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Tesfaye BT, Yizengaw MA, Birhanu TE, Bosho DD. Nutritional status of hospitalized elderly patients in Ethiopia: a cross-sectional study of an important yet neglected problem in clinical practice. Front Nutr 2024; 10:1227840. [PMID: 38260070 PMCID: PMC10800825 DOI: 10.3389/fnut.2023.1227840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Background Malnutrition is a common geriatric syndrome affecting approximately half of the older population with a more pronounced occurrence rate in those hospitalized. It affects the physiology, and results in poor humanistic and clinical outcomes. In Africa, particularly in Ethiopia, albeit multiple studies are available on malnutrition in non-hospitalized older population, similar studies in inpatient settings are scarce. Therefore, this study was conducted with the intention to quantify the prevalence of malnutrition in older patients on inpatient admission and determine its associated factors. Methods A total of 157 older inpatients aged 60 years and above were included in the present study. The data collection format was developed after an in-depth review of relevant literatures. The full Mini-Nutritional Assessment (MNA) tool was employed to assess the nutritional status on admission. Data completeness was checked thoroughly. Descriptive statistics and logistic regression analysis were conducted using STATA 15.0. The area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow test, and classification table were computed to evaluate the final model goodness-of-fit. Results Of the total study subjects, 81% were malnourished (MNA score <17) and 17% were at risk for malnutrition (MNA score of 17.5-23.5). However, upon review of the patients' medical charts, malnutrition diagnosis was recorded in only two patients. Rural residence (AOR = 2.823, 95%CI: 1.088, 7.324), self-reported financial dependence for expenses (AOR = 4.733, 95%CI: 1.011, 22.162), and partial dependence in functional autonomy on admission (AOR = 3.689, 95%CI: 1.190, 11.433) significantly increased the risk of malnutrition. The area under the ROC curve (0.754) and the Hosmer-Lemeshow test (p = 0.7564) indicated that the final model reasonably fits the data. The model`s sensitivity is 96.85%. Conclusion In the present study, an alarmingly high prevalence of malnutrition was identified older inpatients. The problem went undiagnosed in a similar percentage of patients. Several available literatures indicate the presence of an association between nutritional status and patient outcomes, thus strict nutritional screening at inpatient admission and intervention are recommended with special emphasis for those from rural areas, with financial dependence, and with functional impairment on admission.
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Affiliation(s)
- Behailu Terefe Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mengist Awoke Yizengaw
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tesema Etefa Birhanu
- Human Anatomy Unit, Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Dula Dessalegn Bosho
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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Carretero-Randez C, Orts-Cortés MI, Rodríguez-Pérez M, Gonzalez-Chordá VM, Trescastro-López EM, Blanco-Blanco J, Martínez-Soldevila J, Ruiz-Heras-Hera A, Castellano-Santana PR, Marquez-Sixto A, Domingo-Pozo M, Zomeño-Ros AI, Montero-Marco J, Charlo-Bernardos M, Moncho J, Abad-González ÁL, Castillo-García MT, Sánchez-García AB, De Pascual y Medina AM, Clement-Santamaría RA, Franco-Bernal A, Camacho-Bejarano R. Impact of hospitalization on nutritional status in persons aged 65 years and over (NUTRIFRAG Study): Protocol for a prospective observational study. PLoS One 2023; 18:e0288348. [PMID: 37917648 PMCID: PMC10621802 DOI: 10.1371/journal.pone.0288348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/14/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Malnutrition is a recurring problem that has become more relevant in recent years. The aim of this study is to assess the risk of malnutrition and nutritional status on admission and its evolution until discharge in patients aged 65 and over admitted to medical and surgical hospitalization units in hospitals of the Spanish National Health System. METHODS Prospective observational study to be carried out in the medical-surgical hospitalization units of 9 public hospitals between 01/09/2022 and 31/12/2024. Using consecutive sampling, a total of 4077 patients will be included (453 in each hospital). Variables included are related to the care process, functionality, cognition and comorbidity, risk profile, nutritional status and dysphagia; as well as frailty, dietary quality and contextual variables. The incidence of risk of malnutrition, undernutrition and dysphagia during the care process and at discharge will be calculated. The association with risk factors will be studied with logistic regression models and multivariate Cox regression models. In addition, an analysis of participants' satisfaction with food services will be carried out. The study was approved by the Ethics and Research Committee on 30/09/2020, approved for funding on 02/12/2021 and with registration number RBR-5jnbyhk in the Brazilian clinical trials database (ReBEC) for observational studies. DISCUSSION Some studies address nutritional status or dysphagia in older people in various care settings. However, there is a lack of large sample studies including both processes of the impact of hospitalization. The results of the project will provide information on the incidence and prevalence of both pathologies in the study subjects, their associated factors and their relationship with the average length of stay, mortality and early readmission. In addition, early detection of a problem such as malnutrition related to the disease and/or dysphagia during a hospital stay will favor the action of professionals to resolve both pathologies and improve the health status of patients.
