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Keywords = malnutrition risk

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18 pages, 2895 KB  
Study Protocol
Multifaceted Nutrition Intervention for Frail Elderly in the Community: Protocol of a Randomized Controlled Trial (The MINUTE Study)
by Yaxin Han, Haohao Zhang, Meng Sun, Yuxin Ma, Yahui Tu, Jiajing Tian, Rui Fan, Wenli Zhu and Zhaofeng Zhang
Nutrients 2025, 17(20), 3213; https://doi.org/10.3390/nu17203213 - 13 Oct 2025
Abstract
Background: The rapid aging of China’s population poses significant challenges, particularly in public health and medical services. Frailty, a reversible geriatric syndrome, is a critical intervention target for disability prevention among older adults. Objective: We hypothesize that both intervention groups will demonstrate significant [...] Read more.
Background: The rapid aging of China’s population poses significant challenges, particularly in public health and medical services. Frailty, a reversible geriatric syndrome, is a critical intervention target for disability prevention among older adults. Objective: We hypothesize that both intervention groups will demonstrate significant improvements in Short Physical Performance Battery (SPPB) scores compared to the control group, and that these improvements will be accompanied by parallel reductions in inflammatory markers and beneficial alterations in the gut microbiota. Methods: The MultIfaceted NUtrition inTervention for frail Elderly (MINUTE) trial is a randomized, parallel-group controlled trial. In Beijing, China, 315 frail older adults were recruited and randomly assigned to 3 groups: a control group receiving routine community health management only, multifaceted nutrition intervention group, and a multifaceted nutrition and exercise combined intervention group, each comprising 105 participants. The study consists of a three-month intervention period followed by a nine-month follow-up. During the three-month intervention period, the control group receives routine community health management, while the multifaceted nutrition intervention group receives daily dietary guidance, personalized nutrition consultations, and health education. Additionally, the combined intervention group receives exercise interventions in addition to the nutritional components. After the three-month intervention, all three groups will be followed up for nine months to assess the sustainability of the study. Results: The primary outcomes are the changes in the SPPB scores. The secondary outcomes include frailty scores, intrinsic capacity, malnutrition risk, frailty recovery rates, serum differential metabolites, inflammatory factors, and gut microbiota changes. This study aims to establish a scalable and sustainable pathway for frailty prevention among community-dwelling older adults in China and provide valuable insights to inform strategies for healthy aging. Trial registration: This study is conducted in accordance with the Declaration of Helsinki and approved by the Peking University Institutional Review Board (IRB00001052-23178) on February 3, 2024, with all amendments subject to prior review and approval. Informed consent is obtained from participants, and findings will be disseminated through peer-reviewed publications, conference presentations, and summaries for school staff and participants. ClinicalTrials.gov (NCT06547593) registered 30 July 2024. Full article
(This article belongs to the Section Geriatric Nutrition)
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19 pages, 1721 KB  
Article
Effect of Calcium Hydroxy-Methyl-Butyrate-Enriched Diabetes-Specific Oral Nutritional Supplementation on Patients with Heterogeneous Diabetes Mellitus Population with Disease Related Malnutrition Assessed with AI-Assisted Ultrasound Imaging
by Juan J. López-Gómez, Jaime González-Gutiérrez, Paloma Pérez-López, Olatz Izaola-Jauregui, Ángela Cebriá, Lucía Estévez-Asensio, David Primo-Martín, Mario Alfredo Saavedra-Vasquez, Beatriz Ramos-Bachiller, Daniel Rico-Bargues, Eduardo Jorge Godoy and Daniel Antonio De Luis-Román
Nutrients 2025, 17(20), 3208; https://doi.org/10.3390/nu17203208 - 13 Oct 2025
Abstract
Background/Objectives: Sarcopenia is common in patients with diabetes mellitus. The use of branched-chain amino acids may influence muscle mass. The aim of this study is to evaluate the effect of a diabetes-specific formula enriched with calcium hydroxy-methyl-butyrate (CaHMB) on muscle mass in [...] Read more.
