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Orell H, Pohju A, Tuokkola J, Junttila K, Heikkilä A, Österlund P, Schwab U, Mäkitie A. Time to act! - A cross-sectional study on how nutritional risk increases during hospitalization and associates with worse outcome. Clin Nutr ESPEN 2023; 57:364-374. [PMID: 37739680 DOI: 10.1016/j.clnesp.2023.07.016] [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: 12/23/2022] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Nutritional risk is prevalent, and it develops negatively during hospital stay. The aim of this cohort study was to assess the association of nutritional risk with total costs of hospital care, length of stay, and in-hospital mortality. METHODS Cross-sectional study with hospitalized patients (n = 3053). Nutritional risk screening 2002 and outcome were investigated. Chi-square, Fisher, and Mann-Whitney tests, univariable and multivariable generalized linear and binary logistic regression models were used. RESULTS Nutritional risk was detected in 18% (184/1024) of those patients assessed at admission while the number of patients at risk increased 3-fold (47%,152/265) in those screened 14 days after admission (odds ratio 6.25; 95% CI 4.58-8.53, p < 0.001). Nutritionally at-risk patients had 5.6 days longer length of stay (p < 0.001) and 9% higher adjusted total costs compared with non-risk patients (p < 0.001). Adjusted overall risk for in-hospital mortality was 4.4 (95% CI 2.44-7.92, p < 0.001) for patients at nutritional risk. The screening rate was between 52% and 68%, and only 4% of the nutritionally at-risk patients had dietitian consultation during their hospital stay. CONCLUSIONS The number of patients with nutritional risk increased clearly during hospitalization associating with a four times higher in-hospital mortality and substantially increased hospital costs. The results demonstrate that the nutritional risk and its detrimental influence on the outcome increases during hospitalization emphasizing the importance to screen patients at admission and repeated weekly.
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Affiliation(s)
- Helena Orell
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Anne Pohju
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jetta Tuokkola
- Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; School for Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland and Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Kristiina Junttila
- Nursing Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anniina Heikkilä
- HUS Nursing Administrative Group University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pia Österlund
- Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland; Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Oncology/Pathology, Karolinska Institute and Tema Cancer/ GI-cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Ursula Schwab
- School for Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland and Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Kwaśny A, Łokieć K, Uchmanowicz B, Młynarska A, Smereka J, Czapla M. Sex-related differences in the impact of nutritional status on length of hospital stay in atrial fibrillation: a retrospective cohort study. Front Public Health 2023; 11:1223111. [PMID: 37744485 PMCID: PMC10516568 DOI: 10.3389/fpubh.2023.1223111] [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: 05/15/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Background Nutritional status is related to the length of hospitalization of patients with atrial fibrillation (AF). The aim of this study is to assess the prognostic impact of nutritional status and body mass index on length of hospital stay (LOHS) among patients with AF relative to their sex. Methods A retrospective analysis of the medical records of 1,342 patients admitted urgently with a diagnosis of AF (ICD10: I48) to the Cardiology Department (University Hospital in Wroclaw, Poland) between January 2017 and June 2021. Results In the study group, women were significantly older than men (72.94 ± 9.56 vs. 65.11 ± 12.68, p < 0.001). In an unadjusted linear regression model, malnutrition risk was a significant independent predictor of prolonged hospitalization in men (B = 1.95, p = 0.003) but not in women. In the age-adjusted linear regression model, malnutrition risk was a significant independent predictor of prolonged hospitalization in men (B = 1.843, p = 0.005) but not in women. In the model adjusted for age and comorbidities, malnutrition risk was a significant independent predictor of prolonged hospitalization in men only (B = 1.285, p = 0.043). In none of the models was BMI score a predictor of LOHS in either sex. Conclusion The risk of malnutrition directly predicts the length of hospital stays in men but not women. The study did not find a relationship between body mass index and length of hospital stay in both women and men.
