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This article presents the results of the modified Delphi study conducted by the GLIM Risk of Malnutrition Working Group to develop a consensus-based conceptual definition of "risk of malnutrition," as first step in revising the GLIM screening procedure. Focus groups with nutritional care experts and patient/older adult representatives, and a literature exploration informed 46 statements on risk of malnutrition. Malnutrition experts (n = 112) evaluated these statements, using a five-point Likert scale. Statements with ≥75% agreement were accepted; those with ≥75% disagreement and/or neutrality were rejected. Remaining statements were marked "undecided" and re-evaluated in later rounds. In three questionnaire rounds (response rates 63%, 59%, and 54%), 26 statements were ultimately accepted to shape the conceptual definition of "risk of malnutrition". The GLIM Working Group and patient/older adult representatives reviewed the pre-final professional and layperson versions. Risk of malnutrition was defined as: A dynamic state, with or without unintentional weight loss, in which an individual has one or more risk factors, that is, nutrition impact symptoms, and/or disease-related, physical, psychological, social, demographic, and economic risk factors, that may result in malnutrition and may negatively impact clinical outcomes. In the layperson version, sentences were simplified to aid comprehension. GLIM has developed the first global (professional and layperson) conceptual definition of risk of malnutrition. This definition will guide future nutritional screening recommendations and a more preventive malnutrition approach. It also implies that screening tools covering "risk of malnutrition" should no longer be validated against signs or the diagnosis of malnutrition.

Many hospitals implemented prehabilitation programs for colon cancer (CC), but only few studies evaluated prehabilitation in clinical practice. We evaluated the results of a prehabilitation program that was implemented as usual care in our hospital on changes in nutritional status and physical fitness, and by exploring clinical outcomes. We conducted a prospective observational study to evaluate the prehabilitation program. The prehabilitation program that was implemented was as follows: at diagnosis (T0), patients were screened to assess whether they were physically unfit or fit: being unfit was defined as severe malnutrition (following the criteria of the Global Leadership Initiative on Malnutrition) and/or low cardiorespiratory fitness (VO2max <18.2 ml/kg/min). Unfit patients were referred to a 4-6 weeks prehabilitation program supervised by a physiotherapist. Patients who were fit were referred to unsupervised (2 weeks) prehabilitation. Follow-up measurements were conducted 3 days before (T1) and 6 weeks after (T2) surgery. Nutritional status was assessed by fat free mass and protein intake. Physical fitness was evaluated through VO2max, handgrip strength, 5 times-sit-to-stand test and maximal inspiratory pressure. Clinical outcomes were postoperative surgical and non-surgical complications, length of hospital stay and readmission, postoperative mortality and the Modified Iowa Level of Assistance Scale (mILAS). Between July 2022 and September 2023, 90 CC patients were screened for prehabilitation. Of those, 33% were unfit and referred to supervised prehabilitation. At diagnosis, 32% of supervised and 42% of unsupervised patients reached the minimally recommended daily protein intake. This changed to respectively 78% and 81% at T1. Between T0 and T1, improvements in physical fitness were most pronounced in the supervised group. Median length of hospital stay was 4 days (Q1-Q3: 3-7) in the supervised group and 3 days (Q1-Q3: 3-4) in the unsupervised group, while the mILAS score was similar. Complication rates, postoperative mortality and readmission rates appeared similar across groups. Our findings suggest that improvements in nutritional status and physical fitness were most pronounced in the unfit patients. Supervised and unsupervised groups appeared to have similar complication rates after surgery, but these findings should be interpreted with caution given the small sample size.

