Nutritional status is known to be associated with clinical outcomes in head and neck squamous cell carcinoma (HNSCC) patients. The aim of this study was to investigate whether changes in subcutaneous (SAT) and visceral (VAT) adipose tissue mass after concurrent chemoradiotherapy (CCRT) are significantly related to progression-free survival (PFS) and overall survival (OS) in HNSCC patients.

117 HNSCC patients who underwent definitive CCRT were retrospecitively analyzed. Using unenhanced computed tomography images from pretreatment (PET1) and 3 months post-CCRT (PET2) F-18 fluorodeoxyglucose positron emission tomography (PET)/computed tomography scans, we measured the cross-sectional areas of SAT and VAT. The areas of SAT and VAT were adjusted for height squared to calculate the SAT and VAT indices.

Following CCRT, 92 patients (78.6%) exhibited a decrease in VAT index values. The complete metabolic response (CMR) patient group showed significantly higher values of VAT index at PET2 compared to the non-CMR group (P < 0.05). Multivariate survival analysis found that the VAT index at PET2 and the percent changes in both the SAT index and VAT index were significant predictors for both PFS and OS (P < 0.05). Patients with a low VAT index at PET2 and marked losses of SAT index and VAT index after CCRT had poorer survival outcomes. On subgroup survival analysis, the percent change in VAT index was a significant predictor for PFS and OS in both CMR and non-CMR groups (P < 0.05).

The alteration in VAT mass after CCRT was clinically significant for risk stratification of survival outcomes in HNSCC patients.

Aging-associated body composition changes lead to a decrease in muscle mass and strength, affecting the functionality of older adults. Myostatin and musclin are myokines that regulate muscle metabolism and may modulate muscle changes during aging. Our objective was to determine the relationship between myostatin, musclin, and nutritional status with physical functionality in older adults.

This was a cross-sectional study of a subsample of a stratified random sampling population survey in community-dwelling 60-90-year-old adults of both sexes. Serum myostatin and musclin concentrations were measured using MILLIPLEX technology (Merck Millipore, USA). Trained personnel recorded body mass index (BMI), and waist (WC), calf (CC), and arm (AC) circumferences as indicators of nutritional status. Functionality tests included handgrip strength (GS), walking speed (WS), and Advanced Activities of Daily Living.

Of 101 participants, 55.4% were women, 56.4% were between 60 and 69 years old, 53.5% had abdominal obesity, 23.8% had dynapenia, and 33.7% had low WS. Neither myostatin nor musclin showed significant changes from 60 to 90 years. In a multiple lineal regression model, myostatin showed an inverse correlation with BMI, CC, and AC in men (P < 0.05) but did not explain GS or WS. In a similar analysis, musclin and WC showed an inverse correlation with GS (P < 0.05). Moreover, myostatin was lower in the more physically active men (P < 0.05) but musclin did not show any relationship with the Advanced Activities of Daily Living scale.

Myostatin and musclin do not decrease with aging and are associated with nutritional and metabolic status. Musclin is associated with dynapenic obesity in older adults.

The aim was to assess the diagnostic accuracy of four different nutrition screening and evaluation instruments in nasopharyngeal carcinoma patients, benchmarked against Global Leadership Initiative on Malnutrition (GLIM) criteria.

An observational, single-institution study was conducted between June 2022 and May 2023. Nutrition status was assessed using Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Patient-Generated Subjective Global Assessment (PG-SGA), and GLIM criteria at two time points: postadmission and predischarge. Metrics such as sensitivity, specificity, concordance, and Kappa coefficient were computed.

For the trial, 140 participants were enrolled. Based on GLIM criteria, the rate of undernutrition was 22.9% before radiation and 73.6% after it ended. NRS-2002 (k = 0.721) demonstrated substantial concordance with GLIM criteria at admission, followed by MUST (k = 0.604) and MST (k = 0.378). Kappa coefficients were reduced at discharge (NRS-2002: k = 0.696; MUST: k = 0.690; MST: k = 0.496). GLIM criteria were moderately consistent with PG-SGA at admission (k = 0.453) and slightly consistent at discharge (k = 0.136).

NRS-2002 demonstrated greater concordance with GLIM criteria than MUST and MST. Therefore, NRS-2002 could be a more appropriate choice for initial nutrition screening in the diagnostic framework of GLIM for individuals afflicted with nasopharyngeal cancer, both before and after radiotherapy. The alignment of GLIM criteria with PG-SGA in identifying undernourished patients varied from slight to moderate.

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.

Patients with critical illness may present with disease-related malnutrition upon intensive care unit (ICU) admission. They are at risk of development and progression of malnutrition over the disease trajectory because of inflammation, dysregulated metabolism, and challenges with feeding.

