The link between metabolic syndrome (MetS) and sarcopenia has not been extensively studied, but it is evident that they share several common features. Crucial mechanisms involved in sarcopenia-nonalcoholic fatty liver disease (NAFLD) interplay are based on effects of insulin resistance, chronic inflammation, oxidative stress, and crosstalk between organs by secretion of cytokines (hepatokines, adipokines, and myokines). Currently, published studies confirm the association of sarcopenia with the degree of NAFLD defined by liver histology. However, prospective studies that will give us information regarding the causal effect of NAFLD and sarcopenia are still needed. Furthermore, there is a need for a patient-friendly, noninvasive, low-cost method for detection of loss of skeletal muscle mass, strength, and physical performance in the context of NAFLD. Moreover, potential treatment strategies such as physical exercise and nutritional supplementation, that are usually a part of management of sarcopenia, should also be investigated in NAFLD patients, especially given the fact that for now, we do not have a good treatment option for NAFLD. Therefore, future investigations should combine studies on NAFLD and sarcopenia in terms of physical activity and nutritional interventions such as vitamin D supplementation. This review aims to report recent evidence concerning the links between sarcopenia and NAFLD and methods to assess sarcopenia.

Background: The growing challenges of population aging create a pressing need for specialized geriatric medicine services to effectively address the complex health needs of older adults and influence supportive healthcare policies. Older patients may present clinical complexity with multimorbidity, disability, and/or frailty, necessitating a shift from the traditional organ-oriented clinical approach to a holistic, patient-centered care model. Rationale of the action: Despite recommendations from the World Health Organization and scientific and professional societies, geriatric medicine is not universally recognized as a distinct specialty in Europe, and education in this field remains heterogeneous. A notable discrepancy in the availability of geriatric services and education in this field across European countries can be found. Many healthcare professionals lack basic training in geriatric medicine, contributing to fragmented care and poorer health outcomes. To address these challenges, it is essential to integrate geriatric medicine into undergraduate and postgraduate curricula for all healthcare professionals. Expected outcomes: The COST Action 21,122 PROGRAMMING (PROmoting GeRiAtric Medicine in countries where it is still eMergING) initiative aims to promote geriatric medicine by developing targeted educational goals and programs and fostering interdisciplinary collaboration. This initiative aims to assess the current state of geriatric medicine education and identify both global and local educational needs for developing clinical skills among healthcare professionals. In addition, it seeks to establish consensus on core curricula tailored to local contexts and disseminate findings and recommendations to stakeholders, policymakers, and the public. By uniting diverse stakeholders, PROGRAMMING aspires to create sustainable changes in geriatric care across Europe. Graphical

Background: The European Cooperation in Science and Technology (COST) Action 21122, PROmoting GeRiAtric Medicine in countries where it is still eMergING (PROGRAMMING) developed an online open survey to assess the educational interests and needs of health care professionals and final-year medical students across participating countries. This survey aims to establish a current baseline for developing educational content on geriatric medicine for nongeriatricians and a framework for its delivery. Objective: This paper describes the aim, development, structure, content, and dissemination of this survey. Methods: The mixed methods electronic survey, initially developed in English through a cocreation process with key stakeholders, was subsequently translated into 24 languages. It received ethics approval from multiple participating countries. Within- and cross-country analyses of the survey data will be conducted using descriptive and inferential statistics for quantitative data and content analyses for qualitative data. National and international teams will conduct analyses in parallel exploring responses within a specific country or region, professional category (or among medical students), or setting of work. Basic descriptive statistics and chi-square tests will evaluate differences in knowledge, relevance, and interest in geriatric topics across countries, professions, and settings of work. The effectiveness of formal education in geriatric medicine and clinical rotations in geriatric settings versus the lack thereof in promoting higher self-perceived knowledge on geriatric medicine topics will be explored using binary logistic regression. We will provide basic descriptive statistics (frequencies) of reported barriers to receiving further training in geriatric medicine and the effectiveness of various teaching methods as rated by the respondents and explore differences across countries, professions, and settings using chi-square tests. We will conduct qualitative content analyses of free-text responses to the questions exploring professionals’ and medical students’ thoughts on caring for older people and medical students’ thoughts on becoming geriatricians. Results: The survey included the following sections: Informed Consent, Demographics, Topics and Skills, Medical Students vs. Professionals, Current Profession (for professionals), Previous Education in Geriatric Medicine (for professionals), Education in Geriatric Medicine (for medical students), Interest in Care of Older People or Geriatric Medicine, Suggestions for Courses in Care for Older People or Geriatric Medicine, and Closure. The survey was disseminated between October 9, 2023, and June 5, 2024, and received 6099 responses; after cleaning, there were 5922 (97.1%) responses (n=5474, 92.43% from professionals and n=448, 7.57% from medical students). Conclusions: This survey’s findings will inform educational projects across the PROGRAMMING countries. We will share these findings with national and international stakeholders, including professional societies, medical schools, and other relevant organizations. We will advocate for professional educational curricula to include geriatric topics rated as relevant by the survey respondents and promote clinical rotations in geriatric settings and teaching methods rated as effective by the survey respondents. International Registered Report Identifier (IRRID): DERR1-10.2196/64985

Background/Aims: Malnutrition of hospitalized patients is often undetected and untreated due to poor awareness and insufficient knowledge of the attending hospital staff. Nutritional screening has not been part of the daily routine in Croatian hospitals. Our aim was to implement nutritional screening as part of the routine medical examination and to assess the nutritional risk at admission for all hospitalized patients. Methods: All patients hospitalized in departments of internal medicine in tertiary hospitals in Croatia were screened at entry using the Nutrition Risk Screening 2002 (NRS 2002). Results: Between October and December 2010, 1,696 patients were screened and analyzed (948 males and 748 females). 329 (19.4%) had an NRS 2002 score ≥3 and were considered to be at nutritional risk. An NRS 2002 score ≥3 was identified as a significant predictor of the length of hospital stay (beta coefficient = 0.06, p = 0.027) and fatal outcome (OR = 6.18, p < 0.001). Only 32.8% of malnourished patients received some nutritional support. Conclusions: Every fifth patient hospitalized in a general medical department in Croatia is at nutritional risk and the majority of them does not receive nutritional support. More effort is needed to implement nutritional standards in daily clinical practice.