Human lactation has evolved to produce a milk composition that is uniquely-designed for the human infant. Not only does human milk optimize infant growth and development, it also provides protection from infection and disease. More recently, the importance of human milk and breastfeeding in the programming of infant health has risen to the fore. Anchoring of infant feeding in the developmental origins of health and disease has led to a resurgence of research focused in this area. Milk composition is highly variable both between and within mothers. Indeed the distinct maternal human milk signature, including its own microbiome, is influenced by environmental factors, such as diet, health, body composition and geographic residence. An understanding of these changes will lead to unravelling the adaptation of milk to the environment and its impact on the infant. In terms of the promotion of breastfeeding, health economics and epidemiology is instrumental in shaping public health policy and identifying barriers to breastfeeding. Further, basic research is imperative in order to design evidence-based interventions to improve both breastfeeding duration and women’s breastfeeding experience.

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Nutrition, often along with physical activity, is by now acknowledged as a cornerstone in the prevention and even more so the treatment of many diseases. Indeed, food and nutritional intake nowadays are often thought to be the main source of wellbeing sometimes over- but also underestimating the impact of nutritional intake, dietary pattern and food-derived natural compounds in their impact on human health. In this Special Issue entitled `Clinical Nutrition: Recent Advances and Remaining Challenges´ a broad overview and summary on recent findings in various fields of clinical nutrition with special focus on chronic and degenerative diseases like metabolic diseases, cancers, neurodegenerative diseases, inflammatory bowel diseases, sarcopenia but also malnutrition in elderly, infants and children is provided. Nutrition, often along with physical activity, is by now acknowledged as a cornerstone in the prevention and even more so the treatment of many diseases. Indeed, food and nutritional intake nowadays are often thought to be the main source of wellbeing sometimes over- but also underestimating the impact of nutritional intake, dietary pattern and food-derived natural compounds in their impact on human health. In this Special Issue entitled `Clinical Nutrition: Recent Advances and Remaining Challenges´ a broad overview and summary on recent findings in various fields of clinical nutrition with special focus on chronic and degenerative diseases like metabolic diseases, cancers, neurodegenerative diseases, inflammatory bowel diseases, sarcopenia but also malnutrition in elderly, infants and children is provided.

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The prevalence of diabetes is on the increase in the UK and worldwide, partly due to changes in lifestyle which predispose individuals to overweight and obesity. It is estimated that about 90% of the currently diagnosed adults have type 2 diabetes, and based on the World Health Organisation (WHO) report, about 422 million adults were living with diabetes in 2014 compared with 108 million in 1980; this condition caused about 1.5 million deaths in 2012. In the United States of America, it is estimated that about 30.3 million adults are living with diabetes, with a further 1.5 million new diabetes cases diagnosed every year, representing an increasing prevalence of this condition. Diabetes represents a major public health challenge, despite advances in technology and the pharmaceutical industry. These problems may be in the form of acute or long-term complications. Therefore, in order to attenuate the problems of diabetes, management strategies usually include lifestyle changes such as increased physical activity and dietary interventions. Studies which evaluate the role of nutrition in the management of type 2 diabetes often involve human and animal models as these approaches enable us to have a broader and more in-depth understanding of the condition. In some cases, diabetes may co-exist with other conditions, such as stroke, and these may present unique challenges with regard to nutritional interventions. This Special Issue aims to evaluate the risk factors associated with type 2 diabetes and the role of the diet in the management of people with this condition. This evidence is drawn from both human and animal studies.

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Proteins and polysaccharides are two kinds of versatile natural macromolecules that are ubiquitous in nature. A tailored diet fortified with proteins and polysaccharides has been developed to ameliorate a wide array of diseases. This reprint contains experimental studies, reviews and systemic reviews that cover all beneficial aspects related to protein or polysaccharide fortification, especially for the treatment of various disorders and their complications.