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Affiliation(s)
- Cristina Carretero-Randez
- Nursing Department, Community Health and History of Science Team, University of Alicante, Alicante, Spain
- Nursing Research Group: Infection, Inflammation and Chronicity (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Pneumology and Intermediate Respiratory Care Unit, Hospital Arnau de Vilanova, Valencia, Spain
| | - María Isabel Orts-Cortés
- Nursing Department, University of Alicante (BALMIS), Alicante Institute for Health and Biomedical Research (ISABIAL, Group 23), Alicante, Spain
- Institute of Health Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
- (CIBERFES) Institute of Health Carlos III, CIBER of Frailty and Healthy Ageing, Madrid, Spain
| | | | - Víctor Manuel Gonzalez-Chordá
- Institute of Health Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
- Nursing Department, Nursing Research Group (241), Universitat Jaume I, Castellón, Spain
| | - Eva María Trescastro-López
- Alicante Institute for Health and Biomedical Research (ISABIAL, Group 23), Balmis Research Group in History of Science, Health Care and Food, Alicante, Spain
| | - Joan Blanco-Blanco
- (CIBERFES) Institute of Health Carlos III, CIBER of Frailty and Healthy Ageing, Madrid, Spain
- Nursing and Pysiotherapy Department and Grup d’Estudis Societat, Salut, Educació i Cultura (GESEC), University of Lleida, Lleida, Spain
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Health Care Research Group (GRECS), IRBLLEIDA, Lleida, Spain
| | - Jordi Martínez-Soldevila
- Nursing and Pysiotherapy Department and Grup d’Estudis Societat, Salut, Educació i Cultura (GESEC), University of Lleida, Lleida, Spain
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, Health Care Research Group (GRECS), IRBLLEIDA, Lleida, Spain
| | - Aránzazu Ruiz-Heras-Hera
- Diet Department, University Hospital of Navarra, Pamplona, Spain
- Faculty of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | - Pedro Raúl Castellano-Santana
- Surgery Unit of the Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Nursing Department, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | - Manuela Domingo-Pozo
- Department of Nursing University of Alicante, Alicante Institute for Health and biomedical Research (ISABIAL, Group 23), Nursing Information Systems Unit Dr Balmis General University Hospital, Alicante, Spain
| | - Antonia Inmaculada Zomeño-Ros
- Nursing Department, University of Murcia, Murcia, Spain
- Endocrinology and Diet Department, Hospital General Universitario Reina Sofía de Murcia, Murcia, Spain
| | - Jesica Montero-Marco
- Research Unit, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón),. GIIS081-Care Research Group, Zaragoza, Spain
| | - Marta Charlo-Bernardos
- Instituto de Investigación Sanitaria Aragón (IIS Aragón),. GIIS081-Care Research Group, Zaragoza, Spain
- Continued Training Unit, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Joaquín Moncho
- Department of comunity Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public health and History of Science, University of Alicante, Alicante, Spain
| | - Ángel Luís Abad-González
- Endocrinology Department, Dr. Balmis General University Hospital, Institute for Health and Biomedical Research (ISABIAL, Group 20), Alicante, Spain
| | - María Trinidad Castillo-García
- Department of Nursing University of Alicante, Dr Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL, Group 20), Alicante, Spain
| | - Ana Belén Sánchez-García
- Nursing Department, University of Murcia, Murcia, Spain
- Institute Murciano for Biosanitary Research (IMIB), Nursing and Healthcare Research Unit ENFERAVANZA, El Palmar, Murcia, Spain
- Research Ethics Committee UM and University General Hospital Reina Sofía, Murcia, Spain
| | - Ana María De Pascual y Medina
- Evaluation Unit of the Canary Islands Health Service, Tenerife, Spain
- Red de Agencias de Evaluación de Tecnologías Sanitarias del Ministerio de Sanidad, Madrid, Spain
- GREISSEC Grupo Español de Investigación de Cuidados en Servicios de Salud en Enfermedades Crónicas, Unidad de Investigación en Cuidados de Salud (Investén-isciii), Madrid, Spain
| | - Rosa Ana Clement-Santamaría
- Department of Nursing University of Alicante, Alicante Institute for Health and biomedical Research (ISABIAL, Group 23), Nursing Information Systems Unit Dr Balmis General University Hospital, Alicante, Spain
| | - Ascensión Franco-Bernal
- Nursing Research Group: Infection, Inflammation and Chronicity (IIS La Fe), Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Area Manager of Outpatient Care (Day Hospital), Hospital Universitario la Fe, Valencia, Spain
