Anatomía Digital

Nutrigenetics and nutrigenomics. Advances in precision nutrition for NCDs: obesity, diabetes, and hypertension

Valeria Sophia Navas Benavides — 2026-02-06

Introduction. Traditional population-based nutrition guidelines have been effective in reducing nutritional deficiencies but show limitations when addressing individual genetic variability, particularly in the context of non-communicable chronic diseases (NCDs). Precision nutrition, grounded in nutrigenetics and nutrigenomics, offers personalized dietary interventions based on everyone’s molecular profile. Objective. To analyze advances in nutrigenetics and nutrigenomics applied to precision nutrition and their clinical impact on the prevention and management of obesity, type 2 diabetes, and hypertension. Methodology. A narrative review was conducted based on a non-systematic search of scientific databases (PubMed, SciELO, ScienceDirect), including articles published between 2018 and 2023. A total of 42 relevant studies were selected that provided evidence on gene–nutrient interactions with clinical applicability in NCDs. Results. At least 43 clinically relevant genetic variants were identified in relation to obesity, type 2 diabetes, and hypertension. Polymorphisms such as FTO (rs9939609), TCF7L2 (rs7903146), and ACE (rs1799752) modulate the response to specific dietary interventions, including high-fiber diets, sodium restriction, and increased monounsaturated fat intake. Omics technologies and next-generation sequencing have enabled the characterization of individual molecular profiles and the development of evidence-based, genetically tailored nutritional strategies. Conclusion. The integration of nutrigenetics and nutrigenomics into clinical practice enhances the effectiveness of dietary interventions for NCDs through individualized approaches. Despite current implementation challenges, scientific evidence supports the consolidation of precision nutrition as an emerging model within personalized medicine. General Area of Study: Health and Wellness. Specific area of study: Nutrition and Dietetics. Type of study: Bibliographic review.

Refeeding syndrome in the critically ill pediatric patient: a pathophysiological approach

Yanitzia Belalcazar Ortiz — 2026-02-06

Introduction. Refeeding Syndrome (RS) is a potentially life-threatening metabolic complication triggered by the reintroduction of nutrition in pediatric patients with prolonged malnutrition or fasting. It results from an abrupt shift from a catabolic to an insulin-mediated anabolic state, causing rapid intracellular shifts of phosphate, potassium, and magnesium, along with thiamine deficiency, which may lead to multi-organ dysfunction. Children are particularly vulnerable due to limited energy reserves and higher metabolic demands. Objective. To provide an integrative pathophysiological overview of refeeding syndrome in critically ill pediatric patients, emphasizing risk identification, clinical manifestations, and evidence-based strategies for safe nutritional reintroduction. Methodology. A narrative review was conducted through PubMed, SciELO and ScienceDirect, including English and Spanish articles published between 2019 and 2024, with exceptional inclusion of earlier seminal studies. Controlled MeSH/DeCS terms related to “Refeeding Syndrome,” “Pediatric Nutrition” and “Malnutrition” were used. A total of 28 studies were selected based on clinical relevance and pediatric focus. Results. RS typically occurs within 48–120 hours after restarting nutrition, most frequently presenting as hypophosphatemia with associated electrolyte derangements and potential multi-organ impairment. Incidence reaches 7% in pediatric intensive care units and nearly 47% in children with severe malnutrition. Prevention relies on early risk stratification, close biochemical monitoring (every 6–8 h initially), hypocaloric initiation (10–12.5 kcal/kg/day), anticipatory thiamine supplementation and initiative-taking electrolyte replacement. Early, gradual enteral nutrition with adequate protein support (1–3 g/kg/day) is considered optimal. Conclusion. Refeeding syndrome in pediatric critical care demands initiative-taking, gradually titrated nutritional strategies and vigilant monitoring. Early detection and micronutrient correction are key to reducing morbidity and mortality. Further pediatric-specific prospective research is needed to refine metabolic risk-adapted protocols. General Area of Study: Health and Wellness. Specific area of study: Critical Care Medicine. Type of study: Bibliographic review.

Acute metabolic response in the pediatric critical patient

Ronny Richard Mera Flores — 2026-02-06

Introduction. The acute metabolic response in critically ill pediatric patients is a complex phenomenon characterized by hypermetabolism, insulin resistance, systemic inflammation, and accelerated protein catabolism. Children have limited energy reserves and are more vulnerable to early malnutrition, worsening prognosis if nutritional and therapeutic support are not promptly provided. Objective. To provide a comprehensive analysis of pathophysiology, clinical-metabolic evaluation, nutritional implications, and therapeutic strategies associated with the acute metabolic response in critically ill pediatric patients. Methodology. A narrative review was conducted in PubMed, SciELO, and ScienceDirect, including English and Spanish articles from the last five years and older seminal studies when relevant. MeSH and DeCS descriptors related to critical illness, pediatric ICU, metabolic response, energy expenditure, nutritional support, hypermetabolism, and protein catabolism were used. After screening for pediatric focus and relevance, 34 articles were included. Results. The acute metabolic response involves proinflammatory cytokine activation, increased cortisol and catecholamines, insulin resistance, hyperglycemia, accelerated lipolysis, and marked protein catabolism with rapid muscle loss. Indirect calorimetry provides precise energy requirement estimation. Early enteral nutrition (24–48 h) reduces infections and cumulative energy deficit. Protein needs should be 1.5–2.5 g/kg/day. Emerging strategies include immunonutrition, metabolic β-blockade, microbiota modulation, and precision nutrition based on metabolic phenotype. Conclusion. Management of the acute metabolic response in critically ill pediatric patients requires early, individualized, and metabolically directed intervention. Early, monitored nutritional support is crucial to preserve lean mass and modulate inflammation. Pediatric evidence gaps remain, emphasizing the need for studies validating safe and effective strategies. General Area of Study: Health and Wellness. Specific area of study: Critical Care Medicine. Type of study: Bibliographic review.