Malnutrition and frailty independently predict prolonged hospitalization and mortality; however, their combined impact on older patients undergoing elective surgery remains unclear. The study examined the combined association of malnutrition and frailty with postoperative all-cause mortality and adverse outcomes. This prospective multicenter cohort study enrolled across 5 centers in China between December 17, 2023, and October 17, 2024, with follow-up completed on October 18, 2025. The study population included patients 65 years or older who underwent elective surgery. Malnutrition assessed by the Global Leadership Initiative on Malnutrition (GLIM) and frailty assessed by the Fried phenotype before the surgery. The primary outcome was all-cause mortality within one year, analysed using Cox proportional-hazards models adjusted for hospital ID, age, sex, ethnicity, educational level, smoking status, alcohol consumption, age-adjusted Charlson Comorbidity Index (aCCI), American Society of Anesthesiologists (ASA) physical status, and surgical approach. Secondary outcomes included 90-day mortality, major postoperative complications (POCs), and prolonged length of stay (LOS). Among 1361 older adults undergoing elective surgery (median age 71 years), 818 had neither malnutrition nor frailty, 229 had malnutrition only, 130 had frailty only, and 184 had both conditions. After multivariable adjustment, malnutrition alone and frailty alone were each associated with modestly increased risks of adverse outcomes, whereas the highest risks were observed among participants with concurrent malnutrition and frailty. Compared with those with neither condition, concurrent malnutrition and frailty were associated with higher risks of 1-year mortality (hazard ratio [HR], 5.36; 95% confidence interval [CI], 3.00-9.56), 90-day mortality (HR, 13.22; 95% CI, 5.10-34.32), major POCs (odds ratio [OR], 4.83; 95% CI, 2.53-9.19), and prolonged LOS (OR, 2.61; 95% CI, 1.94-3.51). The combined presence of malnutrition and frailty was associated with a 4.44-fold excess risk of 1-year mortality beyond additivity, with 63% of the risk attributable to their interaction. Concurrent preoperative malnutrition and frailty identified a high-risk phenotype independently associated with increased risks of 1-year and 90-day all-cause mortality, major POCs, and prolonged LOS, supporting its use in preoperative risk stratification among older adults undergoing surgery.

Within the original Global Leadership Initiative on Malnutrition (GLIM) procedure (2019), the step on nutritional screening was not further elaborated. A new GLIM Risk of Malnutrition Working Group has recently developed a consensus-based conceptual definition of "risk of malnutrition". The present study aimed to operationalize this definition. This study consisted of: (1) a literature search to identify risk factors for malnutrition, and (2) a two-round online modified Delphi study. International professional experts (n = 113) in the field of malnutrition were invited to rate the importance of identified risk factors using a 9-point Likert scale. In questionnaire round 1, risk factors were rated "critically important" if &#x2265; 70% of the participants rated them 7-9, or "not important" if >30% rated them 1-3. The remaining risk factors were categorized as "undecided." In questionnaire round 2, undecided risk factors were classified as "critically important" or "important, but not critical", based on the same threshold. The literature search revealed 64 risk factors that were included in the Delphi questionnaires. In questionnaire rounds one (n = 57 participants) and two (n = 46 participants), 29 risk factors (from the overarching risk categories unintentional weight loss, nutrition impact symptoms, disease-related factors, physical factors, psychological factors, decreased food intake, food assimilation, and poor diet) were deemed "critically important," 10 "important, but not critical," and 19 "substantially important." In this study, we identified which risk factors are considered critical to operationalize "risk of malnutrition." Screening for risk of malnutrition should take these relevant risk factors into account.

