Clinical nutrition ESPEN最新文献

{"title":"Prognostic significance of the cachexia index (CXI) in patients with cancer: A systematic review and meta-analysis","authors":"Onur Bas ,&nbsp;Taha Koray Sahin ,&nbsp;Latif Karahan ,&nbsp;Alessandro Rizzo ,&nbsp;Deniz Can Guven","doi":"10.1016/j.clnesp.2025.03.023","DOIUrl":"10.1016/j.clnesp.2025.03.023","url":null,"abstract":"<div><h3>Aim</h3><div>The Cachexia Index (CXI) was a useful indicator of malnutrition and inflammatory pressure in patients with cancer and was associated with a poor prognosis. However, the available studies differ in terms of study population, design, and the used cut-offs. Therefore, we aimed to systematically analyze the association between CXI and survival in cancer patients.</div></div><div><h3>Material and method</h3><div>We conducted a systematic literature search across Pubmed, Scopus, and Web of Science databases for studies published up to 24 September 2024. This protocol was registered in the PROSPERO database (Registration Number: CRD42024594228). We performed a meta-analysis and analyzed the results of these studies.</div></div><div><h3>Results</h3><div>Twenty-two studies with a total of 5401 patients were identified. Lower CXI levels were significantly associated with shorter overall survival (OS) (Hazard Ratio (HR): 2.03, 95 % Confidence Interval (CI): 1.83–2.24, p &lt; 0.001) and progression-free survival (PFS) (HR:1.86 95%CI: 1.67–2.08, p &lt; 0.001). This association was similar among tumor types (gastrointestinal (GI), hepatobiliary/pancreas, and other tumors) and tumor stage (localized vs metastatic).</div></div><div><h3>Conclusion</h3><div>In this meta-analysis, we showed a relationship between lower CXI levels and survival in patients with cancer. Our findings suggest that CXI may be a valuable prognostic marker in patients with cancer and help clinicians define high-risk patients.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 240-247"},"PeriodicalIF":2.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742472","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":"Healthy lifestyle indices are associated with breast cancer immunophenotypes in women","authors":"Brianda Armenta-Guirado ,&nbsp;Ángel Mérida-Ortega ,&nbsp;Lizbeth López-Carrillo ,&nbsp;Edgar Denova-Gutiérrez","doi":"10.1016/j.clnesp.2025.03.031","DOIUrl":"10.1016/j.clnesp.2025.03.031","url":null,"abstract":"<div><h3>Background</h3><div>Multiple modifiable lifestyle risk factors are independently associated with breast cancer (BC); however, evidence lacks regarding the joint relationship between lifestyle components and BC immunophenotypes.</div></div><div><h3>Aim</h3><div>We aimed to assess the association among adherence to healthy lifestyle indices and BC immunophenotypes in women.</div></div><div><h3>Methods</h3><div>We conducted a secondary analysis of data from a study performed between 2007 and 2011, comprising 1045 cases and 1030 population controls. We retrieved information on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) expression from medical records to classify BC as luminal (ER+ and/or PR+/HER2–), HER2+ (ER+/− and/or PR+/−/HER2+), or triple negative (TN) (ER– and PR–/HER2–). Through direct interviews, we obtained lifestyle variable information such as diet, physical activity, as well as tobacco and alcohol consumption. We evaluated compliance with the Healthy Lifestyle Index Score (HLIS) and the Healthy Behavior Index (HBI). We used non-conditional logistic regression models to assess the association between BC immunophenotypes and the indices.</div></div><div><h3>Results</h3><div>Women with higher adherence to the HLIS had a 23 % lower probability of BC (Odds ratio [OR]_{Tertil (T)3vsT1} = 0.77; 95%Confidence Interval [CI]: 0.60, 0.99; <em>p</em>-trend = 0.030), while those adhering to the HBI showed a 68 % reduction (OR _T3vsT1 = 0.32; 95%CI: 0.24, 0.42; <em>p</em>-trend = 0.000). These associations remained negative across all BC immunophenotypes.</div></div><div><h3>Conclusion</h3><div>Adherence to healthy lifestyle indices might prevent BC. Further research is warranted to elucidate the intricate interplay among lifestyle factors and BC risk across diverse populations and immunophenotypes.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 410-416"},"PeriodicalIF":2.