For patients undergoing major thoracoabdominal surgery, perioperative nutritional management is essential. Although enteral nutrition is preferred, parenteral nutrition (PN) is needed when oral or enteral intake is inadequate or contraindicated and serves as a key electrolyte source. Electrolytes are crucial for fluid balance, acid-base stability, and metabolic function, and inappropriate supplementation may cause serious disturbances. Real-world evidence on perioperative PN electrolyte use in China remains limited. This multicenter retrospective study included 2018 patients who underwent major thoracoabdominal surgery and received PN between January 1 and December 31, 2024, across 10 medical centers in 8 provinces in China. Daily sodium, potassium, calcium, magnesium, and phosphorus intake and related clinical outcomes were collected from 2 days before to 5 days after surgery. Adequacy was assessed according to current guideline recommendations. Among the 2018 patients included, perioperative electrolyte supplementation showed substantial deviations from guideline recommendations. On the day of surgery, excessive sodium supplementation (>150 mmol) was observed in 73.7% of patients, while insufficient supplementation of potassium, magnesium, and phosphorus occurred in 56.2%, 91.0%, and 94.7%, respectively. Overall, 48.9% of patients experienced at least 1 electrolyte disturbance, with hypocalcemia (30.4%), hypophosphatemia (18.2%), and hyponatremia (17.8%) being the most common abnormalities. Potential PN compatibility risks were identified in 40.4% of prescriptions on the day of surgery and were associated with longer hospital stay. Multivariable analyses showed that supplementation routes were not independently associated with clinical outcomes. In contrast, higher PN volume was independently associated with increased risks of electrolyte disturbances, major complications, and prolonged hospitalization. Phosphate insufficiency was associated with prolonged hospital stay and increased risks of electrolyte disturbance and major complications, particularly on postoperative day 1. Surgical complexity also influenced outcomes, with pancreaticoduodenectomy associated with substantially higher risks of electrolyte disturbances and major complications. Perioperative PN is characterized by sodium overload and multi-electrolyte deficiency. Beyond supplementation routes, PN volume, phosphate insufficiency, and surgical complexity are key independent determinants of adverse clinical outcomes. Optimization of PN dosing strategies and targeted correction of phosphate imbalance may improve postoperative recovery and safety.

Background:Traditional perioperative care is hospital-centric, whereas the efficacy of multidisciplinary team (MDT)-based comprehensive nutrition management remains debated. This study examines how this model impacts postoperative complications and functional recovery in older adults. Methods:A single-center superiority randomized controlled trial (RCT; April 2023-March 2024) randomized 120 older adults (≥65y) undergoing major abdominal surgery (grades 3-4) into intervention (n = 60) and control (n = 60) groups, excluding those with severe organ dysfunction or poor compliance. The MDT-based model included personalized exercise, nutrition, psychological support (3 weekly sessions, smoking/alcohol cessation), and post-discharge monitoring via wearables/WeChat. Control group received standard care. Results:Among 120 participants (mean age 72.6 years; 65.2% male), 5 were lost to follow-up, leaving 56 in the intervention group and 59 in the control group for analysis. The intervention group demonstrated significantly lower postoperative complications compared to controls, with a relative reduction in in-hospital events and lower post-discharge rates (3.6% vs. 6.8%). The Comprehensive Complication Index averaged 6.2 points lower in the intervention group (p = 0.175). Body composition improved significantly, showing reduced weight loss, reduced BMI loss, and increased appendicular skeletal muscle mass index. Postoperative hospital stay was shortened by a median of 3.67 days in the intervention group, which also reported higher rates of mobility improvement and pain relief (all p < 0.05). Conclusion:The MDT-based perioperative model synergistically reduces postoperative complications and accelerates geriatric functional recovery through nutritional, exercise, and psychological interventions, providing evidence-based support for high-risk elderly care.