While hypophosphatemia is known to complicate weaning, the impact of early phosphate dynamics following nutritional support remains unclear. This study aimed to determine the association between the relative rate of phosphate decline after initiation of nutritional support and extubation outcomes in critically ill patients. This retrospective cohort study was conducted in the medical intensive care unit of a tertiary academic hospital. Adult patients receiving invasive mechanical ventilation who underwent planned extubation after initiation of enteral and/or parenteral nutrition between 2022 and 2025 were included. The primary exposure was the phosphate drop rate, defined as the percent decline in serum phosphate from baseline to nadir within 72 h after initiation of nutritional support. The primary outcome was extubation failure, defined as reintubation or death within 7 days after planned extubation. Among 287 patients included in the final analysis, 55 (19.2%) experienced extubation failure. The extubation failure group showed a greater decline in serum phosphate than the success group (35.6 &#xb1; 19.6% vs. 27.3 &#xb1; 19.0%; p = 0.004), while baseline phosphate levels were similar between groups. In multivariable analysis, each 10% increase in phosphate drop rate was independently associated with extubation failure (adjusted odds ratio 1.22; 95% CI, 1.06-1.42). Restricted cubic spline analysis demonstrated that phosphate drop rate was associated with extubation failure (P for overall = 0.025) without evidence of a nonlinear relationship (P for nonlinearity = 0.692). In receiver operating characteristic analysis, the phosphate drop rate showed modest discrimination for extubation failure (area under the curve 0.612; 95% CI, 0.530-0.694). A greater decline in serum phosphate after initiation of nutritional support was independently associated with extubation failure in patients receiving invasive mechanical ventilation. Monitoring early phosphate trajectories during nutritional support may help identify patients at increased risk of extubation failure.

Chronic pancreatitis is a progressive inflammatory disease associated with substantial nutritional and metabolic consequences. Beyond classical malnutrition, patients frequently develop alterations in body composition, particularly sarcopenia, which are increasingly recognised as clinically relevant but remain inconsistently assessed. The reported prevalence of sarcopenia ranges from 20% to 70%, including a substantial proportion of patients with normal or elevated body mass index. Sarcopenia reflects the combined effects of chronic inflammation, pancreatic exocrine insufficiency, endocrine dysfunction, reduced oral intake, malabsorption, and lifestyle factors such as alcohol use, smoking, and physical inactivity. Advances in imaging and functional assessment allow more precise evaluation of muscle mass, fat distribution, and bone density. Computed tomography-derived skeletal muscle indices, often obtained from routine imaging, provide accurate muscle mass quantification, while handgrip strength and gait speed capture clinically meaningful functional impairment. Observational studies associate sarcopenia with increased healthcare utilisation, higher mortality, and poorer surgical outcomes, although heterogeneity in definitions and study design limits causal inference. Most studies rely on CT-derived muscle mass as the sole diagnostic criterion, consistent with pre-EWGSOP2 frameworks, rather than incorporating muscle strength - typically assessed by grip strength - as now recommended by current consensus groups. Evidence regarding sarcopenic obesity, myosteatosis, and ectopic fat deposition remains limited. Structured nutritional assessment, including the GLIM criteria for malnutrition diagnosis, alongside systematic body composition evaluation and multidisciplinary nutritional and exercise-based interventions, may improve risk stratification and outcomes. Further longitudinal and interventional studies are needed to define disease-specific thresholds and optimise management strategies.

The GLIM malnutrition diagnostic framework includes the etiologic criterion for reduced dietary intake or assimilation (i.e., digestion or absorption). This criterion required further specification to support consistent use in clinical practice. Three rounds of a modified Delphi was undertaken to develop consensus on guidance to support identification of this criterion. A working group (n = 11) developed surveys iteratively. Invited global experts with diverse disciplines and practice contexts (n = 30) fully completed surveys; consensus was determined at 75% agreement. Three surveys and rounds of voting resulted in 15 guidance statements. Notable points include: (a) using usual intake as the comparator for reduced dietary intake rather than energy requirement, (b) use of gastrointestinal symptoms and nutrition impact symptoms to determine challenges with absorption or assimilation, rather than solely gastrointestinal conditions, and (c) using clinical judgment to determine severity of these symptoms. The final criterion is "less than or equal to 50% dietary intake in the last week or any reduction in intake greater than 2 weeks OR severe gastrointestinal or nutrition impact symptoms (e.g., dysphagia, nausea, vomiting, diarrhea) as a result of an acute or chronic condition or therapy." Future work should confirm the feasibility of this criterion in clinical practice and its criterion validity within the GLIM framework.

