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16 pages, 875 KiB  
Article
Association of Bioelectrical Impedance Analysis Parameters with Malnutrition in Patients Undergoing Maintenance Hemodialysis: A Cross-Sectional Study
by Minh D. Pham, Thang V. Dao, Anh T. X. Vu, Huong T. Q. Bui, Bon T. Nguyen, An T. T. Nguyen, Thuy T. T. Ta, Duc M. Cap, Toan D. Le, Phuc H. Phan, Ha N. Vu, Tuan D. Le, Toan Q. Pham, Thang V. Le, Thuc C. Luong, Thang B. Ta and Tuyen V. Duong
Medicina 2025, 61(8), 1396; https://doi.org/10.3390/medicina61081396 - 1 Aug 2025
Viewed by 190
Abstract
Background and Objectives: Malnutrition is one of the most common complications in patients undergoing hemodialysis (HD) and is closely linked to increased morbidity and mortality. This study aimed to investigate the nutritional status of HD patients and the clinical relevance of bioelectrical impedance [...] Read more.
Background and Objectives: Malnutrition is one of the most common complications in patients undergoing hemodialysis (HD) and is closely linked to increased morbidity and mortality. This study aimed to investigate the nutritional status of HD patients and the clinical relevance of bioelectrical impedance analysis (BIA) parameters such as the percent body fat (PBF), skeletal muscle mass index (SMI), extracellular water-to-total body water ratio (ECW/TBW), and phase angle (PhA) in assessing malnutrition in Vietnamese HD patients. Materials and Methods: This cross-sectional study was conducted among 184 patients undergoing hemodialysis in Hanoi, Vietnam. The BIA parameters were measured by the InBody S10 body composition analyzer, while malnutrition was assessed by the geriatric nutritional risk index (GNRI), with a GNRI <92 classified as a high risk of malnutrition. The independent BIA variables for predicting malnutrition and its cut-off values were explored using logistic regression models and a receiver operating characteristic (ROC) curve analysis, respectively. Results: Among the study population, 42.9% (79/184) of patients were identified as being at a high risk of malnutrition. The multivariate logistic regression analysis revealed that a higher ECW/TBW was independently associated with an increased risk of malnutrition, while the PBF, SMI, and PhA expressed significant and inverse associations with the malnutrition risk after adjusting for multiple confounders. The cut-off values for predicting the high risk of malnutrition in overall HD patients were determined to be 20.45%, 7.75 kg/m2, 5.45°, and 38.03% for the PBF, the SMI, the PhA, and the ECW/TBW ratio, respectively. Conclusions: BIA parameters, including the PBF, SMI, PhA, and ECW/TBW ratio, could serve as indicators of malnutrition in general Vietnamese patients with HD. Full article
(This article belongs to the Special Issue End-Stage Kidney Disease (ESKD))
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32 pages, 1820 KiB  
Systematic Review
Association and Prevalence of Lower Urinary Tract Symptoms in Individuals with Sarcopenia: A Systematic Review and Meta-Analysis
by Lek-Hong Tan and Eric Chieh-Lung Chou
Medicina 2025, 61(7), 1214; https://doi.org/10.3390/medicina61071214 - 3 Jul 2025
Viewed by 455
Abstract
Background and Objectives: Sarcopenia and lower urinary tract symptoms (LUTSs) are both prevalent among older adults and may share underlying pathophysiological mechanisms. However, their association has not been systematically quantified. This systematic review and meta-analysis aimed to evaluate the association between sarcopenia [...] Read more.
Background and Objectives: Sarcopenia and lower urinary tract symptoms (LUTSs) are both prevalent among older adults and may share underlying pathophysiological mechanisms. However, their association has not been systematically quantified. This systematic review and meta-analysis aimed to evaluate the association between sarcopenia and LUTSs, including the pooled estimates of prevalence and odds ratios (ORs), and to explore the influence of diagnostic definitions and study-level factors. Materials and Methods: A comprehensive literature search was conducted using PubMed and Embase for studies published between 1 January 2000 and 26 April 2025. This study adhered to PRISMA and MOOSE guidelines and was registered in PROSPERO (CRD420251037459). Eligible observational studies reported LUTS prevalence or ORs in individuals with sarcopenia, low muscle strength (LMS), low lean mass (LLM), low gait speed (LGS), or sarcopenia risk identified by SARC-F (score ≥4). Pooled ORs and prevalence rates were calculated using a random-effects model. Subgroup analyses were performed based on sarcopenia definitions—Asian Working Group for Sarcopenia (AWGS) and European Working Group on Sarcopenia in Older People (EWGSOP)—as well as LUTS subtypes and diagnostic components. Univariate meta-regression assessed associations with age, BMI, sex distribution, WHO region, and risk of bias. Results: Twenty-five studies comprising 84,484 participants were included. Sarcopenia was significantly associated with LUTSs (pooled OR = 1.78; 95% CI: 1.29–2.45; p < 0.001), with a pooled LUTS prevalence of 43.2% (95% CI: 26.9–61.0%). Stronger associations were observed in studies using