Background/Objectives: Sarcopenia is common in patients with diabetes mellitus. The use of branched-chain amino acids may influence muscle mass. The aim of this study is to evaluate the effect of a diabetes-specific formula enriched with calcium hydroxy-methyl-butyrate (CaHMB) on muscle mass in patients with diabetes and high risk of malnutrition. Methods: A prospective observational study in 95 patients divided into two cohorts of patients with diabetes, treated with a tailored diet, dietary counseling, and diabetes-specific oral nutritional supplements (ONSs) administered between meals: one enriched with CaHMB (CaHMB Diabetes ONS) 44 (46.32%) patients; and another without CaHMB (Diabetes-Specific ONS) 51 (53.68%) patients. Anthropometric parameters, bioimpedance, artificial intelligence (AI)-assisted ultrasound of the rectus femoris muscle (PIIXMEDTM), and handgrip strength were assessed. Evaluations were conducted at baseline and after 3 months. Results: The mean age was 71.05 (10.67) years; 56.8% were male. After three months, both groups increased their nutritional intake with no differences in dietary protein content between groups. The CaHMB group showed a greater increase in muscle mass as measured by ultrasound, both in muscle area (CaHMB ONS: +5.84 (−3.3 ± 21.58)% vs. Diabetes-Specific ONS: −9.34% (−25.78 ± 12.02)%; p < 0.01) and muscle thickness (CaHMB ONS: +9.17 (−4.40 ± 21.05)% vs. Diabetes-Specific ONS −6.30 (−18.57 ± 12.56)%; p < 0.01). The CaHMB ONS group showed a higher likelihood of increased muscle mass compared to the Diabetes-Specific ONS, with an odds ratio (OR) of 9.31 (95%CI: 2.16–40.13) for thickness and 3.96 (95%CI: 1.11–14.13) for area, adjusted for gender, age, serum albumin, and baseline glycated hemoglobin. Conclusions: Supplementation with Ca-HMB in patients with diabetes and high risk of malnutrition showed significant improvements in muscle mass as assessed by AI-assisted ultrasound. Both groups increased nutritional intake, but only the CaHMB group showed specific benefits in muscle parameters. Full article
(This article belongs to the Special Issue Dietary Recommendations for Clinical Patients After Diagnosis)
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11 pages, 842 KB  
Article
Integrating Nutrition, Inflammation, and Immunity: The CALLY Index as a Novel Prognostic Biomarker in Acute Geriatric Care
by Francesca Mancinetti, Anna Giulia Guazzarini, Martina Gaspari, Michele Francesco Croce, Rocco Serra, Patrizia Mecocci and Virginia Boccardi
Nutrients 2025, 17(20), 3192; https://doi.org/10.3390/nu17203192 - 10 Oct 2025
Viewed by 182
Abstract
Background/Objectives: Malnutrition, systemic inflammation, and immune dysfunction are key determinants of adverse outcomes in older adults following acute illness. Composite biomarkers integrating these domains could enhance early risk stratification. This study investigates, for the first time in acute geriatric care, the prognostic value [...] Read more.
Background/Objectives: Malnutrition, systemic inflammation, and immune dysfunction are key determinants of adverse outcomes in older adults following acute illness. Composite biomarkers integrating these domains could enhance early risk stratification. This study investigates, for the first time in acute geriatric care, the prognostic value of the C-reactive protein–albumin–lymphocyte (CALLY) index—a composite marker of nutritional, inflammatory, and immune status—in predicting short-term survival. Methods: We retrospectively analyzed 264 patients admitted to the acute geriatrics ward of Santa Maria della Misericordia Hospital in Perugia. The CALLY index was calculated as: (Albumin × Lymphocytes)/(CRP × 104). The optimal prognostic cut-off was determined using receiver operating characteristic (ROC) curve analysis. Three-month survival was assessed by Kaplan–Meier analysis. Results: The cohort included 167 women (63.3%) and 97 men (36.7%), with a mean age of 88.0 ± 6.4 years. At 3-month follow-up, 80 patients (30.3%) had died. The CALLY index showed an area under the ROC curve of 0.647 (95% CI: 0.576–0.718; p < 0.001), with a cut-off of 0.055 (sensitivity: 68.5%, specificity: 46.3%). Among deceased patients, 42.5% had a CALLY index <0.055. After multivariable adjustment, a lower CALLY index remained independently associated with increased mortality (B = −0.805; OR = 0.45; 95% CI: 0.215–0.930; p = 0.031). Kaplan–Meier analysis demonstrated significantly higher survival in patients with a CALLY index ≥ 0.055 (Log-rank test: 13.71; p < 0.001). Conclusions: The CALLY index shows a modest but statistically significant discriminative ability for predicting short-term mortality in acutely ill older adults. As a simple, low-cost marker derived from routine laboratory tests, it holds potential for integration into clinical workflows to guide nutritional, metabolic, and prognostic management strategies in geriatric acute care. Full article
(This article belongs to the Special Issue Nutritional Support for Critically Ill Patients)
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14 pages, 659 KB  
Article
CGM-Based Glycemic Metrics Support Estimating Nutritional Risk After Total Pancreatectomy: An Exploratory Retrospective Study
by Ryoma Nakamura, Miyuki Yanagimachi, Kento Mitsuhashi, Masato Yamaichi, Wataru Onodera, Atsufumi Matsumoto, Eri Sato, Yusuke Tando and Yukihiro Fujita
J. Clin. Med. 2025, 14(19), 7124; https://doi.org/10.3390/jcm14197124 - 9 Oct 2025
Viewed by 166
Abstract
Introduction: After total pancreatectomy, patients inevitably develop pancreatogenic diabetes with marked glycemic variability and high risk of malnutrition due to both endocrine and exocrine insufficiency. Weight loss and malnutrition can occur even in those with adequate dietary intake and plausible pancreatic enzyme replacement. [...] Read more.
