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Lopes S, Cunha M, Costa JG, Ferreira-Pêgo C. Analysis of food supplements and sports foods consumption patterns among a sample of gym-goers in Portugal. J Int Soc Sports Nutr 2024; 21:2388077. [PMID: 39114969 PMCID: PMC11312987 DOI: 10.1080/15502783.2024.2388077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 07/29/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Gym-goers usually seek methods to improve performance, muscle gain, and overall health. One of the main strategies is including food supplements (FS) into their routine as aids to enhance their athletic capabilities and satisfy their nutritional needs. Thus, this study aimed to investigate and characterize the main FS and Sports Foods (SF) currently consumed, as well as the main reasons for their use and the source of advice in a group of gym-goers in the Lisbon Metropolitan Area (Portugal). METHODS A cross-sectional study was conducted, including 303 gym-goers from Lisbon, Portugal, who were 133 women and 170 males (30.8 ± 12.9 years old). Face-to-face interviews were used by qualified researchers to gather data. RESULTS Most of the interviewed athletes (71.95 %) took FS/SF, being men the main consumers. On average, 1.59 supplements were consumed per athlete. Logistic regression models indicated significant associations between age, gender, and motivations for gym attendance. While men and younger groups attended mainly for hypertrophy, women and older groups were focused on well-being. Protein (59.17 %) was the most used FS/SF, followed by creatine (41.28 %) and multivitamins (27.06 %). Men and younger individuals preferred protein and creatine, while older individuals focused more on specific vitamins and minerals. Women seemed to prefer L-carnitine and protein yogurts. Main sources of information included the internet, friends, and dietitians with notable gender and age-based preferences. Online stores were the main place of purchase. Monthly expenditures on FS/SF were not significantly affected by age or gender, but motivations for use had an influence. CONCLUSION Most of the athletes interviewed took FS/SF, being men the major consumers. Protein was the principal FS/SF used, with online stores being the main place of purchase and the internet the primary source of information. Age and gender were key factors in adopted training, in the FS/SF chosen, and in the source of information selected. It is crucial that health professionals take primary responsibility for providing this guidance.
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Affiliation(s)
- Sofia Lopes
- CBIOS – Universidade Lusófona’s Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - Madalena Cunha
- Universidade Lusófona, School of Health Sciences and Technologies, Lisbon, Portugal
| | - João Guilherme Costa
- CBIOS – Universidade Lusófona’s Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - Cíntia Ferreira-Pêgo
- CBIOS – Universidade Lusófona’s Research Center for Biosciences and Health Technologies, Lisbon, Portugal
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De Lange E, Boeykens K, Beeckman D, Torsy T. The clinical effectiveness of the corrected nose-earlobe-xiphoid distance formula in determining the internal length of a nasogastric tube in adults: A retrospective study. Intensive Crit Care Nurs 2024; 85:103783. [PMID: 39121690 DOI: 10.1016/j.iccn.2024.103783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Accurate determination of the internal length of nasogastric tubes is essential for the safe and effective completion of blind insertions, a routine nursing procedure. The widely used nose-earlobe-xiphoid distance lacks evidence and effectiveness. A recent randomized controlled trial proposed an alternative, the corrected nose-earlobe-xiphoid distance formula. However, its effectiveness in real-world clinical practice has not yet been studied. OBJECTIVE This study assessed the real-world clinical effectiveness of the corrected nose-earlobe-xiphoid distance formula for determining the internal nasogastric tube length in adult patients admitted to hospitalization or intensive care units. DESIGN A single-center retrospective clinical effectiveness study was conducted, utilizing routinely collected observational data. SETTING AND MAIN OUTCOME MEASURES Between October 2020 and November 2022, 358 adult patients in a general hospital requiring a nasogastric feeding tube were included. The primary outcome involved assessing nasogastric tube tip positioning (>3 cm below the lower esophageal sphincter) by an advanced practice nurse through X-ray verification. Secondary outcomes, obtained from patient records for a random subgroup of 100 participants, were reporting clarity and evaluation of the tip position by reviewing radiologists. RESULTS Following evaluation by an advanced practice nurse, all nasogastric feeding tubes were determined to be correctly positioned. Among the subgroup of 100 tubes, X-ray protocols, as documented by the reviewing radiologists, showed varying levels of reporting clarity for the tube tip: 4.0 % lacked reporting, 33.0 % had ambiguous reporting and 63.0 % had unambiguous reporting. CONCLUSION The corrected nose-earlobe-xiphoid distance formula demonstrates potential to emerge as a safer alternative to existing methods for determining the internal length of nasogastric tubes. IMPLICATIONS FOR CLINICAL PRACTICE In addition to healthcare provider education and training, a checklist-based framework is recommended for radiologists to unambiguously report nasogastric tube tip positions.
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Affiliation(s)
- Eva De Lange
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | | | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| | - Tim Torsy
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Nursing, Odisee University College, Sint-Niklaas, Belgium.
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3
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Shen Q, Zhou S, Song M, Ouyang X, Tan Y, Peng Y, Zhou Z, Peng H. Prevalence and prognostic value of malnutrition in patients with IPF using three scoring systems. Respir Med 2024; 233:107774. [PMID: 39168392 DOI: 10.1016/j.rmed.2024.107774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/31/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND To describe the nutritional status of IPF patients, report clinical associations and evaluate the prognostic value of them in IPF. METHODS 264 IPF patients diagnosed with IPF at the Second Xiangya Hospital of Central South University between January 2011 and January 2021 were recruited. Three different scoring systems, including nutritional risk index (NRI), controlling nutritional status (CONUT) score, and prognostic nutritional index (PNI) were used to describe the nutritional status of IPF patients. RESULT This study investigated the prevalence of malnutrition in 264 IPF patients, of which the percentage with malnutrition varied from 37.5 % with the NRI, to 47.4 % with the CONUT score, and to 6.4 % with the PNI. The moderate to severe malnutrition ranged from 10.2 % to 31.1 % across these indices, with PNI identifying only 4.9 % in this category. Worsening malnutrition status was associated with significantly higher incidence of all-cause mortality and IPF death regard of the malnutrition index as NRI (p < 0.05). When the normal nutrition of NRI was used as a reference, patients in the moderate to severe risk remained at a higher risk of all-cause death (HR = 2.06(1.25-3.41)) and IPF death(HR = 2.36(1.35-4.15)). The adjusted multivariate analysis, identified age(HR = 1.13(1.08-1.20)), DLCO <60, % predicted (HR = 3.31(1,24-9.42)) and the use of anti-fibrotic drugs (HR = 0.25(0.10-0.60)) as independent predictors of mortality. CONCLUSIONS Malnutrition is common among patients with IPF and the baseline as diagnosis of IPF is strongly related to increased mortality.
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Affiliation(s)
- Qinxue Shen
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Shiting Zhou
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Min Song
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Xiaoli Ouyang
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Yuexin Tan
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Yating Peng
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Zijing Zhou
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China
| | - Hong Peng
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China.
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Foo J, Roberts M, Williams L, Osadnik C, Bauer J, O'Shea MC. An Automated Malnutrition Screening Tool Using Routinely Collected Data for Older Adults in Long-Term Care: Development and Internal Validation of AutoMal. J Am Med Dir Assoc 2024:105252. [PMID: 39265634 DOI: 10.1016/j.jamda.2024.105252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 09/14/2024]
Abstract
OBJECTIVE To develop and internally validate a malnutrition screening tool based on routinely collected data in the long-term care setting. DESIGN Diagnostic prediction model development and internal validation study. SETTING AND PARTICIPANTS Residents (n = 539) from 10 long-term care facilities in Australia. METHODS Candidate variables identified through expert consultation were collected from routinely collected data in a convenience sample of long-term care facilities. Logistic regression using the Subjective Global Assessment as the reference standard was conducted on 500 samples derived using bootstrapping from the original sample. Candidate variables were selected if included in more than 95% of samples using backwards stepwise elimination. The final model was developed using logistic regression of selected variables. Internal validation was conducted using bootstrapping to calculate the optimism-adjusted performance. Overall discrimination was evaluated via receiver operator characteristic curves and calculation of the area under the curve. Youden's Index was used to identify the optimal threshold value for classifying malnutrition. Sensitivity and specificity were calculated. RESULTS Body mass index and weight change % over 6 months were included in the automated malnutrition screening model (AutoMal), identified in 100% of bootstrapped samples. AutoMal demonstrated excellent discrimination of malnutrition, with area under the curve of 0.8378 (95% CI, 0.80-0.87). Youden's Index value was 0.37, resulting in sensitivity of 78% (95% CI, 71%-83%) and specificity of 77% (72%-81%). Optimism-corrected area under the curve was 0.8354. CONCLUSIONS AND IMPLICATIONS The AutoMal demonstrates excellent ability to differentiate malnutrition status. It makes automated identification of malnutrition possible by using 2 variables commonly found in electronic health records.
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Affiliation(s)
- Jonathan Foo
- Department of Physiotherapy, Monash University, Melbourne, VIC, Australia.
| | - Melanie Roberts
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
| | - Lauren Williams
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
| | - Christian Osadnik
- Department of Physiotherapy, Monash University, Melbourne, VIC, Australia
| | - Judy Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Marie-Claire O'Shea
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
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Schuetz P, Kerr KW, Cereda E, Sulo S. Impact of nutrition interventions for malnourished patients: Introduction to health economics and outcomes research with findings from nutrition care studies. Nutr Clin Pract 2024. [PMID: 39243219 DOI: 10.1002/ncp.11207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/24/2024] [Accepted: 08/15/2024] [Indexed: 09/09/2024] Open
Abstract
Healthcare systems and patients today are challenged by high and ever-escalating costs for care. With increasing costs and declining affordability, public and private healthcare payers are all seeking value in care. As the evidence regarding health benefits of nutrition products and interventional nutrition care is increasing, cost-effectiveness of these interventions needs consideration. Health economics and outcomes research (HEOR) examines the value of healthcare treatments, including nutrition interventions. This review summarizes how HEOR tools are used to measure health impact, that is, the burden of illness, the effect of interventions on the illness, and the value of the nutrition intervention in terms of health and cost outcomes. How studies are designed to compile data for economic analyses is briefly discussed. Then, studies that use HEOR methods to measure efficacy, cost-effectiveness, and cost savings from nutrition care across the healthcare spectrum-from hospitals to nursing homes and rehabilitation centers, to care for community-living individuals, with an emphasis on individuals who are older or experiencing chronic health issues-are reviewed. Overall, findings from HEOR studies over the past decade build considerable evidence to show that nutrition care improves the health of at-risk or malnourished patients effectively and at a reasonable cost. As such, the evidence suggests that nutrition care brings value to healthcare across multiple settings and populations.
