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  • 1.
    Adamsson, Viola
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Reumark, Anna
    Marklund, Matti
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Role of a prudent breakfast in improving cardiometabolic risk factors in subjects with hypercholesterolemia: A randomized controlled trial2015In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 34, no 1, p. 20-26Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS:

    It is unclear whether advising a prudent breakfast alone is sufficient to improve blood lipids and cardiometabolic risk factors in overweight hypercholesterolemic subjects. The aim of this study was to investigate whether a prudent low-fat breakfast (PB) rich in dietary fiber lowers low-density lipoprotein cholesterol (LDL-C) and other cardiometabolic risk factors in subjects with elevated LDL-cholesterol levels.

    METHODS:

    In a parallel, controlled, 12-week study, 79 healthy overweight subjects (all regular breakfast eaters) were randomly allocated to a group that received a PB based on Nordic foods provided ad libitum or a control group that consumed their usual breakfast. The primary outcome was plasma LDL-C. Secondary outcomes were other blood lipids, body weight, sagittal abdominal diameter (SAD), glucose tolerance, insulin sensitivity and inflammation markers (C-reactive protein [CRP] and tumor necrosis factor receptor-2 [TNF-R2]), and blood pressure. The PB was in accordance with national and Nordic nutrition recommendations and included oat bran porridge with low-fat milk or yogurt, bilberry or lingonberry jam, whole grain bread, low-fat spread, poultry or fatty fish, and fruit.

    RESULTS:

    No differences were found in LDL-C, other blood lipids, body weight, or glucose metabolism, but SAD, plasma CRP, and TNF-R2 decreased more during PB compared with controls (p < 0.05). In the overall diet, PB increased dietary fiber and β-glucan compared with controls (p < 0.05).

    CONCLUSIONS:

    Advising a prudent breakfast for 3 months did not influence blood lipids, body weight, or glucose metabolism but reduced markers of visceral fat and inflammation. The trial was registered in the Current Controlled Trials database (http://www.controlled-trials.com); International Standard Randomized Controlled Trial Number (ISRCTN): 84550872.

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  • 2. Anandavadivelan, Poorna
    et al.
    Wikman, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Malberg, Kalle
    Martin, Lena
    Rosenlund, Helen
    Rueb, Claudia
    Johar, Asif
    Lagergren, Pernilla
    Prevalence and intensity of dumping symptoms and their association with health-related quality of life following surgery for oesophageal cancer2021In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 40, no 3, p. 1233-1240Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: This study aimed to investigate the prevalence and intensity of symptoms of dumping syndrome (early and late) experienced by oesophageal cancer survivors one year after surgery and their association with health related quality of life (HRQL).

    METHODS: A prospective cohort study of patients who underwent surgery for oesophageal cancer in Sweden from January 2013 to April 2018, included at one year after surgery with follow-up at 1.5 years. Common symptoms of dumping syndrome were the exposure, classified as early and late onset, further divided into 'moderate' or 'severe' based on symptom intensity, and no dumping symptoms (reference group). The primary outcome was mean summary score of HRQL, and secondary outcomes were global quality of life, physical, role, emotional, cognitive and social function measured using the EORTC QLQ-C30 1.5 years after surgery. An ANCOVA model, adjusted for potential confounders was used to study the association between dumping symptoms and HRQL, presented as mean score differences (MD) with 95% confidence intervals (CI).

    RESULTS: Among 188 patients, moderate early dumping symptoms was experienced by 45% and severe early dumping by 9%. Moderate late dumping symptoms was reported by 13%, whereas 5% reported severe late dumping symptoms. Severe early dumping symptoms was associated with worse HRQL in 4 out of 7 aspects with worse global quality of life (MD -16, 95% CI: -27 to -4) and social function (MD -17, 95% CI: -32 to -3), which showed clinically large differences compared to having no such symptoms. Patients with moderate late dumping symptoms reported poorer HRQL in 6 out of 7 aspects compared to those with no dumping symptoms. Cognitive function (MD -27, 95% CI: -47 to -7) and emotional function (MD -24, 95% CI: -47 to -2) were significantly declined (clinically large relevance) in those with severe late dumping symptoms.

    CONCLUSIONS: Patients who have undergone curative treatment for oesophageal cancer experience reduced HRQL from early and late dumping symptoms at one year after surgery that indicate clear implications for clinical routine. Medical support and additional dietary counselling are required as potential ways to alleviate dumping symptoms on clinical repercussions.

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  • 3. Andersson, Daniel P.
    et al.
    Thorell, Anders
    Lofgren, Patrik
    Wiren, Mikael
    Toft, Eva
    Qvisth, Veronica
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Berglund, Lars
    Naslund, Erik
    Bringman, Sven
    Thorne, Anders
    Arner, Peter
    Hoffstedt, Johan
    Omentectomy in addition to gastric bypass surgery and influence on insulin sensitivity: A randomized double blind controlled trial2014In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 6, p. 991-996Article in journal (Refereed)
    Abstract [en]

    Background & aims: Accumulation of visceral adipose tissue is associated with insulin resistance and cardio-vascular disease. The aim of this study was to elucidate whether removal of a large amount of visceral fat by omentectomy in conjunction with Roux en-Y gastric bypass operation (RYGB) results in enhanced improvement of insulin sensitivity compared to gastric bypass surgery alone. Methods: Eighty-one obese women scheduled for RYGB were included in the study. They were randomized to RYGB or RYGB in conjunction with omentectomy. Insulin sensitivity was measured by hyperinsulinemic euglycemic clamp before operation and sixty-two women were also reexamined 2 years post-operatively. The primary outcome measure was insulin sensitivity and secondary outcome measures included cardio-metabolic risk factors. Results: Two-year weight loss was profound but unaffected by omentectomy. Before intervention, there were no clinical or metabolic differences between the two groups. The difference in primary outcome measure, insulin sensitivity, was not significant between the non-omentectomy (6.7 +/- 1.6 mg/kg body weight/minute) and omentectomy groups (6.6 +/- 1.5 mg/kg body weight/minute) after 2 years. Nor did any of the cardio-metabolic risk factors that were secondary outcome measures differ significantly. Conclusion: Addition of omentectomy to gastric bypass operation does not give an incremental effect on long term insulin sensitivity or cardio-metabolic risk factors. The clinical usefulness of omentectomy in addition to gastric bypass operation is highly questionable.

  • 4. Barazzoni, R
    et al.
    Deutz, N E P
    Biolo, G
    Bischoff, S
    Boirie, Y
    Cederholm, T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Cuerda, C
    Delzenne, N
    Leon Sanz, M
    Ljungqvist, O
    Muscaritoli, M
    Pichard, C
    Preiser, J C
    Sbraccia, P
    Singer, P
    Tappy, L
    Thorens, B
    Van Gossum, A
    Vettor, R
    Calder, P C
    Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group.2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 2, p. 355-363Article in journal (Refereed)
    Abstract [en]

    Growing evidence underscores the important role of glycemic control in health and recovery from illness. Carbohydrate ingestion in the diet or administration in nutritional support is mandatory, but carbohydrate intake can adversely affect major body organs and tissues if resulting plasma glucose becomes too high, too low, or highly variable. Plasma glucose control is especially important for patients with conditions such as diabetes or metabolic stress resulting from critical illness or surgery. These patients are particularly in need of glycemic management to help lessen glycemic variability and its negative health consequences when nutritional support is administered. Here we report on recent findings and emerging trends in the field based on an ESPEN workshop held in Venice, Italy, 8-9 November 2015. Evidence was discussed on pathophysiology, clinical impact, and nutritional recommendations for carbohydrate utilization and management in nutritional support. The main conclusions were: a) excess glucose and fructose availability may exacerbate metabolic complications in skeletal muscle, adipose tissue, and liver and can result in negative clinical impact; b) low-glycemic index and high-fiber diets, including specialty products for nutritional support, may provide metabolic and clinical benefits in individuals with obesity, insulin resistance, and diabetes; c) in acute conditions such as surgery and critical illness, insulin resistance and elevated circulating glucose levels have a negative impact on patient outcomes and should be prevented through nutritional and/or pharmacological intervention. In such acute settings, efforts should be implemented towards defining optimal plasma glucose targets, avoiding excessive plasma glucose variability, and optimizing glucose control relative to nutritional support.

  • 5.
    Barazzoni, Rocco
    et al.
    Univ Trieste, Dept Med Surg & Hlth Sci, Internal Med, Trieste, Italy.;Azienda Sanit Univ Integrata Trieste ASUITS, Trieste, Italy..
    Bischoff, Stephan C.
    Univ Hohenheim, Dept Nutr Med, Stuttgart, Germany..
    Boirie, Yves
    Univ Clermont Auvergne, INRA, UNH, CRNH Auvergne, F-63000 Clermont Ferrand, France.;CHU Clermont Ferrand, Serv Nutr Clin, F-63000 Clermont Ferrand, France..
    Busetto, Luca
    Univ Padua, Dept Med, Padua, Italy.;Padova Univ Hosp, Ctr Study & Integrated Management Obes EASO COM, Padua, Italy..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Dicker, Dror
    Tel Aviv Univ, Rabin Med Ctr, Internal Med Dept, Hasharon Hosp,Sackler Fac Med, Tel Aviv, Israel.;Tel Aviv Univ, Rabin Med Ctr, Obes Clin, Hasharon Hosp,Sackler Fac Med, Tel Aviv, Israel..
    Toplak, Hermann
    Med Univ Graz, Dept Med, Graz, Austria..
    Van Gossum, Andre
    Free Univ Brussels, Dept Gastroenterol, Clin Intestinal Dis & Nutr Support, Hop Erasme, Brussels, Belgium..
    Yumuk, Volkan
    Istanbul Univ, Div Endocrinol Metab & Diabet, Cerrahpasa Med Fac, Istanbul, Turkey..
    Vettor, Roberto
    Univ Padua, Dept Med, Padua, Italy.;Padova Univ Hosp, Ctr Study & Integrated Management Obes EASO COM, Padua, Italy..
    Sarcopenic obesity: Time to meet the challenge2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6, p. 1787-1793Article in journal (Refereed)
    Abstract [en]

    The prevalence of overweight and obesity has reached epidemic proportions worldwide due to increasingly pervasive obesogenic lifestyle changes. Obesity poses unprecedented individual, social and multi-disciplinary medical challenges by increasing the risk for metabolic diseases, chronic organ failures and cancer, as well as complication rates in the presence of acute disease conditions. Whereas reducing excess adiposity remains the fundamental pathogenetic treatment for obese individuals, complex metabolic and lifestyle abnormalities as well as weight-reduction therapies per se may also compromise the ability to preserve muscle function and mass, especially when chronic disease co-exists with obesity. Emerging evidence indicates that low muscle mass and quality have a strong negative prognostic impact in obese individuals and may lead to frailty, disability and increased morbidity and mortality. Awareness of the importance of skeletal muscle maintenance in obesity is however low among clinicians and scientists. The term "sarcopenic obesity" has been proposed to identify obesity with low skeletal muscle function and mass, but its utilization is largely limited to the aging patient population, and consensus on its definition and diagnostic criteria remains insufficient. Knowledge on prevalence of sarcopenic obesity in various clinical conditions and patient subgroups, on its clinical impacts in patient risk stratification and on effective prevention and treatment strategies remain therefore dramatically inadequate. In particular, optimal dietary options and medical nutritional support strategies to preserve muscle mass in obese individuals remain largely undefined. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recognize and indicate obesity with altered body composition due to low skeletal muscle function and mass (sarcopenic obesity) as a scientific and clinical priority for researchers and clinicians. ESPEN and EASO therefore call for coordinated action aimed at reaching consensus on its definition, diagnostic criteria and optimal treatment with particular regard to nutritional therapy. We are convinced that achievement of these goals has strong potential to reduce the burden of morbidity and mortality in the rapidly increasing obese patient population. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  • 6. Barazzoni, Rocco
    et al.
    Bischoff, Stephan C.
    Busetto, Luca
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Chourdakis, Michael
    Cuerda, Cristina
    Delzenne, Nathalie
    Genton, Laurence
    Schneider, Stephane
    Singer, Pierre
    Boirie, Yves
    Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance2022In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 41, no 12, p. 2869-2886Article in journal (Refereed)
    Abstract [en]

    The COVID-19 pandemics has created unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favoring the onset of COVID-19 complications. In addition, patients with obesity may be at risk for loss of skeletal muscle mass, reflecting a state of hidden malnutrition with a strong negative health impact in all clinical settings. Also importantly, obesity is commonly associated with micronutrient deficiencies that directly influence immune function and infection risk. Finally, the pandemic-related lockdown, deleterious lifestyle changes and other numerous psychosocial consequences may worsen eating behaviors, sedentarity, body weight regulation, ultimately leading to further increments of obesity-associated metabolic complications with loss of skeletal muscle mass and higher non-communicable disease risk. Therefore, prevention, diagnosis and treatment of malnutrition and micronutrient deficiencies should be routinely included in the management of COVID-19 patients in the presence of obesity; lockdown-induced health risks should also be specifically monitored and prevented in this population. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing clinical practice guidance for nutritional management of COVID-19 patients with obesity in various clinical settings.

