Clinical nutrition ESPEN最新文献

{"title":"Loss of skeletal muscle mass during treatment is associated with reduced overall survival in gastric cancer patients undergoing conversion surgery","authors":"Marta Sandini ,&nbsp;Giulio Bagnacci ,&nbsp;Vincenzo Ricchiuti ,&nbsp;Irene Gambassi ,&nbsp;Stefania Piccioni ,&nbsp;Iacopo Capitoni ,&nbsp;Maria Antonietta Mazzei ,&nbsp;Daniele Marrelli ,&nbsp;Franco Roviello","doi":"10.1016/j.clnesp.2025.06.014","DOIUrl":"10.1016/j.clnesp.2025.06.014","url":null,"abstract":"<div><h3>Background</h3><div>The recent introduction of multimodal approach in the setting of conversion surgery (CS) significantly improved survival of stage IV gastric cancer (GC) patients. The prognosis has been related to several tumor and patient factors. Abnormal body composition, specifically the depletion of the lean mass compound, have been associated with impaired short- and long-term outcomes in GC. Aim was to analyze potential variation of body composition during systemic treatment and to evaluate aftermath on further resection and survival.</div></div><div><h3>Methods</h3><div>In this retrospective monocenter analysis, we assessed pre-treatment and preoperative body composition of stage IV GC patients who underwent surgical exploration following systemic treatment in the setting of CS, over a 12-year period. A radiologist blinded to the patient outcomes assessed the areas of skeletal muscle, and adipose tissue by a dedicated software through standardized protocols. Demographics and clinical data were obtained from prospectively maintained databases and patient records.</div></div><div><h3>Results</h3><div>We included 42 GC patients. Median age was 59 years, 27, 64.3 % were male, and 22/42 were Yoshida category 3 and 4. Surgical interventions included curative resection (23/42 cases), or palliation (19/42). We observed difference in the distribution of body components according to gender, at diagnosis, with more subcutaneous adipose tissue in males (p &lt; 0.001) vs. more visceral adipose tissue in females (p = 0.039). During systemic treatment, a significant increase in total muscle area was observed, but nor in males (median delta TMA -7cm² in males and delta TMA +4.8 cm² in females, p = 0.048). Increased TMA during chemotherapy was associated with improved overall survival, with median OS 63 months, vs. 27 months for patients who lost lean mass (p = 0.042). The protective effect of increased TMA was also confirmed at a multivariate analysis after normalization for age and type of surgical procedure (HR 0.98, 95%CI 0.97–0.99; p = 0.035).</div></div><div><h3>Conclusion</h3><div>As increased skeletal muscular mass during systemic treatment independently improved the overall survival, longitudinal evaluation of body composition must be part of routinary work-up of gastric cancer patients in the setting of conversion surgery. Potential effects of nutritional interventions must be evaluated.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 737-743"},"PeriodicalIF":2.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293453","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":"Evaluation of semi-automated versus fully automated technologies for computed tomography scalable body composition analyses in patients with severe acute respiratory syndrome Coronavirus-2","authors":"Amy Wozniak ,&nbsp;Paula O'Connor ,&nbsp;Jared Seigal ,&nbsp;Vasilios Vasilopoulos ,&nbsp;Mirza Faisal Beg ,&nbsp;Karteek Popuri ,&nbsp;Cara Joyce ,&nbsp;Patricia Sheean","doi":"10.1016/j.clnesp.2025.06.006","DOIUrl":"10.1016/j.clnesp.2025.06.006","url":null,"abstract":"<div><h3>Rationale and objectives</h3><div>Fully automated, artificial intelligence (AI) -based software has recently become available for scalable body composition analysis. Prior to broad application in the clinical arena, validation studies are needed. Our goal was to compare the results of a fully automated, AI-based software with a semi-automatic software in a sample of hospitalized patients.