1201
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ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 652] [Impact Index Per Article: 108.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
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1202
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van Doorn-van Atten MN, Haveman-Nies A, Heery D, de Vries JHM, de Groot LCPGM. Feasibility and Effectiveness of Nutritional Telemonitoring for Home Care Clients: A Pilot Study. THE GERONTOLOGIST 2018; 59:158-166. [DOI: 10.1093/geront/gny059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Indexed: 01/05/2023] Open
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1203
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Sanson G, Bertocchi L, Dal Bo E, Di Pasquale CL, Zanetti M. Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults: A prospective longitudinal study. Int J Nurs Stud 2018; 82:40-48. [DOI: 10.1016/j.ijnurstu.2018.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 01/10/2023]
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1204
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Real GG, Frühauf IR, Sedrez JHK, Dall'Aqua EJF, Gonzalez MC. Calf Circumference: A Marker of Muscle Mass as a Predictor of Hospital Readmission. JPEN J Parenter Enteral Nutr 2018; 42:1272-1279. [DOI: 10.1002/jpen.1170] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/19/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Gustavo Gonzales Real
- Internist and Gastroenterologist, Postgraduate Program in Health and Behavior; Universidade Católica de Pelotas (UCPel); Pelotas RS Brazil
| | | | | | | | - Maria Cristina Gonzalez
- Postgraduate Program in Health and Behavior; Universidade Católica de Pelotas; (UCPel), Pelotas RS Brazil
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1205
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Adamski M, Gibson S, Leech M, Truby H. Are doctors nutritionists? What is the role of doctors in providing nutrition advice? NUTR BULL 2018. [DOI: 10.1111/nbu.12320] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - S. Gibson
- Monash University; Melbourne Australia
| | - M. Leech
- Monash University; Melbourne Australia
| | - H. Truby
- Monash University; Melbourne Australia
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1206
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Barazzoni R, Bischoff SC, Boirie Y, Busetto L, Cederholm T, Dicker D, Toplak H, Van Gossum A, Yumuk V, Vettor R. Sarcopenic obesity: Time to meet the challenge. Clin Nutr 2018; 37:1787-1793. [PMID: 29857921 DOI: 10.1016/j.clnu.2018.04.018] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 01/01/2023]
Abstract
The prevalence of overweight and obesity has reached epidemic proportions worldwide due to increasingly pervasive obesogenic lifestyle changes. Obesity poses unprecedented individual, social and multi-disciplinary medical challenges by increasing the risk for metabolic diseases, chronic organ failures and cancer, as well as complication rates in the presence of acute disease conditions. Whereas reducing excess adiposity remains the fundamental pathogenetic treatment for obese individuals, complex metabolic and lifestyle abnormalities as well as weight-reduction therapies per se may also compromise the ability to preserve muscle function and mass, especially when chronic disease co-exists with obesity. Emerging evidence indicates that low muscle mass and quality have a strong negative prognostic impact in obese individuals and may lead to frailty, disability and increased morbidity and mortality. Awareness of the importance of skeletal muscle maintenance in obesity is however low among clinicians and scientists. The term "sarcopenic obesity" has been proposed to identify obesity with low skeletal muscle function and mass, but its utilization is largely limited to the aging patient population, and consensus on its definition and diagnostic criteria remains insufficient. Knowledge on prevalence of sarcopenic obesity in various clinical conditions and patient subgroups, on its clinical impacts in patient risk stratification and on effective prevention and treatment strategies remain therefore dramatically inadequate. In particular, optimal dietary options and medical nutritional support strategies to preserve muscle mass in obese individuals remain largely undefined. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recognize and indicate obesity with altered body composition due to low skeletal muscle function and mass (sarcopenic obesity) as a scientific and clinical priority for researchers and clinicians. ESPEN and EASO therefore call for coordinated action aimed at reaching consensus on its definition, diagnostic criteria and optimal treatment with particular regard to nutritional therapy. We are convinced that achievement of these goals has strong potential to reduce the burden of morbidity and mortality in the rapidly increasing obese patient population.
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Affiliation(s)
- Rocco Barazzoni
- Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy.
| | - Stephan C Bischoff
- University of Hohenheim, Department of Nutritional Medicine, Stuttgart, Germany
| | - Yves Boirie
- Université Clermont Auvergne, INRA, UNH, Unité de Nutrition Humaine, CRNH Auvergne, F-63000 Clermont-Ferrand, France; CHU Clermont-Ferrand, Service Nutrition Clinique, F-63000 Clermont-Ferrand, France
| | - Luca Busetto
- Department of Medicine, University of Padova, Italy; Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy
| | - Tommy Cederholm
- Uppsala University, Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala, Sweden
| | - Dror Dicker
- Internal Medicine Department & Obesity Clinic, Hasharon Hospital-Rabin Medical Center, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hermann Toplak
- Department of Medicine, Medical University Graz, Austria
| | - Andre Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Roberto Vettor
- Department of Medicine, University of Padova, Italy; Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy
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1207
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van der Meij BS, Teleni L, Engelen MPKJ, Deutz NEP. Amino acid kinetics and the response to nutrition in patients with cancer. Int J Radiat Biol 2018; 95:480-492. [PMID: 29667485 DOI: 10.1080/09553002.2018.1466209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE Amino acids are involved in many physiological processes in the body and serve as building blocks of proteins which are the main component of muscle mass. Often patients with cancer experience muscle wasting, which is associated with poor outcomes. The purpose of this paper is to discuss amino acid kinetics in cancer, review the evidence on the response to nutrition in patients with cancer, and to give recommendations on the appropriate level of amino acid or protein intake in cancer. Current evidence shows that amino acid kinetics in patients with cancer are disturbed, as reflected by increased and decreased levels of plasma amino acids, an increased whole body turnover of protein and muscle protein breakdown. A few studies show beneficial effects of acute and short-term supplementation of high protein meals or essential amino acid mixtures on muscle protein synthesis. CONCLUSIONS Cancer is associated with disturbances in amino acid kinetics. A high protein intake or supplementation of amino acids may improve muscle protein synthesis. Future research needs to identify the optimal level and amino acid mixtures for patients with cancer, in particular for those who are malnourished.
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Affiliation(s)
- Barbara S van der Meij
- a Faculty of Health Sciences and Medicine , Bond University , Gold Coast , Australia.,b Nutrition and Dietetics , Mater Group , Brisbane , Australia
| | - Laisa Teleni
- a Faculty of Health Sciences and Medicine , Bond University , Gold Coast , Australia
| | - Marielle P K J Engelen
- c Department Health and Kinesiology , Center for Translational Research in Aging & Longevity, Texas A&M University , College Station , TX , USA
| | - Nicolaas E P Deutz
- c Department Health and Kinesiology , Center for Translational Research in Aging & Longevity, Texas A&M University , College Station , TX , USA
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1208
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Clinical application of the basic definition of malnutrition proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN): Comparison with classical tools in geriatric care. Arch Gerontol Geriatr 2018; 76:210-214. [DOI: 10.1016/j.archger.2018.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 02/03/2018] [Accepted: 03/04/2018] [Indexed: 12/11/2022]
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1209
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Uccella S, Mele MC, Quagliozzi L, Rinninella E, Nero C, Cappuccio S, Cintoni M, Gasbarrini A, Scambia G, Fagotti A. Assessment of preoperative nutritional status using BIA-derived phase angle (PhA) in patients with advanced ovarian cancer: Correlation with the extent of cytoreduction and complications. Gynecol Oncol 2018; 149:263-269. [DOI: 10.1016/j.ygyno.2018.03.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 01/07/2023]
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1210
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Lim ML, Yong BYP, Mar MQM, Ang SY, Chan MM, Lam M, Chong NCJ, Lopez V. Caring for patients on home enteral nutrition: Reported complications by home carers and perspectives of community nurses. J Clin Nurs 2018. [PMID: 29518266 DOI: 10.1111/jocn.14347] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS AND OBJECTIVES To explore the experiences of community nurses and home carers, in caring for patients on home enteral nutrition. BACKGROUND The number of patients on home enteral nutrition is on the increase due to advancement in technology and shift in focus of providing care from acute to community care settings. METHODS A mixed-method approach was adopted. (i) A face-to-face survey design was used to elicit experience of carers of patients on home enteral nutrition. (ii) Focus group interviews were conducted with community nurses. RESULTS Ninety-nine carers (n = 99) were recruited. Patient's mean age that they cared for was aged 77.7 years (SD = 11.2), and they had been on enteral feeding for a mean of 29 months (SD = 23.0). Most were bed-bound (90%) and required full assistance with their feeding (99%). Most were not on follow-up with dietitians (91%) and dentists (96%). The three most common reported gastrointestinal complications were constipation (31%), abdominal distension (28%) and vomiting (22%). Twenty community nurses (n = 20) were recruited for the focus group interviews. Four main themes emerged from the analysis: (i) challenge of accessing allied health services in the community; (ii) shorter length of stay in the acute care setting led to challenges in carers' learning and adaptation; (iii) transition gaps between hospital and home care services; and (iv) managing expectations of family. CONCLUSION To facilitate a better transition of care for patients, adequate training for carers, standardising clinical practice in managing patients with home enteral nutrition and improving communication between home care services and the acute care hospitals are needed. RELEVANCE TO CLINICAL PRACTICE This study highlighted the challenges faced by community home care nurses and carers. Results of this study would help to inform future policies and practice changes that would improve the quality of care received by patients on home enteral nutrition.
