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Takekawa T, Katagi M, Kobayashi K, Toyoda S, Nakamura T, Yoshida H, Abo M. Factors influencing home discharge of hospitalized oldest-old patients (≥90 years): A retrospective quantitative case-control study. Geriatr Nurs 2024; 60:99-106. [PMID: 39236372 DOI: 10.1016/j.gerinurse.2024.08.021] [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: 02/03/2024] [Revised: 07/18/2024] [Accepted: 08/19/2024] [Indexed: 09/07/2024]
Abstract
The purpose of this retrospective study was to identify factors that could predict the discharge destination of oldest-old patients (patients aged ≥90 years). Information on the nutritional status, activities of daily living (ADL), nursing care needs based on nursing need degree (NND), rehabilitation therapy, and discharge destination was obtained from the medical records of 90 oldest-old patients aged ≥90 years admitted to our hospital, excluding orthopedic inpatients and short-term (≤5 days) inpatients. Of these, 64 were discharged home while 4 died during hospitalization. More than half had moderately low total lymphocyte count (<1200/μL). Home discharge was correlated with living with someone else and little need for assistance during eating and getting/standing-up at admission. The cutoff value for ability for basic movement scale (ABMS) at admission for home discharge was 18 points. Nutritional management and early mobilization are important aspects of clinical management of the oldest-olds.
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Affiliation(s)
- Toru Takekawa
- Chiba Prefectural University of Health Sciences, Chiba, 261-0014, Japan; Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, 105-8461, Japan.
| | - Mako Katagi
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, 105-8461, Japan; Ookurayama Memorial Hospital, Yokohama, 222-0001, Japan.
| | - Kazushige Kobayashi
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, 105-8461, Japan; Nomura Hospital, Tokyo, 181-8503, Japan.
| | - Shiori Toyoda
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, 105-8461, Japan.
| | - Takayoshi Nakamura
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Katsushika Medical Center, Tokyo, 125-8506, Japan.
| | - Hiroaki Yoshida
- Department of Rehabilitation Medicine, The Jikei University Kashiwa Hospital, Chiba, 277-8567, Japan.
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, 105-8461, Japan.
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Compher C, Jensen GL, Malone A, Morgan S, Becker S, Cresta L, Paul AM, Steiber A. Clinical Outcomes Associated With Malnutrition Diagnosed by the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Indicators of Malnutrition: A Systematic Review of Content Validity and Meta-Analysis of Predictive Validity. J Acad Nutr Diet 2024; 124:1058-1074.e4. [PMID: 38331188 DOI: 10.1016/j.jand.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/18/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Charlene Compher
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Gordon L Jensen
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland
| | - Sherry Morgan
- University of Pennsylvania Libraries, Philadelphia, Pennsylvania
| | - Saraelena Becker
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura Cresta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alex M Paul
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Lo Buglio A, Bellanti F, Carapellese RM, Capurso C, Serviddio G, Vendemiale G. Adherence to the Mediterranean Diet Mitigates Inflammation and Hospital Stay in Frail Elderly Patients: A Moderation Analysis. Nutrients 2024; 16:2482. [PMID: 39125362 PMCID: PMC11314230 DOI: 10.3390/nu16152482] [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: 07/01/2024] [Revised: 07/17/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Understanding the interaction between dietary patterns and nutritional status in influencing health outcomes is crucial, especially in vulnerable populations. Our study investigates the impact of adherence to the Mediterranean diet (MD) and nutritional status on inflammatory markers (CRP) and the length of stay (LOS) in hospitalized frail elderly patients. METHODS We conducted two-way ANOVA and multiple regression analysis to evaluate the effects of nutritional status and MD adherence on the CRP levels and LOS in a cohort of 117 frail elderly patients aged 65 years or older. Patients with cancer or acute infection were excluded. Adherence to the MD was assessed using the 14-item PREDIMED questionnaire. RESULTS Significant interactions were found between nutritional status and MD adherence for both the CRP and LOS. The patients with low-level MD adherence and a poor nutritional status exhibited higher CRP levels and longer hospital stays compared to those with high MD adherence. Specifically, a statistically significant interaction was observed for the CRP (F (1, 113) = 7.36, p = 0.008) and LOS (F (1, 113) = 15.4, p < 0.001), indicating the protective effect of high-level MD adherence. Moderation analysis confirmed that high-level MD adherence mitigates the adverse effects of malnutrition on both the inflammatory response and LOS. CONCLUSIONS These findings highlight the importance of promoting the MD, particularly in malnourished elderly patients, to improve health outcomes and reduce hospitalization duration. Further longitudinal studies are warranted to establish causality and explore the underlying mechanisms.
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Affiliation(s)
| | - Francesco Bellanti
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy; (A.L.B.); (R.M.C.); (C.C.); (G.S.); (G.V.)
