European Journal of Clinical Nutrition最新文献

Objective: We aimed to explore how free sugar intake varies across the day in secondary school pupils.

Methods: Pupils aged 11-15 years were recruited between December 2019-April 2022 from English secondary schools. Pupils completed a sociodemographic questionnaire and recorded all foods and drinks consumed in the previous day. We undertook mixed-effects regression modelling to explore patterns of sugar consumption across different eating occasions, and in and out of school, accounting for school clustering and adjusting for energy intake and participant sociodemographic variables. 2575 pupils were invited to participate, with 2273 participants ultimately included in the study.

Results: After adjustment for mealtime energy intake, compared to breakfast, free sugar intake was lower at lunch (mean difference: -7.86 g; 95% CI = -8.87 g, -6.84 g; p = <0.001) and dinner (mean difference: -11.82 g; 95% CI -12.85 g, -10.80 g; p = <0.001). Free sugar intake from snacks was higher than breakfast (mean difference: 7.70 g; 95% CI 6.68 g, 8.72 g; p = <0.001). Snacks on average comprised 28.5% of total energy intake and 43.1% of free sugar intake for the day. Free sugar intake outside of school was higher than intake during school time (mean difference: 3.18 g; 95% CI = 1.67 g, 4.69 g; p = <0.001).

Conclusion: Breakfast and snacks made the largest contribution to free sugar intake among adolescents in the study after accounting for variation in energy intake across mealtimes. Free sugar intake was higher outside than inside school. Efforts to reduce free sugar intake in adolescents should focus on breakfast and snack food and drink items, and high sugar items available outside of school.

Background: Early post-pyloric feeding is critical for improving outcomes in critically ill patients. While guided feeding tube placement has demonstrated superior efficacy to blind insertion, its clinical application remains constrained by technical and operational challenges. The integrated real-time imaging system (IRIS) addresses these limitations by combining continuous lumen visualization with device portability, potentially democratizing precise feeding tube placement. This study evaluated whether IRIS-assisted placement achieved higher efficacy while maintaining equivalent safety compared to traditional blind bedside insertion.

Methods: In this prospective randomized controlled trial, a total of 46 critically ill patients requiring enteral nutrition due to dysphagia or high aspiration risk were randomized to IRIS-guided visualization (VG group) or blind insertion (CG group). One patient was excluded from the analysis because of a major protocol violation. The primary and secondary outcomes were the procedural time and first-attempt success rate, respectively. Safety outcomes included adverse events and hemodynamic stability.

Results: Among the 45 analyzed patients (VG: 22, CG: 23), the VG group presented a significantly shorter median procedural time (3.19 vs. 22.52 min; 95% CI, -32.23 to -14.22; P < 0.0001) and a higher first-attempt success rate (95.45% vs. 69.57%; odds ratio, 9.19; 95% CI, 1.02-82.41; P = 0.047) than the CG group. Adverse event incidence and hemodynamic stability were comparable between the groups.

Conclusion: IRIS-guided visualization technology significantly reduces the procedural duration and improves the first-attempt success rate for post-pyloric feeding-tube placement in critically ill patients, while enabling real-time anatomical visualization.

Background/objectives: Food Frequency Questionnaires (FFQs) are widely used in nutritional epidemiology, particularly in substitution modelling to estimate health effects of dietary changes. This review examines validation practices in substitution modelling studies using FFQ-derived data published between 2018 and 2024.

Subjects/methods: A total of 100 studies from 21 countries were included. We assessed the presence and quality of validation data for FFQ variables used in substitution models, focusing on reported validation metrics and correspondence with reference methods.

Results: Fifty-three percent of studies used unvalidated FFQ-derived variables in modelling. Among those providing validation data, correlation coefficients with reference methods ranged from 0.12 to 0.77 (median, Q1-Q3: 0.43, 0.30 to 0.50). Minimal or no documentation was found in 62% of studies. In some cases, deviations from reference values exceeded 450%. Studies using unvalidated inputs were frequently published in high-impact journals.

Conclusions: The widespread use of unvalidated FFQ variables and the broad variability in validation quality raise concerns about the reliability of substitution modelling outcomes. Given the role of these studies in informing dietary guidelines, consistent validation protocols and improved reporting standards are urgently needed.

