Over the last two decades, bioelectrical impedance analysis (BIA) has gained popularity as a method for assessing body compartments in nutrition studies, sports medicine, and evaluating hydration levels, fat mass, and fat-free mass variations in both healthy and diseased individuals. This study aims to offer researchers an overview of the research trends in BIA.

The data was obtained from the Web of Science Core Collection database. Bibliometric analysis was conducted using a package of R software (Bibliometrix 4.0).

A total of 9471 articles have been published over the past 20 years, with an average annual growth rate of 10.1%. The research field primarily focuses on nutrition and dietetics, followed urology and nephrology, endocrinology and metabolism, general and internal medicine, engineering, geriatrics and gerontology, sport sciences, cardiovascular system and cardiology, physiology and science and technology-other topics. The research hotspots of BIA over the past 20 years have transitioned from "water" to "fat," and subsequently to "sarcopenia." "Sarcopenia" and "phase angle" (PhA) have emerged as recent research hotspots in the field of BIA.

A total of 9471 articles have been published over the past 20 years, with an average annual growth rate of 10.1%. Nutrition and dietetics have consistently been the primary research areas in the field of BIA. "Sarcopenia" and "PhA" have emerged as recent research hotspots in the field of BIA. The application of BIA in clinical practice still holds significant untapped potential.

The combination of high energy fractures, extensive soft tissue trauma, and high infection rates in pilon fractures of the distal tibia have long challenged surgeons. Despite the ample evidence, there is no consensus regarding the factors that may influence postoperative infections following surgical management of these fractures. This study aimed to investigate the risk factors for postoperative infections in patients undergoing surgical management for pilon fractures. This retrospective cohort study evaluated demographic variables, smoking status, nutritional status (i.e., pre-and postoperative albumin, pre-and postoperative white blood cell count, use of antibiotics, time to external fixation and ORIF, and hospital length of stay. A multivariate logistic regression model was used to predict risk factors associated with postoperative infection after fixation of a pilon fracture for several independent parameters. A receiver operator characteristic (ROC) curve was constructed, and a threshold was found for the investigated continuous variables, which were significant in the regression analysis. Overall, 416 patients following surgical management for a pilon fracture were identified. A multivariate logistic regression analysis revealed that preoperative albumin, preoperative WBC, and hospital length of stay were associated with postoperative infection following surgical management of pilon fractures. Thresholds determined by the Youden index were 3.05 for preoperative albumin levels, 12.65 for preoperative WBC levels, and 7.1 days for hospital length of stay. Furthermore, older patients were less prone to develop postoperative infection than younger patients. Lower preoperative albumin levels (< 3.05 mg/dL), higher preoperative WBC levels (>12.65 mg/dL), and a longer duration of hospitalization (>7.1 days) were related to an increased risk for postoperative infection after fixation of a pilon fracture.

Malnutrition is prevalent across health care settings and has adverse outcomes for patients and the health system. However, some patients do not recall being informed about their malnutrition risk/diagnosis.

This meta-synthesis of qualitative studies aimed to identify and synthesize patient, carer, and health worker perceptions and understanding of the terminology used by health workers for malnutrition risk/malnutrition.

Four databases were searched (Medline, Cumulated Index in Nursing and Allied Health Literature, PsycINFO, and Embase) up until August 2023. Title, abstract, and full text screening were independently completed by 2 reviewers. The quality of the included studies was assessed using the Critical Appraisal Skills Programme Qualitative Studies Checklist. Data were analyzed by the review team using thematic synthesis. The resulting themes informed review findings. The confidence in each finding was assessed using GRADE-Confidence in the Evidence from Reviews of Qualitative Research.

Seventeen studies were included, contributing perspectives from patients (n = 7 studies), health workers (n = 5 studies), or both patients and health workers (n = 5 studies); no studies included carer perspectives. There were 5 themes: patients have differing understanding, interpretation of, and identification with, malnutrition risk and malnutrition terminology (very low confidence); health workers perceive that patients do not identify with or understand malnutrition risk and malnutrition terminology (low confidence); Patients do not routinely perceive their malnutrition risk or malnutrition diagnosis as problematic (low confidence); health workers use varied terminology for malnutrition risk and malnutrition (low confidence); and action is required to improve malnutrition diagnostic communication (low confidence).

Findings highlighted disparity in patients' perspectives regarding the terms used for malnutrition risk and malnutrition. Varied terms were used by health workers, and patients did not often associate these terms with a health condition that required treatment. Health workers and patients called for action to improve the communication of malnutrition. To do this, further research exploring malnutrition terminology and the broader concept of malnutrition communication is required with patients, carers and health workers.

Head and Neck Cancer (HNC) patients often experience a range of symptoms due to disease which can lead to low energy and protein intake. This scenario can impact body composition as the quality and quantity of muscularity and adiposity changes. This work aims to evaluate the impact of muscularity on the overall survival (OS) of patients with metastatic HNC. This is a retrospective and analytical study, with the population studied being patients diagnosed with metastatic or recurrent HNC, between January 2010 and December 2018, treated at the Clinical Oncology outpatient clinic of the Hospital de Clínicas of the Universidade Estadual de Campinas. To assess body composition, CT images were used at the level of the third cervical vertebra (C3), with the areas of muscle tissue and adipose tissue. The total population included in the sample was 101 patients diagnosed with metastatic or recurrent HNC. It has been shown that low muscularity is associated with the elderly population over 70 years old and with a lower BMI value, below 18.5. The population with low muscularity had a lower amount of total adipose tissue and total adipose tissue index, as well as a lower amount of skeletal muscle and skeletal muscle index in relation to normal muscularity, making it possible to conclude that low muscularity in patients with metastatic or recurrent HNC is an independent factor for mortality.

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.

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.

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 < 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).

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.

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.

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.

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.

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.

