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Benfaremo D, Pacenti N, Paterno I, Dichiara C, Galli FL, Moroncini G. Role of cognitive impairment and malnutrition as determinants of quality of life in patients with systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2024; 9:143-153. [PMID: 38910598 PMCID: PMC11188851 DOI: 10.1177/23971983231224522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 06/25/2024]
Abstract
Background Increasing evidence supports the presence of cognitive impairment in patients with systemic sclerosis. Malnutrition is a well-known severe complication of systemic sclerosis and is a consequence of multiple factors, mainly oropharyngeal and gastrointestinal involvement. Recent studies have shown a link between nutrition and cognitive decline in several chronic diseases. Thus, we decided to evaluate a possible association between malnutrition and cognitive impairment in patients with systemic sclerosis. Methods In total, 100 consecutive systemic sclerosis patients were enrolled in a cross-sectional study to assess clinical and demographic features, nutritional status (body mass index, Global Leadership Initiative on Malnutrition criteria), gastrointestinal involvement (University of California Los Angeles Gastrointestinal Scale 2.0, Eat Assessment Tool 10), cognitive function (Montreal Cognitive Assessment), anxiety and depression (Patient Health Questionnaire 9, Beck Depression Inventory II), and quality of life (Short Form 36, Health Assessment Questionnaire-Disability Index, Scleroderma Health Assessment Questionnaire). Patients were stratified for the presence/absence of malnutrition and cognitive decline and compared for clinical characteristics and quality-of-life measures. Results Half of the patients had cognitive impairment (Montreal Cognitive Assessment < 26). These patients were older, had more comorbidities, and a significantly worse quality of life. There were no statistically significant associations with body mass index, malnutrition, and gastrointestinal involvement. About one-third of patients had clinically relevant malnutrition. They were older, had higher skin score, lung and esophageal involvement. They also showed significantly worse scores for dysphagia, gastrointestinal symptoms, functional disability, and quality of life. Gastrointestinal symptoms and dysphagia, but not body mass index and Montreal Cognitive Assessment, were significantly associated with depression scores, which in turn were negatively associated to quality-of-life measures. With regression analysis, cognitive impairment was predicted only by age, whereas malnutrition was significantly associated with age, dysphagia, and modified Rodnan skin scores. Conclusion In this study, we showed that cognitive impairment and malnutrition are not directly linked but are both independently associated with greater functional disability and worse quality of life of patients with systemic sclerosis. Early recognition of these comorbidities is therefore pivotal to better address the chronic needs of patients affected by this disease.
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Affiliation(s)
- Devis Benfaremo
- Clinica Medica, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Clinica Medica, Department of Internal Medicine, Marche University Hospital, Ancona, Italy
| | - Nikla Pacenti
- Internal Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Ilaria Paterno
- Internal Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Cristina Dichiara
- Internal Medicine Residency Program, Marche Polytechnic University, Ancona, Italy
| | - Federica Lucia Galli
- Deparment of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Gianluca Moroncini
- Clinica Medica, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
- Clinica Medica, Department of Internal Medicine, Marche University Hospital, Ancona, Italy
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Calañas-Continente A, Gutiérrez-Botella J, García-Currás J, Cobos MJ, Vaquero JM, Herrera A, Molina MJ, Gálvez MÁ. Global Leadership Initiative on Malnutrition-Diagnosed Malnutrition in Lung Transplant Candidates. Nutrients 2024; 16:376. [PMID: 38337661 PMCID: PMC10857078 DOI: 10.3390/nu16030376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND AND AIMS Malnutrition in lung transplantation (LT) candidates increases postoperative morbidity and mortality. Early diagnosis of malnutrition could attenuate adverse prognostic factors. This study aimed to assess the prevalence of nutritional risk and malnutrition using GLIM criteria in LT candidates and clinically characterize those with malnutrition. METHODS A prospective longitudinal study was conducted from 2000 to 2020 of LT candidates who underwent complete nutritional assessment (nutritional screening, anthropometry, bioelectrical impedance, blood laboratory tests and malnutrition diagnosis using GLIM criteria). RESULTS Obstructive diseases (45.6%), interstitial diseases (36.6%) and cystic fibrosis/non-cystic fibrosis bronchiectasis (15.4%) were the main conditions assessed for LT. Of the 1060 candidates evaluated, 10.6% were underweight according to BMI, 29% were at risk of malnutrition and 47% were diagnosed with malnutrition using GLIM criteria. Reduced muscle mass was the most frequent GLIM phenotypic criterion. Malnutrition was more prevalent in patients with cystic fibrosis/non-cystic fibrosis bronchiectasis (84.5%) and obstructive (45.4%) and interstitial (31.3%) diseases. GLIM criteria detected some degree of malnutrition in all diseases requiring LT and identified patients with higher CRP levels and worse respiratory function, anthropometric measurements and visceral protein and lipid profiles. CONCLUSIONS LT candidates present a high prevalence of malnutrition using the GLIM algorithm. GLIM criteria detected malnutrition in all diseases requiring LT and defined patients with worse clinical-analytical profiles.
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Affiliation(s)
- Alfonso Calañas-Continente
- Department of Endocrinology and Nutrition, University Hospital Reina Sofia, Avenida Menendez Pidal s/n, 14004 Cordoba, Spain; (A.H.); (M.J.M.); (M.Á.G.)
| | - Jesús Gutiérrez-Botella
- Biostatech Advice Training and Innovation in Biostatistics, SL. Edificio Emprendia, Campus Vida s/n, 15782 Santiago de Compostela, Spain; (J.G.-B.); (J.G.-C.)
| | - Julia García-Currás
- Biostatech Advice Training and Innovation in Biostatistics, SL. Edificio Emprendia, Campus Vida s/n, 15782 Santiago de Compostela, Spain; (J.G.-B.); (J.G.-C.)
| | - Mª Jesús Cobos
- Department of Pulmonary Medicine and Lung Transplantation, University Hospital Reina Sofia, Avenida Menendez Pidal s/n, 14004 Cordoba, Spain; (M.J.C.); (J.M.V.)
| | - José Manuel Vaquero
- Department of Pulmonary Medicine and Lung Transplantation, University Hospital Reina Sofia, Avenida Menendez Pidal s/n, 14004 Cordoba, Spain; (M.J.C.); (J.M.V.)
| | - Aura Herrera
- Department of Endocrinology and Nutrition, University Hospital Reina Sofia, Avenida Menendez Pidal s/n, 14004 Cordoba, Spain; (A.H.); (M.J.M.); (M.Á.G.)
| | - Mª José Molina
- Department of Endocrinology and Nutrition, University Hospital Reina Sofia, Avenida Menendez Pidal s/n, 14004 Cordoba, Spain; (A.H.); (M.J.M.); (M.Á.G.)
| | - Mª Ángeles Gálvez
- Department of Endocrinology and Nutrition, University Hospital Reina Sofia, Avenida Menendez Pidal s/n, 14004 Cordoba, Spain; (A.H.); (M.J.M.); (M.Á.G.)
