Peripheral parenteral nutrition (PPN) is considered a viable alternative to central parenteral nutrition (CPN) for patients requiring short-term nutritional support or presenting contraindications to CPN, but may also be an independent nutritional therapy with specific indications. Furthermore, supplemental PPN may represent a valuable approach for patients unable to meet their nutritional needs through oral or enteral nutrition alone. Frequently, complex situations may prevent physicians from fully adhering to the recommendations of the ESPEN (European Society for Clinical Nutrition and Metabolism) Guidelines. Therefore, a panel of experts convened to identify the appropriate PPN use in surgery and internal medicine departments, aiming to highlight the patient populations suitable for PPN within these hospital settings.
Methods
The panel examined the literature and the main recommendations from the ESPEN Guidelines on PPN for adult patients within surgical and medical settings. They subsequently shared their clinical insights and experiences, ultimately describing the clinical scenarios which could potentially benefit from PPN use.
Results
PPN use may benefit perioperative care and the management of inflammatory bowel disease, hepatic cirrhosis, acute pancreatitis, oncology, dementia or chronic neurodegenerative diseases, anorexia nervosa, chronic obstructive pulmonary disease, chronic intestinal failure dependent on parenteral nutrition and prolonged fasting in malnourished patients admitted to emergency departments.
Conclusions
PPN may facilitate the timely implementation of nutritional support and effectively manage malnutrition. Prompt initiation of PPN may act as a bridge to long-term nutritional strategies, avoiding harmful delays. Further investigations are warranted to assess non-nutritional markers for short-term PPN effects.
{"title":"Peripheral parenteral nutrition in hospitalized patients: Insights from an expert opinion","authors":"Alessandro Laviano , Paolo Pasquero , Emanuele Rinninella , Lidia Santarpia","doi":"10.1016/j.nutos.2025.09.006","DOIUrl":"10.1016/j.nutos.2025.09.006","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Peripheral parenteral nutrition (PPN) is considered a viable alternative to central parenteral nutrition (CPN) for patients requiring short-term nutritional support or presenting contraindications to CPN, but may also be an independent nutritional therapy with specific indications. Furthermore, supplemental PPN may represent a valuable approach for patients unable to meet their nutritional needs through oral or enteral nutrition alone. Frequently, complex situations may prevent physicians from fully adhering to the recommendations of the ESPEN (European Society for Clinical Nutrition and Metabolism) Guidelines. Therefore, a panel of experts convened to identify the appropriate PPN use in surgery and internal medicine departments, aiming to highlight the patient populations suitable for PPN within these hospital settings.</div></div><div><h3>Methods</h3><div>The panel examined the literature and the main recommendations from the ESPEN Guidelines on PPN for adult patients within surgical and medical settings. They subsequently shared their clinical insights and experiences, ultimately describing the clinical scenarios which could potentially benefit from PPN use.</div></div><div><h3>Results</h3><div>PPN use may benefit perioperative care and the management of inflammatory bowel disease, hepatic cirrhosis, acute pancreatitis, oncology, dementia or chronic neurodegenerative diseases, anorexia nervosa, chronic obstructive pulmonary disease, chronic intestinal failure dependent on parenteral nutrition and prolonged fasting in malnourished patients admitted to emergency departments.</div></div><div><h3>Conclusions</h3><div>PPN may facilitate the timely implementation of nutritional support and effectively manage malnutrition. Prompt initiation of PPN may act as a bridge to long-term nutritional strategies, avoiding harmful delays. Further investigations are warranted to assess non-nutritional markers for short-term PPN effects.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"64 ","pages":"Pages 115-135"},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321721","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 : 2025-09-22DOI: 10.1016/j.nutos.2025.09.005
Briana Fahey , Tayla White , Evangeline Mantzioris , Elke Sokoya , Anthony Villani
Background
Diet quality may be an important modifiable risk factor for managing the intensity of symptoms and disease progression in people with Rheumatoid Arthritis (RA). Therefore, the objective of this study was to explore the independent associations between adherence to a Mediterranean diet (MedDiet) and severity of pain and gastrointestinal (GI) symptoms in adults with RA.
Methods
This was a cross-sectional online survey of community-dwelling adults (≥18 years) with a confirmed medical diagnosis of RA. MedDiet adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS); the Rheumatoid Arthritis Pain Scale (RAPS) was used to assess the intensity of pain; and severity of GI symptoms was assessed using the Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS).
Results
A total of n = 80 participants commenced the online questionnaire (67 female; 12 males; 1 unspecified, 54.7 ± 13.8 years; BMI 29.1 ± 7.2 kg/m2), of which n = 70 completed in full and were included in the final analyses. Participants reported a low-moderate MedDiet adherence (4.9 ± 2.3; range: 1–11) and reported moderate levels of pain (RAPS: 81.4 ± 3.8; range: 0–144) and a low severity of GI symptoms (SAGIS: 10 (19); range 0–51). After adjusting for age, gender, BMI, physical activity duration, years active with disease and use of antirheumatic prescription medication, we found that MedDiet adherence was not related to pain (β: -0.10; 95 % CI: -0.02, 0.01; P = 0.44) or severity of GI symptoms (β: -0.09; 95 % CI: 0.06, 0.03; P = 0.49).
Conclusion
Adherence to a MedDiet was not related to severity of pain or GI disturbances in this sample of RA participants. Nevertheless, further exploration of how diet and nutrition can attenuate RA progression and symptom management is important for the development of evidence-based guidelines and dietary recommendations for patients with RA.
