Dietary intervention represents a promising strategy for managing post-surgical patients with Crohn’s disease (CD). This study aims to evaluate the effects of a modified Mediterranean diet (MMD) supplemented with partial enteral nutrition (PEN) for 4–5 weeks on quality of life in post-surgical CD patients, compared with exclusive enteral nutrition (EEN). The study was conducted at The Second Affiliated Hospital of Zhejiang University School of Medicine. The primary outcome was quality of life, measured using the 22-item inflammatory bowel disease quality-of-life questionnaire (IBDQOL-22) at the end of the intervention. Secondary outcomes included nutritional status and disease-related characteristics. Among 115 screened patients, forty-six were randomised to either the EEN group (n 24) or the MMD supplemented with PEN group (n 22). Twenty-three patients in the EEN group and twenty-two in the MMD supplemented with PEN group completed the study and were included for analysis. At the end of the intervention, both groups achieved similar 22-item inflammatory bowel disease quality-of-life questionnaire (IBDQOL-22) scores (EEN v. MMD supplemented with PEN: 88·43 (sd 9·17) v. 87·57 (sd 7·38), P = 0·734). In addition, both groups exhibited comparable nutritional status and disease-related characteristics (all P > 0·05). These results suggest that MMD supplemented with PEN provides comparable clinical benefits to EEN in post-surgical CD patients and may serve as an alternative nutritional strategy.

BACKGROUND & AIMS:Malnutrition is a significant health issue in hospital settings, with persistent diagnostic challenges. Despite the Global Leadership Initiative on Malnutrition (GLIM) criteria providing a standardised approach, nationwide validation and implementation remain limited. We aimed to estimate the national prevalence of GLIM-defined malnutrition among Chinese adult inpatients and assess the predictive value of the GLIM criteria for short-term clinical outcomes. METHODS:We conducted the China Nutrition Fundamental Data 2022 project among adult inpatients from 322 sites across 31 provinces in China between February and October 2023. Malnutrition was defined using the GLIM criteria through a standardised two-step process. The clinical outcomes included discharge outcomes, length of stay, hospitalisation costs, and 30-day mortality. We used logistic and multiple linear regression analyses to examine the association between malnutrition severity and clinical outcomes. RESULTS:The final analysis included 61,283 individuals. Malnutrition was prevalent in 24.6 % of the inpatients (moderate malnutrition: 13.8 %; severe malnutrition: 10.8 %). A dose-response relationship was observed between malnutrition severity and adverse clinical outcomes: moderate and severe malnutrition increased the risk of ineffective discharge outcomes by 1.533 (95 % CI: 1.362-1.725) and 2.200 (1.958-2.473) times, respectively, and 30-day mortality by 1.875 times (1.408-2.496) and 3.065 (2.332-4.028) times, respectively. Additionally, moderate and severe malnutrition were linked to a 0.97-day and 1.20-day increases in hospital stays, respectively. CONCLUSIONS:Malnutrition is prevalent among adult Chinese inpatients and strongly associated with adverse clinical outcomes. GLIM-based assessments and interventions are essential to reduce the burden of malnutrition.

Malnutrition substantially contributes to adverse clinical outcomes. However, no national survey has been conducted to characterize its epidemiology in hospital settings in China. We conducted the China Nutrition Fundamental Data 2020 project among a multistage stratified cluster sample of adult inpatients from 291 study sites across 30 provinces, autonomous regions and municipalities (except for Hong Kong, Macao, Taiwan Province, and the Xizang Autonomous Region, please see MATERIALS AND METHODS for details of the causes) of China to generate reliable data on the prevalence of malnutrition and explore the associated risk factors. We collected information on participants’ sociodemographic characteristics, physical examinations, and laboratory test results. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. The standardized prevalence of malnutrition was calculated, and factors associated with malnutrition were examined using logistic regression analyses. We included 54,652 individuals with seven systemic diseases who completed all the survey documents in the final analysis. The overall prevalence of malnutrition was 12.5

