Yusuf Yilmaz, Behrad Saeedian, Nastaran Babajani, Sara Ashtari, Fereshteh Ghorat, Ehsaneh Taheri
{"title":"Novel Surrogate Markers of Insulin Resistance in Patients with Metabolic Dysfunction-Associated Steatosis Liver Disease: Associations with Dietary and Lifestyle Inflammatory Scores in the Large Cross-sectional Study.","authors":"Yusuf Yilmaz, Behrad Saeedian, Nastaran Babajani, Sara Ashtari, Fereshteh Ghorat, Ehsaneh Taheri","doi":"10.1016/j.clnesp.2025.09.021","DOIUrl":"https://doi.org/10.1016/j.clnesp.2025.09.021","url":null,"abstract":"<p><strong>Background & aims: </strong>Background/Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a major global health challenge, with insulin resistance (IR) and inflammation being key pathophysiological drivers. Here, this study aimed to evaluate the associations between MASLD and novel IR markers, and to examine the interrelationships between dietary (DIS) and lifestyle (LIS) inflammatory scores and IR indices.</p><p><strong>Methods: </strong>This cross-sectional study was conducted among participants in the baseline phase of the Sabzevar Persian Cohort Study (SPCS). We studied 970 patients with MASLD and 961 age- and sex-matched controls. Eight distinct IR markers were assessed: triglyceride-glucose index (TyG), TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-c), lipid accumulation product (LAP), visceral adiposity index (VAI), and metabolic score for insulin resistance (METS-IR). DIS was calculated from 19 dietary components, LIS from three lifestyle parameters, and a combined dietary and lifestyle inflammation score (DLIS) from both measures.</p><p><strong>Results: </strong>Patients with MASLD exhibited higher adiposity measures and comorbidity rates than controls. TyG-BMI demonstrated the strongest association with MASLD (area under the curve [AUC]: 0.994), followed by TyG-WC (AUC: 0.993) and METS-IR (AUC: 0.989). TyG-BMI demonstrated the highest specificity (96.74%), indicating its strong ability to correctly identify individuals without the disease (true negatives), thereby minimizing false positives. In contrast, TyG-WC showed the highest sensitivity (97.31%), reflecting its excellent capacity to correctly detect individuals with the disease (true positives), thus reducing the likelihood of false negatives.LIS correlated most strongly with TyG-BMI (r = 0.811, p < 0.001), whereas DLIS correlated best with METS-IR (r = 0.346, p < 0.001). Canonical correlation analysis revealed significant relationships between inflammatory scores and IR indices (r = 0.835, p < 0.001).</p><p><strong>Conclusions: </strong>Among novel IR markers, TyG-BMI represented the most robust surrogate marker associated with the risk of having MASLD. The strong correlation between LIS and TyG-BMI suggested the potential significant association of lifestyle-related inflammation and IR in MASLD pathophysiology that needs to be investigated in future interventional studies.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M K Nielsen, E D M Pedersen, A W Knudsen, T Munk, A M Beck
{"title":"Authors' reply to the letter to the editor: Comment on \"Addressing nutritional risk and dehydration in vulnerable older adults in the emergency department: A single-arm feasibility study on detection, treatment, and follow-up\".","authors":"M K Nielsen, E D M Pedersen, A W Knudsen, T Munk, A M Beck","doi":"10.1016/j.clnesp.2025.09.017","DOIUrl":"10.1016/j.clnesp.2025.09.017","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to the Editor: Comment on \"Addressing nutritional risk and dehydration in vulnerable older adults in the emergency department: A single-arm feasibility study on detection, treatment, and follow-up\".","authors":"Shashank Dokania, Parth Aphale, Himanshu Shekhar","doi":"10.1016/j.clnesp.2025.09.013","DOIUrl":"10.1016/j.clnesp.2025.09.013","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Schawanya K Rattanapitoon, Nav La, Chadaporn N Gordon, Nathkapach K Rattanapitoon
