World Nutrition Journal

Nutrition assessment in surgical patients: The strategic way to improve outcomes

Kaweesak Chittawatanarat — Sat, 28 Feb 2026 00:00:00 +0000

Malnutrition remains a significant but often under-recognized challenge in the management of surgical patients worldwide. It is estimated that a substantial proportion of patients undergoing major surgery, particularly those with gastrointestinal or oncologic diseases, suffer from some degree of malnutrition^1,2. The physiological stress induced by surgery, characterized by a hypermetabolic state and systemic inflammatory response, exacerbates existing nutritional deficits³. This synergistic effect leads to impaired immune function, delayed wound healing, increased muscle wasting, and a higher predisposition to postoperative complications such as sepsis and anastomotic leakage^1,4. Consequently, malnutrition is directly linked to prolonged hospital stays, increased healthcare costs, and higher mortality rates [2, 5]. Therefore, early and systematic nutrition assessment is no longer optional but a fundamental pillar of perioperative care⁴.

Prognostic performance of GNRI versus PNI for predicting mortality in elderly critically ill patients

Donna Pratiwi, Agustinus I Wayan Harimawan — Fri, 27 Feb 2026 09:21:39 +0000

Background: Malnutrition significantly impacts outcomes in elderly critically ill patients. The Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) are two established tools to assess nutritional status and predict mortality. However, their comparative prognostic performance in this population remains unclear.

Objective: This study aimed to compare the predictive ability of GNRI and PNI for mortality among elderly ICU patients.

Methods: We conducted a systematic search in PubMed, Scopus, and Web of Science for studies assessing GNRI and/or PNI in relation to mortality in ICU patients aged ≥60 years. We extracted mean and standard deviation values for survivors and non-survivors. Meta-analyses were conducted to calculate pooled mean differences (MD) with 95% confidence intervals (CI), and heterogeneity was evaluated using the I² statistic.

Results: Eight studies involving 6,217 ICU patients were included. Both GNRI and PNI scores were significantly lower in non-survivors. The pooled MD for GNRI was −8.99 [95% CI −9.71 to −8.27] (I² = 86%), and for PNI was −4.45 [95% CI −4.94 to −3.96] (I² = 47%). GNRI showed a larger effect size but greater heterogeneity, while PNI results were more consistent. Most studies had low to moderate risk of bias based on the ROBINS-E tool.

Conclusion: GNRI and PNI are valid prognostic tools for predicting mortality in elderly ICU patients. GNRI may provide stronger predictive value, whereas PNI offers more consistent prognostic performance.

The preoperative prognostic nutritional index in patients undergoing major gynecologic oncology surgery and its association with postoperative outcomes

Helena Fabiani, Wiji Lestari, Gatot Purwoto — Sat, 28 Feb 2026 00:00:00 +0000

Background: Patients undergoing major surgery for gynecologic cancer often experience postoperative complications. Postoperative complications are influenced by various factors, one of which is nutritional status. The preoperative prognostic nutritional index (PNI), calculated from serum albumin levels and lymphocyte count, is used as a preoperative nutritional parameter and has been associated with postoperative outcomes.

Objective: To investigate the association between preoperative PNI and postoperative outcomes in patients undergoing major gynecologic oncology surgery.

Methods: This prospective observational study was conducted at Dr. Cipto Mangunkusumo National General Hospital in August-December 2024. Subjects were gynecologic cancer patients aged 18-65 years who underwent major surgery. PNI was calculated based on preoperative serum albumin levels and lymphocyte count. Postoperative complications were assessed within 30 days following surgery using the Clavien-Dindo classification. Statistical analysis was performed using Chi-square or Fisher’s exact test, followed by multivariable logistic regression.

Results: A total of 56 subjects were included, with a mean age of 47.8 ± 12.3 years and a median PNI of 50.2 (28.9-61.3). Postoperative complications occurred in 35.7% of subjects, with surgical site infections being the most common. The median PNI was lower in the complication group, although the difference was not statistically significant. In multivariable analysis, advanced tumor stage was the only independent predictor of postoperative complications (odd ratio [OR] 4.74, 95% CI 1.26–17.83, p = 0.021). Low PNI showed a nonsignificant trend toward higher odds of complications (OR 1.71, 95% CI 0.47–6.28, p=0.420).

Conclusion: PNI was not statistically significant but showed a trend toward association with postoperative complications, suggesting its potential importance of preoperative nutritional status. Advanced tumor stage was an independent predictor of complications. Further multicenter studies are needed to confirm the prognostic role of PNI in gynecologic oncology surgery.

Changes in postprandial plasma malondialdehyde levels between consumption of brown rice compared to white rice in sedentary workers

Wulandari Taradita, Novi Silvia Hardiany, Wahyu Ika Wardhani — Sat, 28 Feb 2026 00:00:00 +0000

Background: Office workers are prone to sedentary behavior and low physical activity, which can increased oxidative stress. The effect of dietary carbohydrates on oxidative stress can be assessed through changes in Malondialdehyde (MDA) levels, typically observed 2-4 hours of postprandially. In Indonesia, white rice remains the dominant carbohydrate source, whereas brown rice is known to contain antioxidants and dietary fiber that help counteract free radicals.

