Diagnostic criteria for malnutrition - An ESPEN Consensus Statement

Methods for diagnosing malnutrition in patients with esophageal cancer, and the association with nutritional and inflammatory indices: A cross‑sectional study

Clinically, it is important to diagnose malnutrition for the treatment and prognosis of cancer patients; however, at present, there are no established standards. The present study evaluated the consistency of malnutrition diagnostic tools in association with relevant nutritional and inflammatory markers in patients with advanced esophageal cancer. Specifically, the Patient-Generated Subjective Global Assessment (PG-SGA) and Global Leadership Initiative on Malnutrition (GLIM) tools were assessed. Patients with a new diagnosis of esophageal cancer at Tengzhou Central People's Hospital (Tengzhou, China) between January 2023 and December 2023 were evaluated within 24 h of admission using Nutritional Risk Screening 2002 (NRS2002), GLIM and PG-SGA. Additionally, relevant physical examinations and laboratory data were collected. The malnutrition occurrence rates based on PG-SGA, GLIM and GLIM with NRS2002 screening (NRS2002-GLIM) were 75.01, 51.88 and 41.25%, respectively. The agreement between PG-SGA and GLIM, and between PG-SGA and NRS2002-GLIM diagnoses was weak (κ=0.379, P<0.001; and κ=0.376, P<0.001, respectively). PG-SGA showed a moderate negative correlation with body mass index (BMI) (rs=-0.460), weak positive correlations with age (rs=0.234) and IL-6 (rs=0.249), and very weak negative correlations with albumin (rs=-0.178) and PNI (rs=-0.168). While the indicators correlated with GLIM and PG-SGA were consistent, the strength of correlation varied slightly. Logistic regression analysis of PG-SGA and GLIM indicated that age and BMI were independent risk factors for malnutrition. In addition, PG-SGA also showed that the neutrophil count was an independent risk factor for malnutrition. Overall, patients with esophageal cancer exhibit a high incidence of malnutrition, and different diagnostic methods provide varying results. Malnutrition is closely associated with age, inflammatory markers and BMI, suggesting their potential utility in guiding nutritional interventions for patients with esophageal cancer.

Exploring the role of anthropometric measurements to assess nutritional status in amyotrophic lateral sclerosis: a longitudinal prospective cohort study

OBJECTIVE

To observe longitudinal correlations between limb anthropometry against weight, BMI and functional decline in patients with amyotrophic lateral sclerosis.

METHODS

A longitudinal, prospective, cohort study was undertaken. Four consecutive measurements of weight, height, triceps skinfold thickness (TSF), mid-upper arm (MUAC) and calf circumferences were collected at three-monthly intervals. Fat- and lean body mass were estimated using measurements of TSF and derivations of arm muscle area, respectively. Correlation analyses indicated associations between anthropometric assessments and functional decline (ALSFRS-R). Longitudinal changes were assessed using repeated measures analyses.

RESULTS

Data from 18 participants was analyzed. At enrollment, weight positively correlated with MUAC (n = 17, p = 0.0001), arm muscle area (n = 17, p = 0.04) and calf circumference (n = 17, p < 0.0001). The ALSFRS-R score negatively correlated with weight (n = 17, p = 0.03), MUAC (n = 18, p = 0.01), TSF (n = 18, p = 0.04), and calf circumference (n = 18, p = 0.003). Function significantly declined by a difference of 6.3 points per month (p = 0.009). A positive correlation was observed between the changes in weight and calf circumference over nine months (r = 0.70, p = 0.02, n = 10).

CONCLUSION

Limb anthropometric measurements may be surrogate indicators of weight and BMI; TSF may be a practical, reliable indicator of fat mass, whilst changes in calf circumference may be alternatively used to monitor changes in nutritional status in the clinic.

Diagnostic performance of GLIM and PG-SGA for malnutrition assessment in adult cancer patients: a systematic review and meta-analysis

OBJECTIVE

Consistency between malnutrition defined by Global Leadership Initiative on Malnutrition (GLIM) and Patient-Generated Subjective Global Assessment (PG-SGA) has not been thoroughly elucidated in patients with cancer. The study aimed to compare their consistency, and summarize the impact of malnutrition defined by GLIM on adverse outcomes.

METHOD

PubMed, Embase, Cochrane library and Web of Science databases were searched from inception to May 1, 2024. Initially, the amalgamated sensitivity, specificity and area under curve (AUC) with 95% confidence intervals (CIs) were calculated. Subsequently, hazard ratios (HR) or odd ratios (OR) and 95% CIs for overall survival (OS), all-cause mortality, postoperative complications, disease-free survival (DFS) and recurrence-free survival (RFS) were pooled.

RESULT

Fifty-six studies (55,767 participants) were included. Compared with PG-SGA criteria, the overall sensitivity, specificity and area under curve (AUC) for GLIM was 0.71 (95% CI: 0.63-0.78), 0.80 (95% CI: 0.65-0.90) and 0.79 (95% CI: 0.75-0.83). Subgroup analysis revealed that the diagnostic value in Asian or among patients aged under 60 years were higher than non-Asian or those aged over 60 years. Moreover, GLIM-defined malnutrition was significantly associated with overall survival (OS) [hazard ratios (HR) = 1.57, 95% CI: 1.46-1.67], all-cause mortality (HR = 1.43, 95% CI: 1.29-1.57), postoperative complications [odd ratios (OR) = 1.57, 95% CI: 1.40-1.73], disease-free survival (DFS) (OR = 1.52, 95% CI: 1.36-1.68) and recurrence-free survival (RFS) (OR = 1.41, 95% CI: 1.10-1.72).

CONCLUSION

GLIM criteria exhibit moderate diagnostic accuracy for identifying malnutrition among patients with cancer, when compared to the PG-SGA. This accuracy is pronounced in the Asian and patients under the age of 60. Furthermore, GLIM-defined malnutrition was significantly associated with OS, DFS, RFS, all-cause mortality and postoperative complication risks in patients with cancer.

Barriers and facilitators in the implementation of nutrition interventions to prevent or treat malnutrition in older adults: A scoping review

Malnutrition among community-dwelling older adults (OAs) is prevalent, particularly in groups using healthcare services. Malnutrition burdens health, social, and aged-care systems in terms of expenses for hospital admissions and care in nursing homes and home care settings. Effective management requires early identification and multimodal interventions; however, studies report a significant gap between recommended nutrition interventions and current healthcare practices. Therefore, this study aimed to identify, present, and map existing evidence on barriers and facilitators in the implementation of nutrition interventions among OAs living in noninstitutional municipal healthcare settings. A scoping review following the Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews checklist were conducted. The study included evidence from bibliographic databases and gray-evidence sources that identify barriers and/or facilitators from stakeholder perspectives that influence the implementation of nutrition interventions for malnutrition prevention or treatment among OAs (≥65 years) in noninstitutional municipal healthcare settings. Stakeholders were OAs, informal caregivers, or healthcare professionals (HCPs). Thirty-seven articles were included and 10 categories identified. Barriers were (1) lack of knowledge and awareness among HCPs, (2) lack of resources, (3) lack of collaboration and communication, (4) missing links between healthcare settings, and (5) poor insight among OAs and caregivers. Facilitators were (1) education and training of HCPs, (2) self-care, (3) person-centered care, (4) technology in nutrition care, and (5) social and psychological factors. Findings from this review indicate an imperative need for targeted implementation strategies for developing evidence-based nutrition home care practice.

Bioelectrical impedance analysis for measuring body composition and predicting low muscle mass in apparently healthy pediatric outpatients: a retrospective observational study

BACKGROUND

The bioelectrical impedance analysis-derived phase angle is a proposed indicator of sarcopenia in adults. This study assessed the body composition of pediatric outpatients without underlying medical conditions to evaluate the predictive value of the phase angle in identifying low muscle mass, a risk factor for pediatric sarcopenia.

METHODS

Analyses were performed separately for each sex among 480 pediatric outpatients aged 5-18 years. Body composition variables were compared between low and normal body mass index-for-age z-score (BMIz) groups, including correlation analysis between the phase angle and other variables. The receiver operating characteristic curves of the phase angle, body mass index, and fat-free mass index (FFMI) were compared to predict a severely low appendicular skeletal muscle mass index (ASMI), defined as an ASMI below - 1 or - 2 standard deviations based on sex- and ethnicity-specific reference curves derived from dual-energy X-ray absorptiometry.

RESULTS

The low BMIz group showed a greater prevalence of a low fat-mass percentage and severely low ASMI, accompanied by notable changes in fat mass, muscle mass, height-squared adjusted indices, body water, protein, visceral fat area, and the phase angle (P < 0.05) compared with the normal BMIz group. The phase angle exhibited moderate correlations (P < 0.001) with the FFMI and ASMI (positive) and the visceral fat area and the extracellular water/total body water (ECW/TBW) ratio (negative) but no or negligible correlation with fat mass, fat-mass percentage, the fat mass index, or minerals. The phase angle' area under the curve for predicting a severely low ASMI was 0.743-0.785 (sensitivity: 62.3-80.4%; specificity: 67.0-75.0%). The area under the curve of the FFMI was 0.853-0.931 (sensitivity: 78.4-92.9%; specificity: 79.6-87.1%).

CONCLUSIONS

Body composition can identify fat and muscle wasting in children with a normal BMIz. The phase angle moderately correlated with the FFMI, ASMI, visceral fat area, and ECW/TBW ratio. The phase angle is a reasonable, although not a surrogate, indicator of the sarcopenia risk in pediatric outpatients.