Objectives: Nutrition support improves ICU patients' nutritional status and outcomes, but optimal models remain unclear. We performed a Bayesian and frequentist network meta-analysis (NMA) and systematic review to assess improvements in nutritional indicators and clinical outcomes.

Methods: We systematically searched PubMed, Embase, Cochrane, and Web of Science up to November 23, 2023 for Randomised controlled trials (RCT), case-control studies, and cohort studies. Outcomes mainly included serum albumin values, length of hospitalization, infection rates, feeding-related complication rates and mortality. All the analyses were conducted using STATA 17.0 and R software version 4.5.1.

Results: A total of 26 studies were included, enrolling 7698 critically ill ICU patients receiving four different types of nutrition support, including parenteral nutrition (PN), enteral nutrition (EN), enteral immunonutrition (EIN), and parenteral nutrition combined with enteral nutrition (PN + EN). The NMA results showed that according to SUCRA, PN + EN had the highest probability of being the most effective intervention for improving serum albumin values (SUCRA = 84.5%) and reducing infection rates (SUCRA = 83.0%) and mortality rates (SUCRA = 82.7%). PN had the highest probability of reducing the length of hospitalization (SUCRA = 77.9%), while EIN had the highest probability of reducing feeding-related complication rates (SUCRA = 81.0%).

Conclusion: The available evidence suggests that all four models of nutrition support affect the nutritional status and clinical outcomes of critically ill patients in the ICU to varying degrees. However, EN + PN appears to be the most effective approach in improving clinical outcomes and nutrition support in critically ill ICU patients. More high-quality studies are needed to validate these findings.

Both underweight and obesity have been linked to increased risk of disability, yet evidence on the relationship between body mass index (BMI) and activities of daily living (ADL) impairment remains inconsistent. To examine these associations in adults, we conducted this systematic review and meta-analysis following the standard methods and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Six databases were searched from inception to August 12, 2024. The protocol is registered in the PROSPERO (CRD42022357046). Abstracts and full-text articles describing associations between BMI and ADL impairment were screened using Rayyan software. Study quality was assessed using the RoBANS tool. A random-effects model meta-analysis was performed using metaanalysisonline, a web-based meta-analytic platform, with BMI categories of <18.5 (underweight), 25-29.9 (overweight), and ≥30 (obese) as exposures, and 18.5-24.9 (normal) as the reference. Of the initial 25,212 articles identified, 132 studies met the inclusion criteria. The meta-analysis showed positive association in both longitudinal studies [odds ratio (OR) 1.77, 95% confidence interval (CI): 1.54-2.03] and cross-sectional studies (OR: 1.56, 95% CI: 1.38-1.76). Overweight individuals exhibited a moderate increase in ADL risk in longitudinal studies (OR: 1.19, 95% CI: 1.09-1.30), but not in cross-sectional studies (OR: 1.06, 95% CI: 0.95-1.18). Both longitudinal and cross-sectional studies revealed a positive association between underweight participants and ADL impairment (OR: 1.20, 95% CI: 1.02-1.42; OR: 1.46, 95% CI: 1.24-1.72, respectively). Individuals with higher BMI, as well as those who are underweight, are at increased risk of ADL limitations.

Following the LEAP and PETIT studies demonstrating that early allergen introduction can prevent food allergies, Japan's Ministry of Health, Labor and Welfare revised its weaning guideline in 2019. The updated guideline recommended earlier egg introduction and noted that delaying specific foods may increase allergy risk. This study examined trends in the timing of solid food introduction among Japanese infants before and after this revision. We conducted a retrospective analysis using data from the parenting application Papatto Ikuji collected between 2014 and 2023. After excluding outliers and errors, 59,433 infants were analyzed. The age at solid food introduction was examined by birth year. From 2014 to 2018, the age distribution showed two peaks at 5 and 6 months. After 2019, the 6-month peak declined, leaving a single 5-month peak by 2021. These findings suggest that national guideline revisions substantially influenced caregivers' feeding behaviors, leading to earlier solid food introduction in Japan.