Disease burden linked to sub-optimal diets in Africa remains under-explored. Using data from the Global Burden of Disease 2021 study, we assessed the disease burden attributable to dietary risks across various locations, age groups, years, and sexes in Africa. Deaths attributable to sub-optimal diet increased from 0.35 million in 1990 to 0.64 million in 2021, and projected increased to 1.62 million in 2040. Disability-adjusted life years (DALYs) similarly increased from 9.79 million in 1990 to 18.1 million in 2021, projected to reach 45.6 million by 2040. In 2021, North Africa had the highest proportion of diet-attributable disease burden at 8.52%. The top dietary risk factors for mortality that year included low fruit intake, insufficient vegetable consumption, and inadequate whole grain intake. Cardiovascular diseases were the leading causes of diet-related deaths. The age-standardized rate of death and disability-adjusted life years linked to dietary risk factors were highest in the Central African Republic, Lesotho, and Guinea-Bissau. Furthermore, the disease burden was found to be greater in males compared to females. These findings will highlight the implementation of evidence-based dietary interventions in Africa.

Aims: Considering the positive association between visceral adiposity index (VAI) and type 2 diabetes mellitus (T2DM), no comprehensive assessment on the summarized and dose -response relationship between VAI and T2DM has yet been reported. Therefore, we performed a meta-analysis, including dose -response analysis, to quantitively elucidate this association. Data synthesis: MEDLINE via PubMed and Embase databases were searched for relevant articles up to December 14, 2021. Random-effects generalized least squares regression models were used to assess the quantitative association between VAI and T2DM risk across studies. Restricted cubic splines were used to model the dose -response association. A total of 9 prospective cohort studies and 5 cross sectional studies were included in our review. Based on the meta-analysis, the pooled RR of T2DM was 2.05 (95% CI 1.74-2.41) for the highest versus reference VAI category. We found that the risk of T2DM was increased by 44% (RR, 1.44; 95% CI, 1.23-1.68) with each 1unit increment of VAI. While, we found no evidence of a nonlinear dose -response association of VAI and T2DM ( P non-linearity Z 0.428). With the linear cubic spline model, when compared to population with VAI at 0.6, for those with VAI at 2.0, the risk of T2DM was increased by 81% (RR, 1.81; 95% CI 1.55-2.12). Conclusions: Our meta-analysis provides quantitative data suggesting that VAI is associated with an increased risk of T2DM. Public health strategies focusing on weight loss among obesity, especially the people characterized by the thin-on-the-outside -fat-on-the-inside phenotype could possibly reduce a substantial risk of T2DM. Systematic review registration: PROSPERO CRD42022372666. (c) 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Metabolic dysfunction-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD), has become the leading cause of chronic liver disease worldwide. Optimal dietary intervention strategies for MAFLD are not standardized. This study aimed to achieve consensus on prevention of MAFLD through dietary modification. A multidisciplinary panel of 55 international experts, including specialists in hepatology, gastroenterology, dietetics, endocrinology and other medical specialties from six continents collaborated in a Delphi-based consensus development process. The consensus statements covered aspects ranging from epidemiology to mechanisms, management, and dietary recommendations for MAFLD. The recommended dietary strategies emphasize adherence to a balanced diet with controlled energy intake and personalized nutritional interventions, such as calorie restriction, high-protein, or low-carbohydrate diets. Specific dietary advice encouraged increasing the consumption of whole grains, plant-based proteins, fish, seafood, low-fat or fat-free dairy products, liquid plant oils, and deeply colored fruits and vegetables. Concurrently, it advised reducing the intake of red and processed meats, saturated and trans fats, ultra-processed foods, added sugars, and alcohol. Additionally, maintaining the Mediterranean or DASH diet, minimizing sedentary behavior, and engaging in regular physical activity are recommended. These consensus statements lay the foundation for customized dietary guidelines and proposing avenues for further research on nutrition and MAFLD.

