The global demand for plant-based milk alternatives is rising, but their health effects compared with cow milk remain uncertain. Therefore, we conducted a systematic review and network meta-analysis (NMA) to compare different plant-based drinks with each other and with cow's milk on cardiometabolic outcomes. A systematic search was conducted in 3 electronic databases (MEDLINE, Cochrane CENTRAL, and Web of Science) and 2 trial registries. Randomized controlled trials (RCTs) with a minimum duration of 3 wk comparing different plant-based drinks (e.g., soy, rice, and oat) with another or with cow milk were included. We rated risk of bias using RoB 2.0 tool. Anthropometric outcomes, blood lipids, fasting glucose, and blood pressure were pooled using mean differences (MDs). NMAs were performed using a random-effects model. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Fourteen RCTs involving 543 participants were included, comparing soy-, rice-, oat drinks, and cow milk. Overall, few differences were observed comparing plant-based drinks with another or with cow milk on cardiometabolic outcomes. Replacing 500 mL/d of cow's milk with soy drink may reduce low-density lipoprotein (LDL) cholesterol [MD: -0.47 mmol/L (-0.85; -0.10); low certainty], but showed no effect for high-density lipoprotein (HDL) cholesterol [MD: 0.01 mmol/L (-0.03; 0.05); moderate certainty]. Oat drink may slightly reduce total cholesterol compared with cow milk and rice drink [MD: -0.12 mmol/L (-0.24; -0.01); MD: -0.23 mmol/L (-0.40; -0.05)], but the evidence is very uncertain. Replacing 500 mL/d of cow milk with soy drink may reduce systolic and diastolic blood pressure [MD: -8.23 mmHg (-10.90; -5.55); MD: -7.82 mmHg (-13.61; -2.02); low certainty]. Our findings suggest that evidence for cardiometabolic differences between plant-based drinks and cow milk is limited. However, soy drink may lower blood pressure and LDL cholesterol compared with cow milk. The certainty of evidence was mainly low, highlighting the need for high-quality RCTs. This study was registered at PROSPERO as CRD42025638028.