{"title":"Adherence to a Mediterranean diet and severity of pain and gastrointestinal symptoms in people with Rheumatoid Arthritis: A cross-sectional analysis","authors":"Briana Fahey , Tayla White , Evangeline Mantzioris , Elke Sokoya , Anthony Villani","doi":"10.1016/j.nutos.2025.09.005","DOIUrl":"10.1016/j.nutos.2025.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Diet quality may be an important modifiable risk factor for managing the intensity of symptoms and disease progression in people with Rheumatoid Arthritis (RA). Therefore, the objective of this study was to explore the independent associations between adherence to a Mediterranean diet (MedDiet) and severity of pain and gastrointestinal (GI) symptoms in adults with RA.</div></div><div><h3>Methods</h3><div>This was a cross-sectional online survey of community-dwelling adults (≥18 years) with a confirmed medical diagnosis of RA. MedDiet adherence was assessed using the Mediterranean Diet Adherence Screener (MEDAS); the Rheumatoid Arthritis Pain Scale (RAPS) was used to assess the intensity of pain; and severity of GI symptoms was assessed using the Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS).</div></div><div><h3>Results</h3><div>A total of <em>n</em> = 80 participants commenced the online questionnaire (67 female; 12 males; 1 unspecified, 54.7 ± 13.8 years; BMI 29.1 ± 7.2 kg/m2), of which <em>n</em> = 70 completed in full and were included in the final analyses. Participants reported a low-moderate MedDiet adherence (4.9 ± 2.3; range: 1–11) and reported moderate levels of pain (RAPS: 81.4 ± 3.8; range: 0–144) and a low severity of GI symptoms (SAGIS: 10 (19); range 0–51). After adjusting for age, gender, BMI, physical activity duration, years active with disease and use of antirheumatic prescription medication, we found that MedDiet adherence was not related to pain (β: -0.10; 95 % CI: -0.02, 0.01; <em>P</em> = 0.44) or severity of GI symptoms (β: -0.09; 95 % CI: 0.06, 0.03; <em>P</em> = 0.49).</div></div><div><h3>Conclusion</h3><div>Adherence to a MedDiet was not related to severity of pain or GI disturbances in this sample of RA participants. Nevertheless, further exploration of how diet and nutrition can attenuate RA progression and symptom management is important for the development of evidence-based guidelines and dietary recommendations for patients with RA.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"64 ","pages":"Pages 101-114"},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321720","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 : 2025-09-18DOI: 10.1016/j.nutos.2025.09.004
Yuanyuan He, Shenshen shi, Zhen liang, Juan Wang
Background & Aims
The muscle quality index (MQI) score is a new indicator of muscle quality and is closely related to physical health. This study aimed to investigate the association between the MQI score and depression in young and middle-aged people.
Methods
Complete MQI and depression data were obtained from the National Health and Nutrition Examination Survey (NHANES) database from 2011-2014 for 5199 subjects aged 20–60 years. An assessment of depression was conducted using the Patient Health Questionnaire (PHQ-9). Appendicular skeletal muscle mass (ASM) and handgrip strength (HGS) were measured via dual-energy X-ray absorptiometry (DXA) and a dynamometer, respectively. MQItotal, MQIapp and MQIarm were calculated by HGS sum/ASM (kg/kg), dominant HGS/ASM (kg/kg), and dominant HGS/dominant arm ASM (kg/kg), respectively. Multivariate regression analyses, subgroup analyses, trend tests, interaction tests, smooth curve fitting, and threshold effect and saturation effect analyses were performed.
Results
The mean age of the included population was 38.76 ± 11.57 years, of which 48.5 1% were female. Multivariate regression analyses revealed that the MQI score was negatively correlated with depression. Subgroup analyses revealed that this association was present in females but not in males. After all included confounders were adjusted, the risk of depression in women decreased by 32 %, 35 %, and 6 %, as MQItotal (OR 0.68, 95% CI 0.54–0.84), MQIapp (OR 0.65, 95% CI 0.47–0.91) and MQIarm (OR 0.94, 95% CI 0.90–0.99) increased per unit, respectively. Women in MQItotal, MQIapp, and MQIarm quartile 4 had a significantly lower incidence of depression than did those in quartile 1. In addition, smoothing curve fitting revealed that MQItotal, MQIapp, and MQIarm were not linearly correlated with the risk of depression in women but rather had a J-shaped relationship, with inflection points of 2.24, 1.01 and 8.35, respectively.
Conclusions
According to the results of this study, MQI scores negatively correlate with depression in women, but not in men, demonstrating a J-shaped relationship.
背景目的肌肉质量指数（muscle quality index， MQI）评分是一种新的肌肉质量指标，与身体健康密切相关。本研究旨在探讨中青年MQI评分与抑郁的关系。方法从2011-2014年全国健康与营养调查（NHANES）数据库中获取5199名年龄在20-60岁的受试者的完整MQI和抑郁数据。使用患者健康问卷（PHQ-9）对抑郁症进行评估。分别用双能x线吸收仪（DXA）和测力仪测量各组阑尾骨骼肌质量（ASM）和握力（HGS）。mqtotal、MQIapp和MQIarm分别采用HGS sum/ASM （kg/kg）、优势HGS/ASM （kg/kg）和优势HGS/优势臂ASM （kg/kg）计算。进行多元回归分析、亚组分析、趋势检验、相互作用检验、平滑曲线拟合、阈值效应和饱和效应分析。结果入选人群平均年龄为38.76±11.57岁，其中女性占48.5%。多因素回归分析显示，MQI评分与抑郁呈负相关。亚组分析显示，这种关联在女性中存在，而在男性中不存在。在调整了所有纳入的混杂因素后，女性患抑郁症的风险分别降低了32%、35%和6%，每单位mqtotal （OR 0.68, 95% CI 0.54-0.84）、MQIapp （OR 0.65, 95% CI 0.47-0.91）和MQIarm （OR 0.94, 95% CI 0.90-0.99）分别增加。mqittotal、MQIapp和MQIarm四分位数4的女性抑郁发生率明显低于四分位数1的女性。此外，平滑曲线拟合显示，mqittotal、MQIapp和MQIarm与女性抑郁风险不呈线性相关，而是呈j型关系，拐点分别为2.24、1.01和8.35。结论：根据本研究的结果，MQI得分与女性抑郁呈负相关，而与男性无负相关，呈j型关系。
{"title":"Association between muscle quality index and depression in adults: A cross-sectional study","authors":"Yuanyuan He, Shenshen shi, Zhen liang, Juan Wang","doi":"10.1016/j.nutos.2025.09.004","DOIUrl":"10.1016/j.nutos.2025.09.004","url":null,"abstract":"<div><h3>Background & Aims</h3><div>The muscle quality index (MQI) score is a new indicator of muscle quality and is closely related to physical health. This study aimed to investigate the association between the MQI score and depression in young and middle-aged people.</div></div><div><h3>Methods</h3><div>Complete MQI and depression data were obtained from the National Health and Nutrition Examination Survey (NHANES) database from 2011-2014 for 5199 subjects aged 20–60 years. An assessment of depression was conducted using the Patient Health Questionnaire (PHQ-9). Appendicular skeletal muscle mass (ASM) and handgrip strength (HGS) were measured via dual-energy X-ray absorptiometry (DXA) and a dynamometer, respectively. MQItotal, MQIapp and MQIarm were calculated by HGS sum/ASM (kg/kg), dominant HGS/ASM (kg/kg), and dominant HGS/dominant arm ASM (kg/kg), respectively. Multivariate regression analyses, subgroup analyses, trend tests, interaction tests, smooth curve fitting, and threshold effect and saturation effect analyses were performed.</div></div><div><h3>Results</h3><div>The mean age of the included population was 38.76 ± 11.57 years, of which 48.5 1% were female. Multivariate regression analyses revealed that the MQI score was negatively correlated with depression. Subgroup analyses revealed that this association was present in females but not in males. After all included confounders were adjusted, the risk of depression in women decreased by 32 %, 35 %, and 6 %, as MQItotal (OR 0.68, 95% CI 0.54–0.84), MQIapp (OR 0.65, 95% CI 0.47–0.91) and MQIarm (OR 0.94, 95% CI 0.90–0.99) increased per unit, respectively. Women in MQItotal, MQIapp, and MQIarm quartile 4 had a significantly lower incidence of depression than did those in quartile 1. In addition, smoothing curve fitting revealed that MQItotal, MQIapp, and MQIarm were not linearly correlated with the risk of depression in women but rather had a J-shaped relationship, with inflection points of 2.24, 1.01 and 8.35, respectively.</div></div><div><h3>Conclusions</h3><div>According to the results of this study, MQI scores negatively correlate with depression in women, but not in men, demonstrating a J-shaped relationship.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"64 ","pages":"Pages 73-83"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159765","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 : 2025-09-12DOI: 10.1016/j.nutos.2025.08.013