The Global Leadership Initiative on Malnutrition (GLIM) convened a panel of 36 clinical nutrition experts to develop consensus-based guidance statements addressing the diagnosis of malnutrition during critical illness, using a modified Delphi approach with a requirement of ≥75% agreement.

CONCLUSION: Research using consistent etiologic and phenotypic variables offers great potential to assess the efficacy of nutrition interventions for critically ill patients with malnutrition. Assessment of these variables at during and beyond the ICU stay will clarify the trajectory of malnutrition and enable exploration of impactful treatment modalities at each juncture. GLIM offers a diagnostic approach that can be used to identify malnutrition in critically ill patients.

This study investigated the significance of the Global Leadership Initiative on Malnutrition (GLIM) for patients with resected biliary tract cancers.

The subjects of this retrospective analysis were 114 patients who underwent radical surgery for cholangiocarcinoma between 2018 and 2023. We analyzed both handgrip force and skeletal muscle area and classified patients as having GLIM malnutrition or modified GLIM malcondition. We also evaluated clinicopathological factors, short-term outcomes, and prognoses.

The GLIM criteria identified 47 patients (41.2%) with malnutrition and 13 patients (11.4%) with modified GLIM malcondition. Overall survival (P = 0.009) and recurrence-free survival (P = 0.016) were significantly different between the well-nourished and malnourished patients according to the GLIM criteria. Furthermore, modified GLIM criteria malcondition was a significant prognostic factor for both recurrence-free and overall survival (P = 0.002 and P < 0.001, respectively). Multivariate analysis identified a higher carcinoembryonic antigen level and modified GLIM malcondition as predictors of overall and recurrence-free survival. Pathological stage ≥ III was also a predictor of recurrence-free survival. On comparing the prognoses of modified GLIM malcondition and GLIM malnutrition using the Akaike Information Criteria, the modified GLIM malcondition was identified as a stronger prognostic factor.

A modified GLIM malcondition can be a highly useful prognostic marker for patients with resected biliary tract cancer.

Malnutrition is related to increased mortality and poor outcome. Therefore, early diagnosis and intervention of malnutrition are recommended. However, the optimal nutrition screening tool for diagnosing malnutrition remains undetermined. This study aimed to verify the discrimination and difficulty of nutrition screening items through item response theory (IRT) analysis and develop a simpler malnutrition screening tool.

This study enrolled 10,375 patients aged ≥18 years who were admitted at Tokushima University Hospital. Patients who were pregnant had short-term hospitalization (≤3 days), were hospitalized only in the weekend, could not hear clearly, and were hospitalized merely for examination were excluded. A skilled dietitian performed the Subjective Global Assessment, rating a good nutritional status as A, moderate malnutrition as B, and severe malnutrition as C.

According to Subjective Global Assessment, we classified 7119 patients as A, 2892 as B, and 364 as C. Between these classes, the total number of application items was significantly lower in class A but significantly higher in class C. In the discrimination of each item calculated by IRT analysis, the highest discrimination item was "Has your food intake been less than usual?", followed by "Have you had anorexia?", "Have you had vomiting?", "Have you had nausea?", "Have you had dehydration?", and "Have you lost weight?".

Human Key Tool of Nutrition, which is based on the IRT analysis results, is a new simple nutrition screening tool developed by us. Human Key Tool of Nutrition can contribute to the widespread use of nutrition screening.

In this study, we aimed to explore the impact of nutrition therapy on clinical outcomes for patients classified according to the Global Leadership Initiative on Malnutrition (GLIM) criteria.

Prospective, multicenter cohort study.

This study was conducted from September 2020 to December 2022 across 28 geriatric centers in China.

A total of 862 patients aged ≥65 years were included.

All participating physicians completed a 6-h training on nutritional support, following international guidelines before the study. Patients had a nutritional risk screening 2002 score ≥3 points within 48 h of admission. Physicians determined specific nutritional support regimens.

GLIM assessments were conducted after enrollment. Nutritional and functional statuses were evaluated at baseline and 90 days after admission. Clinical outcomes-mortality, readmission, new infections, and falls-were documented after 90 days.

Compared to 108 patients without malnutrition per the GLIM criteria, 754 malnourished patients showed lower weight, body mass index (BMI), and Mini Nutritional Assessment-Short Form (MNA-SF) scores and significant reductions in grip strength, calf circumference, and Barthel activities of daily living (ADLs) index. The percentage of patients with adequate caloric intake at the 90-day follow-up was 70.7% (n = 533) and 67.6% (n = 73) in the malnutrition and non-malnutrition groups (p = 0.51) and that of patients with adequate protein intake was 65.9% (n = 497) and 58.3% (n = 63), respectively (p = 0.12). Moreover, malnourished patients showed significant improvements in body weight, BMI, MNA-SF scores, calf circumference, and Barthel ADL index compared to those without malnutrition. Malnourished patients also had lower risks of readmission and falls at follow-up.

