Introduction Malnutrition is common among patients with colorectal cancer (CRC) and is associated with poorer treatment response and survival. However, no consensus exists on which combination of the Global Leadership Initiative on Malnutrition (GLIM) criteria best predicts survival in this population. This study aimed to to investigate the differential associations between the individual components of GLIM-defined malnutrition and overall survival in patients with colorectal cancer who received anticancer treatment during the follow-up period. Methods This longitudinal, prospective, observational study was conducted at a tertiary oncology hospital, including newly diagnosed CRC patients. Malnutrition was diagnosed according to GLIM, combining phenotypic criteria (weight loss, low BMI, and reduced muscle mass, assessed by computed tomography or bioelectrical impedance analysis) and etiologic criteria (reduced food intake, evaluated by the Patient-Generated Subjective Global Assessment [PG-SGA], and inflammation, assessed by tumor stage or neutrophil-to-lymphocyte ratio). Two-year overall survival was analyzed using Kaplan–Meier and Cox proportional hazards models. Results Eighty-one patients were included (median age 62 years; IQR 55–71); 75% had advanced disease (stage III–IV). Malnutrition prevalence ranged from 6% to 57%, depending on the GLIM combination applied. In multivariate analysis, advanced disease stage (HR 4.90; 95% CI 1.72–13.94; p=0.003) and the combination of low muscle mass and reduced food intake (HR 3.44; 95% CI 1.15–10.28; p=0.027) were independent predictors of poorer overall survival. Conclusion In the studied population, the combination of low muscle mass and reduced food intake emerged as an independent predictor of two-year survival.
Background and Objective Children who are hospitalized in a child psychiatry inpatient ward are frequently treated with antipsychotic medications and are also characterized by being overweight. In this study, we aimed to investigate the ramifications of customized dietary plan on weight percentile shifts in children hospitalized in an inpatient psychiatric ward. Methods and Procedures We retrospectively analyzed 42 children, age 6 to12 years admitted to a child psychiatry inpatient ward (from July 21 to February 23), with hospital stays ranging from 46 to 259 days. A clinical dietitian customized a general and personalized dietary plan composed of five meals per day and a plan for diet on weekend vacations. We measured the weight percentile weekly during the first 4 weeks and then once a month. A total of 7 measurements were taken and children underwent a minimum of four out of seven measurements. Results Baseline median weight percentile was 86.5 (range 7-100) and blood metabolic measures were within the normal range both at admission and discharge. Of the total sample, 93% of children received anti-psychotics and 55% were on stimulants. A significant weight percentile decline was noted already after 4 weeks. Higher initial weight percentile and treatment with stimulants (especially males) predicted a more robust reduction in weight percentile over time. Conclusion Customized dietary plan led to a noticeable drop in children's weight percentile in a child psychiatry inpatient ward. This underscores the importance of personalized dietary interventions during psychiatric hospitalizations of children.
Background/Aim Nutritional care also encompasses the evidence-based care of enteral and parenteral nutrition access routes and patient/caregiver education, aiming to minimize nutrition-related complications and optimize outcomes. Turkish Enteral Parenteral Nutrition Society (KEPAN) aimed to develop a consensus report to provide concise, clear, and practical recommendations for all healthcare givers to improve the care of nutritional access routes and ensure safety. Methods This consensus report was developed by a 12-member working group through a five-phase process conducted over 18 months (February 2024–August 2025), involving 6 face-to-face and 18 online meetings. Eighteen questions, were identified across 4 sections: (1) Safety of the Patient and Caregiver and Ensuring Standard Patient Care, (2) Care of Access Routes in Enteral Nutrition, (3) Care of Access Routes in Parenteral Nutrition, and (4) Patient/Caregiver Education. Recommendations and comments were developed through a systematic literature review, meta-analyses, and randomized controlled trials published after 2010 in the EMBASE, PubMed, and Cochrane databases. Finally, the recommendations were sent to KEPAN extended consensus group, comprising 43 members, using a Delphi methodology. All 18 recommendations were accepted in the first Delphi round, with no items rejected; only minor comments were raised during the first and second rounds. The final report was approved by all 43 panelists without further revision. Results The consensus report emphasizes standardized protocols and patient safety practices in nutritional care. Key recommendations address safe management of nutritional access routes, including feeding tube positioning and patency, gastrostomy/jejunostomy and catheter/port care, prevention and management of access-related complications, safe medication administration, and structured patient/caregiver education for home nutritional therapy. Conclusion This consensus report offers a practical and standardized reference for healthcare professionals involved in clinical nutritional therapy. These recommendations are intended to complement international guidelines and to be applied in consideration of individual patient characteristics, available resources, and local clinical practices.