AWGS diagnostic criteria (OR = 2.24; 95% CI: 1.41–3.56; p = 0.001), in those evaluating severe sarcopenia (OR = 1.66; 95% CI: 1.03–2.68; p = 0.038), and in institutionalized populations (OR = 3.68; 95% CI: 2.18–6.24; p < 0.001) compared to community-dwelling populations (OR = 1.43; 95% CI: 1.06–1.92; p = 0.018). Sarcopenia risk identified by SARC-F (score ≥4) showed the strongest association with LUTSs (OR = 3.20; 95% CI: 1.92–5.33; p < 0.001). Significant associations were also found for LLM (OR = 1.52; 95% CI: 1.19–1.95; p = 0.001) and LGS (OR = 1.37; 95% CI: 1.06–1.76; p = 0.015), but not for LMS (OR = 0.94; 95% CI: 0.47–1.89; p = 0.871). Exploratory analyses comparing LLM diagnostic modalities—including standardized criteria (ASMI, ASM/BMI), imaging-based methods (SMI, PMA), and surrogate measures (calf circumference)—revealed no significant differences (all p > 0.05). Heterogeneity was high (I2 > 90%). Egger’s test indicated no evidence of publication bias (p = 0.838), and trim-and-fill analysis did not affect the pooled estimates. Conclusions: Sarcopenia—particularly in its severe forms—is significantly associated with LUTSs. Additionally, individuals who screened positive for sarcopenia using the SARC-F tool demonstrated a heightened risk of LUTSs. Subgroup analyses revealed a stronger association in institutionalized populations, suggesting that care setting may modify risk. These findings underscore the importance of assessing muscle health in older adults with urinary symptoms. Standardization of diagnostic criteria and longitudinal studies are needed to clarify causality and guide targeted interventions. Full article
(This article belongs to the Section Urology & Nephrology)
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15 pages, 1244 KiB  
Article
Can AI-Based ChatGPT Models Accurately Analyze Hand–Wrist Radiographs? A Comparative Study
by Ahmet Yıldırım, Orhan Cicek and Yavuz Selim Genç
Diagnostics 2025, 15(12), 1513; https://doi.org/10.3390/diagnostics15121513 - 14 Jun 2025
Viewed by 654
Abstract
Background/Aims: The aim of this study was to evaluate the effectiveness of large language model (LLM)-based chatbot systems in predicting bone age and identifying growth stages, and to explore their potential as practical, infrastructure-independent alternatives to conventional methods and convolutional neural network (CNN)-based [...] Read more.
Background/Aims: The aim of this study was to evaluate the effectiveness of large language model (LLM)-based chatbot systems in predicting bone age and identifying growth stages, and to explore their potential as practical, infrastructure-independent alternatives to conventional methods and convolutional neural network (CNN)-based deep learning models. Methods: This study evaluated the performance of three ChatGPT-based models (GPT-4o, GPT-o4-mini-high, and GPT-o1-pro) in predicting bone age and growth stage using 90 anonymized hand–wrist radiographs (30 from each growth stage—pre-peak, peak, and post-peak—with equal male and female distribution). Reference standards were ensured by expert orthodontists using Fishman’s Skeletal Maturity Indicators (SMI) system and the Greulich–Pyle Atlas, with each radiograph analyzed by three GPT models using standardized prompts. Model performances were evaluated through statistical analyses assessing agreement and prediction accuracy. Results: All models showed significant agreement with the reference values in bone age prediction (p < 0.001), with GPT-o1-pro having the highest concordance (Pearson r = 0.546). No statistically significant difference was observed in the mean absolute error (MAE) among the models (p > 0.05). The GPT-o4-mini-high model achieved an accuracy rate of 72.2% within a ±2 year deviation range for bone age prediction. The GPT-o1-pro and GPT-o4-mini-high models showed bias in the Bland–Altman analysis of bone age predictions; however, GPT-o1-pro yielded more reliable predictions with narrower limits of agreement. In terms of growth stage classification, the GPT-4o model achieved the highest agreement with the reference values (κ = 0.283, p < 0.001). Conclusions: This study shows that general-purpose GPT models can support bone age and growth stages prediction, with each model having distinct strengths. While GPT models do not replace clinical examination, their contextual reasoning and ability to perform preliminary assessments without domain-specific training make them promising tools, though further development is needed. Full article
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22 pages, 3995 KiB  
Article
Assessing Geographic Barriers to Access Long-Term Services and Supports in Chengdu, China: A Spatial Accessibility Analysis
by Sen Lin, Shikun Qin, Li Peng, Xueying Sun and Xiaolu Dou
Sustainability 2025, 17(7), 3222; https://doi.org/10.3390/su17073222 - 4 Apr 2025
Viewed by 622
Abstract
China’s rapidly aging population has intensified demand for long-term services and supports (LTSSs), yet geographic disparities in accessibility persist despite policy reforms like long-term care insurance (LTCI). This study evaluates spatial inequities in Chengdu, a megacity piloting LTCI, using an enhanced two-step floating [...] Read more.
