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Ravaioli F, Brodosi L, Agnelli G, Albanese MG, Baldo C, Baracco B, Lambertini L, Leoni L, Magnani L, Nicastri A, Perazza F, Rossetti C, Sacilotto F, Stecchi M, Sasdelli AS, Pironi L. Malnutrition independently predicts mortality at 18 months in patients hospitalised for severe acute respiratory syndrome corona virus 2 (SARS-coV-2). Clin Nutr ESPEN 2024; 63:736-747. [PMID: 39074610 DOI: 10.1016/j.clnesp.2024.07.022] [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: 03/31/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 07/31/2024]
Abstract
RATIONALE To investigate the association between malnutrition and patient outcome following hospitalisation for Corona Virus Disease 2019 (COVID-19). METHODS In April 2020, 268 adult patients (235 included in the follow-up) hospitalised for COVID-19 infection were evaluated for malnutrition risk and diagnosis using modified Nutritional Risk Screening 2002 and modified Global Leadership Initiative on Malnutrition criteria (GLIM), respectively. An 18-month follow-up was carried out to assess the incidence and the associated risk factors for death and re-hospitalization. RESULTS The outcome was unknown for 33 patients. Death occurred in 39% of the 235 patients included in the follow-up. The risk of death was independently associated with malnutrition risk or diagnosis of malnutrition, whereas the male sex showed a protective association. The Kaplan-Meier survival curves showed that patients with diagnosis of malnutrition had lower survival rate. The re-hospitalization rate was 31% and was negatively associated with BMI≥25, and positively associated with length of hospitalisation for COVID-19 and with cancer comorbidity. CONCLUSIONS In hospitalized patients for SARS-CoV-2 disease, both malnutrition risk (p = 0.050) and diagnosis of malnutrition (p = 0.047 with modified GLIM and C-reactive protein >0.5 mg/dL; p = 0.024 with modified GLIM and C-reactive protein >5 mg/dL) were predictive risk factors for mortality, whereas male sex was associated with lower risk of death. Overweight at time of hospitalization and the length of hospitalisation were respectively protective and risk factor for re-hospitalization after discharge.
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Affiliation(s)
- Federico Ravaioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Lucia Brodosi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Giulio Agnelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Maria Giuseppina Albanese
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Chiara Baldo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Bianca Baracco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Lorenza Lambertini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Laura Leoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Lucia Magnani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Alba Nicastri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Federica Perazza
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Chiara Rossetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Federica Sacilotto
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Michele Stecchi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | | | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
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Mancin S, Pipitone V, Testori A, Ferrante S, Soekeland F, Sguanci M, Mazzoleni B. Clinical nurse specialists in nutrition: A systematic review of roles and clinical experiences. Int Nurs Rev 2024; 71:521-530. [PMID: 38108545 DOI: 10.1111/inr.12919] [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: 12/05/2022] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND/SCOPE The Clinical Nurse Specialist in Nutrition is a professional capable of providing specialist clinical assistance and leadership-related clinical nutrition. To date, although their role has already been identified, there is still uncertainty about how this figure can actually fit into the various global health systems. The purpose of this review is to clarify and define the role of this professional aimed at analysing clinical experiences and data from nutrition scientific societies. METHODOLOGY A systematic literature review was conducted using the Prisma Statement in the Cochrane Library databases and subsequently in PubMed, Embase, CINAHL, Scopus and Web of Science. In addition, a manual search of studies published in Google Scholar was conducted for the analysis of 'grey literature'. Out of 3,320 identified records, 20 studies were included in the present review. [Correction added on 06 June 2024, after first online publication: The preceding sentence has been corrected from "Out of 2,348 identified records, 21 studies were included in the present review." to "Out of 3,320 identified records, 20 studies were included in the present review" in this version.] RESULTS: The development of specific training, certification and qualification protection courses is contributing to the development of this professional in various hospital and community clinical contexts. The clinical experiences identified have shown that this figure is able to provide specialist assistance by offering high levels of safety, efficacy and quality of the care provided. CONCLUSIONS/ IMPLICATIONS FOR NURSING The implementation of nurse nutrition specialist, to date, is still limited at the global level, and training programmes coordinated between scientific societies and nursing universities could be the basis for the development of this specialization in countries where today this figure is not yet present.
