PURPOSE OF REVIEW:Iron deficiency persists as the most common nutritional deficiency worldwide and is highly prevalent among women of reproductive age. Pregnancy substantially raises iron requirements, increasing the risk of complications for mother and newborn particularly in low-income and middle-income countries. We summarize current evidence on the determinants, physiological adaptations, diagnostic thresholds, and management of iron deficiency during pregnancy and lactation, focusing on recent developments. RECENT FINDINGS:Maternal iron regulation during pregnancy involves progressive hepcidin suppression to enhance absorption and fetal iron transfer, though regulatory mechanisms remain incompletely understood. Daily supplementation may maintain maternal iron status more effectively than an alternate-day regimen but is associated with more side effects; thus, the choice of regimen should be individualized and based on context. Multiple micronutrient supplements offer superior clinical outcomes compared to iron-folic supplements. For moderate-to-severe iron deficiency or late-pregnancy correction, intravenous iron has proven to be well tolerated and highly effective. SUMMARY:Effective management requires early identification using ferritin-based diagnostic thresholds. Intravenous iron is an essential clinical tool for rapid correction or when oral iron is poorly tolerated. Sustainably improving maternal iron status globally would prevent iron deficiency in pregnancy but further necessitates integrated public health approaches - addressing dietary quality, low-dose supplementation, sanitation, and digital health interventions.
PURPOSE OF REVIEW:Despite strong biological plausibility, empiric high-dose micronutrient supplementation has failed to improve outcomes in critically ill patients. This review synthesizes evidence from the past 18 months and outlines the necessary transition toward biomarker-guided precision nutrition. RECENT FINDINGS:Recent evidence has further challenged routine high-dose micronutrient therapy. High-dose intravenous vitamin C failed to improve outcomes and was associated with potential harm in patients with sepsis, COVID-19, severe burns, and post-cardiac arrest syndrome. In contrast, a 2025 meta-analysis reported reduced short-term mortality and shorter ICU stay with vitamin D supplementation in patients on mechanical ventilation. Thiamine may shorten the duration of shock without affecting mortality. Observational studies suggest that carnitine deficiency is common during critical illness, and both deficiency and excess may be associated with adverse outcomes in critically ill patients. Selenium supplementation continues to show no clinical benefits in multiple sepsis phenotypes and high-risk surgical populations. Novel evidence also links trace element dysregulation to critical illness-acquired weakness, implicating copper-dependent cuproptosis, zinc homeostasis, and iron metabolism in the pathogenesis of muscle dysfunction. Advances in biomarkers (e.g. hepcidin, soluble transferrin receptor, ferritin, and selenoprotein P) are enabling more accurate identification of true deficiency states and targeted replacement strategies. SUMMARY:Current evidence does not support routine high-dose single-micronutrient therapy in critically ill patients and suggests potential harm with pharmacological doses of vitamin C. Clinicians should ensure that daily baseline requirements are met and reserve supplementation only for patients with biomarker-confirmed deficiency or biologically defined high-risk phenotypes. Future research should prioritize precision nutritional approaches based on validated biomarkers and individualized metabolic profiling.
Purpose of review Emerging evidence suggests that choline plays a significant role in mediating metabolic disease beyond the regulation of hepatic triglycerides. The aim of this article is to present a current, brief synthesis focused on the impact of choline intake on metabolic health and to identify future directions in this research space. Recent findings Recent work has linked low choline intake to obesity, metabolic dysfunction-associated steatotic liver disease (MASLD), type 2 diabetes, and obesity-associated cognitive decline. A new methodology now enables more precise discrimination of choline intake in clinical populations. Emerging evidence reframes circulating trimethylamine N-oxide (TMAO) as a marker of metabolic dysfunction driven by obesity and a high-fat diet, rather than a direct consequence of dietary choline intake. Preclinical and clinical studies further suggest that adequate choline intake may be protective against obesity-related disease progression, particularly when established early in life. Summary Choline is emerging as an important mediator of metabolic health and disease progression. A deeper understanding of the mechanisms regulating choline metabolism is critical to tailor nutritional therapies and mitigate metabolic disease progression. The impact of new antiobesity medications, including GLP-1 receptor agonists, on choline requirements also warrants investigation.
