Clinical nutrition最新文献

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Reply-Letter to the editor: Comment on: “Probiotic intervention improves metabolic outcomes in gestational diabetes mellitus: A meta-analysis of randomized controlled trials” 回复--致编辑的信：评论"益生菌干预可改善妊娠糖尿病的代谢结果：随机对照试验的荟萃分析"

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2024-07-26 DOI: 10.1016/j.clnu.2024.07.035

引用次数: 0

Reply-Letter to the editor: Application of diversity research and probiotic intervention in gestational diabetes mellitus management 给编辑的回信：多样性研究和益生菌干预在妊娠糖尿病管理中的应用

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2024-07-26 DOI: 10.1016/j.clnu.2024.07.036

引用次数: 0

Letter to the Editor: Comment on: “Probiotic intervention improves metabolic outcomes in gestational diabetes mellitus: A meta-analysis of randomized controlled trials” 致编辑的信评论"益生菌干预可改善妊娠糖尿病患者的代谢结果：随机对照试验荟萃分析 "发表的评论。

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2024-07-26 DOI: 10.1016/j.clnu.2024.07.031

引用次数: 0

Evaluating predictive equations for energy requirements throughout breast cancer trajectory: A comparative study 评估乳腺癌病程中能量需求的预测公式：比较研究

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2024-07-26 DOI: 10.1016/j.clnu.2024.07.032

Background & aims

Accurately estimating resting energy requirements is crucial for optimizing energy intake, particularly in the context of patients with varying energy needs, such as individuals with cancer. We sought to evaluate the agreement between resting energy expenditure (REE) predicted by 40 equations and that measured by reference methods in women undergoing active breast cancer treatment stage (I-IV) and post-completion (i.e., survivors).

Methods

Data from 4 studies were combined. REE values estimated from 40 predictive equations identified by a systematic search were compared with REE assessed by indirect calorimetry (IC) using a metabolic cart (MC-REE N = 46) or a whole-room indirect calorimeter (WRIC-REE N = 44). Agreement between methods was evaluated using Bland–Altman and Lin's concordance coefficient correlation (Lin's CCC).

Results

Ninety participants (24 % survivors, 61.1% had early-stage breast cancer I or II, mean age: 56.8 ± 11 years; body mass index: 28.7 ± 6.4 kg/m²) were included in this analysis. Mean MC-REE and WRIC-REE values were 1389 ± 199 kcal/day and 1506 ± 247 kcal/day, respectively. Limits of agreement were wide for all equations compared to both MC and WRIC (∼300 kcal for both methods), including the most commonly used ones, such as Harris–Benedict and Mifflin ST. Jeor equations; none had a bias within ±10% of measured REE, and all had low agreement per Lin's CCC analysis (<0.90). The Korth equation exhibited the best performance against WRIC and the Lvingston-Kohlstadt equation against MC. Similar patterns of bias were observed between survivors and patients and between patients with stages I-III versus IV cancer.

Conclusion

Most equations failed to accurately predict REE at the group level, and none were effective at the individual level. This inaccuracy has significant implications for women with or surviving breast cancer, who may experience weight gain, maintenance, or loss due to inaccurate energy needs estimations. Therefore, our research underscores the need for further efforts to improve REE estimation.

背景& 目的准确估算静息能量需求对于优化能量摄入至关重要，尤其是在癌症患者等能量需求各不相同的情况下。我们试图评估 40 个方程预测的静息能量消耗（REE）与参考方法测量的静息能量消耗（REE）之间的一致性。将通过系统搜索确定的 40 个预测方程估算出的 REE 值与使用代谢车（MC-RE N = 46）或全室间接热量计（WRIC-RE N = 44）的间接热量计（IC）评估的 REE 值进行比较。结果 90 名参与者（24% 为幸存者，61.1% 患有早期乳腺癌 I 或 II 期，平均年龄：56.8±11 岁；体重指数：28.7±6.4 kg）的热量损失率为 0.5%，其中有 1.1%的人患有早期乳腺癌 I 或 II 期，平均年龄：56.8±11 岁；体重指数：28.7±6.4 kg）的热量损失率为 0.5%，其中有 1.1%的人患有早期乳腺癌 II 期：平均年龄：56.8 ± 11 岁；体重指数：28.7 ± 6.4 kg/m2）。MC-REE 和 WRIC-REE 的平均值分别为 1389 ± 199 千卡/天和 1506 ± 247 千卡/天。与 MC 和 WRIC 相比，所有方程的一致性界限都很宽（两种方法均为∼300 千卡），包括最常用的方程，如 Harris-Benedict 和 Mifflin ST.根据 Lin 的 CCC 分析，所有方程的一致性都很低（<0.90）。Korth 公式在与 WRIC 比较时表现最佳，而 Lvingston-Kohlstadt 公式在与 MC 比较时表现最佳。在幸存者与患者之间，以及 I-III 期癌症患者与 IV 期癌症患者之间，观察到了类似的偏倚模式。这种不准确性对乳腺癌女性患者或存活者有重大影响，她们可能会因能量需求估计不准确而导致体重增加、维持或减轻。因此，我们的研究强调了进一步改进 REE 估算的必要性。

