Search Results (82)

Background: Several studies have reported the association between malnutrition risk and survival outcomes in surgically treated lung cancer patients; in contrast, limited data are available on patients undergoing medical therapies. The aim of this study was to evaluate malnutrition risk (using the CONUT score) and its relationships with treatment response and survival in patients with an advanced stage of non-small cell lung cancer (NSCLC). Methods: We retrospectively evaluated 109 patients with a diagnosis of locally advanced and advanced NSCLC. Patients were assessed at baseline (before any therapy), after four cycles of therapy, and during a follow-up period of 4 years. Results: Thirty-two (29.4%) NSCLC patients had a CONUT score ≥ 2. Patients with a higher CONUT score were more likely to have brain metastases while patients with a CONUT score < 2 had a significantly better response to therapy in terms of partial response/stable disease. In addition, The Kaplan–Meier curves revealed a significantly worse prognosis for the high CONUT than the low CONUT group regarding both OS and PFS. Cox regression analysis indicated that the CONUT score (≥2) was as a significant determinant of OS and PFS in the patients studied even after considering other possible predictors. Conclusion: This study suggests that malnutrition risk assessment with CONUT score may be valuable in the prognosis assessment of advanced-stage NSCLC patients. Full article

Background: Nutritional status affects bone fragility and related fractures. We investigated the relationships between bone fragility fractures and nutritional indicators, including the Geriatric Nutrition Risk Index (GNRI), Prognostic Nutrition Index (PNI), Control Nutrition Status (CONUT) score, and body mass index (BMI). Methods: Postmenopausal female outpatients aged 75 or older who experienced a hip fracture 2 to 4 weeks ago (hip fracture group; G-HF) or who have no history of hip fracture without secondary osteoporosis but have a T-score of bone mineral density less than −2.5 (primary osteoporosis group; G-POP) were studied using both cross-sectional and longitudinal methods. Variables, including blood test results, T-scores, and nutritional indicators at baseline, were compared between the two groups using a crude dataset and after propensity score matching (PSM). Correlations between hip fracture (HF) and baseline variables were statistically analyzed. The relationship between nutritional indicators and the development of subsequent major osteoporotic fractures (MOFs) after baseline was examined, and the relationship between dietary indicators and functional capacity was also investigated. Results: A total of 1201 patients were recruited from these 113 G-HF and 1088 G-POP groups (crude dataset), of whom 113 were included after PSM. There were many differences between the two groups using the crude dataset. However, no items were significantly different after PSM except for white blood cell count (WBC) and serum phosphorus levels. GNRI < 105.5 demonstrated a typical regression curve regarding prevalent hip fractures. Developing MOF was significantly correlated with T-scores in the femoral neck and the presence of a prevalent fragility fracture. PNI and GNRI demonstrated a significant correlation between functional capacity; however, there was no correlation with the development of MOF. Conclusions: GNRI < 105.5 was significantly correlated with the presence of hip fracture, although no significant association was found with the development of MOF. Full article

Background/Objectives: Anaplastic thyroid cancer (ATC) is an aggressive thyroid cancer subtype with a poor prognosis. The Controlling Nutritional Status (CONUT) score, reflecting both immune and nutritional status, is a prognostic marker in several malignancies; however, its utility in ATC has not been established. We aimed to evaluate the predictive value of the pretreatment CONUT score in ATC and compare its prognostic utility with that of other nutritional indices, including the Prognostic Nutritional Index (PNI) and Geriatric Nutritional Risk Index (GNRI). Methods: We retrospectively reviewed clinical characteristics, laboratory parameters, and survival outcomes of 156 patients with ATC at our institution between January 2004 and May 2024. Based on survival analysis, patients were categorized into low- and high-risk groups based on each nutritional index (CONUT score, PNI, GNRI) using optimal cut-off values. One-year survival differences were evaluated using Kaplan–Meier curves and log-rank test. Independent predictors of 1-year mortality were identified using multivariable Cox proportional hazards regression. Results: Optimal thresholds were 3, 42, and 102 for the CONUT score, PNI, and GNRI, respectively. Patients with CONUT scores ≥ 3 exhibited significantly higher 1-year mortality, compared with those with scores < 3. Multivariable analysis revealed that CONUT score ≥ 3, PNI ≤ 42, and GNRI ≤ 102 were independently associated with increased 1-year mortality risk. Incorporation of CONUT score ≥ 3 into the baseline prediction model significantly enhanced its discriminatory performance. Conclusions: These findings underscore the prognostic value of pretreatment immuno-nutritional assessment and support the integration of the CONUT score into early risk stratification strategies for patients with ATC. Full article