PURPOSE OF REVIEW:The Dietary Inflammatory Index (DII) was developed to quantify the inflammatory potential of dietary patterns based on their effects on inflammatory biomarkers. Growing evidence links low-grade inflammation to chronic diseases such as obesity, cardiovascular disease, diabetes, and cancer. This review summarizes current evidence regarding the clinical and epidemiological relevance of the DII and evaluates its potential as a tool for nutritional assessment and disease prevention. RECENT FINDINGS:Recent studies demonstrate consistent associations between higher DII scores and adverse cardiometabolic outcomes, including atherosclerosis, metabolic liver disease, obesity, and increased cardiovascular mortality. Anti-inflammatory dietary patterns, particularly the Mediterranean diet, are associated with lower DII scores, reduced inflammatory markers, and improvements in metabolic parameters and quality of life. Emerging evidence also suggests benefits in cancer survivors, patients with depression, and individuals with chronic inflammatory conditions. Methodological advances, including the energy-adjusted DII (E-DII) and the pediatric C-DII, have improved the applicability and predictive value of the index. SUMMARY:The DII provides a useful framework for assessing the relationship between diet and inflammation across populations and clinical settings. Current evidence supports its value in identifying dietary patterns associated with chronic inflammation and related diseases. Although causal relationships remain to be fully established, the DII may contribute to personalized nutrition strategies and support prevention and management approaches for inflammation-related disorders. Further long-term interventional studies are needed to strengthen its clinical utility and prognostic significance.
PURPOSE OF REVIEW:The purpose of this review was to summarise recent relevant studies examining refeeding syndrome risk and related outcomes in patients provided with enteral nutrition and discuss considerations for clinical practice and future research. RECENT FINDINGS:Recent studies investigating enteral nutrition and refeeding syndrome were heterogeneous. With the exception of physical indicators of nutritional status, there was no agreement across studies regarding commonly agreed upon risk factors including periods of fasting, feeding rates, or specific medical conditions. Comparisons of three different recommended risk criteria had highly variable results in one study. Confounding factors were evident across studies. Management of refeeding syndrome risk is becoming increasingly debated. Recent research has questioned the need for prolonged high thiamin dosages in adult patients with eating disorders. Conservative feeding practices are also called into question when serum electrolyte levels can be monitored and replaced assertively. SUMMARY:Clinical practice and research in refeeding syndrome is slowly changing, with a focus on preventing unnecessary and prolonged underfeeding in malnourished patients and in children during critical stages of growth. Future research should ensure risk criteria is specific to the clinical conditions and/or age groups being investigated. Refeeding syndrome and its subsequent management should also be considered along a spectrum, rather than as an all or nothing event. By incorporating these recommendations, research in the field will evolve to advance knowledge and enhance clinical practice.
PURPOSE OF REVIEW:Cancer cachexia is a highly prevalent multifactorial syndrome with huge prognostic influence. It is primarily characterised by progressive tissue wasting and imaging can be a powerful tool for noninvasive, longitudinal assessment. RECENT FINDINGS:Ongoing exploration and development of imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI), as well as emerging radiological biomarkers, will deepen our understanding of distinct cachexia phenotypes. SUMMARY:Bioelectrical impedance (BIA) and dual-energy X-ray absorptiometry (DEXA) were amongst the earlier modalities used to assess body composition. They are accessible and easy to use; however, concerns remain regarding their accuracy, and a paucity of detail provided in their estimates. CT provides more granular muscle and adipose tissue measurements, and analyses can be augmented with the use of automated segregation systems and multislice volumetric analysis. This could be key for supporting its integration in clinical practice. Beyond conventional quantitative assessments, MRI may aid in characterising emerging, clinically important markers of cachexia such as muscle inflammation, fat infiltration or fibrosis. Positron emission tomography (PET) CT may also become important tools for exploring how specific tissue-level pathophysiology can be accurately detected.