{"title":"Beyond safety: Reassessing autonomy, infection risk, and long-term value of multi-chamber parenteral nutrition in cancer care.","authors":"Schawanya K Rattanapitoon, Nav La, Chadaporn N Gordon, Nathkapach K Rattanapitoon","doi":"10.1016/j.clnesp.2025.09.015","DOIUrl":"10.1016/j.clnesp.2025.09.015","url":null,"abstract":"<p><p>We commend Goetze et al. for evaluating multi-chamber parenteral nutrition (PN) in solid tumor patients requiring home PN. Their study demonstrates improved patient autonomy and fewer PN-related adverse events, yet several limitations remain. First, the premature termination reduces statistical power, especially for infection outcomes. Second, autonomy was defined inclusively, counting family support as self-administration, which may overestimate practical independence. Third, the economic implications of higher upfront costs versus potential savings from fewer nursing visits and complications remain unclear. Finally, survival benefits were not demonstrated, underscoring the need to assess quality of life and patient-reported outcomes. Future trials should integrate cost-effectiveness and long-term endpoints to guide wider adoption.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Addressing malnutrition in cancer care: Where do postgraduate oncology students stand?","authors":"Lidia Santarpia , Michela Zanetti , Federico Bozzetti","doi":"10.1016/j.clnesp.2025.09.010","DOIUrl":"10.1016/j.clnesp.2025.09.010","url":null,"abstract":"<div><h3>Background & aims</h3><div>Disease-associated malnutrition and cachexia affect a high percentage (between 30 % and 80 %<strong>)</strong> of cancer patients; appropriate diagnosis and intervention can improve clinical outcomes. We investigated opinions and knowledge of oncology residents towards nutritional care in cancer patients.</div></div><div><h3>Methods</h3><div>Following mapping post-graduate schools in oncology, an invitation was sent to the directors with a link to be transferred to residents willing to participate to the survey anonymously. The survey consisted in a questionnaire including 42 questions related to nutrition in cancer patients exploring the didactic component, the clinical daily activities in the oncology department, attitude and cultural background.</div></div><div><h3>Results</h3><div>135 residents from 17 universities (54.8 % of total) completed the survey (49 responders were attending the 1st year, 26 the 2nd, 23 the 3rd, 30 the 4th and 7 the 5th or had just finished the specialty). Only 25.9 % of residents reported receiving specific lessons on clinical nutrition during their training, while malnutrition and sarcopenia were covered in 60 % and artificial nutrition in 48.9 %. Nutritional status assessment was routinely performed in 34.3 % of oncology departments, while in 63.5 % it was carried out only if the patient was already (or clearly) malnourished and in 2.2 % it was not performed at all. When performed, the assessment was conducted by oncologists in 53.7 % of cases, whereas 43.4 % relied on the nutritional team. Oral nutritional supplementation was prescribed by oncologists in 41.9 % of cases, and parenteral nutrition in 53 %.</div><div>However, significant gaps in residents' nutritional knowledge emerged: only 13.3 % of residents correctly answered more than 66 % of nutrition-related questions. A majority (84.5 %) achieved scores between 34 and 66 %, while 2.2 % scored below 33 %. Widespread misunderstanding was observed regarding key nutritional concepts such as routes of nutritional support, metabolic needs in cancer, and malnutrition criteria. Despite these deficiencies, nearly all participants (98.5 %) agreed on the importance of oncologists acquiring basic nutritional competencies.</div></div><div><h3>Conclusions</h3><div>The results of this survey indicate that malnutrition in cancer patients remains an undervalued clinical condition and the teaching of clinical nutrition in oncology residency programs remains inadequate and needs to be strengthened. These findings underscore the urgent need to integrate comprehensive nutritional education into oncology curricula and promote interdisciplinary collaboration to ensure early identification and management of malnutrition in cancer patients.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"70 ","pages":"Pages 59-68"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marwa Abd El-Razek Salama, Elham Ahmed Hassan, Nahed A. Makhlouf
