The 2019 Enhanced Recovery After Cardiac Surgery (ERACS) guidelines presented perioperative recommendations to optimize treatment for patients undergoing cardiac surgery (CS). However, the guidelines have not established postoperative nutrition recommendations. Limited studies have analyzed oral intakes after CS, but to our knowledge, none have done so in an ERACS pathway. The main objective of this study was to evaluate the adequacy of postoperative oral intakes, including adherence to oral nutrition supplements (ONSs).

This was an observational prospective study. Postoperative oral intakes were analyzed from postoperative day (POD) 1 to 4, using direct observation of meal plates provided by the hospital. ONSs consumption was evaluated from POD2 to POD4. Adherence to other ERACS recommendations, including nutrition optimization before surgery, was recorded.

Forty-three patients were included in this study. Nutrition optimization before CS was offered to three (7%) patients. Forty-one (95%) patients resumed oral intakes on POD1. Mean oral calorie and protein intakes from POD2 to POD4 were 1088 ± 437 kcal and 0.8 ± 0.3 g/kg, respectively; however, 17 (41%) patients had calorie and protein intakes ≥70% of their estimated requirements. On POD2, ONSs consumption contributed 35% ± 19% and 38% ± 20% of calorie and protein intake, respectively. There was a significant decrease in ONSs consumption starting on POD3.

Within an ERACS pathway and with the contribution of ONSs, 41% of patients achieved sufficient oral intakes within the first 4 days after CS. The optimization of ONSs adherence on postoperative oral intakes should be further studied.

The Global Leadership Initiative on Malnutrition (GLIM) introduced an approach for malnutrition diagnosis in 2019 comprised of screening followed by assessment of three phenotypic criteria: weight loss, low BMI, and low muscle mass, and two etiologic criteria: reduced food intake/assimilation, and inflammation/disease burden. This planned update reconsiders the GLIM framework based on published knowledge and experience over the past five years.

A GLIM working group (n = 43 members) conducted a literature search spanning 2019-2024 using the keywords "Global Leadership Initiative on Malnutrition or GLIM". Prior GLIM activities providing guidance for use of the criteria on muscle mass and inflammation were reviewed. Successive rounds of review and revision were used to achieve consensus.

More than 400 scientific reports are published in peer-reviewed journals, forming the basis of 10 systematic reviews, some including meta-analyses of GLIM validity that indicate strong construct and predictive validity. Limitations and future priorities are discussed. Working group findings suggest that assessment of low muscle mass should be guided by experience and available technological resources. Clinical judgement may suffice to evaluate the inflammation/disease burden etiologic criterion. No revisions of the weight loss, low BMI, or reduced food intake/assimilation criteria are suggested. Following two rounds of review and revision, the working group secured 100 % agreement with the conclusions reported in the 5-year update.

Ongoing initiatives target priorities that include malnutrition risk screening procedures, GLIM adaptation to the intensive care setting, assessment in support of the reduced food intake/assimilation criterion, and determination of malnutrition in obesity.

The prevalence of undernutrition in hospitalized patients and its impact on their length of stay (LOS) varies considerably depending on the population studied, the diagnosis criteria or the screening tools used. Previous reports using controlled data have been done on small populations while large cohorts have been studied on unverified declarative data. This study aims at determining the prevalence of undernutrition in a large population using verified anthropometric data and assessing its impact on the LOS.

- For 10 years (2007-2017), a specialized nutritional assessment unit screened inpatients in a tertiary hospital for undernutrition, with the exception of those in emergency and intensive care, orthopedics, pediatrics and maternity wards. Within each unit, screening was carried out every two to three weeks. The diagnosis of undernutrition in adult inpatients was made using body mass index (BMI) (<18.5 kg/m2 for age <70 or < 21 kg/m2 for age ≥70) or weight loss (weight loss >5 % over a month or >10 % over 6 months). We retrospectively analyzed this database, looking at all adults (>18 years) hospitalized for at least one day. The analysis of the prevalence of undernutrition and its consequence on the LOS was performed on the entire population as well as by sex, age groups and diagnosis-related groups (DRGs). Statistics were performed using the chi-square test, T-test, ANOVA and mixed linear analysis. Age and gender were added as potential confounders, while DRG was included as a random effect.

The analysis included data from 65,226 stays. Mean age 65 years (min 18, max 113), 58.2 % male patients. The overall prevalence of undernutrition was 29.77 %, lower in the 40 to 70-year-old group than in the younger and older population. Undernutrition was present in all of the 53 surveyed DRGs, with a prevalence ranging from 12 % to 57.89 %. In the overall population, undernourished patients had a longer LOS than well-nourished patients, with a median increase of 5 days. In 42 of the 53 DRGs, representing 97.57 % of the total population, undernutrition significantly increased the LOS.

This large study of the prevalence of undernutrition diagnosed from verified anthropometric data in hospitalized adults does not confirm recent findings obtained from unverified data in hospital databases.

Patients with critical illness may present with disease-related malnutrition upon intensive care unit (ICU) admission. They are at risk of development and progression of malnutrition over the disease trajectory because of inflammation, dysregulated metabolism, and challenges with feeding.

The Global Leadership Initiative on Malnutrition (GLIM) convened a panel of 36 clinical nutrition experts to develop consensus-based guidance statements addressing the diagnosis of malnutrition during critical illness, using a modified Delphi approach with a requirement of ≥75% agreement.

CONCLUSION: Research using consistent etiologic and phenotypic variables offers great potential to assess the efficacy of nutrition interventions for critically ill patients with malnutrition. Assessment of these variables at during and beyond the ICU stay will clarify the trajectory of malnutrition and enable exploration of impactful treatment modalities at each juncture. GLIM offers a diagnostic approach that can be used to identify malnutrition in critically ill patients.