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Affiliation(s)
- Stefano Mancin
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata,", Rome, Italy
| | | | | | | | | | - Marco Sguanci
- Research Unit of Nursing Science, University Campus Bio-Medico di Roma, Roma, Italy
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Guðnadóttir SD, Gunnarsdóttir I, Hernandez UB, Ingadóttir ÁR. High risk of malnutrition among hospitalised coronavirus disease 2019 (COVID-19) patients is associated with mortality and other clinical outcomes. Clin Nutr ESPEN 2024; 61:1-7. [PMID: 38777420 DOI: 10.1016/j.clnesp.2024.02.023] [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: 07/09/2023] [Revised: 01/28/2024] [Accepted: 02/21/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Increasing evidence indicates an association between nutritional status and Coronavirus disease 2019 (COVID-19) disease severity. The aim of the study was to describe the risk of malnutrition, body mass index (BMI) and vitamin D status of hospitalised COVID-19 patients and assess whether they are associated with duration of hospital stay, intensive care unit (ICU) admission, mechanical ventilation, and mortality. METHODS The study is a descriptive retrospective study of 273 patients with COVID-19 admitted to Hospital from February 2020 to March 2021. Patients were screened for risk of malnutrition using a validated screening tool. BMI was calculated from height and weight. Insufficient Vitamin D status was defined as 25(OH)vitD <50 nmol/L. Logistic regression analysis was used to assess the association between indicators of nutritional status of patients with COVID-19, and outcomes such as duration of stay >7 days, ICU admission, mechanical ventilation, and mortality. Interaction between risk of malnutrition and BMI of ≥30 kg/m2 was assessed using the likelihood ratio test with hospital stay, ICU admission, mechanical ventilation, and mortality as outcomes. RESULTS Screening for risk of malnutrition identified 201 (74%) patients at a medium to high risk of malnutrition. Patients defined as being at a medium or high risk of malnutrition were more likely to be hospitalised for >7 days compared to those defined as low risk (OR: 10.72; 95% CI: 3.9-29.46; p < 0.001 and OR: 61.57; 95% CI: 19.48-194.62; p < 0.001, respectively). All patients who were admitted to ICU (n = 41) and required mechanical ventilation (n = 27) were defined as having medium or high risk of malnutrition. High risk of malnutrition was also associated with increased odds of mortality (OR: 8.87; 955 CI 1.08-72,96; p = 0.042). BMI of ≥30 kg/m2 (43%) and 25(OH)vitD <50 nmol/L (20%) were not associated with duration of stay >7 days or mortality, although BMI ≥30 kg/m2 was associated with increased risk of ICU admission (OR: 7.12; 95% CI: 1.59-31.94; p = 0.010) and mechanical ventilation (OR: 8.86; 95% CI: 1.12-69.87; p = 0.038). Interactions between risk of malnutrition and BMI ≥30 kg/m2 were not significant to explain the outcomes of hospital stay >7 days, ICU admission, mechanical ventilation, or mortality. CONCLUSION High risk of malnutrition among hospitalised COVID-19 patients was associated with longer duration of hospital stay, ICU admission, mechanical ventilation and mortality, and BMI ≥30 kg/m2 was associated with ICU admission and mechanical ventilation. Insufficient Vitamin D status was not associated with duration of hospital stay, ICU admission, mechanical ventilation, or mortality.
