Annals of Nutrition and Metabolism最新文献

The following document contains a total of 30 abstracts selected by the Board of Directors of the European Childhood Obesity Group (ECOG) for publication in the Annals of Nutrition and Metabolism in the context of the 34th ECOG annual congress.

In the article by Cavdar et al. entitled "Impact of a High-Calorie Diet on Metabolic Health, Carotid Intima-Media Thickness, and Endothelial Function in Individuals with Constitutional Thinness" [Ann Nutr Metab. 2025;81:311-318; https://doi.org/10.1159/000546273], there is an error introduced during production which deleted affiliation 2 (Department of Endocrinology and Metabolic Diseases, Istinye University, Istanbul, Turkey), which belonged to author Bercem Aycicek. The original article has been updated.

Introduction: Creatine is a conditionally essential nutrient central to cellular energy metabolism, with roughly half of daily requirements derived from dietary sources found exclusively in animal-based foods. Insufficient dietary creatine intake has been linked to various adverse health outcomes, yet data on creatine adequacy among individuals following special diets remain limited. This study examined the prevalence of low dietary creatine intake among US individuals adhering to different special diets using cumulative data from the National Health and Nutrition Examination Survey (NHANES).

Methods: Data from NHANES 2003-2023 cycles were merged to identify participants (≥1 year old) reporting adherence to a special diet in the Dietary Data domain. Self-reported diets were categorized into thirteen groups (e.g., weight-loss, diabetic, low-fat, low-carbohydrate, gluten-free). Dietary creatine intake, estimated using established methods and excluding supplements, was classified as adequate (≥1 g/day) or inadequate (<1 g/day). Differences in the prevalence of inadequate creatine intake across diet types were assessed using chi-square tests with Bonferroni-adjusted post hoc comparisons.

Results: Among 8,407 participants (57.8% female; mean age = 45.0 ± 21.5 years) reporting adherence to a single special diet, mean creatine intake was 0.82 ± 0.82 g/day, with 69.5% classified as having inadequate intake. The prevalence of low creatine intake differed significantly across diet types (p < 0.0001), ranging from 83.3% in low-fiber diets to 60.4% in renal diets. Individuals following low-carbohydrate diets exhibited a significantly lower prevalence of inadequate intake (p = 0.00097), while high- and low-fiber, gluten-free, and weight-loss diets were associated with higher prevalence rates. Women showed greater creatine insufficiency than men across several dietary categories.

Conclusion: Inadequate dietary creatine intake is highly prevalent among individuals following a variety of special diets in the US population. Restrictive or plant-forward regimens appear particularly associated with insufficient intake, underscoring the need for nutritional strategies - such as creatine-fortified foods or supplementation - to maintain optimal creatine homeostasis and support metabolic health in at-risk groups.

Introduction: Whether the consumption of fruits, flavonoid-rich fruits, and 100% fruit juice is associated with the risk of gestational diabetes mellitus (GDM) is unclear. We aimed to examine the association of total fruit, flavonoid-rich fruits, and 100% fruit juice consumption with the risk of GDM.

Methods: A total of 93,759 singleton pregnancies who were enrolled in the Japan Environment and Children's Study remained for the analysis. Total fruit consumption including fruits and 100% fruit juice during the past year in the first trimester was assessed using a validated food frequency questionnaire (FFQ). Odds ratios (ORs) and 95% confidence intervals (CIs) for GDM associated with total fruit, flavonoid-rich fruits, non-flavonoid-rich fruits, and 100% fruit juice consumption were estimated using logistic regression analysis.

