Background & Aims Folate supplementation is critical for preventing neural tube defects, while 5-methyltetrahydrofolate (5-MTHF), the predominant circulating form of folate, may offer a pharmacokinetic advantage. However, comparative data in this populations remain limited. Methods This double-blind randomized controlled trial enrolled 110 pregnant women (9–14 weeks gestation). Participants were randomized 1:1 to receive either 600 μg folic acid (equivalent to 1.36 μmol folate) [FA group] or 1100 μg 5-MTHF glucosamine salt (equivalent to 1.35 μmol folate) [5-MTHF group] to precise equimolar dosage for 12 weeks. Primary outcomes included changes in red blood cell (RBC) folate and secondary outcomes were changes in plasma 5-MTHF, plasma homocysteine, and unmetabolized folic acid (UMFA). Subgroup analyses evaluated the impact of maternal body mass index (BMI). Results Ninety-six participants completed the trial (48 per group). Both interventions significantly increased RBC folate (FA: +262.00 ng/mL [IQR: 245.50]; 5-MTHF: +244.50 ng/mL [IQR: 233.50]; p = 0.714) and reduced plasma homocysteine with no significant differences between groups. However, 5-MTHF supplementation resulted in a greater increase in plasma 5-MTHF compared to the FA group (Median change: +5.67 ng/mL [IQR: 5.93] vs. +3.12 ng/mL [IQR: 6.47]; unadjusted p = 0.027; baseline-adjusted p = 0.055), a difference of borderline statistical significance. Median UMFA accumulation was approximately twice as high in the FA group, but the difference failed to reach significance due to non-normal distribution. The bioavailability of 5-MTHF was comparable to folic acid across different BMI categories, with a stronger trend toward higher bioavailability among normal-weight women (p = 0.182) than overweight women (p = 0.304). Conclusions Both supplements effectively improve long-term folate status and reduce homocysteine. 5-MTHF was associated with a greater plasma 5-MTHF response (adjusted p=0.055) and more modest UMFA accumulation, a pattern most pronounced in normal-weight women, supporting its use as a highly effective prenatal supplementation alternative ClinicalTrials Registration No NCT06935630
BACKGROUND & AIMS:The clinical implications of pretransplant malnutrition for perioperative course, long-term outcomes, and longitudinal change after lung transplantation remain uncertain. This study aimed to evaluate the impact of prognostic nutritional index-defined malnutrition on perioperative morbidity and long-term outcomes after lung transplantation. METHODS:In this retrospective single-center cohort, consecutive recipients underwent deceased-donor or living-donor lung transplantation between 2000 and 2020 and were followed through 2025. Malnutrition was defined as a prognostic nutritional index less than 45, calculated from serum albumin and total lymphocyte count. Primary outcomes were overall survival and chronic lung allograft dysfunction-related endpoints. Prolonged mechanical ventilation of 28 days or longer was evaluated using multivariable logistic regression adjusting for age, sex, and ischemic time. Longitudinal changes in body mass index, computed tomography-derived skeletal muscle mass, hand-grip strength, and 6-minute walk distance were assessed up to 5 years and analyzed using mixed-effects models. RESULTS:Of 135 recipients, 37 (27.4%) were malnourished. Malnourished recipients had longer mechanical ventilation, more frequent tracheostomy, and longer intensive care unit and hospital stays. In the primary multivariable analysis, longer ischemic time was associated with prolonged ventilation, whereas malnutrition showed a borderline association with a wide confidence interval; this association was attenuated in a sensitivity analysis excluding recipients with allogeneic lung disorders. Kaplan-Meier analyses did not detect statistically significant between-group differences in overall survival, freedom from chronic lung allograft dysfunction, or chronic lung allograft dysfunction-free survival. Exploratory Cox proportional hazards models adjusted for age and sex also did not show a clear association between malnutrition and these long-term outcomes. At later time points, the between-group difference in skeletal muscle mass appeared smaller, but this finding was limited by the marked decrease in available measurements. Functional measures showed broadly similar patterns. CONCLUSIONS:Pretransplant malnutrition defined by prognostic nutritional index was associated with a more demanding early postoperative course, whereas statistically significant differences in 5-year survival or chronic lung allograft dysfunction-related outcomes were not detected in this limited cohort. Longitudinal analyses were exploratory and should be interpreted cautiously because of incomplete follow-up and survivorship bias.
BACKGROUND AND AIMS:Malnutrition and sarcopenia are common in gastrointestinal malignancies. However, the prognostic value of Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition relative to objective muscle measures in surgical populations remains unclear. To determine the prevalence of sarcopenia and GLIM-defined malnutrition and to evaluate their associations with length of hospital stay (LOS) and one-year mortality. METHODS:Adult patients assessed preoperatively for pancreatoduodenectomy underwent computed tomography (CT) derived body composition analysis and handgrip strength (HGS) assessment. Sarcopenia was defined by the coexistence of low skeletal muscle index (SMI) and low HGS. Malnutrition was diagnosed using GLIM criteria incorporating muscle mass. Associations with postoperative LOS and one-year mortality were examined. RESULTS:Among 352 patients assessed preoperatively, 284 underwent pancreatoduodenectomy and were included in postoperative LOS analyses, while one-year mortality was assessed in 248 patients. Low HGS was present in 49% of patients, low SMI in 42%, sarcopenia in 21%, and GLIM-defined malnutrition in 83%. Neither sarcopenia nor GLIM-defined malnutrition was associated with LOS. On multivariable logistic regression adjusted for age, sex, body mass index, SMI, and sarcopenia, both low HGS (OR 4.4, 95% CI 1.6-12.6; p = 0.004) and GLIM-defined malnutrition (OR 3.99, 95% CI 1.01-15.87; p = 0.049) remained independently associated with one-year mortality. CONCLUSIONS:Low HGS and GLIM-defined malnutrition independently predicted one-year mortality, supporting the complementary value of objective muscle assessment alongside GLIM-defined malnutrition for perioperative risk stratification in patients undergoing pancreatoduodenectomy.
