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Grass F, Hübner M, Schäfer M, Ballabeni P, Cerantola Y, Demartines N, Pralong FP, Bertrand PC. Preoperative nutritional screening by the specialist instead of the nutritional risk score might prevent excess nutrition: a multivariate analysis of nutritional risk factors. Nutr J 2015; 14:37. [PMID: 25890322 PMCID: PMC4404583 DOI: 10.1186/s12937-015-0024-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/02/2015] [Indexed: 01/04/2023] Open
Abstract
Background The aim of the current study was to assess whether widely used nutritional parameters are correlated with the nutritional risk score (NRS-2002) to identify postoperative morbidity and to evaluate the role of nutritionists in nutritional assessment. Methods A randomized trial on preoperative nutritional interventions (NCT00512213) provided the study cohort of 152 patients at nutritional risk (NRS-2002 ≥3) with a comprehensive phenotyping including diverse nutritional parameters (n=17), elaborated by nutritional specialists, and potential demographic and surgical (n=5) confounders. Risk factors for overall, severe (Dindo-Clavien 3-5) and infectious complications were identified by univariate analysis; parameters with P<0.20 were then entered in a multiple logistic regression model. Results Final analysis included 140 patients with complete datasets. Of these, 61 patients (43.6%) were overweight, and 72 patients (51.4%) experienced at least one complication of any degree of severity. Univariate analysis identified a correlation between few (≤3) active co-morbidities (OR=4.94; 95% CI: 1.47-16.56, p=0.01) and overall complications. Patients screened as being malnourished by nutritional specialists presented less overall complications compared to the not malnourished (OR=0.47; 95% CI: 0.22-0.97, p=0.043). Severe postoperative complications occurred more often in patients with low lean body mass (OR=1.06; 95% CI: 1-1.12, p=0.028). Few (≤3) active co-morbidities (OR=8.8; 95% CI: 1.12-68.99, p=0.008) were related with postoperative infections. Patients screened as being malnourished by nutritional specialists presented less infectious complications (OR=0.28; 95% CI: 0.1-0.78), p=0.014) as compared to the not malnourished. Multivariate analysis identified few co-morbidities (OR=6.33; 95% CI: 1.75-22.84, p=0.005), low weight loss (OR=1.08; 95% CI: 1.02-1.14, p=0.006) and low hemoglobin concentration (OR=2.84; 95% CI: 1.22-6.59, p=0.021) as independent risk factors for overall postoperative complications. Compliance with nutritional supplements (OR=0.37; 95% CI: 0.14-0.97, p=0.041) and supplementation of malnourished patients as assessed by nutritional specialists (OR=0.24; 95% CI: 0.08-0.69, p=0.009) were independently associated with decreased infectious complications. Conclusions Nutritional support based upon NRS-2002 screening might result in overnutrition, with potentially deleterious clinical consequences. We emphasize the importance of detailed assessment of the nutritional status by a dedicated specialist before deciding on early nutritional intervention for patients with an initial NRS-2002 score of ≥3.
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Affiliation(s)
- Fabian Grass
- Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
| | - Martin Hübner
- Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
| | - Markus Schäfer
- Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
| | - Pierluigi Ballabeni
- Institute for Social and Preventive Medicine, University Hospital CHUV, Lausanne, Switzerland.
| | - Yannick Cerantola
- Department of Urology, University Hospital CHUV, Lausanne, Switzerland.
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
| | - François P Pralong
- Clinical Nutrition Unit, University Hospital CHUV, Lausanne, Switzerland.
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Berbigier MC, Pasinato VF, Rubin BDA, Moraes RB, Perry IDS. Bioelectrical impedance phase angle in septic patients admitted to intensive care units. Rev Bras Ter Intensiva 2015; 25:25-31. [PMID: 23887756 PMCID: PMC4031866 DOI: 10.1590/s0103-507x2013000100006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/14/2013] [Indexed: 12/20/2022] Open
Abstract
Objective To calculate the values of the phase angle of septic patients using bioelectrical
impedance analysis, correlate the values with clinical and biochemical variables,
and compare them to reference values. Methods Cohort study conducted with 50 septic patients aged ≥18 years old, admitted to
intensive care units, and assessed according to prognostic indexes (APACHE II and
SOFA), clinical progression (mortality, severity of sepsis, length of stay in
intensive care unit), biochemical parameters (albumin and C-reactive protein), and
the phase angle. Results The average age of the sample was 65.6±16.5 years. Most patients were male (58%)
and suffering from septic shock (60%). The average APACHE II and SOFA scores were
22.98±7.1 and 7.5±3.4, respectively. The patients who survived stayed nine days on
average (five to 13) in the intensive care unit, and the mortality rate was 30%.
The average value of the phase angle was 5.4±2.6º in the total sample and was
smaller among the females compared with the males (p=0.01). The phase angle
measures did not exhibit an association with the severity of the sepsis,
mortality, gender, and age or correlate with the length of hospitalization or the
biochemical parameters. The participants' phase angle values adjusted per gender
and age were 1.1 to 1.9 times lower compared with the values for a normal
population. Conclusion The average value of the phase angle of septic patients was lower compared with
the reference values for a healthy population. The phase angle measures did not
exhibit association with the clinical and biochemical variables, which might be
explained by the sample homogeneity.
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Norman K, Wirth R, Neubauer M, Eckardt R, Stobäus N. The Bioimpedance Phase Angle Predicts Low Muscle Strength, Impaired Quality of Life, and Increased Mortality in Old Patients With Cancer. J Am Med Dir Assoc 2015; 16:173.e17-22. [DOI: 10.1016/j.jamda.2014.10.024] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/30/2014] [Accepted: 10/31/2014] [Indexed: 11/24/2022]
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Affiliation(s)
- Urvashi Mulasi
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, Minnesota
| | - Adam J. Kuchnia
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, Minnesota
| | - Abigail J. Cole
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, Minnesota
| | - Carrie P. Earthman
- Department of Food Science and Nutrition, University of Minnesota–Twin Cities, Saint Paul, Minnesota
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Haverkort EB, Reijven PLM, Binnekade JM, de van der Schueren MAE, Earthman CP, Gouma DJ, de Haan RJ. Bioelectrical impedance analysis to estimate body composition in surgical and oncological patients: a systematic review. Eur J Clin Nutr 2014; 69:3-13. [DOI: 10.1038/ejcn.2014.203] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 07/20/2014] [Accepted: 08/24/2014] [Indexed: 01/10/2023]
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Haverkort EB, Binnekade JM, de van der Schueren MAE, Gouma DJ, de Haan RJ. Estimation of Body Composition Depends on Applied Device in Patients Undergoing Major Abdominal Surgery. Nutr Clin Pract 2014; 30:249-56. [DOI: 10.1177/0884533614542614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
| | - Jan M. Binnekade
- Department of Intensive Care, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Dirk J. Gouma
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Rob J. de Haan
- Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands
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Berbel MN, Góes CRD, Balbi AL, Ponce D. Nutritional parameters are associated with mortality in acute kidney injury. Clinics (Sao Paulo) 2014; 69:476-82. [PMID: 25029579 PMCID: PMC4081889 DOI: 10.6061/clinics/2014(07)06] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 10/29/2013] [Accepted: 01/13/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to perform a nutritional assessment of acute kidney injury patients and to identify the relationship between nutritional markers and outcomes. METHOD This was a prospective and observational study. Patients who were hospitalized at the Hospital of Botucatu School of Medicine were evaluated between January 2009 and December 2011. We evaluated a total of 133 patients with a clinical diagnosis of acute kidney injury and a clinical presentation suggestive of acute tubular necrosis. We explored the associations between clinical, laboratory and nutritional markers and in-hospital mortality. Multivariable logistic regression was used to adjust for confounding and selection bias. RESULTS Non-survivor patients were older (67 ± 14 vs. 59 ± 16 years) and exhibited a higher prevalence of sepsis (57.1 vs. 21.4%) and higher Acute Tubular Necrosis-Individual Severity Scores (0.60 ± 0.22 vs. 0.41 ± 0.21) than did survivor patients. Based on the multivariable analysis, laboratorial parameters such as blood urea nitrogen and C-reactive protein were associated with a higher risk of death (OR: 1.013, p=0.0052; OR: 1.050, p=0.01, respectively), and nutritional parameters such as low calorie intake, higher levels of edema, lower resistance based on bioelectrical impedance analysis and a more negative nitrogen balance were significantly associated with a higher risk of death (OR: 0.950, p=0.01; OR: 1.138, p=0.03; OR: 0.995, p=0.03; OR: 0.934, p=0.04, respectively). CONCLUSIONS In acute kidney injury patients, a nutritional assessment seems to identify nutritional markers that are associated with outcome. In this study, a low caloric intake, higher C-reactive protein levels, the presence of edema, a lower resistance measured during a bioelectrical impedance analysis and a lower nitrogen balance were significantly associated with risk of death in acute kidney injury patients.