Background and Objectives: Malnutrition and sarcopenia are highly prevalent and clinically impactful conditions in patients undergoing maintenance hemodialysis (MHD), yet their early detection remains challenging. This study aimed to assess the diagnostic performance of nutritional ultrasonography (NUS) in the morphofunctional evaluation of malnutrition and sarcopenia, and to compare its utility with established tools such as bioimpedance analysis (BIA), biochemical markers, handgrip strength (HGS), and functional performance tests. Materials and Methods: A cross-sectional study was conducted in 74 stable MHD patients. Clinical, analytical, anthropometric, BIA, NUS, and functional parameters were collected, along with validated nutritional and frailty scales. NUS was used to assess the quadriceps rectus femoris (QRF) and preperitoneal visceral fat (PPVF), measuring Y-axis, Y-axis/height, cross-sectional muscle area rectus femoris (CS-MARF), muscle area rectus femoris index adjusted to height (MARFIh), and supramuscular fat (SMF). Sarcopenia was defined according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Results: The prevalence of risk, confirmed, and severe sarcopenia was 24.3%, 40.5%, and 20.3%, respectively. Severe-to-moderate protein-energy wasting (PEW) affected 44.6% of patients. Compared to non-sarcopenic individuals, sarcopenic patients had lower values of HGS, prealbumin, lean body mass, and phase angle. NUS-derived cut-off values for sarcopenia were Y-axis ≤ 8 mm, Y-axis/height ≤ 2.9 mm/m2, CS-MARF ≤ 2.4 cm2, and MARFIh ≤ 0.9 cm2/m2. The most discriminative NUS parameters were Y-axis and SMF (AUC 0.67), followed by Y-axis/height (AUC 0.65) and MARFIh (AUC 0.63). NUS measurements correlated significantly with ASMI, phase angle, HGS, and SPPB scores. Conclusions: Nutritional ultrasonography is a feasible, reproducible, and clinically valuable tool for assessing muscle mass and quality in MHD patients. Its incorporation into routine practice may enhance early detection of malnutrition and sarcopenia, thereby facilitating timely, individualized nutritional interventions.

Background: Malnutrition is increasingly prevalent due to rising life expectancy, oncological cases, and chronic diseases. Early detection is crucial for rehabilitation, complication prevention, and cost reduction. However, nutritional support is often suboptimal. This study aimed to determine malnutrition prevalence and nutritional support status within our hospital. Methods: A point prevalence study was conducted in adult inpatient clinics (excluding pediatrics, infectious diseases, and intensive care) by a 12-member team following ethical approval. NRS-2002 scores, arm/calf circumferences, BMI, and laboratory data (albumin, leukocytes, lymphocytes, neutrophils, hemoglobin, CRP, creatinine) were assessed. Enteral and parenteral nutrition treatments were recorded. Patients with NRS-2002 scores ≥ 3 were classified as at risk of malnutrition. Results: Among 178 patients, 24.7% were at risk of malnutrition. Surgical clinics had a higher malnutrition risk (32.3%) than internal medicine clinics (20.3%). Only 27.1% of at-risk patients received nutritional support (surgical: 19%, internal medicine: 44%). Patients at risk of malnutrition exhibited significantly lower arm circumference (p: 0.000), calf circumference (p: 0.002), lymphocyte counts (p: 0.000), hemoglobin (p: 0.018), albumin (p: 0.001), and BMI (p: 0.038), as well as significantly higher age (p: 0.000) and CRP levels (p: 0.000). Conclusions: Nutritional support remains inadequate despite increased attention to malnutrition. Intensified nutrition education, particularly in surgical inpatient clinics, is needed to improve patient rehabilitation and outcomes.

Introduction: Malnutrition is a recognized risk factor for unfavorable clinical outcomes and complications in cardiovascular and surgical patients. Nutritional status can be assessed with various methods, and the phase angle (PA) derived from bioelectrical impedance analysis is one of the most reliable parameters for that purpose. Methods: The aim of this narrative review was to present the available data regarding PA application in cardiac surgery. After careful analysis of PubMed and Scopus databases, 21 articles were included in the final analysis. Results: PA is a parameter that can be used for nutritional status assessment in a cardiac surgery environment. It is suggested that it is more accurate than other criteria in malnutrition identification in this group of patients. The available data shows its association with mortality, length of intensive care unit stay, and hospital stay. It can also predict adverse events such as blood transfusion or mechanical ventilation. Conclusions: The available data underscores the usefulness of PA in preoperative risk assessment and post-procedural monitoring. PA could be introduced in everyday clinical assessment in cardiac surgery.

Malnutrition, affecting both adults and children globally, results from inadequate nutrient intake or loss of body mass. Traditional screening tools, reliant on detailed questionnaires, are costly, time-consuming, and often lack accuracy and generalizability. Automated machine learning (ML) alternatives promise improvements, offering efficient and versatile methods for nutritional assessment. However, they require clean, pre-processed data and careful model selection. This study aimed to evaluate the effectiveness of various ML models in predicting malnutrition. We benchmarked 22 different models for both regression and classification tasks using a malnutrition dataset. For this, a Neonatal Intensive Care Unit (NICU) patient case study was adopted. The dataset consists of 412 patients of which 232 were used to train the models. For this, a model development pipeline was developed to ensure robustness and enhance the reproducibility of the constructed models. This is achieved by testing a variety of model types including linear models, tree-based models, neural networks, and other ensemble methods. This resulted in machine learning models for both regression and classification tasks, and to optimize model efficiency by minimizing the number of required input features. The results showed that the Generalized Linear Models with Lasso or Elastic Net Regularization (GLMnet) model performed best for the regression task with an R2 of 0.79, while the Extreme Gradient Boosting (XGBoost) model outperformed others in classification, achieving an Area Under the Curve (AUC) of 0.79. This study showcases alternatives to traditional screening methods to alleviate the burden on the healthcare system by providing reliable and automated methods for nutritional assessment that were compared on the same dataset.

Sarcopenia is a progressive and generalised skeletal muscle disorder which presents as loss of muscle mass and function and is associated with increased likelihood of adverse outcomes, reduced quality of life and increased mortality. In developed countries, the prevalence of sarcopenia is rising due to increasing life expectancy. Still, in many clinical settings, sarcopenia may be overlooked and undertreated. While several tools are available for assessment of muscle mass and quality, there remains a need for safe, reliable and accurate diagnostic methods which can be implemented for both sarcopenia diagnosis and the evaluation of treatment efficacy.

