Handgrip strength (HGS) using isometric dynamometry is a convenient and feasible noninvasive measure of physical strength, overall health, and nutritional status among people of all ages. While adult HGS norms have been published in many countries, no study has synthesized available data to produce representative norms during pregnancy. This study used data from an extensive national representative survey to generate gestational age-specific reference norms for HGS during pregnancy.

This cross-sectional study enrolled 1016 pregnant women aged 18-48 years old. HGS was measured using a hand dynamometer with an adjustable grip. Smoothed centile curves and tables for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles were calculated using lambda-mu-sigma (LMS) method to develop gestational age-specific norms for absolute HGS (in kilograms [kg]) and HGS normalized by height (Ht) in meters (m) squared (i.e., HGS/Ht2 in kg/m2).

We found no significant difference in absolute or normalized grip strength between trimesters and gestational weeks (p > 0.05). Median (P50), absolute and normalized HGS levels improved negligibly (equivalent to ∼0.3-1.4 kg for absolute HGS or ∼0.1-0.5 kg/m2 for normalized HGS) throughout early pregnancy (1-4 weeks to 14-17 weeks) and peaked from gestational age 23-27 weeks (at 22.97 kg [absolute HGS] or 8.74 kg/m2 [normalized HGS]) However, the gestational age-related decline in HGS levels was slightly smaller for young women than for women during middle adulthood.

This study provides the first national norms for pregnant women with HGS according to the gestational age. These norms are useful for health screening, monitoring, and surveillance, and for comparison with studies from other countries.

The Global Leadership Initiative on Sarcopenia (GLIS) was proposed recently by creating a widely recognized conceptual definition of sarcopenia, however, the diagnostic framework of GLIS in cancer patients remains unclear. This study aims to evaluate the potential framework of GLIS based on muscle mass and/or strength in cancer patients.

We performed a multicenter cohort study spanning from November 2012 to May 2020. Potential covariates were identified through univariate and multivariate analyses. The association between low muscle mass (LMM) and/or low muscle strength (LMS) with survival was estimated using Kaplan-Meier curves and Cox models. LMM was identified by lean mass index (LMI) or calf circumference (CC) while LMS was identified by hand grip strength (HGS).

A total of 6471 cancer patients were included, with a median follow-up of 50.0 months. Both LMM-LMI or LMS (HR = 1.56; 95%CI: 1.42, 1.71; p < 0.001) and LMM-LMI plus LMS (HR = 2.01; 95%CI: 1.65, 2.44; p < 0.001) were associated with a lower overall survival (OS) compared with patients without sarcopenia. Similarly, both LMM-CC or LMS group (HR = 1.51; 95%CI: 1.37, 1.67; p < 0.001) and LMM-CC plus LMS group (HR = 1.45; 95%CI: 1.28, 1.63; p < 0.001) were associated with a lower OS. Age, alcohol, Nutritional Risk Screening 2002 (NRS2002) score, Karnofsky Performance Status (KPS) score, Tumor Node Metastasis (TNM) stage, cancer category, albumin, direct bilirubin, anticancer therapy plus sex were introduced as covariates in fully-adjusted Cox model. Multivariable-adjusted Cox models revealed that LMM-LMI or LMS was an independent prognosis factor for cancer patients (HR = 1.18; 95%CI: 1.07, 1.31; p = 0.001). LMM-LMI plus LMS also was an independent predictor for survival among cancer patients (HR = 1.58; 95 % CI: 1.30, 1.94; p < 0.001).

The potential framework of GLIS based on muscle mass and/or strength was associated with survival in Chinese cancer patients. This research provides a simplified, clinically outcome-driven potential framework of sarcopenia, and offers new insights for the development of an operational definition of GLIS in the future.

This study investigated the significance of the Global Leadership Initiative on Malnutrition (GLIM) for patients with resected biliary tract cancers.

The subjects of this retrospective analysis were 114 patients who underwent radical surgery for cholangiocarcinoma between 2018 and 2023. We analyzed both handgrip force and skeletal muscle area and classified patients as having GLIM malnutrition or modified GLIM malcondition. We also evaluated clinicopathological factors, short-term outcomes, and prognoses.

The GLIM criteria identified 47 patients (41.2%) with malnutrition and 13 patients (11.4%) with modified GLIM malcondition. Overall survival (P = 0.009) and recurrence-free survival (P = 0.016) were significantly different between the well-nourished and malnourished patients according to the GLIM criteria. Furthermore, modified GLIM criteria malcondition was a significant prognostic factor for both recurrence-free and overall survival (P = 0.002 and P < 0.001, respectively). Multivariate analysis identified a higher carcinoembryonic antigen level and modified GLIM malcondition as predictors of overall and recurrence-free survival. Pathological stage ≥ III was also a predictor of recurrence-free survival. On comparing the prognoses of modified GLIM malcondition and GLIM malnutrition using the Akaike Information Criteria, the modified GLIM malcondition was identified as a stronger prognostic factor.

A modified GLIM malcondition can be a highly useful prognostic marker for patients with resected biliary tract cancer.

Medical nutrition therapy (MNT) is commonly used in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) undergoing intensive remission-induction treatment to prevent malnutrition, particularly the loss of fat-free mass (FFM)/muscle mass, as well as associated adverse outcomes. However, studies examining the associations of proactive versus wait-and-see approaches toward MNT with nutritional, physical, and clinical outcomes in these patients are lacking. Therefore, this study aimed to explore the associations of these different MNT approaches with body composition changes, as well as physical and clinical outcomes in AML/MDS patients undergoing intensive remission-induction treatment. Additionally, the study aimed to explore the relationships between body composition changes and physical and clinical outcomes, and whether these associations varied between the proactive and wait-and-see strategies.

In this multicenter prospective correlational study, newly diagnosed AML/MDS patients undergoing intensive remission-induction treatment were included. Patients were treated in one of five hospitals using a proactive approach toward MNT, initiating MNT when nutritional intake became inadequate, or in the single hospital in the Netherlands that followed a wait-and-see strategy, limiting the use of MNT to exceptional and severe cases only. Body composition was assessed at the start of treatment, weekly during admission and at discharge, and handgrip strength, and patient-reported physical functioning and fatigue at treatment initiation and discharge. Information on number of complications, and duration of fever and hospital length of stay (LOS) was collected from medical records. Within-group changes in body composition and between-group differences were tested using paired or independent t, Wilcoxon signed-rank or two-sample tests, respectively, or chi-square/Fisher's exact tests for proportions. The longitudinal patterns between proactive MNT approach/wait-and-see strategy hospitals were compared by means of linear mixed effects models. Associations between body composition changes and physical and clinical outcomes were explored using multiple linear regression models, and compared between proactive MNT approach/wait-and-see strategy hospitals.