Association between the geriatric nutritional risk index with the risk of frailty and mortality in the elderly population

Frailty is a major health concern among older adults. The Geriatric Nutrition Risk Index (GNRI) is an important instrument for evaluating the nutritional condition in older individuals. Despite its relevance, there remains a paucity of research exploring the relationship between GNRI with the risk of frailty and adverse outcomes. This study aims to investigate the relationship between the GNRI and the risk of frailty and mortality in older adults. Three distinct models were developed, and the association between GNRI and frailty prevalence was investigated using multivariable logistic regression. To explore the relationship between GNRI and mortality among frail individuals, Cox regression analysis was applied. Potential non-linear associations were assessed using restricted cubic spline (RCS) analysis. Interaction tests and stratified analyses were performed to further evaluate the consistency of these associations. This study included 6,753 eligible participants from 2003 to 2018, of whom 34.36% were diagnosed with frailty. After adjusting for all potential covariates, an increase of 1 unit in GNRI was associated with a 7% reduction in frailty prevalence (OR 0.93, 95% CI 0.91-0.95, P < 0.0001). Compared to the low GNRI group, individuals in the high GNRI group had a lower likelihood of being frail (OR 0.41, 95% CI 0.30-0.55, P < 0.0001). Among frail individuals, those with a higher GNRI had a lower risk of mortality relative to those with a lower GNRI (cardiovascular mortality: HR: 0.61, 95% CI 0.43-0.86, P = 0.004; all-cause mortality: HR: 0.58, 95% CI 0.45-0.75, P < 0.0001). The associations between GNRI and frailty prevalence, as well as mortality risk, exhibited consistency in most cases (P for interaction > 0.05). A higher GNRI is significantly related to a diminished prevalence of frailty. In frail older adults, a lower GNRI is an independent predictor of enhanced risk of both total and cardiovascular mortality.

Olfactory Deficits and Mortality in Older Adults

Importance

Olfactory deficits are associated with higher mortality in older adults, but the mechanisms remain unclear. Further understanding this relationship could inform interventions to improve survival and quality of life for those with olfactory deficits.

Objective

To investigate the association of olfactory deficits with all-cause and cause-specific mortality and to explore potential mediating factors.

Design, Setting, and Participants

The Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), is an ongoing population-based, longitudinal cohort study with baseline between 2001 and 2004. Eligible participants were residents of Kungsholmen, Stockholm, Sweden, and aged between 60 and 99 years from March 21, 2001, to August 30, 2004. Twelve-year follow-up was completed in February 2013. Data analysis took place between February 2024 and July 2024.

Main Outcomes and Measures

Olfactory ability was tested with the 16-item Sniffin' Sticks Odor Identification task. Mortality was determined through the Swedish National Cause of Death Register. Cox proportional hazards models examined the associations between olfaction and mortality over 6 years and 12 years. Competing hazard risks regression analyses assessed the olfactory-mortality association for specific death causes. Generalized structural equation models investigated mediators, including incident dementia, baseline chronic diseases, frailty, and malnutrition. The tested hypotheses were formulated after data collection.

Results

Among 2524 participants (baseline mean [SD] age, 71.9 [10.0] years; 1545 [61.2%] female), 445 (17.6%) had died at 6 and 969 (38.4%) at 12 years of follow-up. Each additional incorrect answer on the odor identification test was associated with a 6% increased all-cause mortality risk at 6 years (hazard ratio [HR], 1.06 [95% CI, 1.03-1.08]) and 5% increased risk at 12 years (HR, 1.05 [95% CI, 1.03-1.08]) in multiadjusted models. In cause-specific models, the olfaction-mortality association had the greatest risk in relation to neurodegenerative death causes. Meaningful mediators for death at 6 years included dementia (23% of total association), frailty (11% of total association), and malnutrition (5% of total association). At 12 years, frailty remained a mediator (9% of total association).

Conclusions and Relevance

The results of this cohort study underscore the importance of olfactory function as a mortality risk marker in older adults and highlight the evolving influence of neurodegeneration and frailty on this relationship. Further research is needed to assess the clinical utility of olfactory assessments in identifying individuals at risk of adverse health outcomes.

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 patients with advanced head and neck cancer: Exploring the Global Leadership Initiative on Malnutrition (GLIM) criteria, energy balance and health-related quality of life

BACKGROUND & AIMS

Head and neck cancer (HNC) involves several tumor locations, the most common of which are the oropharynx and oral cavity. Patients with HNC are at high risk of developing malnutrition. Together with treatment, the tumor location contributes to difficulties in eating and swallowing, which can lead to a negative energy balance and weight loss. This study aimed to examine malnutrition via the Global Leadership Initiative on Malnutrition (GLIM) criteria, explore the different combinations of the GLIM criteria, study changes in body composition and body energy content and evaluate health-related quality of life (HRQoL) in patients with locally advanced HNC.

METHODS

Malnutrition was diagnosed via the GLIM criteria. Body weight, muscle mass, body fat, C-reactive protein (CRP) levels, energy intake, use of enteral feeding tubes or parenteral nutrition were assessed, and HRQoL scales from the European Organization for Research and Treatment of Cancer (EORTC), including the Quality of Life Questionnaire-Core 30 (QLQ-C30) and the Quality of Life Questionnaire-Head and Neck 35 (QLQ-HN35), and the M.D. Anderson Dysphagia Inventory (MDADI) were completed at baseline, 6 weeks and at 3, 6 and 12 months after the start of treatment. Body composition was measured via dual-energy X-ray absorptiometry, and body energy content was calculated.

RESULTS

Eighty patients were included. The prevalence of malnutrition varied over time and peaked at the end of treatment at 71 %, and at this time, the most common combination of the GLIM criteria was weight loss + reduced food intake + inflammation (31 %), followed by weight loss + reduced muscle mass + reduced food intake + inflammation (20 %). At the end of treatment patients were in a negative energy balance, and compared to baseline, body weight, body fat, and muscle mass had decreased with 6.0 % (p<0.0001), 5.9 % (p<0.0001), and 8.0 % (p<0.0001) respectively. At the 3-month follow-up, the reduction in muscle mass had ceased, despite a negative energy balance, and patients started to regain muscle mass. At 12 months body weight had decreased with 7.4 % (p<0.0001), body fat with 18.9 % (p<0.0001), and muscle mass with 2.4 % (p<0.0001) compared to baseline. Patients with malnutrition reported significantly worse HRQoL on a majority of the 16 quality of life scales at all time points, except at the end of treatment, when no significant differences were found between malnourished and nonmalnourished patients.

CONCLUSIONS

Patients with advanced HNC receiving combined treatment experience major nutritional problems, and malnutrition is common at the end of treatment. Inflammation-driven muscle depletion during treatment is challenging, but it seems possible to recover muscle mass after treatment. Patients with malnutrition reported worse HRQoL at all time points, except at the end of treatment, when all patients' quality of life was very negatively affected.

Criterion validity of the Global Leadership Initiative on Malnutrition criteria for malnutrition diagnosis compared with the Subjective Global Assessment: Results from a large observational study

AIM

The aim of this study was to assess the criterion validity of the Global Leadership Initiative on Malnutrition criteria compared to the subjective global assessment in a diverse inpatient population.

METHODS

This cross-sectional study was a retrospective analysis of point prevalence audit data. The prevalence of malnutrition determined by the Global Leadership Initiative on Malnutrition criteria was compared to the Subjective Global Assessment. Validity statistics were determined using all of the Global Leadership Initiative on Malnutrition criteria concurrently as well as each pair that could be used to diagnose malnutrition. Subgroup analysis was undertaken based on severe malnutrition, treatment group, age and body mass index.

RESULTS

Nine hundred and eighty-one patients were included (65.1 ± 18.6 years, 54.8% male). The prevalence of malnutrition was 36.7% using the Subjective Global Assessment and 36.1% using the Global Leadership Initiative on Malnutrition criteria. More patients were classified as severely malnourished using the Global Leadership Initiative on Malnutrition criteria (9.8% vs. 6.0%), whilst more rehabilitation patients were classified as malnourished using the Subjective Global Assessment (42.2% vs. 33.6%). The criterion validity of the Global Leadership Initiative on Malnutrition criteria was good, with a sensitivity of 92.5% (95% CI 90.9-94.2) and specificity of 96.6% (95% CI 95.5-97.8). There was a downward trend in sensitivity with increasing body mass index and a lower sensitivity in the rehabilitation population. The criterion validity was fair at best when each pair of the Global Leadership Initiative on Malnutrition criteria was considered independently of other criteria.

CONCLUSIONS

When all criteria are considered concurrently, the Global Leadership Initiative on Malnutrition criteria present good criterion validity and can be applied in clinical practice to diagnose malnutrition.

Self-Determination, Optimism, Social Support, Knowledge, and Skills Have a Positive Influence on the Oral Intake of Long-Stay Acute Patients: A Qualitative Study

BACKGROUND

Although previous research has attempted to understand the barriers and enablers of oral intake in hospitalized patients, these studies have mainly focused on short-stay inpatients and lacked a theory-driven examination of the determinants that influence dietary behavior in the hospital.

OBJECTIVE

To explore and compare the factors influencing adequate and poor oral intake in long-stay acute patients (admitted >14 days).

DESIGN

A qualitative descriptive study with semistructured interviews.

PARTICIPANTS/SETTING

Twenty-one adult inpatients (13 men, 8 women) admitted to 2 medical and 2 surgical wards at a tertiary hospital in Brisbane, Australia, during 2022, stratified by the Subjective Global Assessment. Analysis performed Transcripts were initially deductively analyzed against the Theoretical Domains Framework, and a reflexive thematic approach was used to create overall themes.

RESULTS

Of the 21 included patients (median age = 68.0 years, IQR 34 years), 11 had adequate/improved intake and 10 poor/decreased intake. Six themes were identified to have influenced oral intake in long-stay patients: self-determination to eat; nutrition impact symptoms; foodservice characteristics and processes; nutrition-related knowledge and skills; social support; and optimism, emotions, and emotion regulation. Patients with adequate/improved oral intake were characterized by an autonomous motivation to eat. They had increased awareness about their nutritional status, knowledge, and skills about food for recovery, were more optimistic, and social support was an important enabler to eating. In contrast, patients with poor/decreased oral intake perceived nutrition impact symptoms and dislike of meals as the main barriers to eating in the hospital; however, they also expressed more negative emotions, reduced coping strategies, and decreased knowledge, skills, intrinsic motivation, and capabilities to eat. Social support was present but did not enable oral intake in this patient group.