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Affiliation(s)
- Adrian Kwaśny
- Institute of Dietetics, The Academy of Business and Health Science, Lodz, Poland
| | - Katarzyna Łokieć
- Department of Propaedeutic of Civilization Diseases, Medical University of Lodz, Lodz, Poland
| | - Bartosz Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Młynarska
- Department Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Czapla
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
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Rinninella E, Raoul P, Maccauro V, Cintoni M, Cambieri A, Fiore A, Zega M, Gasbarrini A, Mele MC. Hospital Services to Improve Nutritional Intake and Reduce Food Waste: A Systematic Review. Nutrients 2023; 15:nu15020310. [PMID: 36678180 PMCID: PMC9864175 DOI: 10.3390/nu15020310] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND AIMS Patients' nutritional intake is a crucial issue in modern hospitals, where the high prevalence of disease-related malnutrition may worsen clinical outcomes. On the other hand, food waste raises concerns in terms of sustainability and environmental burden. We conducted a systematic review to ascertain which hospital services could overcome both issues. METHODS A systematic literature search following PRISMA guidelines was conducted across MEDLINE, Web of Science, and Scopus for randomised controlled trials (RCTs) and observational studies comparing the effect of hospital strategies on energy intake, protein intake, and plate/food waste. The quality of included studies was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane Risk of Bias tool from the Cochrane Handbook for Systematic Reviews of Interventions for RCTs. RESULTS Nineteen studies were included, assessing as many hospital strategies such as food service systems-including catering and room service-(n = 9), protected mealtimes and volunteer feeding assistance (n = 4), food presentation strategies (n = 3), nutritional counseling and education (n = 2), plant-based proteins meal (n = 1). Given the heterogeneity of the included studies, the results were narratively analysed. CONCLUSIONS Although the results should be confirmed by prospective and large sample-size studies, the personalisation of the meal and efficient room service may improve nutritional intake while decreasing food waste. Clinical nutritionist staff-especially dietitians-may increase food intake reducing food waste through active monitoring of the patients' nutritional needs.
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Affiliation(s)
- Emanuele Rinninella
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Pauline Raoul
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-7386
| | - Valeria Maccauro
- Scuola di Specializzazione in Medicina Interna, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
| | - Marco Cintoni
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Andrea Cambieri
- Direzione Sanitaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Alberto Fiore
- UOC Qualità e Accreditamento, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maurizio Zega
- UOC Servizio Infermieristico, Tecnico, Riabilitativo, Aziendale (S.I.T.R.A.), Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Cristina Mele
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Scarpellini E, Abenavoli L, Cassano V, Rinninella E, Sorge M, Capretti F, Rasetti C, Svegliati Baroni G, Luzza F, Santori P, Sciacqua A. The Apparent Asymmetrical Relationship Between Small Bowel Bacterial Overgrowth, Endotoxemia, and Liver Steatosis and Fibrosis in Cirrhotic and Non-Cirrhotic Patients: A Single-Center Pilot Study. Front Med (Lausanne) 2022; 9:872428. [PMID: 35559337 PMCID: PMC9090439 DOI: 10.3389/fmed.2022.872428] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Gut microbiota are a complex ecosystem harboring our intestine. They maintain human body equilibrium, while their derangement, namely, “dysbiosis“, has been associated with several gastrointestinal diseases, such as liver steatosis (NAFLD) and liver cirrhosis. Small intestinal bacterial overgrowth (SIBO) is an example of dysbiosis of the upper gastrointestinal (GI) tract. Aim The aim of this study is to evaluate the relationship between SIBO and levels of endotoxemia and grade of liver steatosis (LS) and liver fibrosis (LF) in hepatologic patients. Materials and Methods Consecutive outpatients referred to our hepatology clinic were tested for SIBO by the lactulose breath test (LBT) and peripheral blood levels of endotoxemia; LS grading and LF were assessed by abdominal ultrasound and transient elastography, respectively. Results Fifty-two consecutive patients (17 with alcohol abuse (4.5 ± 0.8 alcohol units per day), 4 with HCV and 2 with HBV infection, 24 of metabolic origin, 2 of autoimmune origin, and 3 with cholangiopathies; mean age 54.7 ± 8.3 years, 31 F, BMI 24.1 ± 1.1 Kg/m2) and 14 healthy volunteers (HV) (mean age 50.1 ± 4.3 years, 9 F, BMI 23.3 ± 1.1 Kg/m2) were enrolled. SIBO prevalence was significantly higher in cirrhotic (LC) vs. non-cirrhotic (LNC) patients and vs. HV (all, p < 0.05), with a significant positive trend according to Child-Pugh status (all, p < 0.05). SIBO prevalence was not correlated with LS stages (all, p = NS). Consensually, endotoxin levels were significantly higher in LC vs. LNC and vs. HV (all, p < 0.05) and significantly correlated with LF in patients with LC, according to Child-Pugh status (all, p < 0.05). Conclusion This study shows that SIBO prevalence and relative endotoxin blood levels seem to be significantly associated with the grade of LF vs. LS in LC. SIBO is also present under pre-cirrhotic conditions, but its prevalence seems to correlate with liver disease irreversible derangement.