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Affiliation(s)
| | - Ingibjörg Gunnarsdóttir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Áróra Rós Ingadóttir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
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Cao A, Luo W, Wang L, Wang J, Zhou Y, Huang C, Zhu B. The prognostic value of prognostic nutritional index and renal function indicators for mortality prediction in severe COVID-19 elderly patients: A retrospective study. Medicine (Baltimore) 2024; 103:e38213. [PMID: 38758852 PMCID: PMC11098216 DOI: 10.1097/md.0000000000038213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/22/2024] [Indexed: 05/19/2024] Open
Abstract
Identifying prognostic factors in elderly patients with severe coronavirus disease 2019 (COVID-19) is crucial for clinical management. Recent evidence suggests malnutrition and renal dysfunction are associated with poor outcome. This study aimed to develop a prognostic model incorporating prognostic nutritional index (PNI), estimated glomerular filtration rate (eGFR), and other parameters to predict mortality risk. This retrospective analysis included 155 elderly patients with severe COVID-19. Clinical data and outcomes were collected. Logistic regression analyzed independent mortality predictors. A joint predictor "L" incorporating PNI, eGFR, D-dimer, and lactate dehydrogenase (LDH) was developed and internally validated using bootstrapping. Decreased PNI (OR = 1.103, 95% CI: 0.78-1.169), decreased eGFR (OR = 0.964, 95% CI: 0.937-0.992), elevated D-dimer (OR = 1.001, 95% CI: 1.000-1.004), and LDH (OR = 1.005, 95% CI: 1.001-1.008) were independent mortality risk factors (all P < .05). The joint predictor "L" showed good discrimination (area under the curve [AUC] = 0.863) and calibration. The bootstrapped area under the curve was 0.858, confirming model stability. A combination of PNI, eGFR, D-dimer, and LDH provides useful prognostic information to identify elderly patients with severe COVID-19 at highest mortality risk for early intervention. Further external validation is warranted.
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Affiliation(s)
- Angyang Cao
- Anesthesiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
- Health Science Center, Ningbo University, Zhejiang, China
| | - Wenjun Luo
- Anesthesiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
- Health Science Center, Ningbo University, Zhejiang, China
| | - Long Wang
- Nephrology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Jianhua Wang
- Radiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Yanling Zhou
- Anesthesiology Department, Kunming Third People’s Hospital, Yunnan, China
| | - Changshun Huang
- Anesthesiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Binbin Zhu
- Anesthesiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
- Health Science Center, Ningbo University, Zhejiang, China
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Mancin S, Sguanci M, Reggiani F, Morenghi E, Piredda M, De Marinis MG. Dysphagia screening post-stroke: systematic review. BMJ Support Palliat Care 2024; 13:e641-e650. [PMID: 37364991 DOI: 10.1136/spcare-2022-004144] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND/SCOPE Stroke is one of the main causes of death, especially when associated with dysphagia. Hence, the assessment of nutritional status and aspiration risk is important to improve clinical outcomes. The aim of this systematic review is to identify which are the most suitable dysphagia screening tools in chronic post-stroke patients. METHODOLOGY A systematic literature search was conducted for articles published from 1 January 2000 to 30 November 2022 in the Cochrane Library, PubMed, Embase, CINAHL, Scopus and Web of Science databases, including primary studies providing quantitative or qualitative data. Additionally, a manual search was conducted scanning the reference lists of relevant articles and Google Scholar was searched to retrieve additional records. The process of screening, selection and inclusion of the articles, as well as the assessment of risk of bias and methodological quality, were conducted by two reviewers. RESULTS Out of the 3672 records identified, we included 10 studies, mostly (n=9) cross-sectional, evaluating screening for dysphagia in 1653 chronic post-stroke patients. Volume-Viscosity Swallow Test was the only test applied in multiple studies with adequate sample size, demonstrating high diagnostic accuracy (sensitivity=96.6%-88.2%; specificity=83.3%-71.4%) compared with the videofluoroscopic swallowing study. CONCLUSIONS Dysphagia is an important complication in chronic post-stroke patients. Early identification of this condition through screening tools with adequate diagnostic accuracy is of paramount importance. The limited number of studies available and their small sample sizes may be a limitation to this study. PROSPERO REGISTRATION NUMBER CRD42022372303.