Ultrasound is an accessible and non-ionizing imaging technique that can potentially be used for that purpose. Several ultrasound parameters have been identified for their utility to provide assessment of muscle mass, quality and/or muscle function. Ultrasound is gaining recognition as an accurate and reproducible method of muscle mass assessment. However, there are still several limitations that preclude the application of ultrasound in routine clinical practice. Implementing a harmonized measurement protocol and conducting large-scale longitudinal studies on both healthy individuals and various patient cohorts could enable the establishment of clearly defined reference values for individual ultrasound parameters and, in turn, potentially reliable differentiation between normal and sarcopenic states.

(Protein-energy) malnutrition in individuals living with obesity presents complex diagnostic challenges due to the distinctive physiological characteristics of obesity. This narrative review critically examines the identification of malnutrition within the population with obesity, distinguishing malnutrition in obesity from related conditions such as sarcopenic obesity. While noting some shared features, the review highlights key differences between these conditions. The review also highlights the limitations of current malnutrition screening tools, which are not designed for individuals living with obesity. These tools primarily rely on anthropometric measurements, neglecting (among others) nutrient intake assessment, which hinders accurate malnutrition detection. Additionally, this review discusses limitations in existing diagnostic criteria, including the Global Leadership Initiative on Malnutrition (GLIM) criteria, when applied to individuals living with obesity. Challenges include the identification of appropriate cut-off values for phenotypic criteria (unintentional weight loss, low body mass index and muscle mass) and aetiological criteria such as reduced food intake and inflammation for the population with obesity. Overall, this review emphasises the need for modified screening tools and diagnostic criteria to recognise and assess malnutrition in obesity, leading to improved clinical outcomes and overall wellbeing.

Malnutrition is prevalent in Australian hospitals, affecting 30%-40% of inpatients. Enhancing patient mealtime experience is a recognised strategy to support improved dietary intake and clinical outcomes. Yet, there is little published data on mealtime experience in acute hospital settings in Australia. This study aims to capture patient mealtime experience in an acute care setting at a regional Australian hospital, using a modified version of the Austin Health Patient Mealtime Experience Tool.

A cross-sectional study was undertaken across six acute care wards at Bendigo Health between July and September 2024. Patient mealtime experience was explored through interviewer-administered surveys, including 32 Likert scaling items and 6 open-ended responses. Descriptive statistics were used to analyse quantitative data, whilst deductive thematic analysis was applied to qualitative data to describe mealtime experience.

Eighty-one patients participated in the study. Patients were most dissatisfied with food quality, particularly sensory characteristics and variety, in both the quantitative and qualitative results. Patients were most frequently satisfied with staff interactions (90% 'always' or 'often' positive), although the qualitative results highlighted insufficient mealtime care. The physical environment was generally highly rated, with a majority of patients (> 70%) reporting that noise, visitors, room surroundings and smells and odours 'rarely' or 'never' impacted food intake. The food ordering system was rated favourably, with 89% of participants rating meal timing as 'always' or 'often' positive and 73% rating meal accuracy as 'always' or 'often' satisfactory. However, qualitative results revealed usability issues related to the electronic meal ordering system. Finally, qualitative responses identified nutrition impact symptoms as a barrier to mealtime experience and intake.

Food quality, sufficient mealtime care, management of nutrition impact symptoms and improving usability of electronic ordering systems are areas highlighted for improvement in mealtime experience. Addressing these factors through targeted quality improvement initiatives can enhance mealtime satisfaction and support nutritional intake. Integrating patient perspectives into service planning is essential for fostering patient-centred hospital foodservices and improving patient outcomes.

Older patients with inflammatory bowel disease (IBD) constitute an increasingly prevalent population. There is growing recognition of the prevalence and impact of geriatric syndromes on patients with IBD. We aimed to critically review available data on geriatric syndromes in patients with IBD.

An electronic systematic bibliographic search was performed in April 2024 using PubMed to identify relevant literature on frailty, functional status assessment, and geriatric syndromes among older adults with IBD.

Frailty is prevalent among patients of all ages with IBD and is associated with worse outcomes. It is associated with an increased risk of infections but may be ameliorated through effective treatment of underlying inflammation. There is less understanding of other geriatric syndromes, such as multi-morbidity, polypharmacy, sarcopenia, fecal incontinence, physical function, falls, fatigue, social isolation, and cognitive impairment in older patients with IBD; existing data suggests an important negative impact of all these syndromes on older adults with IBD.

Geriatric syndromes are prevalent and negatively impact older patients with IBD. Systematic assessment for their presence and multidisciplinary interventions to improve them are important to improve outcomes of older adults with IBD.

In clinical practice, acute-phase reactive proteins (APRPs) are frequently measured at random times. However, it is unclear whether the use of fasting or nonfasting samples affects results. This study aims to investigate the variations of APRPs between fasting and nonfasting conditions.

This study was conducted based on the oral glucose tolerance test (OGTT) experiment due to standard energy intake and strict time flow. Fifty subjects were enrolled and underwent a 12-h fasting period before the experiment. Blood samples were collected the following day at baseline (fasting, T0) and 30 (T1), 60 (T2), 120 (T3), 180 (T4) minutes postglucose intake. A total of 250 blood samples were obtained. To quantify clinical fluctuations, percentage bias was calculated, and Bland-Altman plots were employed.

Our observational study demonstrated significant postprandial variations for APRPs. For CRP, 17 (34%) of 50 subjects at T1, 21 (42%) at T2, 23 (46%) at T3, and 16 (32%) at T4 exhibited levels exceeding the maximum allowable error in medical laboratory testing, indicating clinically unacceptable bias. For IL-6, thirty subjects (60%) at T1, 27 (54%) at T2, 28 (56%) at T3, and 32 (64%) at T4 displayed clinically unacceptable fluctuations. Among other APRPs, the maximum number of subjects exceeding acceptable bias thresholds was 28% (14/50) for procalcitonin, 38% (19/50) for transferrin, 34% (17/50) for prealbumin, and 24% (12/50) for ceruloplasmin.

Clinical fluctuations were observed in the levels of APRPs between fasting and nonfasting states. Clinicians should pay attention to the effects of dietary factors on test results.

The Global Leadership Initiative on Malnutrition (GLIM) introduced an approach for malnutrition diagnosis in 2019 comprised of screening followed by assessment of three phenotypic criteria: weight loss, low BMI, and low muscle mass, and two etiologic criteria: reduced food intake/assimilation, and inflammation/disease burden. This planned update reconsiders the GLIM framework based on published knowledge and experience over the past five years.

