Pub Date : 2025-12-11DOI: 10.1016/j.clnesp.2025.102878
Paulo Ribeiro , Eduardo Leite Vieira Costa , Davi Romão , Naiara Lima Matos , Montserrat Montes Ibarra , Carla M. Prado
<div><h3>Objective</h3><div>Obesity is generally recognized as an independent risk factor for poor outcomes in Coronavirus Disease 2019 (COVID-19); however, some studies report a paradoxical protective effect. Findings may be mediated by low muscle mass, a relevant predictor of poor clinical outcomes in critically ill patients. We aimed to investigate the association of body mass index (BMI), baseline low muscle mass index (SMI) and low muscle density (SMD) with clinical outcomes in critically ill patients with COVID-19.</div></div><div><h3>Design</h3><div>This retrospective cohort study was conducted at a tertiary care center in São Paulo, Brazil. We included all consecutive patients admitted to the intensive care unit (ICU) from March 1st, 2020, to May 31st, 2021, with a confirmed diagnosis of COVID-19 and who had a measured SMI and SMD by thoracic computed tomography (CT) at admission. SMI and SMD were assessed from a transverse image at the level of the 12th thoracic vertebra (T12), and BMI at admission was calculated. The association between coprimary exposures BMI, low SMI, low SMD and hospital mortality was assessed through multivariable analysis accounting for confounding factors such as age, sex, Simplified Acute Physiology Score 3 (SAPS 3) and comorbidities.</div></div><div><h3>Results</h3><div>A total of 962 patients were included; 63.7 (±15.3) years; 75.8 % males. SMI was assessed in all patients; however, 33 with contrast CTs were excluded from the SMD analysis. The prevalence of low SMI was 21.6 % (208/962). The prevalence of low SMD was 22.7 % (211/929). A total of 391 (40.6 %) patients were classified as overweight, and 393 (40.8 %) as having obesity. Hospital mortality was 14.3 %, increasing to 26.2 % for patients aged ≥65 years. We found no significant association between BMI, SMI or SMD and hospital mortality.</div><div>Patients with low SMI were more likely to undergo extracorporeal membrane oxygenation (P = 0.045), required longer duration of mechanical ventilation (MV) (p < 0.001), and had prolonged ICU and hospital stays (p < 0.001). Low SMD was independently associated only with ICU readmission (p = 0.034) and longer hospital stay (p < 0.001). Patients with a higher BMI were more likely to be intubated and placed under MV (p < 0.001). Higher BMI was also associated with longer ICU (p = 0.001) and hospital stays (p = 0.049). Patients with obesity and low SMI had longer ICU (p = 0.033), and hospital (p < 0.001) stays, and extended MV duration compared to those with obesity and normal SMI (p = 0.003).</div></div><div><h3>Conclusions</h3><div>BMI, low SMI, and low SMD were not associated with in-hospital mortality in this cohort. However, these parameters were important predictors of morbidity, including longer ICU and hospital stays, greater need for mechanical ventilation, and ICU readmissions. These findings highlight the importance of assessing body composition parameters in critically ill patients with COVI
{"title":"Impact of muscle mass, muscle density and obesity on clinical outcomes in critically ill patients with COVID-19","authors":"Paulo Ribeiro , Eduardo Leite Vieira Costa , Davi Romão , Naiara Lima Matos , Montserrat Montes Ibarra , Carla M. Prado","doi":"10.1016/j.clnesp.2025.102878","DOIUrl":"10.1016/j.clnesp.2025.102878","url":null,"abstract":"<div><h3>Objective</h3><div>Obesity is generally recognized as an independent risk factor for poor outcomes in Coronavirus Disease 2019 (COVID-19); however, some studies report a paradoxical protective effect. Findings may be mediated by low muscle mass, a relevant predictor of poor clinical outcomes in critically ill patients. We aimed to investigate the association of body mass index (BMI), baseline low muscle mass index (SMI) and low muscle density (SMD) with clinical outcomes in critically ill patients with COVID-19.</div></div><div><h3>Design</h3><div>This retrospective cohort study was conducted at a tertiary care center in São Paulo, Brazil. We included all consecutive patients admitted to the intensive care unit (ICU) from March 1st, 2020, to May 31st, 2021, with a confirmed diagnosis of COVID-19 and who had a measured SMI and SMD by thoracic computed tomography (CT) at admission. SMI and SMD were assessed from a transverse image at the level of the 12th thoracic vertebra (T12), and BMI at admission was calculated. The association between coprimary exposures BMI, low SMI, low SMD and hospital mortality was assessed through multivariable analysis accounting for confounding factors such as age, sex, Simplified Acute Physiology Score 3 (SAPS 3) and comorbidities.</div></div><div><h3>Results</h3><div>A total of 962 patients were included; 63.7 (±15.3) years; 75.8 % males. SMI was assessed in all patients; however, 33 with contrast CTs were excluded from the SMD analysis. The prevalence of low SMI was 21.6 % (208/962). The prevalence of low SMD was 22.7 % (211/929). A total of 391 (40.6 %) patients were classified as overweight, and 393 (40.8 %) as having obesity. Hospital mortality was 14.3 %, increasing to 26.2 % for patients aged ≥65 years. We found no significant association between BMI, SMI or SMD and hospital mortality.</div><div>Patients with low SMI were more likely to undergo extracorporeal membrane oxygenation (P = 0.045), required longer duration of mechanical ventilation (MV) (p < 0.001), and had prolonged ICU and hospital stays (p < 0.001). Low SMD was independently associated only with ICU readmission (p = 0.034) and longer hospital stay (p < 0.001). Patients with a higher BMI were more likely to be intubated and placed under MV (p < 0.001). Higher BMI was also associated with longer ICU (p = 0.001) and hospital stays (p = 0.049). Patients with obesity and low SMI had longer ICU (p = 0.033), and hospital (p < 0.001) stays, and extended MV duration compared to those with obesity and normal SMI (p = 0.003).</div></div><div><h3>Conclusions</h3><div>BMI, low SMI, and low SMD were not associated with in-hospital mortality in this cohort. However, these parameters were important predictors of morbidity, including longer ICU and hospital stays, greater need for mechanical ventilation, and ICU readmissions. These findings highlight the importance of assessing body composition parameters in critically ill patients with COVI","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102878"},"PeriodicalIF":2.6,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751780","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}
Recurrent uncomplicated cystitis is highly prevalent among women. Antioxidants are often used as adjunctive therapy in urinary tract infections (UTIs) to counteract oxidative stress and restore a healthy urinary environment. This study aimed to evaluate the effect of vitamin E on the treatment and prevention of recurrent lower UTIs in women.