Background The Canadian Nutrition Society endorsed commitments aligned with the United Nations Decade of Action on Nutrition to advance policy action for adult undernutrition. Currently, undernutrition is not recognized as a condition impacting the Canadian health care system. The aim was to identify key insights and ongoing policy challenges and outline actionable steps for health leaders and governments to prioritize nutrition care amid shifting priorities. Methods and procedures Evidence was integrated from a targeted undernutrition initiative, and findings were synthesized to develop a conceptual roadmap across health system levels. Results Challenges include limited awareness, inadequate financing for medical nutrition therapy, and insufficient dietetic workforce capacity. Actionable steps include national recognition of undernutrition through standardized metrics and language, provincial funding and workforce planning, and organizational data systems targeting standardized nutrition care processes, such as admission screening. At point-of-care, access to nutrition care, improved food service standards, and continuity across care transitions are essential. The conceptual roadmap delineates responsibilities across national/federal, provincial/territorial, organizational, and point-of-care levels. Conclusions Addressing adult undernutrition requires coordinated, multi-level policy action and buy-in from health leaders and government. The conceptual roadmap provides a structured avenue to support integration of nutrition into health policy, improve accountability, and reduce the burden of undernutrition in Canada.
Background Childhood stunting remains a major public health problem in the Northern Province of Rwanda, where approximately 27.1% of children 1-36 months five are stunted. While many risk factors are documented, less is known about social and parenting processes in high-risk child conditions of undernutrition. We aimed to explore parental experiences and understandings of the risk of childhood stunting in the Northern Province of Rwanda. Methods We conducted a qualitative study using focus group discussions (FGDs) with 120 parents, mothers and fathers separated, of children aged 1–36 months across all five districts of Northern Province. We analysed data using a reflexive thematic analysis approach. Results Parents described interconnected household and caregiving processes perceived to influence children's nutrition and growth. Thematically, household power struggles and resource diversion, vulnerabilities during the first 1,000 days, a paradox whereby food and livestock assets did not always benefit children, and fragile substitute-care arrangements when mothers must go out for work, highlighted how intra-household allocation of resources, caregiving practices, and competing economic priorities shaped children's nutritional environments. The themes indicated that parents see intra-household resource allocation and caregiving as affecting the link between food resources and child growth. Conclusion Parents in Rwanda's Northern Province of Rwanda see childhood growth as shaped by interconnected household power relations, caregiving, and resource allocation practices in the first 1,000 days. Policies should give more decision-making power and resources to infants by promoting shared household decisions, empowering mothers, aligning livestock and market incentives with infant nutrition, and restoring reliable substitute care via public platforms.