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Affiliation(s)
- E. Scarpellini
- Hepatology and Internal Medicine Unit, “Madonna del Soccorso” General Hospital, San Benedetto del Tronto, Italy
- T.A.R.G.I.D., Gasthuisberg University Hospital, KULeuven, Lueven, Belgium
- *Correspondence: E. Scarpellini
| | - L. Abenavoli
- Department of Health Sciences, University “Magna Græcia”, Catanzaro, Italy
| | - V. Cassano
- Department of Medical and Surgical Sciences, University “Magna Græcia”, Catanzaro, Italy
| | - E. Rinninella
- Clinical Nutrition Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M. Sorge
- Gastroenterology and Endoscopy Unit “Madonna del Soccorso” General Hospital, San Benedetto del Tronto, Italy
| | - F. Capretti
- Gastroenterology and Endoscopy Unit “Madonna del Soccorso” General Hospital, San Benedetto del Tronto, Italy
| | - C. Rasetti
- Hepatology and Internal Medicine Unit, “Madonna del Soccorso” General Hospital, San Benedetto del Tronto, Italy
| | - G. Svegliati Baroni
- Gastroenterology Clinic, “Riuniti University Hospital”, Polytechnics University of Marche, Ancona, Italy
| | - F. Luzza
- Department of Health Sciences, University “Magna Græcia”, Catanzaro, Italy
| | - P. Santori
- Hepatology and Internal Medicine Unit, “Madonna del Soccorso” General Hospital, San Benedetto del Tronto, Italy
| | - A. Sciacqua
- Department of Medical and Surgical Sciences, University “Magna Græcia”, Catanzaro, Italy
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Risk factors for malnutrition among hospitalized gastroenterological patients. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp200605085r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Risk factors for malnutrition of patients during hospitalization have not been precisely deter-mined. The aim of the study was to determine these factors in hospitalized gastroenterological patients. Methods. Nutritional status (NS) of 650 gastroenterological patients was assessed at the hospital admission and at discharge by the six parameters: unintentional weight loss, lymphocyte count, serum albumin concentration, body mass index, triceps skinfold thickness, and mid-upper arm muscle circumference. The influence on NS at discharge was tested for ten factors: gender, age, affected organ, the nature, severity, and complications of the disease, the length of hospitalization, mobility worsening during hospitalization, Karnofsky score, and NS on admission. Primary and secondary risk factors were defined among the factors significantly influencing malnutrition. Results. Seven factors were found to be the independent predictors for malnutrition in hospitalized gastroenterological patients. NS at admission was considered as a primary risk factor (Forward: Wald multivariate logistic regression analysis, p < 0.001 for five applied assessment parameters). The other six factors, obtained in the evaluation according to 1-3 assessment parameters, were considered as secondary risk factors: severe disease activity, malignancy, the existence of complications, male gender, hospitalization > 14 days, and mobility worsening during the hospitalization (Forward: Wald multivariate logistic regression analysis, p from 0.001 to 0.027). Conclusion. There are seven risk factors for malnutrition among gastroenterological patients during hospitalization. Timely nutritional support in these patients can prevent the development of intrahospital malnutrition and its negative influence on the clinical outcome.
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Panpetch W, Visitchanakun P, Saisorn W, Sawatpanich A, Chatthanathon P, Somboonna N, Tumwasorn S, Leelahavanichkul A. Lactobacillus rhamnosus attenuates Thai chili extracts induced gut inflammation and dysbiosis despite capsaicin bactericidal effect against the probiotics, a possible toxicity of high dose capsaicin. PLoS One 2021; 16:e0261189. [PMID: 34941893 PMCID: PMC8699716 DOI: 10.1371/journal.pone.0261189] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/24/2021] [Indexed: 12/23/2022] Open
Abstract
Because of a possible impact of capsaicin in the high concentrations on enterocyte injury (cytotoxicity) and bactericidal activity on probiotics, Lactobacillus rhamnosus L34 (L34) and Lactobacillus rhamnosus GG (LGG), the probiotics derived from Thai and Caucasian population, respectively, were tested in the chili-extract administered C57BL/6 mice and in vitro experiments. In comparison with placebo, 2 weeks administration of the extract from Thai chili in mice caused loose feces and induced intestinal permeability defect as indicated by FITC-dextran assay and the reduction in tight junction molecules (occludin and zona occludens-1) using fluorescent staining and gene expression by quantitative real-time polymerase chain reaction (qRT-PCR). Additionally, the chili extracts also induced the translocation of gut pathogen molecules; lipopolysaccharide (LPS) and (1→3)-β-d-glucan (BG) and fecal dysbiosis (microbiome analysis), including reduced Firmicutes, increased Bacteroides, and enhanced total Gram-negative bacteria in feces. Both L34 and LGG attenuated gut barrier defect (FITC-dextran, the fluorescent staining and gene expression of tight junction molecules) but not improved fecal consistency. Additionally, high concentrations of capsaicin (0.02-2 mM) damage enterocytes (Caco-2 and HT-29) as indicated by cell viability test, supernatant cytokine (IL-8), transepithelial electrical resistance (TEER) and transepithelial FITC-dextran (4.4 kDa) but were attenuated by Lactobacillus condition media (LCM) from both probiotic-strains. The 24 h incubation with 2 mM capsaicin (but not the lower concentrations) reduced the abundance of LGG (but not L34) implying a higher capsaicin tolerance of L34. However, Lactobacillus rhamnosus fecal abundance, using qRT-PCR, of L34 or LGG after 3, 7, and 20 days of the administration in the Thai healthy volunteers demonstrated the similarity between both strains. In conclusion, high dose chili extracts impaired gut permeability and induced gut dysbiosis but were attenuated by probiotics. Despite a better capsaicin tolerance of L34 compared with LGG in vitro, L34 abundance in feces was not different to LGG in the healthy volunteers. More studies on probiotics with a higher intake of chili in human are interesting.
