Clinical nutrition ESPEN最新文献

{"title":"Fibre manipulation to manage symptom severity and quality of life in patients with functional bowel disorders: A systematic review","authors":"Rojina Raked ,&nbsp;Mary Ibrahim ,&nbsp;Jennifer Utter ,&nbsp;Shannon Morley ,&nbsp;Kate Mueller","doi":"10.1016/j.clnesp.2025.102896","DOIUrl":"10.1016/j.clnesp.2025.102896","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Functional Bowel Disorders (FBD) are clinically diagnosable conditions impacting the mid to lower gastrointestinal tract. Fibre manipulation (through amount or type) is commonly employed as a first-line treatment for symptom management. This systematic review will investigate the impact of fibre manipulation on symptom management and quality of life in adults diagnosed with FBD.</div></div><div><h3>Methods</h3><div>Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Central) were systematically searched from January 2013 to December 2024. Studies were included if they reported Randomised Controlled Trials (RCTs) examining the impact of fibre manipulation in adults (≥18 years) with FBD. The primary outcome was symptom management, and secondary outcome was Quality of Life (QoL). Study quality was assessed using the Cochrane risk of bias tool 2. Data were narratively synthesised.</div></div><div><h3>Results</h3><div>Searches identified 8864 records; 5167 were screened against the eligibility criteria, and 44 records were assessed at full-text review. Ten studies reporting eight parallel and two crossover RCTs evaluating differing fibre supplements and doses for people with various types of FBD were included. Intervention length ranged from one to eight weeks, and the number of participants ranged from 11 to 250. The reported results varied. Seven studies reported significant improvements in symptom severity, and one study reported significant worsening of symptoms when compared to controls. The results indicated that fibre supplementation with agave fructans improved constipation but worsened flatulence, acacia fibre improved stool frequency, psyllium improved stool consistency, nopal fibre improved symptom severity, vege-powder improved stool hardness and amount, incomplete evacuation, straining and evacuation frequency, pectin powder improved abdominal pain, bloating, stool consistency and symptom severity, and a combination of sugarcane bagasse and resistant starch improved flatulence. One study reported significant worsening in QoL in the intervention group when compared to the placebo control group.</div></div><div><h3>Conclusions</h3><div>This review concluded that fibre supplementation may be an effective treatment to improve symptom management for patients with FBD, though high heterogeneity precluded meta-analysis. Two studies were assessed as low risk of bias, seven had some concerns, and one was assessed as high risk of bias. The included studies reported short-term interventions for small groups of participants. Further research with greater numbers of participants with FBD that evaluate interventions for longer time periods are warranted.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102896"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes and sarcopenia in chronic kidney disease: Moving beyond a \"one-size-fits-all\" approach.","authors":"Marvery P Duarte, Pedro Martins, Diogo V Leal, Otávio T Nóbrega, Heitor S Ribeiro, João L Viana","doi":"10.1016/j.clnesp.2026.102941","DOIUrl":"10.1016/j.clnesp.2026.102941","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":"102941"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146043865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Obesity and risk of post-operative pneumonia among older adult patients with hip fracture: An obesity paradox\" [Clin Nutr ESPEN 68 (2025) 342-347].","authors":"Masao Narita, Ryutaro Matsugaki, Keiji Muramatsu, Kiyohide Fushimi, Shinya Matsuda","doi":"10.1016/j.clnesp.2025.102904","DOIUrl":"10.1016/j.clnesp.2025.102904","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":"102904"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145942801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malnutrition risk in hospitalized patients with diabetes mellitus: Prevalence and associated factors as assessed by Nutritional Risk Screening 2002 (NRS-2002)","authors":"Yanjun Chang ,&nbsp;Wenxing Wang ,&nbsp;Fengni Jin ,&nbsp;Jianhua Li ,&nbsp;Xi Wang ,&nbsp;Jiazhen Zhang ,&nbsp;Yarong Xie","doi":"10.1016/j.clnesp.2026.102910","DOIUrl":"10.1016/j.clnesp.2026.102910","url":null,"abstract":"<div><h3>Background and aims</h3><div>Malnutrition is a common issue among hospitalized diabetic patients, often leading to poor outcomes. The Nutritional Risk Screening 2002 (NRS-2002) is a widely used tool for assessing nutritional risk, but its relevance to diabetic patients and correlation with clinical parameters are unclear. This study aims to assess the prevalence of nutritional risk in hospitalized diabetic patients using NRS-2002, explore its relationship with key clinical indicators, and identify independent factors influencing nutritional risk for better management strategies.