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Liu XY, Kang B, Lv Q, Wang ZW. Phase angle is a predictor for postoperative complications in colorectal cancer. Front Nutr 2024; 11:1446660. [PMID: 39221167 PMCID: PMC11363711 DOI: 10.3389/fnut.2024.1446660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Aim The aim of this study was to develop a validated nomogram to predict the risk of postoperative complications in colorectal cancer (CRC) patients by analyzing the factors that contribute to these complications. Methods We retrospectively collected clinical information on patients who underwent CRC surgery at a single clinical center from January 2021 to December 2021. Univariate and multivariate logistic regression analysis to identify independent risk factors for postoperative complications and to develop a predictive model. A receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC) to assess the predicted probability. Calibration curve was drawn to compare the predicted probability of the nomogram with the actual probability, and decision curve analysis (DCA) was employed to evaluate the clinical utility of the nomogram. Results A total of 190 CRC patients were included in this study. We retrospectively collected baseline information, clinical information, surgical information, and nutrition-related indicators for all patients. Through multivariate logistic regression analysis, preoperative albumin (p = 0.041, OR = 0.906, 95% CI = 0.824-0.996), surgical time (p = 0.009, OR = 1.006, 95% CI = 1.001-1.010), waistline (p = 0.049, OR = 1.011, 95% CI = 1.002-1.020) and phase angle (PA) (p = 0.022, OR = 0.615, 95% CI = 0.405-0.933) were identified as independent risk factors for postoperative complications in CRC, and a nomogram prediction model was established using the above four variables. The AUC of 0.706 for the ROC plot and the high agreement between predicted and actual probabilities in the calibration curves suggested that the prediction model has good predictive power. The DCA also confirmed the good clinical performance of the nomogram. Conclusion This study developed a nomogram to predict the risk of postoperative complications in CRC patients, providing surgeons with a reliable reference to personalized patient management in the perioperative period and preoperative nutritional interventions.
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Affiliation(s)
- Xiao-Yu Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bing Kang
- Department of Clinical Nutrition, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quan Lv
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zi-Wei Wang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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2
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Papadopoulou A, Karayiannis D, Dimitra G, Pafili Z. The Accuracy of Height Prediction Equations in Greek Patients: A Cross-Sectional Study. Nutrients 2024; 16:2062. [PMID: 38999810 PMCID: PMC11243520 DOI: 10.3390/nu16132062] [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: 06/05/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
In clinical settings, standing height measurement is often difficult to perform due to patients' inability to stand upright. Height prediction equations derived from measurements of the length of other body segments have been published; however, they are not readily applicable to all populations since ethnic differences affect the relationship between standing height and body segment length. This cross-sectional study aimed to examine the accuracy of height prediction using the Malnutrition Universal Screening Tool (MUST) height predictive equations among Greek patients and to develop new, nationally representative equations. The study population consisted of 1198 Greek adult outpatients able to stand upright without assistance and without medical conditions that affected their height. Standing height, ulna length, knee height and demi-span measurements were obtained from 599 males and 599 females. Patients were stratified into age groups of <55 and ≥55 years, <60 and ≥60 years and <65 and ≥65 years according to the categories indicated by the MUST for height prediction from alternative measurements. There were positive correlations between standing height and ulna length and knee height and demi-span length (p < 0.001) in both sexes and all age categories. A strong correlation was observed between the measured and predicted standing height using ulna length (rho = 0.870, p < 0.001), knee height (rho = 0.923, p < 0.001) and demi-span length (rho = 0.906, p < 0.001). The average difference between the MUST indicative equations' height predictions from alternative measurements and actual height was -3.04 (-3.32, -2.76), -1.21 (-1.43, -0.988) and 2.16 (1.92, 2.41), respectively. New height prediction equations for Greek patients were identified, with the predicted values closer to the measured standing heights than those predicted with the MUST indicative equations for height prediction from alternative measurements.
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Affiliation(s)
| | | | | | - Zoe Pafili
- Department of Clinical Nutrition, Evangelismos General Hospital, 10676 Athens, Greece; (A.P.); (D.K.); (G.D.)
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Pettit MS, Crowder SL, Ackerman RS, Hafez O, Poch MA, Patel SY. Preoperative Nutritional Status and Enhanced Recovery after Surgery (ERAS) Prior to Radical Cystectomy: A Review of the Literature. Nutr Cancer 2023; 75:1743-1751. [PMID: 37553951 DOI: 10.1080/01635581.2023.2244172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023]
Abstract
Preoperative nutritional status is an important and modifiable risk factor of a patient's recovery and outcome after radical cystectomy. There are multiple malnutrition screening tools and treatment options. In this review, we discuss the best indicators of this condition and how to optimize nutrition status prior to radical cystectomy.
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Affiliation(s)
- Matthew S Pettit
- University of South Florida, Morsani College of Medicine, Tampa, Florida, USA
| | - Sylvia L Crowder
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Robert S Ackerman
- Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Osama Hafez
- Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Michael A Poch
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Sephalie Y Patel
- Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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4
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Ge YZ, Fu ZM, Zhang Q, Song MM, Ruan GT, Zhang X, Zhang XW, Li XR, Zhang KP, Tang M, Liu XY, Yang M, Liu T, Xie HL, Zhang HY, Wang ZW, Hu CL, Lin SQ, Zhang R, Xu HX, Li W, Song CH, Liu M, Chen JQ, Wang KH, Bo L, Cong MH, Li ZN, Guo ZQ, Wang XB, Wang BY, Xu B, Qin XH, Xu XP, Barazzoni R, Yao QH, Weng M, Shen X, Shi HP. AIWW: a new nutrition-screening tool for the oncologic population. SCIENCE CHINA. LIFE SCIENCES 2023; 66:1831-1840. [PMID: 37121939 DOI: 10.1007/s11427-022-2292-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/09/2023] [Indexed: 05/02/2023]
Abstract
Malnutrition is a common comorbidity among patients with cancer. However, no nutrition-screening tool has been recognized in this population. A quick and easy screening tool for nutrition with high sensitivity and easy-to-use is needed. Based on the previous 25 nutrition-screening tools, the Delphi method was made by the members of the Chinese Society of Nutritional Oncology to choose the most useful item from each category. According to these results, we built a nutrition-screening tool named age, intake, weight, and walking (AIWW). Malnutrition was defined based on the scored patient-generated subjective global assessment (PG-SGA). Concurrent validity was evaluated using the Kendall tau coefficient and kappa consistency between the malnutrition risks of AIWW, nutritional risk screening 2002 (NRS-2002), and malnutrition screening tool (MST). Clinical benefit was calculated by the decision curve analysis (DCA), integrated discrimination improvement (IDI), and continuous net reclassification improvement (cNRI). A total of 11,360 patients (male, n=6,024 (53.0%) were included in the final study cohort, and 6,363 patients had malnutrition based on PG-SGA. Based on AIWW, NRS-2002, and MST, 7,545, 3,469, and 1,840 patients were at risk of malnutrition, respectively. The sensitivities of AIWW, NRS-2002, and MST risks were 0.910, 0.531, and 0.285, and the specificities were 0.768, 0.946, and 0.975. The Kendall tau coefficients of AIWW, NRS-2002, and MST risks were 0.588, 0.501, and 0.326, respectively. The area under the curve of AIWW, NRS-2002, and MST risks were 0.785, 0.739, and 0.630, respectively. The IDI, cNRI, and DCA showed that AIWW is non-inferior to NRS-2002 (IDI: 0.002 (-0.009, 0.013), cNRI: -0.015 (-0.049, 0.020)). AIWW scores can also predict the survival of patients with cancer. The missed diagnosis rates of AIWW, NRS-2002, and MST were 0.09%, 49.0%, and 73.2%, respectively. AIWW showed a better nutrition-screening effect than NRS-2002 and MST for patients with cancer and could be recommended as an alternative nutrition-screening tool for this population.
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Affiliation(s)
- Yi-Zhong Ge
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Zhen-Ming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Qi Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
- Department of Colorectal Surgery, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Meng-Meng Song
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Guo-Tian Ruan
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xi Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xiao-Wei Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xiang-Rui Li
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Kang-Ping Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Meng Tang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xiao-Yue Liu
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Ming Yang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Tong Liu
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Hai-Lun Xie
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - He-Yang Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Zi-Wen Wang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Chun-Lei Hu
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Shi-Qi Lin
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Rui Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Hong-Xia Xu
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University, Changchun, 130021, China
| | - Chun-Hua Song
- Department of Epidemiology, College of Public Health, Zhengzhou University, 450001, Zhengzhou, China
| | - Ming Liu
- Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Jun-Qiang Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Kun-Hua Wang
- Yunnan University, Kunming, 650091, China
- General Surgery Clinical Medical Center of Yunnan Province, Kunming, 650032, China
| | - Li Bo
- Affiliated Hospital of Yunnan University, Kunming, 650091, China
| | - Ming-Hua Cong
- Comprehensive Oncology Department, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - Zeng-Ning Li
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, China
| | - Zeng-Qin Guo
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, 350014, China
| | - Xiao-Bin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21228, USA
| | - Bin-Yan Wang
- Shenzhen Evergreen Medical Institute, Shenzhen, 518052, China
| | - Benjamin Xu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Xian-Hui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xi-Ping Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100193, China
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34127, Italy
| | - Qing-Hua Yao
- Department of Integrated Chinese and Western Medicine, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Min Weng
- Department of Clinical Nutrition, The First Affiliated Hospital of Kunming Medical University, Kunming, 650091, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Han-Ping Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China.
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China.
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Stephenson SS, Guligowska A, Cieślak-Skubel A, Wójcik A, Kravchenko G, Kostka T, Sołtysik BK. The Relationship between Nutritional Risk and the Most Common Chronic Diseases in Hospitalized Geriatric Population from Central Poland. Nutrients 2023; 15:nu15071612. [PMID: 37049453 PMCID: PMC10096810 DOI: 10.3390/nu15071612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
The aim of this study was to assess the relationship between Nutrition Risk Screening 2002 (NRS-2002) and the prevalence of concomitant chronic diseases among hospitalized older adults. This study included 2122 consecutively hospitalized older participants with an average age of 82 years. The criteria to participate were the ability to communicate and give consent. In multivariate design, the prevalence of nutritional risk with at least 3 points in the NRS-2002 score was associated with the presence of stroke, atrial fibrillation, dementia and pressure ulcers. Patients with arterial hypertension, lipid disorders, osteoarthritis and urine incontinence had a significantly lower (better) NRS-2002 score. The explanation of the inverse relationship between some disorders and nutritional risk may be their occurrence in relatively earlier age and the relationship with body mass index. In conclusion, the study revealed which medical conditions coexist with the increased nutritional risk in a “real-world” hospitalized geriatric population. The hospital admission of an older subject with stroke, atrial fibrillation, dementia or pressure ulcers should primarily draw attention to the nutritional risk of the patient.
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The status of clinical nutrition in hospitals of Guilan province, Iran - A mixed-method study. NUTR HOSP 2023; 40:88-95. [PMID: 36537320 DOI: 10.20960/nh.04239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction Background: nutritional therapy has an important role in the development of medical care services, and quantitative and qualitative assessments of the status of clinical nutrition in hospitals is crucial. This study aimed to explore the current status of clinical nutrition in hospitals of Guilan province, Iran. Methods: this quantitative-qualitative (mixed method) study was performed on public hospitals in Guilan province, Iran (n = 26). The required information was collected by visiting the hospitals and interviewing with hospital dietitians. The data collection tool had two quantitative and qualitative subscales. The quantitative subscale included a 21-item checklist containing information about the referral system, cooperation of hospital staff in clinical nutrition, clinical nutrition staff status, enteral nutrition, and parenteral nutrition. Results: in more than 55 % of hospitals the patients were not adequately referred to a dietitian. In about 31.2 % of hospitals, cooperation of other departments in the field of clinical nutrition was insufficient. In 37 % of hospitals with intensive care unit (ICU), enteral nutrition was not provided properly. Only 27 % of the hospital properly provided parenteral nutrition for their patients. The most important problems mentioned by hospital dietitians included noncompliance of the food services employers with recommended diets, insufficient number of hospital dietitians, and lack of per case payment method for dietitians. Coverage of diet services by health insurance was the most common suggestion of dietitians to promote diet therapy in public hospitals. Conclusion: the situation of providing nutritional services to patients in public hospitals is not favorable in terms of quantity and quality in Guilan province, Iran. Designing the necessary policies and reorient the clinical nutrition system in hospitals to promote patients' health and accelerate patient recovery is warranted.
