Current Opinion in Clinical Nutrition and Metabolic Care最新文献

Purpose of review: Chronic small intestinal dysmotility is associated with a spectrum of malnutrition, varying in severity from mild nutritional compromise to intestinal failure requiring parenteral nutrition. Feeding patients with chronic small intestinal dysmotility is one of the most complex challenges in contemporary clinical gastroenterology. This review is timely due to rising diagnostic uncertainty reflected in increasing referrals for parenteral nutrition, and the growing awareness of overlapping high symptom burden but non-intestinal failure inducing disorders.

Recent findings: Whilst the pragmatic classification into chronic intestinal pseudo-obstruction (CIPO) and non-CIPO subtypes may help avoid unnecessary invasive investigations and provides insight into nutritional trajectory, this evolving approach requires careful navigation of the emerging diagnostic grey zone that encompasses highly symptomatic disorders of gut-brain interaction, disordered eating, and opioid-related bowel dysfunction that can result in pain/intolerance on small intestinal feeding. Feeding strategies must be tailored to phenotype and symptom burden, with enteral support prioritised wherever possible and parenteral nutrition reserved for clear cases of intestinal failure and/or for a temporising period of time when there is life-threatening nutritional risk. Effective management depends on early multidisciplinary input, optimisation of pharmacotherapy, and psychological assessment to guide appropriate nutritional therapies.

Summary: Individualised feeding strategies must weigh the risks of malnutrition against those associated with parenteral support, while also addressing symptom severity and maintaining oversight of the broader psychosocial context. This review reinforces the importance of early multidisciplinary team engagement, considered therapeutic approaches, and nuanced clinical reasoning in managing patients with chronic small intestinal dysmotility.

Purpose of review: This review examines the latest evidence and highlights the importance of personalized dietary therapies to augment conventional medical treatments in the treatment of inflammatory bowel disease.

Recent findings: Diversity in the maternal diet may reduce the risk of development of ulcerative colitis in utero, while a diverse diet during childhood may reduce the risk of future inflammatory bowel disease. During adulthood, the Mediterranean diet (MED) and Diet A Stop Hypertension may reduce the risk of developing inflammatory bowel disease, with some evidence to support that anthocyanin intake is a beneficial component of the diet. For dietary therapy for the maintenance of remission in Crohn's disease, it appears that the MED and simple carbohydrate diet and variations of this diet may be beneficial, although more trials are needed to confirm this.

Summary: the role of diet in preventing inflammatory bowel disease and treating symptoms continues to evolve and dietary changes may be considered in addition to medical therapy in the treatment of inflammatory bowel disease.

Purpose of review: Confusion and disagreement about malnutrition screening, how, when, why, who to screen, and which screening tool to use, have persisted since the Global Leadership Initiative on Malnutrition (GLIM) established the malnutrition diagnosis in 2019. In this review, we discuss the purpose of malnutrition screening, presents recent validations of screening tools and how the choice of tools affects malnutrition prevalence within the GLIM framework.

Recent findings: The screening for malnutrition should consider the results of recent validations of screening tools against the GLIM criteria, which reveal variations based on the specific tool, the population, and the setting. Likewise, the prevalence of malnutrition varies with the population and setting, and even how screening tools are applied in the process. Currently, all screening tools exclude patients who meet the GLIM criteria for a malnutrition diagnosis, but the extent of exclusion varies.

Summary: In this review, we summarize recent prevalence and validation studies on screening tools related to GLIM. We argue that screening tools should align with GLIM malnutrition diagnosis criteria, need to be validated against GLIM, and discuss the requirement that a positive screening result is mandatory for a malnutrition diagnosis.

Purpose of review: The "One Size fits All" nutritional approach, mainly using the patient's weight, has been challenged by recent progress allowing healthcare professionals to better define energy needs and determine body composition.

Recent findings: The Global Leadership Initiative on Malnutrition (GLIM) assessment has been recognized as a reliable tool for diagnosing malnutrition in the ICU. Complementing this approach, advancements in techniques for evaluating lean muscle mass, such as dual-energy biomarkers and computed tomography (CT), have improved the accuracy of muscle mass determination. When conducted by experienced practitioners, ultrasound offers a fast, reliable, and reproducible method for assessing muscle mass. Additionally, bioelectrical impedance analysis (BIA) has benefited from technological and methodological improvements, allowing the use of body cell mass as a guide for protein administration. Energy expenditure is most accurately measured using indirect calorimetry, which should be performed regularly due to day-to-day fluctuations and prevent the risks of overfeeding or underfeeding.

Summary: All these progresses are paving the way to precision nutrition in intensive care, determining more accurately the energy needs and adapting the macronutrient administration according to body composition and not anymore by kilogram weight.