Background & aims: Malnutrition is prevalent among hospitalised patients, and increases the morbidity, mortality, and medical costs; yet nutritional assessments on admission are not routine. This study assessed the clinical and economic benefits of using an artificial intelligence (AI)-based rapid nutritional diagnostic system for routine nutritional screening of hospitalised patients. Methods: A nationwide multicentre randomised controlled trial was conducted at 11 centres in 10 provinces. Hospitalised patients were randomised to either receive an assessment using an AI-based rapid nutritional diagnostic system as part of routine care (experimental group), or not (control group). The overall medical resource costs were calculated for each participant and a decision-tree was generated based on an intention-to-treat analysis to analyse the cost-effectiveness of various treatment modalities. Subgroup analyses were performed according to clinical characteristics and a probabilistic sensitivity analysis was performed to evaluate the influence of parameter variations on the incremental cost-effectiveness ratio (ICER). Results: In total, 5763 patients participated in the study, 2830 in the experimental arm and 2933 in the control arm. The experimental arm had a significantly higher cure rate than the control arm (23.24% versus 20.18%; p 1/4 0.005). The experimental arm incurred an incremental cost of 276.52 CNY, leading to an additional 3.06 cures, yielding an ICER of 90.37 CNY. Sensitivity analysis revealed that the decisiontree model was relatively stable. Conclusion: The integration of the AI-based rapid nutritional diagnostic system into routine inpatient care substantially enhanced the cure rate among hospitalised patients and was cost-effective. Registration: NCT04776070 (https://clinicaltrials.gov/study/NCT04776070). (c) 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

ObjectiveIn this systematic review and meta-analysis, we aimed to clarify the overall effects of functional foods and dietary supplements in non-alcoholic fatty liver disease (NAFLD) patients.MethodsRandomized controlled trials (RCTs) published in PubMed, ISI Web of Science, Cochrane library, and Embase from January 1, 2000 to January 31, 2022 were systematically searched to assess the effects of functional foods and dietary supplements in patients with NAFLD. The primary outcomes were liver-related measures, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and hepatic fibrosis and steatosis, while the secondary outcomes included body mass index (BMI), waist circumference (WC), triacylglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). These indexes were all continuous variables, so the mean difference (MD) was used for calculating the effect size. Random-effects or fixed-effects models were used to estimate the mean difference (MD). The risk of bias in all studies was assessed with guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions.ResultsTwenty-nine articles investigating functional foods and dietary supplements [antioxidants (phytonutrients and coenzyme Q10) = 18, probiotics/symbiotic/prebiotic = 6, fatty acids = 3, vitamin D = 1, and whole grain = 1] met the eligibility criteria. Our results showed that antioxidants could significantly reduce WC (MD: −1.28 cm; 95% CI: −1.58, −0.99, P < 0.05), ALT (MD: −7.65 IU/L; 95% CI: −11.14, −4.16, P < 0.001), AST (MD: −4.26 IU/L; 95% CI: −5.76, −2.76, P < 0.001), and LDL-C (MD: −0.24 mg/dL; 95% CI: −0.46, −0.02, P < 0.05) increased in patients with NAFLD but had no effect on BMI, TG, and TC. Probiotic/symbiotic/prebiotic supplementation could decrease BMI (MD: −0.57 kg/m2; 95% CI: −0.72, −0.42, P < 0.05), ALT (MD: −3.96 IU/L; 95% CI: −5.24, −2.69, P < 0.001), and AST (MD: −2.76; 95% CI: −3.97, −1.56, P < 0.0001) levels but did not have beneficial effects on serum lipid levels compared to the control group. Moreover, the efficacy of fatty acids for treating NAFLD was full of discrepancies. Additionally, vitamin D had no significant effect on BMI, liver transaminase, and serum lipids, while whole grain could reduce ALT and AST but did not affect serum lipid levels.ConclusionThe current study suggests that antioxidant and probiotic/symbiotic/prebiotic supplements may be a promising regimen for NAFLD patients. However, the usage of fatty acids, vitamin D, and whole grain in clinical treatment is uncertain. Further exploration of the efficacy ranks of functional foods and dietary supplements is needed to provide a reliable basis for clinical application.Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier: CRD42022351763.

