Current Opinion in Clinical Nutrition and Metabolic Care最新文献

Purpose of review: Cancer patients may have a variety of disorders associated with systemic inflammation caused by disease progression. Consequently, we have protein hypercatabolism. In view of this, protein and amino acid adequacy should be considered in relation to nutritional behavior. Therefore, this review aims to evaluate the influence of protein and amino acids in the nutritional therapy of cancer.

Recent findings: Diets with adequate protein levels appear to be beneficial in the treatment of cancer; guidelines suggest consumption of greater than 1.0-1.5 g/kg body weight/day. In patients diagnosed with malnutrition, sarcopenia, or cachexia, it is recommended to use the maximum amount of protein (1.5 g/kg of weight/day) to adapt the diet. In addition, based on the evidence found, there is no consensus on the dose and effects in cancer patients of amino acids such as branched-chain amino acids, glutamine, arginine, and creatine.

Summary: When evaluating the components of the diet of cancer patients, the protein recommendation should be greater than 1.0-1.5 g/kg of weight/day, with a distribution between animal and vegetable proteins. We found little evidence demonstrating clinical benefits regarding individual or combined amino acid supplementation. Still, it is unclear how the use, dose, and specificity for different types of cancer should be prescribed or at what stage of treatment amino acids should be prescribed.

Purpose of review: The aim of this review is to provide an overview of the use of commercial wrist-worn mobile health devices to track and monitor physiological outcomes in behavioral interventions as well as discuss considerations for selecting the optimal device.

Recent findings: Wearable technology can enhance intervention design and implementation. The use of wrist-worn wearables provides the opportunity for tracking physiological outcomes, thus providing a unique approach for assessment and delivery of remote interventions. Recent findings support the utility, acceptability, and benefits of commercial wrist-worn wearables in interventions, and they can be used to continuously monitor outcomes, remotely administer assessments, track adherence, and personalize interventions. Wrist-worn devices show acceptable accuracy when measuring heart rate, blood pressure, step counts, and physical activity; however, accuracy is dependent on activity type, intensity, and device brand. These factors should be considered when designing behavioral interventions that utilize wearable technology.

Summary: With the continuous advancement in technology and frequent product upgrades, the capabilities of commercial wrist-worn devices will continue to expand, thus increasing their potential use in intervention research. Continued research is needed to examine and validate the most recent devices on the market to better inform intervention design and implementation.

Purpose of review: This review examines recent developments in our understanding of iron regulation/absorption around exercise, with specific attention paid towards the female athlete.

Recent findings: Building on the well accepted knowledge that hepcidin concentrations increase in the 3-6 h period following an acute bout of exercise, recent studies have shown that this links to a reduced fractional iron absorption from the gut during feedings provided 2 h postexercise. Further, a window of enhanced iron absorption has recently been identified to occur 30 min either side of exercise commencement/completion, which allows for strategic iron intake to optimize absorption around exercise. Finally, there is burgeoning evidence to show that iron status and iron regulation change throughout the menstrual cycle and with hormonal contraceptive use, which could have implications for iron status in female athletes.

Summary: Exercise can affect iron regulatory hormone activity, which subsequently impairs iron absorption, potentially contributing to the high rates of iron deficiency seen in athletes. Future research should continue to examine strategies to optimize iron absorption, with consideration to the timing, mode and intensity of exercise, the time of day, and in females, the menstrual cycle/menstrual status.

Purpose of review: Metabolic syndrome (MetS) refers to a group of risk factors, which increase the risk of cardiovascular disease (CVD), type 2 diabetes (T2D), and other chronic diseases. Dietary fiber has been shown to mitigate many of the effects of various risk factors associated with MetS. Our review summarizes the recent findings on the association between dietary fiber deficiency and MetS.

Recent findings: A number of studies have shown that dietary fiber deficiency is associated with an increased risk of MetS. The main mechanisms by which dietary fiber may reduce the risk of MetS include reduction of cholesterol levels; improvement of blood sugar control; reduction of inflammation; and promotion of weight loss.

Summary: Literature suggests that a deficiency in dietary fiber consumption is a risk factor for MetS. An increase in dietary fiber intake may help to reduce the risk of developing MetS and its associated chronic diseases.

Purpose of review: Nutrition remains a key focus in the preoptimization of patients undergoing cancer surgery. Given the catabolic nature of cancer, coupled with the physiological insult of surgery, malnutrition (when assessed) is prevalent in a significant proportion of patients. Therefore, robust research on interventions to attenuate the detrimental impact of this is crucial.

Recent findings: As a unimodal prehabilitation intervention, assessment for malnutrition is the first step, as universal supplementation has not been shown to have a significant impact on outcomes. However, targeted nutritional therapy, whether that is enteral or parenteral, has been shown to improve the nutritional state of patients' presurgery, potentially reducing the rate of postoperative complications such as nosocomial infections. As part of multimodal prehabilitation, the situation is more nuanced given the difficulty in attribution of effects to the differing components, and vast heterogeneity in intervention and patient profiles.

Summary: Multimodal prehabilitation is proven to improve length of hospital stay and postoperative outcomes, with nutrition forming a significant part of the therapy given. Further work is required to look at not only the interplay between the optimization of nutritional status and other prehabilitation interventions, but also how to best select which patients will achieve significant benefit.

Purpose of review: This review will highlight recent studies that have examined the endothelial glycocalyx in a variety of health conditions, as well as potential glycocalyx-targeted therapies.

Recent findings: A degraded glycocalyx is present in individuals that consume high sodium diet or have kidney disease, diabetes, preeclampsia, coronavirus disease 2019 (COVID-19), or sepsis. Specifically, these conditions are accompanied by elevated glycocalyx components in the blood, such as syndecan-1, syndecans-4, heparin sulfate, and enhanced heparinase activity. Impaired glycocalyx barrier function is accompanied by decreased nitric oxide bioavailability, increased leukocyte adhesion to endothelial cells, and vascular permeability. Glycocalyx degradation appears to play a key role in the progression of cardiovascular complications. However, studies that have used glycocalyx-targeted therapies to treat these conditions are scarce. Various therapeutics can restore the glycocalyx in kidney disease, diabetes, COVID-19, and sepsis. Exposing endothelial cells to glycocalyx components, such as heparin sulfate and hyaluronan protects the glycocalyx.

Summary: We conclude that the glycocalyx is degraded in a variety of health conditions, although it remains to be determined whether glycocalyx degradation plays a causal role in disease progression and severity, and whether glycocalyx-targeted therapies improve patient health outcomes. Future studies are warranted to investigate therapeutic strategies that target the endothelial glycocalyx.