Search Results (693)

Background: Childhood obesity is a significant global health concern. Butyrylcholinesterase (BChE) has been shown to play a role in lipid metabolism. This study aimed to assess BChE activity, obesity-related and lipid-related indices, and dyslipidemia in obese and non-obese children, and to investigate the associations of these parameters with obesity among Thai children. Methods: The study included 661 Thai children, consisting of 338 with obesity and 323 with a normal weight. Anthropometric measurements, metabolic parameters, obesity- and lipid-related indices, and BChE activity were evaluated. Results: The obese group exhibited significantly higher BChE activity and obesity-related and lipid-related indices compared to the non-obese group (p < 0.01). Additionally, metabolic parameters—including glucose levels, triglyceride-glucose (TyG) index, and TyG-related indices—as well as the lipid profile, which included triglycerides (TG), non-high-density lipoprotein cholesterol (non-HDL-C), and very-low-density lipoprotein cholesterol (VLDL-C), were all significantly elevated in the obese group (p < 0.01). Obesity was associated with dyslipidemia (p < 0.01). Moreover, BChE activity showed a positive correlation with obesity-related and lipid-related indices, along with several metabolic parameters (p < 0.002). The upper stratum of BChE activity (OR = 5.356), the non-HDL-C/HDL-C ratio (OR = 2.185), and the TG/HDL-C ratio (OR = 1.703) were found to be effective in evaluating and predicting the risk of obesity, even after adjusting for potential covariates (p < 0.01). Conclusions: These findings indicate a significant relationship between obesity and increased BChE activity, lipid-related indices, and dyslipidemia in Thai children. Therefore, changes in BChE activity may be considered a factor associated with obesity, enhancing its potential as a marker for obesity assessment. Full article

Background/Objectives: This study aimed to evaluate adipose tissue dysfunction, assessed through adipocytokines and proinflammatory cytokines, in relation to hepatic steatosis (HS) in patients with newly diagnosed type 2 diabetes (T2D). Methods: An observational study evaluated 155 consecutive patients with new-onset T2D; 118 (76.1%) were found to have HS, while the remaining 37 served as the control group without steatosis. Anthropometric status and body mass index (BMI) were evaluated. The biochemical assessment encompassed the measurements of fasting serum lipids, fasting plasma glucose (FPG), liver function tests, adiponectin, leptin, resistin, tumor necrosis factor (TNF-α), and interleukin 6 (IL-6). Insulin resistance (IR) was determined using the homeostasis model assessment (HOMA). HS was evaluated using ultrasonographic criteria. Quantitative evaluation of HS was performed by calculating the hepatic steatosis index (HSI). Results: There were statistically significant differences between the groups for age, BMI, weight, waist circumference (WC) and hip circumference, HSI, glucose profile (fasting plasma glucose (FPG), HOMA-IR), liver function tests, adiponectin, leptin, resistin, TNF-α, and IL-6. In multivariate logistic regression analysis, age, smoking, BMI, WC, HOMA-IR, and hypoadiponectinemia were the only independent factors associated with HS. Conclusions: The adipose tissue dysfunction assessed through adipocytokines and proinflammatory cytokines is part of the associated disorders in HS and new-onset T2D. In patients with newly diagnosed T2D, age, smoking, and hypoadiponectinemia consistently emerged as independent predictors of hepatic steatosis. More prospective trials are needed to clarify the “the temporal onset” of adipose tissue dysfunction. Full article