Abstract Background Complications significantly impact the prognosis and healthcare burden of hospitalized patients, making early identification of high-risk individuals crucial. While nutritional and metabolic status are influencing factors, existing tools struggle to provide an integrated assessment. The Triglyceride-Cholesterol-Body weight Index (TCBI) is a novel indicator that concurrently reflects both nutritional and metabolic status, yet its value in predicting in-hospital complications remains unclear. Methods This observational study leveraged large-scale, multicenter real-world data, enrolling 8,288 eligible hospitalized patients. Demographic information, anthropometric measurements, laboratory results, and clinical outcomes were collected. Due to its skewed distribution, TCBI was analyzed using its natural logarithm-transformed value (TCBI-LN) and categorized into quartiles (Q1-Q4). The primary outcome was the occurrence of complications during hospitalization. Univariate analysis was used to compare inter-group differences. Multivariate logistic regression models were employed to analyze the independent association between TCBI-LN and complication risk. Restricted cubic splines were applied to explore the dose-response relationship. The robustness and generalizability of the association were assessed through subgroup analyses and interaction tests. We further compared five nested logistic regression models incorporating TCBI, its individual components, and existing indices (PNI and TyG) using AUC, NRI, IDI, AIC, and BIC, and performed causal mediation analysis to examine whether complications mediated the associations of TCBI with length of stay (LOS) and hospital cost. Results Complications occurred in 403 patients (4.9%). Patients with complications had significantly lower TCBI-LN levels compared to those without (6.83 ± 0.71 vs. 7.10 ± 0.83, P < 0.001). Multivariate logistic regression analysis revealed that a higher TCBI-LN remained independently associated with a lower risk of complications even after adjusting for multiple potential confounders, including age, sex, body mass index, disease type, comorbidities, and related prognostic factors (adjusted OR = 0.707, 95% CI: 0.553–0.930, P = 0.012). Restricted cubic spline analysis suggested a linear inverse correlation between TCBI-LN and complication risk. Subgroup analyses indicated that the protective association of TCBI-LN was statistically significant in males, patients aged < 65 years, those with a body mass index < 18.5 or ≥ 24 kg/m², and malnourished patients. No significant interactions were observed across all subgroups (P for interaction > 0.05). A risk stratification cutoff was determined based on the Youden index. The complication rate was significantly higher in the high-risk group (6.3%) compared to the intermediate- (5.1%) and low-risk groups (2.9%). In model comparison, adding TCBI-LN to a clinical model significantly improved AUC, NRI and IDI, and the model combining TCBI-LN with PNI and TyG provided the best overall performance. Mediation analysis indicated that TCBI-LN shortened LOS predominantly through reducing in-hospital complications and partially attenuated its direct cost-increasing effect. Conclusion In a large-scale cohort study of hospitalized patients, lower TCBI-LN levels were independently associated with a higher risk of in-hospital complications, and this association was generalizable across different patient subgroups. As a composite index easily derived from routine laboratory tests, TCBI may serve as a practical tool for early identification of patients at high risk for in-hospital complications and ultimately improve clinical outcomes.

