Annals of Nutrition and Metabolism最新文献

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.

Introduction: In Europe, one in three school-aged children live with overweight or obesity and are at high risk of continuing to be affected by it throughout their lives. The objective of our study was to quantify the economic burden of obesity among Austrian children and adolescents born between 2000 and 2019.

Methods: We used obesity projections and the share of young adults assumed to have remained with obesity since childhood or adolescence to project the lifetime costs of birth cohorts from 2000 to 2019. We estimated lifetime costs per individual using population-attributable fractions, considering a discount rate of 3%, obesity-associated mortality, an obesity-associated "income penalty," and future cost increases in the healthcare system.

Results: For Austria, we estimated that around 95,000 of all children and adolescents in 2019 remain with obesity as adults, which leads to a present value of EUR 9.2 billion or an annuity of approximately EUR 285 million (0.07% of GDP in 2019). Approximately 15% of costs arise from direct costs and 85% from indirect costs.

Conclusion: We highlighted the long-term economic burden of early-onset obesity in Austria and concluded that public health programs addressing children and adolescents with obesity could relieve high costs not only for individuals but also for society.

Background: Metabolic flexibility, the capacity to switch between energy sources in response to changing physiological demands, emerges as a critical determinant of perioperative resilience. In the context of surgery, where metabolic demands are high and energy homeostasis is disrupted, patients with metabolic inflexibility may experience worse outcomes due to impaired immune responses and heightened insulin resistance, resulting in prolonged recovery times.

Summary: This article explores the implications of metabolic flexibility in the perioperative period and examines the potential for prehabilitation strategies, such as targeted exercise and nutritional interventions, to improve patient readiness for surgery. Cardiopulmonary exercise testing is discussed as a valuable assessment tool for metabolic flexibility, capable of providing insights into a patient's fuel adaptability and overall metabolic health preoperatively. Evidence suggests that targeted exercise and nutritional strategies can enhance mitochondrial function, improve nutrient-sensing pathways, and increase substrate oxidation, which may reduce perioperative complications and support immune resilience.

Key messages: Future research should prioritise refining methods to identify metabolically inflexible patients and tailoring prehabilitation interventions to optimise metabolic flexibility. Enhancing perioperative metabolic readiness is important for populations vulnerable to metabolic dysfunction, such as those with obesity, diabetes, and cancer. Aligning metabolic optimisation with surgical recovery demands may help establish new standards in perioperative care and improve patient outcomes.

Background: Under the terms of the United Nations Convention on the Rights of the Child (UNCRC), governments are now required to enable all children to fulfil their full potential with the key principles being non-discrimination, the right to life and development, the best interests of the child, and the right to be heard. A recent statement by UNICEF indicated that implementation of the principles of the UNCRC provide a pathway for WHO, WHA, and UNICEF global infant feeding policy documents to be introduced into domestic law. But these documents are not recent and have not been updated, and they represent high levels of non-compliance. Moreover, do they actually comply with the principles set out in the UNCRC?

Summary: Global decisions on infant feeding are being made by organisations who are distant from family circumstances and primarily reflect the views of WHO/UNICEF and activist groups. Evidence of dismissal of public consultation is discriminatory, and an unwillingness to manage differences of opinion is a denial of the right to be heard.

Key message: National governments can serve the best interests of the child through sovereign rights, national responsibility and accountability, and development of national infant feeding policies that reflect UNCRC principles.