</div></div><div><h3>Methods</h3><div>This single-center retrospective study included 329 diabetic inpatients from the Department of Endocrinology at Yuncheng Central Hospital, affiliated with Shanxi Medical University, between December 2022 and June 2025. Data from the Electronic Medical Record (EMR) and Laboratory Information System (LIS) covered demographics, clinical features, anthropometrics, laboratory parameters (nutritional markers, lipids, pancreatic enzymes, inflammatory and metabolic indicators), and comorbidities. Nutritional risk at admission was assessed using NRS-2002 (score ≥3). Associations with clinical indicators were analyzed using Spearman correlation and logistic regression to identify independent predictors.</div></div><div><h3>Results</h3><div>Of the 329 patients, 91 (27.7 %) were at nutritional risk. This group had longer hospital stays, a higher proportion of patients with diabetes duration &lt;5 years, lower BMI, prealbumin, and albumin levels, and higher CRP and HbA1c levels. They also had increased infection and ketosis rates. NRS-2002 scores were positively correlated with ketosis (ρ = 0.468), HbA1c (ρ = 0.386), and infection (ρ = 0.236), and negatively correlated with prealbumin (ρ = −0.404), bicarbonate (ρ = −0.240), and BMI (ρ = −0.205). Multivariate logistic regression identified ketosis (OR = 3.714), HbA1c (OR = 1.265), prealbumin (OR = 0.990), and bicarbonate (OR = 0.896) as independent predictors of nutritional risk. The predictive model showed good performance with an AUC of 0.832.</div></div><div><h3>Conclusion</h3><div>The NRS-2002 tool effectively assesses nutritional risk in hospitalized diabetic patients, with significant correlations to metabolic issues, inflammation, and complications. Low prealbumin, low bicarbonate, high HbA1c, and ketosis were independent predictors of nutritional risk.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102910"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Dietary quality in mid-pregnancy and pubertal timing in offspring: A population-based cohort study\".","authors":"S Dhanya Dedeepya, Vaishali Goel, Nivedita Nikhil Desai","doi":"10.1016/j.clnesp.2025.102880","DOIUrl":"10.1016/j.clnesp.2025.102880","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":" ","pages":"102880"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A two-sample Mendelian Randomization study on the causal relationship between obesity and breast cancer.","authors":"Xinyi Chen, Xu Yan, Yingxuan Fu, Huaiyuan Zheng, Zhonggang Wu, Hanjun Ma, An Yan, Shibo Zhao","doi":"10.1016/j.clnesp.2026.102925","DOIUrl":"https://doi.org/10.1016/j.clnesp.2026.102925","url":null,"abstract":"<p><strong>Background: </strong>The relationship between obesity and breast cancer risk remains complex and inconsistently observed in epidemiological studies due to potential confounding and reverse causation. Comprehensive Mendelian randomization analyses of multiple anthropometric traits, particularly central adiposity measures, and their stratified effects by estrogen receptor (ER) subtype are still lacking.</p><p><strong>Methods: </strong>We conducted a two-sample MR study to assess the causal relationship between nine obesity-related traits (e.g., Body Mass Index (BMI), Waist circumference (WC), basal metabolic rate) and breast cancer risk, overall and by ER subtype. Genetic instruments were selected from large-scale GWAS summary data of European ancestry. FinnGen R12 served as the discovery cohort and IEU OpenGWAS as replication. We applied Inverse Variance Weighted (IVW) as the primary method, supplemented by five other MR approaches and extensive sensitivity analyses for heterogeneity, pleiotropy, and colocalization.</p><p><strong>Results: </strong>Genetically predicted higher BMI and WC were significantly associated with reduced risk of overall breast cancer in the discovery cohort (BMI: OR = 0.89, 95 % CI: 0.83-0.95; WC: OR = 0.84, 95 % CI: 0.77-0.93). These inverse associations were particularly consistent and robust for ER + breast cancer across both discovery and replication datasets. No significant associations were found for the other seven anthropometric traits. Colocalanalysis suggested shared genetic variants for some associations. Sensitivity analyses confirmed the robustness of the findings against pleiotropy and heterogeneity.</p><p><strong>Conclusion: </strong>This study provides robust genetic evidence that higher BMI and WC are inversely associated with breast cancer risk, especially ER + disease. These findings highlight the importance of considering adiposity type and tumor subtype in understanding breast cancer etiology and suggest distinct underlying mechanisms warranting further investigation. Importantly, these results do not support recommending weight gain for cancer prevention; rather, they underscore the need for balanced health strategies that consider multiple risk factors.