China’s rapidly aging population has intensified demand for long-term services and supports (LTSSs), yet geographic disparities in accessibility persist despite policy reforms like long-term care insurance (LTCI). This study evaluates spatial inequities in Chengdu, a megacity piloting LTCI, using an enhanced two-step floating catchment area (2SFCA) method with demand intensity coefficients and a spatial mismatch index (SMI). Results reveal critically low average accessibility: 0.126 LTSS beds and 0.019 formal caregivers per thousand recipients within a 60 min travel threshold. Accessibility declines sharply along urbanization gradients, with urban cores (“first loop”) exceeding suburban “second” and “third loop” by ratios of 1.5–2.1 and 2.0–8.0, respectively. Strong correlations with impervious surface ratios (R2 = 0.513–0.643) highlight systemic urban bias in resource allocation. The SMI analysis uncovers divergent spatial mismatches: home care accessibility predominates in western suburbs due to decentralized small-scale providers, while institutional care clusters in eastern suburbs, reflecting government prioritization of facility-based services. Despite LTCI’s broad coverage (67% of Chengdu’s population), rural and peri-urban older adults face compounded barriers, including sparse LTSS facilities, inadequate transportation infrastructure, and reimbursement policies favoring urban institutional care. To address these inequities, this study proposes a multi-stakeholder framework: (1) strategic expansion of LTSS facilities in underserved suburban zones, prioritizing institutional care in the “third loop”; (2) road network optimization to reduce travel barriers in mountainous regions; (3) financial incentives (e.g., subsidies, tax breaks) to attract formal caregivers to suburban areas; (4) cross-regional LTCI coverage to enable access to adjacent district facilities; and (5) integration of informal caregivers into reimbursement systems through training and telehealth support. These interventions aim to reconcile spatial mismatches, align resource distribution with Chengdu’s urban–rural integration goals, and provide scalable insights for aging megacities in developing contexts. By bridging geospatial analytics with policy design, this study underscores the imperative of data-driven governance to ensure equitable aging-in-place for vulnerable populations. Full article
(This article belongs to the Section Sustainability in Geographic Science)
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14 pages, 1167 KiB  
Article
Possible Use of Body Surface Area Value for Estimating Skeletal Muscle Mass in Chronic Liver Disease
by Kazunori Yoh, Takashi Nishimura, Naoto Ikeda, Tomoyuki Takashima, Nobuhiro Aizawa, Yukihisa Yuri, Taro Kimura, Kohei Yoshihara, Ryota Yoshioka, Shoki Kawata, Yuta Kawase, Ryota Nakano, Hideyuki Shiomi, Shinya Fukunishi, Shinichiro Shinzaki, Shuhei Nishiguchi and Hirayuki Enomoto
Diagnostics 2025, 15(3), 263; https://doi.org/10.3390/diagnostics15030263 - 23 Jan 2025
Viewed by 744
Abstract
Background/Objectives: Sarcopenia is an important clinical feature of patients with chronic liver disease (CLD). However, special devices are required to determine skeletal muscle mass. We evaluated the usefulness of body surface area (BSA) for estimating muscle mass and diagnosing sarcopenia in patients with [...] Read more.
Background/Objectives: Sarcopenia is an important clinical feature of patients with chronic liver disease (CLD). However, special devices are required to determine skeletal muscle mass. We evaluated the usefulness of body surface area (BSA) for estimating muscle mass and diagnosing sarcopenia in patients with CLD. Methods: We retrospectively studied 1889 Japanese patients with CLD who underwent bioimpedance analysis (BIA) (training cohort, n = 983; validation cohort, n = 906). The optimal cutoff values for predicting low skeletal muscle mass index (SMI) were determined using ROC analysis. We also assessed 1229 patients whose BSA and grip strength (GS) data were obtained on the same day and evaluated the diagnostic performance of the determined cutoff values of BSA for the diagnosis of sarcopenia. Results: In the training cohort, a strong correlation was observed between the SMI and BSA (r = 0.883, p < 0.0001). The cutoff values of BSA for predicting low SMI were 1.68 m2 for men and 1.48 m2 for women. Regarding the presence of low SMI, 776 (78.9%) and 730 (80.5%) patients were correctly diagnosed in the training and validation cohorts, respectively. The sensitivity and specificity of the combination of BSA and GS for sarcopenia were 82.7% and 97.1%, respectively, and 1175 patients (95.6%) were correctly diagnosed. Conclusions: BSA was highly correlated with SMI, suggesting that BSA could facilitate noninvasive estimation of low skeletal muscle mass in patients with CLD. Full article
(This article belongs to the Special Issue Diagnosis of Hepatobiliary and Pancreatic Diseases)
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15 pages, 1356 KiB  
Article
Nutritional Management in Stricturing Crohn’s Disease: A Pilot Study
by Elisabetta Cavalcanti, Antonella Marra, Alessia Mileti, Rossella Donghia, Margherita Curlo and Mauro Mastronardi
Nutrients 2024, 16(23), 4153; https://doi.org/10.3390/nu16234153 - 29 Nov 2024
Cited by 1 | Viewed by 1629
Abstract
Background: More than half of patients with Crohn’s disease develop intestinal fibrosis induced intestinal obstruction with debilitating symptoms throughout their disease course. The incidence of stricture formation in CD has remained unchanged over the last several decades. Factors promoting intestinal fibrosis are currently [...] Read more.
