{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:43:42Z","timestamp":1787762622415,"version":"build-2784847793"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100015528","name":"Universidad de la Laguna","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100015528","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Updates Surg"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Sarcopenia predicts negative outcomes in colorectal surgery, including anastomotic leakage (AL). Folic acid (FA) is essential for cellular processes such as DNA synthesis and tissue repair, which may indicate that it could impact anastomotic healing. The objective of this study was to evaluate the association between preoperative blood levels of FA, sarcopenia defined radiologically by psoas density, and postoperative outcomes in patients undergoing resection for colorectal cancer. A prospective study was conducted on patients undergoing oncological colorectal resection with anastomosis between June 2022 and November 2024. FA levels and the average psoas density at the L3 level on computed tomography (CT) were analyzed. Postoperative complications were recorded. Of the 250 patients that were analyzed, 12% had low FA levels (&lt;\u20092.7\u00a0ng\/ml) and 16% were diagnosed with sarcopenia. Furthermore, low FA levels were associated with a higher risk of sarcopenia diagnosis [RR 4.63 (95% CI 2.26\u20139.49)], and radiological sarcopenia was associated with an increased risk of AL [RR 1.98 (95% CI 1.3\u20132.83)]. Low FA levels are associated with an increased risk of sarcopenia, therefore FA deficiency could be considered a modifiable risk factor for sarcopenia and, consequently, its supplementation preoperatively could reduce the risk of anastomotic dehiscence in colorectal cancer patients.<\/jats:p>","DOI":"10.1007\/s13304-025-02273-3","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T04:46:26Z","timestamp":1749012386000},"page":"2365-2370","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Folic acid deficiency as a modifiable risk factor for anastomotic leak in patients undergoing colorectal cancer surgery"],"prefix":"10.1007","volume":"77","author":[{"given":"Andrea","family":"Chirivella-Fernandez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Rivera-Castellano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ester","family":"Ram\u00edrez-Caballero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Morales-D\u00edaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4154-6590","authenticated-orcid":false,"given":"Luciano","family":"Delgado-Plasencia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"issue":"10","key":"2273_CR1","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1093\/ageing\/afac220","volume":"51","author":"AA Sayer","year":"2022","unstructured":"Sayer AA, Cruz-Jentoft A (2022) Sarcopenia definition, diagnosis and treatment: consensus is growing. Age Ageing 51(10):220. https:\/\/doi.org\/10.1093\/ageing\/afac220. (PMID: 36273495; PMCID: PMC9588427)","journal-title":"Age Ageing"},{"issue":"5","key":"2273_CR2","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1002\/jso.27200","volume":"127","author":"RT van Kooten","year":"2023","unstructured":"van Kooten RT, Ravensbergen CJ, van B\u00fcseck SCD, Grootjans W, Peeters KCMJ, Holman FA, Heemskerk JWT, Wouters MWJM, Navas Ca\u00f1ete A, Tollenaar RAEM (2023) Computed tomography-based preoperative muscle measurements as prognostic factors for anastomotic leakage following oncological sigmoid and rectal resections. J Surg Oncol 127(5):823\u2013830. https:\/\/doi.org\/10.1002\/jso.27200. (Epub 2023 Jan 9 PMID: 36620908)","journal-title":"J Surg Oncol"},{"issue":"6","key":"2273_CR3","doi-asserted-by":"publisher","first-page":"2863","DOI":"10.1002\/jcsm.13097","volume":"13","author":"AM Golder","year":"2022","unstructured":"Golder AM, Sin LKE, Alani F, Alasadi A, Dolan R, Mansouri D, Horgan PG, McMillan DC, Roxburgh CS (2022) The relationship between the mode of presentation, CT-derived body composition, systemic inflammatory grade and survival in colon cancer. J Cachexia Sarcopenia Muscle 13(6):2863\u20132874. https:\/\/doi.org\/10.1002\/jcsm.13097. (Epub 2022 Oct 11. PMID: 36218135; PMCID: PMC9745485)","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"1","key":"2273_CR4","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1002\/jcsm.12906","volume":"13","author":"A Takagi","year":"2022","unstructured":"Takagi A, Hawke P, Tokuda S, Toda T, Higashizono K, Nagai E, Watanabe M, Nakatani E, Kanemoto H, Oba N (2022) Serum carnitine as a biomarker of sarcopenia and nutritional status in preoperative gastrointestinal cancer patients. J Cachexia Sarcopenia Muscle 13(1):287\u2013295. https:\/\/doi.org\/10.1002\/jcsm.12906. (Epub 2021 Dec 22. Erratum in: J Cachexia Sarcopenia Muscle. 