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"102925"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of transcranial direct current stimulation and nutritional counseling therapy on attentional bias to food cues: A randomized clinical trial","authors":"Jessica Lorenzzi Elkfury ,&nbsp;Luciana C. Antunes ,&nbsp;Gibson Weydmann ,&nbsp;Lizia Nardi Menegassi ,&nbsp;Liciane Fernandes Medeiros ,&nbsp;Tiago Madeira Cardinal ,&nbsp;Betina Franceschini Tocchetto ,&nbsp;Iraci L.S. Torres ,&nbsp;Felipe Fregni ,&nbsp;Lisiane Bizarro ,&nbsp;Wolnei Caumo","doi":"10.1016/j.clnesp.2025.102886","DOIUrl":"10.1016/j.clnesp.2025.102886","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>This study investigated the effects of transcranial direct current stimulation (tDCS) and nutritional counseling therapy (NCT) on attentional bias (AB) in binge eating disorder.</div></div><div><h3>Methods</h3><div>This study was designed as a pilot randomized, factorial, blind, parallel-controlled clinical trial. Forty women were allocated to one of four groups: active tDCS (a-tDCS), a-tDCS + NCT, s-tDCS (sham tDCS) + NCT, NCT. The 28 home-based tDCS sessions were applied to the DLPFC (anode/right and cathode/left). The outcome was the delta values (pre- and post-treatment AB scores). Each AB score was calculated based on the stimulus onset asynchrony (SOA) at which stimuli were presented (100, 500, and 2000 ms).</div></div><div><h3>Results</h3><div>Mixed analyses of variance revealed a significant interaction between treatment and SOA (p = 0.035). The a-tDCS with NCT group showed a decrease in AB at an SOA of 500 ms. This decrease significantly differed from the increase observed in the s-tDCS with NCT group for the same SOA (p = 0.027). The a-tDCS with NCT group showed an increase in AB at an SOA of 2000 ms, which differed significantly from the decrease observed at the same SOA in the a-tDCS group (p = 0.032).</div></div><div><h3>Conclusions</h3><div>The combined therapy (a-tDCS with NCT) decreased AB at the pre-conscious orientation of attention and increased it when conscious orientation was possible.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov: NCT 04226794. Registered on July 2, 2019.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102886"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145849100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpretable machine learning model for predicting refeeding syndrome after colorectal cancer surgery","authors":"Xing Jin ,&nbsp;Chanjie Cui ,&nbsp;Fangling Xu ,&nbsp;Zhi Lin ,&nbsp;Jinxin Wang","doi":"10.1016/j.clnesp.2026.102946","DOIUrl":"10.1016/j.clnesp.2026.102946","url":null,"abstract":"<div><h3>Objective</h3><div>Refeeding syndrome (RFS) is a common yet frequently overlooked complication during postoperative nutritional support in patients undergoing colorectal cancer surgery. This study aimed to develop an explainable machine learning model for early risk prediction of RFS and to evaluate its predictive performance and clinical utility.</div></div><div><h3>Methods</h3><div>A total of 446 hospitalized patients who underwent curative colorectal cancer surgery were retrospectively included and randomly divided into a training set (<em>n</em> = 312) and a validation set (<em>n</em> = 134) in a 7:3 ratio. Based on clinical variables including preoperative nutritional status, electrolyte levels, and postoperative recovery indicators, four predictive models were constructed: logistic regression, random forest (RF), support vector machine (SVM), and extreme gradient boosting (XGBoost). Their predictive performance in the validation set was compared using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). The XGBoost model was further interpreted using SHapley Additive Explanations (SHAP) for both global and individual-level explanations.</div></div><div><h3>Results</h3><div>In both the training and validation sets, the RFS group had significantly higher proportions of preoperative weight loss and comorbid diabetes than the non-RFS group (both <em>P</em> &lt; 0.05). They also exhibited significantly lower preoperative serum phosphate and albumin levels, and longer postoperative recovery times for bowel sounds and first flatus (all <em>P</em> &lt; 0.05). Among the models, XGBoost demonstrated the best performance in the validation set with an AUC of 0.872 (95 % CI: 0.805–0.925) and the lowest Brier score (0.113), offering the greatest net clinical benefit within the risk threshold range of 0.15–0.60. SHAP global interpretation revealed that preoperative serum phosphate, time to bowel sound recovery, preoperative albumin level, and time to first flatus were the most influential features. Low preoperative phosphate, prolonged bowel sound recovery, and low albumin levels substantially increased RFS risk. At the individual level, SHAP force plots visualized the personalized contribution paths of each feature, aiding in the identification of high-risk patients.