Search Results (391)

In clinical veterinary medicine, the Body Condition Score (BCS) serves as a validated, semi-quantitative estimation of subcutaneous adipose reserves, yet it cannot by itself detect systemic nutrient deficiencies or excesses that do not necessarily imply energy storage. Human clinical dietetics addressed an analogous diagnostic gap through the Nutrition-Focused Physical Examination (NFPE), but veterinary medicine still lacks a unified, multi-species physical examination sequence for nutritional screening. This narrative review synthesizes the comparative and clinical nutrition literature into a proposed, operational interspecies framework for nutritional assessment, designed to complement the BCS and the Muscle Condition Score (MCS) within the existing WSAVA and AAHA nutritional assessment guidelines. The approach sequences a detailed feeding and behavioural anamnesis with a systematic, tissue-by-tissue physical examination of the integument, mucous membranes, skeleton, muscle and joints, and endocrine-metabolic status, supported by metabolic and haematological profiling. Seven synoptic diagnostic tables link observable clinical signs to specific micro- and macronutrient imbalances, the underlying nutritional mechanisms, and the species-specific dependence on key nutrients. Key interspecific determinants are integrated to support differential diagnosis and to caution against uncritical cross-species extrapolation. Each clinical entry is explicitly classified as a primary nutrient deficiency or excess, a nutrition-responsive or nutrition-related metabolic disease, a disease causing secondary malnutrition, or a management or behavioural determinant of intake, and each table states the principal non-nutritional differentials and the confirmatory test required, so that the tables function as screening prompts. The resulting semiotic methodology is intended to extend nutritional assessment beyond fatness (assessed on extension of explorable sub-cutaneous adipose tissue) towards whole-body nourishment. It is presented as a proposed framework and not as a validated instrument, and it requires prospective validation before any routine clinical adoption across animal species. The supporting evidence is substantially stronger for dogs, cats, horses, and ruminants than for avian, reptile, and small exotic mammal species, for which the present extension is a proof of concept requiring dedicated species-specific validation. Full article

Background: Malnutrition and metabolic dysregulation are common in motor neuron disease (MND) and contribute to accelerated functional decline and reduced survival. Routine serum biochemical analytes can be used to assess nutritional status; however, their interpretation in MND is confounded by systemic inflammation and disease-related metabolic changes. This study investigated the relationship between serum biochemical analytes, inflammatory status, disease severity, progression, and body composition in people living with MND. Methods: In this single-centre, longitudinal prospective cohort study, 19 participants with confirmed MND were assessed at enrolment and at three-month intervals up to nine months. Serum concentrations of albumin, prealbumin, creatinine, transferrin, ferritin, retinol-binding protein, and lipid fractions were measured alongside routine inflammatory markers. Disease severity and progression were assessed using the revised ALS functional rating scale and King’s College Staging System. Anthropometry included percentage weight change, body mass index, mid-upper arm circumference, triceps skinfold thickness, arm muscle area, and calf circumference. Participants with evidence of baseline inflammation were excluded from nutritional analyses. Results: Low-grade systemic inflammation was present in 9/19 (47%) of participants at enrolment, most commonly reflected by elevated fibrinogen. In the non-inflammatory sub-cohort (n/N = 10/19), serum creatinine was positively correlated with muscle-related functional subscores (p = 0.007) and declined between enrolment and three months (p = 0.02), showing predominantly negative trajectories by nine months. HDL cholesterol also declined over the nine-month follow-up (p = 0.03) and lipid fractions correlated positively with disease stage (p <0.001–0.02), suggesting evolving metabolic stress. Elevated serum retinol-binding protein was observed in 90% (n/N = 9/10) of participants without inflammation. Biochemical evidence of malnutrition (low transferrin and/or creatinine) was detected in one-third of participants, accompanied by weight loss and reductions in limb anthropometric parameters. Malnutrition risk was identified in 1/10 (10%) of the non-inflammatory sub-cohort using a modified ESPEN-based framework, and in 2/10 (20%) participants using GLIM criteria. Conclusions: Routine serum biochemical analytes provide complementary information on nutritional and metabolic status in MND when interpreted alongside inflammatory markers and anthropometry. Serum creatinine emerged as a longitudinal marker of muscle wasting, reflective of denervation and nutritional depletion, while lipid and retinol-binding protein alterations highlight non-nutritional disease mechanisms that may confound standard biomarker interpretation, informing more targeted nutritional assessments. These findings support a multimodal approach to nutritional monitoring in MND and emphasise the importance of accounting for inflammatory status in biomarker interpretation. Given the small sample size and the limited representation of non-ALS phenotypes, these findings should be regarded as hypothesis-generating and require confirmation in larger, multicentre cohorts with balanced phenotypic representation. Full article