RATIONALE:Malnutrition affects 35% to 64% of hospitalised older people, and is associated with adverse health outcomes such as disease complications and hospital readmission. Identifying effective nutritional interventions is essential to improve clinical outcomes and reduce healthcare costs in this population. OBJECTIVES:To evaluate the effects of various nutritional interventions, compared with either a control group (standard care or placebo) or each other, on patient-relevant outcomes in hospitalised older people at risk of or with established malnutrition, and to rank the effects of these different interventions using network meta-analysis (NMA) based on individual participant data (IPD). SEARCH METHODS:We searched CENTRAL, MEDLINE, five other databases, and two trial registries to 2 July 2024, and checked the reference lists of included studies and relevant systematic reviews. ELIGIBILITY CRITERIA:We included older people (≥ 65 years) hospitalised for different acute conditions at risk of or with malnutrition enrolled in randomised controlled trials (RCTs) comparing oral nutritional interventions with control or each other. For RCTs that met our inclusion criteria, either fully or partially, we requested IPD from the study authors. If we did not receive a response or IPD were unavailable, we used published aggregated data. We excluded RCTs that only partially met the eligibility criteria if neither IPD nor sufficient aggregated data were obtainable. OUTCOMES:Critical outcomes were all-cause mortality, serious adverse events (SAEs), and functional status (e.g. activities of daily living). Important outcomes were health-related quality of life (HRQoL), length of hospital stay (LOS), body weight, and fat-free mass. The main outcome assessment time point was at hospital discharge or 30 days after randomisation. RISK OF BIAS:We used the Cochrane risk of bias 2 (RoB 2) tool. SYNTHESIS METHODS:For each outcome, we first analysed IPD within each study. Second, we pooled results in an NMA which also included the aggregated data from RCTs without available IPD. We performed random-effects NMAs based on the frequentist approach and ranked treatments by P-scores. We rated the certainty of evidence using the GRADE approach. INCLUDED STUDIES:We included 21 RCTs (72 reports; 12 RCTs with IPD) with 3309 older participants (mean age ranged from 75 to 85 years; 1863 participants with IPD) with different acute conditions. Interventions included the provision of additional protein (three studies), energy supplements (two studies), oral nutritional supplements (ONS; eight studies), individualised feeding support (two studies), and comprehensive individualised nutritional care (eight studies). In all but two RCTs, interventions were compared to control (standard care with or without a placebo). We judged 16.1% of outcome assessments to be at low risk of bias and 16.8% at high risk. SYNTHESIS OF RESULTS:ONS may reduce all-cause mortality (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.25 to 0.84; absolute risk difference 57 fewer deaths per 1000 people, 95% CI 79 fewer to 17 fewer; low-certainty evidence) compared to control, while comprehensive individualised nutritional care may show little to no effect (RR 0.98, 95% CI 0.55 to 1.73; 1 fewer per 1000 people, 95% CI 26 fewer to 46 more; low-certainty evidence). For all other treatment comparisons, the evidence is very uncertain (NMA with 13 RCTs, 2728 participants; Q between designs: not applicable (NA)). ONS may reduce SAEs compared to control (RR 0.56, 95% CI 0.32 to 0.95; 84 fewer SAEs per 1000 people, 95% CI 131 fewer to 10 fewer; Q between designs: Q 1.95, df 2, P = 0.3772; low-certainty evidence). For all other treatment comparisons, the evidence is very uncertain (NMA with 14 RCTs, 2184 participants). Comprehensive individualised nutritional care may make little to no difference in activities of daily living compared to control (standardised mean difference (SMD) 0.06, 95% CI -0.08 to 0.20; low-certainty evidence) and ONS compared to energy supplements (SMD -0.15, 95% CI -0.53 to 0.23; low-certainty evidence). For all other treatment comparisons, the evidence is very uncertain (NMA with 5 RCTs, 1128 participants; Q between designs: NA). Energy supplements probably make little to no difference in HRQoL compared with ONS (mean difference (MD) 0.01, 95% CI -0.06 to 0.08; Q between designs: NA; moderate-certainty evidence). All other comparisons of different nutritional interventions may make little to no difference to HRQoL (NMA with 3 RCTs, 1513 participants). The provision of additional protein, energy supplements, ONS, and comprehensive individualised nutritional care may make little to no difference in LOS compared to control (18 RCTs, 3013 participants; Q between designs: Q 2.86, df 3, P = 0.4145). Body weight (16 RCTs, 2114 participants; Q between designs: Q 2.03, df 3, P = 0.5655) may increase with ONS when compared to control (MD 0.9 kg, 95% CI 0.37 to 1.42) or comprehensive individualised nutritional care (MD 1.00 kg, 95% CI 0.12 to 1.87), but the evidence is very uncertain. Energy supplements and ONS probably have similar effects on body weight (MD 0.11 kg, 95% CI -0.85 to 0.63; moderate-certainty evidence). For fat-free mass, no meta-analysis was possible. One RCT (102 participants) compared ONS with energy supplements and found little or no difference between groups (MD 0.13 kg, 95% CI -0.63 to 0.90; low-certainty evidence), while evidence regarding the effects of additional protein compared with control was very uncertain (1 RCT, 19 participants). Rankings of treatments by P-scores were not consistent across outcomes. AUTHORS' CONCLUSIONS:In older hospitalised people at risk of or with malnutrition, oral nutritional supplements may reduce mortality and SAEs compared to control 30 days after randomisation. For other outcomes, there may be little or no differences in results. Overall, the evidence was of low to very low certainty, primarily due to a limited number of studies and participants per comparison. The comparison of treatment effects across outcomes was constrained by variations in network structure. When interpreting the results, the heterogeneity of the population in terms of acute and chronic conditions needs to be considered. To improve certainty, adequately powered studies with robust methodologies should compare interventions with controls as well as against each other. FUNDING:The German Federal Ministry of Education and Research funded this work (grant number: 01KG2102). REGISTRATION:Protocol (2022) doi.org/10.1002/14651858.CD015468.

