Nutrients

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Open AccessEditorial

Morphofunctional Nutritional Assessment in Clinical Practice: A New Approach to Assessing Nutritional Status

by Daniel-Antonio de Luis Roman and Juan José Lopez Gomez

Nutrients 2023, 15(19), 4300; https://doi.org/10.3390/nu15194300 - 9 Oct 2023

Cited by 5 | Viewed by 2034

Abstract

This Special Issue of Nutrients titled “Morphofunctional Nutritional Assessment in Clinical Practice” is oriented to the diagnosis of disease-related malnutrition (DRM) [...] Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

Research

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20 pages, 1299 KiB

Open AccessArticle

Phase Angle and Ultrasound Assessment of the Rectus Femoris for Predicting Malnutrition and Sarcopenia in Patients with Esophagogastric Cancer: A Cross-Sectional Pilot Study

by Erika Vieira Maroun, María Argente Pla, María José Pedraza Serrano, Bianca Tabita Muresan, Agustín Ramos Prol, Eva Gascó Santana, Silvia Martín Sanchis, Ángela Durá De Miguel, Andrea Micó García, Anna Cebrián Vázquez, Alba Durbá Lacruz and Juan Francisco Merino-Torres

Nutrients 2025, 17(1), 91; https://doi.org/10.3390/nu17010091 - 29 Dec 2024

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Abstract

Background: Disease-related malnutrition (DRM) and sarcopenia are prevalent conditions in gastrointestinal cancer patients, whose early diagnosis is essential to establish a nutritional treatment that contributes to optimizing adverse outcomes and improving prognosis. Phase angle (PhA) and rectus femoris ultrasound measurements are considered effort-independent [...] Read more.

Background: Disease-related malnutrition (DRM) and sarcopenia are prevalent conditions in gastrointestinal cancer patients, whose early diagnosis is essential to establish a nutritional treatment that contributes to optimizing adverse outcomes and improving prognosis. Phase angle (PhA) and rectus femoris ultrasound measurements are considered effort-independent markers of muscle wasting, which remains unrecognized in oncology patients. Objective: This study aimed to evaluate the potential utility of PhA, rectus femoris cross-sectional area (RFCSA), and rectus femoris thickness (RF-Y-axis) in predicting malnutrition and sarcopenia in patients with esophagogastric cancer (EGC). Methods: This was a cross-sectional study of patients diagnosed with EGC. PhA was obtained using bioelectrical impedance vector analysis (BIVA) along with ASMMI. The RFCSA and RF-Y-axis were measured using nutritional ultrasound (NU^®). Muscle capacity was assessed using handgrip strength (HGS), and functionality by applying the Short Physical Performance Battery (SPPB). Malnutrition and sarcopenia were determined according to the GLIM and EWGSOP2 criteria, respectively. Results: Out of the 35 patients evaluated, 82.8% had malnutrition and 51.4% had sarcopenia. The RFCSA (r = 0.582) and RF-Y-axis (r = 0.602) showed significant, moderate correlations with ASMMI, unlike PhA (r = 0.439), which displayed a weak correlation with this parameter. However, PhA (OR = 0.167, CI 95%: 0.047–0.591, p = 0.006), RFCSA (OR = 0.212, CI 95%: 0.074–0.605, p = 0.004), and RF-Y-axis (OR = 0.002, CI 95%: 0.000–0.143, p = 0.004) all showed good predicting ability for sarcopenia in the crude models, but only the RF-Y-axis was able to explain malnutrition in the regression model (OR = 0.002, CI 95%: 0.000–0.418, p = 0.023). Conclusions: The RF-Y-axis emerged as the only independent predictor of both malnutrition and sarcopenia in this study, likely due to its stronger correlation with ASMMI compared to PhA and RFCSA. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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23 pages, 3251 KiB

Open AccessArticle

Muscle Biomarkers in Colorectal Cancer Outpatients: Agreement Between Computed Tomography, Bioelectrical Impedance Analysis, and Nutritional Ultrasound

by Andrés Jiménez-Sánchez, María Elisa Soriano-Redondo, María del Carmen Roque-Cuéllar, Silvia García-Rey, Manuel Valladares-Ayerbes, José Luis Pereira-Cunill and Pedro Pablo García-Luna

Nutrients 2024, 16(24), 4312; https://doi.org/10.3390/nu16244312 - 13 Dec 2024

Cited by 2 | Viewed by 1299

Abstract

Background: Muscle quality and mass in cancer patients have prognostic and diagnostic importance. Objectives: The objectives are to analyze agreement between gold-standard and bedside techniques for morphofunctional assessment. Methods: This cross-sectional study included 156 consecutive colorectal cancer outpatients that underwent computed tomography (CT) [...] Read more.

