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13 pages, 1382 KB  
Article
Nutritional Status Assessment Using the Patient-Generated Subjective Global Assessment (PG-SGA) in Individuals with Colorectal Cancer Undergoing Chemotherapy Regimens
by Luis Enrique Sánchez-Diestro, Raquel Macias-Montero, Ana Isabel Ramalho-Galhanas, Ana Maria Aguiar-Frias, María Sandra Paniagua-Vivas and Jorge Guerrero-Martín
J. Clin. Med. 2025, 14(18), 6664; https://doi.org/10.3390/jcm14186664 - 22 Sep 2025
Viewed by 490
Abstract
Background/Objectives: Colorectal cancer (CRC) has high prevalence and mortality, with a high frequency of malnutrition during chemotherapy (60–70%). Malnutrition reduces treatment tolerance, quality of life, and survival. The Patient-Generated Subjective Global Assessment (PG-SGA) is effective in detecting it, but its use is not [...] Read more.
Background/Objectives: Colorectal cancer (CRC) has high prevalence and mortality, with a high frequency of malnutrition during chemotherapy (60–70%). Malnutrition reduces treatment tolerance, quality of life, and survival. The Patient-Generated Subjective Global Assessment (PG-SGA) is effective in detecting it, but its use is not systematic. This study aims to analyze the prevalence and degrees of malnutrition in CRC patients undergoing active chemotherapy, using the PG-SGA, and to propose its systematic implementation in oncology care protocols. Methods: Observational, cross-sectional, and descriptive study in patients with stage III–IV CRC receiving FOLFOX, XELOX, or irinotecan regimens. Nutritional status was assessed with PG-SGA and body composition by bioimpedance. Results: The study includes 91 patients. A total of 45.05% of patients required intensive nutritional intervention, 39.56% needed dietary and pharmacological measures, 10.99% required health education, and only 4.4% did not require intervention. FOLFOX was significantly associated with taste alterations (p < 0.001), nausea (p = 0.020), unpleasant odors, and eating problems; XELOX with diarrhea (p = 0.009) and xerostomia (p = 0.038). Irinotecan was related to poorer functional capacity (p = 0.042). Oxaliplatin was linked to loss of appetite (p = 0.034) and unpleasant odors (p = 0.035). Older age correlated with a greater need for intensive interventions. Conclusions: The study shows a high nutritional risk in oncology patients, particularly in those with colorectal cancer undergoing FOLFOX treatment, associated with symptoms that impair intake and functional capacity. The systematic implementation of nutritional screening from the onset of treatment, using tools such as the PG-SGA and GLIM criteria, is essential for early detection and individualized management, improving therapy tolerance, clinical outcomes, and quality of life. Full article
(This article belongs to the Section Clinical Nutrition & Dietetics)
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19 pages, 2009 KB  
Review
Nutritional Status and Chemotherapy Completion in Resectable Pancreatic Cancer: A Narrative Review
by Naotake Funamizu, Mio Uraoka, Chihiro Ito, Miku Iwata, Akimasa Sakamoto, Yoshiaki Kamei and Yuzo Umeda
Curr. Oncol. 2025, 32(9), 519; https://doi.org/10.3390/curroncol32090519 - 17 Sep 2025
Viewed by 483
Abstract
In this review, we define “malnutrition” according to the Global Leadership Initiative on Malnutrition (GLIM) criteria (phenotypic and etiologic components) and “cachexia” as a multifactorial syndrome characterized by progressive skeletal muscle loss—unresponsive to conventional nutrition—and systemic inflammation (e [...] Full article
(This article belongs to the Section Gastrointestinal Oncology)
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14 pages, 1512 KB  
Article
Integrating Imaging and Nutrition: Chest CT Muscle Analysis in Adults with Cystic Fibrosis
by Virginia Soria-Utrilla, Ana Piñar-Gutiérrez, Francisco José Sánchez-Torralvo, Antonio Adarve-Castro, Nuria Porras, Andrés Jiménez-Sánchez, María Esther Quintana-Gallego, Casilda Olveira, María Victoria Girón, Gabriel Olveira and Pedro Pablo García-Luna
Nutrients 2025, 17(18), 2940; https://doi.org/10.3390/nu17182940 - 12 Sep 2025
Viewed by 411
Abstract
Background: Computed Tomography (CT) is considered a highly accurate tool for assessing body composition. The aim of this study is to assess the usefulness of chest CT for malnutrition diagnosis in people with cystic fibrosis (PwCF), compared with other body composition techniques, as [...] Read more.