Body mass index (BMI) is an inexpensive, easy-to-calculate, and noninvasive marker of malnutrition. Few studies have examined the longitudinal effects of BMI on the incidence of unfavorable physical health outcomes (UPHOs) among older adults receiving homecare nursing. Therefore, this prospective cohort study examined the longitudinal effects of low BMI on the occurrence of UPHOs at multiple time points (i.e., 1-, 3-, and 6-months) among older adults (≥ 75 years) receiving homecare nursing across Japan. Using an online questionnaire, homecare nurses reported clients' height and weight, as well as socio-demographic characteristics (e.g., age and gender) and health conditions (e.g., diagnosis and dependency level). The occurrence of seven UPHOs (urinary tract infection, respiratory infection, pressure ulcer or skin tear, dehydration, poor dyspnea control, poor pain control, and traumatic fall) was also reported. The longitudinal effects of low BMI on the total number of UPHOs at 1-, 3-, and 6-months follow-ups were examined using a Restricted Moment Model (RMM) with a log link function. Among 660 participants included in the analysis, 42.12% were males, 36.96% had dementia, and 44.09% had low BMI. Adjusting for client's characteristics and the number of UPHOs at the baseline, low BMI at the baseline could increase the incidence of UPHOs at 1-, 3- and 6-month follow-ups (incidence rate ratio [95% confidence interval]:1.59 [1.21, 2.07], 1.57 [1.18, 2.07], 1.35 [1.02, 1.79], respectively). Adequate management of low BMI among older adults receiving homecare nursing would have a favorable effect on reducing the occurrence of UPHOs, thereby reducing the deterioration of overall physical conditions.

Lung cancer is the leading cause of cancer-related deaths. Patients with stage I-III non-small cell lung cancer (NSCLC) are candidates for surgical resection; however, patients with low muscle mass, myosteatosis, malnutrition or reduced functional capacity preoperatively have a higher risk of postoperative morbidity. Prehabilitation is a care process aiming to enhance functional capacity before surgery to improve surgical outcomes. Study objectives are to test the effect of prehabilitation interventions of a mixed-nutrient supplement (NUT) alone or its combination with exercise (MM, multimodal prehabilitation), compared with placebo-control (CTL), in NSCLC patients on change in functional capacity pre-surgery and post-discharge, muscle mass and myosteatosis, postoperative health-related quality of life (HRQoL), complications and length of hospital stay. We hypothesise that a multi-nutrient supplement, with or without exercise, will be of benefit.

Randomised controlled trial of three parallel arms: 168 patients with operable NSCLC at nutritional risk are randomised 1:1:1 to CTL, NUT or MM. Patients in the NUT and MM groups receive a nutritional supplement consisting of whey protein, leucine, vitamin D and fish oil 4-6 weeks preoperatively and 6 weeks post-discharge. The exercise programme (MM) consists of daily moderate-intensity aerobic activity and resistance training 3 days/week. The following is assessed at baseline, preoperatively and week six post-discharge: functional capacity using the 6 min walk test, muscle mass and myosteatosis using D3-creatine dilution and peripheral quantitative CT, and HRQoL using the Functional Assessment of Cancer Therapy-Lung. Intention-to-treat analysis of covariance will compare between-group differences adjusted for baseline variables. Postoperative functional recovery will be tested by logistic regression. Between-group differences in clinical outcomes will be tested, applying Bonferroni correction.

This trial is approved by the McGill University Health Centre Research Ethics Board (2022-7782). Results will be published in open-access peer-reviewed journals and conference presentations.

NCT05955248.

This study investigated the prevalence of high nutritional risk (modified Nutrition Risk in Critically Ill (mNUTRIC) score ≥ 5) and its relation with malnutrition and other adverse in-hospital outcomes in severely injured patients (Injury Severity Score ≥ 16), admitted to the ICU. We hypothesized that high nutritional risk is associated with an increased risk of developing malnutrition (primary hypothesis) and of complications and mortality (secondary hypotheses) in adults with severe injuries compared to those with low nutrition risk.

In this observational prospective study, 100 severely injured patients admitted to the ICU of five Level-1 trauma centers in the US and the Netherlands between 2018-2022 were included. During ICU and hospital stay, malnutrition rates (Subjective Global Assessment score ≤ 5), complication rates (systemic complications, pneumonia, urinary tract infection, venous thromboembolism), and mortality of severely injured patients with high versus low nutritional risk were compared. A cause-specific Cox regression model was fitted to analyze whether high nutritional risk was related to developing malnutrition.

Eighteen percent of patients had high nutritional risk (95% confidence interval [CI] 10.5-25.5%) at admission. High nutritional risk was not related to in-ICU or in-hospital developed malnutrition. In patients with high nutritional risk, the hazard ratio for developing malnutrition was 1.3 (95% CI 0.7-2.6, p = 0.45). Severely injured patients with high nutritional risk had more complications during ICU (78% vs 29%, p < 0.001; OR 8.5, 95% CI 2.5-28.3) and hospital stay (83% vs 41%, p < 0.01; OR 6.0, 95% CI 1.5-24.9). ICU mortality (22% vs 4%, p = 0.02; OR 7.5, 95% CI 1.5-37.3) and hospital mortality (33% vs 6%, p < 0.01; OR 5.9, 95% CI 1.3-26.4) were also higher in patients with high nutritional risk.

About one-fifth of severely injured patients admitted to the ICU had high nutritional risk. High nutritional risk in severely injured patients is not associated with malnutrition. It is potentially associated with adverse in-hospital outcomes.

Level III, Prognostic/Epidemiological.

