Annals of Nutrition and Metabolism最新文献

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.

Background: Knowledge of the complex interplay between gut microbiota and human health is gradually increasing as it has just recently been a field of such great interest.

Summary: Recent studies have reported that communities of microorganisms inhabiting the gut influence the immune system through cellular responses and shape many physiological and pathophysiological aspects of the body, including muscle and bone metabolism (formation and resorption). Specifically, the gut microbiota affects skeletal homeostasis through changes in host metabolism, the immune system, hormone secretion, and the gut-brain axis. The major role on gut-bone axis is due to short-chain fatty acids (SCFAs). They have the ability to influence regulatory T-cell (Tregs) development and activate bone metabolism through the action of Wnt10. SCFA production may be a mechanism by which the microbial community, by increasing the serum level of insulin-like growth factor 1 (IGF-1), leads to the growth and regulation of bone homeostasis. A specific SCFA, butyrate, diffuses into the bone marrow where it expands Tregs. The Tregs induce production of the Wnt ligand Wnt10b by CD8+ T cells, leading to activation of Wnt signaling and stimulation of bone formation. At the hormonal level, the effect of the gut microbiota on bone homeostasis is expressed through the biphasic action of serotonin. Some microbiota, such as spore-forming microbes, regulate the level of serotonin in the gut, serum, and feces. Another group of bacterial species (Lactococcus, Mucispirillum, Lactobacillus, and Bifidobacterium) can increase the level of peripheral/vascular leptin, which in turn manages bone homeostasis through the action of brain serotonin.

Background: The gut microbiota, or microbiome, is essential for human health. Early-life factors such as delivery mode, diet, and antibiotic use shape its composition, impacting both short- and long-term health outcomes. Dysbiosis, or alterations in the gut microbiota, is linked to conditions such as allergies, asthma, obesity, diabetes, inflammatory bowel disease, and necrotizing enterocolitis in preterm infants.

Summary: This article reviews current strategies to influence the early-life gut microbiome and their potential health impacts. It also briefly summarizes guidelines on using biotics for gastrointestinal and allergic diseases in children. Key strategies include vaginal or fecal microbiota transplantation for cesarean-born infants, breastfeeding, and biotic-supplemented formulas. While vaginal microbial transfer and maternal fecal microbiota transplantation show short-term benefits, further research is needed to determine long-term safety and efficacy. Breast milk, rich in human milk oligosaccharides, promotes a healthy microbiota and offers protection against infections. Biotic-supplemented formulas can improve the gut microbiota in formula-fed infants and show clinical effects, though each biotic must be evaluated separately. Probiotics given as dietary supplements outside of infant formulas show promise for treating gastrointestinal disorders but require further investigation.

Introduction: This prospective cohort study aimed to assess the predictive capacity of fat-related body composition in early pregnancy for macrosomia and facilitate early screening.

Methods: We analyzed 949 women who delivered at Suzhou Hospital Affiliated to Nanjing Medical University (Suzhou Municipal Hospital) between March 2021 and March 2022, categorized into 54 macrosomia, 869 normal-weight, and 26 low-weight deliveries. At 13 weeks gestation, maternal adiposity indices, including fat mass index (FMI) and percent body fat, were measured. Propensity score matching (PSM) was performed at a 1:2 ratio to compare 53 macrosomic mothers with 106 normal mothers, controlling for maternal height, gestational age, and neonatal sex. Multivariate logistic regression identified independent risk factors for macrosomia.

Results: The macrosomia group exhibited significantly higher prepregnancy BMI (22.44 vs. 20.95 kg/m2), body fat percentage (32.41% vs. 29.58%), and FMI (7.16 vs. 6.09 kg/m2, all p < 0.001) than the control group. Notably, FMI (OR = 1.428, 95% CI: 1.017, 2.003, p = 0.039) and gestational age (OR = 1.619, 95% CI: 1.095, 2.395, p = 0.016) emerged as independent risk factors for macrosomia. The diagnostic accuracy of FMI for predicting macrosomia was moderate, with an area under the curve of 73.2%.

Conclusion: FMI during early pregnancy can serve as a predictive marker for macrosomia. Due to the objectivity and simplicity, FMI can be incorporated into prenatal care, which enables targeted lifestyle interventions, such as dietary counseling and exercise, reducing adverse pregnancy outcomes.

Introduction: Enteral nutrition is used in patients with stroke, head-and-neck or esophageal cancer surgery, or repeated aspiration pneumonia. Japanese enteral nutrition guidelines recommend percutaneous endoscopic gastrostomy tube (PEG) for long-term use of >4 weeks and nasogastric tube (NGT) for short-term use of <4 weeks. Catheters may be contaminated with microorganisms because enteral feeding products passed through them daily, but there are few reports on catheter contamination in Japan and no reports on the duration of catheter use. There are also reports that enteral feeding is a risk factor for the appearance of drug-resistant bacteria. Therefore, this study aimed to determine whether microorganisms could be isolated from enteral feeding catheters and determine the percentage of drug-resistant bacteria.

Methods: Forty-six PEGs and 59 NGTs were collected at Showa University Hospital and Showa University Fujigaoka Rehabilitation Hospital from May 2019 to March 2020. Microorganisms were cultured by incubating 20 mL pass/wash solution of sterile purified water on BHI agar medium (37°C) for 24-72 h. The strains were isolated and cultured, then frozen (80°C) and stored. Antimicrobial susceptibility was determined by broth microdilution method.

Results: Microorganisms were detected in 37 PEGs and 57 NGTs (p = 0.007). Bacteria were detected in 27 PEGs and 53 NGTs (p < 0.001), and yeasts were detected in 29 PEGs and 28 NGTs (p = 0.112). Drug-resistant bacteria were isolated from 19.6% (9 of 46) in PEGs and 23.7% (14 of 59) in NGTs.

Conclusions: PEGs and NGTs were contaminated with microorganisms, and drug-resistant bacteria were isolated. This study provides a rationale for future appropriate use in enteral feeding catheters.