  • 7.
    Barazzoni, Rocco
    et al.
    Univ Trieste, Dept Med Surg & Hlth Sci, Str Fiume 447, I-34149 Trieste, Italy..
    Jensen, Gordon L.
    Univ Vermont, Larner Coll Med, Dept Med, Deans Off, Burlington, VT USA..
    Correia, Maria Isabel T. D.
    Univ Fed Minas Gerais, Med Sch, Dept Surg, Belo Horizonte, MG, Brazil..
    Gonzalez, Maria Cristina
    Univ Catolica Pelotas, Postgrad Program Hlth & Behav, Pelotas, RS, Brazil..
    Higashiguchi, Takashi
    Yonaha Okanoue Hosp, Kuwana, Japan..
    Shi, Han Ping
    Capital Med Univ, Beijing Shijitan Hosp, Dept Gastrointestinal Surg, Key Lab Canc FSMP State Market Regulat, Beijing, Peoples R China.;Capital Med Univ, Beijing Shijitan Hosp, Dept Clin Nutr, Beijing, Peoples R China..
    Bischoff, Stephan C.
    Univ Hohenheim, Dept Nutr Med, Stuttgart, Germany..
    Boirie, Yves
    Univ Clermont Auvergne, Clin Nutr Dept, Unite Nutr Humaine, CRNH Auvergne,INRAE,CHU Clermont Ferrand, Clermont Ferrand, France..
    Carrasco, Fernando
    Univ Chile, Fac Med, Nutr & Bariatr Surg Ctr, Dept Nutr,Clin Las Condes, Santiago, Chile..
    Cruz-Jentoft, Alfonso
    Hosp Univ Ramon y Cajal IRYCIS, Serv Geriatria, Madrid, Spain..
    Fuchs-Tarlovsky, Vanessa
    Hosp Gen Mexico City, Clin Nutr Dept, Ciudad De Mexico, Mexico..
    Fukushima, Ryoji
    Teikyo Univ, Teikyo Heisei Univ, Sch Med Hlth & Dietet, Dept Surg, Tokyo, Japan..
    Heymsfield, Steve
    Louisiana State Univ, Pennington Biomed Res Ctr, Baton Rouge, LA 70808 USA..
    Mourtzakis, Marina
    Univ Waterloo, Dept Kinesiol & Hlth Sci, Waterloo, ON, Canada..
    Muscaritoli, Maurizio
    Sapienza Univ Rome, Dept Translat & Precis Med, Rome, Italy..
    Norman, Kristina
    Charite Univ Med Berlin, Freie Univ Berlin, Humboldt Univ Berlin, Dept Geriatr & Med Gerontol,Berlin Inst Hlth, Berlin, Germany.;German Inst Human Nutr Potsdam Rehbrucke, Dept Nutr & Gerontol, Nuthetal, Germany..
    Nyulasi, Ibolya
    Alfred Hosp, Nutr Dept, Melbourne, Vic, Australia.;La Trobe Univ, Dept Dietet Nutr & Sport, Bundoora, Vic, Australia.;Monash Univ, Cent Clin Sch, Dept Med, Melbourne, Vic, Australia..
    Pisprasert, Veeradej
    Khon Kaen Univ, Fac Med, Dept Med, Khon Kaen, Thailand..
    Prado, Carla
    Univ Alberta, Dept Agr Food & Nutr Sci, Human Nutr Res Unit, Edmonton, AB, Canada..
    de van der Schuren, Marian
    HAN Univ Appl Sci, Sch Allied Hlth, Dept Nutr Dietet & Lifestyle, Nijmegen, Netherlands.;Wageningen Univ & Res Human Nutr & Hlth, Wageningen, Netherlands..
    Yoshida, Sadao
    Chuzan Hosp, Dept Rehabil, Okinawa City, Okinawa, Japan..
    Yu, Yanchun
    Chinese Acad Med Sci, Peking Union Med Coll Hosp, Dept Gen Surg, Beijing, Peoples R China..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Karolinska Univ Hosp, Theme Inflammat & Ageing, Stockholm, Sweden..
    Compher, Charlene
    Univ Penn, Sch Nursing, Dept Biobehav Hlth Sci, Philadelphia, PA 19104 USA..
    Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition2022In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 41, no 6, p. 1425-1433Article in journal (Refereed)
    Abstract [en]

    The Global Leadership Initiative on Malnutrition (GLIM) provides consensus criteria for the diagnosis of malnutrition that can be widely applied. The GLIM approach is based on the assessment of three phenotypic (weight loss, low body mass index, and low skeletal muscle mass) and two etiologic (low food intake and presence of disease with systemic inflammation) criteria, with diagnosis confirmed by any combination of one phenotypic and one etiologic criterion fulfilled. Assessment of muscle mass is less commonly performed than other phenotypic malnutrition criteria, and its interpretation may be less straightforward, particularly in settings that lack access to skilled clinical nutrition practitioners and/or to body composition methodologies. In order to promote the widespread assessment of skeletal muscle mass as an integral part of the GLIM diagnosis of malnutrition, the GLIM consortium appointed a working group to provide consensus-based guidance on assessment of skeletal muscle mass. When such methods and skills are available, quantitative assessment of muscle mass should be measured or estimated using dual-energy x-ray absorptiometry, computerized tomography, or bioelectrical impedance analysis. For settings where these resources are not available, then the use of anthropometric measures and physical examination are also endorsed. Validated ethnic-and sex-specific cutoff values for each measurement and tool are recommended when available. Measurement of skeletal muscle function is not advised as surrogate measurement of muscle mass. However, once malnutrition is diagnosed, skeletal muscle function should be investigated as a relevant component of sarcopenia and for complete nutrition assessment of persons with malnutrition. (c) 2022 Elsevier Ltd. and European Society for Clinical Nutrition and Metabolism and American Society for Parenteral and Enteral Nutrition. All rights reserved.

  • 8.
    Bendavid, Itai
    et al.
    Tel Aviv Univ, Sackler Sch Med, Beilinson Hosp, Rabin Med Ctr,Dept Gen Intens Care, Tel Aviv, Israel.;Tel Aviv Univ, Sackler Sch Med, Beilinson Hosp, Rabin Med Ctr,Inst Nutr Res, Tel Aviv, Israel..
    Lobo, Dileep N.
    Nottingham Univ Hosp NHS Trust, Nottingham Biomed Res Ctr, Natl Inst Hlth Res NIHR, Gastrointestinal Surg,Nottingham Digest Dis Ctr, Nottingham NG7 2UH, England.;Univ Nottingham, Queens Med Ctr, Nottingham NG7 2UH, England.;Univ Nottingham, Queens Med Ctr, Sch Life Sci, MRC Versus Arthrit Ctr Musculoskeletal Ageing Res, Nottingham NG7 2UH, England..
    Barazzoni, Rocco
    Univ Trieste, Dept Med Surg & Hlth Sci, Trieste, Italy..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Theme Ageing, Stockholm, Sweden..
    Coeffier, Moise
    Rouen Univ Hosp, Dept Nutr, CIC1404, Rouen, France.;Normandie Univ, UNIROUEN, Inserm UMR1073, Rouen, France..
    de van der Schueren, Marian
    HAN Univ Appl Sci, Dept Nutr & Dietet, Sch Allied Hlth, Nijmegen, Netherlands..
    Fontaine, Eric
    Univ Grenoble Alpes, LBFA, INSERM U1055, Grenoble, France..
    Hiesmayr, Michael
    Med Univ Vienna, Div Cardiac Thorac Vasc Anesthesia & Intens Care, Waehringerguertel 18-20, A-1090 Vienna, Austria..
    Laviano, Alessandro
    Sapienza Univ, Dept Translat & Precis Med, Rome, Italy..
    Pichard, Claude
    Geneva Univ Hosp, Clin Nutr, Rue Gabrielle Perret Gentil 4, CH-12111 Geneva 4, Switzerland..
    Singer, Pierre
    Tel Aviv Univ, Sackler Sch Med, Beilinson Hosp, Rabin Med Ctr,Dept Gen Intens Care, Tel Aviv, Israel.;Tel Aviv Univ, Sackler Sch Med, Beilinson Hosp, Rabin Med Ctr,Inst Nutr Res, Tel Aviv, Israel..
    The centenary of the Harris-Benedict equations: How to assess energy requirements best? Recommendations from the ESPEN expert group2021In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 40, no 3, p. 690-701Article, review/survey (Refereed)
    Abstract [en]

    Background & aims: The year 2019 marked the centenary of the publication of the Harris and Benedict equations for estimation of energy expenditure. In October 2019 a Scientific Symposium was organized by the European Society for Clinical Nutrition and Metabolism (ESPEN) in Vienna, Austria, to celebrate this historical landmark, looking at what is currently known about the estimation and measurement of energy expenditure.

    Methods: Current evidence was discussed during the symposium, including the scientific basis and clinical knowledge, and is summarized here to assist with the estimation and measurement of energy requirements that later translate into energy prescription.

    Results: In most clinical settings, the majority of predictive equations have low to moderate performance, with the best generally reaching an accuracy of no more than 70%, and often lead to large errors in estimating the true needs of patients. Generally speaking, the addition of body composition measurements did not add to the accuracy of predictive equations. Indirect calorimetry is the most reliable method to measure energy expenditure and guide energy prescription, but carries inherent limitations, greatly restricting its use in real life clinical practice.

    Conclusions: While the limitations of predictive equations are clear, their use is still the mainstay in clinical practice. It is imperative to recognize specific patient populations for whom a specific equation should be preferred. When available, the use of indirect calorimetry is advised in a variety of clinical settings, aiming to avoid under-as well as overfeeding.

  • 9. Biolo, G
    et al.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Muscaritoli, M
    Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of ageing and chronic disease: From sarcopenic obesity to cachexia2014In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 5, p. 737-748Article in journal (Refereed)
    Abstract [en]

    Skeletal muscle is the most abundant body tissue accounting for many physiological functions. However, muscle mass and functions are not routinely assessed. Sarcopenia is defined as skeletal muscle loss and dysfunction in aging and chronic diseases. Inactivity, inflammation, age-related factors, anorexia and unbalanced nutrition affect changes in skeletal muscle. Mechanisms are difficult to distinguish in individual subjects due to the multifactorial character of the condition. Sarcopenia includes both muscle loss and dysfunction which induce contractile impairment and metabolic and endocrine abnormalities, affecting whole-body metabolism and immune/inflammatory response. There are different metabolic trajectories for muscle loss versus fat changes in aging and chronic diseases. Appetite regulation and physical activity affect energy balance and changes in body fat mass. Appetite regulation by inflammatory mediators is poorly understood. In some patients, inflammation induces anorexia and fat loss in combination with sarcopenia. In others, appetite is maintained, despite activation of systemic inflammation, leading to sarcopenia with normal or increased BMI. Inactivity contributes to sarcopenia and increased fat tissue in aging and diseases. At the end of the metabolic trajectories, cachexia and sarcopenic obesity are paradigms of the two patient categories. Pre-cachexia and cachexia are observed in patients with cancer, chronic heart failure or liver cirrhosis. Sarcopenic obesity and sarcopenia with normal/increased BMI are observed in rheumatoid arthritis, breast cancer patients with adjuvant chemotherapy and in most of patients with COPD or chronic kidney disease. In these conditions, sarcopenia is a powerful prognostic factor for morbidity and mortality, independent of BMI.

  • 10. Bischoff, Stephan C
    et al.
    Boirie, Yves
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Chourdakis, Michael
    Cuerda, Cristina
    Delzenne, Nathalie M
    Deutz, Nicolaas E
    Fouque, Denis
    Genton, Laurence
    Gil, Carmen
    Koletzko, Berthold
    Leon-Sanz, Miguel
    Shamir, Raanan
    Singer, Joelle
    Singer, Pierre
    Stroebele-Benschop, Nanette
    Thorell, Anders
    Weimann, Arved
    Barazzoni, Rocco
    Towards a multidisciplinary approach to understand and manage obesity and related diseases2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 4, p. 917-938, article id S0261-5614(16)31323-1Article, review/survey (Refereed)
    Abstract [en]

    Overnutrition and sedentary lifestyle result in overweight or obesity defined as abnormal or excessive fat accumulation that may impair health. According to the WHO, the worldwide prevalence of obesity nearly doubled between 1980 and 2008. In 2008, over 50% of both men and women in the WHO European Region were overweight, and approximately 23% of women and 20% of men were obese. Comprehensive diagnostic and therapeutic approaches should include nutritional treatment to favor the best metabolic and nutritional outcome, as well as to induce potential disease-specific benefits from selected nutritional regimens. Obesity is usually accompanied by an increased muscle mass. This might explain why obesity, under particular circumstances such as cancer or high age, might have protective effects, a phenomenon named the 'obesity paradox'. However, loss of muscle mass or function can also occur, which is associated with poor prognosis and termed 'sarcopenic obesity'. Therefore, treatment recommendations may need to be individualized and adapted to co-morbidities. Since obesity is a chronic systemic disease it requires a multidisciplinary approach, both at the level of prevention and therapy including weight loss and maintenance. In the present personal review and position paper, authors from different disciplines including endocrinology, gastroenterology, nephrology, pediatrics, surgery, geriatrics, intensive care medicine, psychology and psychiatry, sports medicine and rheumatology, both at the basic science and clinical level, present their view on the topic and underline the necessity to provide a multidisciplinary approach, to address this epidemic.

  • 11. Bischoff, Stephan C
    et al.
    Singer, Pierre
    Koller, Michael
    Barazzoni, Rocco
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    van Gossum, André
    Standard operating procedures for ESPEN guidelines and consensus papers2015In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 34, no 6, p. 1043-1051Article in journal (Refereed)
    Abstract [en]

    The ESPEN Guideline standard operating procedures (SOP) is based on the methodology provided by the Association of Scientific Medical Societies of Germany (AWMF), the Scottish Intercollegiate Guidelines Network (SIGN), and the Centre for Evidence-based Medicine at the University of Oxford. The SOP is valid and obligatory for all future ESPEN-sponsored guideline projects aiming to generate high-quality guidelines on a regular basis. The SOP aims to facilitate the preparation of guideline projects, to streamline the consensus process, to ensure quality and transparency, and to facilitate the dissemination and publication of ESPEN guidelines. To achieve this goal, the ESPEN Guidelines Editorial board (GEB) has been established headed by two chairmen. The GEB will support and supervise the guideline processes and is responsible for the strategic planning of ESPEN guideline activities. Key elements of the SOP are the generation of well-built clinical questions according to the PICO system, a systemic literature search, a classification of the selected literature according to the SIGN evidence levels providing an evidence table, and a clear and straight-forward consensus procedure consisting of online voting's and a consensus conference. Only experts who meet the obligation to disclosure any potential conflict of interests and who are not employed by the Industry can participate in the guideline process. All recommendations will be graded according to the SIGN grading and novel outcome models besides biomedical endpoints. This approach will further extent the leadership of ESPEN in creating up-to-date and suitable for implementation guidelines and in sharing knowledge on malnutrition and clinical nutrition.