A GLIM working group (n = 43 members) conducted a literature search spanning 2019-2024 using the keywords "Global Leadership Initiative on Malnutrition or GLIM". Prior GLIM activities providing guidance for use of the criteria on muscle mass and inflammation were reviewed. Successive rounds of review and revision were used to achieve consensus.

More than 400 scientific reports are published in peer-reviewed journals, forming the basis of 10 systematic reviews, some including meta-analyses of GLIM validity that indicate strong construct and predictive validity. Limitations and future priorities are discussed. Working group findings suggest that assessment of low muscle mass should be guided by experience and available technological resources. Clinical judgement may suffice to evaluate the inflammation/disease burden etiologic criterion. No revisions of the weight loss, low BMI, or reduced food intake/assimilation criteria are suggested. Following two rounds of review and revision, the working group secured 100 % agreement with the conclusions reported in the 5-year update.

Ongoing initiatives target priorities that include malnutrition risk screening procedures, GLIM adaptation to the intensive care setting, assessment in support of the reduced food intake/assimilation criterion, and determination of malnutrition in obesity.

Hyperammonemic encephalopathy is a rare but potentially fatal condition, that can occur after obesity surgery.

A 43-year-old Caucasian woman, with history of omega-loop gastric bypass, with hydrops, dyspnoea and severe malnutrition was referred for evaluation. After admission to medical department, she experienced three episodes of coma, and biochemical investigations showed hyperammonemia, hypoalbuminemia and hyperglutaminemia. Etiological investigations were not in favour of a urea cycle disorder, but rather a nutritional catastrophe with severe malnutrition secondary to the omega-loop gastric bypass.

In patients with history of obesity surgery, encephalopathy symptoms should lead to look after hyperammonemia and malnutrition.

This report demonstrates the importance of ammonemia testing in case of neurological symptoms in patients with a history of obesity surgery.

Background: Pancreatic cancer has an increasing incidence and prevalence trend. Its prognosis is negatively affected by poor/altered nutritional status. Therefore, nutritional interventions play a critical/pivotal role at any stage. Despite being included in the prehabilitation items of Enhanced Recovery After Surgery (ERAS) protocols for pancreatic surgery, nutritional recommendations concerning early post-discharge period are lacking. Aim: To assess the acceptability and feasibility of a personalized and standardized food plan for patients following pancreatic surgery. A secondary aim is to determine if adherence to a personalized food plan is linked to improved postoperative outcomes. Methods: A prospective monocentric cohort study will be performed, including 180 patients undergoing pancreatic surgery. Body composition, nutritional, muscular, and hydro-electrolyte status will be assessed with bio-impedance analysis (BIA). Patients will receive a personalized nutritional plan after discharge for the following 45 days. Summary: Detailed nutritional indications have been formulated with broad consensus for the pre-operative (prehabilitation) and postoperative period. No previous study has specifically formulated or validated a nutritional intervention focused on the early post-discharge period. The results of this study might contribute to paving the way for future research and to broaden nutritional recommendations within the ERAS protocol.

There is debate as to the association between dehydration and malnutrition. Thus, this study aimed to investigate the correlation between dehydration and malnutrition and their impact on geriatric syndromes.

This cross-sectional study included older adults (≥60 years) who attended one outpatient geriatric clinic. Malnutrition was defined according to the Mini Nutritional Assessment (MNA) score (<17), and dehydration was based on a single calculation method (plasma osmolarity [Posm] > 295 mmol/L).

Among the 1409 patients studied, the prevalence of malnutrition and dehydration was 19% and 33%, respectively. The rate of malnutrition in the setting of dehydration was 18%, and the rate of dehydration in patients with malnutrition was 30% (P > 0.05). Polypharmacy, hypertension, diabetes mellitus, and higher body mass index (BMI) were associated solely with dehydration, whereas older age, a lower level of education, depression, and lower BMI were associated solely with malnutrition. Among patients with dehydration, there was a significant negative correlation between the MNA and Posm (P < 0.001, r = -0.20). Inversely, among patients without dehydration, the correlation was positive and significant (P < 0.001, r = 0.14).

A negative correlation was found between the MNA score and Posm in patients with dehydration, whereas the correlation is positive among patients without dehydration. This inverse relationship between the MNA score and Posm in patients with different levels of hydration is one potential reason for the lack of a significant correlation between malnutrition and dehydration in previously reported studies. Different risk factors of malnutrition may predominate in settings of dehydration vs no dehydration.

Sarcopenia, characterized by loss of muscle mass and strength, has been linked to various health outcomes, including chronic kidney disease (CKD). This study aims to investigate the association of sarcopenia index, based on serum creatinine and cystatin C levels, with incident CKD in middle-aged and older adults.

This study extracted data from a nation cohort, including age ≥45 years adults without CKD at baseline. Sarcopenia index was calculated based on serum creatinine and cystatin C levels, and incident CKD was assessed through follow-up surveys. Cox proportional hazards regression models were used to analyze the association between sarcopenia index and incident CKD, adjusting for potential confounders, with hazard ratio (HR) with 95 % confidence interval (95 % CI) reported.

A total of 8618 participants were included in the analysis. The median age was 61.0 years, and 44.7 % were male. During a mean follow-up period of 5.0 years, 514 cases of incident CKD were identified. After adjusting for covariates, compared with participants in the lowest tertile, the corresponding CKD HRs (95 % CIs) for participants in the medium and highest tertile were 0.701 (95 % CI: 0.558-0.880, P = 0.002), 0.784 (95 % CI: 0.618-0.994; P = 0.045). Restricted cubic spline curves revealed that incident rate decreased with increase in sarcopenia index.

This study provides national longitudinal evidence on the association of higher sarcopenia index with lower incident CKD. Our findings suggest that sarcopenia index may be a useful biomarker for predicting the risk of CKD in this population.