Background: More than half of patients with Crohn’s disease develop intestinal fibrosis induced intestinal obstruction with debilitating symptoms throughout their disease course. The incidence of stricture formation in CD has remained unchanged over the last several decades. Factors promoting intestinal fibrosis are currently unclear, but diet may represent an underestimated risk factor for intestinal fibrosis by modification of both the host immune response and intestinal microbial composition. Evaluating the impact of diet on the course of IBD is very complex. Sarcopenia is a common problem in IBD patients and correlates with an increased rate of disease. Skeletal muscle index (SMI) is an important parameter to measure sarcopenia and is an easily accessible tool for evaluating the likelihood of complications in individuals with CD. Methods: Using a randomized and controlled pilot design, we aimed to investigate the efficacy of 12 months of short-term dietary intervention based on essential amino acid (EAA) and sodium butyrate (NaB) supplementation in the management of stricturing Crohn’s disease patients. Results: After the treatment in the diet EAA/NaB group, we revealed a statistically significant improvement of muscle mass (61.49 ± 5.47 vs. control 86 ± 10.70, p = 0.01) and SMI index (9.97 ± 1.79 vs. control 7.60 ± 2.29, p = 0.02). In addition, the measurement of skeletal muscle mass in CD patients has been suggested to be crucial for predicting the disease course. Indeed, after one year, surgery was required in 4/10 control group patients (40%) and 1/10 study group (10%) patients, underlining the importance of body composition alterations and adequate dietary intake in the management of these patients. Conclusions: Further prospective studies are needed to confirm these results; nonetheless this nutritional approach could become an integral part in the treatment of stricturing CD patients to improve disease outcomes and increase the quality of life in these patients. Full article
(This article belongs to the Section Clinical Nutrition)
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14 pages, 756 KiB  
Article
Bioelectrical Impedance Analysis of Body Composition in Male Childhood Brain Tumor Survivors
by Alberto Romano, Fabrizio Sollazzo, Fabio Corbo, Giorgio Attinà, Stefano Mastrangelo, Simona Cordaro, Gloria Modica, Isabella Carlotta Zovatto, Riccardo Monti, Massimiliano Bianco, Palma Maurizi, Vincenzo Palmieri and Antonio Ruggiero
Diseases 2024, 12(12), 306; https://doi.org/10.3390/diseases12120306 - 28 Nov 2024
Cited by 2 | Viewed by 1336
Abstract
Background. Childhood brain tumor survivors (CCSs) are at high risk of developing metabolic syndrome (MetS) and sarcopenia. To date, a tool able to predict any body composition changes or detect them early and increased adiposity (and, therefore, increased likelihood of MetS onset) [...] Read more.
Background. Childhood brain tumor survivors (CCSs) are at high risk of developing metabolic syndrome (MetS) and sarcopenia. To date, a tool able to predict any body composition changes or detect them early and increased adiposity (and, therefore, increased likelihood of MetS onset) is still lacking in this population. Objective. The objective was to analyze differences in a bioelectrical impedance analysis (BIA) of body composition between male childhood brain tumor cancer survivors and healthy controls. Methods. In this pilot, prospective, observational study, 14 male CCSs were compared to 14 healthy controls matched for sex and age. Results. CCSs showed statistically significant lower mean values in terms of their body metabolic rate (BMR), body cell mass index (BCMI), fat-free mass (FFM), skeleton muscle mass (SM), skeletal muscle mass index (SMI), and appendicular skeletal muscular mass (ASMM). CCSs also showed a statistically significantly higher mean value of resistance when compared with controls. The BMR, BCM, FFM, and ASMM were significantly correlated with total doses of carboplatin (Tau = −0.601; p = 0.018; Tau = −0.599, p = 0.025; Tau = −0.601, p = 0.018; Tau = −0.509, p = 0.045, respectively). Conclusion. A BIA allows for the detection of changes in body composition in survivors of childhood brain tumors, revealing either the presence of central obesity correlated with the risk of MetS or signs of sarcopenia that deserve early treatment. Full article
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13 pages, 1180 KiB  
Systematic Review
Effectiveness of COVID-19 Vaccines in People with Severe Mental Illness: A Systematic Review and Meta-Analysis
by Wen Dang, Iman Long, Yiwei Zhao, Yu-Tao Xiang and Robert David Smith
Vaccines 2024, 12(9), 1064; https://doi.org/10.3390/vaccines12091064 - 18 Sep 2024
Cited by 2 | Viewed by 1832
Abstract
Prior to the introduction of COVID-19 vaccines, patients with severe mental illness (SMI) were at greater risk of COVID-19-related outcomes than the general population. It is not yet clear whether COVID-19 vaccines have reduced the risk gap. We systematically searched nine international databases [...] Read more.
Prior to the introduction of COVID-19 vaccines, patients with severe mental illness (SMI) were at greater risk of COVID-19-related outcomes than the general population. It is not yet clear whether COVID-19 vaccines have reduced the risk gap. We systematically searched nine international databases and three Chinese databases to identify relevant studies from December 2020 to December 2023 to compare the risk of COVID-19-related outcomes for SMI patients to those without SMI after vaccination. Random effects meta-analysis was performed to estimate the pooled odds ratio (OR) with 95% confidence intervals (CI). Subgroup analysis, sensitivity analysis, and publication bias analysis were conducted with R software 4.3.0. A total of 11 observational studies were included. Compared with controls, SMI patients were associated with a slightly increased risk of infection (pooled OR = 1.10, 95% CI, 1.03–1.17, I2 = 43.4%), while showing a 2-fold higher risk of hospitalization (pooled OR = 2.66, 95% CI, 1.13–6.22, I2 = 99.6%), even after both groups have received COVID-19 vaccines. Limited evidence suggests a higher mortality risk among SMI patients compared to controls post vaccination, but the findings did not reach statistical significance. SMI patients remain at increased risk compared to their peers in COVID-19-related outcomes even after vaccination. Vaccination appears an effective approach to prevent severe COVID-19 illness in SMI patients, and actions should be taken by healthcare providers to improve vaccination coverage in these vulnerable groups. Full article
(This article belongs to the Section COVID-19 Vaccines and Vaccination)
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13 pages, 1189 KiB  
Article
Evaluation of Muscle Mass and Malnutrition in Patients with Colorectal Cancer Using the Global Leadership Initiative on Malnutrition Criteria and Comparing Bioelectrical Impedance Analysis and Computed Tomography Measurements
by Daniel de Luis Roman, Juan José López Gómez, Marife Muñoz, David Primo, Olatz Izaola and Israel Sánchez
Nutrients 2024, 16(17), 3035; https://doi.org/10.3390/nu16173035 - 8 Sep 2024
Cited by 6 | Viewed by 2709
Abstract
Objectives: The aim of this investigation was to evaluate the discrepancies between bioelectrical impedance analysis (BIA) and computed tomography (CT) in assessing skeletal muscle mass and identifying low muscle mass in patients with colorectal cancer. Methods: This study recruited 137 patients with colorectal [...] Read more.