Background/Objectives: This study aims to evaluate the prevalence and degree of malnutrition among patients with type 2 diabetes mellitus using the CONUT and PNI scores. Hypothesis: The CONUT and PNI scores provide a reliable assessment of the nutritional status of patients with type 2 diabetes. Methods: The retrospective study was run at the Department of Internal, Autoimmune and Metabolic Diseases in the Central Clinical Hospital of the Medical University of Silesia in Katowice from January to December of 2022. From 266 patients diagnosed with diabetes, only 64 met the criteria and were included in this study. Results: We found varying degrees of malnutrition among patients. Only 20.3% of them were well nourished. Mild to moderate malnutrition was observed in, altogether, 67.2% of patients. Conclusions: The strong correlation between the CONUT and PNI (r = -0.88) indices confirms their diagnostic value. The introduction of the CONUT or PNI tools into routine practice should be considered in patients with T2DM, especially those over 65 years of age, but taking into account the significant limitations of these indices and the influence of various factors on the laboratory data considered.

there is a need for a kidney-specific nutritional screening tool for patients with renal failure. It was planned to perform the validity and reliability of the Renal Inpatient Nutrition Screening Tool screening tool developed for renal patients in Turkey.

the validity and reliability of the Renal Inpatient Nutrition Screening Tool were investigated by comparing it with the Malnutrition Universal Screening Tool and the Subjective Global Assessment for assessing malnutrition in 153 adult patients newly admitted to the nephrology unit. Nutritional status was assessed using anthropometric measurements and nurse opinion was assessed using a questionnaire.

the Renal Inpatient Nutrition Screening Tool was found to be more sensitive than the Malnutrition Universal Screening Tool in identifying increased malnutrition risks and providing dietary guidance. Cramer V coefficient was 0.238 between the Malnutrition Universal Screening Tool and the Renal Inpatient Nutrition Screening Tool, and 0.137 between the Subjective Global Assessment and the Renal Inpatient Nutrition Screening Tool, indicating the compatibility of the Renal Inpatient Nutrition Screening Tool with the variables in the Malnutrition Universal Screening Tool screening tool. A significant positive moderate correlation was observed between the total number of red boxes in the Renal Inpatient Nutrition Screening Tool and the total score of Malnutrition Universal Screening Tool (p < 0.05; r = 0.404).

the Renal Inpatient Nutrition Screening Tool is a valid and reliable tool for assessing malnutrition risks in renal patients in Turkey, particularly when used by experienced specialist nurses in nephrology units.

Nutrition status evaluation is essential for patients undergoing cardiac surgery. The Nutrition Risk in the Critically Ill (NUTRIC) and modified NUTRIC (mNUTRIC) scores are nutrition risk assessment tools specifically for patients in the intensive care unit (ICU). The objective of this study was to validate and compare the accuracy of these two nutrition scores in predicting hospital mortality in patients undergoing cardiac surgery.

This retrospective study screened adult patients undergoing cardiopulmonary bypass cardiac surgery in the ICU from June 2020 to August 2022. Patients were grouped according to NUTRIC score and mNUTRIC score within 24 h of ICU admission. Logistic regression was used to analyze the risk factors affecting the prognosis of these patients. The area under the receiver operating characteristic curve (AUC-ROC) was used to compare the predictive performance of these two nutrition scores for hospital mortality.

Data from 252 eligible patients (55.6% of whom were male) were analyzed. It was found that Acute Physiological and Chronic Health Evaluation Ⅱ score, aortic surgery, serum albumin level, NUTRIC score, and mNUTRIC score were independent influencing factors of hospital mortality. The AUC-ROC of the NUTRIC score and the mNUTRIC score for predicting hospital mortality were 0.830 (95% confidence interval [CI]: 0.778-0.874) and 0.824 (95% CI: 0.771-0.869), respectively. There was no significant difference in ROC curves between the two scores (P = 0.492).

Both the NUTRIC and mNUTRIC scores showed good predictive performance for hospital mortality in patients undergoing cardiac surgery, and the mNUTRIC score might be a more convenient and cost-effective tool for nutrition risk assessment.

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.

Although nutrition recommendations for patients with necrotizing soft tissue infections (NSTIs) often parallel those for patients with burn injuries, differences in the metabolic response to stress indicate that NSTIs require a unique approach. The sepsis and wound management associated with NSTIs trigger a metabolic response, driven by inflammatory and neuroendocrine changes, that leads to high circulating levels of cortisol, catecholamines, insulin, and pro-inflammatory cytokines. This metabolic response follows four phases of recovery (Early Acute; Late Acute; Persistent Inflammation, Immunosuppression, and Catabolism Syndrome; Recovery) that require a thoughtful approach to nutrition by risk screening, malnutrition assessment, and micronutrient deficiency assessment. Close monitoring of energy expenditure and protein needs is required for appropriate nutrition management. Nutrition intake after transfer from the intensive care unit and hospital discharge is often inadequate. Ongoing monitoring of nutrition intake at all outpatient follow-up appointments is necessary, regardless of the route of delivery, until the nutrition status stabilizes and any nutritional decline experienced during hospitalization has been corrected.

Patients with critical illness may present with disease-related malnutrition upon intensive care unit (ICU) admission. They are at risk of development and progression of malnutrition over the disease trajectory because of inflammation, dysregulated metabolism, and challenges with feeding.

The Global Leadership Initiative on Malnutrition (GLIM) convened a panel of 36 clinical nutrition experts to develop consensus-based guidance statements addressing the diagnosis of malnutrition during critical illness using a modified Delphi approach with a requirement of ≥75% agreement.

(1) To identify pre-existing malnutrition, we suggest evaluation within 48 h of ICU admission when feasible (100% agreement) or within 4 days (94% agreement). (2) To identify the development and progression of malnutrition, we suggest re-evaluation of all patients every 7-10 days (97% agreement). (3) To identify progressive loss of muscle mass, we suggest evaluation of muscle mass as soon as feasible (92% agreement) and again after 7-10 days (89% agreement). (4) To identify the development and progression of malnutrition before and after ICU discharge, we suggest re-evaluating nutrition status before ICU discharge and during clinical visits that follow (100% agreement).

Research using consistent etiologic and phenotypic variables offers great potential to assess the efficacy of nutrition interventions for critically ill patients with malnutrition. Assessment of these variables during and beyond the ICU stay will clarify the trajectory of malnutrition and enable exploration of impactful treatment modalities at each juncture. GLIM offers a diagnostic approach that can be used to identify malnutrition in critically ill patients.

