European Journal of Clinical Nutrition最新文献

Background: Birth by cesarean section (C-section) is associated with a delayed colonization of bifidobacteria and Bacteroidota species with potential negative health consequences. Previously, an infant formula with a synbiotic mixture of short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides (scGOS/lcFOS [9:1]) and Bifidobacterium breve M-16V was found to restore the timely colonization of bifidobacteria in C-section born infants. In this study, we investigated the effect of this synbiotic mixture on gut microbiota development in C-section and vaginally-born infants participating in a growth equivalence trial (NCT03520764).

Methods: Healthy, fully formula-fed Chinese infants were randomized to receive a partially hydrolyzed whey-based protein formula with the synbiotic mixture (n = 112), or an intact protein formula with scGOS/lcFOS (prebiotic, n = 112). Breastfed infants served as reference group (n = 60). Gut microbiota profiling by 16S rRNA gene sequencing of stools collected at baseline, 17 weeks (end of intervention) and 12 months of age was complemented with analysis of stool pH, short-chain fatty acids, lactic acids, and secretory IgA concentrations.

Results: Both the prebiotic and the synbiotic formula supported a dominant and diverse infant-type bifidobacterial community, but with increased abundance of Bifidobacterium breve in the synbiotic group. In C-section born infants (54.8% of randomized) the synbiotic but not the prebiotic, enhanced the bifidobacterial species diversity and showed restoration of Parabacteroides at 17 weeks, and Bacteroides spp. at 12 months closer to that of the vaginally-born infants.

Conclusion: The synbiotic was confirmed to support the restoration of important gut colonizers in infants born by C-section with effects observed even beyond the intervention period.

Background: Low skeletal muscle mass and impaired muscle quality (myosteatosis) have been associated with poor outcomes in cancer patients. This study aimed to evaluate the impact of pre-therapeutic low muscle mass and myosteatosis on chemoradiotherapy (CRT)-induced toxicity and survival outcomes in patients with non-resectable pancreatic cancer (PC).

Methods: In this retrospective study, pre-therapeutic CT scans were used to measure muscle mass/density. Low muscle mass was defined as a skeletal muscle index <38.5 cm²/m² (women) and <52.4 cm²/m² (men), and myosteatosis as a mean psoas density <41 HU if BMI < 25 kg/m² or <33 HU if BMI > 25 kg/m². Adverse effects were collected per week (W) of treatment. Dose-limiting toxicity (DLT) was defined as any toxicity leading to dose reduction, treatment delays or permanent discontinuation.

Results: Among the 85 included patients, 75 (88.2%) and 18 (22.2%) had pre-therapeutic low muscle mass and myosteatosis, respectively. Only 12 patients (14.1%) experienced DLT. Patients with low muscle mass developed significantly more toxicities at W2 (p = 0.013) and W5 (p = 0.026), notably more nausea (p = 0.037) and anemia (p = 0.004). Low muscle mass was associated with poorer overall survival (HR 4.41 [1.50-12.94], p = 0.007) in multivariate Cox analysis, while myosteatosis was not associated with CRT toxicities, DLT and overall survival (p = 0.408).

Conclusion: Patients with low muscle mass experienced more toxicities and poorer outcomes during CRT for non-resectable PC.

People diagnosed with Intestinal Failure (IF) requiring Home Parenteral Nutrition (HPN) have complex medical and nutritional requirements. To date, assessment for, and ongoing management of, HPN has relied on medical, nursing and dietetic input. However, success in assessing suitability for HPN and ongoing management is often reliant on non-medical factors. This paper aims to outline the critical clinical role the social worker can play and their scope of practice in assessing and managing people requiring HPN. This includes assessment across medical, psychosocial, financial, legal, quality-of-life and healthcare-related domains. This perspective paper highlights the vast scope in which the social worker can support people diagnosed with IF requiring HPN. More research is required to quantify the value of the social worker as a key member of the multidisciplinary IF team.

