Current Opinion in Clinical Nutrition and Metabolic Care最新文献

Purpose of review: Poor diet drives cardiovascular and other chronic diseases in older adults, yet behaviour change remains challenging due to physical, cognitive, and social barriers. Despite growing digital health solutions, older adults are often overlooked. This review examines recent innovations aimed at supporting dietary change in this population amid rapid technological advances.

Recent findings: Case studies of six novel digital tools were examined: smart TVs, mobile apps, augmented reality (AR), chatbots, assistive robotics, and intelligent voice assistants. These tools employed a wide range of behaviour change techniques such as tailored feedback, habit formation, goal setting, self-monitoring, and social support. Smart TVs and apps improved nutrition literacy through familiar interfaces and gamification. AR tools enhanced portion control and food decision-making. Socially assistive robots provided interactive, social mealtime support, while chatbots and intelligent voice assistants used Artificial Intelligence to deliver personalized, conversational guidance. Despite these advances, challenges remain around usability, trust, and sustained engagement.

Summary: Digital tools offer promising, personalized support for dietary change in older adults. However, most work remains in its early stages. Realizing broader impact will require co-designed, culturally relevant solutions, real-world testing, and strategies for scale-up that ensure accessibility, trust, and sustained engagement.

Purpose of review: This review summarizes the current literature around sex-based differences in adaptations to diet and exercise in older adults. This review is timely as there is continued debate around the necessity of sex-based interventions across the lifespan.

Recent findings: Evidence shows that exercise does not appear to confer many sex-based differences in adaptation to either muscle strengthening, or cardiovascular types of exercise, especially when these changes are reported in relative (percentage) terms.There appear to be some differences in response to dietary exposures between sexes. However, the extent of sex differences is still largely unclear due to many studies not reporting or analysing data by sex.

Summary: Implications for clinical practice are that there is currently insufficient evidence for exercise-related changes in muscle strengthening or cardiovascular outcomes being significantly affected by sex in older adults. There are some sex-based differences in response to dietary factors, however, the mechanisms remain unclear. At present, individualized lifestyle prescriptions taking into consideration health conditions, risk factors, client history and goals appear to be logical over a blanket sex-based approach.

Purpose of review: Sarcopenia, the age-related loss of skeletal muscle mass and function, poses a major health challenge. While leucine's anabolic properties are well documented, its clinical efficacy as a standalone intervention remains limited. This review explores the potential of integrated strategies combining leucine with other nutrients, physical activity, and gut microbiota modulation to enhance sarcopenia prevention and treatment.

Recent findings: Recent studies confirm that leucine supplementation alone fails to significantly improve muscle mass or strength in older adults. However, its benefits emerge when combined with resistance training, or gut microbiota-targeted interventions. The gut-muscle axis has gained attention as a key modulator of muscle health. Additionally, leucine supports the resumption of physical activity in sarcopenic patients by mitigating exercise-induced muscle damage and inflammation.

Summary: These findings underscore the need for multimodal approaches, leucine, optimized nutrition, exercise, and microbiota modulation, to maximize therapeutic benefits. Future research should focus on defining optimal dosages, personalized protocols, and clinical feasibility. Such strategies could revolutionize sarcopenia management by integrating innovative, patient-centred care.

Purpose of review: Growing interest in the relationship between dietary components and health has intensified research efforts, particularly concerning bioactive peptides. Despite substantial investigations over the past three decades, the therapeutic potential of these peptides remains underutilized. This review summarizes recent scientific evidence from preclinical studies and clinical trials to evaluate the physiological effects of protein hydrolysates and purified peptide fractions. This highlights emerging findings on their impact across multiple biological systems, with a particular focus on metabolic health, cardiovascular regulation, and immune function.

Recent findings: Preclinical studies have provided substantial evidence that protein hydrolysates may improve or prevent metabolic disorders related to obesity, glucose homeostasis, and cardiovascular function. These hydrolysates are also widely incorporated into specialized formulas for allergic infants and have demonstrated modulatory effects on adaptive immune responses. Emerging research has highlighted the intestinal epithelium as a principal site of action, particularly through mechanisms involving gut hormone release and microbiota modulation. Nevertheless, the potential involvement of alternative pathways, whether direct or indirect, via diverse signalling cascades cannot be excluded. Although the clinical evidence remains limited, the number of human studies investigating these effects is steadily increasing.

Summary: Protein hydrolysates exhibit significant potential in supporting metabolic and cardiovascular health and in modulating immune function. Their incorporation into food or pharmaceutical formulations requires the validation of these benefits through rigorous clinical trials.

