Clinical nutrition最新文献

{"title":"Retrospective real world study on vitamin D supplementation: Looking for the most effective molecule and its frequency of use","authors":"Andrea Crafa ,&nbsp;Rossella Cannarella ,&nbsp;Vittorio Cannarella ,&nbsp;Rosita A. Condorelli ,&nbsp;Sandro La Vignera ,&nbsp;Aldo E. Calogero","doi":"10.1016/j.clnu.2025.03.004","DOIUrl":"10.1016/j.clnu.2025.03.004","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>There is still uncertainty regarding the optimal serum levels 25-Hydroxy-vitamin D [25(OH)D] and the most effective supplementation strategies, including the choice of molecule and its dosing frequency. The aim of the study is to compare the effects of calcifediol versus two different frequencies of cholecalciferol administration on vitamin D supplementation, and to identity the key parameters that predict response to treatment.</div></div><div><h3>Methods</h3><div>This retrospective, real-world cohort study included 105 patients, who were divided into three groups. Group 1 (n = 21) received cholecalciferol 50,000 international units (UI) once a month, Group 2 (n = 27) received cholecalciferol 25,000 UI every two weeks, and Group 3 (n = 57) received calcifediol 0.266 mg (mg) once a month. The primary outcome measured was the delta increase in 25(OH)D levels after 6 months of treatment, compared to pre-treatment levels.</div></div><div><h3>Results</h3><div>The study revealed a significant greater delta increase in 25(OH)D levels in Group 1, which received cholecalciferol 50,000 IU once a month, compared to the other two groups. However, multiple regression analysis indicated that neither the type of molecule nor the frequency of administration independently influenced the treatment outcome. Only pre-treatment serum 25(OH)D levels were found to significantly affect the outcome. Based on the receiver operating characteristic curve, serum 25(OH)D levels below 19.5 ng/dL were predictive of a doubling of pre-treatment values, with high sensitivity and specificity.</div></div><div><h3>Conclusion</h3><div>Pre-treatment serum 25(OH)D levels are valuable for selecting patients who should undergo supplementation. This finding suggests the importance of tailoring therapy according to the degree of vitamin D deficiency.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"47 ","pages":"Pages 265-274"},"PeriodicalIF":6.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PNPLA3 gene variation modulates diet-induced improvement in liver lipid content in type 2 diabetes","authors":"Kalliopi Pafili ,&nbsp;Oana-Patricia Zaharia ,&nbsp;Klaus Strassburger ,&nbsp;Birgit Knebel ,&nbsp;Christian Herder ,&nbsp;Maximilian Huttasch ,&nbsp;Yanislava Karusheva ,&nbsp;Stefan Kabisch ,&nbsp;Alexander Strom ,&nbsp;Bettina Nowotny ,&nbsp;Julia Szendroedi ,&nbsp;Michael Roden","doi":"10.1016/j.clnu.2025.02.032","DOIUrl":"10.1016/j.clnu.2025.02.032","url":null,"abstract":"<div><h3>Background&amp;aims</h3><div>Lifestyle-induced weight reduction remains crucial for managing type 2 diabetes and steatotic liver disease, but its effectiveness varies. We postulated that the G allele in the rs738409 single nucleotide polymorphism within patatin-like phospholipase domain-containing protein 3 (<em>PNPLA3</em>), which associates with metabolic dysfunction-associated steatotic liver disease, also modulates diet-related metabolic effects.</div></div><div><h3>Methods</h3><div>Participants with type 2 diabetes were randomized to 8-week hypocaloric diets (energy intake: −1,256 kJ/d of, &lt;30 kcal% fat): high in cereal fiber and coffee excluding red meat (HF-RM + C; n = 16), or low in cereal fiber, devoid of coffee, but high in red meat (LF + RM-C; n = 15). Whole-body insulin sensitivity (M value) was assessed using [²H]glucose and hyperinsulinemic-normoglycemic clamps, hepatic lipid content (HCL) and body fat volumes by magnetic resonance spectroscopy/imaging before and after intervention.</div></div><div><h3>Results</h3><div>Despite comparable weight loss, HCL decreased more in non-carriers (−65 %) than in G-allele carriers (−36 %) upon HF-RM + C diet (both p &lt; 0.05 vs baseline and between groups), but only among non-carriers (−46 %, p &lt; 0.05 vs baseline) upon LF + RM-C. Upon HF-RM + C diet, increase in insulin sensitivity was not different between carriers (+27 % p = 0.051 from baseline) and non-carriers (+21 %, p = 0.032 from baseline), p &gt; 0.05 for between-group comparison. Upon LF + RM-C diet, both groups equally improved their whole-body insulin sensitivity (+42 % for non-carriers and +37 % for carriers, p &lt; 0.05 vs baseline). Upon HF-RM + C diet, non-carriers decreased circulating interleukin-18 from baseline by −31 %, whereas, upon LF + RM-C diet, non-carriers decreased circulating anti-inflammatory interleukin-1 receptor antagonist levels by 14 % (both p &lt; 0.05 vs baseline).