Background and Objectives: Although nutritional status is critical to the clinical outcomes of septic patients, studies on this topic are limited. We aim to assess the prognostic value of five nutritional screening tools (NSTs) for septic patients both at the time of admission to the intensive care unit (ICU) and five days later. Materials and Methods: This prospective observational study included adult septic patients in the ICU. Patients were divided into two groups: survivors and non-survivors. Clinical, laboratory characteristics, and NST values [The Controlling Nutritional Status (CONUT), Prognostic Nutritional Index (PNI), Nutritional Risk Screening (NRS-2002), Geriatric Nutritional Risk Index (GNRI), and Nutrition Risk in the Critically Ill (NUTRIC)] were recorded at admission and on Day-5, and intergroup and intragroup comparisons were performed. Results: A total of 126 patients were included in this study: 97 in the survival group and 29 in the non-survival group. The non-survivors had higher CONUT and NUTRIC scores and lower PNI scores. Multivariate analysis found higher Day-5 NUTRIC scores independently associated with mortality. ROC analysis identified NUTRIC > 6 as a mortality predictor. Conclusions: Although several markers differed significantly between survivors and non-survivors, our findings show that a high Day-5 NUTRIC score was the only factor independently associated with mortality among NSTs. Full article

Background/Objectives: Malnutrition is common among patients with advanced chronic illnesses receiving palliative care, yet comparative data between diagnostic groups are limited. This study aimed to evaluate and compare the nutritional status of patients with end-stage chronic heart failure (CHF) and chronic respiratory disease (CRD), and to assess the clinical utility of the Controlling Nutritional Status (CONUT) score in this setting. Methods: We conducted a retrospective analysis of 80 patients (41 with CHF, 39 with CRD) enrolled in a palliative care program (mean age 77.8 ± 6.8 years, 65% male). Nutritional status was assessed using BMI (Body Mass Index), CONUT score, and routine biochemical markers. Functional and clinical variables, including the Palliative Performance Scale (PPS), were also collected. Results: Moderate-to-severe malnutrition (CONUT ≥ 5) was significantly more prevalent in patients with CHF patients (44%) than CRD patients (10%, p = 0.002). CHF patients exhibited lower BMI, cholesterol, lymphocyte counts, and prealbumin levels. Despite more frequent nutritional follow-up and protein supplementation in the CHF group, these interventions were not associated with improved nutritional classification. The CONUT score correlated more strongly with functional impairment (PPS) than with disease type alone. Conclusions: Patients with CHF receiving palliative care demonstrate higher rates of malnutrition than those with CRD. The CONUT score, derived from standard blood test, may be pragmatic screening tool for identifying nutritional vulnerability and guiding interventions. While it does not predict survival, it may help detect functional decline earlier and support care strategies aimed at maintaining quality of life in end-stage disease. Full article

Background/Objectives: Alcohol-associated hepatitis (AH) is an acute inflammatory condition of alcohol-associated liver disease (ALD) with rapid progression and high mortality. The Age-Bilirubin-INR-Creatinine (ABIC) score is a static algorithm that predicts survivability in AH. The roles of alcohol drinking patterns and nutritional status in AH progression and risk of death are understudied. This study evaluates the impact of alcohol drinking patterns and nutrition on AH progression and mortality. Methods: Sixty-one adult patients diagnosed with AH were stratified by the Model for End-Stage Liver Disease (MELD) as non-severe (MELD < 20, n = 26, Gr.1) and severe (MELD ≥ 20, n = 35, Gr.2). Each group was further subdivided by ABIC: low- (<6.71), intermediate- (6.71–9), and high- (>9) risk categories. We assessed different demographics: nutrition using the Controlling Nutritional Status (CONUT) score; lifetime drinking history (LTDH); recent alcohol use (AUDIT); laboratory measures (complete metabolic panel, complete blood count, and coagulation), and clinical measures (Maddrey DF, Child–Turcotte–Pugh, and Lille). Results: All patients showed a significant and positive correlation between ABIC and LTDH (r = 0.538, p = 0.004), particularly in Gr.2 (r = 0.554, p = 0.011). The low-risk Gr.2 exhibited the highest AST:ALTs. AST:ALTs were significantly associated with LTDH, AUDIT, and CONUT (R² = 0.539, p = 0.031). In all AH patients with intermediate mortality risk, AST:ALTs were strongly linked to CONUT and LTDH (R² = 0.657, p = 0.017). Conclusions: Severe AH demonstrates rapid liver injury progression even when the mortality risk is low. Chronic and recent heavy alcohol consumption and poor nutrition adversely impact AH severity and mortality risk. Alcohol intake and nutritional assessments in routine clinicals could identify high-risk patients, thereby improving treatment and a favorable prognosis. Full article

