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Huang ST, Wang TG, Peng MC, Chen WM, Jao AT, Tang FT, Hsieh YT, Ho CS, Yeh SM. Predictors for Failed Removal of Nasogastric Tube in Patients With Brain Insult. Ann Rehabil Med 2024; 48:220-227. [PMID: 38830633 PMCID: PMC11217763 DOI: 10.5535/arm.230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/25/2024] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE To construct a prognostic model for unsuccessful removal of nasogastric tube (NGT) was the aim of our study. METHODS This study examined patients with swallowing disorders receiving NGT feeding due to stroke or traumatic brain injury in a regional hospital. Clinical data was collected, such as age, sex, body mass index (BMI), level of activities of daily living (ADLs) dependence. Additionally, gather information regarding the enhancement in Functional Oral Intake Scale (FOIS) levels and the increase in food types according to the International Dysphagia Diet Standardization Initiative (IDDSI) after one month of swallowing training. A stepwise logistic regression analysis model was employed to predict NGT removal failure using these parameters. RESULTS Out of 203 patients, 53 patients (26.1%) had experienced a failed removal of NGT after six months of follow-up. The strongest predictors for failed removal were age over 60 years, underweight BMI, total dependence in ADLs, and ischemic stroke. The admission prediction model categorized patients into high, moderate, and low-risk groups for removal failure. The failure rate of NGT removal was high not only in the high-risk group but also in the moderate-risk groups when there was no improvement in FOIS levels and IDDSI food types. CONCLUSION Our predictive model categorizes patients with brain insults into risk groups for swallowing disorders, enabling advanced interventions such as percutaneous endoscopic gastrostomy for high-risk patients struggling with NGT removal, while follow-up assessments using FOIS and IDDSI aid in guiding rehabilitation decisions for those at moderate risk.
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Affiliation(s)
- Shih-Ting Huang
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei City, Taiwan (R.O.C.)
| | - Mei-Chih Peng
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Wan-Ming Chen
- Big Data Center, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - An-Tzu Jao
- Big Data Center, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Fuk Tan Tang
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Yu-Ting Hsieh
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Chun Sheng Ho
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
| | - Shu-Ming Yeh
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, Yilan County, Taiwan (R.O.C.)
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Batisti J, Jakab SS. Hospitalized patients with cirrhosis: Addressing gaps in care. Clin Liver Dis (Hoboken) 2024; 23:e0211. [PMID: 38961874 PMCID: PMC11221856 DOI: 10.1097/cld.0000000000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/15/2024] [Indexed: 07/05/2024] Open
Affiliation(s)
- Jennifer Batisti
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sofia S. Jakab
- Section of Digestive Diseases, Yale University School of Medicine, VA Connecticut Healthcare System, New Haven, Connecticut, USA
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Wang P, Soh KL, Ying Y, Liao J, Huang X, Zhao H, Pan X, Deng L, Yu X. Risk factors for malnutrition in patients with nasopharyngeal carcinoma. Support Care Cancer 2023; 31:723. [PMID: 38008866 DOI: 10.1007/s00520-023-08166-8] [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: 12/29/2022] [Accepted: 11/07/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Malnutrition is a common complication in patients with nasopharyngeal carcinoma (NPC). However, there are few studies on risk factors for malnutrition in NPC patients. Our aims were to identify the risk factors for malnutrition in NPC patients. METHODS NPC patients were recruited in this cross-sectional study, and they were divided into well-nourished and malnourished groups according to the Global Leadership Initiative on Malnutrition (GLIM). Potential risk factors were initially screened using univariate analysis (p < 0.1), and the selected ones were analyzed by logistic regression analysis (p < 0.05) to identify the risk factors for malnutrition in NPC patients. RESULTS In total, 305 NPC patients meeting eligibility criteria were enrolled. Multivariate logistic regression analysis revealed that low body mass index (BMI) (OR = 0.596, 95% CI 0.520-0.683, p < 0.001), the high total radiation dose received (OR = 1.046, 95% CI 1.023-1.069, p < 0.001), appetite loss (OR = 2.839, 95% CI 1.269-6.353, p = 0.011), and low PA (OR = 0.993, 95% CI 0.988-0.998, p = 0.008) were risk factors for malnutrition in NPC patients. CONCLUSIONS The low BMI, the high total radiation dose received, appetite loss, and low prealbumin were risk factors for malnutrition in NPC patients.
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Affiliation(s)
- Pengpeng Wang
- Department of Nursing, Universiti Putra Malaysia, Selangor, Serdang, Malaysia
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Kim Lam Soh
- Department of Nursing, Universiti Putra Malaysia, Selangor, Serdang, Malaysia.
| | - Yanping Ying
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jinlian Liao
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xueling Huang
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Huihan Zhao
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao Pan
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Lan Deng
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoxia Yu
- Faculty of Languages and Linguistics, University Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia
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Funayama M, Koreki A, Takata T, Hisamatsu T, Mizushima J, Ogino S, Kurose S, Oi H, Mimura Y, Shimizu Y, Kudo S, Nishi A, Mukai H, Wakisaka R, Nakano M. Pneumonia Risk Increased by Dementia-Related Daily Living Difficulties: Poor Oral Hygiene and Dysphagia as Contributing Factors. Am J Geriatr Psychiatry 2023; 31:877-885. [PMID: 37286391 DOI: 10.1016/j.jagp.2023.05.007] [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: 04/13/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Although pneumonia is the leading cause of death among patients with dementia, the specific underlying causes remain unclear. In particular, the potential connection between pneumonia risk and dementia-related daily living difficulties, such as oral hygiene practice and mobility impairment, and the use of physical restraint as a management practice, has not been extensively studied. METHODS In our retrospective study, we included 454 admissions corresponding to 336 individual patients with dementia who were admitted to a neuropsychiatric unit due to behavioral and psychological symptoms. The admissions were divided into two groups: those who developed pneumonia while hospitalized (n=62) and those who did not (n=392). We investigated differences between the two groups in terms of dementia etiology, dementia severity, physical conditions, medical complications, medication, dementia-related difficulties in daily living, and physical restraint. To control potential confounding variables, we used mixed effects logistic regression analysis to identify risk factors for pneumonia in this cohort. RESULTS Our study found that the development of pneumonia in patients with dementia was associated with poor oral hygiene, dysphagia, and loss of consciousness. Physical restraint and mobility impairment showed a weaker, nonsignificant association with the development of pneumonia. CONCLUSIONS Our findings suggest that pneumonia in this population may be caused by two primary factors: increased pathogenic microorganisms in the oral cavity due to poor hygiene, and an inability to clear aspirated contents due to dysphagia and loss of consciousness. Further investigation is needed to clarify the relationship between physical restraint, mobility impairment, and pneumonia in this population.
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Affiliation(s)
- Michitaka Funayama
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan.
| | - Akihiro Koreki
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Psychiatry (AK, SK), National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Taketo Takata
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
| | - Tetsuya Hisamatsu
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Psychiatry, Gunma Hospital (TH), Gunma, Japan
| | - Jin Mizushima
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
| | - Satoyuki Ogino
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Trauma and Critical Care Medicine (SO, YS), Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Shin Kurose
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan; Department of Psychiatry (AK, SK), National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Hiroki Oi
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yu Mimura
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yusuke Shimizu
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Trauma and Critical Care Medicine (SO, YS), Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Shun Kudo
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Akira Nishi
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan; Department of Psychiatry, Sakuragaoka Kinen Hospital (AN), Tokyo, Japan
| | - Hiroo Mukai
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Riko Wakisaka
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan; Department of Emergency and Critical Care Medicine (RW), Nippon Medical School, Tokyo, Japan
| | - Masaaki Nakano
- Department of Neuropsychiatry (MF, AK, TT, TH, JM, SO, SK, HO, YM, YS, SK, AN, HM, RW, MN), Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan; Department of Neuropsychiatry (MF, SK, HO, YM, SK, AN, HM, RW, MN), Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Li T, Wang X, Liu Z, Zhang Z, Zhang Y, Wang Z, Feng Y, Wang Q, Guo X, Tang X, Xu J, Song Y, Chen Y, Xu N, Yao Y, Liu R, Zhu P, Han Y, Yuan J. Prevalence and Prognostic Significance of Malnutrition in Patients with Abnormal Glycemic Status and Coronary Artery Disease: A Multicenter Cohort Study in China. Nutrients 2023; 15:nu15030732. [PMID: 36771438 PMCID: PMC9920677 DOI: 10.3390/nu15030732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
This study sought to investigate the prevalence and prognostic significance of malnutrition in patients with an abnormal glycemic status and coronary artery disease (CAD). This secondary analysis of a multicenter prospective cohort included 5710 CAD patients with prediabetes and 9328 with diabetes. Four objective tools were applied to assess the nutritional status of the study population. The primary endpoint was all-cause death. The association of malnutrition with clinical outcomes was examined using Cox proportional hazards regression. The proportion of malnutrition varied from 8% to 57% across the assessment tools. Diabetic patients were more likely to be malnourished than prediabetic patients. During a median follow-up of 2.1 years, 456 all-cause deaths occurred. The adjusted hazard ratios and 95% confidence interval for all-cause deaths of moderate-severe malnutrition defined by different tools ranged from 1.59 (1.03, 2.46) to 2.08 (0.92, 4.73) in prediabetic patients and 1.51 (1.00, 2.34) to 2.41 (1.78, 3.27) in diabetic patients. In conclusion, malnutrition is not rare in CAD patients with abnormal glycemic status. Moderate-severe malnutrition strongly predicted all-cause death regardless of the assessment tool. Assessing the nutritional status for all CAD patients with prediabetes and diabetes to identify individuals at high risk of all-cause death may help the risk assessment and prognosis improvement.
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Affiliation(s)
- Tianyu Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiaozeng Wang
- Cardiovascular Research Institute & Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Zhenyu Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zheng Zhang
- Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Yongzhen Zhang
- Department of Cardiology, Peking University Third Hospital, Beijing 100191, China
| | - Zhifang Wang
- Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453002, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou 510100, China
| | - Qingsheng Wang
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao 066000, China
| | - Xiaogang Guo
- Department of Cardiology, The First Affiliated Hospital of Zhejiang University, Hangzhou 314400, China
| | - Xiaofang Tang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jingjing Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yan Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Na Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yi Yao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ru Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Pei Zhu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yaling Han
- Cardiovascular Research Institute & Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
- Correspondence: (Y.H.); (J.Y.)
| | - Jinqing Yuan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Correspondence: (Y.H.); (J.Y.)