In this study, 204 AML/MDS patients (54 % male, mean age: 56.3 ± 13.0 years) were included, of whom 140 underwent treatment in a hospital using a proactive approach toward MNT and 64 in the hospital following a wait-and-see strategy. In the proactive MNT approach hospitals, 57 % of patients received MNT during the first chemotherapy cycle versus 8 % of patients in the wait-and-see hospital (p < 0.0001). Both approaches toward MNT were associated with significant decreases in body weight, FFM/muscle mass, and muscle strength. However, losses in FFM/muscle mass and muscle strength did not differ significantly between the strategies, while body weight loss was lower with the proactive approach (estimated between-group difference during the first cycle: 0.44 kg/week (95 % CI 0.18-0.70 kg/week, p = 0.0008), primarily due to better preservation of fat mass (FM) (p < 0.05). Additionally, the proactive MNT strategy was associated with fewer nutrition impact symptoms (p < 0.0001), fewer complications (p = 0.01), and shorter LOS (33 days (IQR: 27-41) vs 29 days (IQR: 26-34), p = 0.009). Similar results were observed during the second chemotherapy cycle. Furthermore, better maintenance of body weight and indicators of FFM/muscle mass and FM were significantly associated with shorter LOS and fever duration, fewer complications, improved physical functioning and/or reduced fatigue. Several associations differed significantly between the two MNT strategies, given that decreased body composition parameters were associated with worse physical and clinical outcomes in the wait-and-see hospital, while in the proactive MNT approach hospitals these associations were opposite or attenuated and non-significant.

In AML/MDS patients undergoing intensive remission-induction treatment, a proactive approach toward MNT should be used, as it was associated with fewer nutrition impact symptoms, fewer complications, shorter LOS, and better body weight maintenance, mainly through better preservation of FM, compared to a wait-and-see strategy. Maintenance of body weight, FFM/muscle mass and/or FM was associated with improved physical and clinical outcomes. Given that proactive use of MNT could not prevent loss of FFM/muscle mass and muscle strength, future research should focus on combined nutritional and physical exercise interventions aimed at reducing these losses.

Hemodialysis affects patients' nutritional status in several ways, resulting in malnutrition, which, in turn, increases the rates of morbidity and mortality worldwide. The main aim of this study was to comprehensively examine the effect of sex-based differences on the nutritional status of Palestinian patients on hemodialysis.

This study involved hemodialysis patients from An-Najah National University Hospital (NNUH) at Nablus/Palestine. A structured questionnaire was used in this study to collect data about sociodemographic data, medical history, lifestyle habits, and functional status, as well as nutritional status, which was assessed using 4 components (anthropometric measurements, biochemical data, clinical data, and dietary data). Patients' reports were reviewed to obtain laboratory values. The malnutrition-inflammation score was used to assess the prevalence of malnutrition. Data were analyzed using univariate and multivariate analysis.

A total of 188 hemodialysis patients participated in the study. The mean age was 57.8 ± 14.0 years, ranging from 19 to 86 years old. Females were more likely to experience nausea and headache during hemodialysis than men (p < 0.05). The findings also showed that the MIS score was significantly higher in women than in men. Biochemical findings revealed that female patients had significantly lower levels of blood urea nitrogen (p = 0.003), carbon dioxide (p = 0.020), ferritin levels (p = 0.025), and serum phosphate levels (p = 0.000). In addition, women had significantly lower intakes of total carbohydrate, total fat, saturated fat, monounsaturated fatty acids, water, vitamin B1, vitamin B2, vitamin B3, calcium, phosphate, sodium, and zinc, except for vitamin B12, which was higher in females. Furthermore, functional assessments indicated that males have significantly higher handgrip strength than females, while females represented more severe malnutrition compared to males.

Our data indicates that women have more severe malnutrition compared to men, suggesting the need to consider sex-based nutritional and functional differences in hemodialysis patients by healthcare professionals.

Background: Malnutrition is a prevalent yet often overlooked issue in lung cancer patients, significantly affecting surgical outcomes. This review examines the impact of nutritional status on lung cancer surgery and explores the role of nutritional assessment and intervention strategies. Methods: A comprehensive literature search was conducted using databases such as PubMed, Scopus, and Web of Science. Key studies on nutritional status assessment, preoperative nutritional support, and their impact on surgical outcomes were analyzed. Results: Malnutrition in lung cancer patients is associated with increased postoperative complications, prolonged hospital stays, and reduced survival rates. Various assessment tools, including dietary interviews, physical examinations, laboratory tests, and body composition analyses, can help identify malnourished patients. Nutritional support strategies such as high-protein diets, oral supplements, enteral and parenteral nutrition, and perioperative immunomodulation improve clinical outcomes. Conclusions: Implementing standardized nutritional assessment and support protocols is crucial for optimizing surgical outcomes in lung cancer patients. Integrating these strategies into the Enhanced Recovery After Surgery (ERAS) protocol may further enhance recovery and long-term prognosis.

This study aims to investigate the relationship between handgrip strength (HGS) and the progression of chronic kidney disease (CKD) in non-dialysis patients in China, as part of the Self-Management Program for Patients with CKD Cohort (SMP-CKD).

In the SMP-CKD cohort, we utilized Cox regression and Kaplan-Meier survival analysis to explore the association between HGS and CKD progression. Data were stratified by sex-specific HGS quartiles, sarcopenia status, and HGS thresholds. The HGS thresholds were determined through curve analysis of HGS against composite renal outcomes. Group differences were compared to assess the impact of HGS on CKD outcomes.

A total of 441 participants (mean age 57.0 ± 17 years, 56.0% male) with CKD stages 3-5 from the SMP-CKD cohort who underwent grip strength evaluation between April 2019 and June 2024 were included in the analysis. The findings revealed that participants in the highest bilateral HGS quartile had a significantly lower risk of renal endpoints, with a hazard ratio (HR) of 0.102 (95% CI 0.041-0.255) compared to those in the lowest quartile. Patients without sarcopenia had a significantly lower risk of CKD composite outcomes, including increased serum creatinine or acute CKD exacerbations (HR 0.422, 95% CI 0.211-0.844, p < 0.012), as well as severe renal endpoints (HR 0.265, 95% CI 0.101-0.694, p < 0.003). Gender-specific cutoffs identified through log-rank test were 63.7 kg for men and 34.6 kg for women. Participants with bilateral HGS above these thresholds demonstrated better renal outcomes, underscoring the protective effect of higher HGS against CKD progression.

The study provides strong evidence that HGS is a crucial factor in reducing the risk of CKD progression. Higher levels of HGS are significantly associated with a lower occurrence of renal endpoint events.