Clinically, it is important to diagnose malnutrition for the treatment and prognosis of cancer patients; however, at present, there are no established standards. The present study evaluated the consistency of malnutrition diagnostic tools in association with relevant nutritional and inflammatory markers in patients with advanced esophageal cancer. Specifically, the Patient-Generated Subjective Global Assessment (PG-SGA) and Global Leadership Initiative on Malnutrition (GLIM) tools were assessed. Patients with a new diagnosis of esophageal cancer at Tengzhou Central People's Hospital (Tengzhou, China) between January 2023 and December 2023 were evaluated within 24 h of admission using Nutritional Risk Screening 2002 (NRS2002), GLIM and PG-SGA. Additionally, relevant physical examinations and laboratory data were collected. The malnutrition occurrence rates based on PG-SGA, GLIM and GLIM with NRS2002 screening (NRS2002-GLIM) were 75.01, 51.88 and 41.25%, respectively. The agreement between PG-SGA and GLIM, and between PG-SGA and NRS2002-GLIM diagnoses was weak (κ=0.379, P<0.001; and κ=0.376, P<0.001, respectively). PG-SGA showed a moderate negative correlation with body mass index (BMI) (rs=-0.460), weak positive correlations with age (rs=0.234) and IL-6 (rs=0.249), and very weak negative correlations with albumin (rs=-0.178) and PNI (rs=-0.168). While the indicators correlated with GLIM and PG-SGA were consistent, the strength of correlation varied slightly. Logistic regression analysis of PG-SGA and GLIM indicated that age and BMI were independent risk factors for malnutrition. In addition, PG-SGA also showed that the neutrophil count was an independent risk factor for malnutrition. Overall, patients with esophageal cancer exhibit a high incidence of malnutrition, and different diagnostic methods provide varying results. Malnutrition is closely associated with age, inflammatory markers and BMI, suggesting their potential utility in guiding nutritional interventions for patients with esophageal cancer.

The Global Leadership Initiative on Malnutrition (GLIM) introduced an approach for malnutrition diagnosis in 2019 that comprised screening followed by assessment of three phenotypic criteria (weight loss, low body mass index [BMI], and low muscle mass) and two etiologic criteria (reduced food intake/assimilation and inflammation/disease burden). This planned update reconsiders the GLIM framework based on published knowledge and experience over the past 5 years.

A working group (n = 43 members) conducted a literature search spanning 2019-2024 using the keywords "Global Leadership Initiative on Malnutrition or GLIM." Prior GLIM guidance activities for using the criteria on muscle mass and inflammation were reviewed. Successive rounds of revision and review were used to achieve consensus.

More than 400 scientific reports were published in peer-reviewed journals, forming the basis of 10 systematic reviews, some including meta-analyses of GLIM validity that indicate strong construct and predictive validity. Limitations and future priorities are discussed. Working group findings suggest that assessment of low muscle mass should be guided by experience and available technological resources. Clinical judgment may suffice to evaluate the inflammation/disease burden etiologic criterion. No revisions of the weight loss, low BMI, or reduced food intake/assimilation criteria are suggested. After two rounds of review and revision, the working group secured 100% agreement with the conclusions reported in the 5-year update.

Ongoing initiatives target priorities that include malnutrition risk screening procedures, GLIM adaptation to the intensive care setting, assessment in support of the reduced food intake/assimilation criterion, and determination of malnutrition in obesity.

Nutrition screening is a fundamental step to ensure appropriate intervention in patients with malnutrition. An automatic tool of nutritional risk screening based on electronic health records will improve efficiency and elevate the malnutrition diagnosis rate. We aimed to develop an artificial intelligence (AI) malnutrition screening tool based on electronic medical records and compare it with the patient interview-based tool.

We conducted a cross-sectional study at a comprehensive tertiary hospital in China. Data of malnutrition information were extracted from electronic health records (EHR) and were used to train and test an AI tool for the malnutritional risk screening. We adopted the GLIM framework as a reference standard for assessing malnutrition. Six widely used machine learning algorithms for auxiliary diagnosis prediction, including Support Vector Machine, Random Forest, extreme gradient boosting (XGBoost), Logistic Regression, AdaBoost, and Gradient Boosting were compared and visualized using SHapley Additive exPlanations (SHAP). After feature screening, simplified algoritms were cross validated at an independent data set.

495 inpatients enrolled were randomly divided into training and validation groups for algorithm development. 10 features annotated manually from free texts and 32 features selected from structured EHRs entered the models. XGBoost had the highest area under the receiver operating characteristic curve (AUC) and the top six features were weight loss, decreased food intake, prealbmine, white cell, BMI group, and percent of neutrophils. In simplified models, Random Forest acquired the highest AUC of 0.97 based on first sources data from interviews and 0.87 based on EHR data.

Inpatients' EHR data could be integrated by AI to detect the risk of malnutrition. This AI-enabled tool may hold promise for timely and efficient nutrition screening in newly admitted inpatients.

Malnutrition is a common complication of malignant tumors, and accurate diagnosis and treatment are essential. Although the Global Leadership Initiative on Malnutrition (GLIM) criteria are widely accepted for the diagnosis of malnutrition in a variety of diseases, their diagnostic value in patients with malignant tumors is controversial.

We conducted a comprehensive analysis of studies of the GLIM criteria in patients with malignant tumors and performed a standardized meta-analysis to evaluate the diagnostic value of the GLIM criteria in this patient population.

We conducted a systematic search across the PubMed, Cochrane, Web of Science, and ClinicalTrials.gov databases to identify studies utilizing the GLIM criteria for diagnosing malnutrition in cancer patients during the period from the initial adoption of the criteria in 2020 through February 29, 2024.

The meta-analysis was conducted in accordance with the PRISMA2020 statement. Using the Patient-Generated Subjective Global Assessment (PG-SGA) as a reference standard, we calculated the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) with 95% CI separately for the GLIM criteria. To assess the accuracy of the GLIM criteria, forest plots were drawn to summarize and present the data. The risk of bias and the methodological quality of the primary research were assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool.

