Pub Date : 2026-01-13DOI: 10.1016/j.clnesp.2026.102908
Lei Zhu , Lin Zhu , Youzhuang Zhu , Junwei Zhang , Junwei Fang , Lei Zhang , Dongyue Chai
Background and aims
Emergence delirium (ED) is common after general anesthesia, but preoperative metabolic risk factors are not well defined. This study investigated the association between preoperative serum metabolites and ED in kidney transplant recipients (KTRs).
Methods
Adult KTRs treated between 2023 and 2024 were retrospectively analyzed. ED was defined as a Richmond Agitation–Sedation Scale score of +1 to +4 in the post-anesthesia care unit (PACU). Preoperative serum metabolites were quantified using targeted metabolomics. Metabolites were screened using univariable logistic regression, selected using least absolute shrinkage and selection operator (LASSO) regression, and evaluated using multivariable logistic regression models. Dose–response relationships were assessed across quartiles of selected metabolites.
Results
Among 107 patients, 28 (26 %) developed ED. Six metabolites were retained by LASSO. Higher preoperative isopentenyl pyrophosphate (IPP) levels were independently associated with ED after adjustment for perioperative covariates (adjusted OR 3.16, 95 % CI 1.16–6.40; P = 0.002). ED risk increased progressively across IPP quartiles (P for trend = 0.007).
Conclusion
Elevated preoperative serum IPP levels were associated with an increased risk of ED in KTRs. Further studies are required to confirm these findings.
Trial registration
Chinese Clinical Trial Registry, ChiCTR2500097624 (https://www.chictr.org.cn/).
背景与目的：全麻后突发性谵妄（ED）很常见，但术前代谢危险因素尚未明确。本研究探讨了肾移植受者术前血清代谢物与ED之间的关系。方法：回顾性分析2023 ~ 2024年收治的成人ktr病例。ED定义为麻醉后护理单元（PACU）的Richmond激动-镇静量表评分+1至+4。术前血清代谢物定量使用靶向代谢组学。使用单变量逻辑回归筛选代谢物，使用最小绝对收缩和选择算子（LASSO）回归进行选择，并使用多变量逻辑回归模型进行评估。在所选代谢物的四分位数中评估剂量-反应关系。结果：107例患者中，28例（26%）发生ED。LASSO保留了6种代谢物。围手术期协变量校正后，术前较高的焦磷酸异戊烯基（IPP）水平与ED独立相关（校正OR 3.16, 95% CI 1.16-6.40; P = 0.002）。ED风险在IPP四分位数中逐渐增加（趋势P = 0.007）。结论：术前血清IPP水平升高与ktr患者发生ED的风险增加有关。需要进一步的研究来证实这些发现。试验注册：中国临床试验注册中心，ChiCTR2500097624 （https://www.chictr.org.cn/）。
{"title":"Association between preoperative isopentenyl pyrophosphate and emergence delirium in patients undergoing kidney transplantation","authors":"Lei Zhu , Lin Zhu , Youzhuang Zhu , Junwei Zhang , Junwei Fang , Lei Zhang , Dongyue Chai","doi":"10.1016/j.clnesp.2026.102908","DOIUrl":"10.1016/j.clnesp.2026.102908","url":null,"abstract":"<div><h3>Background and aims</h3><div>Emergence delirium (ED) is common after general anesthesia, but preoperative metabolic risk factors are not well defined. This study investigated the association between preoperative serum metabolites and ED in kidney transplant recipients (KTRs).</div></div><div><h3>Methods</h3><div>Adult KTRs treated between 2023 and 2024 were retrospectively analyzed. ED was defined as a Richmond Agitation–Sedation Scale score of +1 to +4 in the post-anesthesia care unit (PACU). Preoperative serum metabolites were quantified using targeted metabolomics. Metabolites were screened using univariable logistic regression, selected using least absolute shrinkage and selection operator (LASSO) regression, and evaluated using multivariable logistic regression models. Dose–response relationships were assessed across quartiles of selected metabolites.</div></div><div><h3>Results</h3><div>Among 107 patients, 28 (26 %) developed ED. Six metabolites were retained by LASSO. Higher preoperative isopentenyl pyrophosphate (IPP) levels were independently associated with ED after adjustment for perioperative covariates (adjusted OR 3.16, 95 % CI 1.16–6.40; <em>P</em> = 0.002). ED risk increased progressively across IPP quartiles (<em>P</em> for trend = 0.007).</div></div><div><h3>Conclusion</h3><div>Elevated preoperative serum IPP levels were associated with an increased risk of ED in KTRs. Further studies are required to confirm these findings.</div></div><div><h3>Trial registration</h3><div>Chinese Clinical Trial Registry, ChiCTR2500097624 (<span><span>https://www.chictr.org.cn/</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102908"},"PeriodicalIF":2.6,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987975","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}
Pub Date : 2026-01-13DOI: 10.1016/j.clnesp.2026.102917
Lana M. Agraib , Islam Al-Shami , Buthaina Alkhatib , Aliaa Orabi
Background and aims
Eating disorders (EDs) are an emerging issue worldwide. The Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Attitudes Test (EAT) are widely used research standards for evaluating EDs. This study aims to examine and determine the best ED scoring system, which tool demonstrates stronger associations for specific population subgroups, and the determinants for each scoring system in identifying EDs.
Methods
A total of 1267 young adults were enrolled in a cross-sectional study. Anthropometric and general characteristics were collected, and EDs were assessed using the EDE-Q and the EAT-26. Several inter-rater reliability indicators were computed, and a logistic regression model was employed to identify the determinants of EDs.
