Clinical nutrition ESPEN最新文献

{"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}

{"title":"Association between sarcopenic obesity and the risk of knee osteoarthritis in the middle-aged and elderly Chinese population: A 7-year cohort study","authors":"Xinyang Wang,&nbsp;Yubao Liu,&nbsp;Yucheng Lin,&nbsp;Yuanhao Liu,&nbsp;Linshu Guan,&nbsp;Jun Lu","doi":"10.1016/j.clnesp.2025.06.002","DOIUrl":"10.1016/j.clnesp.2025.06.002","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the relationship between sarcopenic obesity and the risk of knee osteoarthritis (KOA) in middle-aged and elderly individuals.</div></div><div><h3>Methods</h3><div>This study utilized cohort data from the China Health and Retirement Longitudinal Study (CHARLS) database, focusing on middle-aged and elderly individuals without knee osteoarthritis in 2011. A total of 4299 participants aged over 45 who met the inclusion and exclusion criteria were included. Using overweight as the criterion for obesity, participants were divided into four groups: normal control, only overweight, only sarcopenia, and sarcopenic overweight. Cox proportional hazards models were employed for survival analysis, comparing the normal control group with the other three groups to assess their impact on the risk of developing knee osteoarthritis. Sensitivity analyses were conducted using sarcopenia obese and sarcopenia abdominal obesity to ensure the robustness of the results. Additionally, subgroup analyses were performed to explore the influence of different populations on the outcomes. Lastly, we investigated the association between probable sarcopenic obesity and KOA.</div></div><div><h3>Results</h3><div>Compared to the normal control group, the sarcopenic obesity group showed a significantly increased risk of KOA Hazard Ratio (HR) = 1.53, 95 % Confidence interval (CI) = 1.19–1.98). Sensitivity analyses demonstrated consistent patterns, with the sarcopenic obese group showing a 57 % elevated risk of KOA (HR = 1.57, 95%CI = 1.04–2.35) and the sarcopenic abdominal obesity group a 40 % increased risk (HR = 1.40, 95%CI = 1.08–1.80), both relative to the normal control cohort. Subgroup analyses revealed a significant interaction effect of gender on the results (P for interaction &lt;0.05), with females in the sarcopenic overweight group showing a statistically significant difference compared to the normal group (HR = 1.45, 95 % CI = 1.06–1.99). Moreover, in the context of probable sarcopenic overweight and KOA, the probable sarcopenic overweight group (HR = 1.44, 95 % CI = 1.11–1.87) was associated with an increased risk of developing KOA.</div></div><div><h3>Conclusion</h3><div>This study is the first longitudinal investigation to examine the association between sarcopenic obesity (and probable sarcopenic obesity) and the risk of KOA in a large sample of middle-aged and elderly individuals. The findings suggest that through weight management and adequate muscle strength, it may be probable to reduce the risk of KOA in middle-aged and elderly populations, especially among women, thereby improving quality of life in later years.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 575-582"},"PeriodicalIF":2.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246765","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":"A comparative study of malnutrition screening tools in advanced liver disease: Sensitivity, specificity, and patient acceptability","authors":"Shaye Ludlow ,&nbsp;Emmah McKeown ,&nbsp;Kelly Squires ,&nbsp;Sarah Pullen ,&nbsp;Paulett Barnes ,&nbsp;Alison Gibberd ,&nbsp;Lucy Leigh ,&nbsp;John Attia ,&nbsp;Katie Wynne","doi":"10.1016/j.clnesp.2025.06.003","DOIUrl":"10.1016/j.clnesp.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Patients with advanced liver disease (ALD) are at increased risk of malnutrition, significantly impacting patient outcomes and quality of life. Screening for malnutrition in ALD can be challenging with changes in weight potentially concealed by fluid from ascites and oedema, or muscle wasting. Current validated malnutrition screening tools used in ALD account for physiological symptoms, but there are no known validated tools that also screen for non-physiological symptoms or fluid overload.</div></div><div><h3>Aim</h3><div>To examine the sensitivity and specificity of a novel malnutrition screening tool for adults with ALD, (Child-Pugh score B or C) with or without ascites attending a regional and metropolitan health site, against three established malnutrition screening tools compared with a Subjective Global Assessment (SGA) as the reference standard.</div></div><div><h3>Methods</h3><div>A cross-sectional study was undertaken within the outpatient and inpatient hepatology services of a metropolitan and a regional hospital. Each participant completed four malnutrition screening tools, the Patient Generated Subjective Global Assessment Short Form (PG-SGA SF), Royal Free Hospital Nutrition Prioritizing Tool (RFH-NPT), Malnutrition Screening Tool (MST), and a newly developed novel screening tool (Nutrition-ALD) as well as a diagnostic SGA with the dietitian. Performance of each tool was compared by calculating sensitivity, specificity, and area under the curve (AUC). Wellbeing scores measured by Integrated Palliative care Outcome scale (IPOS) were correlated with the malnutrition screening tool scores.