{"title":"Impact of L-carnitine supplementation on post-transplant outcomes in liver transplant candidates with sarcopenia: A randomized controlled open-label trial","authors":"Marwa Abd El-Razek Salama, Elham Ahmed Hassan, Nahed A. Makhlouf","doi":"10.1016/j.clnesp.2025.09.008","DOIUrl":"10.1016/j.clnesp.2025.09.008","url":null,"abstract":"<div><h3>Background & aims</h3><div>Sarcopenia, characterized by loss of skeletal muscle mass and strength, is a common complication of advanced liver disease and worsens post-transplant outcomes. While L-carnitine may improve muscle mass and function, its impact on sarcopenic liver transplant candidates remains unclear. We aimed to evaluate the impact of L-carnitine supplementation on clinical outcomes and mortality in sarcopenic patients following liver transplantation.</div></div><div><h3>Methods</h3><div>This randomized, controlled study included 53 HCV-related cirrhotic patients awaiting liver transplantation, divided into three groups: sarcopenia with L-carnitine (n = 18), sarcopenia without L-carnitine (n = 18), and non-sarcopenia (n = 17). Clinical, anthropometric, muscle mass, and biochemical parameters (secondary outcomes) were evaluated before and 6 months after transplantation, along with post-transplant mortality (primary outcome).</div></div><div><h3>Results</h3><div>Sarcopenic patients receiving L-carnitine showed significant post-transplant improvements in ascites, lower limb edema, anthropometric measures (TSF, MAC, handgrip), and biochemical markers (INR, albumin, bilirubin, platelets). Compared to patients without L-carnitine, the supplemented group achieved greater gains in muscle mass index (1 vs. 0 cm<sup>2</sup>/m<sup>2</sup>; <em>P</em> = 0.014), TSF (4 vs. −4 mm; <em>P</em> = 0.049), BMI (2 vs. −2 kg/m<sup>2</sup>; <em>P</em> = 0.026), and reductions in bilirubin (−15.2 vs. 20.5 mmol/L; <em>P</em> = 0.001). Mortality was significantly lower in the L-carnitine group (16.7 % vs. 55.6 %; <em>P</em> = 0.003), with survival rates comparable to non-sarcopenic patients.</div></div><div><h3>Conclusion</h3><div>L-carnitine supplementation in sarcopenic liver transplant candidates significantly improved post-transplant outcomes, muscle mass, and survival with mortality rates comparable to non-sarcopenic patients. These findings suggest a potential role of L-carnitine in optimizing pre-transplant care and enhancing post-transplant outcomes in this high-risk population.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"70 ","pages":"Pages 50-58"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association between dietary acid load and sarcopenia in patients with type 2 diabetes mellitus","authors":"Shinta Yamamoto , Yoshitaka Hashimoto , Fuyuko Takahashi , Ryosuke Sakai , Yuto Saijyo , Chihiro Munekawa , Hanako Nakajima , Noriyuki Kitagawa , Eriko Nakatani , Takafumi Osaka , Hiroshi Okada , Naoko Nakanishi , Saori Majima , Emi Ushigome , Masahide Hamaguchi , Michiaki Fukui","doi":"10.1016/j.clnesp.2025.09.014","DOIUrl":"10.1016/j.clnesp.2025.09.014","url":null,"abstract":"<div><h3>Aim</h3><div>Sarcopenia is a common and serious complication in individuals with type 2 diabetes mellitus (T2DM). Dietary acid load has been linked to metabolic disturbances; however, its relationship with sarcopenia in T2DM remains unclear. This study aimed to investigate the associations of dietary acid load with sarcopenia in older adults with T2DM.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis with aged ≥60 years was conducted. Sarcopenia was defined as both having low muscle strength, evaluated by handgrip strength, and low skeletal muscle mass index, evaluated by bioelectrical impedance analysis. Dietary acid load was evaluated by potential renal acid load (PRAL) and net endogenous acid production (NEAP). Multivariable linear and logistic regression models were used to evaluate associations with muscle mass, muscle strength, and sarcopenia.