Pub Date : 2025-07-31DOI: 10.1016/j.nutos.2025.07.013
Yoshitsugu Tanino, Yuki Fukumoto, Wataru Yamazaki, Takaki Yoshida
Background & Aims
Studies have shown that qualitative changes, such as ectopic fat accumulation, are associated with muscle weakness and degeneration of the articular cartilage. This study aimed to investigate the effects and timing of electrical muscle stimulation on the vastus medialis using a single-case experimental design to evaluate improvement in muscle quality.
Methods
Three healthy males participated in this study. An “ABAB design” was employed over a 14-week period, alternating between baseline phases without electrical muscle stimulation (3 weeks each) and intervention phases with electrical stimulation (4 weeks each). Electrical muscle stimulation was applied to the vastus medialis for 30 min three times per week during the intervention phases. The intensity was adjusted to a tolerable level of discomfort. Sonographic echo intensity of the vastus medialis, reflecting intramuscular fat content, and body fat percentage were measured.
Results
During the first electrical muscle stimulation phase, the effect size based on the percentage of non-overlapping data in echo intensity was 0% for all three subjects compared to the baseline. However, during the second baseline phase, subjects A and C achieved 100% (indicating very effective changes). In the second electrical muscle stimulation phase, all subjects exhibited 100%. No significant changes in body fat percentage were observed during the study.
Conclusions
These findings suggest that electrical muscle stimulation must be sustained for at least 4 weeks to effectively reduce intramuscular fat and improve vastus medialis muscle quality.
{"title":"Electrical muscle stimulation improves vastus medialis quality: A single-case experimental design","authors":"Yoshitsugu Tanino, Yuki Fukumoto, Wataru Yamazaki, Takaki Yoshida","doi":"10.1016/j.nutos.2025.07.013","DOIUrl":"10.1016/j.nutos.2025.07.013","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Studies have shown that qualitative changes, such as ectopic fat accumulation, are associated with muscle weakness and degeneration of the articular cartilage. This study aimed to investigate the effects and timing of electrical muscle stimulation on the vastus medialis using a single-case experimental design to evaluate improvement in muscle quality.</div></div><div><h3>Methods</h3><div>Three healthy males participated in this study. An “ABAB design” was employed over a 14-week period, alternating between baseline phases without electrical muscle stimulation (3 weeks each) and intervention phases with electrical stimulation (4 weeks each). Electrical muscle stimulation was applied to the vastus medialis for 30 min three times per week during the intervention phases. The intensity was adjusted to a tolerable level of discomfort. Sonographic echo intensity of the vastus medialis, reflecting intramuscular fat content, and body fat percentage were measured.</div></div><div><h3>Results</h3><div>During the first electrical muscle stimulation phase, the effect size based on the percentage of non-overlapping data in echo intensity was 0% for all three subjects compared to the baseline. However, during the second baseline phase, subjects A and C achieved 100% (indicating very effective changes). In the second electrical muscle stimulation phase, all subjects exhibited 100%. No significant changes in body fat percentage were observed during the study.</div></div><div><h3>Conclusions</h3><div>These findings suggest that electrical muscle stimulation must be sustained for at least 4 weeks to effectively reduce intramuscular fat and improve vastus medialis muscle quality.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"63 ","pages":"Pages 174-191"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830693","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 : 2025-07-25DOI: 10.1016/j.nutos.2025.07.012
Maria Camila Arbeláez Grajales , Dianna Ramírez-Prada , Frank Carrera-Gil
Background and aim
Early identification of nutritional risk is essential in the care of hospitalized children. Although several screening tools exist, evidence on their performance in identifying at-risk patients and predicting nutrition-related outcomes remains limited, especially in non-Caucasian populations. This protocol outlines the rationale and methods to assess the concurrent and predictive validity of nutritional screening tools in hospitalized pediatric patients.
Methods
This prospective diagnostic accuracy study will enroll at least 204 patients aged 2–17 years, consecutively admitted to the emergency department of a tertiary pediatric hospital in Colombia and expected to remain hospitalized for ≥3 days. Within 48 hours of admission, nutritional risk will be assessed using STRONGkids, PYMS, and WHO criteria, alongside the Subjective Global Nutritional Assessment (SGNA) as the reference standard. The primary outcome is the concurrent validity of each screening tool to detect disease-related malnutrition, assessed via sensitivity, specificity, predictive values, likelihood ratios, and Kappa coefficient. Secondary outcomes include time to complete each tool and associations between baseline nutritional status, clinical outcomes, and sociodemographic variables. Predictive validity will be analyzed through ROC curves and area under the curve (AUC) values for each tool using a composite adverse outcome: ICU admission, hospital stay ≥7 days, in-hospital mortality within 30 days, and infectious complications.
Discussion
This study will generate prospective evidence on the diagnostic accuracy of widely used pediatric screening tools, using an appropriate reference method. Findings may help identify the most effective tool for early nutritional risk detection in underrepresented pediatric populations.