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Radić M, Kolak E, Đogaš H, Gelemanović A, Bučan Nenadić D, Vučković M, Radić J. Body composition parameters in systemic sclerosis-a systematic review and meta-analysis. Rheumatology (Oxford) 2024; 63:16-25. [PMID: 37647631 DOI: 10.1093/rheumatology/kead418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to summarize current evidence regarding body composition (BC) in SSc in order to gain new insights and improve clinical care in the context of the nutritional status of SSc patients. METHODS The databases Web of Science, PubMed, Scopus and Cochrane Library were searched on 4 January 2023. Studies were included if they provided data regarding BC obtained by dual-energy X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) in patients with SSc and healthy controls (HC). The study design criteria for inclusion were cohort and observational studies. The risk of bias assessment was performed using the Newcastle-Ottawa scale. For meta-analysis, mean difference with a 95% confidence interval was obtained and all results were depicted as forest plots. RESULTS The number of retrieved publications was 593, of which nine were included in a random-effects meta-analysis totalling 489 SSc patients and 404 HC. Overall, significantly lower body mass index, lean mass (LM), fat mass (FM) and phase angle values were found in SSc patients when compared with HC. Furthermore, FM and LM were significantly lower in SSc patients when the DXA method was applied, whereas the same parameters were comparable between two groups of participants when BIA was applied. CONCLUSION Altered BC is characteristic of SSc patients indicating the need for regular nutritional status assessment in order to improve the quality of life and clinical care of patients with SSc.
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Affiliation(s)
- Mislav Radić
- Internal Medicine Department, Rheumatology, Allergology and Clinical Immunology Division, University Hospital of Split, Split, Croatia
- Department of Internal Medicine, University of Split, Split, Croatia
| | - Ela Kolak
- Nutrition and Dietetics Department, University Hospital of Split, Split, Croatia
| | - Hana Đogaš
- Internal Medicine Department, Nephrology and Hemodialysis Division, University Hospital of Split, Split, Croatia
| | | | - Dora Bučan Nenadić
- Nutrition and Dietetics Department, University Hospital of Split, Split, Croatia
| | - Marijana Vučković
- Internal Medicine Department, Nephrology and Hemodialysis Division, University Hospital of Split, Split, Croatia
| | - Josipa Radić
- Department of Internal Medicine, University of Split, Split, Croatia
- Internal Medicine Department, Nephrology and Hemodialysis Division, University Hospital of Split, Split, Croatia
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Laudisio D, de Alteriis G, Vetrani C, Aprano S, Pugliese G, Zumbolo F, Colao A, Savastano S. Iron Levels and Markers of Inflammation in a Population of Adults with Severe Obesity, a Cross-Sectional Study. Nutrients 2023; 15:4702. [PMID: 37960355 PMCID: PMC10647820 DOI: 10.3390/nu15214702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023] Open
Abstract
Low-grade chronic inflammation linked to obesity can lead to alterations in biomarkers of iron status. The aim of this study was to investigate the primary determinant of serum iron levels among anthropometric measurements, body fat, and serum biomarkers of low-grade chronic inflammation in a group of adult individuals with severe obesity. We enrolled 114 individuals (84 females; 30 males) aged 40.96 ± 12.54 years. Weight and body mass index (BMI) were 121.20 ± 22.33 kg and 44.94 ± 7.29 kg/m2, respectively. Some 30% of individuals had class-II obesity (BMI ≥ 35 ≤ 39.9 kg/m2) and 70% had class-III obesity (BMI ≥ 40 kg/m2). A weak, albeit significant, inverse correlation was found between serum iron levels and c-reactive protein (CRP) (r = -0.259, p = 0.008), fibrinogen (r = -0.261, p = 0.006), BMI (r = -0.186, p = 0.04), waist circumference (WC) (r = -0.265, p = 0.004), and fat mass % (r = -0.285, p = 0.003). With multiple linear regression analysis including CRP, fibrinogen, BMI, WC, and fat mass % as independent variables and serum iron levels as dependent variable, WC was entered in the first step (p = 0.001), which was followed by fat mass % (p = 0.047) and CRP (p = 0.047). Grouping the individuals according to the interquartile range of BMI, WC, and fat mass % (Q1-Q4), the lowest serum iron levels were found in Q4 groups of WC and fat mass % (p = 0.02), while no significant differences were found between groups in BMI quartiles. In conclusion, in our study, population serum iron levels were inversely associated with BMI, visceral obesity, fat mass %, CRP, and fibrinogen, but WC was the major negative predictor of serum iron level. These results supported the fact that visceral distribution of body fat, more than obesity per se, was associated with low serum iron levels in adult individuals with severe obesity.
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Affiliation(s)
- Daniela Laudisio
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; (C.V.); (S.A.); (A.C.)
| | - Giulia de Alteriis
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; (G.d.A.); (G.P.); (F.Z.)
| | - Claudia Vetrani
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; (C.V.); (S.A.); (A.C.)
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Via Porzio, Centro Isola F2, 80143 Napoli, Italy
| | - Sara Aprano
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; (C.V.); (S.A.); (A.C.)
| | - Gabriella Pugliese
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; (G.d.A.); (G.P.); (F.Z.)
| | - Francesca Zumbolo
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; (G.d.A.); (G.P.); (F.Z.)
| | - Annamaria Colao
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; (C.V.); (S.A.); (A.C.)
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; (G.d.A.); (G.P.); (F.Z.)
- Cattedra Unesco “Educazione Alla Salute e Allo Sviluppo Sostenibile”, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Silvia Savastano
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; (C.V.); (S.A.); (A.C.)
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; (G.d.A.); (G.P.); (F.Z.)
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Rosato E, Gigante A, Colalillo A, Pellicano C, Alunni Fegatelli D, Muscaritoli M. GLIM-diagnosed malnutrition predicts mortality and risk of hospitalization in systemic sclerosis: A retrospective study. Eur J Intern Med 2023; 117:103-110. [PMID: 37482470 DOI: 10.1016/j.ejim.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Malnutrition is a well-known risk factor for morbidity and mortality in many clinical settings and only few studies assessed the role of malnutrition on systemic sclerosis (SSc) patients' outcomes. The aim of this retrospective study was to evaluate the role of malnutrition as a predictive risk factor for mortality and/or hospitalization in SSc patients during a 4-year follow-up. METHODS One hundred and one SSc patients were included in the study. Biochemical analyses, disease activity index, disease severity scale and anthropometric data were recorded at enrollment. Malnutrition was assessed by the Global Leadership Initiative on Malnutrition (GLIM) criteria. RESULTS Malnutrition according to GLIM criteria was found in 22 patients (21.8%). During a 4-year follow-up, 20 (19.8%) SSc patients died or were hospitalized for all causes and 11 of them (55.0%) were malnourished. Kaplan-Meier curves showed that event free-survival for composite end-point of mortality and risk of hospitalization was significantly shorter in malnourished than in non-malnourished patients (p<0.001). The survival probability at 4 years was 0.885 (95% CI=0.818-0.959) in the non-malnourished group and 0.500 (95% CI=0.329-0.759) in the malnourished group (p<0.001). In multivariate analysis, malnutrition [HR=4.380 (95% CI=1.706-11.243), p = 0.002] was the most significant predictive risk factor for the composite end-point. Also, female gender [HR=0.157 (95% CI=0.055-0.449), p<0.001], age [HR=1.0450 (95% CI=1.011-1.090), p = 0.012] and disease severity scale [HR=1.269 (95% CI=1.089-1.479), p = 0.002] were predictive factors for the composite end-point. CONCLUSIONS Malnutrition according to GLIM criteria represents a significant predictive risk factor for composite end-point of mortality and risk of hospitalization in SSc patients.