For patients undergoing major thoracoabdominal surgery, perioperative nutritional management is essential. Although enteral nutrition is preferred, parenteral nutrition (PN) is needed when oral or enteral intake is inadequate or contraindicated and serves as a key electrolyte source. Electrolytes are crucial for fluid balance, acid–base stability, and metabolic function, and inappropriate supplementation may cause serious disturbances. Real-world evidence on perioperative PN electrolyte use in China remains limited. This multicenter retrospective study included 2018 patients who underwent major thoracoabdominal surgery and received PN between January 1 and December 31, 2024, across 10 medical centers in 8 provinces in China. Daily sodium, potassium, calcium, magnesium, and phosphorus intake and related clinical outcomes were collected from 2 days before to 5 days after surgery. Adequacy was assessed according to current guideline recommendations. Among the 2018 patients included, perioperative electrolyte supplementation showed substantial deviations from guideline recommendations. On the day of surgery, excessive sodium supplementation (>150 mmol) was observed in 73.7% of patients, while insufficient supplementation of potassium, magnesium, and phosphorus occurred in 56.2%, 91.0%, and 94.7%, respectively. Overall, 48.9% of patients experienced at least 1 electrolyte disturbance, with hypocalcemia (30.4%), hypophosphatemia (18.2%), and hyponatremia (17.8%) being the most common abnormalities. Potential PN compatibility risks were identified in 40.4% of prescriptions on the day of surgery and were associated with longer hospital stay. Multivariable analyses showed that supplementation routes were not independently associated with clinical outcomes. In contrast, higher PN volume was independently associated with increased risks of electrolyte disturbances, major complications, and prolonged hospitalization. Phosphate insufficiency was associated with prolonged hospital stay and increased risks of electrolyte disturbance and major complications, particularly on postoperative day 1. Surgical complexity also influenced outcomes, with pancreaticoduodenectomy associated with substantially higher risks of electrolyte disturbances and major complications. Perioperative PN is characterized by sodium overload and multi-electrolyte deficiency. Beyond supplementation routes, PN volume, phosphate insufficiency, and surgical complexity are key independent determinants of adverse clinical outcomes. Optimization of PN dosing strategies and targeted correction of phosphate imbalance may improve postoperative recovery and safety.

Hospital-acquired malnutrition (HAM) is prevalent and harmful. Global Leadership Initiative on Malnutrition (GLIM) criteria lack lipid metabolism information, impeding admission risk identification. TCBI integrates lipids and energy reserve, but its predictive utility for HAM remains unclear. This multicenter prospective study (June-September 2014, 34 tertiary hospitals in mainland China) consecutively enrolled 3,382 non-critically ill adults without malnutrition at admission and with hospital stays of 7–30 days. TCBI was calculated as triglyceride (mg/dL) × total cholesterol (mg/dL) × body weight (kg) / 1000 and natural log-transformed (TCBI-LN) due to skewness. The primary outcome was HAM diagnosed at discharge by adapted GLIM framework. Multivariable logistic regression, restricted cubic splines, and subgroup analyses with interaction testing were used to assess the independent association and dose‑response relationship between TCBI-LN and HAM. Among 3,382 patients without admission malnutrition, 21.6

BACKGROUND:The accuracy of current tools for predicting adverse events in older inpatients with possible sarcopenia is still insufficient to develop individualized nutrition-related management strategies. The objectives were to develop a machine learning model based on nutritional assessment for the prediction of all-cause death and infectious complications. METHODS:A cohort of older patients with possible sarcopenia (divided into training group [70%] and validation group [30%]) from 30 hospitals in 14 major cities in China was retrospectively analyzed. Clinical characteristics, laboratory examination, Nutritional risk Screening-2002 (NRS-2002) and mini-nutritional Assessment-Short form (MNA-SF) were used to construct machine learning models to predict in-hospital adverse events, including all-cause mortality and infectious complications. The applied algorithms included decision tree, random forest, gradient boosting machine (GBM), LightGBM, extreme gradient boosting and neural network. Model performance was assessed according to learning a series of learning metrics including area under the receiver operating characteristic curve (AUC) and accuracy. RESULTS:Among 3 999 participants (mean age 75.89 years [SD 7.14]; 1 805 [45.1%] were female), 373 (9.7%) had adverse events, including 62 (1.6%) of in-hospital death and 330 (8.5%) of infectious complications. The decision tree model showed a better AUC of 0.7072 (95% CI 0.6558-0.7586) in the validation cohort, using the five most important variables (i.e., mobility, reduced food intake, white blood cell count, upper arm circumference, and hypoalbuminemia). CONCLUSIONS:Machine learning prediction models are feasible and effective for identifying adverse events, and may be helpful to guide clinical nutrition decision-making in older inpatients with possible sarcopenia.