Ghias Kulsoom, Gupta Ananya
Cancer patients undergoing treatment frequently experience malnutrition due to disease-related factors and side effects of therapies like chemotherapy and radiotherapy. Oral Nutritional Supplements (ONS) play a pivotal role in maintaining nutritional status and improving treatment outcomes. However, adherence to ONS is often poor, influenced by sensory properties such as taste, viscosity, saltiness, and protein content. Thirst perception, an underexplored factor, may also impact ONS adherence, particularly in patients managing xerostomia, dysgeusia, and other treatment-related changes in oral sensations. This cross-sectional sensory evaluation study included 56 cancer patients, of whom 29 participated in detailed sensory testing. The study systematically evaluated the effects of varying salt levels, protein concentrations, and viscosity in ONS formulations on thirst perception, mouth dryness, and sensory acceptability in cancer patients. Modified ONS formulations, including low, medium, and high levels of salt, protein, and viscosity, were compared to a control. Participants completed sensory evaluations using visual analogue scales (VAS) and hedonic scales to rate thirst, mouthfeel, taste, and overall liking. Subgroup analyses examined the influence of patient-specific factors, such as dysgeusia and hydration habits, on these responses. Results indicated that high-salt (1g) and high-protein (5.5 g protein/30ml) formulations were associated with higher thirst perception (VAS scores ≥45 mm) compared to low-salt (0.33g) and low-protein (4.7g protein/30ml) formulations (VAS scores ≤27 mm). Low-viscosity (50 cP) formulations were preferred for their smoother texture, while high-viscosity (250 cP) samples elicited greater thirst due to mouth-coating effects. Dysgeusia amplified thirst and reduced liking scores for high-salt and high-protein ONS. These findings highlight the need for patient-centred ONS formulations that minimize thirst stimulation while enhancing palatability. Optimizing ONS properties may improve adherence and nutritional outcomes for cancer patients, although further studies are needed to confirm any direct impact on quality of life or treatment outcomes.
{"title":"A study on factors influencing thirst perception during oral nutritional supplement intake in cancer patients","authors":"Ghias Kulsoom, Gupta Ananya","doi":"10.1016/j.nutos.2025.08.013","DOIUrl":"10.1016/j.nutos.2025.08.013","url":null,"abstract":"<div><div>Cancer patients undergoing treatment frequently experience malnutrition due to disease-related factors and side effects of therapies like chemotherapy and radiotherapy. Oral Nutritional Supplements (ONS) play a pivotal role in maintaining nutritional status and improving treatment outcomes. However, adherence to ONS is often poor, influenced by sensory properties such as taste, viscosity, saltiness, and protein content. Thirst perception, an underexplored factor, may also impact ONS adherence, particularly in patients managing xerostomia, dysgeusia, and other treatment-related changes in oral sensations. This cross-sectional sensory evaluation study included 56 cancer patients, of whom 29 participated in detailed sensory testing. The study systematically evaluated the effects of varying salt levels, protein concentrations, and viscosity in ONS formulations on thirst perception, mouth dryness, and sensory acceptability in cancer patients. Modified ONS formulations, including low, medium, and high levels of salt, protein, and viscosity, were compared to a control. Participants completed sensory evaluations using visual analogue scales (VAS) and hedonic scales to rate thirst, mouthfeel, taste, and overall liking. Subgroup analyses examined the influence of patient-specific factors, such as dysgeusia and hydration habits, on these responses. Results indicated that high-salt (1g) and high-protein (5.5 g protein/30ml) formulations were associated with higher thirst perception (VAS scores ≥45 mm) compared to low-salt (0.33g) and low-protein (4.7g protein/30ml) formulations (VAS scores ≤27 mm). Low-viscosity (50 cP) formulations were preferred for their smoother texture, while high-viscosity (250 cP) samples elicited greater thirst due to mouth-coating effects. Dysgeusia amplified thirst and reduced liking scores for high-salt and high-protein ONS. These findings highlight the need for patient-centred ONS formulations that minimize thirst stimulation while enhancing palatability. Optimizing ONS properties may improve adherence and nutritional outcomes for cancer patients, although further studies are needed to confirm any direct impact on quality of life or treatment outcomes.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"64 ","pages":"Pages 84-100"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222157","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}
Protein energy wasting (PEW) is a severe form of malnutrition prevalent among hemodialysis (HD) patients. A key diagnostic criterion outlined by the International Society of Renal Nutrition and Metabolism (ISRNM) for PEW is a reduction in mid-arm muscle circumference (MAMC) below the 50th percentile (P50) of the reference population by more than 10%. However, the absence of population-specific MAMC cut-offs makes diagnosing PEW challenging. This study aimed to establish, validate and evaluate MAMC cut-offs for diagnosing PEW in Malaysian HD patients.
Methods
A three-phase cross-sectional study was conducted with training, validation and testing phases using a five-fold cross-validation approach against Frisancho reference. A total of 953 Malaysian HD patients were included in the analysis. Secondary data from previous Malaysian HD studies were utilized for both the training and validation phases, accounting for about 85% of the dataset. The remaining 15% of the dataset, used for the testing phase, comprised newly collected data. Data collection involved face-to-face interviews, anthropometric measurements, biochemical results, clinical data, and dietary assessments. PEW was diagnosed using the ISRNM criteria. Descriptive analysis was used to establish Malaysians HD MAMC cut-offs at P50 for PEW diagnosis, as per ISRNM criteria. The area under the curve (AUC) of the receiver operating characteristics curve assessed and compared the validity of these new cut-offs against the Frisancho reference.