Malnutrition is common among children with cancer in low- and middle-income countries (LMICs). Although baseline undernutrition has been associated with complications and inferior outcomes, prospective data evaluating how longitudinal nutritional changes relate to survival are limited. In this study we aimed to study the longitudinal changes in anthropometric measures during treatment of childhood cancer and their association with event-free survival (EFS) and overall survival (OS). Children aged 18 years or younger with a new diagnosis of malignancy between August 1, 2016, and April 30, 2021, were enrolled in this prospective cohort study conducted at a tertiary care hospital in New Delhi, India. Serial measurements of weight, height, and mid-upper arm circumference were obtained at diagnosis and during follow-up visits up to one year after diagnosis. Multivariable Cox regression models adjusted for age, sex, malignancy type, and baseline anthropometric status were used to evaluate associations between longitudinal nutritional changes and survival in a landmark cohort of patients alive and event-free at 6 months after diagnosis. A total of 1931 children (median [IQR] age, 8 [0.1-18] years; 1374 [71.2%] male) were included, of whom 996 formed the landmark analysis cohort. The 5-year EFS and OS of the overall cohort was of 49.1% and 53.3%, respectively. At diagnosis, 328 children (17.0%) had wasting (body mass index-for-age Z-score < -2 SD), 417 (21.6%) had stunting (height-for-age Z-score < -2 SD), and 979 (55.5%) had mid-upper arm circumference Z-scores < -2 SD. Weight loss greater than 5% was observed in 312 patients (22.1%) at 3 months, 157 (15.1%) at 6 months, 61 (8.6%) at 9 months, and 31 (6.4%) at 12 months among those with available follow-up data. In the landmark cohort, weight loss >5% at or after six months was independently associated with inferior EFS (adjusted hazard ratio [aHR], 1.69; 95% CI, 1.22-2.33; P = 0.002) and OS (aHR, 1.92; 95% CI, 1.37-2.68; P < 0.001). Similarly, children who had wasting at or after six months had inferior EFS and OS compared with those without wasting. Weight loss >5% after six months is independently associated with inferior overall survival. Ongoing nutritional monitoring is essential to improve outcomes in children with cancer in LMICs.

Malnutrition is associated with poor outcomes in various diseases. This study aimed to evaluate the independent prognostic value of the Geriatric Nutritional Risk Index (GNRI) for long-term all-cause mortality in older patients with non-ST-segment elevation myocardial infarction (NSTEMI), and to further explore its joint effects with obesity, inflammation, hypercoagulability, and cardiac dysfunction, as well as potential underlying pathways. This single-center cohort study consecutively enrolled 1686 patients aged &#x2265;60 years hospitalized with NSTEMI at Tianjin Chest Hospital between March 2016 and December 2020. According to admission GNRI, patients were categorized into nutritional risk (GNRI &#x2264;98) and no nutritional risk (GNRI >98) groups. The endpoint was all-cause mortality. Restricted cubic spline analyses and Cox proportional hazards models were used to assess the dose-response relationship and independent association between GNRI and mortality. Joint and mediation analyses were further performed to evaluate combined prognostic effects and explore potential mediating pathways. During a median follow-up of 5.36 years (interquartile range, 4.17-6.57 years), 249 (14.8%) deaths occurred. GNRI showed a near-linear inverse association with mortality in both the overall NSTEMI cohort and the diabetes mellitus and metabolic syndrome subgroups. Each 1-SD decrease in GNRI was associated with a 24% higher mortality risk (HR 1.24, 95% CI 1.10-1.41; P < 0.001). Compared with GNRI >98, GNRI &#x2264;98 was independently associated with increased all-cause mortality after full adjustment (HR 1.45, 95% CI 1.11-1.88; P = 0.006). Joint analyses revealed that all-cause mortality risk further increased when GNRI &#x2264;98 coexisted with BMI &#x2265;28 kg/m2, hs-CRP >5 mg/L, D-dimer >0.5 mg/L, or NT-proBNP &#x2265;945 pg/mL, with the highest risk observed in patients with concomitant elevation of NT-proBNP (HR 2.23, 95% CI 1.47-3.39; P < 0.001). Furthermore, hs-CRP and NT-proBNP mediated 8.6% and 12.4% of the association between GNRI and mortality, respectively. Poor nutritional status independently increases the risk of long-term all-cause mortality in older patients with NSTEMI. Low GNRI combined with obesity, high inflammation, hypercoagulability, and cardiac dysfunction further exacerbates this risk, highlighting their combined value in identifying individuals at extremely high risk of mortality.