Colorectal cancer (CRC) patients often face nutritional disturbances, including malnutrition, changes in skeletal muscle index (SMI), and adipose tissue. We hypothesized that malnutrition, sarcopenia and nutritional disorders, as low muscle strength, low SMI, and reduced adipose tissue can negatively impact survival. This study aimed to assess the impact of malnutrition, SMI, muscle strength, sarcopenia, and adipose tissue on CRC patient survival. We analyzed 2 cohorts of CRC patients in this longitudinal study. Nutritional status was assessed by Patient-Generated Subjective Global Assessment (PG-SGA) and those classified as B and C were considered with malnutrition. Computed tomography (CT) scans of the third lumbar vertebra (L3) measured SMI and various adipose tissue fractions (visceral, subcutaneous, intramuscular, and total). Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). The primary outcome was 5-year overall survival. Of 266 patients (mean age 60.7 years, 53.0% male), 11.3% had sarcopenia, 27.0% were malnourished, and 40.0% died. After adjusting for clinical variables, Cox regression analysis showed that only Malnutrition (HR: 1.96; CI: 1.35-2.84; P ≤ .001) significantly impacted survival. In CRC patients, Malnutrition outweighs sarcopenia and adiposity as a predictor of survival in colorectal cancer patients.

Cancer cachexia, a metabolic syndrome causing muscle loss, inflammation, and malnutrition, adversely affects prognosis and treatment in cancer patients. Despite extensive studies in other malignancies, cachexia remains underexplored in gynecologic cancers, particularly in India. This study evaluates the cachexia index (CXI) in gynecologic cancer patients and its association with Activin A and Myostatin.

In this prospective observational study, 160 women with gynecologic malignancies were assessed for cachexia using Fearon's criteria, the global leadership initiative on malnutrition (GLIM) definition, and CXI, which integrates skeletal muscle index (SMI), albumin, and neutrophil-to-lymphocyte ratio (NLR). Serum Activin A and Myostatin were measured via enzyme-linked immunosorbent assay. A subgroup of 30 ovarian cancer patients received nutritional and physical prehabilitation, with biomarker reassessment post-intervention.

Cachexia prevalence was 22.50% (Fearon's) and 56.25% (GLIM). The median CXI was 56.74, with 33.75% having CXI < 41, indicating severe cachexia. CXI < 41 was correlated with advanced disease (P = 0.000), lower body mass index (P = 0.034), reduced SMI (P = 0.000), and elevated inflammatory markers. Activin A was significantly higher in severe cachexia (P = 0.024), while Myostatin showed no correlation. Prehabilitation significantly improved CXI (P = 0.0001) and reduced Activin A and Myostatin (P = 0.0003, P < 0.0001). In multivariable analysis, platelet-to-lymphocyte ratio emerged as the only independent predictor of low CXI (odds ratio 1.0145; 95% confidence interval 1.0081-1.0210; P < 0.001), while Activin A showed a trend toward significance (P = 0.088).

CXI provides a comprehensive cachexia assessment in gynecologic cancers. Elevated Activin A is linked to muscle degradation. Prehabilitation improves CXI and reduces cachexia biomarkers, emphasizing its therapeutic potential. Further validation of CXI and biomarkers may enhance cachexia diagnosis and management.

Considering the challenges of providing nutrition care in resource-limited settings (RLSs), the International Working Group for Patients' Right to Nutrition Care (WG) organized an expert meeting to propose recommendations and strategies to promote access to nutrition care and address disease-related malnutrition (DRM).

An online survey was developed to assess barriers to providing nutrition care in RLSs and was completed by 58 respondents from low- and middle-income countries between July and August 2024. During the European Society for Clinical Nutrition and Metabolism (ESPEN) Congress in Milan on September 9, 2024, a panel of 30 experts discussed the results of the survey and built consensus statements aimed at defining strategies and recommendations required to address barriers to accessing disease-related nutrition care in RLSs.

The survey and expert consensus panel opinions indicated that there are barriers to delivering quality nutrition care in these settings including low or a lack of medical awareness, patient and family knowledge about DRM and its impact, nutrition risk screening and care implementation, reimbursement, medical devices, adapted diets, nutrition protocols, and access to home medical and nutrition therapy. Gaps identified included (1) epidemiological data and evidence for best practices; (2) education, training, and capacity building; and (3) strengthening health systems.

Tackling DRM in RLSs is challenging because of the high burden of DRM and the fact that current guidelines from high-income countries may not be fully applicable. The WG recommend a three-step strategy to promote access to nutrition care.

Sarcopenia (SP) is described as a prognostic factor in adult and pediatric cancer patients. However, there are no data regarding Wilms tumor (WT). We aimed to study the association between sarcopenia and oncological outcomes in WT.

A retrospective study of patients diagnosed with WT at our institution between 2010 and 2022 was performed. SP at diagnosis was assessed by measuring the psoas muscle area (PMA) at the L4-L5 level on computed tomography (CT)/magnetic resonance imaging (MRI), and was defined as z-score values ≤2. Demographics, complications, and outcomes were analyzed.

Forty-eight patients (50% male) were included, with a mean age of 44.91 ± 31.12 months. Twelve patients (25%) had SP at diagnosis versus 36 (75%) who did not. Forty-one patients (85%) underwent total nephrectomy and seven (15%) nephron-sparing surgery (NSS). No statistical differences were found in demographics, risk group, or treatment between the SP and non-sarcopenic (NSP) groups. SP was associated with a higher rate of postsurgical complications (33% for the SP-group vs. 5.6% for the NSP-group; p = 0.023) and with a higher rate of relapse (33% vs. 14%, respectively; p = 0.09). With a median follow-up of 57.75 (1.87-150.8) months, event-free survival (EFS) was lower for the SP group (84.20 ± 17.45 vs. 135.40 ± 8.65 months, respectively; p = 0,08). One patient in the SP group died. The 5-year overall survival (OS) was 89% for the SP group versus 100% for the NSP group.

Among our patients, SP can be considered a risk factor for complications in patients with WT and could be associated with poor outcomes, increasing the risk of relapse and decreasing EFS.

Possible sarcopenia and malnutrition are critical public health concerns among older adults, particularly in vulnerable populations such as those with a history of homelessness. However, limited evidence exists on the nutritional status and muscle health of this group in Thailand.

