The Use of Visceral Proteins as Nutrition Markers: An ASPEN Position Paper

Nutritional optimization of fecal microbiota transplantation in humans: a scoping review

Diet constitutes a major source of nutrient flow to the gut microbes. As such, it can be used to help shape the gut microbiome. Fecal microbiota transplantation (FMT) is an increasingly promising therapy in disease states beyond recurrent Clostridioides difficile infection, but diet is largely overlooked for its potential to help optimize this therapy. Therefore, the aim of this scoping review is to present the literature landscape that captures pre- and post-FMT dietary intake in humans, identify research gaps, and provide recommendations for future research. A comprehensive search strategy was developed and searches were run in five databases. Studies were included if they discussed adults who underwent FMT for any recognized treatment indication and had dietary intake as a study objective, this search encompassed studies with interventions that included foods and dietary supplements. The initial screening identified a total of 7721 articles, of which 18 met the inclusion criteria for this review. Studies were heterogeneous, but taken together, they introduce a framework that defines important nutritional considerations for both donors and FMT recipients in the period around FMT dosing. This framework is summarized with this review and highlights the opportunities available to develop FMT-based precision nutrition strategies to optimize its clinical efficacy.

Handgrip strength and platelet-to-albumin ratio as joint prognostic indicator for patients with cancer cachexia

BACKGROUND

Handgrip strength (HGS) and platelet-to-albumin ratio (PAR) are established prognostic markers of cancer cachexia. This study evaluates the combined efficacy of HGS and PAR using a single index (HPA) for predicting survival outcomes in cancer patients with cachexia aged ≥18 years.

METHODS

The multicenter Nutrition Status and Its Clinical Outcomes in Common Cancers study, conducted from July 2013 to April 2022, enrolled 5189 participants. Thresholds for HGS and PAR were determined using optimal stratification, leading to the development of HPA index. Prognostic accuracy was assessed using time-dependent receiver operating characteristic analysis, Kaplan-Meier survival curves, and Cox proportional hazards models.

RESULTS

The cohort consisted of 3127 men and 2062 women, with a median follow-up of 36 months, and mean age of 58 years. Low HGS thresholds were 19 kg (female) and 31.9 kg (male), and high PAR cut-offs were 9.07 × 10⁹ (female) and 6.52 × 10⁹ (male). Both low HGS and high PAR levels were linked to increased mortality risk. The HPA index showed superior prognostic accuracy (C-index = 0.611; 95% confidence interval: 0.58-0.61; P < 0.001) compared with HGS or PAR alone. Kaplan-Meier analysis indicated significantly reduced survival in patients with low HGS and high PAR.

CONCLUSIONS

The HPA index is a clinically significant prognostic tool for cancer cachexia, enhancing survival prediction and guiding patient management.

Effects of integrative telehealth-based nutrition care with and without oral nutritional supplements in patients with liver and colorectal cancer: A randomized controlled trial

OBJECTIVES

This study investigated the effects of post-discharge integrative telehealth-based nutritional care alone versus post-discharge integrative telehealth-based nutritional care combined with high-calorie/high-protein oral nutritional supplements (HCHP-ONS) on the nutritional status and quality of life in patients with hepatocellular carcinoma (HCC) or colorectal cancer (CRC) at risk of malnutrition.

METHODS

We recruited HCC or CRC patients who were at moderate to high risk of malnutrition, defined as a score of 4-9 on the abridged Patient-Generated Subjective Global Assessment (aPG-SGA), and randomly assigned them to either a telehealth nutritional care-control group (C group) or a telehealth nutritional care combined with HCHP-ONS group (C+O group) for a 3-month intervention. In group C, a dietitian provided monthly telehealth-based nutritional assessments and guidance through a mobile application (LINE) or phone calls. In the C+O group, in addition to telehealth-based nutritional assessments and guidance, patients received a daily can of HCHP-ONS, which provided 425 kcal and 19.1 g of protein per serving. Blood tests, anthropometric indicators, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and a nutritional status assessment were conducted monthly.

RESULTS

Results showed that the C+O group had significantly reduced malnutrition risk scores at the 1st, 2nd, and 3rd months. By the 3rd month, the C+O group showed significant improvement in the Prognostic Nutritional Index (PNI), and notable improvements in diarrhea and respiratory distress scores.

CONCLUSIONS

In patients with HCC and CRC who were at risk of malnutrition, integrative telehealth-based nutritional care via LINE or phone calls effectively reduced malnutrition risk, maintained PNI, and supported quality of life (QOL). The addition of HCHP-ONS further enhanced nutritional outcomes, leading to greater improvements in PNI, diarrhea, and dyspnea by the 3rd month.

Prevalence, impact, and management of adult disease-related malnutrition in African hospitals: A narrative review and insight from resource-limited clinical settings

Disease-related malnutrition (DRM) is a worldwide problem regarded as a global policy priority, but occurs on an exaggerated scale in Africa. While interpretation of studies is difficult due to the variety of nutrition assessment techniques, DRM in acute care in-patient African settings is commonly reported in the range of 45-75%, with nutritional risk reaching 84%. Challenges to the comprehensive management of DRM in the resource-limited clinical settings with few dietitians reviewed in this paper include the following: first, lack of routine nutrition screening resulting in more than 90% of malnourished or at-risk patients failing to receive nutrition support referrals, or receiving very delayed referrals. The result is worsening of nutritional status during hospital stay, clinical complications two to six times higher, up to a doubling of length of stay, and significantly higher mortality. Second, hospital structures are generally unsupportive of worthwhile nutritional care due to very poor or absent provision of nutritious oral diets, lack of multidisciplinary insight and collaboration, and the nonexistence of formalized nutrition support protocols and standards. Third, there is a grave lack of medical nutrition therapy (MNT) products and feeding pumps, forcing dietitians to improvise suboptimal formulations for enteral and parenteral feeding. Where MNT is available it is expensive and often not reimbursed, placing the responsibility for acquisition onto patients' families at their own expense. Urgent improvements in nutrition protocols adapted for resource-constrained contexts are needed, along with political commitment to facilitate the supply of suitable MNT products and equipment for use in hospitals.

Impact of Vitamin E-Coated Membrane Hemodiafilter on Serum Albumin Redox State in the Acute Kidney Injury Pig Hemodialysis Model

BACKGROUND

Several studies have evaluated the biocompatibility of dialysis membranes. The use of vitamin E-coated membranes has been reported multilaterally in in vitro and clinical studies. Nevertheless, the effect of vitamin E-coated membranes on the redox state of serum albumin, which forms the largest fraction of reactive sulfhydryl groups, has not been reported.

METHODS

Hemodiafiltration (HDF) with and without a vitamin E-coated hemodiafilter (V-RATM group and ABHTM groups, respectively) was performed in an acute kidney injury pig model to determine whether changes in the serum albumin, the oxidized albumin (OxiALB), and the reduced albumin (RedALB) levels differ between the two groups.

RESULTS

Analyses were conducted 22-24 times in the V-RATM group and 16-18 times in the ABHTM group, excluding missing data. The serum albumin levels decreased in both groups after nephrectomy; however, the decrease observed in the V-RATM group was significantly lesser than that in the ABHTM group. RedALB levels were significantly higher in the V-RATM group; in contrast, OxiALB levels did not differ between the two groups. A significant positive correlation was observed between the serum albumin and RedALB levels.

CONCLUSIONS

The present study demonstrated that HDF performed using a vitamin E-coated hemodiafilter effectively minimized the reduction in serum albumin and RedALB levels compared to the vitamin E-non-coated hemodiafilter in an acute kidney injury pig model.

Adequacy of oral intakes after cardiac surgery within an ERAS pathway: A prospective observational study

BACKGROUND

The 2019 Enhanced Recovery After Cardiac Surgery (ERACS) guidelines presented perioperative recommendations to optimize treatment for patients undergoing cardiac surgery (CS). However, the guidelines have not established postoperative nutrition recommendations. Limited studies have analyzed oral intakes after CS, but to our knowledge, none have done so in an ERACS pathway. The main objective of this study was to evaluate the adequacy of postoperative oral intakes, including adherence to oral nutrition supplements (ONSs).

METHODS

This was an observational prospective study. Postoperative oral intakes were analyzed from postoperative day (POD) 1 to 4, using direct observation of meal plates provided by the hospital. ONSs consumption was evaluated from POD2 to POD4. Adherence to other ERACS recommendations, including nutrition optimization before surgery, was recorded.

RESULTS

Forty-three patients were included in this study. Nutrition optimization before CS was offered to three (7%) patients. Forty-one (95%) patients resumed oral intakes on POD1. Mean oral calorie and protein intakes from POD2 to POD4 were 1088 ± 437 kcal and 0.8 ± 0.3 g/kg, respectively; however, 17 (41%) patients had calorie and protein intakes ≥70% of their estimated requirements. On POD2, ONSs consumption contributed 35% ± 19% and 38% ± 20% of calorie and protein intake, respectively. There was a significant decrease in ONSs consumption starting on POD3.

CONCLUSION

Within an ERACS pathway and with the contribution of ONSs, 41% of patients achieved sufficient oral intakes within the first 4 days after CS. The optimization of ONSs adherence on postoperative oral intakes should be further studied.

The GLIM consensus approach to diagnosis of malnutrition: A 5-year update

BACKGROUND

The Global Leadership Initiative on Malnutrition (GLIM) introduced an approach for malnutrition diagnosis in 2019 comprised of screening followed by assessment of three phenotypic criteria: weight loss, low BMI, and low muscle mass, and two etiologic criteria: reduced food intake/assimilation, and inflammation/disease burden. This planned update reconsiders the GLIM framework based on published knowledge and experience over the past five years.

METHODS

A GLIM working group (n = 43 members) conducted a literature search spanning 2019-2024 using the keywords "Global Leadership Initiative on Malnutrition or GLIM". Prior GLIM activities providing guidance for use of the criteria on muscle mass and inflammation were reviewed. Successive rounds of review and revision were used to achieve consensus.

RESULTS

More than 400 scientific reports are published in peer-reviewed journals, forming the basis of 10 systematic reviews, some including meta-analyses of GLIM validity that indicate strong construct and predictive validity. Limitations and future priorities are discussed. Working group findings suggest that assessment of low muscle mass should be guided by experience and available technological resources. Clinical judgement may suffice to evaluate the inflammation/disease burden etiologic criterion. No revisions of the weight loss, low BMI, or reduced food intake/assimilation criteria are suggested. Following two rounds of review and revision, the working group secured 100 % agreement with the conclusions reported in the 5-year update.