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Wang X, Liu Y, Rong Z, Wang W, Han M, Chen M, Fu J, Chong Y, Long X, Tang Y, Chen W. Development and evaluation of a deep learning framework for the diagnosis of malnutrition using a 3D facial points cloud: A cross-sectional study. JPEN J Parenter Enteral Nutr 2024; 48:554-561. [PMID: 38796717 DOI: 10.1002/jpen.2643] [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: 11/13/2023] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND The feasibility of diagnosing malnutrition using facial features has been validated. A tool to integrate all facial features associated with malnutrition for disease screening is still demanded. This work aims to develop and evaluate a deep learning (DL) framework to accurately determine malnutrition based on a 3D facial points cloud. METHODS A group of 482 patients were studied in this perspective work. The 3D facial data were obtained using a 3D camera and represented as a 3D facial points cloud. A DL model, PointNet++, was trained and evaluated using the points cloud as inputs and classified the malnutrition states. The performance was evaluated with the area under the receiver operating characteristic curve, accuracy, specificity, sensitivity, and F1 score. RESULTS Among the 482 patients, 150 patients (31.1%) were diagnosed as having moderate malnutrition and 54 patients (11.2%) as having severe malnutrition. The DL model achieved the performance with an area under the receiver operating characteristic curve of 0.7240 ± 0.0416. CONCLUSION The DL model achieved encouraging performance in accurately classifying nutrition states based on a points cloud of 3D facial information of patients with malnutrition.
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Affiliation(s)
- Xue Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiqin Rong
- Genesis Artificial Intelligence Laboratory, Futong Technology, Chengdu, China
| | - Weijia Wang
- Genesis Artificial Intelligence Laboratory, Futong Technology, Chengdu, China
| | - Meifen Han
- Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Moxi Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Fu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuming Chong
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yong Tang
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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ApSimon M, Steel C, Johnston C, Winder B, Cohen S, Reichert H, Armstrong D. Enteral nutrition on discharge from intensive care and 30-day unplanned readmission: An exploratory, retrospective study of association. Clin Nutr ESPEN 2024; 61:15-21. [PMID: 38777427 DOI: 10.1016/j.clnesp.2024.03.002] [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: 07/04/2023] [Revised: 01/31/2024] [Accepted: 03/05/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS Individuals who survive critical illness are often malnourished with inadequate oral nutrient intake after leaving the intensive care unit (ICU). Enteral nutrition (EN) improves nutrient intake but there is limited evidence on the impact of maintaining EN after discharge from the ICU. The objective of this exploratory study was to understand the association between EN maintenance after ICU and 30-day unplanned hospital re-admission, to inform on future prospective research into the effects of post-ICU nutrition. METHODS This was a single-centre, retrospective study of ICU patients, requiring ventilation, who received EN for at least 3 days in ICU and were discharged to the ward. RESULTS 102 patients met the inclusion criteria; 45 (44.1%) maintained EN and 57 (55.9%) discontinued EN after ICU discharge; there were no significant differences in demographics or clinical measures at ICU admission. Reason for EN discontinuation was documented in 38 (66.7%) patients, with 27 (71%) discontinuing EN due to a routine ward practice of feeding tube removal. Unplanned 30-day hospital re-admission occurred in 17 (16.7%) patients overall, 5 (11.1%) in the EN group and 12 (21.1%) in the non-EN group (crude odds ratio [OR] 0.47, 95% CI 0.15, 1.45, p = 0.188). After adjusting for age, sex, BMI and length of stay, there was a persistent trend to lower re-admission rates in the EN group (OR 0.37, 95% CI 0.09, 1.57, p = 0.176). CONCLUSIONS EN maintenance after ICU discharge was associated with a trend to lower 30-day unplanned hospital re-admission rates. The clinically relevant reduction of about 50% in unplanned re-admission rates in this exploratory study warrants larger, prospective studies of post-ICU nutrition strategies based on clear discontinuation criteria to optimize nutrition and evaluate patient-centred outcomes.
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Affiliation(s)
| | - Cindy Steel
- Nestlé Health Science Canada, North York, ON, Canada.