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Affiliation(s)
- Stefano Mancin
- Nutrition Unit, Cancer Center, IRCCS Humanitas Research Hospital, via Manzoni, 56 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Montpellier, 1- 00128 Rome, Italy
| | - Marco Sguanci
- Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Francesco Reggiani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Emanuela Morenghi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy
- Biostatistic Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Michela Piredda
- Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Maria Grazia De Marinis
- Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
- Fondazione Policlinico Universitario, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
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Andreoli D, Mancin S, Sguanci M, Ricco M, Gazineo D, Godino L. Assessment of healthcare application quality: Development of a standardized methods for healthcare professionals. MethodsX 2023; 11:102391. [PMID: 37791010 PMCID: PMC10542414 DOI: 10.1016/j.mex.2023.102391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/05/2023] Open
Abstract
The advancement of the mobile app market is reshaping healthcare, emphasizing the imperative for quality and efficacy in health applications. This methodology has been devised to assess mobile health applications, aiming to assist healthcare professionals in selecting apps for e-healthcare consumers. Key facets of this approach are: •A stringent selection process within mobile app stores•A standardized assessment using the Mobile App Rating Scale to achieve consistent and replicable evaluations, systematically organizing app evaluations•A comprehensive framework guiding healthcare practitioners in determining which apps to integrate into clinical practice and which to exclude Central to this method is the emphasis on distinguishing apps that enhance clinical practice from those that fall short in important areas such as the effectiveness of proposed health features, data accuracy, adherence to clinical guidelines, data security, and user privacy. With heightened attention to usability and accessibility, the methodology also addresses the common risks inherent in mHealth implementation, ensuring that selected apps not only meet technical criteria but also align with the broader healthcare ecosystem's needs and challenges.
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Affiliation(s)
- Desirèe Andreoli
- Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
- SIAN, Società Infermieri Area Nefrologica, Olbia, Italy
| | - Stefano Mancin
- SIAN, Società Infermieri Area Nefrologica, Olbia, Italy
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Marco Sguanci
- Department of Medicine and Surgery, Research Unit of Nursing Science, Università Campus Bio-Medico di Roma, Italy
| | - Mattia Ricco
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Domenica Gazineo
- SIAN, Società Infermieri Area Nefrologica, Olbia, Italy
- Governo Clinico e Qualità, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lea Godino
- SIAN, Società Infermieri Area Nefrologica, Olbia, Italy
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Crippa C, Matteucci S, Pastore M, Morenghi E, Starace E, De Pasquale G, Pieri G, Soekeland F, Gibbi SM, Lo Cricchio G, Zorloni A, Mazzoleni B, Mancin S. A Comparative Evaluation of the Caloric Intake and Economic Efficiency of Two Types of Homogenized Diets in a Hospital Setting. Nutrients 2023; 15:4731. [PMID: 38004125 PMCID: PMC10675474 DOI: 10.3390/nu15224731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
The prevalence of malnutrition is increasing globally due to factors such as age-related pathological conditions and diseases that impact food and beverage intake. In hospital settings, older adult patients often require homogenised diets, which can lead to malnutrition due to poor palatability and limited variety. This study compared the Standard Homogenised Diet (HSD) and a Modified Homogenized Diet (HMD) proposed in a tertiary hospital in Northern Italy. A retrospective and observational design was used to analyse data from 86 adult patients with various conditions requiring a homogenised diet. The primary goal was to compare food intake, rheological characteristics, and palatability of the two diets. The secondary objective was to evaluate the economic impact by comparing costs and quantifying food waste from unused meals. Patients on HMD had a median daily caloric intake of 852 kcal (IQR 787-926 kcal) compared to 631 kcal (IQR 506-797 kcal) in the HSD group. Taste, texture, palatability, and ease of intake for HMD outperformed HSD with scores such as 3.7 ± 0.6 vs. 2.5 ± 0.4 for taste. Economically, HMD was EUR 0.53 less expensive per day than HSD, and food wastage costs were significantly lower for HMD (EUR 2.66 ± 0.81) than HSD (EUR 4.66 ± 1.27). Overall, HMD presented substantial benefits in patient satisfaction and cost-efficiency. This insight may aid diverse care settings to enhance meal acceptance and nutritional intake for patients needing homogenised diets.
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Affiliation(s)
- Camilla Crippa
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Sofia Matteucci
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Manuela Pastore
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (A.Z.); (B.M.)
| | - Erica Starace
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Giulia De Pasquale
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Gabriella Pieri
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Fanny Soekeland
- School of Health Professions, University of Applied Sciences, 3008 Bern, Switzerland;
| | - Stefano Maria Gibbi
- School of Pharmacy, Department of Drug Science University of Pavia, 27100 Pavia, Italy;
| | - Giuliana Lo Cricchio
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
| | - Andrea Zorloni
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (A.Z.); (B.M.)