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Affiliation(s)
- Philipp Schuetz
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Zabłocka-Słowińska K, Pieczyńska J, Prescha A, Bladowski M, Gajecki D, Kamińska D, Neubauer K, Ottery F, Jager-Wittenaar H. Polish translation, cultural adaptation, and validity confirmation of the Scored Patient-Generated Subjective Global Assessment. Support Care Cancer 2024; 32:634. [PMID: 39230584 PMCID: PMC11374856 DOI: 10.1007/s00520-024-08808-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/13/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE The Scored Patient-Generated Subjective Global Assessment (PG-SGA©) is a validated nutritional screening, assessment, triage, and monitoring tool. The aim of this study was to perform translation, cultural adaptation, linguistic, and content validation of the translated and culturally adapted version of the PG-SGA for the Polish setting. METHODS The study was performed in concordance with the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Principles. Patients (n = 174) and healthcare professionals (HCPs, n = 188) participated in the study. Comprehensibility and difficulty were assessed by patients for the PG-SGA Short Form, and by HCPs for the professional component. Content validity was assessed for the full PG-SGA by HCPs only. Evaluations were operationalized by a 4-point scale. Item and scale indices were calculated using the average item ratings divided by the number of respondents. Item indices < 0.78 required further analysis of the item, while scale indices ≥ 0.90 were defined as excellent and 0.80-0.89 as acceptable. RESULTS The PG-SGA Short Form was rated as excellent for content validity (Scale-CVI = 0.90) by HCPs and easy to comprehend (Scale-CI = 0.96) and use (Scale-DI = 0.94) by patients. The professional component of the PG-SGA was perceived as acceptable for content validity (Scale-CVI = 0.80), comprehension (Scale-CI = 0.87), and difficulty (Scale-DI = 0.80). The physical exam was rated the least comprehensible and the most difficult, and with the lowest content validity. We found significant differences in scale indices (p < 0.05 for all) between HCPs with different professions and between those being familiar with PG-SGA and not. CONCLUSION Translation and cultural adaptation of the PG-SGA for the Polish setting preserved the purpose and conceptual meaning of the original PG-SGA. Validation revealed that the Polish version of PG-SGA is well understood and easy to complete by patients and professionals, and is considered relevant by professionals. However, detailed results indicate the need for appropriate training of the Polish HCPs, especially physicians and nurses, mainly in the worksheets related to the metabolic demand and physical exam.
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Affiliation(s)
- Katarzyna Zabłocka-Słowińska
- The Faculty of Finance and Management, WSB Merito University in Wroclaw, Wroclaw, Poland.
- Department of Health Sciences, University of Opole, Opole, Poland.
- Department of Dietetics and Bromatology, Wroclaw Medical University, Wroclaw, Poland.
| | - Joanna Pieczyńska
- The Faculty of Finance and Management, WSB Merito University in Wroclaw, Wroclaw, Poland
| | - Anna Prescha
- The Faculty of Finance and Management, WSB Merito University in Wroclaw, Wroclaw, Poland
| | - Maciej Bladowski
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Damian Gajecki
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Kamińska
- Department and Clinic of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Neubauer
- Department and Clinic of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Faith Ottery
- Ottery & Associates, LLC, Oncology Care Consultants, Chicago, USA
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
- Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, Netherlands
- Faculty of Physical Education and Physiotherapy, Department Physiotherapy and Human Anatomy, Research Unit Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
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7
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Ji J, Mi S, Hou Z, Zhang Z, Qiu G, Jin Z, Huang J. Impact of imaging-diagnosed sarcopenia on outcomes in patients with biliary tract cancer after surgical resection: a systematic review and meta-analysis. World J Surg Oncol 2024; 22:229. [PMID: 39218917 PMCID: PMC11367777 DOI: 10.1186/s12957-024-03516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND AND AIMS Sarcopenia has been associated with poor prognosis in patients with malignant tumors. However, its impact on the outcomes of patients with biliary tract cancer (BTC) undergoing surgical resection remains unclear and warrants further review. This study aims to summarize the available evidence on this issue. METHODS A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for eligible studies up to March 10, 2024. We extracted data on overall survival (OS), recurrence free survival (RFS), and postoperative major complications from the included studies as the outcomes of interest. Following data synthesis and analysis, we assessed the heterogeneity and performed subgroup analyses. Additionally, the potential for publication bias was evaluated. RESULTS A total of 26 studies involving 4292 BTC patients were ultimately retrieved. The findings indicated that sarcopenia was significantly associated with reduced OS in BTC patients after surgery (adjusted HR: 2.03, 95% CI: 1.65-2.48, P < 0.001, I2 = 57.4%). Moreover, sarcopenia may also be linked to poorer RFS (adjusted HR: 2.15, 95% CI: 1.79-2.59, P < 0.001, I2 = 0%) and increased postoperative major complications (OR: 1.22, 95% CI 1.02-1.47, P = 0.033, I2 = 29.2%) as well. Notably, no significant publication bias was detected through funnel plots and Egger's tests. CONCLUSION Sarcopenia is associated with poorer OS in BTC patients following surgery. Additionally, it may serve as a prognostic indicator for poorer RFS and increased postoperative major complications. Further studies are warrant to standardize existing definitions and validate these findings.
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Affiliation(s)
- Jun Ji
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shizheng Mi
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ziqi Hou
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhihong Zhang
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guoteng Qiu
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhaoxing Jin
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiwei Huang
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
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8
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Nielsen LP, Thomsen KH, Alleslev C, Mikkelsen S, Holst M. Implementation of nutritional care in hospitals: A qualitative study of barriers and facilitators using implementation theory. Scand J Caring Sci 2024; 38:657-668. [PMID: 38520146 DOI: 10.1111/scs.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/19/2024] [Accepted: 02/25/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Disease-related malnutrition is prevalent among hospitalised patients, but not all patients achieve the needed nutritional care. At a Danish University Hospital, focus has been on implementing nutritional practices based on clinical guidelines, but there is continuously variation between the wards regarding the quality of nutritional care. AIM The aim of this study was to identify the potential barriers and facilitators for implementation of the clinical guidelines for nutritional practices and to recommend suggestions for development of nutritional practices, using a theoretical implementation strategy. METHOD The design was a qualitative interview study of employees at a Danish University Hospital, using a semi-structured interview guide. The participants were nurses, nurse's assistant, nurse nutrition expert, head nurse and dieticians. We recruited 11 employees, representing eight different wards. FINDINGS The analysis identified six themes: (1) clear allocation of responsibilities and committed management enhances nutrition practices, (2) leadership support is essential, (3) physical settings and tools affect possibilities for action, (4) selection of equivalent staff is core, (5) teaching promotes the knowledge and skills and (6) a dietitian in the ward facilitates implementation of nutritional care. Barriers and facilitators among the themes were identified and has led to suggestions to strengthen nutritional care, based on implementation theory. CONCLUSION Various factors were identified as having impact on the implementation of nutrition practices and different suggestions have emerged to accommodate those factors, as well as to apply an implementation strategy to facilitate change in practice.
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Affiliation(s)
| | | | - Camilla Alleslev
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Sabina Mikkelsen
- Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Holst
- Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Li CJ, Lee PC, Huang KW, Huang KJ, Chang TE, Chang CC, Wang SE, Shyr YM, Li CP, Luo JC, Hou MC. Postoperative prognostic nutrition index predicts survival in patients with small bowel adenocarcinoma after surgical resection. J Chin Med Assoc 2024; 87:819-827. [PMID: 39017659 DOI: 10.1097/jcma.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Surgical resection (SR) is the main treatment for small bowel adenocarcinoma (SBA), but it increases metabolic demand, systemic inflammation, and digestive dysfunction, resulting in major impacts on the postoperative outcomes of patients. In this study, we aimed to investigate the role of the postoperative prognostic nutritional index (PNI), a surrogate marker of inflammation and nutrition, in patients with SBA after resection. METHODS From June 2014 to March 2022, 44 consecutive patients who underwent SR for SBA in Taipei Veterans General Hospital were retrospectively reviewed. Factors associated with survival including PNI were analyzed. RESULTS PNI decreased in patients after SR for SBA (median change: -1.82), particularly in those who underwent Whipple operation or developed postoperative pancreatic fistula. Postoperative PNI <45.2 best predicted overall survival (OS) (area under the receiver operating characteristic curve [AUROC]: 0.826, p = 0.001). Patients with lower postoperative PNI had significantly worse OS compared to those with higher postoperative values (median OS: 19.3 months vs not reached, p < 0.001). Low postoperative PNI (hazard ratio [HR]: 11.404, p = 0.002), tumoral lymphovascular invasion (HR: 8.023, p = 0.012), and adjuvant chemotherapy (HR: 0.055, p = 0.002) were independent risk factors for OS. Postoperative PNI also significantly predicted recurrence-free survival independent of lymphovascular invasion and adjuvant chemotherapy (HR: 6.705, p = 0.001). CONCLUSION PNI commonly decreases in patients with SBA who undergo Whipple surgery or develop postoperative pancreatic fistula. Postoperative PNI independently predicts survival and may serve as a clinical marker to optimize patient outcomes.
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Affiliation(s)
- Chia-Ju Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kuo-Wei Huang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei City Hospital, Yangming Branch, Taipei, Taiwan, ROC
| | - Kuan-Jung Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tien-En Chang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Chih Chang
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shin-E Wang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ming Shyr
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Pin Li
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Clinical Skills Training, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jiing-Chyuang Luo
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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10
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Janssen SM, Bouzembrak Y, Tekinerdogan B. Artificial Intelligence in Malnutrition: A Systematic Literature Review. Adv Nutr 2024; 15:100264. [PMID: 38971229 DOI: 10.1016/j.advnut.2024.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/03/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024] Open
Abstract
Malnutrition among the population of the world is a frequent yet underdiagnosed problem in both children and adults. Development of malnutrition screening and diagnostic tools for early detection of malnutrition is necessary to prevent long-term complications to patients' health and well-being. Most of these tools are based on predefined questionnaires and consensus guidelines. The use of artificial intelligence (AI) allows for automated tools to detect malnutrition in an earlier stage to prevent long-term consequences. In this study, a systematic literature review was carried out with the goal of providing detailed information on what patient groups, screening tools, machine learning algorithms, data types, and variables are being used, as well as the current limitations and implementation stage of these AI-based tools. The results showed that a staggering majority exceeding 90% of all AI models go unused in day-to-day clinical practice. Furthermore, supervised learning models seemed to be the most popular type of learning. Alongside this, disease-related malnutrition was the most common category of malnutrition found in the analysis of all primary studies. This research provides a resource for researchers to identify directions for their research on the use of AI in malnutrition.
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Affiliation(s)
- Sander Mw Janssen
- Information Technology Group, Wageningen University and Research, Wageningen, The Netherlands
| | - Yamine Bouzembrak
- Information Technology Group, Wageningen University and Research, Wageningen, The Netherlands.
| | - Bedir Tekinerdogan
- Information Technology Group, Wageningen University and Research, Wageningen, The Netherlands
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11
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Kozow JFC, Rabito EI, Kruger JF, Medeiros CO, da Costa RL, Beux MR, Stangarlin-Fiori L. Microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home: a systematic review. Nutr Rev 2024; 82:1226-1238. [PMID: 37824326 DOI: 10.1093/nutrit/nuad123] [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: 10/14/2023] Open
Abstract
CONTEXT The safety of enteral formulas is important to restore and maintain the health of patients. OBJECTIVE A systematic review of the literature was conducted to assess the microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home. DATA SOURCES A systematic search was conducted of the Medline, Scopus, BVS, CAPES/MEC, Embase, Science Direct, and SciELO databases and gray literature. DATA EXTRACTION Eligible studies that analyzed the contamination of enteral formulas manipulated in hospitals and/or at home were selected; a quality assessment tool was used. DATA ANALYSIS Twenty-three studies evaluated 1099 enteral formulations. Of these, 44.67% of enteral formulas (n = 491) exceeded the acceptable bacterial count. Samples of homemade enteral formulation preparations (86.03%; n = 191) had the highest bacterial counts, followed by mixed preparations (79.72%; n = 59), and commercial formulas (30.01%; n = 241). The number of samples of enteral formulations that exceeded the bacterial count at home was 70.79% (n = 160 at the hospital was 37.91% (n = 331). Total coliforms (82.68%; n = 406) and mesophilic aerobes (79.22%; n = 389) were the most common microorganisms. Samples with bacterial pathogens were also identified, with Bacillus cereus (4.07%; n = 20) and Listeria monocytogenes (3.66%; n = 18) being the most prevalent. CONCLUSIONS A high number of samples of enteral formulations exceeded the bacterial count, but the risk to patient's health when consuming enteral tube feeding prepared in hospitals or at home may be low. This is because the bacteria present in the samples are not considered potential causes of disease but rather indicators of hygiene conditions. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022367573.