Materials and methods
This clinical trial included 88 female patients over 18 years old with lower UTI who were referred to the infectious diseases clinic at Vali-Asr Hospital in Birjand. Patients were initially assessed 3–5 days after starting antibiotics, and then at 3 and 6 month intervals for urinary symptoms and UTI recurrence. Patients were randomly assigned into one of the following groups: control group receiving antibiotics and a placebo, and the intervention group receiving antibiotics along with 100 IU of vitamin E daily. After completing a 3-day course of cefixime (400 mg/day), the intervention group continued vitamin E supplementation for six months. Data analysis was performed using SPSS version 19, with statistical significance set at P < 0.05.
Results
The mean age of the patients was 45.48 ± 14.23 years. After 3 days, the intervention group showed a significant improvement in urinary frequency and dysuria compared to the control group (P < 0.05), while improvement in urgency did not significantly differ between groups (P = 0.43). At 3 and 6 month intervals, UTI recurrence was significantly lower in the intervention group (P < 0.001; effect size = 0.52 and 0.69, respectively). Additionally, the average duration of recovery was significantly faster in the intervention group compared to the control group (P = 0.002).
Conclusion
Supplementing women with lower UTI with 100 IU of vitamin E daily to the antibiotic regimen significantly reduces recovery time, improves urinary symptoms (frequency and dysuria), and lowers UTI recurrence rates. However, further randomized clinical trials with large sample size are recommended to confirm these findings.
Trial registration
Iranian Registry of Clinical Trials Identifier: IRCT20210617051604N1 (July 11, 2021).
{"title":"Effect of vitamin E supplementation on recovery and recurrence prevention in women with lower urinary tract infections: A triple-blind randomized clinical trial","authors":"Hajar Mafakher , Azadeh Ebrahimzadeh , Adeleh Sahebnasagh , Melika Ramezani , Razieh Avan","doi":"10.1016/j.clnesp.2025.102876","DOIUrl":"10.1016/j.clnesp.2025.102876","url":null,"abstract":"<div><h3>Background and objective</h3><div>Recurrent uncomplicated cystitis is highly prevalent among women. Antioxidants are often used as adjunctive therapy in urinary tract infections (UTIs) to counteract oxidative stress and restore a healthy urinary environment. This study aimed to evaluate the effect of vitamin E on the treatment and prevention of recurrent lower UTIs in women.</div></div><div><h3>Materials and methods</h3><div>This clinical trial included 88 female patients over 18 years old with lower UTI who were referred to the infectious diseases clinic at Vali-Asr Hospital in Birjand. Patients were initially assessed 3–5 days after starting antibiotics, and then at 3 and 6 month intervals for urinary symptoms and UTI recurrence. Patients were randomly assigned into one of the following groups: control group receiving antibiotics and a placebo, and the intervention group receiving antibiotics along with 100 IU of vitamin E daily. After completing a 3-day course of cefixime (400 mg/day), the intervention group continued vitamin E supplementation for six months. Data analysis was performed using SPSS version 19, with statistical significance set at P < 0.05.</div></div><div><h3>Results</h3><div>The mean age of the patients was 45.48 ± 14.23 years. After 3 days, the intervention group showed a significant improvement in urinary frequency and dysuria compared to the control group (P < 0.05), while improvement in urgency did not significantly differ between groups (P = 0.43). At 3 and 6 month intervals, UTI recurrence was significantly lower in the intervention group (P < 0.001; effect size = 0.52 and 0.69, respectively). Additionally, the average duration of recovery was significantly faster in the intervention group compared to the control group (P = 0.002).</div></div><div><h3>Conclusion</h3><div>Supplementing women with lower UTI with 100 IU of vitamin E daily to the antibiotic regimen significantly reduces recovery time, improves urinary symptoms (frequency and dysuria), and lowers UTI recurrence rates. However, further randomized clinical trials with large sample size are recommended to confirm these findings.</div></div><div><h3>Trial registration</h3><div>Iranian Registry of Clinical Trials Identifier: IRCT20210617051604N1 (July 11, 2021).</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102876"},"PeriodicalIF":2.6,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145751708","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 : 2025-12-06DOI: 10.1016/j.clnesp.2025.102848
Maryory Galvis-Pedraza , Anja Visser-Faassen , Ineke J. Riphagen , Laura Kalsbeek , Hanneke Buter , E. Christiaan Boerma , Tim van Zutphen , Lise F.E. Beumeler
Background and aims
Low blood vitamin levels are common in intensive care unit (ICU) patients and may exacerbate clinical outcomes. Inflammatory status associated with critical illness is known to influence circulating concentrations. This study aimed to assess blood vitamin levels at ICU admission and explore the relationship between dietary intake and blood availability. It also examined the interconnection of multiple low blood vitamin levels, inflammatory status (C-reactive protein concentration), physical frailty and ICU characteristics.