Background/Objectives: Metabolic dysfunction-associated fatty liver disease (MAFLD) is linked to cardiovascular complications, including atrial fibrillation. P-wave indices (PWIs) reflect atrial conduction heterogeneity but have not been fully evaluated in MAFLD. To compare PWIs in MAFLD patients versus controls, assess their association with fibrosis severity, and evaluate their diagnostic performance for MAFLD and fibrosis. Methods: In this retrospective single-center study, 447 subjects were included (noMAFLD: Fatty Liver Index (FLI) < 30 without metabolic dysfunction, n = 205; MAFLD: FLI ≥ 60+ ≥ 1 metabolic risk factor, n = 242). Among MAFLD subjects, the non-alcoholic fatty liver disease (NAFLD) Fibrosis Score (NFS) stratified lower (NFS ≤ −1.455; n = 170), and there was a higher fibrosis risk (NFS > −1.455; n = 72). Standard 12-lead ECGs were digitized for offline PWI measurement. Statistical analyzes included group comparisons, multivariable logistic regression, and ROC curve analysis. Results: MAFLD patients exhibited a longer PWPT-D2 (63 ± 12 vs. 52 ± 10 ms, p = 0.003), PWPT-V1 (68 ± 14 vs. 60 ± 13 ms, p = 0.005), PWdis (55 ± 13 vs. 46 ± 11 ms, p = 0.010), and PTFV₁ (38 [31–46] vs. 28 [22–34] mm·ms, p = 0.021) compared with controls. Within MAFLD, a higher fibrosis risk was associated with a further PWI prolongation (all p < 0.015). Multivariate analysis identified PWPT-D2 (OR 1.05 per ms; 95% CI 1.02–1.08; p = 0.002) and PWDIS (OR 1.03 per ms; 95% CI 1.00–1.06; p = 0.048) as independent MAFLD predictors. ROC curves showed PWPT-D2 had the highest AUC for MAFLD detection (0.78; 95% CI 0.72–0.84) and fibrosis (0.82; 95% CI 0.76–0.88). Combining PWPT-D2 with BMI and waist circumference improved MAFLD discrimination (AUC 0.89; 95% CI 0.85–0.93; p < 0.001 vs. PWPT-D2 alone). Conclusions: PWPT-D2 and PWdis are significantly prolonged in MAFLD and more so with advanced fibrosis. PWPT-D2 may be a simple, noninvasive ECG marker for MAFLD screening and fibrosis staging, particularly when combined with anthropometric measures. Full article

Background/Objective: The body roundness index (BRI) has emerged as a novel anthropometric parameter with potential utility in the assessment of obesity and its associated metabolic complications. This study aimed to identify the optimal BRI cut-off point for the diagnostic process of metabolic syndrome (MetS) in a cohort of postmenopausal women with obesity and to compare its predictive capacity with that of the homeostasis model assessment of insulin resistance (HOMA-IR). Methods: A cross-sectional analysis was conducted in 468 Caucasian postmenopausal women with obesity. Clinical and biochemical assessments included anthropometric measurements, blood pressure, fasting plasma glucose, insulin levels, the HOMA-IR, lipid profile, C-reactive protein, and adipokines. MetS was diagnosed according to the Adult Treatment Panel III (ATP III) criteria. Results: MetS was identified in 270 patients (57.5%). Stratification by the median BRI revealed that individuals in the higher-BRI group had a significantly increased odds of MetS (OR 2.65; 95% CI: 1.99–3.53; p = 0.03). A Receiver Operating Characteristic (ROC) curve analysis showed that the HOMA-IR had an area under the curve (AUC) of 0.72 (95% CI: 0.67–0.77; p = 0.01), with a cut-off value of 2.64 (sensitivity: 64.9%; specificity: 69.7%). In contrast, the BRI exhibited a higher AUC of 0.75 (95% CI: 0.71–0.80; p = 0.001), with an optimal cut-off of 8.15, demonstrating superior sensitivity (85.6%) and specificity (72.5%). Conclusions: The BRI is a promising and practical alternative anthropometric index for identifying MetS in Caucasian postmenopausal women with obesity. Its strong association with markers of adiposity and metabolic dysregulation underscores its potential value in clinical and epidemiological settings. Full article