Results
Across both scoring systems, higher BMI categories were significantly related to a higher likelihood (OR) of disordered eating. Compared to the EAT-26, the EDE-Q found significantly more disordered behaviors, particularly among females and those who were overweight or obese. Moderate agreement (Po = 0.666; κ = 0.281) and significant asymmetry (p < 0.001) were found between the two scales, suggesting that they capture distinct symptom patterns. BMI, female sex, and physical inactivity were significant predictors of disordered eating in multivariable analyses; the EAT-26 showed stronger correlations with physical inactivity, and the EDE-Q showed stronger associations with weight-related symptoms and female sex.
Conclusion
The EAT-26 and EDE-Q captured different patterns of disordered eating, with the EDE-Q identifying more cases, especially among overweight and obese females. Agreement between tools was modest, and BMI, female sex, and physical inactivity were significant predictors of disordered-eating risk. These findings highlight the need to select screening tools based on population characteristics and symptom profiles.
{"title":"Comparing the eating attitudes test (EAT -26) and disorder examination questionnaire (EDE-Q) as screening tools for eating disorders among young adults: A population-specific analysis","authors":"Lana M. Agraib , Islam Al-Shami , Buthaina Alkhatib , Aliaa Orabi","doi":"10.1016/j.clnesp.2026.102917","DOIUrl":"10.1016/j.clnesp.2026.102917","url":null,"abstract":"<div><h3>Background and aims</h3><div>Eating disorders (EDs) are an emerging issue worldwide. The Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Attitudes Test (EAT) are widely used research standards for evaluating EDs. This study aims to examine and determine the best ED scoring system, which tool demonstrates stronger associations for specific population subgroups, and the determinants for each scoring system in identifying EDs.</div></div><div><h3>Methods</h3><div>A total of 1267 young adults were enrolled in a cross-sectional study. Anthropometric and general characteristics were collected, and EDs were assessed using the EDE-Q and the EAT-26. Several inter-rater reliability indicators were computed, and a logistic regression model was employed to identify the determinants of EDs.</div></div><div><h3>Results</h3><div>Across both scoring systems, higher BMI categories were significantly related to a higher likelihood (OR) of disordered eating. Compared to the EAT-26, the EDE-Q found significantly more disordered behaviors, particularly among females and those who were overweight or obese. Moderate agreement (Po = 0.666; κ = 0.281) and significant asymmetry (<em>p</em> < 0.001) were found between the two scales, suggesting that they capture distinct symptom patterns. BMI, female sex, and physical inactivity were significant predictors of disordered eating in multivariable analyses; the EAT-26 showed stronger correlations with physical inactivity, and the EDE-Q showed stronger associations with weight-related symptoms and female sex.</div></div><div><h3>Conclusion</h3><div>The EAT-26 and EDE-Q captured different patterns of disordered eating, with the EDE-Q identifying more cases, especially among overweight and obese females. Agreement between tools was modest, and BMI, female sex, and physical inactivity were significant predictors of disordered-eating risk. These findings highlight the need to select screening tools based on population characteristics and symptom profiles.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102917"},"PeriodicalIF":2.6,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988002","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}
Pub Date : 2026-01-13DOI: 10.1016/j.clnesp.2026.102912
Sílvia Castro , Cristina Granja , Joanna C. Dionne , Teresa Pires , Carolina Oliveira , Alexandra Binnie
Background
Survival of acutely critically ill patients has improved, resulting in a growing population of chronic critically ill (CCI) patients with prolonged organ dysfunction, mechanical ventilation, and high morbidity. While nutritional guidelines during the acute phase of critical illness are well defined, our understanding of metabolism and nutritional needs in CCI patients is limited. Persistent inflammation may influence the metabolic response and nutritional uptake, highlighting the need for prospective studies in this area.
Methods
The MetaChronic Study is a single-center, prospective cohort study of metabolism in patients with CCI. Adult ICU patients with invasive mechanical ventilation ≥48 h and ICU stay >7 days are eligible. Patients are followed for up to 42 days after ICU admission, with final outcomes assessed at 90 days. Resting energy expenditure is measured weekly by serial indirect calorimetry. Weekly protein and calorie intake are recorded and inflammation is assessed using serum C-reactive protein and procalcitonin measurements. Patients are categorized according to high or low protein intake (>1.3 g/kg/day vs. ≤1.3 g/kg/day after the first week). The primary objective is to characterize longitudinal metabolic trajectories. Secondary objectives include subgroup analyses (septic, trauma, neurocritical patients), assessment of the interaction between inflammation and metabolic rate, and exploratory analyses of the association between protein intake and clinical outcomes.
Ethics and dissemination
The study has been approved by the institutional ethics committee. Findings will be disseminated through peer-reviewed journals and scientific conferences.