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Liu W, Ge W, Murong Z, Li L, Liu J, Shen Y, Yang S, Wang S, Hao R, Wang H, Ding L, Li S, Zhuang Z, Zhao M, Wang R, Qin M, Zhang L, Fan X. Efficacy and safety of acupuncture for post-stroke dysphagia: protocol for a multicenter, single-blinded, randomized controlled trial. Eur J Integr Med 2023. [DOI: 10.1016/j.eujim.2023.102225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Totland TH, Krogh HW, Smedshaug GB, Tornes RA, Bye A, Paur I. Harmonization and standardization of malnutrition screening for all adults - A systematic review initiated by the Norwegian Directorate of Health. Clin Nutr ESPEN 2022; 52:32-49. [PMID: 36513471 DOI: 10.1016/j.clnesp.2022.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND & AIMS The Norwegian Directorate of Health has identified a need to harmonize and standardize the malnutrition screening practice in Norwegian hospitals and primary health care settings, in order to provide a seamless communication of malnutrition screening along the patient pathway. Our aim was to perform a systematic review of the validity and reliability of screening tools used to identify risk of malnutrition across health care settings, diagnoses or conditions and adult age groups, as a first step towards a national recommendation of one screening tool. METHODS A systematic literature search for articles evaluating validity, agreement, and reliability of malnutrition screening tools, published up to August 2020, was conducted in: MEDLINE, Embase, APA PsycInfo, Cinahl, Cochrane Databases, Web of Science, Epistemonikos, SveMed+, and Norart. The systematic review was registered in PROSPERO (CRD42022300558). For critical appraisal of each included article, the Quality Criteria Checklist by The Academy of Nutrition and Dietetics was used. RESULTS The review identified 105 articles that fulfilled the inclusion and exclusion criteria. The most frequently validated tools were Mini Nutritional Assessment short form (MNA), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and Nutritional Risk Screening 2002 (NRS-2002). MNA, MST and NRS-2002 displayed overall moderate validity, and MUST low validity. All four tools displayed low agreement. MST and MUST were validated across health care settings and age groups. In general, data on reliability was limited. CONCLUSIONS The screening tools MST and NRS-2002 displayed moderate validity for the identification of malnutrition in adults, of which MST is validated across health care settings. In addition, MNA has moderate validity for the identification of malnutrition in adults 65 years or older.
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Affiliation(s)
- Torunn Holm Totland
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway; Department of Physical Health and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Henriette Walaas Krogh
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway
| | - Guro Berge Smedshaug
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway
| | | | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway; European Palliative Care Research Centre (PRC), Dept. of Oncology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Paur
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway; Norwegian Advisory Unit on Disease-related Undernutrition, Oslo University Hospital, Oslo, Norway; Dept. of Clinical Services, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
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9
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Jones D, Knight SR, Sremanakova J, Lapitan MCM, Qureshi AU, Drake TM, Tabiri S, Ghosh D, Thomas M, Kingsley PA, Sundar S, Maimbo M, Yenli E, Shaw C, Valparaiso AP, Bhangu A, Magill L, Norrie J, Roberts TE, Theodoratou E, Weiser TG, Harrison EM, Burden ST. Malnutrition and nutritional screening in patients undergoing surgery in low and middle income countries: A systematic review. JCSM CLINICAL REPORTS 2022. [DOI: 10.1002/crt2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Debra Jones
- School of Health Sciences University of Manchester Manchester UK
| | - Stephen R. Knight
- Centre for Medical Informatics, Usher Institute University of Edinburgh Edinburgh UK
| | - Jana Sremanakova
- School of Health Sciences University of Manchester Manchester UK
| | - Marie Carmela M. Lapitan
- Department of Surgery, Institute of Clinical Epidemiology, National Institutes of Health University of the Philippines Manila Philippines
| | - Ahmad U. Qureshi
- Department of General Surgery Services Institute of Medical Sciences Lahore Pakistan
| | - Thomas M. Drake
- Centre for Medical Informatics, Usher Institute University of Edinburgh Edinburgh UK
| | - Stephen Tabiri
- Department of Surgery, School of Medicine University for Development Studies Tamale Ghana
| | - Dhruva Ghosh
- Department of Paediatric Surgery Christian Medical College Ludhiana India
| | - Maria Thomas
- Department of Paediatric Surgery Christian Medical College Ludhiana India
| | - Pamela A. Kingsley
- Department of Radiation Oncology Christian Medical College Ludhiana India
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
| | - Mayaba Maimbo
- Department of General Surgery Kitwe Teaching Hospital Kitwe Zambia
| | - Edwin Yenli
- Department of Surgery, School of Medicine University for Development Studies Tamale Ghana
| | - Catherine Shaw
- Centre for Medical Informatics, Usher Institute University of Edinburgh Edinburgh UK
| | - Apple P. Valparaiso
- Department of Surgery, Institute of Clinical Epidemiology, National Institutes of Health University of the Philippines Manila Philippines
| | - Aneel Bhangu
- Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
| | - Laura Magill
- Institute of Applied Health Research University of Birmingham Birmingham UK
| | - John Norrie
- Centre for Global Health, Usher Institute University of Edinburgh Edinburgh UK
| | - Tracey E. Roberts
- Institute of Applied Health Research University of Birmingham Birmingham UK
| | - Evropi Theodoratou
- Centre for Global Health, Usher Institute University of Edinburgh Edinburgh UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer University of Edinburgh Edinburgh UK
| | - Thomas G. Weiser
- Department of Surgery Stanford University Stanford CA USA
- Department of Clinical Surgery University of Edinburgh Edinburgh UK
| | - Ewen M. Harrison
- Centre for Medical Informatics, Usher Institute University of Edinburgh Edinburgh UK
| | - Sorrel T. Burden
- School of Health Sciences University of Manchester Manchester UK
- Intestinal Failure Unit Salford Royal NHS Foundation Trust Manchester UK
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Chen X, Li D, Liu Y, Zhu L, Jia Y, Gao Y. Nutritional risk screening 2002 scale and subsequent risk of stroke-associated infection in ischemic stroke: The REMISE study. Front Nutr 2022; 9:895803. [PMID: 36159470 PMCID: PMC9505510 DOI: 10.3389/fnut.2022.895803] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background and aim Stroke-associated infection (SAI) is a common and serious complication in patients with IS. This study aimed to evaluate the impact of nutritional status at admission assessed on SAI, explore the predictive value of the Nutritional Risk Screening 2002 (NRS-2002 for SAI. Methods This study included patients with IS who were admitted to five major hospitals in Chengdu from January 2017 to February 2019. The nutritional status was assessed using the NRS-2002 tool. Logistic regression analysis was performed to explore the predictive value of NRS-2002 for SAI. Results A total of 594 patients with IS were included in this study; among them, 215 (36.20%) patients were at risk of malnutrition, and 216 (36.36%) patients developed SAI. The area under the curve of the NRS-2002 scores was smaller than A2DS2 (0.644 vs. 0.779), and NRS-2002 improved the predictive values of the A2DS2 score(Age, Atrial fibrillation, Dysphagia, Sex, Stroke Severity) for SAI (P < 0.001). Logistic regression analysis showed that patients with NRS-2002 score ≥ 3 had significantly higher risks of SAI (NRS-2002: odds ratios (OR) = 1.450, 95% confidence interval (CI): 1.184-1.692, P < 0.001). Conclusion NRS-2002 is a useful and simple tool for identifying the risk of SAI. Malnutrition is related to the development of SAI. Malnourished patients with stroke may benefit from further nutritional supplements and management.
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Affiliation(s)
- Xiaoli Chen
- Department of Emergency Medicine and West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine and West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Emergency Medicine and West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Zhu
- Department of Emergency Medicine and West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Jia
- Department of General Practice and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yongli Gao
- Department of Emergency Medicine and West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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11
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A long-term nutritional assessment of maxillary cancer patients undergoing prosthodontic rehabilitation after surgery: A longitudinal study. J Oral Biol Craniofac Res 2022; 12:702-708. [DOI: 10.1016/j.jobcr.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/16/2022] [Accepted: 08/13/2022] [Indexed: 11/19/2022] Open
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12
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Huang Y, Chen Y, Wei L, Hu Y, Huang L. Comparison of three malnutrition risk screening tools in identifying malnutrition according to Global Leadership Initiative on Malnutrition criteria in gastrointestinal cancer. Front Nutr 2022; 9:959038. [PMID: 35990353 PMCID: PMC9386177 DOI: 10.3389/fnut.2022.959038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Malnutrition is common in patients with gastrointestinal cancer. The first step in the diagnosis of malnutrition is to evaluate the malnutrition risk by validated screening tools according to the Global Leadership Initiative on Malnutrition (GLIM). This study aimed to determine the best nutritional screening tool for identifying GLIM malnutrition and validate the performance of these tools in different age subgroups. Materials and methods We did a prospective cohort study of patients who were diagnosed with gastrointestinal cancer from February 2016 to November 2019. The sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and area under the receiver operating characteristic (ROC) curve (AUC) of three screening tools (Nutritional risk screening 2002 (NRS 2002), Geriatric Nutritional Risk Index (GNRI), MNA-SF) were calculated. Results A total of 488 patients were enrolled, and 138 patients (28.27%) were malnutrition according to the GLIM criteria. The consistency of NRS 2002, GNRI, and MNA-SF with GLIM-defined malnutrition was 74.8, 72.1, and 71.1%, respectively. In the subgroup analysis of young patients (<65 years), NRS 2002 exhibited the best discrimination with the AUC of 0.724 (95% CI, 0.567–0.882), the sensitivity of 64.3% (95% CI, 35.6–86.0), and the specificity of 80.6% (95% CI, 69.2–88.6). In patients older than 65 years, MNA-SF exhibited the best discrimination with the AUC of 0.764 (95% CI, 0.714–0.814), the sensitivity of 82.3% (95% CI, 74.1–88.3), and the specificity of 70.5% (95% CI, 64.7–75.7). Conclusions Nutritional risk screening 2002 (NRS 2002) is the best malnutrition screening tool in gastrointestinal cancer patients younger than 65 years, and MNA-SF is the best malnutrition screening tool in patients older than 65 years. It is necessary to select targeted nutritional screening tools according to the difference in age.
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Affiliation(s)
- Yangyang Huang
- Department of Geriatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Chen
- Department of Geriatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Wei
- Department of Geriatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Hu
- Department of Geriatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liya Huang
- Department of Geriatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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The prognostic value of the Controlling Nutritional Status score on patients undergoing nephrectomy for upper tract urothelial carcinoma or renal cell carcinoma: a systematic review and meta-analysis. Br J Nutr 2022; 128:217-224. [PMID: 34338171 DOI: 10.1017/s0007114521002889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In recent years, the controlling nutritional status (CONUT) score has increasingly became an effective indicator associated with tumor prognosis. This study was conducted to synthesise data on the prognostic value of CONUT score on patients with upper tract urothelial carcinoma (UTUC) or renal cell carcinoma (RCC) undergoing nephrectomy. We designed and performed a systematic analysis of studies that verified the correlation between preoperative CONUT score and prognosis for UTUC and RCC using PubMed, Web of Science and Embase. The conclusion was clarified by pooled hazard ratios (HR) and 95% confidence intervals (95% CI). Subgroup analysis were further conducted in accordance with different primary tumor. Six studies involving 3529 patients were included in this evidence synthesis, which revealed that the CONUT score had a potential role to predict the survival of UTUC and RCC patients accepting surgery. Pooled analysis showed that the overall survival (OS, HR 2·32, p < 0·0001), cancer-specific survival (CSS, HR 2·68, p < 0·0001) and disease-free survival (DFS, HR 1·62, p < 0·00001) were inferior in the high CONUT score group when compared with low score group. Subgroup analysis revealed that this result was in line with UTUC (OS: HR 1·86, p = 0·02; CSS: HR 2·24, p = 0·01; DFS: HR 1·54, p < 0·00001) and RCC (OS: HR 3·05, p < 0·00001; CSS: HR 3·47, p < 0·00001; DFS: HR 2·21, p = 0·0005) patients respectively. Consequently, the CONUT score is a valuable preoperative index to predict the survival of patients with UTUC or RCC undergoing nephrectomy.