{"title":"Concurrent and predictive validity of nutritional screening tools in hospitalized pediatric patients: Protocol for a single-center, prospective, observational study","authors":"Maria Camila Arbeláez Grajales , Dianna Ramírez-Prada , Frank Carrera-Gil","doi":"10.1016/j.nutos.2025.07.012","DOIUrl":"10.1016/j.nutos.2025.07.012","url":null,"abstract":"<div><h3>Background and aim</h3><div>Early identification of nutritional risk is essential in the care of hospitalized children. Although several screening tools exist, evidence on their performance in identifying at-risk patients and predicting nutrition-related outcomes remains limited, especially in non-Caucasian populations. This protocol outlines the rationale and methods to assess the concurrent and predictive validity of nutritional screening tools in hospitalized pediatric patients.</div></div><div><h3>Methods</h3><div>This prospective diagnostic accuracy study will enroll at least 204 patients aged 2–17 years, consecutively admitted to the emergency department of a tertiary pediatric hospital in Colombia and expected to remain hospitalized for ≥3 days. Within 48 hours of admission, nutritional risk will be assessed using STRONGkids, PYMS, and WHO criteria, alongside the Subjective Global Nutritional Assessment (SGNA) as the reference standard. The primary outcome is the concurrent validity of each screening tool to detect disease-related malnutrition, assessed via sensitivity, specificity, predictive values, likelihood ratios, and Kappa coefficient. Secondary outcomes include time to complete each tool and associations between baseline nutritional status, clinical outcomes, and sociodemographic variables. Predictive validity will be analyzed through ROC curves and area under the curve (AUC) values for each tool using a composite adverse outcome: ICU admission, hospital stay ≥7 days, in-hospital mortality within 30 days, and infectious complications.</div></div><div><h3>Discussion</h3><div>This study will generate prospective evidence on the diagnostic accuracy of widely used pediatric screening tools, using an appropriate reference method. Findings may help identify the most effective tool for early nutritional risk detection in underrepresented pediatric populations.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"63 ","pages":"Pages 192-200"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144828831","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 : 2025-07-25DOI: 10.1016/j.nutos.2025.07.011
Tzu-Fang Chen , Tsae-Jyy Wang , Shu-Yuan Liang , Chieh-Yu Liu , Shiow-Chwen Tsai , Gwo-Chi Hu
Background
Cancer remains a leading cause of mortality worldwide, with over half of patients dying from cancer-related anorexia–cachexia syndrome (CACS). CACS is characterized by progressive weight loss and reductions in muscle and/or fat mass and considerably affects quality of life, prognosis, treatment tolerance, and length of hospitalization. Nutritional consultation or education is a key strategy for managing cancer-related cachexia. However, its effectiveness is determined by several factors, such as patients' nutritional knowledge. To date, no standardized tool has been developed for assessing the nutrition knowledge of patients with cancer specific to CACS. This study developed and validated the Cancer-Related Anorexia and Cachexia Syndrome Nutrition Knowledge Questionnaire (CACSNKQ) to assess patients' understanding of nutrition in the context of cachexia.
Method
The initial version of the CACSNKQ comprised 35 items. The validation process involved content validity assessment, item analysis, reliability testing by using the Kuder–Richardson Formula 20 (KR-20), and the criterion-groups technique. Exploratory factor analysis was conducted to identify underlying factors and refine the questionnaire by eliminating items with low factor loadings or cross loadings.
Result
The CACSNKQ was validated in a sample of 203 participants. The content validity analysis revealed that item-level content validity indices exceeded 0.80, and internal consistency was strong, with the KR-20 coefficient being >0.80. The exploratory factor analysis yielded a Kaiser–Meyer–Olkin coefficient of 0.869. Following the analysis, the questionnaire was refined to include 21 items, with higher scores indicating greater knowledge of cachexia-related nutrition.
Conclusion
The CACSNKQ is a valid and reliable instrument for assessing cachexia-related nutrition knowledge. In clinical practice, this tool can enhance awareness among patients and health-care providers regarding the importance of nutritional knowledge in managing CACS. In academic and research contexts, it can serve as a valuable tool for evaluating the effectiveness of nutrition education programs.
