Current Opinion in Clinical Nutrition and Metabolic Care最新文献

Purpose of review: This review examines the complex relationship between gestational diabetes mellitus (GDM) and breastfeeding outcomes, integrating recent evidence on maternal health benefits, milk composition, and clinical support strategies. Understanding these relationships is important as GDM affects approximately 14% of pregnancies worldwide, with rates continuing to rise alongside increasing obesity and maternal age.

Recent findings: Women who breastfeed for longer periods after GDM show significant improvements in metabolic health, including reduced weight retention and better cardiometabolic profiles. While macronutrient content of breast milk appears preserved, significant differences exist in human milk oligosaccharides and milk fat globule membrane proteins. A previous history of predominant breastfeeding shows a 47% reduction in abnormal fasting glucose odds in subsequent pregnancies. Initial positive indications of personalized support programs, particularly during pregnancy, are emerging however evaluation in comparison to current evidence-based interventions is yet to be carried out. Lifestyle factors are known to reduce subsequent diabetes after a GDM and recent evidence suggests these are important in pregnancy and may improve breastfeeding outcomes.

Summary: Despite the challenges of delayed secretory activation and reduced milk supply in women with GDM, successful breastfeeding offers substantial health benefits. Healthcare providers could implement comprehensive, individualized support strategies beginning in pregnancy and extending through the postpartum period to optimize outcomes for both mother and infant.

Purpose of review: Human milk is the optimal food choice for infants. Reviewing the latest advances in research about human milk compounds and their effect on health helps understand the benefits of breastfeeding and improves knowledge of key bioactive nutrients that can be used to improve feeding during infancy, with short and long-time effects on health.

Recent findings: In the last years, it has been described how bioactive compounds such as Human milk oligosaccharides, hormones, lipids, cellular components and microbes play an important role in the infants' health, reducing the risk of infectious, metabolic and autoimmune diseases. The mechanisms of transmission from the mother to the infant of these bioactive compounds are not always well described, but there are several lines of research to understand the biological mechanisms of these beneficial effects.

Summary: These findings may help improve research in maternal and infant interventions, the modifiable factors that are able to modulate human milk composition. They may help to improve the development of infant formulas and enhance nutritional plans. Also, human milk bioactive compounds identification and isolation may describe new ways of supplementation.

Purpose of review: Sarcopenia and frailty are common conditions, associated with worse clinical outcomes during critical illness. Recent studies on sarcopenia and frailty in ICU patients are presented in this review, aiming to identify accurate diagnostic tools, investigate the effects on clinical and functional outcomes, and propose possible effective interventions.

Recent findings: The recent change of the sarcopenia definition underlines the importance of muscle strength over mass, this is however challenging to assess in ICU patients. There is currently no unified sarcopenia definition, nor standard frailty assessment tool; Clinical Frailty Scale is most frequently used in the ICU. Meta-analyses show worse clinical and functional outcomes for frail as well as sarcopenic patients admitted to the ICU, regardless of admission diagnosis. Frailty is a dynamic condition, worsening in severity by the time of hospital discharge, but showing improvement by 6 months post-ICU. Therapeutic interventions for frailty and sarcopenia remain limited. Although mobilization strategies show promise in improving functional and cognitive outcomes, inconsistent outcomes are reported. Heterogeneity in definitions, patient populations, and care practices challenge interpretation and comparison of study results and recognition of beneficial interventions. This highlights the need for more research.

Summary: The importance of preexisting sarcopenia and frailty is recognized in ICU patients and associated with worse clinical outcomes. Multidimensional interventions are most promising, including patient-tailored mobilization and nutrition.

Purpose of review: Disease associated malnutrition (DAM) remains an important concern in the care of hospitalized children and children with a chronic disease. This review focused on pediatric literature published since 2023 on the prevalence, assessment and treatment of DAM in different settings.

Recent findings: The prevalence of DAM depends on a variety of factors. Studies focused on the relationship between different assessment methods of DAM and sarcopenia in hospitalized children and children with an underlying disease and clinical outcomes. Several papers focused on exploring the interplay between nutritional management and the evolving metabolic phases of critically ill children. Some studies explored feeding intolerance and barriers to administering enteral nutrition, micronutrient assessment and whether continuous versus intermittent feeding was superior in pediatric intensive care.

Summary: In hospitalized children and chronically ill children, nutritional assessment and assessment of frailty and/or sarcopenia is best done using a comprehensive approach integrating anthropometrics, nutrition focused history and physical examination. Adequate nutritional support for critically ill children is challenging and needs to be tailored to the specific phases of critical illness. Intermittent feeding may offer potential advantages in inducing ketosis and circadian rhythm alignment but requires careful management to prevent nutritional deficits.