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Affiliation(s)
- Wimonrat Panpetch
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Microbiology, Translational Research in Inflammation and Immunology Research Unit (TRIRU), Chulalongkorn University, Bangkok, Thailand
| | - Peerapat Visitchanakun
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Microbiology, Translational Research in Inflammation and Immunology Research Unit (TRIRU), Chulalongkorn University, Bangkok, Thailand
| | - Wilasinee Saisorn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Microbiology, Translational Research in Inflammation and Immunology Research Unit (TRIRU), Chulalongkorn University, Bangkok, Thailand
| | - Ajcharaporn Sawatpanich
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Piraya Chatthanathon
- Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - Naraporn Somboonna
- Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
- Microbiome Research Unit for Probiotics in Food and Cosmetics, Chulalongkorn University, Bangkok, Thailand
| | - Somying Tumwasorn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail: (AL); (ST)
| | - Asada Leelahavanichkul
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Microbiology, Translational Research in Inflammation and Immunology Research Unit (TRIRU), Chulalongkorn University, Bangkok, Thailand
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail: (AL); (ST)
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Castro JDS, Santos CAD, Rosa CDOB, Firmino HH, Ribeiro AQ. STRONGkids nutrition screening tool in pediatrics: An analysis of cutoff points in Brazil. Nutr Clin Pract 2021; 37:1225-1232. [PMID: 34897796 DOI: 10.1002/ncp.10807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Studies have indicated the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) as a method of pediatric nutrition screening with good validity in the hospital setting. However, we need to analyze whether the cutoff values originally proposed are suitable for use in Brazil. METHODS A cross-sectional study was performed in patients admitted to the pediatric ward of a public hospital. STRONGkids was used to assess nutrition risk (low risk, 0 points; moderate risk, 1-3 points; and high risk, 4-5 points). The indexes weight/height or body mass index/age were used to indicate acute malnutrition, and length or height/age was used to indicate chronic malnutrition. Receiver operating characteristic curves were constructed and the areas under the curve were calculated, with respective 95% confidence intervals, to assess the ability of STRONGkids to predict malnutrition and longer hospital stay. RESULTS The study included 599 patients, with a median age of 2.6 years. The frequency of nutrition risk (medium or high) was 83.6%. In comparison with anthropometric indexes, STRONGkids was the only scoring system with the discriminatory capacity to identify patients with longer hospital stays. The comparative analysis of the means of hospital stay according to STRONGkids showed that patients with a score equal to 3 behaved similarly to those classified as high nutrition risk (4-5 points). CONCLUSIONS Considering the best cutoff point to predict prolonged hospitalization, STRONGkids used in Brazil should consider patients with 3 points as having high nutrition risk, as well those scoring 4 and 5.