Obesity is a complex, diverse, and multifactorial disease that has become a significant public health concern. It is a modifiable risk factor for developing type 2 diabetes (T2D). The current classification systems rely on anthropometric measurements, such as body mass index (BMI), which cannot capture the physiopathological diversity of this disease. This study aimed to analyze the metabolic signatures of obesity and diabetes using ¹H-nuclear magnetic resonance (NMR). Obese patients with BMI ≥ 25 kg/m² (according to the Asian cut-off value) with different diabetes status scheduled to undergo metabolic-bariatric surgery at three hospitals were prospectively recruited for this study. Plasma samples of 111 obese patients and 26 healthy controls were analyzed by ¹H-NMR. When compared among groups with different diabetes statuses, four clusters with no differences in BMI but different metabolomics profiles were obtained. These clusters highlight intricate metabolic relationships associated with obesity and diabetes. This study demonstrated the benefits of using precision techniques like ¹H-NMR to better early detection, substantially decreasing the risk of developing T2D and its related complications. This study is the first to report on metabolic markers and altered metabolic profiles of T2D and prediabetes among obese Malaysians with a BMI cut-off value for the Asian population. Full article

Background/Objectives: Malnutrition is prevalent among hospitalized older adults with multimorbidity, leading to adverse health outcomes and increased healthcare costs. An accurate assessment of resting energy expenditure (REE) is crucial because an inaccurate estimation of energy needs may result in unintentional underfeeding or overfeeding, both of which can worsen nutritional status and clinical outcomes. While indirect calorimetry (IC) is the preferred method, its clinical applicability is limited. Prediction equations are commonly used, but their accuracy in older Asian patients with multimorbidity remains unclear. Methods: This multicenter, cross-sectional study enrolled 400 patients aged ≥65 years from March to December 2023 in Outram Community Hospital (OCH) and Sengkang Community Hospital (SKCH). Participants’ REE was measured using indirect calorimetry. We compared the performance of the newly developed novel prediction equations (PEs), derived from readily accessible or easily measured anthropometric data, against established equations. Statistical analysis included the calculation of R², the root mean square error (RMSE), and the intraclass correlation coefficient (ICC) to assess reliability and goodness of fit. Results: A high prevalence (85%) of multimorbidity was observed among the participants. REE increased progressively with body mass index (BMI) across all groups (865.6–1269.4 kcal in females; 889.1–1269.4 kcal in males). The novel PEs (RMSE: 186–191; ICC: 0.5–0.52) demonstrated improved accuracy and stronger reliability compared to conventional equations (RMSE: 222–258; ICC: 0.271–0.460). Conclusions: Our newly developed PEs offer potentially valuable tools for precise REE estimation in hospitalized older Asian patients with multimorbidity. Further external validation and investigation in diverse populations are necessary to confirm these results. Full article

Trimethylamine N-oxide (TMAO), a gut microbiome metabolite linked to cardiovascular health, can be influenced by dietary factors like choline intake and diet quality. This study compared the effects of mixed tree nuts (MTNs) and pretzels, as part of a 12-week hypocaloric weight loss diet, on TMAO levels and identified dietary predictors. Methods: Plasma samples from 95 overweight individuals consuming either 1.5 oz. of mixed tree nuts (MTNs, n = 56) or isocaloric pretzels (n = 39) daily for 12 weeks were analyzed. Nutritional data were collected at baseline and week 12 through dietary recall using the Automated Self-Administered 24 h Dietary Assessment Tool (ASA24), and the overall diet quality was assessed via the Healthy Eating Index (HEI) score. TMAO levels were determined and analyzed using linear mixed-effect models, adjusting for covariates. Wilcoxon signed-rank tests compared baseline and week 12 TMAO and weight. Multiple linear regression identified baseline predictors of TMAO. Results: Baseline demographics, anthropometric measures, HEI scores, and dietary choline intake were similar between the MTN and pretzel groups. A significant positive association was observed between baseline dietary choline and plasma TMAO levels (p = 0.012). The 12-week hypocaloric diet led to significant weight reduction in both groups (p < 0.01), but the magnitude of weight loss did not differ significantly between the MTN (−3.47 lbs) and pretzel (−4.25 lbs) groups (p = 0.18). Plasma TMAO levels decreased significantly in both groups (p < 0.01), but the between-group difference in reduction was not significant. (MTNs: −0.34 vs. pretzels: −0.37; p = 0.43). HEI scores and dietary choline intake remained unchanged, with no significant time–intervention interaction. Participants with low baseline HEI scores (≤53.72) had a more pronounced reduction in TMAO levels in the MTN group compared to the pretzel group (MTN: −0.54 vs. pretzel: −0.23; p = 0.045) over 12 weeks, despite similar weight loss. This difference was not observed in participants with higher HEI scores. Conclusions: The 12-week hypocaloric diet reduced body weight and plasma TMAO levels similarly in both MTN and pretzel groups. Participants with lower dietary quality saw a greater reduction in TMAO levels in the MTN group, suggesting MTNs may better modulate TMAO levels, especially for those with poorer baseline diets. Full article