</div></div><div><h3>Materials and methods</h3><div>A diverse group of patients with Coronovirus-2 (COVID-19) and evaluable computed tomography (CT) images were included in this retrospective cohort. Our goal was to compare multiple aspects of body composition procuring results from fully automated and semi-automated body composition software. Bland-Altman analyses and correlation coefficients were used to calculate average bias and trend of bias for skeletal muscle (SM), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intermuscular adipose tissue (IMAT), and total adipose tissue (TAT-the sum of SAT, VAT, and IMAT).</div></div><div><h3>Results</h3><div>A total of 141 patients (average (standard deviation (SD)) age of 58.2 (18.9), 61 % male, and 31 % White Non-Hispanic, 31 % Black Non-Hispanic, and 33 % Hispanic) contributed to the analysis. Average bias (mean ± SD) was small (in comparison to the SD) and negative for SM (−3.79 cm² ± 7.56 cm²) and SAT (−7.06 cm² ± 19.77 cm²), and small and positive for VAT (2.29 cm² ± 15.54 cm²). A large negative bias was observed for IMAT (−7.77 cm² ± 5.09 cm²), where fully automated software underestimated intramuscular tissue quantity relative to the semi-automated software. The discrepancy in IMAT calculation was not uniform across its range given a correlation coefficient of −0.625; as average IMAT increased, the bias (underestimation by fully automated software) was greater.</div></div><div><h3>Conclusions</h3><div>When compared to a semi-automated software, a fully automated, AI-based software provides consistent findings for key CT body composition measures (SM, SAT, VAT, TAT). While our findings support good overall agreement as evidenced by small biases and limited outliers, additional studies are needed in other clinical populations to further support validity and advanced precision, especially in the context of body composition and malnutrition assessment.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 638-644"},"PeriodicalIF":2.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293382","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":"Growth, neurodevelopmental outcomes and micronutrient intake in 18-month-old children with exposure to maternal human immunodeficiency virus and placental insufficiency: The UmbiGodisa cross-sectional study","authors":"Mothusi Nyofane ,&nbsp;Marinel Hoffman ,&nbsp;Helen Mulol ,&nbsp;Tanita Botha ,&nbsp;Robert Pattinson ,&nbsp;Ute Feucht","doi":"10.1016/j.clnesp.2025.06.010","DOIUrl":"10.1016/j.clnesp.2025.06.010","url":null,"abstract":"<div><h3>Background and aim</h3><div>Maternal human immunodeficiency virus (HIV) and intrauterine growth restriction (IUGR) are both associated with suboptimal childhood growth and neurodevelopment. This study assessed growth and neurodevelopmental outcomes and micronutrient intakes in children who are HIV-exposed-uninfected (CHEU), compared to HIV-unexposed-uninfected children (CHUU), stratified based on evidence of placental insufficiency.</div></div><div><h3>Methods</h3><div>Placental insufficiency, as proxy for IUGR, was identified using abnormal umbilical artery resistance indices (UmA-RI) on pregnancy Doppler ultrasound. At 18-months postpartum, 264 mother–child pairs were evaluated and categorized into four subgroups: CHUU with normal UmA-RI (control group), CHEU with normal UmA-RI (HIV exposure only), CHUU with abnormal UmA-RI (placental insufficiency only) and CHEU with abnormal UmA-RI (double-exposure). Dietary intake was assessed using a single 24-h dietary recall, and dietary intake of iron, zinc, and iodine was quantified by meal analysis on FoodFinder™ 3.0. Anthropometric data were collected and converted into z-scores. The Bayley Scales of Infant and Toddler Development (Bayley-III) assessed cognitive, language, and motor function. Statistical comparisons used t-test or Mann–Whitney U-tests; associations were analyzed with Spearman's correlation.