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Yurut Caloglu V, Akmansu M, Yalman D, Karabulut Gul S, Kocak Z, Arican Alicikus Z, Serarslan A, Akyurek S, Zoto Mustafayev T, Demiroz C, Colpan Oksuz D, Kanyilmaz G, Altinok P, Kaytan Saglam E, Yentek Balkanay A, Akboru H, Keven E, Yildirim B, Onal C, Igdem S, Ozkan E, Ozdener F, Caloglu M. Evaluation of Nutritional Status and Anxiety Levels in Patients Applying to the Radiation Oncology Outpatient Clinic during the COVID-19 Pandemic: Turkish Society for Radiation Oncology Group Study (TROD 12:02). Nutr Cancer 2022; 74:3601-3610. [DOI: 10.1080/01635581.2022.2093386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Muge Akmansu
- Department of Radiation Oncology, Gazi University, Ankara, Turkey
| | - Deniz Yalman
- Department of Radiation Oncology, Ege University, Izmir, Turkey
| | - Sule Karabulut Gul
- Department of Radiation Oncology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey
| | - Zafer Kocak
- Department of Radiation Oncology, Trakya University, Edirne, Turkey
| | | | | | - Serap Akyurek
- Department of Radiation Oncology, Ankara University, Ankara, Turkey
| | | | - Candan Demiroz
- Department of Radiation Oncology, Uludag University, Bursa, Turkey
| | - Didem Colpan Oksuz
- Department of Radiation Oncology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Gul Kanyilmaz
- Department of Radiation Oncology, Necmettin Erbakan University, Konya, Istanbul
| | - Pelin Altinok
- Department of Radiation Oncology, University of Health Sciences Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Esra Kaytan Saglam
- Department of Radiation Oncology, Istanbul University Medical Faculty, Istanbul, Turkey
| | - Ayben Yentek Balkanay
- Department of Radiation Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Halil Akboru
- Department of Radiation Oncology, University of Health Sciences, Okmeydani Hospital, Istanbul, Turkey
| | - Emine Keven
- Department of Radiation Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Berna Yildirim
- Department of Radiation Oncology, Adana Baskent University, Adana, Istanbul
| | - Cem Onal
- Department of Radiation Oncology, Adana Baskent University, Adana, Istanbul
| | - Sefik Igdem
- Department of Radiation Oncology, Istanbul Bilgi University, Istanbul, Turkey
| | - Emre Ozkan
- Medical Department, Nutricia, Advanced Medical Nutrition, Istanbul, Turkey
| | - Fatih Ozdener
- School of Medicine, Department of Pharmacology, Bahcesehir University, İstanbul, Turkey
| | - Murat Caloglu
- Department of Radiation Oncology, Trakya University, Edirne, Turkey
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Su CH, Lin SY, Lee CL, Lin CS, Hsu PS, Lee YS. Prediction of Mortality in Older Hospitalized Patients after Discharge as Determined by Comprehensive Geriatric Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137768. [PMID: 35805424 PMCID: PMC9265607 DOI: 10.3390/ijerph19137768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
Several dimensional impairments regarding Comprehensive Geriatric Assessment (CGA) have been shown to be associated with the prognosis of older patients. The purpose of this study is to investigate mortality prediction factors based upon clinical characteristics and test in CGA, and then subsequently develop a prediction model to classify both short- and long-term mortality risk in hospitalized older patients after discharge. A total of 1565 older patients with a median age of 81 years (74.0−86.0) were consecutively enrolled. The CGA, which included assessment of clinical, cognitive, functional, nutritional, and social parameters during hospitalization, as well as clinical information on each patient was recorded. Within the one-year follow up period, 110 patients (7.0%) had died. Using simple Cox regression analysis, it was shown that a patient’s Length of Stay (LOS), previous hospitalization history, admission Barthel Index (BI) score, Instrumental Activity of Daily Living (IADL) score, Mini Nutritional Assessment (MNA) score, and Charlson’s Comorbidity Index (CCI) score were all associated with one-year mortality after discharge. When these parameters were dichotomized, we discovered that those who were aged ≥90 years, had a LOS ≥ 12 days, an MNA score < 17, a CCI ≥ 2, and a previous admission history were all independently associated with one-year mortality using multiple cox regression analyses. By applying individual scores to these risk factors, the area under the receiver operating characteristics curve (AUC) was 0.691 with a cut-off value score ≧ 3 for one year mortality, 0.801 for within 30-day mortality, and 0.748 for within 90-day mortality. It is suggested that older hospitalized patients with varying risks of mortality may be stratified by a prediction model, with tailored planning being subsequently implemented.
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Affiliation(s)
- Chih-Hsuan Su
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (C.-H.S.); (S.-Y.L.); (C.-S.L.)
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Shih-Yi Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (C.-H.S.); (S.-Y.L.); (C.-S.L.)
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan
| | - Chia-Lin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402010, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Chu-Sheng Lin
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (C.-H.S.); (S.-Y.L.); (C.-S.L.)
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402010, Taiwan
| | - Pi-Shan Hsu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung Hsing University, Taichung 402010, Taiwan
| | - Yu-Shan Lee
- Center for Geriatrics & Gerontology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (C.-H.S.); (S.-Y.L.); (C.-S.L.)
- Division of Neurology, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Correspondence:
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Kutnik P, Borys M, Buszewicz G, Piwowarczyk P, Osak M, Teresiński G, Czuczwar M. Serum Ketone Levels May Correspond with Preoperative Body Weight Loss in Patients Undergoing Elective Surgery: A Single-Center, Prospective, Observational Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116573. [PMID: 35682159 PMCID: PMC9180013 DOI: 10.3390/ijerph19116573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023]
Abstract
Although nutritional-risk scoring systems allow the determination of the patient’s malnutrition at admission, additional tools might be useful in some clinical scenarios. Previous medical history could be unavailable in unconscious or demented patients. This study aimed to assess the ketone bodies serum levels in patients undergoing elective surgeries and to determine the possible correlation between ketone bodies serum levels and preoperative body weight loss. The study included 21 patients who underwent elective surgery. Hyperketonemia, defined as ketone bodies over 1 mmol/L, was observed in seven (33.3%) patients. Patients with hyperketonemia had significantly higher preoperative percentage body weight loss (p = 0.04) and higher nutritional risk scores prior to surgery (p = 0.04). Serum glucose and the percentage of body weight loss were associated with increased ketone bodies serum levels (Odds Ratios: 0.978 (0.961–0.996, p = 0.019) and 1.222 (1.0–1.492, p = 0.05), respectively). A significant linear correlation was found between the percentage of body weight loss and both ketones bodies (r2 = 0.25, p = 0.02) and albumin serum levels (r2 = 0.19, p = 0.04). Our study’s results might suggest a positive association between preoperative body weight loss and ketone bodies serum levels. The observation between increased ketone bodies serum levels in patients and preoperative body mass loss merits further research.
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Affiliation(s)
- Paweł Kutnik
- II Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland; (M.B.); (P.P.); (M.C.)
- Correspondence:
| | - Michał Borys
- II Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland; (M.B.); (P.P.); (M.C.)
| | - Grzegorz Buszewicz
- Laboratory of Forensic Toxicology, Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (G.B.); (M.O.)
| | - Paweł Piwowarczyk
- II Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland; (M.B.); (P.P.); (M.C.)
| | - Marcin Osak
- Laboratory of Forensic Toxicology, Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland; (G.B.); (M.O.)
| | - Grzegorz Teresiński
- Department of Forensic Medicine, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland;
| | - Mirosław Czuczwar
- II Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland; (M.B.); (P.P.); (M.C.)
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Wagenaar MC, van der Putten AA, Douma JG, van der Schans CP, Waninge A. Definitions, signs, and symptoms of constipation in people with severe or profound intellectual disabilities: A systematic review. Heliyon 2022; 8:e09479. [PMID: 35663754 PMCID: PMC9156888 DOI: 10.1016/j.heliyon.2022.e09479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/06/2022] [Accepted: 05/13/2022] [Indexed: 10/25/2022] Open
Abstract
Background It is difficult to diagnose constipation for people with severe or profound intellectual disabilities. Definitions for this are ambiguous, and the symptoms and signs are often unnoticed. The aim of this study is to identify clear definitions of constipation for people with different levels of intellectual disabilities and to identify signs and symptoms. Method Guided by the PRISMA statement, a systematic review of the literature was conducted within electronic databases MEDLINE, Embase, CINAHL, Cochrane, and PsycINFO. Definitions, signs, and symptoms were extracted and the quality of definitions was assessed. Results In total, 24 studies were included. Quality of definitions ranged from poor to good quality. Standard and referenced definitions were used in ten studies, a self-composed definition was employed in eleven studies; and three studies did not refer to a source of the definition. The self-composed definitions had not been evaluated after being used for the target group, and no scientific substantiation was available. A broad range of signs and symptoms were described. Conclusions No substantiated definition has been ascertained for constipation for people with severe or profound intellectual disabilities. Further research will be necessary to identify which signs and symptoms are important for defining constipation in this target group.
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Affiliation(s)
- Marjolijn C. Wagenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, the Netherlands
| | | | - Johanna G. Douma
- Department of Inclusive and Special Needs Education, University of Groningen, Groningen, the Netherlands
| | - Cees P. van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, the Netherlands
- Department Health Psychology, University Medical Centre Groningen, Groningen, the Netherlands
- Department Rehabilitation Medicine, University Medical Centre Groningen, Groningen, the Netherlands
| | - Aly Waninge
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, the Netherlands
- Department Health Psychology, University Medical Centre Groningen, Groningen, the Netherlands
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Speranza E, Santarpia L, Marra M, Di Vincenzo O, Naccarato M, De Caprio C, Morlino D, D'Onofrio G, Contaldo F, Pasanisi F. Nutritional Screening and Anthropometry in Patients Admitted From the Emergency Department. Front Nutr 2022; 9:816167. [PMID: 35237641 PMCID: PMC8882738 DOI: 10.3389/fnut.2022.816167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Due to the high prevalence of malnutrition among hospitalized patients, screening and assessment of nutritional status should be routinely performed upon hospital admission. The main objective of this observational study was to evaluate the prevalence of and the risk for malnutrition, as identified by using three nutritional screening tests, and to observe whether some anthropometric and functional parameters used for nutritional evaluation were related to these test scores. Methods This single-center observational study included 207 patients admitted from the emergency department for hospitalization in either the internal medicine or surgery units of our institution from September 2017 to December 2018. The prevalence of malnutrition among this patient sample was evaluated by using the Nutritional Risk Screening (NRS-2002), the Subjective Global Assessment (SGA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Body mass index (BMI), bioimpedance analysis (BIA), handgrip strength (HGS) and calf circumference (CC) assessments were also performed. Results According to the NRS-2002, 93% of the patients were at no risk or at low nutritional risk (NRS score < 3), and 7% were at a high nutritional risk (NRS score ≥ 3). On the other hand, according to the SGA, 46.3% of the patients were well-nourished (SGA-a), 49.8% were moderately malnourished (SGA-b), and 3.9% were severely malnourished (SGA-c). Finally, according to the GLIM criteria, 18% patients were malnourished. Body weight, body mass index (BMI), phase angle (PhA), CC and HGS were significantly lower in the patients with NRS scores ≥ 3, SGA-c and in patients with stage 1 and stage 2 malnutrition, according to the GLIM criteria. Conclusion The NRS-2002, the SGA and the GLIM criteria appear to be valuable tools for the screening and assessment of nutritional status. In particular, the lowest NRS-2002, SGA and GLIM scores were associated with the lowest PhA and CC. Nevertheless, a weekly re-evaluation of patients with better screening and assessment scores is recommended to facilitate early detection of changes in nutritional status.
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Association of proteomic markers with nutritional risk and response to nutritional support: a secondary pilot study of the EFFORT trial using an untargeted proteomics approach. Clin Nutr ESPEN 2022; 48:282-290. [DOI: 10.1016/j.clnesp.2022.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/05/2022] [Accepted: 01/27/2022] [Indexed: 11/23/2022]
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de Cáceres C, Rico T, Abreu C, Velasco AI, Lozano R, Lozano MC. Caloric adequacy of parenteral nutrition and its influence on the clinical outcome of hospitalised patients. Nutr Health 2022; 29:277-285. [PMID: 35023408 DOI: 10.1177/02601060211070108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Background: The adaptation of Parenteral Nutrition (PN) to actual energy requirements of hospitalised patients is essential, since excessive and insufficient nutritional intake have been associated with poor clinical outcomes. Aim: To evaluate the adaptation of prescribed PN to the estimated nutritional requirements using three predictive equations and the influence of excessive/insufficient nutrient intake on patient clinical outcomes (nutritional parameters, metabolic and infectious complications). Methods: Prospective, observational study in hospitalised patients nutritionally assessed. Data was collected the first and fifth/sixth day of PN with clinical (infection, length of hospital stay), biochemical (visceral proteins, cholesterol, glucose, triglycerides, lymphocytes, CRP) and anthropometric parameters (skin folds, height, weight). Theoretical requirements were calculated using Harris-Benedict (HB), Mifflin-St Jeor (MF) and 25 Kcal/Kg/day formulas. The HB formula was used to compare estimated and provided requirements. Results: A total of 94 patients (mean: 72 ± 13.7 years old) were included with initial mean weight and height of 69.2 Kg and 162.8 cm, respectively (mean BMI: 26.1 Kg/m2). No statistically significant differences were found between the actual (1620 Kcal/day) and estimated caloric mean calculated with HB (1643 Kcal/day) and MF (1628 Kcal/day). When comparing with the caloric estimation, 31.9% of patients were underfed, while 14.9% were overfed. Intergroup analysis demonstrated significant variations in albumin, prealbumin, glucose, cholesterol, triglycerides and MUAC, with a significant increase of hyperglycaemia (+37.86; p < 0.05) and hypertriglyceridemia (+63.10; p < 0.05), being higher in overfed patients. Conclusion: In our study, inadequate nutrient intake was associated with a higher degree of hyperglycaemia and hypertriglyceridemia, without positive impact on anthropometric parameters.