- Operating Room Unit Humanitas San Pio X, 20159 Milan, Italy
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (A.Z.); (B.M.)
| | - Stefano Mancin
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (C.C.); (S.M.); (M.P.); (E.M.); (E.S.); (G.D.P.); (G.P.); (G.L.C.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (A.Z.); (B.M.)
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Matteucci S, De Pasquale G, Pastore M, Morenghi E, Pipitone V, Soekeland F, Caccialanza R, Mazzoleni B, Mancin S. Low-Bacterial Diet in Cancer Patients: A Systematic Review. Nutrients 2023; 15:3171. [PMID: 37513590 PMCID: PMC10385845 DOI: 10.3390/nu15143171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
The low-bacterial diet (LBD) is a widely used dietary regimen to reduce the risk of food-borne infections in patients with neutropenic cancer, but its role is controversial due to its unclear benefits. The purpose of this study was to provide an updated analysis of the available evidence on the efficacy of the LBD to reduce the risk of infections, mortality rates, and quality of life (QoL) in neutropenic patients with cancer. A systematic literature search was conducted in the biomedical databases Cochrane Library, PubMed, CINHAL, and EMBASE. The process of the screening, selection, inclusion of articles, and assessment of risk of bias and methodological quality was conducted by two reviewers. Of the 1985 records identified, 12 were included. The LBD demonstrated heterogeneity in definition, composition, and initiation timing; moreover, the LBD did not demonstrate a reduction in infection and mortality rates compared to a free diet, showing a negative correlation with quality of life. The LBD, in addition to not bringing benefits in terms of reductions in infection and mortality rates, has been shown to worsen the quality of life due to the reduced palatability and limited variety of the food supply, negatively impacting nutritional status.
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Affiliation(s)
- Sofia Matteucci
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Giulia De Pasquale
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Manuela Pastore
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Veronica Pipitone
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Fanny Soekeland
- School of Health Professions, University of Applied Sciences, Schwarztorstrasse 48, 3007 Bern, Switzerland
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Stefano Mancin
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
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Mancin S, Sguanci M, Cattani D, Soekeland F, Axiak G, Mazzoleni B, De Marinis MG, Piredda M. Nutritional knowledge of nursing students: A systematic literature review. NURSE EDUCATION TODAY 2023; 126:105826. [PMID: 37121074 DOI: 10.1016/j.nedt.2023.105826] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/06/2023] [Accepted: 04/10/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To investigate basic, specific and self-care knowledge on nutrition in nursing students, through a literature review and by identifying studies that suggest teaching methodologies used to implement undergraduate nutrition teaching in nursing curricula. METHOD A systematic literature search was conducted in the PubMed, Embase, CINAHL, Scopus and Cochrane Library. The process of screening, selection and inclusion of the articles, as well as the assessment of risk of bias and methodological quality was independently conducted by two reviewers. Out of 1361 records identified, 23 were included in this review. RESULTS Nursing students showed poor knowledge of basic and specific nutrition demonstrating a lack of knowledge also about nutritional self-care. The implementation of alternative teaching methods, such as active teaching strategies improved the students' knowledge of the subject. CONCLUSION The use of nutrition-focused, especially active, teaching methodologies during undergraduate nursing education can remedy the lack of knowledge on this topic. This approach should also be used in postgraduate education.
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Affiliation(s)
- Stefano Mancin
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University,Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Montpellier 1, 00128 Rome, Italy
| | - Marco Sguanci
- Research Unit of Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Daniela Cattani
- Department of Biomedical Sciences, Humanitas University,Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Fanny Soekeland
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Geoffrey Axiak
- Malta Leadership Institute, Valley Towers Suite 9, Valley Road, Birkirkara, Malta; University of Malta, Tal-Qroqq, Msida, Malta
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University,Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
| | - Maria Grazia De Marinis
- Research Unit of Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Michela Piredda
- Research Unit of Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy
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Garrett RE, Palacio CH, Bar-Or D. Long COVID: Is there a kidney link? Front Med (Lausanne) 2023; 10:1138644. [PMID: 37077670 PMCID: PMC10106649 DOI: 10.3389/fmed.2023.1138644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/15/2023] [Indexed: 04/05/2023] Open
Abstract
Metabolic causes such as altered bioenergetics and amino acid metabolism may play a major role in Long COVID. Renal-metabolic regulation is an integral part of these pathways but has not been systematically or routinely investigated in Long COVID. Here we discuss the biochemistry of renal tubular injury as it may contribute to Long COVID symptoms. We propose three potential mechanisms that could be involved in Long COVID namely creatine phosphate metabolism, un-reclaimed glomerular filtrate and COVID specific proximal tubule cells (PTC) injury-a tryptophan paradigm. This approach is intended to allow for improved diagnostics and therapy for the long-haul sufferers.
