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.
BACKGROUND & AIMS:Evidence-based feeding protocols are used to standardize nutritional care in critically ill adults, but their effects on clinical outcomes remain uncertain. We conducted a systematic review and meta-analysis to evaluate the impact of these protocols on clinical outcomes, and to quantify their effects on nutritional delivery (feeding efficiency). METHODS:We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, and ICTRP up to December 2025 for randomized controlled trials (RCTs) to compare feeding protocols with usual care in critically ill adults. The primary outcome was the mortality rate. Secondary outcomes included the length of stay in the intensive care unit, hospital length of stay, length of mechanical ventilation, adverse events, pneumonia, vomiting, and organ dysfunction. Additional outcomes were nutritional delivery outcomes. We used the Cochrane Risk of Bias 2 and the GRADE approach to assess the quality and certainty of the evidence. PROSPERO registration: CRD42023391771. RESULTS:Nine RCTs (5369 patients) were included. Evidence-based feeding protocols resulted in little to no difference in mortality (risk ratio (RR), 0.97; 95% confidence interval (CI), 0.83 to 1.13), length of mechanical ventilation (mean difference (MD), 0.34 days; 95% CI, -1.29 to 1.96), or vomiting (RR, 1.49; 95% CI, 0.68 to 3.27). The protocols likely resulted in little to no difference in adverse events (RR, 0.49; 95% CI, 0.12 to 1.95). The protocols reduced the time to enteral nutrition (EN) initiation and increased daily caloric and protein intake. CONCLUSION:Evidence-based feeding protocols were associated with improved nutritional delivery but little to no difference in key clinical outcomes in critically ill adults. Future research should focus on the consistent integration of patient-centered core outcome sets alongside the establishment of standardized, prespecified safety and gastrointestinal outcome frameworks.
BACKGROUND:Lean metabolic dysfunction-associated steatotic liver disease (MASLD) can be overlooked in adults with a normal body mass index (BMI). We examined whether waist-to-height ratio (WHtR), a simple marker of central adiposity, was associated with prevalent lean MASLD and explored its relative contribution within an anthropometric and metabolic feature set. METHODS:This cross-sectional study used National Health and Nutrition Examination Survey (NHANES) 2021-2023 data for exploratory model development (n = 770) and NHANES 2017-2020 data for independent validation (n = 809). Lean MASLD was defined as controlled attenuation parameter-based steatosis plus at least one cardiometabolic risk factor after excluding participants whose classification depended only on waist circumference. Machine-learning models were used for exploratory feature ranking; the validation analysis used survey-weighted logistic regression and restricted cubic splines. RESULTS:In exploratory model comparison, gradient boosting had the highest discrimination (area under the receiver operating characteristic curve 0.762), and WHtR had the largest mean absolute SHAP value in that model. In the validation cohort, weighted lean MASLD prevalence increased from 2.15% in the lowest WHtR quartile to 36.93% in the highest (P for trend < 0.001). Each 0.01 increase in WHtR was associated with higher odds of prevalent lean MASLD after multivariable adjustment (odds ratio 1.16, 95% confidence interval 1.10-1.22; P = 0.009). CONCLUSIONS:Higher WHtR was independently associated with prevalent lean MASLD in a representative sample of adults with normal BMI. WHtR may be useful as a simple marker for identifying lean adults who warrant further assessment.