PURPOSE OF REVIEW:Undernutrition and sarcopenia are common in patients with cirrhosis and independently predict increased morbidity and mortality. Despite recent guidelines emphasizing nutritional intervention, implementation in clinical practice remains inconsistent. This review is informed by key guidelines including the 2025 ACG guidelines on malnutrition and perioperative management in cirrhosis and the 2024 AASLD practice guidance on acute-on-chronic liver failure, and supplemented by newer meta-analyses and reviews, linking evidence-based recommendations to practical patient care strategies. RECENT FINDINGS:The Royal Free Hospital Nutritional Prioritizing Tool is recommended for screening, with high sensitivity. Current recommendations for dietary intake include 35 kcal/kg/day and 1.2-1.5 g/kg/day of protein, with protein restriction contraindicated even in hepatic encephalopathy. Late evening snacks and micronutrient repletion (particularly vitamin D, zinc, and thiamine) show clinical benefit. Combined exercise and nutritional interventions demonstrate the greatest efficacy for improving sarcopenia. SUMMARY:While recent guidelines have clarified optimal nutritional strategies in cirrhosis, significant implementation gaps persist. Addressing barriers including clinician awareness, resource constraints, and access to specialized nutrition services is essential to improve outcomes in this high-risk population.
PURPOSE OF REVIEW:To summarize recent methodological and technological advances in assessing nutritional and metabolic status among pediatric and adolescent populations, with emphasis on their translational value within precision and personalized nutrition. This review highlights how integrative, multi-omics, and digital approaches may complement the evaluation of body composition, dietary intake, metabolic profiling, and behavioral monitoring in youth. RECENT FINDINGS:Recent findings suggest that combining compositional imaging (DXA, 3D optical, ultrasound) with bioelectrical and omic biomarkers may improve multidimensional nutritional profiling. Digital dietary assessment, biosensors, and continuous glucose monitoring may enhance real-time dietary and metabolic characterization in selected research or clinical contexts. Moreover, machine-learning models and multi-omic integration show promise individualized risk prediction and adaptive feedback, although their clinical utility requires further validation. However, standardization of protocols and pediatric reference datasets remains a key challenge. SUMMARY:Nutritional and metabolic assessment in children and adolescents is progressively moving toward integrative frameworks that combine imaging, omics, and digital monitoring. These approaches may support more individualized and developmentally sensitive evaluations, but harmonization of protocols, ethical governance, accessibility, and pediatric reference datasets remain essential before broad clinical implementation.
PURPOSE OF REVIEW:Early oral feeding after gastrointestinal surgery is safe, promotes recovery, preserves gut integrity and aligns with enhanced recovery after surgery (ERAS) pathways. However, individualization and adaption of the pathway may be necessary postoperatively particularly after upper gastrointestinal procedures, where energy and protein requirements often remain unmet. The 2025 ESPEN guideline update advocates early oral/tube feeding while addressing supplementation strategies. The purpose of this review is to discuss the updated recommendations regarding the very recent literature. RECENT FINDINGS:Early oral intake within 24 h is safe across gastrointestinal surgeries, shortening hospital stay, bowel recovery time and infectious complications without increasing the risk for anastomotic leaks. The choice of oral diet should be individualized and adapted to the performed surgery. Yet, the energy intake remains often inadequate, in particular after upper gastrointestinal surgery, necessitating monitoring and supplementation with enteral or parenteral nutrition if needed. Enteral nutrition via intraoperatively placed feeding jejunostomy should be considered in malnourished or high-risk patients in esophagectomy, total gastrectomy and pancreatoduodenectomy, to improve nutritional status and support weight maintenance, particularly in the postdischarge phase and during adjuvant therapy. SUMMARY:Early oral feeding is feasible and preferred after gastrointestinal surgery, with enteral supplementation provided as needed in high-risk patients. Parenteral nutrition should be administered when patients cannot cover at least 50% of energy needs within 3-4 days. Guideline implementation gaps persist and standardized protocols, screening and nutrition support teams are essential for optimal postoperative nutritional support. More studies are required to evaluate the efficacy and indication of supplementing enteral and parenteral nutrition specifically in the context of ERAS protocols.
PURPOSE OF REVIEW:Individual-level interventions emphasizing diet, clinical management, and structured exercise have been the typical approach to addressing metabolic health. Growing evidence suggests that broader environmental factors that shape metabolic risk have been overlooked. In this opinion paper, metabolic health is reframed within the context of climate change, urbanization, physical activity, and local knowledge, highlighting them as interconnected determinants of metabolic wellbeing. RECENT FINDINGS:Physical activity and metabolic processes are greatly influenced by neighbourhood urban design, transport infrastructure, and climate effects such as extreme heat. Evidence shows that greener neighbourhoods that support walking, cycling, and public transport are associated with more favourable cardiometabolic outcomes. Critical to the integration of such approaches for embedding physical activity into everyday life are insights from Indigenous and local communities that take a relational, place-based approach to movement and wellbeing. SUMMARY:Addressing modern metabolic health may require a paradigm shift from an individual to a systems-level approach. It is proposed that, to achieve this, physical activity, climate resilience, urban design, and Indigenous/local knowledge should be considered together to create more equitable, sustainable, and metabolically supportive environments. This framing, therefore, has important implications for research, clinical practice, policy, and next steps.