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Affiliation(s)
| | - Estela Iraci Rabito
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Jenifer Faria Kruger
- Complexo Hospital de Clínicas, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Caroline Opolski Medeiros
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Rayane Luizi da Costa
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Márcia Regina Beux
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Curitiba, Paraná, Brazil
| | - Lize Stangarlin-Fiori
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Parana, Curitiba, Paraná, Brazil
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12
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Gortan Cappellari G, Zanetti M, Donini LM, Barazzoni R. Detecting sarcopenia in obesity: emerging new approaches. Curr Opin Clin Nutr Metab Care 2024; 27:402-409. [PMID: 39022899 PMCID: PMC11309345 DOI: 10.1097/mco.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
PURPOSE OF REVIEW Sarcopenic obesity is a likely common, but certainly underestimated obesity phenotype, with an important negative clinical impact. Its definition and diagnosis have however remained elusive until recently. RECENT FINDINGS Substantial progress has been recently made in sarcopenic obesity diagnostic tools, with the first international consensus proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). Very encouraging results emerge from initial implementation of the ESPEN-EASO algorithm. In addition, even more recent progress in global consensus on sarcopenia conceptual definition is likely to further enhance consistency in sarcopenic obesity identification. The latter Global Leadership Initiative on Sarcopenia (GLIS) initiative also adopted a new definition of muscle specific strength. Its inclusion in sarcopenia diagnostic constructs opens the possibility of its potential evaluation in sarcopenic obesity, also considering the emerging positive impact of obesity treatment and fat loss on muscle functional parameters. SUMMARY New consensus tools for sarcopenic obesity diagnosis are likely to improve awareness, understanding, identification and treatment of this under-recognized obesity phenotype.
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Affiliation(s)
- Gianluca Gortan Cappellari
- Department of Medical, Surgical and Health Sciences – University of Trieste
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences – University of Trieste
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste
| | | | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences – University of Trieste
- Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Trieste
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Lindström R, Orrevall Y, Belqaid K, McGreevy J, Ottenblad A, Rothenberg E, Slinde F, Ottery FD, Jager-Wittenaar H, Einarsson S. Swedish translation and cultural adaptation of the scored Patient-Generated Subjective Global Assessment (PG-SGA©)-A validated tool for screening and assessing malnutrition in clinical practice and research. Scand J Caring Sci 2024; 38:589-601. [PMID: 38713754 DOI: 10.1111/scs.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 04/09/2024] [Accepted: 04/20/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION The scored Patient-Generated Subjective Global Assessment (PG-SGA©) is a validated tool for the screening, assessment and monitoring of malnutrition, and triaging of interventions. It contains a patient-generated component and a healthcare professional (HCP)-generated component. AIM To translate the PG-SGA into Swedish, assess the linguistic and content validity of the Swedish version, and ensure conceptional, semantic and operational equivalence to the original English PG-SGA. METHODS In line with the methodology used in previously translated and culturally adapted versions, the standardised 10-step process suggested by the International Society for Health Economics and Outcomes Research (ISPOR) was followed. In step 7, a cross-sectional study targeting patients n = 51 and HCPs n = 52 was performed at a university hospital in Sweden. Using separate questionnaires, patients assessed the patient component and HCPs, the professional component regarding perceived comprehensibility and difficulty (linguistic validity). The HCPs also assessed perceived relevance (content validity) of all items on the PG-SGA. Item indices for comprehensibility (I-CI), difficulty (I-DI) and content validity (I-CVI) were calculated and averaged into scale indices (S-CI, S-DI and S-CVI). Cut-off standards for item and scale indices were used as reference. RESULTS The Swedish version of the PG-SGA rated excellent for comprehensibility (S-CI 0.96) and difficulty (S-DI 0.93) for the patient component. The professional component rated acceptable for comprehensibility (S-CI 0.89) and below acceptable for difficulty (S-DI 0.70), with the physical examination rated most difficult (I-DI 0.39 to 0.69). Content validity for the full Swedish PG-SGA was rated excellent (S-CVI 0.94). CONCLUSION The patient component was considered clear and easy to complete. The full Swedish PG-SGA was considered relevant by HCPs for screening and assessment of malnutrition. Due to perceived difficulty with the physical examination, training of Swedish HCPs in using the PG-SGA is essential before implementing the professional component into clinical practice or research.
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Affiliation(s)
- Rebecca Lindström
- Medical Unit Clinical Nutrition, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Solna, Sweden
| | - Ylva Orrevall
- Medical Unit Clinical Nutrition, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Solna, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Belqaid
- Medical Unit Clinical Nutrition, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Solna, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Jenny McGreevy
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Sörmland/Uppsala University, Eskilstuna, Sweden
- Department of Dietetics, Nykoping Hospital, Nykoping, Sweden
| | - Anna Ottenblad
- Medical Department, Nutricia Part of Danone AB, Solna, Sweden
| | - Elisabet Rothenberg
- Department of Nursing and Integrated Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Frode Slinde
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Göteborg, Sweden
| | | | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
- Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Unit Experimental Anatomy, Department Physiotherapy and Human Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sandra Einarsson
- Department of Food, Nutrition and Culinary Science, Umeå University, Umeå, Sweden
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Liu T, Wang G, Chen C, He L, Wang R. Prognostic value of sarcopenia in the patients with locally advanced nasopharyngeal carcinoma. Jpn J Radiol 2024; 42:1047-1057. [PMID: 38727962 DOI: 10.1007/s11604-024-01587-3] [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: 03/04/2024] [Accepted: 04/29/2024] [Indexed: 08/31/2024]
Abstract
PURPOSE Sarcopenia, characterized by loss of muscle mass index (SMI), serves as a diagnostic indicator for malnutrition and has been shown to influence cancer treatment outcomes. The objective of this study was to investigate the prognostic significance of sarcopenia on the locally advanced nasopharyngeal carcinoma (laNPC) patients. PATIENTS AND METHODS 545 patients with stage III-IVa NPC were included in this retrospective study. Sarcopenia was defined using the skeletal muscle index (SMI) determined at the C3 level based on baseline MRI. The log-rank test and the Cox proportional hazards model were used to compare overall survival (OS) and progression-free survival (PFS). RESULTS The results of the multivariate analysis revealed that sarcopenia group (HR = 2.82, 95% CI 1.96-4.06, P < 0.01), T4 stage (HR = 1.64, 95% CI 1.24-2.15, P < 0.01), N3 stage (HR = 1.91, 95% CI 1.52-2.40, P < 0.01), comorbidities (HR = 2.08, 95% CI 1.45-2.97, P < 0.01), and any adverse event grade 3-4 (HR = 1.48, 95% CI 1.04-2.01, P = 0.03) were identified as independent risk factors that significantly impacted the OS. Additionally, sarcopenia group (HR = 2.40, 95% CI 1.73-3.33, P < 0.01), T4 stage (HR = 1.50, 95% CI 1.17-1.92, P < 0.01), N3 stage (HR = 1.80, 95% CI 1.46-2.22, P < 0.01), sarcopenia group (HR = 2.40, 95% CI 1.73-3.33, P < 0.01), and any adverse event grade 3-4 (HR = 1.45, 95% CI 1.04-2.01, P = 0.03) were found to have a significant impact on PFS. CONCLUSION Sarcopenia was identified as a prognostic factor for patients with laNPC. Furthermore, T stage, N stage, comorbidities, and any adverse event grade 3-4 were identified as independent prognostic factors for laNPC.
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Affiliation(s)
- Ting Liu
- Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guimei Wang
- Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chunmei Chen
- Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lihe He
- Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rensheng Wang
- Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China.
- Guangxi Key Laboratory of High-Incidence-Tumor Prevention and Treatment, Ministry of Education, Guangxi Medical University, Nanning, China.
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15
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Jager-Wittenaar H, Sealy M, Naumann E, de van der Schueren M. Nutritional risk screening: a need to guide Alice in Nutritionland. Curr Opin Clin Nutr Metab Care 2024; 27:381-386. [PMID: 38837037 DOI: 10.1097/mco.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
PURPOSE OF REVIEW With the shifts in society, healthcare and the profile of the malnourished individual, a re-consideration of the goal of nutritional risk screening is needed: screening for malnutrition, or screening for risk of malnutrition? In this review article, we reflect on the role of nutritional risk screening in relation to prevention and treatment of malnutrition. RECENT FINDINGS Within the Global Leadership Initiative on Malnutrition (GLIM) Initiative, modified Delphi studies are currently being conducted to reach global consensus on the conceptual definition and operationalization of 'risk of malnutrition'. This is necessary because various studies have demonstrated that different nutritional screening tools identify different individuals, due to variability in screening tool criteria, which influences GLIM outcomes. Upon screening, three different situations can be distinguished: having risk factors for malnutrition without clear signs of presence of malnutrition, having mild signs of malnutrition (malnutrition in progress), or having obvious signs of malnutrition. SUMMARY The outcomes of the studies on 'risk of malnutrition' will guide the screening step within the GLIM process, and will help professionals to make informed choices regarding screening policy and screening tool(s).
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Affiliation(s)
- Harriët Jager-Wittenaar
- Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen
- Radboud University Medical Center, Department of Gastroenterology and Hepatology, Dietetics, Nijmegen, The Netherlands
- Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Department Physiotherapy and Human Anatomy, Research Unit Experimental Anatomy, Brussels, Belgium
| | - Martine Sealy
- Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen
| | - Elke Naumann
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen
| | - Marian de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Kaya T, Ulaş SB, Nalbant A, Yıldırım İ, İşsever K, Karacaer C, Bilgin C, Vatan A, Acar T, Acar BA, Aras YG, Köroğlu M. C-reactive protein/albumin ratio as a novel predictor for nutritional status of geriatric patients. Brain Behav 2024; 14:e70017. [PMID: 39262165 PMCID: PMC11391020 DOI: 10.1002/brb3.70017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 08/13/2024] [Accepted: 08/19/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND AND AIMS The C-reactive protein to albumin ratio (CAR) is a novel parameter that has been reported as a significant prognostic marker in some diseases. The purpose of the present research was to investigate the predictive value of this ratio with regard to nutritional status in geriatric patients. METHODS AND RESULTS A total of 154 geriatric patients (age ≥65 years) who consecutively presented to the internal medicine outpatient clinic were included in this cross-sectional study. The Mini Nutritional Assessment (MNA) was used as a reference to determine the nutritional status of the patients. Based on the MNA results, the patients were divided into two groups: normal nutrition and malnourished or at risk of malnutrition. The median CAR of malnourished patients or those at risk of malnutrition was significantly higher than that of patients with normal nutritional status (p = .012). A significant negative correlation was also observed between the MNA score and the CAR (r = -0.196, p = .015). The receiver operating characteristic curve analysis indicated that the CAR was a significant predictor of malnourishment or the risk of malnutrition (p = .012). CONCLUSION The CAR could predict which geriatric patients were malnourished or at risk of malnutrition. CAR may be used as a new tool in the nutritional screening of geriatric patients.