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Affiliation(s)
- Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
| | - Amalia Colalillo
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Chiara Pellicano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Dávalos-Yerovi V, Pérez-Sáez MJ, Faura-Vendrell A, Muns-Cornellas MD, Duran X, Sánchez-Rodríguez D, Pascual J, Marco E. Association between GLIM-defined malnutrition and hospitalizations in kidney transplant candidates: A post hoc analysis of a cohort study. JPEN J Parenter Enteral Nutr 2023; 47:802-811. [PMID: 37314213 DOI: 10.1002/jpen.2532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Malnutrition is frequent in patients with chronic kidney disease (CKD) and has a negative impact on morbidity, mortality, and quality of life. The objective of this study was to assess the value of the Global Leadership Initiative for Malnutrition (GLIM) criteria to predict hospitalizations and mortality in candidates to kidney transplant during their first year on the waiting list. METHODS This was a post hoc analysis of 368 patients with advanced CKD. The main study variables were malnutrition, according to the GLIM criteria; number of hospital admissions during the first year on the waiting list; and mortality at the end of follow-up. Kaplan-Meier survival curves and binary logistic regression were performed, adjusting for age, frailty status, handgrip strength, and Charlson Index as potential confounders. RESULTS The prevalence of malnutrition was 32.6%. Malnutrition was associated with increased risk of hospitalizations during the first year on the waiting list (odds ratio [OR] = 3.33 [95% CI = 1.34-8.26]), which persisted after adjustment for age and frailty status (adjusted OR = 3.61 [95% CI = 1.38-10.7]), age and handgrip strength (adjusted OR = 3.39 [95% CI = 1.3-8.85]), and age and Charlson Index (adjusted OR = 3.25 [95% CI = 1.29-8.13]). CONCLUSION Malnutrition according to the GLIM criteria was highly prevalent in patients with CKD and was associated with a threefold increased risk of hospitalizations during the first year on the waiting list; these associations remained significant after adjusting for age, frailty status, handgrip strength, and comorbidities.
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Affiliation(s)
- Vanesa Dávalos-Yerovi
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
- PhD Program in Biomedicine, Department of Experimental and Health Sciences, Universitat Pompeu Fabra-Doctoral School, Barcelona, Spain
| | | | - Anna Faura-Vendrell
- Department of Nephrology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - Xavier Duran
- Methodology and Biostatistics Support Unit, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Geriatrics Department, Hospital del Mar-Hospital de l'Esperança, Parc de Salut Mar, Barcelona, Spain
| | - Julio Pascual
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ester Marco
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança), Barcelona, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Alves LF, de Jesus JDS, Britto VNM, de Jesus SA, Santos GS, de Oliveira CC. GLIM criteria to identify malnutrition in patients in hospital settings: A systematic review. JPEN J Parenter Enteral Nutr 2023; 47:702-709. [PMID: 37314206 DOI: 10.1002/jpen.2533] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 04/20/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023]
Abstract
Malnutrition is recognized as one of the main public health problems in hospitals. The Global Leadership Initiative on Malnutrition (GLIM) has established a global consensus on the criteria for diagnosing malnutrition in adults in hospital settings. This study aimed to evaluate the ability of the GLIM criteria as a tool to identify malnutrition in hospital settings and to compare the prevalence of malnutrition identified by GLIM criteria with that identified by other screening and/or nutrition assessment methods. This was a systematic review. Searches were performed using MEDLINE/PubMed, Scopus, and Virtual Health Library, based on established descriptors. The included studies were observational and used screening and/or nutrition assessment tools to compare the prevalence of malnutrition and predictive capacity identified by GLIM criteria in patients aged >18 years in hospital settings. Twelve studies were included in this systematic review. A total of 4066 individuals with different pathologies and clinical conditions participated in the included studies. The prevalence of malnutrition, according to the GLIM criteria, ranged from 16% to 80%. In four studies, the prevalence of malnutrition based on GLIM was higher than that based on the other indicators. Six studies that evaluated the predictive ability of GLIM criteria identified satisfactory sensitivity and specificity. Four studies found low to high agreement between GLIM and the other methods. GLIM criteria can identify malnutrition and find a high prevalence and severity of malnutrition in the hospital setting, proving them to be a sensitive and specific instrument, with good agreement between screening and nutrition assessment methods.
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Affiliation(s)
- Luana Ferreira Alves
- Graduate Program in Nutrition Sciences, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | | | | | - Gabriel Silva Santos
- Department of Nutrition, Federal University of Sergipe, Lagarto, Sergipe, Brazil
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8
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Rosato E, Gigante A, Pellicano C, Colalillo A, Alunni-Fegatelli D, Muscaritoli M. Phase angle, nutritional status, and mortality in systemic sclerosis: An exploratory pilot study. Nutrition 2023; 107:111946. [PMID: 36577164 DOI: 10.1016/j.nut.2022.111946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Systemic sclerosis (SSc) is a rare autoimmune disease characterized by microvascular damage and fibrosis of the skin and internal organs. Among SSc complications, changes in nutritional status have a negative effect on quality of life and predispose patients to malnutrition. The aim of this exploratory pilot study was to examine whether bioelectrical impedance analysis-derived phase angle (PhA) is a parameter of nutritional status and a marker of mortality in patients with SSc. METHODS Consecutive adult patients with SSc were included in the study. Biochemical analyses, anthropometric data, and bioelectrical impedance analysis assessments were recorded at the time of enrollment. The Malnutrition Universal Screening Tool (MUST) and Global Leadership Initiative on Malnutrition (GLIM) were applied to assess nutritional status. RESULTS A total of 104 patients with SSc (88 women; median age: 55 y [interquartile range (IQR), 45.5- 66 y]) were enrolled. In patients with SSc and high malnutrition risk according to MUST, mean values of PhA were significantly lower than those of patients with SSc and low malnutrition risk (4° [IQR, 3.7°-4.4°] vs 4.6° [IQR, 4.2°-5.1°]; P = 0.004). Patients with SSc and malnutrition according to the GLIM criteria showed significantly lower PhA than patients with SSc but without malnutrition (3.8° [IQR, 3.5°-4.3°] vs 4.6° [IQR, 4.2°-5.1°]; P < 0.0001). Kaplan-Meier curves demonstrated that overall survival was significantly shorter (34.57 mo [±13.35] vs 48 mo [±0]; P = 0.001) in patients with SSc and PhA <3.75°. In the multivariate analysis, only PhA was a predictive factor for death (hazard ratio: 0.283; 95% confidence interval, 0.083-0.965; P = 0.044). CONCLUSIONS The data obtained suggest that lower PhA values in patients with SSc are associated with an increased malnutrition risk with MUST, malnutrition with GLIM, and increased mortality. Additional studies are necessary to confirm these preliminary results.