CONCLUSIONS

This study provides novel insights into the factors that influenced oral intake in long-stay acute patients, highlighting the importance of patient-centered nutrition care, encompassing motivational interviewing techniques and collaboration from the multidisciplinary team to create a supportive environment that fosters autonomy and empowers patients to actively participate in their own nutrition and recovery.

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.

Current Practices of Irish Dietitians Assessing and Monitoring Muscle Strength, Mass and Function: A Cross-Sectional Survey

BACKGROUND AND AIMS

Measuring muscle mass, strength, and function is vital in nutritional assessment, offering valuable insights into overall health, including nutritional adequacy, metabolic function and physical well-being. Nonetheless, the use of these measures for nutritional assessment and monitoring in dietetic practice is not widely implemented, and gaps in care remain. This study aimed to explore Irish dietitians' current nutritional assessment practices related to muscle health.

METHODS

A cross-sectional descriptive 29-item online survey was adapted and distributed via link in email and social media to state-registered dietitians (N = 1340) in Ireland between 21 September 2023 and 26 October 2023. Data were analysed descriptively.

RESULTS

The majority of dietitians (84/85) agreed that musculature was important in the assessment of nutritional status, with 80% (n = 56/70) reporting the integration of at least one assessment of muscle health into their clinical practice. Handgrip strength (HGS) was viewed as the most important (95.7%; n = 67/70), frequently applied (64.3%; n = 45/70) and most useful for monitoring muscle health (77.1%; n = 54/70). Regardless, the frequency of muscle health assessment in routine practice was low. The muscle health assessments that are routinely ( > once/week) measured include body weight (82.9%; n = 58/70), BMI (81.4%; n = 57/70), HGS (25.7%; n = 18/70) and the Timed up and go test, chair stand test or short physical performance battery (10%; n = 7/70). The main barriers to muscle health assessment were 'lack of training/application experience' (61.4%, n = 43/70) and 'lack of device availability' (58.5%, n = 41/70).

CONCLUSION

This study provides insights into the application of muscle health assessments within nutritional assessment among Irish dietitians. Results indicate a gap between the recognised value of muscle health and its use in nutritional assessment. Despite an almost unanimous agreement on the importance of musculature, challenges such as insufficient training and lack of equipment hinder the widespread implementation of muscle health assessment as a standard component of nutritional assessment. These findings emphasise the need for further practical education and measures to improve the availability of equipment to bridge this gap and optimise nutritional care.

Assessing the Impact of Nutritional Status on the Quality of Life in Head and Neck Cancer Patients-The Need for Comprehensive Digital Tools

Background/Objectives: Malnutrition is a key determinant of quality of life (QoL) in patients with head and neck cancers (HNCs), influencing treatment outcomes and the occurrence of adverse events (AEs). Despite there being numerous studies on nutritional status and QoL, there is no standardized risk or prognostic model integrating clinical and demographic factors. Methods: A literature search was conducted in September 2024 in Scopus, PubMed, and Web of Science, covering studies published between 2013 and 2024. Articles were selected based on their relevance to AEs, nutritional interventions, and QoL assessments in HNC patients. Results: The key factors influencing QoL in HNC patients include age, sex, weight, BMI, educational level, and tumor features. Mucositis was identified as the most significant food intake-impairing AE, contributing to malnutrition and reduced QoL. Current QoL assessments rely on descriptive questionnaires, which lack personalization and predictive capabilities. Digital tools, including machine learning models and digital twins, offer potential solutions for risk prediction and personalized nutritional interventions. Conclusions: Despite significant research efforts, QoL assessment in HNC patients remains non-uniform, and risk models integrating nutritional status are lacking. A comprehensive, personalized approach is needed, leveraging digital tools to improve nutritional intervention strategies.

Predictors of 1-year mortality in a clinical cohort of hip fracture patients

PURPOSE

Knowledge about factors associated with mortality after hip fracture is important both for analytical and clinical purposes. This study aimed to assess patient risk factors and commonly used composite scores for prediction of 1-year mortality in a large clinical cohort.

METHODS

Hip fracture patient data were prospectively recorded in a local hospital database. Consecutive fractures from 2006 to 2020 were included, 6040 fractures in 5496 patients. Associations between 1-year mortality and different exposures were estimated using univariate and two multivariate logistic regression models. ROC analysis was used to compare the ability of the Nottingham Hip Fracture Score (NHFS), Age-adjusted Charlson Comorbidity Index (ACCI) the American Society of Anesthesiologists score (ASA) and the Orthopedic Frailty Score (OFS) to predict 1-year mortality.

RESULTS

Females sustained 73.9% of the fractures. Total 1-year mortality was 24.8%. Patients with overweight and class 1 obesity had lower 1-year mortality rates than normal weight patients [overweight: adjusted OR 0.58 (0.45-0.77), class 1 obesity: adjusted OR 0.40 (0.21-0.75)]. Mortality was elevated in males (adjusted OR 2.04, 95% CI 1.76-2.36), and nursing home residents (adjusted OR 2.99, 95% CI 2.60-3.44). We found no significant association between waiting time before surgery and mortality. Models including ACCI (AUC 0.74), NHFS (AUC 0.75) and OFS (AUC 0.73) had a similar ability to predict 1-year mortality, while a model including ASA (AUC 0.71) had a significantly lower prediction ability than ACCI and NHFS.

CONCLUSIONS

Sex, age, cognitive impairment, and residential status predicted 1-year mortality. The study found an apparent "obesity paradox", where overweight patients had a lower mortality rate than normal weight patients, but unmeasured confounding may have biased this analysis. ACCI and NHFS predicted mortality better than the combination of age, sex, and ASA.

[Clinical analysis of nutritional components in children with acute leukemia]

OBJECTIVES

To assess the changes in body composition and nutritional risks faced by children with different stages of acute leukemia (AL).

METHODS

Bioelectrical impedance analysis combined with anthropometric measurements was used to detect body composition. This prospective study was conducted from August 2023 to July 2024 at Shandong Provincial Hospital, examining the body composition and physical balance of children with various stages of AL and healthy children.

RESULTS

The non-fat components of children with AL and healthy children both showed a linear increase with age. In the younger age group, there were no significant differences in body composition between children with AL and healthy children. However, in the older age group, the body composition of children undergoing chemotherapy for AL was significantly lower than that of healthy children (P<0.05), and muscle mass recovered first after the completion of AL chemotherapy. The proportion of children with increased trunk fat in AL children who completed chemotherapy was significantly lower than that in healthy children (P<0.05), while the incidence rate of severe left-right imbalance in body composition was significantly higher (P<0.05). Muscle distribution in children with AL primarily showed insufficient limb and overall muscle mass, whereas healthy children mainly exhibited insufficient upper limb muscle mass.

CONCLUSIONS

The body composition of children with AL varies at different treatment stages, indicating that nutritional status is affected by both the disease itself and the treatment. Early screening can provide a basis for reasonable nutritional intervention.

Trace Element Supplementation in Burn Patients: Exploring the Relationship Between Burn Size and Mineral Needs

Trace element deficiency is an adverse nutritional outcome that can occur with burn injuries and can interfere with a patient's recovery. The aim of this study was to review the efficacy of our predominately enteral trace element supplementation strategy and determine the burn size at which patients are at risk for trace element deficiency. We reviewed 53 burn patients admitted to our burn center from August 1, 2019 to May 31, 2022 who had their trace element levels and C-reactive protein monitored in 2 week increments. Receiver operating characteristic analysis indicated a 22.1% body surface area burned (BSAB) cutoff for zinc supplementation to prevent deficiency with 91.7% sensitivity and 92.6% specificity, and a 27.5% BSAB cutoff with 88.9% sensitivity and 81% specificity for copper. No patient in our cohort developed selenium deficiency, regardless of burn size. Patients with greater than 30% BSAB developed deficiencies in both zinc and copper within the first 2 weeks of hospitalization. Our results provide guidance for trace element replacement based on burn size.

Is Myopenia or Myosteatosis Clinically Relevant in Systemic Sclerosis? Skeletal Muscle Assessment Using Computed Tomography

OBJECTIVES

Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis, vascular damage, and immune dysregulation, often leading to muscle abnormalities. This study aimed to evaluate the prevalence of myopenia and myosteatosis in SSc patients using computed tomography (CT) and their associations with clinical features, including lung disease and esophageal dilatation.

MATERIALS AND METHODS

SSc patients followed at Gazi University Rheumatology Clinic (2000-2024) who had thoracic CT imaging were included. Muscle mass and density were assessed at the L1 vertebral level. Skeletal muscle area (SMA) and skeletal muscle radiation attenuation (SMRA) were measured to identify myopenia and myosteatosis. Lung disease involvement and widest esophageal diameter (WED) were assessed via CT. Statistical analyses explored correlations between muscle metrics and clinical variables, with multiple linear regression identifying predictors.

RESULTS

Among 95 patients (54.7% diffuse SSc, 45.3% limited SSc; mean age 57.04 ± 13.65 years; female-to-male ratio 8.5:1), myopenia and myosteatosis prevalence were 27.3% and 41.1%, respectively. Myosteatosis was associated with female sex (p = 0.001), older age (p = 0.001), higher BMI (p = 0.043), and inflammation markers (CRP, ESR). Myopenia correlated with BMI (p = 0.001) but not clinical outcomes. Higher WED correlated with lower SMRA (p = 0.001). BMI predicted muscle mass (R² = 0.42), while age, gender, and BMI determined SMRA (R² = 0.67, p < 0.001).