Background: Muscle quality and mass in cancer patients have prognostic and diagnostic importance. Objectives: The objectives are to analyze agreement between gold-standard and bedside techniques for morphofunctional assessment. Methods: This cross-sectional study included 156 consecutive colorectal cancer outpatients that underwent computed tomography (CT) scanning at lumbar level 3 (L3), whole-body bioelectrical impedance analysis (BIA), point-of-care nutritional ultrasound^® (US), anthropometry, and handgrip strength in the same day. Measured muscle biomarkers were stratified by sex, age, BMI-defined obesity, and malnutrition using Global Leadership in Malnutrition (GLIM) criteria. Whole-body estimations for muscle mass (MM) and fat-free mass were calculated using two different equations in CT (i.e., Shen, and Mourtzakis) and four different equations for BIA (i.e., Janssen, Talluri, Kanellakis, and Kotler). Muscle cross-sectional area at L3 was estimated using the USVALID equation in US. Different cut-off points for muscle atrophy and myosteatosis were applied. Sarcopenia was defined as muscle atrophy plus dynapenia. Intra-technique and inter-technique agreement were analyzed with Pearson, Lin (ρ), and Cohen (k) coefficients, Bland–Altman analyses, and hypothesis tests for measures of central tendency. Results: Intra-technique agreements on muscular atrophy (CT k = 0.134, BIA k = −0.037, US k = 0.127) and myosteatosis (CT k = 0.122) were low, but intra-technique agreement on sarcopenia in CT was fair (k = 0.394). Inter-technique agreement on muscular atrophy and sarcopenia were low. Neither CT and BIA (ρ = 0.468 to 0.772 depending on equation), nor CT and US (ρ = 0.642), were interchangeable. Amongst the BIA equations, MM by Janssen proved the best, with a 1.5 (3.6) kg bias, (−5.6, 8.6) kg LoA, and 9/156 (5.7%) measurements outside the LoA. Muscle biomarkers in all techniques were worse in aged, female, or malnourished participants. Obesity was associated with higher muscle mass or surface biomarkers in all techniques. Conclusions: Bedside techniques adequately detected patterns in skeletal muscle biomarkers, but lacked agreement with a reference technique in the study sample using the current methodology. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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15 pages, 313 KiB

Open AccessArticle

Determinants of Malnourishment in the Institutionalized Older Population: The FRAGILESS Study

by Julia Leira, Ana Maseda, Rocío López-López, Laura Lorenzo-López, Nuria Cibeira, Leire Lodeiro-Fernández and José C. Millán-Calenti

Nutrients 2024, 16(23), 4114; https://doi.org/10.3390/nu16234114 - 28 Nov 2024

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Abstract

Background/Objectives: Malnutrition is a very common condition among older people and strongly affects their quality of life. The current literature relates the presence of nutritional deficiencies to several health-related factors that usually emerge at advanced stages of life. This study aimed to assess [...] Read more.

Background/Objectives: Malnutrition is a very common condition among older people and strongly affects their quality of life. The current literature relates the presence of nutritional deficiencies to several health-related factors that usually emerge at advanced stages of life. This study aimed to assess the associations between malnutrition and its determinants in a group of institutionalized older people via the Mini Nutritional Assessment–Short Form (MNA-SF) and the full MNA. Methods: The MNA-SF was compared with the full MNA to evaluate the nutritional status of 207 older people. A multinomial logistic regression analysis was performed. Results: The data revealed that institutionalized older people with cognitive impairment, frailty syndrome, dysphagia, a low BMI, a high duration of institutionalization, and a low educational level are more likely to be malnourished or at risk of malnutrition. Conclusions: The results reveal that the MNA or MNA-SF may not identify common determinants of malnutrition or nutritional risk. The identified determinants depend on the test. Therefore, the data obtained determine the need to use adequate nutritional screening tools to control the presence of malnutrition. Nutritional screening is essential to decrease public costs, hospitalizations, rates of disability, dependence, morbidity, and even mortality among institutionalized older people. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

13 pages, 508 KiB

Open AccessArticle

Sarcopenia in the Oldest-Old Adults in the Capital of Brazil: Prevalence and Its Associated Risk Factors

by Hudson Azevedo Pinheiro, Ruth Losada de Menezes, Camila Kellen de Souza Cardoso, Rômulo Roosevelt da Silva Filho, Farah Registre, César de Oliveira and Erika Aparecida Silveira

Nutrients 2024, 16(23), 3976; https://doi.org/10.3390/nu16233976 - 21 Nov 2024

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Abstract

Background: In light of the demographic context in which the older adult population is prominent, sarcopenia emerges as a significant concern for the health of these individuals. Aim: To assess the frequency of sarcopenia and severe sarcopenia and the associated risk factors in [...] Read more.