Introduction: After total pancreatectomy, patients inevitably develop pancreatogenic diabetes with marked glycemic variability and high risk of malnutrition due to both endocrine and exocrine insufficiency. Weight loss and malnutrition can occur even in those with adequate dietary intake and plausible pancreatic enzyme replacement. We hypothesized that glycemic variability is associated with nutritional decline. Methods: We retrospectively analyzed 14 patients who underwent continuous glucose monitoring (CGM) after total pancreatectomy. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), and patients were classified into malnutrition-risk progression or nutrition-maintaining groups. Then, we evaluated glycemic indices, dietary intake, anthropometry, and pancreatic enzyme replacement therapy (PERT). Results: Insulin use, PERT dose, and dietary intake were approximately comparable between groups. In contrast, the malnutrition-risk progression group showed significantly higher mean glucose and time above range, and lower time in range (TIR). Importantly, TIR consistently showed an inverse association with malnutrition-risk progression across models adjusted for clinical covariates, including time since pancreatectomy, primary diagnosis, insulin regimen, and pancrelipase dose. These findings indicate that the observed relationship between lower TIR and worsening GNRI was independent of dietary intake and adequacy of enzyme replacement therapy, underscoring TIR as a clinically meaningful indicator of nutritional decline in this population. Conclusions: Hyperglycemia and reduced TIR were significantly associated with worsening GNRI after total pancreatectomy, independent of dietary intake or PERT. CGM-based glycemic metrics may help identify patients at risk of malnutrition and guide postoperative management. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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17 pages, 772 KB  
Systematic Review
Effectiveness of Interventions to Improve Malnutrition Among Older Adults Living with Frailty Who Are Discharged from the Acute Setting: A Systematic Review
by Cerenay Sarier, Siobhan Walsh, Sheila Bowers, Margaret O’Connor, Ahmed Mohamed, Heather Keller, Katherine L. Ford, Rose Galvin and Anne Griffin
Nutrients 2025, 17(19), 3181; https://doi.org/10.3390/nu17193181 - 9 Oct 2025
Viewed by 404
Abstract
Background & Aim: Malnutrition and frailty are prevalent among older adults following discharge from acute care, including emergency departments. This transition period presents a critical window for targeted nutrition interventions. This systematic review synthesises evidence on the effectiveness of nutrition interventions for malnourished, [...] Read more.
Background & Aim: Malnutrition and frailty are prevalent among older adults following discharge from acute care, including emergency departments. This transition period presents a critical window for targeted nutrition interventions. This systematic review synthesises evidence on the effectiveness of nutrition interventions for malnourished, frail older adults and incorporates analyses of stakeholders’ perspectives, including those of patients, caregivers, and healthcare professionals. By integrating clinical outcomes with stakeholder experiences, the review aims to identify strategies that can optimise nutritional care and support recovery in the post-acute setting. Methods: Searches were conducted in Scopus, CINAHL, EBSCO, EMBASE, and PubMed for randomised controlled trials (RCTs) of nutrition interventions in participants ≥65 years living with frailty and identified as malnourished on discharge from acute care. The primary outcome was assessing the effects of nutrition interventions on malnutrition, nutrition status, physical function and frailty, food intake, and quality of life. Secondary outcomes were hospital readmission and mortality. The quality of studies was assessed using the Cochrane Risk of Bias Tool (V2). Results: Five RCTs with 551 participants were included. Nutrition interventions, including counselling, oral nutrition supplements, and multidisciplinary strategies, improved dietary intake, weight, frailty, physical function, BMI, and quality of life in older adults post-discharge. Some studies also reported reduced hospital stays, readmissions, and mortality. However, none explored stakeholder perspectives, highlighting a gap in person-centred transitional care design. Conclusion: This systematic review highlights a critical gap in evidence for nutrition interventions targeting frail older adults at hospital discharge. While short-term benefits were observed, long-term sustainability and real-world feasibility remain uncertain. The absence of stakeholder involvement further limits person-centred design. These findings underscore the need for integrated nutrition care pathways that embed effective interventions into transitional care models. Full article
(This article belongs to the Section Geriatric Nutrition)
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27 pages, 1751 KB  
Systematic Review
Therapeutic Efficacy of Soy-Derived Bioactives: A Systematic Review of Nutritional Potency, Bioactive Therapeutics, and Clinical Biomarker Modulation
by Zara Fatima, Nizwa Itrat, Beenish Israr and Abdul Momin Rizwan Ahmad
Foods 2025, 14(19), 3447; https://doi.org/10.3390/foods14193447 - 9 Oct 2025
Viewed by 390
Abstract
Soybeans (Glycine max) are nutrient-dense legumes and a high-quality plant-based protein source containing all essential amino acids. With a protein content of 36–40%, soy surpasses many other plant-derived proteins in nutritional value. Its bioactive components, particularly peptides and isoflavones, contribute to [...] Read more.