CONCLUSIONS

Myosteatosis was more prevalent and strongly associated with clinical features, including lung disease and esophageal dilatation, than myopenia, underscoring the importance of muscle quality.

Bariatric nutrition and evaluation of the metabolic surgical patient: Update to the 2022 Obesity Medicine Association (OMA) bariatric surgery, gastrointestinal hormones, and the microbiome clinical practice statement (CPS)

Background

In 2022, the Obesity Medicine Association (OMA) published a Clinical Practice Statement (CPS) which provided an overview of bariatric surgery and related procedures, a discussion on gastrointestinal hormones and a review of the microbiome as it relates to patients with obesity. This update to the 2022 OMA CPS provides a focus on nutrition as it relates to the adult bariatric surgery patient, incorporating a detailed discussion on how to conduct a bariatric nutrition assessment and manage patients seeking metabolic and bariatric surgery (MBS) and postoperative nutrition care. In particular, the section on macronutrients, micronutrients, and bariatric surgery has been updated, highlighting practical approaches to nutrient deficiencies typically encountered in the bariatric surgery patient. Also included is a section on how to envision and develop an interdisciplinary team of medical providers with evidence-based nutrition knowledge and consistent information that improves the quality of nutrition care provided to MBS patients. This CPS adds to the series of OMA CPSs meant to provide guidance to clinicians in their care of patients with obesity.

Methods

The foundation of this paper is supported by scientific evidence in the medical literature and expert opinion derived from several bariatric nutrition resources, as well as from the 2022 OMA CPS focused on bariatric surgery.

Results

This OMA Clinical Practice Statement provides an overview of the current bariatric nutrition clinical guidelines and nutrition tools adapted for clinicians who may not have access to an MBS team or a registered dietitian knowledgeable about bariatric nutrition.

Conclusions

This evidence-based review of the literature includes an overview of current bariatric nutrition recommendations. It is intended to provide clinicians with more advanced knowledge and skills in nutrition assessment and management of the preoperative and post-surgical MBS patients. This CPS also addresses macronutrient and micronutrient deficiencies common in MBS patients, and treatment recommendations designed to help the clinician with clinical decision making.

Association between Life's Essential 8 and Infertility as Well as the Mediating Effects of Oxidative Stress and Inflammatory Factors Among U.S. Women Aged 18-45 Years

Management of cardiovascular disease in pregnancy is important, yet the association between cardiovascular health and infertility is rarely reported. In this study, we aimed to explore the association between Life's Essential 8 (LE8), a novel cardiovascular health (CVH) measure, and infertility, and to investigate potential mediating mechanisms. This study investigated cross-sectional data from the 2013-2018 National Health and Nutrition Examination Survey. LE8 score (ranging from 0 to 100) was calculated as the unweighted average of eight CVH metrics. The association between LE8 and infertility was explored through weighted multiple logistic regression. Restricted cubic splines were used to explore nonlinear correlation. In addition, mediation analysis was conducted to investigate the role of oxidative stress and inflammatory markers systematically. After strict exclusion criteria, 1703 American women aged 18-45 years were included. After full adjustment, the LE8 score showed a negative correlation with infertility [per 1 SD increase, OR = 0.675, 95% CI: 0.553-0.824], with a linear dose-response relationship (non-linear P = 0.122). Similar linear negative correlations were found between health factor scores and infertility, with higher body mass index and glucose scores having a significantly lower risk of infertility. Stratified analyses showed a stronger inversed relationship between LE8 and infertility in younger populations. Moreover, mediation analysis revealed that uric acid concentration and lymphocyte count mediated the effect of LE8 on infertility (P < 0.05). LE8 and its subscale scores were linearly and negatively associated with infertility, which may be mediated in part through uric acid and lymphocyte count. Focusing on weight management and glycemic control can effectively reduce the risk of infertility.

Comparison of enteral nutrition methods with weight improvement in patients with T4b esophageal squamous cell carcinoma

Enteral nutrition is the preferred method for providing nutrition to patients who can consume food orally or via a feeding tube. In the case of patients with advanced esophageal cancer, tracking nutritional status is critical and weight is a key factor in this regard. Monitoring weight changes is a simple and non-invasive approach that can be easily incorporated into clinical settings. Therefore, the present study aimed to compare different enteral nutrition techniques and assess the efficacy of weight changes in patients with advanced esophageal cancer. A retrospective study was conducted on patients with advanced esophageal squamous cell carcinoma who received enteral nutrition between January 2012 and December 2022, and included the collection of various data, including baseline characteristics, comorbidities, BMI, route of enteral nutrition, tolerable enteral nutrition, total calories per day and mode of treatment via methods such as nasogastric tube (NG), esophageal stent, percutaneous endoscopic gastrostomy (PEG) or open gastrostomy (OG). The study assessed the impact of enteral nutrition on body weight at the 0-, 1-, 3- and 6-month follow-up, as well as the 1-year survival. After a 3-month follow-up, it was observed that patients with advanced esophageal cancer who underwent enteral nutrition exhibited a significant improvement in weight. This improvement trended to be sustained up to the 6-month follow-up. At 3 months, the groups that underwent NG, OG and PEG exhibited significant optimal results compared with the esophageal stent group (P=0.027, P=0.009 and P=0.001, respectively). No significant differences were observed among the NG, OG and PEG methods. The enteral nutrition can aid in weight improvement for patients who suffer from advanced esophageal cancer. Enteral feeding tubes have been demonstrated to be safe and effective options. Within 3 months of beginning nutrition support, there was a trend of weight improvement, which could be maintained up to the 6-month follow-up.

Difference between estimated and actual body weight in an intensive care unit-A service evaluation

Actual body weight (ABW) is important for drug dosing and calculating nutritional requirements. The aim of this study is to establish the difference between ABW and estimated body weight in a cohort of ICU patients. Our service evaluation compared 100 patients whose weights were initially estimated by staff, and if able by patients also. Weights were then measured. We also compared ABW to Ideal and Predicted Body Weights. We had a ⟩10% error margin in 36% of estimated weights and a ⟩ 20% error margin in 11% of estimated weights. Median error for patients self-estimating their body weight was 4.14% (IQR 1.39-7.74). For patients that were able to estimate their weight the median error margin was 4.14% (IQR 1.39-7.74). The Median difference between ABW and Ideal Body Weight was 18.57% (IQR 9.78-36.57) and 18.15% for ABW and Predicted Body Weight (IQR 9.13-36.58). Estimated body weights should only be used when weighing patients is contraindicated. Patients are more accurate at estimating their own body weight than staff. It is best practice to accurately measure body weight in ICU patients.

Predictive value and model construction of preoperative nutritional indexes for postoperative leakage in gastric cancer

OBJECTIVE

We aimed to explore the predictive significance of the nutritional indexes in the occurrence of postoperative leakage after gastrectomy, aiming to develop and validate a predictive nomogram for assessing the risk of these complications.

METHODS

Patients undergoing radical gastrectomy for gastric cancer were studied, using data from The Sixth Affiliated Hospital of Sun Yat-sen University (2019-2022, n = 1075) for nomogram development and an external cohort from Sun Yat-sen University Cancer Center (2022, n = 286) for validation. The model, focusing on postoperative leakage, was constructed through univariate and backward stepwise regression. The performance of nomogram was assessed using the receiver operating characteristic (ROC) curve, calibration plots, decision curve analysis (DCA), and clinical impact curves (CIC).

RESULTS

The incidence rates of postoperative leakage were 6.51% in the training cohort and 6.71% in the external validation cohort, respectively. The nomogram effectively identifies critical factors influencing postoperative leakage risk, including NRS-2002 score, SFMAI, VSR, blood loss, intraoperative time, type of reconstruction, and Lauren type. The areas under the curve (AUC) for the development and external validation cohorts were 0.763 and 0.761, respectively, demonstrating acceptable predictive accuracy. The validation study showed the nomogram's satisfactory calibration, and both DCA and CIC confirmed its significant clinical utility.

CONCLUSIONS

The nomogram offers an efficient and precise tool for initial screening, effectively identifying individuals at elevated risk for postoperative leakage.

Assessment of Factors Related to Sarcopenia in Patients with Systemic Sclerosis

Objectives: Systemic sclerosis (SSc) patients exhibit a heightened vulnerability to sarcopenia, a condition characterized by the loss of muscle mass and strength. This study aims to determine the prevalence of sarcopenia in patients with SSc and to investigate the associated factors contributing to this condition. Methods: Eighty patients with SSc were included in the study, and their demographic and clinical characteristics, body composition by bioelectrical impedance analysis, SARC-F score, chair-stand test performance, and 4 m walking speed were recorded. Results: Among the 80 participants, 91.3% were female, with a median age of 56.5 years (range 45-65). The majority (70%) had limited SSc, and 71.3% reported at least one comorbidity. According to the International Physical Activity Questionnaire, only 12.5% of participants met the criteria for an active lifestyle. The SARC-F questionnaire indicated that 20% of patients were at risk for sarcopenia. The prevalence of sarcopenia among patients showed considerable variability: 5% (95% CI 0.1-9) were identified through the appendicular skeletal muscle index (ASMI), 8.8% (95% CI 2.4-15) via the fat-free mass index (FFMI), and a concerning 20% (95% CI 11-29) according to the skeletal muscle mass index (SSMI). A multivariate logistic regression analysis identified age as the only factor significantly influencing the SARC-F score, with an odds ratio of 1.081 (95% CI 1.012-1.154, p = 0.020). Additionally, the older age group demonstrated a lower level of physical activity, poorer chair-stand test outcome, and slower 4 m gait speeds (p = 0.013, p = 0.008, p = 0.001, respectively), as well as a higher reported frequency of falls (p = 0.039). Conclusions: Sarcopenia is a prevalent issue among individuals with SSc, particularly in the older population. This study did not identify a direct correlation between sarcopenia and SSc subtype, disease activity, or other clinical parameters. However, the need for an improved cut-off value for diagnosing sarcopenia in this specific cohort is evident.