We read with interest the study by Mureșan et al. on nutritional and inflammatory biomarkers predicting thromboembolic events and mortality in COVID-19 patients. The simultaneous independent significance of eight correlated biomarkers raises concerns about possible multicollinearity. We welcome the authors’ clarification and updated multivariate results, which confirmed that several markers lost significance after adjustment. We recommend clearer statistical terminology and parallel reporting of univariate and multivariate results to improve transparency. Full article

Background: Malnutrition is a prevalent but underrecognized condition in cardiovascular disease (CVD) patients, associated with adverse outcomes including longer hospitalizations, higher readmission rates, and increased mortality. Traditional measures such as body mass index (BMI) often fail to detect malnutrition, especially in patients with fluid retention, sarcopenia, or obesity. Methods: This review critically examines current tools used to assess nutritional status in CVD populations. Screening instruments such as Nutritional Risk Screening 2002 (NRS 2002), Mini Nutritional Assessment (MNA, MNA-SF), Malnutrition Universal Screening Tool (MUST), Subjective Global Assessment (SGA), and the Controlling Nutritional Status (CONUT) score are discussed, alongside diagnostic frameworks including the Global Leadership Initiative on Malnutrition (GLIM) criteria. The role of body composition assessment, particularly bioelectrical impedance analysis (BIA) and phase angle (PA), is also highlighted. Results: These tools differ in diagnostic performance and applicability, with many influenced by the pathophysiological features of CVD, such as inflammation, altered fluid balance, and pharmacotherapy. GLIM criteria provide a standardized two-step approach, combining phenotypic and etiologic factors, but require further validation in cardiology settings. Conclusions: A tailored, multimodal approach could be recommended: initial screening followed by confirmatory assessment using GLIM criteria and objective measures of muscle mass or cellular integrity. Clinicians should be aware of tool-specific limitations and interpret findings in the context of CVD-specific challenges. Full article

Background/Objectives: Patients with stage IV gastric cancer who develop chronic intestinal failure require home parenteral nutrition (HPN). This study aimed to evaluate the prognostic relevance of nutritional and immune–inflammatory biomarkers and to construct an individualised survival prediction model using machine learning techniques. Methods: A secondary analysis was performed on a cohort of 410 patients with TNM stage IV gastric adenocarcinoma who initiated HPN between 2015 and 2023. Nutritional and inflammatory indices, including the Controlling Nutritional Status (CONUT) score and lymphocyte-to-monocyte ratio (LMR), were assessed. Independent prognostic factors were identified using Cox proportional hazards models. A Random Survival Forest (RSF) model was constructed to estimate survival probabilities and quantify variable importance. Results: Both the CONUT score and LMR were independently associated with overall survival. In multivariate analysis, higher CONUT scores were linked to increased mortality risk (HR = 1.656, 95% CI: 1.306–2.101, p < 0.001), whereas higher LMR values were protective (HR = 0.632, 95% CI: 0.514–0.777, p < 0.001). The RSF model demonstrated strong predictive accuracy (C-index: 0.985–0.986) and effectively stratified patients by survival risk. The CONUT score exerted the greatest prognostic influence, with the LMR providing additional discriminatory value. A gradual decline in survival probability was observed with an increasing CONUT score and a decreasing LMR. Conclusions: The application of machine learning to immune–nutritional data offers a robust tool for predicting survival in patients with advanced gastric cancer requiring HPN. This approach may enhance risk stratification, support individualised clinical decision-making regarding nutritional interventions, and inform treatment intensity adjustment. Full article