</div></div><div><h3>Conclusions</h3><div>Humans with the <em>PNPLA3</em> G-allele show modified dietary-induced effects on steatotic liver disease in type 2 diabetes despite body weight reduction.</div><div>Registration at <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span>, Identifier number: NCT01409330.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"48 ","pages":"Pages 6-15"},"PeriodicalIF":6.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcopenic obesity and the risk of atrial fibrillation in non-diabetic older adults: A prospective cohort study","authors":"Xinyi Yu ,&nbsp;Jincheng Chao ,&nbsp;Xin Wang ,&nbsp;Siyi Dun ,&nbsp;Huajing Song ,&nbsp;Yuqi Guo ,&nbsp;Hua Zhang ,&nbsp;Yanli Yao ,&nbsp;Zhendong Liu ,&nbsp;Juan Wang ,&nbsp;Weike Liu","doi":"10.1016/j.clnu.2025.03.001","DOIUrl":"10.1016/j.clnu.2025.03.001","url":null,"abstract":"<div><h3>Background</h3><div>Evidence of an association between sarcopenic obesity (SO) and the risk of long-term atrial fibrillation (AF) is lacking, and the underlying involvement of insulin resistance (IR) and inflammation is not clear.</div></div><div><h3>Methods</h3><div>This community-based prospective cohort study evaluated sarcopenia, obesity, and baseline clinical characteristics in 4321 non-diabetic older adults between 2007 and 2011. Sarcopenia was identified using skeletal muscle mass/body weight (SMM/BW), appendicular lean mass (ALM)/BW, and handgrip strength (HGS), and obesity was identified by fat mass (FM)/BW. The association of sarcopenia and obesity with AF risk was determined by Kaplan–Meier analysis and a Cox proportional hazards model. Interaction analysis, a restricted cubic splines model, mediation analysis, and a Fine–Gray competing-risk model were also used.</div></div><div><h3>Results</h3><div>Over an average of 10.9 years of follow-up, 546 (11.98 per 1000 person-years) participants developed AF. Low SMM/BW, low ALM/BW, low HGS, high FM/BW, sarcopenia and obesity, were significantly associated with an increased AF risk. There was a significant synergistic relationship between sarcopenia and obesity in the increased AF risk [hazard ratio (HR): 2.029, 95 % confidence interval (CI): 1.639–2.512]. Compared with participants without sarcopenia and obesity, AF risk was the highest in those with SO (HR: 2.669, 95 % CI: 2.110–3.377], followed by sarcopenia alone (HR: 1.980, 95%CI: 1.453–2.699) and obesity (HR: 1.839, 95%CI: 1.475–2.292). Mediation analysis found that estimated glucose disposal rate (a surrogate marker of IR), high-sensitivity C-reactive protein, and galectin-3 were mediating factors in the increased AF risk caused by SO, accounting for 34.87 %, 27.56 %, and 21.05 % of the total effect, respectively.</div></div><div><h3>Conclusions</h3><div>SO significantly increased AF risk in these non-diabetic older individuals. Sarcopenia and obesity not only acted alone but also exhibit had a synergistic relationship to increase AF risk. IR and inflammation mediated the increased AF risk associated with SO.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"47 ","pages":"Pages 282-290"},"PeriodicalIF":6.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a short screener to evaluate adherence to the World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations","authors":"Alice Chaplin ,&nbsp;Mar Nafría ,&nbsp;Lara Prohens ,&nbsp;Margarita Morey ,&nbsp;Elena Rayo ,&nbsp;Marissa M. Shams-White ,&nbsp;Nigel Brockton ,&nbsp;Jill Reedy ,&nbsp;Panagiota Mitrou ,&nbsp;Adela Castelló ,&nbsp;Estefanía Toledo ,&nbsp;Montserrat Fitó ,&nbsp;Olga Castañer ,&nbsp;María Dolors Zomeño ,&nbsp;Sonia Eguaras ,&nbsp;Albert Sesé ,&nbsp;Dora Romaguera","doi":"10.1016/j.clnu.2025.02.033","DOIUrl":"10.1016/j.clnu.2025.02.033","url":null,"abstract":"<div><h3>Background and aims</h3><div>Adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations is associated with reduced risk for cancer and all-cause mortality. The aim of this study was to develop and validate a short screener to assess adherence to these guidelines.