| | - Rafaela Camacho-Bejarano
- Institute of Health Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain
- Nursing Faculty, Department of Nursing, University of Huelva, Campus El Carmen, Huelva, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Barcelona, Spain
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3
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Solsona Fernández S, Caverni Muñoz A, Labari Sanz G, Monterde Hernandez B, Martínez Marco MA, Mesa Lampré P. Preliminary Evidence on the Effectiveness of a Multidisciplinary Nutritional Support for Older People with Femur Fracture at an Orthogeriatric Unit in Spain. J Nutr Gerontol Geriatr 2022; 41:270-293. [PMID: 36503421 DOI: 10.1080/21551197.2022.2153959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To describe the nutritional and functional changes that occurred in older patients with a femur fracture following a dietary intervention and oral nutritional support implemented at an orthogeriatric unit in Aragon, Spain. Open-label, prospective study. Patients were consecutively recruited and arranged into three groups based on their CONtrolling NUTritional (CONUT®) score and nutritional needs. Nutritional status was assessed while in hospital, and at 45-, 100- and 180-days post-hospital discharge. One hundred and sixty-nine patients [mean age: 86 years (SD ± 5.48)] were recruited (July 2017 to January 2020). At admission, 53.3% were at risk of malnutrition; 26.6% were malnourished; 20.1% were well-nourished. Variable proportions of malnourished patients at admission were well-nourished 45-, 100-, and 180-days post-discharge. CONUT® and Barthel index correlations showed that as nutritional status enhanced, patients gained functionality. Dietary interventions and nutritional support may help restoring the nutritional and functional status of older patients with a femur fracture.
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Affiliation(s)
| | | | - G Labari Sanz
- Nursing Liaison Service, Nuestra Señora de Gracia Hospital, Zaragoza, Spain
| | - B Monterde Hernandez
- Dietetics and Clinical Nutrition Service, Nuestra Señora de Gracia Hospital, Zaragoza, Spain
| | - M A Martínez Marco
- Orthogeriatric Unit, Nursing Department, Nuestra Señora de Gracia Hospital, Zaragoza, Spain
| | - P Mesa Lampré
- Geriatric Department, Nuestra Señora de Gracia Hospital, Zaragoza, Spain
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Umay E, Eyigor S, Bahat G, Halil M, Giray E, Unsal P, Unlu Z, Tikiz C, Vural M, Cincin AT, Bengisu S, Gurcay E, Keseroglu K, Aydeniz B, Karaca EC, Karaca B, Yalcin A, Ozsurekci C, Seyidoglu D, Yilmaz O, Alicura S, Tokgoz S, Selcuk B, Sen EI, Karahan AY, Yaliman A, Ozkok S, Ilhan B, Oytun MG, Ozturk ZA, Akin S, Yavuz B, Akaltun MS, Sari A, Inanir M, Bilgilisoy M, Çaliskan Z, Saylam G, Ozer T, Eren Y, Bicakli DH, Keskin D, Ulger Z, Demirhan A, Calik Y, Saka B, Yigman ZA, Ozturk EA. Best Practice Recommendations for Geriatric Dysphagia Management with 5 Ws and 1H. Ann Geriatr Med Res 2022; 26:94-124. [PMID: 35527033 PMCID: PMC9271401 DOI: 10.4235/agmr.21.0145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/26/2022] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ebru Umay
- Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
- Corresponding Author Ebru Umay, MD Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara 06200, Turkey E-mail:
| | - Sibel Eyigor
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | - Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Meltem Halil
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Pelin Unsal
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Zeliha Unlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Canan Tikiz
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Meltem Vural
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Asli Tufan Cincin
- Department of Internal Medicine, Marmara University, Istanbul, Turkey
| | - Serkan Bengisu
- Department of Speech and Language Therapy, Uskudar University, Istanbul, Turkey
| | - Eda Gurcay
- Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Kemal Keseroglu
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Banu Aydeniz
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Celik Karaca
- Ministry of Health Eskisehir Provincial Health Directorate, Eskisehir, Turkey
| | - Burak Karaca
- Ministry of Health Inonu Public Health Center, Eskisehir, Turkey
| | - Ahmet Yalcin
- Division of Geriatrics, Department of Internal Medicine, Ankara University, Ankara, Turkey
| | - Cemile Ozsurekci
- Department of Physical Medicine and Rehabilitation, Trabzon Kanuni Training and Research Hospital, University of Health Sciences Turkey, Trabzon, Turkey