Background: Computed Tomography (CT) is considered a highly accurate tool for assessing body composition. The aim of this study is to assess the usefulness of chest CT for malnutrition diagnosis in people with cystic fibrosis (PwCF), compared with other body composition techniques, as well as to assess possible associations with nutritional and respiratory status. Methods: A cross-sectional study was carried out in clinically stable adult PwCF. Subjects who had undergone a CT including the twelfth thoracic vertebra (T12) during the 6 months prior to or after our assessment were included and body composition was assessed using FocusedON-BC. The results were compared with anthropometry, bioelectrical impedance analysis (BIA), muscle ultrasonography, and handgrip strength (HGS). Respiratory parameters were collected, and nutritional status was assessed using Global Leadership Initiative on Malnutrition (GLIM) criteria. Results: A total of 55 PwCF were included. Muscle area assessed by CT correlated significantly with fat-free mass determined by BIA (r = 0.725) and anthropometry (r = 0.645), muscle mass evaluated by ultrasonography (r = 0.657), HGS (r = 0.593), Bhalla score (r = 0.403), and FEV1 (r = 0.488). Differences were observed when comparing muscle area in CT based on the Bhalla score (94.6 ± 21.1 cm2 in normal/mild involvement vs. 79.3 ± 20.9 cm2 in moderate/severe involvement; p = 0.009) and on nutritional status (96.3 ± 17.9 cm2 in normo-nourished vs. 75.9 ± 22.1 cm2 in malnourished; p < 0.001). Conclusions: In adult PwCF, measurements obtained from CT image analysis correlate adequately with anthropometry, BIA, muscle ultrasound, and HGS. Muscle area in CT is related to nutritional and respiratory status. Full article
(This article belongs to the Section Nutrition Methodology & Assessment)
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12 pages, 1603 KB  
Article
Impact of Prolonged Fasting and Refeeding on Enteroendocrine Hormone Expression: One More Piece of the Fasting/Refeeding Metabolic Puzzle
by Gonçalo Nunes, Marta Guimarães, Sofia B. Oliveira, Sofia S. Pereira, Francisco Vara-Luiz, Ivo Mendes, Carolina Palma, Cátia Oliveira and Jorge Fonseca
Biomedicines 2025, 13(9), 2088; https://doi.org/10.3390/biomedicines13092088 - 27 Aug 2025
Viewed by 1382
Abstract
Introduction: Prolonged fasting induces histological and ultrastructural changes of the intestinal mucosa that may reduce absorption in malnourished patients with high risk of refeeding syndrome. Endocrine function of the intestinal mucosa may be affected by starvation with potential implications for nutritional support. Objective: [...] Read more.
Introduction: Prolonged fasting induces histological and ultrastructural changes of the intestinal mucosa that may reduce absorption in malnourished patients with high risk of refeeding syndrome. Endocrine function of the intestinal mucosa may be affected by starvation with potential implications for nutritional support. Objective: The present study aims to evaluate the expression of gastrointestinal hormones in duodenal enteroendocrine cells (EECs) of patients after a long starvation period and to assess the changes in EEC hormonal expression after enteral refeeding in the same individuals. Methods: This was an observational prospective controlled study. Adult patients submitted to endoscopic gastrostomy (PEG) with an ingestion below 50% of daily needs for at least one month were enrolled. Duodenal biopsies were collected before gastrostomy (T0) and after 3–6 months of PEG feeding (T1). Biopsies underwent immunohistochemical analysis for chromogranin-A (CgA), neurotensin and incretin (GLP-1 and GIP) tissue expression. Normal duodenum biopsies were used as controls. Results: A total of 30 patients (16 men/14 women) aged 67.1 ± 13.5 years were included, and 14 patients completed follow-up at both periods (46.7%). Malnutrition was diagnosed in all patients according to GLIM criteria. T0 tissue expression defined by median stained area for CgA, GLP-1, and GIP were significantly higher in patients compared to controls (CgA: 1.04% vs. 0.41%; GLP-1: 0.17% vs. 0.03%; GIP: 0.19% vs. 0.03%) (p < 0.001) without differences for neurotensin (0.01%) (p = 0.96). T1 hormonal tissue expression was not significantly reduced after 3–6 months of enteral refeeding (p > 0.05). Conclusions: Prolonged fasting induces increased expression of incretins and chromogranin-A in the duodenum that probably reflect an adaptative response to maintain the anabolic insulin effect under nutritional deficiency. Hormonal expression does not normalize after PEG refeeding during a short period. Full article
(This article belongs to the Section Endocrinology and Metabolism Research)
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19 pages, 590 KB  
Review
Nutritional Status Assessment Tools in Cardiovascular Patients
by Izabela Jarosz, Kamil Gorecki, Grzegorz Kalisz and Joanna Popiolek-Kalisz
Nutrients 2025, 17(16), 2703; https://doi.org/10.3390/nu17162703 - 20 Aug 2025
Viewed by 988
Abstract
Background: Malnutrition is a prevalent but underrecognized condition in cardiovascular disease (CVD) patients, associated with adverse outcomes including longer hospitalizations, higher readmission rates, and increased mortality. Traditional measures such as body mass index (BMI) often fail to detect malnutrition, especially in patients with [...] Read more.