Parenteral nutrition (PN) in palliative oncology presents profound ethical challenges where the desire to nourish intersects with dependency, vulnerability, and the limits of medicine. For patients with incurable malignancy who cannot maintain nutrition enterally, PN may extend life for months yet impose significant physical, emotional, and moral burdens on patients and families. Prevailing principlist frameworks privilege a thin, procedural conception of autonomy that fails to capture the interdependence inherent in these situations. This essay argues that relational autonomy, enriched by virtue ethics and guided by phronesis (practical wisdom), provides a more ethically adequate foundation for PN decision-making. Relational autonomy recognises autonomy as embedded within relationships of care and trust, while phronesis enables clinicians to exercise moral discernment amid uncertainty and cultural diversity. Together, these approaches reframe feeding from a technical intervention into a relational act of care, demanding wisdom, compassion, and humility at the end of life.

Dietary interventions are first-line management for irritable bowel syndrome (IBS), but their relative efficacy, acceptability, and safety remain incompletely understood. This systematic review and meta-analysis aimed to comprehensively evaluate four dietary interventions for adult patients with IBS: the low FODMAP diet (LFD), Mediterranean-based dietary interventions (including the Mediterranean diet [MD] and Mediterranean low-FODMAP diet [MED-LFD]), traditional dietary advice (TDA), and emerging dietary interventions (including the starch- and sucrose-reduced diet [SSRD] and gluten-free diet [GFD]). We searched PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) for randomized controlled trials (RCTs) published or registered between 2019 and 2025. Meta-analyses were performed using a random-effects model, and risk of bias was assessed using the Cochrane risk of bias tool. Ten RCTs involving 939 participants were included. LFD showed relatively consistent short-term efficacy (responder rate 34%-78%) with no significant difference versus other dietary interventions in pooled analysis (RR = 1.04, 95% CI: 0.91-1.19, P = 0.55, I2 = 0%). Mediterranean-based interventions, particularly MED-LFD, showed promising longer-term benefit in individual trials, with response rates of 81.5% and 70.4% at follow-up and superiority to TDA in one recent RCT (P = 0.007 and P = 0.004). TDA showed moderate efficacy (responder rate 42%-48.1%) but a lower pooled response rate than comparator dietary interventions (RR = 0.75, 95% CI: 0.64-0.88, P = 0.0005, I2 = 0%). SSRD showed favorable efficacy in habitual-diet-controlled trials and was non-inferior to LFD in one head-to-head trial, with better long-term adherence in descriptive follow-up data. GFD showed inconsistent efficacy, and pooled analysis did not demonstrate a significant advantage over comparator interventions (RR = 1.19, 95% CI: 0.83-1.70, I2 = 0%). TDA had the highest acceptability, and no serious adverse events were reported across included studies. The available evidence suggests that the four dietary intervention categories examined in this review have different efficacy, acceptability, and safety profiles. LFD may provide relatively consistent short-term symptom benefit, Mediterranean-based approaches may be promising for longer-term management, TDA may offer practical advantages despite lower pooled efficacy, and SSRD may represent a promising alternative to LFD. GFD may benefit only a subset of patients rather than the general IBS population. Larger, well-designed RCTs are needed to confirm these findings and clarify subgroup-specific responses. Prospero registration: CRD420261335612,https://www.crd.york.ac.uk/PROSPERO/view/CRD420261335612.