{"title":"Metabolism and the impact of protein intake in Chronic critically ill adult patients: Protocol for a unicentric prospective cohort study (MetaChronic Study)","authors":"Sílvia Castro , Cristina Granja , Joanna C. Dionne , Teresa Pires , Carolina Oliveira , Alexandra Binnie","doi":"10.1016/j.clnesp.2026.102912","DOIUrl":"10.1016/j.clnesp.2026.102912","url":null,"abstract":"<div><h3>Background</h3><div>Survival of acutely critically ill patients has improved, resulting in a growing population of chronic critically ill (CCI) patients with prolonged organ dysfunction, mechanical ventilation, and high morbidity. While nutritional guidelines during the acute phase of critical illness are well defined, our understanding of metabolism and nutritional needs in CCI patients is limited. Persistent inflammation may influence the metabolic response and nutritional uptake, highlighting the need for prospective studies in this area.</div></div><div><h3>Methods</h3><div>The MetaChronic Study is a single-center, prospective cohort study of metabolism in patients with CCI. Adult ICU patients with invasive mechanical ventilation ≥48 h and ICU stay >7 days are eligible. Patients are followed for up to 42 days after ICU admission, with final outcomes assessed at 90 days. Resting energy expenditure is measured weekly by serial indirect calorimetry. Weekly protein and calorie intake are recorded and inflammation is assessed using serum C-reactive protein and procalcitonin measurements. Patients are categorized according to high or low protein intake (>1.3 g/kg/day vs. ≤1.3 g/kg/day after the first week). The primary objective is to characterize longitudinal metabolic trajectories. Secondary objectives include subgroup analyses (septic, trauma, neurocritical patients), assessment of the interaction between inflammation and metabolic rate, and exploratory analyses of the association between protein intake and clinical outcomes.</div></div><div><h3>Ethics and dissemination</h3><div>The study has been approved by the institutional ethics committee. Findings will be disseminated through peer-reviewed journals and scientific conferences.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102912"},"PeriodicalIF":2.6,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988182","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}
Pub Date : 2026-01-12DOI: 10.1016/j.clnesp.2025.102898
Favour M.L. Foncha , Joseph Y. Bena Nnang , Samuel G.J. Fodop , Best C.I. Poudjoum , Dimitri S. Tcheuko , Joel G.K. Mekontso
Background & aims
Vaso-occlusive crises (VOCs) in sickle cell disease involve nitric oxide deficiency, creating a rationale for l-arginine. This meta-analysis evaluates its efficacy on clinical VOC outcomes including pain, opioid use, and hospitalization by synthesizing evidence from RCTS.
Methods
The PubMed, Embase, and Cochrane databases were searched for RCTs comparing l-arginine with placebo or standard care in SCD patients. Primary outcomes were pain scores, opioid consumption, time to crisis resolution, and length of hospital stay. Pooled estimates were calculated using random-effects models.
Results
Eight RCTs comprising 830 patients were included. Analysis revealed no statistically significant benefit of arginine on primary outcomes. The evidence, of low certainty, indicated no significant effect on pain scores (SMD -1.55, 95 % CI [-6.72, 3.62]) or opioid consumption (MD -0.78 mg/kg, 95 % CI [-2.80, 1.23]). Similarly, no significant differences were observed for time to crisis resolution (MD -12.64 h, 95 % CI [-25.82, 0.54]) or length of hospital stay (MD -24.83 h, 95 % CI [-71.18, 21.51]). A non-significant 23 % increase in hospital readmission risk was observed (RR 1.23, 95 % CI [0.92, 1.65]). Pharmacodynamic analysis confirmed increased plasma arginine levels but showed no significant change in the arginine-to-ornithine ratio.
Conclusion
In summary, this meta-analysis found that l-arginine showed no statistically significant benefit on any primary clinical outcome in patients with sickle cell disease experiencing VOC. This absence of proven efficacy, coupled with a potential safety signal regarding hospital readmissions, precludes its recommendation for routine clinical use. Consequently, these findings underscore the urgent need for a large, definitive RCT to determine the efficacy and safety of arginine therapy.
{"title":"Arginine therapy in sickle cell disease: A systematic review and meta-analysis of clinical outcomes","authors":"Favour M.L. Foncha , Joseph Y. Bena Nnang , Samuel G.J. Fodop , Best C.I. Poudjoum , Dimitri S. Tcheuko , Joel G.K. Mekontso","doi":"10.1016/j.clnesp.2025.102898","DOIUrl":"10.1016/j.clnesp.2025.102898","url":null,"abstract":"<div><h3>Background & aims</h3><div>Vaso-occlusive crises (VOCs) in sickle cell disease involve nitric oxide deficiency, creating a rationale for <span>l</span>-arginine. This meta-analysis evaluates its efficacy on clinical VOC outcomes including pain, opioid use, and hospitalization by synthesizing evidence from RCTS.</div></div><div><h3>Methods</h3><div>The PubMed, Embase, and Cochrane databases were searched for RCTs comparing <span>l</span>-arginine with placebo or standard care in SCD patients. Primary outcomes were pain scores, opioid consumption, time to crisis resolution, and length of hospital stay. Pooled estimates were calculated using random-effects models.</div></div><div><h3>Results</h3><div>Eight RCTs comprising 830 patients were included. Analysis revealed no statistically significant benefit of arginine on primary outcomes. The evidence, of low certainty, indicated no significant effect on pain scores (SMD -1.55, 95 % CI [-6.72, 3.62]) or opioid consumption (MD -0.78 mg/kg, 95 % CI [-2.80, 1.23]). Similarly, no significant differences were observed for time to crisis resolution (MD -12.64 h, 95 % CI [-25.82, 0.54]) or length of hospital stay (MD -24.83 h, 95 % CI [-71.18, 21.51]). A non-significant 23 % increase in hospital readmission risk was observed (RR 1.23, 95 % CI [0.92, 1.65]). Pharmacodynamic analysis confirmed increased plasma arginine levels but showed no significant change in the arginine-to-ornithine ratio.</div></div><div><h3>Conclusion</h3><div>In summary, this meta-analysis found that <span>l</span>-arginine showed no statistically significant benefit on any primary clinical outcome in patients with sickle cell disease experiencing VOC. This absence of proven efficacy, coupled with a potential safety signal regarding hospital readmissions, precludes its recommendation for routine clinical use. Consequently, these findings underscore the urgent need for a large, definitive RCT to determine the efficacy and safety of arginine therapy.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102898"},"PeriodicalIF":2.6,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984584","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}
Pub Date : 2026-01-12DOI: 10.1016/j.clnesp.2026.102916
Victória Silva Chites , Allanis Krieger Ramos , Juliana Araújo de Menezes Costa , Giulia Bacim de Araujo e Silva , Flávia Moraes Silva , Jussara Carnevale de Almeida
Background & aims
Reduced muscle mass (MM) is frequently underdiagnosed in hospitalized overweight patients due to assessment challenges. This study aimed to examine the association between anthropometric indicators of MM and clinical outcomes, including length of stay (LOS), readmission, and six-month mortality in overweight hospitalized patients.