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Affiliation(s)
- Mei Ling Lim
- Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | | | | | | | - Violeta Lopez
- National University of Singapore, Singapore, Singapore
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1211
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Więch P, Dąbrowski M, Bazaliński D, Sałacińska I, Korczowski B, Binkowska-Bury M. Bioelectrical Impedance Phase Angle as an Indicator of Malnutrition in Hospitalized Children with Diagnosed Inflammatory Bowel Diseases-A Case Control Study. Nutrients 2018; 10:nu10040499. [PMID: 29673210 PMCID: PMC5946284 DOI: 10.3390/nu10040499] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 01/05/2023] Open
Abstract
The phase angle (PhA) seems to be a reliable screening tool for the identification of malnutrition risk in hospitalized children with inflammatory bowel disease (IBD). The aim of the present study was to assess the body composition and nutritional status of hospitalized children and adolescents with IBD by using bioelectrical impedance analysis (BIA) with phase angle (PhA) calculation, which has not been evaluated in hospitalized children with IBD yet. A total of 59 children and adolescents aged 4–18 years, with IBD: 34 ulcerative colitis (UC) and 25 Crohn’s disease (CD) were included in the study. The control group consisted of healthy children and adolescents, strictly matched for gender and age in a 1:1 case-control manner. In both groups, BIA was performed and PhA was calculated. IBD patients had significantly lower PhA (UC: 5.34 ± 1.34 vs. 5.96 ± 0.76, p = 0.040; CD: 5.16 ± 1.18 vs. 5.90 ± 0.62, p = 0.009) compared to the control subjects. Significant changes in selected body composition parameters were observed particularly in CD, especially in fat free mass components. Lower phase angle score together with lower body composition parameters and selected nutrition indicators in children and adolescents with IBD demonstrate their worse nutritional and functional status compared to healthy subjects.
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Affiliation(s)
- Paweł Więch
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, 35959 Rzeszów, Poland.
| | - Mariusz Dąbrowski
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, 35959 Rzeszów, Poland.
- Diabetic Outpatient Clinic, Medical Center "Beta-Med", 35073 Rzeszów, Poland.
| | - Dariusz Bazaliński
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, 35959 Rzeszów, Poland.
| | - Izabela Sałacińska
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, 35959 Rzeszów, Poland.
| | - Bartosz Korczowski
- Pediatric Department, Clinical Provincial Hospital No. 2 in Rzeszów, Faculty of Medicine, University of Rzeszów, 35301 Rzeszów, Poland.
| | - Monika Binkowska-Bury
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, 35959 Rzeszów, Poland.
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1212
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Savas S. Revize mini nütrisyonel değerlendirme-kısa form ile sık kullanılan üç malnütrisyon tarama aracının hastanede yatan yaşlı hastalarda karşılaştırılması. EGE TIP DERGISI 2018. [DOI: 10.19161/etd.454035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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1213
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Elia M, Parsons EL, Cawood AL, Smith TR, Stratton RJ. Cost-effectiveness of oral nutritional supplements in older malnourished care home residents. Clin Nutr 2018; 37:651-658. [DOI: 10.1016/j.clnu.2017.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/30/2017] [Accepted: 02/07/2017] [Indexed: 01/07/2023]
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1214
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Ní Bhuachalla ÉB, Daly LE, Power DG, Cushen SJ, MacEneaney P, Ryan AM. Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition? J Cachexia Sarcopenia Muscle 2018; 9:295-305. [PMID: 29271097 PMCID: PMC5879969 DOI: 10.1002/jcsm.12258] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/15/2017] [Accepted: 10/02/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Nutrition screening on admission to hospital is mandated in many countries, but to date, there is no consensus on which tool is optimal in the oncology setting. Wasting conditions such as cancer cachexia (CC) and sarcopenia are common in cancer patients and negatively impact on outcomes; however, they are often masked by excessive adiposity. This study aimed to inform the application of screening in cancer populations by investigating whether commonly used nutritional screening tools are adequately capturing nutritionally vulnerable patients, including those with abnormal body composition phenotypes (CC, sarcopenia, and myosteatosis). METHODS A prospective study of ambulatory oncology outpatients presenting for chemotherapy was performed. A detailed survey incorporating clinical, nutritional, biochemical, and quality of life data was administered. Participants were screened for malnutrition using the Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and the Nutritional Risk Index (NRI). Computed tomography (CT) assessment of body composition was performed to diagnose CC, sarcopenia, and myosteatosis according to consensus criteria. RESULTS A total of 725 patients (60% male, median age 64 years) with solid tumours participated (45% metastatic disease). The majority were overweight/obese (57%). However, 67% were losing weight, and CT analysis revealed CC in 42%, sarcopenia in 41%, and myosteatosis in 46%. Among patients with CT-identified CC, the MUST, MST, and NRI tools categorized 27%, 35%, and 7% of them as 'low nutritional risk', respectively. The percentage of patients with CT-identified sarcopenia and myosteatosis that were categorised as 'low nutritional risk' by MUST, MST and NRI were 55%, 61%, and 14% and 52%, 50%, and 11%, respectively. Among these tools, the NRI was most sensitive, with scores <97.5 detecting 85.8%, 88.6%, and 92.9% of sarcopenia, myosteatosis, and CC cases, respectively. Using multivariate Cox proportional hazards models, NRI score < 97.5 predicted greater mortality risk (hazard ratio 1.8, confidence interval: 1.2-2.8, P = 0.007). CONCLUSIONS High numbers of nutritionally vulnerable patients, with demonstrated abnormal body composition phenotypes on CT analysis, were misclassified by MUST and MST. Caution should be exercised when categorizing the nutritional risk of oncology patients using these tools. NRI detected the majority of abnormal body composition phenotypes and independently predicted survival. Of the tools examined, the NRI yielded the most valuable information from screening and demonstrated usefulness as an initial nutritional risk grading system in ambulatory oncology patients.
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Affiliation(s)
- Éadaoin B Ní Bhuachalla
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.,Cork Cancer Research Centre, University College Cork, Cork, Ireland
| | - Louise E Daly
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Derek G Power
- Department of Medical Oncology, Mercy and Cork University Hospital, Cork, Ireland
| | - Samantha J Cushen
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Peter MacEneaney
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Aoife M Ryan
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.,Cork Cancer Research Centre, University College Cork, Cork, Ireland
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1215
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Abstract
PURPOSE OF REVIEW This review gives an overview of the evolving concept of physical frailty in patients with cirrhosis. As well as summarizing the available metrics that have been used to diagnose it, this review also examines the major recent trials that have investigated frailty in patients with cirrhosis. The complex relationship between sarcopenia and frailty is explored, and strategies to optimize frailty, such as including pharmacological and non-pharmacological therapies, are discussed. RECENT FINDINGS Though there is heterogeneity between studies on how physical frailty in cirrhosis has been assessed, it is nonetheless becoming increasingly apparent that frailty in cirrhosis contributes to poor outcomes. A growing body of evidence strongly supports that frailty, as an entity distinct from comorbidity or measurable by laboratory-based liver disease severity, contributes to pre-transplant mortality and unplanned hospital admissions. If taken into account, frailty may improve pre-transplant mortality risk prediction. Physical frailty in cirrhosis may be objectively assessed by a number of validated metrics though at present, we lack a uniform consensus on the most appropriate tool. Early identification of frailty may allow optimization of the patient with the potential to avoiding adverse outcomes. Further studies are awaited validating and exploring optimal approaches to diagnosing and reversing frailty.