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Zhang M, Guo Y, Zhang X, Zhang Y, Fan Y, Liu Y, Zhao K, Fan R, Lu P. Nutritional risk screening in malignant tumors: a study of 375 cancer inpatients. Support Care Cancer 2022; 30:8333-8337. [PMID: 35864360 DOI: 10.1007/s00520-022-07242-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
Malnutrition is a common complication in cancer patients. It often accelerates disease progression and affects treatment outcomes. Thus, in the early census of cancer patients, examination for possible nutritional risks and correcting potential causes of malnutrition are needed to improve patients' quality of life. Our study included 375 patients diagnosed with cancer in Henan province and analyzed the relationship between nutritional risk and indicators like age, serum albumin, serum prealbumin, serum hemoglobin, tumor stage, tumor type, and inflammatory factors. We found that age, hemoglobin, and presence of gastrointestinal tumors were independent risk factors for nutritional risk. We also found significant correlation between inflammatory factors and nutritional risk in cancer patients, so as to provide new prediction indexes for clinical management of nutritional risk and dynamic changes of nutritional status.
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Affiliation(s)
- Min Zhang
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China
- Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China
| | - Yuying Guo
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China
| | - Xiaodi Zhang
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China
| | - Yu Zhang
- Internal Medicine Comprehensive Ward, Shangqiu, Third People's Hospital, Shangqiu, Henan Province, 476000, People's Republic of China
| | - Yuanyuan Fan
- Department of Oncology and Hematology, Yanshi City People's Hospital, 2#, Shangdu Dong Road, Luoyang, Henan, 471900, People's Republic of China
| | - Yanting Liu
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China.
- Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China.
| | - Kelei Zhao
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China
| | - Ruijuan Fan
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China
| | - Ping Lu
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China.
- Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China.
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7
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Modified Body Mass Index as a Novel Nutritional and Prognostic Marker in Patients with Cardiac Amyloidosis. CARDIOGENETICS 2022. [DOI: 10.3390/cardiogenetics12020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The nutritional assessment is gaining clinical relevance since cardiac cachexia and malnutrition are emerging as novel markers of functional status and prognosis in many cardiovascular disorders, including cardiac amyloidosis (CA). This study aimed to evaluate the prognostic role of different nutritional indices for cardiovascular mortality in patients with CA and subgroups. Fifty CA patients (26 AL and 24 ATTR wild-type) were retrospectively analyzed. All patients underwent a comprehensive clinical and laboratory evaluation. Conventional body mass index (cBMI), modified BMI (mBMI), new BMI (nBMI) and prognostic nutritional index (PNI) were analyzed. Multivariate regression analysis was performed to identify the association between nutritional and other clinical-laboratory parameters with cardiovascular death. Compared to ATTRwt patients, those with AL showed lower mBMI values. No significant difference was observed for the other nutritional indices. During a median follow-up of 11.2 months, a lower mBMI quartile was associated with worse survival, in both groups. In multivariate analysis, mBMI emerged as an independent predictor for cardiovascular death. This study showed that mBMI is a novel index of malnutrition and an independent risk factor for cardiovascular mortality in patients with CA in both AL and ATTRwt form.
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Huppertz V, Guida S, Holdoway A, Strilciuc S, Baijens L, Schols JMGA, van Helvoort A, Lansink M, Muresanu DF. Impaired Nutritional Condition After Stroke From the Hyperacute to the Chronic Phase: A Systematic Review and Meta-Analysis. Front Neurol 2022; 12:780080. [PMID: 35178021 PMCID: PMC8846185 DOI: 10.3389/fneur.2021.780080] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/09/2021] [Indexed: 12/25/2022] Open
Abstract
Background Malnutrition is common after stroke and can affect rehabilitation and healthcare costs. A comprehensive overview of stroke patients' nutritional condition from the hyperacute to the chronic phase is lacking. This systematic review aimed to investigate the prevalence of impaired nutritional condition (INC) across the continuum of care in specific phases after stroke. Methods CAB ABSTRACTS, Embase, MEDLINE, were used to collect studies published between 01-01-1999 and 26-08-2020. Primary and secondary outcomes were prevalence of INC and prevalence of malnutrition, respectively. Exploratory outcomes were prevalence of INC at follow-up, nutritional examination methods, prevalence of dysphagia, stroke severity, adverse events, and continent-specific prevalence of INC. A random-effects meta-analysis model was used to estimate the phase-specific pooled prevalence of INC and malnutrition. Results The dataset consisted of 78 study groups selected over a total of 1,244 identified records. The pooled prevalence of INC and malnutrition were 19% (95%CI:7–31) (N = 4) and 19% (95%CI:9–29) (N = 3), 34% (95%CI:25–43) (N = 34) and 26% (95%CI:18–35) (N = 29), 52% (95%CI:43–61) (N = 34) and 37% (95%CI:28–45) (N = 31), 21% (95%CI:12–31) (N = 3) and 11% (95%CI:0–24) (N = 3) and 72% (95%CI:41–100) (N = 3) and 30% (95%CI:0–76) (N = 2) in the hyperacute, acute, early subacute, late subacute, and chronic phase, respectively. Conclusion INC and malnutrition are highly prevalent in all stages of stroke care. Since malnutrition has been shown to negatively affect clinical outcomes, mortality, and overall healthcare expenditure in stroke survivors, it is essential to examine and monitor the nutritional status of stroke patients throughout their care journey to guide and plan, timely nutritional support and dietary modification.
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Affiliation(s)
- Viviënne Huppertz
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- *Correspondence: Viviënne Huppertz
| | - Sonia Guida
- Danone Nutricia Research, Utrecht, Netherlands
| | - Anne Holdoway
- DHealth, Consultant Dietitian, BMI/Circle Bath Clinic, Education Officer for the British Association for Parenteral and Enteral Nutrition and Chair of the UK Managing Adult Malnutrition in the Community Panel, Bath, United Kingdom
| | - Stefan Strilciuc
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- “RoNeuro” Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Laura Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, and School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jos M. G. A. Schols
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - Ardy van Helvoort
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | | | - Dafin F. Muresanu
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- “RoNeuro” Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
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Ko N, Lee HH, Sohn MK, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Lee YH, Chang WH, Choi SM, Lee SK, Lee J, Kim YH. Status of dysphagia after ischemic stroke: A Korean nationwide study. Arch Phys Med Rehabil 2021; 102:2343-2352.e3. [PMID: 34348122 DOI: 10.1016/j.apmr.2021.07.788] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the incidence of dysphagia after ischemic stroke and determine factors affecting the presence of dysphagia. DESIGN Retrospective case-control study. This was an interim analysis of a prospective multicenter Korean stroke cohort. SETTING Acute care university hospitals. PARTICIPANTS Patients (N=6000) with first-ever acute ischemic stroke. Patients were divided into two groups according to the presence or absence of dysphagia confirmed at 7 days after onset using the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale, which was determined after conducting screening or standardized tests. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Age at stroke onset, body mass index (BMI), premorbid modified Rankin Scale (mRS), brainstem lesions, National Institutes of Health Stroke Scale (NIHSS), post-stroke mRS, and ASHA-NOMS swallowing level at post-stroke day 7 were evaluated. RESULTS Among ischemic stroke patients, 32.3% (N=1940) had dysphagia at 7 days after stroke onset. At discharge, 80.5% (N=1561) still had dysphagia. The prediction model for the presence of dysphagia identified age at onset, underweight (BMI < 18.5 kg/m2), premorbid mRS, brainstem lesions, and NIHSS as independent predictors. The odds ratio (OR) for the presence of dysphagia significantly increased with underweight (OR [95% confidence interval]: 1.6684 [1.27-2.20]), increased age at onset (1.0318 [1.03-1.04]), premorbid mRS (1.1832 [1.13-1.24]), brainstem lesions (1.6494 [1.39-1.96]), and NIHSS (1.2073 [1.19-1.23]). CONCLUSIONS The incidence of dysphagia after ischemic stroke was 32.3%. The prediction model for the presence of dysphagia identified age, low BMI, premorbid disabilities, brainstem lesions, and NIHSS as predictive factors.
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Affiliation(s)
- Nayeon Ko
- Department of Rehabilitation Medicine, Konkuk University School of Medicine
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School
| | - Junhee Han
- Department of Statistics, Hallym University
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University
| | - Young-Hoon Lee
- Department of Preventive Medicine, Wonkwang University, School of Medicine
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Soo Mi Choi
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease
| | - Seon Kui Lee
- Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine.
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University.
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10
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Hausen A, Henschel D, Heuser R, Harnischmacher M, Kloeß C, Pröbstl A, Schmidt-Wolf I, Strassburg CP, Kalff JC, von Websky M. [Development and Implementation of a Nutrition Medicine Strategy to optimize Medical Service for Malnourished Patients at a Tertiary Referral Centre]. Zentralbl Chir 2021; 146:283-295. [PMID: 34154010 DOI: 10.1055/a-1481-9227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Malnutrition in hospitalised patients is an important and underestimated problem, with a negative impact on outcome and survival - not only in surgical patients. There is a discrepancy between optimal treatment as defined in relevant guidelines on clinical nutrition and the clinical reality. The Main reason for this discrepancy is the lack of established structures for nutrition medicine as an integral part of clinical routines. The necessary structural development is impaired mainly by the lack of resources, but in isolated cases also by the lack of appreciation of the problem. Therefore, practicability and feasibility with regard to local conditions are pivotal for sustainable improvement in a nutrition strategy in hospitalised patients. METHODS We describe the institutional and procedural measures taken at a tertiary referral centre to implement a nutrition medicine strategy. The underlying nutrition medicine methodology and definitions are introduced and practical implementation at our centre is illustrated by four examples of ongoing projects. RESULTS Using the described systematics, structural changes were implemented at our centre within one year that allowed malnutrition screening, the treatment of patients with complex nutritional care and improvements in the nutritive status of hospitalised patients by ongoing and future project initiatives. SUMMARY The successfully implemented structural change at the University Hospital of Bonn described here may serve as a modular example for other hospitals striving to improve clinical nutrition and outcome in hospitalised patients.
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Affiliation(s)
- Annekristin Hausen
- Medizinische Klinik und Poliklinik I - Allgemeine Innere Medizin, Universitätsklinikum Bonn, Deutschland
| | - Diana Henschel
- Abteilung für Integrierte Onkologie, CIO Bonn, Universitätsklinikum Bonn, Deutschland
| | - Regina Heuser
- Abteilung für Integrierte Onkologie, CIO Bonn, Universitätsklinikum Bonn, Deutschland
| | - Marie Harnischmacher
- Abteilung für Integrierte Onkologie, CIO Bonn, Universitätsklinikum Bonn, Deutschland
| | | | | | - Ingo Schmidt-Wolf
- Abteilung für Integrierte Onkologie, CIO Bonn, Universitätsklinikum Bonn, Deutschland
| | - Christian P Strassburg
- Medizinische Klinik und Poliklinik I - Allgemeine Innere Medizin, Universitätsklinikum Bonn, Deutschland
| | - Jörg C Kalff
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland
| | - Martin von Websky
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland
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11
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Navarrete-Reyes AP, Animas-Mijangos K, Gómez-Camacho J, Juárez-Carrillo Y, Torres-Pérez AC, Cataneo-Piña DJ, Negrete-Najar JP, Soto-Perez-de-Celis E. Geriatric principles for patients with cancer. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.5327/z2447-212320212100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cancer is primarily a disease of older persons. Given the heterogeneity of aging, physiological age, rather than chronological age, better expresses the cumulative effect of environmental, medical, and psychosocial stressors, which modifies life expectancy. Comprehensive geriatric assessment, a tool that helps ascertain the physiological age of older individuals, is the gold standard for assessing older adults with cancer. Several international organizations recommend using the geriatric assessment domains to identify unrecognized health problems that can interfere with treatment and predict adverse health-related outcomes, aiding complex treatment decision making. More recently, it has been shown that geriatric assessment-guided interventions improve quality of life and mitigate treatment toxicity without compromising survival. In this review, we discuss the role of comprehensive geriatric assessment in cancer care for older adults and provide the reader with useful information to assess potential treatment risks and benefits, anticipate complications, and plan interventions to better care for older people with cancer.