Soybeans (Glycine max) are nutrient-dense legumes and a high-quality plant-based protein source containing all essential amino acids. With a protein content of 36–40%, soy surpasses many other plant-derived proteins in nutritional value. Its bioactive components, particularly peptides and isoflavones, contribute to reducing inflammation, oxidative stress, and the risk of chronic diseases. In undernourished regions such as Pakistan, where protein-energy malnutrition is prevalent among women and children, soy offers a sustainable and cost-effective nutritional intervention. This review synthesizes findings from biochemical analyses, nutritional profiling, and clinical trials evaluating the impact of soybean protein and its bioactive compounds on growth, metabolic health, immune function, and disease prevention. Emphasis was placed on studies relevant to food-insecure populations and technological innovations enhancing soy product bioavailability. Soy protein has been shown to have positive effects on hormonal regulation, cardiovascular health, cognitive function, and immune support. Technological approaches such as fortification and fermentation improve nutritional bioavailability and sensory acceptance. The integration of soy into local diets enhanced nutritional adequacy, promoted environmental sustainability, and aligned with Sustainable Development Goals. Soybeans represent a sustainable, nutrient-rich solution to combat protein-energy malnutrition in vulnerable communities. Their high-quality protein profile, therapeutic properties, and adaptability to local food systems make them an effective strategy for improving public health and supporting environmental resilience. Full article
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15 pages, 1273 KB  
Article
Child Stunting and Temperature Anomalies: A Cross-Sectional Study in Burkina Faso and Kenya
by Tavis C. Mansfield, Molly E. Brown and Meredith L. Gore
Children 2025, 12(10), 1346; https://doi.org/10.3390/children12101346 - 7 Oct 2025
Viewed by 339
Abstract
Background/Objectives: Extreme temperatures linked to climate change threaten child health, particularly in Sub-Saharan Africa where malnutrition remains widespread. This study examines how exposure to hot and cold temperature anomalies influences child stunting in Burkina Faso and Kenya and evaluates how household infrastructure and [...] Read more.
Background/Objectives: Extreme temperatures linked to climate change threaten child health, particularly in Sub-Saharan Africa where malnutrition remains widespread. This study examines how exposure to hot and cold temperature anomalies influences child stunting in Burkina Faso and Kenya and evaluates how household infrastructure and socio-demographic factors interact with climate stressors to shape outcomes. Methods: We combined nationally representative Demographic and Health Surveys (Burkina Faso 2021; Kenya 2022) with daily maximum and minimum temperature data from the Climate Hazards InfraRed Temperature with Stations (CHIRTS). The analytic sample included children aged 24–59 months. Temperature anomalies were calculated as standardized deviations from local historical averages. Multilevel logistic regression models assessed associations between stunting, climate anomalies, and household-level factors, including electricity, water, sanitation, wealth, and rural/urban residence. Results: Heat anomalies were linked to increased stunting risk in Kenya (β = 2.34, p < 0.001), while in Burkina Faso, higher maximum temperatures unexpectedly reduced stunting odds (β = 0.08, p < 0.05). Cold anomalies showed marginal positive associations with stunting in both countries. Infrastructure and socioeconomic factors varied by context: electricity access and urban residence were protective in Burkina Faso, while improved sanitation, household wealth, and child sex differences were significant in Kenya. Conclusions: Climate anomalies and household conditions jointly influence stunting among children aged 24–59 months, with effects varying by country. Cold anomalies were associated with higher odds of stunting in Burkina Faso (BF OR = 2.14) and Kenya (KE OR = 1.20), while heat anomalies reduced stunting in BF (OR = 0.08) but increased it in KE (OR = 2.34). Electricity access was protective in both countries (BF OR = 0.61; KE OR = 0.71), while improved water, sanitation, and wealth were significant only in KE. Older child age consistently reduced stunting risk, and urban residence was protective only in BF. These findings underscore that climate impacts on stunting are context-specific and highlight the need for policies integrating climate adaptation with investments. Full article
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18 pages, 728 KB  
Review
Healthcare-Associated Infections (HAIs) in the Elderly: Molecular Mechanisms of Immunosenescence and Clinical, Nutritional and Therapeutic Implications
by Livia Moffa and Claudio Tana
Int. J. Mol. Sci. 2025, 26(19), 9649; https://doi.org/10.3390/ijms26199649 - 3 Oct 2025
Viewed by 228
Abstract
Healthcare-associated infections (HAIs) in the elderly represent a growing clinical and public health concern, primarily driven by age-related biological remodeling. Key mechanisms include immunosenescence, inflammaging, gut microbiota dysbiosis, and profound metabolic and epigenetic alterations, all of which progressively weaken host defense and resilience [...] Read more.
Healthcare-associated infections (HAIs) in the elderly represent a growing clinical and public health concern, primarily driven by age-related biological remodeling. Key mechanisms include immunosenescence, inflammaging, gut microbiota dysbiosis, and profound metabolic and epigenetic alterations, all of which progressively weaken host defense and resilience to pathogens. In this review, we delineate the molecular pathways underlying these processes, with particular attention to impaired innate and adaptive immune responses, dysfunctional cellular signaling, and disrupted immunometabolic networks that increase susceptibility to multidrug-resistant organisms and aggravate clinical outcomes in older patients. We also address the synergistic impact of frailty-related factors such as malnutrition, multimorbidity, and polypharmacy on infection risk. Finally, we discuss emerging translational perspectives, including nutritional interventions and microbiota-targeted strategies aimed at restoring immune competence and reducing infection burden. By integrating molecular mechanisms with clinical implications, this review highlights innovative opportunities for personalized prevention and management of HAIs in the aging population. Full article
(This article belongs to the Section Molecular Pathology, Diagnostics, and Therapeutics)
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13 pages, 1276 KB  
Article
Impact of Diabetes Mellitus, Its Duration, and Associated Complications on Nutritional Intake in Patients at Risk of Malnutrition: A Focused Nutritional Assessment
by Paloma Pérez López, Jaime González Gutiérrez, Lucía Estévez Asensio, Olatz Izaola Jauregui, David Primo Martín, Beatriz Ramos Bachiller, Eva López Andrés, Daniel De Luis Román and Juan José López Gómez
Diabetology 2025, 6(10), 108; https://doi.org/10.3390/diabetology6100108 - 2 Oct 2025
Viewed by 295
Abstract
Background/Objectives: Diabetes mellitus (DM) is a disorder which affects carbohydrate metabolism and has been associated with other conditions such as disease-related malnutrition (DRM), leading to specific challenges in its management. This study aims to evaluate the implications of DM, its complications, and its [...] Read more.