CONCLUSION

Ongoing initiatives target priorities that include malnutrition risk screening procedures, GLIM adaptation to the intensive care setting, assessment in support of the reduced food intake/assimilation criterion, and determination of malnutrition in obesity.

Malnutrition in orthopaedic trauma outcomes (MOTO): orthopedic trauma patients can be effectively screened and stratified for risk of malnutrition using prealbumin. A preliminary outcome study

Objectives

To evaluate prealbumin (PAB) as a prognostic indicator for early detection of malnutrition risk upon admission and its correlation with in-hospital complications and length of stay (LOS) in patients with orthopedic trauma.

Methods

Design

Retrospective cohort.

Setting

Urban academic Level 1 trauma center.

Patients/Participants

One hundred fifty-eight patients aged 18 years or older with acute traumatic fractures indicated for primary surgical fixation between 2019 and 2022 were included. Serum laboratory tests consisting of PAB, C-reactive protein, complete blood counts, and complete metabolic panel were obtained within 24 hours of arrival.

Outcome Measures and Comparisons

Primary outcome measures included characterization of patient risk factors for increased intensive care unit LOS, hospital LOS, and in-hospital complications. Secondary outcome measures included characterization of patients who were stratified as "at risk" for malnutrition by PAB < 20 mg/dL and identification of complication predictors.

Results

Fifty-one (32%) patients were stratified as "at risk" for malnutrition based on serum PAB < 20 mg/dL drawn within 24 hours of arrival. These patients had longer median hospital LOS (P < 0.001), were more likely to stay in the hospital longer than 7 days (P < 0.009) and >14 days (OR = 3.20, 95% CI 1.17-9.07, P < 0.001), and had twice the amount of postoperative complications during their hospital stay (P = 0.04) than patients with PAB ≥ 20 mg/dL.

Conclusions

Patients with orthopaedic trauma can reliably and cost-effectively be screened and stratified for risk of malnutrition using PAB drawn with immediate admission labs.

Level of Evidence

Level III.

Increasingly severe malnutrition according to the geriatric nutritional risk index is associated with a greater risk of postoperative adverse events

BACKGROUND

This study investigates the association between the geriatric nutritional risk index (GNRI), a readily available index measuring the risk of malnutrition, and 30-day postoperative complications following revision total knee arthroplasty (rTKA).

METHODS

The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients ≥ 65 who underwent rTKA between 2015 and 2021. The study population was divided into three groups based on preoperative GNRI: normal/reference (GNRI > 98), moderate malnutrition (92 ≤ GNRI ≤ 98), and severe malnutrition (GNRI < 92). Multivariate logistic regression analysis was conducted to investigate the association between preoperative GNRI and postoperative complications.

RESULTS

Compared to normal nutrition, moderate malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, blood transfusions, surgical site infection (SSI), non-home discharge, readmission, length of stay (LOS) > 2 days, and mortality. Severe malnutrition was independently significantly associated with a greater likelihood of experiencing any complication, septic shock, pneumonia, unplanned reintubation, cardiac arrest or myocardial infarction, stroke, blood transfusions, still on ventilator > 48 h, SSI, wound dehiscence, acute renal failure, non-home discharge, readmission, unplanned reoperation, LOS > 2 days, and mortality. Severe malnutrition was independently significantly associated with a greater number of complications and had a stronger association with complications compared to moderate malnutrition.

CONCLUSION

Malnutrition identified by GNRI has strong predictive value for short-term postoperative complications following rTKA in geriatric patients and may have utility as an adjunctive risk stratification tool for geriatric patients undergoing rTKA.

A nutritional prognostic model for hospitalized Belgian blue calves: The Calf-CONUT ratio for predicting survival

Malnutrition is a major factor in disease management failure. In humans, the CONUT (COntrolling NUTritional status) score assesses nutritional status based on albumin, cholesterol, and lymphocyte levels (sensitivity 92,30 %; specificity of 85 %). In bovine medicine, few studies focus on calf nutrition status. This study compares serum urea, cholesterol, and albumin levels in Belgian Blue calves between hospital admission and discharge (or death) and between survivors (S) and non-survivors (NS). At admission, cholesterol levels did not significantly differ between groups (p > 0.1). Albumin levels were higher in S (p = 0.02), while urea levels were lower (p = 0.04). At discharge, S showed a significant increase in cholesterol (p < 0.05) and a decrease in urea (p < 0.01) and albumin (p < 0.05). A urea/albumin ratio, named the Calf-CONUT ratio, above 2.64 was associated with increased mortality risk (Relative Risk: 2.29, Odds Ratio: 5.75) but demonstrated low sensitivity (46 %) and high specificity (87 %), suggesting limited standalone predictive power. If the analysis focuses solely on calves suffering from enteritis, the threshold value is 2.85, with improved sensitivity and specificity (Se 83 %; Sp 78 %; relative risk: 10; odd ratio: 15). This study provides initial insights into the nutritional assessment of hospitalized calves and paves the way for innovative approaches to their nutritional and medical management. Further research on specific diseases and breeds is needed to refine these thresholds.

Nutritional Support for Necrotizing Soft Tissue Infection Patients: From ICU to Outpatient Care

Although nutrition recommendations for patients with necrotizing soft tissue infections (NSTIs) often parallel those for patients with burn injuries, differences in the metabolic response to stress indicate that NSTIs require a unique approach. The sepsis and wound management associated with NSTIs trigger a metabolic response, driven by inflammatory and neuroendocrine changes, that leads to high circulating levels of cortisol, catecholamines, insulin, and pro-inflammatory cytokines. This metabolic response follows four phases of recovery (Early Acute; Late Acute; Persistent Inflammation, Immunosuppression, and Catabolism Syndrome; Recovery) that require a thoughtful approach to nutrition by risk screening, malnutrition assessment, and micronutrient deficiency assessment. Close monitoring of energy expenditure and protein needs is required for appropriate nutrition management. Nutrition intake after transfer from the intensive care unit and hospital discharge is often inadequate. Ongoing monitoring of nutrition intake at all outpatient follow-up appointments is necessary, regardless of the route of delivery, until the nutrition status stabilizes and any nutritional decline experienced during hospitalization has been corrected.

Clinical Implications of the C-Reactive Protein-Albumin Ratio as a Prognostic Marker in Terminally Ill Patients with Cancer

Background: Few studies investigated the clinical implications of C-reactive protein-albumin ratio (CAR) in palliative care. Objectives: To determine the association of CAR with overall survival among terminally ill patients with cance. Design: Datasets were obtained through two multicenter prospective cohort studies. Setting/Subjects: Patients newly referred to palliative care. Measurements: Physicians recorded measures at the baseline. Patients were followed up to their death or observed for 6 months. The patients in cohort 2 were divided using the CAR cutoffs detected using a piecewise linear hazards model in cohort 1. We performed time-to-event analyses using the Kaplan-Meier method and log-rank tests and univariate and multivariate Cox regression analyses for patients in cohort 2. Results: A total of 1554 patients in cohort 1 and 1517 patients in cohort 2 were eligible. The cutoffs were 0.1, 1.2, and 6.4. The patients in cohort 2 were divided into four categories (<0.1 [n = 103], 0.1-1.2 [n = 433], 1.2-6.4 [712], and ≥6.4 [n = 269]). The adjusted p values of the log-rank tests were <0.001. Significantly higher risks of mortality were observed in the Cox proportional hazard model for the higher categories than in the lowest category (CAR 0.1-1.2: adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.18-1.89; CAR 1.2-6.4: adjusted HR 2.08, 95% CI 1.65-2.62; CAR ≥6.4: adjusted HR 2.94, 95% CI 2.29-3.79). Conclusions: Patients with a higher CAR had significantly higher risks of mortality than those with a lower CAR.

Hidden malnutrition in obesity and knee osteoarthritis: Assessment, overlap with sarcopenic obesity and health outcomes

BACKGROUND & AIMS

Malnutrition may be a hidden but relevant health condition in individuals with obesity and osteoarthritis. The Global Leadership Initiative on Malnutrition (GLIM) consensus includes muscle mass as one of the key phenotypic criteria, potentially enhancing its ability to detect malnutrition in individuals with obesity. We comprehensively profiled the nutritional status of individuals with obesity and advanced knee osteoarthritis and explored associations with health outcomes.

METHODS

Data from the Prevention Of MusclE Loss in Osteoarthritis (POMELO) study was used, which included individuals with knee osteoarthritis and BMI≥35 kg/m2. Nutritional status was evaluated using the GLIM and sarcopenic obesity (SO) criteria. Low muscle mass (dual-energy x-ray absorptiometry), inflammation (C-reactive protein [CRP]), low muscle strength (handgrip/BMI), objective physical function (chair-stand test, 6-min walk test), and self-reported measures (quality of life, arthritis symptoms, and self-efficacy) were evaluated. Linear regressions were performed between GLIM-malnutrition and health outcomes, adjusted by age.

RESULTS

Forty-six individuals (73.9% female, age 64.2 ± 6.7 years, BMI 42.4 ± 4.7 kg/m2) were included. Regarding nutritional status, 26.1% were classified with malnutrition (i.e., defined by the combination of low muscle mass and elevated CRP concentration), 26.1% with SO, and 13% shared both conditions. Individuals with malnutrition presented with worse self-reported physical function (WOMAC function: 38.0 ± 6.6 vs. 32.0 ± 12.5, p = 0.04) and lower arthritis self-efficacy ('other symptoms' component: 5.1 ± 1.9 vs. 6.3 ± 1.7, p = 0.04) compared to those without malnutrition. A trend was identified for lower quality of life (visual analog scale 46.8 ± 12.3 vs. 58.3 ± 20.5, p = 0.06) in those with malnutrition. Poor lipid control (R2 = 0.15, β = 0.76, 95% CI 0.08-1.44, p = 0.030), body fat (R2 = 0.14, β = 5.56, 95% CI 1.01-10.11, p = 0.018), and poor arthritis self-efficacy (R2 = 0.09, β = -1.23, 95% CI -2.39-0.06, p = 0.040) were also associated with malnutrition.