Among older inpatients at nutritional risk, those with malnutrition classified according to the GLIM criteria benefited from nutritional support, demonstrating improved BMI, MNA-SF scores, calf circumference, and Barthel ADL index, as well as reduced readmission rates and incidence of falls.

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.

Malnutrition substantially contributes to adverse clinical outcomes. However, no national survey has been conducted to characterize its epidemiology in hospital settings in China. We conducted the China Nutrition Fundamental Data 2020 project among a multistage stratified cluster sample of adult inpatients from 291 study sites across 30 provinces, autonomous regions and municipalities (except for Hong Kong, Macao, Taiwan Province, and the Xizang Autonomous Region, please see MATERIALS AND METHODS for details of the causes) of China to generate reliable data on the prevalence of malnutrition and explore the associated risk factors. We collected information on participants' sociodemographic characteristics, physical examinations, and laboratory test results. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. The standardized prevalence of malnutrition was calculated, and factors associated with malnutrition were examined using logistic regression analyses. We included 54,652 individuals with seven systemic diseases who completed all the survey documents in the final analysis. The overall prevalence of malnutrition was 12.5%, representing 7.6 million adult inpatients in China. The prevalence of malnutrition was higher in men, individuals aged ⩾ 60 years, residents of central and western regions, people from lower economic areas, and those with lower education levels than in women, individuals aged <60 years, residents of eastern regions, individuals from higher economic areas, and those with higher education levels. Patients with higher disease severity scores, infectious diseases, and neoplasms had a higher tendency for malnutrition than those without such conditions. Sex, age, region, economic level, education level, disease severity score, infectious diseases, and neoplasms were independently associated with malnutrition. In conclusion, malnutrition is prevalent among Chinese adult inpatients, necessitating national- and hospital-level interventions. This survey provides several avenues to begin addressing the burden of malnutrition in China.

Patients with critical illness may present with disease-related malnutrition upon intensive care unit (ICU) admission. They are at risk of development and progression of malnutrition over the disease trajectory because of inflammation, dysregulated metabolism, and challenges with feeding.

The Global Leadership Initiative on Malnutrition (GLIM) convened a panel of 36 clinical nutrition experts to develop consensus-based guidance statements addressing the diagnosis of malnutrition during critical illness using a modified Delphi approach with a requirement of ≥75% agreement.

(1) To identify pre-existing malnutrition, we suggest evaluation within 48 h of ICU admission when feasible (100% agreement) or within 4 days (94% agreement). (2) To identify the development and progression of malnutrition, we suggest re-evaluation of all patients every 7-10 days (97% agreement). (3) To identify progressive loss of muscle mass, we suggest evaluation of muscle mass as soon as feasible (92% agreement) and again after 7-10 days (89% agreement). (4) To identify the development and progression of malnutrition before and after ICU discharge, we suggest re-evaluating nutrition status before ICU discharge and during clinical visits that follow (100% agreement).

Research using consistent etiologic and phenotypic variables offers great potential to assess the efficacy of nutrition interventions for critically ill patients with malnutrition. Assessment of these variables during and beyond the ICU stay will clarify the trajectory of malnutrition and enable exploration of impactful treatment modalities at each juncture. GLIM offers a diagnostic approach that can be used to identify malnutrition in critically ill patients.

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.

We sought to characterize the impact of exocrine pancreatic insufficiency (EPI) on primary healthcare utilization and expenditures following partial pancreatectomy (PP).

Patients who underwent PP between 2004 and 2019 were identified using SEER-Medicare. Patients who developed EPI within 6 months following surgery were included in the EPI cohort and were followed for 1-year post-surgery. Differences in post-surgery PCP visit frequency and healthcare expenditures within 1-year were evaluated.

Among 1119 patients, median age was 74 years (IQR: 69-78), about one-half were female (52.5%), and the majority were White (85.2%). Following PP, 22.4% of patients developed EPI. Patients with EPI were more likely to be concomitantly diagnosed with diabetes following PP (EPI: 11.6% vs. no EPI: 3.7%; p < 0.001). On multivariable analyses, EPI was associated with increased PCP visits (Ref. No EPI; percent difference [%diff]: 29.62, 95%CI 15.15-45.90) and higher healthcare costs (Ref. No EPI; total postoperative expenditure: %diff 37.01, 95%CI 12.89-66.29; p < 0.01) within 1-year following PP.