  • 12.
    Blixt, Christina
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Univ, Dept Anesthesia & Intens Care, Hosp Huddinge, Stockholm, Sweden.;Karolinska Univ, Perioperat Med & Intens Care, Hosp Huddinge, Stockholm, Sweden..
    Larsson, Mirjam
    Karolinska Univ, Dept Anesthesia & Intens Care, Hosp Huddinge, Stockholm, Sweden.;Karolinska Univ, Hosp Solna, Perioperat Med & Intens Care, S-17176 Stockholm, Sweden..
    Isaksson, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Ljungqvist, Olle
    Örebro Univ, Dept Surg, Sch Med Sci, SE-70185 Örebro, Sweden.;Örebro Univ Hosp, Dept Surg, SE-70185 Örebro, Sweden..
    Rooyackers, Olav
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden..
    The effect of glucose control in liver surgery on glucose kinetics and insulin resistance2021In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 40, no 7, p. 4526-4534Article in journal (Refereed)
    Abstract [en]

    Background & aims: Clinical outcome is negatively correlated to postoperative insulin resistance and hyperglycemia. The magnitude of insulin resistance can be modulated by glucose control, preoperative nutrition, adequate pain management and minimal invasive surgery. Effects of glucose control on perioperative glucose kinetics in liver surgery is less studied. Methods: 18 patients scheduled for open hepatectomy were studied per protocol in this prospective, randomized study. In the treatment group (n = 9), insulin was administered intravenously to keep arterial blood glucose between 6 and 8 mmol/l during surgery. The control group (n = 9) received insulin if blood glucose >11.5 mmol/l. Insulin sensitivity was measured by an insulin clamp on the day before surgery and immediately postoperatively. Glucose kinetics were assessed during the clamp and surgery. Results: Mean intraoperative glucose was 7.0 mM (SD 0.7) vs 9.1 mM (SD 1.9) in the insulin and control group respectively (p < 0.001; ANOVA). Insulin sensitivity decreased in both groups but significantly (p = 0.03, ANOVA) more in the control group (M value: 4.6 (4.4-6.8) to 2.1 (1.2-2.6) and 4.6 (4.1-5.0) to 0.6 (0.1-1.8) mg/kg/min in the treatment and control group respectively). Endogenous glucose production (EGP) increased and glucose disposal (WGD) decreased significantly between the pre-and postoperative clamps in both groups, with no significant difference between the groups. Intraoperative kinetics demonstrated that glucose control decreased EGP (p = 0.02) while WGD remained unchanged (p = 0.67). Conclusion: Glucose control reduces postoperative insulin resistance in liver surgery. EGP increases and WGD is diminished immediately postoperatively. Insulin seems to modulate both reactions, but mostly the WGD is affected. Intraoperative EGP decreased while WGD remained unaltered. Registration number of clinical trial: ANZCTR 12614000278639. 

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  • 13.
    Cappellari, Gianluca Gortan
    et al.
    Univ Trieste, Dept Med Sci, Trieste, Italy..
    Guillet, Christelle
    Univ Clermont Auvergne, INRA, CRNH, CHU Clermont Ferrand, Clermont Ferrand, France..
    Poggiogalle, Eleonora
    Sapienza Univ, Rome, Italy..
    Pomar, Maria D. Ballesteros
    Complejo Asistencial Univ Leon, Leon, Spain..
    Batsis, John A.
    Univ North Carolina Chapel Hill, Chapel Hill, NC USA..
    Boirie, Yves
    Univ Clermont Auvergne, INRA, CRNH, CHU Clermont Ferrand, Clermont Ferrand, France..
    Breton, Irene
    Hosp Gen Univ Gregorio Maranon, Madrid, Spain..
    Frara, Stefano
    Univ Vita Salute, IRCCS Osped San Raffaele, Milan, Italy..
    Genton, Laurence
    Univ Hosp Geneva, Geneva, Switzerland..
    Gepner, Yftach
    Tel Aviv Univ, Tel Aviv, Israel..
    Gonzalez, Maria Cristina
    Catholic Univ Pelotas UCPEL, Pelotas, RS, Brazil. Pennington Biomed Res Ctr, Baton Rouge, LA USA. Univ Freiburg, Inst Evidence Med, Med Ctr, Freiburg, Germany..
    Heyms, Steven B.
    Kiesswetter, Eva
    Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.
    Laviano, Alessandro
    Sapienza Univ, Rome, Italy..
    Prado, Carla M.
    Santini, Ferruccio
    Serlie, Mireille J.
    Siervo, Mario
    Villareal, Dennis T.
    Volkert, Dorothee
    Voortman, Trudy
    Weijs, Peter J. M.
    Zamboni, Mauro
    Bischoff, Stephan C.
    Busetto, Luca
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Stockholm, Sweden..
    Barazzoni, Rocco
    Univ Trieste, Dept Med Sci, Trieste, Italy..
    Donini, Lorenzo M.
    Sapienza Univ, Rome, Italy.;Sapienza Univ, Dept Expt Med, Ple Aldo Moro 5, I-00185 Rome, Italy..
    Panel, SOGLI Expert
    Sarcopenic obesity research perspectives outlined by the sarcopenic obesity global leadership initiative (SOGLI): Proceedings from the SOGLI consortium meeting in rome November 20222023In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 42, no 5, p. 687-699Article in journal (Refereed)
    Abstract [en]

    The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched the Sarcopenic Obesity Global Leadership Initiative (SOGLI) to reach expert consensus on a definition and diagnostic criteria for Sarcopenic Obesity (SO).The present paper describes the proceeding of the Sarcopenic Obesity Global Leadership Initiative (SOGLI) meeting that was held on November 25th and 26th, 2022 in Rome, Italy. This consortium involved the participation of 50 researchers from different geographic regions and countries.The document outlines an agenda advocated by the SOGLI expert panel regarding the pathophysiology, screening, diagnosis, staging and treatment of SO that needs to be prioritized for future research in the field.

  • 14.
    Cardenas, Diana
    et al.
    Inst Gustave Roussy, Nutr Unit, Villejuif, France..
    Correia, M. Isabel T. D.
    Univ Fed Med, Med Sch, Surg Dept, Eterna Rede Mater & Hosp Semper, Belo Horizonte, Brazil..
    Hardy, Gil
    Ipanema Res Trust, Auckland, New Zealand..
    Gramlich, Leah
    Univ Alberta, Dept Med, Edmonton, AB, Canada..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Stockholm, Sweden.
    Van Ginkel-Res, Annemieke
    European Federat Assoc Dietitians EFAD, Utrecht, Netherlands..
    Remijnse, Wineke
    European Federat Assoc Dietitians EFAD, Utrecht, Netherlands..
    Barrocas, Albert
    Tulane Sch Med, Dept Surg, New Orleans, LA USA..
    Gautier, Juan B. Ochoa
    Hunterdon Med Ctr, Flemington, NJ USA..
    Ljungqvist, Olle
    Örebro Univ, Sch Med Sci, Dept Surg, Örebro, Sweden..
    Ungpinitpong, Winnai
    Surin Hosp, Surg Dept, Surin, Thailand..
    Barazzoni, Rocco
    Univ Trieste, Osped Cattinara, Dept Med Technol & Translat Sci, Trieste, Italy..
    The international declaration on the human right to nutritional care: A global commitment to recognize nutritional care as a human right2023In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 42, no 6, p. 909-918Article in journal (Other academic)
    Abstract [en]

    Access to nutritional care is frequently limited or denied to patients with disease-related malnutrition (DRM), to those with the inability to adequately feed themselves or to maintain their optimal healthy nutritional status which goes against the fundamental human right to food and health care. That is why the International Working Group for Patient's Right to nutritional care is committed to promote a human rights based approach (HRBA) in the field of clinical nutrition. Our group proposed to unite efforts by launching a global call to action against disease-related malnutrition through The International Declaration on the Human Right to Nutritional Care signed in the city of Vienna during the 44th ESPEN congress on September 5th 2022. The Vienna Declaration is a non-legally binding document that sets a shared vision and five principles for implementation of actions that would promote the access to nutritional care. Implementation programs of the Vienna Declaration should be promoted, based on international normative frameworks as The United Nations (UN) 2030 Agenda for Sustainable Development, the Rome Declaration of the Second International Conference on Nutrition and the Working Plan of the Decade of Action on Nutrition 2016-2025. In this paper, we present the general background of the Vienna Declaration, we set out an international normative framework for implementation programs, and shed a light on the progress made by some clinical nutrition societies.

    Through the Vienna Declaration, the global clinical nutrition network is highly motivated to appeal to public authorities, international governmental and non-governmental organizations and other scientific healthcare societies on the importance of optimal nutritional care for all patients.

  • 15.
    Carter, Paul
    et al.
    Univ Cambridge, Dept Med, Cambridge, England..
    Yuan, Shuai
    Karolinska Inst, Inst Environm Med, Unit Cardiovasc & Nutr Epidemiol, Stockholm, Sweden..
    Kar, Siddhartha
    Univ Bristol, Bristol Med Sch, MRC Integrat Epidemiol Unit, Bristol, England..
    Vithayathil, Mathew
    Univ Cambridge, MRC Canc Unit, Cambridge, England..
    Mason, Amy M.
    Univ Cambridge, British Heart Fdn Cardiovasc Epidemiol Unit, Dept Publ Hlth & Primary Care, Cambridge, England.;Univ Cambridge, Natl Inst Hlth Res Cambridge Biomed Res Ctr, Cambridge, England.;Cambridge Univ Hosp, Cambridge, England..
    Burgess, Stephen
    Univ Cambridge, MRC Biostat Unit, Cambridge, England.;Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge, England..
    Larsson, Susanna C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology. Karolinska Inst, Inst Environm Med, Unit Cardiovasc & Nutr Epidemiol, Stockholm, Sweden..
    Coffee consumption and cancer risk: a Mendelian randomisation study2022In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 41, no 10, p. 2113-2123Article in journal (Refereed)
    Abstract [en]

    Background: Coffee contains many bioactive chemicals and associations with cancer have been reported in observational studies. In this Mendelian randomisation (MR) study we investigated the causal associations of coffee consumption with a broad range of cancers.

    Materials and methods: Twelve independent genetic variants proxied coffee consumption. Geneticallypredicted risk of any cancer (59,647 cases) and 22 site-specific cancers was estimated in Europeandescent individuals in UK Biobank. Univariable and multivariable MR analyses were conducted.

    Results: Genetically-predicted coffee consumption was not associated with risk of any cancer in the main analysis (OR 1.05, 95% CI 0.98-1.14, p = 0.183) but was associated with an increased risk of digestive system cancer (OR 1.28, 95% CI 1.09-1.51, p = 0.003), driven by a strong association with oesophageal cancer (OR 2.79, 95% CI 1.73-4.50, p = 2.5x10-5). This association was consistent after adjustment for genetically-predicted body mass index, smoking and alcohol consumption. There was no strong evidence supporting a causal relationship between genetically-predicted coffee consumption and the majority of cancers studied. However, genetically-predicted coffee consumption was associated with increased risk of multiple myeloma (OR 2.25, 95% CI 1.30-3.89, p = 0.004) and reduced ovarian cancer risk (OR 0.63, 95% CI 0.43-0.93, p = 0.020).

    Conclusions: This MR study provides strong support for a causal association of coffee consumption with oesophageal cancer, but not for the majority of cancer types, and the underlying mechanisms require investigation.

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    FULLTEXT01
  • 16.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Letter to Editor - BMI, FFMI not seem universally applicable in nutritional assessment & the place of SGA & functional evaluation shouldn't be overlooked2015In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983Article in journal (Other academic)
  • 17.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Letter to the Editor - Should significant weight loss mandated to be "unintentional" for resulting in and regarded as malnutrition?2016In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 35, no 1, p. 235-235Article in journal (Refereed)
  • 18.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Reply, Letter to Editor - BMI, FFMI do not seem universally applicable in nutritional assessment & the place of SGA & functional evaluation shouldn't be overlooked2016In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 35, no 1, p. 237-237Article in journal (Refereed)
  • 19. Cederholm, Tommy
    Standard operating procedures for ESPEN guidelines and consensus papers2015In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983Article in journal (Refereed)
  • 20.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Barazzoni, R
    Austin, P
    Ballmer, P
    Biolo, G
    Bischoff, S C
    Compher, C
    Correia, I
    Higashiguchi, T
    Holst, M
    Jensen, G L
    Malone, A
    Muscaritoli, M
    Nyulasi, I
    Pirlich, M
    Rothenberg, E
    Schindler, K
    Schneider, S M
    de van der Schueren, M A E
    Sieber, C
    Valentini, L
    Yu, J C
    Van Gossum, A
    Singer, P
    ESPEN guidelines on definitions and terminology of clinical nutrition2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 1, p. 49-64Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research.

    OBJECTIVE: This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures.

    METHODS: The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round.

    RESULTS: Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery.

    CONCLUSION: An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.

  • 21.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Bosaeus, I.
    Barazzoni, R.
    Bauer, J.
    Van Gossum, A.
    Klek, S.
    Muscaritoli, M.
    Nyulasi, I.
    Ockenga, J.
    Schneider, S. M.
    de van der Schueren, M. A. E.
    Singer, P.
    Diagnostic criteria for malnutrition - An ESPEN Consensus Statement2015In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 34, no 3, p. 335-340Article in journal (Refereed)
    Abstract [en]

    Objective: To provide a consensus-based minimum set of criteria for the diagnosis of malnutrition to be applied independent of clinical setting and aetiology, and to unify international terminology. Method: The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a group of clinical scientists to perform a modified Delphi process, encompassing e-mail communications, face-to-face meetings, in group questionnaires and ballots, as well as a ballot for the ESPEN membership. Result: First, ESPEN recommends that subjects at risk of malnutrition are identified by validated screening tools, and should be assessed and treated accordingly. Risk of malnutrition should have its own ICD Code. Second, a unanimous consensus was reached to advocate two options for the diagnosis of malnutrition. Option one requires body mass index (BMI, kg/m(2)) <18.5 to define malnutrition. Option two requires the combined finding of unintentional weight loss (mandatory) and at least one of either reduced BMI or a low fat free mass index (FFMI). Weight loss could be either >10% of habitual weight indefinite of time, or >5% over 3 months. Reduced BMI is <20 or <22 kg/m(2) in subjects younger and older than 70 years, respectively. Low FFMI is <15 and <17 kg/m(2) in females and males, respectively. About 12% of ESPEN members participated in a ballot; >75% agreed; i.e. indicated >= 7 on a 10-graded scale of acceptance, to this definition. Conclusion: In individuals identified by screening as at risk of malnutrition, the diagnosis of malnutrition should be based on either a low BMI (<18.5 kg/m(2)), or on the combined finding of weight loss together with either reduced BMI (age-specific) or a low FFMI using sex-specific cut-offs.