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引用次数: 0

Application of diversity research and probiotic intervention in gestational diabetes mellitus management 多样性研究和益生菌干预在遗传性糖尿病管理中的应用

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2024-07-26 DOI: 10.1016/j.clnu.2024.07.030

引用次数: 0

The combination of handgrip strength and CONUT predicts overall survival in patients with gastrointestinal cancer: A multicenter cohort study 手握强度与 CONUT 的组合可预测胃肠癌患者的总生存期：一项多中心队列研究

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2024-07-25 DOI: 10.1016/j.clnu.2024.07.026

Background

The controlled nutritional status score (CONUT) and handgrip strength (HGS) were both predictive indexes for the prognosis of cancers. However, the combination of CONUT and HGS for predicting the prognosis of gastrointestinal cancer had not been developed. This study aimed to explore the combination of CONUT and HGS as the potential predictive prognosis in patients with gastric and colorectal cancer.

Methods

A cohort study was conducted with gastric and colorectal cancer patients in multicenter in China. Based on the optimal HGS cutoff value for different sex, the HGS cutoff value was determined. The patients were divided into high and low HGS groups based on their HGS scores. A CONUT score of 4 or less was defined as a low CONUT, whereas scores higher than 4 were defined as high CONUT. The Kaplan-Meier method was used to create survival curves, and the log-rank test was used to compare time-event relationships between groups. A Cox proportional hazard regression model was used to determine independent risk factors for overall survival (OS).

Results

A total 2177 gastric and colorectal patients were enrolled in this study, in which 1391 (63.9%) were men (mean [SD] age, 66.11 [11.60] years). Multivariate analysis revealed that patients with high HGS had a lower risk of death than those with low HGS (hazard ratio [HR],0.87; 95% confidence interval [CI], 0.753–1.006, P = 0.06), while high CONUT had a higher risk of death than those with low CONUT (HR, 1.476; 95% CI, 1.227–1.777, P < 0.001). Patients with both low HGS and high CONUT had 1.712 fold increased risk of death (HR, 1.712; 95% CI, 1.364–2.15, P < 0.001). Moreover, cancer type and sex were stratified and found that patients with high CONUT and low HGS had lower survival rate than those with low CONUT and high HGS in both gastric or colorectal cancer, and both male and female.

Conclusion

A combination of low HGS and high CONUT was associated with poor prognosis in patients with gastrointestinal cancer, which could probably predict the prognosis of gastrointestinal cancer more accurate than HGS or CONUT alone.

背景对照营养状况评分（CONUT）和手握力（HGS）都是预测癌症预后的指标。然而，将营养状况评分（CONUT）和手握力（HGS）结合起来预测胃肠道癌症预后的方法尚未开发出来。本研究旨在探索胃癌和结直肠癌患者的潜在预后预测指标--CONUT和HGS的联合应用。方法在中国多中心对胃癌和结直肠癌患者进行队列研究。根据不同性别的最佳 HGS 临界值，确定了 HGS 临界值。根据 HGS 评分将患者分为高 HGS 组和低 HGS 组。CONUT得分在4分或以下被定义为低CONUT，而高于4分被定义为高CONUT。采用 Kaplan-Meier 法绘制生存曲线，并用 log-rank 检验比较各组之间的时间事件关系。结果本研究共纳入 2177 例胃癌和结直肠癌患者，其中 1391 例（63.9%）为男性（平均 [SD] 年龄，66.11 [11.60] 岁）。多变量分析显示，高 HGS 患者的死亡风险低于低 HGS 患者（危险比 [HR]，0.87；95% 置信区间 [CI]，0.753-1.006，P = 0.06），而高 CONUT 患者的死亡风险高于低 CONUT 患者（HR，1.476；95% CI，1.227-1.777，P <0.001）。同时具有低 HGS 和高 CONUT 的患者的死亡风险增加了 1.712 倍（HR，1.712；95% CI，1.364-2.15，P <；0.001）。此外，对癌症类型和性别进行分层后发现，无论是胃癌还是结直肠癌，无论是男性还是女性，高CONUT和低HGS患者的生存率均低于低CONUT和高HGS患者。

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引用次数: 0

Combined mediterranean diet-based sustainable healthy diet and multicomponent training intervention impact on plasma biomarkers and metabolome in older adults 以地中海饮食为基础的可持续健康饮食和多成分训练联合干预对老年人血浆生物标志物和代谢组的影响

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2024-07-25 DOI: 10.1016/j.clnu.2024.07.025

Background and aims

Healthy dietary patterns and exercise practices have been associated with improved metabolic and inflammatory profiles. However, studies regarding the combined effect of these interventions on plasma biomarkers and metabolome in older adults are sparser. The primary aim of this study was to investigate the impact of a combined Mediterranean Diet-based Sustainable Healthy Diet (SHD) and Multicomponent Training (MT) intervention on the plasma biomarkers and metabolome and how dietary intake and exercise could modulate these effects.