Nutritional and Psychological Support as a Multidisciplinary Coordinated Approach in the Management of Chronic Liver Disease: A Scoping Review

OBJECTIVES

This review emphasizes a novel, multidisciplinary, coordinated approach in the management of chronic liver diseases (CLDs).

BACKGROUND

Chronic liver diseases represent a significant global health burden, marked by a notable shift in the prevalence patterns from virus-related to metabolic and alcohol-related entities. Malnutrition, frailty, and sarcopenia exert a substantial impact on patients with cirrhosis, affecting 75%-90% of cases and escalating as the disease progresses. The European Association for the Study of the Liver recommends a comprehensive approach to nutritional care, emphasizing the need for detailed assessments in patients with cirrhosis, using diverse tools such as computed tomography scans, bioelectrical impedance analysis, and evaluations of muscle function. Considering the prevalence of nutritional and psychological disorders in the CLD population, the treatment of these patients should be founded indispensably on a multidisciplinary approach.

METHODS

A systematic search was conducted of the PubMed, MEDLINE, and SCOPUS databases to identify trials investigating the health effects of nutritional and psychological assessments in patients with CLD.

RESULTS

In dealing with the treatment of patients with CLD, an exploration of the psychological domain emerges as crucial, because psychological distress, especially depression, exerts a tangible influence on patient outcomes. Thus, the engagement of psychologists and/or psychotherapists, who might use techniques such as cognitive behavioral therapy, could enhance patients' comprehension of nutritional implications in their treatment and make them more aware of their illness.

CONCLUSION

The review emphasizes the relevance of both nutritional and psychological assessments in patients with CLD that could improve patient education on the pivotal role of nutrition in disease management. Randomized controlled trials evaluating the combined impact of nutritional and psychological support are recommended to further investigate this complex clinical landscape.

Selected Biochemical, Hematological, and Immunological Blood Parameters for the Identification of Malnutrition in Polish Senile Inpatients: A Cross-Sectional Study

Background/Objectives: Malnutrition in senile patients leads to functional disability while reducing quality of life. Medical professionals should routinely assess their nutritional status during hospitalization. However, diagnosing malnutrition may be difficult, especially since obesity may mask malnourishment. Thus, it is essential to search for biomarkers that improve the identification of malnourished inpatients. Methods: In the present cross-sectional study, selected venous blood parameters were analyzed in 137 older inpatients at the age of 80.5 ± 7.78 admitted to the Geriatrics Clinic of the Antoni Jurasz University Hospital No. 1 in Bydgoszcz, Poland between 2017 and 2018, for a comprehensive geriatric assessment. The participants were grouped according to their nutritional risks based on the Mini Nutritional Assessment (MNA) and the Geriatric Nutrition Risk Index (GNRI). The Kruskal-Wallis test was utilized to evaluate the equality of variances for a variable calculated for two or more groups. The level of significance was set at p < 0.05. Results: For total protein, albumin, homocysteine, hemoglobin, hematocrit, total magnesium, total calcium, C-reactive protein (CRP), interleukin 6 (IL-6), and interferon γ-induced protein 10 (IP-10), statistically significant differences were found between groups of patients classified by the MNA. However, additional significant differences were also observed for creatinine, folic acid, and triglycerides, according to the GNRI compartmentalization. The results indicate that decreased levels of albumin (<3 g/dL) and hemoglobin (<11 g/dL), along with elevated homocysteine, CRP, IL-6 (>7.5 pg/mL), and IP-10 (>250 pg/mL), should alert medical professionals to potential malnutrition in hospitalized patients. Conclusions: Routine analysis of venous blood parameters can help rapidly identify malnutrition and the immediate implementation of a specialized diet.

Malnutrition Risk in Older Adults: Evaluating the Diagnostic Relevance of Serum Biomarkers: SIRT-1, CCK-8, Melatonin, and Total Antioxidant Capacity (TAC)

Background/Objectives: Addressing the risk of malnutrition at an early stage is crucial to preventing its development, which can have a detrimental impact on physical and mental health status. This study investigates the potential role of biochemical biomarkers such as sirtuin 1 (SIRT-1), melatonin, cholecystokinin-8 (CCK-8), and total antioxidant capacity (TAC) in identifying the risk of malnutrition. Methods: This cross-sectional study assessed malnutrition risk in 153 community-dwelling older adults using the Mini Nutritional Assessment (MNA). Serum levels of SIRT-1, melatonin, and CCK-8 were analyzed with enzyme-linked immunosorbent assay (ELISA), and total antioxidant capacity (TAC) was measured using the ferric reducing ability of plasma (FRAP) method. Results: Serum levels of TAC and CCK-8 were significantly positively correlated with grip strength and visceral adipose tissue, with TAC levels also showing associations with appendicular skeletal muscle mass index (ASMI), total body water, total energy expenditure, fat-free mass index, and fat mass index (p < 0.001). CCK-8 emerged as a strong predictor of malnutrition risk (AUC = 0.58 in females, AUC = 0.64 in males), whereas SIRT-1 (AUC = 0.57 for both sexes), melatonin (AUC = 0.46 for females, AUC = 0.51 for males), and TAC (AUC = 0.42 for females, AUC = 0.54 for males) exhibited weaker predictive abilities. A multivariate model incorporating CCK-8 demonstrated excellent predictive accuracy (AUC = 0.84, 95% CI: 0.77-0.90) and indicated a potential association between elevated CCK-8 levels and a higher risk of malnutrition. Conclusions: In conclusion, this study highlights the effectiveness of a multi-parameter model incorporating CCK-8 as a reliable approach for assessing malnutrition risk in older adults, offering a comprehensive evaluation of the condition. However, further research is needed to confirm its applicability and accuracy in diverse elderly populations and clinical settings.

Preoperative sarcopenia and postoperative accelerated muscle loss negatively impact survival after resection of locally advanced gastric cancer

BACKGROUND

Gastric cancer remains a major health concern worldwide, with locally advanced gastric cancer (LAGC) posing significant challenges due to frequent lymph node metastasis and poor prognosis. While curative gastrectomy with D2 lymph node dissection is the standard treatment, sarcopenia and perioperative skeletal muscle loss (SML) have emerged as critical prognostic factors.

METHODS

We retrospectively analyzed 198 LAGC patients who underwent curative gastrectomy. Preoperative and postoperative sarcopenia were assessed via computed tomography (CT)-derived skeletal muscle index (SMI) at the L3 level. SML was defined based on sex-specific thresholds of SMI changes (%/30 days). Prognostic significance for overall survival (OS) and disease-free survival (DFS) was evaluated using Kaplan-Meier and Cox regression analyses.

RESULTS

The prevalence of sarcopenia increased from 23.7% preoperatively to 33.3% postoperatively. Patients with significant muscle loss (SML) showed worse OS and DFS compared to non-SML patients (P < 0.05). SML was also associated with a higher incidence of Clavien-Dindo grade ≥ 3a complications (P < 0.05). Multivariate analysis identified preoperative sarcopenia (HR = 2.332, P = 0.001), postoperative sarcopenia (HR = 3.189, P = 0.011), and SML (HR = 11.231, P = 0.002) as independent risk factors for OS. Adjuvant chemotherapy significantly improved both OS (HR = 0.532, P = 0.015) and DFS (HR = 0.587, P = 0.041).

CONCLUSIONS

Both preoperative sarcopenia and perioperative SML may negatively impact postoperative prognosis in LAGC patients, suggesting that perioperative evaluation of skeletal muscle mass may help identify high-risk surgical candidates for targeted interventions.

Personalized Diet With or Without Physical Exercise Improves Nutritional Status, Muscle Strength, Physical Performance, and Quality of Life in Malnourished Older Adults: A Prospective Randomized Controlled Study

Objectives: Malnutrition (MN) is prevalent in older adults and closely related to sarcopenia, frailty, morbidity, mortality, and decreased quality of life. In this study, we aimed to evaluate the effects of a personalized diet combined with planned physical exercise on nutritional status, physical performance, and quality of life (QoL) in malnourished older adult patients. Methods: In this prospective study, 20 older adults with MN risk according to the Mini Nutritional Assessment-Short Form (MNA-SF) were randomized into (i) personalized diet (PD) and (ii) personalized diet with physical exercise (PDE) groups, and followed up with for 12 weeks. The physical exercise included warm-up, strengthening, balance, and cooldown phases, with a frequency of 3-4 days per week. Anthropometric measurements, physical performance, and quality of life were assessed using standardized tools at baseline and at the 4th, 8th, and 12th weeks. QoL was measured using the EQ-5D index and EQ-5D visual analog scale (VAS) scores. Results: A total of 20 patients (55% male) participated in the study. During the study, BMIs, MNA-SF scores, and hand grip strength were increased, and the patients' average duration on the Timed Up and Go (TUG) test decreased significantly in both groups. The EQ-5D index score of the PD group and the EQ-5D VAS scores of both groups were increased. Conclusions: A personalized diet with or without physical exercise therapy was associated with improved nutritional status, physical performance, and QoL.