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12
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Nazar E, Baghishani H, Doosti H, Ghavami V, Aryan E, Nasehi M, Sharafi S, Esmaily H, Yazdani Charati J. Bayesian Spatial Survival Analysis of Duration to Cure among New Smear-Positive Pulmonary Tuberculosis (PTB) Patients in Iran, during 2011-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010054. [PMID: 33374751 PMCID: PMC7794786 DOI: 10.3390/ijerph18010054] [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] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 12/01/2022]
Abstract
Mycobacterium tuberculosis is the causative agent of tuberculosis (TB), and pulmonary TB is the most prevalent form of the disease worldwide. One of the most concrete actions to ensure an effective TB control program is monitoring TB treatment outcomes, particularly duration to cure; but, there is no strong evidence in this respect. Thus, the primary aim of this study was to examine the possible spatial variations of duration to cure and its associated factors in Iran using the Bayesian spatial survival model. All new smear-positive PTB patients have diagnosed from March 2011 to March 2018 were included in the study. Out of 34,744 patients, 27,752 (79.90%) patients cured and 6992 (20.10%) cases were censored. For inferential purposes, the Markov chain Monte Carlo algorithms are applied in a Bayesian framework. According to the Bayesian estimates of the regression parameters in the proposed model, a Bayesian spatial log-logistic model, the variables gender (male vs. female, TR = 1.09), altitude (>750 m vs. ≤750 m, TR = 1.05), bacilli density in initial smear (3+ and 2+ vs. 1–9 Basil & 1+, TR = 1.09 and TR = 1.02, respectively), delayed diagnosis (>3 months vs. <1 month, TR = 1.02), nationality (Iranian vs. other, TR = 1.02), and location (urban vs. rural, TR = 1.02) had a significant influence on prolonging the duration to cure. Indeed, pretreatment weight (TR = 0.99) was substantially associated with shorter duration to cure. In summary, the spatial log-logistic model with convolution prior represented a better performance to analyze the duration to cure of PTB patients. Also, our results provide valuable information on critical determinants of duration to cure. Prolonged duration to cure was observed in provinces with low TB incidence and high average altitude as well. Accordingly, it is essential to pay a special attention to such provinces and monitor them carefully to reduce the duration to cure while maintaining a focus on high-risk provinces in terms of TB prevalence.
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Affiliation(s)
- Eisa Nazar
- Department of Biostatistics, Faculty of Health, Mashhad University of Medical Sciences, Mashhad 913767-3119, Iran;
| | - Hossein Baghishani
- Department of Statistics, Faculty of Mathematical Sciences, Shahrood University of Technology, Shahrood 316-3619995161, Iran;
| | - Hassan Doosti
- Department of Mathematics and Statistics, Macquarie University, Sydney, NSW 2109, Australia;
| | - Vahid Ghavami
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad 913767-3119, Iran;
| | - Ehsan Aryan
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad 917669-9199, Iran;
| | - Mahshid Nasehi
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran 141994-3471, Iran; (M.N.); (S.S.)
| | - Saeid Sharafi
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran 141994-3471, Iran; (M.N.); (S.S.)
| | - Habibollah Esmaily
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad 913767-3119, Iran;
- Correspondence: (H.E.); (J.Y.C.)
| | - Jamshid Yazdani Charati
- Department of Biostatistics, Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari 484711-6548, Iran
- Correspondence: (H.E.); (J.Y.C.)
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13
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Lee JS, Ko SH, Lee J, Jeong KY. The relationship between body mass index and N-terminal pro-B-type natriuretic peptide in community-acquired pneumonia. Eur J Clin Nutr 2020; 75:1088-1098. [PMID: 33318666 DOI: 10.1038/s41430-020-00817-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/02/2020] [Accepted: 11/15/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND The relationship between body mass index (BMI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) has not been fully investigated in patients with community-acquired pneumonia (CAP). METHODS This prospective observational study examined 510 consecutive patients hospitalized for CAP. NT-proBNP, BMI, and the pneumonia severity index (PSI) were determined for all participants. The moderating effects of BMI on the relationship between NT-proBNP and CAP mortality were examined using interaction terms in a multivariable regression model. The ability of NT-proBNP to predict mortality was evaluated using the area under the curve (AUC). RESULTS A significant inverse relationship was observed between BMI and NT-proBNP. After multivariable adjustment including BMI, NT-proBNP remained a significant predictor of CAP mortality. The AUC of the fully adjusted (including BMI) NT-proBNP model was significantly higher than that excluding BMI (p = 0.021) and that of PSI (p = 0.038), respectively. The predictive performance of NT-proBNP for mortality significantly differed by BMI group, with the NT-proBNP of the overweight and obesity group having a significantly higher AUC than that of the underweight and normal-weight group. The AUC of NT-proBNP was significantly higher and tended to be higher than that of PSI in the overweight group (p = 0.013) and the obesity group (p = 0.113), respectively. CONCLUSIONS BMI significantly strengthens the prognostic performance of NT-proBNP in CAP patients. The BMI-NT-proBNP interaction is significantly associated with CAP mortality, but as a prognostic determinant for CAP, NT-proBNP seems to be more useful for overweight and obese patients than for underweight and normal-weight patients.
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Affiliation(s)
- Jong Seok Lee
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea.,Department of Emergency Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seok Hoon Ko
- Division of Pulmonary and Critical Care Medicine, Critical Care Center, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Jungyoup Lee
- Department of Emergency Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Ki Young Jeong
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea. .,Department of Emergency Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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14
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Battaglia Y, Ullo I, Massarenti S, Esposito P, Prencipe M, Ciancio G, Provenzano M, Fiorini F, Andreucci M, Storari A, Sabatino A, Fiaccadori E, Granata A. Ultrasonography of Quadriceps Femoris Muscle and Subcutaneous Fat Tissue and Body Composition by BIVA in Chronic Dialysis Patients. Nutrients 2020; 12:nu12051388. [PMID: 32408709 PMCID: PMC7285004 DOI: 10.3390/nu12051388] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023] Open
Abstract
Protein Energy Wasting (PEW) in hemodialysis (HD) patients is a multifactorial condition due to specific pathology-related pathogenetic mechanisms, leading to loss of skeletal muscle mass in HD patients. Computed Tomography and Magnetic Resonance Imaging still represent the gold standard techniques for body composition assessment. However, their widespread application in clinical practice is difficult and body composition evaluation in HD patients is mainly based on conventional anthropometric nutritional indexes and bioelectrical impedance vector analysis (BIVA). Little data is currently available on ultrasound (US)-based measurements of muscle mass and fat tissue in this clinical setting. The purpose of our study is to ascertain: (1) if there are differences between quadriceps rectus femoris muscle (QRFM) thickness and abdominal/thigh subcutaneous fat tissue (SFT) measured by US between HD patients and healthy subjects; (2) if there is any correlation between QRFM and abdominal/thigh SFT thickness by US, and BIVA/conventional nutritional indexes in HD patients. We enrolled 65 consecutive HD patients and 33 healthy subjects. Demographic and laboratory were collected. The malnutrition inflammation score (MIS) was calculated. Using B-mode US system, the QRFM and SFT thicknesses were measured at the level of three landmarks in both thighs (superior anterior iliac spine, upper pole of the patella, the midpoint of the tract included between the previous points). SFT was also measured at the level of the periumbilical point. The mono frequency (50 KHz) BIVA was conducted using bioelectrical measurements (Rz, resistance; Xc, reactance; adjusted for height, Rz/H and Xc/H; PA, phase angle). 58.5% were men and the mean age was 69 (SD 13.7) years. QRFM and thigh SFT thicknesses were reduced in HD patients as compared to healthy subjects (p < 0.01). Similarly, also BIVA parameters, expression of lean body mass, were lower (p < 0.001), except for Rz and Rz/H in HD patients. The average QRFM thickness of both thighs at top, mid, lower landmarks were positively correlated with PA and body cell mass (BCM) by BIVA, while negatively correlated with Rz/H (p < 0.05). Abdominal SFT was positively correlated with PA, BCM and basal metabolic rate (BMR) (p < 0.05). Our study shows that ultrasound QRFM and thigh SFT thicknesses were reduced in HD patients and that muscle ultrasound measurements were significantly correlated with BIVA parameters.