In this paper, the authors aim to compare the ability of grip strength and the Modified Five-Item Frailty Index (mFI-5) to predict outcomes and complications in patients undergoing long segment spinal fusion.

An IRB-approved chart review was conducted to collect data on patient grip strength, comorbidities, and post-operative course. Hand grip strength was measured with the Camry Digital Hand Dynamometer. Descriptive statistics were performed with IBM SPSS Statistics Software and required Student's t-test, Pearson's correlation coefficient, and Spearman's correlation coefficient.

Patients with an increased grip strength were significantly more likely to be discharged to home as opposed to a rehabilitation facility, while patients with decreased frailty had no increased likelihood of being discharged home. Both grip strength and frailty predicted neurocritical care unit (NCCU) and total hospital stay length. Although the average grip strength was not strongly correlated with days to ambulation, right-hand strength and frailty were.

Although both increased grip strength and decreased frailty are correlated with decreased NCCU stay, only increased grip strength is associated with a higher likelihood of patients returning home postoperatively. Therefore, maximal grip strength is likely a superior predictor of postoperative outcomes than a frailty index such as the mFI-5. Given the ease of grip strength measurement and its reflection of a patient's present physical state, it is likely a very robust measure of a patient's individual preparedness for the physiologic toll of surgery and can be easily incorporated into a pre-operative evaluation.

Hand grip strength-measured by dynamometry-is an essential tool in nutritional assessment, particularly for detecting sarcopenia, even before weight or muscle mass loss is evident. In individuals with obesity, hand grip strength can help identify muscle weakness that may not be apparent due to high body mass. The purpose of this study is to describe the absolute and adjusted hand grip strength values for weight, height, body mass index (BMI), and appendicular skeletal muscle mass (ASMM) in obese patients. It also aims to determine the prevalence of low muscle strength in this group of patients and to compare these results with those obtained in a healthy population.

Prospective observational study including patients with obesity and healthy volunteers. Absolute and adjusted hand grip strength values for weight, height, BMI and appendicular muscle mass were determined in patients with obesity and compared with the results of healthy volunteers. Muscle strength was measured by hand grip strength according to Sánchez-Torralvo, Dodds, and < -2SD cut-off points of healthy reference population.

The results obtained show that the absolute hand grip strength values are higher in healthy volunteers (30.7 ± 10.5 kg) vs patients with obesity (26.6 ± 9.7 kg); p < 0.008. As for hand grip strength values adjusted for height, weight, BMI and ASMM, they are also statistically significantly higher in healthy volunteers (18.0 ± 5.5 vs. 15.9 ± 5.4, p < 0.014; 05 ± 0.10 vs. 0.2 ± 0.06, p < 0.001; 1.4 ± 0.4 vs. 0.6 ± 0.2, p < 0.001; 1.5 ± 0.2 vs. 0.9 ± 0.3, p < 0.001). According to sex, men had significantly higher absolute and adjusted hand grip strength values in both obese patients and healthy volunteers. The prevalence of low muscle strength in patients with obesity goes from 14.5% up and 23.4% depending on the cut-off points used, being higher with those of Sánchez-Torralvo´s cut-off points. Based on sex distribution, obese men had a higher prevalence of low muscle strength with absolute hand grip strength values vs women, being these differences statistically significant only with the Sánchez-Torralvo´s cut-off points. In terms of the prevalence of low muscle strength with adjusted hand grip strength values, more variable percentages (3.2%-96.8%) were observed without clear differences across sexes.

Hand grip strength values in obese patients vary according to absolute or adjusted measurements. Obese patients have lower absolute and adjusted hand grip strength values vs the healthy population. However, more studies are needed to establish specific cut-off points for hand grip strength in patients with obesity.

To investigate the independent associations of hyperandrogenaemia (HA) and polycystic ovary syndrome (PCOS) with physical fitness in women among the general population.

A population-based birth cohort study including 5889 women.

Longitudinal associations of serum testosterone (T), free androgen index (FAI), and PCOS with cardiorespiratory fitness (CRF) (measured by heart rate after a submaximal exercise test) and grip strength over the 31 to 46 years of age timespan were examined using multivariable linear mixed models adjusted for time, body mass index, homeostatic model assessment of insulin resistance, physical activity and smoking. The results are reported as regression coefficients (β) with corresponding 95% confidence intervals [95% CI].

The third and fourth T and FAI quartiles were associated positively with higher heart rate after the submaximal exercise test in multivariable models indicating poorer CRF compared with women in Q1 of T and FAI (Q3: β of T = 1.58 [95% CI: 0.21 to 2.96], β of FAI = 1.97 [0.54 to 3.39]; Q4: β of T = 1.88 [0.46 to 3.30], β of FAI = 2.70 [1.15 to 4.25]). The second, third, and fourth quartiles of FAI were associated with higher grip strength in multivariable models compared with women in Q1 (Q2: β = 0.59 [0.04 to 1.14], Q3: β = 0.74 [0.16 to 1.30], Q4: β = 0.68 [0.06 to 1.27]). Excluding women with PCOS did not alter these results, while PCOS itself was not associated with CRF or grip strength.

Hyperandrogenaemia in premenopausal women was associated with poorer CRF but better grip strength, independently of PCOS, which suggests that HA, rather than PCOS, has an independent and complex association with physical fitness in premenopausal women.

Grip strength and muscle-strengthening activity (MSA) have been independently associated with type 2 diabetes mellitus (T2DM). However, analyses that consider grip strength in conjunction with MSA, while factoring in age and sex as well, are limited. Therefore, we aimed to investigate the association of relative grip strength (RGS) and MSA, separately and in combination, with T2DM, considering differences in age and sex.

A total of 27,702 participants aged 19 years and older were included from 2014 to 2021 from the Korea National Health and Nutrition Examination Survey. The association between RGS, MSA, and T2DM was assessed using logistic regression analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for the independent and joint associations of RGS and MSA on T2DM prevalence.

Highest (Q4) RGS levels were independently associated with lower odds of T2DM (OR, 0.39; 95% CI, 0.32 to 0.46; P for trend <0.001). Similarly, engaging in MSA 2 o 3 days per week was associated with lower odds of T2DM (OR, 0.80; 95% CI, 0.66 to 0.96), although the trend was not statistically significant (P for trend=0.775). In the joint analysis, participants with normal RGS and engaging in MSA ≥2 days per week had the lowest odds of T2DM (OR, 0.60; 95% CI, 0.51 to 0.70).

Higher RGS and engaging in MSA 2 to 3 days per week are independently associated with lower likelihood of T2DM. The combined association of normal RGS and MSA 2 days or more per week shows the greatest benefit for T2DM prevention.