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1216
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Keller HH, Valaitis R, Laur CV, McNicholl T, Xu Y, Dubin JA, Curtis L, Obiorah S, Ray S, Bernier P, Gramlich L, Stickles-White M, Laporte M, Bell J. Multi-site implementation of nutrition screening and diagnosis in medical care units: Success of the More-2-Eat project. Clin Nutr 2018; 38:897-905. [PMID: 29605573 DOI: 10.1016/j.clnu.2018.02.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/04/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Improving the detection and treatment of malnourished patients in hospital is needed to promote recovery. AIM To describe the change in rates of detection and triaging of care for malnourished patients in 5 hospitals that were implementing an evidence-based nutrition care algorithm. To demonstrate that following this algorithm leads to increased detection of malnutrition and increased treatment to mitigate this condition. METHODS Sites worked towards implementing the Integrated Nutrition Pathway for Acute Care (INPAC), including screening (Canadian Nutrition Screening Tool) and triage (Subjective Global Assessment; SGA) to detect and diagnose malnourished patients. Implementation occurred over a 24-month period, including developmental (Period 1), implementation (Periods 2-5), and sustainability (Period 6) phases. Audits (n = 36) of patient health records (n = 5030) were conducted to identify nutrition care practices implemented with a variety of strategies and behaviour change techniques. RESULTS All sites increased nutrition screening from Period 1, with three achieving the goal of 75% of admitted patients being screened by Period 3, and the remainder achieving a rate of 70% by end of implementation. No sites were conducting SGA at Period 1, and sites reached the goal of a 75% completion rate or referral for those identified to be at nutrition risk, by Period 3 or 4. By Period 2, 100% of patients identified as SGA C (severely malnourished) were receiving a comprehensive nutritional assessment. In Period 1, the nutrition diagnosis and documentation by the dietitian of 'malnutrition' was a modest 0.37%, increasing to over 5% of all audited health records. The overall use of any Advanced Nutrition Care practices increased from 31% during Period 1 to 63% during Period 6. CONCLUSION The success of this multi-site study demonstrated that implementation of nutrition screening and diagnosis is feasible and leads to appropriate care. INPAC promotes efficiency in nutrition care while minimizing the risk of missing malnourished patients. TRIAL REGISTRATION Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304, June 7, 2016.
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Affiliation(s)
- Heather H Keller
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada; Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Canada.
| | - Renata Valaitis
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada
| | - Celia V Laur
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada; NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cowley Road, Cambridge CB4 0WS, UK
| | - Tara McNicholl
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada
| | - Yingying Xu
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada
| | - Joel A Dubin
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada
| | - Lori Curtis
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L3G1, Canada
| | - Suzanne Obiorah
- The Ottawa Hospital, L'Hôpital d'Ottawa, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cowley Road, Cambridge CB4 0WS, UK
| | - Paule Bernier
- Ordre professionnel des diététistes du Québec, Montréal, Québec, Canada
| | - Leah Gramlich
- Department of Medicine & Dentistry, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | - Manon Laporte
- Réseau de santé Vitalité Health Network, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada
| | - Jack Bell
- School of Human Movement and Nutrition Sciences, The University of Queensland & The Prince Charles Hospital, Rode Road, Chermside, QLD 4032, Australia
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1217
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Ihle C, Weiß C, Blumenstock G, Stöckle U, Ochs BG, Bahrs C, Nüssler A, Schreiner AJ. Interview based malnutrition assessment can predict adverse events within 6 months after primary and revision arthroplasty - a prospective observational study of 351 patients. BMC Musculoskelet Disord 2018; 19:83. [PMID: 29544497 PMCID: PMC5856317 DOI: 10.1186/s12891-018-2004-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 03/08/2018] [Indexed: 12/22/2022] Open
Abstract
Background Being at risk for malnutrition can be observed among hospitalized patients of all medical specialties. There are only few studies in arthroplasty dealing with defining and assessing malnutrition as such a potentially risk. This study aims to identify the risk for malnutrition following primary (pAP) and revision arthroplasty (rAP) (1) using non-invasive interview based assessment tools and to analyze effects on clinical outcome (2) and quality of life (3). Methods A consecutive series of hospitalized patients of a Department of Arthroplasty at a Level 1 Trauma Center in Western Europe was observed between June 2014 and June 2016. Patients were monitored for being at risk for malnutrition at hospital admission (T1) and 6 months post surgery (T2) by non-invasive interview based assessment tools (NRS 2002, SF-MNA, MNA). Adverse events, length of hospital stay and quality of life (HRQL, SF-36) were monitored. Results 351 (283 pAP/ 68 rAP) patients were included. At T1, 13.4% (47) / 23.9% (84) / 27.4% (96) and at T2 7.3% (18) / 17.1% (42) / 16.0% (39) of all patients were at risk for malnutrition regarding NRS/SF-MNA/MNA. Prevalence of malnutrition risk was higher in rAP (22.1–29.4%) compared to pAP (11.3–26.9%). Patients being at risk for malnutrition showed prolonged hospitalization (NRS 14.5 to 12.5, SF-MNA 13.7 to 12.4, MNA 13.9 to 12.3 days, p < 0.05), delayed mobilization (NRS 2.1 to 1.7, SF-MNA 1.8 to 1.7, MNA 1.9 to 1.7 days), lower values in HRQL and more adverse events. Conclusions There is a moderate to high prevalence of risk for malnutrition in arthroplasty that can easily be assessed through interview based screening tools. Being at risk for malnutrition can reduce the clinical outcome following pAP and rAP. Patients with an impaired nutritional status show reduced values in physical and mental aspects of HRQL. Non-invasive interview-based nutritional assessment can predict adverse events in primary and revision total arthroplasty and can therefore help identifying patients at risk before surgery. Trial registration The study protocol was approved by the local ethics committee (193/2014BO2) and registered at the German Clinical Trials Register according to WHO standard (DKRS00006192).
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Affiliation(s)
- Christoph Ihle
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany
| | - Christoph Weiß
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, Eberhard Karls University Tübingen, Silcherstrasse 5, 72076, Tubingen, Germany
| | - Ulrich Stöckle
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany
| | - Björn Gunnar Ochs
- Department of Orthopedics and Trauma Surgery, Medical Center, Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Christian Bahrs
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany
| | - Andreas Nüssler
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany.
| | - Anna Janine Schreiner
- Siegfried Weller Institute for Trauma Research, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany
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1218
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Agarwal E, Ferguson M, Banks M, Vivanti A, Batterham M, Bauer J, Capra S, Isenring E. Malnutrition, poor food intake, and adverse healthcare outcomes in non-critically ill obese acute care hospital patients. Clin Nutr 2018; 38:759-766. [PMID: 29559233 DOI: 10.1016/j.clnu.2018.02.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Obesity, defined as a BMI ≥ 30 kg/m2, has demonstrated protective associations with mortality in some diseases. However, recent evidence demonstrates that poor nutritional status in critically ill obese patients confounds this relationship. The purpose of this paper is to evaluate if poor nutritional status, poor food intake and adverse health-related outcomes have a demonstrated association in non-critically ill obese acute care hospital patients. METHODS This is a secondary analysis of the Australasian Nutrition Care Day Survey dataset (N = 3122), a prospective cohort study conducted in hospitals from Australia and New Zealand in 2010. At baseline, hospital dietitians recorded participants' BMI, evaluated nutritional status using Subjective Global Assessment (SGA), and recorded 24-h food intake (as 0%, 25%, 50%, 75%, and 100% of the offered food). Post-three months, participants' length of stay (LOS), readmissions, and in-hospital mortality data were collected. Bivariate and regression analyses were conducted to investigate if there were an association between BMI, nutritional status, poor food intake, and health-related outcomes. RESULTS Of the 3122 participants, 2889 (93%) had eligible data. Obesity was prevalent in 26% of the cohort (n = 750; 75% females; 61 ± 15 years; 37 ± 7 kg/m2). Fourteen percent (n = 105) of the obese patients were malnourished. Over a quarter of the malnourished obese patients (N = 30/105, 28%) consumed ≤25% of the offered meals. Most malnourished obese patients (74/105, 70%) received standard diets without additional nutritional support. After controlling for confounders (age, disease type and severity), malnutrition and intake ≤25% of the offered meals independently trebled the odds of in-hospital mortality within 90 days of hospital admission in obese patients. CONCLUSION Although malnourished obese experienced significantly adverse health-related outcomes they were least likely to receive additional nutritional support. This study demonstrates that BMI alone cannot be used as a surrogate measure for nutritional status and warrants routine nutritional screening for all hospital patients, and subsequent nutritional assessment and support for malnourished patients.