Malnutrition is a crucial factor affecting the prognosis of various diseases, especially among elderly, surgical and critically ill patients. With the implementation of Diagnosis Related Groups (DRGs) and Diagnosis-Intervention Packet (DIP) in China, accurate diagnosis and treatment of malnutrition is essential for enhancing clinical decision-making and patient prognosis. These guidelines were developed by multidisciplinary experts through a systematic review of evidence-based medical literature. They adopt the new international standard for malnutrition diagnosis from the Global Leadership Initiative on Malnutrition (GLIM) proposed by the Global Nutrition Organization and categorize evidence levels, providing recommendations tailored to the Chinese population's data and characteristics. The guidelines cover the entire process of malnutrition diagnosis in adult patients, including definition, epidemiology, nutrition risk screening, multi-level nutrition assessment, and diagnostic procedures. They also propose individualized diagnostic strategies for specific patient groups, such as obese or critically ill patients, and establish a standardized process for malnutrition diagnosis. At last, the guidelines form 27 questions, 38 recommendations, in order to improve the practical capacity of malnutrition diagnosis in China.

Background and aims:Frailty and malnutrition are prevalent among older adult inpatients. Our study aimed to analyze the correlation between frailty and malnutrition and determine their effects on the clinical outcomes in older adult surgical inpatients. Methods:This cross-sectional observational study included older adult inpatients (≥ 65 years old) undergoing scheduled surgery. Anthropometric measurements and hematological examination results were collected at the time of admission. Frailty and malnutrition were assessed using the frailty phenotype and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Nutritional support during hospitalization and clinical outcomes, such as the occurrence of postoperative complications, in-hospital death, length of hospital stays, and hospital costs, were recorded. The chi-squared and rank-sum tests were used for comparison. Univariate and multivariate logistic regression analyses were used to calculate the odds ratios (OR) and 95% confidence intervals (CI) for frailty, malnutrition, and postoperative complications. Results:In 394 patients, the frailty prevalence was 17.3% (68/394), and 146 inpatients (37.1%) were malnourished. The overlapping prevalence rate of frailty and malnutrition was 12.2% (48/394). Frailty and malnutrition were correlated (r = 0.464, p < 0.001). Multivariate analysis revealed that frailty significantly increased the risk of postoperative complications (OR: 2.937, 95% CI: 1.475-5.850, p = 0.002). There were significant differences in the length of hospital stays and hospital costs among the four groups of patients with frailty and malnutrition, frailty and no malnutrition, malnutrition and no frailty, and no frailty and malnutrition (p < 0.001; p < 0.001). Conclusion:A significant positive correlation was observed between frailty and malnutrition. Frailty and malnutrition are significantly associated with adverse clinical outcomes. Therefore, it is necessary to manage frailty and malnutrition to improve the prognosis.

Serum albumin (ALB) has traditionally been regarded as a marker of nutritional status. However, recent studies suggest its changes are closely linked to inflammation, metabolic dysregulation, and disease severity, limiting its role as a sole indicator of nutritional status. Yet, clinical practice continues to rely on ALB to monitor nutritional interventions, with a paucity of high-quality evidence on its dynamic associations with clinical outcomes. This study aimed to investigate the comprehensive associations of ALB dynamics with inflammation, nutritional status, and clinical outcomes in hospitalized patients, providing evidence to optimize clinical management. This secondary analysis utilized data from a prospective observational cohort study conducted in 34 tertiary hospitals across China between June and September 2014. A total of 2959 patients hospitalized for 7–30 days with complete data were included. Standardized protocols were used to collect demographics, nutritional indices (Nutritional Risk Screening 2002, Subjective Global Assessment), hematology, biochemistry results, and clinical outcomes (complications, length of stay, costs). Subgroup analyses were performed based on inflammatory status changes, nutritional therapy administration, department type, baseline nutritional status, and advanced age. Receiver operating characteristic curves identified cutoff values for infection-related complications. Correlation analyses and multivariable linear regression models determined independent predictors of ALB changes. Among 2959 patients, 1894 (64.0