PURPOSE OF REVIEW:Obesity is a major risk factor for the development of metabolic disorders, including insulin resistance, hepatic steatosis and metabolic syndrome. The mechanistic link between obesity and metabolic complications largely relay on chronic inflammation and redox status disturbances driven by excess adiposity and reduced glutathione (GSH) levels. This article reviews the latest evidence on the therapeutic potential of glutathione precursors N-acetylcysteine (NAC) and glycine in mitigating metabolic complications associated with obesity. RECENT FINDINGS:NAC demonstrates promising benefits in improving insulin resistance, reducing hepatic steatosis, and mitigating cellular senescence mainly through its antioxidant and anti-inflammatory properties. Glycine, on the other hand, may support metabolic health by enhancing detoxification pathways and improving key metabolic markers in obesity. However, research on this field is limited and predominantly based on animal models and small-scale human trials. SUMMARY:These findings highlight the need for continued investigation on the role of glutathione precursors as part of a broader strategy for the prevention and management of metabolic diseases linked to obesity. In particular, large-scale randomized controlled studies are required to validate the efficacy, safety and optimal dosages for these supplements.
PURPOSE OF REVIEW:Chemotherapy-induced diarrhea (CID) is a clinically significant toxicity that may impair nutritional status, quality of life, treatment continuity, and dose intensity. As CID is increasingly linked to gut dysbiosis, epithelial barrier dysfunction, inflammatory activation, and altered microbiota-host interactions, probiotics have been proposed as a potential preventive strategy. This review evaluates recent clinical and translational evidence on whether probiotics can prevent CID and in which settings benefit appears most plausible. RECENT FINDINGS:Evidence published over the past 18 months has refined rather than fundamentally changed previous conclusions. Most recent data come from systematic reviews and meta-analyses, whereas newly published randomized or prospective clinical studies remain limited. Pooled analyses suggest that probiotic supplementation is associated with a lower risk of diarrhea, particularly in fluoropyrimidine- or irinotecan-based chemotherapy and in gastrointestinal malignancies, including colorectal cancer. Similar signals have also been reported in selected leukemia chemotherapy populations. However, these estimates remain limited by heterogeneity in treatment setting, probiotic formulation, dose, timing, duration, and outcome definition, and many still depend on earlier trials. Translational studies further support a strain-specific and context-dependent model involving microbial metabolites, epithelial barrier protection, inflammatory regulation, and drug-microbiota interactions. SUMMARY:Current evidence does not support routine probiotic prophylaxis for all patients receiving chemotherapy. A more appropriate interpretation is that probiotics may represent candidate adjunctive preventive strategies in selected high-risk CID settings, particularly when the chemotherapy regimen, patient risk profile, probiotic intervention, and clinical endpoints are clearly defined. Future studies should move from broad probiotic supplementation toward regimen-specific, strain-defined, and risk-stratified trials, with standardized CID outcomes, rigorous safety monitoring, and assessment of treatment continuity, dose intensity, and antitumor efficacy.
PURPOSE OF REVIEW:Glucagon-like peptide-1 (GLP-1) is a key incretin hormone regulating insulin secretion, appetite, and energy balance. Recent research highlights complex interactions between dietary composition, gut microbiome metabolism and GLP-1 secretion. Understanding these relationships is increasingly important given the widespread clinical use of GLP-1 receptor agonists for obesity and type 2 diabetes and the growing interest in microbiome-targeted nutritional strategies. RECENT FINDINGS:Recent studies demonstrate that microbial metabolites mediate many nutritional effects on GLP-1 secretion. Fermentation of dietary fibres generates short-chain fatty acids (SCFAs) that stimulate GLP-1 secretion through FFAR2/FFAR3 signalling. Additional microbial metabolites can regulate enteroendocrine signalling, including indole derivatives, N-acyl glycines and bile acid metabolites. Human and preclinical studies show that dietary interventions such as β-glucan supplementation, fermentable carbohydrate diets, probiotics, polyphenols and plant polysaccharides can influence GLP-1 secretion through microbiome-dependent mechanisms. SUMMARY:Evidence supports an interaction between nutrition, the gut microbiome and GLP-1 signalling. Microbial metabolites link dietary substrates to GLP-1 secretion and diet shapes the microbial communities producing them. Integrating microbiome profiling with dietary interventions may help optimise metabolic therapies and explain variability in responses to GLP-1-based treatments.