</div></div><div><h3>Methods</h3><div>The study was divided into two phases: Screener development (Phase I) and a validation study (Phase II). A subsample of participants from the PREDIMED-Plus study, an ongoing randomised lifestyle intervention trial which focuses on cardiovascular disease prevention, were invited from two recruiting centres in Spain for the pilot testing (n = 110) and validation (n = 148) of the tool. Participants completed the WCRF/AICR Screener, and dietary and lifestyle data were collected using validated methods (anthropometric measurements by trained staff, and validated diet and physical activity (PA) questionnaires). A score reflecting adherence to the recommendations was derived for each method (Screener and validated instruments), adapted from the 2018 WCRF/AICR Score. Relative agreement between the total scores was evaluated by Spearman correlation (r) and intraclass correlation coefficients (ICC). Cross-classification and Kappa coefficient (κ) were used for individual recommendations.</div></div><div><h3>Results</h3><div>The WCRF/AICR Screener has 13 questions covering seven recommendations (regarding body weight; PA; plant-based foods; fast and processed foods; red and processed meat; sugar-sweetened drinks; and alcoholic drinks) with a score range of 0–7 (higher scores indicated greater adherence). There was a significant correlation (r = 0.70) and a moderate agreement (ICC = 0.68) between the WCRF/AICR Screener (mean ± SD, 3.20 ± 0.92) and validated methods (3.05 ± 1.01) scores. The scores for individual recommendations showed very good agreement for body weight (κ = 0.84), substantial agreement for alcoholic drinks (κ = 0.71), moderate agreement for PA (κ = 0.58), red and processed meat (κ = 0.58) and sugar-sweetened drinks (κ = 0.56). Fair agreement was observed for plant-based foods (κ = 0.30) and fast and processed foods (κ = 0.27).</div></div><div><h3>Conclusions</h3><div>The WCRF/AICR Screener is a valid tool for assessing adherence to the WCRF/AICR Cancer Prevention Recommendations at an individual level, and could be useful for rapid assessment of diet and lifestyle in clinical settings for cancer prevention strategies.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"47 ","pages":"Pages 275-281"},"PeriodicalIF":6.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between body composition parameters and treatment-related toxicities in patients with metastatic breast cancer receiving cyclin-dependent kinase 4 and 6 inhibitors","authors":"Giovanni Imbimbo ,&nbsp;Marica Pellegrini ,&nbsp;Simone Scagnoli ,&nbsp;Simona Pisegna ,&nbsp;Veronica Rizzo ,&nbsp;Carmen Gallicchio ,&nbsp;Andrea Botticelli ,&nbsp;Alessio Molfino","doi":"10.1016/j.clnu.2025.02.031","DOIUrl":"10.1016/j.clnu.2025.02.031","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Nowadays, limited data or no data are available on body composition changes and the development of treatment-related toxicities in metastatic breast cancer (MBC) patients treated with innovative and promising anticancer therapies, including cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors. Therefore, we evaluated in MBC treated with CDK4/6 inhibitors changes in adiposity and muscularity before and after treatment and whether the changes in these parameters were associated with toxicities, dose reduction or treatment discontinuation.</div></div><div><h3>Methods</h3><div>We considered ER+/HER2- MBC patients undergoing treatment with CDK 4/6 inhibitors, collected clinical data and registered the number and type of toxicities, dose reduction due to adverse events and the rate of discontinuation. We analyzed CT scan images before treatment (T0) and at the first follow-up visit (T1), calculating SAT, VAT, TAT (adipose tissue), SMA and SMI (skeletal muscle mass).