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Aim To validate the role of the albumin-derived neutrophil-to-lymphocyte (ALB-dNLR) score in diagnosing malnutrition in medical inpatients over 70 years old. Methods This is a retrospective cross-sectional study involving 7 departments from 14 Chinese hospitals. The ALB-dNLR score was calculated, and outcomes between groups with positive and negative ALB-dNLR scores were compared after propensity score matching (PSM). Afterwards, the outcomes were compared between the groups receiving nutrition support and those not receiving support among malnourished patients diagnosed using the Global Leadership Initiative Malnutrition (GLIM) criteria after PSM. Results Out of 10,184 cases, 6165 were eligible. 2200 cases were in the positive ALB-dNLR score group. After PSM, 1458 pairs were analyzed, showing lower in-hospital mortality (0.8 % vs. 2.1 %, p = 0.005) and a lower nosocomial infection rate (5.9 % vs. 11.0 %, p < 0.001) in the negative ALB-dNLR score group. In malnourished patients, 259 pairs were analyzed after PSM. It showed better outcomes in mortality (0.8 % vs. 3.5 %, p = 0.033), nosocomial infection rate (5.4 % vs. 15.4 %, p < 0.001), length of stay (LOS) (13.8 ± 10.3 vs. 18.4 ± 14.1, p < 0.001), and total hospital cost (3315.3 ± 2946.4 vs. 4795.3 ± 4198.2, p < 0.001) in the support group. In malnourished patients with ALB-dNLR score as the sole etiological criterion, 94 pairs were calculated. It showed better outcomes in mortality (0.0 % vs. 6.4 %, p = 0.029), nosocomial infection rate (7.4 % vs. 18.1 %, p = 0.029), LOS (13.7 ± 8.3 vs. 19.8 ± 15.2, p = 0.001), and total hospital cost (3379.3 ± 2955.6 vs. 4471.2 ± 4782.4, p = 0.029) in the support group. Conclusions The ALB-dNLR score was validated to predict in-hospital mortality in medical inpatients over 70 years old. Malnutrition patients diagnosed by the GLIM criteria and using the ALB-dNLR score might benefit from nutrition support.

Background and aims Frailty is widespread in the elderly, while there is a bi-directional relationship between frailty and malnutrition. The objectives of this study were to investigate the prevalence and correlation of frailty and nutritional risk in older adult patients and to analyse the factors associated with fatigue which is one indicator of frailty.Methods This cross-sectional multicentre survey study was conducted in five hospitals in the same city from 01 January 2021 to 01 December 2021. We collected information on gender, age, diseases, medication and dietary status. Frailty status was diagnosed using the FRAIL scale, and Nutritional Risk Screening-2002 was used to screen the nutritional risk. Spearman rank correlation was used to analyse the correlation between frailty and nutritional risk. Univariate and multivariate logistic regression analyses were used to analyse the risk factors related to fatigue in all patients and inpatients.Results Among 2016 older adult patients, the prevalence of frailty was 15.1% (305/2016), the prevalence of nutritional risk was 16.2% (327/2016) and the overlap prevalence of frailty and nutritional risk was 7.3% (147/2016). Multivariate analysis showed that nutritional risk (OR 3.109, 95% CI 2.384 to 4.056, p<0.001) was an independent risk factor for fatigue in all patients; similar results were found for nutritional risk (OR 2.717, 95% CI 2.068 to 3.571, p<0.001) in hospitalised patients.Conclusions Frailty and nutritional risk are prevalent among older adult patients, and nutritional risk is associated with the occurrence of fatigue in older adult patients and older adult inpatients.Trial registration number China Clinical Trial Registry (Registered No. ChiCTR-EPC-14005253).

Sarcopenia is an age-related syndrome with progressive, generalized loss of muscle mass, strength, and physiological function. Low muscle mass is an important diagnostic criterion for sarcopenia. Ultrasound is safe, convenient and cost-effective, with extensive availability. It's a promising diagnostic tool for muscle mass assessment and sarcopenia screening in the elderly population. This review focuses on the specific methods and latest research progress on ultrasound assessment of sarcopenia.