Methods
A cross-sectional study was conducted in a tertiary teaching hospital ICU. Patient records were collected within 24 h after admission; phase angle and ultrasound measurements of rectus femoris muscle thickness (QMLT) were taken within 72 h. Pre-admission diet was retrospectively captured by structured recall (patient/proxy) with the Dutch Eetmeter. Blood vitamin and CRP levels were analysed according to ESPEN guidelines. Descriptive statistics, bootstrapping and regression analyses looking for association between CRP and vitamin levels were applied.
Results
A total of 79 ICU patients (69 years [95 % CI, 67–72]; 75 % men) were included; 67.1 % had two or more vitamins below reference range, predominantly in vitamin D (78.5 %), followed by vitamin A (43.0 %), and vitamin C (40.5 %). Significant differences in hospital length of stay were identified in patients with multiple low levels (10 [95 % CI, 7–14] vs 6 days [95 % CI, 5–9], p = 0.015). Discordance between estimated dietary intake and blood levels were observed, particularly for vitamins B6, B12 and E. Higher CRP was independently associated with lower vitamin C, A and B9, and higher vitamin B12 blood sample concentration.
Conclusions
Low blood vitamin levels and low dietary vitamin intake were common at ICU admission. Inflammation significantly affected circulating concentrations. Discordance between estimated intake and blood levels were frequent. Patients with multiple low blood vitamin levels had longer hospital trajectories. This study emphasizes the need for individual nutritional care in critical illness.
{"title":"Prevalence of low blood vitamin levels in critically ill patients at intensive care unit admission: A cross-sectional study","authors":"Maryory Galvis-Pedraza , Anja Visser-Faassen , Ineke J. Riphagen , Laura Kalsbeek , Hanneke Buter , E. Christiaan Boerma , Tim van Zutphen , Lise F.E. Beumeler","doi":"10.1016/j.clnesp.2025.102848","DOIUrl":"10.1016/j.clnesp.2025.102848","url":null,"abstract":"<div><h3>Background and aims</h3><div>Low blood vitamin levels are common in intensive care unit (ICU) patients and may exacerbate clinical outcomes. Inflammatory status associated with critical illness is known to influence circulating concentrations. This study aimed to assess blood vitamin levels at ICU admission and explore the relationship between dietary intake and blood availability. It also examined the interconnection of multiple low blood vitamin levels, inflammatory status (C-reactive protein concentration), physical frailty and ICU characteristics.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted in a tertiary teaching hospital ICU. Patient records were collected within 24 h after admission; phase angle and ultrasound measurements of rectus femoris muscle thickness (QMLT) were taken within 72 h. Pre-admission diet was retrospectively captured by structured recall (patient/proxy) with the Dutch Eetmeter. Blood vitamin and CRP levels were analysed according to ESPEN guidelines. Descriptive statistics, bootstrapping and regression analyses looking for association between CRP and vitamin levels were applied.</div></div><div><h3>Results</h3><div>A total of 79 ICU patients (69 years [95 % CI, 67–72]; 75 % men) were included; 67.1 % had two or more vitamins below reference range, predominantly in vitamin D (78.5 %), followed by vitamin A (43.0 %), and vitamin C (40.5 %). Significant differences in hospital length of stay were identified in patients with multiple low levels (10 [95 % CI, 7–14] vs 6 days [95 % CI, 5–9], p = 0.015). Discordance between estimated dietary intake and blood levels were observed, particularly for vitamins B6, B12 and E. Higher CRP was independently associated with lower vitamin C, A and B9, and higher vitamin B12 blood sample concentration.</div></div><div><h3>Conclusions</h3><div>Low blood vitamin levels and low dietary vitamin intake were common at ICU admission. Inflammation significantly affected circulating concentrations. Discordance between estimated intake and blood levels were frequent. Patients with multiple low blood vitamin levels had longer hospital trajectories. This study emphasizes the need for individual nutritional care in critical illness.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102848"},"PeriodicalIF":2.6,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707665","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 : 2025-12-06DOI: 10.1016/j.clnesp.2025.102846
Cássia Surama Oliveira da Silva , Rafaella Cristhine Pordeus Luna , Mussara Gomes Cavalcanti Alves Monteiro , Carla Patricia Novaes dos Santos Fechine , Josean Fechine Tavares , Augusto Lopes Souto , Flávia Cristina Fernandes Pimenta , Ana Herminia Andrade e Silva , Alcides da Silva Diniz , Celso Costa da Silva Júnior , Caio César Ferreira Alverga , Sócrates Golzio dos Santos , Darlene Camati Persuhn , Maria José de Carvalho Costa
Background & aims
Limited knowledge exists regarding the protective effects of dietary fiber on high-density lipoprotein (HDL) levels and blood pressure (BP). This study aimed to examine associations between cardiometabolic and lifestyle risk variables, with emphasis on HDL metabolites, following a mixed dietary fiber intervention in hypertensive and normotensive overweight women.
Methods
This randomized, double-blind, placebo-controlled trial included four groups: Group 1 (G1, hypertensive) and Group 3 (G3, normotensive) received 12 g/day of mixed dietary fiber, whereas Group 2 (G2, hypertensive) and Group 4 (G4, normotensive) received a placebo (corn starch) for 8 weeks.
Results
Significant associations were observed in G1 and G3. In G1, increases in total serum HDL cholesterol (HDL-C) were positively associated with increases in the relative peak areas of HDL metabolites at 0.84 ppm and 0.88 ppm, and negatively associated with HDL at 1.24 ppm. In G3, positive associations were observed between total serum HDL-C and HDL metabolites at 0.88 ppm and 1.24 ppm. Additionally, reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were found in G1, and reductions in SBP were found in G3 and G4.