Objectives: The aim of this investigation was to evaluate the discrepancies between bioelectrical impedance analysis (BIA) and computed tomography (CT) in assessing skeletal muscle mass and identifying low muscle mass in patients with colorectal cancer. Methods: This study recruited 137 patients with colorectal cancer from February 2028 to December 2023. CT scans were analyzed at the Lumbar 3 vertebral level to determine the area of skeletal muscle, which was then utilized to estimate whole-body skeletal muscle mass. [BIA] was also employed to measure skeletal muscle. Both skeletal muscle mass values [kg] were divided by height2 [m2] to calculate the skeletal muscle index [SMI, kg/m2], denoted as SMI-CT and SMI-BIA, respectively. Results: The median age was 69.8 + 9.5 years, with the sex ratio being 88/49 [male/female]. Whereas more than one-third of the patients were classified as malnourished based on the Global Leadership Initiative on Malnutrition GLIM-CT criteria using L3-SMI [n = 36.5%], fewer patients were classified as malnourished based on GLIM-BIA using SMI-BIA [n = 19.0%]. According to the CT analysis [low SMI-L3], 52 [38.0%] patients were diagnosed as having poor muscle mass, whereas only 18 [13.1%] patients were identified as having low muscle mass using BIA [low SMIBIA]. The measured SMI showed a positive association with SMI-CT in all patients [r = 0.63, p < 0.001]. Using Bland–Altman evaluation, a significant mean bias of 0.45 + 1.41 kg/m2 [95% CI 0.21–0.70; p < 0.001] between SMI-BIA and SMI-CT was reported. Receiver operating characteristic (ROC) curves were generated to detect poor muscle mass using SMI-BIA with CT as the gold standard. The area under the curve (AUC) for SMI-BIA in identifying poor muscle mass was 0.714 (95% CI: 0.624–0.824), with a good cut-off value of 8.1 kg/m2, yielding a sensitivity of 68.3% and a specificity of 66.9%. Conclusions: BIA generally overestimates skeletal muscle mass in colorectal cancer patients when contrasted to CT. As a result, BIA may underestimate the prevalence of poor muscle mass and malnutrition according to the GLIM criteria in this patient population. Full article
(This article belongs to the Special Issue Novel Insight on Nutrition and Colorectal Cancer)
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11 pages, 3046 KiB  
Article
AI-Assisted Body Composition Assessment Using CT Imaging in Colorectal Cancer Patients: Predictive Capacity for Sarcopenia and Malnutrition Diagnosis
by Virginia Soria-Utrilla, Francisco José Sánchez-Torralvo, Fiorella Ximena Palmas-Candia, Rocío Fernández-Jiménez, Fernanda Mucarzel-Suarez-Arana, Patricia Guirado-Peláez, Gabriel Olveira, José Manuel García-Almeida and Rosa Burgos-Peláez
Nutrients 2024, 16(12), 1869; https://doi.org/10.3390/nu16121869 - 14 Jun 2024
Cited by 7 | Viewed by 3093
Abstract
(1) Background: The assessment of muscle mass is crucial in the nutritional evaluation of patients with colorectal cancer (CRC), as decreased muscle mass is linked to increased complications and poorer prognosis. This study aims to evaluate the utility of AI-assisted L3 CT for [...] Read more.
