Current Opinion in Clinical Nutrition and Metabolic Care最新文献

Purpose of review: To review the impact of nutrition on critically ill older adults, focusing on the role of comorbidities such as malnutrition, sarcopenia, and frailty, as well as the importance of nutritional support for outcomes such as mortality, recovery, and long-term disability.

Recent findings: Malnutrition is highly prevalent in the elderly and is strongly associated with adverse outcomes, including increased mortality, longer ICU stays, and higher rates of infection. In addition, frailty, multimorbidity, and cognitive decline significantly contribute to the vulnerability of older patients in the ICU. Evidence suggests that early individualized nutritional management, including adequate protein intake and prevention of the refeeding syndrome, is essential. However, age-specific guidelines are lacking.

Summary: Older adults admitted to the ICU face unique challenges owing to physiological decline, chronic diseases, and diminished nutritional reserves. Frailty and malnutrition are key predictors of poor outcomes in older adults. However, nutritional strategies tailored to older adults remain poorly defined. Whether optimized nutritional support through early assessment and age-appropriate interventions improves survival, reduces complications, and enhances quality of life after ICU discharge is a crucial clinical question to be answered by focused research.

Purpose of review: This review summarizes the most recent evidence on the role of omega-3 polyunsaturated fatty acids (PUFAs) in oncology, focusing on cancer prevention, cachexia and body composition, treatment-related toxicities, and therapeutic response.

Recent findings: Recent large-scale epidemiological and biomarker-based studies confirm a consistent, dose-dependent inverse association between eicosapentaenoic acid (EPA) and colorectal cancer risk, while evidence for docosahexaenoic acid (DHA) remains less consistent. Observational data reinforce the protective role of omega-3-rich dietary patterns, such as the Mediterranean and MIND diets, in reducing cancer risk. In clinical settings, omega-3 PUFA supplementation has shown modest but significant clinical benefits on body weight, inflammation, and quality of life in cancer cachexia, though effects on lean mass are variable. Promising data also support a reduction in severe oral mucositis during chemotherapy, whereas trials on chemotherapy-induced peripheral neuropathy and chemosensitization have produced inconclusive results, mainly due to heterogeneity in design and adherence.

Summary: Omega-3 fatty acids exert measurable biological and clinical effects in oncology, however, their benefits appear context-dependent. Future studies should focus on standardized interventions, patient stratification based on molecular and inflammatory profiles, and integration within immunonutrition frameworks to enhance therapeutic precision and clinical outcomes.

Purpose of review: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have rapidly become central to the management of heart failure and chronic kidney disease. Their widespread use now extends into the peri-acute and critical-care setting, raising questions about whether these agents should be continued or initiated during acute illness. This review summarizes the latest physiological and clinical evidence relevant to these scenarios.

Recent findings: Recent studies have clarified the physiological and clinical effects of SGLT2 inhibitors during acute illness across perioperative, cardiac, and intensive-care settings. Overall, these agents appear renally safe and may promote modest diuresis and decongestion, though this can be accompanied by slightly greater vasopressor requirements in unstable patients. Their metabolic and anti-inflammatory effects remain favorable, and no consistent safety concerns have been identified.

Summary: SGLT2i appear safe for most hemodynamically stable hospitalized or critically ill patients and may confer renal and metabolic benefits. Routine initiation in unselected populations is not supported, but continuation of chronic therapy seems reasonable when patients are stable, euvolemic, and receiving nutrition. Ongoing investigations will clarify optimal timing, dosing, and patient selection for acute-care use.

Purpose of review: Nutritional therapy is challenging in patients admitted to the ICU due to acute hypoxemic respiratory failure (AHRF) and candidates for oxygen therapy through noninvasive modalities, such as noninvasive ventilation (NIV) or high-flow nasal cannulas (HFNC). Nutritional status assessment, the definition of nutritional needs, routes and modes of administration, diet types, monitoring of food tolerance, complications and safety during ICU admission, and nutrition-focused outcomes are not well established in these patients and have not been specifically addressed in international ICU guidelines. This review will focus on the nutritional treatment of patients with AHRF without airway protection admitted to an ICU.