Roughly 1 in 4 patients experienced EPI after PP. EPI was associated with increased PCP utilization and higher healthcare expenditures.

Eating is fundamental to life, encompassing not only nutritional intake but also emotional, social and communicative functions. Since the global ageing population grows, assessing eating ability-related issues, particularly masticatory dysfunction, is of significance. Masticatory dysfunction impairs food absorption, elevates the risk of choking and contributes to malnutrition. Time preferences, such as time discounting and present bias, influence health behaviours and may be related to masticatory function; however, this relation remains unclear.

This study aimed to investigate the association between time preference and masticatory function in community-dwelling older adults.

This cross-sectional survey included older adults (≥ 65 years) participating in senior clubs in an urban area of Japan. Time preferences (time discounting and procrastination) were assessed using selected questions from the Global Preference Survey, while masticatory function was measured by the Gluco Sensor GS-II. Nutritional status was evaluated by the Mini-Nutritional Assessment-Short Form. Linear regression analyses were conducted to assess the association between time preference and outcomes.

Among the participants (N = 65, mean age 79.1 ± 5.5 years), a significant association was found between higher time discounting tendencies and lower masticatory function (β = -19.62, p = 0.014). Procrastination was not associated with masticatory function or nutritional status.

Higher tendencies towards time discounting were associated with lower masticatory function, suggesting that cumulative behavioural decisions might influence oral function. These findings provide a foundation for future research and interventions aimed to promote behavioural changes for improving functional outcomes.

Nutrition screening is a fundamental step to ensure appropriate intervention in patients with malnutrition. An automatic tool of nutritional risk screening based on electronic health records will improve efficiency and elevate the malnutrition diagnosis rate. We aimed to develop an artificial intelligence (AI) malnutrition screening tool based on electronic medical records and compare it with the patient interview-based tool.

We conducted a cross-sectional study at a comprehensive tertiary hospital in China. Data of malnutrition information were extracted from electronic health records (EHR) and were used to train and test an AI tool for the malnutritional risk screening. We adopted the GLIM framework as a reference standard for assessing malnutrition. Six widely used machine learning algorithms for auxiliary diagnosis prediction, including Support Vector Machine, Random Forest, extreme gradient boosting (XGBoost), Logistic Regression, AdaBoost, and Gradient Boosting were compared and visualized using SHapley Additive exPlanations (SHAP). After feature screening, simplified algoritms were cross validated at an independent data set.

495 inpatients enrolled were randomly divided into training and validation groups for algorithm development. 10 features annotated manually from free texts and 32 features selected from structured EHRs entered the models. XGBoost had the highest area under the receiver operating characteristic curve (AUC) and the top six features were weight loss, decreased food intake, prealbmine, white cell, BMI group, and percent of neutrophils. In simplified models, Random Forest acquired the highest AUC of 0.97 based on first sources data from interviews and 0.87 based on EHR data.

Inpatients' EHR data could be integrated by AI to detect the risk of malnutrition. This AI-enabled tool may hold promise for timely and efficient nutrition screening in newly admitted inpatients.

Background: Malnutrition may increase the risk of frailty in individuals with musculoskeletal pain. However, this scenario has not been explored in detail. As such, the present study was conducted to examine the effects of malnutrition on the risk of incident and worsening frailty in community-dwelling older adults with musculoskeletal pain. Methods: Data from 895 community-dwelling older adults participating in the Toledo Study of Healthy Ageing who reported experiencing musculoskeletal pain during the month preceding data collection (mean age: 74.9 ± 5.6 years) were analyzed. Pain characteristics (i.e., intensity, locations, and treatment) were assessed based on self-reported information regarding the last month. Malnutrition was operationalized according to the GLIM criteria. Frailty status was assessed at baseline and at follow-up (~2.99 years), according to the Frailty Phenotype paradigm, operationalized through the Frailty Trait Scale 5. Associations between the variables were tested using logistic regression analyses adjusted for many covariates established a priori. Results: Malnutrition increased the risk of frailty (odds ratio [OR] = 4.41) and worsening of frailty status (OR = 6.25) in the participants who used ≥2 groups of painkillers in comparison to their non-undernourished peers. Conclusions: The findings of the present study indicate that malnutrition increases the risk of both developing and worsening frailty in older adults with musculoskeletal disorders. In particular, an increased risk of incident frailty and worsening frailty status was found in undernourished individuals using ≥2 analgesic drugs. Our results suggest that nutritional assessment should be included in the evaluation of old people living with musculoskeletal pain.

The Global Leadership Initiative on Malnutrition (GLIM) criteria for diagnosing malnutrition were established to provide a standardized approach for diagnosing malnutrition in clinical practice using a nutrition screening tool (NST) as the first step for this process. This study aimed to compare the complementarity of NSTs with the GLIM criteria for malnutrition diagnosis in patients with cancer.

