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BACKGROUND: Emerging evidence on body composition suggests that sarcopenic obesity (obesity with depleted muscle mass) might be predictive of morbidity and mortality in non-malignant disease and also of toxicity to chemotherapy. We aimed to assess the prevalence and clinical implications of sarcopenic obesity in patients with cancer. METHODS: Between Jan 13, 2004, and Jan 19, 2007, 2115 patients with solid tumours of the respiratory or gastrointestinal tract from a cancer treatment centre serving northern Alberta, Canada, were identified. Available lumbar CT images of the obese patients were analysed for total skeletal muscle cross-sectional area; these values were also used to estimate total body fat-free mass (FFM). FINDINGS: Of the 2115 patients initially identified, 325 (15%) were classified as obese (body-mass index [BMI] > or =30). Of these obese patients, 250 had CT images that met the criteria for analysis. The remaining 75 patients were recorded as without assessable scans. Obese patients had a wide range of muscle mass. Sex-specific cut-offs that defined a significant association between low muscle mass with mortality were ascertained by optimum stratification analysis: 38 (15%) of 250 patients who had assessable CT images that met the criteria for analysis were below these cut-offs and were classified as having sarcopenia. Sarcopenic obesity was associated with poorer functional status compared with obese patients who did not have sarcopenia (p=0.009), and was an independent predictor of survival (hazard ratio [HR] 4.2 [95% CI 2.4-7.2], p<0.0001). Estimated FFM showed a poor association with body-surface area (r(2)=0.37). Assuming that FFM represents the volume of distribution of many cytotoxic chemotherapy drugs, we estimated that individual variation in FFM could account for up to three-times variation in effective volume of distribution for chemotherapy administered per unit body-surface area, in this population. INTERPRETATION: This study provides evidence of the great variability of body composition in patients with cancer and links body composition, especially sarcopenic obesity, to clinical implications such as functional status, survival, and potentially, chemotherapy toxicity. [ABSTRACT FROM AUTHOR]

Basal forebrain cholinergic neurons are pivotal for cholinergic signaling in the neocortex and hippocampal formation, crucially implicated in neurodegenerative diseases like late-onset Alzheimer's disease (LOAD), recognition memory impairments, and decision-making. The acetylcholine transporter (VAChT) is essential for loading acetylcholine into synaptic vesicles. Building on our previous findings showing that Ginkgo biloba extract (EGb) preserves recognition memory, we hypothesized EGb would enhance memory in female mice with varying VAChT reductions. We also explored whether reduced cholinergic signaling induces anxiety-like behavior and whether EGb could alleviate such symptoms. Three-month-old female mice with severe VAChT reduction (knockdown homozygotes; VAChT KD HOM ), moderate reduction (heterozygotes; VAChT KD HET ), and wild-type (WT) mice received the vehicle, 5 mg/kg Donepezil, or EGb at doses of 250, 500, and 1000 mg/kg for 30 days. Memory assessments included aversive tasks like discriminative avoidance memory and non-aversive tasks like object recognition and location memory. We assessed VAChT protein expression in the hippocampal formation (HF) using Western blotting and quantified VAChT-immunopositive cells (IR + ) in specific HF subfields (dCA1, dCA3, dDG) using immunohistochemistry. Chronic EGb treatment significantly improved long-term memory in female VAChT KD HOM mice in object recognition and locations memories in a dose-dependent manner, unlike Donepezil. Enhanced memory was correlated with an increase in VAChT-IR + cells in the dCA1 of VAChT KD HOM mice. Additionally, EGb reduced VAChT-IR + cells in the dDG of VAChT KD HET mice, which was associated with decreased anxiety-like behavior. These findings suggest that EGb effectively mitigates deficits caused by cholinergic deficiency in hippocampal-dependent memory consolidation, thereby improving our understanding of its role in modulating long-term memory and hippocampal plasticity., Competing Interests: Declaration of Competing Interest The authors confirm that the research was conducted without any commercial or financial relationships that could potentially create a conflict of interest regarding the subject matter of this study., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Introduction: Brown adipose tissue (BAT) exhibits greater resilience against inflammation compared to white adipose tissue. However, chronic consumption of a high-fat diet can render brown adipocytes vulnerable to pro-inflammatory conditions, leading to a decline in their thermogenic capacity and subsequent dysfunction. The analysis of the effects of type fatty acids intake must be important in the context of the dietary pattern and obesity., Objectives: This study aims to investigate the impact of a low-carbohydrate/high-fat diet, enriched with different types of fatty acids, on mitochondrial activity on brown adipose tissue in obese mice., Methods: Male mice were allocated into different dietary groups: a control diet (CTL), and a high-fat diet (HFD) for a duration of 10 weeks to induce obesity. Subsequently, the HFD group was subdivided into the following categories for an additional 6 weeks: HFD with a low carbohydrate content enriched with saturated fatty acids; HFD with a low carbohydrate content enriched with fish oil; HFD with a low carbohydrate content enriched with soybean oil; and HFD with a low carbohydrate content enriched with olive oil., Results: The findings indicated that in comparison to a low-carbohydrate diet rich in saturated fats, diets rich in unsaturated fatty acids-particularly omega-6 (n-6) and omega-9 (n-9)-resulted in elevated expression of UCP1, a marker of BAT activity. Moreover, there was an increase in the expression of PGC1-α, a protein involved in mitochondrial biogenesis, and enhanced functionality of the oxidative phosphorylation system within BAT mitochondria. These results suggest that n-6 and n-9 fatty acids may confer greater benefits to BAT functionality than saturated fats within the context of a low-carbohydrate diet. Therefore, this study revealed some molecular components that mediate BAT mitochondria function influenced by different fatty acids in a low carbohydrate diet, making it an important therapeutic target in obesity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier Inc.)