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Affiliation(s)
| | | | - André Luis Balbi
- Botucatu School of Medicine, UNESP, Internal Medicine, Botucatu, SP, Brazil
| | - Daniela Ponce
- Botucatu School of Medicine, UNESP, Internal Medicine, Botucatu, SP, Brazil
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Paixão EMDS, Gonzalez MC, Ito MK. A prospective study on the radiation therapy associated changes in body weight and bioelectrical standardized phase angle. Clin Nutr 2014; 34:496-500. [PMID: 24953772 DOI: 10.1016/j.clnu.2014.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/02/2014] [Accepted: 05/31/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Standardized phase angle (SPA) is a value derived from bioelectrical impedance phase angle analysis and has been recognized as marker of nutritional risk and clinical status of cancer patients. This study aimed to evaluate the changes in SPA during radiation therapy of cancer patients and identify possible nutritional and clinical determinants of these changes. METHODS Nutritional assessment was performed before the initiation and at the end of the radiotherapy. It included anthropometrics and bioelectrical impedance analysis. A generalized linear mixed model was used to evaluate the effects of selected independent variables on the changes in standardized phase angle. RESULTS A total of 104 patients entered the study and those with complete information were included in the analysis (n = 62). Most patients (61%) were at clinical stage I and II, the most prevalent irradiation site was the pelvis (39%) and 98% were well nourished or overweight. According to the regression analysis, changes in body weight and irradiation at head and neck/upper abdomen and thorax were associated with standardized phase angle modifications during radiotherapy. Clinical stage and radiation dose were not associated with changes in standardized phase angle. Compared to baseline values, for every 1 kg weight reduction during the radiation therapy, the standardized phase angle also decreased by 0.107 (p < 0.0001). CONCLUSIONS In well nourished or overweight patients, weight loss during radiation therapy is closely associated with decrease in standard phase angle.
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Affiliation(s)
| | - Maria Cristina Gonzalez
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Marina Kiyomi Ito
- Postgraduate Program in Human Nutrition, University of Brasília, Brasilia 70910-900, Distrito Federal, Brazil
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Hui D, Bansal S, Morgado M, Dev R, Chisholm G, Bruera E. Phase angle for prognostication of survival in patients with advanced cancer: preliminary findings. Cancer 2014; 120:2207-14. [PMID: 24899148 DOI: 10.1002/cncr.28624] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/05/2013] [Accepted: 11/25/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Accurate survival prediction is essential for decision-making in cancer therapies and care planning. Objective physiologic measures may improve the accuracy of prognostication. In this prospective study, the authors determined the association of phase angle, handgrip strength, and maximal inspiratory pressure with overall survival in patients with advanced cancer. METHODS Hospitalized patients with advanced cancer who were seen by palliative care specialists for consultation were enrolled. Information regarding phase angle, handgrip strength, maximal inspiratory pressure, and known prognostic factors including the Palliative Prognostic Score, Palliative Prognostic Index, serum albumin, and body composition was collected. Univariate and multivariate survival analysis were performed, and the correlation between phase angle and other prognostic variables was examined. RESULTS A total of 222 patients were enrolled. The average age of the patients was 55 years (range, 22 years-79 years); 59% of the patients were female, with a mean Karnofsky performance status of 55 and a median overall survival of 106 days (95% confidence interval [95% CI], 71 days-128 days). The median survival for patients with phase angle 2 to 2.9°, 3 to 3.9°, 4 to 4.9°, 5 to 5.9° and ≥ 6° was 35 days, 54 days, 112 days, 134 days, and 220 days, respectively (P = .001). On multivariate analysis, phase angle (hazards ratio [HR], 0.86-per degree increase; 95% CI, 0.74-0.99 increase [P = .04]), Palliative Prognostic Score (HR, 1.07; 95% CI, 1.02-1.13 [P = .008]), serum albumin (HR, 0.67; 95% CI, 0.50-0.91 [P = .009]), and fat-free mass (HR, 0.98; 95% CI, 0.96-0.99 [P = .02]) were found to be significantly associated with survival. Phase angle was found to be only weakly (γ < 0.4) associated with other prognostic variables. CONCLUSIONS Phase angle was found to be a novel predictor of poor survival, independent of established prognostic factors, in the advanced cancer setting. This objective and noninvasive tool may be useful for bedside prognostication.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Alves FD, Souza GC, Aliti GB, Rabelo-Silva ER, Clausell N, Biolo A. Dynamic changes in bioelectrical impedance vector analysis and phase angle in acute decompensated heart failure. Nutrition 2014; 31:84-9. [PMID: 25466653 DOI: 10.1016/j.nut.2014.05.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate whether changes in hydration status (reflecting fluid retention) would be detected by bioelectrical impedance vector analysis (BIVA) and phase angle during hospitalization for acute decompensated heart failure (ADHF) and after clinical stabilization. METHODS Patients admitted to ADHF were evaluated at admission, discharge and after clinical stabilization (3 mo after discharge) for dyspnea, weight, brain natriuretic peptide, bioelectrical impedance resistance, reactance, and phase angle. Generalized estimating equations and chi-square detected variations among the three time points of evaluation. RESULTS Were included 57 patients: Mean age was 61 ± 13 y, 65% were male, LVEF was 25 ± 8%. During hospitalization there were improvements in clinical parameters and increase in resistance/height (from 250 ± 72 to 302 ± 59 Ohms/m, P < 0.001), reactance/height (from 24 ± 10 to 31 ± 9 Ohms/m, P < 0.001), and phase angle (from 5.3 ± 1.6 to 6 ± 1.6°, P = 0.007). From discharge to chronic stability, both clinical and BIVA parameters remained stable. At admission, 61% of patients had significant congestion by BIVA, and they lost more weight and had higher improvement in dyspnea during hospitalization (P < 0.05). At discharge, more patients were in the upper half of the graph (characterizing some degree of dehydration) while at chronic stability normal hydration status was more prevalent (P < 0.001). CONCLUSIONS BIVA and phase angle were able to detect significant changes in hydration status during ADHF, which paralleled the clinical course of recompensation, both acutely and chronically. The classification of congestion by BIVA at admission identified patients with more pronounced changes in weight and dyspnea during compensation.