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Affiliation(s)
- Yuri Battaglia
- Division of Nephrology and Dialysis, St. Anna University Hospital, 44121 Ferrara, Italy;
- Correspondence: ; Tel.: +39-393-432-0061
| | - Ines Ullo
- Division of Nephrology, ASST Sette Laghi, 21100 Varese, Italy;
| | - Sara Massarenti
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Pasquale Esposito
- Division of Nephrology, Dialysis and Transplantation, University of Genoa and IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy;
| | - Michele Prencipe
- Division of Nephrology, Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71100 Foggia, Italy;
| | - Giovanni Ciancio
- Division of Rheumatology, University of Ferrara, 44121 Ferrara, Italy;
| | - Michele Provenzano
- Division of Nephrology and Dialysis, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Fulvio Fiorini
- Division of Nephrology and Dialysis, “Santa Maria della Misericordia” Hospital, 45100 Rovigo, Italy;
| | - Michele Andreucci
- Division of Nephrology and Dialysis, Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (M.P.); (M.A.)
| | - Alda Storari
- Division of Nephrology and Dialysis, St. Anna University Hospital, 44121 Ferrara, Italy;
| | - Alice Sabatino
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, 43121 Parma, Italy; (A.S.); (E.F.)
| | - Enrico Fiaccadori
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, 43121 Parma, Italy; (A.S.); (E.F.)
| | - Antonio Granata
- Division of Nephrology, San Giovanni di Dio Hospital, 92100 Agrigento, Italy;
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15
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Okubo T, Atsukawa M, Tsubota A, Yoshida Y, Arai T, Iwashita AN, Itokawa N, Kondo C, Iwakiri K. Relationship between serum vitamin D level and sarcopenia in chronic liver disease. Hepatol Res 2020; 50:588-597. [PMID: 31914479 DOI: 10.1111/hepr.13485] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/25/2019] [Accepted: 12/26/2019] [Indexed: 12/16/2022]
Abstract
AIM Although the association of vitamin D with primary sarcopenia has been extensively investigated, its relationship with secondary sarcopenia in patients with liver disease remains unclear. This study aimed to identify factors associated with sarcopenia in patients with chronic liver disease with a focus on serum vitamin D levels. METHODS The study included 204 patients with chronic liver disease. Independent factors significantly associated with sarcopenia were determined using multiple logistic regression analysis. The sarcopenia diagnosis was based on the sarcopenia criteria proposed by the Japan Society of Hepatology. Serum 25-hydroxyvitamin D3 (25[OH]D3 ) levels to represent serum vitamin D levels were measured using double-antibody radioimmunoassay, and vitamin D deficiency was defined as a serum 25(OH)D3 level of ≤20 ng/mL. RESULTS The prevalence of sarcopenia in the cirrhotic patients (28/76, 36.8%) was significantly higher than that in the non-cirrhotic patients (18/128, 14.1%; P = 2.48 × 10-4 ). Sarcopenia was diagnosed in 44 (27.5%) of the 160 patients with vitamin D deficiency, and two (4.5%) of the 44 patients without vitamin D deficiency (P = 4.90 × 10-3 ). On multivariate analysis, advanced age (odds ratio 1.11; P = 2.10 × 10-4 ), low body mass index (odds ratio 1.42; p = 2.08 × 10-5 ), and low serum 25(OH)D3 level (odds ratio 1.13; p = 1.20 × 10-2 ) were significant, independent factors associated with sarcopenia. Serum 25(OH)D3 was positively correlated with grip strength and skeletal muscle mass index. CONCLUSION Sarcopenia complicated by chronic liver disease was associated with advanced age, low body mass index, and low serum 25(OH)D3 level.
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Affiliation(s)
- Tomomi Okubo
- Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Masanori Atsukawa
- Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.,Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Akihito Tsubota
- Core Research Facilities, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Yoshida
- Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Taeang Arai
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Ai-Nakagawa Iwashita
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Norio Itokawa
- Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Chisa Kondo
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan
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16
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Abstract
Sarcopenia, frailty, and malnutrition are prevalent complications in patients with end-stage liver disease (ESLD) and are associated with increased risk of morbidity and mortality. It is valuable to measure nutritional status, sarcopenia, and frailty over time in order to create interventions tailored to individuals with ESLD. Evaluating sarcopenia and frailty in patients with ESLD is challenging. Further work is needed to perfect these assessments so that clinicians can incorporate these assessments into their decision-making and management plans for cirrhotic patients.
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Affiliation(s)
- Elizabeth S Aby
- Department of Medicine, University of California at Los Angeles, UCLA Medical Center, 757 Westwood Plaza, Suite 7501, Los Angeles, CA 90095, USA. https://twitter.com/lizabmn47
| | - Sammy Saab
- Department of Medicine, University of California at Los Angeles, UCLA Medical Center, 757 Westwood Plaza, Suite 7501, Los Angeles, CA 90095, USA; Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
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17
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Yao J, Zhou X, Yuan L, Niu LY, Zhang A, Shi H, Duan Z, Xu J. Prognostic value of the third lumbar skeletal muscle mass index in patients with liver cirrhosis and ascites. Clin Nutr 2019; 39:1908-1913. [PMID: 31472986 DOI: 10.1016/j.clnu.2019.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/12/2019] [Accepted: 08/09/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS The objective nutritional assessment indicators, body mass index (BMI), upper arm muscle circumference (MAMC), and triceps skinfold thickness (TSF), are often limited due to ascites. This study investigated the prognostic value of the third lumbar vertebrae skeletal muscle mass index (L3 SMI) in addition to the objective nutritional evaluation indicators (BMI, MAMC and TSF) in patients with liver cirrhosis and ascites. METHODS In this retrospective analysis, a total of 147 patients with liver cirrhosis and ascites were included. The L3 SMI, BMI, MAMC and TSF were detected in all patients. The severity of liver disease was assessed by the Model End-Stage Liver Disease (MELD) score and Child-Turcotte-Pugh (CTP) classification. These variables were compared between non-surviving and surviving patients who were classified according to 5-year mortality. RESULTS Of the 147 patients, 62 (42.2%) died and 85 (57.8%) survived within 5 years. The L3 SMI of patients was significantly lower than that of the normal control group (39.58 ± 7.18 cm2/m2 vs. 53.73 ± 7.92 cm2/m,2p < 0.001). The L3 SMI (OR 4.02; 95% CI 2.17-9.63; p < 0.001), MELD score (OR 2.11; 95% CI 1.12-4.13; p < 0.001) and CTP class (OR 2.69; 95% CI 1.09-5.06; p < 0.001) were independent predictive indicators of 5-year mortality. Furthermore, the performance of the two variables (L3 SMI and MELD) together (AUROC: 0.812) was significantly better than that of MELD alone (AUROC: 0.787) for prediction of 5-year mortality (p < 0.001). CONCLUSION Compared with MAMC, TSF and BMI, L3 SMI is an independent risk factor for 5-year mortality in patients with liver cirrhosis and ascites. Further nutritional intervention studies are needed to confirm the impact of the L3 SMI index on clinical outcomes.
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Affiliation(s)
- Jia Yao
- Department of Gastroenterology and General Surgery, Shanxi Dayi Hospital, Shanxi Medical University, Taiyuan, China
| | - Xiaoshuang Zhou
- Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, China
| | - Lili Yuan
- Department of Gastroenterology and General Surgery, Shanxi Dayi Hospital, Shanxi Medical University, Taiyuan, China
| | - Ling Yun Niu
- Department of Gastroenterology and General Surgery, Shanxi Dayi Hospital, Shanxi Medical University, Taiyuan, China
| | - Aiqing Zhang
- Department of Gastroenterology and General Surgery, Shanxi Dayi Hospital, Shanxi Medical University, Taiyuan, China
| | - Hongbo Shi
- Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China.
| | - Zhongping Duan
- Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China.
| | - Jun Xu
- Department of Gastroenterology and General Surgery, Shanxi Dayi Hospital, Shanxi Medical University, Taiyuan, China.
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Özdemir U, Özdemir M, Aygencel G, Kaya B, Türkoğlu M. The role of maximum compressed thickness of the quadriceps femoris muscle measured by ultrasonography in assessing nutritional risk in critically-ill patients with different volume statuses. Rev Assoc Med Bras (1992) 2019; 65:952-958. [DOI: 10.1590/1806-9282.65.7.952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 04/19/2019] [Indexed: 11/22/2022] Open
Abstract
SUMMARY PURPOSE In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status. METHODS 55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected. RESULTS There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04). CONCLUSION Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.
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Zhang X, Pang L, Sharma SV, Li R, Nyitray AG, Edwards BJ. The validity of three malnutrition screening markers among older patients with cancer. BMJ Support Palliat Care 2019; 10:363-368. [DOI: 10.1136/bmjspcare-2018-001706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/22/2019] [Accepted: 05/01/2019] [Indexed: 12/17/2022]
Abstract
BackgroundMalnutrition is common in older adults with cancer and is associated with adverse clinical outcomes. We assessed and compared the validity of three tools commonly used to screen for malnutrition: The Mini Nutritional Assessment (MNA), weight loss and body mass index (BMI).MethodsIn this retrospective study, we reviewed patients over age 65 with a diagnosis of cancer who were treated at the MD Anderson Cancer Center between 1 January 2013 and 31 March 2017. All patients in this study were evaluated by a trained geriatrician as part of a comprehensive geriatric assessment (CGA). Malnutrition was diagnosed by both CGA and clinical examination. The sensitivity, specificity and Cohen’s κ of each tool was also compared with the clinical diagnosis.ResultsA total of 454 older patients with cancer who had malnutrition information available were included in the analyses. The median age was 78%, and 42% (n=190) were clinically diagnosed with malnutrition at baseline. When the MNA was performed, 105 out of 352 patients (30%) were malnourished, and 122 (35%) at risk of malnutrition. Weight loss >3 kg was seen in 183 out of 359 (51%) patients, and BMI <20 kg/m2 was found in 30 of the 454 (7%) patients. MNA had the highest validity (area under curve (AUC)=0.83) and reliability (κ=0.67), weight loss had moderate validity (AUC=0.73) and reliability (κ=0.46), while BMI had the lowest validity (AUC=0.55) and reliability (κ=0.55).ConclusionsFor clinical practice, MNA should be incorporated for standard assessment/screening for these older patients with cancer.
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Uysal H, Öz Alkan H, Enç N, Yiğit Z. Assessment of Dietary Habits in Patients With Chronic Heart Failure. J Nurs Res 2019; 28:e65. [PMID: 31107776 DOI: 10.1097/jnr.0000000000000329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Nutritional deficiency is a critical factor in the development and prognosis of heart failure. An optimal diet should be ensured and maintained to manage the symptoms of heart failure. PURPOSE This study assessed the dietary habits of patients with chronic heart failure using diet quality indices with the goal of determining their nutritional status. METHODS Forty-four female patients and 56 male patients (mean age: 66 ± 11.38 years) who had been admitted to the cardiology clinics of a university hospital in Istanbul between March 2012 and August 2014 were included in this study. RESULTS In terms of body mass index, 34% of the participants were normal weight, 37% were overweight, and 21% were obese. Furthermore, this study found the mean daily total energy intake to be inadequate and the total mean score of the Healthy Eating Index to be 74.6 ± 9.32. The diet quality of most participants fell into the "needs improvement" category. CONCLUSIONS This study used the Healthy Eating Index, a measure developed to assess diet quality, to assess the food consumption patterns of patients with chronic heart failure. The findings support using this index before providing diet recommendations to patients.
