European Journal of Clinical Nutrition最新文献

This study aimed to quantify the associations between adherence to three dietary patterns-the Dietary Approaches to Stop Hypertension (DASH), Mediterranean diet (MED), and Alternative Healthy Eating Index (AHEI)-and the risk of heart failure (HF) through a dose-response meta-analysis. Prospective cohort studies evaluating the associations between these dietary patterns and HF incidence were systematically identified from the PubMed, EMBASE, Web of Science, Cochrane Library, Scopus, and ClinicalTrials.gov databases. Random-effects models were used to pool effect estimates. Generalized least squares regression and restricted cubic spline models were applied to explore potential dose-response relationships between dietary adherence and HF risk. Eleven independent cohorts (n = 450,451; ≥18,877 HF events) were included in the final analysis. Combined across patterns, the highest adherence group had a 25% lower risk of HF than the lowest adherence group did (hazard ratio [HR] 0.75; 95% confidence interval [CI]: 0.67-0.84; P < 0.001). Subgroup analyses revealed significant inverse associations for the DASH (HR 0.81; 95% CI: 0.67-0.98; P = 0.034), MED (HR 0.74; 95% CI: 0.64-0.87; P < 0.001), and AHEI (HR 0.75; 95% CI: 0.63-0.89; P < 0.001) patterns, with no significant differences across patterns (P = 0.860). Dose-response analyses revealed linear associations between adherence to each dietary pattern and HF risk. High adherence to DASH, MED, and AHEI is associated with lower HF risk, with similar effects among the different dietary patterns and linear dose-response relationships. PROSPERO registration: CRD420251024001.

The Enhanced Recovery After Surgery (ERAS) program emphasizes early oral feeding (EOF) as a key component for faster patient recovery. ERAS guidelines recommend resuming oral feeding within 24 h after surgery, but without specification on diet progression, portion sizes, and macronutrient targets. This scoping review aims to analyze existing postoperative oral feeding protocols (OFPs) across various abdominal surgical procedures. A literature search was conducted via PubMed and Scopus. Articles were assessed for eligibility based on prespecified inclusion criteria. The data were synthesized, and the results were reported and discussed thematically. Sixty-eight articles were included (24 for esophageal and/or gastric surgery, 16 for hepatobiliary or pancreatic, 22 for colorectal, 6 for urologic or gynecologic surgery). Our review found that in many studies oral feeding started much later than recommended by the ERAS guidelines. For colorectal surgery, although a low-residue diet is preferred over clear liquids, only few studies prescribed a solid diet immediately postoperatively. Similarly, for gastric and upper GI surgery, where early oral feeding is encouraged, most studies started with liquids and progressed slowly. In gynecologic and urologic surgeries, although early feeding is safe and recommended, alternative approaches were found. This review analyzed dietary protocols within ERAS pathways and identified significant inconsistencies and non-adherence to the ERAS recommendations. A major issue was the lack of standardized terminology and detailed descriptions of diet composition (energy, nutrients, food types, meal frequency) across studies.

Patients undergoing radical cystectomy face substantial nutritional challenges, yet dietary intake patterns and their adequacy remain poorly defined. In this prospective observational study of 25 ERAS-managed patients, energy and protein adequacy was low during the first postoperative week, while body weight remained stable - likely influenced by fluid retention. Significant weight loss emerged by day 14 (-2.3%; p < 0.001), which increased by day 30 (-5.3%; p < 0.001), despite dietetic follow-up and improvements in dietary intake. Patients requiring nasogastric decompression experienced greater weight loss than those without (-7.2% vs. -3.9%; p = 0.004), suggesting an association with nutritional deterioration. We conclude that early weight trajectory alone may not be a good indicator of nutritional status. Evaluating dietary intake, nutritional symptoms, and body composition including fluid balance is likely required for optimal clinical decision-making. This underscores the importance of individualized, symptom-responsive strategies, including consideration of supplemental nutrition in patients with persistent intolerance.

Background/objective: Inadequate oral intake among hospitalized adults contributes to malnutrition and adverse outcomes. While guidelines advocate meals with higher energy and protein content, how meal composition relates to intake under routine conditions is unclear.

Subjects/methods: In this cross-sectional study, 392 lunch and dinner meals were recorded across six departments at a tertiary hospital. Intake was measured by weighing food before and after consumption, and nutrient content was derived from standardized recipes and food composition tables. Meals were stratified by relative energy and protein content (per 100 g food), categorized as above or below the median. Associations between meal composition and intake outcomes were analyzed using non-parametric tests (Mann-Whitney U and Kruskal-Wallis).