Background: Malnutrition is a prevalent but underrecognized condition in cardiovascular disease (CVD) patients, associated with adverse outcomes including longer hospitalizations, higher readmission rates, and increased mortality. Traditional measures such as body mass index (BMI) often fail to detect malnutrition, especially in patients with fluid retention, sarcopenia, or obesity. Methods: This review critically examines current tools used to assess nutritional status in CVD populations. Screening instruments such as Nutritional Risk Screening 2002 (NRS 2002), Mini Nutritional Assessment (MNA, MNA-SF), Malnutrition Universal Screening Tool (MUST), Subjective Global Assessment (SGA), and the Controlling Nutritional Status (CONUT) score are discussed, alongside diagnostic frameworks including the Global Leadership Initiative on Malnutrition (GLIM) criteria. The role of body composition assessment, particularly bioelectrical impedance analysis (BIA) and phase angle (PA), is also highlighted. Results: These tools differ in diagnostic performance and applicability, with many influenced by the pathophysiological features of CVD, such as inflammation, altered fluid balance, and pharmacotherapy. GLIM criteria provide a standardized two-step approach, combining phenotypic and etiologic factors, but require further validation in cardiology settings. Conclusions: A tailored, multimodal approach could be recommended: initial screening followed by confirmatory assessment using GLIM criteria and objective measures of muscle mass or cellular integrity. Clinicians should be aware of tool-specific limitations and interpret findings in the context of CVD-specific challenges. Full article
(This article belongs to the Special Issue Nutritional Aspects of Cardiovascular Disease Risk Factors)
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21 pages, 834 KB  
Article
Mismatch Between Perceived and Actual Dietary Nutrition in Hospitalized Cardiovascular Patients and Clinicians: A Cross-Sectional Assessment and Recommendations for Improvement
by Di Li, Jiaheng Han, Ye Peng, Xi Yu, Ying Xiao, Junxian Song and Peng Liu
Nutrients 2025, 17(16), 2624; https://doi.org/10.3390/nu17162624 - 13 Aug 2025
Viewed by 793
Abstract
Background: Multiple studies demonstrated that nutritional risk and malnutrition were associated with prolonged hospitalization, extended rehabilitation duration, and increased mortality among patients with cardiovascular diseases (CVD). However, current research on dietary behaviors and nutritional status in hospitalized CVD patients remains insufficient. Objective: This [...] Read more.
Background: Multiple studies demonstrated that nutritional risk and malnutrition were associated with prolonged hospitalization, extended rehabilitation duration, and increased mortality among patients with cardiovascular diseases (CVD). However, current research on dietary behaviors and nutritional status in hospitalized CVD patients remains insufficient. Objective: This study systematically evaluated the concordance between cardiology inpatients’ and clinicians’ subjective nutritional status assessments and objective energy and protein intake achievement rates, while comprehensively investigating the multidimensional associations among Nutritional Risk Screening 2002 (NRS 2002), Global Leadership Initiative on Malnutrition (GLIM), blood parameters, and dietary intake. Methods: This study adopted a cross-sectional design to investigate hospitalized patients in the department of cardiology. Dietary knowledge and behavior data were collected through questionnaires, and actual dietary intake was recorded. Nutritional risk assessment and malnutrition diagnosis were performed for all inpatients. Differences between subjective evaluations and actual intake were compared, and the correlation between blood biochemical indicators and nutritional status was analyzed. Results: The study enrolled 618 valid cases, with male and female patients accounting for 67.48% and 32.52%, respectively. The patients’ age was 61.89 ± 12.88 years. The NRS 2002 score was 3.01 ± 0.94, with 132 inpatients diagnosed with malnutrition according to GLIM criteria. Energy and protein intake reached only 63.09 ± 18.23% and 74.98 ± 22.86% of target values, respectively. NRS 2002 showed significant correlations with estimated glomerular filtration rate (eGFR), C-reactive protein (CRP), albumin (ALB), etc. No significant difference was found between physician and inpatient evaluations (χ2 = 1.465, p < 0.05). Both ordinal and multivariable logistic regression analyses demonstrated significant discrepancies between subjective assessments (inpatient perceptions and physician evaluations) and objective energy and protein intake levels (p < 0.05). Conclusions: Hospitalized cardiovascular patients commonly exhibited insufficient nutritional intake and limited dietary awareness. A mismatch existed between patient/clinician perceptions and objectively assessed nutritional intake. Subjective evaluations could not accurately reflect actual nutritional status, necessitating enhanced nutritional monitoring—including nutritional risk screening, biochemical testing, and dietary surveys—along with personalized interventions. Future efforts should enhance collaboration between clinicians and dietitians to improve patients’ nutritional status and clinical prognosis. Full article
(This article belongs to the Section Clinical Nutrition)
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14 pages, 536 KB  
Article
Malnutrition and Frailty as Independent Predictors of Adverse Outcomes in Hospitalized Older Adults: A Prospective Single Center Study
by Abdurrahman Sadıç, Zeynep Şahiner, Mert Eşme, Cafer Balcı, Burcu Balam Doğu, Mustafa Cankurtaran and Meltem Gülhan Halil
Medicina 2025, 61(8), 1354; https://doi.org/10.3390/medicina61081354 - 26 Jul 2025
Viewed by 698
Abstract
Background and Objectives: Adverse clinical outcomes are associated with malnutrition and frailty, which are highly prevalent among hospitalized older patients. This study aimed to evaluate their predictive value for the duration of hospitalization, short-term survival, and rehospitalization of patients admitted to internal medicine [...] Read more.