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Affiliation(s)
- Raymond E. Garrett
- Swedish Medical Center, Trauma Research Dept., Englewood, CO, United States
| | - Carlos H. Palacio
- South Texas Health System, Trauma Research Dept., McAllen, TX, United States
| | - David Bar-Or
- Swedish Medical Center, Trauma Research Dept., Englewood, CO, United States
- South Texas Health System, Trauma Research Dept., McAllen, TX, United States
- *Correspondence: David Bar-Or,
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11
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Feng X, Liu Z, He X, Wang X, Yuan C, Huang L, Song R, Wu Y. Risk of Malnutrition in Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14245267. [PMID: 36558436 PMCID: PMC9780808 DOI: 10.3390/nu14245267] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/26/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Studies have reported that COVID-19 may increase the risk of malnutrition among patients. However, the prevalence of such risk in hospitalized COVID-19 patients is uncertain due to the inconsistent use of assessment methods. (2) Methods: PubMed, Web of Science, and EMBASE were searched to identify studies on the nutritional status of hospitalized COVID-19 patients. A pooled prevalence of malnutrition risk evaluated by Nutrition Risk Score (NRS-2002) was obtained using a random effects model. Differences by study-level characteristics were examined by hospitalization setting, time of assessment, age, and country. Risk of bias was assessed using the Newcastle−Ottawa Scale. (3) Results: 53 studies from 17 countries were identified and summarized. A total of 17 studies using NRS-2002, including 3614 COVID-19 patients were included in the primary meta-analysis. The pooled prevalence of risk of malnutrition was significantly higher among ICU patients (92.2%, 95% CI: 85.9% to 96.8%) than among general ward patients (70.7%, 95% CI: 56.4% to 83.2%) (p = 0.002). No significant differences were found between age groups (≥65 vs. <65 years, p = 0.306) and countries (p = 0.893). (4) Conclusions: High risk of malnutrition is common and concerning in hospitalized patients with COVID-19, suggesting that malnutrition screening and nutritional support during hospitalization are needed.
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Affiliation(s)
- Xiaoru Feng
- Institute for Hospital Management, Tsinghua University, Beijing 100084, China
| | - Zeqi Liu
- Institute for Hospital Management, Tsinghua University, Beijing 100084, China
| | - Xiaotong He
- School of Labor and Human Resources, Renmin University of China, Beijing 100872, China
| | - Xibiao Wang
- Department of Occupational Hygiene Engineering, China University of Labor Relations, Beijing 100048, China
| | - Changzheng Yuan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Liyan Huang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Rui Song
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - You Wu
- Institute for Hospital Management, Tsinghua University, Beijing 100084, China
- School of Medicine, Tsinghua University, Beijing 100084, China
- Correspondence: ; Tel.: +86-13641181601
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12
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A modified nutrition risk screening 2002 predicts the risk of death among hospitalized patients with COVID-19. Clin Nutr ESPEN 2022; 52:365-370. [PMID: 36513477 PMCID: PMC9482444 DOI: 10.1016/j.clnesp.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the ability of a modified Nutrition Risk Screening 2002 (modified NRS) compared with other nutrition screening tools such as NRS 2002, Mini Nutrition Assessment Short Form (MNA-SF), and Malnutrition Universal Screening Tool (MUST) on predicting the risk of death in patients with coronavirus disease 2019 (COVID-19). METHODS We retrospectively collected data of patients who were admitted to the West campus of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 25th, 2020 to April 24th, 2020. The nutritional status of the patients was assessed by modified NRS, NRS 2002, MNA-SF, and MUST. According to the score of modified NRS, patients were divided into malnutrition risk group (score ≥3) and normal nutrition group (score <3). Clinical characteristics were compared between the two groups. Kaplan meier survival curve was used to analyze the difference