Background/Objectives: Diabetes mellitus (DM) is a disorder which affects carbohydrate metabolism and has been associated with other conditions such as disease-related malnutrition (DRM), leading to specific challenges in its management. This study aims to evaluate the implications of DM, its complications, and its duration on energy and protein intake in patients at high risk of malnutrition. Methods: Descriptive cross-sectional study in 179 patients with high risk of malnutrition. Patients were compared based on the presence or absence of DM, diabetes duration and the presence of complications. Age, gender, body mass index, bioimpedanciometry, ultrasonography and dynamometry parameters and the diagnosis of sarcopenia were recorded. Energy and protein requirements were calculated, and the composition of the patients’ three-day diet was analyzed. Results: DM was associated with lower weight-adjusted energy intake (Overall: 29.15 (9.99) vs. DM: 24.87 (8.28) vs. NoDM: 30.65 (10.13) kcal/kg/day; p < 0.01) and lower weight-adjusted protein intake (Overall: 1.29 (0.47) vs. DM: 1.18 (0.39) vs. NoDM: 1.33 (0.49) g of protein/kg/day; p < 0.05). DM was a risk factor for poorer compliance with energy requirements (OR: 2.38, 95% CI: 1.13–5.01, p < 0.05). Similarly, the occurrence of complications was identified as a risk factor associated with reduced adherence to energy intake requirements (OR: 1.78, 95% CI 1.06–2.98; p < 0.05), and a duration of diabetes mellitus exceeding 10 years was linked to lower adherence to protein intake requirements (OR 1.79, 95% CI 1.08–2.99; p < 0.05). Conclusions: Among patients at high risk of malnutrition, diabetes mellitus was associated with suboptimal adherence to both caloric and protein intake requirements. The presence of diabetes and its related complications emerged as risk factors for inadequate fulfillment of energy needs, while a longer disease duration was specifically linked to reduced compliance with protein requirements. Full article
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28 pages, 740 KB  
Review
Nutritional Status and Dietary Challenges in Patients with Systemic Sclerosis: A Comprehensive Review
by Eleni C. Pardali, Arriana Gkouvi, Maria G. Grammatikopoulou, Alexandros Mitropoulos, Christos Cholevas, Dimitrios Poulimeneas and Markos Klonizakis
Nutrients 2025, 17(19), 3144; https://doi.org/10.3390/nu17193144 - 1 Oct 2025
Viewed by 698
Abstract
The gastrointestinal (GI) tract is seriously affected by systemic sclerosis (SSc), due to fibrosis and persistent inflammation. Patients with GI involvement frequently exhibit poor nutritional status, which affects disease burden and quality of life. The aim of the present review was to discuss [...] Read more.
The gastrointestinal (GI) tract is seriously affected by systemic sclerosis (SSc), due to fibrosis and persistent inflammation. Patients with GI involvement frequently exhibit poor nutritional status, which affects disease burden and quality of life. The aim of the present review was to discuss all nutritional issues in SSc and serve as a primer for the nutritional assessment of patients with scleroderma. Patients with SSc suffer from GI impairments that affect the oral cavity, esophagus, stomach, and small and large intestines. Symptomatology includes microstomia, xerostomia, dysphagia, reflux, esophageal dysmotility, small intestinal bacterial overgrowth (SIBO), and fecal incontinence, among others, which may contribute to inadequate food intake. As a result, patients often suffer from malnutrition, sarcopenia, and frailty, while presenting with micronutrient deficiencies that impact disease outcomes and worsen their condition. This aggravated nutritional status is related to greater disease severity, organ involvement, reduced physical function, and increased length of hospitalization and mortality. GI involvement is well-documented within the SSc population, yet routine nutritional assessments are lacking in the hospital setting. Currently, there is a lack of specific recommendations from scientific societies regarding the nutritional care of patients with SSc. Given the high risk of nutritional impairments in this population, systematic assessments should be undertaken, and novel tools tailored to their unique needs should be developed and implemented. Full article
(This article belongs to the Section Nutrition and Public Health)
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12 pages, 639 KB  
Review
Dietary Approaches in the Management of Adrenoleukodystrophy: Evidence Summary for Nutritional Tips
by Alice Di Stefano, Luca Ricci, Davide Ferrari, Francesco Frigerio, Marianna Minnetti, Mario Fontana, Lorenzo M. Donini, Andrea M. Isidori, Silvia Migliaccio and Eleonora Poggiogalle
Nutrients 2025, 17(19), 3130; https://doi.org/10.3390/nu17193130 - 30 Sep 2025
Viewed by 222
Abstract
Background: Adrenoleukodystrophy is a rare, inherited X-linked disease related to mutations in the ABCD1 gene. Peroxisomal β-oxidation is impaired, underpinning the tissue accumulation of very long-chain fatty acids (VLCFAs), especially in the central nervous system (i.e., the white matter and axons), adrenal [...] Read more.