Objectives: the impact of handgrip strength (HGS) on postoperative complications and long-term survival following hepatectomy in patients with primary liver cancer (PLC) remains unclear. This study aimed to evaluate the influence of HGS on postoperative complications and overall survival in patients with PLC. Methods: in total, 298 patients with PLC who underwent liver resection were included in the prospective cohort study. Baseline, surgical, and histopathological factors were analyzed using univariate and multivariate analyses to identify risk factors for postoperative complications and mortality. Results: the incidence of major postoperative complications was 40.3 % and 24.6 % in the low and high HGS groups, respectively. During the median follow-up period of 28.8 months, 57 patients (19.1 %) died. patients with low HGS demonstrated a significantly shorter median overall survival compared to those with high HGS (p < 0.001). Short-term analysis revealed that low HGS (p = 0.022) and intraoperative blood loss (≥ 200 ml) (p < 0.001) were independently associated with postoperative complications. Furthermore, low HGS was identified as an independent predictor of poor overall survival in long-term survival analysis (p = 0.005). Conclusions: preoperative HGS emerged as an independent factor for postoperative complications and a prognostic indicator of poor long-term outcomes in patients with PLC.

Handgrip strength (HGS) is a simple yet effective bed-side tool for assessing muscle strength, which plays an important role in clinical evaluation and monitoring. We hypothesize that repeated measurements of HGS during the hospital stay may serve as a reliable and robust indicator of clinical course and outcomes.

We re-analyzed data from 565 out of 2028 patients who had repeated handgrip measurement (on admission and on day 7) included in EFFORT, a Swiss-wide multicenter, randomized controlled trial comparing individualized nutritional support with usual care nutrition in medical inpatients. The primary endpoint was 180-day all-cause mortality.

The mean change in HGS from baseline to day 7 was 0.6 kg (SD 4.2) in female and 0.7 kg (SD 3.7) in male patients. Patients with a positive HGS trend had a lower risk of dying within 180 days compared to patients without a positive trend (mortality 11.4% vs. 25.4%, adjusted HR 0.45 [95% CI 0.27 to 0.77], p = 0.003). The change in HGS was also associated with the nutritional intake during the hospitalization in male patients: those who met their energy and protein targets were twice as likely to have an increase in HGS during hospitalization (adjusted OR 2.05 [95% CI 1.23 to 3.42], p = 0.006).

Achieving nutritional targets was associated with a short-term increase in HGS during hospitalization, and a positive HGS trend was associated with a lower risk of mortality after 180 days. These data provide evidence that repeated HGS measurements are a robust bedside tool for assessing and monitoring patients receiving nutritional therapy in the hospital.

ClinicalTrials.gov Identifier: NCT02517476.

Pinch and grip strengths are vital indicators of upper limb function, musculoskeletal health, and general health. While most research has focused on older individuals, it is crucial to build normative data for younger populations. This cross-sectional study was conducted to determine the normative values for lateral pinch strength (LPS) and hand grip strength (HGS) in healthy adult Singaporeans.

The study recruited 500 healthy individuals without any serious general illnesses and upper limb pain, aged 21-80 years. LPS and HGS were measured using a standardized JAMAR hand dynamometer. Age, gender, hand dominance, and participant demographics were recorded. Normative values were then established for different age groups and hand dominance. A machine learning approach was employed to determine the most relevant variables for dominant LPS and HGS in our data, respectively.

Our data showed that HGS and LPS peaked between 40-44 years of age in women. In men, average HGS peaked between 35-39 years and LPS peaked between 50-54 years. Compared to the non-dominant side, dominant HGS was 6.86% and 6.23% higher in women and men, respectively. The difference between dominant and non-dominant LPS in men and women was 6.96% and 9.18%, respectively. Age was strongly associated with hand strength for older participants, but not for younger ones. Height, weight, and age were important for predicting dominant HGS and LPS, and gait speed for HGS only.

Our data align with past results, but the normative values are comparatively lower than the consolidated Western norms. Compared to the non-dominant hand, the strength of the dominant hand is significantly higher. No statistical difference between the right- and left-handed participants in terms of dominant HGS and dominant LPS. The results can be valuable for researchers and healthcare providers working with young and older adults.

Human pelvic evolution following the human-chimpanzee divergence is thought to result in an obstetrical dilemma, a mismatch between large infant brains and narrowed female birth canals, but empirical evidence has been equivocal. By using deep learning on 31,115 dual-energy x-ray absorptiometry scans from UK Biobank, we identified 180 loci associated with seven highly heritable pelvic phenotypes. Birth canal phenotypes showed sex-specific genetic architecture, aligning with reproductive function. Larger birth canals were linked to slower walking pace and reduced back pain but increased hip osteoarthritis risk, whereas narrower birth canals were associated with reduced pelvic floor disorder risk but increased obstructed labor risk. Lastly, genetic correlation between birth canal and head widths provides evidence of coevolution between the human pelvis and brain, partially mitigating the dilemma.

Patients with colorectal cancer (CRC) often present with malnutrition upon admission, which is associated with a poor prognosis. However, current traditional tools for diagnosing malnutrition do not assess muscle function. This study aims to explore whether the evaluation of muscle function has predictive value for the prognosis of CRC patients with malnutrition.

We retrospectively analyzed the clinical parameters of patients with CRC and malnutrition based on the Global Leadership Initiative on Malnutrition criteria who underwent radical surgery at our center from 2015 to 2021. Patients were grouped according to their preoperative muscle function assessments. The clinical characteristics and postoperative outcomes were compared between the groups. The risk factors for postoperative complications were analyzed.

A total of 346 patients were included in the study. Patients with low handgrip strength had higher incidences of total (p = 0.001), surgical (p = 0.015) and medical (p = 0.024) complications and longer postoperative hospital stays (p = 0.026). Patients with low gait speed had higher incidences of total (p = 0.027) and medical (p = 0.004) complications. Low handgrip strength was an independent risk factor for total (p = 0.008) complications, surgical (p = 0.038) complications and overall survival (p = 0.003). Low gait speed was an independent risk factor for medical complications (p = 0.021).

For malnourished CRC patients, preoperative assessment of muscle function during perioperative care can predict adverse postoperative outcomes and can be incorporated into a comprehensive nutritional management plan.