  • 22.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Compher, C.
    Univ Penn, Sch Nursing, Philadelphia, PA 19104 USA.
    Correia, M. I. T. D.
    Univ Fed Minas Gerais, Belo Horizante, Brazil.
    Gonzalez, M. C.
    Univ Catolica Pelotas, Pelotas, RS, Brazil.
    Fukushima, R.
    Univ Tokyo, Sch Med, Tokyo, Japan.
    Higashiguchi, T.
    Fujita Hlth Univ, Sch Med, Toyoake, Aichi, Japan.
    Van Gossum, A.
    Free Univ Brussels, Brussels, Belgium.
    Jensen, G. L.
    Univ Vermont, Burlington, VT USA.
    Response to the letter: Comment on "GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community": Some considerations about the GLIM criteria - A consensus report for the diagnosis of malnutrition by Drs. LB da Silva Passos and DA De -Souza2019In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 38, no 3, p. 1480-1481Article in journal (Other academic)
  • 23.
    Cederholm, Tommy E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Letter to the Editor: Diagnostic criteria for malnutrition: Consequences for the nutrition teams2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 1, p. 309-309Article in journal (Refereed)
  • 24.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Jensen, Gordon L.
    Univ Vermont, Coll Med, Deans Off, Burlington, VT USA.; Univ Vermont, Coll Med, Dept Med, Burlington, VT USA..
    To create a consensus on malnutrition diagnostic criteria: A report from the Global Leadership Initiative on Malnutrition (GLIM) meeting at the ESPEN Congress 20162017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 1, p. 7-10, article id S0261-5614(16)31342-5Article in journal (Refereed)
    Abstract [en]

    During the ESPEN Congress in Copenhagen, Denmark (September 2016) representatives of the 4 largest global PEN-societies from Europe (ESPEN), USA (ASPEN), Asia (PENSA) and Latin America (FELANPE), and from national PEN-societies around the world met to continue the conversation on how to diagnose malnutrition that started during the Clinical Nutrition Week, Austin, USA (February 2016). Current thinking on diagnostic approaches was shared; ESPEN suggested a grading approach that could encompass various types of signs, symptoms and etiologies to support diagnosis. ASPEN emphasized where the parties agree; i.e. that the three major published approaches (ESPEN, ASPEN/AND and Subjective Global Assessment (SGA)) all propose weight loss as a key indicator for malnutrition. FELANPE suggested that the anticipated consensus approach needs to prioritize a diagnostic methodology that is available for everybody since resources differ globally. PENSA highlighted that BMI varies by ethnicity/race, and that sarcopenia/muscle mass evaluation is important for the diagnosis of malnutrition. A Core Working Committee of the Global Leadership Initiative on Malnutrition (GLIM) has been established (comprised of two representatives each from the 4 largest PEN-societies) that will lead consensus development in collaboration with a larger Working Group with broad global representation, using e-mail, telephone conferences, and face-to-face meetings during the up-coming ASPEN and ESPEN Congresses. Transparency and external input will be sought. Objectives include: 1. Consensus development around evidence-based criteria for broad application. 2. Promotion of global dissemination of the consensus criteria. 3. Seeking adoption by the World Health Organization (WHO) and the International Classification of Diseases (ICD).

  • 25.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Theme Aging, Stockholm, Sweden..
    Singer, P.
    Rabin Med Ctr, Dept Gen Intens Care, Petah Tiqwa, Israel.;Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel..
    Malnutrition according to the European Society of Clinical Nutrition and Metabolism (ESPEN) definition and falls in general older population: Reply letter to the Editor2020In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 39, no 4, p. 1302-1302Article in journal (Other academic)
  • 26.
    de van der Schueren, M. A. E.
    et al.
    HAN Univ Appl Sci, Sch Allied Hlth, Dept Nutr & Hlth, Nijmegen, Netherlands..
    Keller, H.
    Schlegel Univ Waterloo Res Inst Aging, Waterloo, ON, Canada.;Univ Waterloo, Dept Kinesiol, Waterloo, ON, Canada..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Theme Aging, Stockholm, Sweden..
    Barazzoni, R.
    Univ Trieste, Dept Med Surg & Hlth Sci, Trieste, Italy..
    Compher, C.
    Univ Penn, Hlth Community Practices, Sch Nursing, Biobehav Hlth Sci Dept, Claire M Fagin Hall 331,418 Curie Blvd, Philadelphia, PA 19104 USA..
    Correia, M. I. T. D.
    Univ Fed Minas Gerais, Sch Med, Belo Horizonte, MG, Brazil..
    Gonzalez, M. C.
    Univ Catolica Pelotas, Postgrad Program Hlth & Behav, Pelotas, RS, Brazil.;Univ Fed Pelotas, Postgrad Program Nutr & Food, Pelotas, RS, Brazil..
    Jager-Wittenaar, H.
    Hanze Univ Appl Sci, Res Grp Hlth Ageing Allied Hlth Care & Nursing, Groningen, Netherlands.;Univ Groningen, Univ Med Ctr Groningen, Dept Maxillofacial Surg, Groningen, Netherlands..
    Pirlich, M.
    Imperial Oak Outpatient Clin Kaisereiche, Clin Nutr, Endocrinol, Gastroenterol, Berlin, Germany..
    Steiber, A.
    Acad Nutr & Dietet, 120 South Riverside Plaza,Suite 2190, Chicago, IL 60606 USA..
    Waitzberg, D.
    Univ Sao Paulo, Sch Med, Dept Gastroenterol, Sao Paulo, Brazil..
    Jensen, G. L.
    Univ Vermont, Med & Nutr, Larner Coll Med, Burlington, VT USA..
    Global Leadership Initiative on Malnutrition (GLIM): Guidance on validation of the operational criteria for the diagnosis of protein-energy malnutrition in adults2020In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 39, no 9, p. 2872-2880Article in journal (Refereed)
    Abstract [en]

    Background: The Global Leadership Initiative on Malnutrition (GLIM) created a consensus-based framework consisting of phenotypic and etiologic criteria to record the occurrence of malnutrition in adults. This is a minimum set of practicable indicators for use in characterizing a patient/client as malnourished, considering the global variations in screening and nutrition assessment, and to be used across different health care settings. As with other consensus-based frameworks for diagnosing disease states, these operational criteria require validation and reliability testing as they are currently based solely on expert opinion.

    Methods: Several forms of validation and reliability are reviewed in the context of GLIM, providing guidance on how to conduct retrospective and prospective studies for criterion and construct validity.

    Findings: There are some aspects of GLIM criteria which require refinement; research using large data bases can be employed to reach this goal. Machine learning is also introduced as a potential method to support identification of the best cut-points and combinations of operational criteria for use with the different forms of malnutrition, which the GLIM criteria were created to denote. It is noted as well that the validation and reliability testing need to occur in a variety of sectors, populations and with diverse persons completing the criteria.

    Conclusion: The guidance presented supports the conduct and publication of quality validation and reliability studies for GLIM.

  • 27. Deutz, M.E
    et al.
    Bauer, J.M
    Barazzoni, R
    Biolo, G
    Boirie, Y
    Bosy-Westphal, A
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Cruz-Jentoft, A
    Krznariç, Z
    Nair, K.S
    Singer, P
    Teta, Daniel
    Tipton, K
    Calder, P.C
    Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group2014In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 6, p. 929-936Article in journal (Refereed)
    Abstract [en]

    The aging process is associated with gradual and progressive loss of muscle mass along with lowered strength and physical endurance. This condition, sarcopenia, has been widely observed with aging in sedentary adults. Regular aerobic and resistance exercise programs have been shown to counteract most aspects of sarcopenia. In addition, good nutrition, especially adequate protein and energy intake, can help limit and treat age-related declines in muscle mass, strength, and functional abilities. Protein nutrition in combination with exercise is considered optimal for maintaining muscle function.

    With the goal of providing recommendations for health care professionals to help older adults sustain muscle strength and function into older age, the European Society for Clinical Nutrition and Metabolism (ESPEN) hosted a Workshop on Protein Requirements in the Elderly, held in Dubrovnik on November 24 and 25, 2013. Based on the evidence presented and discussed, the following recommendations are made (a) for healthy older people, the diet should provide at least 1.0–1.2 g protein/kg body weight/day, (b) for older people who are malnourished or at risk of malnutrition because they have acute or chronic illness, the diet should provide 1.2–1.5 g protein/kg body weight/day, with even higher intake for individuals with severe illness or injury, and (c) daily physical activity or exercise (resistance training, aerobic exercise) should be undertaken by all older people, for as long as possible.

  • 28.
    Donini, Lorenzo M.
    et al.
    Sapienza Univ, Rome, Italy..
    Busetto, Luca
    Univ Padua, Padua, Italy..
    Bauer, Juergen M.
    Heidelberg Univ, Heidelberg, Germany..
    Bischoff, Stephan
    Univ Hohenheim, Stuttgart, Germany..
    Boirie, Yves
    Univ Clermont Auvergne, CHU Clermont Ferrand, CRNH, INRA, Clermont Ferrand, France..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Cruz-Jentoft, Alfonso J.
    Hosp Univ Ramon y Cajal IRYCIS, Madrid, Spain..
    Dicker, Dror
    Tel AVIV Univ, Sackler Fac Med, Tel Aviv, Israel..
    Fruhbeck, Gema
    Clin Univ Navarra, IdiSNA, CIBEROBN, Pamplona, Spain..
    Giustina, Andrea
    San Raffaele Univ Hosp, Milan, Italy..
    Gonzalez, Maria Cristina
    Catholic Univ Pelotas UCPEL, Pelotas, RS, Brazil..
    Han, Ho-Seong
    Seoul Natl Univ, Bundang Hosp SNUBH, Seoul, South Korea..
    Heymsfield, Steven B.
    Pennington Biomed Res Ctr, 6400 Perkins Rd, Baton Rouge, LA 70808 USA..
    Higashiguchi, Takashi
    Fujita Hlth Univ, Sch Med, Toyoake, Aichi, Japan..
    Laviano, Alessandro
    Sapienza Univ, Rome, Italy..
    Lenzi, Andrea
    Sapienza Univ, Rome, Italy..
    Parrinello, Edda
    Sapienza Univ, Rome, Italy..
    Poggiogalle, Eleonora
    Sapienza Univ, Rome, Italy..
    Prado, Carla M.
    Univ Alberta, Edmonton, AB, Canada..
    Rodriguez, Javier Salvador
    Clin Univ Navarra, Pamplona, Spain..
    Rolland, Yves
    Toulouse Univ Hosp, INSERM 1027, Gerontopole Toulouse, Toulouse, France..
    Santini, Ferruccio
    Univ Pisa, Pisa, Italy..
    Siervo, Mario
    Univ Nottingham, Nottingham, England..
    Tecilazich, Francesco
    San Raffaele Univ Hosp, Milan, Italy..
    Vettor, Roberto
    Univ Padua, Padua, Italy..
    Yu, Jianchun
    Peking Union Med Coll Hosp, Beijing, Peoples R China..
    Zamboni, Mauro
    Univ Verona, Verona, Italy..
    Barazzoni, Rocco
    Univ Trieste, Trieste, Italy..
    Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review2020In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 39, no 8, p. 2368-2388Article, review/survey (Refereed)
    Abstract [en]

    Background: Sarcopenic obesity is a clinical and functional condition characterized by the coexistence of excess fat mass and sarcopenia. Currently, different definitions of sarcopenic obesity exist and its diagnostic criteria and cut-offs are not universally established. Therefore, the prevalence and sensitivity of this condition for any disease risk prediction is affected significantly. Aim: This work was conducted under the auspices of the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). An international expert panel performed a systematic review as an initial step to analyze and summarize the available scientific literature on the definitions and the diagnostic criteria for sarcopenic obesity proposed and/or applied in human studies to date.

    Methods: The present systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted in April 2018 in three databases (PubMed, Scopus, Web of Science). Human studies conducted in both sexes, irrespective of ethnicity, and published from 2007 to 2018 were included; cohorts of individuals with obesity and acute or chronic conditions and treatments reported to negatively influence skeletal muscle mass and function independently of obesity were excluded from final analyses. The quality of the studies was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross sectional studies.

    Results: The electronic search retrieved 2335 papers of which 75 met the eligibility criteria. A marked heterogeneity in definitions and approaches to diagnose sarcopenic obesity was observed. This was mainly due to differences in the definitions of obesity and sarcopenia, in the methodologies used to assess body composition and physical function, and in the reference values for the variables that have been used (different cut-offs, interquartile analysis, diverse statistical stratification methods). This variability may be attributable, at least in part, to the availability of the methodologies in the different settings, to the variability in specialties and backgrounds of the researcher, and to the different settings (general population, clinical settings, etc.) where studies were performed.

    Conclusion: The results of the current work support the need for consensus proposals on: 1) definition of sarcopenic obesity; 2) diagnostic criteria both at the level of potential gold-standards and acceptable surrogates with wide clinical applicability, and with related cut-off values; 3) methodologies to be used in actions 1 and 2. First steps should be aimed at reaching consensus on plausible proposals that would need subsequent validation based on homogeneous studies and databases, possibly based on analyses of existing cohorts, to help define the prevalence of the condition, its clinical and functional relevance as well as most effective prevention and treatment strategies.

