Clinical nutrition ESPEN最新文献

Background & aims: Prognostic assessment in gastric cancer relies primarily on TNM staging, yet outcomes vary substantially among patients within the same stage. Computed tomography (CT)-derived body composition parameters, particularly adipose and muscle radiodensity, have emerged as independent prognostic factors. We aimed to evaluate a novel variable integrating visceral adipose tissue (VAT) and skeletal muscle (SM) radiodensity as a prognostic marker in gastric cancer.

Methods: In this retrospective study, 461 patients with gastric adenocarcinoma diagnosed between 2009 and 2018 at the University of Campinas Hospital (Brazil) were included. CT images at the L3 level were segmented to quantify VAT, subcutaneous adipose tissue, and SM. Median radiodensity values (Hounsfield units, HU) were extracted. Combinations of CT-derived variables were tested for prognostic value, and the difference between VAT and SM median radiodensity (VMD) was selected. Patients were stratified into tertiles, and survival analyses were performed using Kaplan-Meier and Cox regression models adjusted for clinicopathological covariates.

Results: Higher VMD values were strongly associated with poorer overall survival (OS) and disease-free survival (DFS). Median OS was 13.8 months in the highest tertile versus 58.5 months in the lowest tertile (p < 0.001). In multivariable analysis, VMD remained independently associated with mortality (HR 1.60, 95% CI 1.14 - 2.24, p < 0.05). Associations were particularly pronounced among women.

Conclusions: VMD represents a simple and reproducible CT-derived biomarker that complements TNM staging and enhances prognostic precision in gastric cancer. Its clinical feasibility supports future multicenter validation and potential integration into routine risk assessment.

Background & aims: The serum creatinine-to-cystatin C ratio (Cre/CysC) has been proposed as a surrogate marker of sarcopenia and a predictor of mortality in patients with predialysis chronic kidney disease. However, its prognostic value in patients undergoing dialysis remains controversial. This study examined the association between Cre/CysC at dialysis initiation and subsequent mortality.

Methods: We conducted a single-center retrospective cohort study, enrolling patients who initiated dialysis between January 2013 and December 2019. Patients were categorized into cohort-specific tertiles based on Cre/CysC (cut-off values, 1.66 and 2.03). The primary outcome was five-year all-cause mortality, and patients were followed for up to 5 years. Multivariate Cox regression and the restricted cubic-spline analysis were performed after adjusting for age, sex, body mass index, malignancy, diabetes, history of cardiovascular disease, and activities of daily living (events-per-variable: 7).

Results: Among the 439 patients who initiated dialysis, 245 were included after excluding those who discontinued dialysis or were lost to follow-up within 90 days, those without cystatin C measurements, and those with incomplete data. Median age was 73 (interquartile range, 65-80), and 74.7% were male. During a median follow-up of 1,826 days (interquartile range, 682-1,826), 63 patients died. Both low and high tertiles of Cre/CysC were significantly associated with higher mortality than the middle tertile (hazard ratio 3.04 [1.51-6.11] and 2.90 [1.34-6.29]). A U-shaped association between Cre/CysC and mortality was observed in the spline analysis.

Conclusion: Low and high levels of Cre/CysC at dialysis initiation were independently associated with increased mortality rates.

Background & aims: Traumatic spinal cord injury (SCI) induces rapid and adverse changes in body composition, yet effective strategies to prevent excess fat accumulation are limited. This study aimed to evaluate the effect of an individualized dietitian-led nutrition intervention on change in fat mass and related markers of adiposity during the first year following SCI.

Methods: In this single-center, open-label randomized controlled trial, adults with subacute traumatic SCI were randomized to an individualized dietitian-led intervention or usual care. The primary outcome was change in total fat mass (FM) over one year, assessed by multifrequency bioimpedance analysis. Secondary outcomes included fat mass index (FMI), visceral adipose tissue (VAT), waist circumference, fat-free mass (FFM), fat-free mass index (FFMI), body weight, body mass index (BMI) and biomarkers (fasting glucose, 2-hour oral glucose tolerance test, HbA1c, LDL, HDL and triglycerides). Intention-to-treat analyses used mixed-effects models adjusted for age, sex, and neurological severity.

Results: Sixty-two participants were randomized (32 intervention, 30 control). Participants were predominantly male (76%) with a mean age of 48 (SD 17) years. At 1 year, the adjusted between-group difference in FM change was -1.5 kg (95% CI -4.8 to 1.9; p = 0.39). Significant between-group differences were observed for VAT (-0.5 L; 95% CI -1.0 to -0.1; p = 0.02) and waist circumference (-4.0 cm; 95% CI -7.0 to -1.0; p = 0.01), with borderline significance for FMI (-1.6 kg/m²; 95% CI -3.2 to 0.0; p = 0.05). No significant between-group differences were observed for body weight, BMI, fat-free mass, or biomarkers. Sensitivity and per-protocol analyses yielded consistent results.

Conclusions: Although the intervention did not significantly affect the primary endpoint of total fat mass, between-group differences were observed for VAT and waist circumference. These findings suggest that structured, individualized dietetic care initiated during SCI rehabilitation and continued post-discharge may attenuate accumulation of abdominal adiposity. Longer-term follow-up is needed to determine whether early attenuation of abdominal adiposity translates into reduced cardiometabolic risk and improved functional outcomes.

Clinicaltrials: gov IdentifierNCT04109586.