ObjectiveThis study examined the longitudinal reciprocal association between handgrip strength and cognitive function and the temporal sequence of changes in both factors in a national longitudinal cohort of Chinese older adults.MethodData were derived from 3 waves (2011 baseline and 2013, 2015 follow-up) of the China Health and Retirement Longitudinal Study (CHARLS). Participants were those with no memory-related disorders at baseline and follow-up, and those who had complete handgrip strength and cognitive data. Handgrip strength in at least 1 hand was measured in all 3 waves. The highest recorded value during the handgrip test was used as the outcome of the strength measurement. Mental intactness and episodic memory were used to assess the overall cognitive function at each wave of data collection. Cross-lagged panel models were used to examine the relationship between handgrip strength and cognition over time.ResultsA total of 2550 participants were included in the data analysis. Age of participants at baseline was 60-83 years, and 43.9% were female (n = 1120). The 5.7% of participants with weak muscle strength (n = 145), had slightly lower cognitive function than those in the normal group. Cross-lag panel analysis showed that baseline overall cognitive scores predicted subsequent handgrip strength. At the same time, handgrip strength at baseline predicted subsequent overall cognitive scores. The results remained robust after accounting for confounding factors.ConclusionThere was a longitudinal bidirectional correlation between handgrip strength and cognitive function in elderly Chinese individuals. Future studies should determine whether interventions to improve 1 (e.g., handgrip strength) might slow the development of the other (e.g., cognitive function).

Musculoskeletal disorders (MSDs) represent a significant global health burden. While physical activity (PA) and physical fitness are both thought to reduce MSD risk, their independent and joint associations with MSD incidence have not been fully explored. This study investigated the independent and combined effects of PA, cardiorespiratory fitness (CRF), grip strength (GS), and GS asymmetry on MSD incidence in a large prospective cohort.

We analyzed data from the UK Biobank cohort (2006-2023), including 406,080 participants aged 37-73 years (age = 55.7 ± 8.2 years, mean ± SD; 53.0% female) who were free of MSD at baseline and during the first 2 years of follow-up. PA, derived from self-reported data and expressed in total metabolic equivalent hours per week (MET-h/week); CRF (watts (W)/kilogram (kg)), measured using a cycling exercise test; and GS (kg), measured by hydraulic hand dynamometer, were included as exposures. GS asymmetry was defined by the left-to-right hand strength ratio. MSD incidence was determined via hospital records. Time-to-event associations were analyzed using Cox proportional hazards regression models with restricted cubic splines to account for non-linear relationships. The analysis was conducted in April 2024.

Over a median follow-up of 14.7 years, a total of 73,002 incident cases of MSDs were recorded (rheumatoid arthritis: 2923; osteoarthritis: 54,955; degenerative spinal diseases: 15,124). Lower self-reported PA (<4.8 MET-h/week) was associated with increased MSD risk (hazard ratio (HR) = 1.07, 95% confidence interval (95% CI), 1.07-1.08). Low CRF (<1.7 W/kg; HR = 1.09, 95% CI, 1.06-1.13), low GS (<30.0 kg mean GS; HR = 1.11, 95% CI, 1.10-1.13), and GS asymmetry (HR = 1.11, 95% CI, 1.08-1.13) were also significantly associated with increased MSD risk. Good CRF and GS, and lower GS asymmetry mitigated the higher MSD risk associated with low PA levels.

Low levels of PA, CRF, GS, and GS asymmetry were associated with a higher risk of incident MSD. Meanwhile, improvements in CRF, GS, and GS balance could help offset the risk of MSD incidence in populations with insufficient PA.

Head and neck cancer (HNC) incidence is increasing, and surgery is frequently indicated as curative treatment. Unfortunately, complications and long-term functional impairment are common. Recent promising results of multimodal prehabilitation in colorectal cancer surgery show improved recovery and functional outcomes. The objective of this study is to assess the feasibility of multimodal prehabilitation, which is composed of high-intensity training, a protein-enriched diet, cessation of intoxications, mental support and speech support therapy, in HNC surgery.

A feasibility study was conducted at a large teaching hospital, Northwest Clinics, Alkmaar, the Netherlands, between July 2022 and December 2023. The primary outcome was feasibility, defined as participation, dropout and adherence rate. The secondary outcome was functional capacity 6 weeks postoperatively.

The participation rate was 60% (30 of 50 patients), mainly limited due to the travel distance to the physiotherapist. A dropout rate of 7% was present, as two patients discontinued prehabilitation. Of the remaining 28 patients, 27 patients (96%) attended at least six sessions at the community physiotherapist practice. All functional tests increased by prehabilitation, with the 6-min walking test being significant (p ≤ 0.05). Six weeks postoperatively, all but steep ramp tests remained higher than baseline.

Feasibility of multimodal prehabilitation in HNC surgery patients in this study is limited by its participation rate of 60%. Addressing participation, a widespread network of oncologic physiotherapists or home-based multimodal prehabilitation by an app could possibly potentiate participation. More studies are needed to assess the optimal form of multimodal prehabilitation in this challenging population.

With an aging population, the prevalence of lumbar spinal diseases necessitating surgical intervention is increasing. Handgrip strength (HGS) has emerged as a simple measure of muscle function that may correlate with surgical outcomes. However, the role of HGS concerning postoperative recovery following transforaminal lumbar interbody fusion (TLIF) is not well-studied, highlighting a gap in the literature regarding its potential as a prognostic tool.

This prospective observational study included 89 patients who underwent TLIF performed by a single surgeon. Patients were categorized into normal and low HGS groups based on preoperative HGS measurements. Demographics, baseline HGS, and surgical details were recorded, and outcomes were assessed using the JOA, EQ-5D-3L, and Barthel Index at 3, 6, and 12 months postoperatively. Generalized Estimating Equations were used to examine associations between baseline parameters and outcomes over time.

All patients were followed for at least one year, except for 15 (15.6%) who were lost to follow-up before the one-year mark. Patients with lower preoperative HGS were associated with significantly poorer postoperative functional outcomes. Specifically, a one-unit decrease in HGS was associated with a 2.551-point decrease in the JOA score (p = 0.008), a 0.142-point decrease in the EQ-5D-3L score (p = 0.007), and a 5.784-point decrease in the Barthel Index (p = 0.036). Additionally, male sex, higher body mass index, and lower Charlson comorbidity index were associated with better postoperative outcomes.

Low preoperative handgrip strength is associated with poorer functional, quality of life, and independence outcomes up to 12 months after TLIF surgery. Assessing HGS preoperatively may provide clinicians with valuable information for identifying patients at risk of suboptimal recovery. Future research could explore intervention strategies to improve preoperative muscle function and potentially enhance recovery outcomes for patients undergoing TLIF.

Long-term exercise is increasingly considered an effective strategy to counteract cognitive decline associated with aging. Previous studies have indicated that circuit training exercises integrating aerobic and resistance modalities positively affect cognitive function. Furthermore, a growing body of evidence suggests that long-term exercise alters the gut microbiota, leading to an optimal environment for cognitive enhancement. Recent empirical evidence suggests that exercise plays a significant role in modulating aging-control factors at the protein level. Although the interaction between exercise and cognitive function is multifaceted, most studies have only examined a direct pathway from exercise to cognitive function. Therefore, this study aims to elucidate the effects of long-term circuit training on cognitive function through a comprehensive analysis of factors such as gut microbiota and proteins related to aging control.