  • 29.
    Donini, Lorenzo M.
    et al.
    Sapienza Univ, Rome, Italy.
    Busetto, Luca
    Univ Padua, Padua, Italy.
    Bischoff, Stephan C.
    Univ Hohenheim, Stuttgart, Germany.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Ballesteros-Pomar, Maria D.
    Complejo Asistencial Univ Leon, Leon, Spain.
    Batsis, John A.
    Univ N Carolina, Chapel Hill, NC 27515 USA.
    Bauer, Juergen M.
    Heidelberg Univ, Heidelberg, Germany.
    Boirie, Yves
    Univ Clermont Auvergne, CHU Clermont Ferrand, CRNH, INRA, Clermont Ferrand, France..
    Cruz-Jentoft, Alfonso J.
    Hosp Univ Ramon Y Cajal IRYCIS, Madrid, Spain.
    Dicker, Dror
    Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel.
    Frara, Stefano
    San Raffaele Vita Salute Univ, Milan, Italy.;IRCCS Hosp, Milan, Italy.
    Frühbeck, Gema
    Clin Univ Navarra, IdiSNA, CIBEROBN, Pamplona, Spain.
    Genton, Laurence
    Hop Univ Geneve, Geneva, Switzerland.
    Gepner, Yftach
    Tel Aviv Univ, Tel Aviv, Israel.
    Giustina, Andrea
    San Raffaele Vita Salute Univ, Milan, Italy.;IRCCS Hosp, Milan, Italy.
    Gonzalez, Maria Cristina
    Catholic Univ Pelotas UCPEL, Pelotas, RS, Brazil.
    Han, Ho-Seong
    Seoul Natl Univ, Bundang Hosp SNUBH, Seoul, South Korea.
    Heymsfield, Steven B.
    Pennington Biomed Res Ctr, 6400 Perkins Rd, Baton Rouge, LA 70808 USA.
    Higashiguchi, Takashi
    Fujita Hlth Univ, Sch Med, Toyoake, Aichi, Japan.
    Laviano, Alessandro
    Sapienza Univ, Rome, Italy.
    Lenzi, Andrea
    Sapienza Univ, Rome, Italy.
    Nyulasi, Ibolya
    Monash Univ, Clayton, Vic, Australia.
    Parrinello, Edda
    Sapienza Univ, Rome, Italy.
    Poggiogalle, Eleonora
    Sapienza Univ, Rome, Italy.
    Prado, Carla M.
    Univ Alberta, Edmonton, AB, Canada.
    Salvador, Javier
    Univ Navarra, IdiSNA, CIBEROBN, Pamplona, Spain.
    Rolland, Yves
    Toulouse Univ Hosp, Gerontopole Toulouse, INSERM 1027, Toulouse, France.
    Santini, Ferruccio
    Univ Pisa, Pisa, Italy.
    Serlie, Mireille J.
    Amsterdam Univ Med Ctr, Amsterdam, Netherlands.
    Shi, Hanping
    Capital Med Univ, Beijing Shijitan Hosp, Beijing, Peoples R China.
    Sieber, Cornel C.
    Friedrich Alexander Univ Erlangen Nurnberg, Nurnberg, Germany.
    Siervo, Mario
    Univ Nottingham, Nottingham, England.
    Vettor, Roberto
    Univ Padua, Padua, Italy.
    Villareal, Dennis T.
    Baylor Coll Med, Houston, TX 77030 USA.
    Volkert, Dorothee
    Friedrich Alexander Univ Erlangen Nurnberg, Nurnberg, Germany.
    Yu, Jianchun
    Peking Union Med Coll Hosp, Beijing, Peoples R China.
    Zamboni, Mauro
    Univ Verona, Verona, Italy.
    Barazzoni, Rocco
    Univ Trieste, Dept Med Surg & Hlth Sci, Str Fiume 447, I-34149 Trieste, Italy.
    Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement2022In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 41, no 4, p. 990-1000Article in journal (Refereed)
    Abstract [en]

    Introduction: Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases), and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of an universally established SO Definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes.

    Aims and methods: The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a Definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into Stage I in the absence of clinical complications, or Stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction.

    Conclusions: ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO Definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing datasets, to study the predictive value, treatment efficacy, and clinical impact of this SO definition. (c) 2022 The Author(s). Published by Elsevier Ltd. on behalf of European Society for Clinical Nutrition and Metabolism and Obesity Facts published by S. Karger AG. This article is published under the Creative Commons CC-BY license. All rights reserved.

  • 30. Faxén-Irving, Gerd
    et al.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Energy dense oleic acid rich formula to newly admitted geriatric patients - Feasibility and effects on energy intake2011In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 30, no 2, p. 202-208Article in journal (Refereed)
    Abstract [en]

    Background & aims: Old patients seldom reach their energy requirements. The effects of an oleic acid rich formula on energy intake and appetite were studied.

    Methods: Recently admitted geriatric patients (n = 71), likely to stay > 1 week were randomised to receive 30 ml of a fat emulsion (Calogen (R)) 3 times daily, i.e., 420 kcal, at the regular medication rounds (intervention group (IG)) or to standard care (control group (CG)). Food intake and self-rated appetite were registered at baseline, i.e., 2-3 days after admission and on day 8 or the day prior to discharge. Nutritional risk screening (NRS) 2002, serum lipids and fatty acid profiles were analysed.

    Results: Fifty-one subjects fulfilled the study, i.e., 24 in the IG (83 +/- 7 y) and 27 controls (85 +/- 7 y). NRS showed that two thirds were at risk of malnutrition. Per-protocol analyses indicated that the daily energy intake was around 50% higher in IG compared to CG at the two measurements, respectively (p < 0.0001). The IG displayed a significantly improved appetite compared with the CG (P = 0.021). Serum lipids and fatty acid profile changed favourably by the intervention.

    Conclusions: An energy dense oleic acid rich liquid supplement given three times daily at medication rounds to geriatric patients may result in increased energy intake and better appetite with positive effects on serum lipids. ClinicalTrials.gov Identifier: NCT01042340.

  • 31.
    Fridén, Michael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Martínez Mora, Andrés
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Kullberg, Joel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Antaros Medical AB, Mölndal, Sweden.
    Rosqvist, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Diet composition, nutrient substitutions and circulating fatty acids in relation to ectopic and visceral fat depots2023In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 42, no 10, p. 1922-1931Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Short-term randomized trials have demonstrated that replacing saturated fat (SFA) with polyunsaturated fat (PUFA) causes a reduction or prevention of liver fat accumulation, but population-based studies on diet and body fat distribution are limited. We investigated cross-sectional associations between diet, circulating fatty acids and liver fat, visceral adipose tissue (VAT), intermuscular adipose tissue (IMAT) and other fat depots using different energy-adjustment models.

    METHODS: Sex-stratified analyses of n = 9119 (for serum fatty acids) to 13 849 (for nutrients) participants in UK Biobank were conducted. Fat depots were assessed by MRI, circulating fatty acids by NMR spectroscopy and diet by repeated 24-h recalls. Liver fat, VAT and IMAT were primary outcomes; total adipose tissue (TAT) and abdominal subcutaneous adipose tissue (ASAT) were secondary outcomes. Three a priori defined models were constructed: the all-components model, standard model and leave-one-out model (main model including specified nutrient substitutions). Imiomics (MRI-derived) was used to confirm and visualize associations.

    RESULTS: In women, substituting carbohydrates and free sugars with saturated fat (SFA) was positively associated with liver fat (β (95% CI) = 0.19 (0.02, 0.36) and β (95% CI) = 0.20 (0.05-0.35), respectively) and IMAT (β (95% CI) = 0.07 (0.00, 0.14) and β (95% CI) = 0.08 (0.02, 0.13), respectively), whereas substituting animal fat with plant fat was inversely associated with IMAT, ASAT and TAT. In the all-components and standard models, SFA and animal fat were positively associated with liver fat, IMAT and VAT whereas plant fat was inversely associated with IMAT in women. Few associations were observed in men. Circulating polyunsaturated fatty acids (PUFA) were inversely associated with liver fat, IMAT and VAT in both men and women, whereas SFA and monounsaturated fatty acids were positively associated.

    CONCLUSIONS: Type of dietary fat may be an important determinant of ectopic fat in humans consuming their habitual diet. Plant fat and PUFA should be preferred over animal fat and SFA. This is corroborated by circulating fatty acids and overall consistent through different energy adjustment models.

    TWITTER SUMMARY: In UK Biobank, intake of saturated- and animal fat were positively whereas biomarkers of polyunsaturated fat were inversely associated with liver-, visceral- and intermuscular fat. Type of dietary fat may be a determinant of ectopic fat, a risk factor for cardiometabolic disease.

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  • 32.
    Gomes, Filomena
    et al.
    Cantonal Hosp Aarau, Aarau, Switzerland.;Univ Basel, Med Fac, Basel, Switzerland..
    Schuetz, Philipp
    Cantonal Hosp Aarau, Aarau, Switzerland.;Univ Basel, Med Fac, Basel, Switzerland..
    Bounoure, Lisa
    Cantonal Hosp Aarau, Aarau, Switzerland.;Univ Basel, Med Fac, Basel, Switzerland..
    Austin, Peter
    Oxford Univ Hosp, Oxford, England.;Southampton Univ Hosp, Southampton, Hants, England..
    Ballesteros-Pomar, Maria
    Complejo Asistencial Univ Leon, Leon, Spain..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Fletcher, Jane
    Queen Elizabeth Hosp, Birmingham, W Midlands, England..
    Laviano, Alessandro
    Sapienza Univ Rome, Rome, Italy..
    Norman, Kristina
    Charite Univ Med Berlin, Berlin, Germany..
    Poulia, Kalliopi-Anna
    Laiko Gen Hosp Athens, Athens, Greece..
    Ravasco, Paula
    Univ Lisbon, Lisbon, Portugal..
    Schneider, Stephane M.
    Univ Nice Sophia Antipolis, Nice, France..
    Stanga, Zeno
    Univ Hosp Bern, Bern, Switzerland.;Univ Bern, Bern, Switzerland..
    Elizabeth Weekes, C.
    Guys & St Thomas NHS Fdn Trust, London, England.;Kings Coll London, London, England..
    Bischoff, Stephan C.
    Univ Hohenheim, Inst Nutr Med, Stuttgart, Germany..
    ESPEN guidelines on nutritional support for polymorbid internal medicine patients2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 1, p. 336-353Article in journal (Refereed)
    Abstract [en]

    Background & aims: Polymorbidity (also known as multimorbidity)-defined as the co-occurrence of at least two chronic health conditions - is highly prevalent, particularly in the hospitalized population. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid patients hospitalized in medical wards.

    Methods: The methodology used for the development of the current project follows the standard operating procedures for ESPEN guidelines. It started with an initial meeting of the Working Group in January 2015, where twelve key clinical questions were developed that encompassed different aspects of nutritional support: indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Systematic literature searches were conducted in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until April 2016. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations, which were followed by submission to Delphi voting rounds.

    Results: From a total of 4532 retrieved abstracts, 38 relevant studies were analyzed and used to generate a guideline draft that proposed 22 recommendations and four statements. The results of the first online voting showed a strong consensus (agreement of >90%) in 68% of recommendations and 75% of statements, and consensus (agreement of >75-90%) in 32% of recommendations and 25% of statements. At the final consensus conference, a consensus greater than 89% was reached for all of the recommendations.

    Conclusions: Despite the methodological difficulties in creating non-disease specific guidelines, the evidence behind several important aspects of nutritional support for polymorbid medical inpatients was reviewed and summarized into practical clinical recommendations. Use of these guidelines offer an evidence-based nutritional approach to the polymorbid medical inpatient and may improve their outcomes.

  • 33.
    Gurdeniz, Gozde
    et al.
    Univ Copenhagen, Dept Nutr Exercise & Sports, Frederiksberg, Denmark.;Univ Copenhagen, Dept Food Sci, Frederiksberg, Denmark.
    Uusitupa, Matti
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Kuopio, Finland.
    Hermansen, Kjeld
    Aarhus Univ Hosp, Dept Endocrinol & Internal Med, Aarhus, Denmark.
    Savolainen, Markku J.
    Univ Oulu, Inst Clin Med, Dept Internal Med, Oulu, Finland.
    Schwab, Ursula
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Kuopio, Finland.;Kuopio Univ Hosp, Dept Med Endocrinol & Clin Nutr, Kuopio, Finland.
    Kolehmainen, Marjukka
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Kuopio, Finland.
    Brader, Lea
    Aarhus Univ Hosp, Dept Endocrinol & Internal Med, Aarhus, Denmark.
    Cloetens, Lieselotte
    Lund Univ, Biomed Nutr Pure & Appl Biochem, Lund, Sweden.
    Herzig, Karl-Heinz
    Univ Oulu, Inst Biomed, Oulu, Finland.;Univ Oulu, Bioctr Oulu, Oulu, Finland.;Kuopio Univ Hosp, Dept Psychiat, Kuopio, Finland.
    Hukkanen, Janne
    Univ Oulu, Inst Clin Med, Dept Internal Med, Oulu, Finland.
    Rosqvist, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Ulven, Stine Marie
    Univ Oslo, Inst Basic Med Sci, Dept Nutr, Oslo, Norway.
    Gunnarsdottir, Ingibjorg
    Univ Iceland, Fac Food Sci & Nutr, Unit Nutr Res, Reykjavik, Iceland.;Landspitali Natl Univ Hosp, Unit Nutr Res, Reykjavik, Iceland.
    Thorsdottir, Inga
    Univ Iceland, Fac Food Sci & Nutr, Unit Nutr Res, Reykjavik, Iceland.;Landspitali Natl Univ Hosp, Unit Nutr Res, Reykjavik, Iceland.
    Oresic, Matej
    Univ Turku, Turku Ctr Biotechnol, Turku, Finland.;Abo Akad Univ, Turku, Finland.;VTT Tech Res Ctr Finland, Espoo, Finland.
    Poutanen, Kaisa S.
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Kuopio, Finland.;VTT Tech Res Ctr Finland, Espoo, Finland.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Akesson, Bjorn
    Lund Univ, Biomed Nutr Pure & Appl Biochem, Lund, Sweden.;Skane Univ Hosp, Dept Clin Nutr, Lund, Sweden.
    Dragsted, Lars Ove
    Univ Copenhagen, Dept Nutr Exercise & Sports, Frederiksberg, Denmark.
    Analysis of the SYSDIET Healthy Nordic Diet randomized trial based on metabolic profiling reveal beneficial effects on glucose metabolism and blood lipids2022In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 41, no 2, p. 441-451Article in journal (Refereed)
    Abstract [en]

    Background & aims: Intake assessment in multicenter trials is challenging, yet important for accurate outcome evaluation. The present study aimed to characterize a multicenter randomized controlled trial with a healthy Nordic diet (HND) compared to a Control diet (CD) by plasma and urine metabolic profiles and to associate them with cardiometabolic markers.