La malnutrición (o desnutrición) y la deshidratación son frecuentes en las personas mayores, y la obesidad es un problema creciente. Sin embargo, faltan estrategias adecuadas y efectivas para contrarrestarlas en la práctica clínica.El objetivo de esta guía fue proporcionar recomendaciones para la nutrición clínica e hidratación en la población adulta basadas en la evidencia científica, con el fin de prevenir y/o tratar la malnutrición y la deshidratación. Además, se abordó si las intervenciones para perder peso en las personas mayores con sobrepeso u obesidad son adecuadas.Esta guía fue desarrollada según el procedimiento operativo estándar para las guías y documentos de consenso de ESPEN, con una búsqueda sistemática de la literatura basada en 33 preguntas clínicas en formato PICO (Población, Intervención, Comparación y Resultado). La calidad de la evidencia se evaluó con el sistema SIGN. Las recomendaciones fueron desarrolladas y consensuadas mediante un proceso compuesto por múltiples etapas.En cuanto a resultados se desarrollaron ochenta y 2 recomendaciones basadas en la evidencia para la atención nutricional en las personas mayores, cubriendo 4 temas principales: Cuestiones básicas y principios generales; recomendaciones para las personas mayores con riesgo de malnutrición o con malnutrición; recomendaciones para las personas mayores con enfermedades específicas y recomendaciones para prevenir, identificar y tratar la deshidratación. En general, se recomienda que a todas las personas mayores se les realice un cribado (o tamizaje) de malnutrición para identificar tempranamente un riesgo existente. La nutrición oral se puede apoyar mediante intervenciones de enfermería, educación, consejo nutricional, modificación de alimentos y el uso de suplementos (o complementos) nutricionales orales. La nutrición enteral debe iniciarse si la alimentación por vía oral es insuficiente o imposible. La nutrición parenteral debe iniciarse si la nutrición enteral es insuficiente o imposible y el pronóstico general es favorable. Se deben evitar las restricciones dietéticas; en las personas mayores con problemas de salud relacionados con la obesidad, las dietas para bajar de peso solo deben considerarse en combinación con el ejercicio físico. Se debe considerar a todas las personas mayores como en riesgo de deshidratación debido a una baja ingesta y se les debe animar a consumir suficientes líquidos. Por lo general, las intervenciones serán individualizadas, integrales y parte de un enfoque de equipo multimodal y multidisciplinar.Como conclusión existe una amplia variedad de intervenciones eficaces para respaldar una nutrición e hidratación adecuadas en las personas mayores, con el objetivo de mantener o mejorar el estado nutricional, el curso clínico y la calidad de vida. Estas intervenciones deben ser implementadas en la práctica clínica y utilizarse de manera sistemática.

We respond to the Matters Arising article by Calkins et al. commenting on our meta-epidemiological study “Evaluating agreement between individual nutrition randomised controlled trials and cohort studies”. We appreciate the opportunity to respond to the points raised and to clarify the methods and interpretation of our work.

BACKGROUND/AIM:We conducted a systematic review with network meta-analyses (NMA) summarizing the effects and safety of lifestyle interventions containing nutrition (NUT; e.g., calorie restriction), exercise (EX; e.g., aerobic/resistance exercise) and behavior change interventions (BCI; e.g., behavioral therapy) on physical function, body composition, quality of life, psychosocial outcomes, health and adverse events in community-dwelling older adults with obesity. METHODS:We used the methodology proposed by Cochrane and searched six databases and one trial registry for eligible randomized controlled trials (RCTs; intervention duration ≥ 12 weeks) up to May 2022 with a full new search in MEDLINE and a re-assessment of previously identified eligible trial registry entries in October 2025. Random-effects NMA ((standardized) mean difference ((S)MD), 95% confidence intervals) were conducted if possible. RESULTS:We included 72 RCTs (n = 6716) for descriptive summaries and 54 RCTs (n = 4249) for NMA. NUT+EX+BCI improved physical function (performance batteries) compared to control (SMD 3.37 [1.76;4.97]; high certainty of evidence). NUT+EX+BCI may reduce body (MD -8.69 [-13.14;-4.25]) and fat mass (MD -6.58 [-10.44;-2.73]) while not negatively affecting fat-free mass (MD -1.38 [-3.52;0.76]) or bone mineral density (MD -0.01 [-0.05;0.02]) (evidence very uncertain). Other interventions (single/combined) may also be effective; however, effects were often imprecise. For psychosocial outcomes, quality of life, and health events, data were insufficient or too heterogeneous to derive clear results. CONCLUSION:The evidence suggests that NUT+EX+BCI interventions are most suitable for the management of obesity in older adults. Nevertheless, further RCTs-especially in frail populations and on patient-relevant outcomes-are needed.