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Affiliation(s)
- Hilal Uysal
- PhD, RN, Assistant Professor, Florence Nightingale Faculty of Nursing, Medical Nursing Department, Istanbul University-Cerrahpasa, Turkey
| | - Havva Öz Alkan
- PhD, RN, Assistant Professor, Florence Nightingale Faculty of Nursing, Medical Nursing Department, Istanbul University-Cerrahpasa, Turkey
| | - Nuray Enç
- PhD, RN, Professor, Florence Nightingale Faculty of Nursing, Medical Nursing Department, Istanbul University-Cerrahpasa, Turkey
| | - Zerrin Yiğit
- MD, Professor, Cardiology Department, and Cardiology Institute, Istanbul University-Cerrahpasa, Turkey
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Dent E, Hoogendijk EO, Visvanathan R, Wright ORL. Malnutrition Screening and Assessment in Hospitalised Older People: a Review. J Nutr Health Aging 2019; 23:431-441. [PMID: 31021360 DOI: 10.1007/s12603-019-1176-z] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Malnutrition (undernutrition) remains one of the most serious health problems for older people worldwide. Many factors contribute to malnutrition in older people, including: loss of appetite, polypharmacy, dementia, frailty, poor dentition, swallowing difficulties, social isolation, and poverty. Malnutrition is common in the hospital setting, yet often remains undetected by medical staff. The objective of this review is to compare the validity and reliability of Nutritional Screening Tools (NSTs) for older adults in the hospital setting. We also provide an overview of the various nutritional screening and assessment tools used to identify malnutrition in hospitalised older adults. These include: Subjective Global Assessment (SGA), the Mini Nutritional Assessment (MNA), MNA-short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Simplified Nutritional Appetite Questionnaire (SNAQ), Geriatric Nutrition Risk Index (GNRI) and anthropometric measurements. The prevalence and outcomes of malnutrition in hospitalised older adults are also addressed.
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Affiliation(s)
- E Dent
- Elsa Dent, Torrens University Australia, Level 1, 220 Victoria Square, Adelaide, Australia 5000, Phone: +61 8 8 113 7823,
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22
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Hettiarachchi J, Madubhashini P, Miller M. Agreement between the Malnutrition Universal Screening Tool and the Patient-Generated Subjective Global Assessment for Cancer Outpatients Receiving Chemotherapy: A Cross-Sectional Study. Nutr Cancer 2018; 70:1275-1282. [PMID: 30596277 DOI: 10.1080/01635581.2018.1539186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Malnutrition is a common occurrence in cancer. Early detection of malnutrition is imperative but often overlooked in busy clinical routine. This study aimed to assess the agreement between malnutrition universal screening tool (MUST) and the patient-generated subjective global assessment (PG-SGA) to detect risk of malnutrition in a medical oncology outpatient setting. A cross-sectional study was conducted with 100 adult patients with cancer receiving chemotherapy. Nutrition screening and assessment were performed using MUST and PG-SGA, respectively. Sensitivity, specificity, predictive values, kappa agreement, and receiver operating characteristics (ROC) curve were used to compare MUST with PG-SGA. Prevalence of malnutrition or risk of malnutrition among subjects was 45% according to the MUST. Body mass index (BMI) against PG-SGA indicated a low capacity to detect malnutrition with 28.9% sensitivity and 96.4% specificity. Unintentional weight loss in the last 3-6 mo against PG-SGA resulted in 55.6% sensitivity and 98.2% specificity. MUST against PG-SGA resulted in 86.7% sensitivity and 94.5% specificity. MUST indicated a perfect agreement with PG-SGA (Kappa = 0.81; P < 0.05) and highest area under the ROC curve (AUC ROC = 0.91). MUST has high level of agreement with PG-SGA to detect chemotherapy outpatients at risk of malnutrition.
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Affiliation(s)
- Jeewanadee Hettiarachchi
- a Department Applied Nutrition Faculty of Livestock Fisheries and Nutrition , Wayamba University of Sri Lanka , Makandura , Gonawila , Sri Lanka
| | - Prabodha Madubhashini
- a Department Applied Nutrition Faculty of Livestock Fisheries and Nutrition , Wayamba University of Sri Lanka , Makandura , Gonawila , Sri Lanka
| | - Michelle Miller
- b Nutrition and Dietetics Department , Flinders University , Adelaide , South Australia , Australia
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Sharman Moser S, Doyev R, Cohen B, Kurz R, Sulo S, Shalev V, Chodick G. Prevalence and characteristics of malnutrition among community-dwelling older adults in Israel. Clin Nutr ESPEN 2018; 28:179-185. [DOI: 10.1016/j.clnesp.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 01/14/2023]
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Lu YW, Lu SF, Chou RH, Wu PS, Ku YC, Kuo CS, Chang CC, Tsai YL, Wu CH, Huang PH. Lipid paradox in patients with acute myocardial infarction: Potential impact of malnutrition. Clin Nutr 2018; 38:2311-2318. [PMID: 30482563 DOI: 10.1016/j.clnu.2018.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/04/2018] [Accepted: 10/09/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND & AIMS Aggressive lipid reduction is recommended for patients with AMI, but reverse epidemiology, the lipid paradox, has been reported in several clinical studies. The cause of lipid paradox remains uncertain, and nutrition is one possible explanation. In this single-center retrospective study, we investigated the relationships between baseline LDL concentrations and clinical outcomes in patients with AMI, stratified by different nutritional status. METHODS Totally 409 patients were enrolled for analysis. The Nutritional Risk Index (NRI) was used to estimate the risk of malnutrition. Subjects were grouped into tertiles according to their NRIs. Clinical outcomes were compared among patients with varying NRIs and LDL levels. RESULTS Patients in the lowest NRI tertile had increased incidences of in-hospital mortality, cardiogenic shock, decompensated heart failure, renal failure, and sepsis. This tertile was also associated with increased long-term mortality during the follow-up period of 832 ± 744 days. Mortality was increased among patients with baseline LDL concentrations ≤70 mg/dL in the lowest NRI tertile (log rank test, p = 0.0257), but not in the high or median tertiles. Moreover, baseline LDL level ≤70 mg/dL was an independent risk factor of all-cause mortality (adjusted hazard ratio = 1.73; 95% confidence interval, 1.01-2.94; p = 0.045) in the lowest NRI tertile. CONCLUSIONS Lipid paradox was observed in the high-risk of malnutrition population among patients with AMI. Aggressive lipid-lowering therapy is still recommended for patients with AMI and fair nutritional status. However, when treating patients at high risk of malnutrition, the improvement of nutritional status may be more beneficial than strict LDL control.
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Affiliation(s)
- Ya-Wen Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shu-Fen Lu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan; School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Ruey-Hsing Chou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Po-Shan Wu
- Division of Clinical Nutrition, Department of Dietetics and Nutrition, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Chen Ku
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Sung Kuo
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Chin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Lin Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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Mirsaeidi M, Omar HR, Sweiss N. Hypoalbuminemia is related to inflammation rather than malnutrition in sarcoidosis. Eur J Intern Med 2018; 53:e14-e16. [PMID: 29703691 DOI: 10.1016/j.ejim.2018.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Mehdi Mirsaeidi
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Miami, FL, USA.
| | - Hesham R Omar
- Internal Medicine Department, Mercy Medical Center, Clinton, IA, USA
| | - Nadera Sweiss
- Division of Pulmonary, Critical Care, Sleep and Allergy, Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, USA
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Gu DH, Kim MY, Seo YS, Kim SG, Lee HA, Kim TH, Jung YK, Kandemir A, Kim JH, An H, Yim HJ, Yeon JE, Byun KS, Um SH. Clinical usefulness of psoas muscle thickness for the diagnosis of sarcopenia in patients with liver cirrhosis. Clin Mol Hepatol 2018; 24:319-330. [PMID: 29706058 PMCID: PMC6166111 DOI: 10.3350/cmh.2017.0077] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/05/2018] [Indexed: 12/18/2022] Open
Abstract
Background/Aims The most widely used method for diagnosing sarcopenia is the skeletal muscle index (SMI). Several studies have suggested that psoas muscle thickness per height (PMTH) is also effective for detecting sarcopenia and predicting prognosis in patients with cirrhosis. The aim of this study was to evaluate the optimal cutoff values of PMTH for detecting sarcopenia in cirrhotic patients. Methods All cirrhotic patients who underwent abdominal computed tomography (CT) scan including L3 and umbilical levels for measuring SMI and transverse psoas muscle thickness, respectively, were included. Two definitions of sarcopenia were used: (1) sex-specific cutoffs of SMI (≤52.4 cm2 /m2 in men and ≤38.5 cm2 /m2 in women) for SMI-sarcopenia and (2) cutoff of PMTH (<16.8 mm/m) for PMTH-sarcopenia. Results Six hundred fifty-three patients were included. The average age was 53.6 ± 10.2 years, and 499 patients (76.4%) were men. PMTH correlated well with SMI in both men and women (P<0.001). Two hundred forty-one (36.9%) patients met the criteria for SMI-sarcopenia. The best PMTH cutoff values for predicting SMI-sarcopenia were 17.3 mm/m in men and 10.4 mm/m in women, and these were defined as sex-specific cutoffs of PMTH (SsPMTH). The previously published cutoff of PMTH was defined as sex-nonspecific cutoff of PMTH (SnPMTH). Two hundred thirty (35.2%) patients were diagnosed with SsPMTH-sarcopenia, and 280 (44.4%) patients were diagnosed with SnPMTH-sarcopenia. On a multivariate Cox regression analysis, SsPMTH-sarcopenia (hazard ratio [HR], 1.944; 95% confidence interval [CI], 1.144–3.304; P=0.014) was significantly associated with mortality, while SnPMTH-sarcopenia was not (HR, 1.446; 95% CI, 0.861–2.431; P=0.164). Conclusions PMTH was well correlated with SMI in cirrhotic patients. SsPMTH-sarcopenia was an independent predictor of mortality in these patients and more accurately predicted mortality compared to SnPMTH-sarcopenia.
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Affiliation(s)
- Dae Hoe Gu
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Moon Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Han Ah Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young Kul Jung
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Altay Kandemir
- Department of Gastroenterology, Adnan Menderes University Medical School, Aydin, Turkey
| | - Ji Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyunggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jong Eun Yeon
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kwan Soo Byun
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Soon Ho Um
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Zhang X, Sun M, McKoy JM, Bhulani NNA, Valero V, Barcenas CH, Popat UR, Sri MK, Shah JB, Dinney CP, Hedberg AM, Champlin R, Tripathy D, Holmes HM, Stroehlein JR, Edwards BJ. Malnutrition in older patients with cancer: Appraisal of the Mini Nutritional Assessment, weight loss, and body mass index. J Geriatr Oncol 2018; 9:81-83. [DOI: 10.1016/j.jgo.2017.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/25/2017] [Accepted: 07/26/2017] [Indexed: 12/21/2022]
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Leipold CE, Bertino SB, L'Huillier HM, Howell PM, Rosenkotter M. Validation of the Malnutrition Screening Tool for use in a Community Rehabilitation Program. Nutr Diet 2017; 75:117-122. [PMID: 29411490 DOI: 10.1111/1747-0080.12365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 04/28/2017] [Accepted: 05/31/2017] [Indexed: 12/01/2022]
Abstract
AIM The aim of the present study was to determine if the Malnutrition Screening Tool (MST) is valid for use within the Community Rehabilitation Program (CRP) setting. Secondary outcome measures were to assess malnutrition prevalence in the CRP population and to determine trends between malnutrition and age, body mass index (BMI) and falls history. METHODS This study used a cross-sectional design. All clients admitted to a Melbourne metropolitan CRP during the study period had the MST completed at intake. A total of 160 participants were then selected at random and a Subjective Global Assessment (SGA) was completed by an experienced dietitian. Participants were classified as well nourished or malnourished, and this result was compared to their MST score. Data analysis was completed to determine the predictive value of the MST compared to SGA, which was expressed using sensitivity, specificity, positive and negative predictive values. RESULTS Out of the 160 participants, 34.0% were identified as malnourished. The MST achieved a sensitivity of 72.2% and a specificity of 83.8% with positive predictive value of 69.6% and negative predictive value of 85.4% compared to the SGA. Participants in the malnourished group were older and had a lower BMI (P < 0.05). CONCLUSIONS Considering the demographics and needs of the CRP population group and the predictive value of the MST compared to SGA, it can be concluded that the MST is a valid screening tool for use in this population and has relatively low burden to complete. Consequently, the MST could be included in the client initial needs identification to be completed when admitted to the program.