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Affiliation(s)
- Fernanda Donner Alves
- Postgraduate Program in Cardiovascular Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriela Corrêa Souza
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Graziella Badin Aliti
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; School of Nursing, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Eneida Rejane Rabelo-Silva
- Postgraduate Program in Cardiovascular Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; School of Nursing, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Nadine Clausell
- Postgraduate Program in Cardiovascular Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Andréia Biolo
- Postgraduate Program in Cardiovascular Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Bioimpedance phase angle predicts muscle function, quality of life and clinical outcome in maintenance hemodialysis patients. Eur J Clin Nutr 2014; 68:683-9. [DOI: 10.1038/ejcn.2014.67] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 02/16/2014] [Accepted: 03/08/2014] [Indexed: 01/10/2023]
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Eickemberg M, Oliveira CCD, Roriz AKC, Fontes GAV, Mello AL, Sampaio LR. Bioimpedância elétrica e gordura visceral: uma comparação com a tomografia computadorizada em adultos e idosos. ACTA ACUST UNITED AC 2013; 57:27-32. [DOI: 10.1590/s0004-27302013000100004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 10/04/2012] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Avaliar a associação entre bioimpedância elétrica (BIA) e gordura visceral (GV) em adultos e idosos. SUJEITOS E MÉTODOS: Estudo transversal, 191 indivíduos (52% mulheres, 49% idosos), estratificados por sexo, grupo etário e massa corporal. Obtiveram-se dados sobre tomografia computadorizada (área de GV) e BIA (percentual de gordura corporal total (%GCT-BIA), ângulo de fase, reactância e resistência). Análise estatística: Coeficiente de Correlação de Pearson, Anova, Qui-quadrado de Pearson, Curva ROC. RESULTADOS: Áreas de GV > 130 cm² foram mais observadas em idosos e em homens. Entre as mulheres adultas, mostrou-se correlação mais forte entre GV e %GCT-BIA. Os demais grupos apresentaram resultados semelhantes e correlações estatisticamente significantes. As correlações entre GV e ângulo de fase foram fracas e sem significância estatística. As análises da Curva ROC indicaram os seguintes %GCT-BIA que identificaram excesso de GV: homens: 21,5% (adultos), 24,25% (idosos); mulheres: 35,05% (adultas), 38,45% (idosas), com sensibilidade de 78,6%, 82,1%, 83,3%, 66,7% e especificidade de 70,6%, 62,5%, 79,1%, 69%, respectivamente. CONCLUSÃO: BIA apresentou satisfatória sensibilidade e especificidade para predizer GV, entretanto, outros aparelhos e técnicas devem ser investigados para melhorar essa predição.
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Kalantari K, Chang JN, Ronco C, Rosner MH. Assessment of intravascular volume status and volume responsiveness in critically ill patients. Kidney Int 2013; 83:1017-28. [PMID: 23302716 DOI: 10.1038/ki.2012.424] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Accurate assessment of a patient's volume status, as well as whether they will respond to a fluid challenge with an increase in cardiac output, is a critical task in the care of critically ill patients. Despite this, most decisions regarding fluid therapy are made either empirically or with limited and poor data. Given recent data highlighting the negative impact of either inadequate or overaggressive fluid therapy, understanding the tools and techniques available for accurate volume assessment is critical. This review highlights both static and dynamic methods that can be utilized to help in the assessment of volume status.
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Affiliation(s)
- Kambiz Kalantari
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia 22908, USA
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The bioelectrical impedance phase angle as an indicator of undernutrition and adverse clinical outcome in cardiac surgical patients. Clin Nutr 2012; 31:981-6. [DOI: 10.1016/j.clnu.2012.05.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/26/2012] [Accepted: 05/03/2012] [Indexed: 11/18/2022]
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Burden S, Todd C, Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev 2012; 11:CD008879. [PMID: 23152265 DOI: 10.1002/14651858.cd008879.pub2] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Post-operative management in gastrointestinal (GI) surgery is becoming well established with 'Enhanced Recovery After Surgery' protocols starting 24 hours prior to surgery with carbohydrate loading and early oral or enteral feeding given to patients the first day following surgery. However, whether or not nutritional intervention should be initiated earlier in the preoperative period remains unclear. Poor pre-operative nutritional status has been linked consistently to an increase in post-operative complications and poorer surgical outcome. OBJECTIVES To review the literature on preoperative nutritional support in patients undergoing gastrointestinal surgery (GI). SEARCH METHODS The searches were initially run in March 2011 and subsequently updated in February 2012. Databases including all EBM Reviews (Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA and NHSEED) MEDLINE, EMBASE, AMED, British Nursing Index Archive using OvidSP were included and a search was run on each database separately after which duplicates were excluded. SELECTION CRITERIA The inclusion criteria were randomised controlled trials that evaluated pre-operative nutritional support in GI surgical participants using a nutritional formula delivered by a parenteral, enteral or oral route. The primary outcomes included post-operative complications and length of hospital stay. DATA COLLECTION AND ANALYSIS Two observers screened the abstracts for inclusion in the review and performed data extraction. Bias was assessed for each of the included studies using the bias assessment tables in the Cochrane Software Review Manager (version 5.1, Cochrane Collaboration). The trials were analysed using risk ratios with Mantel-Haenszel in fixed effects methods displayed with heterogeneity. Meta-analyses were undertaken on trials evaluating immune enhancing (IE) nutrition, standard oral supplements, enteral and parenteral nutrition (PN) which were administered pre-operatively.Study characteristics were summarised in tables. Dichotomous and ratio data were entered into meta-analyses for the primary outcomes. These were then summarised in tables with assumed and corresponding risk with relative effect giving 95% confidence intervals. MAIN RESULTS The searches identified 9900 titles and, after excluding duplicates, 6433 titles were initially screened. After the initial title screen, 6266 were excluded. Abstracts were screened for 167 studies and 33 articles were identified as meeting the inclusion criteria, of which 13 were included in the review after an assessment of the complete manuscripts.Seven trials evaluating IE nutrition were included in the review, of which 6 were combined in a meta-analysis. These studies showed a low to moderate level of heterogeneity and significantly reduced total post-operative complications (risk ratio (RR) 0.67 CI 0.53 to 0.84). Three trials evaluating PN were included in a meta-analysis and a significant reduction in post-operative complications was demonstrated (RR 0.64 95% CI 0.46 to 0.87) with low heterogeneity, in predominantly malnourished participants. Two trials evaluating enteral nutrition (RR 0.79, 95% CI 0.56 to 1.10) and 3 trials evaluating standard oral supplements (RR 1.01 95% CI 0.56 to 1.10) were included, neither of which showed any difference in the primary outcomes. AUTHORS' CONCLUSIONS There have been significant benefits demonstrated with pre-operative administration of IE nutrition in some high quality trials. However, bias was identified which may limit the generalizability of these results to all GI surgical candidates and the data needs to be placed in context with other recent innovations in surgical management (eg-ERAS). Some unwanted effects have also been reported with components of IE nutrition in critical care patients and it is unknown whether there would be detrimental effects by administering IE nutrition to patients who could require critical care support after their surgery. The studies evaluating PN demonstrated that the provision of PN to predominantly malnourished surgical candidates reduced post-operative complications; however, these data may not be applicable to current clinical practice, not least because they have involved a high degree of 'hyperalimentation'. Trials evaluating enteral or oral nutrition were inconclusive and further studies are required to select GI surgical patients for these nutritional interventions.
