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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 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. 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.
Nutritional therapy is fundamental in critical care, yet conventional one-size-fits-all feeding strategies might overlook the dynamic metabolic shifts and patient variability inherent to critical illness. This review proposes a stepwise, phase-adapted strategy aiming to align nutrition therapy with three-step conceptual model of metabolic phases: acute catabolic, stabilization, and recovery. Randomized controlled trials have consistently shown no benefit - and potential harm - from early full-dose energy or protein delivery, particularly in patients with severe organ failure. The acute catabolic phase is characterized by systemic inflammation, stress hormone surges, and insulin resistance, where permissive underfeeding minimizes metabolic burden. In the stabilization phase, declining inflammatory markers and improving organ functions support cautious escalation of nutrition, though biomarkers like hyperglycemia and hypophosphatemia may signal unreadiness to target nutrition. In the recovery phase, inflammation resolves, and mobility improves requiring higher energy and protein delivery alongside physical rehabilitation. Patients may regress to earlier phases, necessitating nutrition de-escalation. This stepwise, phase-adapted nutritional strategy - start low, advance judiciously, and individualize throughout - offers a precision framework aimed at aligning feeding with metabolic capacity and minimizes risks of over- or underfeeding. Future priorities include validating biomarkers, identifying metabolic phenotypes, and testing adaptive nutrition algorithms in optimizing nutritional therapy.
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. 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. 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.
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. 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. 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.
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. 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. 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.
Critical care nutrition remains a high-stakes and error-prone domain, particularly given the complex metabolic demands and heterogeneity of ICU populations. This review explores recent progress in integrating artificial intelligence with nutritional therapy in ICUs, highlighting its evolution and potential benefits in precision-guided support, along with current implementation challenges. Widely used in adult and neonatal ICUs, parenteral nutrition faces persistent challenges including ordering errors, practice variability, and insufficient robust long-term outcome evidence. Recent advances in machine learning have demonstrated considerable potential in predicting nutrition-related complications (e.g. neonatal morbidities, cholestasis, feeding intolerances, and malnutrition), optimizing nutrient delivery through dynamic, real-time recommendations, and enhancing clinical decision-making with large language models (LLMs) that synthesize clinical guidelines and patient data into actionable insights. However, future studies must establish causal relationships between optimal parenteral nutrition and long-term outcomes while addressing confounding factors and ingredient heterogeneity. Artificial intelligence-driven nutrition therapies have the potential to significantly improve the precision, safety, and personalization of ICU nutrition practices. Continued development and validation using standardized, comprehensive, longitudinal datasets, and validation in comparative clinical trials will be critical to realizing this transformative potential.
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 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. 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.
Malnutrition is a major concern in patients with digestive disorders. This review examines the ethical imperatives for addressing inequities in nutritional care, specifically focusing on disease-related malnutrition (DRM). It explores the implementation of a human rights-based approach to clinical practice to bridge the gaps between duty-bearers and rights-holders in the management of malnutrition. DRM persists as a neglected crisis affecting 30-50% of hospitalized patients, particularly those with gastrointestinal and oncological conditions. Recent research identifies educational attainment as a super-determinant of diet quality, exerting a more powerful influence than income alone. Systemic barriers remain significant: mandatory screening is frequently unavailable across care settings, and a widespread knowledge gap persists among healthcare professionals. However, the emergence of the Cartagena and Vienna Declarations has established nutritional care as a human right, providing a new legal and ethical paradigm to tackle these disparities. Reducing inequities requires integrating nutritional care into Universal Health Coverage and mandating standardized screening and diagnosis using Global Leadership Initiative on Malnutrition (GLIM) criteria. Strategic alternatives include educational reform, interdisciplinary support teams, and patient empowerment. Ensuring equitable access to medical nutrition is essential to uphold human dignity and fulfill the right to health.