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Affiliation(s)
- Tezcan Kaya
- Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | | | - Ahmet Nalbant
- Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - İlhan Yıldırım
- Department of Internal Medicine, Görele Dr. Ergun Özdemir State Hospital, Giresun, Turkey
| | - Kubilay İşsever
- Department of Internal Medicine, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Cengiz Karacaer
- Department of Internal Medicine, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Cahit Bilgin
- Department of Chest Diseases, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Aslı Vatan
- Department of Infectious Disease, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Türkan Acar
- Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | | | - Yeşim Güzey Aras
- Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Mehmet Köroğlu
- Department of Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Dorner TE, Smeikal M, Unseld M, Gisinger C. Predicting future medical needs and mortality risk in geriatric long-term care patients : Development and validation of the Nascher score and revised Nascher score. Wien Klin Wochenschr 2024; 136:515-522. [PMID: 39102051 PMCID: PMC11390801 DOI: 10.1007/s00508-024-02410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 07/09/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Choosing the right intensity of medical care is a huge challenge particularly in long-term geriatric care. The Nascher score was developed to assess future medical care needs. The aim of this study was to determine whether the Nascher score and a revised version can predict future medical needs. METHODS In this retrospective cohort study, 396 residents in long-term care hospitals, who were admitted over a period of two years and followed up to two and a half yeare, were analysed. Outcome parameters were: (1) number of medication changes, (2) number of ward doctor documentations and (3) number of acute illnesses treated with antibiotics, and mortality risk. Based on the first results, an alternative scoring of the Nascher score with 12 instead of 26 items was developed, called the revised Nascher score. RESULTS The Nascher score significantly correlated with the number of medication changes, the number of ward doctor documentations, and the number of acute ilnesses treated with antibiotics with Spearman correlation coefficients of 0.30, 0.26, and 0.15, respectively. The revised Nascher score showed a higher correlation with correlation coefficients of 0.36, 0.26, and 0.21, respectively. Residents with a Nascher score in the highest quartile had a significantly higher mortality risk than residents in the lowest quartile (hazard ratio, HR 2.97, 95% confidence interval, CI 1.80-4.34). The corresponding values for the revised Nascher score were HR 3.03, 95% CI 2.03-4.54 in the highest and HR 1.80, 95% CI 1.24-2.60 in the middle quartiles. CONCLUSION The Nascher score and even more so the revised Nascher score are well suited to predicting the various parameters of future medical needs and mortality risk.
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Affiliation(s)
- Thomas E Dorner
- Academy for Ageing Research, Haus der Barmherzigkeit, Seeböckgasse 30a, 1160, Vienna, Austria.
- Center for Public Health, Department for Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria.
- Karl Landsteiner Institute for Health Promotion Research, Haus der Barmherzigkeit Clementinum, Kirchstetten, Austria.
| | - Michael Smeikal
- Academy for Ageing Research, Haus der Barmherzigkeit, Seeböckgasse 30a, 1160, Vienna, Austria
| | - Matthias Unseld
- Academy for Ageing Research, Haus der Barmherzigkeit, Seeböckgasse 30a, 1160, Vienna, Austria
| | - Christoph Gisinger
- Academy for Ageing Research, Haus der Barmherzigkeit, Seeböckgasse 30a, 1160, Vienna, Austria
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Gittins M, AlMohaisen N, Todd C, Lal S, Burden S. Overall mortality for community-dwelling adults over 50 years at risk of malnutrition. J Cachexia Sarcopenia Muscle 2024. [PMID: 39210532 DOI: 10.1002/jcsm.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/19/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND It is well reported that malnutrition in acute care is associated with poorer health outcomes including increased mortality. However, the consequences of malnutrition on survival in community settings is uncertain. Malnutrition in people 65 years or over is often cited. Nevertheless, this study includes both middle-aged and older adults as current public health policy is highlighting the need to increase disease-free life years and is moving away from just extending life to increase overall longevity. The aim of this study is to describe the association of the risk of malnutrition using the Malnutrition Universal Screening Tool (MUST) with mortality in community-dwelling middle-aged and older adults. METHODS We used the UK Biobank to investigate the association between those at risk of malnutrition and mortality in participants aged ≥50 years. MUST identified risk of malnutrition and linked data to national death registries confirmed mortality. Years of life lost (YLL) and Cox proportional hazard models with hazard ratios (HR) and confidence intervals (CI) described risk associated with all-cause mortality. RESULTS There were 502 408 participants recruited, 117 830 were ≤50 years leaving 384 578 eligible participants. Based on MUST scores 63 495 (16.5%) were at risk of malnutrition with 401 missing some data and excluded. Incidence of mortality for at risk participants was 755 per 100 000 person-years, corresponding to 153 476 YLL. Of those at risk of malnutrition, 9.5% died versus 7.8% at low risk. Initial survival analysis reported an increased risk of mortality (HR 1.29, 95% CI: 1.25 to 1.33) that decreased after adjusting for confounders (HR 1.14, 95% CI: 1.11 to 1.18) in those at risk of malnutrition versus those at low risk. CONCLUSIONS Risk of malnutrition was associated with increased overall mortality. Modest effect sizes are demonstrated but are supportive of public health policies, which advocate wide-scale community, based nutritional screening for middle-aged and older adults.
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Affiliation(s)
- Matthew Gittins
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Nada AlMohaisen
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Chris Todd
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University Foundation NHS Trust, Manchester, UK
| | - Simon Lal
- Salford Royal Foundation NHS Trust, Salford, UK
| | - Sorrel Burden
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Salford Royal Foundation NHS Trust, Salford, UK
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Li XQ, Liang Y, Huang CF, Li SN, Cheng L, You C, Liu YX, Wang T. Advancements in nutritional diagnosis and support strategies during the perioperative period for patients with liver cancer. World J Gastrointest Surg 2024; 16:2409-2425. [PMID: 39220056 PMCID: PMC11362955 DOI: 10.4240/wjgs.v16.i8.2409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/27/2024] [Accepted: 06/24/2024] [Indexed: 08/16/2024] Open
Abstract
Liver cancer represents a grave hepatic condition and constitutes a significant global health concern. Surgical resection remains the principal therapeutic modality for liver cancer. Nevertheless, perioperative malnutrition exerts a notable impact on patients with liver cancer, emerging as an independent risk factor for disease mortality and adverse outcomes. Hence, precise nutritional diagnosis and timely nutritional support hold the potential to enhance therapeutic efficacy and quality of life for liver cancer patients. This study represents a meticulous foray into the literature, extracting data from PubMed, Web of Science, and EMBASE databases, with a focus on the past 5 years. It scrutinizes the impact of malnutrition on patients undergoing liver cancer surgery, the etiological underpinnings of malnutrition within this patient cohort, the critical assessment of perioperative nutritional status, and the strategic approaches to nutritional support. Utilizing rigorous inclusion and exclusion criteria, the amassed scholarly works are meticulously synthesized, methodically organized, and categorically elaborated upon. Ultimately, the authors propose the incorporation of a multidisciplinary nutrition management team during the perioperative period, comprising nutritionists, pharmacists, physicians, nurses, psychologists, and rehabilitation therapists, among other specialized professionals. Together, they collaborate to devise and implement personalized nutritional support plans, monitor patients' nutritional status, and make necessary adjustments as required. Through comprehensive management and intervention, improvements in the nutritional status of liver cancer patients can be achieved, thereby enhancing surgical success rates and facilitating postoperative recovery. It is believed that this manuscript will offer valuable insights to advance the nutritional management during the perioperative phase of liver cancer, aiding in ameliorating patients' nutritional status and treatment outcomes.
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Affiliation(s)
- Xiao-Qin Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Yun Liang
- Department of Paediatric Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Chen-Feng Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Sui-Ning Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Lei Cheng
- Department of Hepatobiliary Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Chuan You
- Department of Hepatobiliary Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Yao-Xia Liu
- Department of Geriatric Endocrinology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan Province, China
| | - Tao Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
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20
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Verheul EA, Horzum E, Dijkink S, Krijnen P, Hoogendoorn JM, Arbous SM, Peters R, Schipper IB. Fat-soluble vitamins as biomarkers of nutritional status and their relation with complications in polytrauma patients. Nutr Health 2024:2601060241273640. [PMID: 39155642 DOI: 10.1177/02601060241273640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
BACKGROUND AND AIMS This exploratory observational prospective study aimed to evaluate fat-soluble vitamin plasma levels during hospital admission and its relation with the development of malnutrition and complications in polytrauma patients, considering the protocolized multivitamin supplementation during intensive care unit (ICU) admission. METHODS In 49 well-nourished polytrauma (injury severity score ≥ 16) patients admitted to the ICU of two level-1 trauma centers, vitamin A, D, and E levels were assessed weekly during hospital stay. All patients received multivitamin supplementation during ICU stay. Linear mixed-effect models were used to assess a trend in vitamin levels over time during hospital stay. Mixed-effects logistic regression analysis was performed to relate vitamin concentrations with malnutrition, defined as a subjective global assessment score ≤5, and complications. RESULTS Vitamin A levels increased 0.17 µmol/L per week (95% confidence interval 0.12-0.22, p < 0.001), vitamin D levels increased 1.49 nmol/L per week (95% confidence interval 0.64-2.33, p < 0.01), vitamin E levels increased 1.17 µmol/L per week (95% confidence interval 0.61-1.73, p < 0.001) during hospital stay (29 ± 17 days). Vitamin levels were not related to malnutrition or complications during hospital stay. CONCLUSION Vitamin A, D, and E levels increased due to supplementation during hospital admission. Plasma levels of vitamins A, D, and E do not seem to be useful as biomarkers for the nutritional status of polytrauma patients during hospital stay. No correlation with complications could be demonstrated.
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Affiliation(s)
- Esmee Ah Verheul
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ebru Horzum
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Suzan Dijkink
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Department of General Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Pieta Krijnen
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Acute Care Network West Netherlands, Leiden, The Netherlands
| | - Jochem M Hoogendoorn
- Department of General Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Sesmu M Arbous
- Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ron Peters
- Department of Intensive Care, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Inger B Schipper
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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21
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Muangpaisan W, Wichansawakun S, Huynh DTT, Intalapaporn S, Chalermsri C, Thititagul O, Chupisanyarote K, Chuansangeam M, Laiteerapong A, Yalawar M, Huang C, Tey SL, Liu Z. Effects of a Specialized Oral Nutritional Supplement with Dietary Counseling on Nutritional Outcomes in Community-Dwelling Older Adults at Risk of Malnutrition: A Randomized Controlled Trial. Geriatrics (Basel) 2024; 9:104. [PMID: 39195134 DOI: 10.3390/geriatrics9040104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/08/2024] [Accepted: 08/08/2024] [Indexed: 08/29/2024] Open
Abstract
This study investigated the effects of oral nutritional supplements (ONSs) along with dietary counseling (DC) in community-dwelling older adults at risk of malnutrition. In this randomized controlled trial, 196 older adults who were at risk of malnutrition, as identified by the Malnutrition Universal Screening Tool (MUST) were randomly assigned to receive ONSs twice daily with DC (intervention) or DC-only (control) for 60 days. Primary outcome was change in body weight from baseline to day 60. Nutritional status, energy, and macronutrient intakes were measured. A significant larger weight gain was observed in the intervention compared to the control from baseline to day 60 (1.50 ± 0.22 kg, p < 0.0001). The intervention group also showed a significantly greater increase in weight at day 30 (p < 0.0001). Intakes of energy and macronutrients were significantly higher in the intervention group compared to the control group at both days 30 and 60 (all p < 0.0001). The odds of achieving better nutritional status were significantly higher in the intervention group than in the control group (OR:3.9, 95% CI: 1.9, 8.2, p = 0.0001). ONS supplementation combined with DC significantly improved body weight and nutritional outcomes in community-dwelling older adults at risk of malnutrition.