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Affiliation(s)
- Ekta Agarwal
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; Master of Nutrition and Dietetic Practice Program, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
| | - Maree Ferguson
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Merrilyn Banks
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - Angela Vivanti
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Marijka Batterham
- National Institute for Applied Statistics Research Australia, The University of Wollongong, Wollongong, NSW 2522, Australia
| | - Judy Bauer
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Sandra Capra
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Elisabeth Isenring
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; Master of Nutrition and Dietetic Practice Program, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
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1219
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Peric Z, Botti S, Stringer J, Krawczyk J, van der Werf S, van Biezen A, Aljurf M, Murray J, Liptrott S, Greenfield DM, Duarte RF, Ruutu T, Basak GW. Variability of nutritional practices in peritransplant period after allogeneic hematopoietic stem cell transplantation: a survey by the Complications and Quality of Life Working Party of the EBMT. Bone Marrow Transplant 2018. [PMID: 29515252 DOI: 10.1038/s41409-018-0137-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recommendations on screening and nutritional support for patients undergoing hematopoietic stem cell transplantation (HSCT) have been presented by international nutritional societies, but nutritional practices remain poorly standardized. Following the general policy of the European Society for Blood and Marrow Transplantation (EBMT) to standardize transplantation procedures, the Complications and Quality of Life Working Party and Nursing Research Group carried out a survey among all EBMT centers about their current nutritional practices. The aim of this study was to better understand current practices, differences from available guidelines, and possible barriers for recommended nutritional therapy. Responses from 90 centers (19%) from 23 countries were received. We observed a marked variability in nutritional care between EBMT centers and a substantial lack of standardized operating procedures in screening patients for malnutrition and management of gastrointestinal GVHD. Furthermore, our study confirmed neutropenic diet as standard of care in most centers as well a preference for parenteral nutritional support over enteral. On the basis of these findings, future EBMT efforts will focus on better implementation of international nutritional guidelines into clinical practice.
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Affiliation(s)
- Zinaida Peric
- Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Stefano Botti
- Hematology Unit, Oncology Department, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Jacqui Stringer
- Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Joanna Krawczyk
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - John Murray
- Hematology and Transplant Unit, Christie Hospital NHS Foundation Trust, Manchester, UK
| | | | | | - Rafael F Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Tapani Ruutu
- Clinical Research Institute, Helsinki University Hospital, Helsinki, Finland
| | - Grzegorz W Basak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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1220
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Lappas BM, Patel D, Kumpf V, Adams DW, Seidner DL. Parenteral Nutrition: Indications, Access, and Complications. Gastroenterol Clin North Am 2018; 47:39-59. [PMID: 29413018 DOI: 10.1016/j.gtc.2017.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Parenteral nutrition (PN) is a life-sustaining therapy in patients with intestinal failure who are unable to tolerate enteral feedings. Patient selection should be based on a thorough assessment to identify those at high nutrition risk based on both disease severity and nutritional status. This article reviews both the acute and chronic indications for PN as well as special formulation consideration in specific disease states, vascular access, and complications of both short-term and long-term PN.
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Affiliation(s)
- Brian M Lappas
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dhyanesh Patel
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vanessa Kumpf
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dawn Wiese Adams
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas L Seidner
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA.
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1221
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Seiler A, Chen MA, Brown RL, Fagundes CP. Obesity, Dietary Factors, Nutrition, and Breast Cancer Risk. CURRENT BREAST CANCER REPORTS 2018; 10:14-27. [PMID: 30662586 PMCID: PMC6335046 DOI: 10.1007/s12609-018-0264-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW To synthesize the critical role of obesity-associated inflammation, dietary factors, and nutrition in determining breast cancer risk. RECENT FINDINGS Obesity-associated inflammation is strongly linked to breast cancer risk and progression, largely via two processes: inflammatory pathways and dysregulated metabolism. Cytokine production in excess adipose tissues creates a chronic inflammatory microenvironment, which favors tumor development. Lifestyle factors, including diet, have long been recognized as important determinants of breast cancer risk and mortality. SUMMARY Obesity increases the risk of developing breast cancer in both pre- and postmenopausal women and also negatively affects breast cancer recurrence and survival. Poor dietary habits characterized by the high intake of refined starches, sugar, and both saturated and trans-saturated fats, as well as the low intake of omega-3 fatty acids, natural antioxidants, and fiber, modulate inflammation and, thereby, appear to be linked to increased risk of breast cancer and mortality.
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Affiliation(s)
- Annina Seiler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, 8091 Zurich, Switzerland
| | | | - Ryan L Brown
- Department of Psychology, Rice University, Houston, TX, USA
| | - Christopher P Fagundes
- Department of Psychology, Rice University, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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1222
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1223
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ESPEN guideline clinical nutrition in neurology. Clin Nutr 2018; 37:354-396. [DOI: 10.1016/j.clnu.2017.09.003] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
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1224
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Abstract
BACKGROUND Sarcopenia, reflected by decreased psoas muscle surface area (PMSA), has been identified as a novel and independent predictor of wait-list mortality and outcomes in adult liver transplantation (LT). We hypothesized that children with end-stage liver disease (ESLD) would have smaller PMSA than healthy controls. METHODS Computer tomography images of children (ages 0 to 18 years) listed for LT in 2015 and a control group comprised 2:1 age- and gender-matched healthy pediatric trauma victims were reviewed. PMSA was determined at 2 intervertebral disc (L3/4; L4/5) levels. A subset of images was reviewed by 2 radiologists to determine interrater correlation. RESULTS A total of 23 children with ESLD were included, and the most prevalent diagnosis was biliary atresia (61%). On both lumbar levels, median PMSA was significantly smaller in ESLD subjects compared with the 46 healthy controls (L4/5; median total PMSA (tPMSA) 407 mm (interquartile range 339-537) versus controls 513 mm (interquartile range 437-672); P = 0.004), independent of participants' weight z scores (r = 0.01; P = 0.95). Excellent interrater correlation was seen (intraclass correlation 0.99). CONCLUSIONS In this retrospective pilot study, PMSA was significantly lower in children with ESLD compared with healthy age- and gender-matched controls. Because this finding was independent of growth in ESLD subjects, PMSA may represent a novel objective nutritional biomarker in children with advanced liver disease.
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1225
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Abstract
Pediatric patients require specialized attention and have diverse demands for proper growth and development, and thus need a different approach and interest in nutritional assessment and supply. Enteral nutrition is the most basic and important method of nutritional intervention, and its indications should be identified. Also, the sites, modes, types, and timing of nutritional intervention according to the patient's condition should be determined. In addition, various complications associated with enteral nutrition supply should be identified, and prevention and treatment are required. This approach to enteral nutrition and proper administration can help in the proper growth and recovery of pediatric patients with nutritional imbalances or nutritional needs.
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Affiliation(s)
- Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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1226
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Morley JE. Editorial: Defining Undernutrition (Malnutrition) in Older Persons. J Nutr Health Aging 2018; 22:308-310. [PMID: 29484342 DOI: 10.1007/s12603-017-0991-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- J E Morley
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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1227
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Cereda E, Veronese N, Caccialanza R. The final word on nutritional screening and assessment in older persons. Curr Opin Clin Nutr Metab Care 2018; 21:24-29. [PMID: 29035968 DOI: 10.1097/mco.0000000000000431] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To provide an updated perspective of how nutritional screening and assessment in older persons should be performed and reasonably implemented in the near future. RECENT FINDINGS Although nutritional screening and assessment should be fast and easy procedures, there is increasing evidence that more time should be dedicated to them. This is probably an answer to the claim to a medicine being more preventive than curative. Increasing interest is currently given to healthy aging and nutritional status is more likely to be addressed for its implications on functional status and disability. Important prognostic conditions, such as frailty, sarcopenia, and cachexia, which are closely linked to the nutritional domain, are at the top of the agenda. Therefore, body composition is a key issue and functional status is suggested as primary endpoint of nutrition trials. In this scenario, there is also a rationale for systematic assessment of inflammation, protein intake, and vitamin D status as potential contributing factors to reduced muscle mass and function. SUMMARY A 'second-generation' multidimensional nutritional screening and assessment including the evaluation of body composition, frailty, sarcopenia, and cachexia could be hypothesized. Nutritional assessment should be also completed by the systematic evaluation of inflammation, protein intake, and vitamin D status.
