1
|
Firouzabadi D, Ahmadi H. Cancer-Related Malnutrition and the Role of Parenteral Nutrition in Cancer; A Narrative Review. Nutr Cancer 2024:1-15. [PMID: 39039741 DOI: 10.1080/01635581.2024.2381271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 07/10/2024] [Indexed: 07/24/2024]
Abstract
The growing incidence rate of cancer and its associated morbidity and mortality prompts the need to identify factors that could improve the quality of life (QoL) and survival of a patient with cancer. Cancer-associated malnutrition is a common complication that could start at the early stages of cancer and could further develop into advanced cachexia. Response to treatment, length of hospital stay, progression of infection, and other complications of cancer including chemotherapy adverse events could all be influenced by the progression of malnutrition. Nutritional interventions may vary from oral to enteral and parenteral therapy. Parenteral nutrition (PN) therapy may benefit patients at certain stages of cancer in whom contraindications or inefficacy of other modalities of nutritional support are present. This method may seem invasive, costly, and risky but at the same time may improve certain patients' QoL and chance of survival. In trained settings with proper facilities, this method of nutritional support can benefit patients; However, the indication for starting PN must be carefully supervised considering that other nutritional support methods may be equally efficient and at the same time easier to access and apply.
Collapse
Affiliation(s)
- Dena Firouzabadi
- Clinical Pharmacy Department, Shiraz School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Ahmadi
- Clinical Pharmacy Department, Shiraz School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
2
|
Xu J, Hu Y, Wang L, Li P, Zhu M, Song J, Wei J. Albumin-dNLR score could be an etiological criterion to determine inflammation burden for GLIM in medical inpatients over 70 years old: A multicenter retrospective study. Heliyon 2024; 10:e34102. [PMID: 39091958 PMCID: PMC11292551 DOI: 10.1016/j.heliyon.2024.e34102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024] Open
Abstract
Aim To validate the role of the albumin-derived neutrophil-to-lymphocyte (ALB-dNLR) score in diagnosing malnutrition in medical inpatients over 70 years old. Methods This is a retrospective cross-sectional study involving 7 departments from 14 Chinese hospitals. The ALB-dNLR score was calculated, and outcomes between groups with positive and negative ALB-dNLR scores were compared after propensity score matching (PSM). Afterwards, the outcomes were compared between the groups receiving nutrition support and those not receiving support among malnourished patients diagnosed using the Global Leadership Initiative Malnutrition (GLIM) criteria after PSM. Results Out of 10,184 cases, 6165 were eligible. 2200 cases were in the positive ALB-dNLR score group. After PSM, 1458 pairs were analyzed, showing lower in-hospital mortality (0.8 % vs. 2.1 %, p = 0.005) and a lower nosocomial infection rate (5.9 % vs. 11.0 %, p < 0.001) in the negative ALB-dNLR score group. In malnourished patients, 259 pairs were analyzed after PSM. It showed better outcomes in mortality (0.8 % vs. 3.5 %, p = 0.033), nosocomial infection rate (5.4 % vs. 15.4 %, p < 0.001), length of stay (LOS) (13.8 ± 10.3 vs. 18.4 ± 14.1, p < 0.001), and total hospital cost (3315.3 ± 2946.4 vs. 4795.3 ± 4198.2, p < 0.001) in the support group. In malnourished patients with ALB-dNLR score as the sole etiological criterion, 94 pairs were calculated. It showed better outcomes in mortality (0.0 % vs. 6.4 %, p = 0.029), nosocomial infection rate (7.4 % vs. 18.1 %, p = 0.029), LOS (13.7 ± 8.3 vs. 19.8 ± 15.2, p = 0.001), and total hospital cost (3379.3 ± 2955.6 vs. 4471.2 ± 4782.4, p = 0.029) in the support group. Conclusions The ALB-dNLR score was validated to predict in-hospital mortality in medical inpatients over 70 years old. Malnutrition patients diagnosed by the GLIM criteria and using the ALB-dNLR score might benefit from nutrition support.
Collapse
Affiliation(s)
- Jingyong Xu
- Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital, Beijing, China
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yifu Hu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lijuan Wang
- Department of Clinical Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Pengxue Li
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingwei Zhu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinghai Song
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Junmin Wei
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
3
|
Lenga P, Dao Trong P, Papakonstantinou V, Kiening K, Unterberg AW, Ishak B. Reevaluating age restrictions of spinal metastasis surgery in elderly groups with over 2-year follow-up. Neurosurg Rev 2023; 46:309. [PMID: 37987881 PMCID: PMC10663192 DOI: 10.1007/s10143-023-02217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/21/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
This study aimed to compare and assess clinical outcomes of spinal metastasis with epidural spinal cord compression (MESCC) in patients aged 65-79 years and ≥ 80 years with an acute onset of neurological illness who underwent laminectomy. A second goal was to determine morbidity rates and potential risk factors for mortality. This retrospective review of electronic medical records at a single institution was conducted between September 2005 and December 2020. Data on patient demographics, surgical characteristics, complications, hospital clinical course, and 90-day mortality were also collected. Comorbidities were assessed using the age-adjusted Charlson comorbidity index (CCI). A total of 99 patients with an overall mean age of 76.2 ± 3.4 years diagnosed with MESCC within a 16-year period, of which 65 patients aged 65-79 years and 34 patients aged 80 years and older were enrolled in the study. Patients aged 80 and over had higher age-adjusted CCI (9.2 ± 2.1) compared to those aged 65-79 (5.1 ± 1.6; p < 0.001). Prostate cancer was the primary cause of spinal metastasis. Significant neurological and functional decline was more pronounced in the older group, evidenced by Karnofsky Performance Index (KPI) scores (80+ years: 47.8% ± 19.5; 65-79 years: 69.0% ± 23.9; p < 0.001). Despite requiring shorter decompression duration (148.8 ± 62.5 min vs. 199.4 ± 78.9 min; p = 0.004), the older group had more spinal levels needing decompression. Median survival time was 14.1 ± 4.3 months. Mortality risk factors included deteriorating functional status and comorbidities, but not motor weakness, surgical duration, extension of surgery, hospital or ICU stay, or complications. Overcoming age barriers in elderly surgical treatment in MSCC patients can reduce procedural delays and has the potential to significantly improve patient functionality. It emphasizes that age should not be a deterrent for spine surgery when medically necessary, although older MESCC patients may have reduced survival.
Collapse
Affiliation(s)
- Pavlina Lenga
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Philip Dao Trong
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Vassilios Papakonstantinou
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Karl Kiening
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| |
Collapse
|
4
|
Konecka M, Kuczyńska M, Schneider-Matyka D, Stanisławska M, Grochans E, Kamińska M. Analysis of Changes in the Selected Nutritional Parameters of Patients within a Year from the Admission to the Enteral Nutrition Clinic. Nutrients 2023; 15:1803. [PMID: 37111024 PMCID: PMC10145203 DOI: 10.3390/nu15081803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/13/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
(1) The following research question was formulated: What are the relationships between enteral nutrition and selected anthropometric and blood biochemical parameters? The aim of this study was to provide an assessment of the nutritional status of patients within one year from their admission to the Enteral Nutrition Clinic. (2) The study group included 103 participants. For the purpose of analysing their nutritional status, the Subjective Global Assessment (SGA) and Nutritional Risk Score (NRS) scales were used, anthropometric measurements were taken, and blood laboratory tests were performed. The assessment of changes in the indicated parameters was conducted at three time intervals: upon admission (T0) and 6 and 12 months after admission (T6 and T12, respectively). (3) The study group showed a significant improvement in the circumference of their upper and lower limbs. Nutrition therapy had an effect on the levels of erythrocytes, iron concentration, the activity of liver enzymes, and C-reactive protein levels. (4) The enrolment of patients into the Nutritional Therapy Programme had a positive effect on the selected results. 1. Twelve months after the introduction of nutritional intervention, an increase in erythrocyte count was particularly marked, and there was a decrease in the CRP (C Reactive Protein) level as well as the activity of liver enzymes. There was no significant effect of enteral nutrition on albumin and protein values. 2. To ensure the greatest efficiency of enteral nutritional therapy, it is to be continued for more than six months. 3. Nutritional interventions resulted in a significant increase in upper and lower limb circumferences among the study group. 4. For the purpose of identifying patients at risk of malnutrition, medical personnel should systematically raise their qualifications, and educational measures on this issue should be implemented at the stage of medical training at medical universities.
Collapse
Affiliation(s)
- Mariola Konecka
- Subdepartment of Long-Term Care and Palliative Medicine, Department of Social Medicine, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland
| | - Magdalena Kuczyńska
- Subdepartment of Long-Term Care and Palliative Medicine, Department of Social Medicine, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland
| | - Daria Schneider-Matyka
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland
| | - Marzanna Stanisławska
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland
| | - Elżbieta Grochans
- Department of Nursing, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland
| | - Magdalena Kamińska
- Subdepartment of Long-Term Care and Palliative Medicine, Department of Social Medicine, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland
| |
Collapse
|
5
|
Wen Z, Wolfs K, Van Schepdael A, Adams E. Determination of Inorganic Ions in Parenteral Nutrition Solutions by Ion Chromatography. Molecules 2022; 27:molecules27165266. [PMID: 36014505 PMCID: PMC9416023 DOI: 10.3390/molecules27165266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
A new, simple and sensitive ion chromatography (IC) method for the determination of sodium, potassium, magnesium, calcium and chloride in a parenteral nutrition (PN) solution was developed and validated. Before sample analysis, a sample pretreatment by calcination was applied which could totally remove interference from other constituents of the PN solution. Methanesulfonic acid (MSA) and sodium hydroxide were used as the mobile phase for the determination of cations and anions, respectively. The calibration curves showed good correlation between analyte peak area and concentration (r2 > 0.999). Detection limits ranged from 0.0001 to 0.02 mg/L and quantification limits from 0.0002 to 0.06 mg/L. Relative standard deviation (RSD) values for repeatability and inter-day precision did not exceed 1.0% and the recoveries for all analytes were between 99.1−101.1%. The robustness was verified by using an experimental design.