Background: In light of the demographic context in which the older adult population is prominent, sarcopenia emerges as a significant concern for the health of these individuals. Aim: To assess the frequency of sarcopenia and severe sarcopenia and the associated risk factors in the oldest adults living in the community. Methods: There were 399 participants aged 80 or older, of both sexes, using primary health care services in the metropolitan area of Brasília, Brazil. Sarcopenia was evaluated based on European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Muscle mass was measured by calf circumference, muscle function by handgrip strength, and muscle performance by gait speed. Clinical and socioeconomic variables, comorbidities, falls, and urinary incontinence were collected. The prevalence of sarcopenia was calculated with a 95% (IC) prevalence. Multivariate Poisson regression analysis was performed in Stata, with p < 5%. Results: Among participants, 78.2% were women. Prevalence of pre-sarcopenia was 31.8%, sarcopenia 3.3%, and severe sarcopenia 25.1%. After multivariate regression, sarcopenia was associated with the female sex, low weight, and a dependency for activities of daily living (ADLs). Similarly, severe sarcopenia remained associated with female sex, low weight, and an ADLs dependency. Sarcopenia and severe sarcopenia were not associated with the level of education, marital status, income, physical activity, medications, falls, nor comorbidities. Conclusions: A quarter of older adults had severe sarcopenia. Sarcopenia and severe sarcopenia were associated with being a woman, being low weight, and have an ADLs dependence. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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12 pages, 302 KiB

Open AccessArticle

Impact of Elexacaftor–Tezacaftor–Ivacaftor Therapy on Body Composition, Dietary Intake, Biomarkers, and Quality of Life in People with Cystic Fibrosis: A Prospective Observational Study

by Francisco Hevilla, Nuria Porras, María Victoria Girón, María García-Olivares, Marina Padial, Francisco José Sánchez-Torralvo, Casilda Olveira and Gabriel Olveira

Nutrients 2024, 16(19), 3293; https://doi.org/10.3390/nu16193293 - 28 Sep 2024

Cited by 1 | Viewed by 1727

Abstract

Background: The combination of elexacaftor–tezacaftor–ivacaftor modulators (ETI) has improved clinical outcomes for people with cystic fibrosis (pwCF). Objectives: This study aimed to evaluate changes in nutritional and morphofunctional assessments, as well as anxiety, depression symptoms, and quality of life, in pwCF after starting [...] Read more.

Background: The combination of elexacaftor–tezacaftor–ivacaftor modulators (ETI) has improved clinical outcomes for people with cystic fibrosis (pwCF). Objectives: This study aimed to evaluate changes in nutritional and morphofunctional assessments, as well as anxiety, depression symptoms, and quality of life, in pwCF after starting ETI therapy. Methods: This was a prospective observational study. We measured body composition (fat mass [FM] and fat-free mass [FFM]) using bioelectrical impedance analysis (BIA) and skinfold thickness measurements (SMs). We also assessed hand grip strength, dietary intake via surveys, blood and stool biomarkers, symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale [HADS], and quality of life through the Cystic Fibrosis Questionnaire—Revised (CFQR). Results: A total of 31 pwCF were evaluated. Significant improvements were observed in respiratory function and quality of life, alongside an average weight increase of approximately 5 kg (60% FM and 40% FFM). The prevalence of malnutrition, based on BMI and the FFM index, decreased significantly, while the rate of overweight/obesity increased. Biomarker analysis indicated better nutrient absorption and reduced intestinal inflammation, as evidenced by significant changes in faecal calprotectin, nitrogen, and fat levels, as well as blood lipid and vitamin profiles. Conclusions: Despite a reduction in caloric intake, an increase in weight was observed one year after initiating ETI. This increase was attributed to gains in both FM and FFM, suggesting improved metabolic efficiency and nutrient absorption. Both SM and BIA were found to be useful assessment tools. These findings indicate the need to modify the nutritional approach, focusing on the quality rather than the quantity of intake, and aiming for an appropriate body composition (FFM) rather than solely focusing on BMI. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

12 pages, 1015 KiB

Open AccessArticle

Malnutrition in Amyotrophic Lateral Sclerosis: Insights from Morphofunctional Assessment and Global Leadership Initiative on Malnutrition Criteria

by María Teresa Zarco-Martín, Carmen Freire, María Carmen Andreo-López, Socorro Leyva-Martínez and María Luisa Fernández-Soto

Nutrients 2024, 16(16), 2625; https://doi.org/10.3390/nu16162625 - 9 Aug 2024

Viewed by 1865

Abstract

Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease frequently accompanied by malnutrition due to weight loss, increased energy expenditure, and muscle mass loss. This study aimed to evaluate morphofunctional assessment tools as predictors of malnutrition and to investigate their relationship with muscle [...] Read more.

Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease frequently accompanied by malnutrition due to weight loss, increased energy expenditure, and muscle mass loss. This study aimed to evaluate morphofunctional assessment tools as predictors of malnutrition and to investigate their relationship with muscle status and disease severity in ALS patients. A cross-sectional study was conducted with 45 ALS patients at the San Cecilio University Hospital in Granada. Malnutrition was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Morphofunctional assessment was performed using Bioimpedance Vectorial Analysis (BIVA), handgrip strength (HGS), and Short Physical Performance Battery (SPPB). Malnutrition prevalence was 38% according to GLIM criteria. Significant differences were observed between malnourished and non-malnourished groups in age (70 ± 9 vs. 62 ± 10 years, p = 0.01), sex (female prevalence: 58.8% vs. 25.0%, p = 0.02), dysphagia prevalence (83% vs. 29%, p < 0.001), PEG/PRG use (35.3% vs. 3.6%, p = 0.01), and ALSFRS-R scores (30 ± 12 vs. 34 ± 12, p = 0.02). Malnourished patients had lower values in anthropometric measurements, muscle mass obtained by BIVA, and phase angle (PA) (4.05 ± 0.8° vs. 5.09 ± 0.8°, p < 0.001). No significant differences were found in muscle strength or functional status. PA showed significant correlations with muscle strength (r = 0.52, p < 0.001) and muscle mass measures (r = 0.48, p < 0.001). Moreover, PA was associated with poorer disease progression and physical performance. In our sample, BIVA metrics such as PA (<4.3°), SPA (<−0.8), body cell mass (<9.2 kg/m), and extracellular water (>49.75%) were identified as malnutrition risk factors. The study underscores the critical importance of comprehensive morphofunctional assessment and the use of advanced diagnostic criteria, for early identification and intervention in malnutrition among people with ALS. Further research is warranted to validate these findings and develop targeted nutritional strategies into routine clinical practice. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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9 pages, 247 KiB

Open AccessArticle

by Nicoletta Miano, Giorgia Todaro, Maurizio Di Marco, Sabrina Scilletta, Giosiana Bosco, Francesco Di Giacomo Barbagallo, Roberto Scicali, Salvatore Piro, Francesco Purrello and Antonino Di Pino

Nutrients 2024, 16(12), 1925; https://doi.org/10.3390/nu16121925 - 18 Jun 2024

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Abstract

Fatty liver disease has been identified as a marker of malnutrition in different clinical settings. Recently, the COntrolling NUTritional status score (CONUT score) emerged as a promising tool for malnutrition assessment. Our aim was to evaluate short-term outcomes among patients with malnutrition-related liver [...] Read more.

Fatty liver disease has been identified as a marker of malnutrition in different clinical settings. Recently, the COntrolling NUTritional status score (CONUT score) emerged as a promising tool for malnutrition assessment. Our aim was to evaluate short-term outcomes among patients with malnutrition-related liver steatosis in an Internal Medicine department. Furthermore, we evaluated the association of the CONUT score with malnutrition-related liver steatosis. Data from 247 patients hospitalized in an Internal Medicine department were retrospectively collected. The study population was stratified into three groups based on hepatic radiodensity assessed with computed tomography: mild steatosis (≥56.1 HU), moderate steatosis (between 49.7 and 56 HU), and severe steatosis (≤49.6 HU). We then calculated the CONUT score. Severe steatosis patients had higher in-hospital mortality (18.2 vs. 15.5%) and longer in-hospital stays compared with the mild steatosis group (length of in-hospital stay longer than 12 days: 45% vs. 40%). Logistic regression analysis showed that severe steatosis was not significantly associated with in-hospital all-cause death, while a high CONUT score was an independent risk factor for sepsis. We found an independent relationship between malnutrition-associated liver steatosis and the CONUT score. These results identified the CONUT score as a tool for nutritional assessment of hospitalized patients. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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14 pages, 4051 KiB

Open AccessArticle

Validation of an Artificial Intelligence-Based Ultrasound Imaging System for Quantifying Muscle Architecture Parameters of the Rectus Femoris in Disease-Related Malnutrition (DRM)

by Sergio García-Herreros, Juan Jose López Gómez, Angela Cebria, Olatz Izaola, Pablo Salvador Coloma, Sara Nozal, Jesús Cano, David Primo, Eduardo Jorge Godoy and Daniel de Luis

Nutrients 2024, 16(12), 1806; https://doi.org/10.3390/nu16121806 - 8 Jun 2024

Cited by 8 | Viewed by 1940

Abstract

(1) Background: The aim was to validate an AI-based system compared to the classic method of reading ultrasound images of the rectus femur (RF) muscle in a real cohort of patients with disease-related malnutrition. (2) Methods: One hundred adult patients with DRM aged [...] Read more.

