Introduction: The evidence on the efficacy of nutrition therapy to prevent complications of dysphagia is based on observational studies that used different tools for nutritional and dysphagia assessment, and different scales for the definition of diet textures, rendering their results incomparable and the knowledge on dysphagia management inconclusive. Methods: This retrospective observational study was performed in 267 older outpatients who were assessed for dysphagia and nutritional status by a multidisciplinary team at the Clinical Nutrition Unit of IRCCS INRCA geriatric research hospital (Ancona, Italy) from 2018 to 2021. GUSS test and ASHA-NOMS measurement systems were used for dysphagia assessment, GLIM criteria for the assessment of nutritional status, and the IDDSI framework to describe the texture-modified diets. Descriptive statistics were used to summarize the characteristics of the subjects evaluated. Sociodemographic, functional and clinical parameters were compared between patients with and without BMI improvement overtime by an unpaired Student’s t test, Mann–Whitney U test or Chi square test, as appropriate. Results: Dysphagia was diagnosed in more than 96.0% of subjects; 22.1% (n = 59) of dysphagic subjects were also malnourished. Dysphagia was treated exclusively by nutrition therapy, prevalently by individualized texture-modified diets (77.4%). For the classification of diet texture, the IDDSI framework was used. The follow-up visit was attended by 63.7% (n = 102) of subjects. Aspiration pneumonia was registered only in one patient (less than 1%), and BMI improved in 13 of 19 malnourished subjects (68.4%). The improvement of nutritional status was primarily reached in subjects whose energy intake was increased and texture of solids modified, in younger subjects, and in those taking less drugs and not reporting any weight loss before the first assessment. Conclusions: The nutritional management of dysphagia must guarantee both an adequate consistency and energy–protein intake. Evaluations and outcomes should be described with universal scales, in order to allow for comparison between studies and contribute to the collection of a critical mass of evidence on the efficacy of texture-modified diets in the management of dysphagia and its complications.

Cardiovascular diseases (CVDs) persist as the primary cause of death worldwide, accounting for roughly 17.9 million fatalities each year. The prevalence of obesity, metabolic syndrome, and type 2 diabetes (key risk factors for CVD) continues to escalate at an alarming rate, necessitating novel therapeutic strategies to address this global health crisis. Nutritional ketosis, induced through ketogenic diets, modified fasting, intermittent fasting, and medium-chain triglyceride (MCT) oil consumption, has garnered attention for its potential cardioprotective effects. Ketosis is a metabolic state in which the body, due to a significantly reduced intake of carbohydrates, shifts its primary energy source from glucose to ketone bodies, i.e., beta-hydroxybutyrate (BHB), acetoacetate, and acetone, which are produced in the liver from fatty acids. This review examines the mechanisms by which ketone bodies, particularly BHB, mitigate cardiovascular risk. We focus mainly on the anti-inflammatory and antioxidative properties of BHB and summarize recent evidence to highlight the clinical relevance of ketosis in cardiometabolic health.

Background: Malnutrition is highly prevalent in hospitalized older adults and is associated with adverse clinical outcomes. However, the extent to which nutritional care is systematically implemented and its relationship with outcomes remains unclear. Methods: We conducted a retrospective analysis of 4963 patients aged ≥65 years who were admitted to the National Institute for Health and Scientific Research for the Elderly (IRCCS INRCA, Ancona, Italy) between 2012 and 2020 and received at least one nutritional consultation. We examined associations between timing and type of nutritional interventions, the Geriatric Nutritional Risk Index (GNRI), and clinical outcomes, including in-hospital mortality and length of hospital stay (LOS). We also analyzed the prevalence of different complications during Medical Nutritional Therapy (MNT). Results: Only 11% of hospitalized patients received a nutritional consultation. Among them, in-hospital mortality was 35.8%. The Geriatric Nutritional Risk Index was a significant predictor of mortality (HR 1.89; 95% CI: 1.55–2.31; p < 0.001) and inversely associated with LOS, reflecting a frail subset of patients with complex clinical conditions. The timing of nutritional consultation showed no significant association with mortality or LOS, possibly due to relatively prompt intervention (median 4 days). Enteral (EN) and parenteral nutrition (PN) were more frequently prescribed to non-survivors. Medical nutrition therapy-related complications were also more common in non-survivors (22.3% vs. 14%, p < 0.001). Artificial nutrition (AN) was not associated with increased mortality, but it was associated with prolonged hospital stays both in survivors and in non-survivors. Conclusions: Our findings highlight the limited use of nutritional consultations in hospitalized elderly patients despite the high prevalence of malnutrition and its prognostic relevance. The GNRI is a valuable tool for early risk stratification and clinical decision-making. Systematic screening and timely nutritional intervention, integrated with broader therapeutic goals, may improve care and optimize outcomes even in this vulnerable population.

Sarcopenia, characterized by the progressive loss of skeletal muscle mass, strength, and function, represents a growing public health challenge in aging populations. Emerging mechanistic evidence suggests that ketogenic diets (KDs) and elevated circulating β-hydroxybutyrate (βOHB) levels may offer selective and context-dependent nutritional strategies to support muscle health during aging. This review summarizes current evidence on the effects of ketogenic diets and ketone body metabolism on muscle mass and function, with a focus on underlying molecular mechanisms and clinical relevance in older adults. βOHB acts not only as an alternative energy substrate but also as a signaling molecule, notably through histone deacetylase inhibition and modulation of inflammatory pathways. Nutritional ketosis in humans typically results in circulating βOHB concentrations of approximately 0.5–3.0 mM, which may be sufficient to engage some of these signaling pathways, although the extent of these effects in human tissues remains incompletely defined. Preclinical studies indicate that long-term ketogenic diets preserve muscle mass, strength, and mitochondrial function in aging models. Limited clinical evidence, largely derived from populations with sarcopenic obesity or metabolic comorbidities, suggests that protein-adequate ketogenic diets, when implemented as an adjunct to physical exercise, may help preserve fat-free mass and improve functional outcomes, while exogenous ketones show potential to augment post-exercise anabolic signaling. Overall, the integration of mechanistic and preliminary clinical data provides a supplementary and exploratory framework suggesting that ketogenic diets may represent a promising adjunctive strategy for sarcopenia prevention, although well-designed long-term randomized controlled trials are required to define their efficacy, safety, and optimal clinical application.