Collapse
|
6
|
ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr 2022; 41:958-989. [DOI: 10.1016/j.clnu.2022.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
|
7
|
Kohlhof H, Marquardt G, Wirtz DC. Organisation und Klinikstruktur für die integrierte Betreuung orthogeriatrischer Patienten. DER ORTHOPADE 2022; 51:122-130. [DOI: 10.1007/s00132-021-04210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/28/2022]
|
8
|
Maeda K, Murotani K, Kamoshita S, Horikoshi Y, Kuroda A. Effect of parenteral energy or amino acid doses on in-hospital mortality, among patients with aspiration pneumonia: a cohort medical claims database study. J Gerontol A Biol Sci Med Sci 2021; 77:1683-1690. [PMID: 34626471 PMCID: PMC9373951 DOI: 10.1093/gerona/glab306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 12/05/2022] Open
Abstract
Background This study examined the association between parenteral energy/amino acid doses and in-hospital mortality among inpatients on long-term nil per os (NPO) status, using a medical claims database in Japan. Methods Hospitalized patients with aspiration pneumonia, aged 65 and older, and on more than 7-day NPO status were identified in a medical claims database between January 2013 and December 2018. Using multivariate logistic regression and regression analyses, we examined the association between mean parenteral energy/amino acid doses and in-hospital mortality, and secondarily, the association between prognosis (in-hospital mortality, inability to receive full oral intake, readmission, and hospital stay length) and 4 groups of mean amino acid doses (no dose: 0 g/kg/day; very low dose: >0, ≤0.3 g/kg/day; low dose: >0.3, ≤0.6 g/kg/day; moderate dose: >0.6 g/kg/day). Results The analysis population included 20 457 inpatients (≥80 years: 78.3%). In total, 5 920 mortalities were recorded. Increased amino acid doses were significantly associated with reduced in-hospital mortality (p < .001). With a no dose reference level, the odds ratios (95% confidence interval) of in-hospital mortality adjusted for potential confounders were 0.78 (0.72–0.85), 0.74 (0.67–0.82), and 0.69 (0.59–0.81) for very low, low, and moderate amino acid doses, respectively. Additionally, patients prescribed amino acid dose levels more than 0.6 g/kg/day had shorter hospitalization periods than those prescribed none. Conclusions Increased amino acid doses were associated with reduced in-hospital mortality. Sufficient amino acid administration is recommended for patients with aspiration pneumonia requiring NPO status.
Collapse
Affiliation(s)
- Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Morioka-cho, Obu-shi, Aichi-ken, Japan
| | - Kenta Murotani
- Biostatistics Center, Kurume University Graduate School of Medicine, Asahi-machi, Kurume, Japan
| | - Satoru Kamoshita
- Medical Affairs Department, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, Japan
| | - Yuri Horikoshi
- Medical Affairs Department, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, Japan
| | - Akiyoshi Kuroda
- Research and Development Center, Otsuka Pharmaceutical Factory, Inc., Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, Japan
| |
Collapse
|
9
|
Ten Cate D, Schoonhoven L, Huisman-de Waal G, Schuurmans MJ, Ettema RGA. Hospital and home care nurses' experiences and perceptions regarding nutritional care for older adults to prevent and treat malnutrition: A cross-sectional study. J Clin Nurs 2021; 30:2079-2092. [PMID: 33829601 DOI: 10.1111/jocn.15764] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To gain insight into the experiences and perceptions of hospital and home care nurses regarding nutritional care for older adults to prevent and treat malnutrition. BACKGROUND In-depth knowledge about hospital and home care nurses' experiences and perceptions can contribute to optimise nutritional care for older adults across the care continuum between hospital and home to prevent and treat malnutrition. DESIGN Multicentre cross-sectional descriptive study. METHOD A validated questionnaire addressing malnutrition was used. A total of 1,135 questionnaires were sent to hospital and home care nurses. The STROBE statement was followed for reporting. RESULTS The response rate was 49% (n = 556). Of all the nurses, 37% perceived the prevalence of malnutrition among their care recipients between 10% and 25%. Almost 22% of the nurses neither agreed nor disagreed or disagreed with the statement that prevention of malnutrition is possible. More than 28% of the nurses reported that malnutrition is a small or no problem. Over 95% of the hospital nurses and 52.5% of the home care nurses stated they screened routinely for malnutrition. The nurses considered several interventions for treating malnutrition important. Over 81% of the nurses indicated they wanted to follow further training. CONCLUSION Most hospital and home care nurses perceived that nutritional care for older adults to prevent and treat malnutrition was important. A fair group of nurses, however, had the opposite perception. RELEVANCE TO CLINICAL PRACTICE Raising the awareness of all hospital and home care nurses about the importance of nutritional care for older adults is pivotal to increase the chance of successfully providing nursing nutritional care. Nurses should follow training for consolidation of nutritional care. Nurses are well-positioned to take a leadership role to improve continuity and quality of nutritional care across the care continuum between hospital and home.
Collapse
Affiliation(s)
- Debbie Ten Cate
- Research Group Chronic Diseases, Utrecht University of Applied Sciences, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Getty Huisman-de Waal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marieke J Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roelof G A Ettema
- Research Group Chronic Diseases, Utrecht University of Applied Sciences, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
10
|
Daoud DC, Cartagena EMS, Schwenger KJP, Somlaw N, Gramlich L, Whittaker S, Armstrong D, Jurewitsch B, Raman M, Duerksen DR, McHattie JD, Allard JP. Home parenteral nutrition in older vs younger patients: Clinical characteristics and outcomes. JPEN J Parenter Enteral Nutr 2021; 46:348-356. [PMID: 33811677 DOI: 10.1002/jpen.2117] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a demographic shift toward older patients receiving home parenteral nutrition (HPN), but data on clinical outcomes are limited. The objective of this study was to determine differences between older and younger HPN patients in regard to HPN indications, prescriptions, and outcomes over the first 2 years receiving HPN. METHODS This was a retrospective analysis of prospectively collected data from HPN adult patients entered in the Canadian HPN Registry. New HPN patients enrolled between 2003 and 2017 and receiving HPN for at least 2 years were selected. Data included demographics, PN prescriptions, catheter-related bloodstream infections (CRBSIs) over the past year, survival, and quality of life based on Karnofsky Performance Status (KPS). RESULTS Four hundred two patients were included: 184 patients were ≥60 years old, and 219 patients were between 18 and 59 years old. There were no differences in the main indications for HPN, body mass index (BMI), and PN prescriptions at baseline. At 2 years, younger patients received more energy from PN than older patients (27.9 vs 19.6 kcal/kg; P < .001), but BMI remained comparable. There were fewer CRBSIs in the older group (20% vs 36%, P = .0023), but 78% of younger patients remained alive vs 69% in the older group (P = .0401). In those alive, the proportion of patients continuing to receive HPN was comparable and the proportion of patients with a KPS ≥60. CONCLUSIONS Older HPN patients have similar clinical characteristics as younger patients but have fewer CRBSIs and higher 2-year mortality.
Collapse
Affiliation(s)
- Dane Christina Daoud
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Elena M S Cartagena
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Katherine J P Schwenger
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicha Somlaw
- Department of Medicine, The Thai Red Cross Society, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Scott Whittaker
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Armstrong
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Brian Jurewitsch
- Department of Pharmacy, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Matreyi Raman
- Division of Gastroenterology and Hepatology, University of Calgary, Alberta, Canada
| | - Donald R Duerksen
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Johane P Allard
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Maeda K, Murotani K, Kamoshita S, Horikoshi Y, Kuroda A. Nutritional management in inpatients with aspiration pneumonia: a cohort medical claims database study. Arch Gerontol Geriatr 2021; 95:104398. [PMID: 33798999 DOI: 10.1016/j.archger.2021.104398] [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: 01/11/2021] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND/OBJECTIVES This study aimed to describe real-world nutrition management patterns among inpatients hospitalized for aspiration pneumonia, using a medical claims database in Japan. METHODS Patients aged ≥65 years hospitalized for aspiration pneumonia treatment were identified in a medical claims database between January 2013 and December 2018, to evaluate nutrition management initiation and adjustment timing, factors associated with >7-days nil per os (NPO) status, prescribed nutrition doses, and types of parenteral nutrition solutions. Patients who received oral intake or enteral nutrition on the day of admission (Day 1) were excluded. RESULTS The analysis population included 72,315 inpatients. The median (first quartile, third quartile) initiation date of oral nutrition intake was Day 4 (3, 7) and 65.1% of patients received oral nutrition intake by Day 7. Factors associated with >7-day NPO included sex, BMI, treatment years, Barthel Index score, Japan Coma Scale score, and oxygen inhalation on the day of hospital admission. Amongst NPO patients on Day 7, only 5.3% were prescribed the recommended doses of ≥20 kcal/kg; 6.4% were prescribed ≥1.0 g/kg amino acids, and 5.7% were prescribed fat energy ratio at ≥15% of non-protein calories. Commonly prescribed parenteral nutrition solutions on Day 7 were carbohydrate/electrolyte solutions (52.8%) and peripheral parenteral nutrition solutions (49.0%). CONCLUSION Prescribed parenteral energy, amino acids, and fat during the NPO period were lower than the recommended doses in the majority of patients. Prescribing recommended doses of each of these component nutrients may be beneficial when managing parenteral nutrition of patients during NPO.