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Affiliation(s)
- Emanuele Cereda
- Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch
- Institute of Clinical Research and Education in Medicine, Padova, Italy
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1228
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Duarte-Rojo A, Ruiz-Margáin A, Montaño-Loza AJ, Macías-Rodríguez RU, Ferrando A, Kim WR. Exercise and physical activity for patients with end-stage liver disease: Improving functional status and sarcopenia while on the transplant waiting list. Liver Transpl 2018; 24:122-139. [PMID: 29024353 DOI: 10.1002/lt.24958] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/05/2017] [Accepted: 09/09/2017] [Indexed: 12/20/2022]
Abstract
Sarcopenia and physical deconditioning are frequent complications in patients with cirrhosis and end-stage liver disease (ESLD). They are the end result of impaired dietary intake, chronic inflammation, altered macronutrient and micronutrient metabolism, and low physical activity. Frailty is the end result of prolonged sarcopenia and physical deconditioning. It severely affects a patient's functional status and presents in approximately 1 in 5 patients on the liver transplantation waiting list. Sarcopenia, poor physical fitness/cardiopulmonary endurance (CPE), and frailty are all associated with increased mortality in ESLD. Clinical trials addressing the usefulness of exercise in patients with cirrhosis have shown that it improves the metabolic syndrome, sarcopenia, CPE, health-related quality of life, and hepatic venous pressure gradient. Although evidence on the benefits of exercise on clinical outcomes derived from large clinical trials is still missing, based on existing literature from multiple medical subspecialties, we believe that an exercise program coupled to a tailored nutritional intervention benefits both cardiopulmonary and musculoskeletal functions, ultimately translating into improved functional status, sense of well-being, and possibly less complications from portal hypertension. In conclusion, although supervised exercise training is the prevailing approach to manage ESLD patients, such intervention is not sustainable or feasible for most patients. Innovative home-based physical activity interventions may be able to effectively reach a larger number of patients. Liver Transplantation 24 122-139 2018 AASLD.
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Affiliation(s)
| | - Astrid Ruiz-Margáin
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán,", Mexico City, Mexico
| | - Aldo J Montaño-Loza
- Division of Gastroenterology and Hepatology, University of Alberta, Edmonton, Canada
| | - Ricardo U Macías-Rodríguez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán,", Mexico City, Mexico
| | - Arny Ferrando
- Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - W Ray Kim
- Division of Gastroenterology and Hepatology, Stanford School of Medicine, Stanford, CA
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1229
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de Blasio F, Di Gregorio A, de Blasio F, Bianco A, Bellofiore B, Scalfi L. Malnutrition and sarcopenia assessment in patients with chronic obstructive pulmonary disease according to international diagnostic criteria, and evaluation of raw BIA variables. Respir Med 2018; 134:1-5. [DOI: 10.1016/j.rmed.2017.11.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 01/07/2023]
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1230
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Lee TH. Nutritional Assessment and Management for Patients with Chronic Liver Disease. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:185-191. [DOI: 10.4166/kjg.2018.71.4.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Tae Hee Lee
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
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1231
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Hulst JM, Joosten KF. Nutrition Screening: Coding after Discharge Underestimates the Prevalence of Undernutrition. J Acad Nutr Diet 2018; 118:33-36. [DOI: 10.1016/j.jand.2017.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/23/2017] [Indexed: 01/07/2023]
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1232
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Barazzoni R, Bischoff S, Boirie Y, Busetto L, Cederholm T, Dicker D, Toplak H, Van Gossum A, Yumuk V, Vettor R. Sarcopenic Obesity: Time to Meet the Challenge. Obes Facts 2018; 11:294-305. [PMID: 30016792 PMCID: PMC6189532 DOI: 10.1159/000490361] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/17/2018] [Indexed: 12/11/2022] Open
Abstract
The prevalence of overweight and obesity has reached epidemic proportions worldwide due to increasingly pervasive obesogenic lifestyle changes. Obesity poses unprecedented individual, social, and multidisciplinary medical challenges by increasing the risk for metabolic diseases, chronic organ failures, and cancer as well as complication rates in the presence of acute disease conditions. Whereas reducing excess adiposity remains the fundamental pathogenic treatment for obese individuals, complex metabolic and lifestyle abnormalities as well as weight reduction therapies per se may also compromise the ability to preserve muscle function and mass, especially when chronic disease co-exists with obesity. Emerging evidence indicates that low muscle mass and quality have a strong negative prognostic impact in obese individuals and may lead to frailty, disability, and increased morbidity and mortality. Awareness of the importance of skeletal muscle maintenance in obesity is however low among clinicians and scientists. The term 'sarcopenic obesity' has been proposed to identify obesity with low skeletal muscle function and mass, but its utilization is largely limited to the aging patient population, and consensus on its definition and diagnostic criteria remains insufficient. Knowledge on prevalence of sarcopenic obesity in various clinical conditions and patient subgroups, on its clinical impacts in patient risk stratification, and on effective prevention and treatment strategies remain therefore dramatically inadequate. In particular, optimal dietary options and medical nutritional support strategies to preserve muscle mass in obese individuals remain largely undefined. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recognize and indicate obesity with altered body composition due to low skeletal muscle function and mass (sarcopenic obesity) as a scientific and clinical priority for researchers and clinicians. ESPEN and EASO therefore call for coordinated action aimed at reaching consensus on its definition, diagnostic criteria, and optimal treatment with particular regard to nutritional therapy. We are convinced that achievement of these goals has a strong potential to reduce the burden of morbidity and mortality in the rapidly increasing obese patient population.
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Affiliation(s)
- Rocco Barazzoni
- Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
- *Rocco Barazzoni, MD, PhD, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy,
| | - Stephan Bischoff
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Yves Boirie
- Unité de Nutrition Humaine, Université Clermont Auvergne, INRA, UNH, CRNH Auvergne, Clermont-Ferrand, France
- Service Nutrition Clinique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Luca Busetto
- Department of Medicine, University of Padova, Italy
- Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Dror Dicker
- Internal Medicine Department & Obesity Clinic, Hasharon Hospital-Rabin Medical Center, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hermann Toplak
- Department of Medicine, Medical University Graz, Graz, Austria
| | - Andre Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Roberto Vettor
- Department of Medicine, University of Padova, Italy
- Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy
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Dent E, Morley JE, Cruz-Jentoft AJ, Arai H, Kritchevsky SB, Guralnik J, Bauer JM, Pahor M, Clark BC, Cesari M, Ruiz J, Sieber CC, Aubertin-Leheudre M, Waters DL, Visvanathan R, Landi F, Villareal DT, Fielding R, Won CW, Theou O, Martin FC, Dong B, Woo J, Flicker L, Ferrucci L, Merchant RA, Cao L, Cederholm T, Ribeiro SML, Rodríguez-Mañas L, Anker SD, Lundy J, Gutiérrez Robledo LM, Bautmans I, Aprahamian I, Schols JMGA, Izquierdo M, Vellas B. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. J Nutr Health Aging 2018; 22:1148-1161. [PMID: 30498820 DOI: 10.1007/s12603-018-1139-9] [Citation(s) in RCA: 498] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR). METHODS To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefit-harm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process. RECOMMENDATIONS We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.
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Affiliation(s)
- E Dent
- Dr. Elsa Dent, , Torrens University Australia, Wakefield Street, Adelaide, SA, Australia
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De Waele E, Honoré PM, Malbrain MLNG. Between Dream and Reality in Nutritional Therapy: How to Fill the Gap. ANNUAL UPDATE IN INTENSIVE CARE AND EMERGENCY MEDICINE 2018 2018. [DOI: 10.1007/978-3-319-73670-9_44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chen N, Li Y, Fang J, Lu Q, He L. Risk factors for malnutrition in stroke patients: A meta-analysis. Clin Nutr 2017; 38:127-135. [PMID: 29310894 DOI: 10.1016/j.clnu.2017.12.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/11/2017] [Accepted: 12/14/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS Stroke is a common cause of death and disability worldwide. Among stroke patients, malnutrition is a significant problem that contributes to poor outcome. Clinical evidence is required to identify risk factors for malnutrition and to adopt appropriate management strategies during early stroke intervention. Thus, we performed a meta-analysis of potential risk factors related to malnutrition in stroke patients. METHODS We systemically searched relevant observational studies in MEDLINE, EMBASE, Chinese Biomedical Literature Database (CBLD), China National Knowledge Infrastructure (CNKI), and VIP Database of Chinese periodicals from January 1990 to September 2017 in any language. Patients included in this study were adults who suffered from stroke. Stata 12.0 and Review Manager 5.1 software were used to pool useful data and calculate odds ratios (ORs) and their 95% confidence intervals (CIs). We also performed heterogeneity and sensitivity analyses, and evaluated publication bias. RESULTS Twenty-nine observational studies involving 8838 participants who met our inclusion criteria were incorporated into the meta-analysis, and thirteen risk factors related to malnutrition were studied. The following variables probably correlated with an increased risk of malnutrition in stroke patients: malnutrition on admission (OR = 8.34, 95% CI = 4.60-15.10, P < 0.00001), dysphagia (OR = 2.60, 95% CI = 2.24-3.03, P < 0.00001), previous stroke (OR = 3.04, 95% CI = 2.35-3.95, P < 0.00001), diabetes mellitus (OR = 1.79, 95% CI = 1.35-2.38, P < 0.0001), tube feeding (OR = 5.43, 95% CI = 3.99-7.37, P < 0.00001) and reduced level of consciousness (OR = 2.82, 95% CI = 2.12-3.75, P < 0.00001). The factors alcohol consumption, hypertension, male sex, depressed mood, pneumonia and infection need to be re-evaluated. Conversely, smoking was most likely not associated with post-stroke malnutrition. CONCLUSIONS Our meta-analysis has revealed a variety of risk factors for malnutrition during hospital stay among stroke patients. Early identification of these factors is warranted for improving patient outcomes.