Dietary strategies are increasingly recognized as important modulators of breast cancer outcomes, acting through effects on metabolic regulation, weight management, hormone signalling, immune function, and the gut microbiome. However, breast cancer heterogeneity and inter-individual variability mean that generic dietary guidelines may not fully capture patient needs. Precision nutrition offers the opportunity to align dietary interventions with tumour subtype, treatment context, and host biology, potentially enhancing therapeutic response and survivorship in patients diagnosed with breast cancer. In this narrative review, we summarize evidence on dietary patterns and prognosis, and explore how targeted interventions, including fasting regimens, ketogenic diets, and caloric restriction, may be informed by and targeted to host factors such as obesity, metabolic dysfunction, genetics and epigenetics, and microbiome composition, as well as tumour and treatment characteristics. We also discuss the emerging role of digital tools and multi-omics approaches to support personalization. While clinical translation is at an early stage, refining dietary recommendations through precision approaches may open new opportunities to improve prognosis and long-term care in breast cancer.

Atopic dermatitis (AD) poses a substantial burden on affected children and their families. The evidence of the role of feeding choices in infancy for AD development is limited. This study is a two-arm, parallel, randomized, double-blind, controlled trial to assess the effect of infant feeding with whole goat milk formula (WGF) versus cow milk formula (CF) on AD development during the first year of life. Healthy term infants up to 3 months of age were enrolled in 6 Spanish and 4 Polish study centres, without AD risk selection. The primary outcome measure was AD diagnosed by study personnel at three study visits using the United Kingdom Working Party diagnostic criteria (ADPrimary). Reported doctor-diagnosed AD (ADDoctor) was a secondary outcome. Cumulative incidence in the first year of life was calculated. Incidence rate ratios (IRR) were estimated by Poisson regression. Data from 2132 infants were analyzed. 192 infants were diagnosed with ADPrimary and 245 with ADDoctor. The cumulative incidence rate of ADPrimary for both groups was 11.6 per 100 person-years without difference between WGF and CF (IRR: 1.00; 95%CI: 0.75, 1.32; p = 0.991). In the per-protocol population, the incidence of ADDoctor was lower in WGF than CF (IRR: 0.66; 95%CI: 0.49, 0.9; p = 0.008). In infants with parental history of AD, the protective effect of WGF was stronger: ADDoctor IRR 0.36 (95%CI: 0.17, 0.76; p = 0.007). This trial demonstrates that WGF can reduce the incidence of AD in formula-fed infants in the first year of life, especially in presence of parental history of AD. ClinicalTrials.gov Identifier: NCT04599946. Submitted: 2020-10-05.

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Formula diets (FD) lead to weight loss and may result in remission of type 2 diabetes mellitus (T2D). Macronutrient compositions for FD are well studied, however it is not established whether common FD lead to alterations in trace element status, and whether these changes are associated with HbA1c or other glycaemic traits. The FAsting-induced Immune-metabolic Remission of type 2 diabetes (FAIR) study is a monocentric, stratified, randomized, non-blinded clinical nutritional intervention study that enrols participants with T2D. Participants were assigned to one of two different FD (HEPAFAST&#xae; or OPTIFAST&#xae;; the former particularly rich in protein and fibre) for 12 weeks. The present study on trace elements is a subset (n = 44) of FAIR. Weight, BMI and HbA1c were assessed before and after the intervention. As trace element biomarkers, total serum copper, zinc, and selenium were quantified using total reflection X-ray fluorescence, ceruloplasmin and selenoprotein P concentrations were measured with a sandwich chemiluminescent immunoassay (CLIA) and glutathione peroxidase 3 activity was assessed using an enzymatic test. Body weight and HbA1c decreased in both groups after FD. At baseline, there was a positive correlation of copper and ceruloplasmin, and between all three selenium biomarkers (p < 0.001). In the HEPAFAST&#xae; group, selenoprotein P (p = 0.049) and ceruloplasmin (p = 0.020) increased after FD compared to baseline. In the OPTIFAST&#xae; group, copper (p = 0.046), selenium (p = 0.002), selenoprotein P (p = 0.002) and ceruloplasmin (p = 0.001) increased during the intervention. The proportion of subjects displaying trace elements within the reference range increased during the study. Changes in trace elements were mostly unrelated to the FD-induced decline in HbA1c, except for selenoprotein P, which was positively associated with HbA1c in the OPTIFAST&#xae; group (&#x3b2; = 0.21, p = 0.025). This study demonstrates that weight loss and remission of T2D can be achieved through a balanced FD without significant risk of trace element deficiency or excess. The trial was registered at ClinicalTrials.gov (No. NCT05295160).