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Affiliation(s)
- Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - Chiara Pellicano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Amalia Colalillo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Danilo Alunni-Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Bannert K, Sautter LF, Wiese ML, Meyer F, Ehlers L, Fromhold-Treu S, Karbe C, Gärtner S, Lerch MM, Aghdassi AA, Jaster R, Valentini L, Lamprecht G. Analysis of ESPEN and GLIM algorithms reveals specific drivers for the diagnosis of malnutrition in patients with chronic gastrointestinal diseases. Nutrition 2023; 106:111887. [PMID: 36473417 DOI: 10.1016/j.nut.2022.111887] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/09/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Disease-related malnutrition (MN) is common in patients with liver cirrhosis (LC), short bowel syndrome (SBS), and chronic pancreatitis (CP). Different MN risk screening tools and diagnostic criteria of the European Society for Clinical Nutrition and Metabolism (ESPEN) and Global Leadership Initiative on Malnutrition (GLIM) algorithms were analyzed for their diagnostic accuracy and role as specific drivers to diagnose MN in patients with LC, SBS, and CP. METHODS A total of 187 patients with LC, SBS, and CP, as well as control patients were prospectively recruited in a multicenter cross-sectional study. MN risk was screened using Nutritional Risk Screening 2002 (NRS-2002), the Malnutrition Universal Screening Tool (MUST), and the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), and diagnosed using the ESPEN, GLIM, and GLIMCRP+ (GLIM incorporating C-reactive protein [CRP] >5 mg/L) algorithms. For each of the individual diagnostic criteria, relative frequency, sensitivity, specificity, as well as positive and negative predictive values were calculated. RESULTS NRS-2002 was only sensitive in conjunction with ESPEN, while MUST was sensitive additionally with the GLIM algorithm. RFH-NPT worked the best for LC. GLIM and GLIMCRP+ diagnosed MN more frequently than the ESPEN algorithm. Diagnostic criteria were detected at remarkably different relative frequencies starting with reduced food intake/malabsorption and chronic disease/inflammation, followed by weight loss, reduced fat-free mass index, low body mass index, and body mass index <18.5 kg/m². Relative frequencies differed between LC, SBS, and CP. Weight loss in LC and CP and reduced fat-free mass index and food intake in SBS had good diagnostic accuracy, suggesting that these criteria act as specific drivers for MN. CONCLUSIONS RFH-NPT and MUST performed better in conjunction with the GLIM algorithm than NRS-2002. MN was diagnosed more frequently by GLIM than the ESPEN algorithm in LC, SBS, and CP. Individual criteria acted as specific drivers in MN in chronic gastrointestinal diseases.
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Affiliation(s)
- Karen Bannert
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Lea Franziska Sautter
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Mats Lukas Wiese
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Fatuma Meyer
- University of Applied Sciences Neubrandenburg, Institute for Evidence-Based Dietetics, Neubrandenburg, Germany
| | - Luise Ehlers
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Sophie Fromhold-Treu
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Cathleen Karbe
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Simone Gärtner
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Robert Jaster
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Luzia Valentini
- University of Applied Sciences Neubrandenburg, Institute for Evidence-Based Dietetics, Neubrandenburg, Germany
| | - Georg Lamprecht
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany.
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10
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Nassar M, Ghernautan V, Nso N, Nyabera A, Castillo FC, Tu W, Medina L, Ciobanu C, Alfishawy M, Rizzo V, Eskaros S, Mahdi M, Khalifa M, El-Kassas M. Gastrointestinal involvement in systemic sclerosis: An updated review. Medicine (Baltimore) 2022; 101:e31780. [PMID: 36397401 PMCID: PMC9666124 DOI: 10.1097/md.0000000000031780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The gastrointestinal tract (GI) is the second most affected organ system in individuals suffering from systemic/localized scleroderma (SSc) or localized scleroderma. SSc can affect any part of the GI, between the oral cavity and anorectum. The annual incidence of SSc in the United States is estimated to be 19.3 cases per million adults, with the highest incidence reported in people aged 44 to 55. Females are 5 times more likely than males to suffer from SSc. Morbidity and mortality rates associated with SSc are predominantly elevated among patients with GI manifestations. Esophageal and intestinal manifestations impact 90% and 40% to 70% of patients with systemic scleroderma, respectively. SSc patients are known to suffer from small bowel hypomotility and small intestinal bacterial overgrowth, which cause malabsorption and malnutrition, ultimately contributing to the 50% mortality rate. Fecal incontinence is a common symptom of SSc that can lead to depression. SSc patients may suffer from gastrointestinal complications that can negatively impact their quality of life on a daily basis. Multidisciplinary approaches are necessary for systematically managing gastrointestinal complications associated with SSc. A prospective study should focus on developing targeted therapies to improve recovery patterns and prognosis in cases of SSc. This article summarizes the epidemiology, commonly reported clinical manifestations, complications, and available treatments for treating GI pathology in SSc patients.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Victoria Ghernautan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Akwe Nyabera
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Francisco Cuevas Castillo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Wan Tu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Luis Medina
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | | | - Mostafa Alfishawy
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Saphwat Eskaros
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NYC Health+Hospitals, Queens, NY, USA
| | - Mamdouh Mahdi
- Internal Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mohamed Khalifa
- Hospital Management Department, Helwan University, Cairo, Egypt
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
- * Correspondence: Mohamed El-Kassas, Endemic Medicine Department, Faculty of Medicine, Helwan University, Ain Helwan 11795 Cairo, Egypt (e-mail: )
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11
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Pugliese G, Barrea L, Sanduzzi Zamparelli A, de Alteriis G, Laudisio D, Muscogiuri G, Canora A, Bocchino M, Colao A, Savastano S. Body composition and obstructive sleep apnoea assessment in adult patients with Prader-Willi syndrome: a case control study. J Endocrinol Invest 2022; 45:1967-1975. [PMID: 35723851 PMCID: PMC9463306 DOI: 10.1007/s40618-022-01831-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/29/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In Prader-Willi syndrome (PWS) adult patients, sleep-breathing disorders, especially obstructive sleep apnoea syndrome (OSAS), are very common, whose missed or delayed diagnosis can contribute to further increase cardiovascular morbidity and mortality. PURPOSE The aim of this cross-sectional study was to evaluate differences in sleep-breathing parameters obtained by overnight cardiorespiratory polygraphy in 13 adult PWS patients and 13 individuals with non-syndromic obesity as controls matched by age, sex, and BMI. METHODS In all subjects' anthropometric parameters, body composition using bioimpedance analysis and overnight cardiorespiratory monitoring parameters were obtained. RESULTS Ten (76.9%) PWS patients were diagnosed with OSAS, most notably nine (69.2%) and one PWS (7.7%) with mild and severe OSAS, respectively. Compared with the control group, PWS patients had evidence of higher apnoea-hypopnea index (AHI) (p = 0.04) and oxyhaemoglobin desaturation index (ODI) (p = 0.009). However, no differences were found between the two groups regarding OSAS categories or diagnosis of nocturnal respiratory failure. In the PWS group, there were no significant correlations among AHI, ODI and hypoxemia index (T90) and anthropometric measurements, fat mass (FM), and FM percentage (%). Conversely, in the control group, the sleep-related respiratory indices evaluated correlated positively with BMI, waist circumference, FM and FM%. CONCLUSIONS This study confirmed that AHI and ODI indices were worse in PWS than in age, sex and BMI-matched controls. The lack of their significant association with the anthropometric parameters and FM supported the existence of PWS-related mechanisms in OSAS pathophysiology that are independent of visceral obesity and FM.