</div></div><div><h3>Results</h3><div>Children with dual exposure (CHEU/AbN-RI) had significantly lower z-scores compared to the control group, including length-for-age z-score (−1.4 ± 1.4 vs 0.0 ± 1.3; p = 0.001), weight-for-age z-score (−0.6 ± 1.0 vs 0.0 ± 1.2; p = 0.024) and head circumference-for-age z-score (0.4 ± 0.7 vs 0.9 ± 1.2; p = 0.035). Mean cognitive scores were also lower in this group (93.9 ± 12.9 vs 100.1 ± 10.8; p = 0.042). Language composite scores were low across all groups. Higher zinc intake was positively associated with language scores (r = 0.10; p = 0.042) and weight-for-age z-scores were associated with motor outcomes (r = 0.10; p = 0.028). Among CHEU, better growth parameters were positively associated with cognitive and motor developmental domains.</div></div><div><h3>Conclusion</h3><div>Children exposed to both maternal HIV and placental insufficiency showed signs of suboptimal growth, particularly stunting, and delayed cognitive development, compared to unexposed controls. These findings highlight the need for early identification and targeted interventions for high-risk children within Child Health/Nutrition programmes.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 608-618"},"PeriodicalIF":2.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293383","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":"Impulsive behavior is associated with less favorable dietary intake and cardiometabolic profile in adolescents with obesity","authors":"Flavio T. Vieira ,&nbsp;Camila E. Orsso ,&nbsp;Jenneffer R.B. Tibaes ,&nbsp;Nandini Basuray ,&nbsp;Reena L. Duke ,&nbsp;Bradley M. Appelhans ,&nbsp;Graham Finlayson ,&nbsp;Mohammadreza Pakseresht ,&nbsp;Daniela A. Rubin ,&nbsp;Faria Ajamian ,&nbsp;Geoff D.C. Ball ,&nbsp;Catherine J. Field ,&nbsp;Andrea M. Haqq ,&nbsp;Carla M. Prado","doi":"10.1016/j.clnesp.2025.06.012","DOIUrl":"10.1016/j.clnesp.2025.06.012","url":null,"abstract":"<div><h3>Background</h3><div>Unhealthy lifestyle behaviors are important determinants of cardiometabolic health in pediatric obesity. Psychological factors influence decision-making and may influence lifestyle behaviors. Decision-making can be assessed using the delay discounting (DD) method, which assesses the preference for immediate over delayed rewards. We aimed to examine associations of DD with lifestyle behaviors and cardiometabolic risk factors in adolescents with obesity.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of a cross-sectional study. Adolescents (10–18 years) with a body mass index&gt;95^th percentile (n = 39) completed a 5-item adjusting delay task to assess DD. Dietary intake and diet quality (Healthy Eating Index–Canadian Adaptation) were assessed from 3-day food records. Cardiometabolic markers (body composition [air displacement plethysmography], anthropometry, blood pressure, lipids, glucose, and inflammatory markers) and 7-day accelerometer-based physical activity were objectively measured.</div></div><div><h3>Results</h3><div>Individuals with greater choice impulsivity showed lower estimated intake of protein and whole grains, higher carbohydrate intake, and poorer lipid profile despite lower fat intake. Lower choice impulsivity was associated with lower total cholesterol (R² = 0.104, β = −0.003, p = 0.048, 95%CI −0.007, −0.001), low-density lipoprotein (R² = 0.161, β = −0.003, p = 0.011, 95%CI −0.005, −0.001), and triglyceride concentrations (R² = 0.159, β = −0.005, p = 0.012, 95%CI −0.010, −0.001), and higher protein intake (R² = 0.146, β = 0.001, p = 0.018, 95%CI 0.001, 0.001) and diet quality (R² = 0.110, β = −5.233, p = 0.042, 95%CI −10.260, −0.207). DD was not associated with PA.</div></div><div><h3>Conclusion</h3><div>Higher choice impulsivity was associated with less favorable dietary intake and cardiometabolic profile in adolescents with obesity. Incorporating psychological assessments, such as DD, may be a useful addition to conventional assessments in the context of behavioral interventions for managing adolescent obesity, especially in nutrition.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 744-748"},"PeriodicalIF":2.