Parenteral nutrition (PN) is used when sufficient oral or enteral nutrition is not possible or feasible. Current guidelines provide limited practical guidance in emergency surgical patients, and the evidence is sparse.

The EATERS trial aims to investigate the effect of early supplemental parenteral nutrition on postoperative infections in major emergency abdominal surgery patients.

The EATERS trial is an investigator-initiated, multicenter, randomized controlled trial. The trial will include 342 adults with reduced oral intake after emergency abdominal surgery, randomizing them in a 1:1 ratio to early or postponed supplemental PN. The intervention group (early) will receive supplemental PN starting on postoperative day (POD) 2 for up to five days. The control group (postponed) will receive standard care and, if oral intake remains insufficient, will begin supplemental PN on POD5 for up to five days.

The primary outcome is the incidence of postoperative nosocomial infections during admission. Outcome assessors and the statistician will be blinded to the treatment allocation. The secondary outcomes include non-infectious complications during admission, length of stay, mortality risk at 30 and 90 days, energy and protein intake, serious adverse events, and readmission risk within 30 and 90 days of surgery.

Analyses will follow the intention-to-treat principle, and logistic regression used for primary outcome analysis.

The EATERS trial will provide novel insights into the timing of parenteral nutrition in a high-risk patient population. This protocol and statistical analysis plan will reduce bias and increase transparency in the conduct and analysis of the trial.

Chrysobalanus icaco L. (Caco) is a fruit tree distributed in tropical areas of Africa and America. Its seeds are a rich source of bioactive compounds, and their consumption could have a positive impact on human health during dyslipidemias. The objective of this study was to evaluate the hypolipidemic and antioxidant activity of aqueous extract of Caco seeds (AECS) in an in vivo model of hypertriglyceridemia induced by Triton WR-1339 (tyloxapol). Phytochemical characterization revealed saponin and phytic acid contents of 4730 ±190 µg of saponin equivalents and 1.0±0.05 µg phytic acid equivalents g-1 of sample, respectively. Phenolic acids and flavonoids (ellagic acid, apigenin-7-O-glucuronide, and myricetin, among others) were identified by HPLC-QTOF-MS. AECS was administered once daily for three consecutive days at two doses (150 and 600 mg/kg), in male CD1 mice, where treatment with 600 mg/kg reduced serum triglyceride levels by 64% compared to control, decreased oxidative damage to lipids and proteins, and modulated SOD and GPx activity in hepatic tissue. Complementary in silico molecular docking analyses suggested a potential interaction of apigenin-7-O-glucuronide with lipid metabolism-related enzymes. These findings indicate that C. icaco L. seeds may be considered a promising source of bioactive molecules for the treatment and management of early phases of dyslipidemias, as evidenced in an acute model, but their full potential in chronic stages merits further research.

Phenolic compounds may reduce oxidative stress and inflammation, but evidence on inflammatory markers is limited. This study investigated associations between phenolic compounds intake and ten inflammatory markers in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The cross-sectional analysis included participants from the full cohort (n= 14,151) and a São Paulo subsample (n= 681). Food intake was assessed using a semiquantitative food frequency questionnaire, and phenolic content was estimated from Phenol-Explorer and Brazilian Food Composition Database. Logistic regressions models compared the highest versus lowest tertiles of phenolic intake for high-sensitivity C-reactive protein (hs-CRP), glycoprotein acetylation (GlycA), monocyte chemoattractant protein-1 (MCP-1), E-selectin, transforming growth factor β1, tumor necrosis factor α, interleukin-6, interleukin-10, fibrinogen, and leptin levels. Inflammatory markers were dichotomized as low (tertiles 1–2) or high (tertile 3), except hs-CRP (>3 mg/L). Multiple testing was corrected using p<0.0036. Mean age was 52.1 years for hs-CRP/GlycA and 45.6 years for other markers. Compared with T1, participants in T3 of total phenolics, phenolic acids, and flavonoids had 14%, 18%, and 18% lower odds of elevated hs-CRP, respectively. For GlycA, higher intakes of phenolic acids, stilbenes and other phenolics were associated to 18-48% lower odds of high levels (all p≤0.003). Higher intake of hydroxybenzoic acids and stilbenes was associated with lower E-selectin levels, while phenolic acid intake showed an inverse association with MCP-1. No associations were observed for other markers. Higher intakes of phenolic compounds were associated with lower systemic inflammation, suggesting a role in preventing inflammation-related chronic diseases.

Urinary iodine concentration (UIC) is the principal biomarker for assessing iodine status; however, it is subject to marked fluctuations and practical challenges. This proof-of-concept study evaluated protein-corrected salivary iodide (SI/P) as a potential alternative biomarker, comparing it with spot UIC in distinguishing between iodine-deficient and iodine-adequate individuals, assessing its responsiveness to short-term dietary iodine restriction, and exploring its correlation with 24-hour urinary iodine excretion (UIE). Twenty-six participants were categorised into low-iodine (n = 17) and high-iodine (n = 9) groups based on 24 h UIE collected on Day-1. Postprandial spot urine and unstimulated saliva samples were collected under habitual diet (Day-1) and low-iodine diet (Day-2). SI/P was significantly higher in the high-iodine group at all time points on both Day-1 (post-breakfast [1-PB]: 61.28 vs. 27.89 µg/g, p = 0.03; post-lunch [1-PL]: 71.03 vs. 27.4 µg/g, p = 0.003; post-dinner [1-PD]: 114.13 vs. 31.58 µg/g, p = 0.002) and Day-2 (2-PB: 81.86 vs. 26.51 µg/g, p = 0.013; 2-PL: 54.56 vs. 18.83 µg/g, p < 0.001; 2-PD: 38.2 vs. 18.79 µg/g, p = 0.043), whereas UIC only differed significantly post-dinner on Day-1 (156.15 vs. 36.63 µg/L, p = 0.009). SI/P also showed stronger correlation with 24 h UIE (1-PB: r = 0.65, p = 0.001; 1-PL: r = 0.70, p < 0.001; 1-PD: r = 0.67, p < 0.001; 2-PB: r = 0.70, p < 0.001; 2-PL: r = 0.65, p = 0.001; 2-PD: r = 0.50, p = 0.01) compared with UIC (1-PB: r = 0.49, p = 0.011; 1-PL: r = 0.38, p = 0.055; 1-PD: r = 0.58, p = 0.002; 2-PB: r = 0.68, p < 0.001; 2-PL: r = 0.52, p = 0.007; 2-PD: r = 0.44, p = 0.027). Receiver operating characteristic analysis indicated that post-lunch SI/P achieved the highest accuracy (AUC = 0.891; 95%CI: 0.791–0.991; p < 0.0001). Unlike UIC, which is primarily suited for population-level monitoring, SI/P demonstrated stable performance irrespective of diet/sampling time, suggesting utility as a reliable, individual-level biomarker of iodine status.