    Methods: During 18–24 weeks of intervention, 200 participants with metabolic syndrome were advised at six centres to eat either HND (e.g. whole-grain products, berries, rapeseed oil, fish and low-fat dairy) or CD while being weight stable. Of these 166/159 completers delivered blood/urine samples. Metabolic profiles of fasting plasma and 24 h pooled urine were analysed to identify characteristic diet-related patterns. Principal components analysis (PCA) scores (i.e. PC1 and PC2 scores) were used to test their combined effect on blood glucose response (primary endpoint), serum lipoproteins, triglycerides, and inflammatory markers.

    Results: The profiles distinguished HND and CD with AUC of 0.96 ± 0.03 and 0.93 ± 0.02 for plasma and urine, respectively, with limited heterogeneity between centers, reflecting markers of key foods. Markers of fish, whole grain and polyunsaturated lipids characterized HND, while CD was reflected by lipids containing palmitoleic acid. The PC1 scores of plasma metabolites characterizing the intervention is associated with HDL (β = 0.05; 95% CI: 0.02, 0.08; P = 0.001) and triglycerides (β = −0.06; 95% CI: −0.09, −0.03; P < 0.001). PC2 scores were related with glucose metabolism (2 h Glucose, β = 0.1; 95% CI: 0.05, 0.15; P < 0.001), LDL (β = 0.06; 95% CI: 0.01, 0.1; P = 0.02) and triglycerides (β = 0.11; 95% CI: 0.06, 0.15; P < 0.001). For urine, the scores were related with LDL cholesterol.

    Conclusions: Plasma and urine metabolite profiles from SYSDIET reflected good compliance with dietary recommendations across the region. The scores of metabolites characterizing the diets associated with outcomes related with cardio-metabolic risk. Our analysis therefore offers a novel way to approach a per protocol analysis with a balanced compliance assessment in larger multicentre dietary trials.

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  • 34.
    Hedman, Sanna
    et al.
    Department of Clinical Nutrition and dietetics, Karolinska University Hospital, Stockholm, Sweden.
    Nydahl, Margaretha
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food Studies, Nutrition and Dietetics.
    Faxén-Irving, Gerd
    Division of Clinical Geriatrics, department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients2016In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 35, no 3, p. 692-698Article in journal (Refereed)
    Abstract [en]

    Background & aims

    Malnutrition is a well-recognized problem in geriatric patients. Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients. The objective of this study was to investigate routines regarding dietary prescriptions and monitoring of food intake in geriatric patients and to see how well the prescribed diet conforms to the patients' nutritional status and ability to eat. A further aim was to identify the most common reasons and factors interacting with patients not finishing a complete meal.

    Methods

    This study combines two methods using both qualitative and quantitative analysis. Patients (n = 43; 82.5 ± 7.5 yrs; 60% females) at four geriatric wards performed a two-day dietary record, assisted by a dietician. Nurses and assistant nurses at each ward participated in a semi-structured interview regarding prescription of diets and portion size for the patients.

    Results

    The prescribed diet differed significantly (P < 0.01) from a diet based upon the patient's nutritional status and ability to eat. Only 30% of the patients were prescribed an energy-enriched diet in contrast to 60% that was in need of it. The most common reason for not finishing the meal was lack of appetite. Diet prescription for the patient was based upon information about eating difficulties identified in the Mini Nutritional Assessment-Short Form (MNA-SF) at admission and the type of diet that was prescribed on a previous ward. Monitoring of the patients' food intake was described as a continuous process discussed daily between the staff.

    Conclusion

    Patients' nutritional status and to what extent they were able to eat a complete meal was not routinely considered when prescribing food and monitoring food intake in this study. By making use of this information the diet could be tailored to the patients' needs, thereby improving their nutritional treatment.

  • 35.
    Hjort, Anna
    et al.
    Chalmers Univ Technol, Dept Biol & Biol Engn, Div Food & Nutr Sci, Kemivagen 10, S-41296 Gothenburg, Sweden..
    Iggman, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna.
    Rosqvist, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Glycemic variability assessed using continuous glucose monitoring in individuals without diabetes and associations with cardiometabolic risk markers: A systematic review and meta-analysis2024In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 43, no 4, p. 915-925Article, review/survey (Refereed)
    Abstract [en]

    Background & aims: Continuous glucose monitoring (CGM) provides data on short-term glycemic variability (GV). GV is associated with adverse outcomes in individuals with diabetes. Whether GV is associated with cardiometabolic risk in individuals without diabetes is unclear. We systematically reviewed the literature to assess whether GV is associated with cardiometabolic risk markers or outcomes in individuals without diabetes. Methods: Searches were performed in PubMed/Medline, Embase and Cochrane from inception through April 2022. Two researchers were involved in study selection, data extraction and quality assessment. Studies evaluating GV using CGM for >= 24 h were included. Studies in populations with acute and/or critical illness were excluded. Both narrative synthesis and meta -analyzes were performed, depending on outcome. Results: Seventy-one studies were included; the majority were cross-sectional. Multiple measures of GV are higher in individuals with compared to without prediabetes and GV appears to be inversely associated with beta cell function. In contrast, GV is not clearly associated with insulin sensitivity, fatty liver disease, adiposity, blood lipids, blood pressure or oxidative stress. However, GV may be positively associated with the degree of atherosclerosis and cardiovascular events in individuals with coronary disease. Conclusion: GV is elevated in prediabetes, potentially related to beta cell dysfunction, but less clearly associated with obesity or traditional risk factors. GV is associated with coronary atherosclerosis development and may predict cardiovascular events and type 2 diabetes. Prospective studies are warranted, investigating the predictive power of GV in relation to incident disease. GV may be an important risk measure also in individuals without diabetes. (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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  • 36.
    Iversen, Kia Nøhr
    et al.
    Department of Biology and Biological Engineering, Division of Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden..
    Carlsson, Frida
    Department of Biology and Biological Engineering, Division of Food and Nutrition Science, Chalmers University of Technology, SE-412 96, Gothenburg, Sweden.
    Andersson, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of food studies, nutrition and dietetics.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Langton, Maud
    Department of Molecular Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden..
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Hellström, Per M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology.
    Landberg, Rikard
    Department of Biology and Biological Engineering, Division of Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Swede.
    A hypocaloric diet rich in high fiber rye foods causes greater reduction in body weight and body fat than a diet rich in refined wheat: A parallel randomized controlled trial in adults with overweight and obesity (the RyeWeight study)2021In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 45, p. 155-169Article in journal (Refereed)
    Abstract [en]

    Background and aim: A high intake of whole grain foods is inversely associated with body mass index (BMI) and body fat in observational studies, but mixed results have been found in interventional studies. Among whole grains, rye is the richest source of dietary fiber and meals containing high-fiber rye foods have shown increased satiety up to 8 h, compared to meals containing refined wheat products. The aim of the study was to determine the effect of consuming high fiber rye products, compared to refined wheat products, on body weight and body fat loss in the context of an energy restricted diet.

    Methods: After a 2-week run-in period, 242 males and females with overweight or obesity (BMI 27-35 kg/m2), aged 30-70 years, were randomized (1:1) to consume high fiber rye products or refined wheat products for 12 weeks, while adhering to a hypocaloric diet. At week 0, week 6 and week 12 body weight and body composition (dual energy x-ray absorptiometry) was measured and fasting blood samples were collected. Subjective appetite was evaluated for 14 h at week 0, 6 and 12.

    Results: After 12 weeks the participants in the rye group had lost 1.08 kg body weight and 0.54% body fat more than the wheat group (95% confidence interval (CI): 0.36; 1.80, p < 0.01 and 0.05; 1.03, p = 0.03, respectively). C-reactive protein was 28% lower in the rye vs wheat group after 12 weeks of intervention (CI: 7; 53, p < 0.01). There were no consistent group differences on subjective appetite or on other cardiometabolic risk markers.

    Conclusion: Consumption of high fiber rye products as part of a hypocaloric diet for 12 weeks caused a greater weight loss and body fat loss, as well as reduction in C-reactive protein, compared to refined wheat. The difference in weight loss could not be linked to differences in appetite response

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  • 37.
    Johansson, Ulla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Rasmussen, Henrik Hojgaard
    Mowe, Morten
    Staun, Michael
    Clinical nutrition in medical gastroenterology: Room for improvement2009In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 28, no 2, p. 129-133Article in journal (Refereed)
    Abstract [en]

    Background & aims: Undernutrition is a problem in hospitals, with lack of nutritional routines. Recently, guidelines concerning the nutritional care process were developed from ESPEN. This study was conducted to assess the present status of nutritional routines among doctors and nurses in internal medicine (IM) and medical gastroenterology (MG), in comparison with the ESPEN guidelines. Method: A questionnaire-based investigation among doctors and nurses working in departments of internal medicine and gastroenterology in Scandinavia, based on further analysis of previous data. Results: Overall, 4512 (1753 doctors, 2759 nurses) answered the questionnaire, of which 1155 were from internal medicine and 193 from gastroenterology. A similar, non-significant, discrepancy in attitudes and nutritional routines was noted in gastroenterologists and internists. Concerning basic nutritional education, 46% in MG and 48% in IM considered it insufficient (not significant). When comparing all doctors with all nurses, 60% and 39% respectively considered their basic nutritional education insufficient (p < 0.001). Concerning prescription of parenteral nutrition, 65% of the internists and 92% of the gastrorenterologists had sufficient knowledge (p < 0.001), while technical skill did not differ (not significant). Lack of interest was more pronounced in the internists than in the gastroenterologists, 42% vs. 32% (p < 0.05), and more pronounced in doctors when comparing all doctors with all nurses (47 vs. 36%, p < 0.001). Conclusions: A discrepancy between clinical practice and attitudes towards nutrition is evident in both gastroenterology and internal medicine. Although gastroenterologists are more interested, there is room for improvement in both groups. This is true for doctors as well as nurses, even though nurses seem to be more interested and better trained than doctors. (C) 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  • 38.
    Kaegi-Braun, Nina
    et al.
    Kantonsspital Aarau, Div Gen Internal & Emergency Med, Med Univ Dept, Aarau, Switzerland..
    Boesiger, Fabienne
    Kantonsspital Aarau, Div Gen Internal & Emergency Med, Med Univ Dept, Aarau, Switzerland..
    Tribolet, Pascal
    Bern Univ Appl Sci, Dept Hlth Profess, Bern, Switzerland.;Univ Vienna, Fac Life Sci, Vienna, Austria..
    Gomes, Filomena
    New York Acad Sci, New York, NY USA.;Univ Nova Lisboa, NOVA Med Sch, Lisbon, Portugal..
    Kutz, Alexander
    Kantonsspital Aarau, Div Gen Internal & Emergency Med, Med Univ Dept, Aarau, Switzerland..
    Hoess, Claus
    Kantonsspital Munsterlingen, Internal Med, Munsterlingen, Switzerland..
    Pavlicek, Vojtech
    Kantonsspital Munsterlingen, Internal Med, Munsterlingen, Switzerland..
    Bilz, Stefan
    Kantonsspital St Gallen, Internal Med & Endocrinol, St Gallen, Switzerland..
    Sigrist, Sarah
    Kantonsspital St Gallen, Internal Med & Endocrinol, St Gallen, Switzerland..
    Brändle, Michael
    Kantonsspital St Gallen, Internal Med & Endocrinol, St Gallen, Switzerland..
    Henzen, Christoph
    Kantonsspital Luzern, Internal Med, Luzern, Switzerland..
    Thomann, Robert
    Burgerspital, Internal Med, Solothurn, Switzerland..
    Rutishauser, Jonas
    Kantonsspital Baselland, Internal Med, Standort Bruderholz, Switzerland..
    Aujesky, Drahomir
    Univ Bern, Bern Univ Hosp, Dept Gen Internal Med, Inselspital, Bern, Switzerland..
    Rodondi, Nicolas
    Univ Bern, Bern Univ Hosp, Dept Gen Internal Med, Inselspital, Bern, Switzerland.;Univ Bern, Inst Primary Hlth Care BIHAM, Bern, Switzerland..
    Donze, Jacques
    Univ Bern, Bern Univ Hosp, Dept Gen Internal Med, Inselspital, Bern, Switzerland.;Brigham & Womens Hosp, Div Gen Internal Med, 75 Francis St, Boston, MA 02115 USA..
    Stanga, Zeno
    Univ Bern, Bern Univ Hosp, Div Diabet Endocrinol Nutr Med & Metab, Inselspital, Bern, Switzerland..
    Lobo, Dileep N.
    Nottingham Digest Dis Ctr, Nottingham, England.;Nottingham Univ Hosp NHS Trust, Natl Inst Hlth Res, Nottingham Biomed Res Ctr, Nottingham, England.;Univ Nottingham, Queens Med Ctr, Nottingham, England.;Univ Nottingham, MRC Versus Arthrit Ctr Musculoskeletal Ageing Res, Queens Med Ctr, Sch Life Sci, Nottingham, England..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Theme Inflammat & Aging, Stockholm, Sweden..
    Mueller, Beat
    Kantonsspital Aarau, Div Gen Internal & Emergency Med, Med Univ Dept, Aarau, Switzerland.;Univ Basel, Med Fac, Basel, Switzerland..
    Schuetz, Philipp
    Kantonsspital Aarau, Div Gen Internal & Emergency Med, Med Univ Dept, Aarau, Switzerland.;Univ Basel, Med Fac, Basel, Switzerland..
    Validation of modified GLIM criteria to predict adverse clinical outcome and response to nutritional treatment: A secondary analysis of a randomized clinical trial2022In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 41, no 4, p. 795-804Article in journal (Refereed)
    Abstract [en]

    Background & aims: The Global Leadership Initiative on Malnutrition (GLIM) recently suggested specific criteria to standardize the diagnosis of malnutrition. There is need for validation of these criteria regarding response to nutrition treatment. Our aim was to validate modified GLIM (mGLIM) criteria among medical inpatients at risk of disease related malnutrition for prediction of outcome and response to nutritional therapy.

