Current Opinion in Clinical Nutrition and Metabolic Care最新文献

Purpose of review: The aim of this study was to conduct a review of the literature published over the past 18 months and present the latest findings on hydration in individuals with dementia.

Recent findings: A systematic review identified sarcopenia, polypharmacy, delayed oral transit, and poor rinsing ability as markers of eating-drinking-swallowing difficulties in early-stage dementia. A cross-sectional study found a high prevalence of dehydration (57-68%) among dementia patients, associated with hypertension, diabetes, chronic kidney disease, dysphagia, and cognitive decline. An analysis of national dementia care guidelines showed that only the UK and Switzerland addressed assisted nutrition and hydration. "Jelly Drops," a hydrating product for dementia patients, received innovation awards. A study on US Physician Orders for Life Sustaining Treatment forms highlighted inconsistent terminology for end-of-life nutrition and hydration, calling for clearer language to aid decision-making.

Summary: The new hydration-related recommendations in the ESPEN 2024 guidelines for dementia reflect a more individualized, proactive, and comprehensive approach to managing hydration. These guidelines emphasize the importance of early detection, personalized interventions, and consistent monitoring to ensure that dehydration is identified and treated promptly. Furthermore, the current literature supports the need for a specific terminology for dementia management using nutrition and hydration to improve patients' health outcomes.

Purpose of review: New dietary trends driven by environmental and health considerations will undoubtedly lead to the emergence of novel food allergens. Assessment of the allergenic risk of new or modified protein-containing food sources and ingredients, as well as surveillance of emerging food allergies, is then required.

Recent findings: Developments of in silico and in vitro models apprehending protein capacity to cross-react with other homologous proteins and to induce a de novo allergic sensitization are ongoing to better integrate multiple parameters such as 3D structural information or major histocompatibility complex class II (MHC-II) presentation propensity. However, the effects of food matrices and food processing still need to be addressed in these models. Consequently, clinical and postmarket surveillance remain of critical importance to alert on emergent food allergies, which are modulated by regional dietary practices.

Summary: Monitoring of the emergence of food allergens requires close collaborations between allergologists, consumers, patient associations and food safety authorities. We also need to get a consensus on an acceptable level of allergenic risk that offers the possibility to develop and market innovative and sustainable food products.

Purpose of review: This review aimed to synthesize recent literature on perioperative nutritional interventions for older patients.

Recent findings: This review underscores the role of comprehensive preoperative optimization, strategic use of nutritional supplements focusing on calorie, protein, and fluid intake, and active involvement of health consumers in co-designing solutions. Tools like the Geriatric Nutritional Risk Index offer a prediction value for nutrition-related complications in preoperative patients, guiding management strategies. Oral nutritional supplements, particularly those rich in protein and carbohydrates, prevent weight loss and improve functional outcomes postsurgery. However, patient satisfaction with these interventions is inconsistent and often unmeasured. Evidence suggests that prolonged fluid deprivation is harmful and preoperative hydration protocols reduce surgical stress and improve recovery outcomes. Yet, the benefit of preoperative hydration remains under-researched. Multimodal interventions for frail older adults are increasingly considered more effective than single-aspect interventions, which involve combining prehabilitation programs targeting malnutrition with smoking cessation and stabilization of preexisting conditions.

Summary: Comprehensive preoperative nutritional assessment, evidence-based interventions, and health consumer involvement are crucial for improving perioperative care for elderly patients. Implementing multimodal interventions, including nutritional support and proper hydration, can enhance recovery, reduce complications, and improve the quality of life for older surgical patients.

Purpose of review: The human circadian system regulates several physiological processes, including metabolism, which becomes significantly disrupted during critical illness. The common use of 24-h continuous nutrition support feeding in the intensive care unit (ICU) may further exacerbate these disruptions; this review evaluates recent evidence comparing continuous and intermittent feeding schedules in critically ill adults.

Recent findings: Research comparing different feeding schedules in critically ill adults remains limited. Recent meta-analyses suggest that continuous and intermittent feeding schedules in the ICU have comparable adverse event profiles, including gastrointestinal intolerance. A retrospective study found that continuous feeding did not impact the 24-h glucose variation in critically ill adults, and a randomized controlled trial reported no significant differences in amino acid, lipid-based, or small molecule metabolite profiles between the two feeding regimens. Potential benefits of intermittent feeding include stimulation of muscle protein synthesis, preservation of normal hormone secretion, and improved attainment of nutritional goals.