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293452","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":"Preoperative carbohydrate loading as part of an enhanced recovery after surgery (ERAS) protocol confers early postoperative benefits following elective total hip arthroplasty","authors":"Shuvalaxmi D. Haselton,&nbsp;Vivek P. Chadayammuri,&nbsp;Roger H. Emerson","doi":"10.1016/j.clnesp.2025.05.049","DOIUrl":"10.1016/j.clnesp.2025.05.049","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Surgery (ERAS) protocols aim to optimize perioperative physiology and reduce surgical stress, yet their efficacy in total joint arthroplasty (TJA) remains incompletely characterized.</div></div><div><h3>Methods</h3><div>A prospective, randomized observational study was conducted at a single high-volume arthroplasty center between January 2019 and July 2023. A total of 150 patients undergoing primary elective THA were randomized to either a control group following traditional nil per os (NPO) guidelines or an ERAS group receiving a carbohydrate-rich oral nutritional supplement 12 and 2 h prior to surgery. Outcomes included postoperative length of stay (LOS), opioid consumption (measured in morphine milligram equivalents [MME]), Visual Analog Scale (VAS) pain scores, 90-day readmission, and early postoperative functional milestones.</div></div><div><h3>Results</h3><div>Patients in the ERAS cohort demonstrated reduced postoperative LOS (1.3 vs. 1.8 days; <em>p</em> = 0.048), lower peak VAS scores (4.5 vs. 6.0; <em>p</em> = 0.001), and decreased need for Schedule II narcotic medications (5.3 % vs. 22.7 %). A near-significant trend toward reduced average opioid utilization (MME/day) over the first two weeks postoperatively was also observed (36.1 vs. 43.8; p = 0.082). Subgroup analysis demonstrated consistent treatment effects across all age strata.</div></div><div><h3>Conclusions</h3><div>Incorporation of preoperative carbohydrate loading and abbreviated fasting within a standardized ERAS protocol is associated with improved early clinical outcomes following elective THA. Adoption of these measures may represent a cost-effective strategy to enhance perioperative recovery while aligning with performance benchmarks increasingly prioritized in value-based care delivery.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 602-607"},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282684","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":"Dietary Acid Load Increases Odds of Minor ST Segment and T Wave Abnormalities in Electrocardiogram: Results of a Large Population-Based Study.","authors":"Najmeh Seifi, Sara Saffar Soflaei, Ali Ebrahimi Dabagh, Glareh Koochackpoor, Hedieh Alimi, Asal Yadollahi, Habibollah Esmaily, Gordon A Ferns, Mohsen Moohebati, Majid Ghayour-Mobarhan","doi":"10.1016/j.clnesp.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.clnesp.2025.06.004","url":null,"abstract":"<p><strong>Background: </strong>Electrocardiograms (ECGs) are useful in predicting cardiovascular diseases (CVDs) in the general population. Among ECG abnormalities, isolated minor ST segment and T Wave (ST-T) changes are introduced to be associated with CVDs and CVD-associated mortality in apparently-healthy individuals. Diet, a modifiable risk factor of CVDs, is proposed to be associated with ECG abnormalities.</p><p><strong>Objectives: </strong>we aimed to investigate the association between isolated minor ST-T abnormalities and dietary acid load in a community-based adult population.</p><p><strong>Methods: </strong>In this cross-sectional study, 6413 participants aged 35-65 were included. Dietary acidity levels were assessed using the Net Endogenous Acid Production (NEAP) and Potential Renal Acid Load (PRAL) scores, derived from a validated food frequency questionnaire (FFQ). The Minnesota coding system was used to address minor ST-T segment abnormalities on ECGs. Multiple logistic regression was conducted in four distinct models reported as odds ratios (OR).</p><p><strong>Results: </strong>The study revealed that higher dietary acidity was associated with an increased risk of isolated minor ST-T abnormalities across various models. Individuals in the highest tertile of PRAL compared to the lowest, had 79% higher odds of isolated minor ST-T abnormalities in the fully-adjusted model (OR (95%CI): 1.79 (1.13-2.82), p=0.01). The highest tertile of NEAP compared to the lowest was also associated with an increased odds of isolated minor ST-T abnormalities (In the full-adjusted model OR (95%CI): 1.79 (1.13-2.83), p=0.01).