Muscle mass and strength are crucial for physiological function and performance in athletes, playing a significant role in maintaining health and optimal athletic performance. Skeletal muscle, which constitutes the majority of lean soft tissue (LST) and appendicular lean soft tissue (ALST) when measured by dual-energy X-ray absorptiometry (DXA), represents a commonly used surrogate for strength. Research has investigated alternative measures of body composition, such as the assessment of ALST through bioelectrical impedance analysis (BIA) and the determination of whole-body muscle mass from creatine pool size using the deuterated creatine (D 3 Cr) dilution method, for their associations to strength. While the relationship between body composition measures and strength has been studied in older adults, this relationship remains unexplored in athletic populations. This study examined muscle body composition measures using DXA, D 3 Cr, and BIA and their association with strength in a sample of collegiate athletes. The study enrolled 80 collegiate athletes (40 females) of differing sports disciplines who consumed a 60 mg dose of D 3 Cr and completed DXA and BIA measures in addition to trunk and leg strength tests. Analysis was sex-stratified using Pearson's correlations, linear regression, and quartile p trend significance. With an average participant age of 21.8 years, whole-body DXA correlations to muscle strength surpassed height- or mass-normalized values. This trend was especially pronounced in trunk strength's relationship with body composition over leg strength, across measurement methods. While DXA LST values were higher than BIA and D 3 Cr in predicting strength, the values did not differ significantly. Adjustments for age, BMI, and BIA variables didn't enhance this association. A significant trend between DXA LST and all strength measures underscored the equal relevance of DXA and D 3 Cr muscle mass to strength, favoring whole-body over regional assessments. This calls for future research on muscle mass's effects on LST and functional outcomes in broader groups, highlighting the importance of comprehensive body composition analysis in athletic performance studies., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Sporotrichosis by Sporothrix brasiliensis is increasingly reported in South America. Here, we present the first autochthonous human case in Paraguay, transmitted by a local infected cat. After 63 days of clinical signs onset, the patient was correctly diagnosed and antifungal treatment started, highlighting the need to increase awareness for this emerging disease., Competing Interests: Declaration of competing interest EFJM received research grants from Mundipharma and Scynexis, is in the scientific advisory board for Pfizer and has received speaker fees from Gilead Sciences. All other authors declare no conflict of interest., (Copyright © 2025 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

The adaptive and independent interrelationships between different body composition components have been identified as crucial determinants of disease risk. On the basis of this concept, the load-capacity model of body composition, which utilizes measurements obtained through nonanthropometric techniques such as dual-energy X-ray absorptiometry, was proposed. This model is typically operationalized as the ratio of metabolic load (adipose mass) to metabolic capacity (lean mass). In recent years, a series of load-capacity indices (LCIs) have been utilized to identify abnormal body composition phenotypes such as sarcopenic obesity (SO) and to predict the risk of metabolic, cardiovascular, and cognitive disorders. In this review, we comprehensively review the characteristics of different LCIs used in previous studies, with a specific focus on their applications, especially in identifying SO and predicting cardiometabolic outcomes. A systematic literature search was performed using PubMed, MEDLINE, PsycINFO, Embase, and the Cochrane Library. Two meta-analyses were conducted to 1) estimate the overall prevalence of SO mapped by LCIs, and 2) assess the association of LCIs with cardiometabolic outcomes. A total of 48 studies (all observational) were included, comprising 22 different LCIs. Ten studies were included in the meta-analysis of SO prevalence, yielding a pooled prevalence of 14.5% [95% confidence interval (CI): 9.4%, 21.6%]. Seventeen studies were included in the meta-analysis of the association between LCIs and adverse cardiometabolic outcomes, which showed a significant association between higher LCI values and increased risk (odds ratio = 2.22; 95% CI: 1.81, 2.72) of cardiometabolic diseases (e.g. diabetes and metabolic syndrome). These findings suggest that the load-capacity model of body composition could be particularly useful in the identification of SO cases and prediction of cardiometabolic risk. Future longitudinal studies are needed to validate the association of LCIs with chronic cardiometabolic and neurodegenerative diseases. This systematic review and meta-analysis has been registered with PROSPERO (CRD42024457750)., Competing Interests: Conflict of interest CMP reports honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestlé Health Science, Pfizer, and AMRA medical; and investigator-initiated funding from Almased. The other authors declare no conflicts of interest., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Hematopoietic stem cell transplantation (HSCT) is a common therapy for many hematologic malignancies. While advances in transplant practice have improved cancer-specific outcomes, multiple and debilitating long term physical and psychologic effects remain. Patients undergoing allogeneic bone marrow transplantation (allo-BMT) are often critically ill at initial diagnosis and with necessary sequential treatments become increasingly frail and deconditioned. Despite modern treatment regimens and support, cardiovascular disease remains a leading cause of non-relapse mortality among allo-BMT survivors. Well-established multi-disciplinary care models such as cardiac rehabilitation offer holistic care including exercise training, nursing support, physical/occupational therapy, psychosocial support and nutritional education. HSCT patients may be excluded from conventional outpatient physical rehabilitation programs due to prolonged pancytopenia and frequent hospital admissions. In Canada, dedicated cancer-specific rehabilitation programs are available only at major tertiary academic centers., Methods: The primary aim of this study will evaluate the feasibility and acceptability of a multimodal care navigation (nursing, exercise, nutrition) intervention with content delivery facilitated by a supportive care web-based 'app' extending from diagnosis to 1 year in the allogeneic bone marrow transplant population. Adult patients scheduled for allo-BMT will receive support from exercise specialist, nursing support and dietician expertise alongside a supportive care 'app' with additional in-person or virtual cardiac rehabilitation support., Discussion: To our knowledge, no research team is taking such a holistic, multidisciplinary approach to address the debilitating physiologic and psychological consequences of allo-BMT. We expect the findings to inform the optimal timing and patient preferences to develop studies examining risk-specific, individualized interventions (including exercise, pharmacotherapy, combination treatments) to reduce or prevent symptoms and dysfunction. We expect this innovative program to identify ways to benefit innumerable patients with hematologic and other malignancies. Ultimately, we hope to transform supportive care in hematopoietic stem cell transplantation., Trial Registration: Clinicaltrials.gov ID: NCT05579678., Competing Interests: Declarations. Ethics approval and consent to participate: This study was reviewed and approved by the Health Research Ethics Board of Alberta (HREBA) – Cancer Committee, Ethics ID#: HREBA.CC-22-0164. Written informed consent is provided by all study participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Poor muscle quality (MQ) is a hidden health condition in obesity, commonly disregarded and underdiagnosed, associated with poor health-related outcomes. This narrative review provides an in-depth exploration of MQ in obesity, including definitions, available assessment methods and challenges, pathophysiology, association with health outcomes, and potential interventions. MQ is a broad term that can include imaging, histological, functional, or metabolic assessments, evaluating beyond muscle quantity. MQ assessment is highly heterogeneous and requires further standardization. Common definitions of MQ include 1) muscle-specific strength (or functional MQ), the ratio between muscle strength and muscle quantity, and 2) muscle composition (or morphological MQ), mainly evaluating muscle fat infiltration. An individual with obesity might still have normal or higher muscle quantity despite having poor MQ, and techniques for direct measurements are needed. However, the use of body composition and physical function assessments is still limited in clinical practice. Thus, more accessible techniques for assessing strength, muscle mass, and composition should be further explored. Obesity leads to adipocyte dysfunction, generating a low-grade chronic inflammatory state, which leads to mitochondrial dysfunction. Adipocyte and mitochondrial dysfunction result in metabolic dysfunction manifesting clinically as insulin resistance, dyslipidemia, and fat infiltration into organs such as muscle, which in excess is termed myosteatosis. Myosteatosis decreases muscle cell function and insulin sensitivity, creating a vicious cycle of inflammation and metabolic derangements. Myosteatosis increases the risk of poor muscle function, systemic metabolic complications, and mortality, presenting prognostic potential. Interventions shown to improve MQ include nutrition, physical activity/exercise, pharmacology, and metabolic and bariatric surgery., Competing Interests: Declarations. Competing interests: All authors declare no competing interests with this manuscript. MCG has received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, and Nestlé Health Science Brazil. BHG has received speaking honorarium from Baxter Corporation. CMP has received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestle Health Science, Pfizer, Amra Medical, Novo Nordisk, and funding from Almased for unrelated research. AMH is on advisory boards for Rhythm Pharmaceuticals, Novo Nordisk Canada, and Pfizer Canada. She is a clinical trial investigator for Rhythm Pharmaceuticals, Levo Therapeutics, Acadia Pharmaceuticals, Novo Nordisk and Eli Lilly. The remaining authors have no competing interest to declare., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Industrialization adversely affects the gut microbiome and predisposes individuals to chronic non-communicable diseases. We tested a microbiome restoration strategy comprising a diet that recapitulated key characteristics of non-industrialized dietary patterns (restore diet) and a bacterium rarely found in industrialized microbiomes (Limosilactobacillus reuteri) in a randomized controlled feeding trial in healthy Canadian adults. The restore diet, despite reducing gut microbiome diversity, enhanced the persistence of L. reuteri strain from rural Papua New Guinea (PB-W1) and redressed several microbiome features altered by industrialization. The diet also beneficially altered microbiota-derived plasma metabolites implicated in the etiology of chronic non-communicable diseases. Considerable cardiometabolic benefits were observed independently of L. reuteri administration, several of which could be accurately predicted by baseline and diet-responsive microbiome features. The findings suggest that a dietary intervention targeted toward restoring the gut microbiome can improve host-microbiome interactions that likely underpin chronic pathologies, which can guide dietary recommendations and the development of therapeutic and nutritional strategies., Competing Interests: Declaration of interests NiMe is a trademark of A.M.A and J.W. J.W. is an owner of a patent on Limosilactobacillus reuteri PB-W1 (NCIMB 42835), licensed to Novonesis A/S, of which income will be shared with the research institutes in Papua New Guinea and Canada that were involved in isolation and characterization of the strain. J.W. has further received honoraria and/or paid consultancy from PrecisionBiotics/Novonesis A/S. A.G. is an employee of Danone Specialized Nutrition. C.M.P. has previously received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestlé Health Science, Pfizer, AMRA Medical, and Novo Nordisk unrelated to this work., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

