Current Opinion in Clinical Nutrition and Metabolic Care最新文献

Purpose of review: Type 2 diabetes is a complex and multifactorial disease with dietary treatment often recommended as the first line management strategy. Whilst caloric restriction remains the most-effective means of obtaining diabetes remission, high-protein diets (25-35% of energy intake) have garnered interest for their potential role in optimizing postprandial and longer-term glycaemic control. High-protein diets are not currently an established recommendation for people with diabetes and here we discuss the recent evidence for high-protein diets and glycaemic control.

Recent findings: This review highlights the evidence demonstrating improved postprandial glycaemia after acute protein ingestion due to increased insulin secretion, and whether this translates into longer-term dietary intervention trials. The impact of the source of protein is clear within acute postprandial studies, but appears less relevant over longer periods. We also discuss the caveats surrounding high-protein diets, including the weight-loss independent benefits and the accompanying reduction in dietary carbohydrate.

Summary: High-protein diets, in combination with a reduction in carbohydrate intake, may be a useful dietary strategy in the management of glycaemic control in people with type 2 diabetes.

Purpose of review: Muscle loss during hospitalization is a major clinical concern, as it has been associated with reduced physical function, quality of life, and increased mortality. This review outlines the key causes of muscle wasting and highlights practical strategies to support muscle mass preservation during hospitalization.

Recent findings: Physical inactivity, along with reduced energy and protein intake, are the primary drivers of muscle atrophy during hospitalization by suppressing muscle protein synthesis (MPS). Maintaining energy balance is critical to prevent declines in MPS rates and attenuate muscle loss. Preserving habitual protein intake is essential and, when total energy intake is reduced, should be achieved through a more protein-dense diet. Preventing disuse atrophy requires at least some level of daily physical activity. Physical activity sensitizes skeletal muscle to the anabolic properties of protein ingestion, enabling greater use of protein-derived amino acids for MPS. Therefore, frequent in-hospital movements, such as bed-to-chair transfers and walking, should be encouraged. When voluntary activity or muscle contractions are impossible, exercise mimetics, like neuromuscular electrical stimulation, may be applied to stimulate muscle activity and limit muscle mass loss.

Summary: Preserving muscle mass during hospitalization requires a multimodal approach: achieving energy balance, maintaining protein intake, minimizing muscle disuse, and, whenever necessary, apply exercise mimetics.

Purpose of review: The ketogenic diet has gained renewed attention as a nutritional intervention across a range of chronic diseases. This review evaluates the recent clinical evidence supporting ketogenic diet applications beyond epilepsy, with a focus on cardiometabolic, neurodegenerative, psychiatric, and oncological conditions.

Recent findings: Ketogenic diet improves insulin sensitivity and glycemic control in obesity and type 2 diabetes, effect that are partly attributable to weight loss, but also include reduced postprandial glucose excursions, lower insulin levels, and altered substrate metabolism. In neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease, ketogenic diet may increase substrate availability, cerebral perfusion and cognition function. Preliminary data from uncontrolled studies suggests potential benefits in severe mental illness. In oncology, ketogenic diet may influence tumor metabolism via glucose restriction, but clinical efficacy as an adjunct therapy remains unproven. Across studies, conclusions are limited by short intervention durations, inconsistent protocols, low dietary adherence, and high interindividual variability in metabolic response.

Summary: Although emerging data suggest therapeutic potential of ketogenic diet across several conditions, routine clinical implementation is premature. Future trials should employ standardized dietary protocols and assess long-term, clinically relevant outcomes to establish safety and efficacy.

Purpose of review: Frailty, a prevalent geriatric condition marked by reduced physiological reserve and greater vulnerability to stressors, is increasingly linked to mitochondrial dysfunction. This review summarizes current evidence on mitochondrial quality control, bioenergetics, and signaling in frailty, with emphasis on biomarker discovery and translational potential.

Recent findings: Preclinical and human studies have shown that impaired mitochondrial biogenesis, altered dynamics, and defective mitophagy contribute to frailty, sarcopenia, and immune dysregulation. Frail older adults exhibit reduced mitochondrial DNA content, diminished mitochondrial respiratory capacity, elevated reactive oxygen species generation, and distinctive metabolomic changes. Potential biomarkers include mitochondria-derived vesicles, circulating metabolites, and measures of peripheral blood mononuclear cell respiration, which may enable early detection of functional decline. Multivariate profiling approaches have identified sex-specific and shared molecular signatures converging on mitochondrial pathways. Interventions promoting mitochondrial health, including resistance training and targeted immunomodulation, hold promise in slowing frailty progression.

Summary: Mitochondrial dysfunction lies at the intersection of musculoskeletal, metabolic, and immune changes underpinning frailty. While integrative biomarker panels have defined metabolic signatures, early diagnosis and personalized therapies remain unmet needs. Longitudinal studies are required to establish causality, refine biomarker utility, and guide precision medicine strategies to preserve mitochondrial function, extend healthspan, and improve quality of life in aging populations.