</div></div><div><h3>Results</h3><div>Among 298 older adults with T2DM (mean age 70.8 ± 6.0 years), sarcopenia was identified in 13.1 %. Multivariable regression analyses showed that both PRAL and NEAP were significantly associated with skeletal muscle mass index. Regarding muscle strength, NEAP remained significantly associated, while PRAL showed a similar but non-significant negative trend. Compared with lowest tertile, highest tertile of PRAL (odds ratio (OR) = 3.09, 95 % CI: 1.13–9.00; p for trend = 0.02) or NEAP (OR = 3.07, 95 % CI: 1.21–8.30; p for trend = 0.01) was associated with the presence of sarcopenia.</div></div><div><h3>Conclusion</h3><div>Higher dietary acid load is associated with sarcopenia among older individuals with T2DM.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"70 ","pages":"Pages 83-90"},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Phase angle on bioelectrical impedance analysis and chronic obstructive pulmonary disease-related pathophysiology in smokers","authors":"Ryota Hamada , Naoya Tanabe , Yohei Oshima , Yuji Yoshioka , Tomoki Maetani , Yusuke Shiraishi , Atsuyasu Sato , Susumu Sato , Ryosuke Ikeguchi , Toyohiro Hirai","doi":"10.1016/j.clnesp.2025.09.012","DOIUrl":"10.1016/j.clnesp.2025.09.012","url":null,"abstract":"<div><h3>Background</h3><div>Phase angle on bioelectrical impedance analysis detects impaired skeletal muscle quality, which affects outcomes in patients with chronic obstructive pulmonary disease (COPD) and even smokers without COPD. However, its association with COPD-related pathophysiology remains unclear. We examined whether phase angle is associated with physical function and computed tomography (CT) findings of emphysema, airway disease, and skeletal muscle quantity and density in smokers.</div></div><div><h3>Methods</h3><div>This cross-sectional study included smokers with and without COPD, categorized into low- and high-phase angle groups based on a previously reported 4.8° cutoff value. Physical function was assessed using grip strength, respiratory muscle strength, and 6-min walk distance (6MWD). Low-attenuation area percentages (LAA%950 for emphysema; LAA%856 for air trapping), wall area percentage (WA%), the erector spinae muscle cross-sectional area and density (ESMA and ESMD) were measured on chest inspiratory/expiratory CT.</div></div><div><h3>Results</h3><div>Of 172 smokers enrolled, 100 were categorized into the low-phase-angle group. The low-phase angle-group showed lower grip strength, respiratory muscle strength, 6MWD, ESMA, and ESMD, and higher LAA%950, WA%, and LAA%856. In multivariable analyses, the low-phase-angle group was associated with lower ESMD, but not with ESMA, after adjustment for age, sex, body mass index, and smoking history. Higher WA%, but not LAA%950, was associated with the low-phase-angle group after the same adjustment.</div></div><div><h3>Conclusions</h3><div>A low-phase angle reflected lower skeletal muscle density and was associated with physical dysfunction and severe central airway wall thickening. Phase angle may be a noninvasive biomarker reflecting compromised skeletal muscle conditions, physical function, and airway disease severity in smokers.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"70 ","pages":"Pages 91-98"},"PeriodicalIF":2.6,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gege Zhang , Chuying Zhang , Saba Fida , Zengqing Guo , Jiuwei Cui , Wei Li , Min Weng , Kunhua Wang , Suyi Li , Hanping Shi , Hongxia Xu , Chunhua Song
{"title":"Impact of weight change on the prognosis of cancer patients: A multicenter, prospective study","authors":"Gege Zhang , Chuying Zhang , Saba Fida , Zengqing Guo , Jiuwei Cui , Wei Li , Min Weng , Kunhua Wang , Suyi Li , Hanping Shi , Hongxia Xu , Chunhua Song","doi":"10.1016/j.clnesp.2025.09.011","DOIUrl":"10.1016/j.clnesp.2025.09.011","url":null,"abstract":"<div><h3>Background & aims</h3><div>Weight loss may increase the risk of death from cancer; however, research findings are mixed, and little is known about the effects of weight gain. We evaluated the association between weight change in the 2 years after diagnosis and the risk of all-cause mortality in Chinese adult patients with cancer.