</p><p><strong>Conclusion: </strong>Isolated minor ST-T changes were significantly associated with dietary acid load score, in a way that higher NEAP and PRAL scores were related to increased odds of minor isolated ST-T abnormalities.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282683","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":"Efficacy of daily 4,000 International Units (IU) versus 6,000 IU of oral vitamin D3 in vitamin D deficient children with overweight and obesity: An open-label randomized controlled trial","authors":"Priya Setia ,&nbsp;Anju Seth ,&nbsp;Ritu Singh ,&nbsp;Rajeev Kumar Malhotra ,&nbsp;Preeti Singh","doi":"10.1016/j.clnesp.2025.06.007","DOIUrl":"10.1016/j.clnesp.2025.06.007","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Children with overweight/obesity are at increased risk of vitamin D deficiency. This study compares the efficacy and safety of 4000 International Units (IU)/day vs. 6000 IU/day oral vitamin D₃ over 12 weeks for treating vitamin D deficiency and evaluates its impact on metabolic parameters.</div></div><div><h3>Methods</h3><div>In this open-label randomized controlled trial, 90 children (5–18 years) with overweight/obesity and vitamin D deficiency (25 [OH]D &lt; 50 nmol/L) were randomized to receive 4000 IU/day (Group A, n = 45) or 6000 IU/day (Group B, n = 45) along with calcium. Efficacy (25 [OH]D ≥ 50 nmol/L), safety (hypercalcemia, hypercalciuria, hypervitaminosis D), and metabolic impact (HbA1c, lipids) were assessed over 12 weeks. Trial registered with CTRI/2021/02/031591.</div></div><div><h3>Results</h3><div>Sixty-eight children completed the study. Both groups showed significant increases in serum calcium and reductions in alkaline phosphatase and parathormone, with no inter-group differences. Group B showed a faster rise in 25(OH)D levels, with higher means at 4 weeks [66.3 (3.12) vs. 55.6 (2.92)] and 12 weeks [100.6 (3.42) vs. 79.3 (3.17) nmol/L]. At 12 weeks, sufficiency was achieved in 91.4 % (Group A) and 93.4 % (Group B). Mild, asymptomatic hypercalcemia was noted in 7 children (Group A-3, Group B-4; p = 0.70) and resolved spontaneously. No significant metabolic changes were observed in either group.</div></div><div><h3>Conclusions</h3><div>Both 4000 IU/day and 6000 IU/day of vitamin D₃ were effective and safe for treating vitamin D deficiency in overweight or obese children, with no observed effect on metabolic parameters in either group. Higher doses may accelerate sufficiency; however, standard dosing remains effective, emphasizing the need for individualized treatment and monitoring.</div></div><div><h3>Impact statement</h3><div>Comparing 4000 IU/day to 6000 IU/day of vitamin D₃ in children with overweight or obesity showed that both regimens were safe and effective in achieving sufficiency without either regimen influencing metabolic parameters. The higher doses allowed for a quicker attainment of optimal levels. While both doses effectively establish vitamin D sufficiency in the short term, long-term data are necessary to confirm their ongoing efficacy and safety over extended periods.</div></div><div><h3>Clinical trial registration no</h3><div>CTRI (Clinical Trial Registry India) (CTRI/2021/02/031591).</div><div><strong>The protocol can be accessed</strong> at <span><span>https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NTI2NTM=&amp;amp;Enc=&amp;amp;userName=</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 806-813"},"PeriodicalIF":2.