(1) Background: The assessment of muscle mass is crucial in the nutritional evaluation of patients with colorectal cancer (CRC), as decreased muscle mass is linked to increased complications and poorer prognosis. This study aims to evaluate the utility of AI-assisted L3 CT for assessing body composition and determining low muscle mass using both the Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria for sarcopenia in CRC patients prior to surgery. Additionally, we aim to establish cutoff points for muscle mass in men and women and propose their application in these diagnostic frameworks. (2) Methods: This retrospective observational study included CRC patients assessed by the Endocrinology and Nutrition services of the Regional University Hospitals of Malaga, Virgen de la Victoria of Malaga, and Vall d’Hebrón of Barcelona from October 2018 to July 2023. A morphofunctional assessment, including anthropometry, bioimpedance analysis (BIA), and handgrip strength, was conducted to apply the GLIM criteria for malnutrition and the EWGSOP2 criteria for sarcopenia. Body composition evaluation was performed through AI-assisted analysis of CT images at the L3 level. ROC analysis was used to determine the predictive capacity of variables derived from the CT analysis regarding the diagnosis of low muscle mass and to describe cutoff points. (3) Results: A total of 586 patients were enrolled, with a mean age of 68.4 ± 10.2 years. Using the GLIM criteria, 245 patients (41.8%) were diagnosed with malnutrition. Applying the EWGSOP2 criteria, 56 patients (9.6%) were diagnosed with sarcopenia. ROC curve analysis for the skeletal muscle index (SMI) showed a strong discriminative capacity of muscle area to detect low fat-free mass index (FFMI) (AUC = 0.82, 95% CI 0.77–0.87, p < 0.001). The identified SMI cutoff for diagnosing low FFMI was 32.75 cm2/m2 (Sn 77%, Sp 64.3%; AUC = 0.79, 95% CI 0.70–0.87, p < 0.001) in women, and 39.9 cm2/m2 (Sn 77%, Sp 72.7%; AUC = 0.85, 95% CI 0.80–0.90, p < 0.001) in men. Additionally, skeletal muscle area (SMA) showed good discriminative capacity for detecting low appendicular skeletal muscle mass (ASMM) (AUC = 0.71, 95% CI 0.65–0.76, p < 0.001). The identified SMA cutoff points for diagnosing low ASMM were 83.2 cm2 (Sn 76.7%, Sp 55.3%; AUC = 0.77, 95% CI 0.69–0.84, p < 0.001) in women and 112.6 cm2 (Sn 82.3%, Sp 58.6%; AUC = 0.79, 95% CI 0.74–0.85, p < 0.001) in men. (4) Conclusions: AI-assisted body composition assessment using CT is a valuable tool in the morphofunctional evaluation of patients with colorectal cancer prior to surgery. CT provides quantitative data on muscle mass for the application of the GLIM criteria for malnutrition and the EWGSOP2 criteria for sarcopenia, with specific cutoff points established for diagnostic use. Full article
(This article belongs to the Special Issue Novel Insight on Nutrition and Colorectal Cancer)
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12 pages, 1874 KiB  
Article
Evidence That Skeletal Muscles Modulate HDL-Cholesterol in Metabolic Healthy Young Adults
by Maria Serena Lonardo, Bruna Guida, Nunzia Cacciapuoti, Martina Chiurazzi, Daniela Pacella and Mauro Cataldi
Nutrients 2024, 16(8), 1110; https://doi.org/10.3390/nu16081110 - 10 Apr 2024
Cited by 3 | Viewed by 1853
Abstract
The aim of this study was to investigate whether skeletal muscle (SM) mass correlates with plasma lipids in metabolic healthy young adults. The study was designed as a retrospective observational monocentric study. Data on plasma lipids and SM mass of subjects attending our [...] Read more.
The aim of this study was to investigate whether skeletal muscle (SM) mass correlates with plasma lipids in metabolic healthy young adults. The study was designed as a retrospective observational monocentric study. Data on plasma lipids and SM mass of subjects attending our institution from 1999 to 2014 were analyzed. Inclusion criteria were being 18–45 years old and in apparently good health. SM mass was evaluated by bioelectrical impedance analysis (BIA) using the equation proposed by Janssen and normalized to height as skeletal muscle index (SMI: SM mass/height2). The association between SMI and plasma lipids levels was examined using a crude and adjusted linear regression model including age, sex, BMI and waist circumference as additional covariates. The study population consisted of 450 subjects (273 females) without metabolic syndrome (12.2% with normal body weight, 33.1% overweight, and 54.7% with obesity). SMI, total-cholesterol, LDL-cholesterol, and Triglycerides were higher, whereas HDL-cholesterol was lower in overweight and obese patients as compared with normal weight subjects. SMI was inversely associated with HDL-cholesterol in female patients with obesity but not in male patients with obesity, in normal- or over-weight subjects (p < 0.05). These results suggest that changes in SM mass occurring in obesity could have a role in worsening lipid profile with special reference to HDL-cholesterol. Full article
(This article belongs to the Section Nutrition and Metabolism)
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2 pages, 153 KiB  
Abstract
Can We Use Extracellular Water to Total Body Water Ratio as a Predictor of the Nutritional Status of Patients with Colorectal Cancer at the Time of Diagnosis?
by Mirna Šporčić, Irena Martinis, Jelena Pugelnik, Toni Kolak, Josip Baković, Božica Jerak and Martina Bituh
Proceedings 2023, 91(1), 298; https://doi.org/10.3390/proceedings2023091298 - 7 Feb 2024
Viewed by 1094
Abstract
Background and objectives: Early nutritional assessments have the potential to improve prognostic outcomes of patients with colorectal cancer (CRC). Among all parameters measured by bioelectrical impedance analysis (BIA), extracellular water to total body water ratio (ECW/TBW) is a known prognostic factor for various [...] Read more.