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742470","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":"Impact of nutrient intake on bone mineral density and bone quality in patients with acromegaly","authors":"Natália Nachbar Hupalowski ,&nbsp;Claudia Pinheiro Sanches Rocha ,&nbsp;Vicente Florentino Castaldo ,&nbsp;Cesar Luiz Boguszewski ,&nbsp;Victoria Zeghbi Cochenski Borba","doi":"10.1016/j.clnesp.2025.03.035","DOIUrl":"10.1016/j.clnesp.2025.03.035","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Nutrition plays a critical role in maintaining bone health and excessive secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), in patients with acromegaly has been associated with disrupting bone remodeling and increased risk of vertebral fractures. The aim of this study was to assess the dietary quality of patients with acromegaly and its impact on bone density, quality and fractures.</div></div><div><h3>Methods</h3><div>This is a cross-sectional, observational, controlled study which included individuals with acromegaly (AG) and matched controls by sex and age (CG). Food intake was evaluated by a food frequency questionnaire (FFQ) and dietary reference intakes (DRIs). Bone mineral density (BMD) and bone quality [trabecular bone score] (TBS) measured by dual-energy X-ray absorptiometry (DXA) and the history of past fractures captured by a questionnaire.</div></div><div><h3>Results</h3><div>Eighty-two individuals were included, 41 in the AG (58.5 % women, mean age 55.9 ± 11.8 years; mean body mass index (BMI) 31.14 ± 5.16) and 41 in the CG (58.5 % women, 56.8 ± 14.3 years and mean BMI was 25.5 ± 3.3). The mean age at diagnosis of acromegaly was 43.7 ± 13.0 years and 63.4 % of AG had a controlled disease. In both groups, insufficient intake, compared to DRIs, of essential nutrients (fiber, omega-3 and 6, vitamins A and E) and minerals (magnesium, potassium, and calcium) was observed. Compared to the CG, the AG showed a higher intake of carbohydrates, trans fats, and certain micronutrients compared to the CG, p &lt; 0.05 for all, similar BMD values, higher number of fractures (AG 0.63 ± 1.11 vs. CG 0.14 ± 0.43; p = 0.001) and poorer TBS (men AG 1.10 ± 0.43 vs. CG1.43 ± 0.09; p = 0.006; women AG 1.03 ± 0.54 vs. CG 1.35 ± 0.14; p = 0,009). In the AG fractures were negatively associated to flavones and vitamin A, and positively associated to IGF-1 levels (p &lt; 0.05 for all). BMD and TBS were positively associated with different bioactive compounds (flavone, anthocyanin, beta-carotene and vitamin C), macronutrients and vitamins with anti-inflammatory activity.</div></div><div><h3>Conclusion</h3><div>individuals with acromegaly had low bone quality and higher prevalence of fractures despite adequate BMD associated to Inadequate intake of antioxidant and anti-inflammatory compounds, combined with excessive consumption of trans fats and poor-quality carbohydrate.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 398-403"},"PeriodicalIF":2.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742471","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":"Nutritional interventions for preventing cognitive decline in patients with mild cognitive impairment and Alzheimer's disease: A comprehensive network meta-analysis and Mendelian Randomization study","authors":"Qian He ,&nbsp;Adam N. Bennett ,&nbsp;Chuyun Zhang ,&nbsp;Jia Yue Zhang ,&nbsp;Shuyao Tong ,&nbsp;Kei Hang Katie Chan","doi":"10.1016/j.clnesp.2025.03.040","DOIUrl":"10.1016/j.clnesp.2025.03.040","url":null,"abstract":"<div><h3>Background</h3><div>As the population ages rapidly, cognitive impairment, especially in conditions like Alzheimer's disease (AD) and mild cognitive impairment (MCI), has become a crucial public health issue. Nutritional interventions have garnered attention as a promising non-pharmacological strategy for maintaining cognitive function and decelerating its decline.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the effectiveness of various nutritional interventions in preventing cognitive impairment and elucidate intricate biological pathways linking nutritional interventions to cognitive function through a comprehensive approach involving systematic review, network meta-analysis (NMA), and Mendelian randomization (MR) analysis.