Artificial intelligence (AI) has become an non contourable tool in clinical nutrition practice. This review proposes to discuss the most recent advances that can support the physician in nutritional assessment and mainly physician decision support systems trying to predict and prevent nutritional related complications. Advanced data storage systems improve screening and assessment tools using large database analysis. Medical CT images analysis can determine patients suffering from sarcopenia and suggest outcome predictions accordingly. Decision making of the type of parenteral nutrition formula according to cluster obtained by machine of large databases has been shown to be superior to the prescription of neonatologists in preterm children. Machine learning can help to anticipate enteral feeding intolerance and predict enteral nutrition feeding success. Numerous digital technologies support analysis of the meal, allows for the passive monitoring of eating behaviors, including acoustic sensors for swallowing detection and motion sensors for tracking hand-to-mouth gestures. Each step in clinical nutrition, from screening to clinical decision-making, can be improved using AI. However, large data sources, the participation of data scientists, and advanced technologies are required. These improvements have the potential to transform clinical nutrition toward personalized nutrition, but AI integration should be carefully monitored to ensure patient benefit and safety.
The target of critical care nutrition research is moving from short-term physiological surrogate endpoints and mortality toward long-term patient-centered outcomes. This review summarizes recent core outcome set (COS) initiatives relevant to nutrition and metabolism and outcome selection in recent trials. The Core Outcome Measures for Clinical Effectiveness Trials of Nutritional and Metabolic Interventions in Critical Illness (CONCISE) defined essential outcomes: survival, physical function, infection, activities of daily living, nutritional status, and muscle/nerve function to be assessed at 30 and 90 days after randomization, with suggested but nonmandated instruments to preserve feasibility. COSMOGI (core outcome set of daily monitoring of gastrointestinal function in critically ill patients) standardizes daily gastrointestinal monitoring during critical illness. Large, randomized trials testing higher protein or early aggressive energy delivery have not improved survival and functional recovery, although the latter has only recently received more attention. From a mechanistic perspective, outcome selection in critical care nutrition and gastrointestinal function research should prioritize patient-centered (i.e. functional and patient-reported) outcomes. Standardizing outcome selection should improve interpretability and evidence synthesis. Future trials should incorporate robust functional and patient-reported outcomes. Core outcome sets will need updates when new assessment tools (i.e., biomarkers, new functional tests, standardized ultrasound protocols) emerge.
Cancer cachexia is a complex multiorgan wasting syndrome that negatively impacts on cancer patient's survival and quality of life. Standard nutritional support is considered insufficient to counteract cachexia, and no approved nutritional approach or standard of care for cachexia exists so far. This review highlights recent reports focused on nutrition, aimed at sparing skeletal muscle and targeting molecular pathways underlying cachexia with specific supplements. In animal models of cancer cachexia, branched-chain amino acids (BCAAs) help restore skeletal muscle proteostasis. In combination with the alanine dipeptide, with strong proteinogenic potential, BCAAs enhance anabolic signaling and suppress proteolysis via mTOR. α-ketoisocaproate exerts additional protective effects against muscle loss by targeting the Akt/FoxO3a and myostatin signaling. Methionine and the derivative SAM improve muscle status via epigenetic control and REDD1 suppression. L-carnitine shows multitarget functions, including muscle proteostasis control, inflammation attenuation, and reduced muscle fibrosis. Omega-3 polyunsaturated fatty acids show anti-inflammatory properties, improve the nutritional status, and prevent adipose tissue browning. Overall, recent findings in preclinical and partly in clinical studies indicate that nutrient-based interventions target complementary cancer cachexia alterations. It is likely that combinatorial approaches, integrating several specific nutrients, will provide an effective base for managing cancer patients during the long journey of the disease, building future interventions against cancer cachexia.
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 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. 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.
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. 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. 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.