(1) Background: The aim was to validate an AI-based system compared to the classic method of reading ultrasound images of the rectus femur (RF) muscle in a real cohort of patients with disease-related malnutrition. (2) Methods: One hundred adult patients with DRM aged 18 to 85 years were enrolled. The risk of DRM was assessed by the Global Leadership Initiative on Malnutrition (GLIM). The variation, reproducibility, and reliability of measurements for the RF subcutaneous fat thickness (SFT), muscle thickness (MT), and cross-sectional area (CSA), were measured conventionally with the incorporated tools of a portable ultrasound imaging device (method A) and compared with the automated quantification of the ultrasound imaging system (method B). (3) Results: Measurements obtained using method A (i.e., conventionally) and method B (i.e., raw images analyzed by AI), showed similar values with no significant differences in absolute values and coefficients of variation, 58.39–57.68% for SFT, 30.50–28.36% for MT, and 36.50–36.91% for CSA, respectively. The Intraclass Correlation Coefficient (ICC) for reliability and consistency analysis between methods A and B showed correlations of 0.912 and 95% CI [0.872–0.940] for SFT, 0.960 and 95% CI [0.941–0.973] for MT, and 0.995 and 95% CI [0.993–0.997] for CSA; the Bland–Altman Analysis shows that the spread of points is quite uniform around the bias lines with no evidence of strong bias for any variable. (4) Conclusions: The study demonstrated the consistency and reliability of this new automatic system based on machine learning and AI for the quantification of ultrasound imaging of the muscle architecture parameters of the rectus femoris muscle compared with the conventional method of measurement. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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14 pages, 634 KiB

Open AccessEditor’s ChoiceArticle

Ultrasound Cut-Off Values for Rectus Femoris for Detecting Sarcopenia in Patients with Nutritional Risk

by Daniel de Luis Roman, José Manuel García Almeida, Diego Bellido Guerrero, Germán Guzmán Rolo, Andrea Martín, David Primo Martín, Yaiza García-Delgado, Patricia Guirado-Peláez, Fiorella Palmas, Cristina Tejera Pérez, María García Olivares, María Maíz Jiménez, Irene Bretón Lesmes, Carlos Manuel Alzás Teomiro, Juan Manuel Guardia Baena, Laura A. Calles Romero, Inmaculada Prior-Sánchez, Pedro Pablo García-Luna, María González Pacheco, Miguel Ángel Martínez-Olmos, Blanca Alabadí, Valeria Alcántara-Aragón, Samara Palma Milla, Tomás Martín Folgueras, Andrea Micó García, Begoña Molina-Baena, Henry Rendón Barragán, Pablo Rodríguez de Vera Gómez, María Riestra Fernández, Ana Jiménez Portilla, Juan J. López-Gómez, Nuria Pérez Martín, Natalia Montero Madrid, Alba Zabalegui Eguinoa, Cristina Porca Fernández, María José Tapia Guerrero, Marta Ruiz Aguado, Cristina Velasco Gimeno, Aura D Herrera Martínez, María Novo Rodríguez, Natalia C. Iglesias Hernández, María de Damas Medina, Irene González Navarro, Francisco Javier Vílchez López, Antía Fernández-Pombo and Gabriel Olveira Show full author list Hide full author list

Nutrients 2024, 16(11), 1552; https://doi.org/10.3390/nu16111552 - 21 May 2024

Cited by 14 | Viewed by 4704

Abstract

Background: A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound [...] Read more.

Background: A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures. Methods: Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia. Results: A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm² and 3.66 cm² for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women. Conclusions: Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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15 pages, 1765 KiB

Open AccessArticle

Bioelectrical Impedance Vector Analysis, Nutritional Ultrasound^®, and Handgrip Strength as Innovative Methods for Monitoring Critical Anorexia Nervosa Physical Recovery: A Pilot Study

by Jose M. Romero-Márquez, María Novo-Rodríguez, Cristina Novo-Rodríguez, Víctor Siles-Guerrero, Isabel Herrera-Montes, Francisco Garzón Navarro-Pelayo, Martín López-de-la-Torre-Casares and Araceli Muñoz-Garach

Nutrients 2024, 16(10), 1539; https://doi.org/10.3390/nu16101539 - 20 May 2024

Cited by 1 | Viewed by 1877

Abstract

Eating disorders (EDs) manifest as persistent disruptions in eating habits or related behaviors, significantly impacting physical health and psychosocial well-being. Nutritional assessment in ED patients is crucial for monitoring treatment efficacy. While dual-energy X-ray absorptiometry (DEXA) remains standard, interest in alternative methods such [...] Read more.