Prevalence of Malnutrition in People Hospitalized for Surgery: Prospective Cross-Sectional Study

Background/Objectives: Malnutrition poses a significant challenge to public health, affecting millions worldwide, particularly among people in hospital, notably among surgical cases that require adequate nutritional support for effective recovery. Factors contributing to malnutrition include chronic illnesses that hinder nutritional intake and socioeconomic barriers limiting food access. This study aimed to assess malnutrition in surgical patients at admission to enhance recovery, minimize complications, and improve clinical outcomes. Methods: This prospective observational cross-sectional study involved 282 adults hospitalized for over 48 h for surgery. This study utilized the MUST and MNA-SF assessments to evaluate malnutrition risk, confirming diagnoses via the GLIM criteria. Statistical analysis, including the Pearson chi-square test and univariate and multivariate logistic regression, identified significant malnutrition risk factors. Results: This study found an 18.1% malnutrition prevalence among these patients, with Stage 1 malnutrition being the most common at 9.6%. Additionally, a notable proportion of patients were classified as obese (46.5%) or overweight (27.7%). Men had higher malnutrition rates (12.8%) than women (5.3%). Age disparities were also significant, with higher rates among older (7.4%) and younger adults (7.1%) compared to middle-aged individuals (2.5%). Patients undergoing elective surgeries (9.9%) and emergency surgeries (6.7%) had higher malnutrition rates than those admitted for surgical complications. Furthermore, malnutrition was observed in 12% of patients undergoing orthopedic or general surgeries. Conclusions: Among adult patients admitted to surgical wards, malnutrition prevalence during admission was 18%, underscoring the need for comprehensive preoperative nutritional assessments and targeted interventions for patients undergoing surgery.

The association between sarcopenic obesity and malnutrition in community-dwelling older adults

BACKGROUND

The increase in fat tissue and the decrease in muscle mass with advancing age have prompted researchers to explore the coexistence of sarcopenia and obesity, i.e. sarcopenic obesity (SO). SO may lead to malnutrition due to poor diet quality, while malnutrition may contribute to SO by causing further muscle loss and metabolic imbalances.

OBJECTIVES

The aims were to investigate: (i) the prevalence of SO in community-dwelling older adults, (ii) the diagnostic ability of two different malnutrition methods, and (iii) the association between SO and malnutrition.

METHODS

Community-dwelling older adults (≥65 years) were invited to participate. SO assessment was conducted based on the ESPEN/EASO consensus criteria. Malnutrition was evaluated based on both the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Mini-Nutritional Assessment (MNA).

RESULTS

Five hundred and ninety older adults (69.3% women, mean age: 74.31 ± 6.55 years) were included in the study. The overall prevalence of SO was 5.9% (n = 35). The prevalence of malnutrition was 23.9% according to the GLIM criteria, while it was 3.1% according to MNA. The agreement between the two measurements was ĸ = 0.32. There was no association between SO and malnutrition based on either GLIM (P: .06, OR: 1.971, 95% CI: 0.966-4.024) or MNA (P: .948, OR: 1.934, 95% CI: 0.119-7.306).

CONCLUSIONS

Even though the agreement for diagnosing malnutrition between GLIM criteria and MNA was fair, the number of participants diagnosed with malnutrition by GLIM criteria was almost eight times higher than MNA. No association was established between SO and malnutrition defined by GLIM or MNA.

CLINICAL TRIAL NUMBER

NCT05122104.

Pre-operative Serum Albumin as a Predictor of Adverse Outcomes in Open Abdominal Surgery: A Retrospective Study in Central Queensland

Purpose Hypoalbuminemia, which is indicative of protein-energy malnutrition, is linked to increased morbidity and mortality in acute surgical patients due to increased catabolism. This study evaluates the relationship between preoperative serum albumin levels and postoperative morbidity and mortality in patients who underwent open abdominal surgery. Methodology We used the Operating Room Management Information System (ORMIS) and coding to retrospectively find a complete list of surgeries from January 2021 to June 2023 using the term "laparotomy" and "open surgery". Patient demographics, comorbidities, pre-operative serum albumin, laboratory parameters, surgical category, postoperative complications, length of hospital stay, and death up to postoperative day 30 were collected. Serum albumin less than 35g/L is considered as hypoalbuminemia in this study. Results A total of 182 patients were analyzed, with 101 having hypoalbuminemia (serum albumin<35 g/L) and 81 having normal albumin levels (serum albumin≥35 g/L). Patients with hypoalbuminemia had significantly lower haemoglobin levels (126 g/L vs. 142 g/L, p<0.001) and higher American Society of Anaesthesiologists (ASA) scores, with more patients classified as ASA 4 and 5 (33.7% and 12.9% vs. 14.8% and 9.9%, p=0.024). The median hospital stay was longer in the hypoalbuminemia group (10 vs. 7 days, p=0.006). Wound dehiscence was more frequent (11.9% vs. 2.5%, p=0.018), and mortality was significantly higher (11.9% vs. 3.7%, p=0.046), highlighting the association between low preoperative albumin and worse surgical outcomes. Conclusions Preoperative serum albumin effectively predicts surgical outcomes after open abdominal surgery. It serves as a valuable, cost-effective risk predictor that should be further explored for integration into preoperative assessments.

Body composition of older adults with normal body mass index. Cross-sectional analysis of the Toulouse Frailty clinic

BACKGROUND

Body mass index (BMI) determines general corpulence and health, whatever age, sex or clinical background. Normal BMI (18.5-24.9 kgm2) is defined as healthy, normal, weight leading to a false impression that no intervention is needed.

OBJECTIVES

Assess the prevalence of body impairments in the presence of normal BMI.

DESIGN

Cross-sectional design. Bivariate and a multivariate regression analysis assessed the association of body composition with clinical parameters in the presence of normal BMI.

SETTING

Community dwelling older adults attending the Toulouse Frailty Clinic at the University Hospital, Toulouse.

PARTICIPANTS

876 community dwelling, autonomous older adults, 70 years and over.

MEASUREMENTS

Dual X-ray Absorptiometry (DXA) assessment, and cognitive, physical, nutritional, and demographic evaluations were included in the present analysis.

RESULTS

Of the initial sample, 347 (39.61 %) patients had normal BMI, and among them, 152 (43.80 %) had low lean mass, 144 (41.49 %) were osteoporotic and 2 (0.58 %) increased fat mass. A poor nutritional status (Mini-Nutritional Assessment score, MNA-score, <24) was the only independent variable associated with body impairments in the presence of normal BMI (Odd Ratio 2.83; 95 % Confidence Interval 1.64-4.89).

CONCLUSION

Nearly 70 % of the adults with normal BMI had at least one impairment in body composition (low lean mass, osteoporosis, or obesity). In the light of the present study, older adults with normal BMI and an MNA-score under 24 should be assessed with DXA to identify the age-associated impairments in body composition in order to lead to specific interventions.

Small bites, big impact: The importance of evening snacks in patients with advanced chronic liver disease

People with advanced chronic liver disease (ACLD) have an enhanced risk of malnutrition, which has multifactorial etiology and is mainly linked to a reduced energy and protein intake; malnutrition is critical for patients with cirrhosis since it is often associated with sarcopenia, a skeletal muscle depletion with a loss of muscle mass and function. Late-evening snacks have been extensively studied, and guidelines are recommended to counteract the effects of prolonged fasting at night in patients with ACLD. However, it has not been fully explored whether late evening snacking is clarified as a milestone to address the nutritional needs of people with ACLD or whether it has a potential role in improving body composition. In this randomised control trial, Yu et al demonstrated that long-term nocturnal snacks have the potential to significantly improve body composition by body fat mass, visceral fat area and body cell mass in patients with ACLD. While the improvement in skeletal muscle mass was minor, the promising results in other compositions provide hope for future research and patient care.

Can invasive interventions be avoided with a holistic swallowing therapy program in older patients in intensive care units: percutaneous endoscopic gastrostomy tubes or oral intake?

Introduction

The use of percutaneous endoscopic gastrostomy (PEG) tubes in older patients did not show any benefits in terms of survival, improvement in quality of life, or reduction in aspiration pneumonia. Significant gaps exist regarding the evidence for the evaluation and management of dysphagia in older patients. This study aimed to diagnose swallowing disorders and highlight the importance of swallowing therapy in older patients in intensive care units (ICUs).

Materials and methods

Twenty-five older patients (12 men, 13 women, mean age 67.22 ± 24.03 years) hospitalized in the ICUs with complaints of dysphagia were analyzed prospectively. The 12 weeks (14-16 sessions) of swallowing therapy were administered to patients with dysphagia who signed the (voluntary) consent form. The bedside water swallowing test (BWSS), Functional Oral Intake Scale (FOIS) Score, Clinical Swallowing Evaluation, Mini Nutritional Assessment Test (MNAT), Eating Assessment Tool (EAT-10), the Turkish version of the World Health Organisation Quality of Life Scale Elderly Module, and the Swallowing Therapy Programme Protocol were applied. Pretherapy stage (T1) and post-therapy stage (T2) results were compared with videofluoroscopy swallowing study (VFSS) recordings with thin liquids, moderately thick liquids, extremely thick liquids, and crackers (International Dysphagia Diet Standardization Initiative [IDDSI] Levels 0, 3, 4, and 7, respectively).

Results

The World Health Organisation Quality of Life Scale Elderly Module (WHOQOL-OLD) raw scores significantly improved from T1 (38.63 ± 7.05) to T2 (73.07 ± 4.82). The bedside water swallowing test results demonstrated statistically significant differences in therapy timings among older patients (p < 0.001). There were significant improvements in swallowing physiology, as represented by the improved oral and pharyngeal composite scores of the Modified Barium Swallow Impairment Profile (MBSImP) and Penetration-Aspiration Scala (PAS) levels. Before therapy, all patients exhibited high rates of oropharyngeal residue with thin liquids and spoon-thick pudding viscosities (MNA ≤ 17). The results reported in the present study show that malnutrition risk is linked to a poorer QoL in older patients on admission to ICUs. Statistical analyses revealed the dominant effects of functional status and eating-related factors on QoL in this group.

Discussion

Early dysphagia diagnosis of older patients and subsequent application of exercise-based swallowing therapy increase the quality of life of patients. In this study, exercise-based swallowing therapy was developed in Turkey and can be used in older patients as part of a holistic cognitive-communication-swallowing intervention program. Results prove the effectiveness of the developed exercise-based swallowing therapy on the cognitive-communication-swallowing skills of older patients. The present findings reinforce the role of nutrition as a priority for improving patients' perceptions of QoL. Further studies are required to investigate and identify the interventions that improve QoL in older patients. More studies with better research designs are required to establish whether nutritional intervention is effective in enhancing QoL in this vulnerable group.