Methods

SHD intervention included a weekly supply of Mediterranean Diet-based SHD food and four nutrition sessions involving a Mediterranean-Diet culinary workshop, and the exercise program included 50-min MT group sessions, held three times a week, lasting both 12 weeks. Plasma biomarkers were obtained through standard biochemical analysis. A proton (¹H) nuclear magnetic resonance (NMR) spectroscopy-based metabolomics approach was used to study the metabolome in blood plasma. Repeated measures ANOVA were performed and adjusted for confounders.

Results

SHD + MT intervention significantly decreased HDL-C and calcium. SHD + MT showed some changes in common with the SHD and MT group, namely a significant decrease in citrate levels (p = 0.009 for SHD + MT; p = 0.037 for SHDT) and an increase in pyruvate (p < 0.001 for MT and SHD + MT). The SHD + MT group also revealed specific changes in the levels of some amino acids (decrease in alanine, glutamine and lysine: p = 0.026; p < 0.001; p = 0.038, respectively). Increases in formate (p = 0.025) and unsaturated lipids (p = 0.011) are consistent with changes in energy and lipoprotein metabolism.

Conclusion

Our data show that a combined lifestyle intervention program, including a Mediterranean Diet-based SHD and MT, could modulate biomarker and metabolome and there seems to be a metabolic path associated to these interventions in older adults. Due to its wide-ranging relevance, it is pertinent to assess to what extent combined SHD and MT can contribute to better clinical profiles.

背景和目的健康的饮食模式和运动习惯与代谢和炎症状况的改善有关。然而，有关这些干预措施对老年人血浆生物标志物和代谢组的综合影响的研究却较少。本研究的主要目的是调查以地中海饮食为基础的可持续健康饮食（SHD）和多组分训练（MT）联合干预措施对血浆生物标志物和代谢组的影响，以及饮食摄入和运动如何调节这些影响。血浆生物标志物通过标准生化分析获得。质子（1H）核磁共振（NMR）光谱法用于研究血浆中的代谢组。结果SHD + MT干预显著降低了高密度脂蛋白胆固醇（HDL-C）和血钙。SHD + MT组与SHD和MT组有一些共同的变化，即柠檬酸盐水平明显下降（SHD + MT组p = 0.009；SHDT组p = 0.037），丙酮酸盐水平上升（MT和SHD + MT组p < 0.001）。SHD + MT 组还显示出某些氨基酸水平的特殊变化（丙氨酸、谷氨酰胺和赖氨酸减少：p = 0.026；p < 0.001；p = 0.038）。结论我们的数据表明，综合生活方式干预计划（包括基于地中海饮食的 SHD 和 MT）可调节生物标志物和代谢组，而且似乎存在与这些干预措施相关的老年人代谢路径。由于地中海饮食具有广泛的相关性，因此有必要评估结合地中海饮食和 MT 能在多大程度上改善临床症状。

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引用次数: 0

Letter to Editor: Continuing uncertainties: The impact of maternal 1C nutrients and gestational diabetes on early childhood development 回复致编辑的信

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2024-07-24 DOI: 10.1016/j.clnu.2024.07.022

引用次数: 0

Response to Letter to Editor: Comment on “The infant gut microbiome and cognitive development in malnutrition” 回复--Silva-Araujo 等人致编辑的信，题为 "关于'营养不良中的婴儿肠道微生物组和认知发展'的评论

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2024-07-24 DOI: 10.1016/j.clnu.2024.07.023

引用次数: 0

Disturbed carnitine metabolism is independently correlated with sarcopenia and prognosis in patients on hemodialysis 肉碱代谢紊乱与血液透析患者的肌少症和预后密切相关

IF 6.6 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition

Pub Date : 2024-07-23 DOI: 10.1016/j.clnu.2024.07.019

Background & aims

Sarcopenia is frequent in hemodialysis patients and associated with an increased likelihood of adverse outcomes. Early identification of the risk of sarcopenia and effective intervention are of great importance for dialysis patients. However, little research has been carried out on potential biomarkers of sarcopenia in hemodialysis patients. The aim of this study was to investigate whether serum carnitine or acylcarnitine levels are biomarkers of sarcopenia in hemodialysis patients, and whether these are prognostic factors for occurrence of complications.

