{"title":"Impact of gastrectomy for gastric cancer on postoperative bone mineral density loss and fracture risk: A multicenter study","authors":"Atsushi Morito , Kojiro Eto , Hiroki Tsubakihara , Satoshi Ida , Rie Makuuchi , Naoki Miyazaki , Tomoyuki Irino , Masaru Hayami , Souya Nunobe , Masaaki Iwatsuki","doi":"10.1016/j.clnu.2025.08.010","DOIUrl":"10.1016/j.clnu.2025.08.010","url":null,"abstract":"<div><h3>Background</h3><div>Bone mineral density (BMD) reduction and vertebral fractures (VFs) are complications following gastrectomy for gastric cancer (GC), impacting both quality of life and mortality. However, the longitudinal effects of gastrectomy on BMD and VFs remain unclear.</div></div><div><h3>Methods</h3><div>This multicenter retrospective study analyzed 485 patients with GC who underwent curative gastrectomy between 2005 and 2018. The patients were categorized by gastrectomy (distal gastrectomy [DG] or total gastrectomy [TG]) and reconstruction (Billroth-I [BI] or Roux-en-Y [RY]). BMD was assessed using L1 vertebral computed tomography attenuation, and VFs were evaluated preoperatively and 1, 3, and 5 years postoperatively. Statistical analyses identified predictive factors for BMD reduction and VFs.</div></div><div><h3>Results</h3><div>The TGRY group showed the greatest BMD reduction, followed by the DGRY and DGBI groups, over the 5-year period. Patients who underwent TGRY had a significantly greater decrease in BMD than those who underwent DGRY (coefficient: 10.02, 95 % confidence interval [CI]: 5.53–14.50, P < 0.001), while patients who underwent DGBI experienced a significantly smaller decrease (coefficient: −5.55, 95 % CI: −9.52 to −1.55, P = 0.007). The overall incidence of VFs at 5 years was 19.2 %, with a significantly greater BMD reduction observed in the VF group. The type of gastrectomy and reconstruction method were not significant risk factors for VFs.</div></div><div><h3>Conclusions</h3><div>BMD reduction was better contained in DGRY than TGRY and in DGBI than DGRY. While VFs were more frequent in TGRY, these differences were not statistically significant. However, significant BMD reduction was observed in patients with VFs, suggesting a potential correlation.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"53 ","pages":"Pages 1-7"},"PeriodicalIF":7.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Naomi Brosnahan , Catherine Hankey , Anthony Leeds , Wilma Leslie , George Thom , Lisa Hutchison , Lindsay Govan , Hazel Ross , Michael E.J. Lean
{"title":"Diet strategies for maintaining substantial therapeutic weight loss: 78-week mixed methods randomised trial","authors":"Naomi Brosnahan , Catherine Hankey , Anthony Leeds , Wilma Leslie , George Thom , Lisa Hutchison , Lindsay Govan , Hazel Ross , Michael E.J. Lean","doi":"10.1016/j.clnu.2025.08.009","DOIUrl":"10.1016/j.clnu.2025.08.009","url":null,"abstract":"<div><h3>Background and aim</h3><div>Formula low-energy diets (LED), used intermittently, may assist long-term weight-loss maintenance (WLM). This study compared total diet replacement 2 days/week (5:2TDR) and once-daily meal-replacements (DMR), delivered within a structured WLM programme.</div></div><div><h3>Methods</h3><div>A 78-week randomised trial was conducted in 63 individuals (75 % female, BMI 23–61 kg/m<sup>2</sup>), recruited between 12/04/2016 to 05/06/2018, after documented mean (SD) intentional weight-loss >8 kg, achieved using LED, behavioural programmes, or pharmacotherapy. Participants who had received anti-obesity medications were either weight stable or regaining after drug withdrawal. The primary outcome was weight change at 26-weeks following randomisation. Six dietitians and 25/63 (40 %) participants completed qualitative interviews at 26-weeks. Between-group differences were assessed using repeated ANCOVA adjusting for baseline values applying Intention-to-Treat, Per-Protocol, and As-Treated methods.</div></div><div><h3>Results</h3><div>At 26-weeks, 32/33 (97 %) randomised to 5:2TDR, and 29/30 (97 %) randomised to DMR, provided data. Four participants took pre-existing pharmacotherapy (n = 3 orlistat up to 78-weeks and n = 1 liraglutide up to 52-weeks). Mean (SD) pre-study weight-losses were similar between groups: 5:2TDR −15·0 (6·9) kg, DMR −18·8 (9·3) kg, p = 0.056. After 26-weeks WLM, intention-to-treat analysis found further weight-loss −0·9 kg (95 %CI −2·9, 1·5 kg) with 5:2TDR and regain with DMR 3·5 kg (95 %CI 1·3,5·5 kg); between-group difference −4·4 kg (95 %CI −7·3,−1·6 kg), p = 0·005. Maintained weight-losses at 26-weeks from pre-study start of weight loss were −15·8 (9·5) kg with 5:2TDR, −15·2 (10·5) kg with DMR, p = 0·977. Similar results were observed in the per protocol and as treated analyses. Both groups maintained weight losses >15 kg below baseline at 26, 52 and 78-weeks. Results were similar excluding those taking weight loss medications. Both interventions were well accepted. Dietitians successfully adapted LED interventions to overcome social/environmental challenges experienced by participants.