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Affiliation(s)
- Sorrel Burden
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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Meireles MS, Wazlawik E, Bastos JL, Garcia MF. Comparison between Nutritional Risk Tools and Parameters Derived from Bioelectrical Impedance Analysis with Subjective Global Assessment. J Acad Nutr Diet 2012; 112:1543-9. [DOI: 10.1016/j.jand.2012.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 06/25/2012] [Indexed: 01/08/2023]
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Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission. Clin Nutr 2012; 32:294-9. [PMID: 22921419 DOI: 10.1016/j.clnu.2012.08.001] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/26/2012] [Accepted: 08/01/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS This study determined the association between phase angle (PhA), by bioelectrical impedance analysis (BIA) and nutritional risk by Nutritional Risk Screening (NRS-2002), Subjective Global Assessment (SGA), hospital length of stay (LOS) and 30 day non-survival in patients at hospital admission compared to healthy controls. METHODS PhA was determined by BIA in patients (n = 983, 52.7 ± 21.5 yrs, M 520) and compared to healthy age-, sex- and height-matched controls. Low PhA was set at <5.0° (men) and <4.6° (women) as previously determined (Kyle, in press). RESULTS PhA was lower in patients (men 6.0 ± 1.4°, women 5.0 ± 1.3°) than controls (men 7.1 ± 1.2°, women 6.0 ± 1.2°, un-paired t-test p < 0.001). Patients were more likely to have low PhA than controls: NRS-2002: no risk (relative risk (RR) 1.7, 95th confidence interval (CI) 1.2-2.3), moderate risk (RR 4.5, CI 3.4-5.8) and severe risk (RR 7.5, CI 5.9-9.4); similar results were obtained by SGA; LOS ≥21 days (RR 6.9, CI 5.1-9.1) and LOS 5-20 days (RR 5.2, CI 3.9-6.9) and non-survivors (RR 3.1, CI 2.1-3.4) compared to survivors. CONCLUSIONS There is a significant association between low PhA and nutritional risk, LOS and non-survival. PhA is helpful to identify patients who are at nutritional risk at hospital admission in order to limit the number of in-depth nutritional assessments.
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68
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Bioelectrical phase angle and impedance vector analysis--clinical relevance and applicability of impedance parameters. Clin Nutr 2012; 31:854-61. [PMID: 22698802 DOI: 10.1016/j.clnu.2012.05.008] [Citation(s) in RCA: 582] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 03/19/2012] [Accepted: 05/11/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS The use of phase angle (PhA) and raw parameters of bioelectrical impedance analysis (BIA) has gained attention as alternative to conventional error-prone calculation of body composition in disease. This review investigates the clinical relevance and applicability of PhA and Bioelectrical Impedance Vector Analysis (BIVA) which uses the plot of resistance and reactance normalized per height. METHODS A comprehensive literature search was conducted using Medline identifying studies relevant to this review until March 2011. We included studies on the use of PhA or BIVA derived from tetrapolar BIA in out- and in-patient settings or institutionalized elderly. RESULTS Numerous studies have proven the prognostic impact of PhA regarding mortality or postoperative complications in different clinical settings. BIVA has been shown to provide information about hydration and body cell mass and therefore allows assessment of patients in whom calculation of body composition fails due to altered hydration. Reference values exist for PhA and BIVA facilitating interpretation of data. CONCLUSION PhA, a superior prognostic marker, should be considered as a screening tool for the identification of risk patients with impaired nutritional and functional status, BIVA is recommended for further nutritional assessment and monitoring, in particular when calculation of body composition is not feasible.
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Kyle UG, Soundar EP, Genton L, Pichard C. Can phase angle determined by bioelectrical impedance analysis assess nutritional risk? A comparison between healthy and hospitalized subjects. Clin Nutr 2012; 31:875-81. [PMID: 22560739 DOI: 10.1016/j.clnu.2012.04.002] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/22/2012] [Accepted: 04/09/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Low phase angle (PhA) by bioelectrical impedance analysis (BIA), is associated with increased morbidity and nutritional risk. This study determined the cut-off values for PhA compared to Nutritional Risk Screening (NRS-2002) and Subjective Global Assessment (SGA) in patients at hospital admission, and evaluated the association between PhA and serum albumin. METHODS PhA was determined in patients (Men (M)/Women (W)=382/267), and healthy age-, sex- and height-matched controls. Sensitivity and specificity were calculated for PhA compared to NRS-2002, SGA and serum albumin. The cut-off values were assessed by receiver operator characteristics area under the curve (ROC-AUC). RESULTS The best PhA cut-offs were 5.0° and 4.6° in M/W. The sensitivity for NRS-2002 was 70.0/58.1% (M/W); SGA: 73.3/64.5%; albumin: 58.8/23.5%; specificity for NRS-2002: 85.1/81.7% (M/W); SGA: 76.6/76.1% and albumin: 93.2/96.6%. The PhA showed a ROC-AUC for NRS-2002 of 0.85/0.80 (M/W); SGA: 0.83/0.80 and albumin: 0.85/0.91. Patients with albumin levels <35 g/L had a relative risk of 7.5 to have low PhA compared to patients with ≥35 g/L CONCLUSIONS: The consistent sensitivity and specificity between PhA and three screening tools strengthens the validity of our study. PhA appears to be a useful screening tool to assess nutritional risk without having to measure weight or height.
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Affiliation(s)
- Ursula G Kyle
- Baylor College of Medicine/Texas Children's Hospital, Pediatric Critical Care Medicine, 6621 Fannin St WT6-006, Houston, TX 77030, USA.
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Guideline for prophylactic feeding tube insertion in patients undergoing resection of head and neck cancers. J Plast Reconstr Aesthet Surg 2012; 65:610-5. [DOI: 10.1016/j.bjps.2011.11.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 11/08/2011] [Indexed: 01/27/2023]
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Berbel MN, Pinto MPR, Ponce D, Balbi AL. Nutritional aspects in acute kidney injury. Rev Assoc Med Bras (1992) 2012; 57:600-6. [PMID: 22012298 DOI: 10.1590/s0104-42302011000500022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 07/19/2011] [Indexed: 11/22/2022] Open
Abstract
Nutritional assessment is an indispensable tool for the evaluation and clinical monitoring of patients with acute kidney injury (AKI). Acute loss of renal function interferes with the metabolism of all macronutrients, responsible for proinflammatory, pro-oxidative and hypercatabolic situations. The major nutritional disorders in AKI patients are hypercatabolism, hyperglycemia, and hypertriglyceridemia. Those added to the contributions of the underlying disease, complications, and the need for renal replacement therapy can interfere in the nutritional depletion of those patients. Malnutrition in AKI patients is associated with increased incidence of complications, longer hospitalization, and higher hospital mortality. However, there are few studies evaluating the nutritional status of AKI patients. Anthropometric parameters, such as body mass index, arm circumference, and thickness of skin folds, are difficult to interpret due to changes in hydration status in those patients. Biochemical parameters commonly used in clinical practice are also influenced by non-nutritional factors like loss of liver function and inflammatory status. Although there are no prospective data about the behavior of nutritional markers, some authors demonstrated associations of some parameters with clinical outcomes. The use of markers like albumin, cholesterol, prealbumin, IGF-1, subjective global assessment, and calculation of the nitrogen balance seem to be useful as screening parameters for worse prognosis and higher mortality in AKI patients. In patients with AKI on renal replacement therapy, a caloric intake of 25 to 30 kcal/kg and a minimum amount of 1.5 g/kg/day of protein is recommended to minimize protein catabolism and prevent metabolic complications.