Purpose of review: Systemic inflammation represents a complex, widespread physiological response initiated by the body in response to various noxious stressors, including infections, trauma, surgery, and chronic diseases. The assessment of systemic inflammation relies on a spectrum of measurable biological indicators.This review evaluates the current evidence on several systemic inflammation biomarkers, including the traditional Glasgow Prognostic Score (GPS) and other emerging indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI).

Recent findings: Several simple biomarkers can assess systemic inflammation, each with specific strengths and limitations. The GPS is a well validated index in oncology and is increasingly being used in cardiovascular disease, integrating inflammatory and nutritional status. Blood count-derived ratios such as NLR, PLR, LMR, SII, and SIRI are widely available and have shown prognostic value across different clinical conditions. Current evidence supports their use in risk stratification and clinical decision-making, though interpretation should always consider the overall clinical picture.

Summary: Inflammation biomarkers like GPS, NLR, PLR, LMR, SII, and SIRI offer accessible tools for risk stratification, with clinical utility varying by context and requiring further standardization.

Purpose of review: Bioelectrical impedance analysis (BIA) is a widely used, noninvasive method for assessing body composition. Recent technological advances have diversified BIA devices in terms of measurement frequency, electrode configuration, and portability. This review outlines key criteria for selecting a BIA system according to clinical or research needs.

Recent findings: Single-frequency BIA (SF-BIA) devices, typically consumer-grade with hand-to-hand or foot-to-foot configurations, are affordable and easy to use but often lack raw data access, clinical validation, and regulatory certification. In contrast, multifrequency BIA (MF-BIA) systems, especially octopolar models, enable segmental analysis and provide greater accuracy for evaluating fluid distribution and lean mass. However, they are costlier, depend on proprietary algorithms, and generally require standing measurements. In hospital settings, portable MF-BIA devices that allow supine, tetrapolar or octopolar assessments are preferable, particularly for use with bedridden patients. Across all contexts, standardized measurement protocols and access to raw parameters ( Z , R , Xc, PhA) are essential to apply accurate, population-specific predictive equations.

Summary: Reliable use of BIA requires careful consideration of device type, data accessibility, and methodological consistency. Portable, regulatory-certified MF-BIA systems with tetrapolar or octopolar configurations and access to raw data offer the most accurate and adaptable solutions for clinical and research applications.

Purpose of review: To examine in the light of recent data whether diets low in FODMAPs (a now classic exclusion diet for treatment for IBS: irritable bowel syndrome) have shown interest/efficacy in diseases of the digestive tract (beyond IBS) manifesting as diarrhea.

Recent findings: Very little good quality data or publications are available in recent medical literature. It is therefore difficult to estimate that the low FODMAP diet can be considered with a good level of confidence outside of IBS except in borderline symptomatic forms or with associated pathophysiology (e.g. IBD: inflammatory bowel disease).

Summary: There is a lack of quality data on the benefits, safety and value of LFD, outside of IBS. This is particularly the case in the majority of organic digestive diseases, notably with diarrhea, unless accompanied by dysregulation of the intestine-brain axis (and so with IBS symptoms), for example in post-inflammatory situations. When effective, which is currently highly unpredictable, the mechanism of action remains poorly understood.

Purpose of review: Many clinical trials have failed to demonstrate the superiority of one nutritional protocol over another. This raises questions about the assessment tools used. In particular, intention-to-treat data analysis can mask individual truths, especially in cases of protocol noncompliance. If patients do not always achieve their nutritional goals, an intention-to-treat analysis tends to conclude that the two protocols studied are no different.

Recent findings: This is particularly the case in two recent articles published in The Lancet, where patients failed to achieve the predefined protein target in intensive care patients due to protocol deviation.

Summary: I argue here for further analysis, including per-protocol analysis, to avoid the false conclusion that failure to show a difference means there is no difference.

Purpose of review: Skeletal muscle mass is essential for mobility, physical performance, and disease prevention, serving as a predictor of morbidity and mortality, particularly in sarcopenia. Muscle mass decreases with age and is associated with adverse clinical outcomes. Accurate assessment is crucial in clinical practice but presents challenges.

Recent findings: Imaging methods like MRI, DXA, computed tomography (CT), ultrasound, and other techniques like bioelectrical impedance analysis (BIA) are effective but have limitations such as cost, accessibility, and operator dependency. Anthropometric measures - such as calf circumference, mid-upper arm circumference (MUAC), forearm, and thigh circumference - are simple, low-cost alternatives that correlate well with muscle mass, though they can be influenced by factors like age, sex, and body fat. Adjusted measures using skinfold thickness improve accuracy but are less reliable in older adults. Prediction equations based on anthropometry can estimate total muscle mass but must be validated for specific populations. In complex cases like obesity or malnutrition, equations that incorporate biochemical markers or dynamometry may enhance precision.

Summary: Overall, selecting the appropriate muscle mass assessment method requires consideration of population characteristics, available resources, and proper professional training to ensure accurate and clinically useful results.