{"title":"Development and validation of nutrition knowledge questionnaire for cancer-related anorexia and cachexia syndrome in Taiwanese patients with cancer","authors":"Tzu-Fang Chen , Tsae-Jyy Wang , Shu-Yuan Liang , Chieh-Yu Liu , Shiow-Chwen Tsai , Gwo-Chi Hu","doi":"10.1016/j.nutos.2025.07.011","DOIUrl":"10.1016/j.nutos.2025.07.011","url":null,"abstract":"<div><h3>Background</h3><div>Cancer remains a leading cause of mortality worldwide, with over half of patients dying from cancer-related anorexia–cachexia syndrome (CACS). CACS is characterized by progressive weight loss and reductions in muscle and/or fat mass and considerably affects quality of life, prognosis, treatment tolerance, and length of hospitalization. Nutritional consultation or education is a key strategy for managing cancer-related cachexia. However, its effectiveness is determined by several factors, such as patients' nutritional knowledge. To date, no standardized tool has been developed for assessing the nutrition knowledge of patients with cancer specific to CACS. This study developed and validated the Cancer-Related Anorexia and Cachexia Syndrome Nutrition Knowledge Questionnaire (CACSNKQ) to assess patients' understanding of nutrition in the context of cachexia.</div></div><div><h3>Method</h3><div>The initial version of the CACSNKQ comprised 35 items. The validation process involved content validity assessment, item analysis, reliability testing by using the Kuder–Richardson Formula 20 (KR-20), and the criterion-groups technique. Exploratory factor analysis was conducted to identify underlying factors and refine the questionnaire by eliminating items with low factor loadings or cross loadings.</div></div><div><h3>Result</h3><div>The CACSNKQ was validated in a sample of 203 participants. The content validity analysis revealed that item-level content validity indices exceeded 0.80, and internal consistency was strong, with the KR-20 coefficient being >0.80. The exploratory factor analysis yielded a Kaiser–Meyer–Olkin coefficient of 0.869. Following the analysis, the questionnaire was refined to include 21 items, with higher scores indicating greater knowledge of cachexia-related nutrition.</div></div><div><h3>Conclusion</h3><div>The CACSNKQ is a valid and reliable instrument for assessing cachexia-related nutrition knowledge. In clinical practice, this tool can enhance awareness among patients and health-care providers regarding the importance of nutritional knowledge in managing CACS. In academic and research contexts, it can serve as a valuable tool for evaluating the effectiveness of nutrition education programs.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"63 ","pages":"Pages 143-160"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766894","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 : 2025-07-22DOI: 10.1016/j.nutos.2025.07.010
Sarah Maria Barneze Costa , Raghavendra Lakshmana Shetty Hallur , Matheus Naia Fioretto , João Paulo de Castro Marcondes , Igor de Carvalho Deprá , Camila Renata Corrêa , Danielle Cristina Honorio França , David Rafael Abreu Reyes , Sérgio Luis Felisbino , Angélica Mércia Pascon Barbosa , Marilza Cunha Vieira Rudge
Background
Gestational diabetes mellitus (GDM) and pregnancy-specific urinary incontinence (PSUI) pose significant health challenges for pregnant women, but their metabolic and molecular underpinnings remain poorly understood.
Methods
In this cross-sectional study, 1,105 participants from the DIAMATER cohort were categorized based on GDM and PSUI status. Dietary intake of iron, magnesium, zinc, and vitamins A and D was assessed through dietary recalls, while serum levels, gene expression (MTF1, RXRA, TFRC, TRPM6), and protein expression were analyzed using standard techniques. Oxidative stress markers were also measured.
Results
GDM-PSUI participants exhibited lower RXRA and TFRC gene expression and decreased TFRC protein levels despite higher intake of magnesium, zinc, and vitamin D compared to GDM controls without PSUI. Serum mineral levels and oxidative stress markers did not differ significantly between groups.
Conclusions
Lower RXRA and TFRC expression in GDM-PSUI women, despite increased mineral and vitamin intake, suggests potential molecular targets for interventions aimed at improving management strategies in this population.
{"title":"Lower RXRA and TFRC expression despite higher mineral and vitamin intake in diabetic pregnant women with pregnancy-specific urinary incontinence","authors":"Sarah Maria Barneze Costa , Raghavendra Lakshmana Shetty Hallur , Matheus Naia Fioretto , João Paulo de Castro Marcondes , Igor de Carvalho Deprá , Camila Renata Corrêa , Danielle Cristina Honorio França , David Rafael Abreu Reyes , Sérgio Luis Felisbino , Angélica Mércia Pascon Barbosa , Marilza Cunha Vieira Rudge","doi":"10.1016/j.nutos.2025.07.010","DOIUrl":"10.1016/j.nutos.2025.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Gestational diabetes mellitus (GDM) and pregnancy-specific urinary incontinence (PSUI) pose significant health challenges for pregnant women, but their metabolic and molecular underpinnings remain poorly understood.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, 1,105 participants from the DIAMATER cohort were categorized based on GDM and PSUI status. Dietary intake of iron, magnesium, zinc, and vitamins A and D was assessed through dietary recalls, while serum levels, gene expression (MTF1, RXRA, TFRC, TRPM6), and protein expression were analyzed using standard techniques. Oxidative stress markers were also measured.</div></div><div><h3>Results</h3><div>GDM-PSUI participants exhibited lower RXRA and TFRC gene expression and decreased TFRC protein levels despite higher intake of magnesium, zinc, and vitamin D compared to GDM controls without PSUI. Serum mineral levels and oxidative stress markers did not differ significantly between groups.</div></div><div><h3>Conclusions</h3><div>Lower RXRA and TFRC expression in GDM-PSUI women, despite increased mineral and vitamin intake, suggests potential molecular targets for interventions aimed at improving management strategies in this population.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"63 ","pages":"Pages 113-130"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738442","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 : 2025-07-22DOI: 10.1016/j.nutos.2025.07.006
M. Lecha , C. Vaqué-Crusellas , A. Peñalva-Arigita , R. Prats , A. Sansano , D. Rubira , M. Albareda , L. Vila
Background
The prevalence of disease-related malnutrition (DRM) among Chronic Patients with Complex Needs (CPCN), (a population characterised by multimorbidity, functional decline, and frequent health and social needs), remains poorly established in hospital outpatients settings. These individuals, often older and frail, are presumed to be at higher risk of suffering malnutrition. The Mini Nutritional Assessment (MNA), validated for use in older and frail adults, identifies individuals who are malnourished as well as those at risk of malnutrition (RM).