Collapse
Affiliation(s)
- Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu-shi, Aichi-ken, Japan.
| | - Kenta Murotani
- Biostatistics Center, Kurume University Graduate School of Medicine, 67 Asahi-machi, Kurume, Japan
| | - Satoru Kamoshita
- Medical Affairs Department, Otsuka Pharmaceutical Factory, Inc., 2-9 Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, Japan
| | - Yuri Horikoshi
- Medical Affairs Department, Otsuka Pharmaceutical Factory, Inc., 2-9 Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, Japan
| | - Akiyoshi Kuroda
- Medical Affairs Department, Otsuka Pharmaceutical Factory, Inc., 2-9 Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, Japan
| |
Collapse
|
12
|
Sasabuchi Y, Ono S, Kamoshita S, Tsuda T, Kuroda A. Clinical Impact of Prescribed Doses of Nutrients for Patients Exclusively Receiving Parenteral Nutrition in Japanese Hospitals: A Retrospective Cohort Study. JPEN J Parenter Enteral Nutr 2020; 45:1514-1522. [PMID: 33085782 PMCID: PMC8698012 DOI: 10.1002/jpen.2033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/11/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In patients receiving parenteral nutrition (PN), the association between nutrition achievement in accordance with nutrition guidelines and outcomes remains unclear. Our purpose was to assess the association between nutrition achievement and clinical outcomes, including in-hospital mortality, activity of daily living (ADL), and readmission. METHODS In this retrospective cohort study, data were extracted from an inpatient medical-claims database at 380 acute care hospitals. This study included patients who underwent central venous catheter insertion between January 2009 and December 2018. Patients were classified into 3 groups: (1) target-not-achieved; (2) target-partially-achieved; and (3) target-achieved. The target doses of energy, amino acids, and lipid were defined as ≥20 kcal/kg/day, ≥1.0 g/kg/day, and ≥2.5 g/day, respectively. To examine the effect of nutrition achievement on outcomes, a multivariable logistic regression analysis was performed. RESULTS A total of 54,687 patients were included; of these, 21,383 patients were in the target-not-achieved group, 29,610 patients were in the target-partially-achieved group, and 3694 patients were in the target-achieved group. The adjusted odds ratio (OR) (95% CI) for in-hospital mortality was 0.69 (0.66-0.72) in the target-partially-achieved group and 0.47 (0.43-0.52) in the target-achieved group with reference to the target-not-achieved group. The adjusted ORs for deteriorated ADL was 0.93 (0.85-1.01) in the target-partially-achieved group and 0.77 (0.65-0.92) in the target-achieved group with reference to the target-not-achieved group. Readmission was not associated with nutrition achievement. CONCLUSION In-hospital mortality was lower and deteriorated ADL was suppressed in patients whose PN management was in accordance with the nutrition guidelines.
Collapse
Affiliation(s)
- Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Sachiko Ono
- Data Science Center, Jichi Medical University, Yakushiji, Shimotsuke-shi, Tochigi, Japan
| | - Satoru Kamoshita
- Medical Affairs Department, Otsuka Pharmaceutical Factory, Inc, Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, Japan
| | - Tomoe Tsuda
- Medical Affairs Department, Otsuka Pharmaceutical Factory, Inc, Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, Japan
| | - Akiyoshi Kuroda
- Medical Affairs Department, Otsuka Pharmaceutical Factory, Inc, Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, Japan
| |
Collapse
|
13
|
Volkert D. [Current ESPEN Guideline Clinical Nutrition and Hydration in Geriatrics]. Dtsch Med Wochenschr 2020; 145:1306-1314. [PMID: 32906183 DOI: 10.1055/a-0986-2892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Malnutrition, dehydration and obesity are relevant health problems with far-reaching consequences for older people. Routine screening for malnutrition and dehydration should be carried out in order to identify vulnerable and affected persons at an early stage and to be able to take timely countermeasures. In many cases, adequate nutrition and hydration can be supported by simple nursing measures and optimisation of the food and drink supply. Nutritional advice, sip feed, enteral and parenteral nutrition are further effective measures for the prevention and therapy of malnutrition. An ingestion deficiency dehydration should be diagnosed on the basis of serum osmolality and requires a rapid compensation of the deficit by hypotonic fluids - depending on the severity, in the form of drinks, subcutaneously or intravenously. Weight loss in old age should only be considered in cases of obesity with associated health problems and should be achieved by moderate energy reduction in combination with physical exercise.
Collapse
|
14
|
Sasabuchi Y, Ono S, Kamoshita S, Tsuda T, Murano H, Kuroda A. A survey on total parenteral nutrition in 55,000 hospitalized patients: Retrospective cohort study using a medical claims database. Clin Nutr ESPEN 2020; 39:198-205. [PMID: 32859316 DOI: 10.1016/j.clnesp.2020.06.013] [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: 03/11/2020] [Revised: 05/11/2020] [Accepted: 06/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Identifying the prevalence of underfed patients and risk factors for underfeeding in patients with total parenteral nutrition (TPN) is essential to improve the management of patients receiving TPN. The aim of this study was to examine the prevalence and risk factors for underfeeding using a medical claims database. METHODS In this retrospective cohort study using a medical claims database, we analyzed patient characteristics, timing and duration of nutrition prescription, daily dose of nutrients, and types of parenteral nutrition products administered after central venous catheter (CVC) insertion in hospitalized Japanese patients between 2009 and 2018. The mean prescriptions of energy <20 kcal/kg/day, amino acids <1.0 g/kg/day, and fat <2.5 g/day received by patients between the 4th and 10th day after CVC insertion were regarded as underfeeding. To study the association between nutritional adequacy and body mass index (BMI) with TPN, the proportions of patients with a prescription of energy ≥20 kcal/kg/day or amino acids ≥1.0 g/kg/day were calculated and categorized according to BMI, and the Cochran-Armitage trend test was performed. RESULTS Of 54,687 patients included in the study, 70.3% were aged ≥70 years, and 31.3% had a BMI <18.5. The mean prescription of energy was insufficient in 49.9% of patients, and 82.9% were insufficiently prescribed with amino acids. In addition, 44.4% of the patients were never prescribed a single dose of fat emulsion during their hospital stay. On the 10th day after CVC insertion, the majority of patients used commercial 2-in-1 compounds containing carbohydrates and amino acids. A higher BMI was associated with underfeeding of energy and amino acids (both p < 0.001). CONCLUSIONS It is important to adjust the nutrition dose according to the patient's body size and weight, and it is necessary to supplement inadequate nutrients by single-nutrition solutions in addition to compounded solutions.
Collapse
Affiliation(s)
- Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Sachiko Ono
- Data Science Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Satoru Kamoshita
- Medical Affairs Department, Otsuka Pharmaceutical Factory, Inc., 2-9 Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, 101-0048, Japan
| | - Tomoe Tsuda
- Medical Affairs Department, Otsuka Pharmaceutical Factory, Inc., 2-9 Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, 101-0048, Japan
| | - Haruka Murano
- Clinical Study Support, Inc., 1-11-2Naka-ku0 Nishiki, Nagoya, Aichi, 460-0003, Japan
| | - Akiyoshi Kuroda
- Medical Affairs Department, Otsuka Pharmaceutical Factory, Inc., 2-9 Kanda-Tsukasamachi, Chiyoda-ku, Tokyo, 101-0048, Japan
| |
Collapse
|
15
|
Solomon DM, Hollands JM, Pontiggia L, Delic JJ, Bingham AL. Metabolic Complications Occur More Frequently in Older Patients Receiving Parenteral Nutrition. Nutr Clin Pract 2020; 35:627-633. [PMID: 32579257 DOI: 10.1002/ncp.10499] [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: 01/10/2020] [Accepted: 04/25/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The European Society for Clinical Nutrition and Metabolism Guidelines for Parenteral Nutrition in Geriatric Patients state metabolic complications are more frequent in elderly patients. However, literature provides limited information about metabolic complications in older patients receiving parenteral nutrition (PN). Consequently, the purpose of this study was to compare the development of metabolic complications in older vs younger patients receiving PN. METHODS Patients receiving PN from May 1, 2014, to February 7, 2017, at Cooper University Hospital were included. Metabolic complications assessed included acid-base disturbances, hepatic complications, hypercapnia, hyperchloremia, hyperglycemia, hypernatremia, hypertriglyceridemia, hypochloremia, hypoglycemia, hypokalemia, hypophosphatemia, and refeeding syndrome. RESULTS 595 patients were included (older group [≥65 years]: n = 245, median age: 76 years; younger group [<65 years]: n = 350, median age: 53 years]. Certain characteristics were similar between groups (female, 51%; mean body mass index of 28; critically ill, 34%; central PN, 97%; median duration of PN, 7 days; mean energy provision PN, 25.4 kcal/kg/d; mean dextrose infusion rate, 2.31 mg/kg/min). Overall, metabolic complications developed in 58% of patients and occurred more frequently in older vs younger patients (65.7% vs 53.4%; P = .003). Multivariate logistic analysis demonstrated increased odds of metabolic complications in the older group (odds ratio, 1.55; 95% CI, 1.014-2.375). CONCLUSIONS Older hospitalized patients are more likely to develop a metabolic complication during their PN course than younger patients. This study heightens awareness that patients of advanced age are subject to metabolic complications; practitioners should anticipate and resolve complications in a timely manner.
Collapse
Affiliation(s)
- Diana M Solomon
- Department of Pharmacy, Cooper University Hospital, Camden, New Jersey, USA.,Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James M Hollands
- Department of Pharmacy, Cooper University Hospital, Camden, New Jersey, USA.,Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA
| | - Laura Pontiggia
- Department of Mathematics, Physics and Statistics, University of the Sciences, Philadelphia, Pennsylvania, USA
| | - Justin J Delic
- Department of Pharmacy, Cooper University Hospital, Camden, New Jersey, USA.,Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA
| | - Angela L Bingham
- Department of Pharmacy, Cooper University Hospital, Camden, New Jersey, USA.,Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA
| |
Collapse
|
16
|
Zhu M, Cui H, Chen W, Jiang H, Li Z, Dong B, Chen H, Wang Y, Tang Y, Hu Y, Sun J, Chen Y, Tao Y, Zhou S, Cao W, Wei J. Guidelines for parenteral and enteral nutrition in geriatric patients in China. Aging Med (Milton) 2020; 3:110-124. [PMID: 34553111 PMCID: PMC8445042 DOI: 10.1002/agm2.12110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 02/05/2023] Open
Abstract
Based on the expert consensus on parenteral and enteral nutrition support for geriatric patients in China in 2013, domestic multidisciplinary experts were gathered to summarize the new evidence in the field of elderly nutritional support at home and abroad. The 2013 consensus was comprehensively updated and upgraded to a guideline by referring to the World Health Organization (WHO) guidelines for the Grading of Recommendations Assessment, Development, and Evaluation system for grading evidence. These guidelines were divided into two parts: general conditions and common diseases. After discussion by all members of the academic group and consultation with relevant experts, 60 recommendations were ultimately established as standardized nutritional support in the field of geriatrics in China.