of compositing survival rate between the two groups. The predictive efficacy of different nutritional scales on the outcome of death was detected by Receiver operating characteristic (ROC) analysis. RESULTS The modified NRS, NRS 2002, MNA-SF, and MUST identified malnutrition risk in 71.4%, 57.9%, 73.9%, and 43.4% of the patients, respectively. The patients were divided into malnutrition risk group and normal nutrition group by modified NRS score. Patients in the malnutrition risk group were older (65 y vs. 56 y) and with more severe and critical cases (42.30% vs. 5.20%) and diabetes cases (21.50% vs. 9.80%), worse prognosis (death of 13.80% vs. 0.50%), longer hospital stay (29 days vs. 23 days), lower albumin (31.85 g/L vs. 38.55 g/L) and prealbumin (201.95 mg/L vs. 280.25 mg/L) compared with the normal nutrition group (P were <0.001, respectively). There were more patients with chronic respiratory disease in malnutrition risk group (9.70 vs. 2.10%, P = 0.001). BMI was lower in malnutrition risk group (23.45 kg/m2vs. 24.15 kg/m2, P = 0.017). Kaplan meier survival curve demonstrated that the survival of malnutrition risk group was significantly lower than normal nutrition group (P < 0.001). The area under the ROC curve (AUC) of the modified NRS scale (0.895) outperformed NRS 2002 (0.758), MNA-SF (0.688), and MUST (0.485). The former three scales could predict the risk of death (P were < 0.001), while MUST could not (P = 0.690). CONCLUSIONS Patients with COVID-19 at risk of malnutrition have a worse prognosis than those with normal nutrition. The modified NRS scale could effectively predict the risk of death among patients with COVID-19.
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13
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Barazzoni R, Breda J, Cuerda C, Schneider S, Deutz NE, Wickramasinghe K, Abbasoglu O, Meijerink JB, Bischoff S, Pelaez RB, Cardenas D, Cederholm T, Cereda E, Chourdakis M, Toulson Davisson Correia MI, Schuren MDVD, Delzenne N, Frias-Toral E, Genton L, Cappellari GG, Cakir BK, Klek S, Krznaric Z, Laviano A, Lobo D, Muscaritoli M, Ockenga J, Pirlich M, Serlie MJM, Shi HP, Singer P, Soop M, Walrand S, Weimann A. COVID-19: Lessons on malnutrition, nutritional care and public health from the ESPEN-WHO Europe call for papers. Clin Nutr 2022; 41:2858-2868. [PMID: 36075815 PMCID: PMC9365508 DOI: 10.1016/j.clnu.2022.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 01/27/2023]
Abstract
With prolonged pandemic conditions, and emerging evidence but persisting low awareness of the importance of nutritional derangements, ESPEN has promoted in close collaboration with World Health Organization-Europe a call for papers on all aspects relating COVID-19 and nutrition as well as nutritional care, in the Society Journals Clinical Nutrition and Clinical Nutrition ESPEN. Although more COVID-related papers are being submitted and continue to be evaluated, ESPEN and WHO present the current editorial to summarize the many published findings supporting major interactions between nutritional status and COVID-19. These include 1) high risk of developing the disease and high risk of severe disease in the presence of pre-existing undernutrition (malnutrition) including micronutrient deficiencies; 2) high risk of developing malnutrition during the course of COVID-19, with substantial impact on long-term sequelae and risk of long COVID; 3) persons with obesity are also prone to develop or worsen malnutrition and its negative consequences during the course of COVID-19; 4) malnutrition screening and implementation of nutritional care may improve disease outcomes; 5) social and public health determinants contribute to the interaction between nutritional status and COVID-19, including negative impact of lockdown and social limitations on nutrition quality and nutritional status. We believe the evidence supports the need to consider COVID-19 as (also) a case of malnutrition-enhanced disease and disease-related malnutrition, with added risk for persons both with and without obesity. Similarities with many other disease conditions further support recommendations to implement standard nutritional screening and care in COVID-19 patients, and they underscore the relevance of appropriate nutritional and lifestyle prevention policies to limit infection risk and mitigate the negative health impact of acute pandemic bouts.