</div></div><div><h3>Methods</h3><div>This prospective cohort study included 2,795 adults with cancer. The association between weight change and all-cause mortality of cancer patients was explored using Cox proportional hazards model and restricted cubic spline model. Subgroup analysis and interaction terms were used to explore whether weight change was associated with certain variables. Then, 2,067 subjects who did not experience weight gain at the first follow-up visit were used to test the association between all-cause mortality and weight change between baseline and the first follow-up visits and between the first and last follow-up visits.</div></div><div><h3>Results</h3><div>After adjusting for confounding factors, weight loss was linked to a higher risk of all-cause mortality: the hazard ratios for the severe and moderate weight loss groups were 2.03 (95 % CI: 1.62–2.55) and 1.40 (95 % CI: 1.09–1.80), respectively. When assessed by gender, the overall trends were consistent with those of the general population, but the association between weight loss and poor prognosis was more pronounced in male patients. There was no significant association between weight gain and the risk of all-cause mortality. Regardless of subsequent weight regain or weight maintenance and loss, cancer patients who experienced severe weight loss within two years were associated with an increased risk of mortality.</div></div><div><h3>Conclusion</h3><div>Weight loss was linked to an increased risk of all-cause mortality in cancer patients, particularly in males. Regardless of subsequent weight fluctuations, severe weight loss remained associated with an increased risk of all-cause mortality.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"70 ","pages":"Pages 69-76"},"PeriodicalIF":2.6,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association of maximal tongue pressure with dysphagia and prognosis in patients with acute heart failure","authors":"Koji Matsuo , Kei Yoneki , Kikka Kobayashi , Daiki Onoda , Kazuhiro Mibu , Toru Suzuki , Ken Nakao , Hiroaki Tatsuki , Seiji Tamiya","doi":"10.1016/j.clnesp.2025.09.009","DOIUrl":"10.1016/j.clnesp.2025.09.009","url":null,"abstract":"<div><h3>Background & aims</h3><div>Although dysphagia is a highly prevalent complication in patients with acute heart failure (AHF), current AHF guidelines lack guidance on methods for assessing swallowing function. This study aimed to assess the impact of maximal tongue pressure on the occurrence of dysphagia and prognosis of patients with AHF.</div></div><div><h3>Methods</h3><div>This observational study conducted at a single center included 406 patients (mean age 79.4 ± 11.9 years, 170 women) with a diagnosis of AHF and without pre-admission dysphagia (Food Intake LEVEL Scale [FILS] ≥9). Patients were categorized into high tongue pressure group (≥20 kPa) and low tongue pressure group (<20 kPa) based on their maximal tongue pressure at admission. The analysis used the log-rank test and Cox proportional hazards model to examine FILS improvement and all-cause mortality. FILS improvement was defined as a FILS of ≥9 for the first-time during hospitalization.</div></div><div><h3>Results</h3><div>During the hospitalization period, 347 patients (85.5 %) experienced FILS improvement and 36 patients (8.9 %) died during a mean follow-up period of 7.5 ± 3.9 months. Survival analysis revealed that the low tongue pressure group, in comparison to the high tongue pressure group, exhibited notably poorer cumulative FILS improvement rate (log-rank: <em>P</em> < 0.001, adjusted hazard ratio [HR], 0.61; 95 % confidence interval [CI], 0.46–0.82; <em>P</em> = 0.001) and elevated cumulative mortality rate (log-rank: <em>P</em> < 0.001, adjusted HR, 2.38; 95%CI, 1.14–4.98 <em>P</em> = 0.021).</div></div><div><h3>Conclusion</h3><div>A decrease in maximal tongue pressure was correlated with an increased risk of developing dysphagia and all-cause mortality in patients with AHF.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"70 ","pages":"Pages 99-106"},"PeriodicalIF":2.6,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}