The accurate assessment of body composition in cirrhosis is challenging as fluid accumulation affects most techniques. The whole-body counter is a state-of-the-art method that measures total body potassium (TBK) unbiased by fluid, from which body cell mass (BCM) is derived. This pilot study in 20 patients with cirrhosis evaluated bedside tools including the liver frailty index (LFI), bioimpedance analysis-based phase angle, calf circumference (CC), and BMI (body mass index)/edema-adjusted CC, and explored their association with TBK and BCM. Stepwise multiple linear regression analysis and Pearson's correlation tests were conducted. Adjusted for sex, BCM and TBK were inversely associated with frailty (p < 0.0001). LFI r = -0.568 (p = 0.009), CC r = 0.484 (p = 0.031), and edema-adjusted CC r = 0.467 (p = 0.038), demonstrated moderate correlations with BCM. Further research involving a larger sample of participants is needed to confirm these findings associating these bedside tools and gold-standard body composition measures., Competing Interests: Competing interests: CMP reports honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestlé Health Science, Pfizer, and AMRA medical. PT received grants from Lupin Pharma Canada and the Nestlé Nutrition Institute. The remaining authors have no conflicts to report. Ethics approval: This study was approved by the Health Ethics Research Board at the University of Alberta (Pro00099333). Informed consent was obtained from all participants. All methods were performed in accordance with the relevant guidelines and regulations., (© 2025. The Author(s), under exclusive licence to Springer Nature Limited.)

Background/objectives: Myosteatosis has been associated with sarcopenia, and increased mortality risk in patients on hemodialysis. We aimed to explore the associations between myosteatosis, as assessed by computed tomography (CT), with demographic parameters, body composition metrics, muscle strength, metabolic parameters and mortality in patients with chronic kidney disease (CKD)., Subjects/methods: We enrolled 216 patients (age 60.3 ± 10.6 years, 63% men) with CKD stages 3-5. Abdominal CT scans at the third lumbar vertebra (L3) were used to assess body composition. Abdominal obesity was determined by abdominal adipose tissue (AT), sarcopenia by low skeletal muscle area (SMA) and low handgrip strength. Myosteatosis was evaluated by two parameters using CT scans at L3: mean muscle attenuation and percentage of intermuscular adipose tissue (%IMAT) within SMA. We evaluated the correlation between parameters of myosteatosis with demographic, clinical and metabolic variables. To determine independent predictors of myosteatosis, a multiple linear regression model was fitted. Mortality risk was evaluated with Cox-regression analysis., Results: Both parameters of myosteatosis were independently associated with age, metabolic syndrome, abdominal AT and SMA in the multiple linear regression analysis (adjusted R 2 for multiple linear regression: muscle attenuation model 0.535, P < 0.001; %IMAT model 0.462, P < 0.001). Moreover, higher %IMAT and lower attenuation were associated with a higher mortality risk., Conclusion: In patients with CKD, increased myosteatosis, as assessed by abdominal CT, was associated with old age, adiposity, metabolic dysfunction, and higher mortality risk., Competing Interests: Competing interests: CMP has previously received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestlé Health Science, Pfizer, and AMRA medical. AS has previously received honoraria and/or paid consultancy from Fresenius Kabi, Dr Schär and Baxter. CMA has previously received honoraria and/or paid consultancy from Fresenius Kabi, Astra-Zeneca and Baxter. BL was supported by a grant from Baxter Healthcare Corporation to Karolinska Institutet. PS has been on scientific advisory boards for Invizius, CSL, Vifor, GSK, Astra Zeneca, Baxter, and Fresenius. PS has lectured at meetings sponsored by Novo Nordisk, Astra Zeneca, Baxter, Astellas, Fresenius and Pfizer. Ethics approval and consent to participate: The study was conducted according to the Helsinki declaration. Informed consent was signed before patients’ inclusion in the study. The Research Ethical Committee at Dante Pazzanese Institute of Cardiology approved the study., (© 2025. The Author(s).)