Methods
This cohort study included adults and older adults admitted to a university hospital in southern Brazil, with body mass index (BMI) thresholds of ≥25 kg/m2 and ≥27 kg/m2, respectively. Within 72 h of admission, body weight, height, mid-arm muscle circumference (MAMC), adductor pollicis muscle thickness (APMT), and calf circumference (CC) were measured; CC was also adjusted for BMI due to the adiposity influence in this accuracy to estimate MM. Patients were classified as having low or normal MM according to each indicator. LOS was categorized as prolonged using the sample upper quartile. Post-discharge follow-up for readmission and six-month mortality was conducted by telephone. Logistic regression analyses assessed associations between anthropometric indicators and clinical outcomes. The study was approved by the institutional ethics committee (CAAE: 6397222.9.0000.5327).
Results
A total of 475 patients were included (56 ± 14 years; 52 % women, BMI: 31.7 ± 4.4 kg/m2). The majority underwent surgery (84 %), and 23 % had a cancer diagnosis. The prevalence of low MM was 49.9 % based on BMI-adjusted CC, 5.0 % using unadjusted CC, 26.8 % based on APMT, and 8.7 % based on MAMC. Low BMI-adjusted CC was independently associated with 1.63-fold higher odds of prolonged hospitalization (95%CI: 1.04–2.56), while low MAMC was associated with 2.21-fold higher odds (95%CI: 1.10–4.43). No anthropometric measure was associated with readmission or six-month mortality.
Conclusions
Low MM was common among overweight hospitalized patients, particularly when assessed by BMI-adjusted CC, which accounts for adiposity. Among the measures, BMI-adjusted CC and MAMC were independently associated with prolonged hospital stay.
{"title":"Body mass index-adjusted calf circumference and mid-arm muscle circumference are associated with hospital stay in overweight patients: A cohort study","authors":"Victória Silva Chites , Allanis Krieger Ramos , Juliana Araújo de Menezes Costa , Giulia Bacim de Araujo e Silva , Flávia Moraes Silva , Jussara Carnevale de Almeida","doi":"10.1016/j.clnesp.2026.102916","DOIUrl":"10.1016/j.clnesp.2026.102916","url":null,"abstract":"<div><h3>Background & aims</h3><div>Reduced muscle mass (MM) is frequently underdiagnosed in hospitalized overweight patients due to assessment challenges. This study aimed to examine the association between anthropometric indicators of MM and clinical outcomes, including length of stay (LOS), readmission, and six-month mortality in overweight hospitalized patients.</div></div><div><h3>Methods</h3><div>This cohort study included adults and older adults admitted to a university hospital in southern Brazil, with body mass index (BMI) thresholds of ≥25 kg/m<sup>2</sup> and ≥27 kg/m<sup>2</sup>, respectively. Within 72 h of admission, body weight, height, mid-arm muscle circumference (MAMC), adductor pollicis muscle thickness (APMT), and calf circumference (CC) were measured; CC was also adjusted for BMI due to the adiposity influence in this accuracy to estimate MM. Patients were classified as having low or normal MM according to each indicator. LOS was categorized as prolonged using the sample upper quartile. Post-discharge follow-up for readmission and six-month mortality was conducted by telephone. Logistic regression analyses assessed associations between anthropometric indicators and clinical outcomes. The study was approved by the institutional ethics committee (CAAE: 6397222.9.0000.5327).</div></div><div><h3>Results</h3><div>A total of 475 patients were included (56 ± 14 years; 52 % women, BMI: 31.7 ± 4.4 kg/m<sup>2</sup>). The majority underwent surgery (84 %), and 23 % had a cancer diagnosis. The prevalence of low MM was 49.9 % based on BMI-adjusted CC, 5.0 % using unadjusted CC, 26.8 % based on APMT, and 8.7 % based on MAMC. Low BMI-adjusted CC was independently associated with 1.63-fold higher odds of prolonged hospitalization (95%CI: 1.04–2.56), while low MAMC was associated with 2.21-fold higher odds (95%CI: 1.10–4.43). No anthropometric measure was associated with readmission or six-month mortality.</div></div><div><h3>Conclusions</h3><div>Low MM was common among overweight hospitalized patients, particularly when assessed by BMI-adjusted CC, which accounts for adiposity. Among the measures, BMI-adjusted CC and MAMC were independently associated with prolonged hospital stay.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102916"},"PeriodicalIF":2.6,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984591","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}
Limited evidence is available regarding the Global Leadership Initiative on Malnutrition (GLIM), a standardized diagnostic criterion for malnutrition, in outpatients with ulcerative colitis (UC). This study aimed to investigate the prevalence and determinants of GLIM-defined malnutrition and their impact on the quality of life (QOL) in this population.
Methods
This multicenter, cross-sectional study included outpatients with UC from two institutes in Gifu, Japan. Malnutrition was diagnosed using the GLIM criteria and Malnutrition Universal Screening Tool for initial screening. QOL was assessed using the Japanese version of the Inflammatory Bowel Disease questionnaire (J-IBDQ). The malnutrition determinants were evaluated using a multivariate logistic regression model.
Results
Of the 240 outpatients, the median age was 53 years and 41.7 % were female. Extensive colitis was observed in 45.0 % of the patients, and 29.6 % experienced advanced therapy. With nutritional assessment, 28.3 % were at risk of malnutrition and 10.4 % were diagnosed with GLIM-defined malnutrition. Multivariable analysis identified female sex (odds ratio [OR] 3.24, 95 % confidence interval [CI] 1.35–8.28), extensive colitis (OR 2.75, 95 % CI 1.09–7.45), and a history of advanced therapy (OR 2.71, 95 % CI 1.11–6.67) as independent factors for malnutrition. Compared with those of well-nourished patients, those with malnutrition had significantly lower scores in all four domains and total J-IBDQ score.