Background and Objectives: Adverse clinical outcomes are associated with malnutrition and frailty, which are highly prevalent among hospitalized older patients. This study aimed to evaluate their predictive value for the duration of hospitalization, short-term survival, and rehospitalization of patients admitted to internal medicine wards. Materials and Methods: This prospective cohort study included 134 acutely ill patients aged ≥50 years who were hospitalized in an internal medicine department and evaluated within the first 48 h of admission. Nutritional status was evaluated using the Mini nutritional assessment–short form (MNA-SF), Nutritional Risk Screening 2002 (NRS-2002), and Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty was evaluated using the FRAIL scale and Clinical Frailty Scale (CFS). The primary outcomes were prolonged hospitalization (>10 days), mortality, and rehospitalization at 3 and 6 months post-discharge. Results: According to MNA-SF, 33.6% of patients were malnourished; 44% had nutritional risk per NRS-2002, and 44.8% were malnourished per GLIM. Frailty prevalence was 53.7% (FRAIL) and 59% (CFS). Malnutrition defined by all three scales (MNA-SF, NRS-2002, GLIM) was significantly associated with prolonged hospitalization (p = 0.043, 0.014, and 0.023, respectively), increased rehospitalization at both 3 months (p < 0.001) and 6 months (p < 0.001). Mortality was also significantly higher among malnourished patients. Higher CFS scores and low handgrip strength were additional predictors of adverse outcomes (p < 0.05). In multivariable analysis, GLIM-defined malnutrition and CFS remained independent predictors of rehospitalization and mortality. Conclusions: Frailty and malnutrition are highly prevalent and independently associated with prolonged hospital stay, short-term rehospitalization and mortality. Routine screening at admission may facilitate early identification and guide timely interventions to improve patient outcomes. These findings might guide hospital protocols in aging health systems and support the development of standardized geriatric care pathways. Full article
(This article belongs to the Section Epidemiology & Public Health)
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16 pages, 508 KB  
Article
Prognostic Value of Computed Tomography-Derived Muscle Density for Postoperative Complications in Enhanced Recovery After Surgery (ERAS) and Non-ERAS Patients
by Fiorella X. Palmas, Marta Ricart, Amador Lluch, Fernanda Mucarzel, Raul Cartiel, Alba Zabalegui, Elena Barrera, Nuria Roson, Aitor Rodriguez, Eloy Espin-Basany and Rosa M. Burgos
Nutrients 2025, 17(14), 2264; https://doi.org/10.3390/nu17142264 - 9 Jul 2025
Viewed by 1055
Abstract
Background: Prehabilitation programs improve postoperative outcomes in vulnerable patients undergoing major surgery. However, current screening tools such as the Malnutrition Universal Screening Tool (MUST) may lack the sensitivity needed to identify those who would benefit most. Muscle quality assessed by Computed Tomography [...] Read more.
Background: Prehabilitation programs improve postoperative outcomes in vulnerable patients undergoing major surgery. However, current screening tools such as the Malnutrition Universal Screening Tool (MUST) may lack the sensitivity needed to identify those who would benefit most. Muscle quality assessed by Computed Tomography (CT), specifically muscle radiodensity in Hounsfield Units (HUs), has emerged as a promising alternative for risk stratification. Objective: To evaluate the prognostic performance of CT-derived muscle radiodensity in predicting adverse postoperative outcomes in colorectal cancer patients, and to compare it with the performance of the MUST score. Methods: This single-center cross-sectional study included 201 patients with non-metastatic colon cancer undergoing elective laparoscopic resection. Patients were stratified based on enrollment in a multimodal prehabilitation program, either within an Enhanced Recovery After Surgery (ERAS) protocol or a non-ERAS pathway. Nutritional status was assessed using MUST, SARC-F questionnaire (strength, assistance with walking, rise from a chair, climb stairs, and falls), and the Global Leadership Initiative on Malnutrition (GLIM) criteria. CT scans at the L3 level were analyzed using automated segmentation to extract muscle area and radiodensity. Postoperative complications and hospital stay were compared across nutritional screening tools and CT-derived metrics. Results: MUST shows limited sensitivity (<27%) for predicting complications and prolonged hospitalization. In contrast, CT-derived muscle radiodensity demonstrates higher discriminative power (AUC 0.62–0.69), especially using a 37 HU threshold. In the non-ERAS group, patients with HU ≤ 37 had significantly more complications (33% vs. 15%, p = 0.036), longer surgeries, and more severe events (Clavien–Dindo ≥ 3). Conclusions: Opportunistic CT-based assessment of muscle radiodensity outperforms traditional screening tools in identifying patients at risk of poor postoperative outcomes, and may enhance patient selection for prehabilitation strategies like the ERAS program. Full article
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16 pages, 396 KB  
Article
Malnutrition and Osteosarcopenia in Elderly Women with Rheumatoid Arthritis: A Dual Clinical Perspective
by Joan M. Nolla, Carmen Moragues, Lidia Valencia-Muntalà, Laia de Daniel-Bisbe, Laura Berbel-Arcobé, Diego Benavent, Paola Vidal-Montal, Antoni Rozadilla, Javier Narváez and Carmen Gómez-Vaquero
Nutrients 2025, 17(13), 2186; https://doi.org/10.3390/nu17132186 - 30 Jun 2025
Viewed by 904
Abstract
Background/Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory disease frequently accompanied by comorbid conditions that contribute to disability and worsen long-term outcomes. Among these, malnutrition and osteosarcopenia remain under-recognised. This cross-sectional study aimed to assess the prevalence of malnutrition and osteosarcopenia among [...] Read more.