Results: GDM occurred in 2,096 (2.2%) of the 93,759 pregnant women. Total fruit consumption was inversely associated with the risk of GDM; the multivariable ORs (95% CI) for the highest vs. lowest quartiles of total fruit consumption were 0.82 (0.71, 0.95) (p for trend = 0.013). An increase in total fruit consumption by each 100 g/day was inversely associated with the risk of GDM (OR = 0.94 [0.91, 0.98], p for trend = 0.001). The multivariable ORs (95% CIs) for the highest versus lowest quartiles of flavonoid-rich fruits consumption was 0.80 (0.70, 0.93) (p for trend = 0.003), whereas that for non-flavonoid-rich fruits consumption was 0.96 (0.83, 1.11) (p for trend = 0.504); 100% fruit juice consumption was inversely associated with the risk of GDM for each 100 mL/day increase (OR = 0.91, 95% CI: 0.87, 0.96).

Conclusion: Total fruit, flavonoid-rich fruits, and 100% fruit juice consumption were inversely associated with risk of GDM.

Background: The global obesity epidemic necessitates therapies that enhance energy expenditure. Non-shivering thermogenesis (NST) in brown/beige adipose tissue represents a promising target, with fibroblast growth factor 21 (FGF21) emerging as a critical regulator linking environmental stimuli to adipose plasticity and mitochondrial function. However, the precise mechanisms of FGF21 secretion and its specific role in adipose tissue browning and subsequent NST potentiation remain incompletely elucidated.

Summary: FGF21 regulates NST via distinct spatiotemporal mechanisms. Acute cold exposure triggers hepatic FGF21 secretion through a β₃-adrenergic-lipolysis-PPARα axis to provide lipid substrates. In contrast, chronic cold adaptation involves adipose-derived FGF21 signaling via the FGFR1/β-Klotho complex, activating the PLCγ-Ca2+-cAMP response element-binding protein pathway to enhance UCP1 expression and mitochondrial biogenesis. Aging and statins impair NST via mitochondrial dysfunction and CoQ₁₀ depletion, inducing compensatory FGF21 upregulation. Clinically, the efficacy of FGF21-based therapies relies on full activation of adipose FGFR1/β-Klotho signaling, as demonstrated by the superiority of full agonists over partial agonists.

Key messages: FGF21 exhibits dual regulation: hepatic (acute lipid mobilization) and adipose-based (chronic browning); adipose-targeted FGF21 delivery is essential for therapeutic efficacy, and future studies should integrate FGF21 with UCP1-independent pathways (e.g., creatine/succinate cycles) to advance obesity treatment.

Introduction: Observational studies have raised questions regarding the comprehensive metabolomic markers associated with dietary macronutrient intake. This study aimed to identify metabolites that are causally linked to dietary macronutrient consumption using a robust analytical framework.

Methods: This genetic association study employed a two-sample Mendelian randomization (MR) approach. Genetic proxies for metabolites and their summary statistics were sourced from 64 genome-wide association studies, and a meta-analysis provided summary statistics for 3,362 metabolites. Summary statistics for dietary carbohydrate, fat, and protein intakes were obtained from the UK Biobank. MR associations were assessed using inverse-variance weighted, weighted median, and Egger's regression models to enhance robustness. Significant metabolites were subjected to enrichment analysis to identify relevant metabolic pathways. Associations were expressed as odds ratios with 95% confidence intervals, and enrichment analysis was used to identify key KEGG pathways based on p values.

Results: MR analysis identified 540 metabolite-macronutrient associations: 186 for carbohydrate intake, 217 for fat intake, and 137 for protein intake. Metabolites inversely associated with carbohydrate and protein intake, but positively linked to fat intake, were enriched in KEGG pathways, particularly those governing the biosynthesis and metabolism of aromatic amino acids (tryptophan and phenylalanine) and branched-chain amino acids (BCAAs) (tyrosine, valine, leucine, and isoleucine).

Conclusion: This study comprehensively mapped the metabolite associations with dietary macronutrient intake using extensive genetic data. These findings highlight the critical roles of aromatic and BCAA biosynthesis and metabolism as key metabolic pathways in macronutrient regulation.

Introduction: Genetic variations, including rs17782313 (C/T) in the MC4R gene, are associated with lipid levels. Gene-diet interactions contribute to disease development. This study aimed to investigate the effects of interactions between total energy intake, protein intake, and MC4R rs17782313 on lipid parameters in Saudi adults.