The rapid and widespread clinical adoption of highly effective incretin-mimetic drugs (IMDs), particularly semaglutide and tirzepatide, for the treatment of obesity has outpaced the updating of clinical practice guidelines. Consequently, many patients may be at risk for adverse effects and uncertain long-term outcomes related to the use of these drugs. Of emerging concern is the loss of skeletal muscle mass and function that can accompany rapid substantial weight reduction; such losses can lead to reduced functional and metabolic health, weight cycling, compromised quality of life, and other adverse outcomes. Available evidence suggests that clinical trial participants receiving IMDs for the treatment of obesity lost 10% or more of their muscle mass during the 68- to 72-week interventions, approximately equivalent to 20 years of age-related muscle loss. The ability to maintain muscle mass during caloric restriction-induced weight reduction is influenced by two key factors: nutrition and physical exercise. Nutrition therapy should ensure adequate intake and absorption of high-quality protein and micronutrients, which may require the use of oral nutritional supplements. Additionally, concurrent physical activity, especially resistance training, has been shown to effectively minimize loss of muscle mass and function during weight reduction therapy. All patients receiving IMDs for obesity should participate in comprehensive treatment programs emphasizing adequate protein and micronutrient intakes, as well as resistance training, to preserve muscle mass and function, maximize the benefit of IMD therapy, and minimize potential risks., (© 2024 The Author(s). Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

This narrative review provides an overview of body composition methods available for use in critically ill patients. It focuses on the relevance and discussion of the most commonly used techniques. Further, we discuss the validity of these methods with a focus on muscle mass assessment, measuring changes over time and the identification of patients with lower-than-normal muscularity. Current available evidence, as well as future directions is highlighted., Competing Interests: Disclosure K.J. Lambell and M. Paris have nothing to disclose. M.C. Gonzalez has received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia Danone, and Nestlé Brazil. C.M. Prado has received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia Danone, Nestlé Health Science, Pfizer and AMRA medical., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

The intensive care unit (ICU) environment is one of the most challenging for skeletal muscle health. Atrophy associated with clinical care is distinct from that seen with inactivity or immobilization in the absence of disease and is exacerbated by aging. The substantial muscle loss in the ICU is likely due to the presence of inflammation, elevated proteolysis, bedrest, and undernutrition. Skeletal muscle parameters at admission are predictive of mortality and other clinically important outcomes. Treatment goals to mitigate muscle loss are early mobilization and adequate nutrient supply, especially protein, using an individualized approach to support skeletal muscle maintenance and recovery., Competing Interests: Disclosures S.M. Phillips has received grant funding from the Canadian Institutes of Health Research, Canada, the Natural Sciences and Engineering Research Council of Canada, Canada, the US National Institutes for Health, Roquette Freres, France, Nestle Health Science, Friesland Campina, The Netherlands, The US National Dairy Council, Dairy Farmers of Canada and Myos. S.M. Phillips has received travel expenses and honoraria for speaking from Nestle Health Science. S.M. Phillips holds patents licensed to Exerkine Inc. but reports no financial gains. S.M. Phillips and C.M. Prado are supported by a Tier 1 Canada Research Chair award. M.J. Lees is supported by a Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship award (Funding Reference Number 187773). C.M. Prado has received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestle Health Science, Pfizer, Amra Medical, Novo Nordisk and funding from Almased for unrelated research. Dr P.E. Wischmeyer reports receiving investigator-initiated grant funding related to this work from National Institutes of Health, United States, Department of Defense, United States, Abbott, Baxter, United States, and Fresenius. Dr P.E. Wischmeyer has served as a consultant to Abbott, Fresenius, Baxter, Cardinal Health, Mend Inc and Nutricia, for research related to this work. Dr P.E. Wischmeyer has received unrestricted gift donation for nutrition research from Musclesound and DSM. Dr P.E. Wischmeyer has received honoraria or travel expenses for CME lectures on improving nutrition care from Abbott, Baxter, Fresenius, Danone-Nutricia, and DSM., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Body composition abnormalities are prognostic markers in several types of cancer, including colorectal cancer (CRC). Using our data distribution on body composition assessments and classifications could improve clinical evaluations and support population-specific opportune interventions. This study aimed to evaluate the distribution of body composition from computed tomography and assess the associations with overall survival among patients with CRC. In this multicenter cohort study, patients (N = 635) aged 18 years and older with CRC were observed for 12 to 36 months to assess outcomes. Skeletal muscle area (SM) and index (SMI), skeletal muscle radiodensity (SMD), intermuscular adipose tissue (IMAT), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) were evaluated, and classified based on tertile distributions. Low muscle mass (SMI) and poor muscle composition (SMD) were independent predictors of mortality regardless of follow-up period. This risk of mortality increased to more than 3-fold when combining both low SMI and low SMD (HR adjusted 3.1, 95% CI 1.8 to 5.4, respectively). Our study indicates that body composition characteristics may vary across countries, highlighting the need for developing sex- and population-specific cutoff values for computed tomography assessments in patients with different types of cancer., Competing Interests: Declarations. Competing interests: CMP has previously received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestlé Health Science, Pfizer, and AMRA Medical. MCG has received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, and Nestlé Health Science Brazil. APTF reports receiving a grant for research from Prodiet Medical Nutrition. The other authors have no relevant financial or non-financial interests to disclose., (© 2024. The Author(s).)

Background: This meta-review aimed to synthesize the evidence of the effects of exercise on anxiety and depression symptoms amongst adults with cancer, and cancer-survivors, comparing effects sizes between meta-analysis., Methods: Major databases were searched up to February 9, 2024 for meta-analyses evaluating the effects of exercise, using anxiety and/or depression scales. Effect size (ES) values were calculated as standardized differences in the means and expressed as the Standardized Mean Difference (SMD) with the 95% confidence interval (95%CI). A total of eight unique meta-analyses were included., Results: Among meta-analyses examining both anxiety and depression symptoms overall, a small beneficial effect of exercise was shown [SMD = 0.41 (0.25-0.57); p  < 0.0001]. Subgroup analyses revealed that exercise has a small effect on decreasing anxiety [SMD = 0.42 (0.04-0.79); p  = 0.027], and depressive symptoms [SMD = 0.38 (0.21-0.56); p  < 0.0001]. In addition, aerobic exercise has a moderate effect on reducing depressive symptoms [SMD = 0.54 (0.16-0.93); p  = 0.005], whereas resistance exercise has no effect. Subgroup analyses by type of cancer observed a moderate effect on decreasing depressive symptoms in patients with breast cancer [SMD = 0.51 (0.27-0.74); p  < 0.0001]., Conclusions: Exercise (specifically aerobic) should be considered by healthcare professionals as a strategy to treat/manage symptoms of anxiety and depression amongst adults with cancer and cancer-survivors.

