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Morphofunctional Nutritional Assessment in Clinical Practice

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (15 May 2024) | Viewed by 12374

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Dr. Daniel-Antonio de Luis Roman

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1. Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
2. Instituto de Endocrinología y Nutrición (IENVA), Universidad de Valladolid, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain
Interests: obesity; nutrigenetics; enteral nutrition; malnutrition related to the disease
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Dr. Juan J. López-Gómez

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Centro de Investigación Endocrinología y Nutrición, Universidad de Valladolid, 47002 Valladolid, Spain
Interests: obesity and bone metabolismo; hyperglycaemia; stroke; enteral nutrition; nasogastric tube; dysphagia

Special Issue Information

Dear Colleagues,

The diagnosis of malnutrition is difficult because it does not depend only on weight at a given time, but also on its evolution and the underlying pathological situations. Therefore, the clinical use of body composition measurements is essential for adequate assessment of this malnutrition, especially in the evaluation of muscle mass and function. In this context, nutritional assessment can no longer be based on the determination of classical anthropometric measurements. The concept of morphofunctional nutritional assessment postulates that the diagnosis and monitoring of nutritional status must be carried out using techniques and biomarkers that determine the evaluation of intake, anthropometry, body composition, muscle strength, and function that include techniques such as bioelectrical impedance analysis or nutritional ultrasound, and new biological parameters too.

This Special Issue aims to show the implementation of this new concept of nutritional evaluation in the management of patients and in clinical research in nutrition.

Dr. Daniel-Antonio de Luis Roman
Dr. Juan J. López-Gómez
Guest Editors

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Editorial

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3 pages, 214 KiB

Open AccessEditorial

Morphofunctional Nutritional Assessment in Clinical Practice: A New Approach to Assessing Nutritional Status

by Daniel-Antonio de Luis Roman and Juan José Lopez Gomez

Nutrients 2023, 15(19), 4300; https://doi.org/10.3390/nu15194300 - 9 Oct 2023

Cited by 2 | Viewed by 1273

Abstract

This Special Issue of Nutrients titled “Morphofunctional Nutritional Assessment in Clinical Practice” is oriented to the diagnosis of disease-related malnutrition (DRM) [...] Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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9 pages, 247 KiB

Open AccessArticle

by Nicoletta Miano, Giorgia Todaro, Maurizio Di Marco, Sabrina Scilletta, Giosiana Bosco, Francesco Di Giacomo Barbagallo, Roberto Scicali, Salvatore Piro, Francesco Purrello and Antonino Di Pino

Nutrients 2024, 16(12), 1925; https://doi.org/10.3390/nu16121925 - 18 Jun 2024

Viewed by 441

Abstract

Fatty liver disease has been identified as a marker of malnutrition in different clinical settings. Recently, the COntrolling NUTritional status score (CONUT score) emerged as a promising tool for malnutrition assessment. Our aim was to evaluate short-term outcomes among patients with malnutrition-related liver steatosis in an Internal Medicine department. Furthermore, we evaluated the association of the CONUT score with malnutrition-related liver steatosis. Data from 247 patients hospitalized in an Internal Medicine department were retrospectively collected. The study population was stratified into three groups based on hepatic radiodensity assessed with computed tomography: mild steatosis (≥56.1 HU), moderate steatosis (between 49.7 and 56 HU), and severe steatosis (≤49.6 HU). We then calculated the CONUT score. Severe steatosis patients had higher in-hospital mortality (18.2 vs. 15.5%) and longer in-hospital stays compared with the mild steatosis group (length of in-hospital stay longer than 12 days: 45% vs. 40%). Logistic regression analysis showed that severe steatosis was not significantly associated with in-hospital all-cause death, while a high CONUT score was an independent risk factor for sepsis. We found an independent relationship between malnutrition-associated liver steatosis and the CONUT score. These results identified the CONUT score as a tool for nutritional assessment of hospitalized patients. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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14 pages, 4051 KiB