Objectives
1. To determine the prevalence of DRM and RM in CPCN outpatients. 2. To analyse the association between DRM and RM and a set of clinical, dietary, and social factors relevant to this population.
Methods
Single-centre observational study conducted over a cross-sectional period (June 2022–January 2023). Consecutive sampling was used from the CPCN outpatient registry, a clinical listing used to monitor patients receiving specialised chronic care follow-up. Inclusion criteria: outpatients, ≥18 years, CPCN, life expectancy ≥1 year, living at home. Exclusion criteria: enteral nutrition, dementia GDS ≥5. Variables: gender, age, nutritional status (MNA), education, living alone/accompanied, risk of dysphagia (EAT-10), dental status, adherence to Mediterranean diet (MEDAS), exercise time (walking ≥30 minutes or other similar exercise) and quality of life (EuroQoL).
Results
N=340 patients. Mean age=80.8 years (SD 6.6), 51% female. Ninety percent had only primary education or non, and 23.5% lived alone. Quality of life had a mean score of 61/100 (SD: 17.3). Risk of dysphagia found in 20.6% and 38.2% had missing teeth or teeth in poor condition. While 66.8% adhered correctly to the Mediterranean diet, 55% did not exercise regularly. The prevalence of RM was 31.7% (95% CI: 31.2 to 32.3) with 10.9% being malnourished (95% CI: 10.3 to 11.46). In the multivariate analysis, RM was independently associated with being female (OR: 1.894; 95% CI: 1.102–3.255; P=0.021), the presence of risk of dysphagia (OR: 2.375; 95% CI: 1.241–4.545; P=0.009), teeth in poor condition (OR: 2.897; 95% CI: 1.609–5.217; P<0.001) and non-adherence to the Mediterranean diet (OR: 3.595; 95% CI: 2.034–6.354; P<0.001). The DRM was independently associated with being the presence of risk of dysphagia (OR: 2.722; 95% CI: 1.127–6.573; P=0.026) and non-adherence to the Mediterranean diet (OR: 4.428; 95% CI: 2.005–9.781; P<0.001).
Conclusions
There is a high prevalence of CPCN with DRM and RM in the outpatient setting. The results reinforce the need to establish nutritional strategies aimed at improving eating habits and nutritional status in this vulnerable group of people.
{"title":"Prevalence of malnutrition and risk of malnutrition in complex chronic outpatients","authors":"M. Lecha , C. Vaqué-Crusellas , A. Peñalva-Arigita , R. Prats , A. Sansano , D. Rubira , M. Albareda , L. Vila","doi":"10.1016/j.nutos.2025.07.006","DOIUrl":"10.1016/j.nutos.2025.07.006","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence of disease-related malnutrition (DRM) among Chronic Patients with Complex Needs (CPCN), (a population characterised by multimorbidity, functional decline, and frequent health and social needs), remains poorly established in hospital outpatients settings. These individuals, often older and frail, are presumed to be at higher risk of suffering malnutrition. The Mini Nutritional Assessment (MNA), validated for use in older and frail adults, identifies individuals who are malnourished as well as those at risk of malnutrition (RM).</div></div><div><h3>Objectives</h3><div>1. To determine the prevalence of DRM and RM in CPCN outpatients. 2. To analyse the association between DRM and RM and a set of clinical, dietary, and social factors relevant to this population.</div></div><div><h3>Methods</h3><div>Single-centre observational study conducted over a cross-sectional period (June 2022–January 2023). Consecutive sampling was used from the CPCN outpatient registry, a clinical listing used to monitor patients receiving specialised chronic care follow-up. Inclusion criteria: outpatients, ≥18 years, CPCN, life expectancy ≥1 year, living at home. Exclusion criteria: enteral nutrition, dementia GDS ≥5. Variables: gender, age, nutritional status (MNA), education, living alone/accompanied, risk of dysphagia (EAT-10), dental status, adherence to Mediterranean diet (MEDAS), exercise time (walking ≥30 minutes or other similar exercise) and quality of life (EuroQoL).</div></div><div><h3>Results</h3><div>N=340 patients. Mean age=80.8 years (SD 6.6), 51% female. Ninety percent had only primary education or non, and 23.5% lived alone. Quality of life had a mean score of 61/100 (SD: 17.3). Risk of dysphagia found in 20.6% and 38.2% had missing teeth or teeth in poor condition. While 66.8% adhered correctly to the Mediterranean diet, 55% did not exercise regularly. The prevalence of RM was 31.7% (95% CI: 31.2 to 32.3) with 10.9% being malnourished (95% CI: 10.3 to 11.46). In the multivariate analysis, RM was independently associated with being female (OR: 1.894; 95% CI: 1.102–3.255; <em>P</em>=0.021), the presence of risk of dysphagia (OR: 2.375; 95% CI: 1.241–4.545; <em>P</em>=0.009), teeth in poor condition (OR: 2.897; 95% CI: 1.609–5.217; <em>P</em><0.001) and non-adherence to the Mediterranean diet (OR: 3.595; 95% CI: 2.034–6.354; <em>P</em><0.001). The DRM was independently associated with being the presence of risk of dysphagia (OR: 2.722; 95% CI: 1.127–6.573; <em>P</em>=0.026) and non-adherence to the Mediterranean diet (OR: 4.428; 95% CI: 2.005–9.781; <em>P</em><0.001).</div></div><div><h3>Conclusions</h3><div>There is a high prevalence of CPCN with DRM and RM in the outpatient setting. The results reinforce the need to establish nutritional strategies aimed at improving eating habits and nutritional status in this vulnerable group of people.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"63 ","pages":"Pages 131-142"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772652","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 : 2025-07-22DOI: 10.1016/j.nutos.2025.07.008
Xuan Le Thi Thanh , Phuong Duong Thi , Huong Le Thi , Toi Phung Lam , Dung Nguyen Quang , Lan Nguyen Thi Huong , Thuc Luu Thi My , Hong Nguyen Thi Thuy
Background
According to the Global Leadership Initiative on Malnutrition (GLIM), screening for malnutrition risk using a validated tool is the first essential step in the diagnostic process. This study aimed to compare the diagnostic performance of four commonly used tools - Mini Nutritional Assessment Short Form (MNA-SF), Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Screening Tool (MST), and Malnutrition Universal Screening Tool (MUST) as a first-step screening instrument for hospitalized older adults according to the GLIM criteria.