Background and Objectives: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are increasingly used in type 2 diabetes (T2D) due to their cardiorenal benefits and weight-lowering effects. However, concerns have emerged regarding their potential adverse impact on lean mass and muscle strength particularly in patients at risk for sarcopenia. This study aimed to evaluate the effects of empagliflozin on skeletal muscle mass. Secondary objectives were to assess changes in glycemic control, body weight, fat mass and handgrip strength. Materials and Methods: In this 24-week real-world observational study, 31 adult patients with T2D were assigned to either empagliflozin or non-SGLT2i treatment groups. Patients did not receive a high-protein diet, a resistance exercise program or any other weight-reducing medications such as glucagon-like peptide-1 (GLP-1)-based therapies. Anthropometric measurements, body composition via bioelectrical impedance analysis (BIA), and handgrip strength testing were performed at baseline and after 6 months. Sarcopenia was defined according to EWGSOP2 criteria. Results: The empagliflozin group showed significant improvements in HbA1c, fasting plasma glucose, body weight, waist circumference, and fat mass (p < 0.05 for all). No significant changes were observed in the empagliflozin group after 6 months in appendicular skeletal muscle mass index (from 7.81 ± 1.33 kg/m² to 7.84 ± 1.38 kg/m², p = 0.154). No statistically significant changes were observed in handgrip strength in either group. Conclusions: Empagliflozin treatment over six months led to favorable changes in metabolic parameters and fat mass without detrimental effects on skeletal muscle mass or muscle strength. In clinical practice, the selection of antidiabetic therapies should consider individual glycemic targets, cardiovascular and renal risks, weight management, comorbidities and sarcopenia risk. Resistance exercises and adequate dietary protein intake should be recommended to preserve muscle mass in at-risk patients. Larger randomized trials are needed to confirm the long-term effects of SGLT2 inhibitors on body composition particularly in older adults. Full article

Osteogenesis imperfecta (OI) is a rare bone dysplasia that occurs with a frequency of 1/15,000–20,000 live births. It is characterized by increased susceptibility of bone fractures, skeletal deformities, low stature, and low bone mass. It results in impaired production of type I collagen. About 90% of people with OI have heterozygous mutations in the COL1A1 and COL1A2 genes. Fibroblast growth factor 23 (FGF23) is a protein involved in the regulation of phosphate and 1,25-dihydroxyvitamin D₃ metabolism on a negative feedback basis. FGF23 is secreted by osteocytes in response to increased serum calcitriol and phosphorus. The purpose of this study was to evaluate the concentration of FGF23 among children with osteogenesis imperfecta and the differences in reference values in a healthy population of children and adolescents. Then, this study sought to evaluate how the course of osteogenesis imperfecta, including type of disease, number of bone fractures, and bone mineral density, are related to FGF23 concentration. The study included 47 children aged 3 to 17 years with a diagnosis of osteogenesis imperfecta, confirmed by genetic tests. The patients were hospitalized at the Department from August 2019 to September 2020 and were treated with intravenous infusions of sodium pamidronate. The course of the disease was analyzed, including the number of bone fractures, clinical symptoms, and anthropometric parameters, and bone densitometry was performed by dual X-ray absorptiometry (DXA) in Total Body Less Head (TBLH) and Spine options with Z-score evaluation. FGF23 concentration was determined by the ELISA method. The study was prospective in nature. Results: The mean level of FGF23 in the study group of patients was 645.09 pg/mL and was within the reference values for the developmental age population. There was no significant correlation between FGF23 concentration and anthropometric measurements: body weight (p = 0.267), height (p = 0.429), gender (p = 0.291), or pubertal stage (p = 0.223) in the study group of patients. FGF23 levels were not related to the number of fractures (p = 0.749), the number of sodium pamidronate cycles administered (p = 0.580), bone mineral density parameters (Z-score), the form of osteogenesis imperfecta (p = 0.156), or the genetic test result (p = 0.573). FGF23 levels decrease with age (r = −0.32, p = 0.030) and BMI (r = −0.34, p = 0.020). The level of FGF23 in patients with osteogenesis imperfecta is lower among older children and those having a higher BMI. This index cannot be a diagnostic tool in this group of patients, for no differences were found between the concentrations in patients with osteogenesis imperfecta and the developmental age population. Full article

