Current Opinion in Clinical Nutrition and Metabolic Care最新文献

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.

Purpose of review: To describe typical amino acid signatures for cardiometabolic risk and to discuss whether such signatures are a cause or merely a consequence of increased cardiometabolic risk.

Recent findings: Recent studies confirm the association between plasma amino acid levels and cardiometabolic risk across different populations and for multiple cardiometabolic traits, highlighting the value of plasma amino acid signatures as biomarkers. Preclinical studies targeting branched-chain amino acid (BCAA) catabolism show the potential of this novel strategy to improve cardiometabolic health.

Summary: Elevated plasma BCAA, aromatic amino acid (AAA), glutamate, low glycine, and a reduced glutamine-to-glutamate ratio are consistently linked to higher cardiometabolic risk, with impaired BCAA metabolism playing a bidirectional role in insulin resistance. Targeting BCAA catabolism may help lower BCAAs and their metabolites, offering a potential strategy to reduce cardiometabolic risk.

Purpose of review: Older adults with cancer are a vulnerable population at heightened risk of malnutrition. Given its association with adverse outcomes, and the growing burden of cancer with an ageing population, this review summarizes key practical considerations when managing malnutrition in this cohort.

Recent findings: Malnutrition in this cohort is driven by cancer-related, treatment-related, age-related and patient-related factors. This can lead to nutrition impact symptoms (NIS) that propagate the development of cancer cachexia, sarcopenia, and frailty, and adversely affect prognosis and quality of life. To mitigate these complications, early and repeated screening and assessment for malnutrition and its associated syndromes with validated tools should be embedded within a multidisciplinary framework. Interventions should involve regular education of the individual and their caregiver(s), underpinned by exercise and individualized dietary counselling with consideration of nutritional supplementation. This should be supported by strategies to mitigate NIS, with consideration of the psychosocial determinants of malnutrition that can often be unique to this cohort.

Summary: Older adults with cancer require multidisciplinary strategies for the management of malnutrition. Systematic screening and individualized interventions may improve prognosis and quality of life. Practical considerations reviewed here should refine best-practice onco-geriatric models, ensuring nutrition is integrated into standard care.

Purpose of review: to present recent data on amino acid requirements in older adults determined by the minimally invasive indicator amino acid oxidation (IAAO) method, and to compare them to current recommendations derived from young adult data.

Recent findings: using the minimally invasive IAAO method we estimated the requirements for leucine, lysine and Sulphur amino acids (SAA) in older adults. The leucine requirement for older adults is more than twice the current recommendations. A sex effect on SAA requirement demonstrates an increased requirement in males compared to females which represent a >70% higher estimate for older males compared to current recommendations. For lysine, there is both an age and sex effect with older females >70 years requiring close to 50% more lysine than current recommendations.

Summary: Amino acid requirements for older adults derived using the minimally invasive IAAO method demonstrated a higher requirement for key indispensable amino acids in older adults compared to current recommendation. Since amino acid requirements are a necessary consideration when assessing protein quality, these results highlight the need for a separation of the amino acid recommendations between young and older adults for improved assessment and prescription of diets for older adults.

Purpose of review: Protein digestion and amino acid absorption kinetics are quantifiable metrics commonly utilized to determine the quality of a protein source. This review critically evaluates recent evidence (primarily from studies that provided commonly consumed protein-rich foods) regarding the relationship between in vivo protein digestion and amino acid absorption rates with the postprandial stimulation of muscle protein synthesis (MPS), with an emphasis on healthy adults and critically ill patients.

Recent findings: Ingested protein sources that elicit moderate amino acid bioavailability, including leucine, stimulate MPS rates to a comparable extent as protein sources that elicit high amino acid bioavailability in healthy young adults. Amino acid absorption kinetics appear to be modulated in critically ill patients, leading to a marked reduction in postprandial MPS rates. Preliminary studies demonstrate that enteral feeding of high dose free amino acids increase amino acid bioavailability to a greater extent than intact protein, leading to a positive whole-body net protein balance in critically ill patients. However, in practice, the high osmolarity of free amino acids leads to a high prevalence of diarrhoea and thus limits the clinical application of this intervention.

Summary: The enteral provision of free amino acids represents a theoretical, but not practically-relevant, clinical nutrition strategy to mitigate the catabolic response to critical illness. Future studies are warranted to establish targeted protein/amino acid-based interventions to mitigate skeletal muscle atrophy during the metabolic care of critically ill patients.

Purpose of review: Gut microbiome is increasingly recognized as a modulator of the biology of aging. Several preclinical studies suggest that dysbiosis, typically arising in the older age, is associated with osteoporosis and sarcopenia. This review examines the recent findings on the mechanistic aspects of the gut-bone and gut-muscle axes in aging and provides a critical overview on their translation to clinical practice.