Objective:To study the correlation between nutritional status and length of hospital stay in patients with digestive disorders.Methods:The data were collected from the database of a multi-center investigation on the dynamic changes of nutritional status of hospitalized patients in China, a project led by the Geriatric Nutrition Support Group, Society of Parenteral and Enteral Nutrition, Chinese Medical Association. The enrolled patients were screened for malnutrition and possible sarcopenia using Global Leadership Initiative on Malnutrition criteria, and the dynamic changes of serum biochemical indexes during hospital stay and the effects of malnutrition and possible sarcopenia on the length and cost of hospital stay were analyzed.Results:A total of 1 180 patients were enrolled, with an average age of (56.3±16.1) years, the average height of (164.65±8.29) cm, and the average weight of (62.12±12.12) kg. There were significant differences in body weight, body mass index, calf circumference, lymphocyte count, triglyceride, hemoglobin, albumin and total protein between at discharge and at admission ( P<0.001). There might be a correlation between post-admission malnutrition and sarcopenia. There was neither significant difference in the proportion of patients with malnutrition at admission among different age groups ( P=0.438), nor in that at discharge among different age groups ( P=0.439). The proportion of patients with malnutrition showed no significant difference between subgroups with patients<65 years old and ≥ 65 years old, at admission and discharge ( P>0.05). However, comparison of the proportion of patients with sarcopenia between subgroups with patients<65 years old and ≥65 years old displayed significant differences at admission and discharge ( P<0.001), but not the comparison of the proportion of patients with possible sarcopenia ( P>0.05). The length of hospital stay in patients with malnutrition was significantly longer than that in patients without malnutrition [(13.22±6.24) days vs. (12.08±5.25) days, P<0.001]. The length of hospital stay of patients with and without sarcopenia was also significantly different [(12.87±5.93) days vs. (12.02±5.22) days, P<0.001). Patients with concurrent malnutrition and sarcopenia had longer hospital stay [(14.57±7.15) days vs. (12.07±5.22) days, P<0.001], and higher medical cost [(2.78±2.19) ten thousand Chinese Yuan vs. (2.24±2.33) ten thousand Chinese Yuan, P<0.05)] compared with those without concurrent malnutrition and sarcopenia. Conclusions:A large proportion of patients with digestive disorders were diagnosed with malnutrition and/or possible sarcopenia during hospitalization. There is possible correlation between malnutrition and possible sarcopenia, and both can lead to a longer hospital stay and higher medical cost.

由中华医学会肠外肠内营养学分会（CSPEN）主办的中华医学会第十六届全国肠外肠内营养学学术会议于2022年11月21至27日成功召开。为落实会议期间国家和地方疫情常态化防控要求，会议以“网络在线”的形式举办。在为期7天的大会上，设有1个主会场及25个分会场，共有专题发言195个，包括主会场主旨演讲和优秀论文报告各20个。内容涵盖基础研究、临床研究、最新指南共识、治疗策略、疾病管理等多个视角，来自国内外不同专业及学科领域的数万专家学者围绕“医学营养、规范创新”的大会主题展开学术交流，展示了我国肠外肠内营养学领域的最新研究成果，推动了学术水平，提升了学术影响力，促进了肠外肠内营养支持的规范使用。今年大会总注册人数超过2万人，总观看次数近20万次，均创历史新高，也再次体现了CSPEN在该领域的国内学术主导地位和国际影响力，有力地推动了我国临床营养事业的进步与发展。