CONCLUSIONS

Participants presented with high malnutrition rates (1 out of 4), and half of them also had SO. Malnutrition was associated with abnormal metabolic parameters, lower arthritis self-efficacy, and worse self-reported physical function. An early nutritional assessment and intervention may be imperative for individuals with osteoarthritis and obesity to mitigate health consequences.

Internal validation of two nutritional screening tools in hospitalized children and adolescents with cancer

BACKGROUND & AIMS

In cancer patients, malnutrition is associated with poorer treatment outcomes and prolonged hospital stays, negatively affecting prognosis and survival. This study aimed to evaluate the internal validity of the nutritional screening tools Nutrition Screening Tool for Childhood Cancer (SCAN) and Screening Tool Risk on Nutritional Status and Growth (STRONGKids) in predicting nutritional risk in hospitalized pediatric cancer patients.

METHODS

This was a retrospective observational study with pediatric cancer patients hospitalized between February and November 2019. ANPEDCancer was used as a reference to validate SCAN and STRONGKids due to its specificity in nutritional assessment for children and adolescents with cancer. Predictive values and agreement were analyzed. Patients were classified as at nutritional risk or not based on the tools. Nutritional status, anthropometric measures, biochemical markers, and length of stay (LOS) were compared between groups.

RESULTS

Of the 111 patients, 75.7 % (n = 84) were classified as at nutritional risk by SCAN, and 34.2 % (n = 38) as at high risk by STRONGKids. Patients at risk showed greater inadequacy in body composition measures and anthropometric indices. There was an association between nutritional risk as classified by the screening tools and the reduction of lean mass reserves (p = 0.039) and adipose tissue (p = 0.017). C-reactive protein was associated with nutritional risk only in STRONGKids, and with LOS only in SCAN. The agreement was 79.27 % for SCAN and 72.07 % for STRONGKids.

CONCLUSION

The SCAN demonstrated good precision in the nutritional screening of children with cancer, while STRONGKids was associated with inflamation.

Feasibility of whey protein powder supplementation in patients who are neurocritically ill: A post hoc analysis of a pilot randomized controlled trial

BACKGROUND

Hypoalbuminemia, often induced by acute stress and inflammation in patients who are neurocritically ill, is adversely associated with prognosis. This study investigates whether supplementing nutrition support with anti-inflammatory whey protein powder formulations (experimental group) can improve serum albumin levels and overall patient outcomes compared with traditional liquid intact protein formulations (control group) while monitoring for enteral feeding complications and inflammatory markers.

METHODS

In a randomized controlled trial conducted at a neurointensive care unit from January 2020 to May 2022, 116 out of 597 patients who required enteral nutrition (EN) for at least 7 days were randomly assigned to receive either the formula from experimental group or control group. The primary end point was serum albumin levels at 14 days. Secondary outcomes included functional status (modified Rankin Scale [mRS]) at 90 days, EN-related complications, and changes in serum inflammatory and infectious markers.

RESULTS

No significant differences were observed in serum albumin levels or mRS scores (P > 0.05). Complication rates from EN and changes in inflammatory and biochemical markers were comparable between groups. The post hoc analysis showed that the experimental group had a significantly higher median daily protein intake (1.7 g/kg/day; interquartile range [IQR]: 1.6-1.8) compared with the control group (1.5 g/kg/day; IQR: 1.3-1.7), with P ＜ 0.001.

CONCLUSION

Although no significant difference was observed in serum albumin levels on day 14 between the whey protein powder supplementation group and the control group, protein supplementation with whey protein powder may be a viable strategy to meet protein requirements in patients who are neurocritically ill.

Influence of preoperative nutritional status on postoperative dysphagia in lung transplantation

OBJECTIVES

The purpose of this study is to determine the effect of preoperative nutritional status on the severity of postoperative dysphagia in recipients undergoing lung transplantation (LTx).

METHODS

A retrospective analysis was conducted. Preoperative nutritional status was assessed using the Controlling Nutritional Status (CONUT) score and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Dysphagia on postoperative day 14 was evaluated using the Functional Oral Intake Scale (FOIS). Study variables included age, sex, type of LTx, duration of intensive care unit stay, duration of mechanical ventilation use, duration of surgery, tracheostomy, extracorporeal membrane oxygen therapy (ECMO), pulmonary arterial hypertension (PAH), CONUT score, and GLIM criteria. Binary logistic regression (BLR) was used to assess independent factors.

RESULTS

Among 65 recipients (31 females, mean age 43.4 ± 12.0 years), postoperative dysphagia (n = 39) was associated with younger age (P < 0.001), female sex (P = 0.026), double LTx (P < 0.001), longer ICU stay (P < 0.001), longer mechanical ventilation use (P < 0.001), longer duration of surgery (P < 0.001), need of tracheostomy (P < 0.001), use of ECMO (P < 0.001), PAH diagnosis (P = 0.005), higher CONUT score (P < 0.001), and malnutrition by GLIM criteria (P = 0.031). Preoperative CONUT score was the only independent factor by BLR (P = 0.026, OR = 0.221, 95% CI: 0.059-0.837).

CONCLUSIONS

Our findings suggest that preoperative nutritional status may be important for the preservation of postoperative swallowing function in LTx.

Correlation between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index and the prognosis of gastric cancer patients after gastrectomy: a systematic review and meta-analysis

The C-Reactive Protein (CRP)-Albumin-Lymphocyte (CALLY) index is an established immuno-nutritional scoring system. We screened relevant literature from the major databases up until May, 2024, and extracted the data for analysis. A total of 2829 gastric cancer (GC) patients from six studies were included in this meta-analysis, the results of which revealed that the CALLY index was an independent prognostic factor for OS and RFS in both univariate analyses and multivariate analyses, and that a high CALLY index was a favorable prognostic factor. Moreover, GC patients in the high CALLY index group seemed to have better 5-year OS and 5-year RFS than those in the low CALLY index group. There was a higher proportion of patients with T1 status in the high CALLY index group than in the low CALLY index group. However, the opposite results were found in the analyses of lymph node metastasis positivity, lymph-vascular invasion positivity, postoperative complications, differentiated histological type, anastomotic leakage, and adjuvant chemotherapy. The present meta-analysis concluded that the CALLY index was a simple and useful independent prognostic biomarker for GC patients after gastrectomy.

Relationship between the Geriatric Nutrition Risk Index and the Prognosis of Severe Coronavirus Disease 2019 in Korea

BACKGROUND

Malnutrition exacerbates the prognosis of numerous diseases; however, its specific impact on severe coronavirus disease 2019 (COVID-19) outcomes remains insufficiently explored.

METHODS

This multicenter study in Korea evaluated the nutritional status of 1,088 adults with severe COVID-19 using the Geriatric Nutritional Risk Index (GNRI) based on serum albumin levels and body weight. The patients were categorized into two groups: GNRI >98 (no-risk) and GNRI ≤98 (risk). Propensity score matching, adjusted for demographic and clinical variables, was conducted.

RESULTS

Of the 1,088 patients, 642 (59%) were classified as at risk of malnutrition. Propensity score matching revealed significant disparities in hospital (34.3% vs. 19.4%, p<0.001) and intensive care unit (ICU) mortality (31.5% vs. 18.9%, p<0.001) between the groups. The risk group was associated with a higher hospital mortality rate in the multivariate Cox regression analyses following propensity score adjustment (hazard ratio [HR], 1.64; p=0.001). Among the 670 elderly patients, 450 were at risk of malnutrition. Furthermore, the risk group demonstrated significantly higher hospital (52.1% vs. 29.5%, p<0.001) and ICU mortality rates (47.2% vs. 29.1%, p<0.001). The risk group was significantly associated with increased hospital mortality rates in the multivariate analyses following propensity score adjustment (HR, 1.66; p=0.001).

CONCLUSION

Malnutrition, as indicated by a low GNRI, was associated with increased mortality in patients with severe COVID-19. This effect was also observed in the elderly population. These findings underscore the critical importance of nutritional assessment and effective interventions for patients with severe COVID-19.

Geriatric Nutritional Risk Index Assessment in Patients Undergoing Transcatheter Edge-to-Edge Repair

BACKGROUND

Transcatheter edge-to-edge repair (TEER) is used to treat patients with mitral regurgitation (MR). The Geriatric Nutritional Risk Index (GNRI) is a well-known nutritional marker that predicts mortality risk.

OBJECTIVES

The objectives of this study were to elucidate the clinical association between the degree of GNRI and different etiologies of MR and to clarify the patient samples for whom GNRI is more relevant to clinical outcomes following TEER.

METHODS

Data from 3,554 patients with MR who underwent TEER were analyzed using a Japanese multicenter registry. The patients were classified into 4 groups: GNRI <82, GNRI 82 to 92, GNRI 92 to 98, and GNRI >98. Procedural and clinical outcomes were compared between GNRI groups. Short- and long-term all-cause mortality were explored using Cox regression analysis.

RESULTS

Among the 3,554 patients, the median GNRI was 92.3. The mean follow-up period was 586.8 ± 436.5 days; 806 patients died during the follow-up period. Thirty-day mortality occurred in 51 patients (1.4%), and the GNRI <82 group had the highest 30-day mortality rate. Kaplan-Meier curves showed significantly better prognoses for the entire cohort, functional MR, and degenerative MR across the 4 groups (P < 0.001). GNRI values, even after adjustment for multiple confounders, showed a stepwise increase in risk of death in the GNRI 92 to 98, GNRI 82 to 92, and GNRI <82 groups compared to GNRI >98 as the reference.

CONCLUSIONS

Regardless of MR etiology, GNRI is a useful predictor of short- and long-term mortality in patients undergoing TEER. Although TEER is effective for MR patients in malnourished states, further studies focused on the value of identifying and addressing malnutrition in this population are needed.

Comprehensive Evaluation of Frailty and Sarcopenia Markers to Predict Survival in Glioblastoma Patients

BACKGROUND

Glioblastoma (GBM) is the most common primary malignant brain tumour in adults. Patients with GBM are particularly susceptible to moderate-to-high frail. Frailty status has been associated with the outcome of many types of cancer, including GBM, although there is still little consensus regarding the specific criteria for assessing frailty status. This study aimed to determine the predictive significance of the modified frailty score (mFS) in GBM patients using haematological and sarcopenia indicators.