| | | | - Barb Winder
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sarah Cohen
- EpidStrategies, A Division of ToxStrategies, Inc., Katy, TX, USA
| | - Heidi Reichert
- EpidStrategies, A Division of ToxStrategies, Inc., Katy, TX, USA
| | - David Armstrong
- Hamilton Health Sciences, Hamilton, ON, Canada; Division of Gastroenterology & Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
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Cortés-Aguilar R, Malih N, Abbate M, Fresneda S, Yañez A, Bennasar-Veny M. Validity of nutrition screening tools for risk of malnutrition among hospitalized adult patients: A systematic review and meta-analysis. Clin Nutr 2024; 43:1094-1116. [PMID: 38582013 DOI: 10.1016/j.clnu.2024.03.008] [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: 12/23/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUNDS & AIMS Malnutrition is prevalent among hospitalized patients in developed countries, contributing to negative health outcomes and increased healthcare costs. Timely identification and management of malnutrition are crucial. The lack of a universally accepted definition and standardized diagnostic criteria for malnutrition has led to the development of various screening tools, each with varying validity. This complicates early identification of malnutrition, hindering effective intervention strategies. This systematic review and meta-analysis aimed to identify the most valid and reliable nutritional screening tool for assessing the risk of malnutrition in hospitalized adults. METHODS A systematic literature search was conducted to identify validation studies published from inception to November 2023, in the Pubmed/MEDLINE, Embase, and CINAHL databases. This systematic review was registered in INPLASY (INPLASY202090028). The risk of bias and quality of included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2). Meta-analyses were performed for screening tools accuracy using the symmetric hierarchical summary receiver operative characteristics models. RESULTS Of the 1646 articles retrieved, 60 met the inclusion criteria and were included in the systematic review, and 21 were included in the meta-analysis. A total of 51 malnutrition risk screening tools and 9 reference standards were identified. The meta-analyses assessed four common malnutrition risk screening tools against two reference standards (Subjective Global Assessment [SGA] and European Society for Clinical Nutrition and Metabolism [ESPEN] criteria). The Malnutrition Universal Screening Tool (MUST) vs SGA had a sensitivity (95% Confidence Interval) of 0.84 (0.73-0.91), and specificity of 0.85 (0.75-0.91). The MUST vs ESPEN had a sensitivity of 0.97 (0.53-0.99) and specificity of 0.80 (0.50-0.94). The Malnutrition Screening Tool (MST) vs SGA had a sensitivity of 0.81 (0.67-0.90) and specificity of 0.79 (0.72-0.74). The Mini Nutritional Assessment-Short Form (MNA-SF) vs ESPEN had a sensitivity of 0.99 (0.41-0.99) and specificity of 0.60 (0.45-0.73). The Nutrition Universal Screening Tool-2002 (NRS-2002) vs SGA had a sensitivity of 0.76 (0.58-0.87) and specificity of 0.86 (0.76-0.93). CONCLUSIONS The MUST demonstrated high accuracy in detecting malnutrition risk in hospitalized adults. However, the quality of the studies included varied greatly, possibly introducing bias in the results. Future research should compare tools within a specific patient population using a valid and universal gold standard to ensure improved patient care and outcomes.
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Affiliation(s)
| | - Narges Malih
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, 07002 Palma, Spain.
| | - Manuela Abbate
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Sergio Fresneda
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Aina Yañez
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Miquel Bennasar-Veny
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain; Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
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Smith LO, Vest MT, Rovner AJ, Caplan RJ, Trabulsi JC, Patel JB, Meng SW, Shapero M, Earthman CP. Malnutrition and pectoralis muscle index in medical intensive care unit patients: A matched cohort study. JPEN J Parenter Enteral Nutr 2024; 48:300-307. [PMID: 38400547 PMCID: PMC10990767 DOI: 10.1002/jpen.2610] [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: 06/21/2023] [Revised: 12/01/2023] [Accepted: 01/10/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Muscle assessment is an important component of nutrition assessment. The Global Leadership Initiative on Malnutrition (GLIM) consortium recently underscored the need for more objective muscle assessment methods in clinical settings. Various assessment techniques are available; however, many have limitations in clinical populations. Computed tomography (CT) scans, obtained for diagnostic reasons, could serve multiple purposes, including muscle measurement for nutrition assessment. Although CT scans of the chest are commonly performed clinically, there is little research surrounding the utility of pectoralis muscle measurements in nutrition assessment. The primary aim was to determine whether CT-derived measures of pectoralis major cross-sectional area (PMA) and quality (defined as mean pectoralis major Hounsfield units [PMHU]) could be used to identify malnutrition in patients who are mechanically ventilated in an intensive care unit (ICU). A secondary aim was to evaluate the relationship between these measures and clinical outcomes in this population. METHODS A retrospective analysis was conducted on 33 pairs of age- and sex-matched adult patients who are being mechanically ventilated in the ICU. Patients were grouped by nutrition status. Analyses were performed to determine differences in PMA and mean PMHU between groups. Associations between muscle and clinical outcomes were also investigated. RESULTS Compared with nonmalnourished controls, malnourished patients had a significantly lower PMA (P = 0.001) and pectoralis major (PM) index (PMA/height in m2; P = 0.001). No associations were drawn between PM measures and clinical outcomes. CONCLUSION These findings regarding CT PM measures lay the groundwork for actualizing the GLIM call to action to validate quantitative, objective muscle assessment methods in clinical settings.