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Affiliation(s)
- Rocco Barazzoni
- Corresponding author. Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, Strada di Fiume 447, 34149 Trieste, Italy
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Evaluation of the Relationship between Nutritional Status of COVID-19 Patients Admitted to the ICU and Patients' Prognosis: A Cohort Study. J Nutr Metab 2022; 2022:5016649. [PMID: 35865866 PMCID: PMC9295016 DOI: 10.1155/2022/5016649] [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: 04/07/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 01/18/2023] Open
Abstract
Background Malnutrition in COVID-19 critically ill patients can lead to poor prognosis. This study aimed to evaluate the association between nutritional status (or risk) and the prognosis of critically ill COVID-19 patients. In this study, prognosis is the primary outcome of "hospital mortality" patients. The second outcome is defined as "need for mechanical ventilation." Methods and Materials In this single-center prospective cohort study, 110 patients admitted to the Intensive Care Unit of Imam Khomeini Hospital Complex (Tehran, Iran) between April and September 2021 were enrolled. Participants formed a consecutive sample. MNA-SF, NRS-2002, mNUTRIC, and PNI scores were used to evaluate nutritional assessment. Patients' lab results and pulse oximetric saturation SpO2/FiO2 (SF) ratio at the time of intensive care unit (ICU) admission were collected. Patients were screened for nutritional status and categorized into two groups, patients at nutritional risk and nonrisk. Results Sixty-five (59.1%) of all patients were men. The overall range of age was 52 ± 15. Thirty-six (32.7%) of patients were obese (BMI ≥ 30). The hospital mortality rate was 59.1% (n = 65). According to the different criteria, malnutrition rate was 67.3% (n = 74) (NRS), 28.2% (n = 31) (MNA), 34.5% (n = 38) (mNUTRIC), and 58.2% (n = 64) (PNI). There was a statistically significant association between chronic kidney disease (CKD) and mNUTRIC risk (OR = 13.5, 95% CI (1.89-16.05), P=0.002), diabetes mellitus (DM) and MNA risk (OR = 2.82, 95% CI (1.01-7.83), P=0.041), hypertension (HTN) and MNA risk (OR = 5.63, 95% CI (2.26-14.05), P < 0.001), and malignancy and mNUTRIC risk (P=0.048). The nutritional risk (all tools) significantly increased the odds of in-hospital death and need for mechanical ventilation. The length of stay was not significantly different in malnourished patients. Conclusion In the critical care setting of COVID-19 patients, malnutrition is prevalent. Malnutrition (nutritional risk) is associated with an increased risk of need for mechanical ventilation and in-hospital mortality. Patients with a history of HTN, CKD, DM, and cancer are more likely to be at nutritional risk at the time of ICU admission.
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Lange KW. The contribution of food bioactives and nutrition to the management of COVID-19. JOURNAL OF FUTURE FOODS 2022. [PMCID: PMC9012071 DOI: 10.1016/j.jfutfo.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Poor nutrition predisposes to infection, and various food compounds, such as micronutrients, are key elements of immune competence. A large number of scientific publications have suggested a role of phytochemicals, food bioactives and nutrition in combating the current coronavirus pandemic. Various dietary components and specific food supplements have been proposed to be helpful in the prevention or therapy of COVID-19. While findings in preclinical models suggest that food bioactives and micronutrients may potentially augment viral defense, evidence supporting antiviral and immunomodulatory efficacy of these compounds in the prevention or management of COVID-19 is non-existent. Large-scale epidemiological and well-designed clinical studies investigating dosage and combinations of food compounds in different age groups and populations are needed before any recommendations can be made. Both malnutrition and overnutrition can adversely affect the immune system. Malnutrition at population level appears to be associated with elevated rates of fatal outcomes of COVID-19. Obesity and non-communicable diseases have been found to be a prognostic risk factor associated with worse COVID-19 outcomes. A focus on obesity and nutrition-related chronic diseases should be a key element of public health. This approach would be more effective than the far less promising search for food bioactives with potential immune-supportive efficacy.
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