Undernutrition risk and obesity increase the risk of osteosarcopenia in Mexican adults aged 50 and over: a prospective cohort study

Introduction

Undernutrition risk in adults is a common but undiagnosed condition, while obesity is highly prevalent in this population. Osteosarcopenia is the coexistence of sarcopenia and osteopenia/osteoporosis and is related to higher morbidity and mortality. Undernutrition has been identified as an associated factor of osteosarcopenia; however, it is unknown whether undernutrition risk is also related to this condition. On the other hand, obesity has been associated with osteosarcopenia, and several biological mechanisms in the relationship between muscle, bone, and fat have been identified. However, in both cases, there is a lack of longitudinal studies that allow evaluation of whether these conditions precede and increase the risk of osteosarcopenia. Therefore, the objective was to evaluate the association between undernutrition risk and obesity with osteosarcopenia among Mexican community-dwelling adults aged 50 and over.

Methods

This is a secondary longitudinal study from the FraDySMex cohort. We considered data from 2014 and 2015 as baseline evaluations and 2019 as the follow-up evaluation. Undernutrition risk was assessed using the Mini Nutritional Assessment, obesity was assessed based on body fat percentage measured by DXA, and osteosarcopenia was diagnosed according to the FNIH criteria. To evaluate the association of obesity and undernutrition risk, we estimated mixed-effects logistic regression models. The final model was adjusted for sex, age, comorbidity, education, physical activity, and cognitive impairment.

Results

A total of 304 participants with two evaluations (baseline and follow-up) were included in the study. The baseline mean age of participants was 69.6 years (SD 9.1), with ages ranging from 50 to 92 years. Most of the participants were female (83.2%), 40% had between 7 and 12 years of education, and almost half were categorized as sedentary (47.8%) at baseline evaluation. Both undernutrition risk and obesity increased the risk of osteosarcopenia, with an OR of 2.24 (95% CI: 1.20-4.19) and an OR of 2.22 (95% CI: 1.17-4.23), respectively.

Conclusion

Our findings suggest that undernutrition risk, on the one hand, and obesity, on the other hand, can precede and increase the risk of osteosarcopenia in community-dwelling adults aged 50 and over.

Appetite and childhood malnutrition: A narrative review identifying evidence gaps between clinical practice and research

Severe Acute Malnutrition (SAM) is a critical global health issue, contributing to approximately one-half of all child mortality worldwide. SAM management guidelines recommend the use of appetite assessment determined by an "appetite test" to distinguish between complicated and uncomplicated SAM, subsequently guiding clinical decisions regarding outpatient versus inpatient care and discharge from hospital. Despite the widespread utilization of this recommendation, its validity lacks substantial evidence within the existing literature. Hence, the aims of this narrative review were to provide an overview of the SAM diagnostic and management guideline recommendations concerning the use of appetite assessment; to review the existing knowledge base supporting this clinical practice. The review identified gaps between the clinical use of appetite assessment in SAM management and the available supporting scientific evidence. Additionally, both the opportunities and challenges associated with appetite assessment methods used in clinical practice were highlighted and discussed in relation to existing literature. Further studies with more rigorous methods are needed to bridge these gaps and formulate evidence-based clinical practice. There is also a need to adapt and validate the existing appetite assessment tools to ensure they are tailored to the specific population, setting, and primary purpose of assessing appetite in children who have already developed SAM.

Sarcopenia and myosteatosis are associated with low survival in patients receiving lenvatinib for unresectable hepatocellular carcinoma

PURPOSE

To investigate the association of skeletal muscle mass and quality with survival outcomes in patients with advanced hepatocellular carcinoma (HCC) treated with lenvatinib (LEN).

METHODS

In this retrospective study, LEN-treated patients with HCC were enrolled. Sarcopenia and myosteatosis were evaluated on the basis of baseline skeletal muscle index and mean muscle attenuation, respectively, on computed tomography at the L3 level. Low skeletal muscle mass (LSMM) was determined on the basis of index value, and bioinformatics tools were used to determine reliable cutoff values. Myosteatosis was defined on the basis of mean Hounsfield unit values and predefined cutoff values. A logrank test and Cox proportional hazards model were used to compare overall survival (OS) and progression-free survival (PFS).

RESULTS

A total of 81 patients were included. Patients with LSMM exhibited significantly lower PFS (p = 0.003) and OS (p = 0.010) than did patients without LSMM. Patients with myosteatosis exhibited significantly lower PFS (p = 0.012) and OS (p < 0.001) than did patients without myosteatosis. In multivariate analysis adjusted for tumor extent and liver function reserve, LSMM and myosteatosis remained independent predictors of low PFS (p = 0.028, p = 0.031) and OS (p = 0.027, p = 0.001), respectively.

CONCLUSION

LSMM and myosteatosis are independent prognostic factors for PFS and OS in advanced patients with HCC who received LEN and may exert synergistic effects on these survival outcomes.

[Malnutrition and obesity in self-sufficient elderly and health determinants related to both nutritional disorders]

OBJECTIVE

Evaluate the nutritional status in older adults in the community, to determine malnutrition, obesity and their risks and to identify determinants related to both clinical situations.

DESIGN

Cross-sectional study. SITE: 3 Primary care health centers in La Rioja in urban, semiurban and rural areas.

PARTICIPANTS

409 people ≥ 65 years old who came to receive consultation, with 3 abandonments.

INTERVENTIONS

Nutritional assessment by tools screening and anthropometric measurements.

MAIN MEASUREMENT

The MNA SF® was used to determine the prevalence of malnutrition and the BMI for obesity. Sociodemographic, socioeconomic, health-disease variables, lifestyle habits, metabolic status, and anthropometric measurements were included. Binary logistic regression was performed to predict dichotomous dependent variables.

RESULTS

The prevalence of malnutrition and its risk (DR) were 18.7% and obesity and its risk were 66,5%. The multivariate model for malnutrition and DR includes polypharmacy, dyslipidemia, sedentary lifestyle, and having mental pathology (OR=3.09, 2.01, 2.12, 1.72, respectively). On the other hand, the probability of presenting obesity is associated with cardiovascular risk, age, excessive-moderate alcohol consumption, hypertension and low adherence to the Mediterranean diet (OR=2.73, 4.27, 2.03, 1.97, 1.81 respectively).

CONCLUSION

This results stand out that the study population has a poor nutritional status, detecting a risk of malnutrition, obesity and overweight. The identified predictors related to lifestyle habits, presence of diseases, psychosocial problems, metabolic alterations, etc. They can guide the selection of those people who would benefit from screening to detect and approach the risk of malnutrition early.

Clinical consequence of hypophosphatemia during antiviral therapy for chronic hepatitis B

BACKGROUND

Antiviral therapy is an essential treatment for chronic hepatitis B (CHB) infection. Although hypophosphatemia is an important adverse effect of antiviral agents, its clinical significance remains unclear. We investigated the incidence and clinical consequences of hypophosphatemia in a large cohort of CHB patients.

METHODS

This retrospective cohort study included CHB patients who started antiviral therapy between 2005 and 2015 and continued it for at least 1 year. Patients with decompensated liver cirrhosis, diabetes mellitus, hypertension, concomitant diuretic administration, and end-stage renal disease were excluded. The primary outcome was a change in renal function. Secondary outcomes included the incidence of infection and changes in serum potassium, uric acid, and total carbon dioxide (tCO2).

RESULTS

Among the 4,335 patients, hypophosphatemia developed in 75 (1.7%). During the median 2-year follow-up period, patients with hypophosphatemia showed a lower estimated glomerular filtration rate than those in the control group. The incidence of infection and changes in serum potassium, uric acid, and tCO2 were similar between groups.

CONCLUSION

Hypophosphatemia was associated with a renal function decline in patients with CHB receiving antiviral therapy.

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.

The association between nutrition risk status assessment and hospital mortality in Chinese older inpatients: a retrospective study

PURPOSE

The association between nutritional risk status assessment and hospital mortality in older patients remains controversial. The aim of this study was to assess the relationship between nutritional risk on admission and in-hospital mortality, and explore the best Nutritional Risk Status Screening 2002 (NRS2002) threshold for predicting in-hospital mortality of older inpatients in China.

METHOD

The elderly inpatients were recruited from a hospital in Hunan Province, China. Nutritional risk was screened and assessed using the NRS2002. Logistic regression was used to analyze whether NRS2002 scores were independently associated with hospital mortality, and the results were expressed as odds ratios (OR) and 95% confidence intervals (CIs). Receiver operating characteristic curve (ROC) was used to determine the best NRS2002 threshold for predicting in-hospital mortality in elderly inpatients. And 500 bootstrap re-samplings were performed for ROC analysis.

RESULT

In total, 464 elderly inpatients completed the survey (15 of whom died, 205 males and 259 females, mean age = 72.284 ± 5.626 years). Multifactorial analysis revealed that age, the NRS2002 score, and length of hospital stay significantly influenced in-hospital mortality among older inpatients (P < 0.05). The results also showed that higher NRS2002 scores were associated with an increased risk of in-hospital mortality in both the unadjusted (OR = 1.731,95%CI = 1.362-2.20, P < 0.0001), adjusted model I (OR = 1.736, 95% CI = 1.354-2.206, P < 0.0001) and model II (OR = 1.602, 95% CI = 1.734-2.488, P = 0.0005). The optimal NRS2002 threshold for predicting in-hospital mortality in older inpatients was 3.5, with the largest ROC area of 0.84.

CONCLUSION

Our findings indicated that nutritional risk was an independent predictor of in-hospital mortality, with a cut-off value of 3.50 for the NRS2002 nutritional risk assessment being more appropriate than a cut-off value of 3.0.