Open AccessArticle

Validation of an Artificial Intelligence-Based Ultrasound Imaging System for Quantifying Muscle Architecture Parameters of the Rectus Femoris in Disease-Related Malnutrition (DRM)

by Sergio García-Herreros, Juan Jose López Gómez, Angela Cebria, Olatz Izaola, Pablo Salvador Coloma, Sara Nozal, Jesús Cano, David Primo, Eduardo Jorge Godoy and Daniel de Luis

Nutrients 2024, 16(12), 1806; https://doi.org/10.3390/nu16121806 - 8 Jun 2024

Viewed by 734

Abstract

(1) Background: The aim was to validate an AI-based system compared to the classic method of reading ultrasound images of the rectus femur (RF) muscle in a real cohort of patients with disease-related malnutrition. (2) Methods: One hundred adult patients with DRM aged 18 to 85 years were enrolled. The risk of DRM was assessed by the Global Leadership Initiative on Malnutrition (GLIM). The variation, reproducibility, and reliability of measurements for the RF subcutaneous fat thickness (SFT), muscle thickness (MT), and cross-sectional area (CSA), were measured conventionally with the incorporated tools of a portable ultrasound imaging device (method A) and compared with the automated quantification of the ultrasound imaging system (method B). (3) Results: Measurements obtained using method A (i.e., conventionally) and method B (i.e., raw images analyzed by AI), showed similar values with no significant differences in absolute values and coefficients of variation, 58.39–57.68% for SFT, 30.50–28.36% for MT, and 36.50–36.91% for CSA, respectively. The Intraclass Correlation Coefficient (ICC) for reliability and consistency analysis between methods A and B showed correlations of 0.912 and 95% CI [0.872–0.940] for SFT, 0.960 and 95% CI [0.941–0.973] for MT, and 0.995 and 95% CI [0.993–0.997] for CSA; the Bland–Altman Analysis shows that the spread of points is quite uniform around the bias lines with no evidence of strong bias for any variable. (4) Conclusions: The study demonstrated the consistency and reliability of this new automatic system based on machine learning and AI for the quantification of ultrasound imaging of the muscle architecture parameters of the rectus femoris muscle compared with the conventional method of measurement. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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14 pages, 634 KiB

Open AccessArticle

Ultrasound Cut-Off Values for Rectus Femoris for Detecting Sarcopenia in Patients with Nutritional Risk

by Daniel de Luis Roman, José Manuel García Almeida, Diego Bellido Guerrero, Germán Guzmán Rolo, Andrea Martín, David Primo Martín, Yaiza García-Delgado, Patricia Guirado-Peláez, Fiorella Palmas, Cristina Tejera Pérez, María García Olivares, María Maíz Jiménez, Irene Bretón Lesmes, Carlos Manuel Alzás Teomiro, Juan Manuel Guardia Baena, Laura A. Calles Romero, Inmaculada Prior-Sánchez, Pedro Pablo García-Luna, María González Pacheco, Miguel Ángel Martínez-Olmos, Blanca Alabadí, Valeria Alcántara-Aragón, Samara Palma Milla, Tomás Martín Folgueras, Andrea Micó García, Begoña Molina-Baena, Henry Rendón Barragán, Pablo Rodríguez de Vera Gómez, María Riestra Fernández, Ana Jiménez Portilla, Juan J. López-Gómez, Nuria Pérez Martín, Natalia Montero Madrid, Alba Zabalegui Eguinoa, Cristina Porca Fernández, María José Tapia Guerrero, Marta Ruiz Aguado, Cristina Velasco Gimeno, Aura D Herrera Martínez, María Novo Rodríguez, Natalia C. Iglesias Hernández, María de Damas Medina, Irene González Navarro, Francisco Javier Vílchez López, Antía Fernández-Pombo and Gabriel Olveira Show full author list Hide full author list