Despite global prevalence of Menopause, evidence on lived experiences across diverse populations remains limited, particularly in Brazil. Addressing these gaps is essential for designing equitable health policies. MARIE-Brazil conducted a qualitative study to explore menopausal experiences. Twenty women were selected from a cohort of 262 women in the MARIE-Brazil quantitative study who consented to the qualitative phase. Semi-structured interviews were conducted using a topic guide with participants self-identifying as experiencing perimenopause, menopause, or post-menopause. Sampling captured heterogeneity across age, menopausal stage, socio-economic position, ethnicity, and healthcare access. The findings indicate intersecting biological, psychological, socio-cultural, and health system determinants shaping experiences. Participants reported vasomotor symptoms, sleep, cognitive, and urogenital changes that influenced quality of life and occupational participation. Barriers to care included limited clinical knowledge, "front-desk gatekeeping," and financial inaccessibility of treatments. Cultural stigma and gender norms exacerbated inequities, while peer networks and supportive clinicians improved coping. Menopause is not solely a biological milestone but a multifaceted transition shaped by structural and cultural determinants. Findings highlight urgent needs to adapt robust clinical protocols (e.g. Brazilian Federation of Gynecology and Obstetrics Associations-FEBRASGO, Brazilian Society of Climacteric-SOBRAC) for the public sector (SUS) and provide training for non-clinical staff, and accessible treatment pathways. Incorporating lived experiences into service design and policy frameworks is critical to promoting equity in menopause care across diverse Brazilian population.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the hepatic expression of systemic metabolic derangement; however, we have limited understanding of its progression or improvement, and there's a lack of adequate tools to monitor these changes. Metabolomics can provide dynamic biomarkers that reflect pathophysiological change. To describe the effects of weight-loss oriented Mediterranean diet on clinical, laboratory and metabolomic profiles in a cohort of genetically characterized obese and overweight MASLD patients. In a prospective cohort, 148 adults with ultrasound-confirmed MASLD started a personalized, nutritionist-guided, hypocaloric Mediterranean diet, supported by regular counselling. Weight loss was classified as <5%, 5-10%, or >10% of baseline. Single-nucleotide polymorphisms in PNPLA3, TM6SF2, MBOAT7 and GCKR were genotyped and combined into a weighted polygenic risk score. Untargeted gas chromatography-mass spectrometry profiled fasting serum samples at baseline and study end. Data were processed by partial least squares discriminant analysis, variable importance in projection scoring, and pathway enrichment. Mean weight decreased by about 8% and controlled attenuation parameter declined by nearly 17%, with greatest steatosis reduction in PNPLA3 G-allele carriers. Metabolomic modelling achieved 92% classification accuracy and revealed fourteen key metabolites. Caproic acid, glycerol and hydroxypropanedioic acid increased consistently, whereas palmitic acid and d-galactose decreased. Enriched pathways included galactose, butanoate and glycerolipid metabolism. Metabolic shifts scaled with weight loss intensity and differed by genotype. Mediterranean diet-induced weight loss triggers rapid, weight-dependent and genotype-modulated metabolomic reprogramming that parallels hepatic fat clearance. Caproic acid, glycerol and hydroxypropanedioic acid constitute biomarkers and combined with genetic risk assessment, may support precision nutrition strategies for MASLD.