Methods
A prospective cross-sectional study was conducted among 200 hospitalized elderly patients at Hanoi Medical University Hospital, Vietnam, between September and December 2023. Nutritional risk was screened at admission using MNA-SF, NRS-2002, MST, and MUST. Malnutrition was diagnosed using GLIM criteria and full MNA.
Results
Of the 200 patients, malnutrition risk or malnutrition was identified in 65.0% by MNA-SF, 45.0% by MST, 45.5% by MUST, and 45.0% by NRS-2002. According to full MNA, 58.5% of patients were at risk of malnutrition, and the prevalence of malnutrition based on GLIM criteria (without prior screening) was 54.0%. Using different screening tools as the first step for GLIM, MNA-SF showed the best performance (sensitivity: 100%, specificity: 82.9%, AUC: 0.91), followed by MUST (AUC: 0.88), NRS-2002 (AUC: 0.87), and MST (AUC: 0.83). Agreement with GLIM-defined malnutrition was high for all tools (Cohen's kappa: 0.81–0.95), with the highest for NRS-2002 (kappa = 0.93).
Conclusions
All four screening tools showed good diagnostic performance for detecting malnutrition based on GLIM criteria. Among them, MNA-SF showed the highest accuracy, making it the most effective first-step tool for screening and detecting malnutrition in elderly hospitalized patients based on the GLIM criteria.
{"title":"Validity of NRS-2002, MUST, MST, and MNA-SF as first-step screening tools for malnutrition based on GLIM criteria in older adults","authors":"Xuan Le Thi Thanh , Phuong Duong Thi , Huong Le Thi , Toi Phung Lam , Dung Nguyen Quang , Lan Nguyen Thi Huong , Thuc Luu Thi My , Hong Nguyen Thi Thuy","doi":"10.1016/j.nutos.2025.07.008","DOIUrl":"10.1016/j.nutos.2025.07.008","url":null,"abstract":"<div><h3>Background</h3><div>According to the Global Leadership Initiative on Malnutrition (GLIM), screening for malnutrition risk using a validated tool is the first essential step in the diagnostic process. This study aimed to compare the diagnostic performance of four commonly used tools - Mini Nutritional Assessment Short Form (MNA-SF), Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Screening Tool (MST), and Malnutrition Universal Screening Tool (MUST) as a first-step screening instrument for hospitalized older adults according to the GLIM criteria.</div></div><div><h3>Methods</h3><div>A prospective cross-sectional study was conducted among 200 hospitalized elderly patients at Hanoi Medical University Hospital, Vietnam, between September and December 2023. Nutritional risk was screened at admission using MNA-SF, NRS-2002, MST, and MUST. Malnutrition was diagnosed using GLIM criteria and full MNA.</div></div><div><h3>Results</h3><div>Of the 200 patients, malnutrition risk or malnutrition was identified in 65.0% by MNA-SF, 45.0% by MST, 45.5% by MUST, and 45.0% by NRS-2002. According to full MNA, 58.5% of patients were at risk of malnutrition, and the prevalence of malnutrition based on GLIM criteria (without prior screening) was 54.0%. Using different screening tools as the first step for GLIM, MNA-SF showed the best performance (sensitivity: 100%, specificity: 82.9%, AUC: 0.91), followed by MUST (AUC: 0.88), NRS-2002 (AUC: 0.87), and MST (AUC: 0.83). Agreement with GLIM-defined malnutrition was high for all tools (Cohen's kappa: 0.81–0.95), with the highest for NRS-2002 (kappa = 0.93).</div></div><div><h3>Conclusions</h3><div>All four screening tools showed good diagnostic performance for detecting malnutrition based on GLIM criteria. Among them, MNA-SF showed the highest accuracy, making it the most effective first-step tool for screening and detecting malnutrition in elderly hospitalized patients based on the GLIM criteria.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"63 ","pages":"Pages 99-112"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723666","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 : 2025-07-21DOI: 10.1016/j.nutos.2025.07.005
Michael Greger
{"title":"Corrigendum to “Are ultra-processed plant-based meats better than the alternative?” [Clin Nutr Open Sci 61 (2025) 241–252]","authors":"Michael Greger","doi":"10.1016/j.nutos.2025.07.005","DOIUrl":"10.1016/j.nutos.2025.07.005","url":null,"abstract":"","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"63 ","pages":"Page 11"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144672393","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 : 2025-07-17DOI: 10.1016/j.nutos.2025.07.009
Sifundile Zamazulu Maphumulo , Gerrit Jan Breukelman , Brandon Shaw , Ina Shaw
Background
Non-communicable diseases (NCDs) are a leading cause of mortality in South Africa, with their burden influenced by lifestyle, living conditions, ethnicity, and gender.