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Manuscripts in this monograph are sorted into five categories: 1. Case Reports: a description of living as a bedridden patient; structured interviews with severely affected ME/CFS patients; how past events contribute to severe ME/CFS; a comparison of moderately ill, severely ill, and very severely ill; case reports of ME/CFS in children. 2. A healthcare provider’s view of managing ME/CFS patients. 3. Characterization of the Severely and Very Severely Affected: (1) the most troubling symptoms; (2) disease severity diminishes capacity for exercise, (3) operationalized definitions of the severely ill and very severely ill; (4) the usefulness of a modified Korean Chalder Fatigue Scale Questionnaire; (5) cardiac dimensions and function in patients; (6) an easier tilt test; and (7) review of sleep studies. 4. Progress in Diagnosis and Treatment: (1) objective measures for grading ME/CFS; (2) a sitting tilt test for orthostatic intolerance; (3) the benefits of IVIgG; (4) risks and protective factors in suicidality; (5) malnutrition and overcoming it; (7) partnerships between patients, caregivers, and providers, and the use of technology; (8) a holistic model of care, “Compassion in Practice; and (9) the effects of suffering, utilizing a four-phase model. 5. Impact of the Disease: (1) a historical perspective; (2) the impact of ME/CFS on psychosocial dynamics; (3) the educational needs of school-aged; and (4) the economic impact of ME/CFS

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Malnutrition lurks in the background of hospitalized medical patients. A large proportion of patients are malnourished upon hospital admission and patients often experience further nutritional deterioration during their stay and during disease recovery. However, although the negative effects of malnutrition on the outcomes of patients are well recognized, we still struggle to identify appropriate patients and efficacious nutritional interventions to overcome this problem. Recent studies have produced convincing evidence that adequate and timely nutritional management of medical in-patients can contribute to the prevention of negative consequences and thus improve the clinical outcome of patients. This Special Issue of the Journal of Clinical Medicine focuses on multiple practical aspects of nutritional management of medical in-patients, from screening for nutritional risk to the practical implementation of nutritional therapy and its possible complications, including financial aspects, to increasing clinician awareness and knowledge of nutritional care in hospitals.

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Diet contributes to the development of many chronic conditions including obesity, cardiovascular disease, hypertension, stroke, type 2 diabetes, metabolic syndrome, some cancers, non-alcoholic fatty liver disease, and potentially some neurological diseases. This reprint addresses associations between diet (and specific nutrients including vitamin D) and various chronic diseases including obesity, cardiovascular disease, hypertension, stroke, diabetes, metabolic syndrome, non-alcoholic fatty liver disease, neurological conditions, and age-related macular degeneration. More specifically, the impacts of plant-based diets, dairy products, and ketogenic diets are explored in relation to chronic disease risk as well as some benefits of the consumption of oral nutritional supplements in the prevention of malnutrition and sarcopenia and in the treatment of wounds in individuals with diabetes. Additional topics that are covered include some roles of the fatty acid arachidonic acid in the body and the impact of cellular mitochondrial dysfunction on the progression of age-related macular degeneration. The effectiveness of a variety of nutraceuticals is covered as a means for the prevention or treatment of age-related macular degeneration. Lastly, the use of olive oil in reducing gut permeability in those with pre-diabetes is addressed, as well as the complex relationships of diet/food and of disease (metabolic syndrome) with the gut microbiota.

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The subject of enteral nutrition is an interesting one both to the healthcare professionals working in this practice area and to the individuals who may benefit from nutritional support. These individuals usually have functional guts but may be suffering from dysphagia (with the underlying neurological deficits) or the effects of radiotherapy treatment. Enteral nutrition involves the provision of nutritional support to individuals whose nutritional requirements cannot be met by a normal diet. In particular, it is the process of delivering enteral feed via feeding tubes such nasogastric feeding, nasojejunal and percutaneous endoscopic gastrostomy tubes. Often, enteral nutrition provision involves the assessment of nutritional status, the determination of nutritional requirements, the establishment of feeding regimes, and the management of patients, pumps, feeds, and feeding tubes.Researchers in this field are also keen to evaluate the effect of enteral feeding protocols, algorithms, and guidelines on patients with different medical conditions in various care settings. There have also been a series of comparisons between the use of feeding tubes, feeding methods, and management approaches. Economic evaluations of enteral nutrition and Home Enteral Nutrition (HEN) teams show the benefits of Home Enteral Tube Feeding (HETF); however, due to the rising cost of HETF, there has been intense debate on the subject. There have been reviews on advances, challenges, and prospects in enteral nutrition.This Special Issue is intended to provide information on recent advances in the area of enteral nutrition.

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