Background: Malnutrition and micronutrient deficiencies may impact the oral mucosa even before any other symptoms become clinically obvious. This makes the oral cavity an important site for early detection of nutritional imbalance. Across the literature review, the most documented vitamin is vitamin B12. Other widely reported nutrients are iron, folate, and zinc. Less consistently documented are vitamins A, C, and D. Their correlation with recurrent aphthous stomatitis (RAS), atrophic glossitis, angular cheilitis, burning mouth symptoms (BMS), mucosal erythema, and oral candidiasis (OC) is brought to light. This review collects evidence on how nutritional deficiencies influence epithelial turnover, immune competence, oxidative balance, and mucosal repair to understand the pathogenesis of oral mucosal diseases. Methods: This narrative review draws on literature searches of major databases using terms related to malnutrition, nutritional deficiencies, and oral mucosal diseases. Results: The evidence is strongest for RAS and atrophic glossitis, where several observational studies and recent systematic reviews associate hematinic deficiencies with disease presence and, in some cases, symptom improvement after performing replacement therapy. Zinc deficiency has also been linked to recurrent ulceration, burning mouth syndrome, and epithelial alterations, while vitamin B12 deficiency may present with glossitis, BMS, angular cheilitis, mucosal ulceration, and lingual linear lesions even with the absence of systemic anemia. Oral candidiasis is more common in malnourished patients due to reduced host resistance and diminished salivary protection, especially in older or medically compromised patients. Conclusions: Although causality cannot be assumed from all included studies, the literature suggests that unexplained oral mucosal lesions, especially when they are multiple or persistent, warrant nutritional screening as part of a comprehensive oral medicine assessment. Full article

Background and Objectives: Laboratory parameters associated with nutritional and metabolic status may be substantially influenced by inflammatory activity, complicating their interpretation in patients with advanced neurological diseases. This study aimed to characterize within-patient changes in inflammatory biomarkers and laboratory parameters related to nutritional and metabolic status in multimorbid patients receiving long-term enteral nutrition, with particular emphasis on differences between infectious and clinically non-infectious periods. A secondary objective was to propose a conceptual framework for interpreting these laboratory parameters in the context of inflammatory activity. Materials and Methods: A prospective longitudinal observational case series was conducted in an inpatient palliative care facility. Of 23 patients who entered prospective follow-up, five completed the predefined nine-month observation period and were included in the final longitudinal analysis. Twenty-three predefined assessment time points were evaluated for each participant. Inflammatory parameters, serum proteins, micronutrient-related measurements, and vitamin concentrations were analyzed descriptively in relation to the clinical course of each patient. Results: Patients with recurrent infectious episodes demonstrated pronounced increases in inflammatory biomarkers accompanied by decreases in serum proteins, particularly albumin, transferrin, and total protein, as well as changes in serum iron (Fe) and zinc (Zn). The greatest fluctuations were observed in patients with the highest inflammatory burden, whereas patients without recurrent infections showed comparatively stable laboratory profiles. Vitamin A, vitamin D, and folate concentrations showed relatively limited fluctuations. Importantly, all five patients received continued enteral nutritional support, with daily energy intake ranging from 1450 to 1800 kcal, and body weight increased by 1.0–3.0 kg during follow-up. Based on these case-based observations and current evidence, a conceptual framework for interpreting laboratory parameters in the context of inflammatory activity was proposed. Conclusions: In patients with advanced neurological diseases, laboratory parameters associated with nutritional and metabolic status should be interpreted in the context of inflammatory activity and should not be used independently to determine nutritional status. The proposed conceptual framework is intended as an interpretative aid for laboratory findings rather than as an alternative diagnostic system for malnutrition and requires validation in larger prospective studies. Full article