Results
The P50 MAMC for Malaysian HD males was markedly lower than the Frisancho reference (24.29 cm vs 28.08 cm), whereas for females, it was slightly higher (23.14 cm vs 22.17 cm). The newly established Malaysian HD-specific MAMC cut-offs demonstrated excellent discrimination ability, outperforming Frisancho cut-offs for both validation (AUCMalaysian = 0.904 vs AUCFrisancho = 0.812) and evaluation (AUCMalaysia = 0.871 vs AUCFrisancho = 0.749).
Conclusion
These MAMC cut-offs serve as the first Malaysian HD-specific references, enhancing PEW diagnosis for clinical practice and future research.
目的：蛋白质能量消耗（PEW）是血液透析（HD）患者中普遍存在的一种严重的营养不良形式。国际肾脏营养与代谢学会（ISRNM）为PEW制定了一个关键的诊断标准，即参考人群中臂肌围（MAMC）低于第50百分位（P50）减少10%以上。然而，缺乏针对特定人群的MAMC截断值使得诊断PEW具有挑战性。本研究旨在建立、验证和评估马来西亚HD患者诊断PEW的MAMC截止值。方法采用基于Frisancho参考的五重交叉验证方法，分训练、验证和测试三个阶段进行三期横断面研究。共有953名马来西亚HD患者被纳入分析。来自先前马来西亚HD研究的辅助数据被用于训练和验证阶段，约占数据集的85%。剩下的15%的数据集用于测试阶段，包括新收集的数据。数据收集包括面对面访谈、人体测量、生化结果、临床数据和饮食评估。使用ISRNM标准诊断PEW。根据ISRNM标准，描述性分析用于建立马来西亚HD MAMC在P50的皮尤诊断截止值。用受者工作特征曲线的曲线下面积（AUC）对这些新的截止点与弗里桑乔基准的有效性进行了评估和比较。结果马来西亚HD男性的P50 MAMC明显低于Frisancho参考值（24.29 cm vs 28.08 cm），而女性的P50 MAMC略高于Frisancho参考值（23.14 cm vs 22.17 cm）。新建立的马来西亚特异性的MAMC截断值表现出出色的辨别能力，在验证（AUCMalaysian = 0.904 vs AUCFrisancho = 0.812）和评估（AUCMalaysia = 0.871 vs AUCFrisancho = 0.749）方面都优于Frisancho截断值。结论这些MAMC截断值作为马来西亚首个hd特异性参考，为临床实践和未来研究增强了PEW诊断。
{"title":"Clinical utility of mid-arm muscle circumference cut-offs for detecting protein-energy wasting in Malaysian hemodialysis patients","authors":"Qian-Qian Hoong , Jun-Hao Lim , Lee-Fang Teong , Nurul Iman Hafizah Adanan , Ban-Hock Khor , Sharmela Sahathevan , Pramod Khosla , Tilakavati Karupaiah , Zulfitri Azuan Mat Daud","doi":"10.1016/j.nutos.2025.09.002","DOIUrl":"10.1016/j.nutos.2025.09.002","url":null,"abstract":"<div><h3>Objective</h3><div>Protein energy wasting (PEW) is a severe form of malnutrition prevalent among hemodialysis (HD) patients. A key diagnostic criterion outlined by the International Society of Renal Nutrition and Metabolism (ISRNM) for PEW is a reduction in mid-arm muscle circumference (MAMC) below the 50th percentile (P<sub>50</sub>) of the reference population by more than 10%. However, the absence of population-specific MAMC cut-offs makes diagnosing PEW challenging. This study aimed to establish, validate and evaluate MAMC cut-offs for diagnosing PEW in Malaysian HD patients.</div></div><div><h3>Methods</h3><div>A three-phase cross-sectional study was conducted with training, validation and testing phases using a five-fold cross-validation approach against Frisancho reference. A total of 953 Malaysian HD patients were included in the analysis. Secondary data from previous Malaysian HD studies were utilized for both the training and validation phases, accounting for about 85% of the dataset. The remaining 15% of the dataset, used for the testing phase, comprised newly collected data. Data collection involved face-to-face interviews, anthropometric measurements, biochemical results, clinical data, and dietary assessments. PEW was diagnosed using the ISRNM criteria. Descriptive analysis was used to establish Malaysians HD MAMC cut-offs at P<sub>50</sub> for PEW diagnosis, as per ISRNM criteria. The area under the curve (AUC) of the receiver operating characteristics curve assessed and compared the validity of these new cut-offs against the Frisancho reference.</div></div><div><h3>Results</h3><div>The P<sub>50</sub> MAMC for Malaysian HD males was markedly lower than the Frisancho reference (24.29 cm <em>vs</em> 28.08 cm), whereas for females, it was slightly higher (23.14 cm <em>vs</em> 22.17 cm). The newly established Malaysian HD-specific MAMC cut-offs demonstrated excellent discrimination ability, outperforming Frisancho cut-offs for both validation (AUC<sub>Malaysian</sub> = 0.904 <em>vs</em> AUC<sub>Frisancho</sub> = 0.812) and evaluation (AUC<sub>Malaysia</sub> = 0.871 <em>vs</em> AUC<sub>Frisancho</sub> = 0.749).</div></div><div><h3>Conclusion</h3><div>These MAMC cut-offs serve as the first Malaysian HD-specific references, enhancing PEW diagnosis for clinical practice and future research.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"64 ","pages":"Pages 55-72"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159764","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 : 2025-09-09DOI: 10.1016/j.nutos.2025.09.001
Anna Chu , Samir Samman , Nicole C. Roy , Meika Foster
Background & aims
The health benefits of probiotics have long been studied. More recently, postbiotics are recognised as suitable alternatives for delivering associated health benefits. The aim of this systematic literature review is to assess the effects of heat-inactivated Lactobacillus gasseri CP2305 on bowel function and gut microbiota composition in humans.
Methods
A literature search was conducted of peer-reviewed papers published up to 20 August 2024. Intervention trials that investigated the effects of heat-inactivated CP2305 on gut-related parameters were selected for inclusion and data extraction. Quality and risk of bias assessments of individual studies were conducted using two established tools.