PURPOSE OF THE REVIEW:Incretin mimetic drugs (IMDs) induce rapid weight loss and improve cardiometabolic health. However, over 50% of users discontinue and then reinitiate therapy within two years. This drug cycling drives weight loss-regain cycling, which adversely affects body composition and metabolic health. RECENT FINDINGS:Cessation of IMD therapy leads to a rapid and near-complete reversal of weight loss and cardiometabolic improvement within one year and early IMD discontinuation is associated with increased cardiometabolic risk. Concerningly, up to 40% of the weight lost on these therapies is attributed to lean mass loss. Weight cycling compounds these effects and may worsen body composition and metabolic profiles beyond baseline. Supervised exercise programmes attenuate weight regain and may have a lasting 'legacy' effect on metabolic markers. SUMMARY:The benefits of IMDs are short-lived following drug cessation and the loss of lean mass that occurs with IMDs may increase the risk of sarcopenia. Incorporating supervised exercise programmes during and after therapy may preserve lean mass, promote healthier body composition and attenuate some of the observed metabolic rebound. Clinicians should weigh the risks and benefits of short-term, or cyclical use of IMDs, particularly in those with low initial muscle mass reserves or metabolically vulnerable cohorts.
PURPOSE OF REVIEW:Obesity and its metabolic complications remain major global health challenges. Beyond excess caloric intake, emerging evidence implicates diet-induced gut microbiota dysfunction as a modulator of metabolic homeostasis. This review examines recent advances in understanding how functional alterations of the gut microbiota contribute to obesity pathogenesis. RECENT FINDINGS:Current data indicate that obesity is characterized less by specific microbial taxa and more by disruption of key microbial functions. Diet-induced dysbiosis alters short-chain fatty acid production, bile acid metabolism, tryptophan-derived signaling, and intestinal barrier integrity. These changes promote metabolic endotoxemia, impair enteroendocrine hormone secretion, and disrupt gut-brain and gut-liver communication, contributing to adipose tissue inflammation, hepatic steatosis, and insulin resistance. Experimental and clinical studies further suggest that microbiota-targeted interventions, including dietary fiber enrichment, prebiotics, synbiotics, and fecal microbiota transplantation, can partially restore microbial metabolic function and improve selected metabolic outcomes. SUMMARY:Obesity is increasingly conceptualized as a state of diet-driven functional gut microbiota disruption. Targeting microbial metabolic pathways rather than individual taxa may offer a promising adjunctive strategy to complement established therapies for obesity-related metabolic disease.
PURPOSE OF REVIEW:Obesity is a growing public health issue worldwide affecting one in three adults in Australia and two in five adults in the United States. Globally, the prevalence of obesity has doubled or even tripled in many countries over the past two decades, predominately driven by urbanization, sedentary lifestyles and increased consumption of high-calorie processed foods. The aim of this viewpoint article is to highlight recent policy changes and public health Initiatives to curb this obesity epidemic. RECENT FINDINGS:Traditional strategies that focus on individual behaviour have proven insufficient and broader public health policy models to address both societal and environmental contributors to obesity have emerged. Recent public health initiatives directed their focus on promoting healthier lifestyles through policies, family-based interventions, dietary education and sustained community support. Effective obesity prevention requires collaborative efforts across policy, healthcare and community sectors to mitigate its far-reaching physical, psychological and economic impacts from individual to population levels. SUMMARY:Policy and public health efforts against obesity are evolving into comprehensive systems-oriented models. They combine regulation, fiscal tools, healthcare integration, education campaigns, measurement systems and equity-focused approaches. Together, they form a layered strategy aimed at preventing obesity, supporting individuals living with it and ensuring accountability across sectors.