Methods

This prospective clinical pilot study enrolled patients (n = 259) who were treated in the Blood Purification Center from May 2021 to July 2022, all participants were followed-up for 1- year. Serum carnintine and acylcarnitine (AC) were measured using our previously reported targeted liquid chromatography tandem mass spectrometry (LC-MS/MS) method. The correlations between carnitine or acylcarnitine levels with sarcopenia and prognosis in patients were analysed.

Results

The C0 (Free carnitine, FC) and total carnitine (TC) levels were significantly lower in the sarcopenia group than in the nonsarcopenia group [nonsarcopenia vs. sarcopenia: 20.97 (16.96, 25.83) vs. 17.77 (14.30, 22.78); p = 0.002] and [nonsarcopenia vs. sarcopenia: 30.12 (24.76, 36.62) vs. 26.03 (21.30, 32.01); p = 0.003]. Besides, significant difference between the groups were noted in low free carnitine (C0 < 20 μmol/L) patients (nonsarcopenia vs. sarcopenia: 72 (42.4%) vs. 56 (62.9%); p = 0.002) and high C2/C0 ratio (>0.4) patients (nonsarcopenia vs. sarcopenia: 36 (21.2%) vs. 30 (33.7%); p = 0.028). By multivariable analysis, the disturbed CM defined as C0 deficient and/or C2/C0 carnitine ratio abnormal rise was independently and significantly correlated with the prevalence of sarcopenia after adjusting for some confounding factors, such as age, gender and dialysis duration (P values for trend <0.05). Hemodialysis patients with sarcopenia [OR: 3.214 (1.307,7.904)] and disturbed CM [OR: 3.217 (1.112,9.305)] both had a 3-fold increased risk of falling and fracture after one year follow up. In addition, age and sarcopenia [OR: 2.883 (1.321, 6.289)] were independently and positively associated with incidence of Cardio- and cerebro-vascular events.

Conclusion

Disturbed carnitine metabolism is independently correlated with sarcopenia and prognosis in patients with hemodialysis. Serum carnitine level and C0/C2 ratio has the potential to be a simple, objective, and quick test for sarcopenia assessment whether such an intervention should be carried out for dialysis patients.

血液透析患者经常出现肌肉疏松症，并与不良后果的可能性增加有关。及早发现肌肉疏松症的风险并进行有效干预对透析患者来说非常重要。然而，有关血液透析患者肌肉疏松症潜在生物标志物的研究却很少。本研究旨在探讨血清肉碱或酰基肉碱水平是否是血液透析患者肌肉疏松症的生物标志物，以及它们是否是并发症发生的预后因素。这项前瞻性临床试验研究招募了2021年5月至2022年7月期间在血液净化中心接受治疗的患者（n = 259），对所有参与者进行了为期1年的随访。血清肉碱和酰基肉碱（AC）采用我们之前报道的靶向液相色谱串联质谱（LC-MS/MS）方法进行测定。分析了肉碱或酰基肉碱水平与患者肌少症和预后之间的相关性。肌少症组的 C0（游离肉碱，FC）和总肉碱（TC）水平明显低于非肌少症组[非肌少症组 vs. 肌少症组：20.97]。20.97 (16.96, 25.83) vs. 17.77 (14.30, 22.78); p = 0.002]和[非肌肉疏松症 vs. 肌肉疏松症：30.12 (24.76, 36.62) vs. 26.03 (21.30, 32.01); p = 0.003]。此外，低游离肉碱（C0 0.4）患者的组间差异也很明显（非肌肉疏松症 vs. 肌肉疏松症：36 (21.2%) vs. 30 (33.7%)；P = 0.028）。通过多变量分析，在调整了年龄、性别和透析持续时间等混杂因素后，C0 缺乏和/或 C2/C0 肉碱比值异常升高所定义的干扰 CM 与肌肉疏松症的患病率有独立且显著的相关性（趋势值小于 0.05）。患有肌肉疏松症的血液透析患者[OR：3.214（1.307,7.904）]和受到干扰的 CM 患者[OR：3.217（1.112,9.305）]在一年随访后发生跌倒和骨折的风险均增加了 3 倍。此外，年龄和肌肉疏松症[OR：2.883 (1.321, 6.289)]与心脑血管事件的发生率呈独立正相关。肉碱代谢紊乱与血液透析患者的肌少症和预后有独立的相关性。血清肉碱水平和 C0/C2 比值有可能成为评估透析患者是否应进行肌肉疏松症干预的一种简单、客观和快速的检测方法。

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