Gastrointestinal symptoms, including reflux, bloating, dyspepsia, stomach pain, and altered bowel patterns, are commonly reported in individuals with severe obesity and may significantly impact quality of life. Background/Objectives: Curcumin, a bioactive compound found in turmeric (Curcuma longa L.), possesses anti-inflammatory and antioxidant properties and has been investigated for its potential role in gastrointestinal health. However, its effects in individuals with severe obesity remain unclear. Methods: This double-blind, placebo-controlled clinical trial aimed to evaluate the effect of curcumin supplementation on gastrointestinal symptoms in women with severe obesity. Thirty-one women with a body mass index (BMI) ≥ 40 kg/m² undergoing bariatric surgery were randomized to receive either 1500 mg of curcumin (98.75%) or a placebo (1500 mg corn starch) daily for 13 weeks. Gastrointestinal symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS), and stool consistency was assessed using the Bristol Stool Scale. Anthropometric measurements were also collected. Results: Participants had an average age of 33.1 ± 8 years and a BMI of 45.6 ± 3.31 kg/m². No differences were observed between groups at baseline. At the end of the study, the curcumin group showed a significant reduction in the GSRS’s total score compared to the placebo group (p = 0.002), with improvements in eructation (p = 0.011) and constipation (p = 0.007). Additionally, the curcumin group showed reduced BMI (p = 0.019) and neck circumference (p = 0.042). Conclusions: These findings suggest that curcumin supplementation may alleviate some gastrointestinal symptoms and improve anthropometric measures in women with severe obesity, providing a potential dietary strategy. Full article

Background/Objectives: Adolescents in Latin America are experiencing rising rates of overweight/obesity and non-communicable diseases, while public health nutrition efforts targeting this group remain limited. This study explores adherence to the EAT-Lancet diet and its relationship with micronutrient adequacy and ultra-processed food (UPF) consumption. Methods: Cross-sectional data from national nutrition surveys of 19,601 adolescents across six Latin American countries were analyzed. Data on sociodemographics, anthropometrics, and dietary habits were collected using standardized questionnaires and 24 h dietary recalls or food records. Nutrient intake was estimated via statistical modeling, and nutrient adequacy ratios were based on age- and sex-specific requirements. UPF intake was classified using the NOVA system, and adherence to the EAT-Lancet diet was assessed with the Planetary Health Diet Index. Results: Overall adherence to the EAT-Lancet diet was low (mean score: 28.3%). Rural adolescents had higher adherence than urban adolescents, and those aged 10–13 and 17–19 showed better adherence compared to adolescents aged 14–16. Adolescents from lower socioeconomic backgrounds adhered more than those from higher socioeconomic backgrounds. Adherence varied from 20.2% in Argentina to 30.2% in Brazil and Chile. Higher adherence was associated with lower UPF intake. Among urban adolescents, greater adherence was linked to a higher risk of inadequate riboflavin, niacin, and cobalamin intake, a trend not observed in rural adolescents. Conclusions: Adherence to the EAT-Lancet diet is low among Latin American adolescents, particularly in urban areas. Public health efforts should prioritize reducing UPF consumption, improving access to nutrient-dense, culturally appropriate foods, and supporting fortified staple foods. Full article

