Current Opinion in Clinical Nutrition and Metabolic Care最新文献

Purpose of review: Critical care nutrition remains a high-stakes and error-prone domain, particularly given the complex metabolic demands and heterogeneity of ICU populations. This review explores recent progress in integrating artificial intelligence with nutritional therapy in ICUs, highlighting its evolution and potential benefits in precision-guided support, along with current implementation challenges.

Recent findings: Widely used in adult and neonatal ICUs, parenteral nutrition faces persistent challenges including ordering errors, practice variability, and insufficient robust long-term outcome evidence. Recent advances in machine learning have demonstrated considerable potential in predicting nutrition-related complications (e.g. neonatal morbidities, cholestasis, feeding intolerances, and malnutrition), optimizing nutrient delivery through dynamic, real-time recommendations, and enhancing clinical decision-making with large language models (LLMs) that synthesize clinical guidelines and patient data into actionable insights. However, future studies must establish causal relationships between optimal parenteral nutrition and long-term outcomes while addressing confounding factors and ingredient heterogeneity.

Summary: Artificial intelligence-driven nutrition therapies have the potential to significantly improve the precision, safety, and personalization of ICU nutrition practices. Continued development and validation using standardized, comprehensive, longitudinal datasets, and validation in comparative clinical trials will be critical to realizing this transformative potential.

Purpose of review: To critically review recent findings related to the effects of omega-3 fatty acid supplementation on skeletal muscle, with a particular focus on skeletal muscle protein turnover and mitochondrial function.

Recent findings: Evidence indicates that omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may support skeletal muscle health by influencing muscle protein synthesis (MPS), mitochondrial function, and redox balance. However, recent meta-analyses reveal inconsistent effects of omega-3 fatty acid supplementation on basal and stimulus-induced MPS, likely due to methodological variability. Omega-3 fatty acid supplementation is seemingly more beneficial in clinical cohorts and preclinical data suggests omega-3s may reduce oxidative stress.

Summary: Omega-3 fatty acid supplementation is a promising nutritional strategy for supporting skeletal muscle health, via the modulation of MPS and mitochondrial function. However, large-scale trials in a variety of healthy and clinical populations using sustainable sources of omega-3 fatty acids are required before a consensus on efficacy can be made.

Purpose of review: Nutritional therapy is fundamental in critical care, yet conventional one-size-fits-all feeding strategies might overlook the dynamic metabolic shifts and patient variability inherent to critical illness. This review proposes a stepwise, phase-adapted strategy aiming to align nutrition therapy with three-step conceptual model of metabolic phases: acute catabolic, stabilization, and recovery.

Recent findings: Randomized controlled trials have consistently shown no benefit - and potential harm - from early full-dose energy or protein delivery, particularly in patients with severe organ failure. The acute catabolic phase is characterized by systemic inflammation, stress hormone surges, and insulin resistance, where permissive underfeeding minimizes metabolic burden. In the stabilization phase, declining inflammatory markers and improving organ functions support cautious escalation of nutrition, though biomarkers like hyperglycemia and hypophosphatemia may signal unreadiness to target nutrition. In the recovery phase, inflammation resolves, and mobility improves requiring higher energy and protein delivery alongside physical rehabilitation. Patients may regress to earlier phases, necessitating nutrition de-escalation.

Summary: This stepwise, phase-adapted nutritional strategy - start low, advance judiciously, and individualize throughout - offers a precision framework aimed at aligning feeding with metabolic capacity and minimizes risks of over- or underfeeding. Future priorities include validating biomarkers, identifying metabolic phenotypes, and testing adaptive nutrition algorithms in optimizing nutritional therapy.

Purpose of review: To inform about the current evidence on the potential cardiometabolic benefits of replacing saturated fatty acids with unsaturated fatty acids. This review will highlight the recent data from prospective cohort studies that have used substitution analyses to evaluate cardiometabolic [with a focus on cardiovascular disease (CVD)] and total mortality risk when replacing intakes of saturated fatty acids (SFA) with either monounsaturated fatty acids (MUFA) or polyunsaturated fatty acids (PUFA).

Recent findings: Results from recent, prospective cohort studies suggest that replacing SFA (e.g. from butter, meats, or palm oil) with unsaturated fats, particularly PUFA from vegetable oils, nuts, and fatty fish, are not only associated with reduced all-cause mortality and CVD risk but also from other cardiometabolic diseases.

Summary: The current evidence supports replacing SFA with unsaturated fatty acids from MUFA and PUFA on all-cause mortality and CVD risk. Replacing foods rich in SFA such as butter, red meat, and processed red meat with either plant-based MUFA or PUFA-rich sources such as vegetable oils, nuts, or fatty fish is associated with lower risk of all-cause mortality and CVD. These recent findings accord with international dietary recommendations, and also support the use of more plant-based diets for public health.