Recent findings: Gut microbiome can modulate the pathophysiology of osteoporosis and sarcopenia through multiple mechanisms, particularly involving the production of bioactive mediators such as short-chain fatty acids (SCFAs), bile acids and tryptophan metabolites. Dysbiosis increases the risk of osteoporosis, fragility fractures and muscle wasting, with possible sex-specific differences, but the definition of GM traits associated with each condition is inconsistent across studies. Short-term microbiome-modifying treatments, including probiotics and functional foods, slowed down the age-related decline in bone mineral density and improved muscle function in a handful of small-sized clinical studies.

Summary: Gut microbiome remains a very promising therapeutic target against osteoporosis and sarcopenia, but no recommendations can be made for clinical practice at the current state-of-art. Microbiome-targeted strategies may soon emerge as valuable adjuvant therapies in the management of age-related musculoskeletal decline.

Purpose of review: Although survival after critical illness has improved, many intensive care unit (ICU) survivors experience persistent muscle wasting, malnutrition and functional decline - all of which are key components of postintensive care syndrome (PICS). This review discusses the metabolic and nutritional challenges faced after ICU discharge, explaining why addressing these issues through personalized recovery strategies is both timely and clinically relevant.

Recent findings: Recent evidence shows that ICU survivors typically achieve 50-60% of their energy and protein requirements during the recovery phase, particularly after transfer from the ICU to the ward. As, the energy expenditure remains elevated, the energy imbalance may worsen after discharge from the ICU. Factors contributing to this imbalance include hypercatabolism, dysphagia, immobilization and hormonal disturbances. Emerging studies suggest that phased, personalized nutrition, guided by dietitians and supported by early mobilization and metabolic monitoring, can improve outcomes. Research has shown that personalized nutritional support reduces mortality and complications in hospitalized patients.

Summary: Optimizing nutrition from the ICU through to posthospital recovery is essential for restoring muscle mass, reducing disability and enhancing quality of life. Multimodal, personalized nutrition strategies combined with rehabilitation are the cornerstone of post-ICU recovery and should be a major focus of future clinical research and implementation.

Purpose of review: Child malnutrition in low-and-middle-income countries remains persistently high, driven by converging biological, social, economic, environmental, and conflict-related factors. As progress slows and vulnerabilities intensify, this review synthesises emerging evidence from recent years to identify effective strategies and future directions for reducing undernutrition in resource-constrained settings.

Recent findings: Recent literature demonstrates that nutrition-sensitive interventions, including women's empowerment, social protection, WASH, immunisation, kitchen gardens, and biofortification, address key underlying drivers of child malnutrition and contribute to improved growth and dietary diversity. Building on these foundations, nutrition-specific strategies such as antenatal micronutrient supplementation, optimal infant and young child feeding practices, fortified complementary foods, and emerging approaches like microbiota-directed foods and fermentation have shown measurable gains in growth and nutritional status. Across the evidence base, integrated and multisectoral delivery models consistently outperform standalone programs, with particularly strong results when nutrition is combined with health services, social protection, community-based platforms, or climate- and conflict-responsive strategies.

Summary: Current evidence underscores a shift toward integrated, layered, and context-responsive programming as the most effective path to reducing child malnutrition. Future research should prioritise implementation models that bridge nutrition-specific and nutrition-sensitive domains, strengthen health and community systems, and adapt to climate and humanitarian pressures.

Purpose of review: Probiotics are widely used in paediatrics, but efficacy varies by strain and indication. In 2023, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Special Interest Group on Gut Microbiota and Modifications issued strain-specific recommendations for gastrointestinal disorders. This review summarises studies published since 2024 to assess whether new evidence warrants changes to these recommendations.

Recent findings: Lacticaseibacillus rhamnosus GG (LGG) and Saccharomyces boulardii are recommended for preventing antibiotic-associated diarrhoea. LGG, S. boulardii, Limosilactobacillus reuteri DSM 17938, or the combination of L. rhamnosus 19070-2 and L. reuteri DSM 12246 may be considered in acute gastroenteritis. For infant colic, recommendations include L. reuteri DSM 17938 or Bifidobacterium lactis BB-12 in breast-fed infants; for functional abdominal pain, L. reuteri DSM 17938 or LGG. No probiotics are recommended for constipation. For prevention of necrotising enterocolitis, weak recommendations include LGG or a combination of B. infantis BB-02, B. lactis BB-12 and Streptococcus thermophilus TH-4. There is no recommendation for or against probiotic-supplemented formulas.

Summary: Recent trials have not provided sufficient evidence to justify changes to the ESPGHAN recommendations. Evidence for probiotic use in paediatrics is confined to a few strains and indications. Larger multicentre studies with standardised preparations and clearly defined outcomes are still needed.