RATIONALE:Obesity and its associated comorbidities, particularly type 2 diabetes (T2D), have reached epidemic dimensions globally. Both conditions are related to an increased risk of serious health outcomes and impose a substantial burden on those affected. Metabolic and bariatric surgery (MBS) may offer a therapeutic option for achieving sustained weight loss, improving comorbidities and thereby enhancing long-term quality of life. OBJECTIVES:To investigate the medium- and long-term benefits and harms of different MBS procedures compared with each other and to non-surgical treatment on outcomes relevant to adults with obesity and T2D, and to obtain a clinically meaningful ranking of these interventions by considering both randomised controlled trials (RCTs) and cohort studies. SEARCH METHODS:We searched MEDLINE, Cochrane CENTRAL, CINAHL, LILACS, BASE as well as the WHO ICTRP Search Portal and ClinicalTrials.gov. The date of the last search for all databases was 25 June 2024. We did not apply any language restrictions. ELIGIBILITY CRITERIA:We included RCTs and both prospective and retrospective cohort studies with a minimum follow-up of three years in adults (≥ 18 years) with obesity (body mass index ≥ 30 kg/m² or ethnic-specific cut-off values) and T2D. Eligible interventions include MBS procedures (i.e. laparoscopic adjustable gastric banding [LAGB], sleeve gastrectomy [SG], Roux-en-Y gastric bypass [RYGB], one-anastomosis gastric bypass [OAGB], gastric plication [GCP], biliopancreatic diversion with duodenal switch, and their variations) or non-surgical treatment (i.e. lifestyle intervention, medical treatment [LI/MT]). OUTCOMES:Critical outcomes were medium- (≥ 3 to < 5 years) and long-term (≥ 5 years) weight loss (%), waist circumference (cm), T2D remission (complete, partial), and serious adverse events (SAE). Important outcomes included all-cause mortality, T2D complications, glycaemic control (glycated haemoglobin (HbA1c) in %) and health-related quality of life (HRQoL). RISK OF BIAS:We used the Risk of Bias 2 (RoB 2) tool for RCTs and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) for cohort studies. SYNTHESIS METHODS:We performed random-effects network meta-analyses based on the frequentist approach and ranked treatments by P scores. We rated the certainty of evidence according to the GRADE approach for long-term outcomes (≥ 5 years). INCLUDED STUDIES:We included 18 studies (with 70 reports) with 15,282 participants in this review. Of these, 13 studies were RCTs (n = 911) and five were cohort studies (n = 14,371). Two RCTs compared MBS with LI/MT, ten compared two or three different MBS procedures and one with a 3-arm design investigated two different MBS procedures as well as LI/MT. All cohort studies compared different MBS procedures. The networks were based on the following MBS procedures: RYGB, SG, OAGB, LAGB, GCP, and LI/MT. SYNTHESIS OF RESULTS:NMA results (8 RCTs; n = 491) suggest greater long-term weight loss after RYGB compared to LI/MT (MD -16.95%; 95% CI -24.19 to -9.71). OAGB (MD -12.10%; 95% CI -22.85 to -1.34) and SG (MD -9.40 %; 95% CI -17.45 to -1.34) may also result in greater weight loss compared to LI/MT, but the evidence is very uncertain. A reduction in waist circumference at long-term follow-up (6 RCTs; n = 348) is likely higher after RYGB compared to LI/MT (MD -12.34 cm; 95% CI -17.88 to -6.81). OAGB (MD: -13.28 cm; 95% CI -22.04 to -4.53) and SG (MD-9.08 cm; 95% CI -15.74 to -2.43) may also lead to a higher reduction in waist circumference compared to LI/MT, but the evidence is very uncertain. The evidence is very uncertain about the effects of MBS procedures compared to LI/MT on long-term complete T2D remission (9 RCTs; n = 536). All MBS procedures (8 RCTs; n = 588) may result more often in partial T2D remissions than LI/MT, but the evidence is very uncertain. The evidence is very uncertain about the effect of all MBS procedures compared to LI/MT on SAE (9 RCTs; n = 598) and all-cause mortality in the long term (7 RCTs; n = 520). RYGB may reduce total long-term T2D complications compared to LI/MT (Rate ratio (RaR) 0.17; 95% CI 0.03 to 0.89; 5 RCTs; n = 356), but the evidence is very uncertain. Based on NMA results (10 RCTs; n = 612), RYGB may reduce HbA1c compared to LI/MT (MD -1.44%; 95% CI -2.26 to -0.63). OAGB (MD -2.01%; 95%CI -3.42 to -0.60) and SG (MD -1.01%; 95%CI -1.94 to -0.08) may also reduce HbA1c compared to LI/MT, but the evidence is every uncertain. Both RYGB and SG may increase mental and physical components of HRQoL compared to LI/MT (both 2 RCTs; n = 118), but evidence is very uncertain. The inclusion of cohort studies in the analyses of percentage weight loss, partial type 2 diabetes remission, SAE, and all-cause mortality confirmed the main findings. For most outcomes, the main reasons for downgrading certainty of evidence were related to risk of bias and imprecision. AUTHORS' CONCLUSIONS:In people with obesity and T2D, RYGB, OAGB and, to a lesser extent, SG may lead to long-term improvements in body weight, waist circumference, partial T2D remission, and HbA1c compared with LI/MT. However, due to imprecise results, the magnitude of the effects often remains uncertain or very uncertain. For other outcomes, especially complete T2D remission, SAE, all-cause mortality and T2D complications, the evidence is mainly very uncertain, due to a low numbers of participants and events. When interpreting these findings, it should be noted that cohort studies were not, as originally planned, included in the certainty of evidence assessment, as these studies were judged to have a high or critical risk of bias. Larger and well-designed studies may contribute to diminishing the existing uncertainties and enhancing our confidence in the findings. FUNDING:This Cochrane review was funded by the German Federal Ministry of Education and Research (BMBF) (grant number: 01KG2201). REGISTRATION:Protocol (2024) DOI: https://doi.org/10.1002/14651858.CD015622 PROSPERO ID: CRD42023457363.

Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. The objective of this guide was to provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. As a result we provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counselling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. As a conclusion a range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

Food-based dietary guidelines acknowledge non-fortified dairy foods as a source of multiple essential vitamins and minerals as well as high-quality protein. Considering the cultural significance of dairy foods in our diet and the increasing prevalence of non-communicable diseases, it is essential to continuously evaluate the entirety of data regarding the impact of dairy consumption on various health-related outcomes. A systematic literature search was performed in three databases: Medline, Embase, and Web of Science. Systematic reviews published between January 2014 and February 2024 based on randomized controlled trials (RCTs), prospective cohort studies, case-control studies, and/or cross-sectional studies in adults, focusing on the consumption of bovine dairy products were evaluated for inclusion. Reports from the World Cancer Research Fund on selected cancer outcomes were also included in this review. We identified 95 reports encompassing five dairy exposure categories on 29 different health outcomes. Out of 281 associations identified, 37.7% linked dairy consumption to a reduced risk, while 48.0% showed no association with disease risk. Inconclusive results were found in 10.0% of the associations, and 4.3% indicated an increased risk of adverse health outcomes. Overall, the evidence suggests that consuming dairy is not associated with an increased risk of non-communicable diseases or mortality. In fact, it may moderately reduce the risk of several health outcomes, including adverse cardiovascular outcomes and certain cancers such as bladder, breast, colorectal, liver, oral, and ovarian. Some studies have also linked dairy consumption to improved body composition, lower rates of type 2 diabetes, and better bone health.