Background and objectives: Early nutritional assessments have the potential to improve prognostic outcomes of patients with colorectal cancer (CRC). Among all parameters measured by bioelectrical impedance analysis (BIA), extracellular water to total body water ratio (ECW/TBW) is a known prognostic factor for various diseases. The objective was to investigate the relationship between the ECW/TBW ratio and the nutritional status of CRC patients at the time of diagnosis. Methods: In this retrospective study, information about the patients’ demographic characteristics and nutritional status, including anthropometric measurements (determined by Tanita, MC-780 MA) and biochemical parameters at the time of diagnosis, were obtained from 104 patient records. We divided patients into two groups according to median ECW/TBW ratio (45.25%) and compared the differences between groups using a Chi-square or Mann-Whitney U test. A Spearman correlation was used to determine the correlation between the ECW/TBW ratio and all observed parameters. Results: Groups with a lower ECW/TBW ratio were younger (67 [62.25–72] vs. 74 [65–79] (p < 0.05)), had higher body weight (kg) (86 ± 12 vs. 78 ± 13 (p < 0.001)), body mass index (kg/m2) (28.6 ± 3.6 vs. 26.9 ± 4.6 (p < 0.05)), phase angle (⁰PhA) (5.7 ± 0.7 vs. 4.6 ± 0.7 (p < 0.001)), sarcopenia index (⁰SMI) (8.8 ± 1.2 vs. 7.5 ± 0.7 (p < 0.001)), albumin (g/L) (43 ± 3 vs. 41 ± 3 (p < 0.001)) and hemoglobin (g/L) (137.50 ± 19.34 vs. 131.00 ± 19.72 (p < 0.05)) compared to groups with a higher ECW/TBW ratio. A lower ECW/TBW ratio was predominant in males (75.4%) and among overweight patients (p < 0.05). A positive correlation was found between ECW/TBW and age (r = 0.402, p < 0.001), while negative correlations were observed between ECW/TBW and body weight (r = −0.408, p < 0.001), SMI (r = −0.581, p < 0.001), serum albumin (r = −0.390, p < 0.001), serum hemoglobin (r = −0.295, p < 0.001) and PhA (r = −0.703, p < 0.001). Discussion: Analysis indicates that groups with a lower ECW/TBW ratio had overall better nutritional status. Several studies state that abnormal fluid distribution affects prognosis in people with cancer. In our study, patients with a higher ECW/TBW ratio had a much worse degree of cell damage. An ECW/TBW ratio may be useful as an indicator of nutritional status in CRC at the time of diagnosis. Full article
(This article belongs to the Proceedings of The 14th European Nutrition Conference FENS 2023)
14 pages, 1657 KiB  
Systematic Review
Effectiveness and Cost-Effectiveness of Self-Management Interventions for Adults Living with Heart Failure to Improve Patient-Important Outcomes: An Evidence Map of Randomized Controlled Trials
by Marilina Santero, Yang Song, Jessica Beltran, Melixa Medina-Aedo, Carlos Canelo-Aybar, Claudia Valli, Claudio Rocha, Montserrat León-García, Karla Salas-Gama, Chrysoula Kaloteraki, Ena Niño de Guzmán, Marta Ballester, Ana Isabel González-González, Rune Poortvliet, Marieke van der Gaag, Cristina Spoiala, Pema Gurung, Fabienne Willemen, Iza Cools, Julia Bleeker, Angelina Kancheva, Julia Ertl, Tajda Laure, Ivana Kancheva, Kevin Pacheco-Barrios, Jessica Hanae Zafra-Tanaka, Sofia Tsokani, Areti Angeliki Veroniki, Georgios Seitidis, Christos Christogiannis, Katerina Maria Kontouli, Oliver Groene, Rosa Sunol, Carola Orrego, Monique Heijmans and Pablo Alonso-Coelloadd Show full author list remove Hide full author list
Healthcare 2024, 12(3), 302; https://doi.org/10.3390/healthcare12030302 - 24 Jan 2024
Cited by 1 | Viewed by 2761
Abstract
Self-management interventions (SMIs) may enhance heart failure (HF) outcomes and address challenges associated with disease management. This study aims to review randomized evidence and identify knowledge gaps in SMIs for adult HF patients. Within the COMPAR-EU project, from 2010 to 2018, we conducted [...] Read more.
Self-management interventions (SMIs) may enhance heart failure (HF) outcomes and address challenges associated with disease management. This study aims to review randomized evidence and identify knowledge gaps in SMIs for adult HF patients. Within the COMPAR-EU project, from 2010 to 2018, we conducted searches in the databases MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO. We performed a descriptive analysis using predefined categories and developed an evidence map of randomized controlled trials (RCTs). We found 282 RCTs examining SMIs for HF patients, comparing two to four interventions, primarily targeting individual patients (97%) globally (34 countries, only 31% from an European country). These interventions involved support techniques such as information sharing (95%) and self-monitoring (62%), often through a mix of in-person and remote sessions (43%). Commonly assessed outcomes included quality of life, hospital admissions, mortality, exercise capacity, and self-efficacy. Few studies have focused on lower socio-economic or minority groups. Nurses (68%) and physicians (30%) were the primary providers, and most studies were at low risk of bias in generating a random sequence for participant allocation; however, the reporting was noticeably unclear of methods used to conceal the allocation process. Our analysis has revealed prevalent support techniques and delivery methods while highlighting methodological challenges. These findings provide valuable insights for researchers, clinicians, and policymakers striving to optimize SMIs for individuals living with HF. Full article
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17 pages, 2644 KiB  
Article
Rectus Femoris Cross-Sectional Area and Phase Angle asPredictors of 12-Month Mortality in Idiopathic Pulmonary Fibrosis Patients
by Rocío Fernández-Jiménez, Eva Cabrera Cesar, Ana Sánchez García, Francisco Espíldora Hernández, Isabel M. Vegas-Aguilar, Maria del Mar Amaya-Campos, Isabel Cornejo-Pareja, Patricia Guirado-Peláez, Victor Simón-Frapolli, Mora Murri, Lourdes Garrido-Sánchez, Alvaro Martínez Mesa, Lorena Piñel-Jimenez, Miguel Benítez-Cano Gamonoso, Lara Dalla-Rovere, Maria García Olivares, Jose Luis Velasco-Garrido, Francisco Tinahones-Madueño and José Manuel García-Almeida
Nutrients 2023, 15(20), 4473; https://doi.org/10.3390/nu15204473 - 22 Oct 2023
Cited by 7 | Viewed by 2229
Abstract
Background: The value of the phase angle (PhA), measured via bioelectrical impedance analysis (BIA), could be considered a good marker of the cell mass and the cell damage of a patient; however, there are new techniques, such as muscle ultrasonography, that allow the [...] Read more.
