Pub Date : 2025-12-10DOI: 10.1038/s41430-025-01694-y
Jakob Højgaard Hundebøll, Alberte Fisker Olesen, Irene Wessel, Faidon Magkos, Alicia Martin Poulsen, Ane Rytter
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.
{"title":"Not just about weight: Identifying hidden nutritional vulnerability after radical cystectomy","authors":"Jakob Højgaard Hundebøll, Alberte Fisker Olesen, Irene Wessel, Faidon Magkos, Alicia Martin Poulsen, Ane Rytter","doi":"10.1038/s41430-025-01694-y","DOIUrl":"10.1038/s41430-025-01694-y","url":null,"abstract":"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.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 2","pages":"173-176"},"PeriodicalIF":3.3,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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. 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). 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). 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.
{"title":"Meal composition and nutrient intake in hospitalized adults: the role of relative energy and protein content","authors":"Jakob Højgaard Hundebøll, Irene Wessel, Faidon Magkos, Nikoline Sofie Sjøberg, Nicoline Groth, Ane Rytter","doi":"10.1038/s41430-025-01689-9","DOIUrl":"10.1038/s41430-025-01689-9","url":null,"abstract":"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. 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). 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). 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.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 2","pages":"168-172"},"PeriodicalIF":3.3,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Herbal galactagogues to improve breastmilk production and lactation in mothers of preterm babies: a systematic review of clinical trials","authors":"Aislinn Cragg, Ilana Levene, Sharram Darabi, Merlin Willcox","doi":"10.1038/s41430-025-01679-x","DOIUrl":"10.1038/s41430-025-01679-x","url":null,"abstract":"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.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 2","pages":"146-158"},"PeriodicalIF":3.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41430-025-01679-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1038/s41430-025-01681-3
Pierre Senesse, Julie Deffrennes, Nicolas Flori, Chloé Janiszewski, Laure Francioni, Simon Thezenas, Estelle Guerdoux
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. 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. 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]. 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.
{"title":"Screening for reduced food intake in 2 minutes: validation of the ingesta verbal analogue scale in medical geriatric oncology","authors":"Pierre Senesse, Julie Deffrennes, Nicolas Flori, Chloé Janiszewski, Laure Francioni, Simon Thezenas, Estelle Guerdoux","doi":"10.1038/s41430-025-01681-3","DOIUrl":"10.1038/s41430-025-01681-3","url":null,"abstract":"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. 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. 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]. 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.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 2","pages":"203-211"},"PeriodicalIF":3.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41430-025-01681-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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. 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. 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. The combined MeDi-DASH-CHH dietary effectively improves lipid profiles and promotes healthier eating behaviors in older adults with dyslipidemia in northern China.
{"title":"A combined MeDi-DASH-CHH dietary intervention improves lipid profiles and enhances dietary adherence in northern Chinese older adults with dyslipidemia: A randomized controlled trial","authors":"Tongyang Wu, Liyang Zhang, Haoran Yu, Xukun Chen, Li Huang, Qi Wu, Jingwen Zhang, Yue Wang, Changqing Sun, Guowei Huang, Wen Li","doi":"10.1038/s41430-025-01687-x","DOIUrl":"10.1038/s41430-025-01687-x","url":null,"abstract":"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. 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. 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. The combined MeDi-DASH-CHH dietary effectively improves lipid profiles and promotes healthier eating behaviors in older adults with dyslipidemia in northern China.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 2","pages":"189-196"},"PeriodicalIF":3.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41430-025-01687-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1038/s41430-025-01686-y
Beáta Hubková, Jana Mašlanková, Ivana Večurkovská, Anna Birková, Beáta Čižmárová, Martina Zavacká, Daniela Fiľakovská Bobáková
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. 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. 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. 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.
{"title":"Disturbed homeostasis of iron metabolism in children from marginalised Roma communities","authors":"Beáta Hubková, Jana Mašlanková, Ivana Večurkovská, Anna Birková, Beáta Čižmárová, Martina Zavacká, Daniela Fiľakovská Bobáková","doi":"10.1038/s41430-025-01686-y","DOIUrl":"10.1038/s41430-025-01686-y","url":null,"abstract":"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. 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. 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. 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.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 2","pages":"212-220"},"PeriodicalIF":3.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1038/s41430-025-01683-1
Rong Yuan, Lei Liu, Jiao Mi, Xue Li, Fang Yang, Shifang Mao
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. 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. 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. 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.