Myopenia and body fat distribution in hospitalized ulcerative colitis patients: correlations with clinical characteristics and response to vedolizumab

Background

Ulcerative colitis (UC) patients often suffer from impaired nutritional conditions. However, there are few studies focused on muscle loss in UC patients as well as its impact on therapeutic response. This study aimed to investigate the prevalence of myopenia in hospitalized patients with active UC, analyze the relationship between body composition including both skeletal muscle and fat with clinical characteristics, and explore the association between body composition and clinical response to vedolizumab.

Methods

A retrospective cohort study was conducted in hospitalized patients with active UC in Peking Union Medical College Hospital from November 2014 to October 2022. Computed tomography (CT) scans were used to measure skeletal muscle area, visceral fat area (VFA), subcutaneous fat area (SFA), and intramuscular fat infiltration at the third lumbar vertebrae (L3) level. These measurements were standardized by height (m) squared. Myopenia was defined as a skeletal muscle index (SMI) < 44.77 cm2/m2 for males and <32.50 cm2/m2 for females. The VFA/SFA ratio (VSR) served as an indicator of visceral obesity, while intramuscular fat infiltration was evaluated using the mean Hounsfield Unit (HU) value of the L3 skeletal muscle section.

Results

A total of 457 patients were enrolled. The prevalence of myopenia was 49.7% in this cohort. Female patients had significantly higher levels of subcutaneous fat and intramuscular fat but a lower level of visceral fat than male patients. SMI and mean HU showed positive correlations with serum albumin (ALB) and negative correlations with serum high-sensitivity C-reactive protein (hsCRP), whereas VSR showed the opposite trend. Among the 92 patients who received vedolizumab treatment, myopenia was significantly associated with a lower clinical response rate, and this association remained significant after adjusting for vedolizumab duration, ALB, and hsCRP (OR = 3.458, 95% CI 1.238-9.659, p = 0.018). Visceral obesity, defined as VSR ≥ 75th centile of gender-specific VSR, tended to diminish the clinical response rate but did not reach statistical significance.

Conclusion

This study underscores the significance of assessing body composition in UC patients. Optimizing body composition should be considered an integral component of managing UC patients in the future.

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.

Association between length of hospital stay before and after surgery and nutritional risk according to NRE-2017 - A secondary analysis of a cohort study

Introduction

Aim: to evaluate the predictive ability of the Nutritional Risk Emergency - 2017 (NRE) to predict prolonged length of stay, ICU admission intra-mortality and readmission, severe postoperative complications. Methods: a prospective cohort was conducted with surgical patients admitted in a public tertiary hospital. The NRE-2017 tool was applied for detecting malnutrition risk in hospitalized patients. Surgical complications were assessed by Clavien-Dindo. Patients were followed during hospitalization to identify length of stay as well as stay after surgery in the Intensive Care Unit (ICU). Regression analysis was performed to assess the association between risk of malnutrition and clinical outcomes. Results: we included 162 elective surgery patients; 79 patients were identified with nutritional risk using the NRE-2017 (≥ 1.5) tool and 83 without nutritional risk. Patients with nutritional risk were at higher risk of prolonged hospitalization [18 (10-36) days vs. 13 (7-23 days); p: 0.006] and ICU hospitalization [6 (2-14 days vs. 3.5 (1-7 days; p: 0.020]. There was an association between surgical complications and nutritional risk independently, but the significance was lost when adjusting the analysis. There was no association with mortality and readmission in this sample of patients. Conclusion: the NRE-2017 tool was associated with hospital stay in those patients at nutritional risk, however there was no association with mortality and readmission.

Association of geriatric nutritional risk index with total testosterone in elderly adults in the US: evidence from NHANES 2011-2016

Background and objectives

There is growing evidence that deficiencies in specific nutrients can impact testosterone levels in older men. However, research examining the predictive value of overall nutritional status on testosterone levels remains limited. The Geriatric Nutritional Risk Index (GNRI) is an effective tool for assessing the nutritional status of the elderly. Therefore, this study aimed to investigate the potential correlation between the GNRI and serum total testosterone (TT).

Methods

A representative sample of U.S. males aged 60 years and older who participated in the National Health and Nutrition Examination Survey (NHANES) cycles from 2011 to 2016 was utilized for this cross-sectional study. The research included a total of 829 older adults. Tandem mass spectrometry and liquid chromatography were employed to quantify TT. To examine the association between GNRI and TT, restricted cubic splines (RCS) and weighted multivariate regression analyses were conducted. Subgroup analysis was performed to identify the variables influencing the positive association between GNRI and TT. Additionally, a sensitivity analysis was carried out to compare the weighted and unweighted data.

Results

After adjusting for all other factors, a positive association was found between GNRI and TT. The beta coefficient was 5.59, with a 95% confidence interval of 2.16 to 9.01, and a p-value of 0.003. Compared to the lowest quartile of GNRI (Q1), the second quartile (Q2), third quartile (Q3), and fourth quartile (Q4) significantly increased the level of TT. The beta coefficients for Q2, Q3, and Q4 were 70.15 (p = 0.022), 104.40 (p < 0.001), and 84.83 (p < 0.001), respectively. In subgroup analyses, statistically significant associations were observed among participants who did not have diabetes, had hypertension, and had a BMI of 24.9 or less. According to the sensitivity analysis, unweighted data also found GNRI to be associated with TT (beta = 3.09, P = 0.031).

Conclusion

A positive correlation was identified between the GNRI and TT in the elderly male population of the United States. Further prospective studies with larger sample sizes are needed to confirm the causal relationship between GNRI and TT.

Malnutrition and radiation therapy in head and neck cancers, a systematic review on reported definitions and associated factors

Radiation therapy is a major treatment in head and neck cancers that can induce mucositis, pain, and dysgeusia that could impair oral intake and lead to weight loss and malnutrition. Intensity modulation has diminished toxicity of radiation therapy. We performed a review to assess the rate of malnutrition and how malnutrition was defined across cohorts of patients undergoing modern curative radiation therapy. We performed a systematic review of prospective cohorts to assess how was defined malnutrition and severe malnutrition as binary outcomes and to report their rates depending on their definition. We screened 250 papers and included 27 papers in the review. Only two studies reported malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria, and the most reported criteria were PG SGA (patient-graded subjective global assessment) B or C and weight loss above 10%. The most frequently reported factors associated with malnutrition were concomitant chemotherapy, tumoral stage, and tumor site. Our review highlighted the major heterogeneity of the reporting of patient's nutritional state across cohorts of head and neck cancers treated by modern curative radiotherapy. Using consensual definition of malnutrition would help to provide stronger evidence on preventive enteral nutrition as well as the causes and consequences of malnutrition in head and neck cancers.

Development and validation of a predicative model for identifying sarcopenia in Chinese adults using nutrition indicators (AHLC)

Background

Sarcopenia, a condition characterized by low muscle mass, plays a critical role in the health of older adults. Early identification of individuals at risk is essential to prevent sarcopenia-related complications. This study aimed to develop a predictive model using readily available clinical nutrition indicators to facilitate early detection.

Methods

A total of 1,002 participants were categorized into two groups: 819 with normal skeletal muscle mass (SMM) and 183 with low muscle mass (sarcopenia). A predictive model was developed for sarcopenia risk via multivariate logistic regression, and its performance was assessed using four analyses: receiver operating characteristic (ROC) curve analysis, decision curve analysis (DCA), a nomogram chart, and external validation. These methods were used to evaluate the model's discriminative ability and clinical applicability.

Results

In the low-SMM group, more females (55.73% vs. 40.42%) and older individuals (median 61 vs. 55 years) were observed. These patients had lower albumin (41.00 vs. 42.50 g/L) and lymphocyte levels (1.60 vs. 2.02 × 109/L) but higher HDL (1.45 vs. 1.16 mmol/L) and calcium levels (2.24 vs. 2.20 mmol/L) (all p < 0.001). Using LASSO regression, we developed a nutritional AHLC (albumin + HDL cholesterol + lymphocytes + calcium) model for sarcopenia risk prediction. AUROC and DCA analyses, as well as nomogram charts and external validation, confirmed the robustness and clinical relevance of the AHLC model for predicting sarcopenia.

Conclusion

Our study employs serum nutrition indicators to aid clinicians in promoting healthier aging. The AHLC model stands out for weight-independent evaluations. This novel approach could assess sarcopenia risk in the Chinese population, thereby enhancing aging and quality of life.

Deep Learning-Based Body Composition Analysis for Cancer Patients Using Computed Tomographic Imaging

Malnutrition is a commonly observed side effect in cancer patients, with a 30-85% worldwide prevalence in this population. Existing malnutrition screening tools miss ~ 20% of at-risk patients at initial screening and do not capture the abnormal body composition phenotype. Meanwhile, the gold-standard clinical criteria to diagnose malnutrition use changes in body composition as key parameters, particularly body fat and skeletal muscle mass loss. Diagnostic imaging, such as computed tomography (CT), is the gold-standard in analyzing body composition and typically accessible to cancer patients as part of the standard of care. In this study, we developed a deep learning-based body composition analysis approach over a diverse dataset of 200 abdominal/pelvic CT scans from cancer patients. The proposed approach segments adipose tissue and skeletal muscle using Swin UNEt TRansformers (Swin UNETR) at the third lumbar vertebrae (L3) level and automatically localizes L3 before segmentation. The proposed approach involves the first transformer-based deep learning model for body composition analysis and heatmap regression-based vertebra localization in cancer patients. Swin UNETR attained 0.92 Dice score in adipose tissue and 0.87 Dice score in skeletal muscle segmentation, significantly outperforming convolutional benchmarks including the 2D U-Net by 2-12% Dice score (p-values < 0.033). Moreover, Swin UNETR predictions showed high agreement with ground-truth areas of skeletal muscle and adipose tissue by 0.7-0.93 R2, highlighting its potential for accurate body composition analysis. We have presented an accurate body composition analysis based on CT imaging, which can enable the early detection of malnutrition in cancer patients and support timely interventions.