Purpose of review: Cachexia, and cancer-induced cachexia in particular, pose a significant clinical challenge, given its complex etiology, late diagnosis and limited treatment options available today. With advances in precision oncology and systemic metabolic assessment, this review explores the potential of [ 18 F]fluorodeoxyglucose positron emission tomography combined with computed tomography ([ 18 F]FDG-PET/CT) - already integral to cancer patient management - to assess cachexia-related metabolic alterations beyond tumor detection.

Recent findings: Growing evidence suggests that [ 18 F]FDG-PET/CT can capture early metabolic dysfunction in cachexia-affected tissues (e.g., muscle, adipose tissue, liver and heart), often preceding overt weight loss. These metabolic shifts may serve as novel biomarkers for early identification and monitoring. Integrating PET-derived data with automated CT-based body composition analysis could provide a more holistic view of systemic metabolic derangements. However, current evidence relies largely on retrospective or heterogeneous studies.

Summary: Prospective trials in well defined patient populations are needed to validate PET/CT imaging for the management of patients with cachexia. If proven effective, this approach could expand the role of PET/CT from tumor-centric imaging to a broader metabolic assessment platform, thus, enhancing supportive care in oncology.

Purpose of review: To critically evaluate the latest evidence on the weight-loss effects of chrono-nutrition, culminating in identification of remaining gaps in the literature and future recommendations.

Recent findings: There appear to be six articles on this topic published over the past 2 years that have ostensibly examined the weight-loss effects of chrono-nutrition strategies relative to comparator conditions involving standard eating patterns in which meal timing is not manipulated. Some of those studies have concluded that TRE may be superior to standard energy restriction for weight-loss but the data presented do not consistently support that inference.

Summary: Chrono-nutrition strategies remain a popular dietary approach to weight-loss and yet there is a paucity of primary data showing that these strategies are more effective than any other means of eliciting a negative energy balance but without altering daily eating patterns.

Purpose of review: Sarcopenic obesity is a clinical condition characterized by the coexistence of excess adiposity and impaired muscle function, associated with heightened cardiometabolic risk and frailty. The emergence of new incretin-based obesity management medications (OMMs), which allow unprecedented weight loss, has raised concerns regarding weight loss-induced fat-free mass (FFM) reduction, including skeletal muscle mass (SMM). This review examines recent findings on the prevalence, diagnosis, and implications of sarcopenic obesity, explores the effects of weight-loss interventions on body composition and their impact on health, and discusses strategies to preserve muscle mass.

Recent findings: Weight loss induced by incretin-based OMMs results in a variable but significant reduction in FFM. The extent to which this loss affects SMM and function remains uncertain. Nutritional strategies, particularly adequate protein intake, and structured exercise interventions, especially resistance training, play a key role in mitigating FFM loss. Digital health interventions and telemedicine-based exercise programs offer promising approaches for maintaining muscle health during weight loss.

Summary: The clinical significance of FFM loss during weight reduction remains debated. Future research should refine sarcopenic obesity diagnostic criteria, assess the long-term impact of FFM/SMM reduction during intentional weight loss, and evaluate interventions that optimize body composition while preserving functional health.

Purpose of review: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a highly prevalent condition that can progress to fibrosis, steatohepatitis, and hepatocellular carcinoma. This review examines recent advances concerning the role of gut microbiota in MASLD and microbiota-focused interventions to positively impact disease outcome.

Recent findings: Dysbiotic microbiota and a compromised gut barrier facilitate the translocation of microbial-associated molecular patterns and harmful metabolites into the portal circulation and liver, where they exacerbate inflammatory and fibrogenic processes. Conversely, other bacterial metabolites have protective effects in the liver. Therefore, microbiota homeostasis is essential for maintaining liver health.

Summary: Levels of harmful bacterial metabolites including ethanol, NH 3 , trimethylamine-L-oxide, 2-oleylglycerol, and litocholic acid are often increased in patients with MASLD. Conversely, short-chain fatty acids, indole derivatives, histidine, and the acids taurodeoxycholic, 3-succinylcholic, and hyodeoxycholic are decreased. The main aim of current interventions/treatments is to reduce harmful metabolites and increase beneficial ones. These interventions include drugs (pemafibrate, metformin, obeticholic acid), natural compounds (silymarin, lupeol, dietary fiber, peptides), exogenous bacteria (probiotics, gut symbionts), special diets (Mediterranean diet, time-restricted feeding), as well as microbiota transplantation, and phage therapy. Most improve gut permeability, liver inflammation, and fibrosis through microbiota regulation, and are promising alternatives for MASLFD management. However, most results come from animal studies, while clinical trials in MASLD patients are lacking. Further research is therefore needed in this area.