Hospitalized patients with different cancer types were evaluated in a prospective cohort study in which they were initially screened using the Patient-Generated Subjective Global Assessment (PG-SGA), Protocol for Nutritional Risk in Oncology (PRONTO), Malnutrition Universal Screening Tool, Nutritional Risk Screening 2002, Malnutrition Screening Tool, and NutriScore for nutrition risk. Malnutrition diagnosis involved phenotypic and etiological criteria as proposed by the GLIM. Complementarity of NST to GLIM criteria was evaluated by calculating accuracy metrics and investigating association with 12-month mortality.

Nutrition risk ranged from 14.8% (NutriScore) to 82.8% (PRONTO) and frequency of malnutrition from 13.8% (with NutriScore) to 88.9% (with PG-SGA). NutriScore presented the lowest negative predictive value (25.1%) whereas PG-SGA presented the highest (58.32%). Regardless of the NST applied, the risk of malnutrition and diagnosis of malnutrition according to the GLIM criteria, combined or isolated, increased the risk of 12-month mortality.

All NSTs presented low negative predictive value when their complementarity to GLIM criteria for malnutrition diagnosis was tested. Indeed, patients "at risk" presented similar increased risk of 12-month after discharge mortality in comparison with those at risk and malnourished by the GLIM criteria when all NSTs were applied.

The diagnosis of sarcopenic obesity (SO) in patients with gastric cancer has been inconsistent among studies examining postoperative complications because diagnostic methods have not been standardized. This study aimed to clarify the differences in the prevalence of obesity with and without low hand grip strength (HGS) according to the diagnostic criteria proposed using the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) and identify the optimal model for predicting postoperative complications.

Patients who underwent radical gastrectomy for gastric cancer between April 2015 and March 2023 were included. According to the ESPEN/EASO diagnostic criteria, patients with a body mass index ≥ 25 kg/m2 who met the screening criteria were assessed for percent body fat (PBF) and skeletal muscle mass (SMM) adjusted by weight (SMM/W) and HGS. Depending on the respective cutoff values, six models of low SMM-obesity without HGS and six models of low HGS-obesity with HGS were set. The incidence of postoperative complication with the Clavien-Dindo classification grade 2 or higher was compared across models. Multivariate logistic regression analysis was performed to determine the risk model for postoperative complications, with significance set at p < 0.05.

The analysis included 1762 patients with a median age of 67.0 years; 1123 were men (63.7%). The prevalence of low SMM-obesity was significantly higher (5.4%-17.3%) than that of low HGS-obesity (1.2%-2.3%). Among those with low SMM-obesity, PBF > 20.2% for men and > 31.7% for women as well as SMM/W ≤ 42.9% for men and ≤ 35.6% for women had the highest postoperative complication incidence number of cases. This model was an independent risk factor for postoperative complications in the multivariate analysis (odds ratio: 1.671, 95% confidence interval: 1.204-2.299, and p = 0.002).

In obese patients with gastric cancer, the preoperative prevalence of low HGS-obesity or low SMM-obesity differed significantly. One of the low SMM-obesity model was associated with postoperative complication after gastrectomy.

Neuroendocrine neoplasms (NENs) originating in the gastroenteropancreatic (GEP) tract are rare tumors often associated with significant metabolic disturbances and nutritional challenges. This review explores the intricate relationship between nutritional status and the development, progression, and prognosis of GEP-NENs. Through an extensive literature search encompassing studies up to April 2024, we examined various factors, including obesity, malnutrition, metabolic syndrome and type 2 diabetes mellitus, and their roles in the development and progression of GEP-NENs. The review highlights the dual role of obesity, both as a risk factor and a potential prognostic indicator, drawing attention to the 'obesity paradox' observed in cancer research. Additionally, we discuss the impact of malnutrition on patient outcomes and emphasize the need for comprehensive nutritional assessments beyond BMI. This analysis highlights the importance of incorporating nutritional interventions into preventive and therapeutic strategies for GEP-NEN patients. Future research should further clarify these associations and develop personalized nutritional management protocols to improve patient prognosis and quality of life. Acronyms adopted in the text and tables: AOR: adjusted odd ratio, BIA: Bioelectrical Impedance Analysis, BMI: Body Mass Index, CI: confidence interval, CLARINET: Controlled Study of Lanreotide Antiproliferative Response in Neuroendocrine Tumor, FLI: fatty liver index, GEP: gastroenteropancreatic, GLIM: global leadership into malnutrition, HR: hazard ratio, MS: metabolic syndrome, MUST: malabsorption universal screening tool, NEC: neuroendocrine carcinoma, NENs: Neuroendocrine neoplasms, NETs: Neuroendocrine tumors, NRS: Nutritional Risk Screening, OR: odd ratio, OS: overall survival, PFS: progression-free survival, RR: risk ratio, SGA: Subjective Global Assessment, T2DM: type 2 diabetes mellitus, VAI: visceral adiposity index, WD: well-differentiated.