Fifty studies were identified following the initial search of the PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov databases. Fourteen studies including a total of 14 196 cancer patients met the selection criteria and were included in the meta-analysis. With the use of the PG-SGA as a reference standard, 7640 patients with malignant tumors were diagnosed with malnutrition (prevalence of 53.8%). The GLIM criteria had an overall sensitivity of 0.69 (95% CI: 0.62-0.75), specificity of 0.84 (95% CI: 0.75-0.91), PLR of 4.42 (95% CI: 2.71-7.2), NLR of 0.37 (95% CI: 0.30-0.45), DOR of 12.90 (95% CI: 6.68-21.21), and an AUC of 0.80 (95% CI: 0.77-0.84) compared to PG-SGA.

Compared with the PG-SGA, the GLIM criteria showed good diagnostic value in patients with cancer. The GLIM criteria can be considered acceptable in clinical practice and have the potential for wider application in the future.

PROSPERO registration No. CRD4202452675.1.

Objective: This study aimed to identify components of a trauma-informed, culturally sensitive eating-disorder-specific nutrition-focused physical examination (ED-NFPE) tool. Method: The modified Delphi methodology was used to develop a consensus on the clinical relevance of nine evidence-informed ED-specific nutrition examination domains and 46 components within those domains. Purposive sampling was used to recruit a panel of registered dietitian nutritionist (RDN) experts in the ED field. The panelists responded to survey statements on a five-point Likert scale. The panelists also provided qualitative feedback on domain and component additions, exclusions, modifications, and trauma-informed culturally sensitive examination practice techniques. Results: Twenty-two RDN expert panelists completed Round One of the study, and eighteen panelists completed Round Two (82% retention). Twenty-one were female. Fifteen panelists had ten or more years of experience in ED dietetics. Fifty percent held an advanced practice credential from the International Association of Eating Disorders Professionals (IAEDP). After the two survey rounds, the nine ED-NFPE domains and 46 of the 48 components achieved a consensus for clinical relevance. The panelists proposed two new examination components and provided qualitative feedback for trauma-informed culturally sensitive practice techniques in all nine domains. Conclusions: This modified Delphi study design was chosen to reach a consensus on developing an ED-NFPE tool, as there are few current evidence-based guidelines for nutrition examinations in ED care. An NFPE tool specifically designed to detect the nutrition-related findings of individuals with EDs would strengthen the overall nutrition assessment. RDNs at every level of care and with all degrees of experience could use an ED-NFPE to inform patient treatment goals.

The significance of imaging-based assessment of muscles and malnutrition in patients with primary hepatocellular carcinoma (HCC) remains unclear. This study aimed to elucidate the prognostic role of the combination of Low Muscle Volume and Value (LMVV) and malnutrition.

A total of 714 Child-Pugh grade A/ B patients with first-diagnosed HCC were enrolled, and analyzed factors associated with overall survival. LMVV was defined using psoas muscle mass index and computed tomography values of multifidus muscle at the level of the third lumbar vertebra. We used hypoalbuminemia, Child-Pugh grade B, Subjective Global Assessment (SGA) grade B/C, and Royal Free Hospital Nutrition Prioritizing Tool (RFH-NPT) score > 2 as malnutrition factors in this study.

At baseline, 29% showed LMVV, and 59% met one or more of the malnutrition criteria. No items meeting the criteria of LMVV and malnutrition was observed in 41%, 1 of them was found in 29%, and both were found in 29%. The number of items meeting criteria was an independent factor for a shorter survival. The frequency of liver-related deaths did not differ by presence of LMVV alone, while it was associated with malnutrition. In contrast, the incidence of other types of deaths was influenced by LMVV and malnutrition.

The combination of LMVV and malnutrition is a prognostic factor in patients with primary HCC.

Autologous hematopoietic stem cell transplantation (AHSCT) is the treatment for myeloma and lymphoma. posttreatment, significant nutritional and medical issues and malnutrition assessed by Subjective Global Assessment (SGA) arise. No established effective treatment for using either parenteral (PN) or enteral routes (EN) to improve nutritional status, reduce medical complications, and be cost-effective is available. We investigated the effectiveness of EN versus PN in terms of nutritional path of supplementation. AHSCT patients were randomized to either EN or PN and were followed at baseline, 15 and 30 days posttransplant. Age, body mass index, SGA, length of stay (LOS), medical complications, severity of complications, infections, overall survival (Day 100), albumin, random blood glucose, and C-reactive protein were evaluated. Descriptive statistics, Spearman's, chi square, correlations, and uni- and multivariate by type of feed, using SPSS v 29. Thirty-six patients with complete medical and laboratory data were followed. No significance in any of the medical or nutritional parameters between the two groups was found. No correlations between SGA at any time point and type of feeding were identified. No relationship between SGA, LOS, complications, albumin, CRP, or random blood glucose at all three time points was seen. EN is a safe, convenient, and cost-effective option for AHSCT patients since medical and nutritional outcomes were similar between those receiving EN compared to PN.

Introduction: nutritional screening (NS) is crucial for early detection of malnutrition (MN) and prediction of "nutritional risk". Objectives: to establish the prevalence of hospital malnutrition by Subjective Global Assessment (SGA) and evaluate the agreement of NS tools and their ability to predict mortality (M), infectious (IC) and non-infectious complications, and prolonged stay (> 11 days). Methods: a multicenter, prospective, observational study was conducted. Nutritional status was assessed with SGA and simultaneously measured with Malnutrition Screening Tool (MST), Short Nutritional Assessment Questionnaire (SNAQ), Malnutrition Universal Screening Tool (MUST), Nutrition Risk Screening (NRS-2002), and Mini Nutritional Assessment Short Form (MNA-SF). All methods were classified into three categories for equivalence with SGA. Kappa was used to assess agreement and logistic regression, sensitivity, specificity, and area under the ROC curve for predictive ability. Results: a total of 1546 patients from 64 hospitals in Argentina were included, 52.6 % male, median age 58 years. According to SGA, hospital malnutrition prevalence was 48.06 % (95 % CI 45.57; 50.55), with 37 % moderately malnourished (B) and 11 % severely malnourished (C). MST showed the best agreement with SGA (k 0.41), and among methods, MST with SNAQ (k 0.52). Adverse outcomes were associated with MN by any method. SGA, MNA-SF, and NRS-2002 had the best predictive ability (ROC area 0.74 to 0.72 for M). IC were the hardest to predict (maximum ROC area 0.62). Sensitivities ranged from 60 to 96 %, and specificities were above 90 % for MN by SGA. Conclusions: variations in predictive ability among NS methods do not affect their clinical applicability.