Child malnutrition in low-and-middle-income countries remains persistently high, driven by converging biological, social, economic, environmental, and conflict-related factors. As progress slows and vulnerabilities intensify, this review synthesises emerging evidence from recent years to identify effective strategies and future directions for reducing undernutrition in resource-constrained settings. Recent literature demonstrates that nutrition-sensitive interventions, including women's empowerment, social protection, WASH, immunisation, kitchen gardens, and biofortification, address key underlying drivers of child malnutrition and contribute to improved growth and dietary diversity. Building on these foundations, nutrition-specific strategies such as antenatal micronutrient supplementation, optimal infant and young child feeding practices, fortified complementary foods, and emerging approaches like microbiota-directed foods and fermentation have shown measurable gains in growth and nutritional status. Across the evidence base, integrated and multisectoral delivery models consistently outperform standalone programs, with particularly strong results when nutrition is combined with health services, social protection, community-based platforms, or climate- and conflict-responsive strategies. Current evidence underscores a shift toward integrated, layered, and context-responsive programming as the most effective path to reducing child malnutrition. Future research should prioritise implementation models that bridge nutrition-specific and nutrition-sensitive domains, strengthen health and community systems, and adapt to climate and humanitarian pressures.
This review critically evaluates proteomics research applied to clinical nutrition and metabolism published between mid-2024 and early-2026, examining whether recent advances have moved the field closer to clinically actionable precision nutrition applications. Large prospective cohort studies show that circulating proteomic signatures reflect dietary patterns and are associated with incident cardiometabolic, hepatic, and neurodegenerative outcomes. In most analyses, these signatures capture plausible biological pathways, but their incremental predictive value beyond established risk models appears modest. Interventional studies confirm that circulating proteins respond to dietary modification, but these trials are considerably smaller than epidemiological cohorts and proteomic-guided randomized allocation has rarely been implemented to date. Although multiomics integration and machine-learning approaches have expanded discovery and improved pathway modeling, independent validation, cross-platform consistency, and clinically meaningful risk reclassification remain inconsistently demonstrated across studies. Diet-proteome associations are biologically coherent and reproducible at the population level. Nevertheless, translation into individualized dietary prescription remains to be demonstrated at scale. Robust evidence of cross-platform consistency, formal clinical utility, and outcome-driven trials incorporating proteomic-guided interventions will be key to enabling circulating proteomics to support routine precision nutrition practice.
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. 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. 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.
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 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. 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.
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. 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. 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.
This review investigates protein intake in early childhood (2-5 years), with particular attention to the context of climate change. Specifically, it draws on recent evidence regarding different protein sources and their respective benefits and concerns for both human and planetary health. While high protein intake, particularly from animal sources, during early childhood may contribute to excessive weight gain, both the quantity and quality of protein may shape growth trajectories and low intake of total protein or indispensable amino acids may result in growth restriction. The relevance of protein quality and amino acid composition is increasingly recognized. Plant-based and insect-derived proteins are emerging as sustainable alternatives with promising nutrient profiles, though uncertainties persist regarding digestibility, allergenicity, and long-term effects. Early childhood offers a key opportunity to introduce these proteins, yet evidence on acceptance and integration in children aged 2-5 years is still limited. Sensory preferences, food neophobia, and parental attitudes are major determinants of children's willingness to try and regularly consume alternative proteins. Meeting protein needs in early childhood requires balancing developmental demands with environmental sustainability. Alternative proteins may support this transition, but their nutritional adequacy, safety, and cultural acceptability must be ensured. Personalized nutrition strategies will be essential for guiding appropriate protein choices and promoting healthy growth during this formative period.
This review synthesizes current evidence on free sugar intake among European children and adolescents, emphasizing recent trends in consumption, key determinants, associated health outcomes, and implications for preventive strategies. Despite modest reductions in some countries, sugar consumption in youth continues to exceed international recommendations, particularly during adolescence. Longitudinal studies highlight persistent high intakes, with sugar-sweetened beverages (SSBs) and confectionery as primary contributors. Socioeconomic disparities, parental behaviours, screen exposure, and individual traits significantly influence consumption. High sugar intake is linked to increased risk of adiposity, cardiometabolic disturbances, and dental caries, with early exposure potentially impacting long-term disease risk. Recent policy efforts, such as taxation and reformulation, show promise but remain inconsistently implemented across Europe. Free sugar intake in childhood remains a critical nutritional concern in Europe. Evidence supports the need for multilevel approaches, including early-life interventions, updated guidelines, and policy measures targeting the broader food environment. Healthcare professionals play a key role in supporting families through nutrition education and consistent messaging. Coordinated action is essential to reduce sugar intake and prevent chronic diseases across the life course.