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Affiliation(s)
- Marina Nogueira Berbel
- Grupo de Lesão Renal Aguda, Hospital das Clínicas, Faculdade de Medicina de Botucatu, UNESP, Botucatu, SP, Brazil.
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Thibault R, Pichard C. The evaluation of body composition: a useful tool for clinical practice. ANNALS OF NUTRITION AND METABOLISM 2011; 60:6-16. [PMID: 22179189 DOI: 10.1159/000334879] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 11/07/2011] [Indexed: 12/22/2022]
Abstract
Undernutrition is insufficiently detected in in- and outpatients, and this is likely to worsen during the next decades. The increased prevalence of obesity together with chronic illnesses associated with fat-free mass (FFM) loss will result in an increased prevalence of sarcopenic obesity. In patients with sarcopenic obesity, weight loss and the body mass index lack accuracy to detect FFM loss. FFM loss is related to increasing mortality, worse clinical outcomes, and impaired quality of life. In sarcopenic obesity and chronic diseases, body composition measurement with dual-energy X-ray absorptiometry, bioelectrical impedance analysis, or computerized tomography quantifies the loss of FFM. It allows tailored nutritional support and disease-specific therapy and reduces the risk of drug toxicity. Body composition evaluation should be integrated into routine clinical practice for the initial assessment and sequential follow-up of nutritional status. It could allow objective, systematic, and early screening of undernutrition and promote the rational and early initiation of optimal nutritional support, thereby contributing to reducing malnutrition-induced morbidity, mortality, worsening of the quality of life, and global health care costs.
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Affiliation(s)
- Ronan Thibault
- Centre de Recherche en Nutrition Humaine Auvergne, UMR 1019 Nutrition Humaine, INRA, Clermont Université, Service de Nutrition Clinique, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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73
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Jager-Wittenaar H, Dijkstra PU, Vissink A, van Oort RP, van der Laan BFAM, Roodenburg JLN. Malnutrition in patients treated for oral or oropharyngeal cancer--prevalence and relationship with oral symptoms: an explorative study. Support Care Cancer 2011; 19:1675-83. [PMID: 20844902 PMCID: PMC3166597 DOI: 10.1007/s00520-010-1001-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Accepted: 08/31/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to assess prevalence of malnutrition after treatment for oral/oropharyngeal cancer and to explore how oral symptoms relate to malnutrition after treatment. METHODS In this cross-sectional study, malnutrition (weight loss ≥ 10% in 6 months or ≥ 5% in 1 month), oral symptoms (EORTC QLQ-H&N35 questionnaire and additional questions to assess chewing problems), dental status, trismus and dietary intake were assessed in 116 adult patients treated for oral/oropharyngeal cancer. RESULTS Prevalence of malnutrition was 16% (95%CI: 10% to 23%). Prevalence of malnutrition in the period 0-3 months after treatment was significantly higher (25%) than in the periods >3-12 months (13%) and >12-36 months after treatment (3%, p = 0.008). Logistic multivariate regression analysis revealed that swallowing problems (p = 0.021) and insufficient protein intake were significantly related to malnutrition (p = 0.016). CONCLUSIONS In conclusion, malnutrition is a considerable problem in patients treated for oral/oropharyngeal cancer, shortly after treatment. Of all oral symptoms, only swallowing problems were significantly related to malnutrition in the period after treatment for oral/oropharyngeal cancer.
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Affiliation(s)
- Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Internal zip code BB70, PO Box 30001, 9700 RB Groningen, The Netherlands.
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Abstract
Phase angle (PhA), a parameter of bioelectrical impedance analysis, is a well-known predictor of morbidity and mortality in various diseases. The causes of decreased PhA are, however, not yet completely understood. We therefore investigated determinants of PhA in 777 hospitalised patients in a retrospective analysis. PhA was assessed by bioelectrical impedance analysis at 50 KHz. Subjective global assessment (SGA) was used to evaluate nutritional status. Age, sex, BMI as well as nutritional status (SGA), benign or malignant disease and C-reactive protein (CRP) were investigated as potential determinants of PhA and standardised PhA (SPhA) = (observed PhA - mean PhA of reference values)/standard deviation of reference values in a general linear model regression analysis. Next to age (estimated effect size, 46·6%; P<0·0001), malnutrition (39·1%; P<0·0001) emerged as a major PhA determinant in our study population. Moreover, sex (6·4%; P<0·0001), CRP (4·4%; P<0·0001) and BMI (3·5%; P < 0·0001) exhibited a significant influence on PhA, whereas malignant disease showed no significant effect in this model. The only significant determinants of SPhA were malnutrition (85·4%; P<0·0001) and inflammation (9·6 %; P<0·0001). In conclusion, next to the established predictors, malnutrition and inflammation have a strong impact on PhA in sick individuals, which partly explains its prognostic power. When investigating the SPhA, only malnutrition and inflammation were found to be significant predictors, as a result of which the SPhA is considered a more suitable indicator of nutritional and health status.
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75
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Berbel MN, Rodrigues Pinto MP, Ponce D, Balbi AL. Nutritional aspects in acute kidney injury. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70118-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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76
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Ferreira LG, Anastácio LR, Lima AS, Correia MITD. Assessment of nutritional status of patients waiting for liver transplantation. Clin Transplant 2011; 25:248-54. [PMID: 20236138 DOI: 10.1111/j.1399-0012.2010.01228.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patients with advanced liver disease have several risk factors to develop nutritional deficiencies. Accurate nutritional assessment is a real challenge because many of the traditionally measured parameters of nutritional status vary with severity of liver disease independently of nutritional status. The objective of this study was to compare different tools used to assess the nutritional status of patients waiting for a liver transplant. Patients were nutritionally assessed by SGA, anthropometry, handgrip dynamometry and biochemical tests. Clinical variables were cross analyzed with the nutritional assessment methods. There were 159 patients followed. Malnutrition ranged from 6.3% to 80.8% according to the different methods used. Agreement among all the methods was low (K < 0.26). Malnutrition prevalence according to different nutritional assessment tools did not differ among this group of patients in relation to the etiology of liver disease (p > 0.05) but increased with the more advanced stages of disease according to the Child-Pugh score. Only SGA showed significant relationships with clinical variables (Child-Pugh scores, p < 0.05; presence of ascites and/or edema, p < 0.01; and encephalopathy, p < 0.01). The various methods used showed great variability of results, lack agreement among them, and only SGA showed correlation with the progression of liver disease.