Collapse
Affiliation(s)
- Mingwei Zhu
- Department of General SurgeryBeijing HospitalBeijingChina
| | - Hongyuan Cui
- Department of General SurgeryBeijing HospitalBeijingChina
| | - Wei Chen
- Department of Parenteral and Enteral NutritionBeijing Union HospitalBeijingChina
| | - Hua Jiang
- Institute of Emergency and Disaster MedicineSichuan Provincial People’s HospitalChengduChina
| | - Zijian Li
- Department of General SurgeryBeijing HospitalBeijingChina
| | - Birong Dong
- Department of GeriatricsSichuan University West China HospitalChengduChina
| | - Huaihong Chen
- Department of Neurologythe Second Affiliated Hospital of Zhejiang University school of medicineHangzhouChina
| | - Yan Wang
- Department of Cardiovascular medicineBeijing HospitalBeijingChina
| | - Yun Tang
- Department of General SurgeryChinese PLA General HospitalBeijingChina
| | - Yu Hu
- Department of GeriatricsZhongshan Hospital Fudan UniversityShanghaiChina
| | - Jianqin Sun
- Department of NutritionHuadong Hospital Affiliated to Fudan UniversityShanghaiChina
| | - Yanjin Chen
- Department of General SurgeryTianjin Hospital of ITCWMTianjinChina
| | - Yexuan Tao
- Department of Clinical NutritionXinhua Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Suming Zhou
- Department of Geriatrics Intensive Care UnitNanjing Medical University First Affiliated HospitalNanjingChina
| | - Weixin Cao
- Department of clinical NutritionShanghai Jiao Tong University Medical School Affiliated Ruijin HospitalShanghaiChina
| | - Junmin Wei
- Department of General SurgeryBeijing HospitalBeijingChina
| |
Collapse
|
17
|
Bond A, Soop M, Taylor M, Purssell H, Abraham A, Teubner A, Carlson G, Lal S. Home parenteral nutrition and the older adult: Experience from a national intestinal failure unit. Clin Nutr 2020; 39:1418-1422. [DOI: 10.1016/j.clnu.2019.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 12/18/2022]
|
18
|
Factors Contributing to the Preferred Method of Feeding in End-Stage Dementia: A Scoping Review. Dysphagia 2019; 35:616-629. [DOI: 10.1007/s00455-019-10072-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
|
19
|
Veronese N, Cella A, Cruz-Jentoft AJ, Polidori MC, Mattace-Raso F, Paccalin M, Topinkova E, Greco A, Mangoni AA, Daragjati J, Siri G, Pilotto A. Enteral tube feeding and mortality in hospitalized older patients: A multicenter longitudinal study. Clin Nutr 2019; 39:1608-1612. [PMID: 31378515 DOI: 10.1016/j.clnu.2019.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/07/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS The literature regarding enteral nutrition and mortality in older frail people is limited and still conflicting. Moreover, the potential role of comprehensive geriatric assessment is poorly explored. We therefore aimed to investigate whether the Multidimensional Prognostic Index (MPI), an established tool that assesses measures of frailty and predicts mortality, may help physicians in identifying patients in whom ETF (enteral tube feeding) is effective in terms of reduced mortality. METHODS Observational, longitudinal, multicenter study with one year of follow-up. Data regarding ETF were recorded through medical records. A standardized comprehensive geriatric assessment was used to calculate the MPI. Participants were divided in low (MPI-1), moderate (MPI-2) or severe (MPI-3) risk of mortality. Data regarding mortality were recorded through administrative information. RESULTS 1064 patients were included, with 79 (13 in MPI 1-2 and 66 in MPI-3 class) receiving ETF. In multivariable analysis, patients receiving ETF experienced a higher risk of death (odds ratio, OR = 2.00; 95% confidence intervals, CI: 1.19-3.38). However, after stratifying for their MPI at admission, mortality was higher in MPI-3 class patients (OR = 2.03; 95%CI: 1.09-3.76), but not in MPI 1-2 class patients (OR = 1.51; 95%CI: 0.44-5.25). The use of propensity score confirmed these findings. CONCLUSIONS ETF is associated with a higher risk of death. However, this is limited to more frail patients, suggesting the importance of the MPI in the prognostic evaluation of ETF.
Collapse
Affiliation(s)
- Nicola Veronese
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy; Azienda ULSS 3 Serenissima, Primary Care Department, District 3, Venice, Italy.
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy
| | | | | | - Francesco Mattace-Raso
- Section of Geriatric Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marc Paccalin
- Geriatrics Department University Hospital Poitiers, France
| | - Eva Topinkova
- First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Antonio Greco
- Geriatrics Unit, IRCCS CSS, San Giovanni Rotondo, Italy
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Julia Daragjati
- Geriatrics Unit, AULSS 6 Euganea, San Antonio Hospital, Padova, Italy
| | - Giacomo Siri
- Scientific Coordination Unit, E.O. Galliera Hospital, Genova, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy; Department of Interdisciplinary Medicine, 'Aldo Moro' University of Bari, Italy
| | | |
Collapse
|
20
|
Volkert D, Beck AM, Cederholm T, Cereda E, Cruz-Jentoft A, Goisser S, de Groot L, Großhauser F, Kiesswetter E, Norman K, Pourhassan M, Reinders I, Roberts HC, Rolland Y, Schneider SM, Sieber CC, Thiem U, Visser M, Wijnhoven HAH, Wirth R. Management of Malnutrition in Older Patients-Current Approaches, Evidence and Open Questions. J Clin Med 2019; 8:E974. [PMID: 31277488 PMCID: PMC6678789 DOI: 10.3390/jcm8070974] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 01/07/2023] Open
Abstract
Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken-from the identification and elimination of potential causes to enteral and parenteral nutrition-depending on the patient's abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.
Collapse
Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany.
| | - Anne Marie Beck
- Department Nutrition and Health, University College Copenhagen, 2200 Copenhagen, Denmark
- Herlev and Gentofte University Hospital, 2703 Herlev, Denmark
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, 701 05 Uppsala, Sweden
- Theme Ageing, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
| | - Sabine Goisser
- Heidelberg University Centre for Geriatric Medicine and Network Aging Research (NAR), University of Heidelberg, 69126 Heidelberg, Germany
| | - Lisette de Groot
- Division of Human Nutrition, Wageningen University, 6708 WE Wageningen, The Netherlands
| | - Franz Großhauser
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Kristina Norman
- German Institute for Human Nutrition Potsdam-Rehbrücke, Department of Nutrition and Gerontology, 14558 Nuthetal, Germany
- Research Group on Geriatrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Germany
| | - Maryam Pourhassan
- Department for Geriatric Medicine, Marien Hospital Herne-University Hospital, Ruhr-Universität Bochum, 44625 Herne, Germany
| | - Ilse Reinders
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Helen C Roberts
- Southampton NIHR Biomedical Research Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Yves Rolland
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, 31059 Toulouse, France
| | - Stéphane M Schneider
- Nutritional Support Unit, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 06200 Nice, France
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
- Department of Medicine, Kantonsspital Winterthur, 8401 Winterthur, Switzerland
| | - Ulrich Thiem
- Centre of Geriatrics and Gerontology, Albertinen-Haus, Hamburg, and Chair of Geriatrics and Gerontology, University Medical Centre Eppendorf, 20246 Hamburg, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Rainer Wirth
- Department for Geriatric Medicine, Marien Hospital Herne-University Hospital, Ruhr-Universität Bochum, 44625 Herne, Germany
| |
Collapse
|
21
|
Abstract
This article offers a German perspective on orthopaedic management of geriatric populations in higher-income countries. Specific orthopaedic procedures necessitate a more intensive level of care in older adult patients, especially with co-morbidities, than in younger patients. During the pre-, peri- and post-operative periods, several aspects such as patient blood management principles improve the outcomes of geriatric patients. New interdisciplinary geriatric models of care including geriatric and orthopaedic specialties have to be established to take care of the special needs of geriatric patients.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180087
Collapse
Affiliation(s)
- Dieter Wirtz
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Bonn, Germany
| | - Hendrik Kohlhof
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Bonn, Germany
| |
Collapse
|
22
|
Gonçalves SEAB, Ribeiro AAF, Hirose EY, Santos FPDS, Ferreira FM, Koch LDOM, Tanaka M, de Souza MS, Souza PMR, Gonçalves TJM, Pereira AZ. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly. EINSTEIN-SAO PAULO 2019; 17:eAE4340. [PMID: 31116236 PMCID: PMC6533077 DOI: 10.31744/einstein_journal/2019ae4340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 09/05/2018] [Indexed: 12/20/2022] Open
Abstract
The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly was elaborated by nutritionists, nutrologists and hematologists physicians from 15 Brazilians reference centers in hematopoietic stem cell transplantation, in order to emphasize the importancy of nutritional status and the body composition during the treatment, as well as the main characteristics related to patient's nutritional assessment. Establishing the consensus, we intended to improve and standardize the nutritional therapy during the hematopoietic stem cell transplantation. The Consensus was approved by the Brazilian Society of Bone Marrow Transplantation.
Collapse
Affiliation(s)
| | - Andreza Alice Feitosa Ribeiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Centro de Transplante de Medula Óssea, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Márcia Tanaka
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | | | | |
Collapse
|
23
|
Wang ZY, Chen JM, Ni GX. Effect of an indwelling nasogastric tube on swallowing function in elderly post-stroke dysphagia patients with long-term nasal feeding. BMC Neurol 2019; 19:83. [PMID: 31043159 PMCID: PMC6495564 DOI: 10.1186/s12883-019-1314-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 04/22/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In clinical practice, a large number of post-stroke survivors require nasogastric tube (NGT) placement and nasal feeding for a relatively long period. However, its impact on the swallowing function remains largely unknown. This study examines the impact of prolonged placement of an NGT on the swallowing function of elderly post-stroke patients. METHODS The participants of this study were 30 elderly post-stroke patients who had been using an NGT for more than 2 months. A videofluoroscopic swallowing study (VFSS) was performed before and 5 h after removal of the NGT. The following parameters were analyzed and compared, the functional dysphagia scale (FDS), residue in the valleculae, residue in the pyriform sinuses, and the penetration-aspiration scale (PAS). In addition, prior to the VFSS, the pharynx and larynx were examined using a fiberoptic laryngoscope. RESULTS Significant differences were observed between the total scores of the FDS, pharyngeal transit times (PTTs), the residue in the valleculae, and the residue in the pyriform sinuses before and after the NGT removal, suggesting an improved swallowing function following the removal of the NGT. A significantly lower penetration-aspiration degree was found after removing the NGT compared with that before its removal. In addition, examinations using the fiberoptic laryngoscope showed that laryngopharyngeal edema was present in three quarters of the patients. CONCLUSIONS Our results demonstrate that prolonged placement of the NGT had a negative impact on the swallowing function of elderly post-stroke dysphagia patients, mainly on the pharyngeal phase.