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Affiliation(s)
- Ning Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Yanbo Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Jinghuan Fang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Qian Lu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China.
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Percentiles for skeletal muscle index, area and radiation attenuation based on computed tomography imaging in a healthy Caucasian population. Eur J Clin Nutr 2017; 72:288-296. [PMID: 29242526 PMCID: PMC5842880 DOI: 10.1038/s41430-017-0034-5] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/14/2017] [Accepted: 10/04/2017] [Indexed: 12/18/2022]
Abstract
Background/objectives Muscle mass is a key determinant of nutritional status and associated with outcomes in several patient groups. Computed tomography (CT) analysis is increasingly used to assess skeletal muscle area (SMA), skeletal muscle index (SMI) and muscle radiation attenuation (MRA). However, interpretation of these muscle parameters is difficult since values in a healthy population are lacking. The aim of this study was to provide sex specific percentiles for SMA, SMA and MRA in a healthy Caucasian population and to examine the association with age and BMI in order to define age- and BMI specific percentiles. Subjects/methods In this retrospective cross-sectional study CT scans of potential kidney donors were used to assess SMA, SMI and MRA at the level of the third lumbar vertebra. Sex specific distributions were described and, based on the association between age/BMI and muscle parameters, age, and BMI specific predicted percentiles were computed. The 5th percentile was considered as cut-off. Results CT scans of 420 Individuals were included (age range 20–82 years and BMI range 17.5–40.7 kg/m2). Sex specific cut-offs of SMA, SMI and MRA were 134.0 cm2, 41.6 cm2/m2 and 29.3 HU in men and 89.2 cm2, 32.0 cm2/m2 and 22.0 HU in women, respectively. Correlations were negative between age and all three muscle parameters, positive between BMI and SMA/SMI and negative between BMI and MRA, resulting in age- and BMI specific percentiles. Conclusions This study provides sex specific percentiles for SMA, SMI, and MRA. In addition, age- and BMI specific percentiles have been established.
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McDonald MLN, Diaz AA, Rutten E, Lutz SM, Harmouche R, San Jose Estepar R, Kinney G, Hokanson JE, Gower BA, Wouters EFM, Rennard SI, Hersh CP, Casaburi R, Dransfield MT, Silverman EK, Washko GR. Chest computed tomography-derived low fat-free mass index and mortality in COPD. Eur Respir J 2017; 50:50/6/1701134. [PMID: 29242259 DOI: 10.1183/13993003.01134-2017] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/03/2017] [Indexed: 01/06/2023]
Abstract
Low fat-free mass index (FFMI) is an independent risk factor for mortality in chronic obstructive pulmonary disease (COPD) not typically measured during routine care. In the present study, we aimed to derive fat-free mass from the pectoralis muscle area (FFMPMA) and assess whether low FFMIPMA is associated with all-cause mortality in COPD cases. We used data from two independent COPD cohorts, ECLIPSE and COPDGene.Two equal sized groups of COPD cases (n=759) from the ECLIPSE study were used to derive and validate an equation to calculate the FFMPMA measured using bioelectrical impedance from PMA. We then applied the equation in COPD cases (n=3121) from the COPDGene cohort, and assessed survival. Low FFMIPMA was defined, using the Schols classification (FFMI <16 in men, FFMI <15 in women) and the fifth percentile normative values of FFMI from the UK Biobank.The final regression model included PMA, weight, sex and height, and had an adjusted R2 of 0.92 with fat-free mass (FFM) as the outcome. In the test group, the correlation between FFMPMA and FFM remained high (Pearson correlation=0.97). In COPDGene, COPD cases with a low FFMIPMA had an increased risk of death (HR 1.6, p<0.001).We demonstrated COPD cases with a low FFMIPMA have an increased risk of death.
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Affiliation(s)
- Merry-Lynn N McDonald
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA .,Dept of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA.,Both authors contributed equally
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.,Both authors contributed equally
| | - Erica Rutten
- Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Sharon M Lutz
- Dept of Biostatistics, University of Colorado at Denver, Denver, CO, USA
| | - Rola Harmouche
- Division of Pulmonary and Critical Care Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Raul San Jose Estepar
- Dept of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Greg Kinney
- Dept of Epidemiology, University of Colorado, Denver, Aurora, CO, USA
| | - John E Hokanson
- Dept of Epidemiology, University of Colorado, Denver, Aurora, CO, USA
| | - Barbara A Gower
- Division of Physiology and Metabolism, Dept of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emiel F M Wouters
- Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | | | - Craig P Hersh
- Division of Pulmonary and Critical Care Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.,Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edwin K Silverman
- Division of Pulmonary and Critical Care Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.,Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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Keskin M, İpek G, Aldağ M, Altay S, Hayıroğlu Mİ, Börklü EB, İnan D, Kozan Ö. Effect of nutritional status on mortality in patients undergoing coronary artery bypass grafting. Nutrition 2017; 48:82-86. [PMID: 29469026 DOI: 10.1016/j.nut.2017.10.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/04/2017] [Accepted: 10/22/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The prognostic effects of poor nutritional status and cardiac cachexia on coronary artery disease (CAD) are not clearly understood. A well-accepted nutritional status parameter, the prognostic nutritional index (PNI), which was first demonstrated to be valuable in patients with cancer and those undergoing gastrointestinal surgery, was introduced to patients requiring coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the prognostic value of PNI in patients with CAD undergoing CABG. METHODS We evaluated the in-hospital and long-term (3-y) prognostic effect of PNI on 644 patients with CAD undergoing CABG. Baseline characteristics and outcomes were compared among the patients by PNI and categorized accordingly: Q1, Q2, Q3, and Q4. RESULTS Patients with lower PNI had significantly higher in-hospital and long-term mortality. Patients with lower PNI levels (Q1) had higher in-hospital mortality and had 12 times higher mortality rates than those with higher PNI levels (Q4). The higher PNI group had the lower rates and was used as the reference. Long-term mortality was higher in patients with lower PNI (Q1)-4.9 times higher than in the higher PNI group (Q4). In-hospital and long-term mortality rates were similar in the non-lower PNI groups (Q2-4). CONCLUSION The present study demonstrated that PNI, calculated based on serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients undergoing CABG.
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Affiliation(s)
- Muhammed Keskin
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.
| | - Göktük İpek
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Aldağ
- Department of Cardiovascular Surgery, Istanbul Medeniyet University, Istanbul, Turkey
| | - Servet Altay
- Department of Cardiology, Trakya University, Edirne, Turkey
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Edibe Betül Börklü
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Duygu İnan
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ömer Kozan
- Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Alternative terminology for the confusing term “palliative nutrition”. Clin Nutr 2017; 36:1723-1724. [DOI: 10.1016/j.clnu.2017.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/15/2017] [Indexed: 01/07/2023]
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Abstract
As the cirrhosis progresses, development of complication like ascites, hepatic encephalopathy, variceal bleeding, kidney dysfunction, and hepatocellular carcinoma signify increasing risk of short term mortality. Malnutrition and muscle wasting (sarcopenia) is yet other complications that negatively impact survival, quality of life, and response to stressors, such as infection and surgery in patients with cirrhosis. Conventionally, these are not routinely looked for, because nutritional assessment can be a difficult especially if there is associated fluid retention and/or obesity. Patients with cirrhosis may have a combination of loss of skeletal muscle and gain of adipose tissue, culminating in the condition of "sarcopenic obesity." Sarcopenia in cirrhotic patients has been associated with increased mortality, sepsis complications, hyperammonemia, overt hepatic encephalopathy, and increased length of stay after liver transplantation. Assessment of muscles with cross-sectional imaging studies has become an attractive index of nutritional status evaluation in cirrhosis, as sarcopenia, the major component of malnutrition, is primarily responsible for the adverse clinical consequences seen in patients with liver disease. Cirrhosis is a state of accelerated starvation, with increased gluconeogenesis that requires amino acid diversion from other metabolic functions. Protein homeostasis is disturbed in cirrhosis due to several factors such as hyperammonemia, hormonal, and cytokine abnormalities, physical inactivity and direct effects of ethanol and its metabolites. New approaches to manage sarcopenia are being evolved. Branched chain amino acid supplementation, Myostatin inhibitors, and mitochondrial protective agents are currently in various stages of evaluation in preclinical studies to prevent and reverse sarcopenia, in cirrhosis.