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Affiliation(s)
- Joice da Silva Castro
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
| | | | | | - Heloísa Helena Firmino
- Multidisciplinary Nutritional Therapy Team, São Sebastião Hospital, Viçosa, Minas Gerais, Brazil
| | - Andréia Queiroz Ribeiro
- Department of Nutrition and Health, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
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Theron M, O’Halloran S. Patients in public hospitals received insufficient food to meet daily protein and energy requirements: Cape Town Metropole, South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2021.1997267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marieke Theron
- Division of Nutrition and Dietetics, University of Cape Town, Cape Town, South Africa
| | - Siobhan O’Halloran
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Chiu E, Oleynick C, Raman M, Bielawska B. Optimizing Inpatient Nutrition Care of Adult Patients with Inflammatory Bowel Disease in the 21st Century. Nutrients 2021; 13:1581. [PMID: 34065070 PMCID: PMC8151132 DOI: 10.3390/nu13051581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/16/2022] Open
Abstract
Malnutrition is highly prevalent in inflammatory bowel disease (IBD) patients and disproportionately affects those admitted to hospital. Malnutrition is a risk factor for many complications in IBD, including prolonged hospitalization, infection, greater need for surgery, development of venous thromboembolism, post-operative complications, and mortality. Early screening for malnutrition and prompt nutrition intervention if indicated has been shown to prevent or mitigate many of these outlined risk factors. There are many causes of malnutrition in IBD including reduced oral food intake, medications, active inflammation, and prior surgical resections. Hospitalization can further compound pre-existing malnutrition through inappropriate diet restrictions, nil per os (NPO) for endoscopy and imaging, or partial bowel obstruction, resulting in "post-hospital syndrome" after discharge and readmission. The aim of this article is to inform clinicians of the prevalence and consequences of malnutrition in IBD, as well as available screening and assessment tools for diagnosis, and to offer an organized approach to the nutritional care of hospitalized adult IBD patients.
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Affiliation(s)
- Elaine Chiu
- Division of Gastroenterology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Chris Oleynick
- Division of Internal Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Maitreyi Raman
- Division of Gastroenterology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Barbara Bielawska
- Department of Medicine, Division of Gastroenterology, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
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[Weight loss and malnutrition risk in geriatric patients]. Z Gerontol Geriatr 2021; 54:789-794. [PMID: 33954833 PMCID: PMC8636424 DOI: 10.1007/s00391-021-01900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 04/14/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND Malnutrition is a major challenge in routine clinical practice and is associated with increased mortality. OBJECTIVES In the research project Prevention and treatment of malnutrition in geriatric patients in hospital funded by the Federal Ministry of Education and Research (BMBF), routine data were analyzed. The aim was to uncover the causes of malnutrition risks acquired in hospital. MATERIAL AND METHODS Anonymized data from nursing home residents with at least a 3-day hospital stay were analyzed. The study included a total of 2058 residents from 19 nursing homes. The malnutrition risk was assessed by the combined MUST/PEMU (Malnutrition Universal Screening Tool/Nursing Measurement of Malnutrition and its Causes) screening and malnutrition by ESPEN (European Society for Clinical Nutrition and Metabolism) criteria. RESULTS Of the residents 36.2% (n = 744) had an initial risk of malnutrition and 12.7% (n = 262) were already malnourished. The proportions increased to 48.6% (n = 881) and 14.3% (n = 259) at discharge, respectively. The logistic regression analysis showed a significantly increasing probability of developing a malnutrition risk during the hospital stay with the diagnoses diseases of the respiratory system (OR 2.686; CI 95 1.111-4.575), chondropathy and osteopathy (OR 1.892; CI 95 1.149-3.115) and a higher BMI (OR 0.108; CI 95 1.038-1.181), more positive weight changes 6 months before hospital (OR 1.055; CI 95 1.017-1.094) and an increasing hospital stay (OR 1.048; CI 95 1.029-1.067). CONCLUSION The identification of an initial malnutrition and the prevention of developing a malnutrition risk represent major challenges in clinical practise. Both are equally necessary.
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Skeletal Muscle Loss during Multikinase Inhibitors Therapy: Molecular Pathways, Clinical Implications, and Nutritional Challenges. Nutrients 2020; 12:nu12103101. [PMID: 33053632 PMCID: PMC7601327 DOI: 10.3390/nu12103101] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/17/2022] Open
Abstract
In cancer patients, loss of muscle mass is significantly associated with low tolerability of chemotherapy and poor survival. Despite the great strides in the treatment of cancer, targeted therapies such as tyrosine kinase inhibitors (TKIs) could exacerbate muscle wasting. Over recent years, the impact of skeletal muscle loss during TKI therapy on clinical outcomes has been in the spotlight. In this review, we focus on the different molecular pathways of TKIs potentially involved in muscle wasting. Then, we report the results of the studies assessing the effects of different TKI therapies—such as sorafenib, regorafenib, sunitinib, and lenvatinib—on muscle mass, and highlight their potential clinical implications. Finally, we discuss an integrative nutritional approach to be adopted during TKI treatment. The assessment of muscle mass from computerized tomography imaging could be helpful in predicting toxicity and prognosis in patients treated with TKI such as sorafenib. Early recognition of low muscle mass and effective personalized nutritional support could prevent or attenuate muscle mass wasting. However, the role of nutrition is still overlooked, and future clinical trials are needed to find the optimal nutritional support to countermeasure muscle mass depletion during TKI therapy.