    Methods: This is a secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a multicenter randomized controlled trial conducted between April 2014 and February 2018. Adult medical inpatients at nutritional risk (Nutrition Risk Score 2002 > 3 points) were randomly assigned to receive nutritional therapy according to an algorithm based on individualized nutritional requirements (intervention group) or standard hospital food (control group). We included all participants with available information regarding mGLIM criteria. The primary outcome was adverse clinical outcome, which was a composite of 30-day all-cause mortality, ICU-admission, rehospitalization rate, major complications and decline in functional status.

    Results: Of 1917 eligible participants at nutritional risk, 1181 (61.6%) met the diagnosis of malnutrition based on mGLIM criteria. The incidence of adverse clinical outcome was significantly higher in mGLIMpositive participants compared with mGLIM-negative participants [330/1181 (27.9%) versus 140/736 (19.0%); multivariable adjusted odds ratio [OR] 1.53; 95% CI 1.22-1.93; p < 0.001]. Regarding the effect of nutritional therapy, the reduction in adverse clinical outcomes was higher in mGLIM-positive participants [180/581 (31.0%) vs. 150/600 (25.0%), OR 0.69; 95% CI 0.53-0.9, p = 0.007], compared with mGLIMnegative participants [75/379 (19.8%) versus 65/357 (18.2%), OR 0.95; 95% CI 0.65-1.40, p = 0.797], a finding that was, however, not significant in interaction analysis (p for interaction = 0.217).

    Conclusion: Data from this secondary analysis of a multicenter randomized trial involving medical inpatients at nutritional risk validate the strong prognostic value of mGLIM criteria regarding adverse clinical outcomes and other long-term outcomes. However, further research is needed to improve the ability of GLIM criteria to predict therapeutic response to nutritional interventions.

    Trial registration: ClinicalTrials.gov Identifier: NCT02517476.

  • 39. Kaluza, Joanna
    et al.
    Komatsu, Shoko
    Lauriola, Mara
    Harris, Holly R
    Bergkvist, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Wolk, Alicja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Long-term consumption of non-fermented and fermented dairy products and risk of breast cancer by estrogen receptor status - Population-based prospective cohort study.2021In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 40, no 4, p. 1966-1973, article id S0261-5614(20)30469-6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: The impact of dairy consumption on breast cancer development is unclear. We sought to examine associations between long-term consumption of milk and fermented dairy products and risk of breast cancer by estrogen (ER) and progesterone receptor (PR) status and assess whether these associations varied by body weight.

    METHODS: The population-based Swedish Mammography Cohort included 33,780 women (88.2% postmenopausal), with no history of cancer or diabetes at baseline (1997). Long-term consumption of dairy products was assessed using a self-administered food-frequency questionnaire in 1987 and 1997. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

    RESULTS: During 16.6 years of follow-up (559,286 person-years), 1870 total breast cancer cases were diagnosed (1162 ER+/PR+; 195 ER-/PR-). High long-term non-fermented milk consumption was associated with increased ER+/PR+ breast cancer incidence, HR = 1.30, 95%CI:1.02-1.65 for the average of 1987 and 1997 intake ≥2 vs. 0 servings/day and this increased risk was limited to women with BMI<25 kg/m2 HR = 1.55, 95%CI:1.08-2.21, while no significant associations with milk consumption were observed with ER-/PR- breast cancer. In contrast, consumption of fermented dairy products was inversely associated with ER-/PR- breast cancer (for consistently high intake ≥3 vs. <1 servings/day HR = 0.28, 95%CI:0.10-0.78), but not clear association was observed for ER+/PR+ (HR = 0.89, 95%CI:0.69-1.14).

    CONCLUSIONS: In this cohort of mainly postmenopausal women, high long-term consumption of milk was associated with increased risk of ER+/PR+ breast cancer. In contrast, high long-term consumption of fermented dairy products was associated with decreased risk of ER-/PR- breast cancer.

  • 40. Kananen, L.
    et al.
    Eriksdotter, M.
    Boström, A. M.
    Kivipelto, M.
    Annetorp, M.
    Metzner, C.
    Bäck Jerlardtz, V.
    Engström, M.
    Johnson, P.
    Lundberg, L. G.
    Åkesson, E.
    Sühl Öberg, C.
    Hägg, S.
    Religa, D.
    Jylhävä, J.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska institutet; Karolinska universitetssjukhuset.
    Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-192022In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 41, no 12, p. 2973-2979Article in journal (Refereed)
    Abstract [en]

    Background & Aims: Overweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19. As a reference, the analyses were performed also in patients treated for other diagnoses than COVID-19.

    Methods: We analyzed up to 10,031 geriatric patients with a median age of 83 years of which 1409 (14%) were hospitalized for COVID-19 and 8622 (86%) for other diagnoses in seven geriatric hospitals in the Stockholm region, Sweden during March 2020-January 2021. Data were available in electronic hospital records. The associations between 1) BMI and 2) nutritional status, assessed using the Mini-Nutritional Assessment - Short Form (MNA-SF) scale, and short-term in-geriatric hospital mortality were analyzed using logistic regression.

    Results: After adjusting for age, sex, comorbidity, polypharmacy, frailty and the wave of the pandemic (first vs. second), underweight defined as BMI<18.5 increased the risk of in-hospital mortality in COVID-19 patients (odds ratio [OR] = 2.30; confidence interval [CI] = 1.17-4.31). Overweight and obesity were not associated with in-hospital mortality. Malnutrition; i.e. MNA-SF 0-7 points, increased the risk of in-hospital mortality in patients treated for COVID-19 (OR = 2.03; CI = 1.16-3.68) and other causes (OR = 6.01; CI = 2.73-15.91).

    Conclusions: Our results indicate that obesity is not a risk factor for very old patients with COVID-19, but emphasize the role of underweight and malnutrition for in-hospital mortality in geriatric patients with COVID-19.

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  • 41.
    Kananen, Laura
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Religa, Dorota
    Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Karolinska Univ Hosp, Theme Inflammat & Aging, Huddinge, Sweden..
    Eriksdotter, Maria
    Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Karolinska Univ Hosp, Theme Inflammat & Aging, Huddinge, Sweden..
    Hagg, Sara
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Julhava, Juulia
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Karolinska Univ Hosp, Theme Inflammat & Aging, Huddinge, Sweden.
    Comment on "Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19" (by Cafe Balci, MD, Hacettepe University Faculty of Medicine Department of Internal Medicine Division of Geriatric Medicine): Response to Letter to the Editor2022In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 41, no 2, p. 573-574Article in journal (Other academic)
  • 42.
    Karlsson, Mikael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Becker, Wulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Sjögren, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Associations between dietary patterns at age 71 and the prevalence of sarcopenia 16 years later2020In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 39, no 4, p. 1077-1084Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: The growing recognition of the significance of sarcopenia has highlighted the need to understand etiologic factors, where food intake likely plays a role. The aim was to investigate the association between dietary patterns at mean age 71 and the prevalence of sarcopenia at mean age 87 in a Swedish cohort of community dwelling men.

    METHODS: Dietary habits were assessed using a 7-day food record. Adherences to official dietary guidelines, defined by the World Health Organization (WHO) by using the Healthy Diet Indicator, and Mediterranean-like dietary habits by using the Mediterranean Diet Score, were calculated. Sarcopenia was determined using the definition from the European Working Group on Sarcopenia in Older People (EWGSOP) and associations to each dietary pattern were analyzed using logistic regression, adjusted for potential confounders.

    RESULTS: Our study population included 254 men, mean age 71 at baseline, and 53 (21%) were defined as sarcopenic 16 years later. There was no linear relationship between increased adherence to WHO dietary guidelines and future prevalence of sarcopenia, although those with medium adherence seemed to be protected (crude OR = 0.41, 95% CI 0.19-0.92). On the other hand, an inverse relationship to sarcopenia was found for each SD increment in the Mediterranean diet score (crude OR = 0.68, 95% CI 0.46-0.99), which remained after adjusting for potential confounders. Sensitivity analysis indicated relationships to be independent of changes in physical activity and dietary misreporting.

    CONCLUSIONS: In this prospective study of elderly men, using a single measure of diet at age 71 as a reflection of habitual dietary habits, healthy dietary patterns tended to protect against the development of sarcopenia over 16 years. In particular, we found indications that increased adherence to a Mediterranean dietary pattern might be advantageous.

  • 43.
    Laguzzi, F.
    et al.
    Karolinska Inst, Inst Environm Med, Unit Cardiovasc Epidemiol, Nobels Vag 13,Box 210, S-17177 Stockholm, Sweden.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Marklund, Matti
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Vikström, M.
    Karolinska Inst, Inst Environm Med, Unit Cardiovasc Epidemiol, Nobels Vag 13,Box 210, S-17177 Stockholm, Sweden.
    Sjögren, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Gigante, B.
    Karolinska Inst, Inst Environm Med, Unit Cardiovasc Epidemiol, Nobels Vag 13,Box 210, S-17177 Stockholm, Sweden;Danderyd Hosp Univ, Karolinska Inst, Dept Clin Sci, Div Cardiovasc Med, S-18288 Stockholm, Sweden.
    Alsharari, Zayed
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Hellenius, M. -L
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Frumento, P.
    Karolinska Inst, Unit Biostat, Inst Environm Med, Nobels Vag 13,Box 210, S-17177 Stockholm, Sweden.
    de Faire, U.
    Karolinska Inst, Inst Environm Med, Unit Cardiovasc Epidemiol, Nobels Vag 13,Box 210, S-17177 Stockholm, Sweden;Karolinska Inst, Dept Med, Cardiol Unit, S-17176 Stockholm, Sweden.
    Leander, K.
    Karolinska Inst, Inst Environm Med, Unit Cardiovasc Epidemiol, Nobels Vag 13,Box 210, S-17177 Stockholm, Sweden.
    Circulating fatty acids in relation to alcohol consumption: Cross-sectional results from a cohort of 60-year-old men and women2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6, Part A, p. 2001-2010Article in journal (Refereed)
    Abstract [en]

    Background & aims: Alcohol consumption is considered to affect circulating fatty acids (FAs) but knowledge about specific associations is limited. We aimed to assess the relation between alcohol consumption and serum FAs in 60-year-old Swedish men and women.

    Methods: In a random sample of 1917 men and 2058 women residing in Stockholm county, cross-sectional associations between different categories of alcohol consumption and FAs were assessed using linear regression; beta(1) coefficients with 95% confidence interval (Cl) were calculated. Self-reported alcohol consumption was categorized as none, low (<= 9.9 g/day) (reference), moderate (10-29.9 g/day) and high (>= 30 g/day). Moderate alcohol consumption was further subdivided into consumption of beer, wine, liquor and their combinations. Thirteen serum cholesterol ester FM were measured by gas chromatography and individual FM were expressed as percentage of total FAs.

    Results: Increasing alcohol consumption was associated to linear increase of saturated myristic acid, monounsaturated FAs and n-6 polyunsaturated (PUFA) arachidonic acid, whereas linear decrease was noted for saturated pentadecanoic acid and for n-6 PUFA linoleic acid. With non-linear associations, increasing alcohol consumption also associated to decreased saturated stearic acid, n-6 PUFA dihomogamma-linolenic acid, and n-3 PUFA docosahexaenoic acid and increased saturated palmitic acid, n-6 PUFA gamma-linolenic acid and n-3 PUFA eicosapentaenoic acid. Among types of beverages, wine consumption was associated with n-6 PUFA arachidonic acid (beta(1) 0.59; 95% CI: 030;0.88) and the n-3 PUFAs eicosapentaenoic acid (beta(1) 0.54; 95% CI: 0.30;0.78), and docosahexaenoic acid (beta(1) 0.06; 95% CI: 0.00;0.12).

    Conclusions: These findings may give important basis for further investigations to better understand biological mechanisms behind the dose-dependent associations between alcohol consumption and health outcomes observed in many previous studies.

  • 44.
    Landi, F.
    et al.
    Univ Cattolica Sacro Cuore, Inst Internal Med & Geriatr, Ctr Geriatr Med CEMI, Rome, Italy.
    Camprubi-Robles, M.
    Abbott Nutr Res & Dev, Granada, Spain.
    Bear, D. E.
    Guys & St Thomas NHS Fdn Trust, Dept Nutr & Dietet, London, England;Guys & St Thomas NHS Fdn Trust, Dept Crit Care, London, England;Kings Coll London, Ctr Human & Aerosp Physiol Sci, London, England;Guys & St Thomas NHS Fdn Trust, Lane Fox Clin Resp Physiol Res Ctr, London, England.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Dept Publ Hlth & Caring Sci, Stockholm, Sweden;Karolinska Univ Hosp, Theme Ageing, Stockholm, Sweden.
    Malafarina, V.
    Univ Navarra, Sch Pharm & Nutr, Dept Nutr Food Sci & Physiol, Pamplona, Spain;Complejo Hosp Navarra, Dept Geriatr, Pamplona, Spain.
    Welch, A. A.
    Univ East Anglia, Dept Publ Hlth & Primary Care, Norwich Med Sch, Norwich Res Pk, Norwich NR4 7TJ, Norfolk, England.
    Cruz-Jentoft, A. J.
    Hosp Univ Ramon y Cajal IRYCIS, Serv Geriatria, Madrid, Spain.
    Muscle loss: The new malnutrition challenge in clinical practice2019In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 38, no 54, p. 2113-2120Article in journal (Refereed)
    Abstract [en]

    Recent definitions of malnutrition include low muscle mass within its diagnostic criteria. In fact, malnutrition is one of the main risk factors of skeletal muscle loss contributing to the onset of sarcopenia. However, differences in the screening and diagnosis of skeletal muscle loss, especially as a result of malnutrition in clinical and community settings, still occur mainly as techniques and thresholds used vary in clinical practice. The objectives of this position paper are firstly to emphasize the link between skeletal muscle loss and malnutrition-related conditions and secondly to raise awareness for the timely identification of loss of skeletal muscle mass and function in high risk populations. Thirdly to recognize the need to implement appropriate nutritional strategies for prevention and treatment of skeletal muscle loss and malnutrition across the healthcare continuum. Malnutrition needs to be addressed clinically as a muscle-related disorder and clinicians should integrate nutritional assessment with muscle mass measurements for optimal evaluation of these two interrelated entities to tailor interventions appropriately. The design of monitoring/evaluation and discharge plans need to include multimodal interventions with nutrition and physical exercise that are key to preserve patient's muscle mass and function in clinical and community settings. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  • 45.
    Larsson, Susanna C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology. Karolinska institutet.
    Carter, Paul
    Vithayathil, Mathew
    Mason, Amy M.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Baron, John A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology. Geisel School of Medicine at Dartmouth; University of North Carolina School of Medicine; Gillings School of Global Public Health, University of North Carolina .
    Burgess, Stephen
    Genetically predicted plasma phospholipid arachidonic acid concentrations and 10 site-specific cancers in UK biobank and genetic consortia participants: A mendelian randomization study2021In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 40, no 5, p. 3332-3337Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Arachidonic acid (AA) is metabolized by cyclooxygenases and lipoxygenases to pro-inflammatory eicosanoids, which according to experimental research modulate tumor cell proliferation, differentiation, and apoptosis. We employed the Mendelian randomization design to test the hypothesis that higher plasma phospholipid AA concentrations are associated with increased risk of 10 site-specific cancers.