</div></div><div><h3>Results</h3><div>70 MBC patients were enrolled. Median time of observation at T1 was 4 months (3; 12); 68 (97 %) patients experienced at least one G1-G2 adverse event, whereas 37 (53 %) at least one G3-G4. Dose reduction due to toxicity was registered in 17 patients (24 %), whereas discontinuation in 24 (34 %) patients. SMA at baseline inversely correlated with the number of adverse events (G3-G4) (r = −0.30; p = 0.039). Changes in body composition were not associated with G3-G4 toxicities. However, in patients with dose reduction, we observed overtime (T0-T1) an increase in median VAT (118 vs 135; p = 0.023) (median Delta VAT_T0-T1 3.9 %). In patients not discontinuing the treatment, we observed overtime an increase in mean SMA (127 ± 23 vs 131 ± 22, p &lt; 0.05) and median VAT (119 vs 131, p &lt; 0.05). We observed greater reduction in median VAT (Δ%) in patients who discontinued the therapy (p &lt; 0.05). ΔVAT (%) (reduction) was more pronounced in those patients who discontinued therapy for disease progression (p = 0.01).</div></div><div><h3>Conclusion</h3><div>Changes in muscularity and adiposity with not univocal direction were associated with toxicities, treatment discontinuation or dose reduction among patients with breast cancer treated with CDK4/6 inhibitors.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"47 ","pages":"Pages 242-247"},"PeriodicalIF":6.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal relationships of circulating amino acids with sarcopenia-related traits: A bidirectional Mendelian randomization study","authors":"Chenyang Zhan ,&nbsp;Zongjie Quan ,&nbsp;Xiujin Huang ,&nbsp;Jun Bu ,&nbsp;Sheng Li","doi":"10.1016/j.clnu.2025.02.020","DOIUrl":"10.1016/j.clnu.2025.02.020","url":null,"abstract":"<div><h3>Background and aim</h3><div>Recent studies have indicated a correlation between certain Amino acids (AAs) and sarcopenia. However, the exact causal relationship among these associations is still unclear. This study aims to elucidate the causal relationships between 20 types of AAs and the phenotypic characteristics associated with sarcopenia through Mendelian randomization (MR) analysis.</div></div><div><h3>Methods and results</h3><div>This MR study employed single nucleotide polymorphisms (SNPs) that were significantly associated with both AAs and the traits of sarcopenia as instrumental variables (IVs). The main method for estimating causal effects was the inverse-variance weighted (IVW) approach. To ensure the robustness of the findings, additional methods such as weighted median, weighted mode, and MR Egger regression were used. Sensitivity analyses included heterogeneity and pleiotropy tests. In this research, we discovered potential causal relationships between AAs and traits associated with sarcopenia. We not only found that AAs previously studied, such as Glutamine, Tyrosine, Glycine, and branched-chain amino acids, play positive roles in muscle metabolism. Additionally, our study identified the role of AAs previously neglected or not considered in earlier research, such as Alanine, Lysine, Cysteine, and Methionine, which exert potential effects on muscle metabolism and offer considerable research potential and value.</div></div><div><h3>Conclusions</h3><div>This MR study clarified the reciprocal effects between circulating levels of AAs and sarcopenia-related traits. These results indicate that AAs may be used as biomarkers for diagnosing sarcopenia or as intervention targets for its treatment in clinical practice.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"47 ","pages":"Pages 258-264"},"PeriodicalIF":6.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Core elements and principles of nutrition models of care for people with cancer: A scoping review","authors":"J. Loeliger ,&nbsp;A. Ugalde ,&nbsp;J. Porter ,&nbsp;N. Kiss","doi":"10.1016/j.clnu.2025.02.030","DOIUrl":"10.1016/j.clnu.2025.02.030","url":null,"abstract":"<div><h3>Background and aims</h3><div>The development and implementation of evidence-based cancer nutrition models of care into clinical practice is challenging and pragmatic guidance is lacking. This scoping review aimed to identify the core elements and principles of nutrition models of care for people with cancer.</div></div><div><h3>Methods</h3><div>MEDLINE Complete, CINAHL and Embase were systematically searched between 1 January 2003–8 November 2023. Studies were eligible for inclusion and data extraction if they reported on the implementation or evaluation of a nutrition model of care for adults with any cancer diagnosis. The protocol was prospectively registered on Open Science Framework (<span><span>https://doi.org/10.17605/OSF.IO/RQVHJ</span><svg><path></path></svg></span>) on 7 November 2023.