METHODS

Between January 2016 and September 2022, we enrolled 309 adult GBM patients. Data on demographics, haematological examination, and temporal muscle thickness (TMT) were collected and assessed. The prognostic relevance of the frailty parameters was established using Kaplan-Meier and Cox proportional model. The scoring systems were created by integrating these indicators. Variables with independent prognostic values were used to construct the nomograms. Nomogram accuracy was evaluated using the calibration curve, Harrell's concordance index (C-index), and time-dependent receiver operating characteristic curves. Clinical practicality was assessed using decision curve analysis.

RESULTS

The baseline characteristics of the 309 participants revealed a median age of 59 years (interquartile range 52-66) with a predominance of male patients (58.58%). TMT (hazard ratio [HR] = 3.787, 95% confidence interval [CI] 2.576-5.566, p < 0.001), prognostic nutritional index (HR = 1.722, 95% CI 1.098-2.703, p = 0.018), and mean corpuscular volume (HR = 1.958, 95% CI 1.111-3.451, p = 0.020) were identified as independent prognostic markers. The constructed mFS, obtained by integrating these three indices, exhibited independent prognostic significance (HR = 2.461, 95% CI 1.751-3.457, p < 0.001). The patients in the low-risk group had a median overall survival (OS) of 13.9 months, while the patients in the high risk had a median OS of 5.8 months. Importantly, the mFS demonstrated significant independent prognostic value in the subgroup aged > 65 (HR = 1.822, 95% CI 1.011-3.284, p = 0.046). The nomogram, which included the mFS, demonstrated high accuracy, with a c-index of 0.781. The nomogram bootstrapped calibration plot also performed well compared to the ideal model. Nomograms showed promising discriminative potential, with time-dependent areas under the curves of 0.945, 0.835, and 0.820 for 0.5-, 1-, and 2-year overall survival prediction, respectively.

CONCLUSIONS

Preoperative mFS is a comprehensive frailty marker for predicting survival outcomes in patients with GBM. A dynamic nomogram incorporating the mFS may facilitate preoperative survival evaluation. Early and appropriate multimodal interventions, including nutritional support, rehabilitation, and psychological care, may help in the neurosurgical care of patients with GBM or other brain tumours.

What influences emergency general surgeons' treatment preferences for patients requiring nutritional support? A discrete choice experiment

AIM

Identifying and managing malnourished emergency general surgery (EGS) patients can be difficult. There are many tools available, a range of barriers to overcome and variety of guidelines at a surgeon's disposal. This study aimed to determine the impact of key variables on surgeon preference to start nutritional support in EGS.

METHODS

A discrete choice experiment was used to determine the impact of six variables on surgeons' treatment preferences for commencing nutritional support in EGS. Twenty-five hypothetical scenarios regarding a patient with adhesional small bowel obstruction were disseminated electronically. Binomial logistic regression was used to identify significant associations. Ethical approval was obtained (UREC 050436).

RESULTS

In all, 148 participants responded providing 3700 scenario responses. Completion rate was 52.1% (148/284) with an approximately even split of consultants and non-consultants (50.7% vs. 49.3%) and intestinal failure (IF) experience (46.6% experienced vs. 53.4% not experienced). Consultants favoured starting nutritional support (77.7%; 1443/1875) more often than non-consultants (71.8%; 1310/1825). Forming an anastomosis, hypoalbuminaemia, underweight (body mass index <18.5 kg/m2), unintentional weight loss (>10%), ≥5 days without oral intake until now and ≥5 days likely to be without oral intake from now were statistically more likely to be associated with treatment preference, but obesity (body mass index >30 kg/m2) was not. Overall, experience of IF (OR 1.093, 95% CI 0.732-1.631; P = 0.663) and seniority of surgeon (OR 0.711, 95% CI 0.473-1.068; P = 0.100) significantly influenced the results.

CONCLUSIONS

There are many variables that impact the decision to start nutritional support in EGS, but seniority of the surgeon and IF experience do not.

The Malnutrition Universal Screening Tool (MUST) Predicts Postoperative Declines in Activities of Daily Living (ADL) in Patients Undergoing Cardiovascular Open-Heart Surgery

Background: Patients undergoing cardiovascular surgery often experience postoperative complications and Activities of Daily Living (ADL) decline, even in the absence of preoperative malnutrition. Since postoperative ADL decline is particularly serious in elderly patients, this study aimed to identify a nutritional assessment tool that is effective in predicting postoperative ADL decline. Methods: Patients undergoing open-heart surgery with cardiopulmonary bypass were assessed using eight nutritional assessment tools, including the Malnutrition Universal Screening Tool (MUST), the Global Leadership Initiative on Malnutrition (GLIM) criteria, the Nutritional Risk Screening 2002 (NRS-2002), the Subjective Global Assessment (SGA), the Controlling Nutritional Status (CONUT) score, the Prognostic Nutritional Index (PNI), the Geriatric Nutritional Risk Index (GNRI), and the Mini Nutritional Assessment-Short Form (MNA-SF). Results: A total of 197 patients were enrolled in this study, with a mean age of 70.4 ± 11.6 years old; 31.0% were female. Depending on the nutritional assessment tool, 17.8% to 78.2% of patients were identified as at risk of malnutrition. Among the various assessment tools, the MUST was the most effective in predicting postoperative ADL decline (OR 4.75, 95% CI 1.37-16.5, p = 0.014) and was also associated with severe complications and length of hospital stay (OR 3.08, 95% CI 0.20-0.76, p = 0.009). On the other hand, nutritional risk detected by assessment tools other than MUST, including MNA-SF and GLIM, could predict postoperative complications but showed no relationship to ADL decline. Conclusions: We concluded that MUST was the most useful preoperative nutritional assessment tool for predicting outcomes, particularly for assessing the risk of postoperative ADL decline in patients undergoing cardiovascular surgery.

Recommendations of the Spanish Society of Endocrinology and Nutrition (SEEN) on "what not to do" in clinical practice

Quality healthcare should be grounded on clinical practice with the highest benefit-risk ratio and cost-effectiveness according to the available scientific evidence. The overuse of unproven diagnostic or therapeutic procedures is common in our setting and leads to increased healthcare spending and even iatrogenic harm. Previous cost-effectiveness initiatives have proposed identifying diagnostic and therapeutic measures that are better 'not done' in certain clinical contexts under the lens of the available scientific evidence. In this regard, the Spanish Society of Endocrinology and Nutrition (SEEN) has compiled a series of 'not-to-do' recommendations from its various working groups. These recommendations cover common clinical situations classified into the following thematic areas: diabetes, nutrition, pituitary gland, neuroendocrine tumors, thyroid, and hormone replacement therapy in postmenopausal women.

The Value of Integrating the Nutritional Ecology into the Nutrition Care Continuum-A Conceptual and Systems Approach

The domestic and global diet, nutrition, and health context is becoming increasingly complex. Our ability to effectively address the daunting challenges presented by malnutrition in all its forms-both clinically and from a public health perspective-is constrained by a number of issues that coalesce around our understanding of nutrition and the what, why, and how of its assessment. This complexity is further enhanced when screening, assessment, diagnosis, and care are often performed in different settings (hospital compared with school compared with home), across populations, and with a limited care team (e.g. certain care teams may only have a nurse or dietitian within a school district). In this perspective, we make the case that our ability to improve the precision of assessment, diagnosis, and intervention demands a view of nutrition as a biological variable: a complex system resulting from the interactions between our internal (biology, health status, developmental stage, genetics, etc.) and external (social determinants of health, home, community, physical) environments, i.e. a nutritional ecology. We offer both 1) a conceptual framework for more effectively integrating nutrition in medical assessment and etiology-based care; and 2) suggest solutions to overcome some of the systematic challenges in the clinical care continuum. Leveraging the concept of nutrition as a biological variable that emphasizes the integration of both internal and external variables into an assessment within the Nutrition Care Process model allows for both the identification of the nutrition problem and also the root cause (etiology) of the problem. Suggestions are offered for how to integrate this approach from both a clinical and public health perspective.

The Influence of Performance Status, Inflammation, and Nutrition on the Impact of SGLT2 Inhibitors on Cancer Outcomes

BACKGROUND

Sodium-glucose-linked transporter 2 inhibitors (SGLT2i) may have antitumor effects. Previous studies analyzing their role in mortality and progression did not account for potential confounders, including cancer treatment, performance status, inflammatory markers, and nutritional status. This study aims to evaluate the impact of SGLT2i treatment on mortality and progression while considering these potential confounders.

METHODS

A retrospective cohort study was conducted. A total of 526 patients with cancer (302 women, mean age 64 years, range 40-79 years) were divided into two cohorts based on whether they were taking SGLT2i at the time of their cancer diagnosis and followed for 1 year or until death. All patients on SGLT2i were taking these drugs at standard clinical doses. Additional data collected included basic demographic variables, metabolic and lifestyle characteristics, cancer treatment received, performance status, inflammatory markers, and nutritional status. The primary endpoints were mortality and progression.

RESULTS

Patients taking SGLT2i at the time of cancer diagnosis (n = 41) were more likely to have type 2 diabetes, to be male, to be ever-smokers, and to be older than patients not taking SGLT2i. In univariate analyses, SGLT2i treatment at the time of cancer diagnosis was not associated with mortality or cancer progression. Instead, mortality and cancer progression were positively associated with a diagnosis of T2D, male sex, older age, heavy alcohol drinking, ever-smoker status, poor performance status, increased inflammation, malnutrition, tumor site, cancer stage, and lack of cancer treatment. After adjusting for these potential confounders, SGLT2i treatment was not significantly associated with mortality or cancer progression.

CONCLUSIONS

Our results suggest that the impact of SGLT2i treatment on cancer outcomes is limited under standard clinical dosing conditions.

The effects of enteral tube feeding on nutrition, survival, and quality of life outcomes in advanced upper gastrointestinal cancers: a systematic literature review

PURPOSE

Despite guidelines, enteral tube feeding is not routinely provided to advanced upper gastrointestinal (UGI) cancer patients who cannot consume adequate nutrition and who have an expected survival of at least 3 months. This review examined its effect on nutrition status, survival, and quality of life (QOL) in these patients.