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Affiliation(s)
- Carmen de Cáceres
- Pharmacy Department, 222051Hospital General de Segovia, Segovia, Spain
| | - Teresa Rico
- Pharmacy Department, 222051Hospital General de Segovia, Segovia, Spain
| | - Cristina Abreu
- Endocrinology and Nutrition Service, 222051Hospital General de Segovia, Segovia, Spain
| | | | - Rafael Lozano
- 73076Faculty of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain
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Oh SE, Park JS, Jeung HC. Pre-treatment Nutritional Risk Assessment by NRS-2002 Predicts Prognosis in Patients With Advanced Biliary Tract Cancer: A Single Center Retrospective Study. Clin Nutr Res 2022; 11:183-193. [PMID: 35949556 PMCID: PMC9348911 DOI: 10.7762/cnr.2022.11.3.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 11/25/2022] Open
Abstract
We investigated the predictors of survival in patients with advanced BTC according to their baseline nutritional status estimated by the Nutritional Risk Screening (NRS)-2002. From September 2006 to July 2017, we reviewed the data of 601 inpatients with BTC. Data on demographic and clinical parameters was collected from electronic medical records, and overall survival (OS) and progression-free survival were analyzed using the Kaplan-Meier method and the stepwise Cox regression analysis. Patients with an NRS-2002 score of ≤ 2, 3, and ≥ 4 were respectively classified as “no risk,” “moderate risk,” “high risk.” Following initial NRS-2002 score, 333 patients (55%) were classified as “no-risk,” 109 patients (18%) as “moderate-risk,” and 159 patients (27%) as “high-risk.” Survival analysis demonstrated significant differences in the median OS: “no-risk”: 12.6 months (95% confidence interval [CI], 11.5–13.7); “moderate-risk”: 6.1 months (95% CI, 4.3–8.0); and “high-risk”: 3.9 months (95% CI, 3.2–4.6) (p < 0.001). NRS-2002 score was an independent factor for OS (hazard ratio [HR], 1.616 for “moderate-risk”, 95% CI, 1.288–2.027, p < 0.001; HR, 2.121 for “high-risk”, 95% CI, 1.722–2.612, p < 0.001), along with liver metastasis, peritoneal seeding, white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, cholesterol, carcinoembryonic antigen, and carbohydrate antigen 19-9. In conclusion, baseline NRS-2002 is an appropriate method for discriminating those who are already malnourished and who have poor prognosis in advanced BTC patient. Significance of these results merit further validation to be integrated in the routine practice to improve quality of care in BTC patients.
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Affiliation(s)
- Se Eung Oh
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Juong Soon Park
- Department of Clinical Nutrition, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Hei-Cheul Jeung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Pancreato-biliary Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
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22
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Madril P, Golian P, Nahikian-Nelms M, Hinton A, Hart PA, Roberts KM. Identification of Malnutrition Risk Using Malnutrition Screening Tool in an Ambulatory Pancreas Clinic. Pancreas 2022; 51:94-99. [PMID: 35195601 PMCID: PMC8887787 DOI: 10.1097/mpa.0000000000001954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of this project was to assess malnutrition risk in a well-defined cohort of pancreatic diseases. METHODS We performed a retrospective, cross-sectional study of 401 subjects with available malnutrition screening tool scores who received care at a single outpatient pancreas clinic during a 6-month study period. Univariate analyses were performed to compare demographic, anthropometric, symptoms/diseases, and risk for malnutrition characteristics across 3 strata of diseases: acute pancreatitis (n = 141), chronic pancreatitis (n = 193), and other pancreatic diagnoses (n = 67). RESULTS A total of 18% of subjects were identified as at risk for malnutrition, including 25% who reported involuntary weight loss and/or decreased appetite. Subjects categorized as at risk for malnutrition were more likely to have gastrointestinal symptoms. Although the nutrition consultation rates were higher in subjects at risk for malnutrition (P = 0.03), 66% did not receive a clearly indicated dietary evaluation or management recommendations. One fifth of all patients in an ambulatory pancreas clinic are identified as at risk for malnutrition using a simple, validated tool. CONCLUSIONS The majority of patients at increased risk for nutritional complications did not receive nutritional recommendations.
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Affiliation(s)
- Peter Madril
- From the School of Health and Rehabilitation Sciences, The Ohio State University
| | - Paige Golian
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | | | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH
| | - Philip A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Kristen M Roberts
- From the School of Health and Rehabilitation Sciences, The Ohio State University
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23
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Mey JT, Rath MC, McLaughlin K, Galang M, Lynch K, DiMattio J, Nason H, Yang S, Melillo CA, Grove DE, Tonelli AR, Heresi GA, Kirwan JP, Dweik RA. The breath print represents a novel biomarker of malnutrition in pulmonary arterial hypertension: A proof of concept study. JPEN J Parenter Enteral Nutr 2021; 45:1645-1652. [PMID: 34633675 PMCID: PMC9244406 DOI: 10.1002/jpen.2277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The breath print is a quantitative measurement of molecules in exhaled breath and represents a new frontier for biomarker identification. It is unknown whether this state-of-the-art, noninvasive method can detect malnutrition. We hypothesize that individuals with malnutrition will present with a distinguishable breath print. METHODS We conducted a retrospective chart review on patients with previously analyzed breath samples to identify malnutrition. Breath was analyzed by selected-ion flow-tube mass spectrometry. Registered dietitians conducted a retrospective chart review to collect malnutrition diagnoses and nutrition status indicators. Patients were categorized into one of four groups: pulmonary arterial hypertension (PAH), PAH with malnutrition (PAH-Mal), control, and control with malnutrition (Control-Mal), based on the malnutrition diagnosis present in the patient's chart. Principle component analysis was conducted to characterize the breath print. A logistic regression model with forward selection was used to detect the best breath predictor combination of malnutrition. RESULTS A total of 74 patients met inclusion criteria (PAH: 52; PAH-Mal: 10; control: 10; Control-Mal: 2). Levels of 1-octene (PAH-Mal, 5.1 ± 1.2; PAH, 12.5 ± 11.2; P = 0.005) and ammonia (PAH-Mal, 14.6 ± 15.8; PAH, 56.2 ± 64.2; P = 0.013) were reduced in PAH-Mal compared with PAH. The combination of 1-octene (P = 0.010) and 3-methylhexane (P = 0.045) distinguished malnutrition in PAH (receiver operating characteristic area under the curve: 0.8549). CONCLUSIONS This proof of concept study provides the first evidence that the breath print is altered in malnutrition. Larger prospective studies are needed to validate these results and establish whether breath analysis may be a useful tool to screen for malnutrition in the clinical setting.
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Affiliation(s)
- Jacob T. Mey
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Mary C. Rath
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Marianne Galang
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kathryn Lynch
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaime DiMattio
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hillary Nason
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA,Nutrition Department, Case Western Reserve University, Cleveland, Ohio, USA
| | - Shengping Yang
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Celia A. Melillo
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David E. Grove
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - John P. Kirwan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Raed A. Dweik
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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24
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Gao Q, Cheng Y, Li Z, Tang Q, Qiu R, Cai S, Xu X, Peng J, Xie H. Association Between Nutritional Risk Screening Score and Prognosis of Patients with Sepsis. Infect Drug Resist 2021; 14:3817-3825. [PMID: 34557005 PMCID: PMC8455294 DOI: 10.2147/idr.s321385] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Malnutrition is one of the most critical factors affecting patients’ risk of infection and length of stay, and it may affect the prognosis of patients with sepsis. There have been no studies that have applied nutritional risk screening tools to stratify patients with sepsis according to prognosis. Methods We retrospectively analyzed the clinical data of 425 adult sepsis inpatients who were grouped based on nutritional risk screening (NRS) score, including a nutrition score, disease severity score, and age score. Prognostic factors were analyzed using univariate and multivariate regression analyses. Results Of the enrolled patients, 174 had an NRS score of ≥3; these patients were older and had a longer hospitalization time but lower body mass index (BMI), albumin (ALB) than others. Univariate Cox regression analysis showed that age, ALB, C-reactive protein (CRP), and NRS score were significantly (P<0.05) associated with in-hospital mortality. Multivariate analysis showed that age (hazard ratio [HR]=1.020, 95% confidence interval [CI]: 1.005–1.036; P=0.008) and ALB (HR=0.924, 95% CI: 0.885–0.966; P<0.001) were independent risk factors for sepsis-related mortality. The Kaplan–Meier analysis revealed that the cumulative in-hospital mortality of sepsis patients with an NRS score of ≥3 was significantly higher than that of patients with an NRS score of <3 (P=0.022). Conclusion NRS scores can effectively risk stratify sepsis patients. Patients with high NRS scores should be monitored more closely to halt further disease progression.
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Affiliation(s)
- Qiqing Gao
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Yao Cheng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Zhuohong Li
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Qingyun Tang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Rong Qiu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Shaohang Cai
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xuwen Xu
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Hongyan Xie
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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Muthanandam S, Muthu J. Understanding Cachexia in Head and Neck Cancer. Asia Pac J Oncol Nurs 2021; 8:527-538. [PMID: 34527782 PMCID: PMC8420913 DOI: 10.4103/apjon.apjon-2145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/21/2021] [Indexed: 01/06/2023] Open
Abstract
One of the major comorbidities of cancer and cancer therapy is posing a global health problem in cancer cachexia. Cancer cachexia is now considered a multifactorial syndrome that presents with drastic loss of body weight, anorexia, asthenia, and anemia. Head and neck cancer (HNC) patients are at a greater risk for development and severity of cachexia syndrome as there is direct involvement of structures associated with nutritional intake. Yet, the scientific evidence, approach, and management of cachexia in HNCs are yet to be largely explored. The article aims to succinctly review the concepts of cancer cachexia with relevance to HNCs and summarizes the current findings from recent research.
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Affiliation(s)
- Sivaramakrishnan Muthanandam
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (Deemed to be) University, Puducherry, India
| | - Jananni Muthu
- Department of Periodontology, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (Deemed to be) University, Puducherry, India
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26
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Patient-Generated Subjective Global Assessment (PG-SGA) predicts length of hospital stay in lung adenocarcinoma patients. Br J Nutr 2021; 127:1543-1548. [PMID: 34503589 PMCID: PMC9044215 DOI: 10.1017/s0007114521003500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence of malnutrition is high among oncology patients in Northern China. Malnutrition is related to the longer hospital stay, and it can be used to predict the prognostic outcome of patients. This work focused on investigating the relationship of nutritional condition with the length of hospital stay (LOS) in Northern Chinese patients with lung adenocarcinoma (LUAD). The Patient-Generated Subjective Global Assessment (PG-SGA), Nutritional Risk Screening 2002 (NRS 2002) score, recent weight loss and BMI were assessed in a probabilistic sample of 389 LUAD patients without epidermal growth factor receptor (EGFR) mutations. This study collected the demographic and clinical features of patients in a prospective manner. Then, we examined the association of nutritional status with LOS among the population developing LUAD. According to the PG-SGA, 63 (16·3 %), 174 (44·7 %) and 78 (20·1 %) patients were at risk for undernutrition, moderate undernutrition and severe undernutrition, respectively. Nutritional risk was found in 141 (36·2 %) patients based on the NRS 2002. The average LOS for tumour patients in Northern China was 12·5 d. At admission, a risk of undernutrition or undernutrition according to the PG-SGA (P < 0·001), NRS 2002 (P < 0·001) and latest weight loss (P < 0·001) predicted the longer LOS. LOS was related to nutritional status and hospitalisation expenses (P < 0·001). LUAD patients who stayed in the ICU had a poorer nutritional status and a longer LOS (P < 0·001). In Northern Chinese patients with LUAD, a risk for undernutrition evaluated by the PG-SGA, the NRS 2002 and recent weight loss, but not BMI, could predict a longer LOS.