BACKGROUND:Given the global rise in type 2 diabetes mellitus (T2D), the Mediterranean diet (MedDiet) has gained attention as a promising preventive dietary pattern. OBJECTIVES:This study aims to update and extend our previous systematic review by synthesizing current evidence from randomized controlled trials (RCTs) and prospective cohort studies on the association between MedDiet adherence and incident T2D in adults, and to evaluate the certainty of evidence. METHODS:We conducted a systematic search in MEDLINE, Cochrane CENTRAL, and Scopus from 2014 to May 2025. Eligible studies were prospective cohorts reporting on the adherence to an a priori-defined MedDiet or, for RCTs, MedDiet intervention compared with any other diet and T2D incidence. Random-effects dose-response meta-analyses were performed to estimate hazard ratios (HRs) for MedDiet adherence score. Risk of bias was assessed using the Cochrane risk of bias tool 2 and the Risk Of Bias In Nonrandomized Studies-of Exposures tool, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS:A total of 24 prospective cohort studies and 1 RCT were included, comprising 991,878 participants and 68,325 T2D cases and a mean follow-up duration of 12.2 y (range: 3.5- 25 y). Higher MedDiet adherence is likely associated with a reduced risk of T2D [HRper 2-point increment: 0.92; 95% confidence interval (CI): 0.90, 0.94; moderate certainty]. The dose-response curve shows a consistent decline in T2D risk with higher adherence to MedDiet. The association remained robust over several subgroup analyses, including age, sex, and MedDiet score. The included RCT confirmed the main findings (HR: 0.75; 95% CI: 0.56, 1.01, low certainty). CONCLUSION:This updated systematic review and meta-analysis provides moderate-certainty evidence that greater adherence to the MedDiet is associated with a lower risk of T2D. These findings reinforce current dietary guidelines recommending MedDiet as a sound strategy for T2D prevention.

Osteoporosis has become a global public health concern making prevention and treatment essential to reduce severe consequences for individuals and health systems. This systematic review with meta-analysis aimed to determine the effects of combined protein and exercise interventions compared to (a) exercise alone and (b) protein alone on bone mineral content (BMC) or density (BMD) in middle-aged and older adults. We systematically searched Medline, CINAHL, CENTRAL, Web of Science, and SPORTDiscus until 24th January 2023. Pairwise random-effects meta-analyses were performed to calculate weighted mean differences (WMD) with 95

Zusammenfassung Mit der zunehmenden Prävalenz von Adipositas bei älteren Menschen gewinnen maßgeschneiderte therapeutische Strategien an Bedeutung. Aktuelle Leitlinien empfehlen multimodale Ansätze für das Gewichtsmanagement bei Erwachsenen, enthalten jedoch keine spezifischen Empfehlungen für ältere Menschen. Altersbedingte Veränderungen der Körperzusammensetzung, geriatrische Syndrome und Multimorbidität sind bei Therapieentscheidungen zu berücksichtigen. Eine Gewichtsreduktion kann den altersbedingten Verlust von Muskel- und Knochenmasse verstärken und das Risiko ungünstiger Folgen erhöhen. Daher sind Therapiekonzepte notwendig, die den Verlust von Fettmasse, den Erhalt von Muskel- und Knochenmasse sowie die Verbesserung des funktionellen Status anstreben. Dieser Artikel gibt einen Überblick über die multimodale Adipositastherapie im Alter und fasst klinische Studien zusammen, die solche Interventionen bei älteren Menschen mit spezifischen Komorbiditäten durchgeführt haben. Multimodale Interventionen, die moderate Kalorienrestriktion, kombiniertes Kraft- und Ausdauertraining sowie verhaltenstherapeutische Strategien umfassen, haben sich als sicher und effektiv erwiesen. Allerdings wurden Komorbiditäten und geriatrische Syndrome in den Studien selten berücksichtigt. Zudem gibt es wenige Studien, die spezielle Krankheitsbilder oder Syndrome wie Herzinsuffizienz, Arthrose oder Gebrechlichkeit als Einschlusskriterium adressieren, was die Übertragbarkeit der Ansätze einschränkt.