Background Gastric cancer and its surgical treatment impose a substantial burden on patients' physical and psychosocial functioning. Data from lower-middle income settings remain limited. This study evaluated the effectiveness of a structured nutritional intervention on quality of life (QoL) in gastric cancer patients following gastrectomy. Methods A controlled clinical trial with matched groups was conducted in Vietnam (October 2021–March 2024). A total of 102 post-gastrectomy gastric cancer patients were allocated to an intervention group (n = 52) or a control group (n = 50), matched by age, disease stage, and nutritional status. The intervention group received individualized nutritional support including high-energy dietary plans, oral nutritional supplements, and regular nutrition counselingover three months. The control group followed standard hospital or home dietary practices. QoL was assessed at baseline (T0: prior to surgery) and at three months (T4: after the third chemotherapy cycle) using the EORTC QLQ-C30. Results At three months, the intervention group showed statistically significant improvements across all functional scales, including physical (78.3 to 85.0), role (70.8 to 80.4), emotional (74.0 to 79.2), social (75.6 to 83.9), and global health status (57.1 to 69.5) (all p < 0.001); global health status was the pre-specified primary outcome for this analysis, while findings for the remaining individual functional domains should be considered secondary and exploratory. At the individual level, no participant in the intervention group experienced a clinically meaningful (≥10-point) deterioration in any functional domain, compared with 16–22% of control-group patients across domains. Symptom burden was markedly reduced in the intervention group, with significant improvements in fatigue (75.0% vs. 34.0%, p < 0.001), pain (78.8% vs. 50.0%, p = 0.006), and sleep disturbance (30.8% vs. 18.0%, p = 0.002). Conclusions A structured nutritional intervention was associated with significantly improvements in functional outcomes and reduced symptom burden post-gastrectomy supporting further evaluation of its integration into standard oncology care in resource limited settings.
Dietary fibre intake in children remains below recommendations, and short-chain fructo-oligosaccharides (scFOS) prebiotic fibres may help close this gap. This clinical trial assessed gastrointestinal tolerance to two substantial scFOS doses in healthy school-aged children with low fibre intake. In a randomized parallel-group design, 78 children aged 6-12 years consumed 10 or 20 g/day scFOS (Actilight®) for 7 days following a 7-day baseline period. Gastrointestinal symptoms were recorded daily using a 4-point Likert scale (0: none; 3: severe). Stool frequency and consistency (Bristol Stool Scale) and well-being scores were also assessed. Analyses considered age (6-9 vs 10-12 years) and sex.Flatulence mean scores slightly increased at both doses (+0.23 at 10 g/day; +0.31 at 20 g/day; P < 0.001), and abdominal discomfort rose with 20 g/day (+0.19 in week 2 vs week 1; P < 0.001), while remaining mild. All other symptoms stayed <1 (mild). Stool frequency enhanced at 20 g/day (+1.19; P < 0.05), keeping within normal limits. Stool consistency increased in both groups (+0.2 and +0.71; P < 0.05), with a dose-dependent shift toward softer stools but remaining in the expected range (types 3-4). However, 12.8% of children were more sensitive to 20 g/day with declared diarrhea. Overall well-being remained high (>8/10), and no serious adverse events occurred.In conclusion, scFOS up to 20 g/day is well tolerated in children supporting its use to enhance fibre intake. While generally mild, effects at 20 g/day in a small sensitive subgroup highlight inter-individual variability and support gradual introduction to improve tolerance.
Background. The Planetary Health Diet (PHD) has been proposed as a dietary pattern aligned with the planetary boundaries to promote both human and environmental health. This study aimed to assess adherence to the PHD among university students in Spain and to identify sociodemographic and lifestyle factors, as well as sustainability perceptions associated with adherence. Methods & Procedures. A cross-sectional study was conducted during the 2024-2025 academic year among Spanish university students aged ≥18 years without self-reported chronic disease, eating disorders, pregnancy, or lactation. Participants completed a self-administered questionnaire that included: (1) sociodemographic and anthropometric characteristics, (2) lifestyle factors, (3) perceptions about sustainable diets, and (4) dietary intake through a food frequency questionnaire. In the absence of validated PHDI cutoffs, adherence categories were defined a priori to facilitate ordinal analyses. Results. Adherence to the PHD was assessed among 710 university students (21.98 years; 68.3% female; mean BMI was 22.7 kg/m2) using the Planetary Health Diet Index (PHDI). The mean PHDI score was 58.6 (standard deviation (SD) 13.85) of a maximum 150. In univariate analyses, age (p < 0.001), field of study (p = 0.03), type of residence (p < 0.001), municipality size (p = 0.01), and physical activity (p < 0.001) were associated with PHDI scores. In multivariable models, intense physical activity was independently associated with higher adherence to the PHD (2.18; 95% CI (1.50-3.17)), whereas students enrolled in non-health sciences programs showed lower odds of higher adherence compared with health sciences students (0.73; 95% CI (0.54-0.98)), after adjustment for age and total energy intake. Conclusions. Spanish university students showed a mean PHDI score of 58.6 out of 150. Higher physical activity and enrolment in health sciences programs emerged as independent correlates of higher adherence. These findings suggest potential implications for public health, although confirmation in longitudinal studies is required.