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Affiliation(s)
- G. Pugliese
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
| | - L. Barrea
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Naples, Italy
| | - A. Sanduzzi Zamparelli
- Dipartimento di Pneumologia, Ospedale di Alta Specializzazione ‘V. Monaldi’, Università “Federico II” di Napoli, Naples, Italy
- Cattedra Unesco “Educazione alla Salute e allo Sviluppo Sostenibile”, Università “Federico II” di Napoli, Naples, Italy
| | - G. de Alteriis
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
| | - D. Laudisio
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
| | - G. Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
| | - A. Canora
- Dipartimento di Pneumologia, Ospedale di Alta Specializzazione ‘V. Monaldi’, Università “Federico II” di Napoli, Naples, Italy
| | - M. Bocchino
- Dipartimento di Pneumologia, Ospedale di Alta Specializzazione ‘V. Monaldi’, Università “Federico II” di Napoli, Naples, Italy
| | - A. Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
- Cattedra Unesco “Educazione alla Salute e allo Sviluppo Sostenibile”, Università “Federico II” di Napoli, Naples, Italy
| | - S. Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, 80131 Naples, Italy
- Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università “Federico II” di Napoli, Via Sergio Pansini, 5, Naples, Italy
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12
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Compher C, Cederholm T, Correia MITD, Gonzalez MC, Higashiguch T, Shi HP, Bischoff SC, Boirie Y, Carrasco F, Cruz-Jentoft A, Fuchs-Tarlovsky V, Fukushima R, Heymsfield SB, Mourtzakis M, Muscaritoli M, Norman K, Nyulasi I, Pisprasert V, Prado CM, de van der Schuren M, Yoshida S, Yu J, Jensen G, Barazzoni R. Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition diagnosis of malnutrition. JPEN J Parenter Enteral Nutr 2022; 46:1232-1242. [PMID: 35437785 DOI: 10.1002/jpen.2366] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/21/2022] [Accepted: 03/06/2022] [Indexed: 02/06/2023]
Abstract
The Global Leadership Initiative on Malnutrition (GLIM) provides consensus criteria for the diagnosis of malnutrition that can be widely applied. The GLIM approach is based on the assessment of three phenotypic (weight loss, low body mass index, and low skeletal muscle mass) and two etiologic (low food intake and presence of disease with systemic inflammation) criteria, with diagnosis confirmed by any combination of one phenotypic and one etiologic criterion fulfilled. Assessment of muscle mass is less commonly performed than other phenotypic malnutrition criteria, and its interpretation may be less straightforward, particularly in settings that lack access to skilled clinical nutrition practitioners and/or to body composition methodologies. In order to promote the widespread assessment of skeletal muscle mass as an integral part of the GLIM diagnosis of malnutrition, the GLIM consortium appointed a working group to provide consensus-based guidance on assessment of skeletal muscle mass. When such methods and skills are available, quantitative assessment of muscle mass should be measured or estimated using dual-energy x-ray absorptiometry, computerized tomography, or bioelectrical impedance analysis. For settings where these resources are not available, then the use of anthropometric measures and physical examination are also endorsed. Validated ethnic- and sex-specific cutoff values for each measurement and tool are recommended when available. Measurement of skeletal muscle function is not advised as surrogate measurement of muscle mass. However, once malnutrition is diagnosed, skeletal muscle function should be investigated as a relevant component of sarcopenia and for complete nutrition assessment of persons with malnutrition.
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Affiliation(s)
- Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Theme Inflammation & Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Isabel T D Correia
- Department of Surgery, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Cristina Gonzalez
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Han Ping Shi
- Key Laboratory of Cancer FSMP for State Market Regulation, Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Stephan C Bischoff
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Yves Boirie
- Unité de Nutrition Humaine, Clinical Nutrition Department, INRAE, CHU Clermont-Ferrand, CRNH Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Fernando Carrasco
- Department of Nutrition, Faculty of Medicine, Nutrition and Bariatric Surgery Center, University of Chile, and Clínica Las Condes, Santiago, Chile
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Ryoji Fukushima
- Department of Surgery, Teikyo University School of Medicine/Health and Dietetics Teikyo Heisei University, Tokyo, Japan
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Marina Mourtzakis
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Kristina Norman
- Department of Geriatrics and Medical Gerontology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Ibolya Nyulasi
- Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Dietetics, Nutrition and Sport, LaTrobe University, Bundoora, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Veeradej Pisprasert
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Marian de van der Schuren
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Wageningen University & Research, Human Nutrition and Health, Wageningen, The Netherlands
| | - Sadao Yoshida
- Department of Rehabilitation, Chuzan Hospital, Okinawa-city, Okinawa Prefecture, Japan
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Gordon Jensen
- Dean's Office, Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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13
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Barazzoni R, Jensen GL, Correia MITD, Gonzalez MC, Higashiguchi T, Shi HP, Bischoff SC, Boirie Y, Carrasco F, Cruz-Jentoft A, Fuchs-Tarlovsky V, Fukushima R, Heymsfield S, Mourtzakis M, Muscaritoli M, Norman K, Nyulasi I, Pisprasert V, Prado C, de van der Schuren M, Yoshida S, Yu Y, Cederholm T, Compher C. Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition. Clin Nutr 2022; 41:1425-1433. [PMID: 35450768 DOI: 10.1016/j.clnu.2022.02.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 01/02/2023]
Abstract
The Global Leadership Initiative on Malnutrition (GLIM) provides consensus criteria for the diagnosis of malnutrition that can be widely applied. The GLIM approach is based on the assessment of three phenotypic (weight loss, low body mass index, and low skeletal muscle mass) and two etiologic (low food intake and presence of disease with systemic inflammation) criteria, with diagnosis confirmed by any combination of one phenotypic and one etiologic criterion fulfilled. Assessment of muscle mass is less commonly performed than other phenotypic malnutrition criteria, and its interpretation may be less straightforward, particularly in settings that lack access to skilled clinical nutrition practitioners and/or to body composition methodologies. In order to promote the widespread assessment of skeletal muscle mass as an integral part of the GLIM diagnosis of malnutrition, the GLIM consortium appointed a working group to provide consensus-based guidance on assessment of skeletal muscle mass. When such methods and skills are available, quantitative assessment of muscle mass should be measured or estimated using dual-energy x-ray absorptiometry, computerized tomography, or bioelectrical impedance analysis. For settings where these resources are not available, then the use of anthropometric measures and physical examination are also endorsed. Validated ethnic- and sex-specific cutoff values for each measurement and tool are recommended when available. Measurement of skeletal muscle function is not advised as surrogate measurement of muscle mass. However, once malnutrition is diagnosed, skeletal muscle function should be investigated as a relevant component of sarcopenia and for complete nutrition assessment of persons with malnutrition.