This study aimed to assess the nutritional status of formerly homeless older adults residing in supportive housing in Thailand and examine its association with possible sarcopenia. A cross-sectional study was conducted among 116 participants aged 50 years and older. Sociodemographic information was collected using a structured questionnaire. Nutritional status was then assessed using the Mini Nutritional Assessment short form (MNA-SF) and body mass index (BMI). Possible sarcopenia was determined based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, including low calf circumference, reduced handgrip strength, and/or low gait speed. Data were analyzed using descriptive statistics and logistic regression.

Of all participants, 66.4% were male, with a mean age of 59.14 years (SD = 7.791). A total of 78.4% were identified as having possible sarcopenia. Univariate analysis revealed significant associations between possible sarcopenia and malnutrition (OR = 6.111, 95% CI = 2.104-17.750), low BMI (OR = 16.784, 95% CI = 3.729-75.535), and waist circumference (OR = 0.129, 95% CI = 0.049-0.342). Multivariate logistic regression indicated that malnutrition (OR = 3.429, 95% CI = 1.093-10.763) and low BMI (OR = 11.732, 95% CI = 2.523-54.567) were significant predictors of possible sarcopenia, collectively explaining 33.8% of the variance.

The findings underscore a high prevalence of possible sarcopenia among formerly homeless older adults in supportive housing in Thailand and highlight poor nutritional status, particularly low BMI and malnutrition, as a key contributing factor. These results emphasize the importance of early nutritional screening and interventions to prevent or delay sarcopenia in this vulnerable population.

Anxiety and depression are common mental health problems in cancer patients. At the same time, cancer patients often suffer from disease-related catabolic dysregulation and malnutrition. Emerging evidence has suggested the potential link between mental disorders and nutritional status.

This study summarised the evidence for the association of malnutrition with anxiety and depression in cancer patients.

A systematic search of PubMed and EMBASE databases was performed for observational studies published up to December 2024.

Forty-one articles were found eligible for inclusion in the systematic review, and twenty-nine in the meta-analysis. Compared with the normally nourished cancer patients, malnourished patients had a more than threefold (relative risk (RR) = 3.23, 95% CI 2.39, 4.38) and nearly twofold (RR = 1.87, 95% CI 1.48, 2.37) increased risk of depression and anxiety, respectively. Considering the studies that identified lower emotional status as a cause rather than an effect of malnutrition, the inverse association was confirmed only for depression (RR = 2.01, 95% CI 1.62, 2.49), but not for anxiety (RR = 1.38, 95% CI 0.68, 2.80). Finally, the standardised mean differences of the psychological scores showed significantly higher values in individuals with nutritional impairment compared to those with normal nutritional status (SMD = 0.69, 95% CI 0.50, 0.88 for depression and SMD = 0.54, 95% CI 0.26, 0.82 for anxiety).

Mental health problems such as anxiety and depression are associated with malnutrition in cancer patients.

Physiotherapists in nursing homes perform a diversity of roles and tasks. But the delivery of physiotherapy services varies widely between organizations and between individual physiotherapists. This depends on both organizational and personal factors. This study aims to investigate to what extent physiotherapists in Dutch nursing homes agree on the scope and content of their professional roles and tasks.

We performed a cross-sectional survey study of a convenience sample of physiotherapists in nursing homes. The questions were divided into five themes: (1) care and functional problems (falls, incontinence, physical strain, decubitus, inactivity/immobility, pain, problems with lying and sitting, the use of physical restraints, malnutrition and sarcopenia, overweight, behavioral problems, oedema, joint contractures), (2) referrals and accessibility, (3) assessments and examinations, (4) interventions and actions, and (5) organizational matters. We asked the participants to answer the questions on a five-point Likert scale. We defined consensus when ≥75% of the participants rated the question with a Likert-score of 4 or 5 or with a Likert-score of 1 or 2.

Sixty-five physiotherapists returned the survey. They agreed that physiotherapists play an essential role in the management of prevention of falls, mobility problems, transfer problems, ergonomic advice, physical strain, pain, problems with sitting and lying, sarcopenia, and joint contractures. There was a discrepancy in consensus regarding what a physiotherapist should do in the specific cases versus what they actually do.

Physiotherapists in nursing homes agreed they have an important role in a variety of care and functional problems. However, there was a difference between what needs to be done versus what is actually done by the physiotherapists. Future research should focus on the underlying reasons for this inconsistency.

Nutritional status is a factor that impacts the clinical outcomes of various medical conditions, including cardiovascular disease and surgical procedures; however, little is known about its role in percutaneous procedures. This study aimed to assess the association between nutritional status and risk in patients undergoing coronary angiography and in-hospital mortality and length of stay to improve risk stratification and peri-procedural care.

Patients who underwent coronary angiography between January 2022 and August 2023. Nutritional status was assessed with body mass index, and nutritional risk was assessed with the Nutritional Risk Screening 2002 score. Multivariate regression models assessed independent predictors of in-hospital mortality, adjusting for age, sex, coronary event, Canadian Cardiovascular Society class, and cardiac arrest at admission. Subgroup analyses were performed based on coronary event type to evaluate whether the associations differed across clinical presentations.

Patients who underwent angiography (n = 1343) were aged 69.2 ± 11.1 years, 51% male, and 49% had acute coronary syndrome. The mean length of stay at the hospital was 4.5 ± 4.8 days; 38% of patients stayed ≥5 days. The in-hospital mortality rate was 1.3%. Regression analyses revealed that the Nutritional Risk Screening 2002 score independently predicted the length of stay (β = 0.63, p = 0.002), and this relationship was strongest in the non-ST segment elevation myocardial infarction subgroup (β = 1.26, p = 0.02). Body mass index did not predict the length of stay. There was no significant relationship between in-hospital mortality and body mass index or the Nutritional Risk Screening 2002 score.

Nutritional risk significantly predicts the length of stay after coronary angiography, independent of age, sex, and coronary event type. Clinicians should consider routine nutritional risk assessment preceding coronary angiography to help individualise post-procedure, in-hospital care.