Objective: The study aimed to compare the effect of brown rice and white rice consumption on postprandial plasma MDA levels.

Methods: A total 28 sedentary workers subjects from FKUI Salemba participated in this open label, randomized, parallel clinical trial using consecutive sampling. Subjects were allocated to consume either 150 g of white rice (IR-64/Setra Ramos variety) or 150 g of brown rice (Aek Sibundong variety). Each meal was given once accompanied by 60 g of omelette, 70 g of tofu stew, and 220 ml of water. The participants were aged 23-48 years, with 80% being female, and all had normal BMI.

Results and Conclusion: Significant differences in energy intake (p=0.026) and protein intake (p=0,014) were observed between the groups. Postprandial plasma MDA levels in the brown rice group tended to decrease, though not -significantly. (p=0.0649), whereas the white rice group showed a significant increase (p=0.01). No significant difference was found between the two groups (p=0.065). Nevertheless, brown rice can still be considered a better alternative staple food than white rice, as its antioxidants and higher fiber content can protect the body's cells from diet-induced oxidative stress.

Dissecting pathways of cancer-associated cachexia and its evidence-based relation to vitamin D

Sat, 28 Feb 2026 00:00:00 +0000

Introduction: Cancer-associated cachexia (CAC) is a complex metabolic syndrome. It affects 0,5-1% of the general population and 60-83% of cancer patients. Vitamin D has a potential immunological role in cancer cachexia. However, the mechanism remains unclear.

Method: This review outlines the complex mechanisms of CAC, a metabolic syndrome marked by muscle loss affecting 80% of cancer patients and the potential action of vitamin D. We highlight the limited studies exploring vitamin D’s impact on CAC, based on cachexia parameters.

Result: The Warburg effects in CAC are understood to involve elevated energy use, driven by the tumor microenvironment (TME) and pro-inflammatory cytokines. This present review explores the mechanism of cachexia on skeletal, adipose tissue, liver and tumor microenvironment. At the same time vitamin D deficiency in cancer correlates with poor prognosis due to its critical role in immune modulation. Notably, various clinical trials showed the beneficial roles of vitamin D in reducing inflammation, pain and increasing weight.

Conclusion: Few studies had explored the beneficial effects of vitamin D in cancer; However, limited evidence exists on immunomodulatory effects of vitamin D. This critical gaps stressing the need for further clinical research across various cancer types.

The role of maltodextrin in iron nanoparticle formulations for food fortification and pharmaceutical applications

Rizki Ananda, Dono Indarto, Yuliana Heri Suselo — Sat, 28 Feb 2026 00:00:00 +0000

Background: Iron nanoparticle formulation is an innovative approach to enhance the stability and bioavailability of iron, which is crucial in addressing global iron deficiency. However, conventional iron supplementation strategies, like oral ferrous sulfate, face limitations in absorption and bioavailability. Specifically, dietary inhibitors and gastrointestinal conditions can impede iron uptake. Moreover, oral iron supplements often cause side effects such as nausea, constipation, and abdominal discomfort, affecting patient compliance. These challenges highlight the need for innovative approaches to enhance iron delivery. In this context, nanotechnology offers a promising solution to conventional iron supplementation limitations. Iron nanoparticles provide improved solubility, targeted delivery, and controlled release, thereby enhancing therapeutic effectiveness. Both in vitro and in vivo bioavailability studies have demonstrated that nanoparticle-based formulations improve iron absorption and reduce side effects. By improving iron absorption and reducing side effects, nanoparticle-based formulations represent a significant advancement in IDA management. Maltodextrin, a water-soluble and neutral starch-derived polysaccharide, serves as an effective encapsulating agent in nanoparticle formulation, enhancing stability, solubility, and controlled release, thereby overcoming limitations of traditional iron supplementation. Both in vitro and in vivo studies have demonstrated the potential of maltodextrin-based iron nanoparticles to improve bioavailability and therapeutic outcomes.

Objective: This scoping review aims to explore the role of maltodextrin in iron nanoparticle formulations based on the latest scientific evidence.

Methods : A systematic literature search was conducted across four databases: PubMed, ScienceDirect, Scopus, and SpringerLink, using structured keywords. Inclusion criteria consisted of original English language articles published between 2019 and 2024 that discussed the use of maltodextrin in iron nanoparticle systems. Exclusion criteria The selection and data synthesis process followed PRISMA-ScR guidelines.

Results : Out of 8620 articles identified, three met the inclusion criteria: Arazo-Rusindo et al. (2023), Kumari et al. (2023), and Baldelli et al. (2023). These studies demonstrated that maltodextrin acts as a carrier, stabilizer, and bioavailability enhancer, while also improving encapsulation efficiency and nanoparticle stability.

Conclusions : These findings highlight the potential of maltodextrin in developing functional food products and pharmaceutical formulations based on iron nanoparticles; however, further research is needed to optimize formulations and evaluate long-term safety.