Background and/or Objective Muscle mass and strength influence bone and respiratory health in children, yet measuring muscle mass is costly and time-consuming. The body mass-to-waist ratio (BM/W) is a simple anthropometric parameter that may predict muscle mass. This study examined the relationships between BM/W, muscle and bone mass, handgrip strength (HGS), and pulmonary function in children. Methods & Procedures In this cross-sectional study, 189 children aged 7 to 8 years were analysed according to sex-specific BM/W quartiles. Differences across quartiles were tested by one-way ANOVA with Bonferroni post-hoc. Multiple regression analyses, stratified by sex and adjusted for height, were performed. Pulmonary function was assessed in a subsample of 133 children. Results Children in the lowest BM/W quartile showed the lowest muscle (−17%) and bone mass (−25%), HGS (−29%), height-indexed HGS (−21%), FVC (−22%) and FEV1 (−20%) (all p<0.001), accounting for 73.7% of dynapenia cases. In multivariate models, BM/W was independently associated with muscle mass in both sexes; the association with strength was most robust for height-indexed HGS (p<0.001), while that with absolute HGS was attenuated after adjusting for height. Pulmonary function was explained by body size, height being the dominant correlate. Conclusion BM/W is positively associated with muscle mass and strength in school-aged children; lowest-quartile children also show lower bone mass and pulmonary function. Low BM/W may indicate the need for early screening and targeted exercise interventions, especially with low handgrip strength, to prevent functional decline.
Texture critically drives food acceptance or rejection, with oral processing varying widely among individuals and influencing dynamic perception and bolus formation. Adaptive strategies like tongue-palate squeezing often replace chewing in populations with masticatory or swallowing challenges (e.g., tooth loss, sarcopenia, xerostomia), yet their impact on texture perception, muscle activity, and bolus properties remain poorly evaluated, particularly in comparison to traditional chewing. This study compared chewing versus squeezing effects on texture perception, processing parameters (oro-exposure, muscle activity, salivation), and bolus properties using mashed potato (MP) enriched with psyllium (MP-psyllium) or xanthan (MP-xanthan). Twenty-six participants processed samples via chewing or squeezing until they were ready to swallow. Sensory evaluation covered textural (hardness, stickiness, cohesion) and hedonic (taste, texture, overall liking) properties. Electromyography measured masticatory muscle activity and chewing duration. Boluses were collected for saliva and texture analysis. Squeezing increased MP-psyllium hardness ratings (by 26%) and reduced MP-xanthan cohesiveness (by 45%). It prolonged oro-sensory exposure (by 22-31%), halved masseter and temporalis activity, and decreased salivation during MP-xanthan processing. Liking remained moderate (∼6/9). Both strategies softened boluses, but squeezed versions were harder or less cohesive than chewed. Oral processing strategies differentially modulate perception via sensory feedback, ensuring viscoelastic boluses for swallowing. Squeezing highlights tongue tactile sensitivity and compensatory prolonged exposure. These findings underscore texture-modified diets tailored to individual oro-sensory strategies. Rehabilitation for patients with chewing and swallowing disorders should be tailored to their specific oro-sensory processing needs.
