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Background: A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures. Methods: Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia. Results: A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm2 and 3.66 cm2 for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women. Conclusions: Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice.

Background: Disease-related malnutrition (DRM) in outpatients is associated with increased mortality and functional decline. Morphofunctional assessments, including phase angle (PA), rectus femoris cross-sectional area (RF-CSA), and handgrip strength (HGS), provide valuable prognostic insights in the ambulatory setting. Nutritional recovery programs enriched with β-hydroxy-β-methylbutyrate (HMB) offer potential benefits in improving nutritional and functional outcomes. Objective: To evaluate the effects of a six-month nutritional recovery program combining HMB-enriched oral nutritional supplements (HMB-ONS), dietary recommendations, and exercise on survival, morphofunctional markers, and adherence in malnourished outpatients. Methods: This retrospective observational study included 135 malnourished outpatients diagnosed using GLIM criteria. Morphofunctional assessments included PA (bioimpedance analysis), RF-CSA (nutritional ultrasound), HGS (dynamometry), and the Timed Up and Go (TUG) test. Adherence was assessed using pharmacy retrieval records and a validated questionnaire. Changes in morphofunctional markers and their association with mortality were analyzed using multivariate Cox regression models. Results: After six months, significant improvements were observed in PA (+0.47°), RF-CSA (+0.90 cm2), HGS (+4.1 kg), and TUG (−0.93 s) (all p < 0.001). These improvements were more pronounced in the high-adherence group, which also exhibited a reduced mortality risk (HR 0.42, p < 0.05). Changes in PA and HGS were strongly associated with survival, with ΔPA showing an HR of 0.27 (95% CI: 0.15–0.50, p < 0.001) and ΔHGS showing an HR of 0.82 (95% CI: 0.75–0.89, p < 0.001). Conclusions: A nutritional recovery program with HMB-ONS significantly improves survival and morphofunctional markers in malnourished patients, with the greatest benefits observed in those with high adherence. These findings underscore the importance of adherence-support strategies in optimizing clinical outcomes and highlight the need for further research to confirm long-term benefits.