Current Opinion in Clinical Nutrition and Metabolic Care最新文献

Purpose of review: There is a growing interest in plant-derived natural products as alternative means to manage chronic diseases. Terpenes represent a category of phytochemicals with several favourable effects including antioxidant and anti-inflammatory. The aim of this review is to explore the current understanding of how terpenes influence metabolism including glucose, lipid and amino acid and to discuss implications of these effects.

Recent findings: Although most of the scientific evidence is derived from in vitro and animal studies, the effects of terpenes on metabolism have been also evaluated in limited human studies. In regard to the effects of terpenes on glucose metabolism they seem to interact with insulin signalling pathways, increase glucose uptake, inhibit enzymes and regulate the adenosine monophosphate-activated protein kinase (AMPK) pathway. Similarly, terpenes may contribute to modulation of key enzymes and genes involved in lipid metabolism. Their effects on amino acids metabolism are not well understood but it seems that some terpenes can modulate amino acid levels in the plasma, potentially influencing metabolic pathways related to protein synthesis, gene expression, and intracellular protein turnover.

Summary: These effects can have significant implications for the management of chronic diseases such as diabetes and cardiovascular disease, as well as cancer, which is characterised by metabolic reprogramming. However, large-scale human studies are needed to conclude on terpenes effectiveness, safety and suitable dosage for favourable effects.

Purpose of review: (Poly)phenols are bioactive compounds in plant-based foods with well documented health benefits. Their metabolism in dependent on gut microbiota composition, diversity, and function, which modulate their bioavailability and physiological effects. This review examines recent insights into (poly)phenol-gut microbiota interactions, emphasizing their relevance in mediating health benefits and mechanisms of action.

Recent findings: Recent studies have identified a high interindividual variability in (poly)phenol metabolism, explored microbial-derived metabolites with potential health benefits, and revealed bidirectional influences between (poly)phenols and gut microbiota composition. Advances in analytical techniques and large-scale studies have refined our understanding of these interactions, but inconsistencies remain in linking specific microbial signatures to health outcomes.

Summary: Standardized methodologies and long-term studies are needed to clarify the impact of (poly)phenol-derived metabolites on human health. Future research should focus on personalized and targeted nutrition approaches to optimize (poly)phenol benefits.

Aim of the review: Weight loss is a primary goal in the treatment of obesity, but its effect on body composition - particularly fat-free mass (FFM) and skeletal muscle mass (SM) - is of increasing concern. This review examines the effects of antiobesity medications, particularly glucagon-like peptide-1 receptor analogs (GLP-1 RA), on body composition, the risk of sarcopenia, and strategies to preserve muscle mass during pharmacological weight loss.

Recent findings: Studies have shown that while GLP-1 RA are effective in reducing fat mass, up to 40% of the total weight loss can come from FFM. However, it is important to distinguish between FFM and SM, as FFM includes nonmuscle components. Resistance training and adequate protein intake can mitigate muscle loss, but the evidence for their efficacy in the context of GLP-1 RA therapy is mixed. If these measures are insufficient to prevent and maintain muscle mass, the use of some nutrients, such as branched chain amino acids, creatine, leucine, omega-3 fatty acids and vitamin D, may be beneficial. Newer pharmacological approaches, such as bimagrumab, a human monoclonal antibody that acts by binding to the activin type II receptor II (ActRII), and other activin or myostatin inhibitors, show promise in preserving muscle mass while promoting fat loss.

Summary: GLP-1 RA therapy for obesity should include resistance training, optimal protein intake and, if needed, specific nutrients and possibly pharmacological interventions to preserve muscle mass. Further research is needed to assess the long-term effects of GLP-1 RA on muscle health and to refine strategies to prevent sarcopenia in patients undergoing pharmacological weight loss.

Purpose of review: The prevalence of women entering pregnancy with overweight or obesity is increasing which raises concerns for adverse outcomes for mothers and their infants. Evidence suggests that appropriate gestational weight gain is important, irrespective of maternal BMI. The aim of this present article is to review the evidence on weight management during pregnancy and evaluate the evidence on current interventions.

Recent findings: There is currently no standardized definition of 'excessive' gestational weight gain or a unified approach to manage gestational weight, despite the rising prevalence of maternal overweight and obesity globally. Recently, the Dietary Intervention in Gestational Diabetes (DiGest) trial showed promising results for energy restriction as a potential strategy to reduce gestational weight gain and improve maternal and infant outcomes. Pharmacological treatments, including GLP-1 receptor agonists, also show promise, but safety concerns remain requiring further research. More studies are needed to assess the effectiveness of both lifestyle and pharmacological interventions to guide future clinical recommendations.

Summary: There is a need for individualized guidelines that consider maternal characteristics including ethnicity, preexisting conditions and emerging health risks, to tackle weight management during pregnancy and improve pregnancy outcomes. Further research is needed on optimal weight management strategies during pregnancy.

