Current Opinion in Clinical Nutrition and Metabolic Care最新文献

Purpose of review: Osteosarcopenia is an age-related condition characterized by reductions in bone mineral, muscle/lean mass, strength and functional ability which increases the risk of falls, fractures, frailty and premature mortality. One main contributing factor to osteosarcopenia is malnutrition. The purpose was to review recent evidence of creatine monohydrate (CrM) supplementation in older adults and to discuss the potential to manage osteosarcopenia.

Recent findings: Accumulating research shows that CrM supplementation, primarily when combined with exercise training, has the potential to serve as a viable intervention in the management of osteosarcopenia. Collectively, CrM supplementation during exercise training in older adults led to greater improvements in whole-body lean mass, lower-limb muscle density and bone geometry and muscle strength (primarily upper-body) compared to exercise training alone. However, no study has investigated the effects of CrM, with and without exercise training, in older adults with osteosarcopenia.

Summary: Given the positive findings of CrM on measures of muscle and bone in healthy older adults, there is potential for CrM to be added as an adjunct to exercise training in the management of osteosarcopenia. However, randomized clinical trials are needed to confirm the safety and efficacy of this nutrient in this clinical population.

Purpose of review: Nutritional support and optimal glucose control are key components of care during critical illness, yet evidence surrounding their use remains conflicting, making translation into clinical practice challenging. This review explores Bayesian methods to enhance the interpretation of frequentist critical care trials, particularly for interventions with inconclusive outcomes.

Recent findings: Bayesian re-analysis frameworks may clarify conflicting evidence in critical care, thus enhancing interpretability and supporting clinical decision-making. This review focuses on the Bayesian re-analysis of three recent trials with indeterminate results for mortality - NUTRIREA-3, EFFORT Protein, and TGC-Fast - that examined the effects of enteral nutrition and glucose control strategies.

Summary: We re-analyzed the mortality outcomes of these trials within a Bayesian framework, contrasting our findings with the original trial results to illustrate how Bayesian methods can enhance the clinical applicability of trial outcomes. Although Bayesian and frequentist analyses generally agree on the direction and magnitude of effect, Bayesian methods offer the advantage of providing posterior probabilities of benefit and harm, thus identifying promising and potentially harmful interventions. This review underscores the value of Bayesian analysis in re-evaluating clinical trial data and guiding clinical practice.

Purpose of review: Sleep disturbance and low dietary intake of omega-3 fatty acids are common in modern society. Previous research shows that omega-3 fatty acids play an integral role in the regulation of sleep processes, but efficacy data in adults have been equivocal to date. This review examines recent studies highlighting the effects of omega-3 fatty acids on sleep quality and circadian processes.

Recent findings: Two randomized controlled trials in healthy adults found that supplementation with DHA-rich interventions improved sleep quality, though effects may vary depending on age, current sleep habits and habitual omega-3 intake. Conversely, EPA-rich interventions in menopausal women, men with prostate cancer and people experiencing episodic migraines did not improve sleep quality. Advances in lipidomics reveal a bidirectional relationship between sleep disturbance and lipid metabolism, to some extent underpinned by activity of omega-3 fatty acids in circadian processes. Therefore, adequate omega-3 fatty acid intake is both a preventive and therapeutic approach to sleep quality and health.

Summary: Omega-3 fatty acids and DHA in particular show promise for improving sleep quality and limiting the adverse effects of sleep disturbance on health. Future research should focus on developing sex-specific and age-specific recommendations for omega-3 fatty acid intake to optimize sleep health.

Purpose of review: Acute kidney injury (AKI) is common in hospitalized patients and is independently associated with morbidity and mortality. Moreover, AKI increases the risk of chronic kidney disease, which is a major healthcare problem. Currently, no single therapy has been proven to be effective in preventing AKI. The role of amino acids in the context of kidney function and AKI prevention has been controversial and most of the evidence is available from nutritional studies. However, knowledge of amino acids in recruiting renal functional reserve and their potential role to protect renal function under stress has recently expanded.

Recent findings: The nephroprotective effects of amino acids were first postulated in 1973. Recently, this strategy gained renewed interest and has been more extensively studied, reintroducing their use in clinical situations characterized by a high incidence of AKI. Intravenous amino acids administration for kidney protection is now supported by a large multinational randomized double-blind controlled trial in cardiac surgery and by experimental and observational data. All such data support the rationale for a biologically and clinically important nephroprotective effect.

Summary: The infusion of amino acids was recently found to reduce the incidence of AKI in cardiac surgery patients and surgical patients. This strategy for the protection of renal function is supported by a multicenter, international, double-blind randomized trial, with a huge potential for additional application in several clinical fields. Several mechanisms of action support the robustness of these findings and are summarized in this manuscript.

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: This narrative review includes the latest clinical and preclinical evidence on fatty acid exposure and telomere length, a widely accepted hallmark of aging.

Recent findings: A large body of literature focused on n-3 (omega-3) polyunsaturated fatty acids (PUFAs). Observational studies reported beneficial associations with telomere length for self-reported consumption of n-3 PUFA-rich foods; for estimated intake of n-3 PUFAs; and for n-3 PUFAs blood-based biomarkers in most (but not all) studies involving lipidomics, a promising tool in the field. Benefits were also observed in preclinical studies using different mouse models. Regarding other lipids, inconsistent findings were observed for circulating linoleic acid, whereas inverse associations with telomere length were reported for the n-6/n-3 PUFA ratio. Finally, a study using Mendelian randomization reported that monounsaturated fatty acids and PUFAs have a positive effect on telomere length, whereas the opposite was observed for saturated fatty acids.

Summary: Evidence supporting that n-3 PUFAs might have beneficial effects on maintaining telomere length reinforce the salutary effects of these dietary fats. Approach considering the n-6/n-3 PUFA ratio is discouraged because it is sustained in the incorrect assumption that all species from the n-6 and n-3 families are functionally equivalent.

Purpose of review: The Omega-3 Index (O3I) was proposed 20 years ago as not only a marker of body omega-3 fatty acid status, but more importantly, as a risk factor for fatal coronary heart disease. The purpose of this review is to document the continued and growing use of this metric in nutrition research.

Recent findings: Of the 456 citations to the O3I in PubMed, 58 have appeared in the last 18 months. Several of these articles are reviewed, and they underscore the widespread use of the metric.

Summary: Although the O3I was originally developed in the cardiovascular field, it has since been used in the study of a remarkably large number of health conditions, all of which appear to be favorably impacted by higher levels of tissue omega-3 fatty acids as reflected by the O3I.

Purpose of review: The delivery of high-quality personalized nutrition care both during ICU and throughout post-ICU recovery is limited by multifactorial barriers. As families are often a present and consistent resource, family engagement may help to optimize nutrition support during hospitalization and after recovery from critical illness. In this review, we summarize the evidence base for family engagement in nutrition care and hypothesize future roles families may play, throughout the critical illness recovery trajectory.

Recent findings: Family members may be best placed to convey patients' personal nutritional preferences, and premorbid nutrition intake and status, as well as promote and minimize barriers to nutrition intake. The engagement of families in nutrition care is an emerging concept, and as such, few studies have explored the role of family engagement in the delivery of nutritional care. Those that do have shown high levels of family engagement and feasibility but have not yet translated to improved clinical and patient-related outcomes.

Summary: Further research should identify how and where families may best engage to support, or advocate for, improved nutrition care.