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This study aimed to establish prediction model of postoperative undernutrition for patients with complex ARM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective review of 104 patients with complex ARM was conducted with assessments of clinical data. Lasso-Logistic regression analysis was used to identify independent factors, and then establish a Nomogram model for predicting postoperative undernutrition. Harrell\u2019s concordance index and calibration curves were applied to evaluate the performance of this model. R software was used for statistical analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 104 patients, the proportion of malnutrition was 28.85% (30\/104). Lasso-Logistic regression analysis showed that non-parental caregivers (Odds ratio [OR]: 11.20), undernutrition at anorectoplasty (OR: 4.101), surgery for other systemic malformation (OR: 8.378), and feeding method (artificial, OR: 25.320) were independently associated with postoperative undernutrition (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05), and Nomogram model was developed based on these determinants. The area under the receiver operator characteristic curve of this cohort was 0.877 and it still was 0.906 through bootstrapping validation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091000). The H-L goodness-of-fit test showed that there was no significant difference between the predicted and actual incidence of postoperative undernutrition (\u03c72\u2009=\u20097.55,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.273). Meanwhile, the calibration curves indicated that the forecast was in good agreement with the actual situation. Decision curve showed that when the probability threshold of Nomogram model predicting malnutrition was &gt;0.03, application of the model would add net benefit compared to either the treat-all strategy or the treat-none strategy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion\u00a0<\/jats:title>\n                    <jats:p>This Nomogram model for predicting postoperative undernutrition of complex ARM patients showed desirable accuracy and discrimination for clinicians, aiding the early initiation of preventative interventions for undernutrition.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-025-04202-5","type":"journal-article","created":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T07:41:39Z","timestamp":1755330099000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of nomogram model based on LASSO-Logistic regression for predicting postoperative undernutrition to complex anorectal malformation: a pilot exploratory study"],"prefix":"10.1186","volume":"25","author":[{"given":"Wei","family":"Feng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linxiao","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinping","family":"Hou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohong","family":"Die","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,16]]},"reference":[{"issue":"3","key":"4202_CR1","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1002\/bdr2.2129","volume":"115","author":"V Kancherla","year":"2023","unstructured":"Kancherla V, Sundar M, Tandaki L, Lux A, Bakker MK, Bergman JE, et al. 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BMJ. 2015;350: g7594. https:\/\/doi.org\/10.1136\/bmj.g7594.","journal-title":"BMJ"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-025-04202-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-025-04202-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-025-04202-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:39:11Z","timestamp":1781613551000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12876-025-04202-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,16]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4202"],"URL":"https:\/\/doi.org\/10.1186\/s12876-025-04202-5","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,16]]},"assertion":[{"value":"11 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 August 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":"This study was approved by the ethics committee of the Children\u2019s Hospital of Chongqing Medical University (Date: 2023\/No: 01). All procedures in the study were carried out in accordance with national ethical guidelines for medical and health research involving human subjects, as well as the 1964 Helsinki Declaration and its subsequent amendments. Because of the retrospective nature of the study, the need for informed consent to participate was specifically waived by the Institutional Research Ethics Board of Children\u2019s Hospital affiliated Chongqing Medical University.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"588"}}