Haemonchus contortus is one of the most pathogenic gastrointestinal parasites that infect small ruminants. The indiscriminate use of anthelmintics (i.e., benzimidazole class, BZ) to control infections has led to the reduction of drug efficacy in H. contortus populations worldwide. Resistance to BZ is associated with high frequencies of single nucleotide polymorphisms at F200Y, F167Y, and E198A positions of the β-tubulin isotype 1 gene. This study aimed to determine the frequency of single nucleotide polymorphisms associated with BZ resistance in H. contortus from 18 farms (545 sheep and 124 goats) in Paraná, Southern Brazil. Health management practices were identified as risk factors from individual farms. Genomic DNA was extracted from 20,000 larvae/farm and used in quantitative polymerase chain reaction assays for the three mutations. We ran a correlation analysis between flock health and quantitative polymerase chain reaction data. H. contortus was the most prevalent parasite in 67% (12/18) of the farms. Resistant allele frequencies were detected for F200Y (var. 46.4 to 72.0%) and F167Y (var. 15.7 to 23.8%). Only (100.0%) susceptible alleles were detected for the E198A. High treatment frequency (15/18), visual weight estimations for anthelmintic dose (15/18), no integration with other farm practices (14/18), treatment of all animals (14/18), and no quarantine period for newly acquired animals (10/18) were considered the most critical risk factors associated with BZ resistance. This is the first systematic prevalence study linking management practices on smallholder farms and the molecular data of BZ resistance of H. contortus in Southern Brazil.

Background: Although adolescents with obesity have an increased risk of cardiometabolic disease, a subset maintains a healthy cardiometabolic profile. Unhealthy lifestyle behaviors may determine cardiometabolic risk. We aimed to characterize the lifestyle behaviors of adolescents with obesity, compare differences between metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), and assess associations between lifestyle behaviors and cardiometabolic profiles. Methods: Participants aged 10-18 years with body mass index (BMI) ≥ 95 th percentile were included. Dietary intake (DI) was estimated from 3-day food records, and diet quality (DQ) was assessed using the Healthy Eating Index-Canadian Adaptation. Physical activity (PA), body composition, anthropometrics, blood markers, and blood pressure (BP) were objectively measured. MUO was defined as having high triglycerides, BP, glucose, or low high-density lipoprotein. Regression analyses were performed between lifestyle behaviors and cardiometabolic markers. Results: Thirty-nine participants (BMI z-score 2.8 [2.5-3.5], age 12.5 [10.9-13.5] years, 56.4% female) were included. A high proportion of participants failed to meet lifestyle recommendations, particularly for DQ (94.7%, n = 36), fiber (94.7%, n = 36), and PA (90.9%, n = 30). No differences in lifestyle behaviors were found between MUO (59.0%, n = 22) and MHO (41.0%, n = 16). Protein intake was negatively associated with BMI and waist circumference z-scores, fat mass index, insulin resistance, low-density lipoprotein, and C-reactive protein, whereas higher DQ was associated with lower C-reactive protein. Higher light PA levels were associated with lower total cholesterol and triglycerides. Conclusion: Adolescents with either MUO or MHO displayed low adherence to DQ, DI, and PA recommendations; no differences in lifestyle behaviors were found. Protein intake, DQ, and PA were associated with a healthier cardiometabolic profile.

Background & Aims: Phase angle (PhA) is a biomarker derived from raw bioelectrical impedance analysis (BIA) values: resistance (R) and reactance (Xc). PhA reflects cellular membrane integrity and, as a result, has been considered a marker of fluid distribution, making it a potential prognostic indicator. A growing body of research demonstrates independent associations between PhA and muscle strength, mass, and composition. In this context, PhA has the extra potential to serve as a marker of muscle quality. However, the evidence supporting its use for this purpose is not well established. This study aimed to investigate the relationship between PhA and markers of muscle quality., Methods: This systematic review and meta-analysis (Internal Prospective Register of Systematic Reviews - PROSPERO on a registration code: CRD42024507853) focused on observational studies assessing the relationship between PhA and markers of both concepts of muscle quality: the muscle quality index (MQI: strength by a unit of mass) and the muscle composition (i.e., skeletal muscle radiodensity [SMD], muscle echogenicity, muscle fat fraction, inter- and intramuscular adiposity). Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), while the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Meta-analyses with a random-effects model were conducted., Results: Seventeen studies were included in this systematic review, encompassing 2710 participants. Meta-analyses demonstrated that PhA had a moderate positive correlation coefficient with SMD (4 studies, 924 participants; r = 0.54, 95 % confidence interval (CI) 0.38 to 0.69, heterogeneity (I 2 ) = 92 %) and good accuracy (85 %) for classifying low SMD (2 studies, 390 participants; Area Under the Curve - AUC pooled 0.85, 95 % CI 0.78 to 0.92, I 2  = 0 %). PhA was inversely-moderately correlated with muscle echogenicity (8 studies, 1401 participants; r = - 0.42, 95 % CI - 0.57 to - 0.24, I 2  = 82 %) and positively-weakly correlated with MQI (2 studies, 191 participants; r = 0.36, 95 % CI 0.21 to 0.49, I 2  = 17 %). All studies had a higher risk of bias. The certainty of evidence ranged from low to very low., Conclusion: Despite technical challenges, this study demonstrates the potential of PhA as a surrogate marker for muscle quality, particularly expressing muscle composition (SMD). Future studies should utilize BIA with standardized protocols to potentially establish specific cutoff values for PhA, thereby enhancing its diagnostic accuracy and clinical applicability. These studies could additionally explore the mechanisms underlying the associations between PhA and muscle quality aspects. In cases where technical factors are not easily controlled, the use of standardized PhA (SPhA), which converts PhA into Z-scores, could be beneficial. Although this warrants investigation, this approach (SPhA) has the potential to account for variables such as age, sex, device differences, and health status., Competing Interests: Conflict of interest CMP has previously received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestlé Health Science, Pfizer, AMRA Medical; and investigator-initiated funding from Almased. MCG has received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, and Nestlé Health Science Brazil. APTF reports receiving a grant for research from Prodiet Medical Nutrition. The other authors have no relevant financial or non-financial interests to disclose., (Copyright © 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Establishing the effectiveness of high-protein supplementation in reducing cancer-related side effects is crucial., Objective: The study aimed to assess the effectiveness and safety of high-protein supplementation on clinical outcomes of patients undergoing cancer therapy., Methods: Systematic searches were conducted on Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane Central Register of Controlled Trials, and Scopus from inception until July 2023. Randomized controlled trials administering supplements with ≥10 g protein/serving, given to 20+ adult patients undergoing cancer therapy were included. Random-effects meta-analyses were used to estimate the effects of high-protein supplementation on the primary outcomes of body weight and health-related quality of life (HRQoL). We employed a vote-counting approach based on effect direction for secondary outcomes (that is, body composition, muscle function, hospitalization, response to cancer therapy/toxicity, survival, and systemic inflammation). Risk-of-bias (ROB) was assessed., Results: Thirty-five studies involving 3701 patients with diverse cancer types were included. Patients who received high-protein supplementation lost less body weight than controls (mean difference = 1.45 kg; 95% CI: 0.42, 2.48 kg; P = 0.006; I 2 = 80%). No differences in HRQoL were observed; all studies assessing HRQoL were rated as high ROB. A beneficial effect on muscle mass was found in 11 of 13 studies, although most had a high ROB due to assessment techniques. When considering higher quality studies, evidence of a beneficial effect was found in 5 of 5 studies for muscle strength, and 3 of 4 for hospitalization rate. Effects on other secondary outcomes were inconsistent or limited. No serious adverse effects were reported., Conclusions: High-protein supplementation mitigates weight loss, improves muscle strength, and lowers hospitalization rates in patients undergoing cancer therapy. These positive clinical outcomes, along with a favorable safety profile, suggest that high-protein supplementation may be a valuable addition to medical practice. However, given the need for more robust trials and the high ROB observed in the existing studies, these conclusions should be interpreted with caution. This review was prospectively registered with PROSPERO under the registration number CRD42021237372., Competing Interests: Conflict of interest CEO has received honoraria from Abbott Nutrition. JA reports receiving speaking and lecture fees from Baxter and Nutricia. AL reports receiving honoraria and/or paid consultancy from Abbott, Baxter, B. Braun, Fresenius Kabi, Nestlé Health Science, Nutricia, and Smartfish, and research grant from Fresenius Kabi. CMP has previously received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Almased, Nestlé Health Science, Pfizer, and AMRA Medical. NK reports speaking and lecture fees and paid consultancy from Abbott Nutrition. The other authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