METHODS

Five databases (CINAHL, Cochrane, Embase, Ovid, Web of Science) were searched for original research on nutrition, survival, and/or QOL outcomes in adults with inoperable UGI cancers receiving enteral tube feeding. Quality was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist: Primary Research, and a narrative synthesis was conducted.

RESULTS

Five studies were eligible for inclusion, most participants were male (n = 205), with low sample sizes across all studies (n = 16-131). Enteral tube feeding resulted in a similar proportion of participants with weight loss above or below 5% (baseline to 12 weeks) compared to a control group [p > 0.05] (1 study), and a significant increase in mean lean body mass [+1.3 (± 4.0) kg, p = 0.01] (1 study). There was variability in survival outcomes, statistical modelling, and comparators in five studies, with subsequently contradictory results. Only one study reported on QOL. Study quality was assessed as neutral (4 studies) or negative (1 study), reflecting methodological/analytical issues across the studies.

CONCLUSIONS

This systematic literature review highlights a significant knowledge gap, with no high-quality randomised controlled trial-based evidence available on enteral nutrition efficacy, limiting its use in dietetic practice in this sub-population. Despite treatment developments prolonging survival, research investigating feeding and its impact on QOL remains inadequate. Further research is needed to promote change and influence practice, policy, and guidelines, alongside high-quality intervention studies with defined nutrition outcomes, regimens, and robust statistical analyses to determine the benefits of enteral tube feeding in this vulnerable population.

Association between geriatric nutritional risk index and clinical outcome of elderly aneurysmal subarachnoid hemorrhage patients: insights from a large cohort study

Geriatric nutritional risk index (GNRI), a simple, objective index for evaluating nutritional status of elderly patients, is demonstrated to be associated with the prognosis of several diseases. This study aims to explore the association between GNRI and prognosis of elderly aneurysmal subarachnoid hemorrhage (aSAH) patients. A total of 168 patients older than 65 years old were included in this research. The modified Rankin Scale (mRS) was applied to assess the prognosis of patients. Favorable outcome was defined as mRS <3 and unfavorable outcome was defined as mRS ≥ 3. The GNRI, calculated by albumin, height, and weight, was used to evaluate the nutritional status of elderly patients. Multivariate logistic regression was performed to identify the association between GNRI and prognosis of elderly aSAH patients. Compared with unfavorable outcome groups, favorable outcome group had higher GNRI level. After adjusting for several important factors, multivariate logistics regression analysis showed that low GNRI was associated with higher risk of unfavorable outcome. The receiver operating curve (ROC) analysis demonstrated that the area under the curve (AUC) was 0.720, which meant GNRI might be a reliable prognostic predictor. A low GNRI was independently associated with unfavorable outcome of elderly aSAH patients. The registration number is NCT04785976 and the registration data is February 2021.

Hypoalbuminemia and Nutritional Status in Children With Cancer

BACKGROUND

In children with cancer, poor nutritional status adversely affects outcomes. Hypoalbuminemia is common in pediatric oncology patients, and in some groups is associated with inferior survival rates. We sought to determine if serum albumin associates with body mass index (BMI) percentile and if combining serum albumin and BMI is associated with survival.

METHODS

We performed a single institution, retrospective review of pediatric oncology patients and collected data regarding baseline BMI, serum albumin, and survival outcome. Combining baseline BMI and serum albumin, we classified patients' nutritional status as adequately nourished, mildly/moderately depleted, and severely depleted.

RESULTS

In a cohort of 490 pediatric oncology patients, hypoalbuminemia prevalence was 49%. Serum albumin did not associate with BMI percentile for age. Overall, those defined as severely depleted had an increased risk of relapse or death at 3 and 6 months from chemotherapy initiation compared with those defined as adequately nourished (hazard ratio [HR] = 2.37, 95% CI 1.29-4.37 at 3 months, p = 0.006; HR = 1.77, CI 1.11-2.82 at 6 months, p = 0.017). Statistical analyses suggest the inferior survival in those deemed severely depleted was primarily driven by hypoalbuminemia rather than BMI.

CONCLUSIONS

In this cohort of pediatric oncology patients, serum albumin did not correlate with BMI. Severe hypoalbuminemia is an adverse prognostic factor. Baseline BMI had a minimal impact on relapse-free survival and overall survival, independently or in combination with hypoalbuminemia.

The Association of Geriatric Nutritional Risk Index and Chronic Kidney Disease Stages on Survival and Cardiovascular or Limb Events Following Endovascular Therapy

BACKGROUND

There are little available data about the impact of geriatric nutritional risk index (GNRI) on clinical outcomes following endovascular therapy (EVT) in chronic limb-threatening ischemia (CLTI) regarding the severities of renal dysfunction (RD).

AIMS

The aim of this study is to evaluate the impact of GNRI on clinical outcomes following EVT in CLTI regarding the severities of RD.

METHODS

We enrolled 705 consecutive CLTI cases treated with EVT between January 2010 and December 2019 at our hospital. The GNRI on admission was calculated as follows: [14.89 × albumin (g/dL)] + [41.7 × (body weight/ideal body weight)]. Study population were divided into 2 groups based on the median GNRI: low group (GNRI < 92) and high group (GNRI ≥ 92). Next, study population was divided to 3 groups according to estimate glomerular filtration rate (eGFR), which was defined as early RD group (60 ≤ eGFR), advanced RD group (15 ≤ eGFR < 60), and end-stage renal dysfunction (ESRD) group (eGFR < 15). The primary endpoint was 2-year amputation-free survival (AFS).

RESULTS

The median follow-up duration was 25.2 months. Amputation-free survival was significantly lower in the low GNRI group regardless of any severities of RD (59.1% vs 90.2%, Log Rank P<0.001 in early RD group, 59.6% vs 80.8%, Log Rank P=0.011 in advanced RD group, 32.8% vs 61.1%, Log Rank P<0.001 in ESRD group).

CONCLUSION

The decrease of GNRI could predict clinical outcomes in CLTI following EVT regardless of any severities of RD based on eGFR.

CLINICAL IMPACT

The decrease of geriatric nutritional risk index was associated with worse outcomes in chronic limb-threatening ischemia following endovascular therapy regardless of any severities of renal dysfunction. Because both renal dysfunction and chronic limb-threatening ischemia could potentially have any inflammation, the geriatric nutritional risk index, which can reflect both nutrition-related risks and inflammation severity, can be a plausible marker in predicting adverse events after endovascular therapy in chronic limb-threatening ischemia patients with renal dysfunction.

Is There a Need to Reassess Protein Intake Recommendations Following Metabolic Bariatric Surgery?

PURPOSE OF REVIEW

Protein intake is recognized as a key nutritional factor crucial for optimizing Metabolic Bariatric Surgery (MBS) outcomes by preventing protein malnutrition, preserving fat-free mass, and inducing satiety. This paper discusses the current evidence regarding protein intake and its impact on clinical outcomes following MBS.

RECENT FINDINGS

There are considerable gaps in the understanding of protein requirements following MBS, as existing guidelines are based on limited and inconsistent reports. This highlights the urgent need for updated clinical practice recommendations grounded in high-quality evidence. Further investigation using robust methodologies is essential to address existing research gaps related to the individualization of protein requirements following MBS. Future research should consider factors such as the time elapsed since surgery, the form and quantity of protein consumed, and necessary adjustments for physical activity. Ultimately, in alignment with recent literature, a more specific and personalized dietary protein approach should be examined.

Pre-Transplant Hypoalbuminemia Is Not Associated With Early Key Outcomes Among Simultaneous Pancreas and Kidney Transplant Recipients

The role of pre-transplant hypoalbuminemia and its impact on post-transplant outcomes in patients undergoing simultaneous pancreas-kidney (SPK) transplantation remains unclear. We analyzed all SPK recipients at our center, who had at least 2 weeks of pancreas and kidney graft survival and had serum albumin measured within 45 days pre-transplant. Recipients were categorized based on pretransplant albumin level as normal (≥4.0 g/dL, N = 222, 42%), mild hypoalbuminemia (≥3.5-<4.0 g/dL, N = 190, 36%), and moderate hypoalbuminemia (<3.5 g/dL, N = 120, 23%). Kidney delayed graft function (DGF), length of stay (LOS) after transplant, re-hospitalization within 30 days after discharge, and need for a return to the operating room (OR) related to transplant surgical complications, acute rejection, and uncensored and death-censored graft failure, within the first years post-transplant were outcomes of interest. A total of 532 SPK recipients were included. Mild or moderate hypoalbuminemia was not associated with DGF, LOS, re-hospitalization, or return to the OR in unadjusted or adjusted analyses. Similarly, mild or moderate hypoalbuminemia was not associated with a risk of graft rejection or graft failure. Among SPK recipients, pre-transplant hypoalbuminemia was not associated with worse outcomes and should not be the determining factor in selecting patients for SPK transplant.

Serum albumin-carcinoembryonic antigen ratio as an effective clinical tool for predicting recurrence and overall survival in patients with rectal cancer

Background

The albumin-carcinoembryonic antigen ratio (ACR), leveraging the strengths of albumin and CEA, has emerged as a promising serum prognostic marker. However, no studies to date have explored the association between ACR and the prognosis of patients with rectal cancer. This study aimed to determine the value of albumin-carcinoembryonic antigen ratio (ACR) in predicting the progression-free survival (PFS) and overall survival (OS) of patients with rectal cancer.

Methods

Survival analysis was conducted using the Kaplan-Meier method, and hazard ratios (HR) were calculated using Cox regression analyses. Nomograms were created based on variables with p < 0.05 in the multivariate Cox regression analysis. The predictive ability of the model was evaluated using the C-index and calibration curve, and its prognostic predictive abilities were compared to those of traditional Tumor Node Metastasis (TNM) stage using discriminant indices.

Results

A total of 736 patients with rectal cancer were included in the study. ACR was significantly higher in patients with poor survival or cancer recurrence. A low ACR was associated with increased tumor invasiveness, longer hospital stays, and higher hospitalization costs. Patients with a high ACR had significantly better PFS (62.9% vs. 35.2%, p < 0.001) and OS (67.0% vs. 37.2%, p < 0.001) than those with a low ACR. ACR can serve as an effective auxiliary tool for pathological staging, especially in patients with stage III-IV disease. The relationship between ACR and mortality risk was L-shaped. ACR is an independent prognostic factor for PFS [HR = 0.581, 95% confidence interval (CI): 0.458-0.738, p < 0.001] and OS (HR = 0.560, 95% CI: 0.435-0.720, p < 0.001) in rectal cancer patients. ACR-based nomograms have good predictive accuracy and outperform traditional TNM stage in predicting prognosis.