Background: Skeletal muscle mass and radiation attenuation (RA) have been shown to be associated with chemotoxicity and survival in cancer patients. However, little is known about the clinical significance of adipose tissue RA, which has been hypothesized to be associated with tissue inflammation and insulin resistance. We investigated the association between adipose tissue RA, chemotoxicity, and survival in patients with metastatic colorectal cancer (mCRC) by performing a secondary analysis using data from a randomized controlled trial.

Methods: We included 104 mCRC patients treated with standard first-line chemotherapy. Using diagnostic abdominal computed tomography (CT) scans, we assessed height adjusted (cm²) area and RA of skeletal muscle (SM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) at the third lumbar vertebra, and calculated SM index (SMI), VATI, and SATI as cm²/m² based on stature. Associations between these body composition parameters and overall survival as well as chemotoxicity (NCI-CTCAE v 4.03) were evaluated using univariable and multivariable logistic and Cox regression analysis. Multivariable models evaluated body composition parameters, adjusted for age, sex, and significant clinically relevant covariates.

Results: Among the 104 patients in the cohort, 38 were female (36.5%). Mean age was 65.5±9.5 years. 43 patients (41.3%) developed grade 3/4 toxicity. Pre-treatment SAT-RA was independently associated with grade 3/4 toxicities (OR=0.78, 95% CI 0.62-0.98). Chemotherapy regimens and nutritional support were not associated with chemotoxicity. In the multivariable Cox analysis, SAT-RA (HR=1.24, 95% CI 1.08-1.43) and SM-RA (HR=0.74, 95% CI 0.61-0.90) were associated with shorter overall survival.

Conclusion: Higher SAT-RA and lower SM-RA at baseline were associated with shorter overall survival of patients with mCRC, and lower SAT-RA was associated with increased chemotoxicity. These body composition alterations should be investigated in future chemotherapy related studies.

Background&aims: Oral frailty has been conceptualized as an intermediate state of oral functional decline, and assessment with the Oral Frailty 5-item Checklist (OF-5) has been recommended, whereas evidence in heart failure (HF) populations remains unclear. We investigated the frequency of OF-5 defined oral frailty and its associations with swallowing-related muscle function and 1-year all-cause mortality in older patients with HF.

Methods: This single-center retrospective study included consecutive patients aged 65 years or older who were hospitalized for HF. Patients were first classified as having limited oral intake status if the Food Intake LEVEL Scale was 7 or lower. Among those without limited oral intake status, oral frailty was defined as two or more OF-5 items, and the remaining patients were classified as robust. Outcomes were swallowing-related muscle function (maximal tongue pressure, geniohyoid muscle area, and geniohyoid muscle echogenicity) at discharge and 1-year all-cause mortality.

Results: Of 319 screened patients, 269 were analyzed; 90 patients were robust (33.5%), 108 were oral frailty (40.1%), and 71 had limited oral intake status (26.4%). The median age was 83 (75-87) years, and 47.2% were women. In analysis of covariance, swallowing-related muscle function showed graded declines across robust, oral frailty, and limited oral intake status (P<0.001 for all). In adjusted Cox regression, with robust as the reference, oral frailty and limited oral intake status were associated with higher mortality (oral frailty: hazard ratio [HR] 3.11, 95% confidence interval [CI] 1.08-8.95, P=0.032; limited oral intake status: HR 8.22, 95% CI 2.89-23.34, P<0.001).

Conclusion: OF-5 defined oral frailty was frequently observed in older patients with HF, accompanied by reduced swallowing-related muscle function, and was associated with higher 1-year all-cause mortality, suggesting that oral frailty assessment may serve as a valuable clinical marker for risk stratification at discharge.

Background and aims: Malnutrition defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria is frequent in older patients with heart failure (HF) and is associated with poor outcomes. It is uncertain whether specifying inflammation with C-reactive protein (CRP) thresholds adds prognostic value beyond the application of the GLIM criteria in HF. The purpose of this study was to examine whether adding CRP-based inflammation criteria to the GLIM criteria would improve prediction of all-cause mortality.

Methods: We performed a post hoc analysis of the prospective multicenter FRAGILE-HF cohort, which enrolled consecutive patients aged ≥65 years old who were hospitalized with HF. Malnutrition was defined using standard GLIM criteria in which HF was assumed to satisfy the inflammation component of the etiologic criterion in all patients. We also evaluated four modified GLIM criteria in which malnutrition required at least one phenotypic criterion and an etiologic criterion met by reduced food intake or inflammation, with the inflammation component operationalized as CRP at discharge of at least 1.0, 3.0, 5.0, or 10.0 mg/L. The primary outcome was 2-year all-cause mortality after discharge.

Results: Of 1,332 enrolled patients, 835 were analyzed (median [interquartile range] age, 81 years old [74-86 years old], 58.2% men). Malnutrition was associated with higher mortality for the standard GLIM criteria (hazard ratio [HR] 1.66, 95% confidence interval [CI] 1.19-2.32) and for modified criteria with CRP ≥1.0 mg/L (HR 1.59, 95% CI 1.15-2.21), ≥3.0 mg/L (HR 1.47, 95% CI 1.06-2.03), ≥5.0 mg/L (HR 1.45, 95% CI 1.05-2.01), and ≥10.0 mg/L (HR 1.68, 95% CI 1.21-2.34). The net reclassification improvement and integrated discrimination improvement for models that added each modified GLIM criteria were small and not statistically significant across all CRP thresholds.

Conclusion: In older patients with HF, malnutrition defined by the GLIM criteria was associated with 2-year all-cause mortality, and adding CRP-based inflammation thresholds to the GLIM criteria did not improve prognostic discrimination.

Clinical trial registration: UMIN-CTR (unique identifier: UMIN000023929, Date: 2016/09/05).