Nutrients 2024, 16(11), 1552; https://doi.org/10.3390/nu16111552 - 21 May 2024

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Abstract

Background: A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures. Methods: Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia. Results: A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm² and 3.66 cm² for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women. Conclusions: Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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15 pages, 1765 KiB

Open AccessArticle

Bioelectrical Impedance Vector Analysis, Nutritional Ultrasound^®, and Handgrip Strength as Innovative Methods for Monitoring Critical Anorexia Nervosa Physical Recovery: A Pilot Study

by Jose M. Romero-Márquez, María Novo-Rodríguez, Cristina Novo-Rodríguez, Víctor Siles-Guerrero, Isabel Herrera-Montes, Francisco Garzón Navarro-Pelayo, Martín López-de-la-Torre-Casares and Araceli Muñoz-Garach

Nutrients 2024, 16(10), 1539; https://doi.org/10.3390/nu16101539 - 20 May 2024

Viewed by 797

Abstract

Eating disorders (EDs) manifest as persistent disruptions in eating habits or related behaviors, significantly impacting physical health and psychosocial well-being. Nutritional assessment in ED patients is crucial for monitoring treatment efficacy. While dual-energy X-ray absorptiometry (DEXA) remains standard, interest in alternative methods such as bioelectrical impedance vector analysis (BIVA) and Nutritional Ultrasound^® (NU) has risen due to their affordability and portability. Additionally, hand dynamometry offers a user-friendly approach to assessing grip strength (HGS), indicative of nutritional status. A prospective study was carried out to evaluate the utility of BIVA, NU^®, and HGS in 43 female AN patients. Measurements were taken at baseline and hospital discharge. A total of 41 patients completed the study. After the intervention, numerous BIVA-related parameters such as fat (3.5 ± 2 kg vs. 5.3 ± 2.7 kg, p < 0.001) and free fat mass (33.9 ± 3.8 kg vs. 37.5 ± 4.1 kg, p < 0.001) were partially restored. Similarly, Nutritional Ultrasound^® showed promising results in assessing body composition changes such as total abdominal fat tissue (0.5 ± 0.3 cm vs. 0.9 ± 0.3 cm, p < 0.05). In the same way, rectus femoris cross-sectional area values correlated with clinical outcomes such as free fat mass (0.883, p < 0.05) and appendicular muscle mass (0.965, p < 0.001). HGS reached the normality percentile after the intervention (21.6 ± 9.1 kg vs. 25.9 ± 12.3 kg, p < 0.05), demonstrating a significant association between grip strength and body composition parameters such as free fat mass (0.658, p < 0.001) and appendicular muscle mass (0.482, p < 0.001). Incorporating BIVA-, NU^®-, and HGS-enhanced nutritional assessment into the treatment of AN patients offers cost-effective, portable, and non-invasive alternatives to DEXA. These techniques offer valuable insights into changes in body composition and nutritional status, which, in turn, facilitate treatment monitoring and contribute to improved patient outcomes. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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10 pages, 794 KiB

Open AccessArticle

Influence of the Results of Control of Intakes, Proteins and Anthropometry Nutritional Screening, Sarcopenia and Body Composition on the Clinical Evolution of Hospitalized Patients

by Elena Márquez Mesa, José Pablo Suárez Llanos, Patricia Mercedes Afonso Martín, Carla Brito Negrín, María García Ascanio, Samuel González González and Ignacio Llorente Gómez de Segura