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274304","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":"Navigating complexity: The challenge of reaching consensus on the diagnosis of malnutrition in patients with obesity via a modified delphi study","authors":"Natasha Nalucha Mwala ,&nbsp;Jeanne J.F.A. in ’t Hulst ,&nbsp;Barbara S. van der Meij ,&nbsp;Emmelyne Vasse ,&nbsp;Jos W. Borkent ,&nbsp;Carliene van Dronkelaar ,&nbsp;Patty L.M. Lakenman ,&nbsp;Esmee M. Reijnierse ,&nbsp;Josje D. Schoufour ,&nbsp;Peter J.M. Weijs ,&nbsp;Renate Winkels ,&nbsp;Maarten R. Soeters ,&nbsp;Marian A.E. de van der Schueren","doi":"10.1016/j.clnesp.2025.05.043","DOIUrl":"10.1016/j.clnesp.2025.05.043","url":null,"abstract":"<div><h3>Background &amp; aim</h3><div>Diagnosing (disease-related) malnutrition in patients with obesity is challenging due to the complex interplay between excess body weight and physiological changes associated with illness and inadequate dietary intake, factors often overlooked in clinical assessments. Current global definitions of malnutrition do not adequately account for the distinctive characteristics of patients with obesity. This study aimed to develop a working definition of malnutrition in this population.</div></div><div><h3>Methods</h3><div>A modified three-round Delphi method was conducted between March and July 2024, involving 25 experts to achieve consensus on diagnosing malnutrition in obesity. In Round 1, participants evaluated 45 statements using a 5-point Likert scale. Feedback from this round guided revisions for Round 2, which focused on the Global Leadership Initiative on Malnutrition (GLIM) criteria and introduced nine revised statements. Round 3 further refined these statements, with the final consensus assessed using a binary agree/disagree scale. A threshold of ≥70 % agreement was set to define consensus in all rounds, with statements not meeting this threshold left undecided.</div></div><div><h3>Results</h3><div>Participation rates were 88 % (n = 22) in Round 1, 77 % (n = 17) in Round 2, and 50 % (n = 11) in Round 3. Of the 45 statements assessed in Round 1, 11 were accepted, 32 were undecided, and two were rejected. Round 2 introduced nine revised statements, of which seven were accepted and two remained undecided. In Round 3, nine statements were assessed, of which six were accepted, and three remained undecided. Consensus supported adopting the GLIM criteria as the foundation for the working definition. However, thresholds for weight loss and muscle mass and the relevance of functional parameters remained unresolved. C-reactive protein thresholds were agreed upon, but their relevance was debated due to the challenges in interpreting chronic low-grade inflammation in obesity. Participants emphasised the importance of assessing dietary quality and quantity, recommending dietitian involvement for improved accuracy.</div></div><div><h3>Conclusion</h3><div>Although a working definition for diagnosing malnutrition in patients with obesity was not achieved, this study lays a crucial foundation for further research. Key areas for future investigation include refining and validating parameters related to involuntary weight loss, muscle mass, inflammatory markers and dietary intake.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 591-601"},"PeriodicalIF":2.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257497","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":"Fruit type ingestion and risk of hepatic steatosis: Analysis from two national database 2017–2020","authors":"Thanathip Suenghataiphorn ,&nbsp;Narisara Tribuddharat ,&nbsp;Pojsakorn Danpanichkul ,&nbsp;Narathorn Kulthamrongsri","doi":"10.1016/j.clnesp.2025.06.005","DOIUrl":"10.1016/j.clnesp.2025.06.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Hepatic Steatosis is an intrahepatic fat accumulation and can lead to liver dysfunction, inflammation, and advanced forms of nonalcoholic fatty liver disease (NAFLD). Fruits have been explored as a possible beneficial factor for some individuals with metabolic-associated liver diseases, but the evidence regarding the specific relationship between fruit types and hepatic steatosis remains limited.</div></div><div><h3>Methods</h3><div>We examined the data from a nationwide cross-sectional study using the 2017–March 2020 National Health and Nutrition Examination Survey (NHANES) database and the Food Patterns Equivalents Database (FPED) database. Using controlled attenuation parameter scores to differentiate between S0 to S3, for participants aged 18 years and older, we employed multivariable logistic regression to determine the association between specific types of fruit intake (citrus fruits, non-citrus fruits, and fruit juice) and the presence of hepatic steatosis.