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27
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Struja T, Wolski W, Schapbach R, Mueller B, Laczko E, Schuetz P. Association of metabolomic markers and response to nutritional support: A secondary analysis of the EFFORT trial using an untargeted metabolomics approach. Clin Nutr 2021; 40:5062-5070. [PMID: 34455264 DOI: 10.1016/j.clnu.2021.07.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS The EFFORT trial reported a substantial risk reduction for adverse events and mortality in medical in-patients receiving a nutritional support intervention. With the use of an untargeted metabolomics approach, we investigated the prognostic and therapeutic potential of metabolomic markers to understand, whether there are distinct metabolic patterns associated with malnutrition risk as assessed by the Nutritional Risk screening (NRS 2002) score, the risk of 30-day mortality and the response to nutritional support, respectively. METHODS Out of the 2088 samples we randomly selected 120 blood samples drawn on day 1 after hospital admission and before treatment initiation. Samples were stratified by NRS 2002, treatment allocation (intervention vs. control), and mortality at 30 days, but not on the type of medical illness. We performed untargeted analysis by liquid chromatography mass spectrometry (LC-MS/MS). RESULTS We measured 1389 metabolites in 120 patients of which 81 (67.5%) survived until day 30. After filtering, 371 metabolites remained, and 200 were matched to one or more Human Metabolome Data Base (HMDB) entries. Between group analysis showed a slight distinction between the treatment groups for patients with a NRS 3, but not for those with NRS 4 and ≥ 5. C-statistic between those who died and survived at day 30 ranged from 0.49 (95% confidence interval 0.35-0.68) for a combination of 5 metabolites/predictors to 0.66 (95% confidence interval 0.53-0.79) for a combination of 100 metabolites. Pathway analysis found significant enrichment in the pathways for nitrogen, vitamin B3 (nicotinate and nicotinamide), leukotriene, and arachidonic acid metabolisms in nutritional support responders compared to non-responders. CONCLUSION In our heterogenous population of medical inpatients with different illnesses and comorbidities, metabolomic markers showed little prognostic and therapeutic potential for better phenotyping malnutrition and response to nutritional therapy. Future studies should focus on more selected patient populations to understand whether a metabolomic approach can advance the nutritional care of patients.
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Affiliation(s)
- Tristan Struja
- Medical University Clinic, Division of Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Aarau, Switzerland.
| | - Witold Wolski
- Functional Genomics Center Zurich, ETH and University of Zurich, Zurich, Switzerland.
| | - Ralph Schapbach
- Functional Genomics Center Zurich, ETH and University of Zurich, Zurich, Switzerland.
| | - Beat Mueller
- Medical University Clinic, Division of Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
| | - Endre Laczko
- Functional Genomics Center Zurich, ETH and University of Zurich, Zurich, Switzerland.
| | - Philipp Schuetz
- Medical University Clinic, Division of Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
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28
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Skeie E, Sygnestveit K, Nilsen RM, Harthug S, Koch AM, Tangvik RJ. Prevalence of patients "at risk of malnutrition" and nutritional routines among surgical and non-surgical patients at a large university hospital during the years 2008-2018. Clin Nutr 2021; 40:4738-4744. [PMID: 34237701 DOI: 10.1016/j.clnu.2021.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/03/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND & AIMS Being "at risk of malnutrition", which includes both malnutrition and the risk to be so, is associated with increased morbidity and mortality in both surgical and non-surgical patients. Several strategies and guidelines have been introduced to prevent and treat this, but the effects are scarcely investigated. This study aims to evaluate the long-term effects of these efforts by examining trends concerning: 1) the prevalence of patients «at risk of malnutrition» and 2) the use of nutritional support and diagnostic coding related to malnutrition over an 11-year period in a large university hospital. Moreover, we wanted to investigate if there was a difference in trends between surgical and non-surgical patients. METHODS From 2008 to 2018, Haukeland University Hospital, Norway, conducted 34 point-prevalence surveys to investigate the prevalence of patients «at risk of malnutrition», as defined by Nutritional Risk Screening 2002, and the use of nutritional support at the hospital. Diagnostic coding included ICD-10 codes related to malnutrition (E43, E44 and E46) at hospital discharge, which were extracted from the electronic patient journal. Trend analysis by calendar year was investigated using logistic regression models with and without adjustment for age (continuous), gender (male/female) and Charlson Comorbidity Index (none, mild, moderate or severe). RESULTS The number of patients included in the study was 18 933, where 52.1% were male and the median (25th, 75th percentile) age was 65 (51, 76) years. Of these, 5121 (27%) patients were identified to be «at risk of malnutrition». Fewer surgical patients (21.2%) were «at risk of malnutrition», as compared to non-surgical patients (30.9%) (p < 0.001). Adjusted trend analysis did not identify any change in the prevalence of patients «at risk of malnutrition» from 2008 to 2018. The percentage of patients «at risk of malnutrition» who received nutritional support increased from 61.6% in 2008 to 71.9% in 2018 (p < 0.001), with a range from 55.6 to 74.8%. This trend was seen for both surgical and non-surgical patients (p < 0.001 for both). Similarly, dietitians were more involved in the patients' treatment (range: 3.8-16.7%), and there was increased use of ICD-10 codes related to malnutrition during the study period (range: 13.0-41.8%) (p < 0.001). These trends were seen for both surgical patients and non-surgical patients (p < 0.001), despite use being less common for surgical patients, as compared to non-surgical patients (p < 0.001). CONCLUSIONS This large hospital study shows no apparent change in the prevalence of patients «at risk of malnutrition» from 2008 to 2018. However, more patients «at risk of malnutrition», both surgical and non-surgical, received nutritional support, treatment from a dietitian and a related ICD-10 code over the study period, indicating improved nutritional routines as a result of the implementation of nutritional guidelines and strategies.
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Affiliation(s)
- Eli Skeie
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Research and Development, Haukeland University Hospital, Bergen, Norway.
| | - Kari Sygnestveit
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway; Norwegian National Advisory Unit on Disease-related Undernutrition, Oslo University Hospital, Oslo, Norway
| | - Roy M Nilsen
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Stig Harthug
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Anne Mette Koch
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Randi J Tangvik
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway; Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
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Reber E, Schönenberger KA, Vasiloglou MF, Stanga Z. Nutritional Risk Screening in Cancer Patients: The First Step Toward Better Clinical Outcome. Front Nutr 2021; 8:603936. [PMID: 33898493 PMCID: PMC8058175 DOI: 10.3389/fnut.2021.603936] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/15/2021] [Indexed: 01/04/2023] Open
Abstract
Disease-related malnutrition is highly prevalent among cancer patients, with 40-80% suffering from it during the course of their disease. Malnutrition is associated with numerous negative outcomes such as: longer hospital stays, increased morbidity and mortality rates, delayed wound healing, as well as decreased muscle function, autonomy and quality of life. In cancer patients, malnutrition negatively affects treatment tolerance (including anti-cancer drugs, surgery, chemo- and radiotherapy), increases side effects, causes adverse reactions, treatment interruptions, postoperative complications and higher readmission rates. Conversely, anti-cancer treatments are also known to affect body composition and impair nutritional status. Tailoring early nutritional therapy to patients' needs has been shown to prevent, treat and limit the negative consequences of malnutrition and is likely to improve overall prognosis. As the optimisation of treatment outcomes is top priority and evidence for nutritional therapy is growing, it is increasingly recognized as a significant intervention and an autonomous component of multimodal cancer care. The proactive implementation of nutritional screening and assessment is essential for patients suffering from cancer - given the interaction of clinical, metabolic, pharmacological factors with systemic inflammation; and suppressed appetite with accelerated muscle protein catabolism. At the same time, a nutritional care plan must be established, and adequate individualized nutritional intervention started rapidly. Screening tools for nutritional risk should be validated, standardized, non-invasive, quick and easy-to-use in daily clinical practice. Such tools must be able to identify patients who are already malnourished, as well as those at risk for malnutrition, in order to prevent or treat malnutrition and reduce negative outcomes. This review investigates the predictive value of commonly used screening tools, as well as the sensitivity and specificity of their individual components for improving clinical outcomes in oncologic populations. Healthcare professionals' awareness of malnutrition in cancer patients and the pertinence of early nutritional screening must be raised in order to plan the best possible intervention and follow-up during the patients' ordeal with the disease.
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Affiliation(s)
- Emilie Reber
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Katja A. Schönenberger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Maria F. Vasiloglou
- Artificial Organ (ARTORG) Centre for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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30
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Chen Z, Wu H, Jiang J, Xu K, Gao S, Chen L, Wang H, Li X. Nutritional risk screening score as an independent predictor of nonventilator hospital-acquired pneumonia: a cohort study of 67,280 patients. BMC Infect Dis 2021; 21:313. [PMID: 33794788 PMCID: PMC8013169 DOI: 10.1186/s12879-021-06014-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/23/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Currently, the association of nutritional risk screening score with the development of nonventilator hospital-acquired pneumonia (NV-HAP) is unknown. This study investigated whether nutritional risk screening score is an independent predictor of NV-HAP. METHODS This retrospective cohort study was conducted between September 2017 and June 2020 in a tertiary hospital in China. The tool of Nutritional Risk Screening 2002 (NRS-2002) was used for nutritional risk screening. A total score of ≥3 indicated a patient was "at nutritional risk." Logistic regression was applied to explore the association between the NRS score and NV-HAP. RESULTS A total of 67,280 unique patients were included in the study. The incidence of NV-HAP in the cohort for the NRS < 3 and ≥ 3 NRS group was 0.4% (232/62702) and 2.6% (121/4578), respectively. In a multivariable logistic regression model adjusted for all of the covariates, per 1-point increase in the NRS score was associated with a 30% higher risk of NV-HAP (OR = 1.30; 95%CI:1.19-1.43). Similarly, patients with NRS score ≥ 3 had a higher risk of NV-HAP with an odds ratio (OR) of 2.06 (confidence interval (CI): 1.58-2.70) than those with NRS score < 3. Subgroup analyses indicated that the association between the NRS score and the risk of NV-HAP was similar for most strata. Furthermore, the interaction analyses revealed no interactive role in the association between NRS score and NV-HAP. CONCLUSION NRS score is an independent predictor of NV-HAP, irrespective of the patient's characteristics. NRS-2002 has the potential as a convenient tool for risk stratification of adult hospitalized patients with different NV-HAP risks.
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Affiliation(s)
- Zhihui Chen
- Department of Epidemiology and Biostatistics, and Centre for Clinical Big Data Statistics, Second Affiliated Hospital, Zhejiang University College of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, China.,Department of Infection Control, Wenzhou people's Hospital, Wenzhou, China
| | - Hongmei Wu
- Department of Infection Control, Wenzhou people's Hospital, Wenzhou, China
| | - Jiehong Jiang
- XingLin Information Technology Company, Hangzhou, China
| | - Kun Xu
- XingLin Information Technology Company, Hangzhou, China
| | - Shengchun Gao
- Department of Infection Control, Wenzhou people's Hospital, Wenzhou, China
| | - Le Chen
- Department of Infection Control, Wenzhou people's Hospital, Wenzhou, China
| | - Haihong Wang
- Department of Infection Control, Wenzhou people's Hospital, Wenzhou, China
| | - Xiuyang Li
- Department of Epidemiology and Biostatistics, and Centre for Clinical Big Data Statistics, Second Affiliated Hospital, Zhejiang University College of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, China.
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31
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van Vliet IMY, Gomes-Neto AW, de Jong MFC, Bakker SJL, Jager-Wittenaar H, Navis GJ. Malnutrition screening on hospital admission: impact of overweight and obesity on comparative performance of MUST and PG-SGA SF. Eur J Clin Nutr 2021; 75:1398-1406. [PMID: 33589809 PMCID: PMC8416656 DOI: 10.1038/s41430-020-00848-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Traditional malnutrition screening instruments, including the Malnutrition Universal Screening Tool (MUST), strongly rely on low body mass index (BMI) and weight loss. In overweight/obese patients, this may result in underdetection of malnutrition risk. Alternative instruments, like the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), include characteristics and risk factors irrespective of BMI. Therefore, we aimed to compare performance of MUST and PG-SGA SF in malnutrition risk evaluation in overweight/obese hospitalized patients. SUBJECTS/METHODS We assessed malnutrition risk using MUST (≥1 = increased risk) and PG-SGA SF (≥4 = increased risk) in adult patients at hospital admission in a university hospital. We compared results for patients with BMI < 25 kg/m2 vs. BMI ≥ 25 kg/m2. RESULTS Of 430 patients analyzed (58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m2), 35% were overweight and 25% obese. Malnutrition risk was present in 16% according to MUST and 42% according to PG-SGA SF. In patients with BMI < 25 kg/m2, MUST identified 31% as at risk vs. 52% by PG-SGA SF. In patients with BMI ≥ 25 kg/m2, MUST identified 5% as at risk vs. 36% by PG-SGA SF. Agreement between MUST and PG-SGA SF was low (к = 0.143). Of the overweight/obese patients at risk according to PG-SGA SF, 83/92 (90%) were categorized as low risk by MUST. CONCLUSIONS More than one-third of overweight/obese patients is at risk for malnutrition at hospital admission according to PG-SGA SF. Most of them are not identified by MUST. Awareness of BMI-dependency of malnutrition screening instruments and potential underestimation of malnutrition risk in overweight/obese patients by using these instruments is warranted.