Inflammatory bowel disease (IBD) patients with sarcopenia are at increased morbidity risk. The aim of this study was to assess the prevalence of sarcopenia in IBD outpatients using both morphological and functional criteria.

In this prospective cohort study, all IBD patients admitted to the day hospital unit between March 01 and 31, 2023 were included. Muscle mass and function were evaluated using bioelectrical impedance analysis and handgrip strength measurement, respectively. Probable sarcopenia was defined as reduced handgrip strength (<16-27 kg). Myopenia was defined by a low appendicular muscle mass index (<5.5-7 kg/m²). Sarcopenia was diagnosed based on the coexistence of reduced muscle strength and muscle mass. Disease activity, therapeutic changes, hospitalizations, and IBD-related surgeries were assessed at month 6.

Sixty patients with either Crohn's disease (CD, 52 %) or ulcerative colitis (48 %), with a median age of 37 years (interquartile range [IQR]: 28-54), were included. Fifty-five percent were women. Most patients were in remission (67 %, n = 40). In CD patients, the involvement was ileocolic (48 %), ileal (35 %), or colonic (16 %). A history of IBD-related digestive surgery was noted in 30 % of cases. The median body mass index [BMI] was 24 (IQR: 21-27). The prevalence of sarcopenia, probable sarcopenia, and myopenia was 10 %, 18 %, and 20 %, respectively. Sarcopenic patients were significantly older (59 vs 36 years, p = 0.01), had a longer disease duration (20 vs 8 years, p = 0.003), were more likely to have associated joint inflammation (27 % vs 6 %, p = 0.01) and CD (80 % vs 49 %, p = 0.36). Myopenia was significantly associated with a history of surgery (67 % vs 21 %, p = 0.004) and a lower BMI (21 vs 24, p = 0.001).

In this prospective cohort of IBD outpatients, 10 % and 20 % of patients had sarcopenia and myopenia, respectively. Screening for sarcopenia therefore seems essential in this population, including in stable outpatients in remission who do not meet malnutrition criteria and in overweight patients, as according to the literature, sarcopenia is associated with poorer clinical outcomes and increased postoperative complications. Interventional studies are needed to assess the impact of multidisciplinary treatment of sarcopenia on quality of life and disease progression.

Diet, physical function and gut health are important modifiable factors in ageing. However, it is unclear how ageing affects various domains of gut function. Aims of this cross-sectional study were to explore relationships between nutrient intake, physical function, and biomarkers of gut function in older individuals. Healthy participants (n = 94, mean age 71.1 years SD 5.10, 56% female) were recruited to investigate the relationship between nutrient intake (protein, fibre, carbohydrate, fat), physical function (chair rise time, handgrip strength) and lipopolysaccharide (LPS) binding protein (LBP); a marker of gut permeability. Linear regression models, adjusted for age, fat mass/fat free mass ratio, weight and gender, reported LBP changed by; -161.9 ng/mL (95% CI -323.0, -0.8) for every 1 g increase in daily fibre/1,000 kilocalories; 80.5 ng/mL (6.7, 154.2) for 1% increase in daily energy intake as fat; and -88.1 ng/mL (-146.7, -29.6) for 1% increase in daily energy as carbohydrates. When further adjusted for C-reactive protein (CRP), a marker of inflammation, LBP decreased by an additional 6.9 ng/mL for fibre, increased by an additional 4.0 ng/mL for fat and decreased by an additional 3.7 ng/mL for carbohydrate. These findings suggest that in healthy older adults' nutrient intake is associated with LBP, and CRP appears to slightly modify these associations. There were no associations between LBP and handgrip strength or chair rise time. Results suggest that fibre, fat, and carbohydrates are important for maintaining gut function, potentially mediated by inflammation in older adults, although further research is needed to explore the implications for physical function and CRP as a mediator.

Heart failure (HF) is frequently associated with malnutrition or malnutrition risk. The delivery of medically tailored meals (MTM) to the homes of patients with HF and malnutrition risk or malnutrition after hospital discharge holds promise for improving outcomes. However, the number of MTM needed to provide benefit is not established.