Conclusion

Albumin-carcinoembryonic antigen ratio is a simple and effective clinical tool for predicting the recurrence and survival of patients with rectal cancer and is a useful supplement to the TNM stage.

Nutritional Risk Index (NRI) predicts the clinical outcomes of patients with gastric cancer who received immune checkpoint inhibitors (PD-1/PD-L1)

Numerous studies have consistently indicated a connection between the clinical results of individuals who receive immunotherapy and their nutritional condition. This study aims to evaluate the predictive capacity of the Nutritional Risk Index (NRI) in gastric cancer patients who are undergoing treatment with immune checkpoint inhibitors (ICIs). This study included a total of 146 individuals diagnosed with gastric cancer and received a combination of chemotherapy and immunotherapy using PD-1/PD-L1 inhibitors. The threshold was established by utilizing the receiver operating characteristic (ROC) curve. To analyze the clinical and pathological characteristics of the 2 groups, we performed Chi-square test or Fisher exact test. Univariate and multivariate analyses were performed to assess the factors influencing progression-free survival (PFS) and overall survival (OS) rates. Additionally, we developed nomograms to accurately predict the probability of 1- year and 3-year survival in these patients. According to the threshold, there were 38 (26.0%) patients in the low NRI category and 108 (74.0%) patients in the high NRI category. In the high NRI group, the median survival PFS was 32.50 months, while it was 11.77 months in the low NRI group. Likewise, the average survival OS in the 2 categories was 18.57 months compared to an indefinite duration. Individuals classified in the low NRI category encountered reduced PFS and OS, with a hazard ratio (HR) of 2.015 and 2.093 respectively, along with corresponding P-values of .009 and .006. The analysis of multiple variables showed that the number of platelets and TNM stage were separate factors that predicted both PFS and OS. Additionally, NRI was further recognized as a separate predictive factor for overall survival. The analysis of a specific subgroup revealed that individuals in the low NRI category experienced worse PFS and OS, especially within the group receiving ICIs. The C-index and the respective 95% CI of the nomograms to forecast the likelihood of PFS and OS survival were 0.646 (0.583-0.709) and 0.693 (0.635-0.751). NRI has the capability to forecast the clinical results of individuals who were diagnosed with gastric cancer and have received ICIs. This makes it a feasible biomarker for identifying patients who could benefit from ICIs.

Significance of Neutrophil-to-Lymphocyte Ratio in Predicting the Efficacy of Anamorelin for Cancer Cachexia

Introduction Cancer cachexia is a multifactorial syndrome characterized by persistent skeletal muscle loss and poor prognosis in cancer patients. Anamorelin, a ghrelin receptor agonist, may alleviate cachexia symptoms by increasing appetite and promoting weight gain, though its clinical efficacy remains insufficiently explored. Given the involvement of cancer-inducing cytokines in cachexia, the neutrophil-to-lymphocyte ratio (NLR), an inflammatory biomarker, may serve as a predictor of therapeutic outcomes in this condition. This study aimed to evaluate the role of NLR in assessing the therapeutic effects of anamorelin and its prognostic value in patients with cancer cachexia. Methods This study included patients with cancer cachexia associated with pancreatic, non-small cell lung, gastric, or colorectal cancer who received anamorelin between April 2021 and December 2023. Patients were categorized based on their NLR (<5 or ≥5) at four weeks post-anamorelin administration. Changes in NLR and one-year overall survival (OS) rates were compared between groups. Baseline NLR was also assessed for its impact on survival outcomes. Statistical analyses included the Kaplan-Meier method for survival analysis, and receiver operating characteristic (ROC) analysis was used to determine the optimal baseline NLR cutoff for achieving a posttreatment NLR < 5. Results Of the 66 patients who received anamorelin, 42 had pancreatic cancer, 14 had non-small cell lung cancer, 6 had gastric cancer, and 4 had colorectal cancer. Patients were stratified into two groups based on their NLR at four weeks: NLR < 5 (n = 50, 76%) and NLR ≥ 5 (n = 16, 24%). In the NLR < 5 group, the mean NLR decreased significantly from 3.71 to 2.44, while in the NLR ≥ 5 group, it increased from 5.70 to 9.52. The one-year OS was significantly higher in the NLR < 5 group (62%, n = 31/50) compared to the NLR ≥ 5 group (33%, n = 5/16). Baseline NLR classification, however, showed no significant survival difference between the baseline NLR < 5 group (58%, n = 21/51) and the NLR ≥ 5 group (41%, n = 6/15). ROC analysis identified a baseline NLR < 4.4 as predictive of achieving a posttreatment NLR < 5 (AUC, 0.78; sensitivity, 80%; specificity, 75%), with significantly higher one-year OS observed in the baseline NLR < 4.4 group (68%, n = 29/42) compared to the NLR ≥ 4.4 group (34%, n = 8/24). Conclusions These findings highlight the potential of NLR as a prognostic marker and suggest that initiating anamorelin treatment with a baseline NLR < 4.4 is likely to improve outcomes, emphasizing the importance of NLR-based therapeutic interventions.

Differences in association between hypoalbuminaemia and mortality among younger versus older patients on haemodialysis

Background

Ageing often affects biomarker production. Yet, clinical/optimal thresholds to guide clinical decisions do not consider this. Serum albumin decreases with age, but hypoalbuminaemia is defined as serum albumin <4.0 g/dl. This study explores whether age might affect serum albumin levels and its association with mortality in haemodialysis patients.

Methods

COSMOS (Current Management of Secondary Hyperparathyroidism: a Multicentre Observational Study) is a prospective, open-cohort, observational study of haemodialysis patients followed for 3 years. Binary logistic and linear regression were used to analyse the association between age and hypoalbuminaemia or serum albumin (continuous). Cox proportional hazard multivariate regression was used to examine the relationship between hypoalbuminaemia and mortality in patients younger and older than 65 years. Time-dependent receiver operating characteristic (ROC) curves were used to assess the discriminatory ability of serum albumin and optimal thresholds for predicting mortality.

Results

The present analysis included 5585 patients. The odds of experiencing hypoalbuminaemia increased with age [adjusted odds ratios = 1.56(95%CI: 1.31-1.86), 1.89(95%CI: 1.59-2.24), 2.68(95%CI: 2.22-3.23) for 56-65, 66-75, and >75 years, respectively (reference ≤55 years; P value for trend: <0.001)]. Survival analysis showed that the association between hypoalbuminaemia and mortality was weaker in patients aged ≥65 compared to <65 years [hazard ratios: 1.36(95%CI: 1.17-1.57) and 1.81(95%CI:1.42-2.31) respectively; P value for interaction 0.004]. The ability of albumin levels to predict mortality was consistently higher in younger patients. Optimal albumin thresholds for predicting mortality were 3.7 g/dl in patients younger than 65 years and 3.5 g/dl in patients 65 years and older.

Conclusions

Ageing is accompanied by lower albumin levels, and the association between hypoalbuminaemia and mortality may be modified by age. Different clinical thresholds that consider age may better discriminate risks associated with hypoalbuminaemia.

Calf circumference-albumin index significantly predicts the prognosis of older patients with cancer cachexia: A multicenter cohort study

OBJECTIVES

The aim of this study was to evaluate the combined prognostic value of calf circumference (CC) and serum albumin on mortality in patients with cancer cachexia aged ≥65 years.

METHODS

This multicenter cohort study involved 5322 older patients in hospital with cancer cachexia. The combined indicator of CC and albumin was defined as the calf circumference-albumin (CCA) index. Harrell's C index, a time-dependent receiver operating characteristic curve analysis, was used to assess the prognostic performance of the CCA index and other indices. The optimal thresholds method was used to determine the cutoff values of CC and albumin, and the association between the CCA index and all-cause mortality was assessed using Kaplan-Meier analysis and Cox proportional hazard regression models.

RESULTS

A total of 3875 men and 1447 women with a mean age of 72.0 years (range: 68.0-78.0 years) and a mean follow-up time of 55.0 months (range: 25.0-85.0 months) were included in the study. A total of 1269 patients were classified into the low CCA index group (0 score) by the optimal thresholds method. In the overall population, the CCA index showed better differentiating power at predicting mortality in older patients with cancer cachexia compared with CC or albumin alone (C index = 0.639; 95% CI: 0.612-0.666; P < 0.05). The time-dependent receiver operating characteristic curve showed that the CCA index had the highest prognostic value of all the measures studied (P < 0.05). In the overall population, male and female patients with a high CCA index (2 score) showed better performance than those with a low CCA index (0 or 1 score).

CONCLUSIONS

The CCA index could significantly predict the mortality of older patients with cancer cachexia, which might provide renewed assistance for future clinical management.

Controversies regarding albumin therapy in cirrhosis

Albumin is the most abundant protein in the human body and is synthetized exclusively by the liver. Therefore, serum albumin levels are reduced in acute and/or chronic liver disease. In cirrhosis, low levels of albumin predict the outcome. In advanced cirrhosis, the quality of albumin is decreased due to high oxidative stress and a proinflammatory state. Therefore, the administration of i.v. albumin would seem to be of pathophysiological relevance and benefit. Yet, the questions that remain are who, when, how much, and how often. While albumin infusion is recommended after large-volume paracentesis, at diagnosis of spontaneous bacterial peritonitis, in acute kidney injury, and in hepatorenal syndrome, the amount and schedule of albumin to be administered require refinement, particularly given complications related to volume overload that have become increasingly apparent. Other indications for albumin such as infections other than spontaneous bacterial peritonitis, hyponatremia, HE, prevention of poor outcomes in hospitalized, and in outpatients with cirrhosis are still debated. The results of studies in these settings are either negative, controversial, or inconclusive. This sheds some doubts regarding the use of albumin as a "one size fits all" strategy. The indication and patient selection are crucial and not always intuitive. The amount and frequency also seem to play a role in the success or failure of albumin. This review will critically discuss the evidence and underline areas where there are indications for albumin use and others where evidence is still insufficient and will have to await the development/results of randomized controlled trials.