The 2-component molecular-level model dividing body mass into fat and fat-free mass (FFM) is a cornerstone of contemporary body composition research across multiple disciplines. Confusion prevails, however, as the term lean body mass (LBM) is frequently used interchangeably with FFM in scientific discourse. Are LBM and FFM the same or different body components? Captain Albert R. Behnke originated the LBM concept in 1942 and he argued that his "physiological" LBM component included "essential" fat or structural lipids whereas FFM is a chemical entity "free" of fat. Classical experimental animal and human studies conducted during Behnke's era laid the foundation for the widely used body density and total body water 2-component molecular-level body composition models. Refined body composition models, organization of lipids into structural and functional groupings, and lipid extraction methods all have advanced since Behnke's era. Our review provides an in-depth analysis of these developments with the aim of clarifying distinctions between the chemical composition of LBM and FFM. Our retrospective analysis reveals that FFM, derived experimentally as the difference between body weight and extracted neutral or nonpolar lipids (mainly triglycerides), includes polar or structural lipids (that is, Behnke's "essential" fat). Accordingly, LBM as originally proposed by Behnke has the same chemical composition as FFM, thus answering a longstanding ambiguity in the body composition literature. Bringing body composition science into the modern era mandates the use of the chemically correct term FFM with the elimination of the duplicative term LBM that today has value primarily in a historical context. Avoiding the use of the term LBM additionally limits confusion surrounding similar widely used body composition terms such as lean mass, lean soft tissue mass, and lean muscle mass., Competing Interests: Conflict of interest SBH serves on the Medical Advisory Boards of Tanita Corporation, Novo Nordisk, Abbott, Novartis, Versanis, and Medifast. GMT has received support for his research laboratory, in the form of research grants or equipment loan or donation, from manufacturers of body composition assessment devices, including Size Stream LLC; Naked Labs Inc.; Prism Labs Inc.; RJL Systems; MuscleSound; and Biospace, Inc. None of these entities played a role in the present work., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: This study examined (1) associations between sociodemographic and clinical variables with low muscle mass and radiodensity and their loss relative to treatment commencement in patients with lung cancer; and (2) the magnitude of change in muscle mass and association with treatment outcomes and survival., Methods: Prospective study in patients planned for curative (chemo)radiotherapy for lung cancer. Low skeletal muscle mass and radiodensity and muscle loss were determined from pre- and post-treatment computed tomography images. Sociodemographic, clinical, functional, nutritional, physical activity and alternate body composition were assessed pre-treatment. Logistic and linear regression and Fisher's exact tests were used to assess associations between variables and study outcomes. Cox proportional hazards models were fitted to examine associations with survival., Results: Overall, 53 patients (62.3% male) with a mean age of 69 ± 9.3 years and 54.8% with stage III disease were included. Pre-treatment low calf circumference was associated with pre-treatment low muscle mass (p = 0.006). Higher comorbidity scores pre-treatment were associated with normal muscle radiodensity pre- and post-treatment (p = 0.015, p = 0.027, respectively). Pre-treatment low energy and protein intake were associated with low muscle radiodensity post-treatment. Muscle mass and radiodensity were not associated with survival or treatment outcomes., Conclusions: In patients with lung cancer, there is some evidence anthropometric measures of muscle mass are suggestive of low muscle mass pre-radiotherapy, while low energy intake pre-treatment may indicate low muscle radiodensity after treatment. However, these findings are limited by the small sample size and further prospective studies with larger samples are required., Competing Interests: Competing interests: NK reports honoraria from Abbott Nutrition Australasia. CP reports honoraria or consulting fees from Abbott Nutrition, Nestle Health Sciences, Nutricia and Pfizer. RD reports honoraria from Abbott Nutrition Australasia and Fresenius Kabi. GA, ARC, LD, LE, DB, SS, SFF, AU, NH, AW, GW, AL and AC have no conflict of interest to declare. Ethical approval and consent to participate: This study received ethics approval from the Human Research Ethics Committee at Peter MacCallum Cancer Centre (HREC/53147/PMCC-2019) and Deakin University (2019-320). All methods were performed in accordance with the Declaration of Helsinki and relevant ethical guidelines at Peter MacCallum Cancer Centre and Deakin University and written informed consent was obtained from all participants., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

It is estimated that more than one-tenth of adults aged ≥60 years are now classified as having sarcopenic obesity (SO), a clinical condition characterised by the concurrent presence of sarcopenia (low muscle mass and weakness) and obesity (excessive fat mass). Independently, sarcopenia and obesity are associated with a high risk of numerous adverse health outcomes including CVD and neurological conditions (e.g. dementia), but SO may confer a greater risk, exceeding either condition alone. This imposes a substantial burden on individuals, healthcare systems and society. In recent years, an increasing number of observational studies have explored the association between SO and the risk of CVD; however, results are mixed. Moreover, the pathophysiology of SO is governed by a complex interplay of multiple mechanisms including insulin resistance, inflammation, oxidative stress, hormonal shifts and alteration of energy balance, which may also play a role in the occurrence of various CVD. Yet, the exact mechanisms underlying the pathological connection between these two complex conditions remain largely unexplored. The aim of this review is to examine the association between SO and CVD. Specifically, we seek to: (1) discuss the definition, epidemiology and diagnosis of SO; (2) reconcile previously inconsistent findings by synthesising evidence from longitudinal studies on the epidemiological link between SO and CVD and (3) discuss critical mechanisms that may elucidate the complex and potentially bidirectional relationships between SO and CVD.