Purpose of review: Vitamin B12 deficiency is a common yet frequently underdiagnosed condition in older adults. The growing aging population is experiencing an increasing burden of geriatric syndromes, such as cognitive impairment, frailty, and falls. The aim of this review is to synthesize current evidence on the relationship between B12 deficiency and age-related clinical outcomes to guide early recognition and management.

Recent findings: Recent studies link vitamin B12 deficiency to neurodegenerative and neuromuscular changes via disrupted myelin synthesis, elevated homocysteine and methylmalonic acid, oxidative stress, and neurotransmitter dysregulation. Low B12 levels are consistently associated with cognitive decline, depressive symptoms, balance disturbances, gait disorders, sarcopenia, and frailty. Diagnosis is often challenging due to nonspecific or overlapping clinical features and the limited sensitivity of standard serum B12 assays. Clinical improvements in cognitive and physical function have been observed following supplementation, particularly in early or mild cases.

Summary: This narrative review synthesizes current evidence on the epidemiology, pathophysiology, and clinical implications of vitamin B12 deficiency in key geriatric syndromes. Routine screening and early intervention for vitamin B12 deficiency in high-risk older adults may mitigate the progression of geriatric syndromes and preserve functional independence.

Purpose of review: The complex association between nutritional status and sleep quality in older adults remains poorly understood. This review critically examines recent advances and the potential of targeted nutritional interventions to enhance sleep and promote healthy aging.

Recent findings: Emerging evidence links malnutrition and imbalances in key micronutrients and macronutrients to poor sleep quality in older adults. Studies highlight that adherence to plant-based diets, adequate consumption of milk and marine fish, and avoidance of stimulants such as green tea and coffee are associated with better sleep outcomes. Supplementation with specific nutrients, including methyl donor nutrients and amino acid derivatives, shows promise in improving sleep parameters. Additionally, social determinants influencing nutritional status also impact sleep quality. However, the majority of current evidence is observational, and randomized controlled trials remain limited in size, duration, and focus, often examining isolated nutrients rather than comprehensive dietary patterns.

Summary: Nutritional status is a modifiable factor that significantly influences sleep quality in older adults. While current findings support the potential of dietary and supplemental interventions to improve sleep, robust clinical trials and mechanistic research are needed to establish causality and optimize personalized nutrition strategies for healthy aging and better sleep health.

Purpose of review: Microcytic anemia (MA) is common in older adults (OA) with a significant impact on quality of life and survival. We explore current knowledge on the subject.

Recent findings: Nonspecific general signs (delirium, cognitive disorders, apathy, bradyphrenia, falls, …) may be at the forefront of MA in OA.Recent advances have clarified the roles of hepcidin, ferroportin and soluble transferrin receptors. Nevertheless, the assay of these new biomarkers is only recommended in cases of uncertainty.The most common mechanism of MA in OA is iron deficiency. It is often both absolute (decrease in iron reserves) and functional (decrease in circulating iron, while reserves are high), particularly in frail OA characterized by polymorbidity/polypharmacy.The Haute Autorité de Santé (France) has published guidelines establishing a hemoglobin threshold for red blood cell transfusion in OA: <7 g/dl in the case of asymptomatic anemia, <8 g/dl if there is heart failure or coronary insufficiency, and <10 g/dl if there is poor clinical tolerance.Administration of intravenous furosemide after red blood cell transfusion is recommended to prevent transfusion-associated circulatory overload. Iron supplementation will also be prescribed in absolute deficiency.

Summary: Microcytic anemia, often mixed in OA, requires symptomatic and etiological management.

Purpose of review: This review evaluates recent evidence on how total protein and energy intake, amino acid composition, and nutrient delivery modality influence protein synthesis in preterm neonates, with the goal of informing nutritional strategies to support optimal lean mass accretion and growth.

Recent findings: Preterm neonates exhibit anabolic resistance to feeding due to impaired insulin and amino acid signaling in skeletal muscle. Enteral nutrition, especially fortified human milk, supports better lean mass accretion and neurodevelopment than parenteral nutrition. Intermittent bolus feeding and pulsatile leucine supplementation during continuous feeding further enhance mTORC1-dependent translation initiation signaling and protein synthesis efficiency in skeletal muscle, offering promising strategies to optimize lean tissue growth.

Summary: Strategies that prioritize early enteral feeding, appropriate milk fortification, and nutrient delivery patterns that mimic feeding pulsatility may overcome anabolic resistance and enhance lean mass accretion, supporting healthy growth trajectories in preterm infants.