BACKGROUND:Hospitalized patients with gastrointestinal (GI) diseases are predisposed to malnutrition and sarcopenia due to inflammation, malabsorption, and reduced intake, resulting in prolonged hospitalization and increased mortality. AIMS:To determine the prevalence of malnutrition and sarcopenia among adult hospitalized GI patients using the Global Leadership Initiative on Malnutrition (GLIM) criteria, computed tomography (CT)-derived body composition, and handgrip strength (HGS), and to evaluate their associations with length of hospital stay and 1-year mortality. METHODS:A single-center prospective observational study of 847 consecutively hospitalized adults with medical GI diseases. Malnutrition was classified using GLIM criteria, and sarcopenia was assessed via CT-derived skeletal muscle index (SMI), and HGS. Asian cutoffs were applied, and follow-up at 1 year post-discharge. RESULTS:GLIM-defined malnutrition was identified in 65% of patients, low HGS in 54%, and low SMI in 44%. Overall, 28% had both low SMI and low HGS, consistent with sarcopenia. Low SMI was significantly associated with low HGS (P < 0.001). Compared with well-nourished patients, GLIM-malnourished patients had higher odds of low HGS (58.3% vs. 45.3%; OR 1.68, 95% CI 1.26-2.24; P < 0.001). One-year mortality was higher among malnourished patients (7.5% vs. 3.1%; P = 0.018). In forward stepwise multivariable logistic regression, GLIM-defined malnutrition remained independently associated with 1-year mortality after adjustment for age, primary diagnosis, and length of hospital stay (OR 2.56, 95% CI 1.14-5.76; P = 0.023). CONCLUSION:GLIM-defined malnutrition and sarcopenia are highly prevalent and associated with poor outcomes. Findings support integration of body composition, and HGS into routine nutritional assessments.
Background Phase angle (PhA) has been recognized as a marker of cellular integrity and muscle quality. Although cross-sectional evidence suggests associations between PhA and body composition components, longitudinal data in adolescent athletes remain limited. Objective To analyze longitudinal changes in PhA over a six-month period and to investigate its associations with lean soft tissue and body fat percentage in adolescent athletes. Methods This longitudinal study included 47 adolescent athletes (40.4 percent female; median age 15.2 years at baseline) followed over six months. Phase angle (PhA) was assessed via bioelectrical impedance analysis, while lean soft tissue and body fat percentage were measured using dual-energy X-ray absorptiometry. Generalized linear mixed-effects models (GLMMs) were used to examine longitudinal changes in PhA over time and subsequently to investigate the longitudinal association of PhA with lean soft tissue and body fat percentage. Results Adjusted models showed a 1.97% rise in PhA over six months (p = 0.48), but the effect lost significance upon adjusting for body composition (p > 0.05). Regarding longitudinal associations, GLMMs demonstrated that PhA was directly and positively associated with lean soft tissue (β = 1.638; 95% CI: 0.277 to 2.999; p = 0.021), whereas no significant association was observed with body fat percentage [exp(β) = 0.981; 95% CI: 0.947 to 1.016; p = 0.284]. Complementary analyses using fat mass instead of body fat percentage yielded similar non-significant results. Conclusions In adolescent athletes, changes in PhA appear to be concurrently linked to changes in body composition. In addition, these findings indicate that PhA is a robust marker of lean soft tissue in athletes.