Background: The value of the phase angle (PhA), measured via bioelectrical impedance analysis (BIA), could be considered a good marker of the cell mass and the cell damage of a patient; however, there are new techniques, such as muscle ultrasonography, that allow the quantity and quality of muscle to be assessed in a minimally invasive way. The aim of this study is to determine the prognostic value of morphofunctional techniques in the prognosis of mortality in patients with idiopathic pulmonary fibrosis (IPF). Methods: This multicenter, cross-sectional study included 86 patients with idiopathic pulmonary fibrosis with a mean age of 71 years, 82.7% of whom were male. The nutritional risk of the patients was assessed by means of questionnaires, such as the Subjective Global Assessment (SGA), and non-invasive functional techniques, including BIA, nutritional ultrasound, and hand grip strength (HGS). Statistical analysis of the sample was performed using JAMOVI version 2.3.22. Results: Correlations were made between the RF-CSA techniques with PhA (r = 0.48, p < 0.001), BCM (r = 0.70, p < 0.001), SMI (r = 0.64, p < 0.001), and HGS (r = 0.54, p < 0.001). The cut-off points for 12-month mortality were PhA = 4.5° (AUC = 0.722, sensitivity of 72.7% and specificity of 66.6%), BCM = 28.8 kg (AUC = 0.609, sensitivity of 32.4% and specificity of 100.0%), RF-CSA = 3.00 cm2 (AUC = 0.857, sensitivity of 64.4% and specificity of 100.0%), 6MMW = 420 m (AUC = 0.830, sensitivity of 63.27% and specificity of 100.0%), and TUG = 7.2 s (AUC = 0.771, sensitivity of 100.0% and specificity of 56.67%). In addition, a multivariate analysis was performed with RF-CSA, HR = 8.11 (1.39–47.16, p = 0.020), and PhA of 6.35 (1.29–31.15, p = 0.023), taking into account age, sex, and BMI to determine mortality. Finally, a Kaplan–Meier survival analysis was conducted with low or normal values for classical parameters (GAP and T6MM) and new parameters (PhA, BCM, RF-CSA, and TUG). Conclusion: RF-CSA and PhA were shown to be good prognostic markers of 12-month mortality and could, therefore, be useful screening tools to complement the nutritional assessment of IPF patients. Full article
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15 pages, 3298 KiB  
Article
Detection of Sarcopenia in Patients with Liver Cirrhosis Using the Bioelectrical Impedance Analysis
by Dorotea Bozic, Ivica Grgurevic, Bisera Mamic, Vesna Capkun, Josipa Bilandzic-Ivisic, Tomislav Ivanovic, Ivona Bozic, Ivan Zaja, Kristian Podrug, Zeljko Puljiz, Zdravko Perko and Ivana Mikolasevic
Nutrients 2023, 15(15), 3335; https://doi.org/10.3390/nu15153335 - 27 Jul 2023
Cited by 7 | Viewed by 2361
Abstract
Bioelectrical impedance analysis (BIA) is a body composition assessment method. We aimed to determine its accuracy in the detection of sarcopenia in patients with liver cirrhosis (LC), using skeletal muscle index (SMI) at the level of third lumbar vertebra (L3-SMI) obtained using multislice [...] Read more.
Bioelectrical impedance analysis (BIA) is a body composition assessment method. We aimed to determine its accuracy in the detection of sarcopenia in patients with liver cirrhosis (LC), using skeletal muscle index (SMI) at the level of third lumbar vertebra (L3-SMI) obtained using multislice computed tomography as the reference method. Patients with LC were enrolled in the period October 2019–March 2022 and follow-ups were conducted until January 2023. Their BIA parameters were compared against L3-SMI, and BIA cut-off values were proposed using AUROC analysis. Patients underwent outcome analysis based on obtained clinical characteristics. A total of 106 patients were included. We found a fair correlation between BIA parameters with the L3-SMI. We determined cut-off values of ≤11.1 kg/m2 for BIA-SMI (Se 73%, Sp 66%, AUROC 0.737, p < 0.001) and ≤5.05° for phase angle (PA) (Se 79%, Sp 60%, AUROC 0.762, p < 0.001) in the detection of sarcopenia. The relative risk of death was 2.2 times higher in patients with skeletal muscle mass (SMM) ≤ 36.5 kg. SMM was significantly associated with outcome in Kaplan–Meier analysis. This non-invasive and simple method that showed fair performances and a very good outcome prediction could provide for the unmet need for fast and affordable detection of sarcopenia in patients with LC and should be further evaluated. Full article
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