Conclusions
Malnutrition, as defined by the GLIM criteria, was observed in 10.4 % of the outpatients with UC; female sex, extensive colitis, and advanced therapy were robust determinants. Furthermore, patients with malnutrition had a significantly poorer QOL than that of those who were well-nourished.
Clinical trial registration
N/A.
背景与目的：关于溃疡性结肠炎（UC）门诊患者营养不良的标准化诊断标准——全球营养不良领导倡议（GLIM），现有证据有限。本研究旨在调查该人群营养不良的患病率和决定因素及其对生活质量（QOL）的影响。方法：这项多中心横断面研究纳入了来自日本岐阜两所研究所的UC门诊患者。使用GLIM标准和营养不良通用筛查工具进行初始筛查诊断营养不良。使用日本版炎症性肠病问卷（J-IBDQ）评估生活质量。使用多元逻辑回归模型评估营养不良的决定因素。结果：240例门诊患者中位年龄53岁，女性占41.7%。45.0%的患者出现广泛结肠炎，29.6%的患者接受了晚期治疗。通过营养评估，28.3%的人有营养不良的风险，10.4%的人被诊断为营养不良。多变量分析确定女性（优势比[OR] 3.24, 95%可信区间[CI] 1.35-8.28）、广泛结肠炎（OR 2.75, 95% CI 1.09-7.45）和先进治疗史（OR 2.71, 95% CI 1.11-6.67）是营养不良的独立因素。与营养良好的患者相比，营养不良患者在所有四个领域的得分和J-IBDQ总分均显著低于营养不良患者。结论：根据GLIM标准，10.4%的UC门诊患者存在营养不良；女性、广泛的结肠炎和先进的治疗是强有力的决定因素。此外，营养不良患者的生活质量明显低于营养良好的患者。临床试验注册：无。
{"title":"Impact of the global leadership initiative on malnutrition criteria on the quality of life of patients with ulcerative colitis","authors":"Naoya Masuda , Takao Miwa , Kayoko Nishimura , Yoshiyuki Miwa , Kentaro Kojima , Sachiyo Onishi , Jun Takada , Masaya Kubota , Takashi Ibuka , Masahito Shimizu","doi":"10.1016/j.clnesp.2026.102919","DOIUrl":"10.1016/j.clnesp.2026.102919","url":null,"abstract":"<div><h3>Background & aims</h3><div>Limited evidence is available regarding the Global Leadership Initiative on Malnutrition (GLIM), a standardized diagnostic criterion for malnutrition, in outpatients with ulcerative colitis (UC). This study aimed to investigate the prevalence and determinants of GLIM-defined malnutrition and their impact on the quality of life (QOL) in this population.</div></div><div><h3>Methods</h3><div>This multicenter, cross-sectional study included outpatients with UC from two institutes in Gifu, Japan. Malnutrition was diagnosed using the GLIM criteria and Malnutrition Universal Screening Tool for initial screening. QOL was assessed using the Japanese version of the Inflammatory Bowel Disease questionnaire (J-IBDQ). The malnutrition determinants were evaluated using a multivariate logistic regression model.</div></div><div><h3>Results</h3><div>Of the 240 outpatients, the median age was 53 years and 41.7 % were female. Extensive colitis was observed in 45.0 % of the patients, and 29.6 % experienced advanced therapy. With nutritional assessment, 28.3 % were at risk of malnutrition and 10.4 % were diagnosed with GLIM-defined malnutrition. Multivariable analysis identified female sex (odds ratio [OR] 3.24, 95 % confidence interval [CI] 1.35–8.28), extensive colitis (OR 2.75, 95 % CI 1.09–7.45), and a history of advanced therapy (OR 2.71, 95 % CI 1.11–6.67) as independent factors for malnutrition. Compared with those of well-nourished patients, those with malnutrition had significantly lower scores in all four domains and total J-IBDQ score.</div></div><div><h3>Conclusions</h3><div>Malnutrition, as defined by the GLIM criteria, was observed in 10.4 % of the outpatients with UC; female sex, extensive colitis, and advanced therapy were robust determinants. Furthermore, patients with malnutrition had a significantly poorer QOL than that of those who were well-nourished.</div></div><div><h3>Clinical trial registration</h3><div>N/A.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102919"},"PeriodicalIF":2.6,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984568","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}
Pub Date : 2026-01-12DOI: 10.1016/j.clnesp.2025.102905
C. Bouleuc , V. Garabige , G. Grodard , A. Anota , R. Aubry , T. Marchal
Background
Malnutrition is highly prevalent in advanced cancer patients, contributing to reduced quality of life, impaired physical function, and decreased survival. Although parenteral nutrition (PN) is used to supplement oral intake, its effect on oral feeding behaviors and eating pleasure remains unclear. We therefore aimed to evaluate the impact of supplemental PN on oral food intake and eating pleasure in malnourished advanced cancer patients with an intact bowel function.
Methods
This study presents a sub-analysis of data from a larger, multicenter, randomized controlled trial. In this trial, advanced cancer patients with malnutrition and a functional gastrointestinal tract were assigned (1:1) to receive either supplemental PN plus standard oral feeding or oral feeding alone. Dietary intake was assessed at baseline and one month using a 24 h dietary recall, and eating pleasure was measured with the Self-Evaluation of Food Intake (SEFI) score.