Background: Adrenoleukodystrophy is a rare, inherited X-linked disease related to mutations in the ABCD1 gene. Peroxisomal β-oxidation is impaired, underpinning the tissue accumulation of very long-chain fatty acids (VLCFAs), especially in the central nervous system (i.e., the white matter and axons), adrenal glands, and testes. VLCFA accumulation contributes to oxidative stress, neuroinflammation, and progressive demyelination, leading to severe neurological sequelae. Though gene therapies and drug development are advancing, dietary management may still play a crucial role in modulating lipid metabolism and mitigating disease progression. Methods: A narrative review of studies published up to May 2025 in major scientific databases was conducted, focusing on biochemical and clinical outcomes, including VLCFA plasma modulation and nutritional status. Results: VLCFA restriction alone has shown limited efficacy due to the counteractive effect of endogenous synthesis. “Lorenzo’s Oil” inhibits VLCFA elongation, yet with inconsistent clinical benefits. Novel dietary strategies, such as the “Bambino Diet” and innovative dietary supplements similar to Lorenzo’s Oil, composed of glyceryl trioleate, glyceryl trierucate, and antioxidants, provide promising biochemical effects, such as reducing VLCFA plasma levels and improving lipid profiles. Malnutrition risk is also increased in X-ALD patients, underscoring the need for personalized nutritional interventions. Conclusions: Dietary strategies are one of the pillars of X-ALD management, to be further combined with pharmacological, gene therapies, and hematopoietic stem cell transplantation. Future research should refine emerging therapies, assess long-term effects, and develop personalized nutritional strategies. Full article
(This article belongs to the Special Issue Nutrition 3.0: Between Tradition and Innovation)
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14 pages, 1358 KB  
Article
Total Cholesterol and Mortality in Older Adults: A Sex-Stratified Cohort Study
by Maria Serena Iuorio, Diana Lelli, Stefania Bandinelli, Luigi Ferrucci, Claudio Pedone and Raffaele Antonelli Incalzi
Nutrients 2025, 17(19), 3128; https://doi.org/10.3390/nu17193128 - 30 Sep 2025
Viewed by 902
Abstract
Background: The relationship between total cholesterol (TC) levels and mortality in older adults is complex and may differ from younger populations. While hypercholesterolemia is a known midlife risk factor, this association may weaken or reverse with age. Biological differences in cholesterol metabolism—particularly [...] Read more.
Background: The relationship between total cholesterol (TC) levels and mortality in older adults is complex and may differ from younger populations. While hypercholesterolemia is a known midlife risk factor, this association may weaken or reverse with age. Biological differences in cholesterol metabolism—particularly hormonal changes—may contribute to sex-specific mortality risks, but this remains underexplored. We examined the association between TC and all-cause mortality in older adults, assessing sex-specific differences. Methods: We used data from the InCHIANTI study, a longitudinal, population-based study conducted in Tuscany, Italy. From the original cohort (N = 1453), 999 participants ≥ 65 years with baseline TC and mortality data were included. TC levels were categorized as <200 mg/dL, 200–239 mg/dL, and ≥240 mg/dL. The primary outcome was all-cause mortality over 6-years. Kaplan–Meier curves and Cox proportional hazards models assessed mortality risk across TC categories in the overall population and by sex. Restricted cubic splines explored non-linear associations. Models were adjusted for age, sex (only in overall population), BMI, physical activity, diabetes, COPD, hypertension, eGFR, polypharmacy and frailty. Results: A threshold effect was observed: mortality risk rose sharply below ~200 mg/dL and remained stable above. Compared to the <200 mg/dL group, intermediate and high TC levels were associated with lower mortality risk (HR 0.72; 95% CI: 0.53–0.99 and HR 0.71; 95% CI: 0.49–1.02, respectively). In sex-stratified analyses, this pattern was pronounced in women but weaker and not statistically significant in men. Results held after excluding statin users and were confirmed by spline analysis. Conclusions: In older adults, particularly women, low TC may signal underlying vulnerability, including malnutrition or inflammation. Full article
(This article belongs to the Special Issue Geriatric Malnutrition and Frailty)
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11 pages, 234 KB  
Article
Vitamin D Status, Fasting Blood Glucose, and Latent Tuberculosis Infection in a High-Risk Population in Ulaanbaatar, Mongolia
by Davaasambuu Ganmaa, Sukhbaatar Ariunbuyan, Polyna Khudyakov, Enkhtsetseg Tserenkhuu, Sunjidmaa Bolormaa, Buyanjargal Uyanga, Batbayar Ochirbat, Erkhembulgan Purevdorj and J. Lucian Davis
Nutrients 2025, 17(19), 3122; https://doi.org/10.3390/nu17193122 - 30 Sep 2025
Viewed by 313
Abstract
Background: Mongolia is experiencing a rapid epidemiologic transition in which high burdens of micronutrient malnutrition, infection, and cardiometabolic disease are simultaneously prevalent. This cross-sectional study sought to understand how nutritional, lifestyle, and cardiometabolic risk factors are distributed among a population at high-risk for [...] Read more.