There is a common belief that adult critically ill patients diagnosed with or at risk of malnutrition would benefit from higher energy delivery.

This systematic review and meta-analysis aimed to evaluate the association between energy delivery and mortality in adult critically ill patients diagnosed with or at risk of malnutrition.

Databases including Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, and Google Scholar were searched from inception to November 20, 2023.

Randomized controlled trials (RCTs) and observational studies that (1) included critically ill patients (aged ≥18 years) diagnosed with or at risk of malnutrition using validated tools following intensive care unit (ICU) admission, (2) had at least 20% energy difference between intervention and comparison groups, and (3) reported mortality outcomes were included. The random-effects model was used to pool the data.

Two RCTs (4681 at-risk patients) and 5 observational studies (1587 at-risk patients [including 389 high-risk patients]) were included. The pooled mean energy delivered during the first 7-14 days of ICU admission in higher vs lower energy groups was 25.6 ± 5.9 vs 9.7 ± 5.6 kcal/kg per day (P = .004) in RCTs and 21.0 ± 5.2 vs 13.3 ± 5.3 kcal/kg per day (P < .001) in observational studies. No mortality difference was found between higher vs lower energy groups in at-risk patients (risk ratio: 0.99; 95% CI: 0.85, 1.17; P = .94) in RCTs and high-risk patients (adjusted odds ratio: 1.37; 95% CI: 0.43, 4.32; P = .59) in observational studies. Trial sequential analysis was performed and 31 232 patients were required to show a potential treatment effect.

These data do not support the prevailing belief that higher energy delivery improves survival in adult critically ill patients diagnosed with or at risk of malnutrition.

PROSPERO registration no. CRD42021274378.

The primary aim of this study was to evaluate the value of predictive equation (PE) standard care compared with indirect calorimetry (IC)-based nutrition therapy. The secondary aim was to compare the results among 3 groups to assess the accuracy of IC and PE. This was a single-center, retrospective study of patients admitted to the neurosurgery (NS) intensive care unit (ICU), from January 2019, to August 2020. Anthropometric, biochemical, clinical, and dietary data were collected from NS ICU admission to discharge. If patients had an IC: PE ratio of 90%-110%, they were classified into the optimal estimation group (OEG); if the ratio was < 90%, they were classified into the underestimation group (UG); and if the ratio was > 110%, they were classified into the overestimation group (OG). There were no significant differences in anthropometric, biochemical, clinical data and nutrition assessment between baseline and discharge from the NS ICU. The OEG showed a larger cumulative caloric deficit rate compared to UG and OG, though this difference was not statistically significant. There was a negative association between calf circumference (CC) and length of stay (LOS). Repeated measures of CC showed a significant difference according to LOS and groups (p < 0.001). Anthropometric, biochemical, clinical, and dietary data of 77 NS patients were analyzed to determine the effectiveness of concordance between IC and PE. The UG and OG showed a significant decrease in CC during hospitalization, but CC in the OEG was maintained or increased from 4 weeks onward.

Clinical Research Information Service Identifier: KCT0006381.

Delegation of nutrition care activities to Dietetic Assistants in hospitals has been identified as one innovative malnutrition model of care, but there has been limited evaluation of their roles. This study aimed to develop, implement and evaluate a new Malnutrition Model of Care embracing automated delegation and digital systems.

The Malnutrition Model of Care was created to detect patients at risk of malnutrition (using the Malnutrition Screening Tool) and nutritional decline (via routine intake tracking at all meals and snacks). Digital systems generated automated referrals to dietetics, with protocols to support Dietetic Assistants to action these to direct care escalation to the ward dietitian. Dietetic Assistant training included simulations and clinical task instructions. Implementation evaluation was guided by the Donabedian model of quality and included a review of inpatient dietetics occasions of service, survey of Dietetic Assistant role satisfaction and task confidence, and hospital-wide cross-sectional malnutrition audit. Data was descriptively analysed.

During the first year of implementation, 60% of Dietetics inpatient occasions of service were completed by Dietetic Assistants, with 26% of Dietetic Assistant inpatient tasks initiated from nursing malnutrition risk screening. Most Dietetic Assistants reported adequate training and confidence in completing delegated tasks. Malnutrition prevalence was 14% with no hospital-acquired malnutrition identified. No clinical incidents were reported.

The Dietetic Assistant workforce and technology were harnessed to implement an innovative delegated Malnutrition Model of Care that appears to be safe and effective at managing malnutrition from preliminary evaluation. Work continues to formally assess service efficiencies, cost and patient experience.

The aim of this study was to assess the criterion validity of the Global Leadership Initiative on Malnutrition criteria compared to the subjective global assessment in a diverse inpatient population.

This cross-sectional study was a retrospective analysis of point prevalence audit data. The prevalence of malnutrition determined by the Global Leadership Initiative on Malnutrition criteria was compared to the Subjective Global Assessment. Validity statistics were determined using all of the Global Leadership Initiative on Malnutrition criteria concurrently as well as each pair that could be used to diagnose malnutrition. Subgroup analysis was undertaken based on severe malnutrition, treatment group, age and body mass index.

Nine hundred and eighty-one patients were included (65.1 ± 18.6 years, 54.8% male). The prevalence of malnutrition was 36.7% using the Subjective Global Assessment and 36.1% using the Global Leadership Initiative on Malnutrition criteria. More patients were classified as severely malnourished using the Global Leadership Initiative on Malnutrition criteria (9.8% vs. 6.0%), whilst more rehabilitation patients were classified as malnourished using the Subjective Global Assessment (42.2% vs. 33.6%). The criterion validity of the Global Leadership Initiative on Malnutrition criteria was good, with a sensitivity of 92.5% (95% CI 90.9-94.2) and specificity of 96.6% (95% CI 95.5-97.8). There was a downward trend in sensitivity with increasing body mass index and a lower sensitivity in the rehabilitation population. The criterion validity was fair at best when each pair of the Global Leadership Initiative on Malnutrition criteria was considered independently of other criteria.