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Araujo TAD, Oliveira IM, Silva TGVD, Roediger MDA, Duarte YADO. Health conditions and weight change among the older adults over ten years of the SABE Survey. ACTA ACUST UNITED AC 2020; 29:e2020102. [PMID: 32997067 DOI: 10.1590/s1679-49742020000400012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/05/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To analyze the relationship between health conditions and weight changes among elderly people monitored by the SABE Survey over a ten-year period in São Paulo/SP. METHODS This was a longitudinal study that followed (2000-baseline, 2006 and 2010) change in body weight (outcome variable) and associated health conditions (exposure variables) in the elderly (n=571); multinomial logistic regression analyses were employed. RESULTS Average weight increase in the evaluated period was 29.0%. 34.0% (2006) and 12.5% (2010) lost weight and 18.2% (2006) and 39.9% (2010) gained weight. Prevalence of chronic diseases increased from 34.1% (2000) to 51.9% (2006) and 60.1% (2010). Older people with weight gain also rated their overall health as poorer in 2006 (RR:3.15; 95%CI 1.21;8.17) and 2010 (RR:2.46; 95%CI 1.02;5.94). The higher numbers of diseases (RR:2.12; 95%CI 1.00;4.46) and hospitalizations (RR:3.50; 95%CI 1.40;8.72) were associated with a decrease in weight in 2010. CONCLUSION Weight changes are related to poorer health status among the elderly.
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The impact of personalized nutritional support on postoperative outcome within the enhanced recovery after surgery (ERAS) program for liver resections: results from the NutriCatt protocol. Updates Surg 2020; 72:681-691. [PMID: 32410162 DOI: 10.1007/s13304-020-00787-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/02/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Malnutrition in liver surgery is correlated with higher postoperative complications and longer length of hospital stay (LOHS), the same items that ERAS programs try to optimize. However, to date, standardized dietary protocols have not been defined within ERAS programs. Aim of this study was to evaluate the impact on LOHS and postoperative complications, of a personalized nutritional protocol (NutriCatt) with diet and oral branched-chain amino acid (BCAA) supplementation, adopted within the ERAS program. METHODS 1960 consecutive liver resections were performed from January 2000 to September 2018. EXCLUSION CRITERIA perihilar cholangiocarcinoma, simultaneous colorectal and liver resections. Four groups for analysis: resections before 2009 (1st period); from 2009 to 2016 (2nd period, including laparoscopic resections); between 2016 and September 2017 (ERAS); after September 2017 (ERAS + NutriCatt). RESULTS LOHS declined (p < 0.0001), from a median of 10 days (1st period) to 8, 7 and 6 in 2nd period, ERAS and ERAS + NutriCatt groups, respectively. At multivariable analysis for risk of LOHS > 8 days, the 2nd period, ERAS and ERAS + NutriCatt groups showed a protective effect. These results were confirmed for both minor and major resections. LOHS was significantly lower in ERAS + Nutricatt group than in ERAS group, without increasing risk of postoperative complications, although the rate of laparoscopic resections was similar in these two groups and complexity of liver resections was significantly higher in the last period. CONCLUSIONS Adoption of a personalized nutritional protocol with BCAA supplementation within the ERAS program for liver resections was a safe and effective approach that may impact on reducing the LOHS.
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Paulsen MM, Paur I, Gjestland J, Henriksen C, Varsi C, Tangvik RJ, Andersen LF. Effects of using the MyFood decision support system on hospitalized patients' nutritional status and treatment: A randomized controlled trial. Clin Nutr 2020; 39:3607-3617. [PMID: 32241711 DOI: 10.1016/j.clnu.2020.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Compliance to guidelines for disease-related malnutrition is documented as poor. The practice of using paper-based dietary recording forms with manual calculation of the patient's nutritional intake is considered cumbersome, time-consuming and unfeasible among the nurses and does often not lead to appropriate nutritional treatment. We developed the digital decision support system MyFood to deliver a solution to these challenges. MyFood is comprised of an app for patients and a website for nurses and includes functions for dietary recording, evaluation of intake compared to requirements, and a report to nurses including tailored recommendations for nutritional treatment and a nutritional care plan for documentation. The study aimed to investigate the effects of using the MyFood decision support system during hospital stay on adult patients' nutritional status, treatment and hospital length of stay. The main outcome measure was weight change. METHODS The study was a parallel-arm randomized controlled trial. Patients who were allocated to the intervention group used the MyFood app during their hospital stay and the nurses were encouraged to use the MyFood system. Patients who were allocated to the control group received routine care. RESULTS We randomly assigned 100 patients (51.9 ± 14 y) to the intervention group (n = 49) and the control group (n = 51) between August 2018 and February 2019. Losses to follow-up were n = 5 in the intervention group and n = 1 in the control group. No difference was found between the two groups with regard to weight change. Malnutrition risk at discharge was present in 77% of the patients in the intervention group and 94% in the control group (p = 0.019). Nutritional treatment was documented for 81% of the patients in the intervention group and 57% in the control group (p = 0.011). A nutritional care plan was created for 70% of the intervention patients compared to 16% of the control patients (p < 0.001). CONCLUSIONS The intervention had no effect on weight change during hospital stay. A higher proportion of the patients in the control group was malnourished or at risk of malnutrition at hospital discharge compared to the patients in the intervention group. The documentation of nutritional intake, treatment and nutritional care plans was higher for the patients using the MyFood system compared to the control group. This trial was registered at clinicaltrials.gov (NCT03412695).