Background/objectives: Our study evaluated the prospective association between the sulfur microbial diet (SMD), a diet associated with sulfur-metabolizing bacteria in stool, and the chronic kidney disease (CKD) risk, and further investigated whether genetic risk modified this association.

Methods: This study involved 98,491 UK Biobank participants who had completed at least two 24-hour dietary recall measurements. SMD scores were computed by summing the product of β-coefficients for each food group and their corresponding intake values. Incident CKD was identified using UK Biobank algorithms. The polygenic risk score (PRS) for CKD was constructed based on 263 single-nucleotide polymorphisms. Hazard ratios (HRs) with 95% confidence intervals (CIs) and population attributable fractions (PAFs) were calculated using Cox proportional hazard regression models.

Results: During a median follow-up of 9.38 years, we documented 2,032 incident CKD cases. We observed a dose-response association between the SMD score and increased CKD risk (P for non-linearity = 0.78). Participants in the highest tertile of the SMD score had a significantly higher risk of developing CKD compared to those in the lowest tertile (HR: 1.24, 95% CI: 1.11-1.39, PAF: 6.81, 95% CI: 3.29-10.34). No significant multiplicative or additive interactions between PRS and the SMD score were found (all P > 0.05). The positive associations between the SMD and the CKD risk were similar across low or high genetic risk groups.

Conclusion: Higher adherence to SMD was associated with an increased risk of CKD, regardless of genetic risk. Future studies are needed to validate our findings.

The Roma minority is one of Europe's most vulnerable minorities in terms of health status including nutrition-related diseases. A detailed and robust exploration of the dietary behaviors of the Roma population is essential for developing targeted nutrition interventions. This scoping review aims to identify and evaluate the dietary assessment methods used for measuring dietary intake and food consumption among the Roma population. Studies were identified through PubMed, Web of Science, Scopus, and grey literature. Studies written in English that focused on the Roma minority and assessed dietary intake and food consumption were eligible. A qualitative approach was used to summarize the results. Thirteen original studies were reviewed, primarily conducted in Eastern Europe. Nine out of thirteen studies used cross-sectional study designs and quantitative research approaches. The most commonly applied nutritional assessment methods were food frequency questionnaire, 24-h dietary recall, and brief dietary habits questionnaire. Quantitative dietary outcomes were measured through dietary intake, food consumption patterns, and dietary quality, while qualitative dietary outcomes were identified as moderate overconsumption, irregular eating, or the symbolic use of food to denote social status. There was a lack of validity and adaptation of dietary assessment tools for the Roma population. The reviewed studies often did not employ advanced nutritional analysis methods common in the general, non-Roma population. There is a need to develop specific dietary assessment methods for the Roma population. To obtain more reliable results, combining subjective dietary assessment methods with a qualitative, participatory approach may be suitable for this population.

Malnutrition in Inflammatory Bowel Disease (IBD) is an important medical issue leading to adverse clinical outcomes. The Global Leadership Initiative on Malnutrition (GLIM) criteria provide a common approach for the diagnosis of malnutrition and are proposed to be used in different clinical conditions and environments. The aim of this scoping review was to review the findings of all available studies that have already applied the GLIM criteria in IBD, to explore GLIM prognostic value, to highlight challenges and concerns, and to identify knowledge gaps for further research. A comprehensive literature search strategy using the databases PubMed/MEDLINE and Scopus was conducted. Eligible studies were peer-reviewed articles published until May 2025 in the English language, only conducted in adult people with IBD. Fifteen studies were included in this review. Great heterogeneity was recorded in the way both phenotypic and etiologic GLIM criteria have been evaluated leading to important differences between studies and not allowing comparisons between them, but also to increased risk of bias in many of these studies. The prevalence of malnutrition using GLIM criteria in IBD was medium-to-high (31.7-60.1%) depending on the methodology each study implemented for the assessment of phenotypic and etiologic criteria. Only two of the included studies prospectively assessed the impact of malnutrition on clinical outcomes with conflicting results. Future research should focus both on the implementation of robust methodologies to apply the phenotypic and the etiologic criteria, but also to explore the impact of malnutrition diagnosis on disease-related clinical outcomes.