Methods
A cross-sectional study (N=100; n=50 males, n=50 females; mean age 25.15 ± 5.98) followed the WHO STEPwise approach which ensured systematic data collection. Standardized self-reported questionnaires were used to gather data on key behavioural risk factors, including tobacco use, physical activity, and dietary behaviours. The data collection was conducted over a four-month period, during which participants first completed qualitative questionnaires to provide insights into their lifestyle behaviours.
Results
Physical inactivity emerged as the most prevalent risk factor (20%), followed by tobacco use (17%) and poor nutrition (14%). Smoking rates were significantly higher among males compared to females (26% vs. 8%; P = 0.04), and among younger participants (≤25 years) compared to older ones (24.56% vs. 6.97%; P = 0.01). Poor nutrition was also more common in younger individuals (P = 0.05). While females reported lower smoking rates, they exhibited higher levels of physical inactivity than males (23% vs. 14%).
Conclusion
The findings highlight the persistent prevalence of modifiable behavioural risk factors for NCDs among young adults in South Africa, with distinct age and gender-related patterns. Targeted interventions addressing physical inactivity, tobacco use, and poor nutrition, particularly among males and younger individuals, are essential for reducing the long-term burden of NCDs. Gender-sensitive and age-specific public health strategies may improve lifestyle behaviours and contribute to more effective NCD prevention.
{"title":"The prevalence of behavioral non- communicable diseases risk factors among black Africans in peri-urban community in South Africa","authors":"Sifundile Zamazulu Maphumulo , Gerrit Jan Breukelman , Brandon Shaw , Ina Shaw","doi":"10.1016/j.nutos.2025.07.009","DOIUrl":"10.1016/j.nutos.2025.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Non-communicable diseases (NCDs) are a leading cause of mortality in South Africa, with their burden influenced by lifestyle, living conditions, ethnicity, and gender.</div></div><div><h3>Methods</h3><div>A cross-sectional study (N=100; n=50 males, n=50 females; mean age 25.15 ± 5.98) followed the WHO STEPwise approach which ensured systematic data collection. Standardized self-reported questionnaires were used to gather data on key behavioural risk factors, including tobacco use, physical activity, and dietary behaviours. The data collection was conducted over a four-month period, during which participants first completed qualitative questionnaires to provide insights into their lifestyle behaviours.</div></div><div><h3>Results</h3><div>Physical inactivity emerged as the most prevalent risk factor (20%), followed by tobacco use (17%) and poor nutrition (14%). Smoking rates were significantly higher among males compared to females (26% vs. 8%; <em>P</em> = 0.04), and among younger participants (≤25 years) compared to older ones (24.56% vs. 6.97%; <em>P</em> = 0.01). Poor nutrition was also more common in younger individuals (<em>P</em> = 0.05). While females reported lower smoking rates, they exhibited higher levels of physical inactivity than males (23% vs. 14%).</div></div><div><h3>Conclusion</h3><div>The findings highlight the persistent prevalence of modifiable behavioural risk factors for NCDs among young adults in South Africa, with distinct age and gender-related patterns. Targeted interventions addressing physical inactivity, tobacco use, and poor nutrition, particularly among males and younger individuals, are essential for reducing the long-term burden of NCDs. Gender-sensitive and age-specific public health strategies may improve lifestyle behaviours and contribute to more effective NCD prevention.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"63 ","pages":"Pages 55-62"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711005","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 : 2025-07-17DOI: 10.1016/j.nutos.2025.07.007
M.S. Makwela , E. Maimela , C.B. Ntimana , R.G. Mashaba , M.M. Bopape
Background
Exclusive breastfeeding (EBF) rates in South Africa have remained low for nearly two decades, with 7% in 2003 and 12% in 2008. While the 2016 South Africa Demographic and Health Survey (SADHS) reported an increase to 32% for infants aged 0–5 months, data on breastfeeding practices in urban and rural areas remain limited. Hence, the study aimed to compare feeding practices of caregivers of infants aged 0–6 months residing in urban and rural areas of Limpopo Province, South Africa.
Methodology
This was a cross-sectional, facility-based quantitative study. Convenient sampling was used to select 146 caregivers. Data were collected using a structured questionnaire and analysed using SPSS version 29. Chi-square test was applied to determine the relationship at a 95% confidence interval, where a P-value of <0.05 was considered statistically significant.