多囊卵巢综合征(PCOS)是育龄期女性最常见的妇科内分泌疾病之一.生酮饮食(KD)是一种以低碳水化合物、高脂肪、适量蛋白质为特点的饮食结构.2019年专家组组织了妇科专家和营养专家共同制定并发布了《生酮饮食干预多囊卵巢综合征中国专家共识(2018年版)》.鉴于近5年KD治疗在安全性和应用范围方面出现了大量新的临床数据,专家组决定对《生酮饮食干预多囊卵巢综合征中国专家共识(2018年版)》进行修订和数据更新.主要更新内容有:①更新中国PCOS患病率研究数据;②增加PCOS中的代谢综合征与饮食干预临床证据;③增加KD改善PCOS的循证证据及中国临床研究证据;④增加KD对与PCOS相关代谢综合征影响的循证医学证据;⑤提供短期和长期KD有效性和安全性证据;⑥增加低能量生酮饮食(LCKD)在PCOS中的应用及安全性证据;⑦增加PCOS治疗常用药物联合KD干预效果的证据;⑧完善KD干预PCOS的适应证、禁忌证、不良反应及对策;⑨完善KD中食物种类的选择及操作方法建议.

Aspartame (ASP) as an important sugar substitute is widely used in pharmaceutical and food processing. Here, we compared the effects of ASP and sucrose on mice pancreatic islet cells in vivo and observed that ASP with the condition of high concentration and long-term exposure (HASP) could cause insulin secretion (500 mg/kg for 1 month). Next, we conducted iTRAQ mass spectrometry to profile the global phosphoproteome and found that phosphorylation of zipper-interacting protein kinase (ZIPK) in murine pancreatic islet tissues were induced at Thr197, Thr242, Thr282, and Ser328 by high-sucrose (HS) treatment, but only induced at Thr197 and Ser328 by HASP treatment. Simultaneously, phosphorylation of STAT3 could be induced at Tyr705 and Ser727 by HS but not by HASP. Furthermore, presence of activated STAT3 accompanied with autophagy was observed in HS treatment. In turn, the inactivation of STAT3 as well as enhanced expression of caspase 3 was observed in HASP treatment. We generated Thr242APro and Thr282Pro on ZIPK using CRISPR-Cas9 in β-TC3 cells and found the weakened interaction with STAT3 as well as the reduced phosphorylation of STAT3 even under HS stimulation. Finally, we observed that ankyrin repeat domain containing 11 (ANKRD11) could interact with ZIPK and play an inhibitory role in the phosphorylation of Thr242APro and Thr282Pro of ZIPK. However, HASP can induce the retention of ANKRD11 in the cytoplasm by phenylpyruvic acid (the metabolite of ASP). Taken together, this study determined that ASP with high concentration and long-term exposure could lead to caspase-dependent apoptosis of pancreatic islet cells through ANKRD11/ZIPK/STAT3 inhibition. Our results give evidence of adverse effects of aspartame on islet cells in some extreme conditions, which might help people to reconsider the biosafety of non-nutritive sweeteners.

随着我国人口老龄化,老年糖尿病患病率逐年升高.老年糖尿病患者营养不良发生风险增高,更易导致衰弱的发生.糖尿病和衰弱的发生发展相互作用,从而对患者的临床结局产生不利影响.对老年糖尿病患者的衰弱早期识别并进行合理的营养支持,可以减缓或逆转衰弱进程,提高老年患者生活质量并减少医疗负担.本文就目前国内外对于老年糖尿病患者伴衰弱的营养管理研究进展予以综述.