Purpose of review: As global life expectancy increases, age-related neurodegenerative conditions such as dementia impose an increasing public health and socioeconomic burden. Maintaining a healthy lifestyle, particularly through a healthy diet, may reduce cognitive decline and support cognitive performance in aging populations. Despite increasing interest in dietary interventions as a strategy to enhance cognitive performance, research findings remain inconclusive. This narrative review aims to synthesize evidence on the longer-term effects (published February 2023-October 2024) and underlying mechanisms of dietary intervention strategies on cognitive performance in adults with preexisting cognitive impairment.

Recent findings: Recent evidence from randomized controlled trials suggests that both single- and multifactor dietary interventions may improve one or more cognitive domains in aging adults with preexisting cognitive impairment. However, variability in intervention types, durations, and participant characteristics limits the ability to draw definitive conclusions.

Summary: This review highlights the potential benefits of longer-term dietary interventions on cognitive performance in adults with cognitive impairment. It further integrates emerging mechanistic insights, suggesting that specific dietary components may exert neuroprotective effects primarily by reducing oxidative stress and neuroinflammation, and by enhancing brain vascular function. These mechanisms may promote neuroplasticity through the modulation of neurotrophic signaling pathways. Future research should focus on replicating these findings to validate their efficacy and the underlying mechanisms involved. This is essential for integrating dietary approaches into evidence-based guidelines for promoting long-term cognitive health.

Purpose of review: In people living with kidney disease (KD) Fatigue is a whole-body tiredness that is not related to activity or exertion. Often self-reported, fatigue is a common and highly burdensome symptom, yet poorly defined and understood. While its mechanisms are complex, many fatigue-related factors may be altered by exercise and physical activity intervention. Thus, this review aims to review the latest research on exercise in reducing fatigue in people living with KD.

Recent findings: The benefits of exercise in KD are well known, yet recent data from clinical trials on fatigue are scarce. Favourable effects on fatigue were found through a myriad of physical activity and exercise-based interventions, including using exercise-based video games, exercise during dialysis, nurse-led exercise programs, and home-based exercise delivered by a novel digital health intervention. Yet, whilst the handful of recent trials show positive efficacy on fatigue across the spectrum of KD, contemporary exercise-based research was impacted critically by COVID-19, and the field is limited by underpowered trials and heterogeneity of assessment tools.

Summary: Fatigue remains, at best, a secondary outcome measure in trials despite it being the most commonly reported symptom in KD. Given its importance to the people it impacts most, better quality evidence is needed to fully understand and optimize the impact of exercise in this group.

Purpose of review: Iron deficiency (ID) affects one in five children before they reach preschool age. Existing evidence on ID contributing to suboptimal development and neurodevelopmental disorders come mostly from mechanistic and observational studies. Recommendations for screening and treatment are diverging, emphasizing the knowledge gap. The purpose of this review is to summarize recent evidence on ID in infants and children, its possible role in developmental disorders, and effects of iron supplementation.

Recent findings: Recent well powered randomized controlled trials showed no effect of early iron supplementation on psychomotor development in infants, neither in populations at high nor low risk of ID. Treatment of nonanemic ID in children 1-3 years did not improve their cognitive scores. Evidence from observational and imaging studies suggests association of brain ID and attention deficit hyperactivity disorder in children (ADHD).

Summary: Universal prophylactic iron supplementation in infants is not supported by current evidence. Whether non anemic ID needs to be treated is uncertain and so is the legitimacy and timing of screening for ID and anemia. The role of ID and iron availability for the brain in pathogenesis of neurodevelopmental conditions such as ADHD requires further studies.

Purpose of review: Since the introduction of the prehabilitation concept for optimizing functional capacity before surgery 20 years ago, evidence and interest has grown considerably. This review summarizes the recent evidence and proposes questions for prehabilitation with special regard to the nutritional component.

Recent findings: Several meta-analyses of multimodal prehabilitation (exercise, nutrition, and psychological support) have been published recently. These reviews suggest that preoperative conditioning can improve functional capacity and reduce the complication rate for many patient groups (risk of bias: moderate to low). A prerequisite is the identification of high-risk patients using suitable screening and assessment tools. Additionally, there are currently no standardized, clear recommendations for the organization and implementation of prehabilitation programs. The programs vary greatly in duration, content, and outcome measurement. Although the preoperative nutrition interventions enhanced outcomes consistently, there was no clear evidence for which nutritional intervention should be applied to whom over consistent time frame four to six weeks (timeframe consistent with most prehabilitation programs).

Summary: To advance our understanding of which prehabilitation interventions work best, how they work, and for whom they work best, additional low risk of bias and adequately powered trials are required. Nevertheless, our review presents evidence that prehabilitation should be offered before major surgery on a risk-stratified basis.