</div></div><div><h3>Conclusions</h3><div>Structured dietary WLM is well accepted and can prevent weight regain after substantial loss, including after glucagon-like peptide-1 agonist withdrawal, and can maintain >15 kg loss up to 78-weeks</div></div><div><h3>Trial registration</h3><div>Clinicaltrials.gov: identifier NCT02683798.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"53 ","pages":"Pages 188-198"},"PeriodicalIF":7.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nejat Emre Öksüz, Ergin Aydemir, Kadriye Bir Yucel
{"title":"Prognostic impact of preoperative cachexia in patients undergoing major hepatopancreatobiliary surgery for malignancy","authors":"Nejat Emre Öksüz, Ergin Aydemir, Kadriye Bir Yucel","doi":"10.1016/j.clnu.2025.07.037","DOIUrl":"10.1016/j.clnu.2025.07.037","url":null,"abstract":"","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"53 ","pages":"Page 211"},"PeriodicalIF":7.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145045102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yinghao Cao , Yixin Heng , Mingming Song , Tong Nie , Zhihao Liu , Jiaxin Xu , Xiaoyu Wu , Le Qin , Tao Liu , Feihong Wu , Chuansheng Zheng , Kailin Cai
{"title":"Preoperative myosteatosis and intermuscular adiposity as CT-Derived nutritional prognostic markers in colorectal cancer: A multicenter development-validation study","authors":"Yinghao Cao , Yixin Heng , Mingming Song , Tong Nie , Zhihao Liu , Jiaxin Xu , Xiaoyu Wu , Le Qin , Tao Liu , Feihong Wu , Chuansheng Zheng , Kailin Cai","doi":"10.1016/j.clnu.2025.08.007","DOIUrl":"10.1016/j.clnu.2025.08.007","url":null,"abstract":"<div><h3>Background</h3><div>Body composition alterations quantified by routine preoperative imaging may refine risk stratification and guide nutritional interventions in colorectal cancer (CRC). We aimed to establish the prognostic value of CT-assessed muscle quality and ectopic fat deposition for long-term survival.</div></div><div><h3>Methods</h3><div>This dual-center retrospective study analyzed 850 patients from Wuhan Union Hospital (original cohort) and 647 from Shihezi University Hospital (validation cohort) undergoing curative CRC resection. Using pretreatment abdominal CT at L3, we quantified: Adipose metrics: Visceral fat area (VFA), subcutaneous fat area (SFA), and intermuscular fat area (IMFA). Muscle metrics: Skeletal muscle index (SMI) and radiodensity (SMD) Sex-specific thresholds determined by X-tile categorized patients into high/low groups. Primary endpoints were overall survival (OS) and disease-free survival (DFS).</div></div><div><h3>Results</h3><div>The mortality rates of the original cohort and the validation cohort were 25.65 % (218/850) and 26.28 % (170/647), respectively. Multivariable Cox regression analysis revealed that Myosteatosis (low SMD: HR 0.58, 95%CI 0.41–0.83), elevated IMFI (HR 1.61, 1.09–2.39), low SFA (HR 0.66, 0.44–0.98), and IMFA/VFA ratio (HR 1.52, 1.06–2.18) were independent prognostic factors for OS (all P < 0.050). High IMFA (HR 1.46, 1.02–2.08) and IMFA/SFA ratio (HR 1.57, 1.06–2.38) were also significantly associated with DFS (all P < 0.050). The model combining clinico-radiological (CRAD) factors demonstrated better predictive ability compared to the model based on Tumor Node Metastasis staging alone or in combination with body composition (AUC: Original cohort: 0.815 vs. 0.701/0.772 for OS, 0.794 vs. 0.720/0.755 for DFS; Validation cohort: 0.841 vs. 0.707/0.750 for OS and 0.736 vs. 0.662/0.676 for DFS). Decision curve analysis confirmed superior net benefit of CRAD model across risk thresholds.</div></div><div><h3>Conclusions</h3><div>Low SMD and high IMFA independently predict adverse CRC outcomes. The CRAD model synergizing CT-derived body composition with clinical parameters enables personalized prognostic stratification, supporting targeted nutritional strategies to mitigate muscle quality deterioration and ectopic fat accumulation.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"53 ","pages":"Pages 8-25"},"PeriodicalIF":7.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Priya Iyer , Cham Kei Kwong , Hong Ethan Li , Zoe Flick , Suzanne Kennewell