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Affiliation(s)
- Luke O. Smith
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
| | - Michael T. Vest
- Critical Care Medicine, Department of Medicine, Christiana Care Healthcare System, Sidney Kimmel Medical College, Newark, Delaware, USA
| | - Alisha J. Rovner
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
| | - Richard J. Caplan
- Institute for Research in Health Equity and Community Health, Christiana Care Health Service Inc, Newark, Delaware, USA
| | - Jillian C. Trabulsi
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
| | - Juhie B. Patel
- Department of Internal Medicine, Christiana Care Healthcare System, Newark, Delaware, USA
| | - Sarah W. Meng
- Division of Community Radiology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Mary Shapero
- Department of Food and Nutrition Services, Christiana Care Healthcare System, Newark, Delaware, USA
| | - Carrie P. Earthman
- Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA
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Demarest-Litchford M, Munoz N, Strange N, Casirati A, Cereda E. The Impact of Malnutrition on Skin Integrity and Wound Healing. Adv Skin Wound Care 2024; 37:126-135. [PMID: 38393703 DOI: 10.1097/asw.0000000000000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
GENERAL PURPOSE To recognize valuable resources from the Malnutrition Quality Improvement Initiative for acute care patients and malnutrition quality improvement measures for postacute care residents. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Distinguish the prevalence of malnutrition among acute care patients.2. Explain the assessment guidelines for identifying malnutrition.3. Identify the resources available for measuring malnutrition quality improvement.
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Wunderle C, Gomes F, Schuetz P, Stumpf F, Austin P, Ballesteros-Pomar MD, Cederholm T, Fletcher J, Laviano A, Norman K, Poulia KA, Schneider SM, Stanga Z, Bischoff SC. ESPEN practical guideline: Nutritional support for polymorbid medical inpatients. Clin Nutr 2024; 43:674-691. [PMID: 38309229 DOI: 10.1016/j.clnu.2024.01.008] [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: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Disease-related malnutrition in polymorbid medical inpatients is a highly prevalent syndrome associated with significantly increased morbidity, disability, short- and long-term mortality, impaired recovery from illness, and healthcare costs. AIM As there are uncertainties in applying disease-specific guidelines to patients with multiple conditions, our aim was to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. METHODS The 2023 update adheres to the standard operating procedures for ESPEN guidelines. We undertook a systematic literature search for 15 clinical questions in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g., published guidelines), until July 12th, 2022. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations (including SIGN grading), which was followed by submission to Delphi voting. Here, the practical version of the guideline is presented which has been shortened and equipped with flow charts for patients care. RESULTS 32 recommendations (7× A, 11× B, 10× O and 4× GPP), which encompass different aspects of nutritional support were included from the scientific guideline including indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Here, the practical version of the guideline is presented which has been shortened and equipped with flow charts for patients care. CONCLUSIONS Recent high-quality trials have provided increasing evidence that nutritional support can reduce morbidity and other complications associated with malnutrition in polymorbid patients. The timely screening of patients for risk of malnutrition at hospital admission followed by individualized nutritional support interventions for at-risk patients should be part of routine clinical care and multimodal treatment in hospitals worldwide. Use of this updated practical guideline offers an evidence-based nutritional approach to polymorbid medical inpatients and may improve their outcomes.
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Affiliation(s)
- Carla Wunderle
- Cantonal Hospital Aarau and University of Basel, Switzerland
| | - Filomena Gomes
- Cantonal Hospital Aarau and University of Basel, Switzerland; NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Philipp Schuetz
- Cantonal Hospital Aarau and University of Basel, Switzerland.
| | - Franziska Stumpf
- Cantonal Hospital Aarau and University of Basel, Switzerland; Institute of Clinical Nutrition, University of Hohenheim, 70599 Stuttgart, Germany
| | - Peter Austin
- Oxford University Hospitals, and University College London, United Kingdom
| | | | - Tommy Cederholm
- Uppsala University, Uppsala and Karolinska University Hospital, Stockholm Sweden
| | - Jane Fletcher
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - Kristina Norman
- Charité University Medicine Berlin and German Institute for Human Nutrition, Germany
| | | | | | - Zeno Stanga
- University Hospital and University of Bern, Switzerland
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