Background: This study aimed to investigate and propose novel approaches to calculate muscle quality index (MQI) using muscle mass derived from single-frequency bioelectrical impedance analysis (SF-BIA) and calf circumference in both unadjusted and body mass index (BMI)-adjusted forms. In addition, we examined their prognostic significance in patients with cancer., Methods: A secondary analysis was conducted on a prospective cohort study of patients with cancer. Handgrip strength was measured. SF-BIA was conducted to estimate appendicular lean soft tissue (ALST, in kilograms). MQI was calculated using three approaches: (1) the ratio of handgrip strength to ALST (MQI SF-BIA ), (2) the ratio of handgrip strength to calf circumference (MQI calf circumference ), and (3) the ratio of handgrip strength to BMI-adjusted calf circumference (MQI adj. calf circumference ). Maximally selected log-rank was calculated to estimate their cutoff values to predict survival., Results: Two hundred eighty-four patients were included (51.1% men; median age, 61 years). Solid tumors were the most frequent (89.8%). All approaches to MQI (MQI SF-BIA , MQI calf circumference , and MQI adj. calf circumference ) were independent predictors of 6-month mortality. The found cutoffs were (1) MQI SF-BIA (<1.52 for men, <0.63 for women), (2) MQI calf circumference (<0.74 for men, <0.24 for women), and (3) MQI adj. calf circumference (<0.75 for men, <0.25 for women)., Conclusion: This study introduces MQI SF-BIA, MQI calf circumference , and MQI adj. calf circumference as future potential surrogate methods for computing MQI in clinical practice when other robust procedures are unavailable, pending further validation., (© 2024 American Society for Parenteral and Enteral Nutrition.)

Individuals with Post COVID-19 condition (PCC), or long COVID, experience symptoms such as fatigue, muscle weakness, and psychological distress, including anxiety, depression, or sleep disorders that persist after recovery from COVID-19. These ongoing symptoms significantly compromise quality of life and diminish functional capacity and independence. Multimodal digital interventions targeting behavioural factors such as nutrition and mindfulness have shown promise in improving health outcomes of people with chronic health conditions and may be beneficial for those with PCC. The BLEND study (weB-based pLatform to improve nutrition, mindfulnEss, and physical function, in patients with loNg COVID) study is an 8-week pilot randomized controlled trial evaluating the feasibility of a digital wellness platform compared to usual care among individuals with PCC. The web-based wellness platform employed in this study, My Viva Plan (MVP)®, integrates a holistic, multicomponent approach to promote wellness. The intervention group receives access to the digital health platform for 8 weeks with encouragement for frequent interactions to improve dietary intake and mindfulness. The control group receives general content focusing on improvements in dietary intake and mindfulness. Assessments are conducted at baseline and week 8. The primary outcome is the feasibility of platform use. Secondary and exploratory outcomes include a between-group comparison of changes in body composition, nutritional status, quality of life, mindfulness, physical activity, and physical performance after 8 weeks. Findings of this study will inform the development of effective web-based wellness programs tailored for individuals with PCC to promote sustainable behavioural changes and improved health outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper other then funding disclosures listed above., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Competing Interests: CMP has previously received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, Nestlé Health Science, Pfizer, AMRA Medical, and Novo Nordisk; served as a steering committee member (from 2013 to 2015) and received research funding in 2013 from GTx, the developer of Enobosarm. SMP reports grants or research contracts from the US National Dairy Council, the Canadian Institutes for Health Research, Dairy Farmers of Canada, Roquette Freres, Ontario Centre of Innovation, Nestle Health Sciences, Myos, National Science and Engineering Research Council, and the US National Institutes of Health; reports personal fees from Nestle Health Sciences; reports non-financial support from Enhanced Recovery outside the submitted work; has patents licensed to Exerkine, but reports no financial gains. MCG has previously received honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, and Nestlé Health Science Brazil. SBH serves on the Medical Advisory Boards of Tanita Corporation, Novo Nordisk, Abbott, and Medifast.