Background/Objectives: The nutritional habits of older adults are increasingly relevant to public health, particularly given the rising prevalence of obesity and its associated chronic diseases. This study aims to analyze the relationship between the Healthy Eating Index (IASE) and Body Mass Index (BMI) in older adults in Spain, focusing on food frequency, dietary preferences, and socioeconomic factors influencing nutritional security. Methods: The study is part of the Eating Matters project, assessing food (in)security in older adults across Andalusia and Catalonia between April 2022 and January 2024. A cross-sectional survey was conducted among 190 participants (≥65 years), recruited in primary healthcare centers. The questionnaire included three blocks: food insecurity assessment (FIES scale), diet quality with the Healthy Eating Index for the Spanish Population (IASE), and sociodemographic factors. Data analysis involved descriptive statistics, Pearson correlations, and logistic regression models to identify associated factors with overweight and obesity. Results: The average BMI was 28.5 kg/m2 (SD = 4.29), with 46.3% of participants classified as overweight and 32.1% as obese. A significant negative correlation (r = -0.79, p < 0.05) was found between healthy food consumption and BMI, while personal income showed a moderate positive correlation with adherence to a healthy diet (r = 0.42, p < 0.05). Logistic regression indicated that frequent consumption of processed meats and confectionery was a significant identify associated factors with overweight/obesity, with a model accuracy of 68% and sensitivity of 95%. Conclusions: Older adults with lower incomes and higher consumption of ultra-processed foods exhibited a higher risk of obesity. These findings highlight the need for public policies promoting food accessibility and targeted nutrition education for older adults, including guidance on balanced diets, adequate protein intake, and the prevention of sarcopenia, to encourage healthier dietary patterns in aging populations.

This descriptive and cross-sectional study evaluated the nutrition status of geriatric patients with cancer undergoing chemotherapy.

Data were collected by researchers in the Medical Oncology Unit of a university hospital between January and September 2024 to assess the nutrition status of 100 geriatric patients with cancer undergoing chemotherapy. Malnutrition risk was evaluated using the Mini Nutritional Assessment (MNA).

The mean ± SD age of the study participants was 72.03 ± 5.40 years. The study found that 21% of the patients were undergoing treatment for colon cancer, 20% for lung cancer, and 16% for pancreatic cancer. Most patients were diagnosed at advanced stages, with 28% at stage III and 65% at stage IV. The nutrition risk assessment of the patients found that 34% had a normal MNA score (24-30 points), 30% were at risk of malnutrition (17-23.5 points), and 36% were malnourished (<17 points). The following symptoms affecting nutrition were observed: nausea and vomiting (39%), taste changes (24%), weakness and fatigue (73%), pain (5%), and weight loss (27%). The most commonly used type of chemotherapy was FOLFOX (folinic acid, 5-fluorouracil and oxaliplatin, 18%).

Malnutrition was very common in geriatric patients with cancer undergoing chemotherapy. Therefore, it is crucial for healthcare professionals, particularly dietitians and nutritionists, to diagnose and manage malnutrition risk early and effectively.

The combination of a reduction in the Danish hospital bed count, the shortage of hospital staff and demographic changes challenges the Danish hospital capacity. This was further highlighted during the COVID-19 pandemic when hospitals worldwide were overwhelmed by infected patients requiring acute hospital care. To address these challenges, a hospital-at-home (HaH) programme offers an alternative to conventional in-hospital admission. Furthermore, HaH has the potential to improve patient outcomes, reduce costs and increase patient satisfaction. However, few studies have evaluated HaH in a Scandinavian setting, and this article describes the protocol for a randomised controlled trial (RCT) comparing an HaH model with continued conventional in-hospital admission. The main aim of the trial is to evaluate physical activity level and mental wellbeing in patients admitted at home compared with conventionally admitted patients.

110 clinically stable patients from two internal medical wards at Nordsjaellands Hospital in Denmark will be included and randomised in a ratio of 1:1 to either continued conventional in-hospital admission (control group) or virtual HaH model (intervention group). The control group will receive standard hospital treatment, and the intervention group will be transferred home for continued treatment (eg, intravenous antibiotics or oxygen treatment). The primary outcome measures are physical activity assessed using daily step count (during the first 24 hours after inclusion, as an intermediary indicator of the risk of adverse events) and treatment satisfaction (assessed using a patient satisfaction survey). Secondary outcome measures are adverse events of special interest, escalation of care, readmission rate postdischarge (30 days and 90 days), mortality (associated and 7 days, 30 days and 90 days postdischarge), process data (eg, the number of teleconsultations) and a health economic evaluation.

The study was approved by the Danish Research Ethics Committees (no. 2303051) and the Danish Medicines Agency (CIV-23-03-042542) and will be monitored by the Copenhagen University Hospital Good Clinical Practice unit. Results will be published in peer-reviewed journals and presented at relevant national and international conferences. We also plan to communicate the results to relevant stakeholders in the Danish healthcare system.

NCT05920304.

There is no gold standard tool for nutritional assessment in critically ill patients. The modified Nutrition Risk in Critically Ill (mNUTRIC) score assesses risk of future malnutrition, whereas the Global Leadership Initiative on Malnutrition (GLIM) criteria diagnose only current malnutrition.

We aimed to evaluate the prognostic performance of a novel nutritional assessment tool that combines the mNUTRIC score and GLIM criteria for hospital outcomes among intensive care unit (ICU) patients.

A single-center, retrospective observational cohort study was conducted on patients admitted to the ICU between 1 August, 2018, and 7 June, 2021. The novel tool was categorized into 4 groups: group 1: low risk (0-4 points) by mNUTRIC plus no malnutrition from the GLIM; group 2: low risk plus moderate malnutrition or high risk (5-9 points) plus no malnutrition; group 3: high risk plus moderate malnutrition or low risk plus severe malnutrition; and group 4: high risk plus severe malnutrition.

A total of 724 patients were enrolled. The in-hospital mortality rates for groups 1-4 were 3%, 16%, 32%, and 52%, respectively. A poor nutritional status by the novel nutritional assessment tool was an independent risk factor for in-hospital mortality when compared with group 1, particularly as patients progressed to group 4 (odds ratio: 2.32; 95% confidence interval: 1.84, 2.93). In the receiver operating characteristic (ROC) analysis, the novel tool demonstrated the strongest prognostic performance for in-hospital mortality (area under the ROC curve: 0.759; 95% CI: 0.723, 0.795) compared with validated severity scoring systems and other significant risk factors such as use of mechanical ventilation.