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Gorenshtein L, Leraas H, Eze A, Lumpkin S, Chime C, Chang D, Wischmeyer P, Agarwal S, Fernandez J, Haines KL. The Use of Parenteral Nutrition and Disparities in Its Allocation Following Traumatic Injury. J Surg Res 2024; 293:121-127. [PMID: 37738853 DOI: 10.1016/j.jss.2023.07.036] [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: 12/02/2022] [Revised: 07/08/2023] [Accepted: 07/24/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Severe traumatic injury requires rapid and extensive deployment of resources to save the lives of the critically injured. The sequelae of traumatic injuries frequently require extensive intervention obligating patients to a complicated recovery process devoid of meaningful nutrition. In this setting, parenteral nutrition (PN) is key in enabling appropriate wound healing, recovery, and rehabilitation. We sought to examine the use of PN in adult trauma management and to highlight any disparities in the utilization of PN in adult trauma patients. METHODS We queried the 2017-2019 Trauma Quality Improvement Program (TQIP) for adult patients (aged > 18 y) who sustained blunt or penetrating traumatic injuries and received PN as part of their hospitalization. We compared time to PN administration based on demographics. We then used a multivariable logistic regression model to identify factors associated with the use of PN. We hypothesized that PN would be less commonly employed in the uninsured and minority groups. RESULTS We identified 2,449,498 patients with sufficient data for analysis. Of these, 1831 patients were treated with PN. On univariate analysis, PN patients were more commonly male (74.7% PN versus 60.2% non-PN; P < 0.001). PN use was more frequent in the Black population (24.3% PN versus 15.5% non-PN; P < 0.001) and less frequent in the White population (72.7% PN versus 81.2% non-PN; P < 0.001). PN use was also much more common among patients covered by Medicaid. Penetrating trauma was over twice as common among PN recipients relative to non-PN patients (% PN versus % non-PN). PN patients had higher injury severity scores (ISSs), more intensive care unit days, longer hospitalizations, and increased mortality compared to non-PN patients. PN patients were half as likely to discharge home and twice as likely to discharge to a long-term care facility. Multivariable analysis including age, race, trauma mechanism, primary payer, and ISS, demonstrated an association of PN use with increasing age (OR 1.01, P < 0.001), cases of penetrating trauma (odds ratio [OR], 2.47; P < 0.001), and patients with high ISS (OR, 0.1.06; P < 0.001). There was decreased use in Uninsured patient (OR, 0.54; P < 0.001). CONCLUSIONS PN use following traumatic injury is rarely required. Patients treated with PN typically have a resource-intense hospital course. More severe injuries, penetrating trauma, and increased age are more likely to result in PN use. Variations in PN use are apparent based on insurance payer, further examination into allocation of hospital and intensive care resources, as it pertains to patient socioeconomic status, is warranted in light of these findings.
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Affiliation(s)
| | - Harold Leraas
- Department of Surgery, Duke University, Durham, North Carolina.
| | - Anthony Eze
- Department of Surgery, Duke University, Durham, North Carolina
| | | | - Chinecherem Chime
- School of Medicine, Howard University College of Medicine, Washington, District of Columbia
| | - Doreen Chang
- Department of Surgery, Duke University, Durham, North Carolina
| | - Paul Wischmeyer
- Department of Surgery, Duke University, Durham, North Carolina
| | - Suresh Agarwal
- Department of Surgery, Duke University, Durham, North Carolina
| | | | - Krista L Haines
- Department of Surgery, Duke University, Durham, North Carolina
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Gonçalves F, Cabral S, Moreira AP, Cunha J, Magalhães B. Characterization and monitoring of nutritional risk and nutritional status in oncological patients admitted to an oncological surgery unit: A longitudinal study. Clin Nutr ESPEN 2023; 57:637-646. [PMID: 37739717 DOI: 10.1016/j.clnesp.2023.08.015] [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: 04/29/2023] [Revised: 08/06/2023] [Accepted: 08/14/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS malnutrition is a common phenomenon in people with cancer and can occur at all stages of the disease trajectory. Prevention, early identification of patients at risk of malnutrition, nutritional diagnosis, and personalized intervention, monitoring and follow-up are essential measures to minimize the occurrence of malnutrition and its consequences. This study aims to evaluate if current institutional practices regarding nutritional intervention guarantees nutritional/dietary care for cancer patients. METHODS adescriptive, analytical and longitudinal study was carried out, lasting five months, in a hospital inpatient surgical oncology unit. All patients admitted to the unit in the period between 1 March and 31 July 2022, who underwent nutritional screening at the time of admission to the service, were included. During hospitalization, they were subjected to periodic assessments of weight, body mass index and nutritional screening every 7 days until discharge. RESULTS a total of 659 patients were admitted to the inpatient unit. The highest prevalence of malnutrition was observed in Head and Neck (37.6%), Genitourinary (30.8%) and Digestive (27.7%) cancers. Weight loss was especially significant in digestive, skin and sarcoma cancers, as well as genitourinary cancers, but not in breast cancer patients. During the hospitalization period, 14.0% of the hospitalized patients received nutrition-related nursing intervention, and 21.5% were referred for clinical dietetic intervention (by a registered dietitian). CONCLUSION this work reinforces the high prevalence of malnutrition in oncological patients and the need to systematically track cancer patients throughout their disease/treatment trajectory, from admission to the hospital, to the day of admission to inpatient unit, and subsequent follow-up. We also propose expedited referrals to different specialized centres in nutritional support for cancer patients from the first day of hospitalization. Assessment of patients should always be accompanied by active referral capacity to a specialized and duly trained nutritional care team that is quick, proactive, and responsive.