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Affiliation(s)
- Claire E Leipold
- Angliss Hospital Community Rehabilitation Program, Eastern Health, Melbourne, Victoria, Australia
| | - Shaylyn B Bertino
- Yarra Ranges Health Community Rehabilitation Program, Eastern Health, Melbourne, Victoria, Australia
| | - Heather M L'Huillier
- Wantirna Health Community Rehabilitation Program, Eastern Health, Melbourne, Victoria, Australia.,Outer East Aged Care Assessment Service, Eastern Health, Melbourne, Victoria, Australia
| | - Paula M Howell
- Peter James Centre Community Rehabilitation Program, Eastern Health, Melbourne, Victoria, Australia
| | - Michelina Rosenkotter
- Wantirna Health Community Rehabilitation Program, Eastern Health, Melbourne, Victoria, Australia
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Disorders of nutritional status in sepsis - facts and myths. GASTROENTEROLOGY REVIEW 2017; 12:73-82. [PMID: 28702094 PMCID: PMC5497135 DOI: 10.5114/pg.2017.68165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/28/2017] [Indexed: 12/18/2022]
Abstract
The problem of diagnosing nutritional status disorders in septic patients remains unresolved. This is associated with the necessity of the introduction of newer and newer methods of assessing nutritional status, often requiring precise and expensive equipment as well as employment of professionals in this field in hospital wards, primarily including intensive care units (ICU). Methods that have been applied thus far for assessing nutritional status, also used in severely ill septic patients, have little impact on improving treatment results. This is due to the high dynamics of changes in nutritional status in these patients, healing process variability in individual patients, and the “mismatch” of methods for assessing nutritional status in relation to the patient’s clinical status. The diagnostic value of the traditional methods of assessing nutritional status, i.e. anthropometric analysis and selected laboratory tests, as markers of nutritional status disorders in septic patients, is still debatable. There is still no precise method that could become the “gold standard” allowing for early identification of malnutrition in these group of patients. Phase angle, bioelectrical impedance vector analysis (BIVA), and the “illness marker”, obtained directly from the resistance, reactance, and impedance, can be used as prognostic or nutritional indices in severely ill septic patients, but the intensity of research on this subject needs to be increased. Detailed assessment of nutritional status should include tests of selected inflammation markers (including TLC, HMGB1, IL-6, IL-10, IL-1ra, sTNFRI).
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Puma F, Vannucci J, Santoprete S, Urbani M, Cagini L, Andolfi M, Potenza R, Daddi N. Surgery and perioperative management for post-intubation tracheoesophageal fistula: case series analysis. J Thorac Dis 2017; 9:278-286. [PMID: 28275475 DOI: 10.21037/jtd.2017.02.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Post-intubation tracheoesophageal fistula (PITEF) is an often mistreated, severe condition. This case series reviewed for both the choice and timing of surgical technique and outcome PITEF patients. METHODS This case series reviewed ten consecutive patients who had undergone esophageal defect repair and airway resection/reconstruction between 2000 and 2014. All cases were examined for patients: general condition, medical history, preparation to surgery, diagnostic work-up, timing of surgery and procedure, fistula size and site, ventilation type, nutrition, post-operative course and complications. RESULTS All patients were treated according to Grillo's technique. Overall, 6/10 patients had undergone a preliminary period of medical preparation. Additionally, 3 patients had already had a tracheostomy, one had had a gastrostomy and 4 had both. One patient had a Dumon stent with enlargement of the fistula. Concomitant tracheal stenosis had been found in 7 patients. The mean length of the fistulas was 20.5 mm (median 17.5 mm; range, 8-45 mm), at a median distance from the glottis of 43 mm (range, 20-68 mm). Tracheal resection was performed in all ten cases. The fistula was included in the resection in 6 patients, while it was excluded in the remaining 4 due to their distance. Post-repair tracheotomy was performed in 3 patients. The procedure was performed in 2 ventilated patients. Morbidity related to fistula and anastomosis was recorded in 3 patients (30%), with one postoperative death (10%); T-Tube placement was necessary in 3 patients, with 2/3 decannulations after long-stenting. Definitive PITEF closure was obtained for all patients. At 5-year follow-up, the 9 surviving patients had no fistula-related morbidity. CONCLUSIONS Primary esophageal closure with tracheal resection/reconstruction seemed to be effective treatment both short and long-term. Systemic conditions, mechanical ventilation, detailed preoperative assessment and appropriate preparation were associated with outcome. Indeed, the 3 patients who had received T-Tube recovered from anastomotic complications.
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Affiliation(s)
- Francesco Puma
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Jacopo Vannucci
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Stefano Santoprete
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Moira Urbani
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Lucio Cagini
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Marco Andolfi
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Rossella Potenza
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Niccolò Daddi
- Thoracic Surgery Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Sarcopenia from mechanism to diagnosis and treatment in liver disease. J Hepatol 2016; 65:1232-1244. [PMID: 27515775 PMCID: PMC5116259 DOI: 10.1016/j.jhep.2016.07.040] [Citation(s) in RCA: 376] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 07/09/2016] [Accepted: 07/25/2016] [Indexed: 12/12/2022]
Abstract
Sarcopenia or loss of skeletal muscle mass is the major component of malnutrition and is a frequent complication in cirrhosis that adversely affects clinical outcomes. These include survival, quality of life, development of other complications and post liver transplantation survival. Radiological image analysis is currently utilized to diagnose sarcopenia in cirrhosis. Nutrient supplementation and physical activity are used to counter sarcopenia but have not been consistently effective because the underlying molecular and metabolic abnormalities persist or are not influenced by these treatments. Even though alterations in food intake, hypermetabolism, alterations in amino acid profiles, endotoxemia, accelerated starvation and decreased mobility may all contribute to sarcopenia in cirrhosis, hyperammonemia has recently gained attention as a possible mediator of the liver-muscle axis. Increased muscle ammonia causes: cataplerosis of α-ketoglutarate, increased transport of leucine in exchange for glutamine, impaired signaling by leucine, increased expression of myostatin (a transforming growth factor beta superfamily member) and an increased phosphorylation of eukaryotic initiation factor 2α. In addition, mitochondrial dysfunction, increased reactive oxygen species that decrease protein synthesis and increased autophagy mediated proteolysis, also play a role. These molecular and metabolic alterations may contribute to the anabolic resistance and inadequate response to nutrient supplementation in cirrhosis. Central and skeletal muscle fatigue contributes to impaired exercise capacity and responses. Use of proteins with low ammoniagenic potential, leucine enriched amino acid supplementation, long-term ammonia lowering strategies and a combination of resistance and endurance exercise to increase muscle mass and function may target the molecular abnormalities in the muscle. Strategies targeting endotoxemia and the gut microbiome need further evaluation.
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Duration of treatment in pulmonary tuberculosis: are international guidelines on the management of tuberculosis missing something? Public Health 2015; 129:777-82. [PMID: 25999175 DOI: 10.1016/j.puhe.2015.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 12/30/2014] [Accepted: 04/13/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Despite evidence of an association between tuberculosis (TB) treatment outcomes and the performance of national tuberculosis programmes (NTP), no study to date has rigorously documented the duration of treatment among TB patients. As such, this study was conducted to report the durations of the intensive and continuation phases of TB treatment and their predictors among new smear-positive pulmonary tuberculosis (PTB) patients in Malaysia. STUDY DESIGN Descriptive, non-experimental, follow-up cohort study. METHODS This study was conducted at the Chest Clinic of Penang General Hospital between March 2010 and February 2011. The medical records and TB notification forms of all new smear-positive PTB patients, diagnosed during the study period, were reviewed to obtain sociodemographic and clinical data. Based on standard guidelines, the normal benchmarks for the durations of the intensive and continuation phases of PTB treatment were taken as two and four months, respectively. A patient in whom the clinicians decided to extend the intensive phase of treatment by ≥2 weeks was categorized as a case with a prolonged intensive phase. The same criterion applied for the continuation phase. Multiple logistic regression analysis was performed to find independent factors associated with the duration of TB treatment. Data were analyzed using Predictive Analysis Software Version 19.0. RESULTS Of the 336 patients included in this study, 261 completed the intensive phase of treatment, and 226 completed the continuation phase of treatment. The mean duration of TB treatment (n = 226) was 8.19 (standard deviation 1.65) months. Half (49.4%, 129/261) of the patients completed the intensive phase of treatment in two months, whereas only 37.6% (85/226) of the patients completed the continuation phase of treatment in four months. On multiple logistic regression analysis, being a smoker, being underweight and having a history of cough for ≥4 weeks at TB diagnosis were found to be predictive of a prolonged intensive phase of treatment. Diabetes mellitus and the presence of lung cavities at the start of treatment were the only predictors found for a prolonged continuation phase of treatment. CONCLUSIONS The average durations of the intensive and continuation phases of treatment among PTB patients were longer than the targets recommended by the World Health Organization. As there are no internationally agreed criteria, it was not possible to judge how well the Malaysian NTP performed in terms of managing treatment duration among PTB patients.
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Rahman A, Jafry S, Jeejeebhoy K, Nagpal AD, Pisani B, Agarwala R. Malnutrition and Cachexia in Heart Failure. JPEN J Parenter Enteral Nutr 2015; 40:475-86. [PMID: 25634161 DOI: 10.1177/0148607114566854] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/04/2014] [Indexed: 12/12/2022]
Abstract
Heart failure is a growing public health concern. Advanced heart failure is frequently associated with severe muscle wasting, termed cardiac cachexia This process is driven by systemic inflammation and tumor necrosis factor in a manner common to other forms of disease-related wasting seen with cancer or human immunodeficiency virus. A variable degree of malnutrition is often superimposed from poor nutrient intake. Cardiac cachexia significantly decreases quality of life and survival in patients with heart failure. This review outlines the evaluation of nutrition status in heart failure, explores the pathophysiology of cardiac cachexia, and discusses therapeutic interventions targeting wasting in these patients.