</div></div><div><h3>Methods</h3><div>We utilized pair-wise comparisons and NMA to evaluate the efficacy of different nutritional interventions on cognitive function in patients with decreased cognitive abilities. A systematic search in three biomedical databases was performed for double-blinded, randomized controlled trials (RCTs) or head-to-head comparisons up to December 31, 2024. The NMA has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022331173). Moreover, to clarify the biological mechanisms linking nutritional interventions to cognitive impairment, we conducted two-sample MR analyses to assess the potential causal relationships between 9 genetically predicted nutrient levels derived from extensive genome-wide association studies (GWASs) and 12 biomarkers linked to brain aging.</div></div><div><h3>Results</h3><div>This study encompassed 52 trials with 8452 participants, 9 GWASs examining genetically predicted nutrient levels with a total of 603,996 participants, and 12 GWASs investigating brain aging biomarkers with a total of 2,405,530 participants. The NMA demonstrated that the multi-ingredient intervention outperformed other interventions significantly (standardized mean difference [SMD] = 2.03; 95 % credible interval [95 % CrI] = 0.97–3.09, P = 0.0002). In the MR analysis, the findings indicated that the multi-ingredient intervention was linked to reduced C-reactive protein (CRP) levels (odds ratios [OR] = 0.96, 95 % confidence interval [95 % CI] = 0.93–0.99, P = 0.014), suggesting that the multi-ingredient intervention may mitigate cognitive impairment by reducing inflammation.</div></div><div><h3>Conclusions</h3><div>Our NMA amalgamated evidence underscoring multi-ingredient interventions as the most efficacious strategy for attenuating cognitive decline in individuals with MCI and AD. Furthermore, the MR analysis unveiled the mechanisms underpinning the protective effects of multi-ingredient interventions, potentially offering benefits even in the early stages of neurodegeneration by mitigating oxidative stress and inflammation.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 555-566"},"PeriodicalIF":2.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729054","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":"High protein intake in formula-fed term infants: Abridged republication of the cochrane systematic review","authors":"Alejandro G. Gonzalez-Garay ,&nbsp;Aurora E. Serralde-Zúñiga ,&nbsp;Liliana Velasco Hidalgo ,&nbsp;Mathy Victoria Alonso Ocaña ,&nbsp;Fernando Estrada-Moya ,&nbsp;Isabel Medina Vera","doi":"10.1016/j.clnesp.2025.03.038","DOIUrl":"10.1016/j.clnesp.2025.03.038","url":null,"abstract":"<div><h3>Background</h3><div>Many infants receive formulas to support growth, some of which contain high protein (≥2.5 g per 100 kcal) to increase weight gain. The risk-benefit of these formulas is unclear. This review evaluated high-protein formula (HPF) versus standard-protein formula (SPF) and low-protein formula (LPF) in healthy, formula-fed term infants to prevent undernutrition, obesity, and adverse events.</div></div><div><h3>Methods</h3><div>We searched CENTRAL, MEDLINE, Embase and other databases without language restrictions. Cochrane Collaboration tool and GRADE instrument assessed the risk of bias of randomized controlled trials and certainty of their evidence. We performed random-effects meta-analyses, calculating risk ratios (RR) and mean differences (MD) with 95 % confidence intervals (95 % CI) for the outcomes.</div></div><div><h3>Results</h3><div>We included 11 trials (1185 infants) and found very low-certainty evidence that HPF versus SPF had little or no effect on underweight, stunting, and wasting (MD weight-for-age z-score 0.05 standard deviations (SDs), 95 % CI −0.09 to 0.19; P = 0.51; height-for-age 0.15 SDs, 95 % CI −0.05 to 0.35; P = 0.14). HPF versus SPF had little or no effect on overweight or obesity at five years (RR 1.26, 95 % CI 0.63 to 2.51; P = 0.51). Very low-certainty evidence indicated SPF versus LPF had little or no effect on underweight, stunting, and wasting. HPF versus SPF or LPF may have little or no effect on adverse effects in the first year.</div></div><div><h3>Conclusions</h3><div>We are unsure if HPF versus SPF influences undernutrition or obesity, and there may be little difference in the risk of adverse effects between formulas. Ongoing studies may change these conclusions.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 476-492"},"PeriodicalIF":2.