| | | | - Ozlem Yilmaz
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Alicura
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Serhat Tokgoz
- Department of General Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Barin Selcuk
- Department of Physical Medicine, Goztepe Medicalpark Hospital, Bahcesehir University, Istanbul, Turkey
| | - Ekin Ilke Sen
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Ali Yavuz Karahan
- Department of Physical Medicine and Rehabilitation, Usak University, Usak, Turkey
| | - Ayse Yaliman
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Serdar Ozkok
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Birkan Ilhan
- Department of Internal Medicine, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Merve Guner Oytun
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | | | - Sibel Akin
- Department Internal Medicine, Erciyes University, Kayseri, Turkey
| | - Betul Yavuz
- Department of Physical Medicine and Rehabilitation, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Gaziantep University, Gaziantep, Turkey
| | - Aylin Sari
- Istanbul Erenkoy Physical Medicine and Rehabilitation Hospital, Istanbul, Turkey
| | - Murat Inanir
- Department of Physical Medicine and Rehabilitation, Kocaeli University, Kocaeli, Turkey
| | - Meral Bilgilisoy
- Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Turkey
| | - Zuhal Çaliskan
- Department of Gastroenterology, Umraniye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Guleser Saylam
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Tugce Ozer
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Yasemin Eren
- Department of Neurology, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | | | - Dilek Keskin
- Department of Physical Medicine and Rehabilitation, Kirikkale University, Kirikkale, Turkey
| | - Zekeriya Ulger
- Department of Internal Medicine, Kirikkale University, Kirikkale, Turkey
| | - Aylin Demirhan
- Aylin Demirhan Physical Medicine and Rehabilitation Clinic, Izmir, Turkey
| | - Yalkin Calik
- Department of Physical Medicine and Rehabilitation, Bolu Izzet Baysal Training and Research Hospital, Bolu Turkey
| | - Bulent Saka
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Aykin Yigman
- Department of Physical Medicine and Rehabilitation, Polatli City Hospital, Ministry of Health, Ankara, Turkey
| | - Erhan Arif Ozturk
- Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Krznarić Ž, Bender DV, Laviano A, Cuerda C, Landi F, Monteiro R, Pirlich M, Barazzoni R. A simple remote nutritional screening tool and practical guidance for nutritional care in primary practice during the COVID-19 pandemic. Clin Nutr 2020; 39:1983-1987. [PMID: 32425292 PMCID: PMC7227572 DOI: 10.1016/j.clnu.2020.05.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/15/2022]
Abstract
Challenging periods like the COVID-19 pandemic require fast and efficient adaptations of the healthcare system. It is vital that every patient has access to nutritional care as a part of primary healthcare services, even if social distancing measures are adopted. Therefore, we propose a simple remote nutritional screening tool and practical guidance for nutritional care in primary practice, and their implementation into telemedicine processes and digital platforms suitable for healthcare providers. The acronym for the tool is R-MAPP, as for Remote – Malnutrition APP, while the tool will be available also as an app. This protocol consists of two simple validated clinical tools for identifying nutritional risk and loss of muscle mass and function –Malnutrition Universal Screening Tool (‘MUST’) and SARC-F (5-item questionnaire: Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) - and additional practical guidance on nutritional interventions for family physicians.
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Affiliation(s)
- Željko Krznarić
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre, University of Zagreb, Croatia.
| | - Darija Vranešić Bender
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre, University of Zagreb, Croatia
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francesco Landi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Catholic University, Rome, Italy
| | - Rosario Monteiro
- Department of Biomedicine, Biochemistry Unit, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, Portugal
| | - Matthias Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology & Clinical Nutrition, Berlin, Germany
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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