Background: Energy requirement assessment is a cornerstone for nutrition practice. The extent to which total energy expenditure (TEE; indicator of energy requirements) has been measured in adults with chronic diseases has not been explored., Objectives: This systematic review aimed to characterize evidence on TEE among individuals with chronic diseases and describe TEE across chronic diseases and in comparison to controls without a chronic disease., Methods: A literature search using terms related to doubly labeled water and TEE was conducted in PubMed, MEDLINE, Web of Science, and Embase. Eligible articles included those that measured TEE using doubly labeled water in adults with a major chronic disease. Methodological quality was determined using the Academy of Nutrition and Dietetics quality criteria checklist. Sample size-weighted TEE was calculated in each chronic disease subgroup., Results: Fifty studies were included, of which 15 had a control group. Median sample size was 20 participants, and approximately half of studies were published over 10 y ago. Thirty-five (70%) studies reported resting energy expenditure, and approximately half (k = 26) reported physical activity level. Methodological quality was neutral (k = 25) or positive (k = 23) for most studies. TEE among individual studies ranged from 934 to 3274 kcal/d. Mean weighted TEE was lowest among gastrointestinal (1786 kcal/d) and neurologic (2104 kcal/d) subgroups and highest among cancer (2903 kcal/d), endocrine (2661 kcal/d), and autoimmune (2625 kcal/d) subgroups. Excluding 1 article in cancer survivors resulted in a low TEE in the cancer subgroup (2112 kcal/d). Most studies with a control group reported no differences in TEE between controls and patients; however, only 1 study was powered for between-group comparisons., Conclusions: Energy requirements vary across chronic diseases, although there is insufficient evidence to suggest that TEE in patients with chronic disease is different than that among controls. Further research is needed to inform energy requirement recommendations that consider chronic disease. This review was registered at PROSPERO as CRD42022336500 (https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=336500)., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Excess body weight, suboptimal diet, physical inactivity, alcohol consumption, sleep disruption, and elevated stress are modifiable risk factors associated with the development of chronic diseases. Digital behavioural interventions targeting these factors have shown promise in improving health and reducing chronic disease risk. The Digital Intervention for behaviouR changE and Chronic disease prevenTION (DIRECTION) study is a parallel group, two-arm, randomized controlled trial evaluating the effects of adding healthcare professional guidance and peer support via group-based sessions to a web-based wellness platform (experimental group, n = 90) compared to a self-guided use of the platform (active control group, n = 90) among individuals with a body mass index (BMI) of 30 to <35 kg/m 2 and aged 40-65 years. Obesity is defined by a high BMI. The web-based wellness platform employed in this study is My Viva Plan (MVP)®, which holistically integrates nutrition, physical activity, and mindfulness programs. Over 16 weeks, the experimental group uses the web-based wellness platform daily and engages in weekly online support group sessions. The active control group exclusively uses the web-based wellness platform daily. Assessments are conducted at baseline and weeks 8 and 16. The primary outcome is between-group difference in weight loss (kg) at week 16, and secondary outcomes are BMI, percent weight change, proportion of participants achieving 5% or more weight loss, dietary intake, physical activity, alcohol consumption, sleep, and stress across the study. A web-based wellness platform may be a scalable approach to promote behavioural changes that positively impact health. This study will inform the development and implementation of interventions using web-based wellness platforms and personalized digital interventions to improve health outcomes and reduce chronic disease risk among individuals with obesity., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: CMP has previously received honoraria and/or paid consultancy from Almased. NM has since become an employee of My Viva Plan. CEO, TG, SV, CFT, IMS, MFP, STJ, AAK, DK, NM, JFM, SENS, MQ, BOS – no conflicts of interest. See Funding section above for additional competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Individuals diagnosed with Chronic Obstructive Pulmonary Disease (COPD) are exposed to an increased risk of metabolic syndrome (MetS), which negatively affects their health outcomes and quality of life. Lifestyle interventions have shown promise in managing MetS. This study outlines the protocol for a web-based multimodal self-care program, Digital Metabolic Rehabilitation, for managing MetS in patients with COPD. The Digital Metabolic Rehabilitation is a single-arm pilot trial that integrates the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) Program and a web-based wellness platform. The web-based wellness platform employed in this study is My Viva Plan (MVP)®, which integrates a holistic, multicomponent approach to promote wellness. The intervention will primarily focus on lifestyle changes for patients with COPD. Over 6 months, participants will use the web-based wellness platform and engage in weekly online support group sessions. Fifty patients diagnosed with stage I-II COPD and MetS will participate. Blood tests, anthropometrics, body composition, physical function, muscle strength, physical activity, energy metabolism, quality of life and mental health will be assessed at baseline, 3, and 6 months. The Digital Metabolic Rehabilitation program aims to explore whether a multimodal integrative intervention delivered through a web-based wellness platform can be implemented by patients with COPD with MetS. By combining the expertise of the CHANGE Program with the digital delivery format, the intervention seeks to enhance self-monitoring and foster better self-management practices. The protocol outlines a novel and potentially impactful intervention for managing MetS in patients with COPD., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: CMP has previously received honoraria and/or paid consultancy from Almased. NM has since become an employee of My Viva Plan. BRS receives a Mitacs Accelerate program fellowship partially funded by My Viva Inc. AR, LC, MFP, DK – no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background & Aims: Breast cancer (BC) is frequently linked with obesity, metabolic syndrome, and sarcopenia. Therefore, measuring or accurately estimating resting energy expenditure (REE) is crucial for tailoring nutritional needs, managing weight and prevent under- or over-nutrition. We aimed to measure and compare REE between women with BC and a matched control group. Moreover, the prediction accuracy of selected formulas was evaluated., Methods: Women aged ≥18 years with newly diagnosis of BC (stage 0-III) and body mass index (BMI) ≤ 30 kg/m 2 were included in this cross-sectional analysis. Anthropometry, indirect calorimetry, and bioelectrical impedance analysis (BIA) were performed. Patients with BC data were compared to healthy women with similar age and BMI range. Measured REE (mREE) was compared against 15 predictive equations. Agreement between methods was evaluated using Bland-Altman analysis., Results: We included 106 women with BC (age 49.9 ± 11.1 years and BMI 24.5 ± 2.8 kg/m 2 ) and 75 women as control group. There were no differences in age, anthropometry, and BIA variables between groups, except for percentage fat mass. Measured REE values, alone and adjusted for fat-free mass (FFM) and age, were higher in patients with BC compared to controls (+4.3 % and +6.1 %, respectively). Regarding REE prediction, most of the selected equations underestimated mREE. Precision varied widely, with the two Marra equations showing the highest agreement (73 % and 74.5 %) along with the Müller equation (74 %), however, the wide limit of agreement range indicates substantial variability., Conclusions: Women with early-stage BC exhibited higher mREE compared to controls, albeit its clinical significance is unknown. None of the selected predictive equations provided accurate and precise REE estimates in this group. Although the Marra equation displayed the highest agreement, further studies are needed to evaluate REE variability and its prediction in women with BC., Competing Interests: Conflict of interest Authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: This narrative review summarizes the evidence for nutrition, exercise, and multimodal interventions to maintain weight and muscle mass and prevent malnutrition from meta-analysis, systematic reviews, and randomized controlled trials published within the last 5 years, and in comparison to future research priority areas identified by international guidelines., Recent Findings: Dietary counseling with oral nutrition support (ONS), escalated to enteral nutrition if weight loss continues, is the gold standard treatment approach to maintaining weight and preventing malnutrition. Recent ONS trials with dietary counseling show promising findings for weight maintenance, extending the literature to include studies in chemoradiotherapy, however, change in body composition is rarely evaluated. Emerging trials have evaluated the impact of isolated nutrients, amino acids, and their derivatives (ie, β-hydroxy β-methylbutyrate) on muscle mass albeit with mixed effects. There is insufficient evidence evaluating the effect of exercise interventions on unintentional weight loss, muscle mass, and malnutrition, however, our knowledge of the impact of multimodal nutrition and exercise interventions is advancing. Prehabilitation interventions may attenuate weight and muscle loss after surgery, particularly for patients having gastrointestinal and colorectal surgery. Multimodal trials that commence during treatment show mixed effects on weight and muscle mass when measured., Summary: This review highlights that the evidence for preventing unintentional weight loss and malnutrition from cancer treatment is strong within nutrition. Multimodal interventions are emerging as effective interventions to prevent unintentional weight loss. Promising interventions are demonstrating improvements in muscle mass, however further exploration through studies designed to determine the effect on muscle is required., (© The Author(s) 2024. Published by Oxford University Press.)