Nutrition strategies for obesity management

Diyah Eka Andayani, Vitia ajeng Nur Linda, Fadilah, Diana Sunardi — Sat, 28 Feb 2026 00:00:00 +0000

ABSTRACT

Background

Obesity is a chronic disease that necessitates nutritional strategy for effective weight management. Behavioural modification relating to nutrients intake, food selection and dietary patterns are essential for sustaining long-term outcomes. Many diets intervention have been developed to facilitate weight loss among obesity patients.

Objective

This literature review aims to provide an in-depth exploration of nutrition-based strategies that can effectively address the obesity epidemic and their applicability in the Indonesian context.

Methods

This literature review was conducted in Google Scholar, Pubmed, and Sciencedirect between 1987-2024. The research term are “Obesity” “Diet” “Strategies” “Weight loss”.

Results

Several diet approaches are utilized in weight-control programs, including traditional calorie restriction, intermittent fasting, low-carbohydrate and low-fat diets, plant-based diets, the Mediterranean diet, and personalized/mindful eating. These diets differ in the quantity and type of food consumed, timing of food intake, and other influencing factors.

Conclusions

The optimal dietary approach for weight loss depends on individual preferences, metabolic factors, and health considerations. Given the potential alignment between the Mediterranean diet and traditional Indonesian foods, it may serve suitable and sustainable long-term option in the Indonesian context.

The relationship between diet patterns and physical activity with the incidence of overweight in adolescents at SMAN 8 Maros

Firdhawati, St Masithah, Siti Uswatun Hasanah, Andi Rahmaniar MB — Sat, 28 Feb 2026 00:00:00 +0000

Background: Adolescents are a vulnerable age group prone to nutritional problems, particularly overweight and obesity, which often result from an imbalance between energy intake and energy expenditure. Dietary patterns high in energy and fat but low in fiber, combined with insufficient physical activity, contribute to the rising prevalence of overweight and obesity. Preliminary data at SMAN 8 Maros showed that 10.13% of students were overweight and 9.03% were obese.

Objective: This study aimed to examine the relationship between dietary patterns and physical activity with the incidence of overweight among adolescents at SMAN 8 Maros.

Methods: This research employed a quantitative design with a case-control approach. A total of 82 students from grades X and XI were selected using simple random sampling, with a 1:1 ratio between the case group (41 students with overweight/obesity) and the control group (41 students with normal nutritional status). Dietary data were collected using 2x24-hour food recall and Food Frequency Questionnaire (FFQ), while physical activity was measured using the Global Physical Activity Questionnaire (GPAQ). Data were analyzed using the Spearman rank correlation test.

Results: Statistical analysis revealed a significant relationship between dietary intake including energy (p=0.000), protein (p=0.006), fat (p=0.008), and carbohydrate (p=0.002)—and the incidence of being overweight. In contrast, no significant association was found between the frequency of main meal and processed food consumption (p=0.828 & p=0.824) and overweight incidence. Physical activity demonstrated a significant correlation (p=0.002) with being overweight.

Conclusion: Dietary intake (energy, protein, fat, carbohydrates) and physical activity are significantly associated with being overweight among adolescents. However, no significant relationship was observed between meal frequency and overweight incidence among adolescents at SMAN 8 Maros.

Association of blood glucose levels and body mass index with menstrual cycle patterns among female medical students at Universitas Syiah Kuala

Sat, 28 Feb 2026 00:00:00 +0000

Background: Menstrual cycle disorders are prevalent among women of reproductive age and may be influenced by nutritional and metabolic factors. Body mass index (BMI) and blood glucose levels play important roles in hormonal regulation and reproductive function.

Objective: This study examined the association between blood glucose levels and body mass index with menstrual cycle patterns among female medical students at Universitas Syiah Kuala.

Methods: An analytical cross-sectional study was conducted among 249 female medical students from the 2022–2024 cohorts using quota sampling. Data were collected from 8 - 16 September 2025. Menstrual cycle patterns were assessed using an online menstrual diary based on International Federation of Gynecology and Obstetrics criteria. Blood glucose levels were measured using random blood glucose testing, and BMI was calculated from measured weight and height. Associations were analyzed using Spearman rank correlation and ordinal logistic regression.

Results: Most participants had normal blood glucose levels (61.8%) and normal BMI (44.6%). Normal menstrual cycles were reported by 57% of participants. Blood glucose levels were significantly associated with menstrual cycle patterns (p = 0.022; rₛ = 0.145). BMI was also significantly associated with menstrual cycle patterns (p = 0.038; rₛ = 0.132). The correlation coefficients indicated weak positive relationships between blood glucose levels and BMI with menstrual cycle. Multivariate analysis showed that BMI (OR = 5.06) had a stronger association with menstrual cycle disturbances than blood glucose levels (OR = 4.66).

Conclusion: Blood glucose levels and body mass index are significantly associated with menstrual cycle patterns, with BMI identified as the dominant factor. Maintaining optimal nutritional and metabolic status may support menstrual health in young women.