2023 Apr;14(2):1142. 10.1002\/jcsm.13172. PMID: 34939358; PMCID: PMC8818668)","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"22","key":"2273_CR5","doi-asserted-by":"publisher","first-page":"8844","DOI":"10.3390\/ijms21228844","volume":"21","author":"J Pascual-Fern\u00e1ndez","year":"2020","unstructured":"Pascual-Fern\u00e1ndez J, Fern\u00e1ndez-Montero A, C\u00f3rdova-Mart\u00ednez A, Pastor D, Mart\u00ednez-Rodr\u00edguez A, Roche E (2020) Sarcopenia: molecular pathways and potential targets for intervention. Int J Mol Sci 21(22):8844. https:\/\/doi.org\/10.3390\/ijms21228844. (PMID:33266508;PMCID:PMC7700275)","journal-title":"Int J Mol Sci"},{"key":"2273_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.exger.2024.112560","volume":"196","author":"H Huang","year":"2024","unstructured":"Huang H, Yu X, Jiang S, Wang C, Chen Z, Chen D, Yang X, Zhao Q (2024) The relationship between serum lipid with sarcopenia: results from the NHANES 2011\u20132018 and bidirectional Mendelian randomization study. Exp Gerontol 196:112560. https:\/\/doi.org\/10.1016\/j.exger.2024.112560. (Epub 2024 Aug 29 PMID: 39214262)","journal-title":"Exp Gerontol"},{"issue":"12","key":"2273_CR7","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1093\/nutrit\/nuaa145","volume":"79","author":"ECS Santiago","year":"2021","unstructured":"Santiago ECS, Roriz AKC, Ramos LB, Ferreira AJF, Oliveira CC, Gomes-Neto M (2021) Comparison of calorie and nutrient intake among elderly with and without sarcopenia: a systematic review and meta-analysis. Nutr Rev 79(12):1338\u20131352. https:\/\/doi.org\/10.1093\/nutrit\/nuaa145. (PMID: 33616172)","journal-title":"Nutr Rev"},{"issue":"12","key":"2273_CR8","doi-asserted-by":"publisher","first-page":"3731","DOI":"10.3390\/molecules26123731","volume":"26","author":"Y Shulpekova","year":"2021","unstructured":"Shulpekova Y, Nechaev V, Kardasheva S, Sedova A, Kurbatova A, Bueverova E, Kopylov A, Malsagova K, Dlamini JC, Ivashkin V (2021) The concept of folic acid in health and disease. Molecules 26(12):3731. https:\/\/doi.org\/10.3390\/molecules26123731","journal-title":"Molecules"},{"issue":"10","key":"2273_CR9","doi-asserted-by":"publisher","first-page":"3618","DOI":"10.3390\/nu13103618","volume":"13","author":"MR Lee","year":"2021","unstructured":"Lee MR, Jung SM (2021) Folic acid is related to muscle strength and vitamin a is related to health-related quality of life: results of the Korea National Health and Nutrition Examination Survey (KNHANES VII 2016-2018). Nutrients 13(10):3618. https:\/\/doi.org\/10.3390\/nu13103618. (PMID: 34684620; PMCID: PMC8541020)","journal-title":"Nutrients"},{"issue":"18","key":"2273_CR10","doi-asserted-by":"publisher","first-page":"1535","DOI":"10.2147\/CIA.S414620","volume":"14","author":"MM Leite","year":"2023","unstructured":"Leite MM, de Sousa Neto IV, Dutra MT, Funghetto SS, de Oliveira SA, da Silva ICR, Ramos de Lima L, Morato Stival M (2023) Predictive models of muscle strength in older people with type 2 diabetes mellitus. Clin Interv Aging 14(18):1535\u20131546. https:\/\/doi.org\/10.2147\/CIA.S414620. (PMID:37727449;PMCID:PMC10506670)","journal-title":"Clin Interv Aging"}],"container-title":["Updates in Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13304-025-02273-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13304-025-02273-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13304-025-02273-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T20:02:53Z","timestamp":1763582573000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13304-025-02273-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":10,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["2273"],"URL":"https:\/\/doi.org\/10.1007\/s13304-025-02273-3","relation":{},"ISSN":["2038-131X","2038-3312"],"issn-type":[{"value":"2038-131X","type":"print"},{"value":"2038-3312","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,4]]},"assertion":[{"value":"28 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors did not receive support from any organisation for the submitted work. The authors declare they have no financial interests. The authors have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Approval was obtained from the ethics committee of our hospital. The procedures used in this study adhere to the tenets of the Declaration of Helsinki. The Approval No. was CHUC_23_203.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors affirm that human research participants provided informed consent for publication of the images in Fig.\n                      \n                      a\u2013c.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}}]}}