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Volume 17
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Article

Adherence to β-hydroxy-β-methylbutyrate-Enriched Oral Nutritional Supplements Enhances Survival and Nutritional Recovery in Malnourished Outpatients: Prognostic Insights

by
Isabel Vegas-Aguilar
1,2,
Rocío Fernández-Jiménez
1,2,3,4,*,
Isabel Cornejo-Pareja
1,2,5,
María Del Mar Amaya-Campos
1,2,
Patricia Guirado-Peláez
1,
Natalia Montero-Madrid
1,
Álvaro Vidal-Suarez
1,
Maria Angeles Martín-Fontalba
1,
Victor Simon-Frapolli
1,
Francisco J. Tinahones
1,2,3,5,† and
José Manuel García-Almeida
1,2,3,4,5,†
1
Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain
2
Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina—IBIMA Plataforma BIONAND, 29010 Málaga, Spain
3
Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain
4
Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, Av. Imperio Argentina, 29004 Malaga, Spain
5
Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
*
Author to whom correspondence should be addressed.
†
These authors also contributed equally to this work and are Joint Senior Authors.
Nutrients 2025, 17(9), 1601; https://doi.org/10.3390/nu17091601
Submission received: 16 April 2025 / Revised: 2 May 2025 / Accepted: 4 May 2025 / Published: 7 May 2025
(This article belongs to the Special Issue Nutritional Status and Lifestyle in Metabolic Disorders)
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Abstract

Background: Disease-related malnutrition (DRM) in outpatients is associated with increased mortality and functional decline. Morphofunctional assessments, including phase angle (PA), rectus femoris cross-sectional area (RF-CSA), and handgrip strength (HGS), provide valuable prognostic insights in the ambulatory setting. Nutritional recovery programs enriched with β-hydroxy-β-methylbutyrate (HMB) offer potential benefits in improving nutritional and functional outcomes. Objective: To evaluate the effects of a six-month nutritional recovery program combining HMB-enriched oral nutritional supplements (HMB-ONS), dietary recommendations, and exercise on survival, morphofunctional markers, and adherence in malnourished outpatients. Methods: This retrospective observational study included 135 malnourished outpatients diagnosed using GLIM criteria. Morphofunctional assessments included PA (bioimpedance analysis), RF-CSA (nutritional ultrasound), HGS (dynamometry), and the Timed Up and Go (TUG) test. Adherence was assessed using pharmacy retrieval records and a validated questionnaire. Changes in morphofunctional markers and their association with mortality were analyzed using multivariate Cox regression models. Results: After six months, significant improvements were observed in PA (+0.47°), RF-CSA (+0.90 cm2), HGS (+4.1 kg), and TUG (−0.93 s) (all p < 0.001). These improvements were more pronounced in the high-adherence group, which also exhibited a reduced mortality risk (HR 0.42, p < 0.05). Changes in PA and HGS were strongly associated with survival, with ΔPA showing an HR of 0.27 (95% CI: 0.15–0.50, p < 0.001) and ΔHGS showing an HR of 0.82 (95% CI: 0.75–0.89, p < 0.001). Conclusions: A nutritional recovery program with HMB-ONS significantly improves survival and morphofunctional markers in malnourished patients, with the greatest benefits observed in those with high adherence. These findings underscore the importance of adherence-support strategies in optimizing clinical outcomes and highlight the need for further research to confirm long-term benefits.
Keywords: malnutrition; dietary supplements; muscle strength; nutritional status; prognosis malnutrition; dietary supplements; muscle strength; nutritional status; prognosis

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MDPI and ACS Style

Vegas-Aguilar, I.; Fernández-Jiménez, R.; Cornejo-Pareja, I.; Amaya-Campos, M.D.M.; Guirado-Peláez, P.; Montero-Madrid, N.; Vidal-Suarez, Á.; Martín-Fontalba, M.A.; Simon-Frapolli, V.; Tinahones, F.J.; et al. Adherence to β-hydroxy-β-methylbutyrate-Enriched Oral Nutritional Supplements Enhances Survival and Nutritional Recovery in Malnourished Outpatients: Prognostic Insights. Nutrients 2025, 17, 1601. https://doi.org/10.3390/nu17091601

AMA Style

Vegas-Aguilar I, Fernández-Jiménez R, Cornejo-Pareja I, Amaya-Campos MDM, Guirado-Peláez P, Montero-Madrid N, Vidal-Suarez Á, Martín-Fontalba MA, Simon-Frapolli V, Tinahones FJ, et al. Adherence to β-hydroxy-β-methylbutyrate-Enriched Oral Nutritional Supplements Enhances Survival and Nutritional Recovery in Malnourished Outpatients: Prognostic Insights. Nutrients. 2025; 17(9):1601. https://doi.org/10.3390/nu17091601

Chicago/Turabian Style

Vegas-Aguilar, Isabel, Rocío Fernández-Jiménez, Isabel Cornejo-Pareja, María Del Mar Amaya-Campos, Patricia Guirado-Peláez, Natalia Montero-Madrid, Álvaro Vidal-Suarez, Maria Angeles Martín-Fontalba, Victor Simon-Frapolli, Francisco J. Tinahones, and et al. 2025. "Adherence to β-hydroxy-β-methylbutyrate-Enriched Oral Nutritional Supplements Enhances Survival and Nutritional Recovery in Malnourished Outpatients: Prognostic Insights" Nutrients 17, no. 9: 1601. https://doi.org/10.3390/nu17091601

APA Style

Vegas-Aguilar, I., Fernández-Jiménez, R., Cornejo-Pareja, I., Amaya-Campos, M. D. M., Guirado-Peláez, P., Montero-Madrid, N., Vidal-Suarez, Á., Martín-Fontalba, M. A., Simon-Frapolli, V., Tinahones, F. J., & García-Almeida, J. M. (2025). Adherence to β-hydroxy-β-methylbutyrate-Enriched Oral Nutritional Supplements Enhances Survival and Nutritional Recovery in Malnourished Outpatients: Prognostic Insights. Nutrients, 17(9), 1601. https://doi.org/10.3390/nu17091601

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