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729053","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 butyric acid intake, kidney function, and survival: The National Health and Nutrition Examination Surveys, 2005–2018","authors":"Wei Tang ,&nbsp;Zhengyi Long ,&nbsp;Yang Xiao ,&nbsp;Jingyun Du ,&nbsp;Chenyuan Tang ,&nbsp;JunXiang Chen ,&nbsp;Can Hou","doi":"10.1016/j.clnesp.2025.03.011","DOIUrl":"10.1016/j.clnesp.2025.03.011","url":null,"abstract":"<div><h3>Background</h3><div>Although preclinical data support the hypothesis that butyric acid supplementation improves kidney health, the clinical significance of dietary butyric acid intake in patients with chronic kidney disease (CKD) remains unconfirmed in large-sample studies. This study aimed to investigate the association between dietary butyric acid intake and all-cause mortality in the United States population, stratified by kidney function.</div></div><div><h3>Methods</h3><div>We examined the relationship between dietary butyric acid intake, assessed through a 24-h dietary recall, and all-cause mortality among 23,008 consecutive adult participants from the National Health and Nutrition Examination Surveys (NHANES, 2005–2018), categorized by impaired versus normal kidney function (estimated glomerular filtration rate &lt;60 vs ≥ 60 mL/min/1.72 m²), using multivariable Cox models. We also employed a restricted cubic spline based on Cox regression models to elucidate the nonlinear relationship between dietary butyric acid intake and mortality in patients.</div></div><div><h3>Result</h3><div>In participants with impaired kidney function, high dietary butyric acid intake was associated with lower mortality, while lower intake levels (reference) showed no such association: adjusted HRs (aHRs) were 0.67 (95 % CI: 0.45, 1.00), 0.65 (95 % CI: 0.45, 0.94), and 0.58 (95 % CI: 0.38, 0.89) for intake levels of the square root of butyric acid 0.25–0.45, 0.45–0.75, and &gt;0.75 g/day, respectively. However, in participants with normal kidney function, no association between butyric acid levels and mortality was observed. Additionally, we identified an L-shaped association between the levels of the square root of dietary butyric acid intake and all-cause mortality in the CKD population, reaching a plateau at 0.52 g/day (butyric acid intake of approximately 0.27 g/day).</div></div><div><h3>Conclusion</h3><div>This study revealed a nonlinear association between high dietary butyric acid intake and reduced all-cause mortality in patients with chronic kidney disease. A plateau occurs after 0.27 g/day, and for individuals with CKD whose butyric acid intake is below approximately 0.27 g/day, increasing a butyrate-rich diet or supplementing with butyric acid preparations may help prevent progression to renal failure and associated adverse outcomes in CKD patients, thereby reducing mortality. Therefore, it can be considered a new therapeutic strategy for the treatment of chronic kidney disease.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 453-462"},"PeriodicalIF":2.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729050","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":"The global leadership initiative on malnutrition criteria can predict a long-term prognosis among community-onset pneumonia","authors":"Nobuhiro Asai ,&nbsp;Wataru Ohashi ,&nbsp;Hideo Kato ,&nbsp;Mao Hagihara ,&nbsp;Hiroshige Mikamo","doi":"10.1016/j.clnesp.2025.03.020","DOIUrl":"10.1016/j.clnesp.2025.03.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite advances in rapid diagnostic tests and antibiotic therapy, pneumonia remains the leading cause of infection-related death worldwide. Few reports document a long-term prognosis among patients with pneumonia. We hypothesize that nutritional status could impact this prognosis.</div></div><div><h3>Patients and methods</h3><div>We reviewed all community-onset pneumonia patients admitted to our institute between 2014 and 2017 to examine whether the Global Leadership Initiative on Malnutrition (GLIM) criteria could predict the patients’ outcome for a 5-year survival rate.</div></div><div><h3>Results</h3><div>A total of 406 patients were enrolled in the study, and the 5-year mortality rate was 36%. We analyzed prognostic factors for long-term survival among community-onset pneumonia. Male gender, severe malnutrition status by the GLIM criteria, higher controlling nutritional status (CONUT) score (≥6), higher Charlson comorbidity index (CCI) score (≥3), and usage of anti-pseudomonal agents as the initial treatment were poor prognostic factors by univariate analysis. Of these 5, cox progressive hazard analysis showed that severe malnutrition status by the GLIM criteria [hazard ratio (HR) 2.3, 95% confidence interval (CI) 1.56–3.39, <em>p</em> &lt; 0.001], higher CCI score (HR 1.7, 95%CI 1.22–2.37, <em>p</em> = 0.002), higher CONUT score (HR 1.66, 95%CI 1.18–2.33, <em>p</em> = 0.003) and usage of anti-pseudomonal agents (HR 1.76, 95%CI 1.23–2.53, <em>p</em> = 0.002) were independently poor prognostic factors. Malnourished patients by the GLIM criteria had a significantly shorter overall survival time than those without malnutrition (<em>p</em> &lt; 0.001 by <em>Long-Rank</em> test).