Collapse
Affiliation(s)
- Zhi-Yong Wang
- 0000 0004 1758 0400grid.412683.aDepartment of Rehabilitation Medicine, First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005 China
| | - Jian-Min Chen
- 0000 0004 1758 0400grid.412683.aDepartment of Rehabilitation Medicine, First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005 China
| | - Guo-Xin Ni
- 0000 0004 1758 0400grid.412683.aDepartment of Rehabilitation Medicine, First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005 China
- 0000 0001 2223 5394grid.411614.7School of Sports Medicine and Rehabilitation, Beijing Sport University, No. 48 Shangdi Information Road, Beijing, 100084 China
| |
Collapse
|
24
|
Inadequate Postoperative Energy Intake Relative to Total Energy Requirements Diminishes Acute Phase Functional Recovery From Hip Fracture. Arch Phys Med Rehabil 2019; 100:32-38. [DOI: 10.1016/j.apmr.2018.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/04/2018] [Accepted: 06/07/2018] [Indexed: 01/12/2023]
|
25
|
Iacone R, Scanzano C, Santarpia L, Alfonsi L, Marra M, Pagano MC, D'Isanto A, Frangipane I, Vitalone A, D'Angeli M, Contaldo F, Pasanisi F. Essential Amino Acid Profile in Parenteral Nutrition Mixtures: Does It Meet Needs? Nutrients 2018; 10:nu10121937. [PMID: 30563270 PMCID: PMC6316548 DOI: 10.3390/nu10121937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND AIMS The study compares the essential amino acid (EAA) composition of different parenteral nutrition (PN) mixtures with whey protein EAA profile and the theoretical daily EAA requirements (set by WHO/FAO/UNU or IAAO method). According to the individual EAA profile, the potential effect of several PN mixtures was evaluated on the skeletal muscle mass (SMM) of patients on home PN. METHODS Eight AA solutions and fifteen complete PN mixtures were considered. Twenty-nine clinically stable patients with short bowel syndrome on home total PN were retrospectively evaluated. SMM was estimated by bioelectrical impedance analysis. RESULTS The prescribed doses of EAA that showed a significant increase in home PN patients muscle mass were considerably greater than the theoretical ones, showing an EAA profile similar to whey protein. At the daily dose of 1 g of total AA s/kg body weight (BW), the considered PN mixtures mostly failed to improve SMM. Only prescribed doses which included more than 0.25 g/kg BW of total BCAA with at least 0.10 g/kg BW leucine, 0.08 g/kg BW isoleucine, and 0.06 g/kg BW methionine showed a significant increase in SMM. CONCLUSIONS The theoretical daily requirement for each EAA was met by all considered PN solutions when the prescribed daily dose of total AAs was set at 1 g/kg BW. Nevertheless, our data suggest that only an increase in total BCAA, also richer in single AA leucine, isoleucine, and methionine, is associated with the maintenance and/or increase of SMM. According to these preliminary observations, we support the prescription of an EAA composition of PN mixtures close to that of whey protein for the preservation of SMM in patients on long-term total PN.
Collapse
Affiliation(s)
- Roberto Iacone
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Clelia Scanzano
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Lidia Santarpia
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Maurizio Marra
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Maria Carmen Pagano
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Anna D'Isanto
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Ignazio Frangipane
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Andrea Vitalone
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Mariana D'Angeli
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Franco Contaldo
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, "Federico II", University Hospital, 80131 Naples, Italy.
| |
Collapse
|
26
|
Akashi Y, Suzuki H, Kanemoto K, Hirose Y, Yamashita K, Yamamoto T, Miyazawa T, Hirose K, Ishikawa H, Maeno T. Thiamine Concentrations in Newly Hospitalized Elderly Patients with Infectious Diseases at a Community Hospital in Japan. J Nutr Sci Vitaminol (Tokyo) 2018; 64:209-214. [PMID: 29962432 DOI: 10.3177/jnsv.64.209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The association between advanced age and the thiamine concentration has not been conclusively determined. A recent report from Japan showed that more than half of nursing home elderly residents at an institution had a low whole-blood thiamine concentration (<20 ng/mL). Therefore, a high incidence of low thiamine concentrations among hospitalized elderly has been anticipated in the Japanese population but never investigated. We evaluated the whole thiamine concentration in newly hospitalized elderly patients (≥65 y old) with infectious diseases. Evaluations were performed on admission and at days 6-8 of hospitalization with liquid chromatography tandem mass spectrometry (LC/MS/MS). As a result, we enrolled a total of 471 patients from September 2015 to December 2016. The median thiamine concentration was 46 ng/mL (IQR, 37-58 ng/mL). Only 7 patients (1%) had thiamine concentrations below 20 ng/mL (66 nmol/L) on admission. Five of these patients were bedridden and unable to eat food by themselves, and the other two patients used loop diuretics for chronic heart failure. The thiamine concentration declined in most patients (84%) at days 6-8 of admission, regardless of their dietary intake during hospitalization. In conclusion, a low thiamine concentration was not prevalent among newly hospitalized elderly patients with infectious diseases. However, the thiamine concentration significantly decreased during the 6-8 d of hospitalization.
Collapse
Affiliation(s)
- Yusaku Akashi
- Department of Clinical Laboratory Medicine, Tsukuba Medical Center Hospital.,Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Hiromichi Suzuki
- Department of Clinical Laboratory Medicine, Tsukuba Medical Center Hospital.,Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital
| | - Koji Kanemoto
- Department of Respiratory Medicine, Tsukuba Medical Center Hospital
| | - Yumi Hirose
- Department of General Medicine and Primary Care, Tsukuba Medical Center Hospital
| | - Keita Yamashita
- Department of Clinical Laboratory, Tsukuba Medical Center Hospital
| | | | | | - Kazuhito Hirose
- Department of General Medicine and Primary Care, Tsukuba Medical Center Hospital
| | - Hiroichi Ishikawa
- Department of Clinical Laboratory Medicine, Tsukuba Medical Center Hospital.,Department of Respiratory Medicine, Tsukuba Medical Center Hospital
| | - Tetsuhiro Maeno
- Graduate School of Comprehensive Human Sciences, University of Tsukuba
| |
Collapse
|
27
|
Hsiao HT, Lee JJ, Chen HH, Wu MK, Huang CW, Chang YT, Lien CY, Wang JJ, Chang HI, Chang CC. Adequacy of nutrition and body weight in patients with early stage dementia: The cognition and aging study. Clin Nutr 2018; 38:2187-2194. [PMID: 30316533 DOI: 10.1016/j.clnu.2018.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Recent evidence highlights the effects of obesity, diabetes and hypertension in the development of Alzheimer's disease. Involuntary body weight changes in patients with different stages of dementia can be related to clinical factors of the patient per se or support from their caregivers. Understanding the interactions among factors is important to establish a monitoring paradigm to guide treatment strategies. METHODS A total of 345 patients with very mild (n = 224) and mild stage (n = 121) dementia were enrolled from a multi-disciplinary dementia clinic. Clinical data (comorbidities, Mini-Mental State Examination [MMSE] scores, neuropsychiatric inventory [NPI] scores, eating behavior questionnaire), nutritional state (Mini-Nutritional Assessment [MNA] or MNA short form [MNA-SF]) and body mass index (BMI) were recorded. Nutritional state and BMI served as the two major outcome measures, and factors for analysis included diagnosis, dementia severity and clinical data. RESULTS There was a significant correlation between MNA-SF and MNA (r = .898, p < 0.01), but a 24% mismatch in case dislocation was found using the at-risk or malnutrition criteria. Factors related to obesity included male sex, higher MNA-SF and MNA scores, diabetes mellitus and hypertension, while acceptable discrimination for obesity (BMI≧23 kg/m2) was obtained with a MNA-SF score of 12/13 or MNA score of 21/22. NPI was the only independent factor related to both MNA-SF (β = -.06, P < 0.001) and MNA (β = -.1, P < 0.001). A BMI of 22-23 kg/m2 was adequate in this group of patients with early stage dementia from nutritional and comorbidity perspectives. After controlling for BMI, the patients with advanced dementia had higher swallowing problem and appetite change scores. CONCLUSIONS In these patients with early stage dementia, a higher BMI indicated adequate nutritional status and higher MMSE, but also higher rates of comorbidities, diabetes mellitus and hypertension.
Collapse
Affiliation(s)
- Hua-Tsen Hsiao
- Department of Nursing, National Tainan Junior College of Nursing, Taiwan
| | - Jun-Jun Lee
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Hui Chen
- Department of Physical Education, National Kaohsiung University of Science and Technology, Taiwan
| | - Ming-Kung Wu
- Department of Psychiatry, Cognition and Aging Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Wei Huang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ya-Ting Chang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Yi Lien
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jing-Jy Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
| | - Hsin-I Chang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute of Human Resource Management, National Sun Yat-Sen University, Taiwan
| | - Chiung-Chih Chang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| |
Collapse
|
28
|
Current clinical trials in paediatrics: Report of the ESPEN special interest group in paediatrics. Clin Nutr ESPEN 2018; 27:75-78. [DOI: 10.1016/j.clnesp.2018.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 11/20/2022]
|
29
|
Pelegrina-Cortés B, Bermejo LM, López-Plaza B, Palma-Milla S, García-Vázquez N, Gómez-Candela C. Nutritional Composition Assessment of 3000 Individualized Parenteral Nutrition Bags in a Tertiary Referral Hospital: Current Prescribing Patterns. Nutrients 2018; 10:nu10081079. [PMID: 30104490 PMCID: PMC6115948 DOI: 10.3390/nu10081079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/01/2018] [Accepted: 08/09/2018] [Indexed: 11/17/2022] Open
Abstract
Individualized parenteral nutrition is the most specialized type of nutritional support in the hospital setting. The composition and prescribing patterns for parenteral nutrition have evolved due to new emerging scientific evidence. In the last few years, there has been a tendency to increase the nitrogen and lipid content and decrease the carbohydrate content. To assess the prescribing pattern in a tertiary referral hospital in Spain, the nutritional composition of individualized parenteral nutrition was evaluated retrospectively from January to December of 2016. A total of 3029 parenteral nutrition units were analysed, corresponding to 257 hospitalized adult patients. Medical specialists in General Surgery and Haematology were the most common petitioners. The three most frequently prescribed parenteral nutrition formulae contained 13.4 (28.8%), 15.7 (19.54%) and 17.9 (17.79%) g of nitrogen. The quantity of carbohydrates and lipids showed a mean non-protein calories-to-nitrogen ratio of approximately 78:1 and a carbohydrate-to-lipid ratio that was near 50:50 in most cases. These results suggest a trend towards the administration of parenteral nutrition with a high content of nitrogen and smaller proportion of the non-protein components.