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Affiliation(s)
- Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Gordon L Jensen
- Dean's Office, Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Maria Isabel T D Correia
- Department of Surgery, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Cristina Gonzalez
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Han Ping Shi
- Key Laboratory of Cancer FSMP for State Market Regulation, Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Stephan C Bischoff
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Yves Boirie
- Unité de Nutrition Humaine, Clinical Nutrition Department, INRAE, CHU Clermont-Ferrand, CRNH Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Fernando Carrasco
- Department of Nutrition, Faculty of Medicine, Nutrition and Bariatric Surgery Center, University of Chile, Clínica Las Condes, Santiago, Chile
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Ryoji Fukushima
- Department of Surgery Teikyo University School of Medicine/Health and Dietetics Teikyo Heisei University, Tokyo, Japan
| | - Steve Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Marina Mourtzakis
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Kristina Norman
- Department of Geriatrics and Medical Gerontology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Ibolya Nyulasi
- Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Dietetics, Nutrition and Sport, LaTrobe University, Bundoora, Victoria, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Veeradej Pisprasert
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Carla Prado
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Marian de van der Schuren
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands; Wageningen University & Research, Human Nutrition and Health, Wageningen, the Netherlands
| | - Sadao Yoshida
- Department of Rehabilitation, Chuzan Hospital, Okinawa-city, Okinawa Prefecture, Japan
| | - Yanchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Theme Inflammation & Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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14
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Rosato E, Gigante A, Pellicano C, Villa A, Iannazzo F, Alunni Fegatelli D, Muscaritoli M. Symptoms related to gastrointestinal tract involvement and low muscularity in systemic sclerosis. Clin Rheumatol 2022; 41:1687-1696. [PMID: 35149929 PMCID: PMC9119878 DOI: 10.1007/s10067-022-06059-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION/OBJECTIVES Gastrointestinal tract (GIT) involvement is frequently observed in systemic sclerosis (SSc) and may lead to nutritional impairment. The aim of the study was to assess the prevalence of symptoms related to GIT involvement and to analyze the possible association between gastrointestinal symptoms and low muscularity in SSc patients. METHODS Sixty-nine consecutive patients (60 females, median age 53 (IQR 43-63), body mass index (BMI) 23.2 (IQR 20.9-24.6) kg/m2) with diagnosis of SSc admitted to our Scleroderma Unit were enrolled. Clinical status, anthropometric data, and bioelectrical impedance (Inbody 770, USA) analysis-assessed Fat-Free Mass Index (FFMI) were recorded upon enrollment. UCLA questionnaire was used to quantify GIT involvement with seven specific scales. RESULTS Mean FFMI was 16.2 kg/m2 (IQR 15.2-17.6). The median UCLA total score was 0.53 (IQR 0.19-0.89). FFMI showed a significant negative correlation with UCLA total score (r = -0.29, p = 0.016) and UCLA distention/bloating (r = -0.35, p < 0.01). In 16 patients (23.1%), FFMI was reduced and UCLA distention/bloating was significantly higher (p = 0.039) in SSc patients with lower FFMI [1.75 (IQR 0.75-2.12) vs 0.75 (IQR 0.25-1.75)]. At multiple linear regression model, FFMI showed association with UCLA distention/bloating [beta coefficient - 0.315 (95% CI of beta coefficient: -0.591; -0.039), p = 0.026], BMI [beta coefficient 0.259 (95% CI of beta coefficient: 0.163; 0.355), p = 0.001], and disease duration [beta coefficient - 0.033 (95% CI of beta coefficient: -0.059; -0.007), p = 0.015]. CONCLUSIONS In SSc, low FFMI is associated with symptoms related to GIT involvement, in particular with distension/bloating. Key Points • FFMI is associated with symptoms related to GIT involvement. • Low FFMI is associated with symptoms related to UCLA distention/bloating. • Malnutrition is not associated with symptoms related to GIT involvement.
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Affiliation(s)
- Edoardo Rosato
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale dell' Università 37, 00185, Rome, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale dell' Università 37, 00185, Rome, Italy
| | - Chiara Pellicano
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale dell' Università 37, 00185, Rome, Italy
| | - Annalisa Villa
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale dell' Università 37, 00185, Rome, Italy
| | - Francesco Iannazzo
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale dell' Università 37, 00185, Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale dell' Università 37, 00185, Rome, Italy.
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15
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El Chaar D, Mattar L, Fakih El Khoury C. AND/ASPEN and the GLIM Malnutrition Diagnostic Criteria have a High Degree of Criterion Validity and Reliability for the Identification of Malnutrition in a Hospital Setting: A Single-Center Prospective Study. JPEN J Parenter Enteral Nutr 2022; 46:1061-1070. [PMID: 35147234 DOI: 10.1002/jpen.2347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/14/2022] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Multiple malnutrition diagnostic tools are available in clinical practice yet evidence on their validity and reliability is limited. We aim to assess and compare the validity and reliability of the different combinations of indicators of the three diagnostic tools most used compared to two validated malnutrition screening tools. METHODS Nutritional risk screening was evaluated using the Mini-Nutritional Assessment Short Form (MNA-SF) and Nutrition Risk Screening-2002 (NRS-2002), and nutritional assessment was conducted using different combinations of the Academy of Nutrition and Dietetics/American Society of Parenteral and Enteral Nutrition (AND/ASPEN), The European Society of Clinical Nutrition and Metabolism (ESPEN), and Global Leadership Initiative on Malnutrition (GLIM). Concurrent criterion validity and inter-rater reliability of the overall and the different combinations of indicators in the diagnostic tools were evaluated and compared. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen's kappa (ĸ) were calculated to determine tool validity and reliability. RESULTS AND/ASPEN [132(22.8%)] combination and GLIM-1 [133(23.0%)] (weight loss + compromised food intake) predicted the highest number of malnourished patients and reported a high degree of concurrent criterion validity, agreement, and reliability. On the contrary, overall ESPEN (using any combination) and GLIM-2 (reduced Body Mass Index-BMI + compromised food intake) reported only moderate criterion validity and low agreement and reliability. CONCLUSION Different combinations of diagnostic criteria led to varying validity and reliability, with the lowest validation results rising from the combinations of indicators using BMI as a criterion for malnutrition diagnosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dayana El Chaar
- School of Arts and Sciences, Department of Natural Sciences, Lebanese American University
| | - Lama Mattar
- School of Arts and Sciences, Department of Natural Sciences, Lebanese American University
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16
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Correia MIT, Tappenden KA, Malone A, Prado CM, Evans DC, Sauer AC, Hegazi R, Gramlich L. Utilization and validation of the Global Leadership Initiative on Malnutrition (GLIM): A scoping review. Clin Nutr 2022; 41:687-697. [DOI: 10.1016/j.clnu.2022.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/05/2022] [Accepted: 01/20/2022] [Indexed: 12/27/2022]
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17
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Huang S, Niu Y, Liu X, Gu Z, Huang A, Wu J. Characteristics of malnutrition according to Global Leadership Initiative on Malnutrition criteria in non-surgical patients with irritable bowel disease. Nutrition 2021; 94:111514. [PMID: 34844157 DOI: 10.1016/j.nut.2021.111514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Malnutrition is common in patients with inflammatory bowel disease (IBD). The Global Leadership Initiative on Malnutrition (GLIM) was proposed to assess the severity and characteristics of malnutrition. Thus, we aimed to use the latest consensus on the diagnosis of malnutrition, GLIM criteria, to evaluate malnutrition in patients with IBD. METHODS We performed a retrospective cohort study of 73 adult patients with IBD (48 with Crohn disease and 25 with ulcerative colitis). Demographic data, clinical characteristics, and nutrition status defined by Nutritional Risk Screening (NRS) 2002 and GLIM criteria were recorded at enrollment. RESULTS According to the GLIM criteria, 43 (58.90%) patients were identified with malnutrition, and the incidence of mild to moderate malnutrition and severe malnutrition was 28.77% (21 of 73 patients) and 30.14% (22 of 73 patients), respectively. The severity of malnutrition in patients with IBD increased with the cumulative number of phenotypic criteria they met (P < 0.01). The difference in the number of etiologic indicators was only identified between patients with severe malnutrition and those without malnutrition (P < 0.05). Patients with Crohns disease had a significantly higher rate of muscle mass loss than patients with ulcerative colitis (P = 0.038) but a lower incidence of reduced food intake or assimilation (P = 0.039). CONCLUSION The prevalence of malnutrition according to the GLIM criteria was high in non-surgical patients with IBD, and as the degree of malnutrition worsened, more phenotypes and etiologic types appeared. The phenotypic and etiologic characteristics of GLIM were different in patients with Crohn disease than in those with ulcerative colitis.