A total of fifty-one participants will be randomly assigned to either the circuit training or waitlist control group. The intervention group will participate in a circuit training program developed by Curves Japan Co., Ltd. two to three times weekly for 16 weeks. The control group will continue their usual daily routines without participating in any new active lifestyle program. The participants will undergo cognitive assessments at baseline and after the intervention. Fecal and blood samples for protein analysis will be collected before and after the intervention. The effect of exercise on cognition will be analyzed by comparing the measured outcomes before and after the intervention. The associations among these outcomes will be assessed using a linear mixed model and structural equation modeling approaches.

This study aims to provide the first insights into the comprehensive effects of exercise on cognitive function from the perspectives of gut microbiota and aging control. The findings are expected to contribute to improving brain health and combating age-related cognitive decline. Furthermore, the findings may help establish new guidelines for future studies on the relationship between exercise and cognitive function.

After COVID-19 infection, long-term impacts on functioning may occur. We studied the functioning of patients with post-COVID-19 condition (PCC) and compared them to controls without PCC.

This cross-sectional study consisted of 442 patients with PCC referred to rehabilitation at the Helsinki University Hospital (HUS) Outpatient Clinic for the Long-Term Effects of COVID-19, and 198 controls without PCC. Functioning was assessed with a questionnaire including WHODAS 2.0. Patients underwent physical testing including a hand grip strength test (HGST) and a 6-minute walking test (6MWT). Lifestyle was assessed by questionnaire and comorbidities were collected as ICD-10 codes from the HUS Data Lake on the HUS Acamedic platform.

The WHODAS 2.0 average total score was 34 (SD 18) (moderate functional limitation) for patients with PCC and 6 (SD 8) (normal or mild limitation) for the controls. The disability was higher in all aspects of WHODAS 2.0 in patients with PCC. Bivariate binomial and multivariable regression analyses showed that the presence of comorbidities, anxiety, depression, and smoking predicted a WHODAS 2.0 score of 24 (moderate functional limitation) or above in the PCC group. The average 6MWT distance was 435 m (SD 98 m) in patients with PCC and 627 m (SD 70 m) in controls. HGST measurements showed no significant differences from controls.

In conclusion, patients with PCC had significantly reduced functioning based on WHODAS 2.0 scores and the 6MWT results. Comorbidities, anxiety, depression, and smoking were associated with moderate or severe limitations in functioning. Findings support that PCC is multifactorial and requires a holistic approach to rehabilitation.

Multicenter comparative cohort.

Studies have shown markedly higher rates of complications and all-cause mortality following surgery for adult cervical deformity (ACD) compared with adult thoracolumbar deformity (ATLD), though the reasons for these differences remain unclear. Our objectives were to compare baseline frailty, disability, and comorbidities between ACD and complex ATLD patients undergoing surgery.

Two multicenter prospective adult spinal deformity registries were queried, one ATLD and one ACD. Baseline clinical and frailty measures were compared between the cohorts.

616 patients were identified (107 ACD and 509 ATLD). These groups had similar mean age (64.6 vs 60.8 years, respectively, P = .07). ACD patients were less likely to be women (51.9% vs 69.5%, P < .001) and had greater Charlson Comorbidity Index (1.5 vs .9, P < .001) and ASA grade (2.7 vs 2.4, P < .001). ACD patients had worse VR-12 Physical Component Score (PCS, 25.7 vs 29.9, P < .001) and PROMIS Physical Function Score (33.3 vs 35.3, P = .031). All frailty measures were significantly worse for ACD patients, including hand dynamometer (44.6 vs 55.6 lbs, P < .001), CSHA Clinical Frailty Score (CFS, 4.0 vs 3.2, P < .001), and Edmonton Frailty Scale (EFS, 5.15 vs 3.21, P < .001). Greater proportions of ACD patients were frail (22.9% vs 5.7%) or vulnerable (15.6% vs 10.9%) based on EFS (P < .001).

Compared with ATLD patients, ACD patients had worse baseline characteristics on all measures assessed (comorbidities/disability/frailty). These differences may help account for greater risk of complications and all-cause mortality previously observed in ACD patients and facilitate strategies for better preoperative optimization.

To determine whether calf circumference, hand grip strength, and physical performance are linked to the incidence of serious adverse events (SAEs) in patients with subacute stroke.

Retrospective cohort study.

Single rehabilitation hospital.

Patients with stroke admitted for rehabilitation hospital.

Not applicable.

The incidence of SAEs, such as death, cardiovascular events including recurrent stroke, and conditions requiring transfer to another hospital for specialized care or immediate treatment for an acute illness during hospitalization.

A total of 341 patients (median age: 74y) participated in this study, with 232 patients (68%) exhibiting low-physical performance. In the adjusted model, low-physical performance was significantly associated with SAEs (hazard ratio [HR], 3.01; 95% confidence interval [CI], 1.04-8.68; P=.042). However, low calf circumference (HR, 1.60; 95% CI, 0.76-3.38; P=.219) and low hand grip strength (HR, 0.98; 95% CI, 0.39-2.42; P=.960) did not show an independent association.

Low-physical performance was independently associated with the occurrence of SAEs during hospitalization for rehabilitation in patients with subacute stroke.

Background: This study aimed to develop machine learning models for estimating the handgrip strength (HGS) in healthy adults and to identify the model with the highest accuracy and generalizability. Methods: Data from the Korean National Health and Nutrition Examination Survey (2014-2019), including 21,147 participants aged >19 years, were analyzed. The maximum HGS was measured using a standardized protocol, with 11 demographic, anthropometric, and physical activity predictors. Polynomial regression (PR), multilayer perceptron (MLP), and extreme gradient boosting (XGBoost) models were developed and evaluated using the root-mean-square error (RMSE) and coefficient of determination (R2). Results: The HGS was found to vary by gender, age, and hand dominance, with males and younger individuals showing higher values. The XGBoost model achieved the highest R2 (0.717), demonstrating superior predictive accuracy and generalizability compared with PR and MLP. Key predictors in the XGBoost model included weight, age, height, and waist circumference, while hand dominance was less significant. Conclusions: The XGBoost model outperformed the MLP and PR models, achieving the highest R2 value. It holds promise for clinical applications, enabling accurate HGS estimation to support early diagnosis, targeted interventions, and personalized goal setting.