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Affiliation(s)
- Lívia G Ferreira
- Liver Transplantation Outpatient Clinic, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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77
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Thibault R, Pichard C. Évaluation de la composition corporelle en réanimation : avantages et limites. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-011-0288-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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78
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Cartmill B, Cornwell P, Ward E, Davidson W, Porceddu S. A prospective investigation of swallowing, nutrition, and patient-rated functional impact following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer. Dysphagia 2011; 27:32-45. [PMID: 21344190 DOI: 10.1007/s00455-011-9333-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Accepted: 01/22/2011] [Indexed: 11/30/2022]
Abstract
Altered fractionation radiotherapy for head and neck cancer has been associated with improved locoregional control, overall survival, and heightened toxicity compared with conventional treatment. Swallowing, nutrition, and patient-perceived function for altered fractionation radiotherapy with concomitant boost (AFRT-CB) for T1-T3 oropharyngeal squamous cell carcinoma (SCC) have not been previously reported. Fourteen consecutive patients treated with AFRT-CB for oropharyngeal SCC were recruited from November 2006 to August 2009 in a tertiary hospital in Brisbane, Australia. Swallowing, nutrition, and patient-perceived functional impact assessments were conducted pretreatment, at 4-6 weeks post-treatment, and at 6 months post-treatment. Deterioration from pretreatment to 4-6 weeks post-treatment in swallowing, nutrition, and functional impact was evident, likely due to the heightened toxicity associated with AFRT-CB. There was significant improvement at 6 months post-treatment in functional swallowing, nutritional status, patient-perceived swallowing, and overall function, consistent with recovery from acute toxicity. However, weight and patient perception of physical function and side effects remained significantly worse than pretreatment scores. The ongoing deficits related to weight and patient-perceived outcomes at 6 months revealed that this treatment has a long-term impact on function possibly related to the chronic effects of AFRT-CB.
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Affiliation(s)
- Bena Cartmill
- Speech Pathology Department, Princess Alexandra Hospital, Australia.
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79
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Cardinal TR, Wazlawik E, Bastos JL, Nakazora LM, Scheunemann L. Standardized phase angle indicates nutritional status in hospitalized preoperative patients. Nutr Res 2011; 30:594-600. [PMID: 20934600 DOI: 10.1016/j.nutres.2010.08.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 08/21/2010] [Accepted: 08/30/2010] [Indexed: 12/11/2022]
Abstract
There is currently no criterion standard to assess nutritional status, and different methods have been used in hospitalized patients. The aim of this study was to investigate the agreement and the association between bioelectrical impedance analysis derived by standardized phase angle (SPA) and other methods used for the nutritional assessment of body composition, metabolic status, and functional status in surgical patients. The hypothesis was that the SPA is effective for evaluating nutritional status in surgical patients; therefore, it could be used when the application of other assessment methods is not possible. The sample consisted of 125 patients (20-94 years of age) before elective gastrointestinal or hernia repair. The participants were from the Surgical Clinic 1 at the University Hospital of the Federal University of Santa Catarina, Florianópolis, SC, Brazil. Nutritional status was evaluated during the preoperative period based on the triceps skinfold thickness, mid-arm circumference, body mass index, percent weight loss, nutritional risk screening 2002 (NRS 2002), subjective global assessment (SGA), and SPA. The agreement between the SPA and the other methods was assessed with the k coefficient. The agreement between the SPA and the methods of nutritional assessment that were investigated for diagnosing malnutrition was moderate for NRS 2002 and SGA, weak for percent weight loss, and poor for triceps skinfold thickness, mid-arm circumference, and body mass index. There was a significant association between SPA and both NRS 2002 and SGA (P < .001). Our results suggest that SPA is able to indicate the risk of nutritional deficiency in the patients assessed. However, good agreement between SPA and the methods investigated was not observed.
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Affiliation(s)
- Thiane R Cardinal
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
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80
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Burden S, Todd C, Hill J, Lal S. Preoperative Nutrition in Patients Undergoing Gastrointestinal Surgery. Cochrane Database Syst Rev 2010. [DOI: 10.1002/14651858.cd008879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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81
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Wirth R, Volkert D, Rösler A, Sieber C, Bauer J. Bioelectric impedance phase angle is associated with hospital mortality of geriatric patients. Arch Gerontol Geriatr 2010; 51:290-4. [DOI: 10.1016/j.archger.2009.12.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 11/29/2009] [Accepted: 12/02/2009] [Indexed: 12/22/2022]
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Jager-Wittenaar H, Dijkstra PU, Vissink A, van der Laan BFAM, van Oort RP, Roodenburg JLN. Malnutrition and quality of life in patients treated for oral or oropharyngeal cancer. Head Neck 2010; 33:490-6. [DOI: 10.1002/hed.21473] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 03/16/2010] [Accepted: 03/31/2010] [Indexed: 11/12/2022] Open
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Norman K, Stobäus N, Zocher D, Bosy-Westphal A, Szramek A, Scheufele R, Smoliner C, Pirlich M. Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life, and mortality in patients with cancer. Am J Clin Nutr 2010; 92:612-9. [PMID: 20631202 DOI: 10.3945/ajcn.2010.29215] [Citation(s) in RCA: 245] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The bioelectrical phase angle has shown predictive potential in various diseases, but general cutoffs are lacking in the clinical setting. OBJECTIVES This study evaluated the prognostic value of the fifth percentile of sex-, age-, and body mass index-stratified phase angle reference values in patients with cancer with respect to nutritional and functional status, quality of life, and 6-mo mortality. In a second step, we also studied the effect of the standardized phase angle (with a z score to determine individual deviations from the population average) on these variables. DESIGN A total of 399 patients with cancer were studied. Phase angle was obtained with bioelectrical impedance analysis; muscle function was assessed by handgrip strength and peak expiratory flow. Quality of life was determined by the European Organization for Research and Treatment of Cancer questionnaire. Nutritional status was assessed by using Subjective Global Assessment. Survival of patients was documented after 6 mo. RESULTS Patients with a phase angle of less than the fifth reference percentile had significantly lower nutritional and functional status, impaired quality of life (P lt 0.0001), and increased mortality (P lt 0.001). The standardized phase angle emerged as a significant predictor for malnutrition and impaired functional status in generalized linear model regression analyses. It was also a stronger indicator of 6-mo survival than were malnutrition and disease severity in the Cox regression model (P lt 0.0001) and according to the receiver operating characteristic curve. CONCLUSIONS The standardized phase angle is an independent predictor for impaired nutritional and functional status and survival. The fifth phase angle reference percentile is a simple and prognostically relevant cutoff for detection of patients with cancer at risk for these factors.
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Affiliation(s)
- Kristina Norman
- Department of Gastroenterology, Charité-Universitätsmedizin Berlin, Germany.
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84
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Heersink JT, Brown CJ, Dimaria-Ghalili RA, Locher JL. Undernutrition in hospitalized older adults: patterns and correlates, outcomes, and opportunities for intervention with a focus on processes of care. ACTA ACUST UNITED AC 2010; 29:4-41. [PMID: 20391041 DOI: 10.1080/01639360903574585] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Undernutrition in hospitalized older adults is increasingly being recognized as a serious problem with implications for both patient care and outcomes and health service utilization and costs. This article presents an overview of research that has been conducted examining undernutrition in hospitalized older adults. First, findings from observational studies examining patterns and predictors of undernutrition in hospitalized older adults will be described, with a focus on methodological challenges. Second, clinical outcomes and costs associated with undernutrition in hospitalized older adults will be presented, both while in the hospital and subsequent to discharge. Third, a description of interventions that have already been implemented in hospitalized older adults will be described. Finally, future areas of inquiry and opportunities for evidence-based nutritional interventions targeted at older adults during and following hospitalization will be suggested. The emphasis of the discussion on interventions will focus on processes of care and the hospital environment.