{"title":"Early prediction of enteral nutrition feeding intolerance risk in neurocritical patients and development of a simplified risk scoring tables","authors":"Rong Yuan, Lei Liu, Jiao Mi, Xue Li, Fang Yang, Shifang Mao","doi":"10.1038/s41430-025-01683-1","DOIUrl":"10.1038/s41430-025-01683-1","url":null,"abstract":"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. 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. 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. 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.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 2","pages":"159-167"},"PeriodicalIF":3.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41430-025-01683-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-28DOI: 10.1038/s41430-025-01685-z
Isabelle Herter-Aeberli, Maria Andersson, Valeria Galetti
Iron deficiency in women of childbearing age remains a public health challenge, but prevalence data in high-income countries is scarce and the role of predictors remains uncertain. We determined the prevalence of iron deficiency in women in Switzerland and assessed the influence of BMI, inflammation, and age on iron status. In addition, we determined the ferritin concentration below which hemoglobin (Hb) starts to decline. This is a secondary, pooled data analysis including data from 26 studies conducted in Switzerland between 2009 and 2020. Participants were a convenience sample of generally healthy women aged between 18 and 54 years (n = 2709). The prevalence of iron deficiency in women (median 23.3 years; IQR: 21.1–26.4) was 18.9%, while 4.7% of the women were anemic and 3.3% were iron deficient anemic. The prevalence of overweight (BMI ≥ 25 kg/m2) was 7.2%, and 1.4% were obese (BMI ≥ 30 kg/m2); 8.9% suffered from acute inflammation (CRP ≥ 5 mg/l). In multivariate regression analysis, BMI and age were positive predictors of ferritin (p < 0.001), while inflammation was not. Correcting iron status for inflammation had a negligible effect on the prevalence of iron deficiency. We observed a decrease in Hb below a ferritin concentration of 28.5 µg/l. In this convenience sample of young women in Switzerland, one in five was iron deficient and one in 30 was anemic due to iron deficiency. Controlling ferritin concentrations for inflammation did not substantially affect the prevalence of iron deficiency, indicating that such corrections are redundant in a healthy population with a low prevalence of inflammation. Impaired erythropoiesis was observed when the ferritin concentration fell below 28.5 µg/l, providing further evidence for a physiologically based ferritin threshold to identify the onset of iron-deficient erythropoiesis.
{"title":"Iron status in women of reproductive age in Switzerland: the role of inflammation and ferritin thresholds for the prevalence of iron deficiency–a cross-sectional study","authors":"Isabelle Herter-Aeberli, Maria Andersson, Valeria Galetti","doi":"10.1038/s41430-025-01685-z","DOIUrl":"10.1038/s41430-025-01685-z","url":null,"abstract":"Iron deficiency in women of childbearing age remains a public health challenge, but prevalence data in high-income countries is scarce and the role of predictors remains uncertain. We determined the prevalence of iron deficiency in women in Switzerland and assessed the influence of BMI, inflammation, and age on iron status. In addition, we determined the ferritin concentration below which hemoglobin (Hb) starts to decline. This is a secondary, pooled data analysis including data from 26 studies conducted in Switzerland between 2009 and 2020. Participants were a convenience sample of generally healthy women aged between 18 and 54 years (n = 2709). The prevalence of iron deficiency in women (median 23.3 years; IQR: 21.1–26.4) was 18.9%, while 4.7% of the women were anemic and 3.3% were iron deficient anemic. The prevalence of overweight (BMI ≥ 25 kg/m2) was 7.2%, and 1.4% were obese (BMI ≥ 30 kg/m2); 8.9% suffered from acute inflammation (CRP ≥ 5 mg/l). In multivariate regression analysis, BMI and age were positive predictors of ferritin (p < 0.001), while inflammation was not. Correcting iron status for inflammation had a negligible effect on the prevalence of iron deficiency. We observed a decrease in Hb below a ferritin concentration of 28.5 µg/l. In this convenience sample of young women in Switzerland, one in five was iron deficient and one in 30 was anemic due to iron deficiency. Controlling ferritin concentrations for inflammation did not substantially affect the prevalence of iron deficiency, indicating that such corrections are redundant in a healthy population with a low prevalence of inflammation. Impaired erythropoiesis was observed when the ferritin concentration fell below 28.5 µg/l, providing further evidence for a physiologically based ferritin threshold to identify the onset of iron-deficient erythropoiesis.