Short bowel syndrome (SBS) is the leading cause of pediatric intestinal failure and is frequently associated with impaired growth due to malabsorption and prolonged dependence on parenteral nutrition (PN). Teduglutide (TED), a glucagon-like peptide-2 analogue, promotes intestinal adaptation and may reduce PN requirements. Recent real-world data suggest that baseline nutritional status influences treatment response, but growth trajectories during TED therapy remain poorly characterized. This study aimed to evaluate linear and ponderal growth over the first 12 months of TED treatment, stratified by treatment response and achievement of PN weaning. Data were drawn from a large European multicenter cohort of children with SBS-associated intestinal failure treated with TED. Response was defined as a >20% reduction in PN volume or calories; PN weaning was defined as full discontinuation of PN within 52 weeks. Weight, height, and BMI were measured every 3 months, and z-scores were calculated using CDC growth charts. Longitudinal changes were compared between responders and non-responders; and between children who achieved PN weaning and responders which were not weaned. Among 104 treated children, 68 were responders and 21 achieved full PN weaning. Responders showed significantly better baseline weight (-1.2 vs - 2.1 p: 0.013) and BMI z-scores (-0.7 vs -1.2 p: 0.021) compared to non-responders and maintained its significantly higher throughout follow-up and until 12 months (-1.2 vs -1.7 p: 0.046; -0.4 vs -1.4 p < 0.001 respectively). Children who achieved PN weaning did not show any significant variation on growth parameters at baseline when compared to non-weaned; during follow-up they showed a significant difference at nine months in weight (-1.6 vs -0.9 p: 0.018) and height z-score (-1.4 vs -0.9 p:0.034) which were non-significant at the end of 12 months follow-up (-1.4 vs -1.3 p: 0.15; -1.8 vs -1.2 p: 0.19). TED treatment was associated with more favourable weight and BMI trajectories compared to non-responders, particularly in responders, who maintained higher z-scores throughout follow-up despite modest within-group changes. However, PN withdrawal appeared to coincide with a period of growth vulnerability, highlighting the need for close nutritional monitoring. These findings support a potentially beneficial role of TED on growth, while emphasizing that PN weaning should be managed cautiously to avoid compromising linear and ponderal growth.

Catheter-related bloodstream infections (CRBSIs) are a major complication in patients with chronic intestinal failure (CIF) dependent on home parenteral support (HPS), contributing substantially to morbidity, mortality, and costs. Taurolidine-containing catheter lock solutions reduce CRBSIs, but data on cost-effectiveness remain limited. This cost-effectiveness analysis used data from a double-blind, randomized controlled trial (2019-2022; ClinicalTrials.gov: NCT06660641) comparing 1.35% taurolidine with 0.9% saline as catheter lock solutions for secondary prevention of recurrent CRBSIs in 61 adults with CIF and a history of CRBSI. Economic analyses adopted a healthcare-provider perspective and included direct medical costs related to treatment and CRBSI management. Clinical outcomes were evaluated using recurrent-event methods, and costs were estimated using Diagnosis-Related Group (DRG) tariffs and a micro-costing approach (MCAP). Incremental cost-effectiveness ratios (ICERs) were calculated. Taurolidine significantly reduced recurrent CRBSIs (ratio: 0.23; 95% CI: 0.09-0.60; p = 0.0028) and associated CVC removals (ratio: 0.09; 95% CI: 0.02-0.41; p = 0.0019). The number needed to treat was 2.4 patients per year. Patients in the taurolidine group had fewer admission days (mean 3.3 vs 16.0; p = 0.015). Despite higher acquisition costs, taurolidine reduced the total hospital expenditures by 39% (DRG) to 64% (MCAP). Mean savings per patient at 24 months were &#x20ac;6395 (DRG; p = 0.016) and &#x20ac;15,434 (MCAP; p = 0.014). Taurolidine also reduced the probability of extreme high-cost CRBSI episodes. Incremental cost-effectiveness ratios (ICERs) indicated dominance, with 94.5-99.6% of bootstrap replications showing taurolidine to be more effective and less costly. In patients with CIF and prior CRBSI, 1.35% taurolidine is a clinically superior and cost-saving secondary prevention strategy that reduces recurrent CRBSIs, CVC removals, and hospital resource use. These findings support routine use in secondary prevention and highlight the need to evaluate taurolidine for primary prevention, where early risk stratification remains challenging.