Results
Seven trials met the inclusion criteria. CP2305 intervention resulted in improved stool properties (output, form, color, odor) in the four studies reporting these outcomes. CP2305 effects on defecation frequency were mixed; however, defecation frequency was improved in populations with constipation tendencies. CP2305 was associated with some positive changes in gut microbiota composition and associated metabolites in studies which included these outcomes.
Conclusion
The current systematic review illustrates that heat-inactivated CP2305 can improve bowel function and gut microbiota diversity and composition in generally healthy adults, supporting its use in food and beverage applications for maintenance of a healthy gut.
{"title":"Heat-inactivated Lactobacillus gasseri CP2305 improves bowel function and gut microbiota – A systematic literature review","authors":"Anna Chu , Samir Samman , Nicole C. Roy , Meika Foster","doi":"10.1016/j.nutos.2025.09.001","DOIUrl":"10.1016/j.nutos.2025.09.001","url":null,"abstract":"<div><h3>Background & aims</h3><div>The health benefits of probiotics have long been studied. More recently, postbiotics are recognised as suitable alternatives for delivering associated health benefits. The aim of this systematic literature review is to assess the effects of heat-inactivated <em>Lactobacillus gasseri</em> CP2305 on bowel function and gut microbiota composition in humans.</div></div><div><h3>Methods</h3><div>A literature search was conducted of peer-reviewed papers published up to 20 August 2024. Intervention trials that investigated the effects of heat-inactivated CP2305 on gut-related parameters were selected for inclusion and data extraction. Quality and risk of bias assessments of individual studies were conducted using two established tools.</div></div><div><h3>Results</h3><div>Seven trials met the inclusion criteria. CP2305 intervention resulted in improved stool properties (output, form, color, odor) in the four studies reporting these outcomes. CP2305 effects on defecation frequency were mixed; however, defecation frequency was improved in populations with constipation tendencies. CP2305 was associated with some positive changes in gut microbiota composition and associated metabolites in studies which included these outcomes.</div></div><div><h3>Conclusion</h3><div>The current systematic review illustrates that heat-inactivated CP2305 can improve bowel function and gut microbiota diversity and composition in generally healthy adults, supporting its use in food and beverage applications for maintenance of a healthy gut.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"64 ","pages":"Pages 25-38"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120573","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 : 2025-09-07DOI: 10.1016/j.nutos.2025.08.011
Ahmed Abd Elaziz Bahey Abd Elbari , Sandro B. Rizoli , Ruben Peralta , Talat Chughtai , Ayman El-Menyar , Hassan Ali Saoud Al Thani , Saibu George , Nadir Kharma , Mohammed Omar Saad , Hasan Mitwally , Mohamed Elkhateeb , Mostafa Elshafi , Ignacio Miguel Gomez Macineira , Anyali Bacallao , Ammar Ibrahim Abed Al-Hassani , Ibrahim Yassin Taha , Judith Jacobi , Airton Leonardo de Oliveira Manoel
Background
The efficacy and safety of omega-3 fatty acid in the treatment of severe acute respiratory syndrome remains controversial. We assessed if the addition of omega-3 fatty acid to standard of care would improve clinical outcomes in patients with SARS-CoV-2.
Methods: double blinded randomized clinical trial of adults with PCR-confirmed severe or critical COVID-19. Patients were enrolled through block stratified randomization to omega-3 fatty acid 2g enterally twice daily for 28 days in addition to standard of care vs. standard of care alone. The primary outcome was ventilator-free days at day 28. Secondary outcomes included length of ICU and hospital stay, and in-hospital mortality.
Results
380 patients (211 in the intervention group and 169 patients in the standard of care group). Ventilator-free days were similar between the intervention and standard of care groups [mean 12.4 days (9.3–15.5) vs 11.1 (7.2–15.0), P = 0.48), respectively]. There was no difference in the length of ICU (7 days for both groups) or hospital stay (Omega-3 = 16 days vs control = 15 days). Patients who received Omega-3 fatty acid had a trend toward lower mortality (4.3% vs 7.7%, P = 0.15). In pre-specified exploratory subgroup of mechanically ventilated patients (89 patients), Omega-3 group was associated with a significantly lower mortality (15.1% vs 33.3%, P = 0.04), however, the trial was not powered to detect mortality differences in this subgroup.
Conclusions
In patients with severe or critical COVID-19, the addition of Omega-3 fatty acids to standard of care did not increase ventilator-free days. An exploratory analysis suggested a possible mortality benefit in patients requiring mechanical ventilation, but the study was not powered for this endpoint, and these findings require confirmation in future trials.
Trial Registration
ClinicalTrials.gov, NCT04836052.
背景：omega-3脂肪酸治疗严重急性呼吸综合征的有效性和安全性仍存在争议。我们评估了在标准护理中加入omega-3脂肪酸是否会改善SARS-CoV-2患者的临床结果。方法：对pcr确诊的成人重症、危重型COVID-19患者进行双盲随机临床试验。患者通过分组分层随机分组，在标准治疗组与单独标准治疗组的基础上，每天两次肠内注射omega-3脂肪酸2g，持续28天。主要终点为第28天无呼吸机天数。次要结局包括ICU和住院时间，以及住院死亡率。结果380例患者（干预组211例，标准护理组169例）。干预组和标准护理组无呼吸机天数相似[平均12.4天（9.3-15.5）vs 11.1天（7.2-15.0），P = 0.48]。ICU的时间（两组均为7天）或住院时间（Omega-3 = 16天，对照组= 15天）均无差异。接受Omega-3脂肪酸治疗的患者有降低死亡率的趋势（4.3% vs 7.7%, P = 0.15）。在预先指定的探索性机械通气患者亚组（89例患者）中，Omega-3组与显著较低的死亡率相关（15.1% vs 33.3%, P = 0.04），然而，该试验无法检测该亚组的死亡率差异。结论在重症或危重型COVID-19患者中，在标准护理中添加Omega-3脂肪酸并没有增加无呼吸机天数。一项探索性分析表明，在需要机械通气的患者中，可能会降低死亡率，但该研究没有为这一终点提供支持，这些发现需要在未来的试验中得到证实。临床试验注册中心，NCT04836052。
{"title":"Omega-3 fatty acids in addition to standard of care in the treatment of critically ill patients with COVID-19 (The OMEGA-COVID study), a randomized controlled multicenter trial","authors":"Ahmed Abd Elaziz Bahey Abd Elbari , Sandro B. Rizoli , Ruben Peralta , Talat Chughtai , Ayman El-Menyar , Hassan Ali Saoud Al Thani , Saibu George , Nadir Kharma , Mohammed Omar Saad , Hasan Mitwally , Mohamed Elkhateeb , Mostafa Elshafi , Ignacio Miguel Gomez Macineira , Anyali Bacallao , Ammar Ibrahim Abed Al-Hassani , Ibrahim Yassin Taha , Judith Jacobi , Airton Leonardo de Oliveira Manoel","doi":"10.1016/j.nutos.2025.08.011","DOIUrl":"10.1016/j.nutos.2025.08.011","url":null,"abstract":"<div><h3>Background</h3><div>The efficacy and safety of omega-3 fatty acid in the treatment of severe acute respiratory syndrome remains controversial. We assessed if the addition of omega-3 fatty acid to standard of care would improve clinical outcomes in patients with SARS-CoV-2.