When all criteria are considered concurrently, the Global Leadership Initiative on Malnutrition criteria present good criterion validity and can be applied in clinical practice to diagnose malnutrition.

Although previous research has attempted to understand the barriers and enablers of oral intake in hospitalized patients, these studies have mainly focused on short-stay inpatients and lacked a theory-driven examination of the determinants that influence dietary behavior in the hospital.

To explore and compare the factors influencing adequate and poor oral intake in long-stay acute patients (admitted >14 days).

A qualitative descriptive study with semistructured interviews.

Twenty-one adult inpatients (13 men, 8 women) admitted to 2 medical and 2 surgical wards at a tertiary hospital in Brisbane, Australia, during 2022, stratified by the Subjective Global Assessment. Analysis performed Transcripts were initially deductively analyzed against the Theoretical Domains Framework, and a reflexive thematic approach was used to create overall themes.

Of the 21 included patients (median age = 68.0 years, IQR 34 years), 11 had adequate/improved intake and 10 poor/decreased intake. Six themes were identified to have influenced oral intake in long-stay patients: self-determination to eat; nutrition impact symptoms; foodservice characteristics and processes; nutrition-related knowledge and skills; social support; and optimism, emotions, and emotion regulation. Patients with adequate/improved oral intake were characterized by an autonomous motivation to eat. They had increased awareness about their nutritional status, knowledge, and skills about food for recovery, were more optimistic, and social support was an important enabler to eating. In contrast, patients with poor/decreased oral intake perceived nutrition impact symptoms and dislike of meals as the main barriers to eating in the hospital; however, they also expressed more negative emotions, reduced coping strategies, and decreased knowledge, skills, intrinsic motivation, and capabilities to eat. Social support was present but did not enable oral intake in this patient group.

This study provides novel insights into the factors that influenced oral intake in long-stay acute patients, highlighting the importance of patient-centered nutrition care, encompassing motivational interviewing techniques and collaboration from the multidisciplinary team to create a supportive environment that fosters autonomy and empowers patients to actively participate in their own nutrition and recovery.

Head and neck cancer (HNC) involves several tumor locations, the most common of which are the oropharynx and oral cavity. Patients with HNC are at high risk of developing malnutrition. Together with treatment, the tumor location contributes to difficulties in eating and swallowing, which can lead to a negative energy balance and weight loss. This study aimed to examine malnutrition via the Global Leadership Initiative on Malnutrition (GLIM) criteria, explore the different combinations of the GLIM criteria, study changes in body composition and body energy content and evaluate health-related quality of life (HRQoL) in patients with locally advanced HNC.

Malnutrition was diagnosed via the GLIM criteria. Body weight, muscle mass, body fat, C-reactive protein (CRP) levels, energy intake, use of enteral feeding tubes or parenteral nutrition were assessed, and HRQoL scales from the European Organization for Research and Treatment of Cancer (EORTC), including the Quality of Life Questionnaire-Core 30 (QLQ-C30) and the Quality of Life Questionnaire-Head and Neck 35 (QLQ-HN35), and the M.D. Anderson Dysphagia Inventory (MDADI) were completed at baseline, 6 weeks and at 3, 6 and 12 months after the start of treatment. Body composition was measured via dual-energy X-ray absorptiometry, and body energy content was calculated.

Eighty patients were included. The prevalence of malnutrition varied over time and peaked at the end of treatment at 71 %, and at this time, the most common combination of the GLIM criteria was weight loss + reduced food intake + inflammation (31 %), followed by weight loss + reduced muscle mass + reduced food intake + inflammation (20 %). At the end of treatment patients were in a negative energy balance, and compared to baseline, body weight, body fat, and muscle mass had decreased with 6.0 % (p<0.0001), 5.9 % (p<0.0001), and 8.0 % (p<0.0001) respectively. At the 3-month follow-up, the reduction in muscle mass had ceased, despite a negative energy balance, and patients started to regain muscle mass. At 12 months body weight had decreased with 7.4 % (p<0.0001), body fat with 18.9 % (p<0.0001), and muscle mass with 2.4 % (p<0.0001) compared to baseline. Patients with malnutrition reported significantly worse HRQoL on a majority of the 16 quality of life scales at all time points, except at the end of treatment, when no significant differences were found between malnourished and nonmalnourished patients.

Patients with advanced HNC receiving combined treatment experience major nutritional problems, and malnutrition is common at the end of treatment. Inflammation-driven muscle depletion during treatment is challenging, but it seems possible to recover muscle mass after treatment. Patients with malnutrition reported worse HRQoL at all time points, except at the end of treatment, when all patients' quality of life was very negatively affected.

Malnutrition is common in liver cirrhosis and is associated with increased rates of complications, hospitalization, and mortality. There are no consensus guidelines for malnutrition assessment in liver cirrhosis and a large number of clinicians do not routinely assess for malnutrition in patients with liver cirrhosis. This review explores the tools available for assessment of malnutrition in patients with liver cirrhosis, including nutritional screening protocols, anthropometric tools, biochemical tools, techniques analyzing body composition and functional assessments. We evaluate these tools and offer recommendations regarding their suitability for outpatient settings. In this review, we recommend the Royal Free Hospital-Nutritional Prioritising Tool for identifying patients at risk of malnutrition. Additionally, we recommend the use of the anthropometric tools Triceps Skinfold Thickness for females and Mid-Arm Muscle Circumference for males, due to differing patterns of muscle and fat malnutrition. Complementing this Bioelectrical Impedance Analysis can be utilized to assess body composition for the diagnosis of malnutrition. Biochemical markers have thus far failed to show a correlation with malnutrition. While hand grip strength is useful for detecting sarcopenia, a common complication of malnutrition, further evidence is required to validate its correlation with malnutrition.

To explore the prevalence of vitamin C deficiency, 'undetectable' vitamin C status, and scurvy features, in adult hospitalised patients with protein-energy malnutrition diagnosed using validated malnutrition screening and assessment tools commonly used in clinical practice.