Background/Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory disease frequently accompanied by comorbid conditions that contribute to disability and worsen long-term outcomes. Among these, malnutrition and osteosarcopenia remain under-recognised. This cross-sectional study aimed to assess the prevalence of malnutrition and osteosarcopenia among elderly women with RA and explore the clinical impact of these conditions. Methods: Sixty-five women over 65 years with RA were evaluated using Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and EWGSOP2-based assessments for sarcopenia; bone status was measured by dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and three-dimensional DXA (3D-DXA). Results: Malnutrition was identified in 49.2% and osteosarcopenia in 52.3% of participants. A significant bidirectional association was observed: malnourished patients had higher rates of osteosarcopenia (65.6% vs. 34.4%; p < 0.05), and osteosarcopenic patients were more frequently malnourished (61.8% vs. 39.1%; p < 0.05). Both conditions were associated with older age, lower body mass index (BMI), impaired muscle parameters, and reduced bone mineral density. Malnourished and osteosarcopenic patients reported worse fatigue and lower physical quality of life, despite similar inflammatory activity. Significant correlations were found between muscle mass indices and bone quality metrics assessed by 3D-DXA. These findings highlight a substantial burden of malnutrition and osteosarcopenia in elderly women with RA, even with well-controlled disease despite similar inflammatory activity (mean Disease Activity Score 28: 2.8 ± 1.0; 43.1% in remission. Conclusions: There is a substantial burden of malnutrition and osteosarcopenia in elderly women with RA that support the integration of systematic nutritional and musculoskeletal screening into routine care. Future studies should evaluate age- and disease-specific mechanisms and assess the benefit of multidisciplinary strategies to prevent frailty and improve long-term outcomes. Full article
(This article belongs to the Section Clinical Nutrition)
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13 pages, 237 KB  
Article
Nutritional and Morphofunctional Assessment in a Cohort of Adults Living with Cystic Fibrosis with or Without Pancreatic Exocrine and/or Endocrine Involvement
by Ana Piñar-Gutiérrez, José Luis Pereira-Cunill, Andrés Jiménez-Sánchez, Silvia García-Rey, María del Carmen Roque-Cuéllar, Antonio J. Martínez-Ortega, Irene González-Navarro, Esther Quintana-Gallego, Ángeles Pizarro, Francisco Javier Castell, Manuel Romero-Gómez and Pedro Pablo García-Luna
Nutrients 2025, 17(13), 2057; https://doi.org/10.3390/nu17132057 - 20 Jun 2025
Viewed by 537
Abstract
Objectives: To describe the results of nutritional and morphofunctional assessment in a cohort of adults with cystic fibrosis; to evaluate differences in nutritional status between patients with and without exocrine and/or endocrine pancreatic involvement. Methods: Cross-sectional study: A cohort of adults [...] Read more.
Objectives: To describe the results of nutritional and morphofunctional assessment in a cohort of adults with cystic fibrosis; to evaluate differences in nutritional status between patients with and without exocrine and/or endocrine pancreatic involvement. Methods: Cross-sectional study: A cohort of adults with cystic fibrosis evaluated in a multidisciplinary unit was analyzed. Pancreatic status was examined, and malnutrition was diagnosed according to GLIM criteria. Morphofunctional assessment consisted of nutritional ultrasound, bioelectrical impedance, handgrip dynamometry, and anthropometry. Qualitative variables are expressed as n (%), quantitative variables as median (IQR). For group comparisons, Fisher’s exact test was used for qualitative variables and the non-parametric median comparison test for quantitative variables. Results: n = 101 participants were recruited, of whom 44 (43.6%) were women. Median age was 33 (25–40.5) years. A total of 64 participants (63.4%) had exocrine pancreatic insufficiency (EPI), 44 (43.6%) had endocrine pancreatic insufficiency, and 28 (27.7%) had cystic fibrosis-related diabetes (CFRD). Median BMI was 23.4 (20.1–24.89) kg/m2. A total of 48 patients (47.5%) were malnourished. Males with EPI had a higher prevalence of undernourishment than those without (56.4% vs. 16.7%, p = 0.005), but not women. CFRD patients displayed no differences in morphofunctional assessment. Conclusions: Almost half the sample was undernourished using GLIM criteria. Males with exocrine pancreatic insufficiency had worse nutritional status. Endocrine pancreatic involvement did not affect nutritional status. Full article
(This article belongs to the Section Clinical Nutrition)
16 pages, 2548 KB  
Article
Combined Predictive Value of GLIM-Defined Malnutrition and Preoperative Adipose Tissue 18F-FDG Uptake for Recurrence-Free Survival After Radical Gastrectomy in Patients with Gastric Cancer
by Xuan Zhou, Kailai Yin, Huanhuan Hong, Heqing Yi and Linfa Li
Curr. Oncol. 2025, 32(6), 363; https://doi.org/10.3390/curroncol32060363 - 19 Jun 2025
Viewed by 557
Abstract
Background: The Global Leadership Initiative on Malnutrition (GLIM) criteria provide a standardized approach for assessing the nutritional status of patients and demonstrate strong predictive value for the prognosis of patients with gastric cancer. However, these criteria do not incorporate indicators of adipose tissue [...] Read more.