Conclusions
These HDL metabolites may serve as potential targets for the prevention of cardiovascular risk factors, particularly through increasing HDL-C and reducing total cholesterol and BP, as observed in this sample following the mixed dietary fiber intervention.
Brazilian Registry of Clinical Trials: RBR-2PH4F9 https://ensaiosclinicos.gov.br/rg/RBR-2ph4f9.
{"title":"Association of cardiometabolic and lifestyle risk variables with high-density lipoprotein metabolites in hypertensive and normotensive overweight women: Findings from a randomized trial of mixed dietary fibers","authors":"Cássia Surama Oliveira da Silva , Rafaella Cristhine Pordeus Luna , Mussara Gomes Cavalcanti Alves Monteiro , Carla Patricia Novaes dos Santos Fechine , Josean Fechine Tavares , Augusto Lopes Souto , Flávia Cristina Fernandes Pimenta , Ana Herminia Andrade e Silva , Alcides da Silva Diniz , Celso Costa da Silva Júnior , Caio César Ferreira Alverga , Sócrates Golzio dos Santos , Darlene Camati Persuhn , Maria José de Carvalho Costa","doi":"10.1016/j.clnesp.2025.102846","DOIUrl":"10.1016/j.clnesp.2025.102846","url":null,"abstract":"<div><h3>Background & aims</h3><div>Limited knowledge exists regarding the protective effects of dietary fiber on high-density lipoprotein (HDL) levels and blood pressure (BP). This study aimed to examine associations between cardiometabolic and lifestyle risk variables, with emphasis on HDL metabolites, following a mixed dietary fiber intervention in hypertensive and normotensive overweight women.</div></div><div><h3>Methods</h3><div>This randomized, double-blind, placebo-controlled trial included four groups: Group 1 (G1, hypertensive) and Group 3 (G3, normotensive) received 12 g/day of mixed dietary fiber, whereas Group 2 (G2, hypertensive) and Group 4 (G4, normotensive) received a placebo (corn starch) for 8 weeks.</div></div><div><h3>Results</h3><div>Significant associations were observed in G1 and G3. In G1, increases in total serum HDL cholesterol (HDL-C) were positively associated with increases in the relative peak areas of HDL metabolites at 0.84 ppm and 0.88 ppm, and negatively associated with HDL at 1.24 ppm. In G3, positive associations were observed between total serum HDL-C and HDL metabolites at 0.88 ppm and 1.24 ppm. Additionally, reductions in systolic blood pressure (SBP) and diastolic blood pressure (DBP) were found in G1, and reductions in SBP were found in G3 and G4.</div></div><div><h3>Conclusions</h3><div>These HDL metabolites may serve as potential targets for the prevention of cardiovascular risk factors, particularly through increasing HDL-C and reducing total cholesterol and BP, as observed in this sample following the mixed dietary fiber intervention.</div><div>Brazilian Registry of Clinical Trials: RBR-2PH4F9 <span><span>https://ensaiosclinicos.gov.br/rg/RBR-2ph4f9</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102846"},"PeriodicalIF":2.6,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707598","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 : 2025-12-05DOI: 10.1016/j.clnesp.2025.11.163
André Luiz de Góes Pacheco , Gabriela Carvalho Jurema Santos , Denise Mirelli Leão Costa , João Victor Cavalcanti Fraga , Henrique Silva Sacramento , Jonathan Manoel da Costa , Shyrley Fernanda Mbanze , Cheid Chongo , Jéssica Gonzaga Pereira , Thiago França de Santana , Fabiane de Oliveira Freitas , Estevan Luiz da Silva , Jaime Cesar dos Santos Fh , Rafael dos Santos Henrique , Carol Góis Leandro
Background & aims
Accurate diagnosis of obesity relies on valid body composition assessment methods. Dual-energy X-ray absorptiometry (DEXA) is the clinical gold standard for assessing body composition. Still, it is costly, leading to the widespread use of bioelectrical impedance analysis (BIA) scales, which often yield values that differ from those obtained with DEXA. This study aimed to: (a) quantify the error between anthropometric variables measured by BIA and DEXA; (b) identify variables with the highest and lowest errors, including sex- and body mass index (BMI)- specific analyses; and (c) propose a percentile-based calibration and ordinary least squares (OLS) linear regression method to reduce measurement error.
Methods
Sixty-one participants (33 men, 28 women; aged 24–63 years) underwent height, weight, BMI, and body composition assessments using BIA and DEXA. A mirrored dataset was created using both methods. A linear-percentile calibration and OLS approach was used to align empirical quantiles, adjusting BIA measurements to DEXA standards.
Results
After calibration, the variables showed the highest predictive accuracy, while the trunk and limb BFM variables performed the worst, with trunk FFM (fat-free mass) improving only by the OLS method. Calibration reduced errors in most BMI and sex groups, except for trunk FFM and leg FFM, for which calibration showed no benefit.
Conclusion
BIA demonstrates systematic measurement errors compared to DEXA. However, calibration through percentile alignment led to notable improvements, with the regression models showing a significant improvement in agreement between methods within this sample. offering a practical strategy to enhance the accuracy of BIA-based assessments in clinical and research contexts.
