Phenotype profiling of disease-related malnutrition with inflammation: Document elaborated by the ESPEN special interest group (SIG) ‘‘cachexia-anorexia in chronic wasting diseases’’

In the ESPEN SIG meetings the similarities and differences between cachexia and disease-related malnutrition (DRM) were previously analyzed, as well as the role of inflammation in DRM. In the years 2023-2025, the SIG moving forward emphasized the relevance of the evolution of the cachexia definition and the advantage of considering DRM with chronic inflammation and cachexia as synonyms. We focused on the evidence regarding: i) the impact of DRM phenotypes and grade of inflammation on the efficacy of nutritional treatments, ii) the distinction between cachexia and end-of-life conditions, and iii) the identification of the barriers, facilitators and solutions for the implementation of the DRM definition among experts and non-experts in the field of nutrition. We underlined the importance of phenotyping those patients with DRM with inflammation to identify the most appropriate nutritional and metabolic interventions. Based on the role of inflammation in chronic and acute diseases, we discussed the impact of inflammation on the effectiveness of nutritional interventions. We discussed the differences between DRM with inflammation/cachexia and "end-of-life" conditions and the limited evidence on the efficacy of nutritional therapies in a palliative setting. Finally, the SIG discussed the barriers to the implementation of the concept of DRM, and suggested solutions. We emphasize the need for primary care training programs, to identify and address DRM early, and advocate for evidence-based interdisciplinary treatment strategies. The SIG recommends to enhance primary care nutritional and dietetic services, to support general practitioners and improve patient care through increased healthcare system engagement in clinical nutrition.