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Key Words
- (PG) SGA, patient-generated SGA
- AMPK, 5′ adenosine monophosphate-activated protein kinase
- ASPEN, American Society of Parenteral and Enteral Nutrition
- ATP, adenosine triphosphate
- Akt/PKB, serine/threonine-specific protein kinase B
- BIA, bio-electric impedance analysis
- BMC, bone mineral content
- BMI, body mass index
- CT, computed tomography
- DDLT, deceased donor liver transplantation
- DRM, disease-related malnutrition
- DXA, dual X-ray absorptiometry
- ESPEN, European Society of Parenteral and Enteral Nutrition
- FFI, Fried Frailty Index
- FFM, fat free mass
- FFMI, fat free mass index
- FM, fat mass
- HE, hepatic encephalopathy
- LDLT, living donor liver transplant
- LST, lean soft tissue
- MAC, mid arm circumference
- MAMC, mid arm muscle circumference
- MELD, model for end-stage liver disease
- MNA, Mini Nutritional Assessment
- MRI, magnetic resonance imaging
- NASH, non-alcoholic steatohepatitis
- PCM, protein-calorie nalnutrition
- REE, resting energy expenditure
- RQ, respiratory quotient (or RQ or respiratory coefficient)
- SGA, Subjective Global Assessment
- SMI, Skeletal Muscle Index
- SPPB, Short Physical Performance Battery
- TIPS, trans jugular intrahepatic portocaval shunts
- TNF, tumour necrosis factor
- TSF, triceps skin fild thickness
- WHO, World Health Organisation
- YPA, total psoas area
- aKG, alfa keto glutarate
- cirrhosis
- mTORC1, mammalian target of rapamycin complex 1
- nutrition
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Nurse's perceptions of barriers to optimal nutritional therapy for hospitalized patients. Clin Nutr ESPEN 2017; 22:92-96. [DOI: 10.1016/j.clnesp.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/18/2017] [Accepted: 08/09/2017] [Indexed: 01/07/2023]
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Abstract
Although malnutrition is a common health and social care problem, there is no universal agreement about its definition, prevalence, or method of identification and report. Fifteen definitions of malnutrition were critically examined to assess their variability. They ranged from descriptions of undernutrition alone to under- and overnutrition, with intakes ranging from dietary protein and energy alone to dietary and nondietary sources of all nutrients and energy. Definitions also varied from non-outcome based to those based on functional, physiological, and/or clinical outcomes. Some definitions relied on the pathways by which malnutrition develops, with one apparently requiring loss of fat-free mass. Also examined were nutrition screening tools, diversely developed for detection of malnutrition, management of malnutrition, and prediction of clinical outcomes or health care usage. Their intended use also varied from specific care settings (hospital, community, care homes) to all settings and from specific age groups to all age groups. With all these definitions and tools, there is considerable scope for confusion and misunderstanding. Therefore, to clarify the burden and significance of malnutrition, guidelines for documenting it in routine practice and reporting it in scientific literature are provided.
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Affiliation(s)
- Marinos Elia
- 1 Faculty of Medicine, University of Southampton, Southampton, UK
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Sánchez-Rodríguez D, Marco E, Annweiler C, Ronquillo-Moreno N, Tortosa A, Vázquez-Ibar O, Escalada F, Duran X, Muniesa JM. Malnutrition in postacute geriatric care: Basic ESPEN diagnosis and etiology based diagnoses analyzed by length of stay, in-hospital mortality, and functional rehabilitation indexes. Arch Gerontol Geriatr 2017; 73:169-176. [DOI: 10.1016/j.archger.2017.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/16/2017] [Accepted: 07/19/2017] [Indexed: 01/07/2023]
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Son YG, Kwon IG, Ryu SW. Assessment of nutritional status in laparoscopic gastrectomy for gastric cancer. Transl Gastroenterol Hepatol 2017; 2:85. [PMID: 29167832 DOI: 10.21037/tgh.2017.09.08] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/13/2017] [Indexed: 12/19/2022] Open
Abstract
Malnutrition is very common in gastric cancer patients and can be detected in up to 85% of patients with gastric cancer. Malnutrition is associated with increased morbidity and mortality, prolonged hospital stay, poor treatment tolerance, and lower survival rate. Malnutrition also has an impact on quality of life. The early detection of nutritional risk with appropriate nutritional care can significantly reduce patient's postoperative morbidity and mortality. Because there is no gold standard tool, appropriate tools should be selected and applied depending on one's institutional conditions. And, it is recommended that nutritional assessment should be achieved for every patient at pre/post-operative period.
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Affiliation(s)
- Young-Gil Son
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - In Gyu Kwon
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Seung Wan Ryu
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
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Aubry E, Aeberhard C, Bally L, Nuoffer JM, Risch L, Mühlebach S, Burgunder JM, Stanga Z. Are patients affected by mitochondrial disorders at nutritional risk? Nutrition 2017; 47:56-62. [PMID: 29429536 DOI: 10.1016/j.nut.2017.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/18/2017] [Accepted: 09/23/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Patients with mitochondrial disorders (MD) frequently present with gastrointestinal complaints, mainly gastrointestinal dysmotility, that interfere with their food intake. A deterioration of their nutritional state may worsen the course of the disease. Our study aimed to evaluate a simple screening tool to identify nutritional risk and perform an extended nutritional assessment to explore the potential presence of deficiencies in this population compared with controls. METHODS A prospective cohort study was conducted to compare outpatients with MD to matched healthy controls. Nutritional screening and full nutritional assessments were performed, including quantitative and qualitative dietary habits (7-d food log), body function and composition, and resting energy expenditure and quality of life (QoL) measurements. Blood and 24-h urine sample analyses were performed in the patient group. RESULTS Twenty-six subjects were included in the study, with 11 in the patient group and 15 in the control group. No patient was deemed malnourished according to the nutritional risk score NRS-2002. When compared with the controls, however, the patients with MD had significantly lower muscle mass (P = 0.04), reduced handgrip strength (P = 0.07), and significant changes in QoL and pathologic creatinine height index, which indicate malnutrition. The patients with MD also had a significantly lower protein intake (P = 0.01). CONCLUSIONS According to the current definition by the European Society of Clinical Nutrition and Metabolism (ESPEN) and the American Society of Parenteral and Enteral Nutrition (ASPEN), all patients fulfilled the criteria for malnutrition. Thus, the usual nutritional screening tool is less sensitive for chronically ill outpatients. These results provide a rationale to increase protein intake and adapt patients' energy stores to improve symptoms and QoL.
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Affiliation(s)
- Emilie Aubry
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Switzerland
| | - Carla Aeberhard
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Switzerland.
| | - Lia Bally
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Switzerland
| | - Jean-Marc Nuoffer
- University Institute of Clinical Chemistry, Bern University Hospital, Bern, Switzerland
| | - Lorenz Risch
- University Institute of Clinical Chemistry, Bern University Hospital, Bern, Switzerland; Division of Clinical Chemistry, Labormedizinisches Zentrum Dr. Risch, Liebefeld b. Bern, Switzerland; Private University of the Principality of Lichtenstein, Triesen, Principality of Liechtenstein
| | - Stefan Mühlebach
- Department of Clinical Pharmacy and Epidemiology, University of Basel, Basel, Switzerland
| | - Jean-Marc Burgunder
- Division of Neurology, Bern University Hospital, University of Bern, Switzerland; Department of Neurology Sichuan University, Chengdu, P.R. China; Central South University, Hunan, P.R. China; Sun Yat Sen University, Guangzhou, P.R. China
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Switzerland
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A systematic review and meta-analysis of the criterion validity of nutrition assessment tools for diagnosing protein-energy malnutrition in the older community setting (the MACRo study). Clin Nutr 2017; 37:1902-1912. [PMID: 29102322 DOI: 10.1016/j.clnu.2017.09.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/24/2017] [Accepted: 09/28/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Malnutrition is a significant barrier to healthy and independent ageing in older adults who live in their own homes, and accurate diagnosis is a key step in managing the condition. However, there has not been sufficient systematic review or pooling of existing data regarding malnutrition diagnosis in the geriatric community setting. The current paper was conducted as part of the MACRo (Malnutrition in the Ageing Community Review) Study and seeks to determine the criterion (concurrent and predictive) validity and reliability of nutrition assessment tools in making a diagnosis of protein-energy malnutrition in the general older adult community. METHODS A systematic literature review was undertaken using six electronic databases in September 2016. Studies in any language were included which measured malnutrition via a nutrition assessment tool in adults ≥65 years living in their own homes. Data relating to the predictive validity of tools were analysed via meta-analyses. GRADE was used to evaluate the body of evidence. RESULTS There were 6412 records identified, of which 104 potentially eligible records were screened via full text. Eight papers were included; two which evaluated the concurrent validity of the Mini Nutritional Assessment (MNA) and Subjective Global Assessment (SGA) and six which evaluated the predictive validity of the MNA. The quality of the body of evidence for the concurrent validity of both the MNA and SGA was very low. The quality of the body of evidence for the predictive validity of the MNA in detecting risk of death was moderate (RR: 1.92 [95% CI: 1.55-2.39]; P < 0.00001; n = 2013 participants; n = 4 studies; I2: 0%). The quality of the body of evidence for the predictive validity of the MNA in detecting risk of poor physical function was very low (SMD: 1.02 [95%CI: 0.24-1.80]; P = 0.01; n = 4046 participants; n = 3 studies; I2:89%). CONCLUSIONS Due to the small number of studies identified and no evaluation of the predictive validity of tools other than the MNA, there is insufficient evidence to recommend a particular nutrition assessment tool for diagnosing PEM in older adults in the community. High quality diagnostic accuracy studies are needed for all nutrition assessment tools used in older community samples, including measuring of health outcomes subsequent to nutrition assessment by the SGA and PG-SGA.
