1
|
Quist JR, Rud CL, Brantlov S, Ward LC, Dahl Baunwall SM, Hvas CL. Bioelectrical impedance analysis as a clinical marker of health status in adult patients with benign gastrointestinal disease: A systematic review. Clin Nutr ESPEN 2024; 59:387-397. [PMID: 38220401 DOI: 10.1016/j.clnesp.2023.12.145] [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: 07/16/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Body composition reflects nutritional status, disease status and progression, and treatment responses. Mounting evidence supports the use of bioelectrical impedance analysis (BIA) as a non-invasive tool to assess body composition. Patients with benign gastrointestinal (GI) disease experience disease-related alterations in their body composition, and bioimpedance outcomes in patients with benign GI diseases have not previously been summarized. We aimed to evaluate BIA as a clinical body composition marker for benign GI diseases and describe its association with physical health status. METHODS We systematically searched PubMed, Scopus, Web of Science, Embase, and CINAHL from inception to October 2023 (PROSPERO registration: CRD42021265866). Of 971 screened studies, 26 studies were included in the final analysis, comprising a total of 2398 adult patients with benign GI disease. The main outcome was raw impedance data. RESULTS The most frequently reported BIA outcome was phase angle (PhA) (reported in 18 of 26 studies), followed by fat-free-mass (FFM) (reported in 13 of 26 studies). The consensus view of the included studies illustrates that BIA can be a useful tool for evaluating body composition in patients with benign GI diseases, and low PhA and FFM were associated with increased nutritional risk, abnormal physical characteristics, and increased mortality risk. CONCLUSION To fully utilize BIA as a clinical marker of health in patients with benign GI disease, standardized protocols specific to this population are needed and prospective studies testing cut-offs and ranges, accuracy, and other raw BIA parameters for classifying disease status.
Collapse
Affiliation(s)
| | - Charlotte Lock Rud
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - Steven Brantlov
- Department of Procurement & Clinical Engineering, Central Denmark Region, Denmark
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | | | | |
Collapse
|
2
|
Casirati A, Crotti S, Raffaele A, Caccialanza R, Cereda E. The use of phase angle in patients with digestive and liver diseases. Rev Endocr Metab Disord 2023; 24:503-524. [PMID: 36745355 DOI: 10.1007/s11154-023-09785-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 02/07/2023]
Abstract
Diseases of the liver and the digestive system can lead to malnutrition through an action of reduced food intake or nutrient use, inflammation and impaired metabolism, which result in substantial changes in body composition. Frequently, malnutrition manifests itself with weight loss and reduced muscle mass. However, weight loss and body mass index lack sensitivity to detect the loss of muscle mass and are not informative in distinguishing body water compartments and in characterizing their distribution. This issue is particularly relevant to these two disease models, which are frequently associated with fluid volume imbalances. Phase angle is a useful indicator for cell membrane integrity, water distribution between the intracellular and extracellular spaces and prediction of body cell mass as it is described by measured components of electrical impedance. Malnutrition, inflammation and oxidative stress impair electric tissue properties leading to lower values of PhA. In patients with inflammatory bowel and liver diseases, PhA was consistently found to be related to nutritional status and body composition, particularly the depletion of lean body mass and sarcopenia. It has been associated with prognosis, disease stage and severity and found to be helpful in monitoring fluid shifts and response to interventions.
Collapse
Affiliation(s)
- Amanda Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Silvia Crotti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Alessandro Raffaele
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Caccialanza
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| |
Collapse
|
3
|
Smith LO, Olieman JF, Berk KA, Ligthart-Melis GC, Earthman CP. Clinical applications of body composition and functional status tools for nutrition assessment of hospitalized adults: A systematic review. JPEN J Parenter Enteral Nutr 2023; 47:11-29. [PMID: 36036239 DOI: 10.1002/jpen.2444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND No global consensus exists on diagnostic criteria for malnutrition. Muscular deficits and functional impairments are major components of available malnutrition diagnostic frameworks because these facets of nutrition status significantly impact outcomes. The purpose of this review is to explore which body composition assessment (BCA) and functional status assessment (FSA) tools are being used for nutrition assessment (NA) and monitoring the response to nutrition interventions (RNIs) in adult inpatients. METHODS A literature search of Embase, Medline (Ovid), Web of Science, and Cochrane Central was performed to identify studies that used BCA and/or FSA tools for NA (along with an accepted NA diagnostic framework) and/or for monitoring RNI in adult inpatients. RESULTS The search yielded 3667 articles; 94 were included in the review. The number of studies using BCA and/or FSA tools for NA was 47 and also 47 for monitoring RNI. Seventy-nine percent of studies used bioimpedance for BCA, and 97% that included FSA utilized handgrip strength. When compared against sets of diagnostic criteria, many of the BCA and FSA tools showed promising associations with nutrition status. CONCLUSION Bioimpedance methods are the most widely used bedside BCA tools, and handgrip strength is the most widely used FSA tool; however, these methods are being used with a variety of protocols, algorithms, and interpretation practices in heterogeneous populations. To create a standardized nutrition status assessment process there is a need for validation studies on bedside methods and the development of globally standardized assessment protocols in clinical inpatient settings.