</div></div><div><h3>Conclusion</h3><div>The GLIM criteria could predict 5-year survival among patients with community-onset pneumonia.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"68 ","pages":"Pages 118-126"},"PeriodicalIF":2.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728543","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":"Prevalence and prognostic value of global leadership initiative on malnutrition (GLIM) phenotypic cachexia criteria in cancer patients: A systematic review and meta-analysis","authors":"Chattarin Pumtako,&nbsp;Ross D. Dolan,&nbsp;Donald C. McMillan","doi":"10.1016/j.clnesp.2025.03.044","DOIUrl":"10.1016/j.clnesp.2025.03.044","url":null,"abstract":"<div><h3>Introduction</h3><div>The Global Leadership Initiative on Malnutrition (GLIM) criteria provide a framework for evaluating cachexia in cancer patients, yet variability in diagnostic application hinders its use. The aim of the present study was to examine the prevalence and prognostic value of GLIM phenotypic criteria in patients with cachexia cancer.</div></div><div><h3>Methods</h3><div>This review adhered to a pre-defined protocol. A comprehensive search of PubMed and EMBASE databases was conducted using specific keywords up to June 12, 2024. Titles and abstracts were screened for relevance, and eligible full-text studies focused on the phenotypic criteria of the GLIM framework and their impact on overall survival OS in adult cancer patients. Studies with fewer than 100 patients or lacking OS data were excluded.</div></div><div><h3>Results</h3><div>Of 477 studies identified 82 met the inclusion criteria (114,458 patients). Lung cancer was the most studied tumour type, followed by gastrointestinal and head and neck cancers. Within the GLIM framework, the prevalence of weight loss (WL) &gt; 5 %, BMI &lt;18.5, BMI &lt;20.0, and lower muscle mass (LMM) were 34.21 %, 10.02 %, 9.51 %, and 41.89 %, respectively. Of the 82 studies, WL, BMI, and LMM were reported in 62 (75.6 %), 57 (69.5 %), and 16 (19.5 %) studies respectively and meta-analysis showed significant associations between phenotypic criteria and OS, with hazard ratios (HR) of 1.56 (1.24; 1.95), 1.18 (1.08; 1.28), and 2.03 (1.32; 3.12) respectively.</div></div><div><h3>Conclusion</h3><div>The present systematic review and meta-analysis highlights the prevalence and prognostic value of GLIM phenotypic criteria in patients with advanced cancer. The limitations of BMI as a phenotypic criterion is clear. Future studies should prioritize and standardise WL measurement and muscle mass assessment within the GLIM framework.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 387-397"},"PeriodicalIF":2.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TIAMAT- towards an interdisciplinary automated malnutrition screening tool","authors":"N. Ilves,&nbsp;K. Muhhamedjanov,&nbsp;A. Lõhmus,&nbsp;A. Merilo,&nbsp;P. Kool,&nbsp;A. Forbes","doi":"10.1016/j.clnesp.2025.03.037","DOIUrl":"10.1016/j.clnesp.2025.03.037","url":null,"abstract":"<div><h3>Background</h3><div>Malnutrition remains a major problem in the world's hospitals, and although nutrition screening (such as by Nutrition Risk Screening NRS-2002) improves detection and management, it has proved difficult to ensure that this is routinely performed. There is a case for automated approaches that are independent of staff time. As common laboratory tests such as serum albumin are not considered markers of malnutrition, they are not included in screening tools, but it is possible that combinations of tests would predict malnutrition, and probable that high risk patients would be identified.</div></div><div><h3>Methods</h3><div>We studied 300 unselected consenting internal medicine patients recently admitted to a university hospital. We determined NRS-2002, Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA). No additional interventions were performed. The laboratory database was searched for investigations already performed. The dataset was split randomly into 200 for training and 100 for validation. The primary endpoint was an algorithm to predict SGA (Towards Interdisciplinary Automated MAlnutrition screening Tool - TIAMAT). Blood results for which there were data from at least 60 % of patients were selected; dimensionality was checked with factor analysis, and a multivariate logistic model using stepwise regression was formed. The predictions of SGA from NRS-2002 and MUST were compared with those from the newly created score.