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1247
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Muscaritoli M, Lucia S, Farcomeni A, Lorusso V, Saracino V, Barone C, Plastino F, Gori S, Magarotto R, Carteni G, Chiurazzi B, Pavese I, Marchetti L, Zagonel V, Bergo E, Tonini G, Imperatori M, Iacono C, Maiorana L, Pinto C, Rubino D, Cavanna L, Di Cicilia R, Gamucci T, Quadrini S, Palazzo S, Minardi S, Merlano M, Colucci G, Marchetti P. Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget 2017; 8:79884-79896. [PMID: 29108370 PMCID: PMC5668103 DOI: 10.18632/oncotarget.20168] [Citation(s) in RCA: 211] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In cancer patients, malnutrition is associated with treatment toxicity, complications, reduced physical functioning, and decreased survival. The Prevalence of Malnutrition in Oncology (PreMiO) study identified malnutrition or its risk among cancer patients making their first medical oncology visit. Innovatively, oncologists, not nutritionists, evaluated the nutritional status of the patients in this study. METHODS PreMiO was a prospective, observational study conducted at 22 medical oncology centers across Italy. For inclusion, adult patients (>18 years) had a solid tumor diagnosis, were treatment-naive, and had a life expectancy >3 months. Malnutrition was identified by the Mini Nutritional Assessment (MNA), appetite status with a visual analog scale (VAS), and appetite loss with a modified version of Anorexia-Cachexia Subscale (AC/S-12) of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT). FINDINGS Of patients enrolled (N=1,952), 51% had nutritional impairment; 9% were overtly malnourished, and 43% were at risk for malnutrition. Severity of malnutrition was positively correlated with the stage of cancer. Over 40% of patients were experiencing anorexia, as reported in the VAS and FAACT questionnaire. During the prior six months, 64% of patients lost weight (1-10 kg). INTERPRETATION Malnutrition, anorexia, and weight loss are common in cancer patients, even at their first visit to a medical oncology center.
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Affiliation(s)
| | - Simone Lucia
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessio Farcomeni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vito Lorusso
- Department of Medical Oncology, National Cancer Research Centre Giovanni Paolo II, Bari, Italy
| | - Valeria Saracino
- Department of Medical Oncology, National Cancer Research Centre Giovanni Paolo II, Bari, Italy
| | - Carlo Barone
- Department of Medical Oncology, Catholic University of Sacred Heart, Largo A. Gemelli, Rome, Italy
| | - Francesca Plastino
- Department of Medical Oncology, Catholic University of Sacred Heart, Largo A. Gemelli, Rome, Italy
| | - Stefania Gori
- Medical Oncology Unit, Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | - Roberto Magarotto
- Medical Oncology Unit, Ospedale Sacro Cuore Don Calabria, Verona, Italy
| | | | | | - Ida Pavese
- Oncology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Luca Marchetti
- Oncology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Vittorina Zagonel
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Eleonora Bergo
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Giuseppe Tonini
- Department of Oncology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Marco Imperatori
- Department of Oncology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Carmelo Iacono
- Department of Medical Oncology, Azienda Ospedaliera Civile - Maria Paternò Arezzo, Ragusa, Italy
| | - Luigi Maiorana
- Department of Medical Oncology, Azienda Ospedaliera Civile - Maria Paternò Arezzo, Ragusa, Italy
| | - Carmine Pinto
- Medical Oncology, Clinical Cancer Centre, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Daniela Rubino
- Medical Oncology, Clinical Cancer Centre, IRCCS-Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Luigi Cavanna
- Department of Oncology-Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Roberto Di Cicilia
- Department of Oncology-Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Teresa Gamucci
- Medical Oncology Unit, S.S. Trinita Hospital, Sora, Italy
| | | | - Salvatore Palazzo
- Division of Medical Oncology, Mariano Santo Hospital, Azienda Ospedaliera, Cosenza, Italy
| | - Stefano Minardi
- Division of Medical Oncology, Mariano Santo Hospital, Azienda Ospedaliera, Cosenza, Italy
| | - Marco Merlano
- Medical Oncology, Oncology Department, S. Croce & Carle Teaching Hospital, Cuneo, Italy
| | - Giuseppe Colucci
- Medical Oncology Department, National Cancer Research Centre Giovanni Paolo II, Bari, Italy
| | - Paolo Marchetti
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology Sapienza, St. Andrea Hospital, Rome, Italy
- IDI-IRCCS, Rome, Italy
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1248
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Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, Erickson N, Laviano A, Lisanti MP, Lobo DN, McMillan DC, Muscaritoli M, Ockenga J, Pirlich M, Strasser F, de van der Schueren M, Van Gossum A, Vaupel P, Weimann A. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr 2017; 36:1187-1196. [PMID: 28689670 DOI: 10.1016/j.clnu.2017.06.017] [Citation(s) in RCA: 683] [Impact Index Per Article: 97.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/15/2017] [Indexed: 12/13/2022]
Abstract
Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatments threaten their nutritional status. Yet cancer-related nutritional risk is sometimes overlooked or under-treated by clinicians, patients, and their families. The European Society for Clinical Nutrition and Metabolism (ESPEN) recently published evidence-based guidelines for nutritional care in patients with cancer. In further support of these guidelines, an ESPEN oncology expert group met for a Cancer and Nutrition Workshop in Berlin on October 24 and 25, 2016. The group examined the causes and consequences of cancer-related malnutrition, reviewed treatment approaches currently available, and built the rationale and impetus for clinicians involved with care of patients with cancer to take actions that facilitate nutrition support in practice. The content of this position paper is based on presentations and discussions at the Berlin meeting. The expert group emphasized 3 key steps to update nutritional care for people with cancer: (1) screen all patients with cancer for nutritional risk early in the course of their care, regardless of body mass index and weight history; (2) expand nutrition-related assessment practices to include measures of anorexia, body composition, inflammatory biomarkers, resting energy expenditure, and physical function; (3) use multimodal nutritional interventions with individualized plans, including care focused on increasing nutritional intake, lessening inflammation and hypermetabolic stress, and increasing physical activity.
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Affiliation(s)
- J Arends
- Department of Medicine I, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - V Baracos
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - H Bertz
- Department of Medicine I, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - F Bozzetti
- Faculty of Medicine, University of Milan, Milan, Italy
| | - P C Calder
- Faculty of Medicine, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - N E P Deutz
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - N Erickson
- Comprehensive Cancer Center, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - A Laviano
- Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - M P Lisanti
- Department of Translational Medicine, University of Salford, Salford, UK
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - D C McMillan
- Department of Surgical Science, University of Glasgow, Glasgow, UK
| | - M Muscaritoli
- Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - J Ockenga
- Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany
| | - M Pirlich
- Department of Internal Medicine, Elisabeth Protestant Hospital, Berlin, Germany
| | - F Strasser
- Department Internal Medicine and Palliative Care Centre, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - M de van der Schueren
- Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - A Van Gossum
- Gastroenterology Service, Hôpital Erasme, University Hospitals of Brussels, Brussels, Belgium
| | - P Vaupel
- Department of Radiation Oncology and Radiotherapy, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - A Weimann
- Department of General, Visceral, and Oncological Surgery, Hospital St Georg, Leipzig, Germany
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1249
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The definition of “palliative nutrition” is misleading. Clin Nutr 2017; 36:1451. [DOI: 10.1016/j.clnu.2017.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/26/2017] [Indexed: 01/07/2023]
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1250
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Siddique N, O'Donoghue M, Casey MC, Walsh J. Malnutrition in the elderly and its effects on bone health – A review. Clin Nutr ESPEN 2017; 21:31-39. [DOI: 10.1016/j.clnesp.2017.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/14/2017] [Accepted: 06/07/2017] [Indexed: 01/04/2023]
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