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Affiliation(s)
- Weerasak Muangpaisan
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | | | - Dieu Thi Thu Huynh
- Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore 138668, Singapore
| | - Somboon Intalapaporn
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chalobol Chalermsri
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Ornicha Thititagul
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | | | | | | | - Menaka Yalawar
- Biostatistics and Statistical Programming, Cognizant Technologies Solution Pvt. Ltd., Bangalore 560092, India
| | - Chengrong Huang
- Abbott Nutrition Research and Development, Shanghai 200233, China
| | - Siew Ling Tey
- Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore 138668, Singapore
| | - Zhongyuan Liu
- Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore 138668, Singapore
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22
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Li H, Fang C, Hu Y, Xu J, Zhao W, Li L. The Comparative Analysis of Peptides in Enteral Nutrition Products and Foods for Special Medical Purposes. Foods 2024; 13:2557. [PMID: 39200483 PMCID: PMC11353486 DOI: 10.3390/foods13162557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/31/2024] [Accepted: 08/12/2024] [Indexed: 09/02/2024] Open
Abstract
Enteral nutrition (EN) and foods for special medical purposes (FSMPs) can be used to meet the specific nutritional needs of patients. There are multiple types of EN products and nutritionally complete FSMPs on the market. The peptides in these products are important nutritional components, while their presence in different products remains unclear. To provide better clinical guidelines, we analyzed and compared the molecular weight (MW) distribution, types, and quantities of peptides and bioactive peptides of two EN products (liquid products) and two FSMPs with nutritionally complete formulas (powder products). Our results showed that each product had a unique peptide profile. The two liquid products and one powder product (Samples 1-3) had a higher content of peptides. Sample 1 contained 75.60% peptides with an MW less than 375 Da and contained 95.21% peptides with an MW less than 1000 Da, being rich in short peptides. Sample 2 and 3 had high levels of peptides with MW values between 180 Da and 2000 Da. Additionally, Sample 4 contained high levels of proteins, containing 69.18% peptides with MW values larger than 10,000 Da. Further, Sample 1 had more bioactive dipeptides and Sample 2 had more long bioactive peptides. Our results suggest that peptides in different EN and FSMP products are very different and should be evaluated in more detail. This will provide valuable information for clinical medical professionals, help them to guide patients with different physiological conditions better, and ultimately benefit patients.
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Affiliation(s)
- Hao Li
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Chenlu Fang
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Yushan Hu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Jing Xu
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Wei Zhao
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Li Li
- State Key Laboratory of Food Science and Resources, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
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23
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Wojteczek A, Dardzińska J, Ziętkiewicz M, Smoleńska Ż, Czuszyńska Z, De Cock D, Zdrojewski Z, Małgorzewicz S, Chmielewski M. High-Protein Nutritional Supplements Improve Nutritional Status in Malnourished Patients with Systemic Sclerosis. Nutrients 2024; 16:2622. [PMID: 39203760 PMCID: PMC11357555 DOI: 10.3390/nu16162622] [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: 07/07/2024] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 09/03/2024] Open
Abstract
(1) Background: Impaired nutritional status in systemic sclerosis (SSc) is prevalent. (2) Objective: This study aimed to identify pre-cachexia and malnutrition in SSc patients and to estimate the effectiveness of a high-protein oral nutritional supplement (ONS) in improving their nutritional status. (3) Materials and methods: The SSc population comprised 56 patients and a control group of 49 healthy persons. After a baseline clinical evaluation, bioelectrical impedance analysis (BIA), and laboratory tests, SSc patients were divided into well-nourished, pre-cachectic, and malnourished categories. SSc patients with a nutritional disbalance received a high-protein ONS once daily for 3 months. Patients were reassessed at 3 and 12 months after inclusion in the study. (4) Results: SSc patients, in comparison to the control group, had a significantly lower seven-point SGA value [6(0) vs. 7(1), p < 0.001)], lean tissue mass [LTM, 35.1 (10.5) vs. 40.1 (10.10), p = 0.008], and lean tissue index [LTI, 13.5 (3) vs. 14.9 (4), p = 0.009]. Of the 56 SSc patients, 40 (71.4%) were well nourished, 5 (8.9%) had pre-cachexia, and 11 (19.7%) were malnourished. A high-protein ONS in the pre-cachexia group stabilized the SGA value, anthropometric measurements, and BIA after 3 and 12 months. In malnourished patients, it significantly improved the SGA value [5(0) vs. 6(0), p = 0.002], LTI [12.1 (2.1) vs. 12.7 (3.2), p = 0.021] and LTM [31.1 (7.7) vs. 35.1 (9.1), p = 0.021], and that effect remained stable at 12 months. (5) Conclusion: Malnutrition is a common complication of SSc that can be improved with nutritional intervention.
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Affiliation(s)
- Anna Wojteczek
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (M.Z.); (Ż.S.); (Z.C.); (Z.Z.); (M.C.)
| | - Jolanta Dardzińska
- Department of Clinical Nutrition, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (J.D.); (S.M.)
| | - Marcin Ziętkiewicz
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (M.Z.); (Ż.S.); (Z.C.); (Z.Z.); (M.C.)
| | - Żaneta Smoleńska
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (M.Z.); (Ż.S.); (Z.C.); (Z.Z.); (M.C.)
| | - Zenobia Czuszyńska
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (M.Z.); (Ż.S.); (Z.C.); (Z.Z.); (M.C.)
| | - Diederik De Cock
- Biostatistics and Medical Informatics Research Group, Department of Public Health, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Zbigniew Zdrojewski
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (M.Z.); (Ż.S.); (Z.C.); (Z.Z.); (M.C.)
| | - Sylwia Małgorzewicz
- Department of Clinical Nutrition, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (J.D.); (S.M.)
| | - Michał Chmielewski
- Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland; (M.Z.); (Ż.S.); (Z.C.); (Z.Z.); (M.C.)
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24
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Liu S, Qiao L, Liu Y, Liu H, Li Y, Sun J, Chen W, Shang R, Zhang L, Liu X. Efficacy and safety evaluation of mixed nutrition for postoperative esophageal cancer patients in China: a meta-analysis. Front Oncol 2024; 14:1417765. [PMID: 39175475 PMCID: PMC11339871 DOI: 10.3389/fonc.2024.1417765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/16/2024] [Indexed: 08/24/2024] Open
Abstract
Objective The purpose of this study was to evaluate the clinical effect of mixed nutrition and parenteral nutrition support on postoperative patients with esophageal cancer. Method By searching PubMed, Web of Science, Cochrane, CNKI, Wanfang and other databases, all the literatures until March 2024 about the comparison of randomized controlled Trial (RCT) of mixed nutrition and parenteral nutrition support in postoperative patients with esophageal cancer were screened. The inclusion criteria were that the patients were from randomized controlled trials or clinical trials in China, and the patients were all diagnosed with esophageal cancer by pathological biopsy. The exclusion criteria were the literature other than the above, including repeated published literature, non-Chinese and English literature, incomplete or missing analysis data, etc. After two researchers independently screened the literature, extracted the data and evaluated the risk of bias according to the criteria, Meta-analysis was carried out with RevMan 5.4 software. Results A total of 11 studies were included, including 1216 patients. Meta-analysis showed that, compared with parenteral nutrition, mixed nutrition can improve the levels of transferrin, serum albumin, prealbumin and lymphocyte counts in patients with esophageal cancer after surgery, shorten the time of anal recovery of exhaust, defecation and hospital stay after surgery, and reduce the incidence of pulmonary infection, abdominal distension, incision infection and anastomotic fistula, with statistical significance between the two groups (P < 0.05). The heterogeneity of individual results in this study is relatively high, the analysis comes from clinical heterogeneity, and the publication bias is analyzed through Funnel plot. Taking the incidence of lung infection as an example, the results are evenly distributed on both sides of the Funnel plot, and the publication bias has little impact on the results of the study. Conclusion Compared with parenteral nutrition, mixed nutrition can improve the prognosis of postoperative patients with esophageal cancer and reduce the incidence of related adverse events.
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Affiliation(s)
- Shui Liu
- Department of Pharmacy, Emergency General Hospital, Beijing, China
| | - Lin Qiao
- Department of Pharmacy, Emergency General Hospital, Beijing, China
| | - Yang Liu
- Department of Pharmacy, Emergency General Hospital, Beijing, China
| | - Hangmei Liu
- Department of Pharmacy, Emergency General Hospital, Beijing, China
| | - Yiwen Li
- Department of Pharmacy, Emergency General Hospital, Beijing, China
| | - Jingbo Sun
- Department of Pharmacy, Emergency General Hospital, Beijing, China
| | - Wei Chen
- Department of Pharmacy, Emergency General Hospital, Beijing, China
| | - Rongguo Shang
- Department of Pharmacy, Emergency General Hospital, Beijing, China
| | - Lili Zhang
- Department of Pharmacy, Emergency General Hospital, Beijing, China
| | - Xiaochuan Liu
- Department of Gastroenterology, Emergency General Hospital, Beijing, China
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25
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Pironi L, Cuerda C, Jeppesen PB, Joly F, Lal S, Lamprecht G, Mundi MS, Szczepanek K, Van Gossum A, Vanuytsel T, Wanten G, Weimann A, Bischoff SC. Operational recommendations for the implementation of home parenteral nutrition program of care according to the guidelines of the European society for clinical nutrition and metabolism. Clin Nutr ESPEN 2024; 63:668-675. [PMID: 39117145 DOI: 10.1016/j.clnesp.2024.07.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/19/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024]
Abstract
Home parenteral nutrition (HPN) is a complex therapy, which requires dedicated facilities and expertise. However, the management and provision of HPN differs significantly between countries and between HPN centers within countries. These differences lead to heterogeneity in the quality of care received by patients, with variable impact on the appropriateness, safety, and effectiveness of HPN, and resultant variability in the quality of life that a patient may expect. The European Society for Clinical Nutrition and Metabolism (ESPEN) have published guidelines on the appropriate and safe provision of HPN, with an associated practical version describing a short and precise way to implement the guidelines' recommendations in clinical practice. This educational paper suggests means of implementation of evidence supported HPN guidelines, using "operational recommendations" applitngto healthcare professionals, administrators and stakeholders, with the ultimate aim of enhancing equity of patient access to an appropriate and safe HPN program of care.
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Affiliation(s)
- Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy.