Nutrients 2024, 16(1), 14; https://doi.org/10.3390/nu16010014 - 20 Dec 2023

Viewed by 1020

Abstract

(1) Background: Hospital malnutrition and sarcopenia are common in inpatients and are associated with worse prognosis. Our objective is to determine the association of the positivity of CIPA (Control of Intakes, Proteins and Anthropometry) nutrition screening tool and sarcopenia and evaluate its prognostic implications (length of stay, readmissions and mortality) as well as different components of body composition. (2) Methodology: Cross-sectional single-center study and prospective six months follow-up for prognostic variables. On admission, CIPA and EWGSOP2 criteria were assessed. (3) Results: Four hundred inpatients, a median of 65.71 years old and 83.6% with high comorbidity, were evaluated. In total, 34.8% had positive CIPA and 19.3% sarcopenia. Positive CIPA and sarcopenia had worse results in body composition (fat mass (FM), fat-free mass (FFM) and appendicular skeletal muscle mass index (ASMI)) and dynamometry. Positive CIPA is significantly associated with worse prognosis (mortality (OR = 1.99), readmissions (OR = 1.86) and length of stay (B = 0.19)). Positive CIPA and sarcopenia combined are associated with a tendency to higher mortality (OR = 2.1, p = 0.088). Low hand grip strength (HGS) is significantly related to a higher length of stay (B = −0.12). (4) Conclusions: In hospitalized patients, malnutrition independently and combined with sarcopenia is associated with a worse prognosis but not body composition. Low HGS is related to a higher length of stay. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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15 pages, 2166 KiB

Open AccessArticle

Nutritional Ultrasonography, a Method to Evaluate Muscle Mass and Quality in Morphofunctional Assessment of Disease Related Malnutrition

by Juan José López-Gómez, David García-Beneitez, Rebeca Jiménez-Sahagún, Olatz Izaola-Jauregui, David Primo-Martín, Beatriz Ramos-Bachiller, Emilia Gómez-Hoyos, Esther Delgado-García, Paloma Pérez-López and Daniel A. De Luis-Román

Nutrients 2023, 15(18), 3923; https://doi.org/10.3390/nu15183923 - 9 Sep 2023

Cited by 6 | Viewed by 2011

Abstract

Nutritional ultrasonography is an emerging technique for measuring muscle mass and quality. The study aimed to evaluate the relationship between the parameters of body mass and quality of ultrasonography with other parameters of morphofunctional assessment in patients with disease-related malnutrition (DRM). Methods: A cross-sectional study was developed on 144 patients diagnosed with DRM according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Morphofunctional evaluation was assessed with anthropometric variables, handgrip strength and bioelectrical impedanciometry (BIA). Nutritional ultrasonography of quadriceps rectus femoris (QRF) was made (muscle mass (Muscle Area of Rectus Femoris index (MARFI)), Y axis and muscle quality (X-Y index and echogenicity). Results: The mean age of patients was 61.4 (17.34) years. The prevalence of sarcopenia in the sample was 33.3%. Patients with sarcopenia (S) had lower values of MARFI [(S: 1.09 (0.39) cm²/m²; NoS: 1.27 (0.45); p = 0.02), Y axis (S: 0.88 (0.27); NoS: 1.19 (0.60); p < 0.01) and X-Y index (S: 1.52 (0.61); NoS: 1.30 (0.53); p < 0.01)]. There was a correlation between BIA parameters (phase angle) and muscle mass ultrasonographic variables (MARFI) (r = 0.35; p < 0.01); there was an inverse correlation between muscle quality ultrasonographic variables (echogenicity) and handgrip strength (r = −0.36; p < 0.01). In the multivariate analysis adjusted by age, the highest quartile of the X-Y index had more risk of death OR: 4.54 CI95% (1.11–18.47). Conclusions: In patients with DRM and sarcopenia, standardized muscle mass and muscle quality parameters determined by ultrasonography of QRF are worse than in patients without sarcopenia. Muscle quality parameters had an inverse correlation with electric parameters from BIA and muscle strength. The highest quartile of the X-Y index determined by ultrasonography was associated with increased mortality risk. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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12 pages, 704 KiB

Open AccessArticle

Global Subjective Assessment and Mini Nutritional Assessment Short Form Better Predict Mortality Than GLIM Malnutrition Criteria in Elderly Patients with Hip Fracture

by Francisco José Sánchez-Torralvo, Verónica Pérez-del-Río, María García-Olivares, Nuria Porras, Jose Abuín-Fernández, Manuel Francisco Bravo-Bardají, David García-de-Quevedo and Gabriel Olveira