Eating disorders (EDs) manifest as persistent disruptions in eating habits or related behaviors, significantly impacting physical health and psychosocial well-being. Nutritional assessment in ED patients is crucial for monitoring treatment efficacy. While dual-energy X-ray absorptiometry (DEXA) remains standard, interest in alternative methods such as bioelectrical impedance vector analysis (BIVA) and Nutritional Ultrasound^® (NU) has risen due to their affordability and portability. Additionally, hand dynamometry offers a user-friendly approach to assessing grip strength (HGS), indicative of nutritional status. A prospective study was carried out to evaluate the utility of BIVA, NU^®, and HGS in 43 female AN patients. Measurements were taken at baseline and hospital discharge. A total of 41 patients completed the study. After the intervention, numerous BIVA-related parameters such as fat (3.5 ± 2 kg vs. 5.3 ± 2.7 kg, p < 0.001) and free fat mass (33.9 ± 3.8 kg vs. 37.5 ± 4.1 kg, p < 0.001) were partially restored. Similarly, Nutritional Ultrasound^® showed promising results in assessing body composition changes such as total abdominal fat tissue (0.5 ± 0.3 cm vs. 0.9 ± 0.3 cm, p < 0.05). In the same way, rectus femoris cross-sectional area values correlated with clinical outcomes such as free fat mass (0.883, p < 0.05) and appendicular muscle mass (0.965, p < 0.001). HGS reached the normality percentile after the intervention (21.6 ± 9.1 kg vs. 25.9 ± 12.3 kg, p < 0.05), demonstrating a significant association between grip strength and body composition parameters such as free fat mass (0.658, p < 0.001) and appendicular muscle mass (0.482, p < 0.001). Incorporating BIVA-, NU^®-, and HGS-enhanced nutritional assessment into the treatment of AN patients offers cost-effective, portable, and non-invasive alternatives to DEXA. These techniques offer valuable insights into changes in body composition and nutritional status, which, in turn, facilitate treatment monitoring and contribute to improved patient outcomes. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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10 pages, 794 KiB

Open AccessArticle

Influence of the Results of Control of Intakes, Proteins and Anthropometry Nutritional Screening, Sarcopenia and Body Composition on the Clinical Evolution of Hospitalized Patients

by Elena Márquez Mesa, José Pablo Suárez Llanos, Patricia Mercedes Afonso Martín, Carla Brito Negrín, María García Ascanio, Samuel González González and Ignacio Llorente Gómez de Segura

Nutrients 2024, 16(1), 14; https://doi.org/10.3390/nu16010014 - 20 Dec 2023

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Abstract

(1) Background: Hospital malnutrition and sarcopenia are common in inpatients and are associated with worse prognosis. Our objective is to determine the association of the positivity of CIPA (Control of Intakes, Proteins and Anthropometry) nutrition screening tool and sarcopenia and evaluate its prognostic [...] Read more.

(1) Background: Hospital malnutrition and sarcopenia are common in inpatients and are associated with worse prognosis. Our objective is to determine the association of the positivity of CIPA (Control of Intakes, Proteins and Anthropometry) nutrition screening tool and sarcopenia and evaluate its prognostic implications (length of stay, readmissions and mortality) as well as different components of body composition. (2) Methodology: Cross-sectional single-center study and prospective six months follow-up for prognostic variables. On admission, CIPA and EWGSOP2 criteria were assessed. (3) Results: Four hundred inpatients, a median of 65.71 years old and 83.6% with high comorbidity, were evaluated. In total, 34.8% had positive CIPA and 19.3% sarcopenia. Positive CIPA and sarcopenia had worse results in body composition (fat mass (FM), fat-free mass (FFM) and appendicular skeletal muscle mass index (ASMI)) and dynamometry. Positive CIPA is significantly associated with worse prognosis (mortality (OR = 1.99), readmissions (OR = 1.86) and length of stay (B = 0.19)). Positive CIPA and sarcopenia combined are associated with a tendency to higher mortality (OR = 2.1, p = 0.088). Low hand grip strength (HGS) is significantly related to a higher length of stay (B = −0.12). (4) Conclusions: In hospitalized patients, malnutrition independently and combined with sarcopenia is associated with a worse prognosis but not body composition. Low HGS is related to a higher length of stay. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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15 pages, 2166 KiB

Open AccessArticle

Nutritional Ultrasonography, a Method to Evaluate Muscle Mass and Quality in Morphofunctional Assessment of Disease Related Malnutrition

by Juan José López-Gómez, David García-Beneitez, Rebeca Jiménez-Sahagún, Olatz Izaola-Jauregui, David Primo-Martín, Beatriz Ramos-Bachiller, Emilia Gómez-Hoyos, Esther Delgado-García, Paloma Pérez-López and Daniel A. De Luis-Román

Nutrients 2023, 15(18), 3923; https://doi.org/10.3390/nu15183923 - 9 Sep 2023

Cited by 11 | Viewed by 3132

Abstract

Nutritional ultrasonography is an emerging technique for measuring muscle mass and quality. The study aimed to evaluate the relationship between the parameters of body mass and quality of ultrasonography with other parameters of morphofunctional assessment in patients with disease-related malnutrition (DRM). Methods: A [...] Read more.

