Current Opinion in Clinical Nutrition and Metabolic Care最新文献

Purpose of review: In people living with kidney disease (KD) Fatigue is a whole-body tiredness that is not related to activity or exertion. Often self-reported, fatigue is a common and highly burdensome symptom, yet poorly defined and understood. While its mechanisms are complex, many fatigue-related factors may be altered by exercise and physical activity intervention. Thus, this review aims to review the latest research on exercise in reducing fatigue in people living with KD.

Recent findings: The benefits of exercise in KD are well known, yet recent data from clinical trials on fatigue are scarce. Favourable effects on fatigue were found through a myriad of physical activity and exercise-based interventions, including using exercise-based video games, exercise during dialysis, nurse-led exercise programs, and home-based exercise delivered by a novel digital health intervention. Yet, whilst the handful of recent trials show positive efficacy on fatigue across the spectrum of KD, contemporary exercise-based research was impacted critically by COVID-19, and the field is limited by underpowered trials and heterogeneity of assessment tools.

Summary: Fatigue remains, at best, a secondary outcome measure in trials despite it being the most commonly reported symptom in KD. Given its importance to the people it impacts most, better quality evidence is needed to fully understand and optimize the impact of exercise in this group.

Purpose of review: To share current concepts and provide an overview of the contextual issues and nutrition practices in critically ill patients in resource-limited settings (RLSs)/low- and middle-income countries (LMICs). Most of the world's population reside in these settings which also carries the greatest burden of critical illness.

Recent findings: There is a paucity of evidence on nutrition practice in critically ill patients in RLSs and international guidelines are largely based on evidence derived from high-income countries (HICs). While some recommendations are adaptable to RLSs, many are not feasible or directly transferable. Despite the challenges that may prevail, pragmatic solutions can address many of the difficulties to enhance nutrition practice and improve patient outcomes.

Summary: This review provides a contemporary synopsis of nutrition practice in critically ill patients in RLSs covering the relevance of optimal nutrition, gives insights into relevant contextual issues and challenges in RLSs, evaluates recent scientific evidence and available literature pertinent to critically ill patients in RLSs, addresses nutrition guidelines, discusses some pragmatic options and solutions, deals with relevant and important complications that may arise, and offers suggestions and future considerations to enhance nutrition practice in critically ill patients in these settings.

Purpose of review: The objective of this review is to examine the available evidence concerning feeding interruptions before extubation and other medical procedures in ICUs. We will analyze the physiological mechanisms involved, the potential risks associated with feeding interruptions, as well as the results of recent clinical studies. Additionally, we will explore current practices and recommendations from major professional societies, as well as recent innovations aimed at minimizing feeding interruptions.

Recent findings: Fasting before extubation is a common yet heterogeneous practice, varying across ICUs. Although dysphagia is a frequent complication after extubation, its prevalence decreases over time. However, physiologically, fasting before extubation appears ineffective in reducing gastric content or preventing aspiration. The Ambroisie study demonstrated that continuing enteral nutrition up to extubation is not inferior to a 6 h fasting strategy in terms of extubation failure at 7 days. The management of perioperative nutrition in intubated patients is debated. A retrospective study found no significant difference in postoperative respiratory events between patients fasting for at least 6 h and those fasting less or not at all but further prospective randomized studies are needed for definitive conclusions. For abdominal and digestive surgeries, fasting remains necessary to simplify procedures and reduce contamination risks. For invasive ICU procedures, such as catheter placement, the continuation of enteral nutrition appears reasonable. However, for percutaneous tracheotomy, limited evidence suggests no clear benefit from fasting, though the risk of large-volume aspiration during the procedure raises concerns. The approach to nutrition in this context requires further investigation.

Summary: Fasting before extubation in ICUs is a common practice inherited from anesthesia, aiming to reduce the risk of aspiration. The Ambroisie study demonstrates that continuing enteral nutrition until extubation is not inferior to a 6 h fasting strategy regarding extubation failure at 7 days.

Purpose of review: This review aims to examine recent research on the role of specialized pro-resolving mediators (SPMs) in the regulation of gut immunophysiology.

Recent findings: Inflammatory bowel disease (IBD) is characterized by chronic inflammation in the gastrointestinal tract, driven by disruptions in the intestinal barrier and an imbalance between the host immune system and gut microbiota. Dietary polyunsaturated fatty acids (PUFAs), especially ω-3 and ω-6, are key regulators of immune responses and help maintain the integrity of the intestinal barrier. These PUFAs serve as precursors to SPMs, lipid mediators that play a critical role in resolving inflammation. SPMs actively reprogram immune cells, promoting the clearance of cellular debris, reducing cytokine production, and restoring tissue homeostasis without suppressing the immune response. Emerging evidence indicates that in the gut, SPMs strengthen intestinal barrier function, modulate immune responses in colitis and colon cancer, and influence gut microbiota composition.

Summary: The recent evidence strongly supports the central role of SPMs in maintaining gut health and restoring organ function following inflammatory challenges. This evidence highlights the potential of therapeutic approaches that target these pathways for both the prevention and treatment of gut-related inflammatory conditions.