</div><div>Methods: double blinded randomized clinical trial of adults with PCR-confirmed severe or critical COVID-19. Patients were enrolled through block stratified randomization to omega-3 fatty acid 2g enterally twice daily for 28 days in addition to standard of care vs. standard of care alone. The primary outcome was ventilator-free days at day 28. Secondary outcomes included length of ICU and hospital stay, and in-hospital mortality.</div></div><div><h3>Results</h3><div>380 patients (211 in the intervention group and 169 patients in the standard of care group). Ventilator-free days were similar between the intervention and standard of care groups [mean 12.4 days (9.3–15.5) vs 11.1 (7.2–15.0), <em>P</em> = 0.48), respectively]. There was no difference in the length of ICU (7 days for both groups) or hospital stay (Omega-3 = 16 days vs control = 15 days). Patients who received Omega-3 fatty acid had a trend toward lower mortality (4.3% vs 7.7%, <em>P</em> = 0.15). In pre-specified exploratory subgroup of mechanically ventilated patients (89 patients), Omega-3 group was associated with a significantly lower mortality (15.1% vs 33.3%, <em>P</em> = 0.04), however, the trial was not powered to detect mortality differences in this subgroup.</div></div><div><h3>Conclusions</h3><div>In patients with severe or critical COVID-19, the addition of Omega-3 fatty acids to standard of care did not increase ventilator-free days. An exploratory analysis suggested a possible mortality benefit in patients requiring mechanical ventilation, but the study was not powered for this endpoint, and these findings require confirmation in future trials.</div></div><div><h3>Trial Registration</h3><div>ClinicalTrials.gov, NCT04836052.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"64 ","pages":"Pages 13-24"},"PeriodicalIF":0.0,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145098795","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 : 2025-09-05DOI: 10.1016/j.nutos.2025.08.012
Chen Fei Liang
Background
There is no clear consensus on the association between tea intake and cancer, particularly its protective causal relationship with gastrointestinal tumors. This study aims to investigate this causal association using Mendelian randomization (MR) analysis to inform dietary interventions.
Methods
This two-sample MR study utilized summary statistics on tea consumption from genome-wide association studies (GWAS) conducted by the UK Biobank (UKB) and Biobank Japan (BBJ). Data on gastrointestinal tumors were sourced from GWAS by the FinnGen consortium and BBJ. The causal relationship was assessed using methods such as inverse variance weighted (IVW), MR-Egger, and MR-PRESSO. Horizontal pleiotropy and heterogeneity of instrumental variables (IVs) were evaluated using MR-PRESSO and Cochran's Q tests.
Results
IVW estimates indicated that in the Asian population, tea intake was negatively associated with colorectal cancer risk (OR=0.372, 95%CI: 0.157–0.881). In the European population, higher green tea consumption was linked to a lower risk of malignant neoplasm of the small intestine (OR=0.940, 95%CI: 0.901–0.982).
Conclusions
Tea intake may have a causal association with a reduced risk of colorectal cancer, offering new insights for its prevention. Further studies are needed to explore the specific protective mechanisms of tea consumption on gastrointestinal tumors.
{"title":"Role of tea in digestive tract malignancies: A two-sample Mendelian randomization study","authors":"Chen Fei Liang","doi":"10.1016/j.nutos.2025.08.012","DOIUrl":"10.1016/j.nutos.2025.08.012","url":null,"abstract":"<div><h3>Background</h3><div>There is no clear consensus on the association between tea intake and cancer, particularly its protective causal relationship with gastrointestinal tumors. This study aims to investigate this causal association using Mendelian randomization (MR) analysis to inform dietary interventions.</div></div><div><h3>Methods</h3><div>This two-sample MR study utilized summary statistics on tea consumption from genome-wide association studies (GWAS) conducted by the UK Biobank (UKB) and Biobank Japan (BBJ). Data on gastrointestinal tumors were sourced from GWAS by the FinnGen consortium and BBJ. The causal relationship was assessed using methods such as inverse variance weighted (IVW), MR-Egger, and MR-PRESSO. Horizontal pleiotropy and heterogeneity of instrumental variables (IVs) were evaluated using MR-PRESSO and Cochran's Q tests.</div></div><div><h3>Results</h3><div>IVW estimates indicated that in the Asian population, tea intake was negatively associated with colorectal cancer risk (OR=0.372, 95%CI: 0.157–0.881). In the European population, higher green tea consumption was linked to a lower risk of malignant neoplasm of the small intestine (OR=0.940, 95%CI: 0.901–0.982).</div></div><div><h3>Conclusions</h3><div>Tea intake may have a causal association with a reduced risk of colorectal cancer, offering new insights for its prevention. Further studies are needed to explore the specific protective mechanisms of tea consumption on gastrointestinal tumors.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"64 ","pages":"Pages 39-54"},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159758","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 : 2025-09-04DOI: 10.1016/j.nutos.2025.08.010
Carlos Cano-Gutierrez , Luis Carlos Venegas-Sanabria , Gabriel Gomez , Estephania Chacón-Valenzuela , María Fernanda Dueñas , Daniela Gracia , Juan Diego Misas , Elkin Garcia-Cifuentes , Suela Sulo , Leocadio Rodríguez-Mañas
<div><h3>Background</h3><div>Healthcare professionals today aim to boost the years older people live in good health by reducing the impact of aging-related frailty. Toward healthier aging, our current analysis quantified frailty changes that occurred when poorly nourished, community-living, older adults received interventional nutrition care.</div></div><div><h3>Methods</h3><div>We recruited outpatient study participants ≥ 60 years and malnourished or at-risk on screening (Mini Nutrition Assessment-Short Form, MNA-SF). For quasi-experimental analysis, we selected those who were prefrail or frail by Fried phenotype criteria (n=524). Each followed a comprehensive nutrition-focused Quality Improvement Program (QIP)—counseling on nutrition and physical activity, daily consumption of oral nutritional supplements for 60 days (Ensure with Hydroxymethylbutyrate® and Glucerna®, Abbott, USA), with follow-up through day 90. We quantified outcomes as changes from baseline to post-intervention for (i) overall frailty status (frail, prefrail, normal) or (ii) number of positive Fried frailty criteria of five (weight loss, exhaustion, low physical activity, slow gait speed, and muscular weakness) using change categories <em>Worse, Same, or Better</em>. We also measured baseline and post-intervention status of nutritional state (MNA-SF), mental state/cognitive status (Mini-Mental State Exam, MMSE), depression/psychological health (Geriatric Depression Scale, GDS), and disability (Barthel Index, BI). We applied logistic regression analyses to identify factors that predicted post-intervention improvement in frailty status.