Background: The Global Leadership Initiative on Malnutrition (GLIM) criteria provide a standardized approach for assessing the nutritional status of patients and demonstrate strong predictive value for the prognosis of patients with gastric cancer. However, these criteria do not incorporate indicators of adipose tissue metabolic activity, which may reflect pro-tumor microenvironmental factors. This study investigated the combined predictive value of malnutrition, defined by the GLIM criteria, and preoperative adipose tissue 18F-fluorodeoxyglucose (18F-FDG) uptake for recurrence-free survival (RFS) in patients with gastric cancer following radical surgery. Methods: A total of 105 patients were retrospectively enrolled and classified into malnourished and non-malnourished groups based on the GLIM criteria. Preoperative 18F-FDG positron emission tomography/computed tomography (18F-FDG PET/CT) was used to measure the mean standardized uptake value (SUVmean) of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). The predictive values of these indicators for RFS in patients with gastric cancer were assessed. Results: Multivariate survival analysis was used to identify GLIM-defined malnutrition (p = 0.020) and increased preoperative VAT SUVmean (p = 0.042) as independent risk factors for RFS. The combined analysis revealed that patients with both malnutrition and a high preoperative VAT SUVmean had the poorest RFS (HR = 18.41, p < 0.001). The predictive model integrating GLIM criteria and VAT SUVmean outperformed the GLIM criteria alone. Conclusions: This study demonstrated that combining malnutrition defined by the GLIM criteria with preoperative visceral adipose tissue 18F-FDG uptake optimizes recurrence risk stratification and exhibits superior prognostic predictive efficacy compared to using the GLIM criteria alone. This approach provides new insights into individualized prognostic assessment and intervention strategies. Full article
(This article belongs to the Section Gastrointestinal Oncology)
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20 pages, 1238 KB  
Article
Association of Oral Frailty with Physical Frailty and Malnutrition in Patients on Peritoneal Dialysis
by Yu Kobayashi, Tomomi Matsuoka, Ryo Yamaguchi, Kiyomi Ichijo, Miya Suzuki, Tomoyuki Saito, Kimihiro Igarashi, Tokiko Sato, Hiroyuki Takashima and Masanori Abe
Nutrients 2025, 17(12), 1950; https://doi.org/10.3390/nu17121950 - 6 Jun 2025
Viewed by 1241
Abstract
Background: Oral frailty is a state between normal oral function and oral hypofunction. Oral frailty progresses to oral hypofunction and dysphagia, which leads to malnutrition, and then to physical frailty and sarcopenia. Oral frailty is reported to be associated with physical frailty [...] Read more.
Background: Oral frailty is a state between normal oral function and oral hypofunction. Oral frailty progresses to oral hypofunction and dysphagia, which leads to malnutrition, and then to physical frailty and sarcopenia. Oral frailty is reported to be associated with physical frailty and malnutrition in hemodialysis patients, but there have been no reports on peritoneal dialysis (PD) patients. Methods: This prospective cohort study investigated the associations of oral frailty with physical frailty, sarcopenia, and malnutrition in patients on PD. Patients were divided into an oral frailty group and a non-oral frailty group according to the Oral Frailty Index-8. Patients were assessed for physical frailty, sarcopenia, and malnutrition at baseline and 1 year later, and changes in each measure were compared between the two groups. Physical frailty was assessed using the Revised Japanese version of the Cardiovascular Health Study Criteria (Revised J-CHS) and the FRAIL scale. Sarcopenia was assessed using the diagnostic criteria reported by the Asian Working Group for Sarcopenia in 2019 (AWGS2019 criteria) and the Screening Tool for Sarcopenia Combined with Calf Circumference (SARC-CalF), skeletal muscle index (SMI), calf circumference (CC), grip strength, and gait speed. Nutritional status was assessed with the Short-Form Mini-Nutritional Assessment (MNA-SF), the Malnutrition Universal Screening Tool (MUST), the Global Leadership Initiative on Malnutrition (GLIM) criteria, weight, and body mass index (BMI). Results: Of the 58 eligible patients, 51 completed the study. The oral frailty group was significantly older and had slower gait speed, fewer teeth, higher intact parathyroid hormone, higher C-reactive protein, higher frequency of cardiovascular disease, and lower employment at baseline. The oral frailty group had significantly worse physical frailty (Revised J-CHS, p = 0.047; FRAIL scale, p = 0.012), sarcopenia (SMI, p = 0.018; CC, p = 0.002), and nutritional status (MNA-SF, p = 0.029; MUST, p = 0.005; GLIM criteria, p = 0.022; weight, p < 0.001; BMI, p < 0.001). However, there were no significant differences in the worsening of sarcopenia (AWGS2019 criteria, SARC-CalF, grip strength, and gait speed). Conclusions: Oral frailty in patients on PD was associated with the development and progression of physical frailty and malnutrition, and may be associated with the development and progression of sarcopenia. Full article
(This article belongs to the Section Clinical Nutrition)
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14 pages, 482 KB  
Article
Malnutrition, Sarcopenia, and Malnutrition Sarcopenia Syndrome in Idiopathic Pulmonary Fibrosis
by Eva Cabrera-César, Rocío Fernández-Jiménez, Javier Lopez-Garcia, Alicia Sanmartín-Sánchez, Miguel Benítez Cano-Gamonoso, Isabel Asschert Agüero, Francisco Espíldora-Hernández, Luis Fernandez de Rota Garcia, Isabel Vega-Aguilar, Maria del Mar Amaya-Campos, Francisco J. Tinahones, Jose Manuel Garcia-Almeida and Jose Luis Velasco-Garrido
Adv. Respir. Med. 2025, 93(3), 11; https://doi.org/10.3390/arm93030011 - 29 May 2025
Viewed by 1114
Abstract
Introduction: Idiopathic pulmonaryy fibrosis (IPF) is a progressive interstitial lung disease with a poor prognosis. While comorbidities like pulmonary hypertension and lung cancer have been studied extensively, less attention has been paid to the implications of malnutrition and sarcopenia in patients with IPF. [...] Read more.