Anorexia nervosa (AN) is an eating disorder that is mediated by psychological and metabolic factors, yet it is unclear how these factors interact. The NAMA trial objective is to clarify the metabo-psychiatric interaction and identify how it affects AN-patients’ behavior. This randomized trial will recruit 36 treatment-naïve female AN patients, 13–18 years of age, and 36 matched healthy controls. Participants will undergo psychiatric assessments followed by 12-hour overnight fasting. In the next morning baseline assessments of outcomes will be performed. Patients will be randomly allocated 1:1 to receive a mixture with calories or receive a mixture without calories. Healthy controls will also be allocated to receive mixtures with/without calories. Mixtures will be standardized for taste and appearance and allocation will be masked. Primary outcome measure is resting-state functional magnetic resonance brain imaging 60 minutes post-consumption of the mixture. Secondary outcomes include: 1. Blood samples to study markers reflecting metabolic states, hunger/satiety, and stress responses, 2. psychometric evaluations of subjective experiences, and 3. In a second meal 3 hours later, effects of previous calorie intake on subsequent food consumption will be assessed. This article describes the study protocol, including analysis plan, for a randomized controlled trial to comprehensively evaluate the effects of calorie intake in AN. The trial will distinguish psychological and metabolic neuronal networks associated with food intake and uncover how their integration affects food intake and other hallmark symptoms in AN. The aim is to accelerate treatment development by identifying brain mechanisms that drive AN. Clinicaltrials.gov identifier: NCT06814002.

A high serum total cholesterol (TC) concentration is a major risk factor for CVD, and lifestyle modifications including a healthy diet is among the first-line strategies for lowering cholesterol concentration and reducing CVD risk. Several studies in rodents have demonstrated a lower circulating TC concentration after intake of cetoleic acid (CA, C22:1n-11). The primary aim was to investigate the effect of consuming herring oil containing CA or a CA concentrate on the circulating TC concentration in obese hypercholesterolemic rats. Secondary aims included investigating effects of CA on a selection of hepatic enzymes and receptors involved in cholesterol metabolism, lipogenesis and VLDL assembly. Thirty male obese Zucker fa/fa rats were fed a diet containing either herring oil (HERO) or a CA concentrate (CECO), containing 0.70 or 1.40 wt% CA, respectively, or a control diet with soyabean oil for 5 weeks. Data were analysed using one-way ANOVA. The serum TC concentration was lower in the HERO and CECO groups compared to the Control group (17 and 20 percent, respectively). Both the HERO and the CECO diets downregulated de novo lipogenesis, cholesterol esterification and lipidation of VLDL in the liver compared to the Control diet, but did not affect the hepatic cholesterol synthesis, the LDL receptor or the faecal excretion of cholesterol and bile acids. To conclude, rats fed the HERO or CECO diets had a lower serum concentration of TC, probably as a result of downregulated VLDL-secretion in response to lower lipogenesis. This may have relevance for lowering TC in hypercholesteraemic humans.

Despite increasing efforts to promote and support breastfeeding, the United States continues to have some of the lowest exclusive and sustained breastfeeding rates globally. Foreign-born immigrants and refugees specifically have been reported to have high initiation but low exclusive breastfeeding (EBF) rates. This scoping review aims to explore what is known about strategies to support breastfeeding among foreign-born mothers in the United States using the Arksey & O’Malley framework for scoping reviews and PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Six databases were searched using a comprehensive search strategy and 2,103 articles were identified, of which 31 met eligibility criteria and discussed 33 specific breastfeeding interventions. The articles describe a range of interventions including breastfeeding promotion and education (n=30), hands-on breastfeeding support (n=9), material support -like giving breastfeeding supplies and food- (n=16), social support (n=18), and social marketing campaigns (n=1) to promote community support for breastfeeding. Common strategies for implementing these interventions include individual counseling (n=21), group breastfeeding education (n=17), informational materials (n=12) and family support promotion (n=11). 87.2% of the immigrant mothers targeted by these breastfeeding support interventions were Hispanic; 4.5% and 7.0% were mothers of African and Asian descent respectively. This study reveals limited data and key gaps in efforts to preserve the culture of breastfeeding and promote EBF among multicultural immigrant and refugee families, particularly non-Hispanic groups. Addressing these gaps will improve optimal infant feeding practices among foreign-born mothers in the U.S and consequently maternal and infant health outcomes.

This commentary responds to the study by Kelly Garton et al., “Monitoring the impacts of international trade and investment agreements on food environments: a Canadian case study,” published in Public Health Nutrition, which applies the INFORMAS trade and investment monitoring framework to the Canadian food system.