Recent definitions of malnutrition include low muscle mass within its diagnostic criteria. In fact, malnutrition is one of the main risk factors of skeletal muscle loss contributing to the onset of sarcopenia. However, differences in the screening and diagnosis of skeletal muscle loss, especially as a result of malnutrition in clinical and community settings, still occur mainly as techniques and thresholds used vary in clinical practice. The objectives of this position paper are firstly to emphasize the link between skeletal muscle loss and malnutrition-related conditions and secondly to raise awareness for the timely identification of loss of skeletal muscle mass and function in high risk populations. Thirdly to recognize the need to implement appropriate nutritional strategies for prevention and treatment of skeletal muscle loss and malnutrition across the healthcare continuum. Malnutrition needs to be addressed clinically as a muscle-related disorder and clinicians should integrate nutritional assessment with muscle mass measurements for optimal evaluation of these two interrelated entities to tailor interventions appropriately. The design of monitoring/evaluation and discharge plans need to include multimodal interventions with nutrition and physical exercise that are key to preserve patient's muscle mass and function in clinical and community settings.

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.

This is a retrospective study of data from clinical practice to observe the effect of a high-calorie, high-protein oral nutritional supplement (ONS) with β-hydroxy-β-methylbutyrate (HMB) on nutritional status, body weight, and muscle-related parameters in 283 adult patients with or at risk of malnutrition under standard of care, 63% being cancer patients. They were recommended to increase physical activity and energy and protein intake from regular diet plus two servings per day of a specialized ONS enriched with HMB or standard ONS for up to 6 months. Dietary records, adherence and tolerance to ONS, nutritional status, body composition, handgrip strength, and blood analysis at the beginning and the end of the intervention were recorded. This program improved nutritional status from 100% malnourished or at risk of malnutrition at baseline to 80% well-nourished at final visit. It also increased body weight by 3.6–3.8 kg, fat-free mass by 0.9 to 1.3 kg, and handgrip strength by 4.7 to 6.2 kg. In a subgroup of patients (n = 43), phase angle (PhA), and body cell mass (BCM) increased only in the patients receiving the ONS enriched with HMB (0.95 (0.13) vs. −0.36 (0.4), and 2.98 (0.5) vs. −0.6 (1.5) kg, mean difference (SE) from baseline for PhA and BCM, respectively), suggesting the potential efficacy of this supplement on muscle health.

Background: Hip fractures are prevalent among older people, often leading to reduced mobility, muscle loss, and bone density decline. Malnutrition exacerbates the prognosis post surgery. This study aimed to evaluate the impact of a 12-week regimen of a high-calorie, high-protein oral supplement with β-hydroxy-β-methylbutyrate (HC-HP-HMB-ONS) on nutritional status, daily activities, and compliance in malnourished or at-risk older patients with hip fractures receiving standard care. Subjects and Methods: A total of 270 subjects ≥75 years of age, residing at home or in nursing homes, malnourished or at risk of malnutrition, and post hip fracture surgery, received HC-HP-HMB-ONS for 12 weeks. Various scales and questionnaires assessed outcomes. Results: During the 12 weeks of follow-up, 82.8% consumed ≥75% of HC-HP-HMB-ONS. By week 12, 62.4% gained or maintained weight (+0.3 kg), 29.2% achieved normal nutritional status (mean MNA score +2.8), and 46.8% improved nutritional status. Biochemical parameters improved significantly. Subjects reported good tolerability (mean score 8.5/10), with 87.1% of healthcare providers concurring. Conclusions: The administration of HC-HP-HMB-ONS markedly enhanced nutritional status and biochemical parameters in older hip-fracture patients, with high compliance and tolerability. Both patients and healthcare professionals expressed satisfaction with HC-HP-HMB-ONS.

Background/Objective: We compared healthcare utilization and cost outcomes for patients before and after they underwent a nutrition care intervention that included daily consumption of specialized or standard oral nutritional supplements (ONS) as part of a multimodal program. We sought to determine whether this nutritional intervention was associated with reduced use of healthcare resources and lowered costs. Methods: This retrospective analysis included adult patients who were referred to the medical nutrition office with malnutrition or its risk. We followed outcomes for patients who had received nutritional interventions (3–6 months) that included diet and exercise recommendations as well as a specialized ONS enriched with β-hydroxy-β-methylbutyrate (HMB-ONS) or a standard ONS (S-ONS). We reviewed hospital records for resource utilization data—hospital (re)admissions, number of days in the hospital, patient visits to the emergency department (ED), and visits to general practitioners (GP) and specialty physician clinics. We compared healthcare utilization for intervals up to 12 months before and after the initiation of the nutrition care intervention. We also examined healthcare utilization and costs as well as changes in oncology treatment following initiations of the nutrition care intervention for a subgroup of cancer patients. Results: Over a 12-month period following the start of nutritional intervention with ONS, the patients had lower healthcare resource use and costs. With daily use of S-ONS or HMB-ONS for up to 6 months, the patients’ healthcare utilization was significantly reduced at 3-, 6-, and 12-month time points for hospital admissions, ED visits, GP visits, and specialty visits (all p < 0.001). Overall, ONS use was associated with reduced patient healthcare costs by half (EUR 27,024.80 to EUR 13,349.60, p < 0.001). Significant clinical predictors of higher use of healthcare resources and costs were older age, having positive indications of malnutrition, exhibiting a greater Charlson Comorbidity Index (CCI), and having been hospitalized for oncology surgery. Regression analysis revealed that ONS intervention was associated with lower total healthcare costs (β_Post-ONS = −0.504), and that patients receiving HMB-ONS (β_ONS-HMB = −0.583) had a greater reduction in costs than did patients receiving S-ONS in the 12 months after nutritional intervention. Patients with cancer who received HMB-ONS were less likely than those receiving S-ONS to need suspension or dose reduction in oncology drug treatment due to failure or intolerance of the treatment drug. Conclusions: multimodal programs including ONS improve health economic outcomes for patients with poor nutritional status due to disease. Health economic outcome improvements included lower healthcare resource use, lower healthcare costs, and, for patients being treated for cancer, a reduced likelihood of treatment failure. The use of ONS enriched with HMB provided advantages over standard ONS, both in health outcomes and cost-of-care reductions.

At the end of October 2024, ILSI Europe brought together industry and academic experts from different fields to identify research gaps and challenges in nutritional interventions supporting healthy ageing. The objectives of the Healthy Ageing Working Group workshop were to address the urgent need to define ageing outcomes and associated biomarkers, determine the trajectory of functional ageing across the lifespan, and leverage technology to tailor nutritional and lifestyle interventions for healthy ageing. This brief report presents the key points highlighted during this workshop.