Álvaro Vidal-Suárez

Background: Nutrition assessment in patients receiving parenteral nutrition often relies on classical parameters with limited prognostic value. Morphofunctional tools such as phase angle and handgrip strength measurement offer a more comprehensive evaluation of nutrition status and may better predict clinical outcomes. Objective: To evaluate the predictive value of phase angle and handgrip strength for 12‐month mortality in hospitalized patients receiving parenteral nutrition. Methods: A retrospective observational study was conducted in 614 patients treated with parenteral nutrition. Anthropometric assessments were realized. Morphofunctional assessments included bioelectrical impedance analysis to determine phase angle and dynamometry to measure handgrip strength. Survival analysis was performed using Cox proportional hazards models and Kaplan‐Meier curves and cutoff values by receiver operating characteristic curve analysis. Results: Six hundred fourteen patients received parenteral nutrition, with a mean age of 64 ± 14.6 years; 58.2% were male. After 1 year, the mortality rate was 26.1%, and the average hospital stay was 27.9 ± 23.8 days. Twelve‐month survival was reduced in patients with low phase angle (57%) and low handgrip strength (62.8%) compared with those with preserved values (84% and 82.2%, respectively). In the multivariable logistic regression model adjusted for age, sex, and body mass index, each unit increase in phase angle and handgrip strength was associated with a 4% and 2% reduction in mortality odds, respectively (phase angle: odds ratio [OR], 0.6; 95% CI, 0.5–0.7; P < 0.001; handgrip strength: OR, 0.9; 95% CI, 0.9–1.0; P = 0.03624). Conclusion: Phase angle and handgrip strength are predictors of 12‐month mortality in patients receiving parenteral nutrition.

Background/Objetives: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with poor prognosis. Nutritional disorders, particularly cachexia, significantly impact morbidity and mortality in IPF but remain under-investigated. This study aimed to characterize cachexia phenotypes in IPF through morphofunctional assessment (MFA) and to evaluate their prognostic relevance, including the role of mitochondrial biomarkers. Methods: In this prospective bicenter study, 85 IPF patients underwent MFA including bioelectrical impedance vector analysis (BIVA), nutritional ultrasound (NU), and T12-level computed tomography (T12-CT) for body composition. Functional and strength assessments included timed up and go test (TUG) and handgrip strength (HGS), respectively. Cachexia was defined by Evans’ criteria, Martin’s CT-based criteria, and our IPF-specific proposed definition. Serum GDF-15 and PGC-1α levels were also measured. Results: Cachexia prevalence varied by definition: 24.71% (Evans), 29.5% (Martin) and 42.4% (IPF Cachexia Syndrome). Cachectic patients showed significantly lower muscle mass, function, and quality (measured by reduced muscle attenuation at T12-CT), along with higher GDF-15 and lower PGC-1α levels. The presence of IPF Cachexia syndrome (HR 2.56; 95% CI, 1.08–6.07; p = 0.033), GDF-15 > 4412.0 pg/mL (HR 3.21; 95% CI, 1.04–9.90; p = 0.042) and impaired TUG (>8 s) (HR 3.77; 95% CI, 1.63–8.71; 0.002) were all independently associated with increased 24-month mortality. Conclusions: Cachexia is prevalent in IPF and showed strong concordance between the three diagnostic criteria. The IPF Cachexia syndrome, based on comprehensive morphofunctional phenotyping, demonstrated superior discriminatory capacity. The addition of mitochondrial biomarkers may improve early detection and support personalized interventions to improve patient outcomes.

Background: Disease-related malnutrition (DRM) in outpatients is associated with increased mortality and functional decline. Morphofunctional assessments, including phase angle (PA), rectus femoris cross-sectional area (RF-CSA), and handgrip strength (HGS), provide valuable prognostic insights in the ambulatory setting. Nutritional recovery programs enriched with β-hydroxy-β-methylbutyrate (HMB) offer potential benefits in improving nutritional and functional outcomes. Objective: To evaluate the effects of a six-month nutritional recovery program combining HMB-enriched oral nutritional supplements (HMB-ONS), dietary recommendations, and exercise on survival, morphofunctional markers, and adherence in malnourished outpatients. Methods: This retrospective observational study included 135 malnourished outpatients diagnosed using GLIM criteria. Morphofunctional assessments included PA (bioimpedance analysis), RF-CSA (nutritional ultrasound), HGS (dynamometry), and the Timed Up and Go (TUG) test. Adherence was assessed using pharmacy retrieval records and a validated questionnaire. Changes in morphofunctional markers and their association with mortality were analyzed using multivariate Cox regression models. Results: After six months, significant improvements were observed in PA (+0.47°), RF-CSA (+0.90 cm²), HGS (+4.1 kg), and TUG (−0.93 s) (all p < 0.001). These improvements were more pronounced in the high-adherence group, which also exhibited a reduced mortality risk (HR 0.42, p < 0.05). Changes in PA and HGS were strongly associated with survival, with ΔPA showing an HR of 0.27 (95% CI: 0.15–0.50, p < 0.001) and ΔHGS showing an HR of 0.82 (95% CI: 0.75–0.89, p < 0.001). Conclusions: A nutritional recovery program with HMB-ONS significantly improves survival and morphofunctional markers in malnourished patients, with the greatest benefits observed in those with high adherence. These findings underscore the importance of adherence-support strategies in optimizing clinical outcomes and highlight the need for further research to confirm long-term benefits.