Results
Eighty-nine patients were analyzed. In the overall cohort, mean daily energy intake assessed by 24 h recall increased significantly from 986 ± 475 kcal at baseline to 1082 ± 420 kcal at one month (p = 0.02), whereas SEFI score remained stable. At baseline, a significant positive correlation was found between the SEFI score and the ratio of calorie intake to estimated energy requirements (Spearman's ρ = 0.55, P < 0.001). In arm-specific analyses using paired t-test, patients in the oral-feeding arm experienced a significant rise at one month in mean energy intake (1009 ± 476 to 1224 ± 474 kcal; p = 0.045) with no significant change for patients in the PN arm (859 ± 437 to 856 ± 234 kcal, p = 0.71). Using McNemar's test, patients from the oral-feeding arm experienced a significant rise in oral nutritional supplement use ate one month compared with patients from the PN arm (6/19 % to 20/65 %, p = 0.01). Meal frequency, snack consumption, and pleasure to eat did not change in the overall population and in either arm.
Conclusion
Supplemental PN does not negatively impact oral food intake or eating pleasure in malnourished advanced cancer patients with intact bowel function. These findings support the use of PN as a nutritional support option without compromising oral feeding behaviors.
Registration number of clinical trial
NCT02151214.
背景：营养不良在晚期癌症患者中非常普遍，导致生活质量下降、身体功能受损和生存率降低。虽然肠外营养（PN）被用于补充口服摄入，但其对口服喂养行为和进食愉悦的影响尚不清楚。因此，我们旨在评估补充PN对肠道功能完好的营养不良晚期癌症患者口服食物摄入量和进食乐趣的影响。方法：本研究对一项大型、多中心、随机对照试验的数据进行亚分析。在这项试验中，营养不良且胃肠道功能正常的晚期癌症患者被分配（1:1）接受补充PN加标准口服喂养或单独口服喂养。在基线和一个月时使用24小时饮食回忆评估饮食摄入量，并使用食物摄入自我评估（SEFI）评分测量饮食愉悦度。结果：共分析89例患者。在整个队列中，24小时回忆评估的平均每日能量摄入从基线时的986±475千卡显著增加到一个月后的1082±420千卡（p = 0.02），而SEFI评分保持稳定。基线时，SEFI评分与卡路里摄入与估计能量需求之比之间存在显著的正相关（Spearman ρ = 0.55, P < 0.001）。在采用配对t检验的分组分析中，口服喂养组的患者在一个月的平均能量摄入显著增加（1009±476至1224±474 kcal， p = 0.045），而口服喂养组的患者无显著变化（859±437至856±234 kcal， p = 0.71）。使用McNemar的测试，与来自PN组的患者相比，来自口服喂养组的患者在一个月内口服营养补充剂的使用显著增加（6/19%至20/65%，p = 0.01）。在总体人群和两组中，用餐频率、零食消费和饮食乐趣没有变化。结论：补充PN不会对肠功能完好的营养不良晚期癌症患者的口服食物摄入量或进食乐趣产生负面影响。这些发现支持在不影响口服喂养行为的情况下使用PN作为营养支持选择。临床试验注册号：NCT02151214。
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Pub Date : 2026-01-10DOI: 10.1016/j.clnesp.2025.102896
Rojina Raked , Mary Ibrahim , Jennifer Utter , Shannon Morley , Kate Mueller
Background & aims
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.
Methods
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.
Results
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.
Conclusions
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.
背景与目的：功能性肠病（FBD）是临床上可诊断的影响中、下胃肠道的疾病。纤维操作（通过量或类型）通常被用作症状管理的一线治疗。本系统综述将调查纤维操纵对诊断为FBD的成人症状管理和生活质量的影响。方法：系统检索2013年1月至2024年12月的PubMed、EMBASE、CINAHL和Cochrane Central 4个电子数据库。研究纳入随机对照试验（RCTs），检查纤维操作对成年（≥18岁）FBD患者的影响。主要结局是症状管理，次要结局是生活质量（QoL）。使用Cochrane偏倚风险工具2评估研究质量。数据以叙述的方式合成。结果：检索确定了8864条记录；5167人根据资格标准进行筛选，47条记录在全文审查中进行评估。10项研究报告了8项平行随机对照试验和2项交叉随机对照试验，评估了不同类型FBD患者的不同纤维补充剂和剂量。干预时间从一周到八周不等，参与者人数从11人到250人不等。报告的结果各不相同。七项研究报告了症状严重程度的显著改善，一项研究报告了与对照组相比症状的显著恶化。结果表明，添加龙舌兰果糖的纤维可改善便秘，但会加重胀气，金合子纤维可改善大便频率，车前草可改善大便一致性，不腐纤维可改善症状严重程度，蔬菜粉可改善大便硬度和数量、不完全排便、拉伤和排便频率，果胶粉可改善腹痛、腹胀、大便一致性和症状严重程度。甘蔗渣和抗性淀粉的组合改善了肠胃胀气。一项研究报告，与安慰剂对照组相比，干预组的生活质量明显恶化。结论：本综述得出结论，纤维补充可能是改善FBD患者症状管理的有效治疗方法，尽管高异质性排除了荟萃分析。两项研究被评估为低偏倚风险，七项有一些担忧，一项被评估为高偏倚风险。纳入的研究报告了一小群参与者的短期干预措施。有必要对更多的FBD参与者进行进一步的研究，以评估更长时间的干预措施。
{"title":"Fibre manipulation to manage symptom severity and quality of life in patients with functional bowel disorders: A systematic review","authors":"Rojina Raked , Mary Ibrahim , Jennifer Utter , Shannon Morley , Kate Mueller","doi":"10.1016/j.clnesp.2025.102896","DOIUrl":"10.1016/j.clnesp.2025.102896","url":null,"abstract":"<div><h3>Background & 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":"2026-01-10","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}
Malnutrition is prevalent among gastrointestinal cancer patients undergoing surgery. The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend 10–14 days of preoperative nutrition therapy for patients at nutritional risk, and perioperative immunonutrition to improve outcomes. However, benefits of preoperative immunonutrients versus standard formulas remain unclear. This study evaluated a novel curcumin-containing immunonutrient formula compared to a standard formula administered for 10–14 days preoperatively in gastrointestinal cancer patients at nutritional risk.