Background and aims Malnutrition is one of the most frequent and significant complications of cancer, driven by cachexia, a multifactorial metabolic syndrome characterized by systemic inflammation, anorexia, and progressive loss of muscle mass and function. It affects up to 80% of patients with cancer and contributes to treatment intolerance, reduced quality of life, and poor survival. Despite its major nutritional and prognostic burden, cachexia-related malnutrition remains insufficiently characterized and inadequately managed in routine oncology practice. Methods We conducted a narrative review of the current literature on the pathophysiology of cancer cachexia, the role of resting energy expenditure (REE) as an emerging host depending metabolic biomarker, nutritional recommendations, and therapeutic strategies targeting cachexia, such as adapted physical activity and anti-cachexia pharmacological agents. Results Cancer cachexia results from tumor-host metabolic interactions involving pro-inflammatory cytokines, skeletal muscle proteolysis, adipose tissue browning, and tumor-derived endocrine mediators such as GDF-15. REE measurement by indirect calorimetry identifies hypermetabolism as an independent prognostic factor across cancer types and treatments, including immunotherapy. Current nutritional recommendations lack granularity and do not account for individual metabolic phenotypes, cancer type, disease stage, or therapeutic modality. Emerging therapies, including GDF-15 inhibitors, offer promising but still incomplete responses to cachexia-related wasting. Conclusion Addressing cancer cachexia requires extension of tumor-centered precision oncology to the management of the tumor-bearing host. A personalized medicine approach integrating REE, given its growing evidence for prognostic and clinical utility, with nutritional support, adapted physical activity, and targeted anti-cachexia therapies, all coordinated by the oncologist, represents a promising path forward.
Background and aim Nutritional guidelines for managing hyperkalaemia in individuals with chronic kidney disease (CKD) emphasise an individualised approach, focusing on adjusting dietary potassium intake by selecting low-potassium foods and avoiding ultra-processed food (UPF). However, little is known about potassium additives in UPFs. Therefore, this study aimed to assess i) the prevalence of UPFs containing potassium additives across three supermarket chain stores, ii) which food categories most frequently contained potassium additives, iii) which potassium additives were most common and iv) which functional class were most common among potassium additives. Methods A cross-sectional label-analysis was conducted from September 2024 to December 2025. UPFs were identified according to the NOVA classification system. Three supermarket chain stores in Denmark were selected to capture a representative range of products. Products were examined via the supermarkets’ online platforms and assigned to twelve predefined food categories, and the potassium additives they contained. Results After analysing 5,884 UPFs, 27.8% of the products contained at least one potassium-based additive, while the presence of potassium additives was unknown for 6.5% of the products. Across all categories, products containing at least one potassium additive were most frequently observed in non-alcoholic beverages (70.9%), sauces (57.0%), fish, seafood and derivatives (44.5%), fruit, vegetables and derivatives (30.1%) and ready-to-eat products (29.6%). The most frequent potassium additive was E202 (potassium sorbate, 60.6%) followed by E950 (Acesulfame K, 19.7%) and E501 (Potassium carbonates, 8.8%). Conclusion Potassium additives are widespread in UPFs and can be a hidden source of potassium, particularly in non-alcoholic beverages, sauces, and fish, seafood and derivatives. These findings underline the importance of dietary guidance for individuals with CKD at risk of hyperkalaemia and raise awareness of additive exposure in food choices.
BACKGROUND & AIMS:Hepatogenous diabetes (DM) and sarcopenia (reduced muscle strength) are well-known complications of advanced cirrhosis. However, the clinical impact of their co-presence in liver transplant (LT) candidates has not been previously studied. METHODS:A single-centre observational study evaluated 119 cirrhotic patients on the LT waiting list to investigate the link between DM and reduced muscle strength, measured with handgrip strength. RESULTS:Within this cohort, 61.3% of patients had DM and 39.9% had probable sarcopenia. Notably, the prevalence of reduced muscle strength was significantly higher in the DM group compared to the non-DM group (49.3% vs. 30.4%). Regression analysis identified DM as a predictor of reduced handgrip strength (OR 2.72, 95% CI 1.15-6.43; p = 0.022), independently from age. Patients with DM were generally older and had a higher waist circumference. Interestingly, while total daily energy intake was similar between both groups, patients with DM consumed a higher relative percentage of dietary protein. CONCLUSION:These findings suggest that diabetes negatively impacts muscle function in cirrhotic patients, likely due to the combined effects of insulin resistance and systemic inflammation. Early identification of this frail phenotype is crucial for implementing targeted nutritional and lifestyle interventions to optimize patient outcomes.