Results: Median consumption was 205 g [IQR: 119-286], providing 250 kcal [137-385] and 10.0 g [5.8-15.6] of protein per meal. Meals above the median for relative energy content were associated with higher energy (+117 kcal; p < 0.001) and protein intake (+3.6 g; p < 0.001) compared with meals below the median, with no difference in food weight. Meals above the median for relative protein content provided +4.9 g more protein (p < 0.001) despite a 23 g reduction in weight (p = 0.007).

Conclusions: Hospitalized patients consume modest energy and protein. Higher relative energy and protein content of foods was associated with greater intake despite similar or smaller portions. These findings support targeted meal-composition strategies focusing on energy and protein enrichment.

Premature infants suffer from conditions such as necrotising enterocolitis and sepsis, whose risk is reduced by breastmilk. Rates of breastfeeding are lower in premature infants compared to term infants. Insufficient breastmilk is the most commonly cited reason for breastfeeding termination. Herbal medicines are commonly used for promoting breastmilk production, but their safety and efficacy are unclear. We wanted to assess whether specific herbal galactagogues can safely and effectively increase lactation in mothers who delivered prematurely. Six databases were searched (Medline, Embase, CINAHL, AMED, COCHRANE library, ProQuest Dissertations and Theses Global) with no language or date restrictions. We included randomised controlled trials (RCTs) of herbal galactagogue use in preterm infant mothers. Ten RCTs were included, each investigating a different galactagogue or mixture. Two scored 'high' for risk of bias, the remainder scored 'some concerns'. There was low certainty evidence of an increase in milk volumes by day 7 of the intervention period with barley malt and lemon balm (mean difference 149 ml, 95% CI: 38-260); silymarin in combination with phosphatidylserine and Galega (mean difference 105 ml, 95% CI: 27-183); Pimpinella anisum seed tea (mean difference 98 ml, 95% CI: 63-133); and Latuca sativa (lettuce) syrup (mean difference 82 ml, 95% CI: 60-105). There is a lack of high-quality RCTs on herbal galactagogues within the preterm population. There is low certainty evidence that Barley malt with lemon balm, silymarin phytosomes with Galega, Pimpinella anisum seed tea, Moringa oleifera leaf capsules and Latuca sativa (lettuce) syrup increase breastmilk production. Higher-quality trials are needed to confirm this effect.

Background/objectives: Reduced food intake is a key aetiological factor of malnutrition. The study purpose was to validate the ingesta Verbal Analogue Scale (ingesta-VAS), a promising tool for rapid food intake assessment, in older adults with cancer in whom malnutrition is frequent and affects treatment outcomes and survival.

Subjects/methods: This prospective study focused on ≥70-year-old patients with a diet history undergoing their first oncological treatment at a French cancer centre. Exclusion criteria included surgery, oral intake cessation, or artificial nutrition use. Dietitians evaluated nutritional status, daily energy intake, and used the ingesta-VAS and Mini-Nutritional Assessment-Short Form (MNA-SF). The ingesta-VAS validity, sensitivity, specificity, and prognostic impact were assessed using daily food intake as primary criterion, then <25 kcal/kg/day as reference standard for inadequate energy intake. The Area Under the Curve was used to select the cut-off. Overall survival was assessed with the Kaplan-Meier analysis.

Results: The analysis involved 441 participants. The correlation between ingesta-VAS scores and energy intake was strong ( $\rho$  = 0.71), and moderate with the MNA-SF scores ( $\rho$  = 0.55, p < .001). Its sensitivity and specificity for detecting inadequate energy intake was 79.0% and 72.6%, respectively. Combined with performance status and body mass index, ingesta-VAS significantly predicted the inadequate energy intake (odds ratio: 10.2, p < 0.001). Difference in overall survival groups was significant with the cut-off of ≤7 [HR = 1.60 (95% CI: 1.29-1.98), p < 0.001].

Conclusions: The ingesta-VAS exhibits reliable metrological properties and may serve as an early, non-invasive, and simple tool to screen reduced food intake in older adults with cancer for detecting the risk of malnutrition.