Methods
This is a randomized, double-blind pilot trial. Patients with Nutrition Risk Score (NRS)2002 ≥ 3 were assigned to receive 2 servings/day (360 kcal, 17 g protein per serving) of either the immunonutrient or standard formula. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-alpha were measured at baseline, preoperative, and postoperative periods. Nutrition outcomes, complications, hospital stay, 30-day readmission, mortality, compliance, and acceptance were assessed.
Results
Thirty patients were enrolled (15 per group). Preoperative immunonutrient supplementation was associated with a significant reduction in preoperative hs-CRP concentrations (−4.4 vs. 4.5 mg/L, p = 0.030) and a greater increase in body weight (1.9 vs. 0.3 kg, p = 0.041) compared with the standard formula. No significant differences were observed in postoperative complications, hospital stay, readmission, or mortality. Compliance and acceptance of the novel formula were high, with minimal gastrointestinal adverse events.
Conclusions
Preoperative supplementation with the curcumin-containing immunonutrient for 10–14 days reduced preoperative inflammatory response and greater weight gain compared to the standard formula in gastrointestinal cancer patients at nutritional risk. Further studies with larger populations are needed to validate these findings.
Registration number
ClinicalTrials.gov (NCT06825221).
背景与目的：在接受手术的胃肠道肿瘤患者中，营养不良非常普遍。欧洲临床营养与代谢学会（ESPEN）指南建议有营养风险的患者术前进行10-14天的营养治疗，围手术期进行免疫营养以改善预后。然而，术前免疫营养素与标准配方相比的益处仍不清楚。本研究评估了一种新的含有姜黄素的免疫营养配方，并将其与术前10-14天给予有营养风险的胃肠道癌症患者的标准配方进行了比较。方法：随机、双盲先导试验。营养风险评分（NRS）2002≥3的患者被分配接受2份/天（360千卡，每份17克蛋白质）的免疫营养素或标准配方。在基线、术前和术后测量血清高敏c反应蛋白（hs-CRP）、白细胞介素(IL)-6和肿瘤坏死因子(TNF)- α。评估营养结果、并发症、住院时间、30天再入院、死亡率、依从性和接受度。结果：30例患者入组，每组15例。与标准配方相比，术前补充免疫营养素与术前hs-CRP浓度显著降低（-4.4 vs. 4.5 mg/L, p=0.030）和体重增加（1.9 vs. 0.3 kg, p=0.041）相关。术后并发症、住院时间、再入院或死亡率均无显著差异。新配方的依从性和接受度很高，胃肠道不良事件最少。结论：与标准配方相比，术前补充含有姜黄素的免疫营养素10-14天可减少术前炎症反应，并使有营养风险的胃肠道癌症患者体重增加。需要在更大的人群中进行进一步的研究来验证这些发现。注册号：ClinicalTrials.gov （NCT06825221）。
{"title":"Novel immune-modulating formula versus standard formula for gastrointestinal cancer patients at risk of malnutrition undergoing surgery: A pilot randomized controlled trial","authors":"Narisorn Lakananurak , Prok Laosuwan , Phuphat Vongwattanakit , Amnad Jittivasurat , Varanya Techasukthavorn","doi":"10.1016/j.clnesp.2026.102909","DOIUrl":"10.1016/j.clnesp.2026.102909","url":null,"abstract":"<div><h3>Background & aims</h3><div>Malnutrition is prevalent among gastrointestinal cancer patients undergoing surgery. The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend 10–14 days of preoperative nutrition therapy for patients at nutritional risk, and perioperative immunonutrition to improve outcomes. However, benefits of preoperative immunonutrients versus standard formulas remain unclear. This study evaluated a novel curcumin-containing immunonutrient formula compared to a standard formula administered for 10–14 days preoperatively in gastrointestinal cancer patients at nutritional risk.</div></div><div><h3>Methods</h3><div>This is a randomized, double-blind pilot trial. Patients with Nutrition Risk Score (NRS)2002 ≥ 3 were assigned to receive 2 servings/day (360 kcal, 17 g protein per serving) of either the immunonutrient or standard formula. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-alpha were measured at baseline, preoperative, and postoperative periods. Nutrition outcomes, complications, hospital stay, 30-day readmission, mortality, compliance, and acceptance were assessed.</div></div><div><h3>Results</h3><div>Thirty patients were enrolled (15 per group). Preoperative immunonutrient supplementation was associated with a significant reduction in preoperative hs-CRP concentrations (−4.4 vs. 4.5 mg/L, p = 0.030) and a greater increase in body weight (1.9 vs. 0.3 kg, p = 0.041) compared with the standard formula. No significant differences were observed in postoperative complications, hospital stay, readmission, or mortality. Compliance and acceptance of the novel formula were high, with minimal gastrointestinal adverse events.</div></div><div><h3>Conclusions</h3><div>Preoperative supplementation with the curcumin-containing immunonutrient for 10–14 days reduced preoperative inflammatory response and greater weight gain compared to the standard formula in gastrointestinal cancer patients at nutritional risk. Further studies with larger populations are needed to validate these findings.</div></div><div><h3>Registration number</h3><div>ClinicalTrials.gov (NCT06825221).</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102909"},"PeriodicalIF":2.6,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959052","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}
Pub Date : 2026-01-10DOI: 10.1016/j.clnesp.2025.102901
Jun Han , Diya Sun , Qifeng Yao , Qiulei Xi , Shanjun Tan , Hongyan Yin , Guohao Wu