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Affiliation(s)
- Adam Rahman
- University of Western Ontario, London, Ontario, Canada Lawson Health Research Institute Program of Experimental Medicine (POEM), London, Ontario, Canada
| | - Syed Jafry
- University of Western Ontario, London, Ontario, Canada
| | - Khursheed Jeejeebhoy
- Department of Medicine, University of Toronto, Ancaster, Ontario, Canada Department of Nutritional Sciences, University of Toronto, Ancaster, Ontario, Canada Department of Physiology, University of Toronto, Ancaster, Ontario, Canada
| | - A Dave Nagpal
- University of Western Ontario, London, Ontario, Canada
| | - Barbara Pisani
- Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ravi Agarwala
- Department of Anesthesia, Section on Critical Care, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Rodríguez-Castro KI, De Martin E, Gambato M, Lazzaro S, Villa E, Burra P. Female gender in the setting of liver transplantation. World J Transplant 2014; 4:229-242. [PMID: 25540733 PMCID: PMC4274594 DOI: 10.5500/wjt.v4.i4.229] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/27/2014] [Accepted: 07/15/2014] [Indexed: 02/05/2023] Open
Abstract
The evolution of liver diseases to end-stage liver disease or to acute hepatic failure, the evaluation process for liver transplantation, the organ allocation decision-making, as well as the post-transplant outcomes are different between female and male genders. Women’s access to liver transplantation is hampered by the use of model for end-stage liver disease (MELD) score, in which creatinine values exert a systematic bias against women due to their lower values even in the presence of variable degrees of renal dysfunction. Furthermore, even when correcting MELD score for gender-appropriate creatinine determination, a quantifiable uneven access to transplant prevails, demonstrating that other factors are also involved. While some of the differences can be explained from the epidemiological point of view, hormonal status plays an important role. Moreover, the pre-menopausal and post-menopausal stages imply profound differences in a woman’s physiology, including not only the passage from the fertile age to the non-fertile stage, but also the loss of estrogens and their potentially protective role in delaying liver fibrosis progression, amongst others. With menopause, the tendency to gain weight may contribute to the development of or worsening of pre-existing metabolic syndrome. As an increasing number of patients are transplanted for non-alcoholic steatohepatitis, and as the average age at transplant increases, clinicians must be prepared for the management of this particular condition, especially in post-menopausal women, who are at particular risk of developing metabolic complications after menopause.
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Lorini C, Collini F, Castagnoli M, Di Bari M, Cavallini MC, Zaffarana N, Pepe P, Lucenteforte E, Vannacci A, Bonaccorsi G. Using alternative or direct anthropometric measurements to assess risk for malnutrition in nursing homes. Nutrition 2014; 30:1171-6. [DOI: 10.1016/j.nut.2014.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 11/29/2022]
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Mayasari M, . S, Lestariana W. Simple Nutritional Screening Tool (SNST) Has Good Validity to Identify Risk of Malnutrition on Hospitalized Elderly Patients. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/pjn.2014.573.578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Li F, Liu YW, Wang XF, Liu GW. Evaluation of malnutrition in patients with nervous system disease. Expert Rev Neurother 2014; 14:1229-37. [PMID: 25192880 DOI: 10.1586/14737175.2014.957184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nutritional deficiencies are independent risk factors for adverse outcomes in patients with nervous system disease. Patients with nervous system disease can often become malnourished due to swallowing difficulties or unconsciousness. This malnourishment increases hospitalization duration; average total hospital cost; occurrence of infection, pressure ulcers, and other complications. These problems need to be addressed in the clinic. In this paper, we review the relevant literature, including studies on influencing factors, evaluations, indexes, and methods: Our aim is to understand the current status of malnutrition in patients with nervous system disease and reasons associated with nutritional deficiencies by using malnutrition evaluation methods to assess the risk of nutritional deficiencies in the early stages.
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Affiliation(s)
- Feng Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Platek ME, Myrick E, McCloskey SA, Gupta V, Reid ME, Wilding GE, Cohan D, Arshad H, Rigual NR, Hicks WL, Sullivan M, Warren GW, Singh AK. Pretreatment weight status and weight loss among head and neck cancer patients receiving definitive concurrent chemoradiation therapy: implications for nutrition integrated treatment pathways. Support Care Cancer 2013; 21:2825-33. [PMID: 23743980 DOI: 10.1007/s00520-013-1861-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 05/21/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose was to examine the effect of pretreatment weight status on loco-regional progression for patients with squamous cell carcinoma of the head and neck (SCCHN) after receiving definitive concurrent chemoradiation therapy (CCRT). METHODS In an expanded cohort of 140 patients, we retrospectively reviewed weight status and loco-regional progression of SCCHN patients treated with CCRT between 2004 and 2010. RESULTS Pretreatment ideal body weight percentage (IBW%) was statistically significantly different for patients with disease progression than for those without progression (p = 0.02) but was not an independent predictor of progression. Median pretreatment IBW% was 118 (72-193) for the progression-free group and was 101.5 (73-163) for the group with progression. Both groups suffered clinically severe weight loss of approximately 9 % from baseline to end treatment. CONCLUSIONS Pretreatment weight status, a very crude indicator of nutrition status, may have prognostic value in patients with SCCHN undergoing definitive CCRT. Inadequate nutritional status in these patients has been associated with poor clinical outcomes and decreased quality of life. Based on this report and others, the best next steps include routine validated malnutrition screening and the testing of evidence-based nutrition care protocols with the goals of minimizing weight loss and improvement of quality of life.
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Affiliation(s)
- Mary E Platek
- Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA,
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Kastorini CM, Panagiotakos DB. The obesity paradox: Methodological considerations based on epidemiological and clinical evidence—New insights. Maturitas 2012; 72:220-4. [DOI: 10.1016/j.maturitas.2012.04.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 04/24/2012] [Accepted: 04/25/2012] [Indexed: 11/26/2022]
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Die Ernährungsversorgung in geriatrischen Krankenhausabteilungen in Deutschland. Z Gerontol Geriatr 2012; 46:48, 50-5. [DOI: 10.1007/s00391-012-0334-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rivera Irigoin R, Abilés J. [Nutritional support in patients with liver cirrhosis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35:594-601. [PMID: 22657567 DOI: 10.1016/j.gastrohep.2012.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 03/06/2012] [Indexed: 01/01/2023]
Abstract
Given the liver's multiple synthetic, regulatory and detoxifying functions, one of the characteristics accompanying severe hepatocellular dysfunction is the presence of malnutrition. This disorder is highly frequent in liver cirrhosis, even in the relatively early stages of the disease. Independently of the cause of the cirrhosis, poor nutritional status is associated with a worse prognosis and therefore early intervention to correct nutrient deficiency can prolong life expectancy, improve quality of life, reduce complications and increase the probability of successful transplantation. The present article reviews current knowledge of the diagnosis and management of malnutrition in patients with cirrhosis. Special attention is paid to the concept of the late evening snack and its characteristics, composition and probable benefits in the course of the disease.
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Affiliation(s)
- Robin Rivera Irigoin
- Servicio de Aparato Digestivo, Hospital Costa del Sol, Marbella, Málaga, España.
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Gastelurrutia P, Lupón J, Domingo M, Ribas N, Noguero M, Martinez C, Cortes M, Bayes-Genis A. Usefulness of body mass index to characterize nutritional status in patients with heart failure. Am J Cardiol 2011; 108:1166-70. [PMID: 21798500 DOI: 10.1016/j.amjcard.2011.06.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 06/02/2011] [Accepted: 06/02/2011] [Indexed: 11/25/2022]
Abstract
The obesity paradox in heart failure (HF) is criticized because of the limitations of body mass index (BMI) in correctly characterizing overweight and obese patients, necessitating a better evaluation of nutritional status. The aim of this study was to assess nutritional status, BMI, and significance in terms of HF survival. Anthropometry and biochemical nutritional markers were assessed in 55 HF patients. Undernourishment was defined as the presence of ≥2 of the following indexes below the normal range: triceps skinfold, subscapular skinfold, arm muscle circumference, albumin, and total lymphocyte count. Patients were also stratified by BMI and followed for a median of 26.7 months. Across BMI strata, no patient was underweight, 31% were normal weight, 42% were overweight, and 27% were obese. Undernourishment was present in 53% of normal-weight patients, 22% of overweight patients, and none of the obese patients (p = 0.001). Undernourished patients had significantly higher mortality (p = 0.009) compared to well-nourished patients. In multivariate analysis, only undernutrition (hazard ratio 3.149, 95% confidence interval 1.367 to 7.253), New York Heart Association functional class (hazard ratio 3.374, 95% confidence interval 1.486 to 7.659), and age (hazard ratio 1.115, 95% confidence interval 1.045 to 1.189) remained in the model. Among nutritional indicators, subscapular skinfold was the best predictor of mortality; patients with subscapular skinfold in the fifth percentile had higher mortality (p = 0.0001). In conclusion, BMI does not indicate true nutritional status in HF. Classifying patients as well nourished or undernourished may improve risk stratification.
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Platek ME, Popp JV, Possinger CS, Denysschen CA, Horvath P, Brown JK. Comparison of the prevalence of malnutrition diagnosis in head and neck, gastrointestinal, and lung cancer patients by 3 classification methods. Cancer Nurs 2011; 34:410-6. [PMID: 21242767 PMCID: PMC3116020 DOI: 10.1097/ncc.0b013e318206b013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Malnutrition is prevalent among patients within certain cancer types. There is lack of universal standard of care for nutrition screening and a lack of agreement on an operational definition and on validity of malnutrition indicators. OBJECTIVE In a secondary data analysis, we investigated prevalence of malnutrition diagnosis with 3 classification methods using data from medical records of a National Cancer Institute-designated comprehensive cancer center. METHODS Records of 227 patients hospitalized during 1998 with head and neck, gastrointestinal, or lung cancer were reviewed for malnutrition based on 3 methods: (1) physician-diagnosed malnutrition-related International Classification of Diseases, Ninth Revision codes; (2) in-hospital nutritional assessment summaries conducted by registered dietitians; and (3) body mass indexes (BMIs). For patients with multiple admissions, only data from the first hospitalization were included. RESULTS Prevalence of malnutrition diagnosis ranged from 8.8% based on BMI to approximately 26% of all cases based on dietitian assessment. κ coefficients between any methods indicated a weak (κ = 0.23, BMI and dietitians; and κ = 0.28, dietitians and physicians)-to-fair strength of agreement (κ = 0.38, BMI and physicians). CONCLUSIONS Available methods to identify patients with malnutrition in a National Cancer Institute-designated comprehensive cancer center resulted in varied prevalence of malnutrition diagnosis. A universal standard of care for nutrition screening that uses validated tools is needed. IMPLICATIONS FOR PRACTICE The Joint Commission on the Accreditation of Healthcare Organizations requires nutritional screening of patients within 24 hours of admission. For this purpose, implementation of a validated tool that can be used by various healthcare practitioners, including nurses, needs to be considered.