Anorexia nervosa (AN) is a severe eating disorder. With a lifetime prevalence of 1.4

Abstract Background In nutrition research, randomised controlled trials (RCTs) and cohort studies provide complementary evidence. This meta-epidemiological study aims to evaluate the agreement of effect estimates from individual nutrition RCTs and cohort studies investigating a highly similar research question and to investigate determinants of disagreement. Methods MEDLINE, Epistemonikos, and the Cochrane Database of Systematic Reviews were searched from January 2010 to September 2021. We matched individual RCTs to cohort studies based on population, intervention/exposure, comparator, and outcome (PI/ECO) characteristics. Two reviewers independently extracted study characteristics and effect estimates and rated the risk of bias using RoB2 and ROBINS-E. Agreement of matched RCTs/cohort studies was analysed by pooling ratio of risk ratios (RRR) and difference of (standardised) mean differences (DSMD). Results We included 64 RCT/cohort study pairs with 4,136,837 participants. Regarding PI/ECO similarity, 20.3% pairs were “more or less identical”, 71.9% “similar but not identical” and 7.8% “broadly similar”. Most RCTs were classified as “low risk of bias” (26.6%) or with “some concerns” (65.6%); cohort studies were mostly rated with “some concerns” (46.6%) or “high risk of bias” (47.9%), driven by inadequate control of important confounding factors. Effect estimates across RCTs and cohort studies were in high agreement (RRR 1.00 (95% CI 0.91–1.10, n = 54); and DSMD − 0.26 (95% CI − 0.87–0.35, n = 7)). In meta-regression analyses exploring determinants of disagreements, risk-of-bias judgements tend to have had more influence on the effect estimate than “PI/ECO similarity” degree. Conclusions Effect estimates of nutrition RCTs and cohort studies were generally similar. Careful consideration and evaluation of PI/ECO characteristics and risk of bias is crucial for a trustworthy utilisation of evidence from RCTs and cohort studies.

Introduction:The shape of the oral glucose tolerance test (OGTT) curve is an early predictor of metabolic disturbances. In this study, we analyzed which parameters are associated with different OGTT-curve shapes (CS) in healthy middle-aged and older adults. Methods:In the cross-sectional Enable Study, 354 participants were comprehensively phenotyped. Based on a 2-hour OGTT, CS was classified according to the presence (polyphasic) or absence (monophasic, mp) of a rise in plasma glucose of more than 4.5 mg/dL after the first decline of the plasma glucose level. Associations between CS and age, sex, anthropometric, metabolic, and inflammatory parameters were analyzed by binomial logistic regression. Results:Curve shape was mp in 77.4% of the participants without age group difference, but a higher frequency was observed in men (89.3%) compared to women (65.5%, P < .001). The odds of mp CS increased with higher fasting GLP-1 (odds ratio [OR], 1.066; 95% CI, 1.006-1.133; P < .05) and 1-hour plasma glucose (OR, 1.054; 95% CI, 1.037-1.072; P < .001) and lower 2-hour plasma glucose (OR, 0.975; 95% CI, 0.959-0.992; P < .01). Conclusion:In healthy adults, mp CS was widespread and associated with more unfavorable metabolic parameters. A higher fasting GLP-1 level was associated with an mp CS.

It has been reported that a distinct 'old person smell' can develop with advancing age, however, this odour has not yet been sufficiently described in previous research. Sensory evaluation by a trained panel might be useful to describe alterations with age in body odour (BO). To evaluate the alterations and achieve first insights into the 'old person smell', this pilot study determined the odour profiles of BO samples from both a younger and an older age group with a trained panel. In addition, we aimed to assess whether the panellists can recognize the age group based on the smell of the BO samples. Eight younger (20-28 years) and eight older (80-83 years) participants sampled their BO by wearing a cotton T-shirt for one night. The samples were sensorially evaluated by a trained panel, including ratings of total intensity and pleasantness. Additionally, an age labelling task was performed as a forced-choice decision. Results revealed that the odour profiles of the BO samples were very similar for both age groups. Nevertheless, trained panellists were able to predict the age group with significantly higher accuracy (p = .042) than expected by chance (61% mean accuracy over all panellists). Furthermore, a linear support vector machine (SVM) classifier achieved an average accuracy of 69%. This finding indicates that the age of a person affects the BO, though it is not reflected in significantly distinct odour profiles.