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Francisca Joly
- Department of Gastroenterology and Nutritional Support, Center for Intestinal Failure, Reference Centre of Rare Disease MarDI, AP-HP Beaujon Hospital, University of Paris Inserm UMR, 1149, Paris, France
| | - Simon Lal
- National Intestinal Failure Reference Centre, Northern Care Alliance and University of Manchester, Manchester, Stott Lane, Salford, M6 8HD, UK
| | - Georg Lamprecht
- Division of Gastroenterology and Endocrinology, Department of Medicine II, Rostock University Medical Center, Rostock, Germany
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kinga Szczepanek
- General Surgery Unit with Intestinal Failure Center, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - André Van Gossum
- Department of medical oncology, Bordet Institute, Hopital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Tom Vanuytsel
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
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26
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Gabrielli F, Biagi F, Avossa A, Falcini M, Nascimbeni F, Andreone P, Gitto S. Frailty after Liver Transplantation: A Complex Unexplored Issue. J Clin Med 2024; 13:4537. [PMID: 39124803 PMCID: PMC11313396 DOI: 10.3390/jcm13154537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Frailty is a multidimensional syndrome predominantly studied in the elderly, characterized by reduced resistance to stressors due to diminished physiological reserve and resilience. Advances in surgical techniques and immunosuppressive drugs have improved long-term survival rates in solid organ transplant recipients, yet the 10-year survival is satisfying. However, liver transplant recipients have a noteworthy risk of developing frailty status. After liver transplant, frailty can be favored by socioeconomic, cultural, and health-related factors, leading to increased risks of hospitalization, morbidity, and mortality. Various tools for frailty assessment exist, but none are universally validated for post-transplant patients. The integration of socioeconomic and psychological factors into frailty evaluation could improve quality of life and long-term outcomes for transplant recipients. Multidisciplinary approaches, including psychosocial support, are essential for managing frailty and enhancing the overall care of transplanted patients. This narrative review aims to comprehensively address the principal frailty risk factors associated with liver transplantation.
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Affiliation(s)
- Filippo Gabrielli
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU of Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy; (F.G.)
- Department of Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Filippo Biagi
- Internal Medicine, University Hospital Careggi and Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Alessandra Avossa
- Internal Medicine, University Hospital Careggi and Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Margherita Falcini
- Internal Medicine, University Hospital Careggi and Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Fabio Nascimbeni
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU of Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy; (F.G.)
| | - Pietro Andreone
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU of Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy; (F.G.)
- Postgraduate School of Allergology and Clinical Immunology, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Stefano Gitto
- Internal Medicine, University Hospital Careggi and Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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27
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Thet D, Lappichetpaiboon S, Trakultritrung C, Sotangkur N, Phonphithak S, Lwin HMS, Apornpong T, Han WM, Avihingsanon A, Siritientong T. The Risk of Malnutrition and Sarcopenia in Elderly People Living with HIV during the COVID-19 Pandemic. Nutrients 2024; 16:2540. [PMID: 39125419 PMCID: PMC11313797 DOI: 10.3390/nu16152540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/25/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Malnutrition is a risk factor of sarcopenia in the elderly. During the COVID-19 pandemic, limited transportation and supply chain disruptions restricted access to nutritious foods. We assessed the nutritional status and sarcopenia risk in older people living with HIV (PLWH) on combination antiretroviral therapy in Thailand. This study was a hospital-based cohort among virally suppressed older PLWH who came for routine HIV clinic visits. The mini nutritional assessment (MNA), body composition analysis and 5-time chair stand test (CST) were performed to assess the nutritional status, muscle mass and physical performance, respectively. A total of 177 PLWH were enrolled (57.60% male). The median age was 58 years (IQR 55-62 years). Thirty-five participants (19.8%) were at risk of developing sarcopenia, and 28.2% had abnormal nutritional status. Muscle mass correlated positively with nutritional scores (r = 0.355, p < 0.001) but negatively with 5-time CST duration (r = -0.173, p = 0.021). In the multivariate model, muscle mass was associated with age, sex, mid-arm circumference, calf circumference and 5-time CST duration. In a well-viral-suppressed older Asian PLWH cohort, given the positive correlation between nutritional status and muscle mass, the nutritional status of older PLWH should be routinely evaluated and monitored.
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Affiliation(s)
- Daylia Thet
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (D.T.); (S.L.); (C.T.); (N.S.)
| | - Sawitee Lappichetpaiboon
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (D.T.); (S.L.); (C.T.); (N.S.)
| | - Chidchanok Trakultritrung
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (D.T.); (S.L.); (C.T.); (N.S.)
| | - Nongnapas Sotangkur
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (D.T.); (S.L.); (C.T.); (N.S.)
| | - Supalak Phonphithak
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand; (S.P.); (H.M.S.L.); (T.A.); (W.M.H.); (A.A.)
| | - Hay Mar Su Lwin
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand; (S.P.); (H.M.S.L.); (T.A.); (W.M.H.); (A.A.)
| | - Tanakorn Apornpong
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand; (S.P.); (H.M.S.L.); (T.A.); (W.M.H.); (A.A.)
| | - Win Min Han
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand; (S.P.); (H.M.S.L.); (T.A.); (W.M.H.); (A.A.)
| | - Anchalee Avihingsanon
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand; (S.P.); (H.M.S.L.); (T.A.); (W.M.H.); (A.A.)
- Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Tippawan Siritientong
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand; (D.T.); (S.L.); (C.T.); (N.S.)
- Center of Excellence in Burn and Wound Care, Chulalongkorn University, Bangkok 10330, Thailand
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28
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García-Mateo S, Martínez-Domínguez SJ, Gargallo-Puyuelo CJ, Villarino MTA, Laredo V, Gallego B, Alfambra E, Sanz B, Gomollón F. When metabolic comorbidities and risk of malnutrition coexist: The new era of inflammatory bowel disease. Am J Med Sci 2024:S0002-9629(24)01393-4. [PMID: 39098709 DOI: 10.1016/j.amjms.2024.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Metabolic dysfunction-associated steatotic liver disease (MASLD) and risk of malnutrition can coexist in patients with inflammatory bowel disease (IBD). We performed a malnutrition risk assessment as part of the standard follow-up of IBD patients and studied the potential risk factors for being at risk of malnutrition based on the presence or absence of MASLD. METHODS The Malnutrition Universal Screening Tool (MUST) was used to screen malnutrition risk (MUST ≥1) and controlled attenuation parameter (CAP ≥248 dB/min) to assess MASLD. Adherence to a Mediterranean diet, physical activity, and quality of life were also assessed. RESULTS Of 686 evaluated IBD patients, 130 (18.9 %) were identified as being at risk of malnutrition. Patients without MASLD (n = 89 [68.5 %]) were more likely to be at risk than those with MASLD (n = 41 [31.5 %], p = 0.005). However, among patients at risk of malnutrition, those with MASLD were more likely to have active IBD (82.9 %) than patients without MASLD (39.3 %, p < 0.001). Female sex (OR 1.984, p = 0.027) and young age (OR 1.014, p = 0.006) were associated with malnutrition risk only in patients with IBD without MASLD. Being at risk of malnutrition was associated with worse quality of life (p < 0.001), especially in IBD patients with MASLD. CONCLUSIONS Malnutrition risk and quality of life are modified by the presence of MASLD in IBD patients.
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Affiliation(s)
- Sandra García-Mateo
- Department of Gastroenterology, Lozano Blesa University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain.
| | - Samuel Jesús Martínez-Domínguez
- Department of Gastroenterology, Lozano Blesa University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Carla Jerusalén Gargallo-Puyuelo
- Department of Gastroenterology, Lozano Blesa University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - María Teresa Arroyo Villarino
- Department of Gastroenterology, Lozano Blesa University Clinical Hospital, 50009 Zaragoza, Spain; School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Viviana Laredo
- Department of Gastroenterology, Lozano Blesa University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - Beatriz Gallego
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - Erika Alfambra
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - Borja Sanz
- Department of Endocrinology, Manises Hospital, 46940 Valencia, Spain
| | - Fernando Gomollón
- Department of Gastroenterology, Lozano Blesa University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
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Korzilius JW, van Asseldonk MJMD, Wanten GJA, Zweers-van Essen HEE. Body composition of adults with chronic intestinal failure receiving home parenteral nutrition: A descriptive cohort study. JPEN J Parenter Enteral Nutr 2024; 48:718-725. [PMID: 38850079 DOI: 10.1002/jpen.2658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/23/2024] [Accepted: 05/18/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Chronic intestinal failure (CIF) refers to the long-lasting reduction of gut function below the minimum necessary to absorb macronutrients, water, and/or electrolytes. Patients with CIF likely develop various forms of malnutrition and dehydration, yet studies that focus primarily on body composition are lacking. Therefore, this study aimed to evaluate the body composition of adult patients with CIF. METHODS This retrospective descriptive cohort study was performed at the Radboud University Medical Center, a tertiary referral center for CIF treatment in the form of home parenteral nutrition. We collected available bioelectrical impedance analysis (BIA) data from routine care between 2019 and 2023. The primary outcome was body composition, which was evaluated by assessing body mass index (BMI), fat-free mass index (FFMI), and fat percentage (fat%). RESULTS Overall, 147 adult patients with CIF were included with a median (interquartile range) age of 58 (25-68) years; 69% were female. The mean (SD) BMI was 22.1 (4.3) kg/m2, FFMI was 14.2 (1.9) kg/m2 in females and 17.0 (2.0) kg/m2 in males, and fat% was 33.7% (6.8%) in females and 24.6% (6.4%) in males. 63% had an FFMI below references, and 48% had a high fat%. CONCLUSION This study found that most adult patients with CIF have an unfavorable body composition characterized by a high fat% and low FFMI despite having a normal mean BMI. These results highlight the necessity for in-depth nutrition assessment, including BIA measurement. Moreover, future studies should focus on exercise interventions to increase FFMI and improve body composition and function.