Purpose of review: The review summarizes current knowledge, recent findings and knowledge gaps about the pathophysiology and therapy of oropharyngeal dysphagia in older persons.

Recent findings: Oropharyngeal dysphagia is a major yet underrecognized health problem in older persons. Due to its high prevalence, its multifactorial etiology and multimodal treatment it has been classified as a geriatric syndrome. Although the knowledge of its pathophysiology and the effective diagnostic approach increased substantially during the last years, there is still minor evidence on how to effectively manage and treat dysphagia. However, treatment should be a multicomponent approach, combining swallowing training, nutritional therapy and oral hygiene. Emerging new fields are neurostimulation and chemical sensory stimulation which may be added in selected patients and indications. The individual components to be chosen should be based on the individual dysphagia pattern and severity as well as the capabilities of the patient. Frequently, the competing risks of inadequate nutrition and unsafe swallowing represent a challenge in determining the individual relevance of each component.

Summary: The understanding of the pathophysiology of oropharyngeal dysphagia increased substantially during recent years. However, due the multifaceted appearance of dysphagia, which requires an individualized treatment, the evidence for therapeutic approaches increases rather slowly.

Purpose of review: The colon is an effective bioreactor with auxotrophic microbiota that can serve by hydrolyzing dietary and endogenous protein, as well as by synthesizing essential amino acids through nitrogen salvage. Due to assumed negligible amino acid absorption, this colonic contribution was thought to be minimal, but this may not be true.

Recent findings: Several studies that examined the colonic environment in health and disease, show the presence of proteases in the colonic lumen, which are of both host and microbial origin, along with indirect evidence of amino acid transporters in the colonic epithelium. There are also amino acid biosynthetic pathways in the microflora, and the contribution of colonic amino acid to host amino acid nutrition has been shown in wild animals. Yet, current direct and quantitative evidence on amino acid absorption in human colon is minimal.

Summary: Although amino acid absorption in colon is not very well established, current studies show that substantial amounts of amino acid could possibly be contributed to the host by the colon. There is a need for assessing this contribution quantitatively using direct isotopic methods under different nutritional conditions, dietary intakes, and clinical conditions.

Purpose of review: The combined obesity and ageing pandemic require action to avoid a total health system infarct. Obesity is largely challenged with caloric restriction and endurance exercise, likely to be assisted by drugs. The older adults with the highest obesity levels may face extreme loss of muscle mass and increased risk of sarcopenic obesity.Within this context the question of what is the protein requirement is extremely urgent.

Recent findings: While the topic is essential, no trials have directly assessed protein requirements for obesity. Therefore, we will have to deal with more indirect evidence. Several systematic reviews have appeared for obesity treatment involving protein and a few randomized controlled trials during weight loss are worth mentioning considering the amount of protein needed, especially with increasing age.

Summary: Protein requirements are hard to derive for obesity defined by BMI over 30 perse. During weight loss the rebuilding of the body is likely to need at least 1.2 g/kg body weight/d with a maximum weight of BMI 30, especially in the aged. Obesity might increase protein requirements, however being obese with a healthy and active lifestyle might result in normal protein requirements.

Purpose of review: This review aims to evaluate the latest available evidence on the differences between human milk proteins versus infant formula proteins and its effects on growth and development in preterm infants.

Recent findings: High protein intake supports initial growth in preterm infants, although the long-term benefits remain unclear. Human milk requires adequate fortification to meet nutritional needs of preterm born infants. Formula feeding, with its higher protein content, may accelerate early weight gain but also increases the risk of necrotizing enterocolitis. Current evidence showed no significant advantages of human milk-derived fortifiers over bovine milk-derived fortifiers. Furthermore, studies published during the review period do not provide new evidence that alters the existing understanding of differences in neurodevelopmental outcomes between infants fed human milk and those fed formula.

Summary: Both fortified human milk and preterm formula support growth in preterm infants, but human milk offers additional protective benefits, such as reducing the risk of necrotizing enterocolitis, making it the preferred option. Balancing immediate growth needs with potential long-term developmental outcomes remains crucial, highlighting the need for further research to determine the optimal protein intake for preterm infants.

Purpose of review: Considering the ageing of the population, age-related syndromes, such as frailty, are prominent. In this context, nutrition is a modifiable factor considered a key nonpharmacological approach to prevention and treatment. Yet, its contribution to the frailty pathophysiology is conflicting in the literature. This paper discusses the recent literature (January 2023-June 2024) on the implication of nutrition in frailty management.

Recent findings: Malnutrition is one of the main frailty risk factors. Proteins are the targeted macronutrient for their effects on muscle anabolism, not only in terms of quantity consumed but also in terms of sources. The diversity in plant and animal sources demonstrates better results than relying on a single source. More globally, anti-inflammatory and antioxidant diets are associated with a lower risk of frailty, like the Mediterranean Diet and specific food groups, like seafood, nuts, and seeds. Nutrition is pivotal in frailty prevention and treatment, and multidomain interventions providing exercises seem to yield even better results.

Summary: Diverse protein sources and anti-inflammatory and antioxidant diets associated with exercises are the primary recommendations for frailty prevention and treatment. However, there is a need to evaluate how to achieve and maintain this healthy behaviour in real life.