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Affiliation(s)
- Mary E Platek
- Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Belbraouet S, Chau N, Tebi A, Debry G. Anthropometric characteristics of hospitalised elderly women: a case-control study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:2584-92. [PMID: 21845147 PMCID: PMC3155318 DOI: 10.3390/ijerph8072584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 06/14/2011] [Accepted: 06/15/2011] [Indexed: 01/04/2023]
Abstract
This study assessed the anthropometric status of 451 hospitalised female patients aged 70 or over, at their admission to hospital, in reference to 77 healthy women of the same age. The most frequent diseases were circulatory diseases (40.8%), mental disorders (29.9%), respiratory diseases (12.4%), endocrine and metabolic diseases (11.5%), osteomuscular diseases (8.4%), and traumatisms (6.9%). The differences were significantly high for mid-arm circumference (MAC), triceps skinfold thickness (TSF), weight, weight/height, and body mass index (BMI). The patients with cancers, blood diseases, mental disorders, respiratory disease, digestive diseases, or traumatisms had the lowest values. All the indicators correlated in a similarly negative way with age. The decreased TSF was more pronounced among subjects with respiratory diseases. Measurement of anthropometric indicators, TSF in particular, should be part of preventive measures aimed at reducing malnutrition and its consequences in a hospital setting.
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Affiliation(s)
- Slimane Belbraouet
- Ecole de Nutrition, 51 A Maillet, Université de Moncton, Moncton, NB, E1A 3E9, Canada
| | - Nearkasen Chau
- INSERM, U669, IFR25-IFRH, Maison de Solenn, 97 Boulevard de Port Royal, F-75679 Paris cedex 14, France; E-Mail:
- Université Paris Descartes, UMR-S0669, rue de l’Ecole de Médecine, 75270 Paris, France
| | - Ambroise Tebi
- Centre de Nutrition Humaine, Université Henri Poincaré-Nancy 1, rue Lionnois, F-54000 Nancy, France; E-Mails: (A.T.); (G.D.)
| | - Gérard Debry
- Centre de Nutrition Humaine, Université Henri Poincaré-Nancy 1, rue Lionnois, F-54000 Nancy, France; E-Mails: (A.T.); (G.D.)
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Lomivorotov VV, Efremov SM, Boboshko VA, Leyderman IN, Lomivorotov VN, Cheung AT, Karaskov AM. Preoperative total lymphocyte count in peripheral blood as a predictor of poor outcome in adult cardiac surgery. J Cardiothorac Vasc Anesth 2011; 25:975-80. [PMID: 21354824 DOI: 10.1053/j.jvca.2010.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prognostic value of the preoperative total lymphocyte count in peripheral blood as a predictor of postoperative complications and mortality in cardiac surgery. DESIGN A retrospective, observational study. SETTING The Novosibirsk State Research Institute of Circulation Pathology (single institution). PARTICIPANTS All adults undergoing primary cardiopulmonary bypass in 2009. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The cohort size was 1,368 patients operated upon with cardiopulmonary bypass. Patient characteristics, hospital mortality, postoperative complications, ventilation time, intensive care unit, and hospital stay were analyzed. A preoperative total lymphocyte count <1,500 cells/μL was associated with significantly higher mortality by univariate (p < 0.0001) and multivariate (p < 0.044) analyses. A low preoperative total lymphocyte count was associated with more frequent inotropic support (p < 0.001); postoperative heart arrhythmia (p < 0.001); dialysis-dependent acute renal failure (p < 0.001); and a prolonged ventilation time (p = 0.001), intensive care unit stay (p < 0.001), and hospital stay (p = 0.007). CONCLUSIONS A low preoperative total lymphocyte count in peripheral blood is a useful prognostic criterion for the evaluation of a complicated postoperative period in cardiac patients operated under cardiopulmonary bypass.
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Affiliation(s)
- Vladimir V Lomivorotov
- Department of Anaestesiology and Intensive Care, Federal State Institution Academician EN Meshalkin Novosibirsk State Research Institute of Circulation Pathology Rusmedtechnology, Novosibirsk, Russia
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Corrales-Medina VF, Valayam J, Serpa JA, Rueda AM, Musher DM. The obesity paradox in community-acquired bacterial pneumonia. Int J Infect Dis 2011; 15:e54-7. [DOI: 10.1016/j.ijid.2010.09.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 08/17/2010] [Accepted: 09/21/2010] [Indexed: 10/18/2022] Open
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Wie GA, Cho YA, Kim SY, Kim SM, Bae JM, Joung H. Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea. Nutrition 2010; 26:263-8. [DOI: 10.1016/j.nut.2009.04.013] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 04/17/2009] [Accepted: 04/17/2009] [Indexed: 10/20/2022]
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Kruizenga HM, de Vet HCW, Van Marissing CME, Stassen EEPM, Strijk JE, Van Bokhorst-de Van der Schueren MAE, Horman JCH, Schols JMGA, Van Binsbergen JJ, Eliens A, Knol DL, Visser M. The SNAQ(RC), an easy traffic light system as a first step in the recognition of undernutrition in residential care. J Nutr Health Aging 2010; 14:83-9. [PMID: 20126953 DOI: 10.1007/s12603-009-0147-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Development and validation of a quick and easy screening tool for the early detection of undernourished residents in nursing homes and residential homes. DESIGN Multi-center, cross sectional observational study. SETTING Nursing homes and residential homes. PARTICIPANTS The screening tool was developed in a total of 308 residents (development sample; sample A) and cross validated in a new sample of 720 residents (validation sample) consisting of 476 nursing home residents (Sample B1) and 244 residential home residents (sample B2). MEASUREMENTS Patients were defined severely undernourished when they met at least one of the following criteria: BMI or= 5% unintentional weight loss in the past month and/or >or= 10% unintentional weight loss in the past 6 months. Patients were defined as moderately undernourished if they met the following criteria: BMI 20.1-22 kg/m2 and/or 5-10% unintentional weight loss in the past six months. The most predictive questions (originally derived from previously developed screening instruments) of undernourishment were selected in sample A and cross validated in sample B. In a second stage BMI was added to the SNAQRC in sample B. The diagnostic accuracy of the screening tool in the development and validation samples was expressed in sensitivity, specificity, and the negative and positive predictive value. RESULTS The four most predictive questions for undernutrition related to: unintentional weight loss more than 6 kg during the past 6 months and more than 3 kg in the past month, capability of eating and drinking with help, and decreased appetite during the past month. The diagnostic accuracy of these questions alone was insufficient (Se=45%, Sp=87%, PPV=50% and NPV=84%). However, combining the questions with measured BMI sufficiently improved the diagnostic accuracy (Se=87%, Sp=82%, PPV=59% and NPV=95%). CONCLUSION Early detection of undernourished nursing- and residential home residents is possible using four screening questions and measured BMI.
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Affiliation(s)
- H M Kruizenga
- Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands
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Kvamme JM, Wilsgaard T, Florholmen J, Jacobsen BK. Body mass index and disease burden in elderly men and women: the Tromsø Study. Eur J Epidemiol 2010; 25:183-93. [PMID: 20087630 DOI: 10.1007/s10654-009-9422-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 12/31/2009] [Indexed: 12/12/2022]
Abstract
Chronic health problems may be related to body mass index (BMI, kg/m(2)), but this has been best documented in overweight and obese adults. The primary objective of this study was to identify factors associated with different categories of BMI in elderly men and women from the general population, also including the lower categories of BMI. In a cross-sectional population survey from the municipality of Tromsø, Norway we analyzed associations between BMI and a wide range of chronic disease conditions, lifestyle and socioeconomic factors. BMI was categorized into six groups (<20, 20.0-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, > or =30.0 kg/m(2)). The study included 4,259 men and women aged 65 years and older from the general population. We found low relative weight (BMI < 20 kg/m(2)) to be associated with increasing prevalence of mental distress, hip fracture, smoking and low handgrip strength. A U-shaped relation to BMI was found for asthma and chronic bronchitis, poor current health and low physical activity. The higher categories of BMI were associated with low education level, a difficult economical situation, diabetes mellitus and ischemic heart disease. These results demonstrate that both low and high BMI are associated with a wide range of prevalent conditions and diseases in elderly men and women. For the clinician the findings emphasize the importance of nutritional assessment as part of the medical evaluation of elderly patients.
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Affiliation(s)
- Jan-Magnus Kvamme
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
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How close do gastroenterologists follow specific guidelines for nutrition recommendations in liver cirrhosis? A survey of current practice. Eur J Gastroenterol Hepatol 2009; 21:756-61. [PMID: 19322099 DOI: 10.1097/meg.0b013e328311f281] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIM Malnutrition is a common feature of terminal chronic liver disease. In Great Britain earlier studies revealed a widespread use of inappropriate dietary management for example, protein restriction in patients with liver cirrhosis (LC). Therefore, it was the aim of this study to evaluate the current dietary recommendations for patients with LC, recommended by gastroenterologists in Germany. METHODS Anonymous questionnaires were sent to 576 members of the Bavarian Society of Gastroenterology. Information was requested on the dietary management and on the diagnostic assessment of nutritional status of all patients with LC seen in the past 12 months. Further questions were included concerning knowledge of recent guidelines on enteral nutrition (EN) in LC, use of an adequate EN and estimated prevalence of malnutrition. RESULTS Forty-four percent of all questionnaires were returned within 4 weeks; of those 94% were fully completed and appropriate for further analysis. Fifty-six percent respondents stated that they were familiar with guidelines concerning EN in patients with LC and 92% believed that evidence-based recommendations are both important and relevant for everyday practice. Only 23% of the respondents gave a correct estimate of the prevalence of protein-calorie malnutrition in patients with chronic liver disease. The majority underestimated the correct amount of energy and protein intake that is recommended by the European Society for Parenteral and Enteral Nutrition guidelines on EN for patients with LC. Only 42% respondents recommended a protein-rich diet whereas most of the respondents under or overestimated the required daily energy (55%) and protein intake (58%). As simple bedside methods such as the subjective global assessment or anthropometry are considered adequate to identify malnutrition in LC, these methods were familiar only to 24 and 55% of the respondents, respectively. Forty-one percent, however, believed that an evaluation of the body mass index represents the best diagnostic tool to detect malnourished patients although body mass index may be misleading in cirrhotics with tense ascites. CONCLUSION The dietary management of German cirrhotic patients should be improved, especially concerning the required daily energy and protein intake. Simple bedside methods for the diagnosis of malnutrition are widely unknown. In general, malnutrition in LC clearly represents a widely underestimated problem even in a highly specialized sample of medical practitioners in digestive and hepatological diseases. At the same time the number of nutrition support teams in German speaking countries are very low. A higher number of multidisciplinary teams including dietitians, psychologists and physical activity supervisors caring for undernourished patients might be an important step for an improvement towards correct management of malnutrition in LC.
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