Background: Neurological disease may lead to malnutrition through disease-related complications, underscoring the need for accurate muscle assessment. This study aims to evaluate an AI-based tool for quantifying and characterizing muscle ultrasound images, comparing its performance with the usual techniques of muscle mass and function. Methods: This was a prospective, open-label, longitudinal observational study of 117 adults with neurological disorders at high nutritional risk, designed to evaluate nutritional status and clinical evolution. The clinical assessment integrated anthropometry, bioelectrical impedanciometry, handgrip strength, dysphagia testing, and rectus femoris quadriceps ultrasound. Ultrasound images were evaluated through an AI-based platform to extract muscle quantity (rectus femoris muscle area (RFMA) and rectus femoris muscle thickness (RFMT) and quality biomarkers (percentage of low-echogenicity areas (Mi), interpreted as muscle; percentage of medium-echogenicity areas (FATi), interpreted as intramuscular fat). Patients were followed for two years to record mortality. Results: The sample included 117 adults with neurological disorders (52.1% women), with a mean age of 63.01 (16.14) years. A total of 77 patients (65.8%) had a condition with direct neuromuscular involvement. According to Global Leadership Initiative on Malnutrition (GLIM) criteria, 73 patients (62.4%) had malnutrition, while 30 patients (25.6%) had severe malnutrition. There were no differences in muscle mass parameters, but patients with neuromuscular involvement (NM) had lower values of percentage of Mi (NM: 42.44 (9.09%) vs. 47.36 (7.74)%; p < 0.01), and higher values of FATi (41.91 (5.71)% vs. 39.15 (4.89)%). The prevalence of mortality was 26 patients (22.2%). In the multivariate analysis, FATi (above median) (OR = 5.11 (IC95%: 1.26–20.67)) increased risk of death, adjusted by age, neuromuscular involvement, sex, and Mi. Conclusions: Patients with neuromuscular disorders showed a markedly lower proportion of Mi and a higher presence of FATi compared to those with non-neuromuscular conditions. Mortality was associated with greater FATi on AI-based ultrasound analysis. These findings suggest AI-enhanced imaging captures clinically relevant tissue alterations with potential prognostic value; however, given the observational data and heterogeneity of neurological conditions, these implications should be interpreted cautiously. Full article

Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease where malnutrition significantly worsens clinical outcomes. We performed a multidimensional analysis to identify clinical, social, and healthcare factors associated with nutritional vulnerability in a real-world setting. Methods: This cross-sectional study included 97 adults with ALS recruited through a national association (APELA) and a hospital-based outpatient consultation (ANOC). Nutritional status was assessed using the Mini Nutritional Assessment (MNA^®), Body Mass Index (BMI), and Global Leadership Initiative on Malnutrition (GLIM) criteria. Associations with total MNA^® scores were evaluated using a prespecified multivariable linear model with HC3 robust standard errors and bootstrap validation to assess inferential stability. Results: Malnutrition prevalence was high, with 42.3% of participants classified as moderately malnourished and 43.3% as severely malnourished under GLIM criteria. Mean MNA^® score was 19.69 (SD 4.53). In the adjusted model, ANOC recruitment was associated, after adjustment, with a 4.477-point lower MNA^® score compared with APELA (HC3 95% CI −7.071 to −1.884; $p<0.001$). Other sociodemographic and clinical factors yielded imprecise estimates. Although explanatory power was modest (Adjusted $R^2=0.067$; optimism-corrected $R^2=-0.005$), the recruitment setting remained a robust correlate across sensitivity analyses. Conclusions: Recruitment setting emerged as the most consistent adjusted correlate of MNA^® scores, likely reflecting differences in clinical case mix and referral pathways in the Portuguese healthcare context. These findings highlight nutritional vulnerability in ALS as a multifaceted construct that should be interpreted in relation to both clinical and healthcare-contextual factors. This study supports considering systemic factors and the need for longitudinal research that incorporates comprehensive functional and social metrics to optimize multidisciplinary nutritional interventions. Full article