Serum alkaline phosphatase (ALP) plays a crucial role in bone and muscle health. Previous studies have demonstrated that serum alkaline phosphatase (ALP) is closely associated with muscle mass. Nevertheless, the association between serum alkaline phosphatase (ALP) and grip strength remains unclear. Therefore, the present study focused on exploring the association of serum ALP with grip strength in middle-aged and elderly people.

We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey conducted from 2011 to 2014. A total of 3514 participants (1891 males and 1623 females) aged 40-80 years were included in this study. Serum ALP and pelvic grip strength were analyzed as independent and dependent variables, additional variables were the possible impact modifiers. weighted generalized linear models and stratified analysis by gender, age group, and race were applied to assess the relationship between serum ALP and grip strength. Smooth curve fitting and threshold effect analysis/saturation effect analysis were used to analyze the nonlinear relationship between the 2 variables.

In the gender-stratified subgroup analysis, we observed an inverse association between serum ALP and grip strength in both male and female. When stratified by age group, the association remained significant among participants 40-59 years of age, but not among those ≥ 60 years old. When stratified by race, the association remained significant among Non-Hispanic White and Non-Hispanic Black. It is noteworthy that serum ALP and grip strength showed a significant negative correlation among female aged 40-59 years, but not among female aged ≥ 60 years. Additionally, Smooth curve fitting showed that serum ALP had a nonlinear relationship with grip strength in male aged 40-59 years and male aged over 60 years, the inflection points are 54 IU and 97 IU respectively.

Our study revealed an inverse relationship between serum ALP and grip strength, this finding offers new insights and avenues for understanding how serum alkaline phosphatase affects skeletal muscle health.

To investigate the prevalence of malnutrition and sarcopenia in different disciplines of inpatient rehabilitation and the course of nutritional status parameters.

Multi-centre cross-sectional prevalence study and longitudinal observational study.

Inpatients (> 18 years) in geriatric, pulmonary, cardiovascular, internal medicine/oncological, musculoskeletal, or neurological rehabilitation in 5 rehabilitation centres were included.

Malnutrition was assessed according to the Global Leadership Initiative on Malnutrition criteria. Sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People criteria. Bodyweight, hand grip strength (HGS), and functional independence measure (FIM) were assessed within 3 days of admission and after 21 days of rehabilitation and analysed using linear mixed models with time*diagnosis interaction.

The study included 558 patients (51.8% male, median age 73.0 years). The overall prevalence of malnutrition and sarcopenia was 35.5% (95% CI 31.5, 39.6%) and 32.7% (95% CI 28.8, 36.8%), respectively. Patients with risk of malnutrition lost on average 1.14 kg (95% CI -1.64, -0.63) during rehabilitation. Patients slightly increased their HGS and FIM, irrespective of risk or diagnosis of malnutrition or sarcopenia. However, at the end of the rehabilitation, malnourished or sarcopenic patients had still a significantly lower bodyweight, HGS, and FIM than patients without (p < 0.01). Some 37.3% of patients at risk of and 35.4% with diagnosed -malnutrition did not receive group or individual nutritional -counselling.

Malnutrition and sarcopenia are highly prevalent during inpatient rehabilitation. Nevertheless, dietitians are often not involved in the therapy. While nutritional parameters and functional independence improve, patients with malnutrition and sarcopenia remain on a lower level after 3 weeks of rehabilitation. Long-term follow-up after rehabilitation is recommended to prevent nutritional and muscular decline and related negative health outcomes.

There is a need for population-based reference values of handgrip strength, which is an objective measurement reflecting muscle status, in the paediatric population and there is limited data on the prognostic importance of handgrip strength. The aim of the study was to establish reference percentiles for handgrip strength in healthy Turkish children and to investigate the relationship between handgrip strength and clinical outcomes in hospitalised children.

A total of 1437 healthy children and 103 hospitalised children aged 6-16 years were included in this cross-sectional study. Healthy children were used for the development of sex-specific handgrip strength centiles adjusted for age and height using the Generalised Additive Models for Location, Scale and Shape package. Reference values of age and height specific handgrip strength of children between the ages of 6 and 16 were calculated and curves were plotted. Nutritional risk was assessed in the first 48 h of hospital admission using Paediatric Yorkhill Malnutrition Score.

Of the hospitalised children, 32% were at medium risk and 46.6% were at high risk of malnutrition. Lower handgrip strength was 28.2% in the hospitalised children. High risk of malnutrition and lower handgrip strength increased the length of hospital stay in all regression models.

The reference centiles for age- and height-specific handgrip strength, developed for the first time for Turkish children, will enable assessment and interpretation of muscle status. Lower handgrip strength is associated with longer hospital stay in hospitalised children.

There is limited evidence about the association of muscle mass, strength and quality with respiratory disease, especially in Chinese populations. We aimed to comprehensively examine such associations and identify better metrics with more clinical and public health relevance.

We conducted a prospective cohort study based on data from the second resurvey of the China Kadoorie Biobank (CKB) study in participants with no prevalent respiratory disease or cancer. Arm muscle quality was calculated as the ratio of grip strength to arm muscle mass. Low muscle mass, grip strength and arm muscle quality were defined as the sex-specific lowest quintiles of corresponding variables. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for respiratory disease.

In total, 17 510 participants aged 38-88 (65.4% women; mean age 57.8 ± 9.6) were enrolled in 2013-2014 and followed up until 31 December 2018. During a median follow-up of 4.82 years, 1346 participants developed respiratory disease. After adjustment for sociodemographic characteristics, lifestyle factors and medical histories, the elevated HR of respiratory disease was 1.31 (1.14-1.51) for low grip strength and 1.25 (1.09-1.44) for low arm muscle quality. Grip strength and arm muscle quality exhibited a linearly inverse association between respiratory disease (p = 0.137 and 0.102), with each standard deviation (SD) decrease in grip strength and arm muscle quality associated with a 22% (95% CI: 11%-34%) and 14% (95% CI: 7%-22%) increased risk of respiratory disease. No association was found for low total muscle mass index and low appendicular muscle mass index.

Low grip strength and arm muscle quality are associated with increased risks of respiratory disease, and they are better muscle-related metrics for identifying adults at high risk of respiratory disease. Chinese adults may need to maintain normal muscle mass, strength and quality to achieve better respiratory health, but this needs to be validated in appropriately designed clinical trials.

Weak handgrip strength and slow timed up-and-go (TUG) time are known risk factors for hospitalization among older adults; however, few studies have investigated the relationships between these physical tests and future hospitalization costs.

We used data from 13,613 participants in the population-based Singapore Chinese Health Study who underwent assessment for handgrip strength and TUG time at a mean age of 74 years. Hospitalization costs for the subsequent year, among those who survived for at least one year thereafter, were ascertained via linkage with administrative healthcare finance data. We analyzed costs using a two-part model that contained a probit regression model in the first part, and a generalized linear regression model with gamma distribution and log link in the second.