A random order crossover study was designed to compare the delivery of 7 versus 21 MTM for four weeks each to patients discharged from the hospital with HF and malnutrition risk. Telephone surveys were conducted at baseline, 30, and 60 days post-discharge to evaluate change in malnutrition risk, American Heart Association (AHA) diet goals, sarcopenia risk, and 30-day readmissions.

Forty-six patients were enrolled. Patients had reduced odds of having malnutrition risk relative to the baseline score at one and two months (OR 0.18, 95% CI 0.04-0.74 and OR 0.21, 95% CI 0.05-0.99, respectively). The AHA diet score improved over time from baseline by 0.73 ± 0.22 units at one month (p = 0.0014), and by 0.48 ± 0.23 units at two months (p = 0.0430), regardless of the number of MTM provided. Sarcopenia risk improved over time (p = 0.01), decreasing by 0.43 ± 0.2 units by one (p = 0.03) and 0.59 ± 0.21 units by two months (p = 0.007) regardless of the number of MTM provided. Readmissions by 30 days were not significantly different based on the number of MTM provided (9% for 21 MTM vs 12.5% for 7 MTM), but well below national data at 23%.

The provision of at least seven MTM per week in the early window after hospital discharge to patients with HF and malnutrition or malnutrition risk is a promising strategy to improve malnutrition and sarcopenia risk and diet adherence, while keeping readmissions below national averages.

Clinicaltrials.gov NCT06142903, registered 11/23/2023.

Malabsorption is a complex and multifaceted condition characterised by the defective passage of nutrients into the blood and lymphatic streams. Several congenital or acquired disorders may cause either selective or global malabsorption in both children and adults, such as cystic fibrosis, exocrine pancreatic insufficiency (EPI), coeliac disease (CD) and other enteropathies, lactase deficiency, small intestinal bacterial overgrowth (SIBO), autoimmune atrophic gastritis, Crohn's disease, and gastric or small bowel resections. Early recognition of malabsorption is key for tailoring a proper diagnostic work-up for identifying the cause of malabsorption. Patient's medical and pharmacological history are essential for identifying risk factors. Several examinations like endoscopy with small intestinal biopsies, non-invasive functional tests, and radiologic imaging are useful in diagnosing malabsorption. Due to its high prevalence, CD should always be looked for in case of malabsorption with no other obvious explanations and in high-risk individuals. Nutritional support is key in management of patients with malabsorption; different options are available, including oral supplements, enteral or parenteral nutrition. In patients with short bowel syndrome, teduglutide proved effective in reducing the need for parenteral nutrition, thus improving the quality of life of these patients. Primary care physicians have a central role in early detection of malabsorption and should be involved into multidisciplinary teams for improving the overall management of these patients. In this European consensus, involving 10 scientific societies and several experts, we have dissected all the issues around malabsorption, including the definitions and diagnostic testing (Part 1), high-risk categories and special populations, nutritional assessment and management, and primary care perspective (Part 2).

Dehydration and malnutrition are common conditions in older adults. Although both are regulated by different pathways, they seem to share common risk factors, such as dysphagia and dementia. Only scarce data on their co-occurrence are published. An exploratory analysis of a multicenter prospective trial on the determinants of malnutrition to evaluate the potential association between malnutrition and dehydration in older hospitalized patients was performed.

Patients underwent a comprehensive geriatric assessment, their nutritional status was evaluated using the Global Leadership Initiative on Malnutrition (GLIM) criteria, and routine laboratory tests were performed, including calculated serum osmolality.

A total of 454 patients were included in the analysis. Of those, 45% were classified as malnourished based on MNA-SF, and 42% according to GLIM criteria. Dehydration as determined by calculated serum osmolality was present in 32%. Multivariate binomial regression analysis revealed elevated serum creatinine (p < 0.001) and higher body mass index (BMI) (p = 0.020) as predictive factors for dehydration. Overlap between dehydration and malnutrition was present in 13% of patients; malnourished patients had no higher risk for dehydration and vice versa (p = 0.903).

Malnutrition and dehydration are common in hospitalized older adults but do not frequently occur together. We identified that BMI and creatinine levels are significant predictors of dehydration risk among this population. Consequently, the implementation of separate screening assessments for malnutrition and dehydration is recommended to better identify and address these conditions individually.

Home parenteral support (PS) is the standard treatment of chronic intestinal failure (CIF) with short bowel syndrome (SBS) as the leading cause. However, outcomes of PS in older patients remain poorly studied.

This retrospective observational study evaluated patients with newly diagnosed SBS-CIF initiating PS between 2015 and 2020 at a national French CIF referral center. Patients were stratified into 2 groups: 65 y or older (older group) and younger than 65 y (younger group). Multivariate Cox regression identified predictors of mortality and PS dependence in older patients.