Background/objectives: Nutritional status is increasingly acknowledged as a pivotal determinant of clinical course and recovery in patients with acute ischemic stroke (AIS). Malnutrition can compromise immune competence, delay neurological recovery, and exacerbate adverse outcomes, particularly in those undergoing intensive interventions such as mechanical thrombectomy (MT). To objectively assess nutritional status, indices such as the Prognostic Nutritional Index (PNI) and the Controlling Nutritional Status (CONUT) score have been utilized in various clinical populations. These indices incorporate routinely available laboratory parameters, reflecting both nutritional and inflammatory states. This study explores whether PNI and CONUT scores are associated with 90-day clinical outcomes in AIS patients treated with MT, aiming to evaluate their potential utility as prognostic biomarkers in acute stroke care. Methods: A total of 404 patients with AIS who underwent MT between 2023 and 2024 were retrospectively evaluated. Demographic, clinical, and laboratory data were collected, and nutritional status was assessed using PNI and CONUT scores. Clinical outcomes were stratified as favorable (modified Rankin Scale [mRS] 0–2) or unfavorable (mRS 3–6) at 90 days post-stroke. Results: Among the 404 patients included in the study, 50.5% had favorable and 49.5% had unfavorable clinical outcomes. Patients with favorable outcomes were younger (71 vs. 78 years, p = 0.001), had lower National Institutes of Health Stroke Scale (NIHSS) scores, and higher Alberta Stroke Program Early CT Scores (ASPECTS) (p = 0.001). The puncture-to-recanalization time was significantly longer in the unfavorable outcome group (47.5 min vs. 30.0 min, p = 0.003). Laboratory findings revealed higher glucose levels (p = 0.029), and lower serum albumin (p = 0.003) and lymphocyte levels (p = 0.001) in the unfavorable outcome group. Among nutritional indices, the CONUT score was significantly higher in the unfavorable outcome group (p = 0.001), whereas the PNI score was higher in the favorable outcome group (p = 0.001). ROC analysis showed that the CONUT score had significant prognostic performance (AUC = 0.721, p < 0.001), while the PNI had poor discriminatory power (AUC = 0.274, p < 0.001). Multivariate logistic regression identified age, baseline NIHSS, ASPECT score, and CONUT score as independent predictors of clinical outcome (p < 0.05). Conclusions: Among the two nutritional indices evaluated, the CONUT score demonstrated significant prognostic value in predicting 90-day clinical outcomes after MT. In contrast, the PNI showed limited discriminatory power, highlighting the superiority of CONUT as a reliable biomarker in acute stroke care. Full article

Background/Objectives: Loop diuretics are among the most commonly used drugs in patients with heart failure with reduced ejection fraction (HFrEF). Higher doses of these diuretics are associated with poorer clinical status and may contribute to malnutrition. The study aims to assess the relationship between the use of high-dose loop diuretics and nutritional status in patients with HFrEF. Methods: The study included 353 hospitalized patients with HFrEF. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), the Geriatric Nutritional Index (GNRI), and the CONtrolling NUTritional status (CONUT). Patients were divided into three groups according to the daily dose of loop diuretics (defined as furosemide equivalent = 1 × furosemide dose and 2 × torsemide dose): low dose (LD), 40 mg/day or no treatment; medium dose (MD), 41–160 mg/day; or high dose (HD), >160 mg/day. Results: Of the evaluated patients, the mean MNA score was 23.31 ± 2.93 points, and 49.8% were at risk of malnutrition or malnourished. According to the MNA, patients in HD and MD groups had worse nutritional status than the LD group, similarly according to the GNRI. For CONUT, the differences were significant between all groups: nutritional status was the worst in the HD group, intermediate in the MD group, and the best in the LD group. Conclusions: The intake of loop diuretics, especially in high doses, correlates with an elevated risk of malnutrition in patients with HFrEF independently of sex, age, NYHA class, and left ventricular ejection fraction. Full article