</div></div><div><h3>Results</h3><div>At baseline, the mean age of participants was 74.2 (±8.7) years, 71% (n=372/524) of participants were prefrail, and 29% (n=152/524) were frail; 16.2% (n=85/524) were malnourished, and 83.8% (n=439/524) were at risk. By study day 90, 34.4% (180/524) of participants had a <em>better</em> frailty status, while 55% (n=288/524) met fewer frailty criteria. <em>Better</em> frailty status was also associated with significantly higher MNA-SF score (12.3 vs 9.1, P < 0.001), improved mental state/cognitive status as higher MMSE score (28.1 vs 27.7, P < 0.05), decreased depression/improved psychological health as lower GDS score (3.3 vs 4.5, P < 0.001), and greater independence as higher BI score (96.9 vs 96.1, P < 0.05). Logistic regression analyses showed that MNA-SF score improvement was predictive of frailty improvement in response to the nutrition-focused QIP intervention. Specifically, individuals who experienced improvement from prefrail or frail to normal were nearly 8-times more likely than others to have a parallel increase in MNA-SF score (Odds ratio of 7.83, 95% CI 4.3–15.2, P < 0.01).</div></div><div><h3>Conclusion</h3><div>Healthy aging can be supported by addressing poor nutritional status, a frailty risk contributor. We found that community-living older adults achieved a <em>better</em> frai
医疗保健专业人员今天的目标是通过减少与衰老有关的虚弱的影响来延长老年人的健康寿命。为了更健康的老龄化，我们目前的分析量化了营养不良、社区生活的老年人接受介入性营养护理时发生的虚弱变化。方法：我们招募年龄≥60岁、营养不良或有筛查风险的门诊研究参与者（Mini Nutrition Assessment-Short Form, MNA-SF）。为了进行准实验分析，我们根据Fried表型标准选择了那些体弱或体弱的人（n=524）。每个人都接受了全面的以营养为重点的质量改进计划(QIP) -营养和身体活动咨询，每天服用口服营养补充剂60天（确保服用羟甲基丁酸酯®和Glucerna®，雅培，美国），随访至第90天。我们将结果量化为从基线到干预后的变化(i)总体虚弱状态（虚弱，虚弱前期，正常）或（ii）五个阳性Fried虚弱标准的数量（体重减轻，疲惫，低体力活动，慢速步态和肌肉无力），使用变化类别更糟，相同或更好。我们还测量了基线和干预后的营养状态（MNA-SF）、精神状态/认知状态（Mini-Mental state Exam， MMSE）、抑郁/心理健康（Geriatric depression Scale， GDS）和残疾（Barthel指数，BI）。我们应用逻辑回归分析来确定预测干预后虚弱状态改善的因素。结果基线时，参与者平均年龄为74.2（±8.7）岁，71% （n=372/524）的参与者体弱，29% （n=152/524）的参与者体弱；16.2% （n=85/524）营养不良，83.8% （n=439/524）处于危险状态。到研究第90天，34.4%（180/524）的参与者虚弱状态较好，而55% （n=288/524）的参与者虚弱状态较差。较好的虚弱状态还与较高的MNA-SF评分（12.3比9.1,P < 0.001）、较高的MMSE评分（28.1比27.7,P < 0.05）、较低的GDS评分（3.3比4.5,P < 0.001）、较高的BI评分（96.9比96.1,P < 0.05）相关，与改善的精神状态/认知状态相关。Logistic回归分析显示，MNA-SF评分的改善可预测以营养为重点的QIP干预对虚弱的改善。具体而言，从体弱或体弱改善到正常的个体MNA-SF评分平行增加的可能性是其他人的近8倍（优势比为7.83,95% CI 4.3-15.2, P < 0.01）。结论通过解决营养不良这一脆弱的危险因素，可以支持健康老龄化。我们发现，在以营养为重点的QIP之后，社区生活的老年人获得了更好的虚弱状态。值得注意的是，营养状况的改善预示着虚弱状态的改善，并与之平行。
{"title":"Improving aging-related frailty status among older adults: Results of a nutrition-focused program","authors":"Carlos Cano-Gutierrez , Luis Carlos Venegas-Sanabria , Gabriel Gomez , Estephania Chacón-Valenzuela , María Fernanda Dueñas , Daniela Gracia , Juan Diego Misas , Elkin Garcia-Cifuentes , Suela Sulo , Leocadio Rodríguez-Mañas","doi":"10.1016/j.nutos.2025.08.010","DOIUrl":"10.1016/j.nutos.2025.08.010","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare professionals today aim to boost the years older people live in good health by reducing the impact of aging-related frailty. Toward healthier aging, our current analysis quantified frailty changes that occurred when poorly nourished, community-living, older adults received interventional nutrition care.</div></div><div><h3>Methods</h3><div>We recruited outpatient study participants ≥ 60 years and malnourished or at-risk on screening (Mini Nutrition Assessment-Short Form, MNA-SF). For quasi-experimental analysis, we selected those who were prefrail or frail by Fried phenotype criteria (n=524). Each followed a comprehensive nutrition-focused Quality Improvement Program (QIP)—counseling on nutrition and physical activity, daily consumption of oral nutritional supplements for 60 days (Ensure with Hydroxymethylbutyrate® and Glucerna®, Abbott, USA), with follow-up through day 90. We quantified outcomes as changes from baseline to post-intervention for (i) overall frailty status (frail, prefrail, normal) or (ii) number of positive Fried frailty criteria of five (weight loss, exhaustion, low physical activity, slow gait speed, and muscular weakness) using change categories <em>Worse, Same, or Better</em>. We also measured baseline and post-intervention status of nutritional state (MNA-SF), mental state/cognitive status (Mini-Mental State Exam, MMSE), depression/psychological health (Geriatric Depression Scale, GDS), and disability (Barthel Index, BI). We applied logistic regression analyses to identify factors that predicted post-intervention improvement in frailty status.</div></div><div><h3>Results</h3><div>At baseline, the mean age of participants was 74.2 (±8.7) years, 71% (n=372/524) of participants were prefrail, and 29% (n=152/524) were frail; 16.2% (n=85/524) were malnourished, and 83.8% (n=439/524) were at risk. By study day 90, 34.4% (180/524) of participants had a <em>better</em> frailty status, while 55% (n=288/524) met fewer frailty criteria. <em>Better</em> frailty status was also associated with significantly higher MNA-SF score (12.3 vs 9.1, P < 0.001), improved mental state/cognitive status as higher MMSE score (28.1 vs 27.7, P < 0.05), decreased depression/improved psychological health as lower GDS score (3.3 vs 4.5, P < 0.001), and greater independence as higher BI score (96.9 vs 96.1, P < 0.05). Logistic regression analyses showed that MNA-SF score improvement was predictive of frailty improvement in response to the nutrition-focused QIP intervention. Specifically, individuals who experienced improvement from prefrail or frail to normal were nearly 8-times more likely than others to have a parallel increase in MNA-SF score (Odds ratio of 7.83, 95% CI 4.3–15.2, P < 0.01).</div></div><div><h3>Conclusion</h3><div>Healthy aging can be supported by addressing poor nutritional status, a frailty risk contributor. We found that community-living older adults achieved a <em>better</em> frai","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"64 ","pages":"Pages 1-12"},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145098796","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}
Parkinson's disease (PD) is a progressive neurodegenerative disorder often accompanied by malnutrition and dysphagia, which significantly impact quality of life and clinical outcomes. This study aimed to evaluate the prevalence of nutritional risk, malnutrition, sarcopenia and risk of dysphagia among individuals with PD in a Danish rehabilitation setting. Additionally, it examined the prevalence and impact of nutrition impact symptoms (NIS) on dietary intake.