    METHODS: Two genetic variants associated with plasma phospholipid concentrations of AA (rs174547 in FADS1 [P = 3.0 × 10-971] and rs16966952 in PDXDC1 [P = 2.4 × 10-10]) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium were used as genetic instruments. The associations of those variants with cancer were taken from the UK Biobank (n = 367,643), FinnGen consortium (n = 135,638), International Lung Cancer Consortium (n = 27,209), Prostate Cancer Association Group to Investigate Cancer Associated Alterations in the Genome consortium (n = 140,254), Breast Cancer Association Consortium (n = 228,951), Ovarian Cancer Association Consortium (n = 66,450), and BioBank Japan (n = 212,453).

    RESULTS: Higher genetically predicted plasma phospholipid AA concentrations were associated with increased risk of colorectal and lung cancer. Results were consistent across data sources and variants. The combined odds ratios per standard deviation increase of AA concentrations were 1.08 (95% CI 1.05-1.11; P = 6.3 × 10-8) for colorectal cancer and 1.07 (95%CI 1.05-1.10; P = 3.5 × 10-7) for lung cancer. Genetically predicted AA concentrations had a suggestive positive association with esophageal cancer (odds ratio 1.09; 95% CI 1.02-1.17; P = 0.016) but were not associated with cancers of the stomach, pancreas, bladder, prostate, breast, uterus, or ovary.

    CONCLUSION: These results indicate that AA may be implicated in the development of colorectal and lung cancer and possibly esophageal cancer. Treatments with plasma AA-lowering properties should be evaluated for clinical benefit.

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  • 46.
    Larsson, Susanna C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Mason, Amy M.
    Karolinska Inst, Inst Environm Med, Unit Cardiovasc & Nutr Epidemiol, Stockholm, Sweden.;Univ Cambridge, British Heart Fdn Cardiovasc Epidemiol Unit, Dept Publ Hlth & Primary Care, Cambridge, Cambs, England.;Univ Cambridge, Natl Inst Hlth Res Cambridge Biomed Res Ctr, Cambridge, Cambs, England.;Cambridge Univ Hosp, Cambridge, Cambs, England..
    Vithayathil, Mathew
    Univ Cambridge, MRC Canc Unit, Cambridge, Cambs, England..
    Carter, Paul
    Univ Cambridge, Dept Med, Cambridge, Cambs, England..
    Kar, Siddhartha
    Univ Bristol, Bristol Med Sch, MRC Integrat Epidemiol Unit, Bristol, Glos, England..
    Zheng, Ju-Sheng
    Westlake Univ, Sch Life Sci, Key Lab Growth Regulat & Translat Res Zhejiang Pro, Hangzhou, Peoples R China.;Westlake Inst Adv Study, Inst Basic Med Sci, Hangzhou, Peoples R China..
    Burgess, Stephen
    Univ Cambridge, Dept Publ Hlth & Primary Care, Cambridge, Cambs, England.;Univ Cambridge, MRC Biostat Unit, Cambridge, Cambs, England..
    Circulating vitamin C and digestive system cancers: Mendelian randomization study2022In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 41, no 9, p. 2031-2035Article in journal (Refereed)
    Abstract [en]

    Background & aims: Vitamin C is an antioxidant with a potential role in the prevention of digestive system cancers, but there is yet no consensus whether vitamin C has a causal role in these cancers. The aim of this study was to utilize Mendelian randomization to decipher the potential causal associations of vitamin C with risk of digestive system cancers.Methods: Ten genetic variants previously found to be significantly associated with circulating vitamin C were used as instrumental variables. Effect size estimates for the genetic associations of the vitamin Cassociated genetic variants with six major malignancies of digestive system were obtained from the FinnGen (N = 309 154) and UK Biobank (N = 367 542) studies. Results from the two studies were combined using meta-analysis.Results: Genetically predicted higher circulating vitamin C showed a suggestive association with lower risk of small intestine and colorectal cancer after accounting for multiple testing. The odds ratio per 1 standard deviation increment in circulating vitamin C was 0.55 (95% confidence interval 0.32-0.94; P = 0.029) for small intestine cancer and 0.84 (95% confidence interval 0.73-0.96; P = 0.013) for colorectal cancer. There was a suggestive association between genetically predicted higher circulating vitamin C with lower risk of liver cancer in FinnGen but no association in the meta-analysis (odds ratio 0.69; 95% CI 0.36-1.32; P = 0.265). Genetically predicted circulating vitamin C was not associated with cancers of the esophagus, stomach, or pancreas.Conclusion: This Mendelian randomization study indicates that vitamin C might play a role in the prevention of small intestine and colorectal cancer. (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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  • 47.
    Larsson, Susanna C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Wallin, Alice
    Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Wolk, Alicja
    Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Alcohol consumption and risk of heart failure: Meta-analysis of 13 prospective studies2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 4, p. 1247-1251Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Controversy exists on the association between alcohol consumption and risk of heart failure (HF). We carried out a meta-analysis to summarize available prospective data on alcohol consumption and HF.

    METHODS: We searched PubMed for relevant studies published until January 1, 2017. Relative risk (RR) estimates from individual studies were pooled in a random-effects meta-analysis.

    RESULTS: A total of 13 prospective studies, with 13,738 HF cases and 355,804 participants, were included in the meta-analysis. Light alcohol drinking (0.1-7 drinks/week) was inversely associated with risk of HF (RR, 0.86; 95% confidence interval, 0.81-0.90). There was no statistically significant association between moderate (7.1-14 drinks/week), high (14.1-28 drinks/week), or heavy (>28 drinks/week) alcohol consumption and HF risk. Former drinking was associated with an increased risk of HF compared with never or occasional drinking (RR, 1.22; 95% confidence interval, 1.11-1.33).

    CONCLUSIONS: This meta-analysis found that light alcohol drinking was associated with a lower risk of HF. Former drinking was associated with a higher risk of HF.

  • 48.
    Larsson, Susanna C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Wolk, Alicja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Fish, long-chain omega-3 polyunsaturated fatty acid intake and incidence of atrial fibrillation: A pooled analysis of two prospective studies2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 2, p. 537-541, article id S0261-5614(16)00046-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Whether high intakes of fish and long-chain omega-3 polyunsaturated fatty acids (PUFAs) reduce the risk of atrial fibrillation (AF) remains uncertain. Thus, we aimed to evaluate the associations of total fish, types of fish, and omega-3 PUFA intake with AF incidence in a large prospective study.

    METHODS: We used data from the Cohort of Swedish Men and the Swedish Mammography Cohort to examine the associations of fish consumption and long-chain omega-3 PUFA intake with AF incidence. At baseline, information on fish and omega-3 PUFA intakes was available from 72,984 men and women, aged 45-83 years, without cardiac disease. Cases of AF were identified through linkage with the Swedish National Patient Register. Multivariable-adjusted relative risks were estimated with the use of Cox proportional hazards models.

    RESULTS: Over a follow-up period of 12 years, 6095 participants (3595 men and 2500 women) developed AF. Intakes of total fish, fatty fish (herring/mackerel and salmon/whitefish/char), and long-chain omega-3 PUFAs were not associated with AF incidence after adjustment for other risk factors. However, high consumption of lean fish (cod/saithe/fish fingers) was associated with a lower risk; multivariable relative risk of AF for ≥3 servings/week compared with never consumption was 0.79 (95% confidence interval, 0.65-0.95).

    CONCLUSIONS: These findings do not support a beneficial association of fatty fish or omega-3 PUFA intake with incident AF. The association between lean fish consumption and AF risk warrants further investigation.

  • 49.
    Liljeberg, Evelina
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food Studies, Nutrition and Dietetics. Function Area Clinical Nutrition, Karolinska University Hospital, Norrbacka S1:03, SE-17176 Stockholm, Sweden.
    Andersson, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food Studies, Nutrition and Dietetics.
    Lövestam, Elin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food Studies, Nutrition and Dietetics.
    Nydahl, Margaretha
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food Studies, Nutrition and Dietetics.
    Incomplete descriptions of oral nutritional supplement interventions in reports of randomised controlled trials2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 1, p. 61-71Article in journal (Refereed)
    Abstract [en]

    Background & aims

    The effects of oral nutritional supplements (ONS) have been evaluated in several clinical trials and more studies have been requested. To facilitate replication, support accurate evaluations of research results and avoid research waste, high quality reporting of interventions in clinical trials is needed. The aim of this study is to assess the quality of reporting of interventions in publications describing randomised controlled trials of ONS in populations with malnutrition or at nutritional risk.

    Methods

    The PubMed database was searched for articles describing ONS trials published between January 2002 and December 2015. The quality of intervention descriptions was evaluated using the Template for Intervention Description and Replication (TIDieR) checklist and guide, which contains twelve items. Articles published before and after 2011 were compared.

    Results

    Of 76 articles identified, only 3% reported all TIDieR items in sufficient detail. The most frequently missing elements were descriptions of the intervention procedures (e.g. how the ONS were to be taken and if participants were given a choice of flavours), which were adequately presented in only 26% of the articles. Less than half of the articles included a description of the intervention provider and sufficient information about the location(s) for the intervention. Information about adherence and mode of delivery was reported in 60–65% of the articles. Most frequently reported, in >70% of the articles, were items regarding the brief name of the intervention, the rationale for the intervention and the materials used (i.e. information about the specific ONS product(s) administered). The reporting quality for two of the items (materials and provider) was higher in articles published after 2011.

    Conclusions

    The quality of reporting of ONS interventions was found to be poor. The descriptions mostly lacked information about intervention procedures, provider and location(s). A moderately higher reporting quality was observed in articles published after 2011. These findings imply that an improvement in the descriptions of ONS interventions is required in future clinical trials of malnutrition treatment.

  • 50.
    Munoz Fernandez, Shirley Steffany
    et al.
    Univ Sao Paulo, Sch Publ Hlth, Nutr Dept, Sao Paulo, Brazil..
    Garcez, Flavia Barreto
    Univ Sao Paulo, Fac Med, Geriatr Div, Sao Paulo, Brazil..
    Garcia de Alencar, Julio Cesar
    Univ Sao Paulo, Fac Med, Dept Clin Med, Disciplina Emergencias Clin, Sao Paulo, Brazil..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Stockholm, Sweden..
    Aprahamian, Ivan
    Univ Sao Paulo, Fac Med, Geriatr Div, Sao Paulo, Brazil..
    Morley, John Edward
    St Louis Univ, Sch Med, Div Geriatr Med, St Louis, MO 63104 USA..
    de Souza, Heraldo Possolo
    Univ Sao Paulo, Fac Med, Dept Clin Med, Disciplina Emergencias Clin, Sao Paulo, Brazil..
    Avelino da Silva, Thiago Junqueira
    Univ Sao Paulo, Fac Med, Geriatr Div, Sao Paulo, Brazil..
    Lima Ribeiro, Sandra Maria
    Univ Sao Paulo, Sch Publ Hlth, Nutr Dept, Sao Paulo, Brazil.;Univ Sao Paulo, Sch Arts Sci & Humanity, Sao Paulo, Brazil..
    Applicability of the GLIM criteria for the diagnosis of malnutrition in older adults in the emergency ward: A pilot validation study2021In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 40, no 11, p. 5447-5456Article in journal (Refereed)
    Abstract [en]

    Background & aims: Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW).

    Methods: We performed a retrospective secondary analysis, of an ongoing cohort study, in 165 participants over 65 years of age admitted to the EW of a Brazilian university hospital. Nutrition assessment included anthropometry, the Simplified Nutritional Assessment Questionnaire (SNAQ), the Malnutrition Screening Tool (MST), and the Mini-Nutritional Assessment (MNA). We diagnosed malnutrition using GLIM criteria, defined by the parallel presence of at least one phenotypic [nonvolitional weight loss (WL), low BMI, low muscle mass (MM)] and one etiologic criterion [reduced food intake or assimilation (RFI), disease burden/inflammation]. We used the receiver operating characteristic (ROC) curves and Cox and logistic regression for data analyses.

    Results: GLIM criteria, following the MNA-SF screening, classified 50.3% of participants as malnourished, 29.1% of them in a severe stage. Validation of the diagnosis using MNA-FF as a reference showed good accuracy (AUC = 0.84), and moderate sensitivity (76%) and specificity (75.1%). All phenotypic criteria combined with RFI showed the best metrics. Malnutrition showed a trend for an increased risk of transference to intensive care unit (OR = 2.08, 95% CI 0.99, 4.35), and severe malnutrition for in-hospital mortality (HR = 4.23, 95% CI 1.2, 14.9).

    Conclusion: GLIM criteria, following MNA-SF screening, appear to be a feasible approach to diagnose malnutrition in acutely ill older adults in the EW. Nonvolitional WL combined with RFI or acute inflammation were the best components identified and are easily accessible, allowing their potential use in clinical practice.

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