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Affiliation(s)
- Juanita Titrud Heersink
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-2041, USA
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85
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Aslani A, Gill AJ, Roach PJ, Allen BJ, Smith RC. Preoperative body composition is influenced by the stage of operable pancreatic adenocarcinoma but does not predict survival after Whipple's procedure. HPB (Oxford) 2010; 12:325-33. [PMID: 20590908 PMCID: PMC2951821 DOI: 10.1111/j.1477-2574.2010.00171.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Cachexia is common in pancreatic cancer and may have an influence on longterm survival but few studies have investigated this in patients with operable tumours. Therefore, this study was carried out to document body composition status in patients with pancreatic adenocarcinoma (PCa) presenting for a Whipple's procedure (WP) and to relate the findings to histopathology and longterm survival. METHODS Body composition was measured 1 day before a WP for ductal PCa in 36 patients (15 men, 21 women) aged 41-81 years. Results for total body nitrogen (TBN), nitrogen index (NI), total body water (TBW), fat mass (FM) and total body potassium (TBK) were compared with results in 73 age- and sex-matched controls. Patients' survival and details from histopathology synoptic reports were documented. RESULTS Patients undergoing WPs had low TBK values (P < 0.001) and females had lower body fat (P = 0.007) compared with controls. Five of 36 presented with significant protein deficiency, but this was not associated with a prolonged length of stay or reduced survival. The 12 patients who had involved surgical margins had larger tumours and reduced weight (P = 0.015), FM (P = 0.001), TBN (P = 0.045), TBK (P = 0.014) and survival (P = 0.036). However, multivariate Cox's regression analysis only included FM along with vascular invasion and margin status as independent predictors of survival. CONCLUSIONS PCa patients undergoing a WP have reduced body fat and TBK compared with community controls while those with stage III tumours had greater deficits of fat, TBK and protein stores. However, preoperative body composition was a poor predictor of postoperative survival after pathological data were considered.
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Affiliation(s)
- Alireza Aslani
- Department of Nuclear Medicine, Northern Clinical School, University of Sydney at Royal North Shore HospitalSt Leonards, NSW, Australia
| | - Anthony J Gill
- Department of Anatomical Pathology, Northern Clinical School, University of Sydney at Royal North Shore HospitalSt Leonards, NSW, Australia
| | - Paul J Roach
- Department of Nuclear Medicine, Northern Clinical School, University of Sydney at Royal North Shore HospitalSt Leonards, NSW, Australia
| | - Barry J Allen
- Department of Nuclear Medicine, Northern Clinical School, University of Sydney at Royal North Shore HospitalSt Leonards, NSW, Australia
| | - Ross C Smith
- University Department of Surgery, Northern Clinical School, University of Sydney at Royal North Shore HospitalSt Leonards, NSW, Australia
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Paiva SI, Borges LR, Halpern-Silveira D, Assunção MCF, Barros AJD, Gonzalez MC. Standardized phase angle from bioelectrical impedance analysis as prognostic factor for survival in patients with cancer. Support Care Cancer 2009; 19:187-92. [PMID: 20039074 DOI: 10.1007/s00520-009-0798-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 12/08/2009] [Indexed: 12/13/2022]
Abstract
PURPOSE Phase angle (PA), determined by bioelectrical impedance analysis (BIA), has been considered as a prognostic factor in several clinical conditions. The purpose of this study is to investigate PA, after adjusting for sex and age (standardized phase angle; SPA) as a prognostic factor for survival in cancer patients. METHODS A prospective study was conducted in 195 patients before the first chemotherapy course. BIA was performed in all patients and SPA was calculated. The Kaplan-Meier method was used to calculate survival. The Cox regression method was used to evaluate the independent prognostic effect of PA after adjustment for other variables. RESULTS Patients with SPA < -1.65 had a smaller survival rate than those with SPA ≥ -1.65 (p < 0.001). Using Cox regression, the mortality rate was higher in patients with SPA < -1.65 (RR 3.12 CI: 2.03-4.79; p < 0.001). After multivariate analysis, patients with PA < -1.65 still presented a higher mortality rate (RR 2.35 CI: 1.41-3.90; p = 0.001). CONCLUSIONS The present study demonstrates that PA, used as SPA, is an independent prognostic indicator in this group of cancer patients receiving chemotherapy treatment even after adjustment for other prognostic variables.
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Affiliation(s)
- Silvana Iturriet Paiva
- Post-graduate Program, Health and Behaviour, Catholic University of Pelotas, Rua Porto Alegre 492, 96090-520 Pelotas, RS, Brazil.
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87
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Wu B, Yin TT, Cao W, Gu ZD, Wang X, Yan M, Liu B. Validation of the Chinese version of the Subjective Global Assessment scale of nutritional status in a sample of patients with gastrointestinal cancer. Int J Nurs Stud 2009; 47:323-31. [PMID: 19700157 DOI: 10.1016/j.ijnurstu.2009.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 07/12/2009] [Accepted: 07/14/2009] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS To verify the validity of the Subjective Global Assessment (SGA) on the nutritional assessment and prognosis prediction in Chinese patients with gastrointestinal cancer. METHODS Five hundred and five patients with newly diagnosed gastrointestinal cancer who underwent surgeries were enrolled between August 2004 and August 2006. The sample consisted of 307 males (60.8%) and 198 females (39.2%). The nutritional status was assessed using SGA for each patient prior to operation. Simultaneously, anthropometric parameters and laboratory tests including serum albumin (ALB) and prealbumin (PA) levels were also obtained. The postoperative evaluation included length of stay, occurrence of complications, and in-hospital medical expenditures. RESULTS Based on the results of preoperative SGA, the patients were classified into 3 groups: well nourished (group A), mildly to moderately malnourished (group B), and severely malnourished (group C). The number in each group was 275 (54.4%), 214 (42.4%), and 16 (3.2%), respectively. ANOVA tests revealed significant group differences existed for body mass index (BMI), triceps skinfold thickness (TSF), PA, ALB, length of stay, and in-hospital medical expenditures (p<0.05). The more severely malnourished the patient, the BMI, TSF, PA, and ALB became lower, the length of stay became longer and the medical cost became higher. The occurrence of postoperative complications did not show significant difference among the different SGA groups (X(2)=4.16, p=0.125). And patients in different cancer stages (TNM staging) had no statistical differences in terms of their length of stay (F=1.433, p=0.232) and the occurrence of postoperative complications (X(2)=4.836, p=0.184). CONCLUSIONS The SGA is safe, inexpensive, and easy to use clinically for nurses. This study demonstrated that it can be a reliable method to assess the nutritional status of Chinese patients with gastrointestinal cancer. The SGA could also help predict certain health outcomes, such as length of stay, in-hospital medical expenditures.
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Affiliation(s)
- Beiwen Wu
- School of Nursing, Shanghai JiaoTong University, Shanghai, 200025, PR China
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88
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Desport JC, Marin B, Funalot B, Preux PM, Couratier P. Phase angle is a prognostic factor for survival in amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2009; 9:273-8. [DOI: 10.1080/17482960801925039] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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89
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Feferbaum R, Delgado AF, Zamberlan P, Leone C. Challenges of nutritional assessment in pediatric ICU. Curr Opin Clin Nutr Metab Care 2009; 12:245-50. [PMID: 19318938 DOI: 10.1097/mco.0b013e32832a3f43] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The nutritional assessment of children in the pediatric ICU is unique in view of the metabolic changes of the underlying disease. This review addresses the use and limitations of anthropometry and laboratorial and body composition markers in the diagnosis of the nutritional status of such patients. RECENT FINDINGS The presence of inflammatory activity leads to body composition changes (lean mass reduction) and undernutrition. Nutritional assessment in pediatric ICU must prioritize anthropometric and laboratory markers that can differentiate body composition to detect specific macronutrient and micronutrient deficiencies and assessment of the inflammatory activity. SUMMARY Nutritional assessment is one of the main aspects of the pediatric intensive care patient and is the most important tool to avoid hospital undernutrition. There is currently no gold standard for nutritional assessment in the pediatric ICU. The results of anthropometric and laboratory markers must be jointly analyzed, but individually interpreted according to disease and metabolic changes, in order to reach a correct diagnosis of the nutritional status and to plan and monitor the nutritional treatment.