This novel nutritional assessment tool has strong prognostic value in being associated with in-hospital mortality. Prospective validation with an external dataset is warranted. A comprehensive nutritional assessment of the current status and future risk at ICU admission could be the most critical factor in assessing the prognosis of critically ill patients.

The Controlling Nutritional Status (CONUT) and Geriatric Nutritional Risk Index (GNRI) are indices that identify individuals at risk of malnutrition. Our study sought to examine the incidence and prognostic implications of abnormal CONUT and/or GNRI in patients with heart failure with preserved ejection fraction.

The CONUT score and GNRI were serially analyzed in this post hoc analysis of the PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Receptor Blockers Global Outcomes in Heart Failure With Preserved Ejection Fraction) trial. A CONUT score >2 or GNRI ≤98 was considered to be abnormal. The association between abnormal CONUT and/or GNRI (analyzed using a time-updated approach) and total heart failure hospitalizations and cardiovascular death was analyzed. Other outcomes included cardiovascular death, all-cause death, total heart failure hospitalizations, first all-cause hospitalization, and first noncardiovascular hospitalization. We also explored the effect of incident hospitalization on subsequent incident abnormal CONUT and/or GNRI. In 4794 patients (55% women, mean age 72±8 years), 1119 (23.3%) had at least 1 abnormal score at randomization. Among the remaining 3675 patients, 1405 (38.2%) developed at least 1 abnormal score over a median follow-up of 2.9 years. Any abnormal score during follow-up was associated with a significantly higher risk of fatal and nonfatal outcomes, and all types of hospitalizations (all-cause, heart failure, and noncardiovascular hospitalizations). Among patients with normal scores at randomization, any hospitalization during follow-up was associated with a significantly higher risk of developing at least 1 abnormal score posthospitalization, compared with prehospitalization and never-hospitalized patients (adjusted hazard ratio, 1.37 [95% CI, 1.22-1.55]).

Among patients with heart failure with preserved ejection fraction, the rate of individuals with abnormal CONUT and/or GNRI was high, especially following a heart failure hospitalization, and was linked with excess cardiovascular and noncardiovascular events.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711.

To translate, cross-culturally adapt, and validate the Malnutrition Awareness Scale (MAS) among Chinese community-dwelling older adults.

This study consists of two parts. First, we developed the Chinese version of the MAS (C-MAS) through direct translation, back translation, cross-cultural adaptation, and pilot testing. Then, we selected 380 community-dwelling older adults from two community healthcare centers in Zhengzhou from May to July 2024 for a questionnaire survey to assess the scale's reliability and validity, including internal reliability, test-retest reliability, split-half reliability, content validity, and construct validity.

The C-MAS included 4 dimensions and 23 items. At the scale level, the content validity index (S-CVI) was 0.91; at the item level, the content validity ranged from 0.86 to 1.00. The exploratory factor analysis (EFA) extracted four common factors with factor loads of 0.646 to 0.893 for each item, and the cumulative variance contribution rate was 71.418%. The confirmatory factor analysis (CFA) indicated a satisfactory fit for each indicator. The Cronbach's alpha coefficient for this scale was 0.908, with test-retest reliability of 0.952 and split-half reliability of 0.738.

The reliability and validity of C-MAS are up to standard and can be used to assess malnutrition awareness among Chinese community-dwelling older adults.

Socioeconomic disparities and malnutrition are significant contributors to global health challenges, yet the relationship between socioeconomic status (SES) and malnutrition, and the subsequent risk of mortality in cancer patients remains underexplored. This study aimed to investigate the complex relationships between SES, nutritional status, and both all-cause and cancer-specific mortality in cancer patients.

Prospective cohort study.

Participants from the UK Biobank with a cancer diagnosis within two years prior to baseline assessment were included (n = 4216, 47.3 % male). Latent class analysis (LCA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria were employed to evaluate patients' SES and nutritional status. Logistic regression was applied to assess the associations between SES and nutritional status. Cox-proportional hazards models, along with mediation, joint association, and interaction analyses, were done to establish the relationship between SES, nutritional status, and both all-cause and cancer-specific mortality.

During a median follow-up of 15.14 (IQR: 15.09-15.20) years, 1039 participants died, of which 788 deaths were cancer-specific. Participants with low SES (vs high) had an increased risk of malnutrition (OR 1.60, 95 % CI 1.08-2.39) and all-cause mortality (HR 1.22, 95 % CI 1.03-1.44). Malnutrition accounted for 6.8 % of the association between low SES and all-cause mortality. Compared to well-nourished patients with high SES, those with malnutrition and low SES had the highest risk of all-cause mortality (3.12, 2.26-4.29), while those with malnutrition and high SES faced the highest risk of cancer-specific mortality (2.88, 1.97-4.21).

While addressing malnutrition alone may not significantly reduce mortality disparities arising from socioeconomic differences, it remains a crucial strategy for alleviating cancer burden, especially among patients with low SES.

The Global Leadership Initiative on Malnutrition (GLIM) introduced an approach for malnutrition diagnosis in 2019 that comprised screening followed by assessment of three phenotypic criteria (weight loss, low body mass index [BMI], and low muscle mass) and two etiologic criteria (reduced food intake/assimilation and inflammation/disease burden). This planned update reconsiders the GLIM framework based on published knowledge and experience over the past 5 years.

A working group (n = 43 members) conducted a literature search spanning 2019-2024 using the keywords "Global Leadership Initiative on Malnutrition or GLIM." Prior GLIM guidance activities for using the criteria on muscle mass and inflammation were reviewed. Successive rounds of revision and review were used to achieve consensus.

More than 400 scientific reports were published in peer-reviewed journals, forming the basis of 10 systematic reviews, some including meta-analyses of GLIM validity that indicate strong construct and predictive validity. Limitations and future priorities are discussed. Working group findings suggest that assessment of low muscle mass should be guided by experience and available technological resources. Clinical judgment may suffice to evaluate the inflammation/disease burden etiologic criterion. No revisions of the weight loss, low BMI, or reduced food intake/assimilation criteria are suggested. After two rounds of review and revision, the working group secured 100% agreement with the conclusions reported in the 5-year update.

Ongoing initiatives target priorities that include malnutrition risk screening procedures, GLIM adaptation to the intensive care setting, assessment in support of the reduced food intake/assimilation criterion, and determination of malnutrition in obesity.