Objective Water load fluctuations may drive hyper-catabolism and inflammation, contributing to nutritional and functional impairment. This hypothesis-generating study investigated the relationship of volemia with malnutrition and physical function among patients with chronic kidney disease (CKD). Design and Methods Assessment and diagnoses were performed at mid-week, after hemodialysis or removal of peritoneal fluid. Volemia was assessed by bioelectrical impedance vector analysis (BIVA) and applied to stratify total sample in hypovolemic (HV-) and euvolemic-hypervolemic (EV-HV+) groups. Muscle and adiposity-related measurements were assessed. Hand-grip strength (HGS) evaluated muscle strength. Low muscle strength, malnutrition, sarcopenia and sarcopenic obesity were diagnosed. Regression analysis verified association between variables. Hotelling's T2 test assessed impedance vectors differences. Results Of 362 individuals, 254 were HV- and 108 were EV-HV+. HV- group presented lower muscle and fat (p<0.05). Differences in malnutrition, sarcopenia and sarcopenic obesity prevalence between groups were dependent on definition for muscle mass impairment: applying low calf circumference, HV- individuals presented 2.53, 2.58 and 3.27 higher risk for malnutrition, sarcopenia and sarcopenic obesity (p<0.05), respectively. Low HGS was present in 41% and 27% of HV- and EV-HV+ groups (p=0.000). HV- status lowered HGS by 2kgs (ꞵ= -2.01; p=0.059), with a 1.75 odds ratio for low muscle strength (p=0.070) as compared to EV-HV+ status. BIVA revealed significant differences in the confidence ellipses for presence and absence of conditions diagnosed. Conclusions In CKD, hypovolemia presented a non-significant trend toward lower muscle strength, warranting confirmation in future studies. Associations of volemia with malnutrition, sarcopenia and sarcopenic obesity were dependent on muscle mass parameter applied.
Objective To investigate the effects of dietary restriction (DR), methionine restriction (MR), and pioglitazone (PIO) on energy metabolism, bone metabolism, and bone quality. Methods and procedures Six-month-old male Sprague-Dawley (SD) rats were subjected to: 1) control (CON) diet, 2) 40% dietary restriction (DR), 3) 80% dietary methionine restriction (MR), or 4) oral pioglitazone (PIO) treatment for 9 wk. Results Compared with the CON group, the DR group experienced lower body weight (BW) gain and epididymal fat tissue weight, whereas the PIO group had higher BW gain. DR, MR, and PIO demonstrated distinct effects on serum markers of energy metabolism, aging, and inflammation, despite the fact that all interventions increased insulin sensitivity and glucose tolerance compared to the CON group (P < 0.05). Procollagen type 1 N-terminal propeptide (P1NP), a serum bone formation marker, was lower in DR-, MR-, and PIO-treated rats than in CON rats, while C-terminal telopeptide of type I collagen (CTX-1), as a serum bone resorption marker, showed no difference among groups. In histomorphometry and densitometry, the PIO group had a comprehensive loss in cancellous bone structures, bone mineral density (BMD) and/or bone mineral content (BMC) in tibiae and femora, as well as a lower cortical BMD of tibiae when compared with the CON group (P < 0.05). The bone mineral loss in the DR and MR groups was minor, such that both groups were lower in cancellous BMD of tibiae, and the MR group was lower in cancellous BMC of tibiae and femora when compared with the CON group (P < 0.05). In dimensional measurements, the PIO group had lower cortical thickness than the CON group in femora (P < 0.05). Conclusion While all interventions improved energy metabolism, DR and MR resulted in a minor compromise in bone mineral regulation relative to pioglitazone treatment in male SD rats.
A healthy lifestyle and diet may improve outcomes of patients with non-muscle invasive bladder cancer (NMIBC), potentially through reducing systemic inflammation. Therefore, this study investigated the association of a post-diagnosis Lifestyle (LIS) and Dietary Inflammation Score (DIS), and high-sensitivity C-reactive protein (hsCRP) with the risks of NMIBC recurrence and progression. Patients with newly diagnosed NMIBC between 2014 and 2021 were recruited for the prospective multi-center cohort UroLife. Lifestyle (n = 1334) and/or diet (n = 1306) were self-reported at 3 months post-diagnosis using lifestyle and food frequency questionnaires. The LIS and DIS were calculated to capture the inflammatory potential of lifestyle and diet; higher scores indicate more pro-inflammatory exposures. Plasma hsCRP was measured at 3 months postdiagnosis. The association of LIS and DIS with hsCRP was ascertained in multivariable linear regression models. The association of the LIS, DIS, and hsCRP with risks of first or multiple recurrence(s), and stage and/or grade progression was assessed using multivariable Cox proportional hazards models. Over a median follow-up time of 4.7 years, 466 patients had at least one recurrence, and 155 had progression. Each 1-point increment in LIS and DIS was associated with a 43% (95% CI 29%-58%) and 6% (95% CI 3%-10%) increase in hsCRP, respectively. Higher LIS, DIS, and hsCRP were not associated with risks of first or multiple recurrence(s), and progression. In conclusion, a pro-inflammatory lifestyle and diet, and systemic inflammation, as measured by hsCRP, were not associated with NMIBC outcomes in our cohort. Yet, contributions from specific inflammatory processes or other biomarkers cannot be excluded.