Background: Chronic obstructive pulmonary disease (COPD) disproportionately affects older adults. While targeted biologic therapies have shown efficacy in type 2 eosinophilic endotypes, elderly patients remain underrepresented in pivotal clinical trials. This narrative review examines the pathophysiological rationale, efficacy data, and unique geriatric challenges of biologic therapies in older adults. Methods: A literature search was conducted in PubMed and Scopus for phase II and III randomized controlled trials (RCTs) and observational studies evaluating biologic agents (anti-IL-5, anti-IL-4/IL-13, and anti-alarmins) in COPD, focusing on populations aged ≥ 65 years, comorbidities, and frailty. Discussion: Phase III data for dupilumab and mepolizumab indicate significant reductions in annualized exacerbations in patients with blood eosinophils ≥ 300 cells/μL. However, the mean age in the landmark trials (65 years) is a decade lower than the real-world average. Age-related immune remodeling—specifically immunosenescence and inflammaging—coexists with disease-specific pathways, potentially altering therapeutic responses. Furthermore, clinical trials systematically exclude older individuals with severe multimorbidity, physical frailty, cognitive impairment, and malnutrition. Conclusions: Biologics provide a precise, mechanism-based approach, yet evidence in the oldest-old remains limited. Future management should utilize the treatable traits framework, shifting selection criteria from chronological age to biological age metrics, including frailty status and functional reserve. Full article

We conducted an online cross-sectional study to assess malnutrition risk, food and nutrition insecurity, and perceived barriers and facilitators to dietary management among adults (18–64 years old) with a self-reported clinical diagnosis of inflammatory bowel disease (IBD) in outpatient and community settings. We assessed malnutrition risk using the Saskatchewan IBD-Nutrition Risk screening tool, food security risk using the two-item Hunger Vital Signs questionnaire, and nutrition security risk using a validated four-item tool. Open-ended questions elucidated barriers and facilitators to dietary management of IBD. Among 57 participants who self-reported a clinical diagnosis of IBD, 52.6% (n = 30/57) had ulcerative colitis, and 47.4% (n = 27/57) had Crohn’s disease. Nutrition insecurity was higher among those at high risk of malnutrition than among those at low-to-medium risk (p = 0.018), and there were no differences in food security status (p = 0.081). Using univariate logistic regression, the odds of being classified as having a high risk of malnutrition were associated with being male, following a special diet or nutrition plan, experiencing IBD-related flare-ups, and nutrition insecurity. Furthermore, healthcare professionals and social support, as well as digital resources/nutrition-related apps, were identified as facilitators to dietary management, while barriers included food access and expense, limited nutrition knowledge and resources, and fear of IBD-related symptom flare-ups. Although self-reported malnutrition risk and food and nutrition insecurity are common, larger prospective studies incorporating validated disease-activity measures and comprehensive nutritional assessment are needed to clarify these relationships and evaluate integrated dietetic and social-support interventions. Full article