Several clinical trials suggest that β-glucans may reduce feelings of fatigue, however the results of clinical trials are inconsistent. Additionally, no systematic reviews or meta-analyses have assessed the effects of β-glucans on fatigue. Therefore, this study investigates the effects of β-glucans on fatigue in healthy subjects through a systematic review and meta-analysis. PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database inception to March 15, 2024. The inclusion criterion was a randomized controlled trial (RCT) investigating the effects of β-glucans on healthy subjects' fatigue, vigor, and mood state. To assess risk of bias, we employed the Cochrane risk of bias tool. A random-effects meta-analysis was conducted for the standardized mean difference (SMD). Sixteen RCTs with a total of 1,449 participants were included, and 12 studies provided data suitable for meta-analysis. Meta-analysis revealed that β-glucans significantly reduced feelings of fatigue (SMD = -0.32, 95% CI = -0.53 to -0.12; p = 0.0021), increased vigor (SMD = 0.46, 95% CI = 0.26-0.66; p < 0.0001), and improved mood state (SMD = 0.32, 95% CI = 0.11-0.53; p = 0.0026) compared to the placebo group. The results of the systematic review and meta-analysis indicate that β-glucans may be effective in reducing feelings of fatigue in healthy individuals. However, the number of studies included is insufficient, suggesting that further clinical trials are needed to validate this effect.

Background/objective: To evaluate the weight and height status of under-five children between 1992 and 2021 in relation to nutritional context.

Subjects/methods: The study is based on the lengths/heights and weights of children <5 years in five national surveys (n = 505,026). After evaluating normality of the distributions, heights, and weights were expressed as z-scores relative to the WHO reference. Nonparametric tests were used as the heights and weights did not have normal distributions.

Results: Heights and weights of boys and girls increased systematically, on average, across the five national surveys, indicating improvement in nutritional status over time. Nevertheless, median z-scores for height and weight relative to the WHO reference indicated the persistence of relatively poor nutritional status across the surveys.

Conclusions: The growth status of Indian children <5 years improved over three decades, indicating that national initiatives promoting child health had a positive impact. Unfortunately, the nutritional status of significant numbers of children has not sufficiently improved and merits further attention.

Background: The long-term effects of breakfast on childhood z-BMI remain inconclusive.

Objective: To prospectively assess the impact of stable and altered breakfast consumption habits on z-BMI change over two years, in school-aged children across six European countries.

Methods: Data of 6,528 children (8.2 ± 1.0 years, 48.9% male) from the Feel4Diabetes study were used. Children's lifestyle behaviors, including breakfast frequency, were assessed through parent-reported questionnaires. Weight and height were objectively measured and converted to z-BMI. Participants were categorized into trajectories combining breakfast consumption habit (i.e., regular consumption, irregular consumption or omission) at baseline and follow up. Logistic regression analyzed the prospective association between breakfast trajectories and z-BMI increase, with adjustment for demographic and lifestyle variables.

Results: A statistically significant effect of breakfast trajectories was observed in z-BMI, both at baseline and follow up. Stable skippers was the only trajectory that showed a significant increase in BMI z-score from baseline to follow up (0.891 ± 1.058 vs. 1.034 ± 1.072 respectively, p < 0.05). BMI z-score at follow up of regular eaters (0.615 ± 0.967) was significantly lower, compared to both irregular eaters (1.229 ± 0.890) and stable skippers (both p < 0.05). Stable regular consumption and transition from omission to regular consumption were independently associated with significantly lower risk of z-BMI gain, compared to stable omission [OR, 95% CI: 0.55 (0.31, 0.97), p = 0.039 and 0.43 (0.21, 0.88), p = 0.021 respectively].

Conclusion: Stable regular breakfast consumption or transition from omission to regular consumption seem to contribute to superior weight regulation in children and to independently protect against z-BMI gain, compared to stable omission. Further studies are warranted to extend the evidence on the breakfast habit-BMI association among children.