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Affiliation(s)
- Mari Mohn Paulsen
- Norwegian National Advisory Unit on Disease Related Undernutrition, Division of Cancer Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway; Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Box 1110 Blindern, 0317 Oslo, Norway.
| | - Ingvild Paur
- Norwegian National Advisory Unit on Disease Related Undernutrition, Division of Cancer Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Johanna Gjestland
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Box 1110 Blindern, 0317 Oslo, Norway; Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Christine Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Box 1110 Blindern, 0317 Oslo, Norway
| | - Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Aker Hospital, Box 4959 Nydalen, 0424 Oslo, Norway
| | - Randi Julie Tangvik
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Box 7804, 5020 Bergen, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Box 1110 Blindern, 0317 Oslo, Norway
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Hestevik CH, Molin M, Debesay J, Bergland A, Bye A. Older patients' and their family caregivers' perceptions of food, meals and nutritional care in the transition between hospital and home care: a qualitative study. BMC Nutr 2020; 6:11. [PMID: 32206325 PMCID: PMC7079473 DOI: 10.1186/s40795-020-00335-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 02/17/2020] [Indexed: 02/07/2023] Open
Abstract
Background Older people have varying degrees of unmet nutritional needs following discharge from hospital. Inadequate involvement of the older person and his or her family caregivers in care and care planning, and inadequate support of self-management in the discharge process and follow-up care at home, negatively affects the quality of care. Research on older patients’ and their family caregivers’ experiences with nutritional care in hospital and home care and in the transition between these settings is limited. Thus, the aim of this study was to explore older patients’ and their family caregivers’ perceptions regarding the food, meals and nutritional care provided in the transition between hospital and home care services, focusing on the first 30 days at home. The overall aim of this study is to produce knowledge that can inform policy and clinical practice about how to optimise the care provided to older persons that are malnourished or at risk of malnutrition. Methods Using a qualitative interpretive descriptive design, we carried out face-to-face semi-structured interviews with 15 older patients, with documented risk of malnutrition or malnourishment (Mini Nutritional Assessment [MNA]), two and five weeks after hospital discharge. In addition, we interviewed nine family caregivers once during this five week period. The questions focused on perceptions of food, meals and nutritional care in hospital and home care and in the transition between these settings. We analysed the data thematically. Results Four overarching themes emerged from the material: 1) the need for a comprehensive approach to nutritional care, 2) non-individualised nutritional care at home, 3) lack of mutual comprehension and shared decision making and 4) the role of family caregivers. Conclusion The organisation of nutritional care and food provision to older people, depending on care, lack consideration for the individual’s values, needs and preferences. Older patients’ and their family caregivers’ needs and preferences should guide how nutritional care is provided.