Background/Objectives: Alcohol-associated liver disease (ALD) is driven by gut-liver axis dysfunction, including intestinal barrier disruption, dysbiosis, microbial translocation, inflammation, metabolic dysfunction, and malnutrition. Fermented dairy foods may modulate several of these domains, yet whether sheep yogurt, as an intact fermented dairy matrix, is relevant in ALD is unknown. This scoping review mapped evidence relevant to sheep yogurt, ALD, and gut-liver axis biology. Methods: A PRISMA-ScR-guided scoping review searched PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar from January 2006 to February 2026. Eligible sources were charted using a prespecified framework classifying evidence as direct, indirect, or mechanistic inference. Mapped domains included ALD pathophysiology; intestinal barrier integrity; bacterial and fungal microbial ecology; bile acid and tryptophan-aryl hydrocarbon receptor signaling; nutritional vulnerability; fermented dairy interventions; and ovine dairy-matrix characteristics. Results: Of 1388 records identified, 121 sources were included after duplication and screening. No eligible study directly tested sheep yogurt or a defined sheep yogurt preparation in ALD-relevant experimental or clinical settings. Indirect evidence supported the relevance of gut-liver axis dysfunction to ALD and indicated that selected fermented dairy products, probiotics, postbiotics, and microbial preparations may influence intestinal permeability, inflammatory signaling, microbial ecology, oxidative stress, and liver-injury outcomes. Compositional data supported sheep yogurt as a distinct food matrix. However, findings from isolated components, probiotic-only interventions, and non-ALD models could not be interpreted as evidence of sheep yogurt efficacy in ALD. Conclusions: The current literature supports a hypothesis-driven research framework rather than any therapeutic claim for sheep yogurt in ALD. Any potential benefit of sheep yogurt in ALD remains hypothetical and cannot support clinical or dietary recommendations until validated experimentally. Future direct, comparator-controlled studies of intact sheep yogurt should assess liver injury, barrier integrity, microbial translocation, relevant metabolites, and nutrition-related outcomes. Full article

Osteosarcopenia combines low bone mass or skeletal fragility with sarcopenia, yet its metabolic biology is commonly assessed using single-time-point measurements. We conducted a structured narrative review of PubMed/MEDLINE, Web of Science Core Collection, Embase and Scopus from inception through 28 June 2026, supplemented by ScienceDirect, Google Scholar and citation chaining. Evidence was classified as direct human osteosarcopenia evidence, indirect human evidence, preclinical evidence or conceptual inference. Here, chronometabolomics denotes time-anchored or repeated metabolomic profiling used to estimate variation in phase, amplitude and pathway coordination in relation to sleep, feeding, activity and endocrine timing. Direct human evidence remains scarce. Component-specific human studies and experimental models suggest, but do not establish, that aging, chronic disease and irregular schedules may alter glucose–insulin, amino-acid, lipid, mitochondrial, redox-inflammatory, mineral-endocrine and microbial rhythms relevant to the bone–muscle unit. Chronometabolomics is therefore an emerging research framework, not a validated diagnostic or therapeutic approach. Daytime light, sleep regularization, protein distribution, time-restricted eating, exercise timing and medication timing remain candidates for controlled trials rather than current clinical recommendations; safety evaluation must address frailty, low body mass index, malnutrition, kidney disease, diabetes, polypharmacy, falls and inadequate protein or calcium intake. Full article

Caloric restriction (CR), defined as a 30–60% decrease in ad libitum food intake without malnutrition, has emerged as one of the most robust non-pharmacological interventions for promoting metabolic health and longevity in various species, including yeast, worms, flies, rodents, and perhaps non-human primates. In addition, CR has been shown to reduce the incidence of age-related disorders (for example, diabetes, cancer, and cardiovascular disorders) in mammals. Among the key organs influenced by CR, the pancreas—particularly the insulin-producing β-cells—plays a central role in maintaining glucose homeostasis and metabolic balance. A growing body of evidence suggests that CR exerts its beneficial effects, at least in part, through the modulation of nutrient-sensing pathways and epigenetic regulators. Sirtuins, a family of NAD⁺-dependent deacetylases and ADP-ribosyltransferases, have gained attention as pivotal molecular mediators of CR. By responding to changes in cellular energy status, sirtuins regulate diverse processes including gene expression, oxidative stress response, mitochondrial function, and autophagy. In the pancreas, sirtuins such as SIRT1, SIRT3, and SIRT6 have been implicated in preserving β-cell function, enhancing insulin secretion, and protecting against metabolic stress and inflammation. This review critically examines current evidence regarding the role of individual sirtuins in mediating the pancreatic response to caloric restriction, with particular emphasis on β-cell physiology, insulin secretion, mitochondrial function, autophagy, oxidative stress, and inflammatory signaling. We further discuss how these molecular mechanisms contribute to systemic metabolic homeostasis and may influence healthy longevity. Importantly, we integrate experimental findings with emerging clinical evidence demonstrating the recovery of β-cell function following dietary energy restriction and identify current controversies, limitations, and key knowledge gaps that should guide future translational research. Collectively, available evidence suggests that sirtuins represent central molecular links between caloric restriction and β-cell adaptation, highlighting their potential as therapeutic targets for preserving pancreatic function and preventing metabolic disease. Full article