Collapse
Affiliation(s)
| | - Laura M Bermejo
- Nutrition Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain.
| | - Bricia López-Plaza
- Nutrition Research Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain.
| | - Samara Palma-Milla
- Dietetic and Clinical Nutrition Department, La Paz University Hospital, Hospital La Paz Institute for Health Research (IdiPAZ), University Autonoma of Madrid, 28046 Madrid, Spain.
| | | | - Carmen Gómez-Candela
- Dietetic and Clinical Nutrition Department, La Paz University Hospital, Hospital La Paz Institute for Health Research (IdiPAZ), University Autonoma of Madrid, 28046 Madrid, Spain.
| |
Collapse
|
30
|
Artico M, D'Angelo D, Piredda M, Petitti T, Lamarca L, De Marinis MG, Dante A, Lusignani M, Matarese M. Pressure Injury Progression and Factors Associated With Different End-Points in a Home Palliative Care Setting: A Retrospective Chart Review Study. J Pain Symptom Manage 2018; 56:23-32. [PMID: 29548891 DOI: 10.1016/j.jpainsymman.2018.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Patients with advanced illnesses show the highest prevalence for pressure injuries. In the palliative care setting, the ultimate goal is injury healing, but equally important is wound maintenance, wound palliation (wound-related pain and symptom management), and primary and secondary wound prevention. OBJECTIVES To describe the course of healing for pressure injuries in a home palliative care setting according to different end-points, and to explore patient and caregiver characteristics and specific care activities associated with their achievement. METHODS Four-year retrospective chart review of 669 patients cared for in a home palliative care service, of those 124 patients (18.5%) had at least one pressure injury with a survival rate less than or equal to six months. RESULTS The proportion of healed pressure injuries was 24.4%. Of the injuries not healed, 34.0% were in a maintenance phase, whereas 63.6% were in a process of deterioration. Body mass index (P = 0.0014), artificial nutrition (P = 0.002), and age <70 years (P = 0.022) emerged as predictive factors of pressure injury complete healing. Artificial nutrition, age, male caregiver (P = 0.034), and spouse (P = 0.036) were factors significantly associated with a more rapid pressure injury healing. Continuous deep sedation was a predictive factor for pressure injury deterioration and significantly associated with a more rapid worsening. CONCLUSION Pressure injury healing is a realistic aim in home palliative care, particularly for injuries not exceeding Stage II occurring at least two weeks before death. When assessing pressure injuries, our results highlight the need to also pay attention to artificial nutrition, continuous deep sedation, and the caregiver's role and gender.
Collapse
Affiliation(s)
- Marco Artico
- School of Nursing, Faculty of Medicine, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy; Palliative Care and Pain Therapy Unit, Azienda ULSS 4 Veneto Orientale, San Donà di Piave, Venice, Italy
| | | | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| | - Tommasangelo Petitti
- Research Unit Hygiene, Statistics and Public Health, Campus Bio-Medico di Roma University, Rome, Italy
| | - Luciano Lamarca
- Palliative Care and Pain Therapy Unit, Azienda ULSS 4 Veneto Orientale, San Donà di Piave, Venice, Italy
| | | | - Angelo Dante
- Department of Health, Life and Environmental Sciences, University of L'Aquila, Coppito (L'Aquila), Italy
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maria Matarese
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| |
Collapse
|
31
|
ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 642] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
Collapse
|
32
|
Prell T, Perner C. Disease Specific Aspects of Malnutrition in Neurogeriatric Patients. Front Aging Neurosci 2018; 10:80. [PMID: 29628887 PMCID: PMC5876291 DOI: 10.3389/fnagi.2018.00080] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/12/2018] [Indexed: 12/12/2022] Open
Abstract
Malnutrition in elderly patients is a common condition. Nevertheless, there is evidence on specific risk factors and problems of malnutrition in geriatric patients with neurological diseases. In this review, we summarize recent knowledge on malnutrition in different neurological diseases with a focus on elderly patients. This overview also provides strategies for a more specific and profound assessment of neurogeriatric patients to improve identification and treatment of malnutrition. Early and consequent treatment of malnutrition can lead to a decreased progression of the neurological disease and to a better quality of life in geriatric patients.
Collapse
Affiliation(s)
- Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Caroline Perner
- Department of Neurology, Jena University Hospital, Jena, Germany
| |
Collapse
|
33
|
Protein Requirements in Critically Ill Older Adults. Nutrients 2018; 10:nu10030378. [PMID: 29558388 PMCID: PMC5872796 DOI: 10.3390/nu10030378] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022] Open
Abstract
Critically ill elderly patients' nutritional needs are not well understood and vary with the phase of illness and recovery. Patients' nutritional needs should be assessed early in hospitalization and re-assessed throughout the stay with additional attention during the transitions from critical illness, to severe illness, to post-hospital rehabilitation. In this review, we summarize recent findings and highlight recommendations for protein supplementation in critically ill geriatric patients throughout the stages of recovery. Future research specifically focusing on protein dose, its relationship with caloric needs, and delivery modality must be conducted to provide more specific guidelines for clinical practice.
Collapse
|
34
|
Sahin A, Tunc N, Demirel U, Kursat Poyrazoglu O, Yalniz M, Halil Bahcecioglu I. Relationship between diverticulosis and nonalcoholic fatty liver disease in elderly patients. J Int Med Res 2018; 46:1545-1554. [PMID: 29432700 PMCID: PMC6091830 DOI: 10.1177/0300060517751740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To compare clinical and laboratory features of elderly patients with and without diverticulosis and assess factors related to hepatosteatosis. Method This retrospective case–control study analysed the clinical and laboratory data, colonoscopy and abdominal ultrasonography records of patients >65 years who underwent colonoscopies. Subjects were categorized according to the presence and absence of colonic diverticulosis. Univariate/multivariate logistic regression analyses were performed to evaluate the independent predictive factors of hepatosteatosis. Results A total of 355 patients were enrolled in the study: 169 had colonic diverticulosis; and 186 without colonic diverticulosis formed the control group. Age, sex and chronic disorders associated with the metabolic syndrome did not differ between the diverticulosis and control groups. The rate of hepatosteatosis was lower in patients with diverticulosis compared with the control group (27% versus 42%, respectively). Diabetes mellitus, hyperlipidaemia and hepatosteatosis were more common among patients aged <75 years. In the multivariate logistic regression analysis, diverticulosis remained an independent predictor of hepatosteatosis (odds ratio 0.529; 95% confidence interval 0.323, 0.866). Other independent predictive factors in the multivariate analysis were triglyceride and albumin. Conclusion Diverticulosis in the elderly was found to be a negative predictor of hepatosteatosis. Higher values of albumin and triglyceride in conjunction with the absence of diverticulosis may be suggestive of nonalcoholic fatty liver disease in the elderly.
Collapse
Affiliation(s)
- Abdurrahman Sahin
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| | - Nurettin Tunc
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| | - Ulvi Demirel
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| | - Orhan Kursat Poyrazoglu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| | - Mehmet Yalniz
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| | - Ibrahim Halil Bahcecioglu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Firat University School of Medicine, Elazig, Turkey
| |
Collapse
|
35
|
Mislang AR, Di Donato S, Hubbard J, Krishna L, Mottino G, Bozzetti F, Biganzoli L. Nutritional management of older adults with gastrointestinal cancers: An International Society of Geriatric Oncology (SIOG) review paper. J Geriatr Oncol 2018; 9:382-392. [PMID: 29396234 DOI: 10.1016/j.jgo.2018.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/28/2017] [Accepted: 01/08/2018] [Indexed: 12/15/2022]
Abstract
Malnutrition is one of the most common physical manifestations of gastrointestinal (GI) cancers and is often under-diagnosed and under-treated. Like cancers, malnutrition occurs more commonly in older adults, with potential negative consequences to quality of life, functional status, tolerance to treatment, and prognosis. Nutritional assessment and management require a proactive and systematic, multi-disciplinary approach. Early assessment, detection, and prompt intervention of cancer-associated malnutrition and cachexia are equally essential to achieve better quality nutritional care for older oncology patients. This article aims to provide an overview of the evidence associated with poor nutrition and outcomes in older adults with GI cancers, and recommends a management approach from a geriatric oncologist's perspective.