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Affiliation(s)
| | - Marianne Molin
- 2Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Bjorknes University College, Lovisenberggata 13, 0456 Oslo, Norway
| | - Jonas Debesay
- 2Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- 1Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- 2Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Reber E, Strahm R, Bally L, Schuetz P, Stanga Z. Efficacy and Efficiency of Nutritional Support Teams. J Clin Med 2019; 8:jcm8091281. [PMID: 31443543 PMCID: PMC6780521 DOI: 10.3390/jcm8091281] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 01/06/2023] Open
Abstract
Malnutrition is frequent in patients during a hospital admission and may further worsen during the hospital stay without appropriate nutritional support. Malnutrition causes greater complication rates, morbidity, and mortality rates, which increases the length of hospital stay and prolongs rehabilitation. Early recognition of individual nutritional risk and timely initiation of a tailored nutritional therapy are crucial. Recent evidence from large-scale trials suggests that efficient nutritional management not only improves the nutritional status, but also prevents negative clinical outcomes and increases patients’ quality of life. Multifaceted clinical knowledge is required to ensure optimal nutritional support, according to a patient’s individual situation and to avoid potential complications. Furthermore, clear definition of responsibilities and structuring of patient, and work processes are indispensable. Interdisciplinary and multiprofessional nutritional support teams have been built up to ensure and improve the quality and safety of nutritional treatments. These teams continuously check and optimize the quality of procedures in the core areas of nutritional management by implementing nutritional screening processes using a validated tool, nutritional status assessment, an adequate nutritional care plan development, prompt and targeted nutritional treatment delivery, and provision of accurate monitoring to oversee all aspects of care, from catering to artificial nutrition. The foundation of any nutritional care plan is the identification of patients at risk. The aim of this narrative review is to provide an overview about composition, tasks, and challenges of nutritional support teams, and to discuss the current evidence regarding their efficiency and efficacy in terms of clinical outcome and cost effectiveness.
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Affiliation(s)
- Emilie Reber
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland.
| | - Rachel Strahm
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Philipp Schuetz
- Department of Medical University, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, 5000 Aarau, Switzerland
- Department for Clinical Research, Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
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Rinninella E, Silvestri G, Cintoni M, Perna A, Martorana GE, De Lorenzo A, Rossini PM, Miggiano GAD, Gasbarrini A, Mele MC. Clinical use of bioelectrical impedance analysis in patients affected by myotonic dystrophy type 1: A cross-sectional study. Nutrition 2019; 67-68:110546. [PMID: 31376676 DOI: 10.1016/j.nut.2019.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/06/2019] [Accepted: 05/10/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Myotonic dystrophy type 1 (DM1) is an inherited muscle disorder characterized by slowly progressive weakness due to muscle degeneration. The Muscular Impairment Rating Scale (MIRS) is validated to assess clinical muscle severity of patients with DM1, although the scale is not sensitive enough to assess disease progression in time intervals fit for clinical trials. The aim of this study was to analyze bioelectrical whole body and arm segmental parameters in patients with DM1 to explore a correlation between bioelectrical impedance analysis (BIA) parameters and disease stage. METHODS Forty patients with DM1 were enrolled in a cross-sectional study. In all patients, MIRS, handgrip strength (HGS), and BIA were assessed. A Kruskal-Wallis test was used to assess the difference in continuous variables according to MIRS. Correlation between BIA values and HGS were made by Pearson's coefficient analysis. A linear regression analysis was performed. RESULTS Eighteen of 40 patients were men (45%). The median age of the cohort was 42 y (30-58 y). Four patients (10%) were classified as MIRS 1; 20 (50%) MIRS 2; 11 (27.5%) MIRS 3; and 5 (12.5%) as MIRS 4. A correlation was observed between phase angle and MIRS (P = 0.0001). MIRS correlated with other BIA values such as resistance, impedance ratio, and capacitance (P = 0.005, P = 0.0001, P = 0.0006, respectively). At linear regression analysis, segmental resistance, phase angle, impedance ratio, and capacitance of both arms significantly correlated with HGS. CONCLUSIONS Results from the study support the use of BIA as a suitable procedure for staging DM1 muscle involvement and as a measure of muscle disease outcome, in clinical practice and in clinical trial design of therapeutic drugs.
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Affiliation(s)
- Emanuele Rinninella
- UOC di Nutrizione Clinica, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Gabriella Silvestri
- UOC di Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo; Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Cintoni
- Scuola di Specializzazione in Scienza dell'Alimentazione, Università di Roma Tor Vergata, Rome, Italy
| | - Alessia Perna
- UOC di Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo; Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Ettore Martorana
- UOC di Nutrizione Clinica, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonino De Lorenzo
- Sezione di Nutrizione Clinica e Nutrigenomica, Dipartimento di Biomedicina e Prevenzione, Università di Roma Tor Vergata, Rome, Italy
| | - Paolo Maria Rossini
- UOC di Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo; Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacinto Abele Donato Miggiano
- UOC di Nutrizione Clinica, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy; UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Cristina Mele
- UOC di Nutrizione Clinica, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy
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Finocchiaro C, Fanni G, Bo S. Clinical impact of hospital malnutrition. Intern Emerg Med 2019; 14:7-9. [PMID: 30474790 DOI: 10.1007/s11739-018-1987-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/14/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Concetta Finocchiaro
- Unit of Clinical Nutrition, Hospital of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Giovanni Fanni
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy
| | - Simona Bo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Turin, Italy.
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