Recent findings: Oral nutrition, following swallowing tests, remains the preferred route for feeding these patients. However, the prevalence of insufficient feeding remains high, especially in those receiving NIV compared to HFNC modality. Artificial nutrition is used less frequently. Finally, trophic nutrition, either orally or via a nasogastric tube (NGT), has emerged as a new modality of nutritional treatment for these patients and has been shown to be safe and feasible.

Summary: Insufficient feeding appears to be the norm in ICU patients treated for AHRF with noninvasive ventilation modalities. New approaches, protocols, guideline updates, and more high-quality studies are needed.

Purpose of review: To systematically evaluate recent evidence on vitamin D supplementation during infancy, focusing on optimal dosing, population variability, and emerging nonskeletal effects. The review emphasizes current controversies and gaps that remain in translating evidence into policy and clinical practice.

Recent findings: Recent randomized trials and meta-analyses confirm that daily supplementation of 400 IU vitamin D maintains adequate 25-hydroxyvitamin D levels in most healthy, term infants. However, higher doses (600-1200 IU) may be required for infants at elevated risk of deficiency, including those with limited sunlight exposure, darker skin pigmentation, or residing in northern latitudes. Evidence for extra-skeletal benefits, such as immune modulation or respiratory protection, remains inconclusive. Methodological heterogeneity, differing baseline vitamin D status, and variable adherence complicate comparisons across studies.

Summary: Current evidence supports universal vitamin D supplementation during infancy to prevent deficiency and ensure skeletal health. The benefit of higher doses or supplementation beyond infancy remains uncertain. Future studies should clarify dose-response relationships, long-term safety, and potential systemic effects, while integrating population-specific determinants of deficiency into clinical and public health guidelines.

Purpose of review: Many patients undergoing abdominal surgery are considered at-risk of malnutrition and may have a multitude of modifiable risk factors for adverse surgical outcomes. Prior to surgery, risk factors should be identified and mitigated via prehabilitation. This review aims to highlight recent research in nutritional screening, assessment and interventions being incorporated into surgical prehabilitation programmes.

Recent findings: Nutritional screening identifies at-risk patients most likely to benefit from prehabilitation. Assessment of body composition using radiological methods provides an integrated accurate means of risk stratification, allowing intervention in those most likely to benefit. Biochemical immune-nutrition prognostic markers may provide a useful adjunct but lack robust clinical evidence. Unimodal nutritional prehabilitation interventions have mixed evidence of benefit in improving clinical outcomes, such as infectious complications and length of stay. Multimodal interventions are considered more pragmatic and may positively impact functional outcomes and reduce complication rates.

Summary: Utilizing nutrition as part of multimodal prehabilitation shows promise for improving clinical and functional outcomes yet requires strong collaboration between key stakeholders. Significant heterogeneity in study designs and patient characteristics renders difficulties in establishing the most efficacious approaches. Further research is required to determine optimal strategies and the cost effectiveness of such programmes.

Purpose of review: This review synthesizes current evidence on free sugar intake among European children and adolescents, emphasizing recent trends in consumption, key determinants, associated health outcomes, and implications for preventive strategies.

Recent findings: Despite modest reductions in some countries, sugar consumption in youth continues to exceed international recommendations, particularly during adolescence. Longitudinal studies highlight persistent high intakes, with sugar-sweetened beverages (SSBs) and confectionery as primary contributors. Socioeconomic disparities, parental behaviours, screen exposure, and individual traits significantly influence consumption. High sugar intake is linked to increased risk of adiposity, cardiometabolic disturbances, and dental caries, with early exposure potentially impacting long-term disease risk. Recent policy efforts, such as taxation and reformulation, show promise but remain inconsistently implemented across Europe.

Summary: Free sugar intake in childhood remains a critical nutritional concern in Europe. Evidence supports the need for multilevel approaches, including early-life interventions, updated guidelines, and policy measures targeting the broader food environment. Healthcare professionals play a key role in supporting families through nutrition education and consistent messaging. Coordinated action is essential to reduce sugar intake and prevent chronic diseases across the life course.