Background/Objectives: Metabolic syndrome (Mets) risk is influenced by both parents’ preconception lifestyle, yet most interventions target individuals rather than couples. True couples-based interventions that engage both partners equally remain rare. This study aimed to assess the feasibility and adherence of a 10-week lifestyle intervention delivered to heterosexual couples in the preconception period. Methods: This was a pre-post mixed-methods study involving eight nulliparous, cohabiting couples (N = 16 participants) planning a pregnancy within three years. Couples received tailored dietary and physical activity advice via remote sessions. Qualitative data were collected through post-intervention dyadic interviews and thematically analysed to explore participants’ experiences and perspectives on feasibility and adherence. Quantitative data on anthropometry, dietary intake (serves from five food groups), and sedentary behaviour were descriptively analysed. Wilcoxon signed-rank tests were used to assess changes in paired outcomes. Results: qualitative findings highlighted shared motivation, mutual accountability, cultural barriers, and the practicality of the intervention structure. All couples completed the intervention (100% retention). Among participants who required change, improvements were observed in all eight individuals for body mass index and in five out of seven individuals for waist-to-hip ratio. Statistically significant improvements were found in BMI (p = 0.027) and grain intake (p = 0.002), while other dietary and anthropometric changes were not significant. Dietary improvements were noted in 43 out of 80 observations across vegetables, fruits, grains, protein, and dairy intake. Sedentary hours were reduced in 12 of 16 participants, though increases in physical activity intensity were limited. Conclusions: A true-couples-based lifestyle intervention is feasible and acceptable in the preconception period. The approach shows potential for improving diet and reducing sedentary behaviour. Future research with a larger sample and longer duration is recommended to assess long-term effectiveness and broader applicability. Full article

Background: The Mediterranean diet is considered one of the healthiest and safest diets for preventing chronic diseases. The primary objective of this study was to assess the association between adherence to the Mediterranean diet and the occurrence of prediabetes in a representative population of Bialystok, Poland. Prediabetes is a condition characterized by elevated blood glucose levels that are higher than normal but not yet in the diabetic range, indicating an increased risk of developing type 2 diabetes. Methods: The study participants were selected into healthy control (HC) and prediabetic (PreD) groups based on age and gender. Biochemical measurements included total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), fasting glucose (FG), glycated hemoglobin (HbA1c), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6). Additionally, blood pressure, handgrip strength, anthropometric parameters, and body composition were measured. Information on patients’ social data, medical history, and lifestyle history was collected using questionnaires developed for this study. A standardized questionnaire, the Satisfaction with Life Scale (SWLS), was used to assess life satisfaction. Dietary total antioxidant capacity (DTAC) and dietary total polyphenol intake (DTPI) were determined using a 3-day nutritional interview and appropriate databases containing information on polyphenols and the antioxidant potential of food products. To assess adherence to the Mediterranean diet recommendations, a 9-item Mediterranean Diet Index (MDI) was used. Results: It was found that the mean MDI for the entire group was low (3.98 ± 1.74), and the HC was characterized by a significantly higher MDI compared to the PreD. A statistically significant positive correlation was found between MDI and HDL-C, whereas a negative correlation was found between MDI and FG, homeostatic model assessment for insulin resistance (HOMA-IR), diastolic blood pressure (DBP), IL-6, body mass index (BMI), waist-hip ratio (WHR), waist circumference, visceral fat mass, android/gynoid fat ratio. Conclusions: Abdominal obesity was shown to significantly reduce life satisfaction. In model 3, after adjusting for age, sex, dietary energy intake, alcohol consumption, and smoking, each additional MDI point indicated a 10% lower risk of prediabetes. Full article