We included 175 patients [median age: 61 y (IQR: 46-70 y); 58% female]. Mesenteric ischemia was the primary cause of CIF (32%). Surgical anatomy included jejunostomy (47%), jejunocolic (39%), and ileocolic anastomosis (14%). Older patients [n = 73 (42%); median age: 72 y; IQR: 68-76 y] had higher rates of arterial hypertension, dyslipidemia, cancer, and SBS-CIF caused by radiation enteritis, but fewer cases attributed to Crohn disease. After a median follow-up of 27 mo (95% confidence interval [CI]: 22, 32 mo), the probability of survival was 92% (95% CI: 88%, 97%), and the probability of PS dependence was 68% (95% CI: 60%, 785), with no significant difference between age groups. In older patients, the presence of a jejunostomy (hazard ratios [HR]: 3.4; 95% CI: 1.1, 10.6) was an independent predictor of PS dependence, and BMI of <22 kg/m2 (HR: 10.9; 95% CI: 1.4, 87.4) was an independent predictor of mortality. Fourteen patients (8%) were treated with teduglutide, with no significant difference between age groups.

Nearly half of patients with SBS-CIF on PS are aged 65 y or older, with PS dependence and survival rates comparable with those of younger patients. These findings suggest that age should not be a barrier to PS initiation.

Malnutrition is strongly related to mortality in intensive care unit (ICU) patients. The Patient- and Nutrition-Derived Outcome Risk Assessment Score (PANDORA) is a novel mortality prediction tool encompassing nutritional assessment. Since there is limited evidence regarding the power of PANDORA in predicting mortality in critically ill patients, we aimed to evaluate the benefit of adding PANDORA to the Global Leadership Initiative on Malnutrition (GLIM) for mortality prediction in the ICU setting by comparing it with the other valid mortality predictors.

A total of 251 ICU patients were enrolled in the study. Malnutrition evaluation tools (i.e., GLIM criteria, The nutritional risk screening 2002, The modified Nutrition Risk in Critically Ill score), and mortality/disease severity tools (PANDORA, The Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment) were performed. Scores ≥43 were defined as high PANDORA score.

The median age (IQR) of participants was 67 (52-78) years, and 47.0% (n = 118) were female. Patients were evaluated according to 30th, 60th, 90th, and 180th-day mortalities. In all groups, patients were older, had a lower body mass index and longer hospitalization time, and were more likely to have malnutrition and higher PANDORA, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores. In the Cox regression analyses, even if adjusted for various confounders, malnutrition according to GLIM criteria and a high PANDORA score had the highest hazard ratio (HR) for mortality (HR: 3.62; 95% confidence interval [CI]: 1.49-8.77; P = 0.004, HR: 3.71; 95% CI: 1.69-8.12; P = 0.001, HR: 3.46; 95% CI: 1.69-7.06; P = 0.001 and HR: 4.00; 95% CI: 1.98-8.09; P = 0.004 for 30th, 60th, 90th, and 180th days, respectively).

PANDORA is a valid tool for predicting mortality in ICU patients. Furthermore, to our knowledge this is the first study to reveal that integrating GLIM criteria into PANDORA may enhance its power in this setting.

The Global Leadership Initiative on Malnutrition (GLIM) suggested a two-step framework for the assessment of malnutrition based on screening and diagnosis. Malnutrition, as defined by the GLIM criteria, and the risk of malnutrition determined through nutritional screening are associated with adverse outcomes in patients with heart failure (HF). This study investigated the prognostic impact of malnutrition, as defined by the GLIM criteria, compared with the risk of malnutrition determined by the Mini Nutritional Assessment-Short Form (MNA-SF) screening tool among patients hospitalized for acute HF. A total of 446 patients with acute HF who underwent nutritional screening using the MNA-SF and were diagnosed with malnutrition based on the GLIM criteria were include in this study. The primary outcome was the incidence of all-cause death or HF-related readmission after discharge. Patients diagnosed with malnutrition based on both indices had a higher incidence of adverse events within one year post-discharge than patients diagnosed without malnutrition. However, a landmark analysis of years one to three post-discharge found that the incidence of the primary outcome was comparable between patients diagnosed with malnutrition and those that here not. Furthermore, although malnutrition as defined by the GLIM criteria was found to be an independent predictor of the 1 year incidence of all-cause death or rehospitalization for HF even after adjusting for other prognostic indicators (hazard ratio, 1.593; 95% confidence interval, 1.056-2.403; P = 0.026), the risk of malnutrition based on the MNA-SF was not. In conclusion, a diagnosis of malnutrition based on the GLIM criteria provides better prognostic stratification in the first year post-discharge in patients with acute HF as compared with nutritional screening based only on the MNA-SF.