RATIONALE:Poor appetite is considered a key factor in the development of malnutrition, a link that can be explained by alterations in dietary intake. Given the limited data on dietary characteristics in community-dwelling older adults with poor appetite, the present study aimed to examine whether poor appetite is associated with lower nutrient intake and more unfavourable food choices. METHODS:In 569 participants of the Longitudinal Aging Study Amsterdam aged ≥70 years appetite was assessed using the Simplified Nutritional Appetite Questionnaire and dichotomised into normal (>14) and poor (≤14). Intake of energy, 19 nutrients, 15 food groups, the Dutch Healthy Diet Index 2015 (DHD15) and Mediterranean Diet Score (MDS) were calculated from a food frequency questionnaire. Dietary differences between appetite groups were examined using Mann-Whitney U test and binary logistic regression adjusted for potential confounders. RESULTS:Mean age was 78 ± 6 years and 52% were female. Appetite was poor in 12.5% of participants. Energy intake was 1951 (median; quartiles 1-3: 1,653-2,384) kcal/day with no difference between appetite groups. Poor appetite was associated with lower intake of protein (OR 0.948, 95%CI 0.922-0.973), folate (0.981, 0.973-0.989), zinc (0.619, 0.454-0.846), vegetables (0.988, 0.982-0.994) and lower scores of DHD15 (0.964, 0.945-0.983) and MDS (0.904, 0.850-0.961), as well as higher intake of carbohydrates (1.015, 1.006-1.023), and vitamins B2 (4.577, 1.650-12.694) and C (1.013, 1.005-1.021). CONCLUSIONS:Community-dwelling older adults with poor appetite showed poorer diet quality with a lower intake of protein, folate, zinc and vegetables, compared with those reporting normal appetite and should be advised accordingly.

Substitution models in epidemiologic studies specifying both substitute and substituted food in relation to disease risk may be useful to inform dietary guidelines. A systematic review of prospective observational studies was performed to quantify the risks of all-cause mortality, cardiovascular disease, and type 2 diabetes (T2D) associated with the substitution of dairy products with other foods and between different dairy products. We systematically searched MEDLINE, Embase, and Web of Science until 28th June, 2023. We calculated summary relative risks (SRRs) and 95% confidence intervals (95% CI) in random-effects meta-analyses. We assessed the risk of bias with the Risk Of Bias In Non-randomized Studies - of Exposure (ROBINS-E) tool and certainty of evidence (CoE) using the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) approach. Fifteen studies (with 34 publications) were included. There was moderate CoE that the substitution of low-fat dairy with red meat was associated with a higher risk of mortality, coronary artery disease, and T2D [SRR (95% CI): 1.11 (1.06, 1.16), 1.13 (1.08, 1.18), and 1.20 (1.16, 1.25)]. A higher risk of mortality and T2D was also observed when substituting low-fat dairy with processed meat [SRR (95% CI): 1.19 (1.11, 1.28) and 1.41 (1.33, 1.49); moderate CoE]. A lower mortality risk was associated with the substitution of dairy and yogurt with whole grains [SRR (95% CI): 0.89 (0.84, 0.93) and 0.91 (0.85, 0.97)], and butter with olive oil [SRR (95% CI): 0.94 (0.92, 0.97); all moderate CoE]. Mainly no associations were observed when substituting dairy products against each other on disease and mortality risk. Our findings indicate associations between substituting dairy with red or processed meat and higher disease risk, whereas its substitution with whole grains was associated with a lower risk. However, there is little robust evidence that substituting whole-fat with low-fat dairy is associated with disease risk. (CRD42022303198).