</div></div><div><h3>Conclusion</h3><div>The XGBoost model combined with SHAP interpretation enables accurate and interpretable prediction of postoperative RFS risk. This approach may support individualized nutritional management strategies in patients following colorectal cancer surgery.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102946"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between phase angle and one-year heart failure rehospitalization and all-cause mortality in patients with heart failure","authors":"Masaya Hori ,&nbsp;Koya Takino ,&nbsp;Takuji Adachi ,&nbsp;Yoji Kuze ,&nbsp;Takashi Nagai ,&nbsp;Nao Ichiba ,&nbsp;Kenya Usui ,&nbsp;Tsuyoshi Tanabe ,&nbsp;Misuzu Ide ,&nbsp;Masayasu Nakagawa ,&nbsp;Hitoshi Matsuo","doi":"10.1016/j.clnesp.2026.102928","DOIUrl":"10.1016/j.clnesp.2026.102928","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Phase angle (PhA) reflects cellular health and nutritional status. Although PhA has been linked to mortality in various populations, its prognostic value for heart failure (HF), especially rehospitalization, remains unclear. This study investigated the association between PhA and the composite outcome of HF rehospitalization and all-cause mortality after discharge in patients hospitalized for acute HF.</div></div><div><h3>Methods</h3><div>Patients hospitalized with HF who underwent rehabilitation during hospitalization. The primary outcome was a composite of HF rehospitalization and all-cause mortality within one year. Associations were evaluated with multivariate Cox proportional hazards models. Receiver operating characteristic analysis determined the optimal PhA cut-off. The cumulative incidence of the composite outcome and all-cause mortality were estimated using Kaplan–Meier analysis with log-rank tests. For HF rehospitalization, the cumulative incidence was calculated using Gray's test, with death as a competing risk.</div></div><div><h3>Results</h3><div>The one-year incidence of the composite outcome was 23.3 % (n = 97) among the 417 patients. In multivariate models, PhA independently predicted the composite outcome (hazard ratio: 0.74; 95 % confidence interval: 0.55–0.99, <em>p</em> = 0.048). The optimal PhA cut-off was 3.8. Patients with PhA &lt;3.8 had significantly higher rates of HF rehospitalization (<em>p</em> = 0.033), composite outcomes (<em>p</em> = 0.001), and all-cause mortality (<em>p</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>In patients with HF, PhA assessed during hospitalization was significantly associated with HF rehospitalization and all-cause mortality within one year. These findings support PhA as a useful biomarker for prognostic assessment in clinical practice.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102928"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between body water compartments and muscle mechanical properties: A correlational study using bioimpedance and myotonometry","authors":"Martyna Sochor,&nbsp;Marcelina Mrowiec,&nbsp;Dawid Bączkowicz","doi":"10.1016/j.clnesp.2026.102927","DOIUrl":"10.1016/j.clnesp.2026.102927","url":null,"abstract":"<div><h3>Background and aims</h3><div>Water plays a vital role in muscle function, and its distribution between intracellular (ICW) and extracellular (ECW) compartments serves as a key indicator of muscle quality. Bioelectrical impedance analysis (BIA) quantifies body water (BW), while myotonometry measures muscle mechanical properties; however, the relationship between these measures remains underexplored. This study aimed to assess the association between BW compartments and the resting mechanical properties of lower limb muscles.</div></div><div><h3>Methods</h3><div>A total of 158 healthy adults (97 men, 61 women; mean age 20.8 years) participated. BW compartments, including total body water (TBW), ICW, and ECW, were measured using a multi-frequency body composition analyser (TANITA MC-780 MA). A MyotonPRO® device assessed the mechanical properties (e.g. tone, stiffness) in the tibialis anterior, peroneus longus, and gastrocnemius muscles. Spearman's rank correlation and multiple linear regression models were used to analyse the relationships between BIA and myotonometry.</div></div><div><h3>Results</h3><div>The analysis revealed a consistent bipolar pattern of associations. Absolute hydration volumes (TBW, ICW, ECW expressed in kilograms) were positively correlated with muscle tone and stiffness, with correlations ranging from weak to high (r ≈ 0.30–0.70, p &lt; 0.001). ICW was the strongest determinant. In contrast, relative ECW (expressed as a percentage) showed moderate negative correlations with tone and stiffness. This pattern was consistent across all muscles and between limbs.</div></div><div><h3>Conclusions</h3><div>In healthy young adults, the resting mechanical properties of lower limb muscles are significantly associated not only with TBW but, more importantly, with its compartmental distribution. Higher ICW corresponds to greater muscle tone and stiffness, whereas a high ECW proportion is linked to lower values.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102927"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}