{"title":"Error reduction as a calibration strategy for body composition measurements: A comparison between bioelectrical impedance analysis and dual-energy X-ray absorption","authors":"André Luiz de Góes Pacheco , Gabriela Carvalho Jurema Santos , Denise Mirelli Leão Costa , João Victor Cavalcanti Fraga , Henrique Silva Sacramento , Jonathan Manoel da Costa , Shyrley Fernanda Mbanze , Cheid Chongo , Jéssica Gonzaga Pereira , Thiago França de Santana , Fabiane de Oliveira Freitas , Estevan Luiz da Silva , Jaime Cesar dos Santos Fh , Rafael dos Santos Henrique , Carol Góis Leandro","doi":"10.1016/j.clnesp.2025.11.163","DOIUrl":"10.1016/j.clnesp.2025.11.163","url":null,"abstract":"<div><h3>Background & aims</h3><div>Accurate diagnosis of obesity relies on valid body composition assessment methods. Dual-energy X-ray absorptiometry (DEXA) is the clinical gold standard for assessing body composition. Still, it is costly, leading to the widespread use of bioelectrical impedance analysis (BIA) scales, which often yield values that differ from those obtained with DEXA. This study aimed to: (a) quantify the error between anthropometric variables measured by BIA and DEXA; (b) identify variables with the highest and lowest errors, including sex- and body mass index (BMI)- specific analyses; and (c) propose a percentile-based calibration and ordinary least squares (OLS) linear regression method to reduce measurement error.</div></div><div><h3>Methods</h3><div>Sixty-one participants (33 men, 28 women; aged 24–63 years) underwent height, weight, BMI, and body composition assessments using BIA and DEXA. A mirrored dataset was created using both methods. A linear-percentile calibration and OLS approach was used to align empirical quantiles, adjusting BIA measurements to DEXA standards.</div></div><div><h3>Results</h3><div>After calibration, the variables showed the highest predictive accuracy, while the trunk and limb BFM variables performed the worst, with trunk FFM (fat-free mass) improving only by the OLS method. Calibration reduced errors in most BMI and sex groups, except for trunk FFM and leg FFM, for which calibration showed no benefit.</div></div><div><h3>Conclusion</h3><div>BIA demonstrates systematic measurement errors compared to DEXA. However, calibration through percentile alignment led to notable improvements, with the regression models showing a significant improvement in agreement between methods within this sample. offering a practical strategy to enhance the accuracy of BIA-based assessments in clinical and research contexts.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102843"},"PeriodicalIF":2.6,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699928","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 : 2025-12-04DOI: 10.1016/j.clnesp.2025.11.157
Animesh Saha , Shreya Manna , Biplab Sarkar , Subhrasnigdha Biswal , Kirubha George , Sandipan Roy Chowdhury , Swati Modak
Background
Curative-intent radiotherapy (RT) or chemoradiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC) frequently leads to mucositis, dysphagia, and odynophagia, resulting in nutritional compromise, weight loss, and the need for feeding tube (FT) insertion. This study aimed to develop and internally validate an artificial neural network (ANN)–based machine learning model to predict patients at risk of requiring reactive FT insertion, >10 % weight loss, or grade ≥3 dysphagia during or after treatment.
Methods
This prospective, single-institutional observational study included 100 patients with HNSCC treated between August 2022 and June 2024. Clinical and dosimetric data were collected, including prescription planning target volume (prescPTV), total PTV, and mean doses to the oral cavity, superior–middle pharyngeal constrictor (SMPC), inferior pharyngeal constrictor (IPC), cervical esophagus, esophageal inlet muscle (EIM), larynx, pharyngeal mucosa (PM), and base of tongue (BOT). Toxicities were graded using CTCAE v5.0. An “event” was defined as reactive FT placement, >10 % weight loss, or grade ≥3 dysphagia. Binary logistic regression analyses and a multilayer perceptron ANN model were applied, using a 67:33 training–testing split.
Results
Of 100 patients (median age = 54 years; 74 % male), 47 % received concurrent chemotherapy. Grade ≥3 dysphagia or FT placement occurred in 62 % of cases. Mean oral cavity dose >50.3 Gy and concurrent chemotherapy were significantly associated with the event (AUC = 0.646). The ANN model achieved 81.1 % accuracy with an AUC = 0.896. The most influential predictors (normalized importance) were concurrent chemotherapy (91.5 %), mean oral cavity dose (83.3 %), mean BOT dose (79.8 %), mean EIM dose (65.3 %), and mean glottic larynx dose (58.6 %).
Conclusion
The ANN-based model demonstrated strong predictive performance for identifying patients at risk of aggressive nutritional intervention during RT/CRT for HNSCC. Incorporating mean oral cavity dose and chemotherapy status into treatment planning may facilitate early nutritional assessment and proactive feeding support. External validation in larger cohorts is warranted.
