{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:11:42Z","timestamp":1789996302653,"version":"4.0.1"},"reference-count":35,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background and aims: Early phenotyping in the ICU is challenging because severity scores do not capture malnutrition, cellular integrity, or muscle reserve. We assessed whether phase angle (PhA), GLIM-defined malnutrition, and rectus femoris ultrasound were associated with 30-day mortality and whether continuous PhA added prognostic information beyond illness severity. Methods: We analyzed a prospective single-center cohort of adults admitted to a 12-bed ICU. Within 24\u201348 h, patients underwent bioelectrical impedance analysis, rectus femoris ultrasound, GLIM, mNUTRIC, CONUT, APACHE II, and SOFA assessment. Primary multivariable analyses treated PhA and rectus femoris cross-sectional area (CSA) as continuous variables; ROC-derived cut-offs were considered exploratory. Potential non-linearity was examined with restricted cubic splines, and the continuous PhA model underwent bootstrap internal validation. Results: Among 125 patients (63.2% men; median age 68 [60\u201376] years), 30-day mortality was 24.0% (30\/125). GLIM-defined malnutrition was present in 78.4%, including 12.0% with severe malnutrition. Non-survivors had lower PhA (4.3 [3.6\u20134.8] vs. 4.8 [4.2\u20135.5]\u00b0; p = 0.008) and smaller rectus femoris CSA (2.6 [1.9\u20133.4] vs. 3.6 [2.5\u20135.0] cm2; p = 0.007). In the adjusted continuous PhA model, APACHE II (OR 1.23 per point, 95% CI 1.13\u20131.34; p &lt; 0.001) and severe GLIM-defined malnutrition (OR 5.95, 95% CI 1.45\u201324.32; p = 0.013) remained independently associated with mortality, whereas lower PhA did not (OR 1.11 per 1\u00b0 lower, 95% CI 0.74\u20131.69; p = 0.611). Adding continuous PhA to the reference model changed AUC from 0.868 to 0.867 and did not improve fit (likelihood ratio p = 0.607). Continuous CSA was also not independently associated with mortality (OR 1.17 per 1 cm2 lower, 95% CI 0.81\u20131.69; p = 0.412). Conclusions: APACHE II and protocol-defined severe GLIM malnutrition, but not continuous admission PhA or rectus femoris CSA, retained independent associations with 30-day mortality; the GLIM association should be interpreted in light of the protocol-specific morphofunctional operationalization of the muscle criterion. Lower PhA and CSA characterized non-survivors in unadjusted analyses; cohort-derived thresholds should be considered hypothesis-generating and require external validation.<\/jats:p>","DOI":"10.3390\/nu18183059","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:50:03Z","timestamp":1789995003000},"page":"3059","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of Phase Angle, GLIM-Defined Malnutrition, and Rectus Femoris Ultrasound with 30-Day Mortality in Critically Ill Adults: A Prospective Cohort Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0404-4863","authenticated-orcid":false,"given":"Alejandro","family":"Garc\u00eda-Garc\u00eda","sequence":"first","affiliation":[{"name":"Biomedical Research and Innovation Institute of C\u00e1diz (INiBICA), Puerta del Mar University Hospital, 11009 C\u00e1diz, Spain"},{"name":"Intensive Care Unit, Punta de Europa University Hospital, 11207 Algeciras, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Alejandro","family":"\u00dabeda-Iglesias","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Punta de Europa University Hospital, 11207 Algeciras, 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Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3378-0985","authenticated-orcid":false,"given":"Nuria","family":"Trujillo-Garrido","sequence":"additional","affiliation":[{"name":"Biomedical Research and Innovation Institute of C\u00e1diz (INiBICA), Puerta del Mar University Hospital, 11009 C\u00e1diz, Spain"},{"name":"Department of Nursing and Physiotherapy, University of C\u00e1diz, 11009 C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1598-7728","authenticated-orcid":false,"given":"Mar\u00eda Jos\u00e9 M.","family":"Alf\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Physiology, Institute of Nutrition and Food Technology Jos\u00e9 Mataix, University of Granada, 18071 Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Eduardo","family":"S\u00e1nchez-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Biomedical Research and Innovation Institute of C\u00e1diz (INiBICA), Puerta del Mar University Hospital, 11009 C\u00e1diz, Spain"},{"name":"Intensive Care Unit, Punta de Europa University Hospital, 11207 Algeciras, Spain"},{"name":"Department of Nursing and Physiotherapy, University of C\u00e1diz, 11009 C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.ccc.2024.08.011","article-title":"Skeletal muscle: A critical organ for survival and recovery in critical illness","volume":"41","author":"Lees","year":"2025","journal-title":"Crit. 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