Today, type 2 diabetes mellitus (T2DM) and skeletal muscle atrophy (SMA) have become increasingly common occurrences. Whether the onset of T2DM increases the risk of SMA or vice versa has long been under investigation. Both conditions are associated with negative changes in skeletal muscle health, which can, in turn, lead to impaired physical function, a lowered quality of life, and an increased risk of mortality. Poor nutrition can exacerbate both T2DM and SMA. T2DM and SMA are linked by a vicious cycle of events that reinforce and worsen each other. Muscle insulin resistance appears to be the pathophysiological link between T2DM and SMA. To explore this association, our review (i) compiles evidence on the clinical association between T2DM and SMA, (ii) reviews mechanisms underlying biochemical changes in the muscles of people with or at risk of T2DM and SMA, and (iii) examines how nutritional therapy and increased physical activity as muscle-targeted treatments benefit this population. Based on the evidence, we conclude that effective treatment of patients with T2DM-SMA depends on the restoration and maintenance of muscle mass. We thus propose that regular intake of key functional nutrients, along with guidance for physical activity, can help maintain euglycemia and improve muscle status in all patients with T2DM and SMA.

Background: A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures. Methods: Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia. Results: A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm² and 3.66 cm² for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women. Conclusions: Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice.

Compliance in outpatients with gastrointestinal (GI) malabsorption is key in nutritional treatment. The objective of this study was to assess compliance in patients with GI impairment and malnutrition taking a high-calorie, high-protein, peptide-based oral nutritional supplement (ONS-PBD). A prospective, multicenter, observational study was conducted in 19 medical sites in Spain where ONS-PBD were prescribed as standard of care. Patients consumed ONS-PBD daily for 12 wk. Compliance was calculated as the percentage consumed of the prescribed amount of ONS per day. A total of 90 adult patients were included in the study, of whom 64 completed the 12-wk regimine. Mean compliance was 78.8% ± 24.5%. Risk of malnutrition decreased in 56.3% of patients at 12 wk, as measured with the malnutrition universal screening tool. A reduction in abdominal pain was observed and stool consistency improved, with a mean of 54.7% and 27.5%, respectively. Improvements in quality of life and a decrease in percentage of patients with severe functional impairment were observed. These data show that ONS-PBD compliance in malnourished patients with GI symptoms is high, reducing GI symptoms and improving patients' nutritional status.

Sarcopenia is a progressive muscle disease characterized by loss of skeletal muscle mass and strength, commonly associated with ageing and chronic diseases. Type 2 diabetes mellitus (T2DM) accelerates its development through insulin resistance, chronic inflammation, oxidative stress, and hyperglycaemia. Sarcopenia may worsen diabetes-related outcomes, including increased risk of falls, functional decline, reduced quality of life, and impaired metabolic control. Despite its clinical impact, sarcopenia remains underdiagnosed in people with diabetes, particularly in those with high body mass index and excess adiposity. This paper reviews appropriate and sensitive methodologies for screening and diagnosing sarcopenia in people with diabetes. A structured expert consensus was conducted in two phases, informed by a targeted PubMed literature review and discussions with an international multidisciplinary panel. The consensus informed the development of a clinically applicable algorithm. The proposed approach integrates screening, diagnosis, staging, and management of sarcopenia, including exercise and muscle-targeted nutritional interventions, to improve clinical care. Sarcopenia is an under-recognised complication of diabetes requiring systematic assessment. This consensus provides an integrated algorithm combining functional, nutritional, and metabolic evaluation to guide personalised management.

SUMMARY: Background: The application of nutritional ultrasound for the morphological and structural study of muscle mass is an emerging technique in clinical nutrition. Currently, all definitions of malnutrition include the measurement of muscle mass involvement, however, there is no single way to assess it. It is necessary to develop new techniques to identify muscle involvement in malnutrition that are valid, standardized, reliable, accurate and profitable. Objectives: The objective of this study is to value the new muscle ultrasound techniques aimed to measure muscle and functional status, to make a more accurate diagnosis and a better prediction of complications and morbidity and mortality in patients at nutritional risk. Primary outcome: to assess the feasibility of ultrasound or muscle ultrasound techniques in both nutritional diagnosis and follow-up, over 3 to 6 months, in a nutritional intervention program. Methods: DRECO (Disease-Related caloric-protein malnutrition EChOgraphy) is a prospective, multicenter, uncontrolled clinical study in standard clinical practice to value the usefulness of nutritional ultrasound (muscle ultrasound) in the nutritional diagnosis and follow-up of patients over a period of 3 to 6 consecutive months, after standard nutritional clinical practice intervention, and physical activity to control their disease-related malnutrition. Discussion: This study will standardize nutritional ultrasound measures. It will validate and define specific cut-off values for nutritional ultrasound and get its correlation with already well-known nutritional tools such as SGA (Subjective Global Assessment) or GLIM (Global Leadership Initiative on Malnutrition) criteria. Thus, muscle ultrasound will become not only a tool to assess the diagnosis of malnutrition, but it will be integrated in the routine clinical practices to evaluate nutritional interventions. Registration: This study is registered at clinicaltrials.gov ( NCT05433831 ), registered on June 27 ^th , 2022. https://clinicaltrials.gov/ct2/show/NCT05433831 .

Background: Malnutrition or its risk is common among patients with cancer (from 15% to 90%) and can negatively impact treatment outcomes and quality of life. Early detection and nutritional intervention are essential to improve clinical, health, and economic outcomes. This study evaluates the PRONTO (PROtocol for NuTritional risk in Oncology), a novel tool designed for the early identification of nutritional risk in patients with cancer. Objectives: To assess the feasibility of the PRONTO in detecting nutritional risk among newly diagnosed oncology patients. Methods: This cross-sectional, observational pilot study included 200 patients from two oncology centers in Madrid, Spain. The PRONTO was applied during the first oncology visit. Nutritional risk was assessed using PRONTO and nutritional status was evaluated with the Global Leadership Initiative on Malnutrition (GLIM) criteria. Tool acceptability was measured using the System Usability Scale (SUS) and Net Promoter Score (NPS) among participating oncologists. Results: The PRONTO identified 62.0% of patients at nutritional risk, while malnutrition was confirmed in 57.0% of patients using GLIM criteria. The PRONTO demonstrated high sensitivity (90.4%) and specificity (75.6%) compared to the GLIM. Oncologists rated the PRONTO highly, with a SUS score of 87.9 and an NPS of 9.1, indicating strong usability and recommendation potential. Conclusions: The PRONTO is a feasible and practical tool for early nutritional risk screening in oncology settings. Its simplicity and efficiency support its integration into routine clinical practice. The high prevalence of nutritional risk underscores the need for early screening to guide timely nutrition care. Further research with larger and diverse groups of patients and oncologists is needed to validate scalability and assess the impact of nutritional interventions on patient outcomes.