</div></div><div><h3>Results</h3><div>50 participants with Child-Pugh B and C liver disease [n = 33 (66 %) outpatient setting; n = 17 (34 %) inpatient setting] were recruited for this study. 82 % of participants were diagnosed with mild to moderate or severe malnutrition using SGA. Relative to the SGA, the PG-SGA SF had the highest AUROC, followed by the novel screening tool. PG-SGA SF demonstrated the highest sensitivity (0.88) and specificity (0.89). Participant-reported experience was most favourable for the novel screening tool, followed by PG-SGA SF.</div></div><div><h3>Conclusion</h3><div>A nutrition screening tool should be quick, sensitive, and specific to detect malnutrition risk to allow for early nutrition intervention. In this study population, the PG-SGA SF had the highest sensitivity and specificity, and the novel tool was most acceptable to the participants. Consideration of wellbeing with a holistic and supportive approach to malnutrition screening may improve accuracy and timeliness of referrals for patients requiring nutrition support and improve efficiency in low-resource settings.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 557-566"},"PeriodicalIF":2.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246763","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":"Hepatoprotective properties of Cordia africana leaf extract inhibiting isoniazid and rifampicin-related toxicity in mice","authors":"Endalkachew Gugsa Andargie ,&nbsp;Wubet Tizazu Ferede ,&nbsp;Tadesse Asmamaw Dejenie ,&nbsp;Markeshaw Tiruneh Gebremedhin ,&nbsp;Gashaw Dessie ,&nbsp;Bewketu Abebe Alemu ,&nbsp;Banchamlak Teferi ,&nbsp;Tewodros Shibabaw Molla","doi":"10.1016/j.clnesp.2025.05.028","DOIUrl":"10.1016/j.clnesp.2025.05.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite baseline investigation before the start of therapeutic management, patients being treated for pulmonary tuberculosis often suffer from liver injury due to the effects of anti-tuberculosis drugs, particularly isoniazid (INH) and rifampin (RIF). However, there is no treatment against the hepatotoxic effect of INH and RIF. Therefore, it is better to focus on medicinal plants for the prevention of liver injury caused by these drugs. <em>Cordia africana</em> has been used traditionally as a treatment for liver related diseases. This study aimed to evaluate the hepatoprotective effect of aqueous extract of <em>Cordia africana</em> leaves against isoniazid and rifampicin-induced liver toxicity in mice.</div></div><div><h3>Methods</h3><div><em>Cordia africana</em> leaf powder was decocted in water and 30 Swiss albino mice 28.0–35.0 g were grouped into five groups: Group I mice were given 20 ml/kg distilled water and Group II mice were given 75mg/kg INH and 150 mg/kg RIF body weight. Group III, group IV, and group V mice were given, 75 mg/kg INH plus 150 mg/kg RIF in addition to 200 mg/kg extract, 400 mg/kg extract, and 50 mg/kg silymarin respectively. The treatments lasted for 14 days. Blood samples were taken from each study subject for liver biochemical tests. In addition, livers were also taken for histopathological examination.</div></div><div><h3>Results</h3><div>Compared to Group I, Group II showed a significant increase (P &lt; 0.05) in serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and total bilirubin. This elevation likely dictates the possibility of liver dysfunction or damage. Also, in the groups of mice that were treated with <em>Cordia africana</em> at a dose of 400 mg/kg and silymarin demonstrated that a marked decrease in ALT, AST, ALP and total bilirubin levels. This reduction indicates that both <em>Cordia africana</em> and silymarin might have a protective effect on liver function, especially when compared to Group II which they didn't receive such treatment. The liver index of Group IV mice showed a decrease significantly (P &lt; 0.05) compared to Group II. Besides histopathologic analysis showed that the plant extract at a higher dose did not show inflammation and showed negligible degeneration of hepatocytes and congestion in sinusoids, whereas in the negative control severe degeneration of hepatocytes and moderate inflammation were seen.</div></div><div><h3>Conclusion</h3><div>From this experiment we found that the aqueous extract of <em>Cordia africana</em> has hepatoprotective effect against isoniazid and rifampicin-induced hepatotoxicity in mice. This protective effect of <em>Cordia africana</em> extract might be due to its anti-inflammatory and antioxidant activity and could be considered a potential therapeutic option against INH and RIF induced liver injury.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 567-574"},"PeriodicalIF":2.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246766","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}