{"title":"Application of machine learning to create a prediction model for the need of aggressive nutritional intervention during head & neck cancer radiotherapy","authors":"Animesh Saha , Shreya Manna , Biplab Sarkar , Subhrasnigdha Biswal , Kirubha George , Sandipan Roy Chowdhury , Swati Modak","doi":"10.1016/j.clnesp.2025.11.157","DOIUrl":"10.1016/j.clnesp.2025.11.157","url":null,"abstract":"<div><h3>Background</h3><div>Curative-intent radiotherapy (RT) or chemoradiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC) frequently leads to mucositis, dysphagia, and odynophagia, resulting in nutritional compromise, weight loss, and the need for feeding tube (FT) insertion. This study aimed to develop and internally validate an artificial neural network (ANN)–based machine learning model to predict patients at risk of requiring reactive FT insertion, >10 % weight loss, or grade ≥3 dysphagia during or after treatment.</div></div><div><h3>Methods</h3><div>This prospective, single-institutional observational study included 100 patients with HNSCC treated between August 2022 and June 2024. Clinical and dosimetric data were collected, including prescription planning target volume (prescPTV), total PTV, and mean doses to the oral cavity, superior–middle pharyngeal constrictor (SMPC), inferior pharyngeal constrictor (IPC), cervical esophagus, esophageal inlet muscle (EIM), larynx, pharyngeal mucosa (PM), and base of tongue (BOT). Toxicities were graded using CTCAE v5.0. An “event” was defined as reactive FT placement, >10 % weight loss, or grade ≥3 dysphagia. Binary logistic regression analyses and a multilayer perceptron ANN model were applied, using a 67:33 training–testing split.</div></div><div><h3>Results</h3><div>Of 100 patients (median age = 54 years; 74 % male), 47 % received concurrent chemotherapy. Grade ≥3 dysphagia or FT placement occurred in 62 % of cases. Mean oral cavity dose >50.3 Gy and concurrent chemotherapy were significantly associated with the event (AUC = 0.646). The ANN model achieved 81.1 % accuracy with an AUC = 0.896. The most influential predictors (normalized importance) were concurrent chemotherapy (91.5 %), mean oral cavity dose (83.3 %), mean BOT dose (79.8 %), mean EIM dose (65.3 %), and mean glottic larynx dose (58.6 %).</div></div><div><h3>Conclusion</h3><div>The ANN-based model demonstrated strong predictive performance for identifying patients at risk of aggressive nutritional intervention during RT/CRT for HNSCC. Incorporating mean oral cavity dose and chemotherapy status into treatment planning may facilitate early nutritional assessment and proactive feeding support. External validation in larger cohorts is warranted.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102837"},"PeriodicalIF":2.6,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696007","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}
Myostatin (M), activin-A (A) and follistatin (F), three TGF-β superfamily members, play a role in cancer sarcopenia. The aim of our study was to assess the association of MAF in head and neck cancer (HNC) skeletal muscle loss.
Materials and methods
This prospective study involved 55 patients, 32 with HNC and 23 controls. The patients underwent a full nutritional assessment just before surgery. Tumor, muscle and plasma were harvested at the time of surgery. Plasma was harvested a second time 7 days after the procedure. Tumor explants were cultured and MAF were measured in the incubation medium.
Results
A and F plasma levels were higher in cancer patients compared to control (320 vs. 203 pg/ml, p < 0.001, ES = 0.96 95 % CI [0.40; 1.52] and 3593 vs 2148 pg/ml, p < 0.001, ES = 1.10 95%CI [0.53; 1.66], respectively) and M plasma level lower (1542 vs. 2100 pg/ml, p = 0.01, ES = −0.70 95%CI [-1.24; −0.15]). M plasma level was correlated with the skeletal muscle index at the third lumbar vertebra (r = 0.44; p < 0.05) and negatively correlated with weight loss (r = −0.65; p < 0.05) and the C Reactive protein level (−0.44; p = 0.02). At the seventh postoperative day (D), A was increased (D7 vs D0) in the cancer group (379 vs 320 pg/ml; p < 0.001) while the concentrations of M and F were unchanged from the presurgical level. There was no difference between groups in the transcript levels of M and A in skeletal muscles. MAF were systematically detected in the tumor incubation medium with no correlation between tumor incubation medium level and plasma level at D0.
Conclusion
The MAF secretory profile is modified in HNC. In particular, A seems to play a role in muscle loss while F protects against skeletal muscle mass loss.
{"title":"Myostatin, activin-A and follistatin are produced by the tumor in head and neck cancer and likely contribute to sarcopenia: A case-control, cross-sectional exploratory study","authors":"Nicolas Saroul , Alexis Dissard , Bruno Pereira , Thierry Mom , Yves Boirie , Laurent Gilain , Mathilde Puechmaille , Veronique Patrac , Jérôme Salles , Stéphane Walrand","doi":"10.1016/j.clnesp.2025.11.159","DOIUrl":"10.1016/j.clnesp.2025.11.159","url":null,"abstract":"<div><h3>Background and aims</h3><div>Myostatin (M), activin-A (A) and follistatin (F), three TGF-β superfamily members, play a role in cancer sarcopenia. The aim of our study was to assess the association of MAF in head and neck cancer (HNC) skeletal muscle loss.</div></div><div><h3>Materials and methods</h3><div>This prospective study involved 55 patients, 32 with HNC and 23 controls. The patients underwent a full nutritional assessment just before surgery. Tumor, muscle and plasma were harvested at the time of surgery. Plasma was harvested a second time 7 days after the procedure. Tumor explants were cultured and MAF were measured in the incubation medium.</div></div><div><h3>Results</h3><div>A and F plasma levels were higher in cancer patients compared to control (320 vs. 203 pg/ml, p < 0.001, ES = 0.96 95 % CI [0.40; 1.52] and 3593 vs 2148 pg/ml, p < 0.001, ES = 1.10 95%CI [0.53; 1.66], respectively) and M plasma level lower (1542 vs. 2100 pg/ml, p = 0.01, ES = −0.70 95%CI [-1.24; −0.15]). M plasma level was correlated with the skeletal muscle index at the third lumbar vertebra (r = 0.44; p < 0.05) and negatively correlated with weight loss (r = −0.65; p < 0.05) and the C Reactive protein level (−0.44; p = 0.02). At the seventh postoperative day (D), A was increased (D7 vs D0) in the cancer group (379 vs 320 pg/ml; p < 0.001) while the concentrations of M and F were unchanged from the presurgical level. There was no difference between groups in the transcript levels of M and A in skeletal muscles. MAF were systematically detected in the tumor incubation medium with no correlation between tumor incubation medium level and plasma level at D0.</div></div><div><h3>Conclusion</h3><div>The MAF secretory profile is modified in HNC. In particular, A seems to play a role in muscle loss while F protects against skeletal muscle mass loss.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102839"},"PeriodicalIF":2.6,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667471","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 : 2025-12-02DOI: 10.1016/j.clnesp.2025.11.156
Ana T. Arias-Marroquín , Ivan Torre-Villalvazo , Omar Granados Portillo , Mariana Villegas-Romero , Alberto Camacho-Morales , Armando R. Tovar , Carlos A. Aguilar Salinas , Daniel Illescas-Zárate , Natalia Vázquez-Manjarrez
Background
Ceramides (Cer) are signaling sphingolipids that participate in insulin signaling, mitochondrial integrity, and inflammation. In obesity and insulin resistance (IR), Cer biosynthesis is exacerbated, leading to metabolic dysfunction and chronic diseases.