Collapse
Affiliation(s)
- Anna Rachelle Mislang
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy; Cancer Clinical Trials Unit, Department of Medical Oncology, Royal Adelaide Hospital, 1 Port Road, Thebarton, South Australia 5000, Australia
| | - Samantha Di Donato
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy
| | - Joleen Hubbard
- Mayo Clinic Medical Oncology, 200 First St. SW, Rochester, MN 55905, United States
| | - Lalit Krishna
- Duke-NUS Graduate Medical School, Singapore; National Cancer Centre Singapore, Singapore; Centre of Biomedical Ethics at National University Singapore, Singapore
| | - Giuseppe Mottino
- Geriatric Medicine, Nuovo Ospedale-Santo Stefano, 59100 Prato, Italy
| | - Federico Bozzetti
- Faculty of Medicine, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Laura Biganzoli
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy.
| |
Collapse
|
36
|
Hortencio TDR, Golucci APBS, Marson FAL, Ribeiro AF, Nogueira RJ. Mineral Disorders in Adult Inpatients Receiving Parenteral Nutrition. Is Older Age a Contributory Factor? J Nutr Health Aging 2018; 22:811-818. [PMID: 30080225 DOI: 10.1007/s12603-018-1035-3] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Parenteral nutrition (PN)-dependent adults and elderly individuals who are admitted to hospital treatment are potentially susceptible to mineral disorder complications due to depleted physiological reserves, loss of lean body mass, and increased fat mass, thus worsening inflammation. AIM The purpose of this study is to evaluate the prevalence of hypophosphatemia, hypokalemia, and hypomagnesaemia prior and within the first 7 days of PN infusion. Furthermore, whether malnutrition and old age are associated with these disorders was also investigated. METHODS This study included a historical cohort of adult patients, and 1,040 patients whose information was prospectively entered in the database were evaluated. RESULTS Of the 781 patients, 27.3% were ≥65 years, 80.9% had undergone surgical treatment, 74.3% were in the intensive care unit, and 17.9% died during the hospitalization period. About 17.1% patients were malnourished. Protein energy malnutrition (PEM) was observed in 31.9% of the elderly patients and 27.1% of adults in general. Hypophosphatemia, hypokalemia, and hypomagnesemia were more prevalent before the start of PN infusion (D0: 214 [18.4%]), and new events were more common during the first 2 days of PN infusion (D1: 283 [23.1%]; D2: 243 [20.1%]. Elderly patients were more susceptible to developing hypophosphatemia (odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.29-2.19; p<0.001). Patients with PEM were also more susceptible to hypophosphatemia (OR: 3.75; 95% CI: 1.13-12.47; p=0.036). CONCLUSION Hypophosphatemia, hypokalemia, and hypomagnesemia were frequently observed in hospitalized adults and elderly patients before and particularly during the first 2 days of PN infusion. Elderly patients and patients with PEM are more susceptible to developing hypophosphatemia.
Collapse
Affiliation(s)
- T D R Hortencio
- Tais Daiene Russo Hortencio, Universidade Estadual de Campinas, Campinas, Sao Paulo, Brazil,
| | | | | | | | | |
Collapse
|
37
|
Abstract
The increasing older adult population guarantees that healthcare providers are more likely to encounter patients requiring treatment for unintended weight loss. Due to physiologic changes that occur in the older adult, it is important to know how to assess for, and diagnose unintended weight loss, as well as understand the treatment options. In addition to the use of enteral and parenteral nutrition, appetite stimulants have been used in older adults. Understanding the dosage, side effects, and proper usage of appetite stimulants, such megestrol acetate, mirtazapine, and dronabinol, is crucial in order to provide safe and effective patient care.
Collapse
Affiliation(s)
- Avi Levitt
- Avi Levitt, BSN, RN, is an MSN Student, Family Nurse Practitioner Program, Patricia A. Chin School of Nursing, California State University, Los Angeles, California. Jean O'Neil, DNP, RN, FNP-BC, is an Assistant Professor of Nursing, MSN Program, Patricia A. Chin School of Nursing, California State University, Los Angeles, California
| | | |
Collapse
|
38
|
Vargas N, Tibullo L, Landi E, Carifi G, Pirone A, Pippo A, Alviggi I, Tizzano R, Salsano E, Di Grezia F, Vargas M. Caring for critically ill oldest old patients: a clinical review. Aging Clin Exp Res 2017; 29:833-845. [PMID: 27761759 DOI: 10.1007/s40520-016-0638-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/29/2016] [Indexed: 11/24/2022]
Abstract
Despite technological advances, the mortality rate for critically ill oldest old patients remains high. The intensive caring should be able to combine technology and a deep humanity considering that the patients are living the last part of their lives. In addition to the traditional goals of ICU of reducing morbidity and mortality, of maintaining organ functions and restoring health, caring for seriously oldest old patients should take into account their end-of-life preferences, the advance or proxy directives if available, the prognosis, the communication, their life expectancy and the impact of multimorbidity. The aim of this review was to focus on all these aspects with an emphasis on some intensive procedures such as mechanical ventilation, noninvasive mechanical ventilation, cardiopulmonary resuscitation, renal replacement therapy, hemodynamic support, evaluation of delirium and malnutrition in this heterogeneous frail ICU population.
Collapse
Affiliation(s)
- Nicola Vargas
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy.
| | - Loredana Tibullo
- Medicine Ward, Medicine Department, "San Giuseppe Moscati" Hospital, via Gramsci, 81031, Aversa, CE, Italy
| | - Emanuela Landi
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Giovanni Carifi
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Alfonso Pirone
- Clinical Nutrition and Dietology Unit, Medicine Department, Azienda Ospedaliera di Rilievo Nazionale e di alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Antonio Pippo
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Immacolata Alviggi
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Renato Tizzano
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Elisa Salsano
- Department of Clinical Disease and Internal Medicine, Federico II University of Naples, via Pansini, 80121, Naples, Italy
| | - Francesco Di Grezia
- Geriatric and Intensive Geriatric Care Ward, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialità "San Giuseppe Moscati", via Contrada Amoretta, 83100, Avellino, Italy
| | - Maria Vargas
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini, 89121, Naples, Italy
| |
Collapse
|
39
|
Gomes F, Schuetz P, Bounoure L, Austin P, Ballesteros-Pomar M, Cederholm T, Fletcher J, Laviano A, Norman K, Poulia KA, Ravasco P, Schneider SM, Stanga Z, Weekes CE, Bischoff SC. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clin Nutr 2017; 37:336-353. [PMID: 28802519 DOI: 10.1016/j.clnu.2017.06.025] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Polymorbidity (also known as multimorbidity) - defined as the co-occurrence of at least two chronic health conditions - is highly prevalent, particularly in the hospitalized population. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid patients hospitalized in medical wards. METHODS The methodology used for the development of the current project follows the standard operating procedures for ESPEN guidelines. It started with an initial meeting of the Working Group in January 2015, where twelve key clinical questions were developed that encompassed different aspects of nutritional support: indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Systematic literature searches were conducted in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until April 2016. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations, which were followed by submission to Delphi voting rounds. RESULTS From a total of 4532 retrieved abstracts, 38 relevant studies were analyzed and used to generate a guideline draft that proposed 22 recommendations and four statements. The results of the first online voting showed a strong consensus (agreement of >90%) in 68% of recommendations and 75% of statements, and consensus (agreement of >75-90%) in 32% of recommendations and 25% of statements. At the final consensus conference, a consensus greater than 89% was reached for all of the recommendations. CONCLUSIONS Despite the methodological difficulties in creating non-disease specific guidelines, the evidence behind several important aspects of nutritional support for polymorbid medical inpatients was reviewed and summarized into practical clinical recommendations. Use of these guidelines offer an evidence-based nutritional approach to the polymorbid medical inpatient and may improve their outcomes.
Collapse
Affiliation(s)
- Filomena Gomes
- Cantonal Hospital Aarau, Switzerland; Medical Faculty, University of Basel, Switzerland
| | - Philipp Schuetz
- Cantonal Hospital Aarau, Switzerland; Medical Faculty, University of Basel, Switzerland.
| | - Lisa Bounoure
- Cantonal Hospital Aarau, Switzerland; Medical Faculty, University of Basel, Switzerland
| | - Peter Austin
- Oxford and Southampton University Hospitals, United Kingdom
| | | | | | - Jane Fletcher
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | | | | | | | | | - Zeno Stanga
- University Hospital and University of Bern, Switzerland
| | - C Elizabeth Weekes
- Guy's & St. Thomas' NHS Foundation Trust and King's College London, United Kingdom
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
40
|
Cotogni P. Management of parenteral nutrition in critically ill patients. World J Crit Care Med 2017; 6:13-20. [PMID: 28224103 PMCID: PMC5295165 DOI: 10.5492/wjccm.v6.i1.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/10/2016] [Accepted: 12/09/2016] [Indexed: 02/06/2023] Open
Abstract
Artificial nutrition (AN) is necessary to meet the nutritional requirements of critically ill patients at nutrition risk because undernutrition determines a poorer prognosis in these patients. There is debate over which route of delivery of AN provides better outcomes and lesser complications. This review describes the management of parenteral nutrition (PN) in critically ill patients. The first aim is to discuss what should be done in order that the PN is safe. The second aim is to dispel “myths” about PN-related complications and show how prevention and monitoring are able to reach the goal of “near zero” PN complications. Finally, in this review is discussed the controversial issue of the route for delivering AN in critically ill patients. The fighting against PN complications should consider: (1) an appropriate blood glucose control; (2) the use of olive oil- and fish oil-based lipid emulsions alternative to soybean oil-based ones; (3) the adoption of insertion and care bundles for central venous access devices; and (4) the implementation of a policy of targeting “near zero” catheter-related bloodstream infections. Adopting all these strategies, the goal of “near zero” PN complications is achievable. If accurately managed, PN can be safely provided for most critically ill patients without expecting a relevant incidence of PN-related complications. Moreover, the use of protocols for the management of nutritional support and the presence of nutrition support teams may decrease PN-related complications. In conclusion, the key messages about the management of PN in critically ill patients are two. First, the dangers of PN-related complications have been exaggerated because complications are uncommon; moreover, infectious complications, as mechanical complications, are more properly catheter-related and not PN-related complications. Second, when enteral nutrition is not feasible or tolerated, PN is as effective and safe as enteral nutrition.
Collapse
|
41
|
Worthington P, Balint J, Bechtold M, Bingham A, Chan LN, Durfee S, Jevenn AK, Malone A, Mascarenhas M, Robinson DT, Holcombe B. When Is Parenteral Nutrition Appropriate? JPEN J Parenter Enteral Nutr 2017; 41:324-377. [PMID: 28333597 DOI: 10.1177/0148607117695251] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings.