<div><h3>Background</h3><div>With the application of positron emission tomography-computed tomography (PET-CT) in recent years, studies have found that brown adipose tissue is not only present in infants and hibernating mammals but also persists in the neck regions of adults. Cancer-associated cachexia, a complex metabolic syndrome, is characterized by adipose tissue loss and heightened metabolic activity. Despite the profound impact of cachexia on patient outcomes, research into the metabolic dynamics of brown adipose tissue has been sparse. The objective of this study is to quantify the metabolic activity of adipose tissue in the neck regions of gastric cancer patients using PET-CT and to elucidate the relationship between adipose tissue metabolic activity and cachexia, along with its potential predictive value for survival outcomes.</div></div><div><h3>Methods</h3><div>We collected PET-CT imaging data and 18F-fluorodeoxyglucose (FDG) standardized uptake values from the nuchal adipose tissue of 310 patients diagnosed with gastric cancer. Concurrently, we gathered clinical data from these patients to facilitate a thorough analysis. The t-test was employed to evaluate the FDG uptake differences in nuchal adipose tissue between gastric cancer patients exhibiting cancer cachexia or not. The correlation between FDG uptake of nuchal adipose tissue and clinical indicators, along with weight loss and nutritional status, was further analyzed using Spearman's rank correlation test. Kaplan–Meier curves and Cox Proportional Hazards Model were employed to clarify the survival of gastric cancer patients in different FDG uptake groups.</div></div><div><h3>Results</h3><div>The 310 gastric cancer patients were divided into 103 patients with cachexia and 207 patients without cachexia. Patients with cachexia exhibited a significantly elevated FDG uptake of nuchal adipose tissue compared to those without cachexia (<em>p</em> < 0.05). Furthermore, correlation analyses demonstrated notable inverse relationships between the FDG uptake of nuchal adipose tissue with body mass index and serum albumin concentrations (<em>p</em> < 0.05). We also observed a positive correlation between the FDG uptake of nuchal adipose tissue with both the weight loss ratio and serum concentrations of tumor necrosis factor-alpha (all <em>p</em> < 0.05). Additionally, patients with elevated FDG uptake of nuchal adipose tissue had a significantly lower survival rate compared to those with lower FDG uptake (<em>p</em> = 0.04). Furthermore, FDG uptake in nuchal adipose tissue was an independent prognostic indicator in gastric cancer patients (HR = 1.81, <em>p</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>In gastric patients with cachexia, the metabolic activity of nuchal adipose tissue was significantly elevated and correlated with weight loss, compromised nutritional status, and an unfavorable survival prognosis. This study could provide valuable insights into the pathophysio
{"title":"Association of adipose tissue activity in cervical regions with weight loss and prognostic survival in gastric cancer patients","authors":"Jun Han , Diya Sun , Qifeng Yao , Qiulei Xi , Shanjun Tan , Hongyan Yin , Guohao Wu","doi":"10.1016/j.clnesp.2025.102901","DOIUrl":"10.1016/j.clnesp.2025.102901","url":null,"abstract":"<div><h3>Background</h3><div>With the application of positron emission tomography-computed tomography (PET-CT) in recent years, studies have found that brown adipose tissue is not only present in infants and hibernating mammals but also persists in the neck regions of adults. Cancer-associated cachexia, a complex metabolic syndrome, is characterized by adipose tissue loss and heightened metabolic activity. Despite the profound impact of cachexia on patient outcomes, research into the metabolic dynamics of brown adipose tissue has been sparse. The objective of this study is to quantify the metabolic activity of adipose tissue in the neck regions of gastric cancer patients using PET-CT and to elucidate the relationship between adipose tissue metabolic activity and cachexia, along with its potential predictive value for survival outcomes.</div></div><div><h3>Methods</h3><div>We collected PET-CT imaging data and 18F-fluorodeoxyglucose (FDG) standardized uptake values from the nuchal adipose tissue of 310 patients diagnosed with gastric cancer. Concurrently, we gathered clinical data from these patients to facilitate a thorough analysis. The t-test was employed to evaluate the FDG uptake differences in nuchal adipose tissue between gastric cancer patients exhibiting cancer cachexia or not. The correlation between FDG uptake of nuchal adipose tissue and clinical indicators, along with weight loss and nutritional status, was further analyzed using Spearman's rank correlation test. Kaplan–Meier curves and Cox Proportional Hazards Model were employed to clarify the survival of gastric cancer patients in different FDG uptake groups.</div></div><div><h3>Results</h3><div>The 310 gastric cancer patients were divided into 103 patients with cachexia and 207 patients without cachexia. Patients with cachexia exhibited a significantly elevated FDG uptake of nuchal adipose tissue compared to those without cachexia (<em>p</em> < 0.05). Furthermore, correlation analyses demonstrated notable inverse relationships between the FDG uptake of nuchal adipose tissue with body mass index and serum albumin concentrations (<em>p</em> < 0.05). We also observed a positive correlation between the FDG uptake of nuchal adipose tissue with both the weight loss ratio and serum concentrations of tumor necrosis factor-alpha (all <em>p</em> < 0.05). Additionally, patients with elevated FDG uptake of nuchal adipose tissue had a significantly lower survival rate compared to those with lower FDG uptake (<em>p</em> = 0.04). Furthermore, FDG uptake in nuchal adipose tissue was an independent prognostic indicator in gastric cancer patients (HR = 1.81, <em>p</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>In gastric patients with cachexia, the metabolic activity of nuchal adipose tissue was significantly elevated and correlated with weight loss, compromised nutritional status, and an unfavorable survival prognosis. This study could provide valuable insights into the pathophysio","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"72 ","pages":"Article 102901"},"PeriodicalIF":2.6,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959086","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}
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