Objective:To investigate the prevalence of malnutrition in elderly patients with neurological diseases and the of nutrition, and to explore their association with clinical outcomes.Methods:A retrospective study was conducted to analyze 566 elderly patients with neurological diseases in the database of the "National Multicenter Survey on the Dynamic Changes of Nutritional Status of Hospitalized Patients" by using the Global leadership Initiative on Malnutrition(GLIM)criteria and subjective global assessment(SGA). The two diagnostic tools for malnutrition were compared to explore the correlation between malnutrition and clinical outcomes.Results:Based on the GLIM criteria, 83 cases were diagnosed with malnutrition and the incidence of malnutrition was 14.66%(83/566), with 14.72%(48/326)in men and 14.58%(35/240)in women.Patients with moderate malnutrition accounted for 8.30%(47/566)and patients with severe malnutrition accounted for 6.36%(36/566). According to the SGA, the incidence of moderate malnutrition(SGA Grade B)was 15.55%(88/566), the incidence of severe malnutrition(SGA Grade C)was 1.94%(11/566), and all cases of malnutrition(SGA Grade B+ C)accounted for 17.49% of the participants(99/566). The total length of hospital stay was(15.46±6.49)days in the malnutrition group and(13.55±5.09)days in the non-malnutrition group, with a statistical difference between the two groups( t=-3.02, P<0.01). The body weight of the malnutrition group was significantly lower than non-malnutrition group[(52.0±8.5)kg vs.(65.2±9.6)kg, t=12.92, P<0.01]. There were also statistically significant differences in BMI(19.1±2.7 kg/m 2vs.23.9±2.6 kg/m 2, t=15.48, P<0.01), upper arm circumference[(22.3±2.5)cm vs.(28.3±3.9)cm, t=7.01, P<0.01], and lower leg circumference[(28.9±3.4)cm vs.(32.5±3.3)cm, t=6.81, P<0.01]between the two groups.Laboratory tests showed that there were significant differences in lymphocytes[(5.0±8.5)×10 9/L vs.(9.4±11.8)×10 9/L, t=3.61, P<0.01]and albumin[(38.5±4.4)g/L vs.(40.7±5.1)g/L, t=3.18, P<0.01]between the malnutrition group and the non-malnutrition group.The correlation between GLIM and SGA was good, and the consistency was reasonable(AUC=0.711). Conclusions:The incidence of malnutrition in elderly patients with neurological diseases is relatively high; The GLIM criteria are suitable for the diagnosis of malnutrition in elderly patients with neurological diseases, and the diagnostic results have a good correlation with those of SGA.Malnutrition is associated with anthropometric measurements, laboratory indicators, and clinical outcomes.

Objective:To evaluate the clinical effectiveness of the standardized peripherally inserted central catheter (PICC) implantation procedure in the management of parenteral nutrition infusion routes.Methods:Patients were enrolled from January 2018 to January 2020 and were divided into the study and control groups, receiving standard operating procedures of PICC or insertion through below elbow with or without ultrasonic guidance. The differences in the success rate of PICC insertion, catheter indwelling time, incidence rate of complications, and patient satisfaction were compared.Results:A total of 943 subjects were included. The study group and the control group were comparable in terms of baseline characteristics such as disease type, body mass index and prevalence of nutritional risk. The overall success rate was 100% in both groups. The first-attempt success rate in the study group was higher compared with the control group (92.6% vs 72.2%, χ 2 = 66.229, P < 0.001), and the catheter indwelling time was longer ([25.4 ± 2.3] d vs [21.6 ± 3.1] d, t = 21.271, P < 0.001). The incidence rate of short-term complications in the study group was significantly lower than that in the control group (3.50% vs 11.52%, χ 2 = 21.490, P <0.001), while there was no significant difference in the incidence rate of long-term complications between the two groups (6.78% vs 8.85%, χ 2 = 1.388, P = 0.239). Conclusion:Establishing and implementing the standardized operating procedure of PICC is an effective method to improve the management of parenteral nutrition infusion routes.