Nutritional ultrasonography is an emerging technique for measuring muscle mass and quality. The study aimed to evaluate the relationship between the parameters of body mass and quality of ultrasonography with other parameters of morphofunctional assessment in patients with disease-related malnutrition (DRM). Methods: A cross-sectional study was developed on 144 patients diagnosed with DRM according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Morphofunctional evaluation was assessed with anthropometric variables, handgrip strength and bioelectrical impedanciometry (BIA). Nutritional ultrasonography of quadriceps rectus femoris (QRF) was made (muscle mass (Muscle Area of Rectus Femoris index (MARFI)), Y axis and muscle quality (X-Y index and echogenicity). Results: The mean age of patients was 61.4 (17.34) years. The prevalence of sarcopenia in the sample was 33.3%. Patients with sarcopenia (S) had lower values of MARFI [(S: 1.09 (0.39) cm²/m²; NoS: 1.27 (0.45); p = 0.02), Y axis (S: 0.88 (0.27); NoS: 1.19 (0.60); p < 0.01) and X-Y index (S: 1.52 (0.61); NoS: 1.30 (0.53); p < 0.01)]. There was a correlation between BIA parameters (phase angle) and muscle mass ultrasonographic variables (MARFI) (r = 0.35; p < 0.01); there was an inverse correlation between muscle quality ultrasonographic variables (echogenicity) and handgrip strength (r = −0.36; p < 0.01). In the multivariate analysis adjusted by age, the highest quartile of the X-Y index had more risk of death OR: 4.54 CI95% (1.11–18.47). Conclusions: In patients with DRM and sarcopenia, standardized muscle mass and muscle quality parameters determined by ultrasonography of QRF are worse than in patients without sarcopenia. Muscle quality parameters had an inverse correlation with electric parameters from BIA and muscle strength. The highest quartile of the X-Y index determined by ultrasonography was associated with increased mortality risk. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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12 pages, 704 KiB

Open AccessArticle

Global Subjective Assessment and Mini Nutritional Assessment Short Form Better Predict Mortality Than GLIM Malnutrition Criteria in Elderly Patients with Hip Fracture

by Francisco José Sánchez-Torralvo, Verónica Pérez-del-Río, María García-Olivares, Nuria Porras, Jose Abuín-Fernández, Manuel Francisco Bravo-Bardají, David García-de-Quevedo and Gabriel Olveira

Nutrients 2023, 15(8), 1828; https://doi.org/10.3390/nu15081828 - 10 Apr 2023

Cited by 17 | Viewed by 3782

Abstract

The objective of our study is to determine the prevalence of malnutrition in elderly patients with fragility hip fractures through different diagnostic tools and to determine which nutritional assessment tool better predicts mortality. Methods: This is a prospective study in patients over 65 [...] Read more.

The objective of our study is to determine the prevalence of malnutrition in elderly patients with fragility hip fractures through different diagnostic tools and to determine which nutritional assessment tool better predicts mortality. Methods: This is a prospective study in patients over 65 years of age hospitalized with a diagnosis of hip fracture. A nutritional assessment was performed using several tools: the Mini Nutritional Assessment Short Form (MNA-SF), the Subjective Global Assessment (SGA), and the GLIM criteria. For the definition of low muscle mass, four different methods were used: hand grip strength (HGS), calf circumference (CC), anthropometry, and bioelectrical impedance (BIA). Mortality was registered at three, six and twelve months. Results: 300 patients were included, 79.3% female, mean age 82.9 ± 7.1 years. The MNA-SF found 42% at risk of malnutrition, and 37.3% malnourished. Using SGA, there were 44% with moderate malnutrition, and 21.7% with severe malnutrition. In application of the GLIM criteria, 84.3%, 47%, 46%, and 72.7% of patients were malnourished when HGS, anthropometry, BIA, and CC were used, respectively. Mortality was 10%, 16.3% and 22% at 3, 6 and 12 months, respectively. In malnourished patients according to MNA-SF, mortality was 5.7 times greater [95%CI 1.3–25.4; p = 0.022] at 6 months and 3.8 times greater [95%CI 1.3–11.6; p = 0.018] at 12 months. In malnourished patients according to SGA, mortality was 3.6 times greater [95%CI 1.02–13.04; p = 0.047] at 3 months, 3.4 times greater [95%CI 1.3–8.6; p = 0.012] at 6 months and 3 times greater [95%CI 1.35–6.7; p = 0.007] at 12 months. Conclusion: The prevalence of malnutrition in patients admitted for fragility hip fracture is high. The SGA and MNA-SF are postulated as adequate tools to diagnose malnutrition in these patients, with predictive value for mortality at three, six, and twelve months. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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31 pages, 1546 KiB