</div></div><div><h3>Results</h3><div>Simple haematological and biochemical tests had been performed in all patients. To predict SGA (none <em>vs</em> moderately/severely malnourished) the training set yielded a score with an optimal sensitivity of 71 % (95 % CI 58–81 %), specificity 81 % (70–89), positive predictive value (PPV) 79 % (66–88) negative predictive value (NPV) 73 % (62–83) and AUC 0.81 (0.74–0.88). In the validation cohort - in which missing data were imputed with the relevant median – TIAMAT had sensitivity of 60 % (44–75) specificity of 75 % (62–86), PPV 65 % (48–79), NPV 72 % (59–83) and AUC 0.77 (0.69–0.82) compared with MUST ≥2 for which sensitivity was 63 % (47–77), specificity 91 % (81–97), PPV 84 % (67–95), NPV 76 % (65–86) and AUC 0.80 (0.72–0.89), and NRS-2002 for which sensitivity was 93 % (81–99), specificity 91 % (81–97), PPV 89 % (76–96), NPV 95 % (85–99) and AUC 0.92 (0.86–0.97).</div></div><div><h3>Conclusion</h3><div>Composites of standard laboratory data form a potential alternative to current screening methods, the results of which could be displayed to all data viewers without any human intervention. This could facilitate and thus improve the efficacy of screening by extending it to the entire hospital population.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 321-328"},"PeriodicalIF":2.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143714337","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":"The Global Leadership Initiative on Malnutrition (GLIM) inflammation criteria to predict survival in patients with advanced cancer: A prospective cohort study","authors":"Chattarin Pumtako ,&nbsp;Ross D. Dolan ,&nbsp;Marie Fallon ,&nbsp;Erin S. Sullivan ,&nbsp;Claribel Pl Simmons ,&nbsp;Aoife M. Ryan ,&nbsp;Josh McGovern ,&nbsp;Derek G. Power ,&nbsp;Barry J. Laird ,&nbsp;Donald C. McMillan","doi":"10.1016/j.clnesp.2025.03.027","DOIUrl":"10.1016/j.clnesp.2025.03.027","url":null,"abstract":"<div><h3>Background</h3><div>The Global Leadership Initiative on Malnutrition (GLIM) criteria provides a framework for assessing cachexia in cancer patients. However, the role of systemic inflammation in this framework needs further exploration.</div></div><div><h3>Methods</h3><div>This study analyzed a cohort of 388 advanced cancer patients from 18 oncological care settings. C-reactive protein (CRP), the modified Glasgow Prognostic Score (mGPS) and Neutrophil-to-Lymphocyte Ratio (NLR) were used to assess systemic inflammation. Associations between these inflammatory markers and Weight Loss (WL), Body Mass Index (BMI), Skeletal Muscle Index (SMI), and survival outcomes (OS) were evaluated using Chi-square and Kaplan–Meier survival analyses.</div></div><div><h3>Results</h3><div>CRP was significantly associated with ECOG-PS (p &lt; 0.01), and WL (p &lt; 0.05). mGPS was significantly associated with ECOG-PS (p &lt; 0.001), WL (p &lt; 0.001), and BMI (p &lt; 0.05). NLR was significantly associated with ECOG-PS (p &lt; 0.05), WL (p &lt; 0.001), and BMI (p &lt; 0.05). CRP (p &lt; 0.001), mGPS (p &lt; 0.001), NLR (p &lt; 0.001), WL (p &lt; 0.001), and SMI (p &lt; 0.05) were significantly associated with OS, but not BMI (p = 0.23). Combining CRP, mGPS, NLR, with WL, BMI, and SMI significantly improved OS prediction. WL was significantly associated with OS in patients with NLR&lt;3 (p &lt; 0.05) but not in CRP≤10 mg/L or mGPS = 0. SMI was significantly associated with OS in patients with mGPS = 0 (p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Systemic inflammation, as assessed by CRP, mGPS and NLR, significantly improves the relationship between phenotypic criteria and OS. These findings support the GLIM framework's inclusion of systemic inflammation as a critical factor. Given its strong predictive value, systemic inflammation should be prioritized in routine clinical assessments of cancer patients, with mGPS having greater prognostic value within the GLIM framework.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"67 ","pages":"Pages 344-352"},"PeriodicalIF":2.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143714336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}