OBJECTIVES:Diagnosing malnutrition in older individuals with excess weight is challenging, as commonly used tools rely on anthropometric measures such as body mass index (BMI) and calf circumference (CC), which can be affected by excess weight. To partially address this concern, we have previously proposed an adaptation of the mini nutritional assessmen-short form (MNA-SF), incorporating sex-, population-, and BMI-adjusted CC cutoff values. However, it still requires exploration and validation across diverse settings, particularly in large cohorts. This study aimed to evaluate the impact of this adapted MNA-SF and compare it with traditional MNA-SF versions regarding malnutrition prevalence and adverse outcomes among older patients with cancer, in the overall sample and in a subsample of patients with excess weight. METHODS:A multicenter cohort included older patients (≥60 years) with cancer hospitalized in 50 hospitals across two countries. MNA-SF used four approaches: BMI, CC<31, sex-specific unadjusted, and BMI-adjusted CC ≤33/34 cm. Malnutrition was defined as scores ≤ 7. Outcomes of interest were length of hospital stay (LOS) and 60-day mortality. RESULTS:A total of 2128 patients were included (mean age: 73 ± 6 years, 56.6% males). The prevalence of malnutrition ranged from 29% using BMI to 47.5% using sex-specific BMI-adjusted CC. Among patients with excess weight, the prevalence of malnutrition ranged from 13.5% (CC < 31 cm) to 32.4% using sex-specific BMI-adjusted CC. MNA-SF score across all approaches was associated with LOS. All MNA-SF methods showed similar survival AUROC: 0.76 to 0.77. Each 1-point decrease in MNA-SF using CCBMI-adjusted was associated with a 30% higher risk in the total cohort (RR adjusted 1.30, 95% CI: 1.18-1.45), and a 32% higher risk among patients with excess weight (RR adjusted 1.32, 95% CI: 1.06-1.61). CONCLUSION:MNA-SF using CCBMI-adjusted and adequate cutoffs is a potential approach to diagnose malnutrition in older patients with cancer, even if they present with excess weight.
Niacin deficiency has been recognized for decades in patients with carcinoid syndrome, but its prevalence, biological meaning, and optimal assessment remain uncertain because definitions and biomarkers vary across studies. We conducted a scoping review, in accordance with PRISMA-ScR guidance, to map how niacin deficiency has been conceptualized and assessed in carcinoid syndrome, including mechanistic hypotheses, biochemical and functional measures, and overt clinical pellagra. PubMed was searched from inception to February 2026, with additional citation chasing. Twenty-four sources were included, comprising primary studies, case reports/series, and narrative syntheses.The literature shows marked heterogeneity across biological levels of assessment. Upstream markers such as urinary 5-hydroxyindoleacetic acid and plasma tryptophan provide context on serotonin burden and substrate availability, but they do not define niacin status. Biochemical depletion has most often been assessed using urinary niacin metabolites, particularly 24-hour N1-methylnicotinamide, whereas functional depletion has been evaluated with whole-blood NAD/NADP-based indices. Overt pellagra is uncommon and represents a late clinical endpoint that is insensitive for subclinical depletion. Differences in biomarkers and operational definitions largely explain why results are difficult to compare across studies.Niacin deficiency in carcinoid syndrome cannot be reduced to a single marker or phenotype. A non-prescriptive framework that separates mechanistic context, biochemical and functional depletion, and clinical manifestations may improve reporting and interpretation across studies. Because the evidence base is dominated by small observational studies and case-based reports, the conclusions remain hypothesis-generating and point to the need for prospective validation of biomarkers against patient-relevant outcomes.