{"title":"Amplifying the quiet patient voices: Capturing patient meal experiences through proxy feedback","authors":"Priya Iyer , Cham Kei Kwong , Hong Ethan Li , Zoe Flick , Suzanne Kennewell","doi":"10.1016/j.clnu.2025.08.006","DOIUrl":"10.1016/j.clnu.2025.08.006","url":null,"abstract":"<div><h3>Background and aims</h3><div>Current tools for evaluating patient meal experiences in hospitals often emphasise sensory qualities, dining environment, and nutritional intake. However, these approaches typically exclude patients who face challenges in providing direct feedback due to frailty, cognitive impairments, or language barriers limiting the representativeness of the data. To address this gap, this study explored patient mealtime experiences through proxy feedback collected from healthcare staff during routine real-time interactions. Furthermore, we evaluated the utility and effectiveness of this novel approach in capturing the perspectives of ‘quiet patients’, who might otherwise remain unheard.</div></div><div><h3>Methods</h3><div>This exploratory qualitative study employed interpretive description methodology to gather and analyse proxy feedback documented by staff over a four-week period in a geriatric and rehabilitation facility. A focus group with staff further assessed the methodology's effectiveness.</div></div><div><h3>Results</h3><div>Thematic analysis of 78 logs by 27 participants identified four key themes: <em>Getting it right, What about me?, Sensory dynamics of meal appeal</em>, and <em>Food really matters</em>. Additionally, two main themes emerged from the focus group regarding the tool's utility: <em>The potential of this method and Helping give patients their voice.</em></div></div><div><h3>Conclusions</h3><div>The proxy feedback approach effectively amplified quiet patients’ voices, complementing traditional surveys. Its real-time convenience and user-friendliness offer a valuable adjunct for a more inclusive and comprehensive understanding of patient mealtime experiences.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"52 ","pages":"Pages 323-330"},"PeriodicalIF":7.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liang Zhang , Fang Wang , Syoichi Tashiro , Peng Ju Liu
{"title":"Nutritional and exercise interventions for muscle status in hemodialysis patients: A systematic review and network meta-analysis","authors":"Liang Zhang , Fang Wang , Syoichi Tashiro , Peng Ju Liu","doi":"10.1016/j.clnu.2025.08.005","DOIUrl":"10.1016/j.clnu.2025.08.005","url":null,"abstract":"<div><h3>Background</h3><div>Muscle mass depletion and functional decline in hemodialysis (HD) patients are associated with an increased risk of mortality. This study systematically assessed the effectiveness of nutritional and exercise interventions on muscle status in HD patients.</div></div><div><h3>Methods</h3><div>We conducted a network meta-analysis of 89 randomized controlled trials retrieved from four databases, including 6,128 HD patients across 26 intervention arms. Data on muscle mass, strength, function, and quality of life were extracted from primary studies. Results were presented as mean difference (MD) with 95 % credible interval (CrI).</div></div><div><h3>Results</h3><div>Combined aerobic exercise (AE) and resistance exercise (RE) significantly improved 6-min walk test (6MWT) (MD = 52.2 m; 95 % CrI, 31.7–73.0). Multi-modality exercise (MME) performed best in enhancing the handgrip strength (MD = 9.1 kg; 95%CrI, 1.8–16.4), also showed potential superiority over AE + RE in improving 6MWT and 30STS performance. Protein oral nutritional supplements positively affected lean body mass (MD = 0.3 kg; 95%CrI, 0.1–0.45).</div></div><div><h3>Conclusion</h3><div>Our research validates the role of AE + RE in improving muscle function and reveals the potential of MME to surpass AE + RE in enhancing muscle strength and function. Protein supplementation may improve muscle mass. These findings support clinical decisions regarding effective exercise and nutritional interventions for HD patients and provide a foundation for exploring optimal combination strategies. Larger-scale, high-quality studies are needed in the future to expand and strengthen our conclusions.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"53 ","pages":"Pages 35-48"},"PeriodicalIF":7.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}