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Affiliation(s)
- Shanshan Huang
- Department of Clinical Nutrition, Huadong Hospital, affiliated to Fudan University, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Yang Niu
- Department of Clinical Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong
| | - Xiaowei Liu
- Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China
| | - Zhengye Gu
- Department of Clinical Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong
| | - Aiyue Huang
- Department of Clinical Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong
| | - Jiang Wu
- Department of Clinical Nutrition, Huadong Hospital, affiliated to Fudan University, Shanghai, China.
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18
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Rosnes KS, Henriksen C, Høidalen A, Paur I. Agreement between the GLIM criteria and PG-SGA in a mixed patient population at a nutrition outpatient clinic. Clin Nutr 2021; 40:5030-5037. [PMID: 34365037 DOI: 10.1016/j.clnu.2021.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 06/16/2021] [Accepted: 07/13/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS The Global Leadership Initiative on Malnutrition (GLIM) criteria is a step-wise process including a screening tool of choice for risk assessment of malnutrition before assessment of diagnosis and grading of malnutrition severity. The agreement between GLIM and the established malnutrition assessment method Patient Generated-Subjective Global Assessment (PG-SGA) is uncertain. Also, several aspects of GLIM remain to be clearly defined. In this study, we compared diagnosis of malnutrition with the GLIM criteria to the PG-SGA, and explored the differences between the methods. METHODS This cross-sectional study was conducted at the Nutrition Outpatient Clinic at Oslo University Hospital, Norway. Patients were included from September-December 2019. Nutritional Risk Screening 2002 (NRS-2002) was used as the screening tool in the GLIM process before diagnosing and grading the severity of malnutrition. Results are presented with and without the initial risk screening. The diagnostic results from the GLIM process were compared to the malnutrition diagnosis using the PG-SGA. RESULTS In total, 144 patients, median age 58 years, participated in the study. The full GLIM process identified 36% of the patients as malnourished, while the PG-SGA identified 69% of the patients as malnourished. Comparison of GLIM and PG-SGA showed fair agreement, however the agreement was better when the NRS-2002 screening was excluded. Considering the PG-SGA a gold standard, GLIM had a sensitivity of 51% and a specificity of 98%. The introduction of new cut-off values for fat-free mass did not considerably alter the diagnosis of malnutrition within GLIM. CONCLUSIONS The GLIM criteria showed only fair agreement with the PG-SGA, however the agreement was better when the initial NRS-2002 screening was excluded. A joint consensus on how to perform the GLIM process is needed for comparisons of future studies, and before routine use in clinical practice.
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Affiliation(s)
- Kristin S Rosnes
- Norwegian Advisory Unit on Disease-Related Undernutrition, Oslo, Norway; Department of Nutrition, Faculty of Medicine, University of Oslo, Norway
| | | | - Anne Høidalen
- Division of Cancer Medicine, Department of Clinical Services, Section of Clinical Nutrition, Oslo University Hospital, Norway.
| | - Ingvild Paur
- Norwegian Advisory Unit on Disease-Related Undernutrition, Oslo, Norway; Division of Cancer Medicine, Department of Clinical Services, Section of Clinical Nutrition, Oslo University Hospital, Norway.
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19
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Ozturk Y, Deniz O, Coteli S, Unsal P, Dikmeer A, Burkuk S, Koca M, Cavusoglu C, Dogu BB, Cankurtaran M, Halil M. Global Leadership Initiative on Malnutrition criteria with different muscle assessments including muscle ultrasound with hospitalized internal medicine patients. JPEN J Parenter Enteral Nutr 2021; 46:936-945. [PMID: 34287973 DOI: 10.1002/jpen.2230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The aim of this study is to identify cutoff values for muscle ultrasound (US) to be used in Global Leadership Initiative on Malnutrition (GLIM) criteria, and to define the effect of reduced muscle mass assessment on malnutrition prevalence at hospital admission. METHODS A total of 118 inpatients were enrolled in this cross-sectional study. Six different muscles were evaluated by US. Following defining thresholds for muscle US to predict low muscle mass measured by bioelectrical impedance analysis, malnutrition was diagnosed by GLIM criteria with seven approaches, including calf circumference, mid-upper arm circumference (MAC), handgrip strength (HGS), skeletal muscle index (SMI), rectus femoris (RF) muscle thickness, and cross-sectional area (CSA) in addition to without using the reduced muscle mass criterion. RESULTS The median age of patients was 64 (18-93) years, 55.9% were female. RF muscle thickness had moderate positive correlations with both HGS (r = 0.572) and SMI (r = 0.405). RF CSA had moderate correlation with HGS (r = 0.567) and low correlation with SMI (r = 0.389). The cutoff thresholds were 11.3 mm (area under the curve [AUC] = 0.835) and 17 mm (AUC = 0.737) for RF muscle thickness and 4 cm² (AUC = 0.937) and 7.2 cm² (AUC = 0.755) for RF CSA in females and males, respectively. Without using the reduced muscle mass criterion, malnutrition prevalence was 46.6%; otherwise, it ranged from 47.5% (using MAC) to 65.2% (using HGS). CONCLUSIONS Muscle US may be used in GLIM criteria. However, muscle US needs a standard measurement technique and specific cutoff values in future studies.
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Affiliation(s)
- Yelda Ozturk
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Olgun Deniz
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Suheyla Coteli
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pelin Unsal
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayse Dikmeer
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Suna Burkuk
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Koca
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cagatay Cavusoglu
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Dogu
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Halil
- Division of Geriatric Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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20
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Burgel CF, Eckert IDC, Brito JE, Rodrigues FW, Silva FM. Accuracy of three tools for malnutrition diagnosis in hospitalised patients: Comparison to subjective global assessment. J Hum Nutr Diet 2021; 34:935-944. [PMID: 33908107 DOI: 10.1111/jhn.12907] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Malnutrition is prevalent in hospital, and the Subjective Global Assessment (SGA) has been widely used for its identification. However, in the last decade, new tools were proposed by the Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition (AND-ASPEN), European Society for Clinical Nutrition and Metabolism (ESPEN) and Global Leadership Initiative on Malnutrition (GLIM). The diagnostic test accuracy of these tools has been scarcely investigated. Thus, we aimed to compare the accuracy of AND-ASPEN, ESPEN and GLIM for malnutrition diagnosis in hospitalised patients. METHODS A cross-sectional study was conducted with hospitalised patients aged ≥ 18 years from a five-unit complex hospital. Malnutrition was diagnosed within 48 h of admission using SGA, AND-ASPEN, ESPEN and GLIM. The accuracy of these tools was evaluated by the area under the receiver operating characteristic (AUROC) curve, considering SGA as reference, which was compared by the DeLong test. RESULTS Six hundred patients (55.7 ± 14.8 years, 51.3% male) were evaluated. AND-ASPEN [AUROC 0.846; 95% confidence interval (CI) = 0.810-0.883] and GLIM presented a satisfactory accuracy (AUROC 0.842; 95% CI, 0.807-0.877), whereas ESPEN had a substantially lower accuracy (AUROC, 0.572; 95% CI, 0.522-0.622). The AUROC of AND-ASPEN and GLIM were not different from each other (p = 0.785) and both had significantly higher accuracy than ESPEN (p < 0.001). AND-ASPEN and GLIM presented sensitivity, specificity and negative predictive value > 80%, whereas ESPEN sensitivity was < 20%. CONCLUSIONS AND-ASPEN and GLIM were accurate methods for diagnosing malnutrition and could be applied in hospitalised patients. By contrast, the ESPEN criteria had unsatisfactory accuracy.