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Affiliation(s)
- Filipe Gonçalves
- University of A Coruña, Faculty of Health Sciences, Campuz de Oza, 15006, A Coruña, Spain; Faculty of Nutrition and Food Sciences, University of Porto, 4150-180, Porto, Portugal.
| | - Sónia Cabral
- Portuguese Oncology Institute of Porto, IPOPFG, EPE, 4200-072, Porto, Portugal
| | - Ana Paula Moreira
- Portuguese Oncology Institute of Porto, IPOPFG, EPE, 4200-072, Porto, Portugal
| | - Joana Cunha
- Portuguese Oncology Institute of Porto, IPOPFG, EPE, 4200-072, Porto, Portugal
| | - Bruno Magalhães
- School of Health, University of Trás-os-Montes and Alto Douro (ESS-UTAD), 5000-801, Vila Real, Portugal; Clinical Academic Centre of Trás-os-Montes and Alto Douro (CACTMAD), Vila Real, Portugal; Oncology Nursing Research Unit, IPO-Porto Research (CI-POP), Portuguese Oncology Institute of Porto, Portugal (IPO-Porto)/Porto Comprehensive Cancer Center (Porto. CCC) & Rise@CI-IPOP (Health Research Network), Porto, Portugal
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12
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Wunderle C, Gomes F, Schuetz P, Stumpf F, Austin P, Ballesteros-Pomar MD, Cederholm T, Fletcher J, Laviano A, Norman K, Poulia KA, Schneider SM, Stanga Z, Bischoff SC. ESPEN guideline on nutritional support for polymorbid medical inpatients. Clin Nutr 2023; 42:1545-1568. [PMID: 37478809 DOI: 10.1016/j.clnu.2023.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Disease-related malnutrition in polymorbid medical inpatients is a highly prevalent syndrome associated with significantly increased morbidity, disability, short- and long-term mortality, impaired recovery from illness, and cost of care. AIM As there are uncertainties in applying disease-specific guidelines to patients with multiple conditions, our aim was to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. METHODS This update adheres to the standard operating procedures for ESPEN guidelines. We did a systematic literature search for 15 clinical questions in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until July 12th. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations (incl. SIGN grading), which was followed by submission to Delphi voting. RESULTS From a total of 3527 retrieved abstracts, 60 new relevant studies were analyzed and used to generate a guideline draft that proposed 32 recommendations (7x A, 11x B, 10x O and 4x GPP), which encompass different aspects of nutritional support including indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. The results of the first online voting showed a strong consensus (agreement of >90%) on 100% of the recommendations. Therefore, no final consensus conference was needed. CONCLUSIONS Recent high-quality trials have provided increasing evidence that nutritional support can reduce morbidity and other complications associated with malnutrition in polymorbid patients. The timely screening of patients for risk of malnutrition at hospital admission followed by individualized nutritional support interventions for at-risk patients should be part of routine clinical care and multimodal treatment in hospitals worldwide. Use of this updated guideline offers an evidence-based nutritional approach to the polymorbid medical inpatients and may improve their outcomes.
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Affiliation(s)
- Carla Wunderle
- Cantonal Hospital Aarau and University of Basel, Switzerland
| | - Filomena Gomes
- Cantonal Hospital Aarau and University of Basel, Switzerland; NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Philipp Schuetz
- Cantonal Hospital Aarau and University of Basel, Switzerland.
| | - Franziska Stumpf
- Cantonal Hospital Aarau and University of Basel, Switzerland; Institute of Clinical Nutrition, University of Hohenheim, 70599 Stuttgart, Germany
| | - Peter Austin
- Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK, University College London School of Pharmacy, London, United Kingdom
| | | | - Tommy Cederholm
- Uppsala University, Uppsala and Karolinska University Hospital, Stockholm Sweden
| | - Jane Fletcher
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - Kristina Norman
- Charité University Medicine Berlin and German Institute for Human Nutrition, Germany
| | | | | | - Zeno Stanga
- University Hospital and University of Bern, Switzerland
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
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Bioletto F, Evangelista A, Ciccone G, Brunani A, Ponzo V, Migliore E, Pagano E, Comazzi I, Merlo FD, Rahimi F, Ghigo E, Bo S. Prediction of Early and Long-Term Hospital Readmission in Patients with Severe Obesity: A Retrospective Cohort Study. Nutrients 2023; 15:3648. [PMID: 37630838 PMCID: PMC10458036 DOI: 10.3390/nu15163648] [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: 07/26/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Adults with obesity have a higher risk of hospitalization and high hospitalization-related healthcare costs. However, a predictive model for the risk of readmission in patients with severe obesity is lacking. We conducted a retrospective cohort study enrolling all patients admitted for severe obesity (BMI ≥ 40 kg/m2) between 2009 and 2018 to the Istituto Auxologico Italiano in Piancavallo. For each patient, all subsequent hospitalizations were identified from the regional database by a deterministic record-linkage procedure. A total of 1136 patients were enrolled and followed up for a median of 5.7 years (IQR: 3.1-8.2). The predictive factors associated with hospital readmission were age (HR = 1.02, 95%CI: 1.01-1.03, p < 0.001), BMI (HR = 1.02, 95%CI: 1.01-1.03, p = 0.001), smoking habit (HR = 1.17, 95%CI: 0.99-1.38, p = 0.060), serum creatinine (HR = 1.22, 95%CI: 1.04-1.44, p = 0.016), diabetes (HR = 1.17, 95%CI: 1.00-1.36, p = 0.045), and number of admissions in the previous two years (HR = 1.15, 95%CI: 1.07-1.23, p < 0.001). BMI lost its predictive role when restricting the analysis to readmissions within 90 days. BMI and diabetes lost their predictive roles when further restricting the analysis to readmissions within 30 days. In conclusion, in this study, we identified predictive variables associated with early and long-term hospital readmission in patients with severe obesity. Whether addressing modifiable risk factors could improve the outcome remains to be established.