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Affiliation(s)
- Julia Wilhelmina Korzilius
- Department of Gastroenterology and Hepatology - Dietetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Geert Jacobus Antonius Wanten
- Department of Gastroenterology and Hepatology - Dietetics, Radboud University Medical Center, Nijmegen, the Netherlands
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Mackay S, Botero L, Bell J, Young A. Exploring adult inpatients' perceptions, understanding and preferences regarding the term 'malnutrition': A qualitative study. J Clin Nurs 2024; 33:3236-3246. [PMID: 38629591 DOI: 10.1111/jocn.17175] [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: 10/27/2023] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 07/09/2024]
Abstract
AIMS To explore adult inpatients' perceptions, understanding and preferences regarding the term 'malnutrition' and to identify the terms that adult inpatients report are used by themselves and health workers to describe malnutrition. DESIGN This qualitative study was conducted using data collected for a separate qualitative study that investigated factors that influence the dietary intake of long-stay, acute adult inpatients. METHODS Semi-structured interviews were conducted with a purposive sample of current inpatients. Data were analysed using inductive content analysis. RESULTS Nineteen interviews were included (mean age 64 years (standard deviation ±17), 10 female (53%), 12 malnourished (63%)). Four categories were identified. 'Variation in patients' recognition of malnutrition' represents the differing abilities of patients to understand and identify with the term 'malnutrition'. 'Recognising individuals' needs and preferences' highlights patients' varying beliefs regarding whether 'malnutrition' is or is not an appropriate term and participants' suggestion that health workers should tailor the term used to each patient. 'Inconsistencies in health workers' and patients' practice regarding malnutrition terminology' encapsulates the multiple terms that were used to describe malnutrition by health workers and patients. 'Importance of malnutrition education' summarises patients' views that health workers should provide patient education on malnutrition prevention, management and complications. CONCLUSION Findings highlight variations in patients' perceptions and understanding of the term 'malnutrition' and differences in the terms used by patients and health workers to describe malnutrition. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The terminology used by health workers to describe malnutrition risk or malnutrition to their patients can influence patients' recognition of their nutritional status and thus the multidisciplinary management of the condition. To ensure that patients receive information about their malnutrition risk or diagnosis in a way that meets their needs, health workers' practices must be revised. To do this, it is imperative to conduct further collaborative research with patients and health workers to identify optimum terms for 'malnutrition' and how health workers should communicate this to patients. IMPACT There is a disparity in patients' perceptions, understanding and preferences for the term 'malnutrition' and there are inconsistencies in how health workers communicate malnutrition to patients. To support patients' recognition and understanding of their nutritional status, it is imperative for health workers to consider how they discuss malnutrition with patients. REPORTING METHOD Adheres to the Consolidated Criteria for Reporting Qualitative Research (Tong et al., 2007). PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Sarah Mackay
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Nutrition and Dietetics, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Liliana Botero
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Jack Bell
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Adrienne Young
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Talebi S, Zeraattalab‐Motlagh S, Barkhordar M, Vaezi M, Ghoreishy SM, Ghavami A, Hosseini Y, Travica N, Mohammadi H. Dose-dependent effect of megestrol acetate supplementation in cancer patients with anorexia-cachexia syndrome: A meta-analysis. J Cachexia Sarcopenia Muscle 2024; 15:1254-1263. [PMID: 39031821 PMCID: PMC11294013 DOI: 10.1002/jcsm.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/10/2024] [Accepted: 04/23/2024] [Indexed: 07/22/2024] Open
Abstract
There is inconsistent evidence relating to the effects of megestrol acetate (MA) supplementation on cancer patients suffering from anorexia-cachexia syndrome. This review aimed to examine the dose-response effect of MA supplementation in patients with cancer-associated anorexia/cachexia. Relevant keywords were searched in PubMed, Scopus and ISI Web of Science from inception to June 2023 for randomized controlled trials (RCTs) examining the effect of MA on pathologies in patients with cancer-associated cachexia. Our primary outcomes were changes in body weight and appetite. However, fatigue and quality of life were secondary outcomes. The mean difference (MD) and 95% confidence interval (95% CI) were estimated using the random-effects method. Thirteen trials comprising 1229 participants (mean age 60 years) were identified. The results of our highest versus lowest analysis revealed that MA supplementation was not associated with any increase in body weight (MD: 0.64 kg, 95% CI [-0.11, 1.38], P = 0.093, I2 = 69.1%; GRADE = very low certainty). Twelve trials, including 14 effect sizes derived from 1369 patients (intervention = 689, control = 680), provided data on the effect of MA on body weight. Subgroup analyses showed a significant increase in body weight following short-term intervention (≤8 weeks) and a combination of radiation/chemotherapy as concurrent treatment. A linear dose-response meta-analysis indicated that each 200 mg/day increment in MA consumption had a significant increase in weight gain (MD: 0.44; 95% CI [0.13, 0.74], P = 0.005; I2 = 97.1%); however, the magnitude of the effect was small. MA administration significantly affected the quality of life based on pooled effect sizes (MD: 1.15, 95% CI [0.76, 1.54], P < 0.001, I2 = 0%; n = 2 RCTs including 176 patients; GRADE = very low certainty). However, no significant effect of MA supplementation was observed on appetite (MD: 0.29, 95% CI [-0.05, 0.64], P = 0.096, I2 = 18.3%; n = 3 RCTs including 163 patients; GRADE = very low certainty) and fatigue (MD: 0.14, 95% CI [-0.09, 0.36], P = 0.236, I2 = 0%; n = 2 RCTs including 300 patients; GRADE = very low certainty). With very low certainty of the evidence, MA supplementation may not lead to a significantly increased weight gain and other outcomes.
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Affiliation(s)
- Sepide Talebi
- Students' Scientific Research Center (SSRC)Tehran University of Medical SciencesTehranIran
- Department of Clinical Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
| | | | - Maryam Barkhordar
- Cell Therapy and Hematopoietic Stem Cell Transplantation Research CenterTehran University of Medical SciencesTehranIran
- Research Institute for Oncology, Hematology and Cell TherapyTehran University of Medical SciencesTehranIran
| | - Mohammad Vaezi
- Hematology, Oncology and Stem Cell Transplantation Research CenterTehran University of Medical SciencesTehranIran
- Research Institute for Oncology, Hematology and Cell TherapyTehran University of Medical SciencesTehranIran
| | - Seyed Mojtaba Ghoreishy
- Department of Nutrition, School of Public HealthIran University of Medical SciencesTehranIran
- Student Research Committee, School of Public HealthIran University of Medical SciencesTehranIran
| | - Abed Ghavami
- Department of Clinical Nutrition, School of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | - Yasaman Hosseini
- Department of Clinical Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
| | - Nikolaj Travica
- IMPACT—Institute for Mental and Physical Health and Clinical Translation, Food and Mood Centre, School of Medicine, Barwon HealthDeakin UniversityGeelongAustralia
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
- Research Institute for Oncology, Hematology and Cell TherapyTehran University of Medical SciencesTehranIran
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Vanderstappen J, Hoekx S, Bislenghi G, D'Hoore A, Verstockt B, Sabino J. Preoperative optimization: Review on nutritional assessment and strategies in IBD. Curr Opin Pharmacol 2024; 77:102475. [PMID: 39121554 DOI: 10.1016/j.coph.2024.102475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Abstract
Inflammatory bowel diseases (IBD), encompassing conditions like Crohn's disease and ulcerative colitis, present multifaceted challenges requiring a comprehensive management approach. Patients often necessitate a combination of medical therapy, surgical interventions, and nutritional support. Despite advancements in medical and dietary therapies, the prevalence of surgery remains high among the IBD population, alongside the persistent risk of malnutrition. Preoperative nutritional optimization has thus become a critical element in the perioperative pathway, given its association with improved surgical outcomes. However, standardized protocols for preoperative optimization of IBD patients are lacking, and available data are mainly retrospective. This review provides an overview of the current knowledge on preoperative nutritional screening and optimization in IBD patients and identifies avenues for future research and clinical practice. Interdisciplinary collaboration among healthcare professionals, including gastroenterologists, surgeons, dietitians, physiotherapists, and psychologists, is crucial for comprehensive preoperative nutritional management in IBD patients. By addressing the interplay between inflammation, malnutrition, and surgical risk, clinicians can strive to enhance surgical care and postoperative outcomes. In conclusion, while recognizing the importance of preoperative nutritional optimization in improving surgical outcomes for IBD patients, challenges persist in standardizing management protocols. Prospective studies are needed to establish such protocols and evaluate the effectiveness of different nutritional strategies.
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Affiliation(s)
- Julie Vanderstappen
- Department of Gastroenterology and Hepatology, University Hospitals of Leuven, Leuven, Belgium.
| | - Sien Hoekx
- Department of Gastroenterology and Hepatology, University Hospitals of Leuven, Leuven, Belgium
| | - Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - André D'Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals of Leuven, Leuven, Belgium; KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
| | - João Sabino
- Department of Gastroenterology and Hepatology, University Hospitals of Leuven, Leuven, Belgium; KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
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Dos Santos JG, Saueressig C, Wolf R, Dos Santos JC, Silva FM, Franzosi OS, Alba VD. Identifying nutrition risk in emergency patients: What is the most appropriate screening tool? Nutr Clin Pract 2024; 39:911-919. [PMID: 38575550 DOI: 10.1002/ncp.11147] [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: 10/04/2023] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The emergency department (ED) is the most frequent access route to the hospital. Nutrition risk (NR) screening allows the early identification of patients at risk of malnutrition. This study aimed to evaluate the feasibility and predictive validity of five different tools in EDs: Nutritional Risk Screening 2002 (NRS-2002), Nutritional Risk Emergency 2017 (NRE-2017), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), Malnutrition Universal Screening (MUST), and Malnutrition Screening Tool (MST). METHODS Patients with scores ≥3 according to the NRS-2002, ≥1.5 according to the NRE-2017, and ≥2 according to the MUST, RFH-NPT, or MST were classified with NR. Prolonged length of stay (LOS) and 1-year mortality were evaluated. RESULTS 431 patients were evaluated (57.31 ± 15.6 years of age; 54.4% women) in a public hospital in southern Brazil. The prevalence of NR was: 35% according to the NRS-2002, 43% according to the MST, 45% according to the NRE-2017 and MUST, and 49% according to the RFH-NPT. Patients with NR, had a greater risk of prolonged LOS (P < 0.001). The presence of NR was associated with an increased risk of 1-year mortality according to the NRS-2002 (hazard ratio [HR]: 4.04; 95% CI, 2.513-6.503), MST (HR: 2.60; 95% CI, 1.701-3.996), NRE-2017 (HR: 4.82; 95% CI, 2.753-8.443), MUST (HR: 4.00; 95% CI, 2.385-6.710), and RFH-NPT (HR: 5.43; 95% CI, 2.984-9.907). CONCLUSIONS NRE-2017 does not require objective data and presented predictive validity for all outcomes assessed, regardless of the severity of the disease, and thus appears to be the most appropriate tool for carrying out NR screening in the ED.
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Affiliation(s)
- Johnny Galhano Dos Santos
- Graduate Program in Food, Nutrition, and Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila Saueressig
- Graduate Program Sciences in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Renata Wolf
- Nutrition Course, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jéssica Correa Dos Santos
- Nutrition Course, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Graduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Oellen Stuani Franzosi
- Nutrition and Dietetics Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Valesca Dall' Alba
- Graduate Program in Food, Nutrition, and Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program Sciences in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Nutrition Course, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Nutrition and Dietetics Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Zhang ZL, Luo M, Sun RY, Liu Y. Development and validation of a risk prediction model for community-acquired pressure injury in a cancer population: A case-control study. J Tissue Viability 2024; 33:433-439. [PMID: 38697891 DOI: 10.1016/j.jtv.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/30/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Patients with cancer are susceptible to pressure injuries, which accelerate deterioration and death. In patients with post-acute cancer, the risk of pressure injury is ignored in home or community settings. OBJECTIVE To develop and validate a community-acquired pressure injury risk prediction model for cancer patients. METHODS All research data were extracted from the hospital's electronic medical record system. The identification of optimal predictors is based on least absolute shrinkage and selection operator regression analysis combined with clinical judgment. The performance of the model was evaluated by drawing a receiver operating characteristic curve and calculating the area under the curve (AUC), calibration analysis and decision curve analysis. The model was used for internal and external validation, and was presented as a nomogram. RESULTS In total, 6257 participants were recruited for this study. Age, malnutrition, chronic respiratory failure, body mass index, and activities of daily living scores were identified as the final predictors. The AUC of the model in the training and validation set was 0.87 (95 % confidence interval [CI], 0.85-0.89), 0.88 (95 % CI, 0.85-0.91), respectively. The model demonstrated acceptable calibration and clinical benefits. CONCLUSIONS Comorbidities in patients with cancer are closely related to the etiology of pressure injury, and can be used to predict the risk of pressure injury. IMPLICATIONS FOR PRACTICE This study provides a tool to predict the risk of pressure injury for cancer patients. This suggests that improving the respiratory function and nutritional status of cancer patients may reduce the risk of community-acquired pressure injury.