Methods: In a cross-sectional study of 268 Saudi adults (aged 20-55 years), dietary data were assessed using a 136-item validated semiquantitative food frequency questionnaire, and MC4R (rs17782313) was genotyped using real-time polymerase chain reaction.

Results: Total energy and protein calorie intake interacted with the MC4R rs17782313 polymorphism to influence total cholesterol (TC) (p_interaction = 0.036 and p_interaction = 0.021, respectively). Low total energy and protein intake was associated with decreased TC levels in all genotypes at rs17782313. The interaction between total energy intake and MC4R rs17782313 affected triglyceride levels (p_interaction = 0.039). Protein calorie intake significantly interacted with MC4R rs17782313 in determining low-density lipoprotein (p_interaction = 0.042). However, none of these interactions remained significant after applying Bonferroni correction (p > 0.01).

Conclusion: Low total energy and protein intake is associated with low lipid levels among all genotypes at rs17782313 in Saudi adults. Further validation in larger cohorts is warranted to confirm these findings and explore their clinical implications.

Background: Obesity is a significant threat to national and global public health in terms of its prevalence and economic burden due to obesity-related complications (ORCs) and morbidities. The aim of this study is to calculate obesity-related public expenditures in Hungary in order to estimate the expenses and contribution of patients in 2019 and in 2022, before and after the COVID-19 pandemic, respectively.

Method: Expenditures related to patients with obesity, who suffered from more frequent co-morbidities, were requested from the national database of the National Health Insurance Fund. Financial information related to the inpatient and the outpatient providers and reimbursement for the prescription of medicines and healing aids was collected.

Results: Obesity-related morbidities represent 10-12 % of all cases in the public health care system. National public health care expenses were reported to be close to HUF 144 billion (EUR 444 million) for 2019 and HUF 133 billion (EUR 393 million) for 2022. These sums represent 7-11% of the total national spending for health care provision, not accounting for sick leave expenditures. The co-payment of patients was estimated to be around HUF 34 billion (EUR 104 million) for 2019 and HUF 43 billion (EUR 109 million) for 2022. Public expenditures and co-payments related to Type 2 diabetes and hypertension were the highest. Public and individual expenditures represent 0.3-0.4% of the GDP, which is equivalent to EUR 56 and EUR 52 per capita, respectively, for all inhabitants of the country.

Conclusion: Reducing these high expenses is possible through the introduction of appropriate education and public health policies to prevent obesity at an individual level and enable weight reduction among persons living with obesity. To calculate the cost of obesity, an international consensus on standardized methods is required to improve homogeneity and comparability.

Introduction: Efficacy and safety of a novel total parenteral nutrition formula for chronic kidney disease patients, OPF-109, containing multivitamins based on the FDA2000 recommendation were investigated.

Methods: We conducted a phase III clinical trial administering OPF-109 (n = 63) or the control solutions (combination of marketed products including multivitamin based on American Medical Association 1975 guidelines) (n = 61) to the chronic kidney disease patients for 8 days. Blood concentrations of proteins and vitamins and safety were evaluated. The primary efficacy endpoint was protein concentration (serum T-P, ALB, pre-ALB, transferrin) on day 8. Safety endpoints were hematological data, blood biochemistry data, vital signs, and adverse events.

Results: Values of blood protein until day 8 were similar in 2 groups although those of vitamins B1, B6, C, and folic acid (contained more in OPF-109) were higher in the OPF-109 group. For both groups, vitamin C concentration of day 1 was below the normal range, which restored to within the range in the OPF-109 group but decreased in the control group on day 8. Vitamin K concentration (contained less in OPF-109) was over the normal range on day 1 in both groups and decreased to slightly higher than the normal range in the OPF-109 group while increased to higher than day 1 value in the control group on day 8. Safety was similar in 2 groups.

Conclusion: Efficacy and safety of OPF-109 and usefulness of multivitamins based on the FDA2000 recommendation formula were confirmed in chronic kidney disease patients.