Nutrients 2023, 15(8), 1828; https://doi.org/10.3390/nu15081828 - 10 Apr 2023

Cited by 10 | Viewed by 2549

Abstract

The objective of our study is to determine the prevalence of malnutrition in elderly patients with fragility hip fractures through different diagnostic tools and to determine which nutritional assessment tool better predicts mortality. Methods: This is a prospective study in patients over 65 years of age hospitalized with a diagnosis of hip fracture. A nutritional assessment was performed using several tools: the Mini Nutritional Assessment Short Form (MNA-SF), the Subjective Global Assessment (SGA), and the GLIM criteria. For the definition of low muscle mass, four different methods were used: hand grip strength (HGS), calf circumference (CC), anthropometry, and bioelectrical impedance (BIA). Mortality was registered at three, six and twelve months. Results: 300 patients were included, 79.3% female, mean age 82.9 ± 7.1 years. The MNA-SF found 42% at risk of malnutrition, and 37.3% malnourished. Using SGA, there were 44% with moderate malnutrition, and 21.7% with severe malnutrition. In application of the GLIM criteria, 84.3%, 47%, 46%, and 72.7% of patients were malnourished when HGS, anthropometry, BIA, and CC were used, respectively. Mortality was 10%, 16.3% and 22% at 3, 6 and 12 months, respectively. In malnourished patients according to MNA-SF, mortality was 5.7 times greater [95%CI 1.3–25.4; p = 0.022] at 6 months and 3.8 times greater [95%CI 1.3–11.6; p = 0.018] at 12 months. In malnourished patients according to SGA, mortality was 3.6 times greater [95%CI 1.02–13.04; p = 0.047] at 3 months, 3.4 times greater [95%CI 1.3–8.6; p = 0.012] at 6 months and 3 times greater [95%CI 1.35–6.7; p = 0.007] at 12 months. Conclusion: The prevalence of malnutrition in patients admitted for fragility hip fracture is high. The SGA and MNA-SF are postulated as adequate tools to diagnose malnutrition in these patients, with predictive value for mortality at three, six, and twelve months. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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17 pages, 909 KiB

Open AccessSystematic Review

Morphofunctional Assessment beyond Malnutrition: Fat Mass Assessment in Adult Patients with Phenylketonuria—Systematic Review

by Luis M. Luengo-Pérez, Mercedes Fernández-Bueso, Carlos Guzmán-Carmona, Ana López-Navia and Claudia García-Lobato

Nutrients 2024, 16(12), 1833; https://doi.org/10.3390/nu16121833 - 11 Jun 2024

Viewed by 452

Abstract

Morphofunctional assessment was developed to evaluate disease-related malnutrition. However, it can also be used to assess cardiometabolic risk, as excess adiposity increases this risk. Phenylketonuria (PKU) is the most prevalent inherited metabolic disease among adults, and obesity in PKU has recently gained interest, although fat mass correlates better with cardiometabolic risk than body mass index. In this systematic review, the objective was to assess whether adult patients with PKU have higher fat mass than healthy controls. Studies of adult PKU patients undergoing dietary treatment in a metabolic clinic reporting fat mass were included. The PubMed and EMBASE databases were searched. Relevance of articles, data collection, and risk of bias were evaluated by two independent reviewers. Ten articles were evaluated, six with a control group, including 310 subjects with PKU, 62 with mild hyperphenylalaninemia, and 157 controls. One study reported a significant and four a tendency towards an increased fat mass in all patients or only females with PKU. Limitations included not having a healthy control group, not reporting sex-specific results and using different techniques to assess fat mass. Evaluation of fat mass should be included in the morphofunctional assessment of cardiometabolic risk in adult patients with PKU. Full article

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