</div></div><div><h3>Results</h3><div>The search identified 4599 papers, 28 studies met inclusion criteria. Studies were primarily conducted in Australia (71.4 %), within a hospital (96.4 %), metropolitan setting (89.3 %) and with various cancer diagnoses. Most studies described a nutrition screening process and 50 % used a valid and reliable assessment tool. Studies described provision of direct care by the dietitian (n = 26), primarily conducted in the outpatient setting (n = 26) and lesser in the inpatient setting (n = 12), and frequently face-to-face (n = 25) [phone (n = 14), telehealth (n = 3)]. Ten core elements were identified that underpinned the models of care including: timely care driven by a care pathway, protocol or clinic (100.0 %); nutrition expertise and leadership (100.0 %); flexible and integrated (100.0 %); with multi-directional communication (96.4 %); accessible (92.9 %); stratified by risk (89.3 %); multidisciplinary engagement (85.7 %); across different care time-points and settings (85.7 %); supported by training/education (50.0 %) and data integration (25.0 %).</div></div><div><h3>Conclusions</h3><div>Nutrition expert-led cancer nutrition models of care literature was primarily limited to metropolitan, hospital settings and many lacked valid nutrition assessment tools. Ten core elements were identified that underpinned nutrition care, with the most utilised being: timely care driven by a care pathway, protocol or clinic; nutrition expert-led; flexible and integrated; with multi-directional communication; accessible; and stratified by risk. There is great potential for an evidence-based model of nutrition care to improve the implementation and embedding of high-quality nutrition elements into the cancer pathway.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"47 ","pages":"Pages 227-241"},"PeriodicalIF":6.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “Emerging EAT-Lancet planetary health diet is associated with major cardiovascular diseases and all-cause mortality: A global systematic review and meta-analysis”","authors":"Wan-Ling Tu,&nbsp;Chia-Chen Chen,&nbsp;Jheng-Yan Wu","doi":"10.1016/j.clnu.2025.02.026","DOIUrl":"10.1016/j.clnu.2025.02.026","url":null,"abstract":"","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"47 ","pages":"Pages 185-186"},"PeriodicalIF":6.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low plasma pancreatic lipase as a novel predictor of nutritional target achievement and response to nutritional interventions in malnourished inpatients: Secondary analysis of a randomized clinical trial","authors":"Selina Randegger ,&nbsp;Carla Wunderle ,&nbsp;Odd Erik Johansen ,&nbsp;Pascal Tribolet ,&nbsp;Vojtech Pavlicek ,&nbsp;Michael Braendle ,&nbsp;Christoph Henzen ,&nbsp;Robert Thomann ,&nbsp;Peter Neyer ,&nbsp;Zeno Stanga ,&nbsp;Beat Mueller ,&nbsp;Philipp Schuetz","doi":"10.1016/j.clnu.2025.02.029","DOIUrl":"10.1016/j.clnu.2025.02.029","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Pancreatic lipase plays an essential role in digesting dietary fats in the intestine, facilitating nutrient absorption. Plasma lipase serves as a surrogate for pancreatic exocrine function, which decreases with age and potentially leads to inadequate nutrient digestion and gastrointestinal symptoms. We investigated clinical implications of plasma lipase among medical inpatients at nutritional risk.</div></div><div><h3>Methods</h3><div>This secondary analysis investigated admission plasma lipase concentrations among patients at risk for malnutrition regarding clinical outcomes and treatment response in patients included in the <em>Effect of Early Nutritional Support on Frailty Outcomes, and Recovery of Malnourished Medical Inpatients Trial</em> (EFFORT), a randomized controlled trial comparing individualized nutritional support to usual care.</div></div><div><h3>Results</h3><div>Of 810 patients with available admission plasma lipase concentrations, 158 (19.5 %) had concentrations below the reference range. Patients with low concentrations had a 1.6-fold higher risk of not reaching energy or protein targets during hospitalization (adjusted odds ratio 1.62 [95 % confidence interval 1.07 to 2.45], p = 0.022 and 1.61 [95 % confidence interval 1.07 to 2.44], p = 0.023, respectively). They also tended to have a more pronounced benefit from nutritional interventions in terms of reduced mortality (adjusted hazard ratio for patients with low lipase 0.48 [95 % confidence interval 0.18 to 1.26] compared to 0.99 [95 % confidence interval 0.60 to 1.63] in patients with normal lipase concentrations, p for interaction = 0.224).