Results
The prevalence of EBF was higher in caregivers residing in rural areas (41% versus 39%), while mixed feeding was prevalent in urban areas (56% versus 52%). Meanwhile, the proposition of mixed feeding increased with the increase in the age of the infants. There was no significant difference in both groups in terms of as age of the caregivers, level of education, home language, and employment status. Breastfeeding practices improve with increasing age of the caregivers.
Conclusions
Caregivers who reside in urban areas tend to practice EBF less compared to those in rural areas. Interventions to promote EBF should focus on women living in urban areas. Breastfeeding increases with the increasing age of the caregivers, therefore, educational interventions that focus on best infant feeding practice, including EBF and misconceptions around EBF, should be implemented with a special focus on younger caregivers.
{"title":"A comparison of feeding practices of caregivers of infants aged 0–6 months residing in urban and rural areas of Limpopo province, South Africa","authors":"M.S. Makwela , E. Maimela , C.B. Ntimana , R.G. Mashaba , M.M. Bopape","doi":"10.1016/j.nutos.2025.07.007","DOIUrl":"10.1016/j.nutos.2025.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Exclusive breastfeeding (EBF) rates in South Africa have remained low for nearly two decades, with 7% in 2003 and 12% in 2008. While the 2016 South Africa Demographic and Health Survey (SADHS) reported an increase to 32% for infants aged 0–5 months, data on breastfeeding practices in urban and rural areas remain limited. Hence, the study aimed to compare feeding practices of caregivers of infants aged 0–6 months residing in urban and rural areas of Limpopo Province, South Africa.</div></div><div><h3>Methodology</h3><div>This was a cross-sectional, facility-based quantitative study. Convenient sampling was used to select 146 caregivers. Data were collected using a structured questionnaire and analysed using SPSS version 29. Chi-square test was applied to determine the relationship at a 95% confidence interval, where a P-value of <0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>The prevalence of EBF was higher in caregivers residing in rural areas (41% versus 39%), while mixed feeding was prevalent in urban areas (56% versus 52%). Meanwhile, the proposition of mixed feeding increased with the increase in the age of the infants. There was no significant difference in both groups in terms of as age of the caregivers, level of education, home language, and employment status. Breastfeeding practices improve with increasing age of the caregivers.</div></div><div><h3>Conclusions</h3><div>Caregivers who reside in urban areas tend to practice EBF less compared to those in rural areas. Interventions to promote EBF should focus on women living in urban areas. Breastfeeding increases with the increasing age of the caregivers, therefore, educational interventions that focus on best infant feeding practice, including EBF and misconceptions around EBF, should be implemented with a special focus on younger caregivers.</div></div>","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"63 ","pages":"Pages 44-54"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711004","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 : 2025-07-16DOI: 10.1016/j.nutos.2025.07.003
Lora Van Loenhout , Eline Snijders , Anne-Sophie Vercammen , Kristof Van Dessel , An Verrijken , Patrick Lauwers , Eveline Dirinck
<div><h3>Background & Aims</h3><div>This study aimed to assess the eventual discrepancy between predicted resting metabolic rate (p-RMR) using equations (Harris-Benedict (HB), Mifflin-St. Jeor (MSJ), World Health Organization (WHO), Cunningham (CU), Lührmann (LU) and Owen) and the gold standard of the measured resting metabolic rate (m-RMR) using indirect calorimetry (IC), in patients admitted to the Antwerp University Hospital (UZA) with a diabetic foot ulcer (DFU). Secondly, the impact of nutritional status on this discrepancy was assessed.</div></div><div><h3>Methods</h3><div>This prospective observational cohort study recruited patients admitted to the UZA due to a DFU from November 1st, 2021, to June 30th, 2023. A thorough nutritional assessment (nutritional questionnaires, anthropometry and bio-electrical impedance analysis) was performed upon admission. The Global Leadership Initiative on Malnutrition (GLIM) criteria were used to diagnose malnutrition. On admission, daily caloric requirements were measured by IC and predicted using six equations (MSJ, HB, WHO, CU, LU and Owen). Data were analysed using paired t-tests and Bland-Altman plots to assess statistically significant and clinically significant (>150 kcal/day) differences.