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Affiliation(s)
- Iris M Y van Vliet
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Antonio W Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Margriet F C de Jong
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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GÜZEL S, KESER A, KEPENEKCİ BAYRAM İ. Risk of malnutrition in general surgical patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.823458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Comparison of Nutrition Risk Screening 2002 and Subjective Global Assessment Form as Short Nutrition Assessment Tools in Older Hospitalized Adults. Nutrients 2021; 13:nu13010225. [PMID: 33466724 PMCID: PMC7828813 DOI: 10.3390/nu13010225] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to compare two widely recommended short nutrition assessment tools—Nutrition Risk Screening 2002 (NRS-2002) and Subjective Global Assessment Form (SGA)—with other Comprehensive Geriatric Assessment (CGA) measurements. The study included 622 consecutively hospitalized older subjects, aged 81.7 ± 7.8 years. The criteria to participate were the ability to communicate and given consent. Both NRS-2002 and SGA were inversely related to anthropometric measurements, functional assessment tests, Mini-Mental State Examination (MMSE) and positively associated with the Vulnerable Elders Survey-13 (VES-13) score. Results of SGA and NRS-2002 were not related to sex and 15-item Geriatric Depression Scale (GDS) score. Comparison of well-nourished subjects and patients with suggested problems with nutrition according to NRS-2002 (0–2 vs. 3–7) and SGA (A vs. B + C) gave comparable results. Both nutritional scales at given cut-off points similarly discriminated anthropometric data and other CGA tools in the populations of well-nourished vs. malnourished hospitalized older subjects. In conclusion, we can recommend using both NRS-2002 and SGA to detect malnutrition or risk of malnutrition in a routine clinical practice of the geriatric department ward.
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Belin CHS, Sarmento RA, Refosco LF, Bernardi JR. Description of a Nutrition Screening and Assessment Tool and Associations with Clinical Outcomes in Preterm Newborns. Nutr Clin Pract 2021; 36:1252-1261. [PMID: 33410545 DOI: 10.1002/ncp.10618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Preterm newborns have higher nutrition risk and mortality. Nutrition risk screening enables early intervention. This article evaluates a nutrition screening tool in a neonatal intensive care unit (NICU). METHOD Retrospective longitudinal study of preterm newborns (aged <37 weeks) in a NICU in Brazil from May 2018 to January 2019. Weight, length, and head circumference (HC) were analyzed. Nutrition screening was defined by care levels (CLs). Outcomes analyzed were bronchopulmonary dysplasia (BPD), peri-intraventricular hemorrhage (PIVH), retinopathy of prematurity (ROP), late sepsis, length of stay, mortality, and time receiving enteral and parenteral nutrition. RESULTS Data on 110 newborns were studied, with median gestational age 34 (31-35) weeks, mean weight 1914.92 g (±657.7), length 42.2 cm (±4.45), and HC 29.9 cm (±2.97). Most (82.7%) of them were adequate for gestational age. Screening classifications were 41.8% (n = 46) at CL 2, 41.8% (n = 46) at CL 3, and 16.4% (n = 18) at CL 4. CL 3 and CL 4 patients had higher frequencies of BPD (P = .003), ROP (P = .027), and PIVH (P = .006) and longer enteral time (P < .001) and length of stay (P < .001). All mortality occurred in CL 4 patients (P < .001). CONCLUSIONS CL 3 and CL 4 patients had more BPD, ROP, PIVH, and mortality and longer enteral nutrition. Hospital stay was longer for CL ≥3 than CL 2 patients. Patients classified as CL 3 and CL 4 by the nutrition screening tool may have higher nutrition risk.
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Affiliation(s)
- Christy Hannah Sanini Belin
- Child and Adolescent Health Program, Department of Nutrition, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Nutrition and Dietetic Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Roberta Aguiar Sarmento
- Nutrition and Dietetic Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lília Farret Refosco
- Nutrition and Dietetic Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Rombaldi Bernardi
- Child and Adolescent Health Program, Food, Nutrition and Health Program, Department of Nutrition, Medical School, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Recio-Saucedo A, Smith GB, Redfern O, Maruotti A, Griffiths P. Observational study of the relationship between nurse staffing levels and compliance with mandatory nutritional assessments in hospital. J Hum Nutr Diet 2021; 34:679-686. [PMID: 33406321 DOI: 10.1111/jhn.12847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/24/2020] [Accepted: 10/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the UK, it is recommended that hospital patients have their nutritional status assessed within 24 h of admission using the Malnutrition Universal Screening Tool (MUST). The present study aimed to examine the association between nurse staffing levels and missed nutritional status assessments. METHODS A single-centre, retrospective, observational study was employed using routinely collected MUST assessments from 32 general adult hospital wards over 2 years, matched to ward nurse staffing levels. We used mixed-effects logistic regression to control for ward characteristics and patient factors. RESULTS Of 43 451 instances where staffing levels could be linked to a patient for whom an assessment was due, 21.4% had no MUST score recorded within 24 h of admission. Missed assessments varied between wards (8-100%). There was no overall association between registered nurse staffing levels and missed assessments; although higher admissions per registered nurse were associated with more missed assessments [odds ratio (OR) = 1.09, P = 0.005]. Higher healthcare assistant staffing was associated with lower rates of missed assessments (OR = 0.80, P < 0.001). There was a significant interaction between registered nurses and healthcare assistants staffing levels (OR = 0.97, P = 0.011). CONCLUSIONS Despite a written hospital policy requiring a nutritional assessment within 24 h of admission, missed assessments were common. The observed results show that compliance with the policy for routine MUST assessments within 24 h of hospital admission is sensitive to staffing levels and workload. This has implications for planning nurse staffing.
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Affiliation(s)
- A Recio-Saucedo
- NIHR Collaboration for Leadership in Applied Heath Research and Care (Wessex, University of Southampton, Southampton, UK
| | - G B Smith
- Faculty of Health and Social Sciences, University of Bournemouth, Bournemouth, UK
| | - O Redfern
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - A Maruotti
- Dipartimento di Scienze Economiche, Libera Universita Maria Santissima Assunta, Roma, Italy
| | - P Griffiths
- NIHR Collaboration for Leadership in Applied Heath Research and Care (Wessex, University of Southampton, Southampton, UK
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Poor Interrater Reliability of Retrospectively Applied Subjective Global Assessment for Malnutrition in the Critically Ill. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lai X, Zhu H, Du H, Huo X, Yu K. Nutritional status of Chinese oldest-old adults (≥80 years of age): a cross-sectional study in Beijing. Eur J Clin Nutr 2020; 75:1040-1046. [PMID: 33323962 DOI: 10.1038/s41430-020-00826-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/29/2020] [Accepted: 11/27/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nutrition is associated with frailty, functional impairments, and mortality in elderly people. Only a few studies focused on oldest-old hospitalized patients with worse health and more comorbidities compared with the general older adults in China. OBJECTIVE This study aimed to investigate the nutritional risk, malnutrition, and nutritional support status of oldest-old hospitalized patients (≥80 years of age) in China, and to provide a basis for implementing an effective nutritional intervention. METHODS This study involved 358 oldest-old patients of Peking Union Medical College Hospital in China. The Nutrition Risk Screening 2002 scale was used to assess nutritional risk. Malnutrition was defined as body mass index (BMI) < 18.5 kg/m2; or unwanted weight loss >10% at any time, or unwanted weight loss >5% in recent 3 months and BMI < 22 kg/m2. Logistic regression analysis was used to identify factors associated with nutritional risk. RESULTS The overall frequency of nutritional risk and malnutrition was 50.3% (180/358) and 36.0% (129/358), respectively. Also, 134 (37.3%) patients received nutritional support; the ratio of parenteral nutrition (PN) to enteral nutrition (EN) was 1.35:1. Further, 106 (58.9%) patients with nutritional risk received nutritional support. The number of chronic diseases and age were protective factors, and activities of daily living (ADL) were risk factors. CONCLUSIONS The overall frequencies of nutritional risk and malnutrition of oldest-old hospitalized patients were high, and the rates of EN and PN were low. Nutritional risk was associated with the number of chronic diseases, age, and ADL.
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Affiliation(s)
- Xiaoxing Lai
- Department of Health Care, Peking Union Medical College Hospital, 100730, Beijing, China.
| | - Hongwei Zhu
- Department of Health Care, Peking Union Medical College Hospital, 100730, Beijing, China
| | - Hongdi Du
- Department of Health Care, Peking Union Medical College Hospital, 100730, Beijing, China
| | - Xiaopeng Huo
- Department of Health Care, Peking Union Medical College Hospital, 100730, Beijing, China.
| | - Kang Yu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, 100730, Beijing, China
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Sugaya MC, Maio R, Soares BLDM, Calado CKM, Morais GQ, Arruda IKGD, Burgos MGPDA. Discriminative power of an adapted version of Nutritional Risk Screening 2002 applied to Brazilian older adults. EINSTEIN-SAO PAULO 2020; 18:eAO5309. [PMID: 33111808 PMCID: PMC8639137 DOI: 10.31744/einstein_journal/2020ao5309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/06/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the discriminative power of Nutritional Risk Screening 2002. METHODS A cross sectional study involving one hundred participants aged ≥60 years. The original and adapted versions of Nutritional Risk Screening 2002 and the Mini Nutritional Assessment were used. Nutritional Risk Screening 2002 adaptation consisted of a lower age cutoff (60 years or older) for addition of one extra point to the final score. RESULTS Screening using Nutritional Risk Screening 2002 revealed higher nutritional risk among patients aged ≥70 years (p=0.009), whereas screening using the adapted version of Nutritional Risk Screening 2002 revealed similar nutritional risk in both age groups (60-69 years and ≥70 years; p=0.117). Frequency of nutritional risk was highest when the Mini Nutritional Assessment was administered (52.7%), followed by the adapted and original versions of Nutritional Risk Screening 2002 (35.5% and 29.1%, respectively). CONCLUSION The adapted version of Nutritional Risk Screening 2002 was more effective than the original version. However, further studies are needed to confirm these findings.
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Affiliation(s)
| | - Regiane Maio
- Universidade Federal de Pernambuco, Recife, PE, Brazil
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Cortes R, Bennasar-Veny M, Castro-Sanchez E, Fresneda S, de Pedro-Gomez J, Yañez A. Nutrition screening tools for risk of malnutrition among hospitalized patients: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e22601. [PMID: 33120747 PMCID: PMC7581116 DOI: 10.1097/md.0000000000022601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Malnutrition is a clinical problem with a high prevalence in hospitalized adult patients. Many nutritional screening tools have been developed but there is no consensus on which 1 is more useful. The purpose of this review protocol is to provide an overview of which nutritional screening tool is most valid to identify malnutritional risk in hospitalized adult patients and to analyze the sensitivity and specificity of the different tools. METHODS The protocol of this systematic review and meta-analysis was registered on the INPLASY website (https://inplasy.com/inplasy-2020-9-0028/) and INPLASY registration number is INPLASY202090028. We will perform a systematic literature search of main databases: PubMed, EMBASE, CINAHL and Web of Science and the Cochrane database. Also, grey literature will be search. Peer-reviewed studies published in English, Portuguese or Spanish language will be selected. Screening of titles, abstract and full text will be assessed for eligibility by 2 independent blinded reviewers and any discrepancies will be resolved via consensus. After screening the studies, a meta-analysis will be conducted, if it is possible. RESULTS Results from this systematic review will help health professionals to identify malnutrition in hospitalized patients and to make decisions to prevent or treat it as well as provide new clues to researchers. CONCLUSION Our systematic review will provide aknowledge about the most valid malnutrition risk screening tool in hospitalized adult patients.