Purpose of review: Perioperative management within an enhanced recovery after surgery (ERAS) protocol is increasingly implemented worldwide not only for abdominal, but all types of major surgery. The available evidence regarding ERAS in critical illness is limited. The purpose of this review is to discuss the feasibility, effectiveness, and safety of ERAS with special regard to the application in emergency surgery and intensive care settings.

Recent findings: ERAS has been increasingly applied after emergency and trauma surgery as well as in the ICU. Despite the inherent challenges posed by critical illness and limited patient engagement, given some adaptations implementation of ERAS treatment bundles may be feasible. Recent guidelines providing recommendations are available.

Summary: ERAS may be feasible after emergency surgery and in the ICU in an interdisciplinary approach. Patient-centered effectiveness may be expected even when active patient engagement is not feasible as in mechanically ventilated patients. With special regard to patients with organ failure effectiveness and safety have to be elucidated. Therefore, implementation should weigh potential risks and benefits carefully.

Purpose of review: Elovanoids are homeostatic lipid mediators derived from the very long-chain n-3 polyunsaturated fatty acids, which are in turn derived from docosahexaenoic acid (DHA). The aim of this review is to summarize the latest research on these lipid mediators.

Recent findings: Elovanoids beneficially modulate thioredoxin reductase 1, a key component in the activation of the cellular glutathione antioxidant system. Elovanoids prevent oligomeric amyloid-beta-induced senescence and inflammaging in retinal pigment epithelium and other cells. Rod cells' ability to use DHA to produce elovanoid precursors is decreased in age-related macular degeneration, a disease that causes photoreceptor loss and blindness.

Summary: Elovanoids are molecular guardians of nervous system integrity that introduce a new aspect of neuroprotective signaling by serving as an initial line of defense when neural cell homeostasis is jeopardized. Appropriate diet contributes to healthy aging by providing the precursor (DHA) that favors elovanoid-mediated neuroprotection in conditions including stroke, traumatic brain injury, macular degeneration, Alzheimer's, and Parkinson's.

Purpose of review: The target of critical care nutrition research is moving from short-term physiological surrogate endpoints and mortality toward long-term patient-centered outcomes. This review summarizes recent core outcome set (COS) initiatives relevant to nutrition and metabolism and outcome selection in recent trials.

Recent findings: The Core Outcome Measures for Clinical Effectiveness Trials of Nutritional and Metabolic Interventions in Critical Illness (CONCISE) defined essential outcomes: survival, physical function, infection, activities of daily living, nutritional status, and muscle/nerve function to be assessed at 30 and 90 days after randomization, with suggested but nonmandated instruments to preserve feasibility. COSMOGI (core outcome set of daily monitoring of gastrointestinal function in critically ill patients) standardizes daily gastrointestinal monitoring during critical illness. Large, randomized trials testing higher protein or early aggressive energy delivery have not improved survival and functional recovery, although the latter has only recently received more attention. From a mechanistic perspective, outcome selection in critical care nutrition and gastrointestinal function research should prioritize patient-centered (i.e. functional and patient-reported) outcomes.

Summary: Standardizing outcome selection should improve interpretability and evidence synthesis. Future trials should incorporate robust functional and patient-reported outcomes. Core outcome sets will need updates when new assessment tools (i.e., biomarkers, new functional tests, standardized ultrasound protocols) emerge.

Purpose of review: Oral intake of n (omega)-3 polyunsaturated fatty acids (PUFAs) is associated with changes to gut microbiota. We review recent findings from 2024 onwards, which build the scientific case that changes to bacterial abundance, and their metabolites, contribute to the health benefits associated with n -3 PUFAs.

Recent findings: There are now multiple studies in rodent disease models that demonstrate that n -3 PUFAs do not significantly alter bacterial diversity but, instead, alter abundance of several species that are implicated in short-chain fatty acid synthesis, in a model-specific manner. Limited intervention studies in humans, backed by larger observational studies, concur with the preclinical findings. Importantly, faecal transplantation experiments have confirmed that n -3 PUFA-induced changes to gut microbiota are causally related to reversal of the disease phenotype in two rodent models. In-vitro colonic models are now being used to understand the mechanism(s) underlying n -3 PUFA-induced changes to the gut microbiota and metabolome.

Summary: Despite emerging proof that the gut microbiota contributes to n -3 PUFA activity in animal models, human data are sparse. It remains unclear how n -3 PUFAs affect changes to the gut microbiota or whether n -3 PUFA metabolism by gut microbes contributes to the host metabolome.