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Affiliation(s)
- Camila Ferri Burgel
- Nutrition Science Post graduation Program from the Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | - Julia Epping Brito
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | - Flávia Moraes Silva
- Nutrition Department and Nutrition Science Postgraduation Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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21
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Aotani N, Yasui-Yamada S, Kagiya N, Takimoto M, Oiwa Y, Matsubara A, Matsuura S, Tanimura M, Tani-Suzuki Y, Kashihara H, Saito Y, Nishi M, Shimada M, Hamada Y. Malnutrition by European Society for Clinical Nutrition and Metabolism criteria predicts prognosis in patients with gastrointestinal and hepatobiliary-pancreatic cancer. Clin Nutr ESPEN 2021; 42:265-271. [PMID: 33745591 DOI: 10.1016/j.clnesp.2021.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/13/2020] [Accepted: 01/17/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS The European Society for Clinical Nutrition and Metabolism (ESPEN) proposed the ESPEN diagnostic criteria (EDC) for malnutrition in 2015. There is no report on the association between the EDC and prognosis in patients with gastrointestinal (GI) and hepatobiliary-pancreatic (HBP) cancer. This study aimed to (1) determine the prevalence of EDC malnutrition, (2) investigate the validity of the EDC as a nutritional and prognostic indicator, and (3) examine which components of the EDC are most related to long-term prognosis in patients with GI and HBP cancers. METHODS A total of 634 patients with primary GI and HBP cancers who underwent their first resection surgery between July 2014 and March 2018 were retrospectively recruited. According to the EDC, patients were divided into malnourished and non-malnourished groups. Clinical parameters and survival between these two groups were compared. The prognostic effects of the EDC and the EDC components were analyzed using Cox proportional hazard models. RESULTS The prevalence of EDC malnutrition was 22%. Anthropometric data and biochemical data were associated with EDC malnutrition. The 5-year survival rate was lower in the malnourished group (72%) than in the non-malnourished group (73%; P = 0.007). The multivariate analysis demonstrated that the malnourished group was an independent risk factor for mortality (hazard ratio = 1.70 in the malnourished group; 95% confidence interval 1.08-2.63; P = 0.024). Among EDC components, body mass index (BMI) of <18.5 kg/m2 was an independent poor prognostic factor. CONCLUSIONS EDC malnutrition is associated with poor postoperative long-term prognosis. Among the EDC components, BMI of <18.5 kg/m2 is most associated with prognosis in patients with preoperative GI and HBP cancers.
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Affiliation(s)
- Nozomi Aotani
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Sonoko Yasui-Yamada
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan; Department of Nutrition, Tokushima University Hospital, 2-50-1, Tokushima 770-8503, Japan.
| | - Natsumi Kagiya
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Mami Takimoto
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Yu Oiwa
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Atsumi Matsubara
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Sayaka Matsuura
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Mayu Tanimura
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Yoshiko Tani-Suzuki
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan; Department of Nutrition, Tokushima University Hospital, 2-50-1, Tokushima 770-8503, Japan
| | - Hideya Kashihara
- Department of Nutrition, Tokushima University Hospital, 2-50-1, Tokushima 770-8503, Japan; Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Yu Saito
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan; Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Masaaki Nishi
- Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Mitsuo Shimada
- Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Yasuhiro Hamada
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan; Department of Nutrition, Tokushima University Hospital, 2-50-1, Tokushima 770-8503, Japan
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22
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Balci C, Bolayir B, Eşme M, Arik G, Kuyumcu ME, Yeşil Y, Varan HD, Kara Ö, Güngör AE, Doğu BB, Cankurtaran M, Halil M. Comparison of the Efficacy of the Global Leadership Initiative on Malnutrition Criteria, Subjective Global Assessment, and Nutrition Risk Screening 2002 in Diagnosing Malnutrition and Predicting 5‐Year Mortality in Patients Hospitalized for Acute Illnesses. JPEN J Parenter Enteral Nutr 2020; 45:1172-1180. [DOI: 10.1002/jpen.2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Cafer Balci
- Department of Internal Medicine, Division of Geriatric Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Başak Bolayir
- Department of Internal Medicine, Division of Endocrinology and Metabolism Gazi University Faculty of Medicine Ankara Turkey
| | - Mert Eşme
- Department of Internal Medicine, Division of Geriatric Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Güneş Arik
- Department of Geriatric Medicine Ankara City Hospital Ankara Turkey
| | - Mehmet Emin Kuyumcu
- Department of Internal Medicine, Division of Geriatric Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Yusuf Yeşil
- Department of Internal Medicine, Division of Geriatric Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Hacer Doğan Varan
- Department of Internal Medicine, Division of Geriatric Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Özgür Kara
- Department of Geriatric Medicine Ankara Yenimahalle Education and Research Hospital Ankara Turkey
| | - A. Evrim Güngör
- Department of Nutrition and Dietetics Ankara Güven Hospital Ankara Turkey
| | - Burcu Balam Doğu
- Department of Internal Medicine, Division of Geriatric Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatric Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Meltem Halil
- Department of Internal Medicine, Division of Geriatric Medicine Hacettepe University Faculty of Medicine Ankara Turkey
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Molfino A, Gasperini ML, Gigante A, Rosato E, Muscaritoli M. Left Ventricular Mass Index as Potential Surrogate of Muscularity in Patients With Systemic Sclerosis Without Cardiovascular Disease. JPEN J Parenter Enteral Nutr 2020; 45:1302-1308. [PMID: 32794588 DOI: 10.1002/jpen.1999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 08/04/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Systemic sclerosis (SSc) may be associated with protein-energy malnutrition. It was demonstrated that left ventricular mass (LVM) reflected poor nutrition status in SSc patients, and no data are available on LVM as a surrogate measure of muscularity. We aimed to evaluate, in SSc patients, the relationship between muscle mass and LVM as a novel indicator of muscularity in this setting. METHODS SSc patients and healthy controls (HCs) were considered and underwent echocardiography to assess LVM and LVM index (LVMI). Body composition, including fat-free mass index (FFMI), phase angle (PhA), and body cell mass index (BCMI), was analyzed by multifrequency bioelectrical impedance analysis. RESULTS Sixty-four SSc patients (aged 51 ± 13 years) and 30 HCs (aged 46 ± 13 years) were enrolled. BCMI and PhA were lower in SSc patients compared with HCs (P < .001). LVM and LVMI were not different between SSc patients and HCs (P = .068, P = .14, respectively). In SSc patients, a significant correlation was shown between LVMI and FFMI (τ = 0.192, P = .026); in multiple regression analysis, FFMI was significantly associated with the Malnutrition Universal Screening Tool (P < .0001), LVMI (P = .01), and disease severity scale (P = .02). CONCLUSION Changes in body composition were present in SSc patients, particularly in terms of BMCI and PhA. A correlation between LVMI and FFMI as indexes of muscularity exists in this cohort, suggesting that cardiac mass might be used as a surrogate of nutrition status in this setting.
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Affiliation(s)
- Alessio Molfino
- Department of Translational and Precision Medicine (formerly Department of Clinical Medicine), Sapienza University of Rome, Rome, Italy
| | - Maria Ludovica Gasperini
- Department of Translational and Precision Medicine (formerly Department of Clinical Medicine), Sapienza University of Rome, Rome, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine (formerly Department of Clinical Medicine), Sapienza University of Rome, Rome, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine (formerly Department of Clinical Medicine), Sapienza University of Rome, Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine (formerly Department of Clinical Medicine), Sapienza University of Rome, Rome, Italy
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