Objective
This narrative review synthesizes current evidence on how Cer metabolism can be modulated through dietary components and dietary patterns, with emphasis on lipidomic analyses.
Key findings
The synthesis and accumulation of Cer are influenced by dietary abundance and quality, such as carbohydrates, fat and phenolic compounds. High-fructose corn syrup and saturated fatty acids promote Cer accumulation and IR, while monounsaturated and polyunsaturated fatty acids—abundant in the Mediterranean and Nordic diets—attenuate these effects. Polyphenol-rich foods and caloric restriction may also reduce Cer concentrations and improve metabolic markers. The emerging evidence from lipidomic analyses is expanding our knowledge on the role of diet in Cer modulation.
Conclusion
Nutritional strategies targeting ceramide metabolism represent a promising approach to improve metabolic health. Beyond their therapeutic potential, ceramides also emerge as dynamic lipidomic biomarkers capable of reflecting early metabolic changes and monitoring the efficacy of nutritional interventions.
{"title":"Modulation of ceramides through nutrition: A new target in obesity and insulin resistance (Narrative Review)","authors":"Ana T. Arias-Marroquín , Ivan Torre-Villalvazo , Omar Granados Portillo , Mariana Villegas-Romero , Alberto Camacho-Morales , Armando R. Tovar , Carlos A. Aguilar Salinas , Daniel Illescas-Zárate , Natalia Vázquez-Manjarrez","doi":"10.1016/j.clnesp.2025.11.156","DOIUrl":"10.1016/j.clnesp.2025.11.156","url":null,"abstract":"<div><h3>Background</h3><div>Ceramides (Cer) are signaling sphingolipids that participate in insulin signaling, mitochondrial integrity, and inflammation. In obesity and insulin resistance (IR), Cer biosynthesis is exacerbated, leading to metabolic dysfunction and chronic diseases.</div></div><div><h3>Objective</h3><div>This narrative review synthesizes current evidence on how Cer metabolism can be modulated through dietary components and dietary patterns, with emphasis on lipidomic analyses.</div></div><div><h3>Key findings</h3><div>The synthesis and accumulation of Cer are influenced by dietary abundance and quality, such as carbohydrates, fat and phenolic compounds. High-fructose corn syrup and saturated fatty acids promote Cer accumulation and IR, while monounsaturated and polyunsaturated fatty acids—abundant in the Mediterranean and Nordic diets—attenuate these effects. Polyphenol-rich foods and caloric restriction may also reduce Cer concentrations and improve metabolic markers. The emerging evidence from lipidomic analyses is expanding our knowledge on the role of diet in Cer modulation.</div></div><div><h3>Conclusion</h3><div>Nutritional strategies targeting ceramide metabolism represent a promising approach to improve metabolic health. Beyond their therapeutic potential, ceramides also emerge as dynamic lipidomic biomarkers capable of reflecting early metabolic changes and monitoring the efficacy of nutritional interventions.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102836"},"PeriodicalIF":2.6,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676727","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 : 2025-12-02DOI: 10.1016/j.clnesp.2025.11.132
Alysia Bastas , Kyle Williams , Darren Wong
Aim
Glucagon-like peptide-2 analogues are part of the treatment algorithm for chronic intestinal failure to improve enteral nutrient absorption and reduce reliance on parenteral support. The purpose of this review is to update, consolidate and comprehensively evaluate the existing body of evidence, highlighting the breadth of positive clinical outcomes associated with glucagon-like peptide-2 analogue treatment.
Methods
A systematic review was conducted using OVID Medline, Embase, Cochrane Library, CINAHL, and Web of Science. Studies reporting on glucagon-like peptide-2 analogue use in adults focusing on any change in clinical outcomes were included, while studies reporting solely biochemical outcomes were excluded. Meta-analyses and meta-regressions were conducted using R software. Where insufficient data was present, results were pooled and weighted by sample size or presented as a narrative synthesis.
Results
23 studies were included in the final review and analysis. Teduglutide demonstrated a positive and incremental effect on the proportion of short bowel syndrome-associated intestinal failure patients achieving a ≥20 % reduction in PS requirements, with response rates increasing from 64 % (95 % CI: 51 %–75 %) at 6 months to 73 % (95 % CI: 65 %–80 %) after ≥2 years of therapy. A similar trend was observed in patients achieving enteral autonomy, which rose from 13 % (95 % CI: 6 %–25 %) at 6 months to 31 % (95 % CI: 23 %–40 %) after ≥2 years of treatment. Moreover, early data shows teduglutide to have a positive effect on quality of life and stool characteristics of patients. Teduglutide appears to be an acceptable therapy, with a discontinuation rate of 14 %. Early reports suggest similar benefits for emerging GLP-2 including glepaglutide and apraglutide.