There is increasing evidence supporting the use of morphofunctional assessment (MFA) as a tool for clinical characterization and decision-making in malnourished patients. MFA enables the diagnosis of malnutrition, sarcopenia, obesity, and cachexia, leading to a novel phenotype-based classification of nutritional disorders. Bioelectrical impedance analysis (BIVA), nutritional ultrasound^® (NU) and computed tomography (CT) are included, along with functional tests like the Timed Up and Go test (TUG). Myoesteatosis, detectable via CT, can occur independently from nutritional phenotypes and has been identified as a significant mortality predictor in idiophatic pulmonary fibrosis (IPF). Our aim is to analyze the prevalence and overlap of nutritional phenotypes in IPF and evaluate the prognostic value of myoesteatosis. Our bicenter cross-sectional study included 82 IPF patients (84.1% male and with a medium age of 71.1 ± 7.35 years). MFA was performed using BIVA, NU, CT at the T12 level (CT-T12), the handgrip strength (HGS) test, and the TUG. CT-T12 BC parameters were analyzed using FocusedON^® software, while statistical analyses were conducted with JAMOVI version 2.3.22. All four major nutritional phenotypes were represented in our cohort, with significant overlap. A total of 80.5% met the GLIM criteria for malnutrition, 14.6% had cachexia, 17% were sarcopenic, and 28% were obese. Of the obese patients, 70% were also malnourished, while 100% of sarcopenic obese patients (5.9% of total) had malnutrition. A total of 55% of sarcopenic patients with available CT also had myosteatosis, suggesting muscle quality deterioration as a potential driver of functional impairment. The presence of myosteatosis > 15% in T12-CT was an independent predictor of 12-month mortality (HR = 3.13; 95% CI: 1.01–9.70; p = 0.049), with survival rates of 78.1% vs. 96.6% in patients with vs. without myosteatosis, respectively. To conclude, this study underscores the relevance of MFA in the nutritional characterization of patients with IPF, demonstrating its potential to identify specific phenotypes associated with malnutrition, functional impairment, and the presence of myoesteatosis, thereby providing a valuable tool for clinical decision-making.

Background: Body composition (BC) techniques, including bioelectrical impedance analysis (BIVA), nutritional ultrasound^® (NU), and computed tomography (CT), can detect nutritional diagnoses such as sarcopenia (Sc). Sc in idiopathic pulmonary fibrosis (IPF) is associated with greater severity and lower survival. Our aim was to explore the correlation of BIVA, NU and functional parameters with BC at T12 level CT scans in patients with IPF but also its relationship with degree of Sc, malnutrition and mortality. Methods: This bicentric cross-sectional study included 60 IPF patients (85.2% male, 70.9 ± 7.8 years). Morphofunctional assessment (MFA) techniques included BIVA, NU, CT at T12 level (T12-CT), handgrip strength, and timed up and go. CT data were obtained using FocusedON^®. Statistical analysis was conducted using JAMOVI version 2.3.22 to determine the cutoff points for Sc in T12-CT and to analyze correlations with other MFA techniques. Results: the cutoff for muscle area in T12-CT was ≤77.44 cm² (area under the curve (AUC) = 0.734, sensitivity = 41.7%, specificity = 100%). The skeletal muscle index (SMI_T12CT) cutoff was ≤24.5 cm²/m² (AUC = 0.689, sensitivity = 66.7%, specificity = 66.7%). Low SMI_T12CT exhibited significantly reduced median survival and higher risk of mortality compared to those with normal muscle mass (SMI cut off ≥ 28.8 cm/m²). SMI_T12CT was highly correlated with body cell mass from BIVA (r = 0.681) and rectus femoris cross-sectional area (RF-CSA) from NU (r = 0.599). Cronbach’s α for muscle parameters across different MFA techniques and CT was 0.735, confirming their validity for evaluating muscle composition. Conclusions: T12-CT scan is a reliable technique for measuring low muscle mass in patients with IPF, specifically when the L3 vertebrae are not captured. An SMI value of <28.8 is a good predictor of low lean mass and 12-month mortality in IPF patients.

Alterations in ambulatory blood pressure detected by monitoring (ABPM) have been associated with perinatal complications in hypertensive pregnant women. Aim: To establish the relationships between the blood pressure (BP) profiles detected by ABPM and adverse perinatal outcomes in normotensive women with gestational diabetes mellitus (GDM). Methods: A prospective study of normotensive women in whom 24 h ABPM was performed at 28–32 weeks of pregnancy. The obstetric and perinatal outcomes were evaluated. Results: Two hundred patients were included. Thirty-seven women with GDM and obesity had significantly higher mean systolic BP (SBP) and nocturnal SBP and diastolic BP (DBP) compared to women with only GDM (n = 86). Nocturnal SBP (OR = 1.077; p = 0.015) and obesity (OR = 1.131; p = 0.035) were risk factors for the development of hypertensive disorders of pregnancy (HDPs). Mothers of newborns with neonatal complications (n = 27) had higher nocturnal SBP (103.8 vs. 100 mmHg; p = 0.047) and DBP (62.7 vs. 59.4; p = 0.016). Women who delivered preterm (n = 10) had higher BP and a non-dipper pattern (p = 0.005). Conclusions: Nocturnal SBP was a predictor of HDPs in normotensive women with obesity or GDM. Alterations in ABPM in these patients were associated with poor obstetric and perinatal outcomes.