Background The potential role of Phase angle (PhA) as a biomarker of systemic inflammation in chronic hepatitis C (CHC) remains underexplored. Objective To assess the association between PhA values and the inflammatory marker—tumour necrosis factor alpha (TNF‑α) in patients with CHC. In addition, associations between PhA and a set of demographics, clinical, nutritional, and biochemical data were evaluated. Methods This cross-sectional study included 81 adults with confirmed CHC (72.8% male; mean age 50.0 ± 11.7 y; 30.9% with liver cirrhosis). Nutritional status and body composition were assessed using anthropometry and bioelectrical impedance analysis (BIA). Reduced PhA was defined as ≤5.6° for men and ≤5.4° for women. Serum TNF-α concentrations were measured using an enzyme-linked immunosorbent assay (ELISA), including 81 and 39 samples from patients with CHC and healthy donors, respectively. Logistic regression analyses were conducted to evaluate associations between PhA and inflammatory, demographic, clinical, nutritional, and biochemical variables. Results Reduced PhA was observed in 14.8% of participants. Among male patients, reduced PhA was independently associated with elevated TNF-α levels (OR: 1.21; 95% CI: 1.06-1.39). However, no significant associations were found in the female patients. Conclusions Male patients with CHC who present lower PhA values also exhibit elevated TNF‑α levels, independent of liver disease stage. Given the clinical relevance of identifying systemic inflammation and nutritional risk in this population, integrating a practical and reliable screening tool, such as PhA, into routine care may provide substantial value in health care settings.
BACKGROUND:Energy requirement (ER) in young adults is commonly estimated from predicted resting metabolic rate (RMR) and assumed physical activity level (PAL). These assumptions may not fully reflect free-living total energy expenditure (TEE) in healthy young adults from Southwest China with low-activity daily routines. OBJECTIVE:This study compared doubly labeled water (DLW)-measured TEE with factorial TEE based on measured RMR and with equation-estimated TEE, interpreted as estimated ER, derived from Chinese and FAO/WHO/UNU RMR prediction equations. Measured and predicted RMR, TEE partitioning, and energy intake-TEE agreement were also examined. METHODS:Twenty healthy adults aged 18-30 years from Southwest China completed a 7-d free-living assessment. TEE was measured using DLW, and RMR was measured by indirect calorimetry. Physical activity was assessed using triaxial accelerometry with activity records. Dietary intake was measured using the duplicate-portion method and laboratory analysis. PAL was calculated as TEE/RMR, and thermic effect of food (TEF) was estimated by difference. Agreement was further evaluated using Bland-Altman analysis. RESULTS:DLW-measured TEE was 2039.63 ± 304.43 kcal/d and did not differ significantly from factorial TEE or equation-estimated TEE derived using the Chinese and FAO/WHO/UNU equations. However, Chinese equation-predicted RMR was significantly lower than measured RMR (1584.29 ± 232.97 kcal/d, p < 0.05), whereas FAO/WHO/UNU-predicted RMR was comparable with measured RMR. Measured PAL was low (1.29 ± 0.12), and RMR, physical activity energy expenditure (PAEE), and TEF accounted for 78.0%, 12.9%, and 9.1% of TEE, respectively. Energy intake was broadly comparable with DLW-measured TEE at the group level, although Bland-Altman analysis indicated individual-level variability. CONCLUSIONS:Equation-estimated TEE, interpreted as estimated ER, was broadly comparable with DLW-measured TEE at the group level. However, this apparent agreement depended on both RMR prediction and PAL assumptions. The findings support component-based evaluation of ER in young Chinese adults, with attention to RMR, PAL, PAEE, TEF, FQ, and energy balance.