Collapse
Affiliation(s)
| | - Jane Balint
- 2 Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | | | - Angela Bingham
- 4 University of the Sciences, Philadelphia, Pennsylvania, USA
| | | | - Sharon Durfee
- 6 Central Admixture Pharmacy Services, Inc, Denver, Colorado, USA
| | | | | | - Maria Mascarenhas
- 9 The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel T Robinson
- 10 Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Beverly Holcombe
- 11 American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| |
Collapse
|
42
|
Revisiting nutritional support for allogeneic hematologic stem cell transplantation-a systematic review. Bone Marrow Transplant 2017; 52:506-513. [PMID: 28067888 DOI: 10.1038/bmt.2016.310] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/05/2016] [Accepted: 10/17/2016] [Indexed: 12/22/2022]
Abstract
In 2009, the American Society of Parenteral and Enteral Nutrition and its European counterpart (Euopean Society for Parenteral and Enteral Nutrition) published guidelines regarding nutritional support of patients with hematologic stem cell transplantation. Our aim was to do an up-to-date literature review regarding benefit of nutritional interventions and treatment recommendations. We searched MEDLINE, EMBASE and Cochrane Library for interventional and observational clinical studies. We extracted data based on a predefined case report form and assessed bias. Out of 459 potential abstracts, 13 studies of mostly moderate quality with a total of 18 167 patients were included. Two very large trials reported negative associations of malnutrition and survival, transplant-related mortality and relapse risk. Some trials found enteral nutrition (EN) to be as effective as parenteral nutrition (PN) with lower complication rates. In addition, EN was associated with better survival, less acute GvHD and faster neutrophil recovery. A neutropenic diet was not superior regarding overall survival, but in contrast resulted in higher infection risk. Current moderate quality studies show negative associations of malnutrition and clinical outcomes, with EN being superior to PN. There was no benefit of neutropenic diets. Large, randomized controlled studies are needed to better understand optimal nutritional support in this patient population.
Collapse
|
43
|
Ann DiMaria-Ghalili R. Development of an Integrated Theory of Surgical Recovery in Older Adults. J Nutr Gerontol Geriatr 2016; 35:1-14. [PMID: 26885942 DOI: 10.1080/21551197.2016.1140535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Experts argue the health care system is not prepared to meet the unique needs of older surgical patients, including how to provide the best care during the recovery phase. Nutrition plays a critical role in the recovery of surgical patients. Since older adults are at risk for malnutrition, examining the role of nutrition as a mediator for surgical recovery across the care continuum in older adults is critical. Presently there is a paucity of frameworks, models, and guidelines that integrate the role of nutrition on the trajectory of postoperative recovery in older surgical patients. The purpose of this article is to introduce the Integrated Theory of Surgical Recovery in Older Adults, an interdisciplinary middle-range theory, so that scholars, researchers, and clinicians can use this framework to promote recovery from surgery in older adults by considering the contribution of mediators of recovery (nutritional status, functional status, and frailty) unique to the older adults.
Collapse
Affiliation(s)
- Rose Ann DiMaria-Ghalili
- a Doctoral Nursing Department and Nutrition Sciences Department, College of Nursing and Health Professions , Drexel University , Philadelphia , Pennsylvania , USA
| |
Collapse
|
44
|
Abd-El-Gawad WM, Rasheedy D. Nutrition in the Hospitalized Elderly. MOLECULAR BASIS OF NUTRITION AND AGING 2016:57-72. [DOI: 10.1016/b978-0-12-801816-3.00006-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
45
|
Bartoszek A, Domżał-Drzewicka R, Kachaniuk H, Kocka K, Muzyczka K. The state of nutrition and the self-assessment of symptoms of depression in the group of seniors living in the countryside of Lublin province - preliminary report. PRZEGLAD GASTROENTEROLOGICZNY 2015; 10:208-14. [PMID: 26759627 PMCID: PMC4697030 DOI: 10.5114/pg.2015.49476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 12/22/2014] [Accepted: 01/07/2015] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The incidence of malnutrition increases together with the number of chronic diseases and medications taken daily. There are also other factors causing changes in the nutrition of the elderly, raising the risk of undernourishment. Such factors include difficulties with daily shopping, meal preparation and other everyday activities, hindering access to food with proper quantitative and qualitative properties. The nutritional state of the elderly is influenced not only by somatic disorders, but also by mental disorders such as depression. AIM To define the relationship between the nutritional state of the elderly living in their home environment and the incidence of depression. MATERIAL AND METHODS The described sample consisted of 116 (100%) elderly persons living in the Lubelskie Voivodeship, using the services carried out within primary healthcare. The nutritional state of the elderly was assessed with the use of the full version of the Mini Nutritional Assessment (MNA) questionnaire. In order to determine the intensity of depression symptoms, the Geriatric Depression Scale (GDS) (the 15-item version by Yesavage) was applied. RESULTS During analysis of the impact of depression on malnutrition risk, a correlation with a high statistical significance level was found. Malnutrition was significantly more often identified in people in whom the GDS scale revealed severe depression (p = 0.00002). The risk of depression has a substantial impact on nutritional state. The nutritional state of the elderly deteriorates together with the increase of the risk of depression. CONCLUSIONS In over 48% of respondents, including those living with their families, an intensification of depression symptoms was found.
Collapse
Affiliation(s)
- Agnieszka Bartoszek
- Chair of Oncology and Environmental Health, Faculty of Nursing and Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Renata Domżał-Drzewicka
- Chair of Oncology and Environmental Health, Faculty of Nursing and Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Hanna Kachaniuk
- Chair of Oncology and Environmental Health, Faculty of Nursing and Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Kocka
- Chair of Oncology and Environmental Health, Faculty of Nursing and Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Muzyczka
- Chair of Oncology and Environmental Health, Faculty of Nursing and Health Sciences, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
46
|
Schneider SM, Hébuterne X. Nutritional support of the elderly cancer patient: Long-term nutritional support. Nutrition 2015; 31:617-8. [DOI: 10.1016/j.nut.2014.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 11/24/2014] [Indexed: 11/16/2022]
|
47
|
Jaafar MH, Mahadeva S, Morgan K, Tan MP. Percutaneous endoscopic gastrostomy versus nasogastric feeding in older individuals with non-stroke dysphagia: a systematic review. J Nutr Health Aging 2015; 19:190-7. [PMID: 25651445 DOI: 10.1007/s12603-014-0527-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of this systematic review was to evaluate existing studies on the effectiveness of percutaneous endoscopic gastrostomy (PEG) feeding compared to nasogastric (NG) feeding for patients with non-stroke related dysphagia. METHODS We searched Ovid MEDLINE, EMBASE, the Cochrane Library, Web of Science and PubMed databases through to December 2013 using the terms "percutaneous endoscopic gastrostomy", "gastrostomy", "PEG", "nasogastric", "nasogastric tube", "nasogastric feeding" and "intubation". We included randomized controlled trials (RCTs) and non-RCTs which compared PEG with NG feeding in individuals with non-stroke dysphagia. RESULTS 9 studies involving 847 participants were included in the final analysis, including two randomized trials. Pooled analysis indicated no significant difference in the risk of pneumonia [relative risk (RR) = 1.18, 95% confidence interval (CI) = 0.87-1.60] and overall complications [relative risk (RR) = 0.80, 95% confidence interval (CI) = 0.63-1.02] between PEG and NG feeding. A meta-analysis was not possible for mortality and nutritional outcomes, but three studies suggested improved mortality outcomes with PEG feeding while two out of three studies reported PEG feeding to be better from a nutritional perspective. CONCLUSIONS Firm conclusions could not be derived on whether PEG feeding is beneficial over NG feeding in older persons with non-stroke dysphagia, as previously published literature were unclear or had a high risk of bias. A well-designed and adequately powered RCT, which includes carer strain and quality of life as outcome measures is therefore urgently needed.
Collapse
Affiliation(s)
- M H Jaafar
- M.P. Tan, Department of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia,
| | | | | | | |
Collapse
|
48
|
Hanna JS. Sarcopenia and critical illness: a deadly combination in the elderly. JPEN J Parenter Enteral Nutr 2015; 39:273-81. [PMID: 25591973 DOI: 10.1177/0148607114567710] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sarcopenia is the age-associated loss of lean skeletal muscle mass. It is the result of multiple physiologic derangements, ultimately resulting in an insidious functional decline. Frailty, the clinical manifestation of sarcopenia and physical infirmity, is associated with significant morbidity and mortality in the elderly population. The underlying pathology results in a disruption of the individual's ability to tolerate internal and external stressors such as injury or illness. This infirmity results in a markedly increased risk of falls and subsequent morbidity and mortality from the resulting traumatic injury, as well as an inability to recover from medical insults, resulting in critical illness. The increasing prevalence of sarcopenia and critical illness in the elderly has resulted in a deadly intersection of disease processes. The lethality of this combination appears to be the result of altered muscle metabolism, decreased mitochondrial energetics needed to survive critical illness, and a chronically activated catabolic state likely mediated by tumor necrosis factor-α. Furthermore, these underlying derangements are independently associated with an increased incidence of critical illness, resulting in a progressive downward spiral. Considerable evidence has been gathered supporting the role of aggressive nutrition support and physical therapy in improving outcomes. Critical care practitioners must consider sarcopenia and the resulting frailty phenotype a comorbid condition so that the targeted interventions can be instituted and research efforts focused.
Collapse
Affiliation(s)
- Joseph S Hanna
- Department of Surgery, Division of Acute Care Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| |
Collapse
|
49
|
Parenteral nutrition in the elderly cancer patient. Nutrition 2014; 31:610-1. [PMID: 25770329 DOI: 10.1016/j.nut.2014.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 11/20/2014] [Indexed: 11/23/2022]
Abstract
Parenteral nutrition may be considered when oral intake and/or enteral nutrition are not sufficient to maintain nutritional status and the patient is likely to die sooner from starvation than from the cancer. A detailed assessment should be made prior to the decision about whether parenteral nutrition should be started. A follow up plan should be documented with objective and patient centred treatment goals as well as specific time points for evaluation.
Collapse
|
50
|
Cotogni P, Pittiruti M. Focus on peripherally inserted central catheters in critically ill patients. World J Crit Care Med 2014; 3:80-94. [PMID: 25374804 PMCID: PMC4220141 DOI: 10.5492/wjccm.v3.i4.80] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/25/2014] [Accepted: 10/14/2014] [Indexed: 02/06/2023] Open
Abstract
Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings (emergency, intensive care, surgery) and for different purposes (fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device (CVAD) (mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe -due to their placement into peripheral veins of the arm- and the advantage of a central location of catheter tip suitable for all osmolarity and pH solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as well as the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs (i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD (CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.
Collapse
|