Introduction & aims Cancer anorexia (CA) is a prevalent and debilitating complication in postoperative patients with gastric cancer (GC). Standardized tools for the early prediction of CA risk in this specific population remain lacking. This study aimed to identify predictor domains retained in a TRIPOD-compliant multivariable model and to develop a nomogram for CA risk assessment in postoperative patients with GC. Methods We performed a cross-sectional predictive modeling study of 440 postoperative patients with GC at a tertiary cancer center. Using a date-level temporal split by questionnaire assessment date (cut date: 2024-09-08), patients assessed on or before the cut (2023-04-07 to 2024-09-08; n = 309) formed the training cohort and those assessed after the cut (2024-09-09 to 2024-11-30; n = 131) formed the temporal validation cohort. CA was defined using the Anorexia/Cachexia Subscale-12 (A/CS-12) of the FAACT questionnaire, a validated screening instrument with a cut-off of total score 37. A pool of 30 candidate predictors spanning sociodemographic, lifestyle, AJCC 8th edition pathological staging (pT/pN/pM), surgical access, multi-organ resection, chemotherapy status at assessment, nutritional (GLIM), psychosocial (K-10, PSSS), and symptom (MDASI-GI) domains was screened by LASSO regression with 10-fold cross-validation, restricted to the training cohort in accordance with TRIPOD guidance. Surviving variables were entered into a multivariable logistic regression with AIC-based backward elimination. A nomogram was constructed from the final model. Discrimination, calibration (Hosmer-Lemeshow chi-square, calibration slope and intercept, Brier score), and clinical utility (decision curve analysis) were evaluated in the temporal validation cohort.. Results The prevalence of A/CS-12-defined CA was 39.55%. LASSO retained 15 variables on the training cohort; AIC backward elimination produced a final model with 11 predictor domains: sex, education level, commercial medical insurance, albumin level, scope of gastrectomy, multi-organ resection, malnutrition (GLIM), psychological distress (K-10 total), symptom severity (MDASI-GI mean), symptom interference (MDASI-GI mean), perceived social support (categorical). Domain-level likelihood-ratio tests are reported in Table 4b. The nomogram, constructed in one-to-one correspondence with the AIC-final model, achieved an area under the receiver operating characteristic curve (AUC) of 0.84 (0.793-0.881) in training and 0.75 (0.664-0.831) in temporal validation. Decision curve analysis showed net benefit over default strategies across a clinically meaningful range of threshold probabilities. Calibration in the validation cohort was imperfect (Hosmer-Lemeshow chi-square = 14.79, p = 0.063; calibration slope = 0.66; intercept = -0.42). Intercept + slope recalibration in the validation cohort improved the slope to 1.00 and Hosmer-Lemeshow p to 0.698. Conclusions The nomogram provides good discrimination for A/CS-12-defined cancer-anorexia risk in postoperative gastric-cancer patients and may be useful as a screening aid to direct early nutritional and psychosocial interventions toward the highest-risk patients. The model is best regarded as a potentially useful screening tool that requires recalibration and external multicenter validation before clinical implementation.
BACKGROUND & AIMS:Reducing sugar intake is one of the key targets for improving metabolic health in metabolic dysfunction-associated steatotic liver disease (MASLD), and natural sugar substitutes remain insufficiently studied. Brazzein, a natural sweet protein 500-2000 times sweeter than sucrose, may allow replacement of sucrose while preserving sweetness, but clinical data are lacking. We aimed to evaluate postprandial glycemic responses to brazzein-sweetened ice cream, with and without inulin, compared with sucrose-sweetened ice cream in adults with MASLD, using continuous glucose monitoring (CGM). METHODS:In this double-blind, randomized, 3-period crossover trial, 101 adults with MASLD (mean age: 54.6 y; 76% female; 44% with type 2 diabetes) consumed 100 g of ice cream sweetened with sucrose (14 g), brazzein (0.014%), or brazzein plus inulin (0.014% + 4 g) on separate days. Factory-calibrated CGM sensors were used. Principal analytic outcomes were glucose over 150 min and incremental area under the curve (iAUC). Linear mixed-effects models estimated treatment effects with adjustment for baseline glucose, period, sequence, and diabetes status. Complementary analyses evaluated whether between-formulation differences were explained by total carbohydrate content alone. RESULTS:Compared with sucrose-sweetened, both brazzein-containing formulations produced smaller postprandial glucose excursions from 30 to 135 min (treatment × time interaction, P < 0.001). Model-adjusted iAUC was 66.3 mmol/L × min (95% CI: 54.5, 78.0) for sucrose, 31.7 (19.9, 43.6) for brazzein, and 34.3 (22.5, 46.1) for brazzein plus inulin formulations. Relative to sucrose-sweetened, iAUC was 52% lower with brazzein and 48% lower with brazzein plus inulin formulations (both P < 0.001), whereas brazzein and brazzein plus inulin formulations did not differ significantly. Complementary analyses showed that the between-formulation differences were not explained by total carbohydrate content alone. Exploratory analyses showed that formulation-related glucose trajectories differed according to diabetes status (P < 0.001). Within-stratum analyses showed lower iAUC for both brazzein-sweetened products relative to the sucrose control in participants with and without diabetes. No period, sequence, or carryover effects were observed. CONCLUSIONS:In adults with MASLD, the tested sucrose-free brazzein-containing ice cream formulations produced substantially smaller acute CGM-derived postprandial glucose excursions and lower iAUC over 150 min than sucrose-sweetened ice cream. The similar responses observed with brazzein alone and brazzein plus inulin suggest that adding 4 g inulin did not abolish the acute glycemic advantage of the brazzein-containing formulation. Longer-term studies are needed to determine whether repeated substitution of sucrose-containing desserts with brazzein-sweetened alternatives translates into sustained metabolic, hepatic, microbiome, or behavioral benefits. TRIAL REGISTRATION:ClinicalTrials.gov NCT06724913.