{"title":"Positive clinical outcomes associated with use of glucagon-like peptide-2 (GLP-2) analogues in patients with intestinal failure: A systematic review and meta-analysis","authors":"Alysia Bastas , Kyle Williams , Darren Wong","doi":"10.1016/j.clnesp.2025.11.132","DOIUrl":"10.1016/j.clnesp.2025.11.132","url":null,"abstract":"<div><h3>Aim</h3><div>Glucagon-like peptide-2 analogues are part of the treatment algorithm for chronic intestinal failure to improve enteral nutrient absorption and reduce reliance on parenteral support. The purpose of this review is to update, consolidate and comprehensively evaluate the existing body of evidence, highlighting the breadth of positive clinical outcomes associated with glucagon-like peptide-2 analogue treatment.</div></div><div><h3>Methods</h3><div>A systematic review was conducted using OVID Medline, Embase, Cochrane Library, CINAHL, and Web of Science. Studies reporting on glucagon-like peptide-2 analogue use in adults focusing on any change in clinical outcomes were included, while studies reporting solely biochemical outcomes were excluded. Meta-analyses and meta-regressions were conducted using R software. Where insufficient data was present, results were pooled and weighted by sample size or presented as a narrative synthesis.</div></div><div><h3>Results</h3><div>23 studies were included in the final review and analysis. Teduglutide demonstrated a positive and incremental effect on the proportion of short bowel syndrome-associated intestinal failure patients achieving a ≥20 % reduction in PS requirements, with response rates increasing from 64 % (95 % CI: 51 %–75 %) at 6 months to 73 % (95 % CI: 65 %–80 %) after ≥2 years of therapy. A similar trend was observed in patients achieving enteral autonomy, which rose from 13 % (95 % CI: 6 %–25 %) at 6 months to 31 % (95 % CI: 23 %–40 %) after ≥2 years of treatment. Moreover, early data shows teduglutide to have a positive effect on quality of life and stool characteristics of patients. Teduglutide appears to be an acceptable therapy, with a discontinuation rate of 14 %. Early reports suggest similar benefits for emerging GLP-2 including glepaglutide and apraglutide.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102817"},"PeriodicalIF":2.6,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676758","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 : 2025-12-02DOI: 10.1016/j.clnesp.2025.11.164
Alana Smaniotto Biolo , Rafael Vinícius Patzer , Rosicler Colet , Ana Luiza Lira , Geciane Toniazzo Backes , Jamile Zeni , André Keng Wei Hsu
Objective
This study aimed to develop and validate an instant powdered broth, reconstitutable as a clear liquid, to shorten preoperative fasting, in accordance with ERAS and ACERTO protocols. Prolonged fasting is associated with discomfort, increased insulin resistance, and delayed recovery, while carbohydrate-rich clear liquids consumed up to 2 h before anesthesia are considered safe and beneficial.
Methods
Three formulations were prepared using maltodextrin, glucose, sodium chloride, and chicken flavoring, all fat-free and with high caloric value. After microbiological and sensory analyses with 30 evaluators, the most accepted formulation was selected for physicochemical characterization and clinical evaluation. Gastric emptying was assessed in 29 healthy volunteers (18–65 years) after consumption of 200 mL of the broth 2 h before elective surgery. Gastric ultrasound was performed in 28 participants using standardized qualitative assessment of the gastric antrum, while one participant underwent abdominal computed tomography (CT) solely as an illustrative and confirmatory imaging method. Subjective perceptions of satiety, thirst, palatability, and satisfaction were collected through questionnaires.
Results
The product showed pH 5.17, low water activity, clear appearance, and microbiological safety. Imaging demonstrated adequate gastric emptying in all participants 2 h after consumption. Subjectively, 60 % reported complete satiety, 75 % absence of thirst, 71 % approved palatability, and 92 % expressed overall satisfaction.
Conclusion
The developed broth proved to be a safe, palatable, and effective clear fluid alternative to reduce preoperative fasting, offering an innovative, low-cost option with potential application in hospital settings and personalized nutritional therapy.
{"title":"Development of an instantly reconstitutable powdered broth as a clear fluid to shorten preoperative fasting","authors":"Alana Smaniotto Biolo , Rafael Vinícius Patzer , Rosicler Colet , Ana Luiza Lira , Geciane Toniazzo Backes , Jamile Zeni , André Keng Wei Hsu","doi":"10.1016/j.clnesp.2025.11.164","DOIUrl":"10.1016/j.clnesp.2025.11.164","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to develop and validate an instant powdered broth, reconstitutable as a clear liquid, to shorten preoperative fasting, in accordance with ERAS and ACERTO protocols. Prolonged fasting is associated with discomfort, increased insulin resistance, and delayed recovery, while carbohydrate-rich clear liquids consumed up to 2 h before anesthesia are considered safe and beneficial.</div></div><div><h3>Methods</h3><div>Three formulations were prepared using maltodextrin, glucose, sodium chloride, and chicken flavoring, all fat-free and with high caloric value. After microbiological and sensory analyses with 30 evaluators, the most accepted formulation was selected for physicochemical characterization and clinical evaluation. Gastric emptying was assessed in 29 healthy volunteers (18–65 years) after consumption of 200 mL of the broth 2 h before elective surgery. Gastric ultrasound was performed in 28 participants using standardized qualitative assessment of the gastric antrum, while one participant underwent abdominal computed tomography (CT) solely as an illustrative and confirmatory imaging method. Subjective perceptions of satiety, thirst, palatability, and satisfaction were collected through questionnaires.</div></div><div><h3>Results</h3><div>The product showed pH 5.17, low water activity, clear appearance, and microbiological safety. Imaging demonstrated adequate gastric emptying in all participants 2 h after consumption. Subjectively, 60 % reported complete satiety, 75 % absence of thirst, 71 % approved palatability, and 92 % expressed overall satisfaction.</div></div><div><h3>Conclusion</h3><div>The developed broth proved to be a safe, palatable, and effective clear fluid alternative to reduce preoperative fasting, offering an innovative, low-cost option with potential application in hospital settings and personalized nutritional therapy.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"71 ","pages":"Article 102844"},"PeriodicalIF":2.6,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676594","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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