Editorial: Assessment of Nutritional Status in Chronic Diseases

Olivia Di Vincenzo^1*Mariacristina Siotto²

• ¹Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
• ²IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy, Florence, Italy

Nutritional status has been assessed through anthropometric, body composition, and functional measures across diverse clinical populations, revealing critical insights into health outcomes. Undernutrition is a major concern among adolescents; for instance, as shown by (Zafar et al., 2025), the high prevalence of underweight among school-going girls in Pakistan, highlights the urgent need for targeted nutritional education and policy interventions to promote healthy dietary habits and ensure equitable access to safe and nutritious food. In pediatric populations, alterations in body composition can indicate early cardiometabolic risk: longitudinal data by (Jin et al., 2024) indicated that increasing waist circumference and waist-to-height ratio trajectories in children were associated with higher left ventricular mass index and a greater likelihood of developing left ventricular hypertrophy, underscoring the importance of early lifestyle interventions and continuous monitoring. Among older adults, functional measures such as handgrip strength (HGS) have been explored as potential indicators of nutritional status. In a study by (Alamri and Simbawa, 2024) in hospitalized geriatric patients, HGS was found to be influenced by factors such as advanced age, low hemoglobin, and elevated HbA1c. Although it is a sensitive tool in identifying malnutrition or risk of malnutrition, its low specificity limits its standalone use for diagnosis. Similarly, as reported by (Kaluźniak-Szymanowska et al., 2024) in older patients with COPD, distinct body composition phenotypes, including sarcopenia, obesity, and sarcopenic obesity, were associated with greater disease severity and significantly impaired physical performance. These findings reinforce the need for comprehensive nutritional evaluations that go beyond traditional measures like body mass index (BMI). Furthermore, a study by (Fernández-Jiménez et al., 2024) showed that in patients with idiopathic pulmonary fibrosis, sarcopenia was highly prevalent and associated to both disease severity and reduced quality of life. Notably, a combination of anthropometric and functional measures was effective in predicting sarcopenia and one-year mortality risk, highlighting the importance of early, integrated assessments to inform timely and targeted interventions. A systematic review by (Mentxakatorre et al., 2024) highlighted the complex and clinically significant relationship between nutritional status and quality of life in patients with Parkinson's disease (PD). Both motor and non-motor symptoms were found to be influenced by nutritional status, with undernutrition or unintentional weight loss negatively affecting disease progression and functional independence. Additionally, PD treatments were shown to impact body weight, emphasizing the need for continuous nutritional monitoring. Notably, the review highlighted the emerging role of the gut-brain axis: adequate nutritional status was associated with a more balanced intestinal microbiota, which, in turn, was associated with slower cognitive decline, better performance in activities of daily living, and enhanced overall quality of life. Nutritional status and its prognostic implications have also been assessed adopting several tools and/or indices across diverse clinical populations. These tools are being refined or complemented by emerging methodologies and integrated assessments. For example, the Global Leadership Initiative on Malnutrition (GLIM) criteria remain a cornerstone for malnutrition diagnosis, incorporating parameters such as weight loss, reduced food intake, and inflammation. Recent advances, such as the application of machine learning (Rischmüller et al., 2024) in patients with chronic gastrointestinal diseases, have reaffirmed the value of GLIM while also highlighting additional relevant indicators, such as phase angle, skeletal muscle mass index, limb circumferences, and nutritional biomarkers like albumin and prealbumin, that enhance diagnostic accuracy. Comparative studies further emphasize the variability in malnutrition detection depending on the tools employed. In hospitalized older adults (da Silva et al., 2024), the GLIM criteria identified significantly more malnourished individuals than the Mini Nutritional Assessment (MNA), with a notable proportion classified as severely malnourished. Both tools correlated with frailty and sarcopenia, though the MNA-functional form showed stronger associations, suggesting different clinical utilities in geriatric populations. Beyond diagnostic scope, several indices have demonstrated prognostic value in predicting adverse outcomes. The Prognostic Nutritional Index (PNI), which reflects immunonutritional status, was shown to be independently associated with lower all-cause and cardiovascular mortality among individuals with cardiovascular disease and (pre)diabetes in a large NHANES study by (Xu et al., 2025). Similarly, in gynecologic cancer survivors with lower limb lymphedema, the study by (Zhu et al., 2024) showed that low PNI and serum albumin levels were prevalent and associated with poor nutritional status and anemia, underscoring the importance of routine nutritional monitoring in oncology follow-up care. In patients with CKD (Wang et al., 2024), malnutrition often coexists with systemic inflammation and other metabolic disturbances. Predictive models have identified hypoalbuminemia risk factors, such as anemia, hyponatremia, and hypocalcemia, that can be used to guide early intervention strategies. Moreover, combined markers of nutritional and inflammatory status, such as the Advanced Lung Cancer Inflammation Index (ALI), have emerged as useful predictors of mortality in several chronic diseases. Among asthma and CKD populations (Li et al., 2025), higher ALI scores were consistently associated with reduced risk of all-cause and cardiovascular mortality. In CKD (Zhou et al., 2024), the prognostic significance was particularly notable when depression was also considered: individuals with poor nutritional-inflammatory status and coexisting depressive symptoms had markedly elevated mortality risks, emphasizing the need for integrated psychosocial and nutritional care. Other composite scores, such as the Naples Prognostic Score (NPS), have shown similar utility. As reported by (Kang et al., 2024), in individuals with COPD, elevated NPS values were linked to greater disease susceptibility, impaired lung function, and increased mortality, especially in smokers. These findings highlight the NPS as a promising tool for early identification and risk stratification. The Oxidative Balance Score (OBS), which integrates dietary and lifestyle-related antioxidant/pro-oxidant exposures, was inversely associated with muscular dystrophy risk, as reported in the study by (Tang et al., 2024). This suggests a potential protective role of favorable oxidative balance, expanding the relevance of nutrition-related indices into the neuromuscular disease domain. Finally, a case-report by (Oliveira et al., 2024) describes the case of a 78-year-old underweight and weakened male with a history of ischemic stroke and multiple comorbidities. Over a 10-month followup period, a percutaneous endoscopic gastrostomy tube was placed, and nutritional management was tailored based on regular biochemical and nutritional assessments. Personalized nutritional intervention, including a caloric surplus and dietary modifications, led to weight gain, improved muscle mass, and enhanced biochemical blood parameters, highlighting the importance of comprehensive nutritional management in post-stroke patients to improve clinical outcomes and quality of life. In summary, the articles included in this Research Topic highlight the increasingly recognized role of nutrition in the management of several chronic diseases, including renal, respiratory, neurodegenerative, and metabolic disorders. Together, these findings demonstrate how dietary intake, nutritional status, and tailored assessment tools not only inform clinical decision-making but also contribute to preventing complications, enhancing quality of life, and improving patient outcomes. Moving forward, the integration of evidence-based nutritional strategies into routine chronic care, supported by comprehensive, multidimensional assessments, will be essential in advancing more effective, personalized, and patient-centered healthcare models.