Background: Mongolia is experiencing a rapid epidemiologic transition in which high burdens of micronutrient malnutrition, infection, and cardiometabolic disease are simultaneously prevalent. This cross-sectional study sought to understand how nutritional, lifestyle, and cardiometabolic risk factors are distributed among a population at high-risk for tuberculosis (TB), comprising household contacts (HHCs) and healthcare workers, (HCWs) in Ulaanbaatar, Mongolia, and how these factors are associated with TB infection. Methods: A total of 196 HHCs and 241 HCWs were assessed for latent TB infection (LTBI) using the QuantiFERON-TB Gold Plus (QFT-Plus) assay and for diabetes using fingerprick samples for fasting blood glucose. Participants also underwent assessments of their diet and physical activity, nicotine dependence, body mass index, and serum 25(OH)D concentration. We examined associations between assessed risk factors and LTBI using multivariate logistic regression. Results: The prevalence of LTBI was 47% for both HHCs and HCWs. A total of 54% percent of HHCs and 68% of HCWs had low physical activity levels; 63% of HHCs and 95% of HCWs were overweight or obese; 7% of HHCs and 4% of HCWs had impaired or diabetic fasting blood glucose [FBG]; and 49% of HHCs and 70% of HCWs were vitamin D deficient. In a multivariable analysis of HHCs, LTBI was independently associated with lower serum [25(OH)D], and the odds ratio (OR) was 3.18 (95% CI 1.38–7.79; p = 0.009). In contrast, the probability of LTBI did not differ significantly between vitamin D-deficient and non-deficient HCWs, and the OR was 0.89 (95% CI 0.59–1.37; p = 0.42). In a pooled analysis of HHCs and HCWs, the probability of LTBI did not significantly differ between vitamin D-deficient vs. non-deficient participants. The association between serum [25(OH)D] and LTBI among HHCs and HCWs was significantly modified by fasting blood glucose (FBG), such that a lower vitamin D status was significantly more common among those in the highest tertile of FBG than among those in the lowest tertile of FBG. Conclusions: Nutritional, lifestyle, and cardiometabolic risk factors are highly prevalent among HHCs and HCWs with TB in Ulaanbaatar, Mongolia. These findings underscore the importance of simultaneously controlling TB infection, malnutrition, and cardiometabolic risks among HHCs and HCWs to reduce the disease burden in Mongolia. Full article
(This article belongs to the Section Micronutrients and Human Health)
22 pages, 490 KB  
Review
Correlation Between Hypophosphatemia and Hyperventilation in Critically Ill Patients: Causes, Clinical Manifestations, and Management Strategies
by Nicola Sinatra, Giuseppe Cuttone, Giulio Geraci, Caterina Carollo, Michele Fici, Tarek Senussi Testa and Luigi La Via
Biomedicines 2025, 13(10), 2382; https://doi.org/10.3390/biomedicines13102382 - 28 Sep 2025
Viewed by 368
Abstract
Hypophosphatemia, defined as serum phosphate levels below 2.5 mg/dL, is a common yet underrecognized electrolyte disturbance in critically ill patients, with prevalence estimates reaching up to 80%. This review explores the intricate bidirectional relationship between hypophosphatemia and hyperventilation, emphasizing its profound implications for [...] Read more.