Background: The simultaneous surgical treatment of acute appendicitis and inguinal hernia in children is still controversial. However, there are no established guidelines for the simultaneous surgical treatment of pediatric patients with acute appendicitis and inguinal hernia. The aim of this study is to evaluate the safety and efficacy of a simultaneous laparoscopic approach for acute appendicitis and inguinal hernia in a pediatric population. Methods: The case records of 2254 pediatric patients who underwent appendectomy at our institution between 1 January 2012 and 1 January 2025 were reviewed. Finally, 44 patients who met the inclusion criteria and had an inguinal hernia at the time of laparoscopic appendectomy were selected for further analysis. The patients who underwent single-stage surgery (simultaneous laparoscopic appendectomy and hernia repair) were assigned to group I (n = 25), while the patients who underwent delayed laparoscopic hernia repair were assigned to group II (n = 19). The groups were compared for final outcome, complications, rate of readmissions within 30 days of index surgery, duration of surgery, and length of hospital stay. Results: The mean age of all the included patients was 11.5 ± 4.0 years, with males slightly outnumbering females (n = 25, 56.8%). The study population consisted of two comparable groups in terms of age, anthropometric measures, gender distribution, and baseline clinical characteristics. A major difference between the two methods was the operation time, which was significantly longer in the single-stage group (53.5 ± 11.2 min vs. 41.5 ± 10.9 min; p = 0.001). Despite the difference in operative time, the length of hospital stay (3.5 ± 2.0 days vs. 3.5 ± 2.2 days; p = 0.899) was almost identical between the two groups, suggesting that the additional intraoperative time was not reflected in a prolonged recovery time. In addition, postoperative complications were rare and evenly distributed between both surgical strategies (n = 2 (8%) vs. n = 2 (10.5%); p = 0.772). All the complications were minor and were treated conservatively. Importantly, there was no recurrence of hernia in either group during the follow-up period. Conclusions: From a clinical perspective, these results suggest that the single-stage approach is feasible and safe, even in complicated appendicitis, particularly in cases where the postponement of hernia repair is not desirable. The longer operative time associated with the single-stage approach must be weighed against the potential benefits of avoiding a second surgical procedure and unnecessary anesthesia, reducing overall healthcare utilization, and minimizing patient burden. Full article

Background and Objectives: Malnutrition and sarcopenia are highly prevalent and clinically impactful conditions in patients undergoing maintenance hemodialysis (MHD), yet their early detection remains challenging. This study aimed to assess the diagnostic performance of nutritional ultrasonography (NUS) in the morphofunctional evaluation of malnutrition and sarcopenia, and to compare its utility with established tools such as bioimpedance analysis (BIA), biochemical markers, handgrip strength (HGS), and functional performance tests. Materials and Methods: A cross-sectional study was conducted in 74 stable MHD patients. Clinical, analytical, anthropometric, BIA, NUS, and functional parameters were collected, along with validated nutritional and frailty scales. NUS was used to assess the quadriceps rectus femoris (QRF) and preperitoneal visceral fat (PPVF), measuring Y-axis, Y-axis/height, cross-sectional muscle area rectus femoris (CS-MARF), muscle area rectus femoris index adjusted to height (MARFI_h), and supramuscular fat (SMF). Sarcopenia was defined according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Results: The prevalence of risk, confirmed, and severe sarcopenia was 24.3%, 40.5%, and 20.3%, respectively. Severe-to-moderate protein-energy wasting (PEW) affected 44.6% of patients. Compared to non-sarcopenic individuals, sarcopenic patients had lower values of HGS, prealbumin, lean body mass, and phase angle. NUS-derived cut-off values for sarcopenia were Y-axis ≤ 8 mm, Y-axis/height ≤ 2.9 mm/m², CS-MARF ≤ 2.4 cm², and MARFIh ≤ 0.9 cm²/m². The most discriminative NUS parameters were Y-axis and SMF (AUC 0.67), followed by Y-axis/height (AUC 0.65) and MARFI_h (AUC 0.63). NUS measurements correlated significantly with ASMI, phase angle, HGS, and SPPB scores. Conclusions: Nutritional ultrasonography is a feasible, reproducible, and clinically valuable tool for assessing muscle mass and quality in MHD patients. Its incorporation into routine practice may enhance early detection of malnutrition and sarcopenia, thereby facilitating timely, individualized nutritional interventions. Full article