Background/Objectives: People with severe mental illness experience high rates of malnutrition and cardiometabolic disease, and hospital food is increasingly regarded as part of clinical care rather than mere catering. Although nutrition is increasingly recognised as a therapeutic component of psychiatric care, little is known about how the professionals closest to nutritional care would design an inpatient meal concept. Methods: We conducted a cross-sectional, anonymous online survey of 26 nutrition professionals working in psychiatric settings in the German-speaking D-A-CH region (Germany, Austria, and Switzerland), who rated the goals, patient needs, dietary forms, meal characteristics, organisational aspects, and barriers relevant to an inpatient meal concept on five-point Likert scales. Free-text responses were analysed thematically. Results: Respondents prioritised eating enjoyment (mean [M] = 4.65) and psychological stability over economic goals, and rated both appetite loss and hyperphagia, together with medication-related metabolic change, as key patient needs. A Mediterranean dietary pattern was clearly the preferred model (M = 4.62), whereas low-carbohydrate options were the least endorsed form (M = 2.65). Interprofessional communication between nursing, kitchen, and dietetics was the highest-rated item overall (M = 4.75), while budget restrictions were seen as the principal barrier. Conclusions: In this small, self-selected expert sample, experts largely converged on a patient-centred, Mediterranean, flexible and choice-based meal concept delivered through strong interprofessional processes, supporting a shift from catering toward nutrition as a therapeutic component of inpatient psychiatry. Full article

Background: Sarcopenia and malnutrition may contribute to persistent functional vulnerability after lung transplantation, yet their prevalence using actual criteria, relationship and clinical correlates remain incompletely defined. Methods: Ninety-nine adult lung transplant recipients (Ltx) were included in the study during their routine follow-up. Sarcopenia was defined using EWGSOP2 criteria, integrating muscle strength, dual-energy X-ray absorptiometry-derived appendicular lean mass, and physical performance. Malnutrition was assessed using GLIM criteria before transplantation and at follow-up. Clinical, nutritional, biological, body-composition, and pulmonary-function variables were compared according to sarcopenia status. Results: Sarcopenia was identified in 17 recipients (17.2%), including 12 (12.1%) with severe sarcopenia. Malnutrition was frequent before transplantation and persisted at follow-up, affecting 52 of 98 recipients (53.1%) before transplantation and 23 of 99 recipients (23.2%) after transplantation. Sarcopenia was related to underlying diseases leading to transplantation (mainly COPD and ILD) and sarcopenic Ltx were older (66.1 ± 6.7 vs. 57.7 ± 12.6 years; p = 0.05), had greater smoking exposure (38.2 ± 25.6 vs. 22.2 ± 20.2 pack-years; p = 0.02) and prednisone dose (13.5 ± 8.1 vs. 8.9 ± 2.7 mg/day; p = 0.001). Despite a trend towards lower albuminemia (40.5 ± 4.7 vs. 42.1 ± 4.3 g/L; p = 0.07), malnutrition was not associated with sarcopenia status. Lung function improved substantially after transplantation, with mean FEV₁ increasing from 25.7 ± 16.6% to 82.0 ± 25.4% predicted at assessment (p < 0.001); however, FEV₁ at assessment did not differ considering sarcopenia status. Conclusions: In lung transplant recipients, EWGSOP2-defined sarcopenia was common and largely uncaptured by BMI, malnutrition status, routine biomarkers, adiposity indices, or spirometry recovery. Malnutrition was reduced by personalized nutritional support but persisted in many patients, supporting more systematic muscle-health and nutritional assessment to allow reduced post-transplant morbidity. Full article

