Current Opinion in Clinical Nutrition and Metabolic Care最新文献

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: 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: Several types of injectable lipid emulsions (ILEs) have become available for parenteral nutrition. The purpose of this review is to highlight the most recent and interesting articles in the field of ILEs.

Recent findings: Recent literature has compared ILEs in various clinical scenarios (e.g. abdominal surgery, chronic intestinal failure, critical illness, and preterm birth). Favorable clinical effects of ILEs containing fish oil have been observed in studies on surgical patients with Crohn's disease, critically ill patients, and patients with intestinal failure-associated liver dysfunction, whereas other trials have shown no clear benefit. Ongoing research is focused on finding novel strategies to reduce liver toxicity of ILEs, including the use of 'artificial intelligence' tools and liver organoids. Promising new applications for ILEs are emerging, including the prevention of neonatal hypoxic brain injury.

Summary: Although ILEs with the goal of reducing the levels of pro-inflammatory omega-6 fatty acids appear to confer some advantage in some settings (e.g. surgery), conclusive data on the superiority of one ILE over another are lacking. In particular, research is needed to compare different types of mixed-oil ILEs with each other and with pure fish oil ILEs.

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: 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 aim of this review is to outline recent studies relating to nutritional status and outcomes in pediatric end-stage liver disease.

Main findings: Pediatric patients with chronic and end-stage liver disease are at high risk of malnutrition. Given additional growth demands in children and the inherent complications of chronic liver disease, achieving adequate nutrition in these patients remains a challenge. In addition, while guidelines on nutrition in chronic liver disease exist, global approaches and definitions of malnutrition vary. Recent literature has focused on sarcopenia and nutrition-related transplant outcomes, with some studies exploring nutritional assessment and management. Pediatric studies however continue to lag adult research, with limited prospective and interventional studies.

Summary: Optimizing nutrition in pediatric end-stage liver disease remains a challenge, however understanding of the mechanisms and clinical manifestations of malnutrition in this population is improving. Despite these efforts, high quality studies to determine optimal nutrition strategies and interventions are lacking behind adult evidence and should be the focus of future research.

Purpose of review: Amino acids are critical to health, serving both as constituents of proteins and in signaling and metabolism. Amino acids are consumed as nutrients, supplements, and nutraceuticals. Much remains to be learned about amino acid function. Physiologically based pharmacokinetic and pharmacodynamic (PBPK-PD) modeling is an emerging tool for studying their complex biology. This review highlights recent PBPK-PD models developed to study amino acid physiology and metabolism and discusses their potential for addressing unresolved questions in the field.

Recent findings: PBPK-PD models provided several insights. They revealed the interplay between the mechanisms by which leucine governs skeletal muscle protein metabolism in healthy adults. The models also identified optimal dosing regimens of amino acid supplementation to treat sickle-cell disease and recurrent hypoglycemia, and to minimize drug side effects in seizure disorders. Additionally, they characterized the effects of novel anticancer drugs that seek to deprive cancer cells of amino acids. Future models may inform treatment strategies for sarcopenia, characterize distinctions between animal- and plant-based nutrition, and inform nutrient-drug interactions in Parkinson's disease.

Summary: PBPK-PD models are powerful tools for studying amino acid physiology and metabolism, with applications to nutrition, pharmacology, and their interplay.

Purpose of review: With obesity affecting over one billion people globally, understanding and managing this complex condition is more crucial than ever. This review explores the emerging role of GLP-1 receptor agonists (GLP-1RA) in weight management, focusing on their impact on energy balance. It highlights the necessity of this investigation due to the limited knowledge on both the short-term and long-term implications of GLP-1RA on energy expenditure (EE) and energy intake (EI).

Recent findings: GLP-1RA, such as liraglutide and semaglutide, have shown significant efficacy in promoting weight loss by reducing appetite, cravings and consequently, EI. Newer medications such as tirzepatide have demonstrated even greater weight loss success. Emerging evidence also suggests potential effects on EE, which could explain the greater weight loss success achieved with GLP-1 RA rather than typical lifestyle changes. However, comprehensive data on the total impact of these drugs on energy balance remain limited.

Summary: The findings underscore the promising role of GLP-1RA in obesity management, particularly through mechanisms influencing both EI and EE. Future research should focus on systematically measuring all components of energy balance to fully elucidate the mechanisms of GLP-1RA and optimize their therapeutic use for personalized medicine.

Purpose of review: The impact of vitamin D on improving insulin resistance in prediabetes remains controversial. The purpose of this review is to examine whether vitamin D supplementation improves insulin resistance in adults with prediabetes, and if so, to identify the mechanisms and the specific populations.

Recent findings: Global prevalence of prediabetes is increasing, and prevention is a critical issue because these people with prediabetes will develop type 2 diabetes soon, which will put pressure on healthcare costs. Recent evidence on the effectiveness of vitamin D administration in improving insulin resistance and preventing the onset of type 2 diabetes in adults with prediabetes has been accumulating. The 2024 updated clinical practice guideline of the American Diabetes Association states that vitamin D administration to patients with prediabetes potentially benefits type 2 diabetes incidence in specific populations. There are also reports that vitamin D administration improves insulin resistance via increased serum osteocalcin levels, a marker of bone turnover.

Summary: Vitamin D is likely to improve insulin resistance, which is already present at the time of prediabetes. However, the effectiveness may vary depending on ethnic differences and blood vitamin D levels at the start of administration.