Open AccessSystematic Review

Practical Guidelines by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) on Nutritional Management of Patients with Chronic Obstructive Pulmonary Disease: A Review

by Alicia Justel Enríquez, Juana M. Rabat-Restrepo, Francisco J. Vilchez-López, Carmen Tenorio-Jiménez, José M. García-Almeida, José-Antonio Irles Rocamora, José L. Pereira-Cunill, María J. Martínez Ramírez, María J. Molina-Puerta, Juan B. Molina Soria, María I. Rebollo-Pérez, Gabriel Olveira and Pedro P. García-Luna

Nutrients 2024, 16(18), 3105; https://doi.org/10.3390/nu16183105 - 14 Sep 2024

Cited by 2 | Viewed by 2382

Abstract

Malnutrition is common in chronic obstructive pulmonary disease (COPD) patients and is associated with worse lung function and greater severity. This review by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) addresses the nutritional management of adult COPD patients, focusing on Morphofunctional [...] Read more.

Malnutrition is common in chronic obstructive pulmonary disease (COPD) patients and is associated with worse lung function and greater severity. This review by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) addresses the nutritional management of adult COPD patients, focusing on Morphofunctional Nutritional Assessment and intervention in clinical practice. A systematic literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, followed by critical appraisal based on Scottish Intercollegiate Guidelines Network (SIGN) guidelines. Recommendations were graded according to the European Society for Clinical Nutrition and Metabolism (ESPEN) system. The results were discussed among GARIN members, with consensus determined using a Likert scale. A total of 24 recommendations were made: 2(A), 6(B), 2(O), and 14(GPP). Consensus exceeded 90% for 17 recommendations and was 75–90% for 7. The care of COPD patients is approached from a nutritional perspective, emphasizing nutritional screening, morphofunctional assessment, and food intake in early disease stages. Nutritional interventions include dietary advice, recommendations on food group intake, and the impact of specialized nutritional treatment, particularly oral nutritional supplements. Other critical aspects, such as physical activity and quality of life, are also analyzed. These recommendations provide practical guidance for managing COPD patients nutritionally in clinical practice. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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17 pages, 909 KiB

Open AccessSystematic Review

Morphofunctional Assessment beyond Malnutrition: Fat Mass Assessment in Adult Patients with Phenylketonuria—Systematic Review

by Luis M. Luengo-Pérez, Mercedes Fernández-Bueso, Carlos Guzmán-Carmona, Ana López-Navia and Claudia García-Lobato

Nutrients 2024, 16(12), 1833; https://doi.org/10.3390/nu16121833 - 11 Jun 2024

Cited by 1 | Viewed by 1504

Abstract

Morphofunctional assessment was developed to evaluate disease-related malnutrition. However, it can also be used to assess cardiometabolic risk, as excess adiposity increases this risk. Phenylketonuria (PKU) is the most prevalent inherited metabolic disease among adults, and obesity in PKU has recently gained interest, [...] Read more.

Morphofunctional assessment was developed to evaluate disease-related malnutrition. However, it can also be used to assess cardiometabolic risk, as excess adiposity increases this risk. Phenylketonuria (PKU) is the most prevalent inherited metabolic disease among adults, and obesity in PKU has recently gained interest, although fat mass correlates better with cardiometabolic risk than body mass index. In this systematic review, the objective was to assess whether adult patients with PKU have higher fat mass than healthy controls. Studies of adult PKU patients undergoing dietary treatment in a metabolic clinic reporting fat mass were included. The PubMed and EMBASE databases were searched. Relevance of articles, data collection, and risk of bias were evaluated by two independent reviewers. Ten articles were evaluated, six with a control group, including 310 subjects with PKU, 62 with mild hyperphenylalaninemia, and 157 controls. One study reported a significant and four a tendency towards an increased fat mass in all patients or only females with PKU. Limitations included not having a healthy control group, not reporting sex-specific results and using different techniques to assess fat mass. Evaluation of fat mass should be included in the morphofunctional assessment of cardiometabolic risk in adult patients with PKU. Full article

(This article belongs to the Special Issue Morphofunctional Nutritional Assessment in Clinical Practice)

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