Summary: Current evidence suggests comparable safety profiles for continuous and intermittent feeding schedules in critically ill adult patients. However, intermittent and daytime cyclic feeding are expected to align more closely with normal circadian physiology. Given the lack of existing supportive data, a dynamic approach - transitioning from continuous feeding in the early-acute metabolic phase to intermittent feeding or daytime cyclic feeding - may be appropriate.

Purpose of review: This review summarizes recent literature falling broadly under the topic of n-3 polyunsaturated fatty acids (PUFAs) in the oncology setting, highlighting emerging themes and emphasizing novel explorations.

Recent findings: Meta-analyses continue to confirm safety and efficacy of n-3 PUFA supplementation on reducing inflammation and improving survival in people with cancer. Common themes in recent studies emphasize improving tumor-directed efficacy and reducing toxicities of common cancer therapies. New areas of interest include the impact of n-3 PUFA when combined with immunotherapies and applications in pediatric acute lymphoid leukemia. Novel assessments include specialized pro-resolving lipid mediators, the intestinal microbiome and psychological well being. A variety of clinically relevant outcomes including nutritional status, toxicities and survival are being explored in ongoing clinical studies.

Summary: Evidence confirms the safety of n-3 PUFA for patients with cancers, as well as benefits in some, but not all areas of exploration. Larger, well designed trials with biological assessment of compliance compared to the prescribed n-3 PUFA dose would strengthen the evidence needed to integrate n-3 PUFA recommendations into clinical practice for patients with cancer.

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.

Purpose of review: This paper reviews the most recent literature from January 2023 to August 2024 on the physiological effects of n-6 polyunsaturated fatty acids (PUFAs), with a focus on linoleic acid (LA).

Recent findings: Contrary to previous concerns that high LA intake may increase inflammation, most recent evidence supports the benefits of LA for cardiometabolic health. Several large studies report that higher blood LA levels correlate with reduced risks of coronary heart disease, stroke, and type 2 diabetes. Potential mechanisms include activation of peroxisome proliferator-activated receptors and modulation of oxylipins involved in glucose and lipid metabolism. The ideal LA intake level remains uncertain, but current intakes around 5-10% of energy appear beneficial. In other areas like cancer, asthma and sleep, the evidence is still inconclusive on LA's effects.

Summary: More research on diverse populations is needed to determine optimal LA levels, effects on specific conditions, and interactions with genetic factors affecting PUFA metabolism. Overall, the review highlights the emerging view that LA, the primary dietary n-6 PUFA, has cardiometabolic benefits rather than harmful effects.

Purpose of review: The use of functional outcomes in critical care nutrition research is increasingly advocated; however, this inevitably gives rise to missing data. Consequently there is a need to adopt modern approaches to the foreseeable problem of missing functional and survival outcomes in research trials.

Recent findings: Analyses that ignore unobserved or missing data will often return biased effect estimates. An improved approach is to routinely anticipate the types and extent of missing data, and consider the likely mechanisms of that missingness. The researcher and their statistical advisor may then choose from a number of modern strategies to assess the sensitivity of the research conclusions to the patterns of missingness contained in these research data. Methods widely employed include multiple imputation of missing observations, mixed regression models, use of composite outcome variables with patients who die being attributed a value reflecting the lack of ability to function, and selected Bayesian methodology.

Summary: Conclusions from clinical research in critical care nutrition will become more clinically interpretable and generalizable with the adoption of modern methods for the statistical handling of missing data.

Purpose of review: Critically ill patients are at risk of gastrointestinal bleeding (GIB) due to stress ulceration. Strategies to reduce the risk include administration of prophylactic ulcer healing medications. Enteral nutrition (EN) may be favourably associated with GIB risks. This manuscript summarizes available evidence regarding EN effects on GIB.

Recent findings: There are few data available to directly compare the effect of EN on GIB. Direct comparison in animal models generally indicate a beneficial effect. Human data provide indirect evidence from pharmacological stress ulcer prophylaxis studies. EN exposure has been randomized in nutrition trials of critically ill patients, but GIB outcomes were not recorded. Detailed EN exposure data were recorded in two large pharmacological stress ulcer trials. One finds EN is associated with lower GIB, lower mortality, and increased pneumonia, and notes a possible interaction between EN and pharmacological stress ulcer prophylaxis. The second has yet to report associations with EN.

Summary: EN may reduce the risk of GIB, although robust direct evidence is absent. Potential interactions between EN and pharmacological stress ulcer prophylaxis require further study.