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 2","pages":"221-227"},"PeriodicalIF":3.3,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41430-025-01685-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145631654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Appropriate hydration is essential for track-and-field sprinters to optimize training and competition performance. A recently developed estimation equation evaluates water turnover (WT) based on body size, environmental, and lifestyle factors. However, the assumption in the estimation equation—which may imply that athletes feel thirstier and have greater voluntary water intake than non-athletes because of an attenuated thirst-suppressing response—may not be applicable to sprinters engaged in high-intensity training. This study aimed to validate the estimation equation for WT in sprinters. Twenty-four male collegiate sprinters participated in this study. The WT in participants was estimated and measured using the estimation equation (WTEstimated) and the doubly labeled water (DLW) method (WTMeasured), respectively. Additionally, the total training time was evaluated using activity record. Preformed water volume was calculated by subtracting metabolic water, respiratory water uptake, and transcutaneous water uptake from WTMeasured. WTEstimated (4.95 ± 0.39 L/day) was significantly higher than WTMeasured (4.42 ± 0.74 L/day) (d = 0.57, P < 0.05). Total training time was significantly correlated with preformed water volume (r = 0.55, P < 0.05), and preformed water volume was significantly correlated with the difference between WTEstimated and WTMeasured (P < 0.05). Our findings indicate that the estimation equation overestimated WT by approximately 500 mL/day in male collegiate sprinters. These results suggest that sprinters should carefully consider the discrepancy difference between estimated WT and WT measurand using DLW method when using the estimation equation for hydration management.
背景/目的：适当的补水是田径运动员优化训练和比赛表现的必要条件。最近开发的估算公式评估水周转量（WT）基于体型，环境和生活方式因素。然而，估计方程中的假设——这可能意味着运动员比非运动员感到更渴，并且由于口渴抑制反应减弱而有更多的自愿饮水——可能不适用于从事高强度训练的短跑运动员。本研究旨在验证短跑运动员WT的估计方程。材料/方法：选取24名男大学生短跑运动员为研究对象。分别使用估计方程（WTEstimated）和双标记水（DLW）方法（WTMeasured）估计和测量参与者的WT。此外，使用活动记录评估总训练时间。预成型水量通过从WTMeasured中减去代谢水、呼吸水摄取和经皮水摄取来计算。结果：WTEstimated（4.95±0.39 L/day）显著高于WTMeasured(4.42±0.74 L/day) （d = 0.57， P Estimated和WTMeasured (P)）。结论：我们的研究结果表明，估计方程高估了男大学生短跑运动员约500 mL/day的WT。这些结果表明，短跑运动员在使用估计方程进行水分管理时，应仔细考虑使用DLW方法估计的WT与测量的WT之间的差异。
{"title":"Evaluation of an estimation equation for water turnover in male collegiate sprinters based on the doubly labeled water method","authors":"Yuki Shimamura, Yuki Ahagon, Mariko Ikai, Suraiya Khatun, Satoru Tanigawa, Daisuke Yamamoto, Miki Kosugi, Yasuki Higaki, Akiko Uchizawa, Hiroyuki Sagayama, Kaito Iwayama","doi":"10.1038/s41430-025-01680-4","DOIUrl":"10.1038/s41430-025-01680-4","url":null,"abstract":"Appropriate hydration is essential for track-and-field sprinters to optimize training and competition performance. A recently developed estimation equation evaluates water turnover (WT) based on body size, environmental, and lifestyle factors. However, the assumption in the estimation equation—which may imply that athletes feel thirstier and have greater voluntary water intake than non-athletes because of an attenuated thirst-suppressing response—may not be applicable to sprinters engaged in high-intensity training. This study aimed to validate the estimation equation for WT in sprinters. Twenty-four male collegiate sprinters participated in this study. The WT in participants was estimated and measured using the estimation equation (WTEstimated) and the doubly labeled water (DLW) method (WTMeasured), respectively. Additionally, the total training time was evaluated using activity record. Preformed water volume was calculated by subtracting metabolic water, respiratory water uptake, and transcutaneous water uptake from WTMeasured. WTEstimated (4.95 ± 0.39 L/day) was significantly higher than WTMeasured (4.42 ± 0.74 L/day) (d = 0.57, P < 0.05). Total training time was significantly correlated with preformed water volume (r = 0.55, P < 0.05), and preformed water volume was significantly correlated with the difference between WTEstimated and WTMeasured (P < 0.05). Our findings indicate that the estimation equation overestimated WT by approximately 500 mL/day in male collegiate sprinters. These results suggest that sprinters should carefully consider the discrepancy difference between estimated WT and WT measurand using DLW method when using the estimation equation for hydration management.