Methods
A cross-sectional pilot study was conducted at the Sano Rehabilitation Centre, Denmark, including 44 participants with PD in phases 2 and 3 of disease progression. Nutritional risk was assessed using the Nutritional Risk Screening 2002 (NRS-2002), and malnutrition was classified according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Swallowing difficulties were evaluated using the Eating Assessment Tool-10 (EAT-10), and NIS were assessed using a modified questionnaire from the Danish Health Authority. Sarcopenia was identified using handgrip strength, bioimpedance analysis and the Timed Up and Go test.
Results
The study found that 23% of the participants were at nutritional risk, with 7% classified with malnutrition. Risk of dysphagia was identified in 34% of the participants, whereas swallowing difficulties (34.1%), constipation (45.5%) and rapid satiety (31.8%) were the most common NIS. Notably, 90% of the participants reported experiencing at least one NIS, and 59% indicated that these symptoms affected their dietary intake. Sarcopenia was confirmed in 2.5% of the participants.
Conclusion
This study highlights the prevalence of nutritional risk, risk of dysphagia and NIS among individuals with PD undergoing rehabilitation.
背景和目的帕金森病（PD）是一种进行性神经退行性疾病，常伴有营养不良和吞咽困难，严重影响患者的生活质量和临床结果。本研究旨在评估丹麦康复环境中PD患者营养风险、营养不良、肌肉减少症和吞咽困难风险的患病率。此外，它还调查了营养影响症状（NIS）对饮食摄入的流行程度和影响。方法在丹麦Sano康复中心进行了一项横断面试点研究，包括44名处于疾病进展2期和3期的PD患者。采用2002年营养风险筛查（NRS-2002）对营养风险进行评估，并根据全球营养不良领导倡议（GLIM）标准对营养不良进行分类。使用进食评估工具-10 （EAT-10）评估吞咽困难，使用丹麦卫生当局修改的问卷评估NIS。通过握力、生物阻抗分析和Timed Up and Go测试来确定肌肉减少症。结果研究发现，23%的参与者有营养风险，7%的人营养不良。34%的参与者有吞咽困难的风险，而吞咽困难（34.1%）、便秘（45.5%）和快速饱腹感（31.8%）是最常见的NIS。值得注意的是，90%的参与者报告至少经历过一次NIS， 59%的参与者表示这些症状影响了他们的饮食摄入。2.5%的参与者确诊为肌肉减少症。结论本研究突出了PD康复患者营养风险、吞咽困难风险和NIS的患病率。
{"title":"Nutritional risk and risk of dysphagia in Parkinson's disease: Insights from a rehabilitation setting","authors":"Jonas Anias Svendsen , Steffen Arild Kronvold , Malene Sofie Malmstrøm , Anja Weirsøe Dynesen","doi":"10.1016/j.nutos.2025.08.008","DOIUrl":"10.1016/j.nutos.2025.08.008","url":null,"abstract":"<div><h3>Background and Aim</h3><div>Parkinson's disease (PD) is a progressive neurodegenerative disorder often accompanied by malnutrition and dysphagia, which significantly impact quality of life and clinical outcomes. This study aimed to evaluate the prevalence of nutritional risk, malnutrition, sarcopenia and risk of dysphagia among individuals with PD in a Danish rehabilitation setting. Additionally, it examined the prevalence and impact of nutrition impact symptoms (NIS) on dietary intake.</div></div><div><h3>Methods</h3><div>A cross-sectional pilot study was conducted at the Sano Rehabilitation Centre, Denmark, including 44 participants with PD in phases 2 and 3 of disease progression. Nutritional risk was assessed using the Nutritional Risk Screening 2002 (NRS-2002), and malnutrition was classified according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Swallowing difficulties were evaluated using the Eating Assessment Tool-10 (EAT-10), and NIS were assessed using a modified questionnaire from the Danish Health Authority. Sarcopenia was identified using handgrip strength, bioimpedance analysis and the Timed Up and Go test.</div></div><div><h3>Results</h3><div>The study found that 23% of the participants were at nutritional risk, with 7% classified with malnutrition. Risk of dysphagia was identified in 34% of the participants, whereas swallowing difficulties (34.1%), constipation (45.5%) and rapid satiety (31.8%) were the most common NIS. Notably, 90% of the participants reported experiencing at least one NIS, and 59% indicated that these symptoms affected their dietary intake. Sarcopenia was confirmed in 2.5% of the participants.</div></div><div><h3>Conclusion</h3><div>This study highlights the prevalence of nutritional risk, risk of dysphagia and NIS among individuals with PD undergoing rehabilitation.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"64 ","pages":"Pages 136-146"},"PeriodicalIF":0.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363625","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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