Collapse
Affiliation(s)
- Luke O Smith
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
| | - Joanne F Olieman
- Division of Dietetics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Kirsten A Berk
- Division of Dietetics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Gerdien C Ligthart-Melis
- Division of Dietetics, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Carrie P Earthman
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
| |
Collapse
|
4
|
Arero G, Arero AG, Mohammed SH, Vasheghani-Farahani A. Prognostic Potential of the Controlling Nutritional Status (CONUT) Score in Predicting All-Cause Mortality and Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease: A Meta-Analysis. Front Nutr 2022; 9:850641. [PMID: 35614981 PMCID: PMC9125241 DOI: 10.3389/fnut.2022.850641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/30/2022] [Indexed: 01/01/2023] Open
Abstract
Background As defined by the Controlling Nutrition Status (CONUT) score, the prognostic significance of nutritional status has attracted attention in patients with cardiovascular disease. This meta-analysis aimed to determine the importance of CONUT score for prediction of all-cause mortality and major adverse cardiovascular events (MACE) in adult patients with coronary artery disease (CAD). Methods Observational studies conducted to evaluate the association of CONUT score with adverse clinical outcomes in patients with CAD were included. We searched MEDLINE, Embase, Scopus, Cochrane library, Google scholar, medRxiv pre-print as well as Science Direct search engine for studies published from the inception of each database until March 21, 2022. Studies reporting the utility of CONUT score in prediction of all-cause mortality and MACE among patients with CAD were eligible. Predictive potential of the CONUT score were summarized by pooling the multivariable adjusted hazard ratio (aHR) with 95% CI for the malnourished vs. normal nutritional status or per point CONUT score increase. Results Of 2,547 screened citation, nine observational studies involving 81,257 patients with CAD were analyzed. Malnutrition defined by the CONUT score was associated with significantly increased risk of all-cause mortality when compared with the normal nutritional state (aHR for mild, moderate, and severe malnutrition, respectively: (1.21 [95% CI: 1.15–1.27], I2 = 0%), (1.53 [95% CI: 1.26–1.84], I2 = 84%), and (2.24 [95% CI: 1.57–3.19], I2 = 77%). Similarly, moderate (aHR 1.71 [95% CI: 1.44–2.03], I2 = 0%) and severe (aHR 2.66 [95% CI: 1.82–3.89], I2 = 0%) malnutrition was associated with a significantly higher risk of MACE compared with the normal nutritional state. Additionally, per point increase in the CONUT score was correlated with 20 and 23% additional risk of all-cause mortality and MACE, respectively. Conclusion As defined by the CONUT score, malnutrition is an independent predictor of all-cause mortality and MACE in CAD patients. Nutritional assessment with CONUT score could allow clinicians to identify patients with CAD at high risk for adverse clinical outcomes.
Collapse
Affiliation(s)
- Godana Arero
- Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
- *Correspondence: Godana Arero,
| | - Amanuel Godana Arero
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Addis Ababa, Ethiopia
| | | | - Ali Vasheghani-Farahani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Dubé MD, Rothfusz CA, Emara AK, Hadad M, Surace P, Krebs VE, Molloy RM, Piuzzi NS. Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty: a Detailed Review and Guide to Management. Curr Rev Musculoskelet Med 2022; 15:311-322. [PMID: 35501548 DOI: 10.1007/s12178-022-09762-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW 8.5 to 50% of total joint arthroplasty (TJA) patients are reported to have preoperative malnutrition. The narrative review identifies the relationship between preoperative malnutrition for TJA patients and postoperative outcomes as well as the use of perioperative nutritional intervention to improve postoperative complications. RECENT FINDINGS Biochemical/laboratory, anthropometric, and clinical measures have been widely used to identify preoperative nutritional deficiency. Specifically, serum albumin is the most prevalent used marker in TJA because it has been proven to be correlated with protein-energy malnutrition due to the surgical stress response. However, there remains a sustained incidence of preoperative malnutrition in total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients due to a lack of agreement among the available nutritional screening tools and utilization of isolated laboratory, anthropometric, and clinical variables. Previous investigations have also suggested preoperative malnutrition to be a prognostic indicator of complications in general, cardiac, vascular, and orthopaedic surgery specialties. Serum albumin, prealbumin, transferrin, and total lymphocyte count (TLC) can be used to identify at-risk patients. It is important to employ these markers in the preoperative setting because malnourished TKA and THA patients have shown to have worse postoperative outcomes including prolonged length, increased reoperation rates, increased infection rates, and increased mortality rates. Although benefits from high-protein and high-anti-inflammatory diets have been exhibited, additional research is needed to confirm the use of perioperative nutritional intervention as an appropriate treatment for preoperative TJA patients.
Collapse
Affiliation(s)
- Michael D Dubé
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | | | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Matthew Hadad
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Peter Surace
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA.
| |
Collapse
|
6
|
Sahin N, Tek NA. Validity of the Graz Malnutrition Screening as an indicator of malnutrition in hospitalized patients. Nutr Clin Pract 2022; 37:1336-1347. [DOI: 10.1002/ncp.10825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Nursel Sahin
- Department of Nutrition and Dietetic Bandirma Onyedi Eylul University Balikesir Turkey
| | - Nilufer Acar Tek
- Department of Nutrition and Dietetic Gazi University Ankara Turkey
| |
Collapse
|
7
|
GÜZEL S, KESER A, KEPENEKCİ BAYRAM İ. Risk of malnutrition in general surgical patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.823458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|