Background/Objectives: Lung cancer remains the leading cause of cancer-related mortality worldwide, and surgical resection is the primary curative treatment for patients with early-stage non-small cell lung cancer (NSCLC). Patients undergoing lung cancer surgery are frequently affected by malnutrition, systemic inflammation, sarcopenia, and cancer-related cachexia, which may adversely affect postoperative recovery and clinical outcomes. Perioperative immunonutrition has been proposed as a strategy to support immune and metabolic responses associated with surgical stress. This narrative review summarizes current evidence regarding the role of perioperative immunonutrition in patients undergoing lung cancer surgery. Methods: This narrative review summarizes current evidence regarding perioperative immunonutrition in patients undergoing lung cancer surgery. Relevant studies evaluating perioperative immunonutrition, including formulations enriched with arginine, omega-3 fatty acids, glutamine, and nucleotides, were analyzed. Particular attention was given to clinical studies in thoracic surgical oncology, perioperative outcomes, inflammatory response, and current nutritional guideline recommendations. Results: Available evidence suggests that perioperative immunonutrition may improve nutritional and immunological status in patients undergoing lung cancer surgery. Clinical studies have reported reductions in postoperative complications, shorter chest drainage duration, improved nutritional indices, and decreased inflammatory markers in patients receiving immunonutritional support. Experimental and translational studies also indicate potential beneficial effects on immune cell function and inflammatory regulation. However, current thoracic-specific evidence remains limited because of small study populations, heterogeneity of nutritional protocols, and variability in study design. Conclusions: Perioperative immunonutrition appears to be a promising adjunct to comprehensive perioperative care in patients undergoing lung cancer surgery. Although preliminary evidence suggests potential benefits in postoperative recovery and nutritional optimization, its implementation should be individualized according to the patient’s nutritional status, disease stage, and overall treatment strategy. As immunonutrition modulates metabolic and immune pathways that may also influence tumor biology, nutritional interventions should be evidence-based, carefully monitored, and integrated within multidisciplinary perioperative care to maximize clinical benefits while minimizing potential unintended effects. Further large, well-designed randomized clinical trials are needed to establish standardized protocols and clarify the role of immunonutrition in thoracic surgical oncology. Full article

Background: Nutrition and nutrition-related interventions are a salient yet under-recognized component of preventing the development of and complications of metabolic dysfunction-associated steatotic liver disease (MASLD). Additionally, malnutrition affects a significant proportion of patients with MASLD, yet remains under-treated in the primary care setting. The objective of this narrative review is to synthesize the available evidence regarding nutritional screening, diet, and supplements in patients with MASLD. This review is aimed at primary care physicians to improve the recognition of malnutrition in MASLD patients and provide appropriate nutritional guidance. Methods: Between November 2025 and June 2026, the authors conducted a literature review using the PubMed database. Search terms included combinations of the following: MASLD, non-alcoholic fatty liver disease (NAFLD), malnutrition, sarcopenia, nutritional screening, Mediterranean diet, micronutrients, and physical activity. Randomized controlled trials (RCTs), systematic reviews, and meta-analyses addressing nutritional outcomes in liver disease were prioritized, and consensus guidelines were incorporated where primary trial evidence was limited. Evidence was appraised by study design, risk of bias, and endpoint; recommendations resting on expert opinion or extrapolation from cirrhosis populations are identified as such. Results: Author review of the studies yielded the following conclusions. Nutritional assessment should be risk-stratified by fibrosis stage using liver disease-specific tools, as BMI and body weight are unreliable in MASLD. Weight loss has been shown to improve histological and clinical progression in MASLD. The Mediterranean diet has the strongest support for steatosis reduction among the dietary interventions discussed. Coffee consumption is consistently associated with reduced fibrosis risk in observational data, but no randomized evidence exists. GLP-1 receptor agonists achieve histological MASH resolution in up to 63% of patients but require concurrent nutritional monitoring to mitigate lean mass loss. Systemic barriers, including time constraints and limited dietitian access, remain the primary impediment to primary care implementation. Conclusions: Primary care physicians are central in managing many aspects of care for patients with MASLD. This review highlights the established evidence behind diet, exercise and malnutrition prevention in the primary care setting. Full article