Background and aims Malnutrition is strongly linked to adverse outcomes in patients with Crohn’s disease (CD). In this study, our objective was to validate the Global Leadership Initiative on Malnutrition (GLIM) criteria and develop a fast and accurate diagnostic approach for identifying malnutrition in CD patients. Methods This study assessed 177 CD patients from four general hospitals. The efficacy of the GLIM criteria for the diagnosis of CD malnutrition was compared. By analyzing the independent factors, a nomogram model was derived and internally validated to predict the diagnosis of malnutrition in patients with CD. Model performance was assessed using discrimination and calibration, decision curves, and net benefit analyses. Results Compared with the SGA criteria, the GLIM criteria was consistent in sensitivity (88.89%) and specificity (78.43%) [AUC = 0.84; 95% Confidence Interval (CI): 0.77–0.89]. The Harvey-Bradshaw index(HBI) score (OR: 1.58; 95% CI: 1.15–2.18), body mass index (OR: 0.41; 95% CI: 0.27–0.64), and mid-upper arm circumference (OR: 0.68; 95% CI: 0.47–0.9) were independent factors associated with malnutrition. The nomogram was developed based on these indicators showing good discrimination in malnutrition diagnosis (AUC = 0.953; 95% CI: 0.922–0.984), with agreement after calibration curve and decision curve analysis. Conclusion The GLIM criteria are appropriate for diagnosing malnutrition in CD patients. The HBI score may be used to diagnose malnutrition in patients with CD and become a possible selection for the GLIM etiologic criteria of inflammation. The HBM nomogram could be a simple, rapid, and efficient method for diagnosing malnutrition in CD patients.

Background Older patients are at an increased risk of malnutrition due to many factors related to poor clinical outcomes. Objective This study aims to develop an assisted diagnosis model using machine learning (ML) for identifying older patients with malnutrition and providing the focus of individualized treatment. Methods We reanalyzed a multicenter, observational cohort study including 2660 older patients. Baseline malnutrition was defined using the global leadership initiative on malnutrition (GLIM) criteria, and the study population was randomly divided into a derivation group (2128/2660, 80%) and a validation group (532/2660, 20%). We applied 5 ML algorithms and further explored the relationship between features and the risk of malnutrition by using the Shapley additive explanations visualization method. Results The proposed ML models were capable to identify older patients with malnutrition. In the external validation cohort, the top 3 models by the area under the receiver operating characteristic curve were light gradient boosting machine (92.1%), extreme gradient boosting (91.9%), and the random forest model (91.5%). Additionally, the analysis of the importance of features revealed that BMI, weight loss, and calf circumference were the strongest predictors to affect GLIM. A BMI of below 21 kg/m2 was associated with a higher risk of GLIM in older people. Conclusions We developed ML models for assisting diagnosis of malnutrition based on the GLIM criteria. The cutoff values of laboratory tests generated by Shapley additive explanations could provide references for the identification of malnutrition. Trial Registration Chinese Clinical Trial Registry ChiCTR-EPC-14005253; https://www.chictr.org.cn/showproj.aspx?proj=9542

Objective:To study the association of frailty status with nutritional risk and the effect on clinical outcomes among elderly surgical inpatients.Methods:Elderly inpatients from the surgery department of Beijing Hospital were enrolled from January to June 2021. Frail scale and nutritional risk screening 2002 (NRS 2002) were used for frailty evaluation and nutrition risk screening. The influence of frailty and associated nutrition risk in elderly surgical inpatients was analyzed.Results:487 elderly surgical patients were included, of whom 131 cases were in the non-frailty group, 279 cases were in the pre-frailty group and 77 cases were in the frailty group, according to the Frail scale score. 146 cases were at nutritional risk, of whom 8 (6.1% of 131) were in the non-frailty group, 87 (31.2% of 279) in the pre-frailty group and 51 (66.2% of 77) were in the frailty group. According to univariate/multivariate logistic regression analysis of frailty in elderly surgical patients, a higher NRS 2002 score, older age, and the presence of multiple concurrent diseases (≥ 5) were significantly associated with frailty ( P < 0.001). The Frail scale score was positively correlated with NRS 2002 score ( r = 0.448, P < 0.01). Multiple comparisons showed that frailty had statistically significant effects on hospital stay and medical costs in elderly surgical patients ( P < 0.05). Conclusions:The prevalence of frailty is higher in elderly surgical patients, and the prevalence of nutritional risk increases with the progression of frailty. Frailty can lead to prolonged hospital stays and increased hospital costs in elderly surgical patients.