Introduction: Idiopathic pulmonaryy fibrosis (IPF) is a progressive interstitial lung disease with a poor prognosis. While comorbidities like pulmonary hypertension and lung cancer have been studied extensively, less attention has been paid to the implications of malnutrition and sarcopenia in patients with IPF. This study aimed to assess the prevalence of malnutrition, sarcopenia, and the combined malnutrition-sarcopenia syndrome in patients with IPF using the latest diagnostic criteria from the Global Leadership Initiative on Malnutrition (GLIM) and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Methods: A prospective, observational, multicenter study was conducted, focusing on patients with idiopathic pulmonary fibrosis (IPF). All participants provided informed consent, and the study followed ethical guidelines. Malnutrition was diagnosed based on the GLIM criteria, requiring one phenotypic and one etiological criterion, with muscle mass assessed via bioelectrical impedance analysis (BIA). Sarcopenia was screened following the EWGSOP2 recommendations. The statistical analysis was performed using JAMOVI version 2.3.22, with significance set at p < 0.05. Results: The findings revealed that 77.65% of the participants were malnourished, and 20% had sarcopenia. The malnourished patients had significantly lower body weight, height, and muscle mass compared to the non-malnourished patients. Furthermore, the patients with malnutrition exhibited poorer health-related quality of life scores. This study also identified the malnutrition-sarcopenia syndrome in 8.23% of the participants. Conclusions: Malnutrition, based on the GLIM criteria was identified in three out of four patients with IPF, while sarcopenia according to the EWGSOP2 was present in one out of five. This study underscores the necessity for routine screening for malnutrition and sarcopenia in patients with IPF. Full article
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20 pages, 1085 KB  
Article
Nutritional and Physical Rehabilitation in Post-Critical Coronavirus Disease 2019 (COVID-19) Ambulatory Patients: The NutriEcoMuscle Study
by Clara Joaquín, Irene Bretón, María Julia Ocón-Bretón, Alba Zabalegui, Diego Bellido, Pilar Matía Martín, Miguel Ángel Martínez-Olmos, Ana Zugasti, María Riestra, Francisco Botella and José Manuel García-Almeida
Nutrients 2025, 17(10), 1722; https://doi.org/10.3390/nu17101722 - 20 May 2025
Cited by 1 | Viewed by 1143
Abstract
Background: The prevalence of malnutrition is high in post-intensive care unit (ICU) coronavirus disease 2019 (COVID-19) patients during hospitalization and after hospital discharge. This paper presents prospective results from the NutriEcoMuscle study, a multicenter observational study. The study aimed to evaluate changes [...] Read more.