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Affiliation(s)
- Fabio Bioletto
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (V.P.); (I.C.); (E.G.)
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, CPO, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (A.E.); (G.C.); (E.M.); (E.P.)
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, CPO, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (A.E.); (G.C.); (E.M.); (E.P.)
| | - Amelia Brunani
- Rehabilitation Medicine Unit, IRCCS Istituto Auxologico Italiano Piancavallo, 28824 Oggebbio, Italy;
| | - Valentina Ponzo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (V.P.); (I.C.); (E.G.)
| | - Enrica Migliore
- Unit of Clinical Epidemiology, CPO, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (A.E.); (G.C.); (E.M.); (E.P.)
| | - Eva Pagano
- Unit of Clinical Epidemiology, CPO, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (A.E.); (G.C.); (E.M.); (E.P.)
| | - Isabella Comazzi
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (V.P.); (I.C.); (E.G.)
| | - Fabio Dario Merlo
- Dietetic Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (F.D.M.); (F.R.)
| | - Farnaz Rahimi
- Dietetic Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy; (F.D.M.); (F.R.)
| | - Ezio Ghigo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (V.P.); (I.C.); (E.G.)
| | - Simona Bo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (F.B.); (V.P.); (I.C.); (E.G.)
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Hiraike T, Momoki C, Habu D. Comparison of the adequacy of geriatric nutritional risk index with that of the mini nutritional assessment-short form and global leadership initiative on malnutrition criteria in assessing nutritional status to predict the 1-year prognosis of hospitalized Japanese older adults: a single-institutional cohort study. BMC Geriatr 2023; 23:35. [PMID: 36670357 PMCID: PMC9854135 DOI: 10.1186/s12877-023-03740-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The global leadership initiative on malnutrition (GLIM) proposed the first international standards (GLIM criteria) for malnutrition diagnosis. Early screening using nutritional tools is recommended to improve the prognosis of older patients. The association between Mini Nutritional Assessment-Short Form (MNAⓇ-SF) and Geriatric Nutritional Risk Index (GNRI) and prognosis has been reported, but there is insufficient evidence to develop the GLIM criteria for older inpatients. We aimed to evaluate the MNAⓇ-SF, GNRI, and GLIM criteria to determine their contribution to the prognosis prediction of hospitalized older patients at 1 year after discharge. METHODS This study included 386 patients hospitalized between September 2014 and October 2015, and May and December 2019. After excluding 17 patients who died at the time of initial hospitalization, 23 who were lost to follow-up after 1 year, and 28 who had missing data on admission, only 318 were included in the final analysis. The primary outcome was death within 1 year after discharge, assessed using the MNA®-SF, GNRI, and GLIM criteria, and survival analysis was conducted. Multivariate Cox proportional hazards analysis was performed to identify the nutritional assessment tools that contributed to the prognosis prediction. RESULTS A total of 43 patients died within 1 year. Of them, 58.1% had malnutrition and 37.2% were at risk of malnutrition, assessed using the MNAⓇ-SF; 27.9% had severely malnourished assessed using the GNRI; and 58.1% had severely malnourished assessed using the GLIM criteria. The proportions of malnourished and severely malnourished patients were significantly higher in the mortality group than in the survival group. Multivariate Cox proportional hazards analysis showed hazard ratios of 1.06 (95% confidence interval [CI]: 0.24-4.71) for at risk and 2.17 (95% CI: 0.48-9.84) for malnutrition (MNAⓇ-SF); 5.68 (95% CI: 2.74-11.80) for moderately malnourished and 7.69 (95% CI: 3.13-18.91) for severely malnourished (GNRI); and 1.47 (95% CI: 0.48-4.50) for moderately malnourished and 2.45 (95% CI: 1.22-4.93) for severely malnourished (GLIM criteria); GNRI had the most significant contribution to prognosis prediction. CONCLUSIONS GNRI significantly contributed to the prognosis prediction 1 year after hospital discharge of older patients.