Hypophosphatemia, defined as serum phosphate levels below 2.5 mg/dL, is a common yet underrecognized electrolyte disturbance in critically ill patients, with prevalence estimates reaching up to 80%. This review explores the intricate bidirectional relationship between hypophosphatemia and hyperventilation, emphasizing its profound implications for respiratory function and critical care management. Hypophosphatemia impairs oxygen delivery by depleting 2,3-diphosphoglycerate (2,3-DPG), disrupts central respiratory drive, and weakens respiratory muscles, leading to hyperventilation, ventilatory failure, and prolonged mechanical ventilation. Conversely, hyperventilation exacerbates hypophosphatemia through respiratory alkalosis, triggering intracellular phosphate shifts and metabolic cascades that rapidly deplete serum levels. This cycle creates significant challenges for ventilator weaning and increases morbidity and mortality. Underlying mechanisms include impaired ATP synthesis, altered chemoreceptor sensitivity, and systemic inflammatory responses. Hypophosphatemia-induced hyperventilation manifests as unexplained tachypnea and respiratory alkalosis, often misdiagnosed as anxiety or pain, while hyperventilation-induced hypophosphatemia contributes to diaphragmatic dysfunction and poor ventilatory performance. Common precipitating factors include refeeding syndrome, diabetic ketoacidosis, continuous renal replacement therapy, and malnutrition. Complications extend beyond respiratory dysfunction to include cardiac depression, immune dysfunction, prolonged ICU stays, and increased healthcare costs. Current diagnostic approaches rely on serum phosphate measurements, which poorly reflect total body stores due to significant intracellular shifts. Emerging biomarkers such as fibroblast growth factor 23 (FGF23) and advanced monitoring technologies, including continuous phosphate tracking, may enhance recognition. Treatment strategies emphasize targeted phosphate repletion based on severity, with intravenous supplementation and ventilatory support tailored to minimize complications. Preventive measures, including risk stratification, prophylactic supplementation, and ventilator management, are critical for high-risk populations. Despite advances, knowledge gaps persist in optimizing monitoring and repletion protocols, understanding genetic variations, and identifying ideal phosphate targets for improved respiratory outcomes. This review provides a comprehensive framework for recognizing and managing hypophosphatemia’s impact on respiratory dysfunction in critically ill patients. Adopting evidence-based interventions and leveraging emerging technologies can significantly improve clinical outcomes, reduce ICU complications, and enhance recovery in this vulnerable population. Full article
(This article belongs to the Special Issue Emerging Trends in Kidney Disease)
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12 pages, 853 KB  
Article
Predictive Value of C-Reactive Protein/Albumin Ratio (CAR) for Malnutrition and Sarcopenia in Acute Ischemic Stroke Patients
by Hasan Dogan, Sugra Simsek, Ahmet Hakan Bayram, Aydan Topal, Mehlika Berra Pamuk, Ozkan Ozmuk, Nedim Ongun and Cetin Kursad Akpinar
J. Clin. Med. 2025, 14(19), 6804; https://doi.org/10.3390/jcm14196804 - 26 Sep 2025
Viewed by 281
Abstract
Background/Objective: Malnutrition and sarcopenia are common complications after ischemic stroke and have a negative impact on prognosis. The C-reactive protein/albumin ratio (CAR) reflects both inflammation and nutritional status, but its predictive role in this setting has not been widely studied. This study aimed [...] Read more.
Background/Objective: Malnutrition and sarcopenia are common complications after ischemic stroke and have a negative impact on prognosis. The C-reactive protein/albumin ratio (CAR) reflects both inflammation and nutritional status, but its predictive role in this setting has not been widely studied. This study aimed to investigate the predictive value of CAR (C-reactive protein/albumin ratio) for malnutrition risk and probable sarcopenia in patients with ischemic stroke. Methods: In this prospective observational study, 197 patients with acute ischemic stroke were evaluated. Patients with chronic renal or hepatic failure, malignancy, active infection, and hand disability preventing grip strength measurement were excluded. Demographic data (age, sex), vascular risk factors, the NIHSS score, and laboratory parameters were recorded. The nutritional status of patients was assessed using the Nutritional Risk Screening-2002 (NRS-2002), and sarcopenia risk was evaluated with the SARC-F questionnaire. Handgrip strength was measured in patients with high SARC-F scores to define probable sarcopenia. CAR was calculated from serum CRP and albumin levels. Logistic regression was applied to identify independent predictors, and receiver operating characteristic (ROC) analyses were performed to determine the discriminatory ability and cut-off values of CAR. The nutritional status of patients admitted to the neurology clinic with acute ischemic stroke was assessed using the Nutritional Risk Screening-2002 (NRS-2002), and sarcopenia risk was evaluated with the SARC-F questionnaire. Handgrip strength was measured in patients with high SARC-F scores to define probable sarcopenia. CAR was calculated from serum CRP and albumin levels. Logistic regression and receiver operating characteristic (ROC) analyses were performed. Results: Malnutrition risk was identified in 32.5% of patients, and probable sarcopenia was identified in 19.3% of patients. ROC analysis showed that CAR had acceptable discriminatory power for both conditions. In multivariate analysis, CAR was consistently identified as an independent predictor of malnutrition risk and possible sarcopenia. ROC analysis for malnutrition risk showed an AUC of 0.750 (cut-off: 0.306; sensitivity 68.8%; specificity 75.2%). In regression analysis, CAR (OR = 2.13; 95% CI: 1.39–3.26; p < 0.001), age (OR = 1.05; 95% CI: 1.02–1.09; p = 0.003), and NIHSS (OR = 1.11; 95% CI: 1.01–1.23; p = 0.026) were independent predictors. For probable sarcopenia, ROC analysis revealed an AUC of 0.814 (cut-off: 0.320; sensitivity 81.6%; specificity 71.7%). Multivariate analysis identified CAR (OR = 1.73; 95% CI: 1.19–2.52; p = 0.004), age (OR = 1.11; 95% CI: 1.05–1.18; p < 0.001), and NIHSS (OR = 1.19; 95% CI: 1.05–1.35; p = 0.007) as independent predictors. Conclusions: CAR was identified as an independent predictor of both malnutrition risk and probable sarcopenia in ischemic stroke patients. CAR may serve as a reliable biomarker for early nutritional and functional risk stratification in clinical practice. Full article
(This article belongs to the Section Clinical Neurology)
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