Purpose of review: The EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems recommended a diet that is higher in plant-based food in 2019. Whilst plant-based diets have been followed in many regions of the world, the planetary concern and the published health benefits has increased the uptake of such diets. This review sets out to explore the impact on growth in children following a plant-based diet.

Recent findings: Twelve observational studies were published between 2017 and 2024, assessing the impact of vegan and vegetarian diets compared to omnivorous diets in children. Ten studies found no significant difference in growth parameters between children on the plant-based diet vs. the omnivorous diet, however there is a trend of lower growth parameters including undernutrition, but also lower rates of overweight in children on a plant-based diet. One study found that that children were shorter on a vegan diet and another found that infants born to mothers following a vegan diet had significantly lower weight. None of the studies assessed children that received professional dietary advice.

Summary: Overall, growth is comparable in children following a plant-based diet, but a higher risk for undernutrition has been highlighted. Children can follow a plant-based diet and establish good growth with the help of a qualified healthcare professional understanding macro and micronutrient provision on such a diet.

Purpose of review: Muscle health helps maintain locomotor capacity, a key component of intrinsic capacity, which is required for healthy ageing. Sarcopenia is characterized by the age-related decline in muscle mass and strength leading to impaired physical performance, and has been described as a biological substrate of physical frailty. Both sarcopenia and physical frailty share phenotypic features of weakness and slowness, lead to common adverse outcomes, and have potential for reversal through early identification and intervention. The purpose of this review is to present recent evidence for the impact of lifestyle interventions across the life course on sarcopenia and physical frailty.

Recent findings: Resistance exercise alone or combined with balance and aerobic training as part of a multicomponent exercise program and high-quality diets incorporating adequate protein remain the mainstay of treatment for sarcopenia and physical frailty. Reducing sedentary time and increasing physical activity, adherence to Mediterranean diet, increasing vegetable and caffeinated beverage intake, cardiovascular risk factor modification, improving sleep hygiene and depressive symptoms may also contribute to slowing down age-related decline in muscle health.

Summary: Lifestyle interventions such as physical activity, diet, sleep and mental health are effective against sarcopenia and physical frailty. Targeting lifestyle modifications in early to midlife may retard further decline in locomotor capacity and optimize intrinsic capacity of older persons, reducing the risk of sarcopenia, physical frailty and their attendant negative health outcomes.

Purpose of review: Pasteurized donor human milk (PDHM) is the recommended supplement when there is inadequate volume of mother's own milk (MOM) for very low birth weight (<1500 g, VLBW) infants. Differences in the composition of these milks may impact growth, morbidities or long-term development of infants. The aim of this review is to highlight current trends in understanding compositional differences between MOM and PDHM, technological advances in processing PDHM, and infant outcomes when VLBW infants are fed these milks.

Recent findings: Reported differences in the composition between MOM and PDHM are due to several factors including when and how milk is collected, sampled for analysis, and processed. Systematic reviews and primary research studies demonstrate that PDHM reduces the risk of necrotizing enterocolitis in VLBW infants but is also associated with slower postnatal growth. Work is ongoing to determine if alternative approaches to processing PDHM can improve milk composition and thereby infant growth and neurodevelopment and reduce morbidity.

Summary: PDHM is a key component of feeding VLBW infants when there is inadequate volume of MOM. Recent developments aim to optimize this source of nutrition and bioactive compounds for VLBW infants while further understanding limitations of its use.

Purpose of review: This review focuses on the latest information regarding the role of complementary feeding practices and food allergen introduction in the prevention of food allergies.

Recent findings: Early introduction of food allergens for food allergy prevention is recommended by food allergy prevention guidelines and is supported by the latest randomized controlled trials. Diet diversity is recommended, supported by the latest studies from Asia. A European study indicated that diet diversity after the first year of life may still be important for food allergy prevention. The latest systematic reviews indicate there may be an association between ultra-processed food intake and food allergy development. Plant based foods and fiber play an important role in modulating the gut microbiome which has been associated with reduced food allergy outcomes. However, increased intake of food allergens within a diverse diet raises questions about excessive calorie and protein intake but can be managed by focusing on infant satiety cues.

Summary: The latest studies clearly indicate and further supports that introduction of food allergies should not be delayed once complementary feeding is commenced. A diverse diet is recommended to further support the prevention of food allergies.