Purpose of review: The early-life gut microbiome is a dynamic ecosystem that alongside other niches, such as the oral and skin microbiomes, undergoes rapid assembly and genetic evolution from birth through to adulthood. Although it was originally considered to be a passive colonisation process, recent findings suggest that early microbial development is a co-evolving, host-modulated process influenced by multiple factors, including maternal microbiota, mode of delivery, human milk, feeding practices, environmental exposure, and genetics, highlighting the timeliness of this review.

Recent findings: In recent years, high-resolution sequencing and longitudinal multiomics have enabled the detailed observation of the early stages of microbial adaptation, assembly, strain transmission, diversification, and horizontal gene transfer in the early stages of life. New data also reveal maternal-foetal microbial signalling via metabolites and extracellular vesicles, as well as the evolutionary role of human milk oligosaccharides, and the involvement of phages, plasmids, and mobile genetic elements in infant gut microbial evolution.

Summary: This review provides a summary of advances during gestation, birth, breastfeeding and infancy. However, further research is required into microbial evolution, and predicting its clinical significance, as well as  the role of artificial intelligence tools. Understanding early microbial adaptation processes could transform nutrition, precision medicine, and paediatric care.

Purpose of review: While moderate and late preterm infants (MLPTI, gestational age 32 0/7-36 6/7 weeks) represent the largest group of preterm infants worldwide, studies on nutritional needs remain scarce. This review evaluated the latest evidence on nutritional strategies for MLPTI and their effect on growth and body composition.

Recent findings: For the first time, specific recommended nutritional intakes were defined by a group of experts, resulting in a recommended protein intake of 3.1-3.5 g/kg/day and a recommended energy intake of 127-130 kcal/kg/day. However, most MLPTI fail to meet these targets in the first week of life. Higher early protein and energy intakes were associated with improved weight gain, head growth, and reduced extra-uterine growth restriction in the first months of life, but data beyond those first months were limited. Feeding type also influenced outcomes: infants who were exclusively fed mother's milk showed lower fat mass and higher lean mass compared to those receiving formula.

Summary: Nutrition in MLPTI is critical for early growth and body composition. Breastfeeding support and adequate early protein and energy intake appear beneficial for early growth. Further longitudinal studies are needed to clarify the lasting impact of early nutrition on growth and body composition in MLPTI.

Purpose of review: Despite advances in targeted therapy and immunotherapy, glioblastoma (GBM) remains a therapeutic challenge because of its intrinsic adaptability, driven by intratumoural heterogeneity, cell-state plasticity, tumour-stroma crosstalk, and an immunosuppressive tumour microenvironment. The aggressive mesenchymal subtype, linked to treatment resistance and poor prognosis, exemplifies these adaptive mechanisms. Recent studies identify tractable oncogenic dependencies within these processes, opening routes to subtype-informed, multiaxis therapies.

Recent findings: GBM exploits extrachromosomal DNA (ecDNA) and structural variants to rewire enhancer networks, reinforcing therapy-resistant mesenchymal states with distinct kinase dependencies (e.g. p38 MAPK signalling, STAT3). Tumour cells further hijack neuronal activity, glutamate/GABA, and long-range neuromodulatory (e.g. cholinergic) inputs, to promote growth, with synaptically enriched regions exhibiting immune suppression and mesenchymal enrichment. Myeloid-derived ligands (e.g. TNF and Oncostatin M) can drive proneural to mesenchymal transition, while Thrombospondin-1-mediated synaptic remodelling suppresses T-cell function, mechanistically coupling neural connectivity to immune evasion.

Summary: The resilience of GBM arises from the interplay of epigenetic plasticity, neural circuit co-option, and myeloid-skewed immunosuppression. A coordinated strategy, kinome-guided targeting plus circuit disruption and myeloid reprogramming, offers a credible path to contain adaptation and improve outcomes.