This study included adult inpatients from four acute hospitals within a single Australian tertiary health service, over a 3.5-year period. A medical file review activity retrospectively determined malnutrition risk and diagnosis, via Malnutrition Screening Tool, Malnutrition Universal Screening Tool, Subjective Global Assessment and Global Leadership Initiative on Malnutrition criteria. Prevalence of vitamin C deficiency and scurvy features was examined in adult patients with plasma vitamin C levels <11.4 μmol/L and <5 μmol/L ('undetectable'), respectively.

In the final cohort (n = 364), prevalence of vitamin C deficiency was 30.2%. Malnutrition was present in 76.1% and 79.8% of patients via Subjective Global Assessment (n = 310) and Global Leadership Initiative on Malnutrition criteria (n = 342) respectively. Patients with high nutrition risk and those diagnosed with severe malnutrition had the highest prevalence of vitamin C deficiency, reported as 32.8% for malnutrition detected via Malnutrition Screening Tool (n = 244), 32.9% via Malnutrition Universal Screening Tool (n = 222), 35.8% via Subjective Global Assessment (n = 106), and 34.2% via Global Leadership Initiative on Malnutrition (n = 152). Scurvy features were associated with severe malnutrition in patients with 'undetectable' vitamin C status.

Severely malnourished adult hospital patients have a high prevalence of vitamin C deficiency, and scurvy features in those with 'undetectable' vitamin C status. Leveraging existing malnutrition screening and assessment practices may support early identification of patients with vitamin C deficiency during hospitalisation.

To present and discuss recent and previous literature on the nutritional implications and management of gastroparesis. We also briefly review its epidemiology, pathophysiology, and clinical manifestations.

- Low viscosity soluble fibers are well-tolerated in patients with mild to moderate gastroparesis symptoms and can thus be used to supplement the diets of these patients. - High-fat liquid meals are reasonably well-tolerated in patients with gastroparesis and can be used to supplement diet as tolerated. - The risk of tardive dyskinesia (TD) with long-term use of metoclopramide is much lower than previously thought. The nutritional status of patients with gastroparesis ranges across a wide spectrum, depending on the severity of their disease. Some patients improve simply with dietary modifications, others respond well to medical therapy, and those with severe, drug-refractory disease often require enteral nutrition or TPN (total parenteral nutrition). Generally, the recommended diet is composed of small particles, low fat, and low fiber; however recent studies showed that low viscosity soluble fibers and high-fat liquid fats can be tolerated. Metoclopramide is the first prokinetic agent of choice, and while the risk of TD is lower than previously thought, long-term use should be avoided in certain patient populations. For those on enteral nutrition, the choice of formula should be based on osmolarity, fat content, and fiber content, in accordance with the patient's tolerance.

Background/Objectives: Assessment of vitamin C status rarely occurs in hospital patients within high-income countries on the assumption that vitamin C deficiency (VCD) is rare, and evidence on prevalence, risk factors, and clinical outcomes of VCD is limited. This study aimed to describe the prevalence of VCD, characteristics of patients with VCD, and identify risk factors and clinical outcomes associated with VCD status in adult hospitalised patients. Methods: This retrospective observational study included adult inpatients from five metropolitan hospitals within a single public health service in Australia which provides tertiary, acute, and sub-acute care, over a 3.5-year period. Non-fasting vitamin C levels were examined for the prevalence of VCD, defined as <11.4 µmol/L. Multivariate regression models were used to identify risk factors and clinical outcomes associated with VCD. Results: The prevalence of VCD was 22.9% (n = 1791), comprising 23.2% (n = 1717) and 16.2% (n = 74) within acute and sub-acute settings, respectively. VCD prevalence was high in acute setting subgroups including patients with malnutrition (30%, n = 611) and patients admitted to ICU during hospitalisation (37.3%, n = 327). Malnutrition (OR 1.50, 95% CI 1.19-1.91, p < 0.001) and male gender (OR 1.47, 95% CI 1.17-1.86, p = 0.001) were associated with VCD. VCD was not associated with clinical outcomes including in-hospital death, hospital or intensive care unit LOS, or hospital-acquired complications. Conclusions: VCD exists within adult hospital patients in high-income countries, and early, targeted detection of VCD in this setting is warranted. Further research is needed to explore the impact of VCD on hospital clinical outcomes.

Background: Patients undergoing cardiovascular surgery often experience postoperative complications and Activities of Daily Living (ADL) decline, even in the absence of preoperative malnutrition. Since postoperative ADL decline is particularly serious in elderly patients, this study aimed to identify a nutritional assessment tool that is effective in predicting postoperative ADL decline. Methods: Patients undergoing open-heart surgery with cardiopulmonary bypass were assessed using eight nutritional assessment tools, including the Malnutrition Universal Screening Tool (MUST), the Global Leadership Initiative on Malnutrition (GLIM) criteria, the Nutritional Risk Screening 2002 (NRS-2002), the Subjective Global Assessment (SGA), the Controlling Nutritional Status (CONUT) score, the Prognostic Nutritional Index (PNI), the Geriatric Nutritional Risk Index (GNRI), and the Mini Nutritional Assessment-Short Form (MNA-SF). Results: A total of 197 patients were enrolled in this study, with a mean age of 70.4 ± 11.6 years old; 31.0% were female. Depending on the nutritional assessment tool, 17.8% to 78.2% of patients were identified as at risk of malnutrition. Among the various assessment tools, the MUST was the most effective in predicting postoperative ADL decline (OR 4.75, 95% CI 1.37-16.5, p = 0.014) and was also associated with severe complications and length of hospital stay (OR 3.08, 95% CI 0.20-0.76, p = 0.009). On the other hand, nutritional risk detected by assessment tools other than MUST, including MNA-SF and GLIM, could predict postoperative complications but showed no relationship to ADL decline. Conclusions: We concluded that MUST was the most useful preoperative nutritional assessment tool for predicting outcomes, particularly for assessing the risk of postoperative ADL decline in patients undergoing cardiovascular surgery.