Background: Dietary patterns targeting cardiometabolic health, such as the Mediterranean diet, DASH diet, and the Chinese Healthy Heart (CHH) dietary pattern have demonstrated lipid-lowering effects, yet culturally adapted strategies for older adults in northern China remain understudied. This study developed a combined MeDi-DASH-CHH dietary pattern by integrating key components of Western evidence-based diets (Mediterranean and DASH) with local dietary preferences (e.g., whole grain consumption, seasonal vegetable intake) to evaluate its impact on blood lipid control in northern Chinese older adults with dyslipidemia.

Methods: A total of 210 dyslipidemic adults aged 60-75 years were stratified by sex, then randomized (1:1) to a 6-month intervention group (MeDi-DASH-CHH diet, with emphasized intake of aquatic products, dairy, and whole grains) or a control group (conventional guidance per Dietary Guidelines for Chinese Residents (2024)). Both groups received monthly follow-up visits. The primary outcome was the changes from baseline to six months in lipoprotein cholesterol (LDL-C). Secondary outcomes included changes in total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), dietary intake, and body composition indicators.

Results: After intervention, the intervention group showed improvements in lipid profiles compared to the control group (all P < 0.05). Dietary intake indicated increased consumption of whole grains, potatoes, vegetables, fruits, aquatic products, dairy products, and nuts, alongside reduced intake of livestock meat, poultry meat, and egg intake.

Conclusion: The combined MeDi-DASH-CHH dietary effectively improves lipid profiles and promotes healthier eating behaviors in older adults with dyslipidemia in northern China.

Objectives: The purpose of this study was to compare selected iron markers (serum iron, total iron-binding capacity (TIBC), transferrin and ferritin concentration, transferrin saturation, and free haemoglobin) in children from marginalised Roma communities (MRCs) with children from the majority population and explore their associations with diet composition.

Methods: We obtained cross-sectional data (questionnaires, blood samples from children) from 119 mother-child dyads from MRCs and the majority population. Group differences were tested using Chi-square and Mann-Whitney U tests. Associations of belonging to MRCs and diet with iron markers (transferrin, ferritin, TIBC, serum iron, transferrin saturation) were examined using bootstrapped linear regression models, and mediation analyses assessed whether eating habits mediated group differences.

Results: Statistically significant differences between children from MRCs, and the majority were found in serum transferrin, ferritin, and TIBC levels. The more frequent consumption of sweetened drinks, sweets, and salty snacks is associated with lower levels of transferrin, and more frequent consumption of dairy products is associated with higher levels of total iron-binding capacity. Current breastfeeding was found to be negatively associated with ferritin. Consumption of sweets and salty snacks partially mediates the differences in transferrin between children from MRCs and the majority.

Conclusions: Our findings suggest that the observed low ferritin levels, elevated TIBC, and reduced transferrin saturation in Roma children are likely indicative of early-stage iron deficiency, potentially driven by underlying malnutrition. This study underscores the significant disparities in iron metabolism between children from MRCs and those from the majority population, primarily driven by social determinants of health, including diet composition.

Background: This study collected and analyzed clinical data on enteral nutrition therapy in neurocritical patients, developed and validated a risk prediction model for feeding intolerance (FI), and transformed the model into a visual risk scoring tool,provide a reference for clinical staff to screen for people at high risk of enteral nutrition feeding intolerance in neurocritically ill patients.

Methods: Using prospective study,440 eligible inpatients from a Chinese tertiary hospital (April-December 2022) were divided into derivation (70%) and validation (30%) cohorts.Univariate and binary logistic regression analyses were conducted to construct the FI prediction model, and a simplified risk assessment scale for FI in the neurological intensive care unit (NCU) was developed.

Results: FI incidence was 71.0% (213/300) in the derivation cohort. Independent risk factors included age, Glasgow Coma Scale (GCS) score, APACHE II score, mechanical ventilation, nasogastric tube feeding, hyperglycemia, and hypoalbuminemia (P < 0.05). The model showed excellent discrimination (AUC = 0.941, 95% CI:0.912-0.970) and calibration (Hosmer-Lemeshow P = 0.293), with 85.9% sensitivity and 90.8% specificity. In the validation cohort (140 patients, FI incidence was 72.1%), predictive accuracy was 82.9% (AUC = 0.924, 95% CI:0.878-0.970; sensitivity=96.0%, specificity=74.4%). The visual scoring tool achieved 84.3% accuracy (Kappa=0.700, P < 0.001), aligning with the original model.

Conclusion: The early enteral nutrition FI risk prediction model and corresponding scoring table developed in this study showed good predictive performance and could serve as a useful reference for the clinical assessment of FI risk in neurocritical patients.