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Affiliation(s)
- Regina Cortes
- Son Espases University Hospital, Balearic Islands Health Service
| | - Miquel Bennasar-Veny
- Department of Nursing and Physiotherapy, Balearic Islands University
- Research group on Evidence, Lifestyles and Health, Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), Balearic Islands, Palma, Spain
| | | | - Sergio Fresneda
- Son Espases University Hospital, Balearic Islands Health Service
- Department of Nursing and Physiotherapy, Balearic Islands University
| | - Joan de Pedro-Gomez
- Department of Nursing and Physiotherapy, Balearic Islands University
- Research group on Evidence, Lifestyles and Health, Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), Balearic Islands, Palma, Spain
| | - Aina Yañez
- Department of Nursing and Physiotherapy, Balearic Islands University
- Research group on Evidence, Lifestyles and Health, Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), Balearic Islands, Palma, Spain
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Serrano Valles C, López Gómez JJ, García Calvo S, Jiménez Sahagún R, Torres Torres B, Gómez Hoyos E, Ortolá Buigues A, de Luis Román D. Influence of nutritional status on hospital length of stay in patients with type 2 diabetes. ACTA ACUST UNITED AC 2020; 67:617-624. [PMID: 33054996 DOI: 10.1016/j.endinu.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In the hospitalized patient, Diabetes mellitus type 2 (DM2) may result in a worse nutritional status due to its pathophysiology and dietary treatment. OBJECTIVES The aim of this study was to know if a hospitalized diabetic patient has a worse nutritional status, and to establish the influence of DM2 on the hospital length of stay in patients with malnutrition. MATERIAL AND METHODS This was a transveral study from January 2014 to October 2016; 1017 patients were included who were assessed by the Endocrinology and Nutrition Department. The data collected included anthropometry, plasma albumin, delay in performing the nutrition interconsultation and hospital length of stay. Nutritional status was evaluated using the Mini Nutritional Assesment (MNA) questionnaire and the nutritional risk score (NRS). RESULTS 24.4% of the patients were diabetic and 75.6% were not. Diabetic patients had a higher body mass index (BMI) [23.18 (20.78-25.99) kg/m2 vs. 22.31 (19.79-25.30) kg/m2, P˂.01], a lower total score in the MNA questionnaire [16.5(13.12-19) points vs. 17(14-20) points, P˂.01], and a lower NRS score [83.09(77.72-91.12) points vs. 85.78(79.27-92.83) points, p=0.03]. According to the MNA and the NRS, diabetic patients had an increased risk of malnutrition (<17.5 points) [OR=1.39, IC95%(1.04-1.86), p=0.02]; and NRS (<85 points) [OR=1.65, IC 95% (1.07-2.54) p=0.02], respectively. When adjusted for age these significant results disappeared. Diabetes combined with malnutrition showed that diabetic patients with malnutrition (MNA˂17.5) spent longer in hospital [21(12-36) days vs. 17(9-30) days, P=.01]. CONCLUSIONS Diabetic patients have a worse nutritional status than non-diabetic patients. Diabetic patients with a poor nutritional status spend a longer period in hospital.
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Affiliation(s)
- Cristina Serrano Valles
- Hospital Clínico Universitario de Valladolid (HCUV), Instituto de Endocrinología y Nutrición (IENVA), Valladolid, España.
| | - Juan José López Gómez
- Hospital Clínico Universitario de Valladolid (HCUV), Instituto de Endocrinología y Nutrición (IENVA), Valladolid, España
| | - Susana García Calvo
- Hospital Clínico Universitario de Valladolid (HCUV), Instituto de Endocrinología y Nutrición (IENVA), Valladolid, España
| | - Rebeca Jiménez Sahagún
- Hospital Clínico Universitario de Valladolid (HCUV), Instituto de Endocrinología y Nutrición (IENVA), Valladolid, España
| | - Beatriz Torres Torres
- Hospital Clínico Universitario de Valladolid (HCUV), Instituto de Endocrinología y Nutrición (IENVA), Valladolid, España
| | - Emilia Gómez Hoyos
- Hospital Clínico Universitario de Valladolid (HCUV), Instituto de Endocrinología y Nutrición (IENVA), Valladolid, España
| | - Ana Ortolá Buigues
- Hospital Clínico Universitario de Valladolid (HCUV), Instituto de Endocrinología y Nutrición (IENVA), Valladolid, España
| | - Daniel de Luis Román
- Hospital Clínico Universitario de Valladolid (HCUV), Instituto de Endocrinología y Nutrición (IENVA), Valladolid, España
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Nutritional screening tools for adult cancer patients: A hierarchical Bayesian latent-class meta-analysis. Clin Nutr 2020; 40:1733-1743. [PMID: 33041089 DOI: 10.1016/j.clnu.2020.09.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/20/2020] [Accepted: 09/24/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Cancer treatment requires attentiveness to its broader effect on the body. Cancer's effect on appetite, strength, and body composition is contained in the summary term malnutrition. The tools used to detect malnutrition are a critical part of effective cancer care. In clinical care, selection of any specific tool is random. The relative validity of these tools have not been systematically compared. Using hierarchical Bayesian latent-class meta-analysis methods, this report compares three tools used for adult cancer patients - the Mini Nutritional Assessment (MNA), the Nutritional Risk Screening 2002 (NRS-2002) and the Patient Generated Subjective Global Assessment (PG-SGA). METHOD Drawing from English and Chinese language databases, a broad pool of eligible studies were identified for further selection and assessment. Using the hierarchical summary receiver operating characteristic (HSROC) model, pooled sensitivity, specificity, and other measurements the accuracy of the three tools were compared. RESULT A total of 37 eligible studies involving the MNA, NRS-2002 and PG-SGA were included in this meta-analysis. The pooled sensitivity was 0.910 (95% CI: 0.763 to 0.970) for MNA, 0.747 (95% CI: 0.680 to 0.804) for NRS-2002, and 0.964 (95% CI: 0.913 to 0.986) for PG-SGA. The pooled specificity was 0.720 (95% CI: 0.623 to 0.800) for MNA, 0.854 (95% CI: 0.808 to 0.891) for NRS-2002, 0.905 (95% CI: 0.807 to 0.956) for PG-SGA, respectively. The back-calculated likelihood ratio (LR) showed that MNA had a low negative likelihood ratio (LR-), NRS-2002 corresponded to a high positive likelihood ratio (LR+) and PG-SGA represented the best LR+ and LR-. CONCLUSIONS While there is no standard approach to assessment of malnutrition, the PG-SGA has the best diagnostic performance with cancer patients. Further work is needed to refine the utility of these tools in larger clinical samples.
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Hedayati S, Nachvak SM, Samadi M, Motamedi-Motlagh A, Moradi S. Malnutrition and nutritional status in critically ill patients with enteral nutrition. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2020. [DOI: 10.3233/mnm-200421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND & OBJECTIVE: The prevention of malnutrition is an important factor in the survival of critically ill patients with enteral nutrition. The present study aims to assess the nutritional status and its association with some blood-related markers in critically ill patients with enteral nutrition during hospitalization in the intensive care units (ICUs). METHODS: Totally, 110 patients participated in this study from the time of admission to discharge at five ICUs. The patients’ nutritional status was assessed by subjective global assessment (SGA), Acute Physiology and Chronic Health Evaluation and Albumin, Total Iron Binding Capacity (TIBC), Hemoglobin (Hb), Hematocrit (HCT), Ferritin, and Feas biochemical indices and anthropometric parameters. RESULTS: Malnutrition prevalence increased significantly on the day of discharge (83.6%) compared to the day of admission (41.8%), according to SGA (P < 0.001). Hb, HCT, serum Fe decreased and ferritin, also TIBC were increased during hospitalization in ICU. The malnutrition risk predictors based on the logistic regression were low levels of Hb (OR = 0.6), HCT (OR = 0.9), Fe (OR = 0.9), Albumin (OR = 0.3) and High Ferritin level (OR = 1.006) on the admission day. Anemia of inflammation (AI) was observed during ICU stay. CONCLUSION: This study demonstrated that malnutrition is an increasing phenomenon in the ICU patients and the delay in patient’s enteral feeding had a direct influence in the prevalence of malnutrition on discharge day.
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Affiliation(s)
- Safoora Hedayati
- Department of Nutrition, School of Nutrition Science and Food Technology, Committee of the Deputy of Research and Technology of Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyyed Mostafa Nachvak
- Department of Nutritional Sciences, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehnoosh Samadi
- Department of Nutritional Sciences, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Shima Moradi
- Department of Nutritional Sciences, Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Chang Y, Liu QY, Zhang Q, Rong YM, Lu CZ, Li H. Role of nutritional status and nutritional support in outcome of hepatitis B virus-associated acute-on-chronic liver failure. World J Gastroenterol 2020; 26:4288-4301. [PMID: 32848334 PMCID: PMC7422541 DOI: 10.3748/wjg.v26.i29.4288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/04/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is an important type of liver failure in Asia. There is a direct relationship between HBV-ACLF and gastrointestinal barrier function. However, the nutritional status of HBV-ACLF patients has been poorly studied.
AIM To investigate the nutritional risk and nutritional status of HBV-ACLF patients and evaluated the impact of nutritional support on the gastrointestinal barrier and 28-d mortality.
METHODS Nutritional risk screening assessment and gastrointestinal barrier biomarkers of patients with HBV-ACLF (n = 234) and patients in the compensatory period of liver cirrhosis (the control group) (n = 234) were compared during the period between 2016 and 2018. Changes were analyzed after nutritional support in HBV-ACLF patients. Valuable biomarkers have been explored to predict 28-d death. The 28-d survival between HBV-ACLF patients with nutritional support (n = 234) or no nutritional support (2014-2016) (n = 207) was compared.
RESULTS The nutritional risk of the HBV-ACLF patients was significantly higher than that of the control group. The nutritional intake of the patients with HBV-ACLF was lower than that of the control group. The decrease in skeletal muscle and fat content and the deficiency of fat intake were more obvious (P < 0.001). The coccus-bacillus ratio, secretory immunoglobulin A, and serum D-lactate were significantly increased in HBV-ACLF patients. The survival group had a lower nutritional risk, lower D-lactate, and cytokine levels (endotoxin, tumor necrosis factor alpha, interleukin-10, and interleukin-1). Interleukin-10 may be a potential predictor of death in HBV-ACLF patients. The 28-d survival of the nutritional support group was better than that of the non-nutritional support group (P = 0.016).
CONCLUSION Patients with HBV-ACLF have insufficient nutritional intake and high nutritional risk, and their intestinal barrier function is impaired. Individualized and dynamic nutritional support is associated with a better prognosis of 28-d mortality in HBV-ACLF patients.
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Affiliation(s)
- Yue Chang
- Division of Gastroenterology and Hepatology, Tianjin Xiqing Hospital, Tianjin 300380, China
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis and Treatment, Tianjin 300162, China
- Department of Hepatopancreatobiliary and Splenic Medicine, Characteristic Medical Center of People's Armed Police Force, Tianjin 300162, China
| | - Qin-Yu Liu
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis and Treatment, Tianjin 300162, China
- Department of Hepatopancreatobiliary and Splenic Medicine, Characteristic Medical Center of People's Armed Police Force, Tianjin 300162, China
| | - Qing Zhang
- Division of Gastroenterology and Hepatology, Tianjin Xiqing Hospital, Tianjin 300380, China
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis and Treatment, Tianjin 300162, China
| | - Ya-Mei Rong
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis and Treatment, Tianjin 300162, China
- Department of Hepatopancreatobiliary and Splenic Medicine, Characteristic Medical Center of People's Armed Police Force, Tianjin 300162, China
| | - Cheng-Zhen Lu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Hai Li
- Division of Gastroenterology and Hepatology, Tianjin Xiqing Hospital, Tianjin 300380, China
- Tianjin Key Laboratory of Hepatopancreatic Fibrosis and Molecular Diagnosis and Treatment, Tianjin 300162, China
- Department of Hepatopancreatobiliary and Splenic Medicine, Characteristic Medical Center of People's Armed Police Force, Tianjin 300162, China
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Wilson H, Cummings J, Rasprasith S, Stadler D. Evaluation of a nutrition-risk screening tool in Lao PDR: Identifying malnutrition in a low-resource clinical setting. Clin Nutr ESPEN 2020; 38:99-110. [PMID: 32690186 DOI: 10.1016/j.clnesp.2020.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/15/2020] [Accepted: 05/25/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Malnutrition is a top priority in Lao PDR. In 2017, 33% of children under five years of age were stunted, 21.1% were underweight, 9% were wasted while 16.6% of adults in community settings were malnourished. Rates of malnutrition are presumed to be higher among hospitalized patients however, malnutrition risk screening in inpatient settings does not occur in Lao PDR. To address this gap, this study aimed to determine the prevalence of malnutrition among hospitalized patients and investigated the inter-user reliability and validity of a nutrition-risk screening tool (NRST). METHODS A cross-sectional study of pediatric (n = 69) and adult (n = 125) patients was conducted at two hospitals in Vientiane, Lao PDR. Inter-observer reliability of the NRST was determined by comparing final scores of two independent observers. Validity of the NRST was determined using sensitivity, specificity, and area-under-the-receiver-operating-characteristics (ROC) curve analyses. RESULTS Among participants 0-4 years of age, 51% were diagnosed with malnutrition, while 58% of participants aged 5-17 years were malnourished. Among participants 18 years of age or older, 47% were diagnosed with moderate to severe malnutrition. The NRST showed 'fair' agreement between Observer 1 and Observer 2 NRST final scores (0.2737, p-value <0.001). Observer 1 and Observer 2 had a 64% and 70% probability of correctly distinguishing a malnourished from a not malnourished participant. The Lao NRST had a sensitivity of 85% and a specificity 35%. CONCLUSION There is a high prevalence of malnutrition among hospitalized patients in Lao PDR. This study provides proof of concept that a nutrition-risk screening tool can be successfully administered in a low-resource setting. Timely identification of malnutrition among newly admitted hospitalized patients will help minimize adverse patient health outcomes and reduce the economic burden of healthcare in Lao PDR.