Nutritional Optimization of the Surgical Patient: A Narrative Review

An increasing body of literature supports the clinical benefit of nutritional assessment and optimization in surgical patients; however, this data has yet to be consolidated in a practical fashion for use by surgeons. In this narrative review, we concisely aggregate emerging data to highlight the role of nutritional optimization as a promising, practical perioperative intervention to reduce complications and improve outcomes in surgical patients. This review of the surgical nutrition literature was conducted via large database review. There were no distinct inclusion/exclusion criteria for this review; however, we focused on adult populations using up-to-date literature from high-quality systematic reviews or randomized controlled trials when available. Current perioperative management focuses on the mitigation of intraoperative and immediate postoperative complications. Well-defined risk calculators attempt to stratify patient surgical risk preoperatively to reduce adverse events directly related to surgical procedures, such as hemorrhage, cardiopulmonary compromise, or infection. However, there is a lack of standardization of prognostic tools, nutritional protocols, and guidelines governing the assessment, composition, and administration of nutritional supplementation. Substantial data exist demonstrating the clinical benefit in the operative setting. In this work, we provide a fundamental primer for surgeons to understand the clinical importance of nutritional optimization along with practical prognostic tools and recommendations for use in their practice. While the extent to which nutritional optimization improves patient outcomes is debatable, the evidence clearly demonstrates a clinically meaningful benefit. Evaluating nutritional status differs based on disease severity and etiology of presentation, thus surgeons must select the appropriate prognostic tools to assess their patients during the perioperative period. This information will catalyze subsequent work with a multidisciplinary team to provide personalized dietary plans for patients and spark research to establish protocols for specific presentations.

Nutritional Status in a Group of Patients with Wounds Due to Diabetic Foot Disease and Chronic Venous Insufficiency

Background: Wound healing is a complex physiological process that begins immediately upon injury. Nutritional status significantly affects the course of regenerative processes. Malnutrition can prolong the inflammatory phase, limit collagen synthesis, and increase the risk of new wound formation. The issue of malnutrition is becoming increasingly prevalent and remains a significant concern, particularly among older adults dealing with chronic conditions. Methods: The study was conducted at the Wound Treatment Clinic of the Specialist Hospital at the Podkarpackie Oncology Center in Brzozów, Poland, over 12 months (31 December 2022 to 31 December 2023). A prospective assessment was carried out on 106 patients with chronic wounds. The sample selection was purposeful, based on the following criteria: individuals with hard-to-heal vascular wounds related to diabetic foot disease or venous insufficiency, who provided informed consent to participate after reviewing the study concept. The assessment included a questionnaire and biochemical blood analysis. Further evaluations covered wound characteristics and classification based on clinical scales. The morphotic and biochemical blood parameter assessment included albumin concentration, hemoglobin, C-reactive protein (CRP), and the nutritional risk index (NRI). Results: A larger wound area was associated with lower morphotic values in both groups. Exudate levels and severity in chronic venous insufficiency (CVI) patients and diabetic foot disease (DFD) were associated with lower hemoglobin, albumin, and NRI values. At the same time, the depth of tissue structure damage correlated with the measured biochemical parameters. Conclusions: NRI values and morphotic blood parameters, along with albumin, hemoglobin, and CRP levels, are closely associated with wound characteristics, including surface area, exudate level, and the severity of tissue destruction. The greater the destruction of tissue structures, the higher the risk of malnutrition and wound infection, as indicated by biochemical assessment.

Severe malnutrition predicts early postoperative complications in aseptic revision total shoulder arthroplasty

Background

This study investigates the association between the Geriatric Nutritional Risk Index (GNRI), a simple readily available measure of malnutrition risk, and 30-day postoperative complications following revision total shoulder arthroplasty (TSA).

Methods

The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015 and 2022. The study population was divided into three groups based on preoperative GNRI: normal/reference (GNRI > 98), moderate malnutrition (92 ≤ GNRI ≤ 98), and severe malnutrition (GNRI < 92). Logistic regression analysis was conducted to investigate the connection between preoperative GNRI and postoperative complications.

Results

Compared to normal nutrition, moderate malnutrition was not independently associated with postoperative complications. Compared to normal nutrition, severe malnutrition was independently associated with a greater likelihood of experiencing any complication (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.80-5.27; P < 0.001), blood transfusions (OR 3.68, 95% CI 1.40-9.66; P = 0.008), non-home discharge (OR 2.99, 95% CI 1.50-5.98; P = 0.002), and length of stay >2 days (OR 3.10, 95% CI 1.77-5.42; P < 0.001).

Discussion

Severe malnutrition based on GNRI is a predictor of early complications following revision TSA, however moderate malnutrition is not.

Do nutritional assessment scores have a relationship with transthyretin levels?

Introduction

Background and aims: nutritional screening tools assess factors like weight loss, BMI, food intake, and disease severity to determine a patient's nutritional risk and needed care. Plasma transthyretin is a practical measurement used to assess nutritional evolution due to its rapid response to food intake. This study examines the relationship between nutritional scores, transthyretin protein levels, and the possibility of death. Methods: the sample consisted of 302 patients hospitalized in the wards or intensive care unit of a public teaching hospital, using parenteral nutrition as the primary source of nutrition. Five nutritional screening tools were applied, and patient charts were verified for transthyretin levels. Results: from the sample, 260 were adults, and 42 were children, with a mean age of 48.3 years. When evaluating the patient's outcome in relation to the scores, the Malnutrition Universal Screening Tool proved to be better at predicting death (p-value = 0.02). None of the scores were related to transthyretin levels, showing that lower transthyretin values did not influence nutritional risk. Conclusion: we believe early identification of nutritional risk through nutritional scores is necessary for better nutritional monitoring to minimize unfavorable outcomes. This study corroborates the more recent concept that transthyretin is not useful for determining unfavorable outcomes in hospitalized patients with a severe inflammatory process. In clinical practice, identifying a patient at nutritional risk according to the Malnutrition Universal Screening Tool and promoting adequate nutritional monitoring may reduce mortality.

Identification of key factors for malnutrition diagnosis in chronic gastrointestinal diseases using machine learning underscores the importance of GLIM criteria as well as additional parameters

Introduction

Disease-related malnutrition is common but often underdiagnosed in patients with chronic gastrointestinal diseases, such as liver cirrhosis, short bowel and intestinal insufficiency, and chronic pancreatitis. To improve malnutrition diagnosis in these patients, an evaluation of the current Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria, and possibly the implementation of additional criteria, is needed.

Aim

This study aimed to identify previously unknown and potentially specific features of malnutrition in patients with different chronic gastrointestinal diseases and to validate the relevance of the GLIM criteria for clinical practice using machine learning (ML).

Methods

Between 10/2018 and 09/2021, n = 314 patients and controls were prospectively enrolled in a cross-sectional study. A total of n = 230 features (anthropometric data, body composition, handgrip strength, gait speed, laboratory values, dietary habits, physical activity, mental health) were recorded. After data preprocessing (cleaning, feature exploration, imputation of missing data), n = 135 features were included in the ML analyses. Supervised ML models were used to classify malnutrition, and key features were identified using SHapley Additive exPlanations (SHAP).

Results

Supervised ML effectively classified malnourished versus non-malnourished patients and controls. Excluding the existing GLIM criteria and malnutrition risk reduced model performance (sensitivity -19%, specificity -8%, F1-score -10%), highlighting their significance. Besides some GLIM criteria (weight loss, reduced food intake, disease/inflammation), additional anthropometric (hip and upper arm circumference), body composition (phase angle, SMMI), and laboratory markers (albumin, pseudocholinesterase, prealbumin) were key features for malnutrition classification.

Conclusion

ML analysis confirmed the clinical applicability of the current GLIM criteria and identified additional features that may improve malnutrition diagnosis and understanding of the pathophysiology of malnutrition in chronic gastrointestinal diseases.

Barriers faced by surgeons in identifying and managing malnutrition in emergency general surgery: A qualitative study

AIM

Many patients undergoing emergency surgery are malnourished. Identifying malnutrition is a prerequisite to offering targeted nutritional support. Guidelines exist but little is known regarding exactly how surgeons identify malnutrition, or the barriers that influence surgeons' clinical decision-making. The aim of this work was to explore how consultant surgeons identify malnutrition in emergency general surgery (EGS) patients and the barriers to nutritional assessment and intervention.

METHOD

Consultant surgeons with emergency surgery duties were invited to participate. Semi-structured interviews were conducted online, audiovisually recorded and transcribed. An inductive approach was used for data analysis using the framework method. Coding and analysis were performed by two independent researchers using NVivo software. Themes were developed and reviewed with the supervising team. Interviews continued until data saturation was reached. Ethical approval was gained prior to interviews.

RESULTS

Eighteen interviews were conducted across three hospital settings. Identification of malnutrition consisted of three themes: 'The surgeon' (knowledge, experience, planning ahead); 'The patient' (selection, composition, clinical progress, operative considerations); and 'The institution' (collaboration, extended surgical team). Three themes encompassed barriers experienced: 'The surgeon' (understanding, culture, ownership, time constraints); 'The institution' (provision, staffing, conflict, hospital setting); and 'The wider context' (research, external factors). These influenced clinical decision-making, which had two themes: 'To join or not to join' (risk taking, site of anastomosis) and 'Nutritional support' (timing, referral pathways).

CONCLUSIONS

The identification and management of malnutrition in EGS is fraught with barriers, impacting operative and clinical decision-making. Improvements in surgeon education, culture, collaborative working and resources are needed.

