza-Diaz ,&nbsp;Isabel Rueda-De Torre ,&nbsp;Santiago Navas-Carretero","doi":"10.1016/j.clnu.2025.106558","DOIUrl":"10.1016/j.clnu.2025.106558","url":null,"abstract":"<div><h3>Background and aims</h3><div>Childhood obesity is a growing public health concern increasingly linked to gut microbiota. We analysed associations between microbiota composition, functionality, and weight status in 1134 children aged 3–6 years from the CORALS cohort.</div></div><div><h3>Methods</h3><div>The baseline cross-sectional study stratified participants by weight status (underweight, normal weight, overweight, obesity) and performed shotgun metagenomic sequencing of stool samples. Analyses in R assessed alpha/beta diversity, taxonomic composition, enterotypes, and microbial pathways.</div></div><div><h3>Results</h3><div>Alpha diversity decreased with increasing BMI, particularly in obesity (Shannon adj.P = 0.00301; Simpson adj.P = 0.00158). Beta diversity revealed distinct microbial structures across groups (p = 0.001). Four enterotypes were identified: obesity was associated with Enterotype 3 (Segatella-dominated, p = 0.023), while Enterotype 1 (Alistipes, Akkermansia, Coprococcus) was enriched in underweight/normal weight. Species linked to obesity included higher <em>Phocaeicola dorei</em> (adj.P = 0.003) and <em>Segatella hominis</em> (adj.P = 0.001), and lower <em>Longicatena caecimuris</em> (adj.P = 0.03) and <em>Blautia parvula</em> (adj.P = 0.003). Functional analyses showed downregulation of vitamin and nucleotide biosynthesis pathways and reduced carbohydrate metabolism in overweight/obesity.</div></div><div><h3>Conclusions</h3><div>Gut microbiota composition and functionality are strongly associated with weight status in early childhood, suggesting microbial biomarkers and metabolic pathways relevant to understand early obesity development.</div><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> ID <span><span>NCT06317883</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"57 ","pages":"Article 106558"},"PeriodicalIF":7.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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":"2026-01-01","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":"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":"2026-01-01","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":"Daily oral iron supplementation produced greater improvements in hematological parameters than alternate day doses – A pilot double-blind randomized control trial in iron-deficient young women","authors":"Nikhitha M. John ,&nbsp;Bhargavi Ashok ,&nbsp;Obed John ,&nbsp;Kanagalakshmi V ,&nbsp;Dilip Abraham ,&nbsp;Prasanna Samuel ,&nbsp;Yesudas Sudhakar ,&nbsp;Surjit K.S. Srai ,&nbsp;Molly Jacob","doi":"10.1016/j.clnu.2025.11.005","DOIUrl":"10.1016/j.clnu.2025.11.005","url":null,"abstract":"<div><h3>Background and aims</h3><div>There is little universal consensus on the optimal regime for oral iron supplementation to treat iron deficiency (ID) and iron-deficiency anemia (IDA) in women of reproductive age (WRA). A few studies in a high-income country have reported higher fractional absorption from oral iron supplements (OIS) given on alternate days than daily doses; however, there were no significant improvements in hematological indices in the women in these studies who received the alternate-day doses. There are also concerns about adverse gastrointestinal effects resulting from daily OIS. Data on these aspects from low and middle-income countries (LMIC), where the burden of IDA is high, are limited.</div></div><div><h3>Methods</h3><div>We conducted a double-blinded, parallel-arm, non-inferiority, randomized controlled trial in non-pregnant WRA aged 18–45 years with ID (serum ferritin &lt;20 μg/L) (CTRI/2020/03/024144). They were randomized to receive either 60 mg elemental iron daily (n = 30) or 120 mg elemental iron on alternate days (n = 30) for 14 days. The primary outcome was to determine the comparative effectiveness of daily versus alternate-day OIS in improving hematological and iron-related parameters in blood, at the end of the intervention. Secondary outcomes included extent of adherence to intervention, adverse events experienced, and changes in fecal calprotectin concentrations (a marker of gut inflammation) and the gut microbiome profile.</div></div><div><h3>Results</h3><div>Adherence to the regimes was excellent (≥90 %) in both arms. Both regimes significantly improved hematological and iron-related parameters in blood at the end of 14 days. Daily OIS resulted in greater increases in mean corpuscular volume (fL) [1.25 (0.25, 2.32) vs. 0.50 (−0.35, 1.42); <em>p</em> = 0.043], mean corpuscular hemoglobin (pg/cell) [0.52 (0.54) vs. 0.17 (0.56); <em>p</em> = 0.019], and reticulocyte counts (%) [0.32 (0.13, 0.75) vs. 0.27 (0.02, 0.45); <em>p</em> = 0.055] than alternate-day doses. There were no significant differences between the groups in extent of improvements in iron-related parameters, incidence of adverse effects, and effects on gut inflammation and microbiome profile.</div></div><div><h3>Conclusion</h3><div>In iron-deficient WRA in an LMIC setting, daily OIS (60 mg) for 14 days was more effective than equivalent amounts on alternate days in improving hematological parameters.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106520"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualised growth charts for preterm infants based on a cohort with healthy neurodevelopment","authors":"Aneurin Young ,&nbsp;Tim J. Cole ,&nbsp;James Ashton ,&nbsp;R Mark Beattie ,&nbsp;Mark J. Johnson","doi":"10.1016/j.clnu.2025.106551","DOIUrl":"10.1016/j.clnu.2025.106551","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Early growth of very preterm infants is associated with later neurodevelopmental outcome. Current growth charts are based on in utero growth rather than a growth pattern associated with good outcomes. This study aimed to generate growth standards using infants who were developing normally.</div></div><div><h3>Methods</h3><div>Data were obtained from the National Neonatal Research Database. Logistic regression identified associations of in-hospital and post-discharge weight gain and head circumference growth with the chance of healthy development at two years. The LMS method was used to construct centile curves reflecting the growth of very preterm infants with a positive developmental outcome. Infants with surgical necrotising enterocolitis or a significant brain injury were excluded from the cohort used to generate growth charts.</div></div><div><h3>Results</h3><div>Growth data were available for 37700 infants, of whom 14120 had a documented developmental assessment. Healthy development was positively associated with three factors: In-hospital weight gain (adjusted OR 1·09 per unit z-score change, 95 % CI: 1·02–1·17), weight gain from discharge to two-year assessment (aOR 1·08, 1·04–1·12) and in-hospital head growth (aOR 1·12, 1.04–1·21). A web app is available (<span><span>www.bit.ly/preterm-plotter</span><svg><path></path></svg></span>) to generate individualised growth charts for preterm infants, conditioned on their weight and head circumference at birth, to plot their growth and indicate whether their growth was expected to align with that of healthily developing infants.</div></div><div><h3>Conclusion</h3><div>This study presents a novel method of forming individualised growth charts. It can be implemented using a web app or by integration with clinical information systems to allow an infant's growth to be compared to a cohort of infants with a favourable developmental outcome.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"56 ","pages":"Article 106551"},"PeriodicalIF":7.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881578","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":"2026-01-01","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}

{"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":"2026-01-01","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":"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":"2026-01-01","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":"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":"2026-01-01","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}