Background: The prevalence of malnutrition is high in post-intensive care unit (ICU) coronavirus disease 2019 (COVID-19) patients during hospitalization and after hospital discharge. This paper presents prospective results from the NutriEcoMuscle study, a multicenter observational study. The study aimed to evaluate changes in nutritional and functional status in post-ICU COVID-19 patients following nutritional and physical rehabilitation interventions. Secondary aims included assessing adherence to and tolerance of the oral nutritional supplement (ONS) used in the nutritional intervention. Methods: The study enrolled adults who had been admitted to the ICU due to severe COVID-19. At hospital discharge, the patients underwent a nutritional intervention based on oral nutritional supplements (ONSs) with 100% serum lactoprotein enriched with leucine and vitamin D and a physical rehabilitation program. They were followed up during three months. Performed assessments included Subjective Global Assessment (SGA), Global Leadership Initiative on Malnutrition (GLIM) criteria, Barthel index (BI), handgrip strength and Timed Up and Go test, bioelectrical impedance analysis (BIA), nutritional ultrasound (US), and tolerance and adherence to ONS. Sample size was calculated based on handgrip strength, and parametric and non-parametric tests were used to assess differences between the baseline and three-month outcomes. Results: The study included 96 patients (71.9% male, mean age 58.8 years, mean body mass index (BMI) of 28.8 kg/m2, 36.5% obese). A total of 85 patients (62 men and 23 women) completed the 90-day follow-up. The mean weight gain after the intervention was 6.8 (SD 5.2) kg (similar in men and women; p = 0.263). The proportion of patients with malnutrition according to the SGA or GLIM criteria decreased from 100% to 11.8% and 36.4%, respectively (p < 0.00001 in both cases). The proportion of patients with functional limitations by BI decreased from 66.7% to 27.0% (p < 0.0001). Handgrip strength increased more than 40% in both men and women (p < 0.00001). The time to perform the Timed Up and Go (TUG) test decreased more than 40% in both men and women (p < 0.00001). According to BIA, the mean fat mass did not increase significantly in either men or women. The mean fat-free mass index (FFMI) increased significantly in both men and women. There were also significant increases in body cell mass, skeletal muscle mass index, and appendicular skeletal muscle mass index. The phase angle (PhA) increased significantly in both men (26.5%) and women (17.4%). In a multivariate analysis, age and baseline PhA were related to the PhA increase (adjusted R2 = 0.5573). The US study showed a significant increase in the mean measurements of muscle area, muscle circumference, X-axis, and Y-axis in the rectus femoris. Regarding abdominal fat, there were no significant increases in total, superficial, or preperitoneal adipose tissue by US. Participants engaged in a median interquartile range (IQR) of 70 (0–120) min/week of strength exercise and 60 (0–120) min/week of moderate physical exercise. The supplement was well tolerated, and poor adherence (less than 50%) was low (4% of the participants). Conclusions: A three-month intervention, including ONS and physical rehabilitation, is associated with a significant improvement in nutritional and functional status. Patients gained weight primarily by increasing their muscle mass. There was no significant increase in fat mass, as measured by BIA or US. The intervention was well tolerated and had good adherence. Full article
(This article belongs to the Section Nutritional Epidemiology)
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20 pages, 267 KB  
Article
Crohn’s Disease Patients Referred for Home Parenteral Nutrition—A Comprehensive Analysis of 18 Years’ Experience at a National Reference Centre
by Sandra Banasiak, Mariusz Panczyk, Jacek Sobocki and Zuzanna Zaczek
Nutrients 2025, 17(10), 1697; https://doi.org/10.3390/nu17101697 - 16 May 2025
Viewed by 872
Abstract
Background: Within 10 years of diagnosis, about 50% of patients with Crohn’s disease (CD) require surgery. Repeated small bowel resections can lead to the development of short bowel syndrome (SBS). It is estimated that 65–75% of CD patients are malnourished. This retrospective [...] Read more.
Background: Within 10 years of diagnosis, about 50% of patients with Crohn’s disease (CD) require surgery. Repeated small bowel resections can lead to the development of short bowel syndrome (SBS). It is estimated that 65–75% of CD patients are malnourished. This retrospective observational study was conducted in a Polish reference centre for home parenteral nutrition (HPN). The aim of the study was to investigate the nutritional status and characteristics of patients with CD referred to HPN and to analyse the course of their HPN treatment. Methods: The study group consisted of all adult patients (N = 46) with CD who qualified for HPN between November 2004 and April 2022. Results: The most common indication for HPN was SBS (n = 27; 58.70%), followed by ineffective gastrointestinal nutrition causing progressive malnutrition (N = 9; 19.57%), fistulas (N = 6; 13.04%), and short bowel syndrome and fistulas (N = 4; 8.70%). According to the results of Subjective Global Assessment (SGA), 47.83% (N = 22) of patients were diagnosed with severe malnutrition, followed by 15 patients (32.61%) with moderate malnutrition. Global Leadership Initiative on Malnutrition (GLIM) criteria showed that 71.73% (n = 33) of patients were malnourished on admission to the HPN centre. All patients received parenteral formulas based on individually tailored prescriptions. The results showed that patients with a stoma received statistically significantly higher PN volumes (p = 0.027) and higher amounts of amino acids (p = 0.046) and fat emulsion (p = 0.046). Septic complications were twice as common as mechanical or metabolic complications, although 43.47% of patients had no complications. At the time of data analysis, 19 patients (41.30%) had been successfully weaned from HPN, of whom 12 (26%) achieved nutritional autonomy after 136–1419 days (mean: 560 ± 380.9). Conclusions: Malnutrition is a major problem in CD patients, especially those with SBS. Early nutritional intervention and consideration of artificial nutrition in this study group (HPN) are necessary to prevent the long-term consequences of severe malnutrition. To our knowledge, this was the first study to report on Crohn’s patients referred to long-term HPN. Further studies are needed to assess the impact of HPN on functional, laboratory, and anthropometric outcomes with a view to optimising treatment outcomes. Full article
(This article belongs to the Special Issue Nutritional Strategies in Inflammatory Bowel Disease)
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