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Affiliation(s)
- Taeko Hiraike
- grid.261445.00000 0001 1009 6411Department of Medical Nutrition, Graduate School of Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-Ku Osaka-Shi, Osaka, 558-8585 Japan
| | - Chika Momoki
- Department of Food Science and Human Nutrition, Faculty of Agriculture, Setsunan University, 45-1, Nagaotoge-Cho, Hirakata-Shi, Osaka, 573-0101, Japan.
| | - Daiki Habu
- Department of Nutritional Medicine, Graduate School of Human Life and Ecology, Osaka Metropolitan University, 3-3-138 Sugimoto, Sumiyoshi-Ku Osaka-Shi, Osaka, 558-8585 Japan
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Liu J, Xu S, Wang J, Liu J, Yan Z, Liang Q, Luan X. A novel nomogram for predicting risk of malnutrition in patients with heart failure. Front Cardiovasc Med 2023; 10:1162035. [PMID: 37034317 PMCID: PMC10076782 DOI: 10.3389/fcvm.2023.1162035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background and aims This study aimed to explore the risk factors of malnutrition in patients with heart failure and construct a novel nomogram model. Methods and results A cross-sectional study based on the STROBE checklist. Patients with heart failure from July 2020 to August 2021 were included. Patients were divided into a malnutrition group and a normal nutrition group based on the Society's recommended AND-ASPEN standard. Logistic regression was used to analyze the independent risk factors for malnutrition. A new prediction model of nomogram was constructed based on the risk factors, and its fit and prediction performance were evaluated. Of 433 patients, 66 (15.2%) had malnutrition and 367 (84.8%) had normal nutrition, Logistic regression analyses showed that the risk factors for malnutrition were total protein, hemoglobin, triglyceride, and glucose levels. The regression model based on the above four variables showed an area under the curve of 0.858. The novel nomogram model had a sensitivity of 78.5% and a specificity of 77.3%. After 2000 bootstrap resampling iterations, AUC was 0.852. Conclusions The novel nomogram model can predict the odds of malnutrition in patients with heart failure at the early stage of admission, and can provide a reference for nursing staff to optimize nutritional care for inpatient with heart failure and to develop a discharge nutritional care plan.
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Affiliation(s)
- Jian Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shengjia Xu
- The First Clinical College, Shandong University, Jinan, China
| | - Jiurui Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jing Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zeping Yan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Qian Liang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaorong Luan
- School of Nursing and Rehabilitation, Shandong University/Department of Infection Control, Qilu Hospital, Shandong University, Jinan, China
- Correspondence: Xiaorong Luan
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Malnutrition Increases Hospital Length of Stay and Mortality among Adult Inpatients with COVID-19. Nutrients 2022; 14:nu14061310. [PMID: 35334967 PMCID: PMC8949069 DOI: 10.3390/nu14061310] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 12/18/2022] Open
Abstract
Background: Malnutrition has been linked to adverse health economic outcomes. There is a paucity of data on malnutrition in patients admitted with COVID-19. Methods: This is a retrospective cohort study consisting of 4311 COVID-19 adult (18 years and older) inpatients at 5 Johns Hopkins-affiliated hospitals between 1 March and 3 December 2020. Malnourishment was identified using the malnutrition universal screening tool (MUST), then confirmed by registered dietitians. Statistics were conducted with SAS v9.4 (Cary, NC, USA) software to examine the effect of malnutrition on mortality and hospital length of stay among COVID-19 inpatient encounters, while accounting for possible covariates in regression analysis predicting mortality or the log-transformed length of stay. Results: COVID-19 patients who were older, male, or had lower BMIs had a higher likelihood of mortality. Patients with malnutrition were 76% more likely to have mortality (p < 0.001) and to have a 105% longer hospital length of stay (p < 0.001). Overall, 12.9% (555/4311) of adult COVID-19 patients were diagnosed with malnutrition and were associated with an 87.9% increase in hospital length of stay (p < 0.001). Conclusions: In a cohort of COVID-19 adult inpatients, malnutrition was associated with a higher likelihood of mortality and increased hospital length of stay.
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Bellanti F, lo Buglio A, Quiete S, Vendemiale G. Malnutrition in Hospitalized Old Patients: Screening and Diagnosis, Clinical Outcomes, and Management. Nutrients 2022; 14:nu14040910. [PMID: 35215559 PMCID: PMC8880030 DOI: 10.3390/nu14040910] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 02/05/2023] Open
Abstract
Malnutrition in hospitalized patients heavily affects several clinical outcomes. The prevalence of malnutrition increases with age, comorbidities, and intensity of care in up to 90% of old populations. However, malnutrition frequently remains underdiagnosed and undertreated in the hospital. Thus, an accurate screening to identify patients at risk of malnutrition or malnourishment is determinant to elaborate a personal nutritional intervention. Several definitions of malnutrition were proposed in the last years, affecting the real frequency of nutritional disorders and the timing of intervention. Diagnosis of malnutrition needs a complete nutritional assessment, which is often challenging to perform during a hospital stay. For this purpose, various screening tools were proposed, allowing patients to be stratified according to the risk of malnutrition. The present review aims to summarize the actual evidence in terms of diagnosis, association with clinical outcomes, and management of malnutrition in a hospital setting.
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