Background: There are limited data on the amount of discretionary foods that people normally consume and consider as appropriate at one eating occasion. This study aimed to provide an overview of the range and assess differences of the 'normal portion size' and 'perceived appropriate portion size' of energy-dense nutrient-poor discretionary foods among consumers aged 18-65 years.

Methods: To measure normal and perceived appropriate portion sizes, a validated online image-series questionnaire consisting of eight successive portion size options for 15 discretionary foods was completed at two timepoints. Quantile regression models were used to estimate the ranges (lower boundary at 17^th percentile, upper boundary at 83^rd percentile) of normal and perceived appropriate portion sizes selected by two thirds of the study population. Models were adjusted for the effects of potential influencing factors including biological sex, age, usual physical activity level, cooking confidence, socio-economic status, body mass index, and baseline hunger levels.

Results: A final sample of 295 participants were included in the analysis (51% females, mean age 39.5 ± 14.1 years). The normal portion sizes were significantly higher than the perceived appropriate portion sizes across all test foods, with the effects of sex, age, and BMI being significant for some foods.

Conclusion: The finding suggests that consumers would normally consume a portion size that was larger than what they perceive to be appropriate for discretionary foods. The estimated lower and upper boundaries would be valuable for the development of pragmatic public health messages to empower consumers towards better portion control.

The accurate assessment of body composition in cirrhosis is challenging as fluid accumulation affects most techniques. The whole-body counter is a state-of-the-art method that measures total body potassium (TBK) unbiased by fluid, from which body cell mass (BCM) is derived. This pilot study in 20 patients with cirrhosis evaluated bedside tools including the liver frailty index (LFI), bioimpedance analysis-based phase angle, calf circumference (CC), and BMI (body mass index)/edema-adjusted CC, and explored their association with TBK and BCM. Stepwise multiple linear regression analysis and Pearson's correlation tests were conducted. Adjusted for sex, BCM and TBK were inversely associated with frailty (p < 0.0001). LFI r = -0.568 (p = 0.009), CC r = 0.484 (p = 0.031), and edema-adjusted CC r = 0.467 (p = 0.038), demonstrated moderate correlations with BCM. Further research involving a larger sample of participants is needed to confirm these findings associating these bedside tools and gold-standard body composition measures.

Background/objectives: Understanding the dynamic changes in nutritional status of patients with non-Hodgkin's lymphoma (NHL) during chemotherapy is crucial, as it significantly impacts chemotherapy-related toxicity and survival outcomes.

Subjects/methods: This multi-center study included newly diagnosed NHL patients. Nutritional status and chemotherapy-related toxic effects were assessed over the first five chemotherapy sessions, with follow-ups conducted every 3 months. Patients were categorized into three groups based on pre-chemotherapy Patient-Generated Subjective Global Assessment (PG-SGA) scores: Group A (0-1), Group B (2-8), and Group C (>9). Repeated-measures ANOVA and Generalized Estimating Equations (GEE) models were used for analysis, with survival outcomes evaluated via Kaplan-Meier and Cox regression.

Results: A total of 143 patients (mean age 50.26 ± 15.02 years) completed the study, over a median follow-up of 18.8 months. PG-SGA scores were highest in Group C during chemotherapy (P < 0.001), with significant time-group interaction effects (P < 0.001). Liver and kidney impairments worsened across all groups (P < 0.05), while gastrointestinal toxicity and bone marrow suppression initially decreased before increasing. GEE analysis showed that nutritional status positively influenced gastrointestinal toxicity (β = 0.05, P = 0.001) and bone marrow suppression (β = 0.04, P = 0.014). Malnourished patients exhibited worse pulmonary infection-free survival and overall survival (P < 0.05).

Conclusions: NHL patients are highly susceptible to malnutrition during chemotherapy, which exacerbates chemotherapy-related toxicities, particularly gastrointestinal effects and myelosuppression. Maintaining good initial nutrition is vital for reducing toxicities and improving survival outcomes.