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Affiliation(s)
- Rubens Feferbaum
- Division of Neonatology, Department of Pediatrics, Instituto da Criança, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.
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90
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Schiesser M, Kirchhoff P, Müller MK, Schäfer M, Clavien PA. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery 2009; 145:519-26. [PMID: 19375611 DOI: 10.1016/j.surg.2009.02.001] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 02/04/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Malnutrition in gastrointestinal (GI) surgery is associated with increased morbidity. Therefore, careful screening remains crucial to identify patients at risk for malnutrition and consequently postoperative complications. The aim of this study was to evaluate the ability of 3 established score systems to identify patients at risk of developing postoperative complications in GI surgery and to assess the correlation among the score systems. METHODS We evaluated prospectively 200 patients admitted for elective GI surgery using (1) nutrition risk index, (2) nutrition risk score, and (3) bioelectrical impedance analysis. Complications were assessed using a standardized complication classification. The findings of the score systems were correlated with the incidence and severity of complications. Parametric and nonparametric correlation analysis was performed among the different score systems. RESULTS All 3 score systems correlated significantly with the incidence and severity of postoperative complications and the duration of hospital stay. Using multiple regression analysis, only nutrition risk score and malignancy remained prognostic factors for the development of complications with odds ratios of 4.2 (P = .024) and 5.6 (P < .001), respectively. The correlation between nutrition risk score and nutrition risk index was only moderate (Pearson coefficient = 0.54). Bioelectrical impedance analysis displayed only weak to trivial correlation to the nutrition risk index (0.32) and nutrition risk score (0.19), respectively. CONCLUSION The nutrition risk score, nutrition risk index, and bioimpedance analysis correlate with the incidence and severity of perioperative complications in GI surgery. The nutrition risk score was the best score in predicting patients who will develop complications in this study population. The correlation between the individual scores was only moderate, and therefore, they do not necessarily identify the same patients.
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Affiliation(s)
- Marc Schiesser
- Department of Surgery, University Hospital Zürich, Switzerland
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91
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Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008; 27:5-15. [PMID: 18061312 DOI: 10.1016/j.clnu.2007.10.007] [Citation(s) in RCA: 873] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 06/21/2007] [Accepted: 10/12/2007] [Indexed: 12/15/2022]
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García Sánchez I, Pérez de Oteyza C, Calvo Lasso de la Vega E, Castuera Gil A. [Nutrition alterations in internal medicine. Body composition analysis with bioelectrical impedance]. Rev Clin Esp 2007; 207:6-12. [PMID: 17306146 DOI: 10.1157/13098492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To determine the prevalence of malnutrition in patients in Internal Medicine. To describe the changes of corporal composition depending on body mass index (BMI). To evaluate validity of the different screening tools for the estimation of body composition. MATERIAL AND METHODS Prospective observational cross-sectional study of the prevalence of malnutrition in 300 patients (sample 1); these were chosen 136 patients (sample 2), classifying in four groups: BMI < 20: 30 patients; BMI = 20-25: 46 patients; BMI = 25-30: 30 patients, and BMI > 30: 30 patients. In the patients of sample 2, we carried out a protocol of nutritional evaluation with anthropometry, laboratory and bioelectrical impedance analysis. RESULTS The prevalence of desnutrition was 9.3% and the obesity was 22.3%. In undernourished patients, the measure of body compartments with bioelectrical impedance, expressed in percentage of body weight, were: fat mass 20.5%, fat-free mass 79.4% and total body mater 58.3%. The body composition in obeses was: fat mass 40.1%, fat-free mass 60.6% and total body water 44.3%. The patients with normal BMI, the meta index (impedance at 50 kHz/BMI) was 25.9 +/- 5.21; in undernourished the index was higher (36.7) and obeses lower (15.5). The meta index (30-20) estimates desnutrition-obesity with high sensibility and specificity. The prevalence of desnutrition varies from 6% to 69% and obesity from 23% to 74%, using different methods and criterions for the estimation of body composition. CONCLUSIONS In Internal Medicine, the overweight (BMI > 25) is the most prevalent nutritional alteration. The bioelectrical impedance analysis helps for estimation of body composition and meta index is a very useful indicator of malnutrition (desnutrition-obesity).
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Affiliation(s)
- I García Sánchez
- Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España.
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93
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Jager-Wittenaar H, Dijkstra PU, Vissink A, van der Laan BFAM, van Oort RP, Roodenburg JLN. Critical weight loss in head and neck cancer—prevalence and risk factors at diagnosis: an explorative study. Support Care Cancer 2007; 15:1045-50. [PMID: 17277925 DOI: 10.1007/s00520-006-0212-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 12/20/2006] [Indexed: 01/17/2023]
Abstract
GOALS OF WORK Critical weight loss (> or =5% in 1 month or > or =10% in 6 months) is a common phenomenon in head and neck cancer patients. It is unknown which complaints are most strongly related to critical weight loss in head and neck cancer patients at the time of diagnosis. The aim of this explorative study was to assess the prevalence of critical weight loss and to analyze risk factors for critical weight loss in head and neck cancer patients before treatment. MATERIALS AND METHODS Critical weight loss and factors reducing dietary intake were assessed in 447 patients referred to an ear, nose and throat clinic at the time of diagnosis. MAIN RESULTS In total, data of 407 patients were analyzed. Critical weight loss was present in 19% of the patients. Patients with cancer in the hypopharynx, oropharynx/oral cavity and supraglottic larynx had the highest risk for critical weight loss. Loss of appetite, dysphagia/passage difficulties and loss of taste/aversion were significantly (p < 0.05) associated with critical weight loss. CONCLUSIONS Already before treatment, critical weight loss is a considerable problem in head and neck cancer patients. Critical weight loss is frequently observed in patients with cancer in the hypopharynx, oropharynx/oral cavity and supraglottic larynx.
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Affiliation(s)
- Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
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Barbosa-Silva MCG, Barros AJD. Indications and limitations of the use of subjective global assessment in clinical practice: an update. Curr Opin Clin Nutr Metab Care 2006; 9:263-9. [PMID: 16607126 DOI: 10.1097/01.mco.0000222109.53665.ed] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Subjective global assessment is a clinical tool for assessing nutritional status that merges alterations in body composition and physiological function. Although it was first described almost two decades ago, many studies using this method have been published during the past few years. This review describes recent findings from such studies. RECENT FINDINGS Subjective global assessment has proved to be a good nutritional assessment and prognostic indicator in several clinical situations. Agreement between subjective global assessment and newer screening methods is not always acceptable, and it has not been validated with respect to clinical outcome. Some modifications have been suggested that may increase the sensitivity of subjective global assessment as a screening tool. A scored version of subjective global assessment for cancer patients is now being validated for use in other patient groups. This could increase its utility in nutritional intervention studies if it can be demonstrated that subtle changes in nutritional status are reflected by numerical scores in patient-generated subjective global assessment. SUMMARY Subjective global assessment represents a good option for assessing nutritional status in various clinical situations. As a screening tool, it better identifies established malnutrition than nutritional risk but its sensitivity is suboptimal. The scored version of subjective global assessment may have advantages and extend the usefulness of this tool even further.
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