Objective:To evaluate nutritional status and to analyse risk factors of acute exacerbation of chronic obstructive pulmonary disease (COPD) in the elderly.Methods:Data of elderly hospitalized patients with COPD mainly from 5 grade A, class 3 hospitals (Beijing Hospital, Shanghai Huadong Hospital, Tianjin Nankai hospital, the Second Affiliated Hospital of Medical College of Zhejiang University, Guangzhou First People′s Hospital) from January 2012 to December 2020 were retrospectively analyzed. According to the global initiative for chronic obstructive lung disease criteria (GOLD), elderly COPD patients were divided into acute exacerbation group and stable group. The differences in age, gender, medical history, anthropometry, laboratory examination, nutritional support, results of nutritional risk screening 2002 (NRS2002) and global leadership initiative on malnutrition (GLIM) were compared between the two groups after admission, and the risk factors of acute exacerbation of COPD in the elderly were analyzed by multivariate Logistic regression.Results:A total of 339 elderly patients with COPD aged 65-100 years were included in this study, including 177 cases (52.21%) in acute exacerbation stage. The detection rate of malnutrition in acute exacerbation stage was higher than that in stable stage (51.98% vs 41.98%, P<0.05). The weight, body mass index and grip strength of patients in the acute exacerbation stage were significantly lower than those in the stable period [(55.47±8.42) vs (60.63±9.30) kg, (20.52±4.25) vs (22.39±4.57) kg/m 2, (12.32±4.21) vs (16.59±2.97) kg] (all P<0.05). Spearman correlation analysis showed that the acute exacerbation of elderly patients with COPD was positively correlated with malnutrition ( r=0.443, P<0.001), and negatively correlated with body weight, body mass index and calf circumference ( r=-0.200, -0.214, -0.135, all P<0.05). Multiple Logistic regression analysis showed that acute exacerbation in elderly patients with COPD was only related to malnutrition ( OR=7.799, 95% CI: 4.466-13.622, P<0.001). Conclusions:The incidence of malnutrition in acute exacerbation stage of elderly COPD patients is high. Malnutrition is independently related to acute exacerbation of COPD.

王先生(化名)是一位资深美食爱好者,但最近,他的嘴可受了"委屈".1个月前,王先生因为肿瘤做了手术,术后康复阶段,王先生听身边的病友说,吃得太好容易把"肿瘤细胞再次养肥",这可吓到了王先生."好不容易手术把肿瘤给治了,要是又复发,又得受一次罪."

BackgroundInflammatory Bowel Diseases (IBDs) have been emerging in recent years with the advance of global industrialization and diet pattern transformation. Marine n-3 polyunsaturated fatty acids (n-3 PUFAs), enriched in fish oils, have well-known human health promotion. Evidence on the association of fish oil supplementation with the risk of developing IBDs was scarce. This study aimed to examine the association between the use of fish oil supplements and the risk of developing inflammatory bowel diseases (IBDs) among the general population.MethodsWe conducted a prospective cohort study of 447,890 participants aged 40–69 years from the UK Biobank. A touch screen questionnaire was used to get the data about fish oil intake at baseline. Incident diagnoses of IBDs were ascertained by the International Classification of Diseases (ICD-9 and ICD-10) or self-report. Cox proportional hazards model was applied to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of developing IBDs and their subtypes.ResultsWe documented 1,646 incident cases of IBDs, including 533 incident cases of Crohn’s disease (CD) and 1,185 incident cases of ulcerative colitis (UC) during an average of 8 years of follow-up. After multivariate adjustment, the use of fish oil was associated with a 12% lower risk of IBDs (HR: 0.88, 95% CI: 0.78–0.99, p = 0.03) compared with non-consumers. For subtypes of IBDs, fish oil supplementation was inversely associated with a 15% lower risk of UC (HR: 0.85, 95% CI: 0.75–0.99, p = 0.02) but was not correlated with the risk of CD (p = 0.22). Besides, fish oil supplementation showed a significant inverse correlation with baseline CRP levels (β = –0.021, p < 0.001) and a positive association with baseline albumin levels (β = 0.135, p < 0.001) after adjustment for multiple variates.ConclusionHabitual intake of fish oil supplements was associated with a lower risk of IBDs and UC. Fish oil users tended to have lower baseline C-reactive protein levels and higher baseline albumin levels compared with non-users. It was concluded that fish oil supplement use may be recommended for the prevention and control of IBDs.