</div></div><div><h3>Results</h3><div>A total of 59 subjects were enrolled in this study, including 46 men (78%). Patients included had a median age of 74 (38–90) years, had diabetes for 21±15 years and had a median Body Mass Index (BMI) of 27,1 kg/m<sup>2</sup>. Fifty-four percent were malnourished on admission. The mean m-RMR using IC was 1570±290 kcal/day while the mean p-RMR were 1584±241 kcal/day (MSJ), 1625±263 kcal/day (HB), 1685±210 kcal/day (WHO), 1596±203 kcal/day (CU), 1666±249 kcal/day (LU) and 1525±222 kcal/day (Owen). The WHO equation overestimated the m-RMR to the greatest extent (+115±213 kcal/day; <em>P</em><0,001), followed by the Lührmann equation (+96±229 kcal/day; <em>P</em>=0,002). The equation most precisely predicting the m-RMR values was the MSJ equation (+14±213 kcal/day; <em>P</em>=0,610). The MSJ, WHO and Owen equations differed on average more from the m-RMR in patients who were malnourished (MSJ: +24±212 kcal/day; <em>P</em>=0,523) (WHO: +137±217 kcal/day; <em>P</em>=0,001) (Owen: -63±217 kcal/day; <em>P</em>=0,109) than in patients who were normally fed (MSJ: +2±218 kcal/day; <em>P</em>=0,955) (WHO: +90±211 kcal/day; <em>P</em>=0,036) (Owen: -23±188 kcal/day; <em>P</em>=0,524). For the HB, CU and LU equations, the p-RMR differed on average more from the m-RMR in patients who were normally fed (HB: +57±216 kcal/day; <em>P</em>=0,185) (CU: +42±189 kcal/day; <em>P</em>=0,261) (LU: +96±229 kcal/day; <em>P</em>=0,038) than in malnourished patients (HB: +54±218 kcal/day; <em>P</em>=0,174) (CU: +12±216 kcal/day; <em>P</em>=0,760) (LU: +96±232 kcal/day; <em>P</em>=0,027). For all equations, a subset of patients (WHO: 27/59; HB: 28/59; MSJ: 25/59; Owen: 22/59; CU: 20/59; LU: 28/59) e
{"title":"Measured versus predicted resting metabolic rate in patients hospitalised due to a diabetic foot ulcer: a prospective observational cohort study","authors":"Lora Van Loenhout , Eline Snijders , Anne-Sophie Vercammen , Kristof Van Dessel , An Verrijken , Patrick Lauwers , Eveline Dirinck","doi":"10.1016/j.nutos.2025.07.003","DOIUrl":"10.1016/j.nutos.2025.07.003","url":null,"abstract":"<div><h3>Background & Aims</h3><div>This study aimed to assess the eventual discrepancy between predicted resting metabolic rate (p-RMR) using equations (Harris-Benedict (HB), Mifflin-St. Jeor (MSJ), World Health Organization (WHO), Cunningham (CU), Lührmann (LU) and Owen) and the gold standard of the measured resting metabolic rate (m-RMR) using indirect calorimetry (IC), in patients admitted to the Antwerp University Hospital (UZA) with a diabetic foot ulcer (DFU). Secondly, the impact of nutritional status on this discrepancy was assessed.</div></div><div><h3>Methods</h3><div>This prospective observational cohort study recruited patients admitted to the UZA due to a DFU from November 1st, 2021, to June 30th, 2023. A thorough nutritional assessment (nutritional questionnaires, anthropometry and bio-electrical impedance analysis) was performed upon admission. The Global Leadership Initiative on Malnutrition (GLIM) criteria were used to diagnose malnutrition. On admission, daily caloric requirements were measured by IC and predicted using six equations (MSJ, HB, WHO, CU, LU and Owen). Data were analysed using paired t-tests and Bland-Altman plots to assess statistically significant and clinically significant (>150 kcal/day) differences.</div></div><div><h3>Results</h3><div>A total of 59 subjects were enrolled in this study, including 46 men (78%). Patients included had a median age of 74 (38–90) years, had diabetes for 21±15 years and had a median Body Mass Index (BMI) of 27,1 kg/m<sup>2</sup>. Fifty-four percent were malnourished on admission. The mean m-RMR using IC was 1570±290 kcal/day while the mean p-RMR were 1584±241 kcal/day (MSJ), 1625±263 kcal/day (HB), 1685±210 kcal/day (WHO), 1596±203 kcal/day (CU), 1666±249 kcal/day (LU) and 1525±222 kcal/day (Owen). The WHO equation overestimated the m-RMR to the greatest extent (+115±213 kcal/day; <em>P</em><0,001), followed by the Lührmann equation (+96±229 kcal/day; <em>P</em>=0,002). The equation most precisely predicting the m-RMR values was the MSJ equation (+14±213 kcal/day; <em>P</em>=0,610). The MSJ, WHO and Owen equations differed on average more from the m-RMR in patients who were malnourished (MSJ: +24±212 kcal/day; <em>P</em>=0,523) (WHO: +137±217 kcal/day; <em>P</em>=0,001) (Owen: -63±217 kcal/day; <em>P</em>=0,109) than in patients who were normally fed (MSJ: +2±218 kcal/day; <em>P</em>=0,955) (WHO: +90±211 kcal/day; <em>P</em>=0,036) (Owen: -23±188 kcal/day; <em>P</em>=0,524). For the HB, CU and LU equations, the p-RMR differed on average more from the m-RMR in patients who were normally fed (HB: +57±216 kcal/day; <em>P</em>=0,185) (CU: +42±189 kcal/day; <em>P</em>=0,261) (LU: +96±229 kcal/day; <em>P</em>=0,038) than in malnourished patients (HB: +54±218 kcal/day; <em>P</em>=0,174) (CU: +12±216 kcal/day; <em>P</em>=0,760) (LU: +96±232 kcal/day; <em>P</em>=0,027). For all equations, a subset of patients (WHO: 27/59; HB: 28/59; MSJ: 25/59; Owen: 22/59; CU: 20/59; LU: 28/59) e","PeriodicalId":36134,"journal":{"name":"Clinical Nutrition Open Science","volume":"63 ","pages":"Pages 63-78"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723307","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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