{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:58:37Z","timestamp":1790845117049,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Obesity Science &amp; Practice"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>High\u2010potency incretin therapy achieved substantial weight loss, but the extreme energy deficits it induced may obscure the underlying nutritional deterioration. This meta\u2010analysis synthesized data from 19 randomized trials across the SURMOUNT, STEP, SCALE, and OASIS programs to quantify the nutritional and body composition consequences of these agents in adults with obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review and meta\u2010analysis followed PRISMA 2020 guidelines. Risk of bias was assessed using the Cochrane RoB2 tool, and certainty of evidence was rated using the GRADE approach. Continuous outcomes were pooled using mean differences within a random\u2010effects model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Daily energy intake declined by 24.00%\u201339.20% across drug classes, with model\u2010estimated daily deficits reaching 1200\u00a0kcal. Tirzepatide 15\u00a0mg was associated with a mean fat\u2010free mass (FFM) reduction of 1.60\u00a0kg, representing 2.80% of body weight. Investigator\u2010reported malnutrition occurred in only 0.12% of participants. Objective laboratory screening identified low total lymphocyte counts below 910 per microliter in 2.90% of active\u2010therapy participants, nearly double the 1.77% in placebo arms, indicating that standard adverse event reporting underestimates true nutritional risk. Pancreatic lipase increased by a mean of 31% in the SCALE program, representing a secondary metabolic signal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Given these findings, a Tiered Stepped\u2010Care Algorithm is proposed, mandating baseline screening of albumin and total lymphocyte count, periodic monitoring at weeks 12, 24, and 52, and defined intervention thresholds to prevent sarcopenia and frailty, particularly in adults aged 65\u00a0years and older.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/osp4.70188","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T06:22:57Z","timestamp":1788762177000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Systematic Review and Meta\u2010Analysis of Malnutrition and Metabolic Failure in High\u2010Potency Incretin Therapy"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8197-6258","authenticated-orcid":false,"given":"Eugene","family":"Ampofo","sequence":"first","affiliation":[{"name":"Department of Biochemistry and Biotechnology Kwame Nkrumah University of Science and Technology University Post Office  Kumasi Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Apprey","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Biotechnology Kwame Nkrumah University of Science and Technology University Post Office  Kumasi Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Amoako","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Biotechnology Kwame Nkrumah University of Science and Technology University Post Office  Kumasi 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