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 2","pages":"1-6"},"PeriodicalIF":3.3,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145631610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We assessed the effectiveness of weekly iron and semestrial high-dose vitamin A supplementation on hemoglobin (Hb) concentration, and iron and vitamin A status of schoolchildren in rural Ethiopia. Using a 2 × 2 factorial design, 504 schoolchildren aged 7–10 years were randomly assigned to one of the four arms: control placebo; high-dose vitamin A; iron; or iron and high-dose vitamin A. Semestrial 200,000 IU vitamin A and weekly 42 mg of iron supplement were provided for 11 months. At baseline and at endline, Hb and serum concentrations of ferritin (sF), soluble transferrin receptor (sTfR), and retinol-binding protein (RBP) were measured. Serum indicators were adjusted for inflammation indicators, while Hb was adjusted for village altitude. Total body iron was calculated from sTfR and sF concentrations using an established formula. At baseline, prevalence of anemia (Hb < 11.0 g/dL), iron deficiency (sTfR > 8.3 mg/L or sF < 15 μg/L), iron-deficiency anemia, and vitamin A deficiency (RBP < 0.7 μmol/L) were 27.8%, 21.7%, 6.3% and 12.2%, respectively. Both iron and vitamin A supplementation had no significant effect on Hb, sTfR, and RBP concentrations. Supplementing iron weekly significantly increased sF (6.86 μg/L, 95%CI: 1.67, 12.05) and total body iron (0.45 mg/Kg, 95%CI: 0.17, 0.74), while semestrial vitamin A supplementation had no significant effect on both sF and total body iron. Intermittent iron and vitamin A supplementation had no significant detectable effects on Hb, sTfR, and RBP concentrations of schoolchildren. Weekly iron supplementation improved sF concentrations. These findings suggest that providing iron and vitamin A supplements to populations where the extent of the deficiencies is not a major public health problem may not be beneficial.
{"title":"Effectiveness of intermittent iron and high-dose vitamin A supplementation on hemoglobin, iron and vitamin A status of schoolchildren in southern Ethiopia: a randomized placebo controlled trial","authors":"Befikadu Tariku Gutema, Muluken Bekele Sorrie, Sifray Batire Belayneh, Eshetu Zerihun Tariku, Wanzahun Godana Boynito, Tadiwos Hailu Zewdie, Tsegaye Yohanes, Stefaan De Henauw, Bruno Levecke, Souheila Abbeddou","doi":"10.1038/s41430-025-01678-y","DOIUrl":"10.1038/s41430-025-01678-y","url":null,"abstract":"We assessed the effectiveness of weekly iron and semestrial high-dose vitamin A supplementation on hemoglobin (Hb) concentration, and iron and vitamin A status of schoolchildren in rural Ethiopia. Using a 2 × 2 factorial design, 504 schoolchildren aged 7–10 years were randomly assigned to one of the four arms: control placebo; high-dose vitamin A; iron; or iron and high-dose vitamin A. Semestrial 200,000 IU vitamin A and weekly 42 mg of iron supplement were provided for 11 months. At baseline and at endline, Hb and serum concentrations of ferritin (sF), soluble transferrin receptor (sTfR), and retinol-binding protein (RBP) were measured. Serum indicators were adjusted for inflammation indicators, while Hb was adjusted for village altitude. Total body iron was calculated from sTfR and sF concentrations using an established formula. At baseline, prevalence of anemia (Hb < 11.0 g/dL), iron deficiency (sTfR > 8.3 mg/L or sF < 15 μg/L), iron-deficiency anemia, and vitamin A deficiency (RBP < 0.7 μmol/L) were 27.8%, 21.7%, 6.3% and 12.2%, respectively. Both iron and vitamin A supplementation had no significant effect on Hb, sTfR, and RBP concentrations. Supplementing iron weekly significantly increased sF (6.86 μg/L, 95%CI: 1.67, 12.05) and total body iron (0.45 mg/Kg, 95%CI: 0.17, 0.74), while semestrial vitamin A supplementation had no significant effect on both sF and total body iron. Intermittent iron and vitamin A supplementation had no significant detectable effects on Hb, sTfR, and RBP concentrations of schoolchildren. Weekly iron supplementation improved sF concentrations. These findings suggest that providing iron and vitamin A supplements to populations where the extent of the deficiencies is not a major public health problem may not be beneficial.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":"80 2","pages":"177-188"},"PeriodicalIF":3.3,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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