Bioelectrical impedance analysis-derived phase angle (PhA) has been gaining attention in the clinical evaluation of nutritional status because it is thought to be a proxy of water distribution and body cell mass; it is also associated to muscle strength and is an effective predictor of different clinical outcomes. Since an association may be expected between PhA and sarcopenia (defined by low skeletal muscle mass and impaired muscle function), the aim of this systematic review was to evaluate: a) changes in PhA due to sarcopenia; b) prevalence of sarcopenia according to PhA values; c) derivation of phase angle cut-offs for detecting sarcopenia; d) sarcopenia and PhA as predictors of clinical outcomes. A systematic research on electronic databases (PubMed, Embase, Scopus and Web of Science) from inception to January 31st, 2020 was performed according to PRISMA checklist. Using PICOS strategy, "P" corresponded to participants of any age, gender or ethnicity, "I" designated diagnosis of sarcopenia, "C" indicated subjects without sarcopenia, "O" corresponded to PhA, and "S" selected all study types. Methodological quality was assessed using the National Institute of Health (NIH) quality assessment tool. Through the initial literature search and after removing duplicates and excluding papers by screening titles and abstracts, 79 potentially relevant studies were examined. Thirteen studies (7668 subjects) met the inclusion criteria. The overall risk of bias was low. Sarcopenia was associated with a significant lower PhA in seven studies out of eight, while five studies out of six reported a high prevalence of sarcopenia was in patients with low PhA. Different cut-off point values from 4.05 to 5.05° have been derived for the identification of sarcopenia. PhA and sarcopenia were independent predictors of survival in cancer patients and geriatric hospitalized patients. Data from the selected papers demonstrate that PhA is decreased in sarcopenic subjects and the prevalence of sarcopenia is higher in subjects with low PhA. Further studies are needed to determine to what extent PhA may be valuable in detecting low muscle quality and/or identifying sarcopenia.

Malnutrition is common in stroke patients, as it is associated with neurological and cognitive impairment as well as clinical outcomes. Nutritional screening is a process with which to categorize the risk of malnutrition (i.e., nutritional risk) based on validated tools/procedures, which need to be rapid, simple, cost-effective, and reliable in the clinical setting. This review focuses on the tools/procedures used in stroke patients to assess nutritional risk, with a particular focus on their relationships with patients’ clinical characteristics and outcomes. Different screening tools/procedures have been used in stroke patients, which have shown varying prevalence in terms of nutritional risk (higher in rehabilitation units) and significant relationships with clinical outcomes in the short- and long term, such as infection, disability, and mortality. Indeed, there have been few attempts to compare the usefulness and reliability of the different tools/procedures. More evidence is needed to identify appropriate approaches to assessing nutritional risk among stroke patients in the acute and sub-acute phase of disease or during rehabilitation; to evaluate the impact of nutritional treatment on the risk of malnutrition during hospital stay or rehabilitation unit; and to include nutritional screening in well-defined nutritional care protocols.

In idiopathic pulmonary fibrosis (IPF), several factors may have a negative impact on the nutritional status, including an increased respiratory muscles load, release of inflammation mediators, the coexistence of hypoxemia, and physical inactivity. Nutritional abnormalities also have an impact on IPF clinical outcomes. Given the relevance of nutritional status in IPF patients, we sought to focus on some critical issues, highlighting what is known and what should be further learned about these issues. We revised scientific literature published between 1995 and August 2019 by searching on Medline/PubMed and EMBASE databases including observational and interventional studies. We conducted a narrative review on nutritional assessment in IPF, underlining the importance of nutritional evaluation not only in the diagnostic process, but also during follow-up. We also highlighted the need to keep a high level of attention on cardiovascular comorbidities. We also focused on current clinical treatment in IPF with Nintedanib and Pirfenidone and management of gastrointestinal adverse events, such as diarrhea, induced by these antifibrotic drugs. Finally, we concentrated on the importance of pulmonary rehabilitation program, including nutritional assessment, education and behavioral change, and psychological support among its essential components. More attention should be devoted to the assessment of the undernutrition and overnutrition, as well as of muscle strength and physical performance in IPF patients, taking also into account that an adequate clinical management of gastrointestinal complications makes IPF drug treatments more feasible.

Background and aim: Excess sodium intake is a recognised causal factor of hypertension and its cardiovascular complications; there is however a lack of practical instruments to assess and monitor the level of knowledge and behaviour about dietary salt intake and to relate these factors to the population general dietary habits. Methods and Results: A self-administered questionnaire was developed to assess the salt and health related knowledge and behaviour of the Italian population through an online survey. A sample of 11,618 Italian participants completed the questionnaire. The degree of knowledge and the reported behaviour about salt intake were both found to be related to age, gender, home region, level of education and occupation. There was a significant interrelation between salt knowledge and behaviour and both were significantly and directly related to the degree of adherence to a Mediterranean-like dietary pattern. A hierarchical evaluation was also made of the relevance of any single question to the overall assessment of knowledge and behaviour about salt intake. Conclusions: The study population overall appeared to have a decent level of knowledge about salt, but a less satisfactory behaviour. Our findings point to social inequalities and young age as the main factors having a negative impact on knowledge and behaviour about salt intake as part of generally inadequate dietary habits. The degrees of knowledge and behaviour were significantly and directly interrelated, confirming that improving knowledge is a key step for behavioural changes, and suggesting that educational campaigns are crucial for the implementation of good practices in nutrition.