</div></div><div><h3>Results</h3><div>A total of 7568 participants were included in our study. Hepatic steatosis was present in 63 % of our participants. The average age was 48.8 years, with 50 % being females. Patients who consumed at least 0.86 cup-equivalents of citrus fruits daily (adjusted odds ratio [aOR] 0.82, 95 % confidence interval [CI] (0.71, 0.94), p = 0.004) had lower odds of having hepatic steatosis, whereas intake of fruit juice and non-citrus fruits was not statistically significantly associated with hepatic steatosis.</div></div><div><h3>Conclusion</h3><div>Citrus fruit consumption was associated with reduced odds of having hepatic steatosis in this U.S. adult population. Additional investigations into the pathophysiology, as well as longitudinal studies, are required to understand this relationship further and establish causality.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 583-590"},"PeriodicalIF":2.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257496","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 estimated glucose disposal rate and cardiovascular disease risk across different Sarcopenia statuses: A retrospective cohort study","authors":"Xiongmu Tan ,&nbsp;Xiaoqin Chen ,&nbsp;Yanrui shen,&nbsp;Yinqiu Wang,&nbsp;Linyan Huang,&nbsp;Liqing Peng","doi":"10.1016/j.clnesp.2025.06.001","DOIUrl":"10.1016/j.clnesp.2025.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Recent research indicates that the estimated glucose disposal rate (eGDR) is regarded as a reliable surrogate marker for insulin resistance (IR) and is associated with the incidence of cardiovascular diseases (CVD). Sarcopenia, characterized by a decline in skeletal muscle mass, strength, or physical function, exhibits complex interactions with chronic diseases. This study aims to investigate the association between eGDR, sarcopenia, and CVD among middle-aged and elderly individuals, and to explore the potential impact of eGDR on CVD risk in the overall population as well as stratified by sarcopenia status.</div></div><div><h3>Materials and methods</h3><div>This study comprised 5938 participants who were free of cardiovascular disease at baseline and possessed complete data on sarcopenia-related indicators and eGDR. The primary endpoint was the occurrence of cardiovascular events. The relationship between baseline eGDR levels and the incidence of CVD among individuals with sarcopenia was analyzed using Kaplan–Meier curves, multivariable Cox proportional hazards models, restricted cubic spline analysis, subgroup analysis, and sensitivity analysis.</div></div><div><h3>Results</h3><div>During an average follow-up of 8.14 years, cardiovascular events occurred in 1164 participants (19.6 %). The risk of cardiovascular events decreased with each quartile (Q) increase in baseline eGDR levels. Kaplan–Meier curve analysis revealed significant differences in cardiovascular incidence among all participants across eGDR groups (P &lt; 0.05). After adjusting for potential confounding factors, the cardiovascular risk for participants in Q2, Q3, and Q4 was significantly lower than that in Q1. The hazard ratios (95 % confidence intervals) for CVD in groups Q2, Q3, and Q4 were 0.71 (0.61–0.82), 0.57 (0.47–0.68), and 0.55 (0.45–0.67), respectively. Furthermore, in all three Cox models, high levels of eGDR were associated with a reduced risk of cardiovascular events in non-sarcopenic, possibly sarcopenic, and sarcopenic individuals.</div></div><div><h3>Conclusion</h3><div>Elevated baseline eGDR levels are significantly associated with a reduced risk of CVD in middle-aged and elderly individuals, exhibiting notable characteristics in both non-sarcopenic and sarcopenic populations.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 749-760"},"PeriodicalIF":2.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246764","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}