</div></div><div><h3>Conclusion</h3><div>Findings from this multicenter trial indicate that around 20 % of polymorbid older patients had plasma lipase concentrations below the reference range, suggesting exocrine pancreatic insufficiency, which placed them at a greater risk for failing to meet nutritional targets; however, they also demonstrated a pronounced improvement from nutritional support. Further studies should assess the impact of pancreatic enzyme replacement therapy in this population.</div></div><div><h3>Trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> Identifier: NCT02517476.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"47 ","pages":"Pages 196-203"},"PeriodicalIF":6.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The usefulness of the updated bioelectrical impedance vector analysis references for assessing malnutrition, sarcopenia and predicting mortality in hospitalized patients","authors":"Alessandro Guerrini ,&nbsp;Lara Dalla Rovere ,&nbsp;Rocío Fernández-Jiménez ,&nbsp;Carmen Hardy-Añón ,&nbsp;Cristina Herola-Cobos ,&nbsp;Maria Garcia-Olivares ,&nbsp;José Abuín Fernández ,&nbsp;Francisco Hevilla Sánchez ,&nbsp;Virginia Morilla Jiménez ,&nbsp;Isabel Vegas Aguilar ,&nbsp;Abelardo Adarve Castro ,&nbsp;Yeganeh Manon Khazrai ,&nbsp;Francesco Campa ,&nbsp;José Manuel García-Almeida","doi":"10.1016/j.clnu.2025.02.025","DOIUrl":"10.1016/j.clnu.2025.02.025","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>The application of validated pre-screening tools is crucial in clinical practice to identify patients at risk for disease. Bioelectrical Impedance Vector Analysis (BIVA) has gained recognition as a qualitative method for monitoring body composition and assessing the health status of hospitalized patients. This study investigates the utility of updated BIVA reference standards in evaluating malnutrition, sarcopenia, and mortality among hospitalized individuals.</div></div><div><h3>Material and method</h3><div>This retrospective observational study included 2.872 patients admitted to Quironsalud Málaga Hospital between January 2019 and January 2024. Malnutrition and sarcopenia were diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines. Mortality was defined as death within one year of their initial discharge or later admissions. BIVA was performed using the former and the new 50th, 75th, and 95th reference tolerance ellipses of general population.</div></div><div><h3>Results</h3><div>BIVA revealed significant differences in bioimpedance vectors between malnourished (n = 1187, 544 women) and non-malnourished patients, sarcopenic (n = 136, 51 women) and non-sarcopenic patients, and non-survivors (n = 317, 160 women) compared to survivors. When previous BIVA references (Piccoli 1995) were applied, the bioimpedance vectors for malnourished, sarcopenic, and non-surviving patients fell within the 75th tolerance ellipses. However, with updated references, these vectors shifted rightward, moving outside the 75th and 95th tolerance ellipses. Univariate Cox analysis showed that participants with vectors outside the new 95th tolerance ellipses faced significantly higher mortality risk (HR = 6.22 [95 % CI 4.40–8.80], p &lt; 0.001) and lower survival rates (log-rank test p &lt; 0.001) compared to those within the 75th ellipses. These trends persisted even after adjusting for age, sex, and BMI (HR = 4.79 [95 % CI 3.29–6.97], p &lt; 0.001). The new reference ellipses demonstrated greater prognostic accuracy compared to the older ones, emphasizing their value in identifying high-risk patients.</div></div><div><h3>Conclusion</h3><div>The implementation of BIVA with newly established reference tolerance ellipses significantly enhances the evaluation of body composition and overall health in hospitalized patients. These updated tolerance ellipses are instrumental in accurately identifying malnutrition, sarcopenia, and heightened mortality risks. The delineation of specific mortality risk zones underscores the potential of incorporating these advanced BIVA ellipses into routine pre-screening protocols, thereby optimizing clinical nutritional assessments and interventions.</div></div>","PeriodicalId":10517,"journal":{"name":"Clinical nutrition","volume":"47 ","pages":"Pages 187-195"},"PeriodicalIF":6.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}