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Affiliation(s)
- Hannah Wilson
- Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, OR, USA
| | - Joanna Cummings
- Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, OR, USA.
| | - Slackchay Rasprasith
- Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, OR, USA
| | - Diane Stadler
- Graduate Programs in Human Nutrition, Oregon Health & Science University, Portland, OR, USA
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Bellanti F, Lo Buglio A, Quiete S, Pellegrino G, Dobrakowski M, Kasperczyk A, Kasperczyk S, Vendemiale G. Comparison of Three Nutritional Screening Tools with the New Glim Criteria for Malnutrition and Association with Sarcopenia in Hospitalized Older Patients. J Clin Med 2020; 9:jcm9061898. [PMID: 32560480 PMCID: PMC7356988 DOI: 10.3390/jcm9061898] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 02/05/2023] Open
Abstract
The integrated assessment of nutritional status and presence of sarcopenia would help improve clinical outcomes of in-hospital aged patients. We compared three common nutritional screening tools with the new Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria among hospitalized older patients. To this, 152 older patients were assessed consecutively at hospital admission by the Malnutrition Universal Screening Tool (MUST), the Subjective Global Assessment (SGA), and the Nutritional Risk Screening 2002 (NRS-2002). A 46% prevalence of malnutrition was reported according to GLIM. Sensitivity was 64%, 96% and 47%, and specificity was 82%, 15% and 76% with the MUST, SGA, and NRS-2002, respectively. The concordance with GLIM criteria was 89%, 53% and 62% for the MUST, SGA, and NRS-2002, respectively. All the screening tools had a moderate value to diagnose malnutrition. Moreover, patients at high nutritional risk by MUST were more likely to present with sarcopenia than those at low risk (OR 2.5, CI 1.3-3.6). To conclude, MUST is better than SGA and NRS-2002 at detecting malnutrition in hospitalized older patients diagnosed by the new GLIM criteria. Furthermore, hospitalized older patients at high risk of malnutrition according to MUST are at high risk of presenting with sarcopenia. Nutritional status should be determined by MUST in older patients at hospital admission, followed by both GLIM and the European Working Group on Sarcopenia in Older People (EWGSOP2) assessment.
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Affiliation(s)
- Francesco Bellanti
- Department of Medical and Surgical Sciences, University of Foggia, viale Pinto 1, 71122 Foggia, Italy; (A.L.B.); (S.Q.); (G.P.); (G.V.)
- Correspondence:
| | - Aurelio Lo Buglio
- Department of Medical and Surgical Sciences, University of Foggia, viale Pinto 1, 71122 Foggia, Italy; (A.L.B.); (S.Q.); (G.P.); (G.V.)
| | - Stefano Quiete
- Department of Medical and Surgical Sciences, University of Foggia, viale Pinto 1, 71122 Foggia, Italy; (A.L.B.); (S.Q.); (G.P.); (G.V.)
| | - Giuseppe Pellegrino
- Department of Medical and Surgical Sciences, University of Foggia, viale Pinto 1, 71122 Foggia, Italy; (A.L.B.); (S.Q.); (G.P.); (G.V.)
| | - Michał Dobrakowski
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 19, 41-808 Zabrze, Poland; (M.D.); (A.K.); (S.K.)
| | - Aleksandra Kasperczyk
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 19, 41-808 Zabrze, Poland; (M.D.); (A.K.); (S.K.)
| | - Sławomir Kasperczyk
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 19, 41-808 Zabrze, Poland; (M.D.); (A.K.); (S.K.)
| | - Gianluigi Vendemiale
- Department of Medical and Surgical Sciences, University of Foggia, viale Pinto 1, 71122 Foggia, Italy; (A.L.B.); (S.Q.); (G.P.); (G.V.)
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Eckart A, Struja T, Kutz A, Baumgartner A, Baumgartner T, Zurfluh S, Neeser O, Huber A, Stanga Z, Mueller B, Schuetz P. Relationship of Nutritional Status, Inflammation, and Serum Albumin Levels During Acute Illness: A Prospective Study. Am J Med 2020; 133:713-722.e7. [PMID: 31751531 DOI: 10.1016/j.amjmed.2019.10.031] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Low serum albumin levels resulting from inflammation-induced capillary leakage or disease-related anorexia during acute illness are associated with poor outcomes. We investigated the relationship of nutritional status and inflammation with low serum albumin levels and 30-day mortality in a large cohort. METHODS We prospectively enrolled adult patients in the medical emergency department of a Swiss tertiary care center and investigated associations of C-reactive protein (CRP) and Nutritional Risk Screening 2002 as markers of inflammation and poor nutritional status, respectively, with low serum albumin levels and mortality using multivariate regression analyses. RESULTS Among the 2465 patients, 1019 (41%) had low serum albumin levels (<34 g/L), 619 (25.1%) had increased nutritional risk (Nutritional Risk Screening 2002 ≥3), and 1086 (44.1%) had CRP values >20 mg/L. Multivariate analyses adjusted for age, gender, diagnosis, and comorbidities revealed elevated CRP values (adjusted odds ratio [OR] 10.51, 95% confidence interval, 7.51-14.72, P <.001) and increased malnutrition risk (adjusted OR 2.87, 95% confidence interval, 1.98-4.15, P <.001) to be associated with low serum albumin levels, even adjusting for both parameters. Low serum albumin levels, elevated CRP values, and increased nutritional risk independently predicted 30-day mortality, with areas under the curve of 0.77, 0.70, and 0.75, respectively. Combination of these 3 parameters showed an area under the curve of 0.82 to predict mortality. CONCLUSIONS Elevated parameters of inflammation and high nutritional risk were independently associated with hypoalbuminemia. All 3 parameters independently predicted mortality. Combining them during initial evaluation of patients in emergency departments facilitates mortality risk stratification.
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Affiliation(s)
- Andreas Eckart
- Division of General Internal and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
| | - Tristan Struja
- Division of General Internal and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; Division of Endocrinology, Diabetes and Metabolism; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Division of General Internal and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Annic Baumgartner
- Division of General Internal and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; Division of Endocrinology, Diabetes and Metabolism; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Thomas Baumgartner
- Division of General Internal and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Seline Zurfluh
- Division of General Internal and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Olivia Neeser
- Division of General Internal and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Bern University Hospital, Inselspital Bern, Bern, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetes and Metabolism; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland
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47
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Jayanth KS, Maroju NK. Utility of nutritional indices in preoperative assessment of cancer patients. Clin Nutr ESPEN 2020; 37:141-147. [PMID: 32359736 DOI: 10.1016/j.clnesp.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/15/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Malnutrition is an important but neglected predictor for outcomes and healthcare costs in cancer patients. A simple screening tool for detecting malnutrition may have clinical utility in their preoperative assessment. OBJECTIVES This study compared three validated indices, for their predictive ability for prolonged length of stay (LOS) and 30-day postsurgical complications in malignancies in a tertiary hospital in South India. METHODS 342 cancer patients admitted for elective surgery were stratified on their preoperative day using MUST - Malnutrition Universal Screening Tool, SGA - Subjective Global Assessment and NRI - Nutritional Risk Index. The postoperative LOS and 30-day morbidity as per Clavien-Dindo classification (CDC) were compared to calculate the predictive accuracy of the various nutritional indices. RESULTS In our study, 44% patients were classified as malnourished by SGA. SGA was found to have maximum correlation coefficient with LOS (σ = 0.410), followed by MUST (σ = 0.401) and NRI (σ = 0.36). On logistic regression, MUST, NRI and SGA were all found to be significant independent predictors of LOS and CDC class. Age, acute illness and comorbidities were found to have significant confounding effects. Sensitivity of MUST and SGA to predict prolonged LOS (>10 d) were. DISCUSSION Our study showed that surgical cancer population was at high risk for malnutrition. MUST and SGA were good risk-stratification tools with independent predictive ability for prolonged LOS and postoperative complications. Patients having higher MUST and SGA scores fared poorly postoperatively with significant prolongation of stay. MUST had 88% agreement with SGA, and took shorter time to administer in the in-patient setting. CONCLUSION Routine preoperative nutritional assessment is important in cancer patients. SGA and MUST were found to be reliable tools, with MUST being the simplest and quickest tool for preoperative nutritional assessment. Patients stratified to be at risk for malnutrition may benefit with nutritional therapy.
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Affiliation(s)
- Kalkunte Sriram Jayanth
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
| | - Nanda Kishore Maroju
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
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Takagi K, Buettner S, Ijzermans JNM. Prognostic significance of the controlling nutritional status (CONUT) score in patients with colorectal cancer: A systematic review and meta-analysis. Int J Surg 2020; 78:91-96. [PMID: 32335238 DOI: 10.1016/j.ijsu.2020.04.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The clinical evidence of the controlling nutritional status (CONUT) score for outcomes has increased in gastroenterological surgical oncology. The aim of this study was to investigate the impact of the CONUT score on outcomes in patients with colorectal cancer (CRC). METHODS A literature review was systematically conducted to evaluate the significance of the CONUT score in CRC patients. Meta-analyses of survival were performed to investigate the effects of the CONUT score in CRC patients. RESULTS Nine studies met the inclusion criteria, and six studies with 2601 patients were included in the present meta-analyses. High CONUT score was associated with poor overall survival (HR 1.97, 95%CI = 1.40-2.77, P < 0.001), cancer-specific survival (HR 3.64, 95%CI = 1.96-6.75, P < 0.001), and recurrence/relapse-free survival (HR 1.68, 95%CI = 1.23-2.29, P = 0.001) after CRC surgery. CONCLUSIONS The CONUT score is a practical prognostic factor associated with prognosis of CRC. Further studies are needed to clarify the significance of the CONUT score in CRC patients.
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Affiliation(s)
- Kosei Takagi
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Stefan Buettner
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jan N M Ijzermans
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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49
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Reber E, Messmer Ivanova A, Cadisch P, Stirnimann J, Perrig M, Roten C, Stanga Z. Does multifaceted nutritional education improve malnutrition management? Nutrition 2020; 78:110810. [PMID: 32544848 DOI: 10.1016/j.nut.2020.110810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/11/2020] [Accepted: 02/27/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Malnutrition is a challenging issue in hospitals, but mostly reversible. However, despite being associated with increased morbidity and mortality risk, malnutrition is hardly recognized and treated. There is a strong need to raise awareness of treating residents to improve patients' nutritional management. This study aimed to investigate the impact of an educational intervention on residents' nutritional knowledge, perception, and prescribed nutritional therapies. METHODS This prospective intervention study was conducted at the Department of General Internal Medicine of the Bern University Hospital. Nutritional risk was evaluated in consecutive patients admitted to the wards using the Nutritional Risk Screening 2002 and the number of prescribed nutritional therapies were assessed. The educational intervention included an interactive case discussion headed by nutritional medicine consultants. A pocket card with basic nutritional information was handed out. Each resident's nutritional knowledge was checked with a multiple choice test before the intervention, immediately after, and after 2 months. RESULTS In total, 609 patients were included (121 preintervention, 161 postintervention phase I, 327 postintervention phase II). Overall prevalence of malnutrition was 35%. The percentage of prescribed nutritional therapies was 36%. There was no significant difference between the phases (46% preintervention, 52% postintervention phase I, 27% postintervention phase II) or between the test results (mean percentage of correct answers 61 ± 15%; 57 ± 12%, and 60 ± 10%). CONCLUSIONS The multimodal intervention failed to achieve both objectives, as neither residents' knowledge and awareness nor the number of prescribed therapies could be increased. Nutritional risk remains highly prevalent; thus, innovative and more effective teaching strategies are needed to increase knowledge, abilities, and skills to fight malnutrition.
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Affiliation(s)
- Emilie Reber
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Switzerland.
| | - Anna Messmer Ivanova
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Switzerland
| | - Patricia Cadisch
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Switzerland
| | - Jessica Stirnimann
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Switzerland
| | - Martin Perrig
- Department of General Internal Medicine, Bern University Hospital, Switzerland
| | - Christine Roten
- Department of General Internal Medicine, Bern University Hospital, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Switzerland
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50
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A fluorescence-based indicator for nanofiltration fouling propensity caused by effluent organic matter (EfOM). Process Biochem 2020. [DOI: 10.1016/j.procbio.2019.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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