Background: Assessing nutrition-related health risks in older individuals is often overlooked in clinical practice due to the lack of appropriate methods of evaluation. While anthropometric measurements and body composition analyses are mainly used, these tools are not standardized for the oldest old and fail to account for age-related changes. This underscores the need for improved assessment techniques that accurately capture the progressive and non-linear shifts in nutritional status throughout the aging process. Accordingly, the primary aim of our paper is to identify the most effective tools to use for evaluating nutritional status in the oldest population. Methods: To address this gap, we conducted a cross-sectional study, investigating the nutritional status of a cohort of Sicilian individuals aged between 65 and 111, using methods commonly applied to adult and older adult populations. These included the BIoimpedance Analysis (BIA), the Mini Nutritional Assessment (MNA) evaluation, and nutritional risk indices such as the COntrolling NUTritional Status (CONUT) score and Geriatric Nutritional Risk Index (GNRI). Results: Despite the oldest population being classified as “at risk” of malnutrition by the MNA or “cachetic” by BIA, our results indicated a “normal” or “low risk” of malnutrition when assessments were performed using tools (GNRI and CONUT) that were not reliant on body composition parameters. These findings align with clinical history assessments conducted during their recruitment. Conclusions: This pilot study highlights the need for future research aimed at developing standardized, multidimensional assessment models tailored to the heterogeneity of each age group, to improve risk stratification, clinical outcomes, and personalized nutritional care. Full article

Heart failure (HF) is a major global health burden and a leading cause of morbidity and mortality. Nutritional status has emerged as an essential factor influencing outcomes in HF, with the Controlling Nutritional Status (CONUT) score gaining attention as a simple, objective marker derived from serum albumin, total cholesterol, and lymphocyte count. This meta-analysis evaluated the prognostic value of the CONUT score in predicting all-cause mortality in patients with acute and chronic heart failure. A systematic search was conducted in the PubMed, MEDLINE, Google Scholar, and Cochrane Library databases for the past ten years, using combinations of keywords such as “heart failure”, “CONUT score”, “malnutrition”, and “mortality”. Studies were included if they reported hazard ratios (HRs) for all-cause mortality in relation to CONUT score categories in adult HF populations. Eight eligible studies comprising 15,761 patients were included. Pooled analysis showed that higher CONUT scores were significantly associated with increased all-cause mortality (pooled HR = 1.47; 95% CI: 1.30–1.66). Despite substantial heterogeneity (I² = 80%), the direction of effect was consistent across studies. The CONUT score is a useful prognostic marker in acute and chronic heart failure patients. Further research should explore the effects of targeted nutritional interventions in high-risk HF patients identified by elevated CONUT scores and efforts to standardize malnutrition cut-offs in clinical practice. Full article

Background/Objectives: Reports on oral frailty as a risk factor for chronic constipation are scarce. In this study, we examined the relationship between Oral Frailty Index-8 (OFI-8) and constipation severity. Methods: This cross-sectional analysis involved patients aged ≥65 years (outpatients between November 2020 and November 2021). Patient background (age, sex, body mass index, medical history, lifestyle history, and oral medications), a constipation severity questionnaire (Constipation Scoring System [CSS]), grip strength, walking speed, skeletal muscle mass index (dual-energy X-ray absorptiometry), a frailty questionnaire, an oral frailty questionnaire (OFI-8), an abdominal symptoms quality of life (QOL) questionnaire (Izumo scale), a swallowing evaluation questionnaire (10-item Eating Assessment Tool [EAT-10]), a chronic obstructive pulmonary disease (COPD) evaluation questionnaire (COPD assessment test [CAT]), a simplified QOL evaluation (EuroQol-five dimensions [EQ-5D]), the Dietary Variety Score, a nutritional evaluation (CONtrolling NUTritional Status [CONUT] score), and the 15-item Geriatric Depression Scale (GDS-15) were analyzed. Risk factors for constipation severity (CSS) were examined using multivariate analysis. Patients with advanced gastrointestinal cancer, inflammatory bowel disease, and active gastroduodenal ulcer were excluded. Results: In total, 1029 patients (male/female: 450/579; mean age: 78.3 ± 6.1 years; mean body mass index: 22.9 ± 3) were included. Multivariate analysis demonstrated a significant association between CSS and OFI-8 (β = 0.065), EAT-10 (β = 0.061), sarcopenia (β = 0.050), laxative (β = 0.126), constipation-related QOL score (β = 0.625), diarrhea-related QOL score (β = −0.064), and CAT (β = 0.061). Conclusions: Comprehensive risk factors associated with CSS included a high oral frailty score, impaired swallowing (EAT-10), sarcopenia, laxative use, a high constipation QOL score, a low diarrhea QOL score, and COPD assessment through CAT. Full article