Handgrip strength showed a dose-dependent inverse relationship with hospitalization costs (Ptrend<0.001). Compared to the strongest quartile, participants in the weakest quartile experienced a 38.2% (95% CI: 18.0-58.5%) increase of US$599 (US$281-US$917) in mean costs. Conversely, TUG time demonstrated a dose-dependent positive association with hospitalization costs (Ptrend<0.001). Compared to the fastest quartile, participants in the slowest quartile had a 103.0% (72.1-133.9%) increase of US$1431 (US$1002-US$1859) in mean costs. We then examined combinations of handgrip strength and TUG time. Compared to participants who were both strong and fast, participants who were either weak or slow only had 12.9-48.7% higher mean costs. Meanwhile, participants who were both weak and slow experienced a 99.9% (68.5-131.4%) increase of US$1630 (US$1116-US$2144) in mean costs.

Weak handgrip strength and slow TUG time were independently associated with increased hospitalization costs among older adults.

Hand grip strength is a critical indicator of upper extremity function, especially important in healthcare professions. Effective upper extremity function relies on proximal stability from the scapula and distal mobility from hand actions. This study aimed to examine the relationship between scapular dyskinesia and hand grip strength in healthcare students with smartphone addiction.

A descriptive cross-sectional study was conducted with 63 students with smartphone addiction. Scapular dyskinesia was measured using Lateral Scapular Slide Test (LSST) at neutral, 45 and 90 degrees. Hand grip strength was measured using the Jamar Hydraulic hand dynamometer. The Short version of Smartphone Addiction Scale (SAS-SV) questionnaire assessed the severity of smartphone addiction, while the Disability of Arm, Shoulder and Hand (DASH) questionnaire evaluated the impact on upper extremity function.

A negative correlation was found between LSST at 45degrees and hand grip strength. However, no significant correlation was observed between SAS-SV, DASH, and scapular dyskinesia.

Findings of the present study report a negative association between scapular dyskinesia at 45 degrees of LSST and hand grip strength. This suggests greater the scapular dyskinesis, lower will be the hand grip strength.

This study investigated elite German athletes to (1) assess their serum 25(OH)D levels and the prevalence of insufficiency, (2) identify key factors influencing serum 25(OH)D levels, and (3) analyze the association between serum 25(OH)D levels and handgrip strength.

In this cross-sectional study, a total of 474 athletes (231 female), aged 13-39 years (mean 19.3 years), from ten Olympic disciplines were included. Serum 25(OH)D levels were analyzed via liquid chromatography-mass spectrometry, and 17 single nucleotide polymorphisms (SNPs) related to vitamin D metabolism were determined using leukocyte DNA. Grip strength was measured unimanually using a hand-held dynamometer. Multiple linear regressions were used to analyze the influence of SNPs, age, sex, season (summer vs. winter), and discipline (indoor vs. outdoor) on 25(OH)D status. Linear regression analyzed the relationship between handgrip strength and serum 25(OH)D levels.

In total, 55.5% (n = 263) of athletes demonstrated insufficient serum 25(OH)D levels (< 30 ng/mL, < 75 nmol/L), with 16% (n = 76) showing levels below 20 ng/mL (50 nmol/L). After correction for multiple testing, significant influences on 25(OH)D levels were observed for the C allele of VDBP rs7041 (AC Genotype: β ^  = 7.46, p < .001; CC Genotype: β ^  = 6.23, p = .001). Age (all p < .01) and discipline (indoor vs. outdoor; all p < .05) also influenced serum 25(OH)D levels. Furthermore, serum 25(OH)D was positively associated with handgrip strength ( β ^ = 0.01, p < .001).

A high prevalence of insufficient 25(OH)D levels (< 30 ng/mL, < 75 nmol/L) was observed. We identified certain genetic variants as well as age and discipline as predictors of serum 25(OH)D levels. This knowledge may guide individualized diagnostic, nutritional, and supplementation strategies.

Frailty is a well-known complication of chronic liver disease and has been recognized as a poor prognostic factor in cirrhotic patients being associated with increased morbidity and mortality. There is limited available pediatric literature in this regard. The current study aimed to estimate the prevalence of frailty and analyze the predictive factors and their association with long-term outcomes in children with liver disease.

Children (6-18 years of age) with cirrhotic liver disease (CLD) and noncirrhotic portal hypertension (NCPH) were prospectively enrolled. Frailty assessment was performed using the five classic Fried Frailty criteria. The children were followed up for 12 months to assess long-term outcomes.

The study included 170 children (CLD [n = 149; compensated CLD or CCLD, n = 109; decompensated CLD or DCLD, n = 40) and NCPH [n = 21]). The overall prevalence of frailty was 48% (40% in CCLD, 80% in DCLD group and 33% in NCPH group [p < 0.05]). Among the patients with CLD, 76 (51%) were identified as frail. Frail children had a significantly higher risk of decompensation and poorer hepatic synthetic functions, and their presence at baseline predicted future risk of decompensation, infectious complications, need for readmissions, and poor outcome (death) (p < 0.05).

There is a high prevalence of frailty in children with liver disease, which is associated with poorer clinical outcomes, including the risk of mortality. Thus, its presence in children with liver disease highlights the urgent unmet need for additional interventions to improve overall muscle mass and function.

Orthognathic surgery often leads to decreased nutrient intake and increased metabolic demands, potentially resulting in muscle mass loss and delayed recovery. The use of oral nutritional supplements (ONS) alongside nutritional counselling has been proposed to mitigate these effects. This study aimed to investigate the impact of ONS on the postoperative nutritional status of patients undergoing orthognathic surgery.

A 12-week randomized controlled trial was conducted at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand. The recruitment period was extended from July to December 2022 due to unforeseen delays. Patients aged 18 or older, undergoing orthognathic surgery involving at least one jaw, and without metabolic diseases or allergies were included. The intervention group received nutritional counselling and ONS for one-month post-surgery, while the control group received only nutritional counselling. The primary outcome was nutritional status, assessed through anthropometric, biomarker, and muscle strength measurements at various time points.

A total of 28 participants completed the study (control group: n=12, intervention group: n=16). Both groups experienced postoperative weight and muscle mass loss. While the intervention group showed a significantly lower weight loss at two- and four-weeks post-surgery, no significant differences were found in other nutritional status parameters or oral health-related quality of life between the groups after 12 weeks.

The addition of ONS to nutritional counselling did not significantly improve the overall nutritional status of orthognathic surgery patients in the long term. Further research is needed to explore more personalized and intensive nutritional interventions to enhance postoperative recovery in this population.

Thai Clinical Trials Registry, TCTR20220624006. Registered 24 June 2022.