Objective This study aimed to assess the prognostic value of the Nutritional Risk Score 2002 (NRS2002) and patient-generated subjective global assessment (PG-SGA) for post-operative infections in patients with gastric cancer (GC) and colorectal cancer (CRC) who underwent curative surgery. Methods This prospective study included 1,493 GC patients and 879 CRC patients who underwent curative surgery at 18 hospitals in China between April 2017 and March 2020. The NRS2002 and PG-SGA were performed on the day of admission. The relationship between the nutritional status of patients before surgery and post-surgical incidence of infection was analyzed using univariate and multiple logistic regression analyses. Results According to NRS2002, the prevalence of nutritional risk was 51.1% in GC patients and 63.9% in CRC patients. According to the PG-SGA, 38.9% of GC patients and 54.2% of CRC patients had malnutrition. Approximately 4.4% of the GC patients and 9.9% of the CRC patients developed infectious complications after surgery. The univariate and multiple logistic regression analyses showed that the risk of infections was significantly higher in GC patients with a high nutritional risk score (NRS2002 ≥5) than in those with a low score (NRS2002 <3), and the PG-SGA score was identified as a predictor of post-operative infection complications of CRC. Conclusion The pre-operative nutritional status of patients with GC or CRC has an impact on post-operative infection occurrence. NRS2002 ≥5 was a risk factor for post-operative infection in patients with GC, and the PG-SGA B/C was a predictor of infections in patients with CRC.

OBJECTIVE:We compared the efficacy and safety of ketogenic diet (KD) therapy as a treatment for Chinese adults versus children with drug-resistant epilepsy. METHODS:The classic KD was initiated in 19 adults and 29 children with drug-resistant epilepsy. The KD ratio and the dosage of antiseizure medication (ASM) were delicately modulated by the ketogenic team. RESULTS:At 12 months after diet initiation, 11 adults (8 on a KD ratio of 3:1 and 3 on a ratio of 2:1) and 20 children (9 on a ketogenic diet ratio of 3:1 and 11 on a ratio of 2:1) remained on the diet. The retention rate for adult KD therapy recipients was 79.0% at 6 months and 57.9% at 12 months after diet initiation, which was not significantly different from the retention rate for children (82.8% at 6 months and 68.9% at 12 months; P > 0.05). The efficacy rate of KD therapy (seizure freedom or ≥50% reduction in seizure frequency) did not significantly differ between adults (63.2%) and children (75.8%, P = 0.517). Alleviation of seizure severity was observed in 68.4% of adults and 63.6% of children who were not seizure free on KD therapy. Antiseizure medication was reduced in 34 out of all 48 individuals at the final follow-up. CONCLUSION:Our study demonstrated that KD therapy is a safe and effective treatment for Chinese adults as well as children with drug-resistant epilepsy.

BACKGROUND AND OBJECTIVES The aim of this study was to compare the effects of low-carbohydrate diet (LCD) versus low-fat diet (LFD) on weight loss, glycemic control and metabolic risk factors in individuals with impaired glucose regulation (IGR) after 10-week intervention. METHODS AND STUDY DESIGN In this 10-week randomized controlled trial, 90 obese/overweight adults with IGR were randomly assigned to consume either low-carbohydrate diet (20%-25% energy from carbohydrates, 30%-45% energy from fat, 40%-45% en-ergy from protein), or low-fat diet (40%-55% energy from carbohydrates, 20%-30% energy from fat, 20%-30% energy from protein), or heath education (HE) group. The anthropometry and body composition were collected at baseline, week 4, week 8 and week 10. The glycemia and metabolic indicators were assessed at baseline and week 10. RESULTS A total of 69 participants (mean±SE age: 39.2±1.0 years, 72.5% women) completed the intervention and were included in the final analysis. At week 10, all three groups presented similar mean reduction in weight (LCD: 5.80±0.6 kg; LFD: 6.36±0.57 kg; HE: 4.49±0.98 kg), and fasting blood glucose (LCD: 0.73±0.13 mmol/L; LFD: 0.84±0.17 mmol/L; HE: 0.58±0.14 mmol/L). Additionally, there were no differences in the improvements of TG and liver function markers between diets, the low-fat diet exhibited more favorable effects on TC level. CONCLUSIONS Both diets achieved similar weight loss, fasting glucose, and insulin reduction in short-term, suggesting each diet pattern could be an effective strategy for the prediabetes management.