Prehabilitation approaches for gastrointestinal cancer surgery: a narrative review

Gastrointestinal (GI) cancer patients undergoing surgery are particularly vulnerable to malnutrition, which can significantly impact surgical outcomes. Prehabilitation interventions encompassing nutritional, physical, and psychosocial support have gained attention for their potential to mitigate these risks. However, the efficacy of multidisciplinary prehabilitation programs in this context remains underexplored. This narrative review synthesizes existing literature to evaluate the effectiveness of prehabilitation interventions in improving outcomes for GI cancer patients undergoing surgery. Drawing on a comprehensive analysis of available evidence, the review examines the integration of nutritional, physical, and psychosocial interventions and explores the implications for clinical practice and future research. The review highlights the importance of standardized protocols and interdisciplinary collaboration in optimizing prehabilitation programs for GI cancer patients. It identifies gaps in current research, particularly regarding the synergistic effects of integrating various intervention modalities and the role of innovative strategies such as immunonutrition. Moreover, the review underscores the need for larger studies to assess the effectiveness of multimodal prehabilitation approaches and establish standardized outcome measures. In conclusion, despite advancements in understanding the importance of prehabilitation, significant gaps persist in the literature, warranting further research to refine prehabilitation protocols and improve perioperative outcomes for GI cancer patients. By addressing these research gaps and fostering interdisciplinary partnerships, future studies have the potential to enhance the effectiveness of prehabilitation interventions and optimize perioperative care in this population.

Malnutrition in patients with obesity: An overview perspective

Malnutrition in patients with obesity presents a complex and often overlooked clinical challenge. Although obesity is traditionally associated with overnutrition and excessive caloric intake, it can also coincide with varying degrees of malnutrition. The etiopathogenesis of obesity is multifaceted and may arise from several factors such as poor diet quality, nutrient deficiencies despite excess calorie consumption, genetics, and metabolic abnormalities affecting nutrient absorption and utilization. Moreover, a chronic low-grade inflammatory state resulting from excess adipose tissue, commonly observed in obesity, can further exacerbate malnutrition by altering nutrient metabolism and increasing metabolic demands. The dual burden of obesity and malnutrition poses significant risks, including immune dysfunction, delayed wound healing, anemia, metabolic disturbances, and deficiencies in micronutrients such as vitamin D, iron, magnesium, and zinc, among others. Malnutrition is often neglected or not given enough attention in individuals with obesity undergoing rapid weight loss through aggressive caloric restriction, pharmacological therapies, and/or surgical interventions. These factors often exacerbate vulnerability to nutrition deficiencies. We advocate for healthcare practitioners to prioritize nutrition assessment and initiate medical intervention strategies tailored to address both excessive caloric intake and insufficient consumption of essential nutrients. Raising awareness among healthcare professionals and the general population about the critical role of adequate nutrition in caring for patients with obesity is vital for mitigating the adverse health effects associated with malnutrition in this population.

Prognostic value of preoperative nutritional status for postoperative moderate to severe acute kidney injury among older patients undergoing coronary artery bypass graft surgery: a retrospective study based on the MIMIC-IV database

OBJECTIVE

To investigate the association between preoperative nutritional scores and moderate-to-severe acute kidney injury (AKI) after coronary artery bypass graft (CABG) surgery and the predictive significance of nutritional indices for moderate to severe AKI.

METHODS

This study retrospectively included older patients underwent CABG surgery from the Medical Information Mart for Intensive Care (MIMIC) database. Nutritional scores were calculated by the Geriatric Nutritional Risk Index (GNRI) and the Prognostic Nutritional Index (PNI), respectively. Moderate-to-severe injury was determined by KDIGO criteria. Logistic regression, subgroup analysis, and restricted cubic splines were utilized to investigate the association. The predictive value was also assessed by the area under the curve (AUC), net reclassification index (NRI), and integrated discrimination improvement (IDI).

RESULTS

A total of 1,007 patients were retrospectively included, of which 100 (9.9%) and 380 (37.7%) had malnutrition calculated by GNRI and PNI scores. The incidence of moderate-to-severe AKI was 524 (52.0%). After adjustment for selected risk factors, worse nutritional scores were associated with a higher incidence of moderate-to-severe AKI (PGNRI<0.001; PPNI=0.001). Integrating these indices into different base models improves their performance, as manifested by significant improvements in AUCs and NRIs (p < 0.05).

CONCLUSION

Worse preoperative nutritional status was associated with an elevated risk of postoperative moderate-to-severe AKI. Integrating these indices into base models improve their predictive performance. These results highlight the importance of assessing nutritional status among older patients had CABG surgery.

Gut Microbiota as Predictive Biomarker for Chronic Heart Failure in Patients with Different Nutritional Risk

To examine the relationship between gut microbiota and disease development in chronic heart failure patients with different nutritional risk. The study analyzed stool samples from 62 CHF patients and 21 healthy peoples using 16S rRNA gene sequencing. CHF patients were separated into risk (n = 30) and non-risk group (n = 32) based on NRS2002 scores. Analysis methods used were LEfSe, random forest regression model, ROC curves, BugBase, PICRUSt2, metagenomeSeq. Risk group includes 11 cases of HFrEF, 6 cases of HFpEF, and 13 cases of HFmrEF. LefSe analysis confirmed that the risk group had higher levels of Enterobacter and Escherichia-Shigella. Correlation analysis revealed a negative correlation between prealbumin and Escherichia-Shigella. The presence of Enterobacter and Escherichia-Shigella worsens intestinal inflammation in CHF patients, impacting lysine metabolism by influencing its degradation metabolic function. This interference further disrupts albumin and prealbumin synthesis, leading to malnutrition in CHF patients and ultimately worsening the disease.

GLIM-defined malnutrition in patients with acute abdomen associated with poor prognosis and increased economic burden: A cross-sectional study

BACKGROUND

The Global Leadership Initiative on Malnutrition (GLIM) criteria have rapidly developed into a principal methodological framework for nutrition diagnosis. However, the applicability of the GLIM criteria in patients with acute abdomen has not been validated.

METHODS

This is a cross-sectional study conducted on patients diagnosed with acute abdomen and admitted to a tertiary hospital in southwest China. Nutrition risk screening was conducted using the Nutrition Risk Screening 2002, and patients identified with nutrition risk were assessed for malnutrition based on the GLIM criteria.

RESULTS

We enrolled a total of 440 patients with acute abdomen. The top three diagnoses of acute abdomen were intestinal obstruction (47.2%), acute appendicitis (23.1%), and digestive system perforation (8.8%). The prevalence of nutrition risk was 46.5%, with a malnutrition rate of 32.5% based on the GLIM. Patients with malnutrition according to the GLIM showed significantly higher rates of intensive care unit (ICU) admission (13.28% vs 7.07%; P = 0.003), increased hospitalization costs (median: 3315USD [interquartile range (IQR): 978-7852] vs 1641 [IQR: 816-3523] USD; P < 0.001), and longer length of hospital stay (LOS) (median: 8 [IQR: 5-13] vs 6 [IQR: 4-8] days; P < 0.001) compared with patients without malnutrition. Multivariate analysis indicated that GLIM-defined malnutrition was an independent predictor of hospitalization costs, and severe malnutrition was an independent predictor of ICU admission.

CONCLUSION

GLIM criteria are applicable for diagnosing malnutrition in patients with acute abdomen. The prevalence of malnutrition was high in patients with acute abdomen. Malnutrition was associated with increased ICU admission and LOS, along with higher economic burden.

Malnutrition in adult patients treated with venoarterial extracorporeal membrane oxygenation: A descriptive cohort study

Objective

To evaluate malnutrition and its association with outcomes in adult patients requiring venoarterial (VA) extracorporeal membrane oxygenation (ECMO).

Methods

Patients cannulated for VA ECMO between January 1, 2020, and January 1, 2023, were screened. Patients on ECMO for <48 hours or without a nutritional evaluation were excluded. Demographic and anthropometric data were collected retrospectively. Malnutrition assessments were conducted using the Global Leadership Initiative on Malnutrition framework. Outcomes analyzed were duration of ECMO and in-hospital mortality. Patients were stratified by admission and discharge nutritional status for analysis. Baseline characteristics were controlled for with propensity score matching.

Results

Data from 197 patients was analyzed. The cohort was 68% male. The median duration of ECMO was 139.5 hours (interquartile range [IQR], 94.8-257 hours), and mortality was 35%. Thirty-three patients presented with malnutrition, and 61 developed hospital-acquired malnutrition, for an incidence of 47.7%. Malnutrition at any point was associated with longer duration of ECMO (median, 180 hours [IQR, 107.8-335.8 hours] vs 120 hours [IQR, 90-185.8 hours]; P < .001). Patients with hospital-acquired malnutrition required a 50% longer duration of ECMO (median, 182.5 hours [IQR, 101.5-367 hours] vs 123 hours [IQR, 90.8-211.5 hours]; P < .001). Preexisting malnutrition was associated with a nonsignificant increase in mortality (48.2% vs 32.9%; P = .13), which was similar after 3:1 propensity score matching (43.3% vs 35.4%; P = .44).

Conclusions

In adult patients, malnutrition appears to be associated with prolonged duration of VA ECMO. Adequately powered studies are needed to further investigate the relationship between malnutrition and mortality.

Development of a robust predictive model for neutropenia after esophageal cancer chemotherapy using GLMMLasso

BACKGROUND

Neutropenia can easily progress to febrile neutropenia and is a risk factor for life-threatening infections. Predicting and preventing severe neutropenia can help avoid such infections.

AIM

This study aimed to develop an optimal model using advanced statistical methods to predict neutropenia after 5-fluorouracil/cisplatin chemotherapy for esophageal cancer and to create a nomogram for clinical application.

METHOD

Patients who received 5-fluorouracil/cisplatin chemotherapy at Chiba University Hospital, Japan, between January 2011 and March 2021 were included. Clinical parameters were measured before the first, second, and third chemotherapy cycles and were randomly divided by patient into a training cohort (60%) and test cohort (40%). The predictive performance of Logistic, Stepwise, Lasso, and GLMMLasso models was evaluated by the area under the receiver-operating characteristic curve (AUC). A nomogram based on GLMMLasso was developed, and the accuracy of probabilistic predictions was evaluated by the Brier score.

RESULTS

The AUC for the first cycle of chemotherapy was 0.781 for GLMMLasso, 0.751 for Lasso, 0.697 for Stepwise, and 0.669 for Logistic. The respective AUCs for GLMMLasso in the second and third cycles were 0.704 and 0.900. The variables selected by GLMMLasso were cisplatin dose, 5-fluorouracil dose, use of leucovorin, sex, cholinesterase, and platelets. A nomogram predicting neutropenia was created based on each regression coefficient. The Brier score for the nomogram was 0.139.

CONCLUSION

We have developed a predictive model with high performance using GLMMLasso. Our nomogram can represent risk visually and may facilitate the assessment of the probability of chemotherapy-induced severe neutropenia in clinical practice.