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Affiliation(s)
- Zhi-Li Zhang
- Department of Surgical, Tongren Hospital of Wuhan University, Wuhan Third Hospital, Wuhan, China.
| | - Man Luo
- Nursing Department, Tongren Hospital of Wuhan University, Wuhan Third Hospital, Wuhan, China
| | - Ru-Yin Sun
- Department of Orthopaedics, Tongren Hospital of Wuhan University, Wuhan Third Hospital, Wuhan, China
| | - Yan Liu
- Rehabilitation Department, Tongren Hospital of Wuhan University, Wuhan Third Hospital, Wuhan, China
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Linden MA, Freitas RGBDON, Teles LODS, Morcillo AM, Ferreira MT, Nogueira RJN. Transthyretin and Nutritional Status in Critically Ill Adults on Parenteral Nutrition: A Prospective Cohort Study. Nutrients 2024; 16:2448. [PMID: 39125329 PMCID: PMC11313740 DOI: 10.3390/nu16152448] [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: 07/02/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND AND AIMS Correctly characterizing malnutrition is a challenge. Transthyretin (TTR) rapidly responds to adequate protein intake/infusion, which could be used as a marker to identify malnutrition. Nutritional therapy is used to prevent malnutrition. Parenteral nutrition (PN) requires daily monitoring to determine whether what is being offered is adequate. This article aims to investigate whether the practice of measuring TTR is justified. METHODS Data from patients admitted to the ward or intensive care unit (ICU) were collected at three different times: within the first 72 h (T1) of PN use, on the 7th day (T2), and the 14th day (T3) after the initial assessment. RESULTS 302 patients were included; the average age was 48.3 years old; the prevalence of death was 22.2%, and 61.6% of the sample were male. TTR values and the effectiveness of nutritional support in these patients were not associated with the outcome; however, meeting caloric needs was related to the outcome (p = 0.047). No association was found when TTR values were compared to the nutritional status. Thus, TTR was not a good indicator of nutritional risk or nutritional status in hospitalized patients. CONCLUSIONS Undoubtedly, the TTR measurement was inversely proportional to CRP measurements. It was possible to conclude in this follow-up cohort of hospitalized patients that TTR values were not useful for determining whether the patient was malnourished, predicting death or effectiveness of nutritional support, yet based upon our analyses, a decrease in TTR greater than 0.024 units for every 1 unit increase in CRP might be due to ineffective nutritional supply.
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Affiliation(s)
- Marcela Almeida Linden
- Pediatrics Department, State University of Campinas—UNICAMP, Street Tessália Vieira de Camargo, 126, Barão Geraldo, Campinas 13083-887, SP, Brazil; (L.O.d.S.T.); (A.M.M.)
| | | | - Lidiane Oliveira de Souza Teles
- Pediatrics Department, State University of Campinas—UNICAMP, Street Tessália Vieira de Camargo, 126, Barão Geraldo, Campinas 13083-887, SP, Brazil; (L.O.d.S.T.); (A.M.M.)
| | - André Moreno Morcillo
- Pediatrics Department, State University of Campinas—UNICAMP, Street Tessália Vieira de Camargo, 126, Barão Geraldo, Campinas 13083-887, SP, Brazil; (L.O.d.S.T.); (A.M.M.)
| | - Matthew Thomas Ferreira
- Faculty of Medicine, University of Sao Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, Sao Paulo 01246-904, SP, Brazil
| | - Roberto José Negrão Nogueira
- São Leopoldo Mandic Faculty, Street Dr. José Rocha Junqueira, 13, Pte. Preta, Campinas 13045-755, SP, Brazil
- Internal Medicine Department, State University of Campinas—UNICAMP, Street Tessália Vieira de Camargo, 126, Barão Geraldo, Campinas 13083-887, SP, Brazil
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Olmos Martínez JM, Hernández Martínez P, González Macías J. [Frailty, Sarcopenia and Osteoporosis]. Med Clin (Barc) 2024; 163:e17-e23. [PMID: 38724319 DOI: 10.1016/j.medcli.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 02/17/2024] [Accepted: 03/07/2024] [Indexed: 07/16/2024]
Abstract
Frailty, sarcopenia and osteoporosis are entities specific to the elderly, who share some risk factors. For this reason, their relationship has been studied in different works, which have provided disparate results, probably because these studies have not always focused on the same aspects. This article reviews the relationship of frailty and sarcopenia with osteoporosis.
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Affiliation(s)
- José Manuel Olmos Martínez
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Cantabria, España; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Cantabria, España; Instituto de Investigación Valdecilla (IDIVAL), Cantabria, España.
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Lin Y, Wang X, Zhang K, Wang L, Zhang L, Yang J. Trajectories of acute gastrointestinal injury grade in critically Ill children. BMC Pediatr 2024; 24:470. [PMID: 39044193 PMCID: PMC11265350 DOI: 10.1186/s12887-024-04947-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To investigate the characteristics of different Acute Gastrointestinal Injury (AGI) grading trajectories and examine their impact on prognosis in the Pediatric Intensive Care Unit (PICU). METHODS This retrospective cohort study was conducted at a large children's hospital in China. The children admitted to the PICU were included. AGI grade was assessed every other day during the initial nine days following PICU admission. RESULTS A total of 642 children were included, of which 364 children (56.7%) exhibited varying degrees of gastrointestinal dysfunction (AGI grade ≥ 2). Based on the patterns of AGI grading over time, six groups were identified: low-stable group, low-fluctuating group, medium-decreasing group, medium-increasing group, high-decreasing group, high-persistent group. The high-persistent group accounted for approximately 90% of all recorded deaths. Compared to low-stable group, both the medium-increasing and high-persistent groups exhibited positive correlations with length of stay in PICU (PICU LOS) and length of stay (LOS). Compared to low-stable group, the five groups exhibited a negative correlation with the percentage of energy received by enteral nutrition (EN), as well as the protein received by EN. CONCLUSION This study identified six distinct trajectory groups of AGI grade in critically ill children. The pattern of AGI grade trajectories over time were associated with EN delivery proportions and clinical outcomes.
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Affiliation(s)
- Ying Lin
- Department of Nutrition, Tianjin Children's Hospital, Tianjin University Children's Hospital, 225 Longyan Rd, Beichen Dist, Tianjin, China
| | - Xiaomin Wang
- Pediatric Intensive Care Unit, Tianjin Children's Hospital, Tianjin University Children's Hospital, Tianjin, China
| | - Kai Zhang
- Department of Nutrition, Tianjin Children's Hospital, Tianjin University Children's Hospital, 225 Longyan Rd, Beichen Dist, Tianjin, China
| | - Lijing Wang
- Pediatric Intensive Care Unit, Tianjin Children's Hospital, Tianjin University Children's Hospital, Tianjin, China
| | - Liping Zhang
- Pediatric Intensive Care Unit, Tianjin Children's Hospital, Tianjin University Children's Hospital, Tianjin, China
| | - Junhong Yang
- Department of Nutrition, Tianjin Children's Hospital, Tianjin University Children's Hospital, 225 Longyan Rd, Beichen Dist, Tianjin, China.
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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.
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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
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Pfortmueller CA, Dabrowski W, Wise R, van Regenmortel N, Malbrain MLNG. Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment-a comprehensive review. Ann Intensive Care 2024; 14:115. [PMID: 39033219 PMCID: PMC11264678 DOI: 10.1186/s13613-024-01336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
In this review, we aimed to comprehensively summarize current literature on pathophysiology, relevance, diagnosis and treatment of fluid accumulation in patients with sepsis/septic shock. Fluid accumulation syndrome (FAS) is defined as fluid accumulation (any degree, expressed as percentage from baseline body weight) with new onset organ-failure. Over the years, many studies have described the negative impact of FAS on clinically relevant outcomes. While the relationship between FAS and ICU outcomes is well described, uncertainty exists regarding its diagnosis, monitoring and treatment. A stepwise approach is suggested to prevent and treat FAS in patients with septic shock, including minimizing fluid intake (e.g., by limiting intravenous fluid administration and employing de-escalation whenever possible), limiting sodium and chloride administration, and maximizing fluid output (e.g., with diuretics, or renal replacement therapy). Current literature implies the need for a multi-tier, multi-modal approach to de-resuscitation, combining a restrictive fluid management regime with a standardized early active de-resuscitation, maintenance fluid reduction (avoiding fluid creep) and potentially using physical measures such as compression stockings.Trial registration: Not applicable.
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Affiliation(s)
- Carmen Andrea Pfortmueller
- Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
| | - Wojciech Dabrowski
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Rob Wise
- Department of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Intensive Care Department, John Radcliffe Hospital, Oxford University Trust Hospitals, Oxford, UK
| | - Niels van Regenmortel
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg/Cadix, Antwerp, Belgium
- Department of Intensive Care Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
- International Fluid Academy, Lovenjoel, Belgium
- Medical Data Management, Medaman, Geel, Belgium
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He Y, Wang Z, Wu S, Li L, Li J, Zhang Y, Chen B, Sun X, Sun C, Wu L. Screening and assessment of malnutrition in patients with liver cirrhosis. Front Nutr 2024; 11:1398690. [PMID: 39091687 PMCID: PMC11292113 DOI: 10.3389/fnut.2024.1398690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 07/09/2024] [Indexed: 08/04/2024] Open
Abstract
The development and advancement of malnutrition is associated not only with the progression of hepatic dysfunction, but also with cirrhosis-related complications. However, the prevalence of malnutrition reported in different studies varies widely due to differences in diagnostic methods and patient investigation settings. Therefore, we need to identify malnourished patients promptly and accurately. The purpose of this review was to compare the validity and reliability of nutritional screening tools and to select the most appropriate nutritional risk screening for patients with cirrhosis. We compared nutritional risk screening tools such as the Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) and Liver Disease Undernutrition Screening Tool (LDUST). Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) is more feasible to screen cirrhotic patients for nutritional risk, and is highly reproducible, considering the impact of sodium and water retention; so it is practical to screen cirrhotic patients via RFH-NPT for nutritional risk, subsequently, to evaluate the nutritional status of patients with nutritional risk via the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria. L3-SMI (third lumbar-skeletal muscle index) can accurately define sarcopenia in cirrhotic patients and also be used for clinical nutritional status assessment.
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Affiliation(s)
- Yumei He
- North Sichuan Medical College, Nanchong, China
- Department of Gastroenterology, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Zhiming Wang
- Department of Gastroenterology, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Shiyan Wu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lu Li
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jiazhen Li
- Department of Clinical Nutrition, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yexing Zhang
- Department of Gastroenterology, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Boshi Chen
- Department of Gastroenterology, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Xiaobin Sun
- Department of Gastroenterology, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Liping Wu
- Department of Gastroenterology, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
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Wu T, Zhou M, Xu K, Zou Y, Zhang S, Cheng H, Guo P, Song C. GLIM Achieves Best Diagnostic Performance in Non-Cancer Patients with Low BMI: A Hierarchical Bayesian Latent-Class Meta-Analysis. Nutr Rev 2024:nuae096. [PMID: 39013202 DOI: 10.1093/nutrit/nuae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
CONTEXT Global Leadership Initiative on Malnutrition (GLIM) and Patient-Generated Subjective Global Assessment (PG-SGA) are commonly used nutrition assessment tools, whose performance does not reach a consensus due to different and imperfect reference standards. OBJECTIVE This study aimed to evaluate and compare the diagnostic accuracy of GLIM and PG-SGA, using a hierarchical Bayesian latent class model, in the absence of a gold standard. DATA SOURCES A systematic search was undertaken in PubMed, Embase, and Web of Science from inception to October 2022. Diagnostic test studies comparing (1) the GLIM and/or (2) PG-SGA with "semi-gold" standard assessment tools for malnutrition were included. DATA EXTRACTION Two authors independently extracted data on sensitivity, specificity, and other key characteristics. The methodological quality of each included study was appraised according to the criteria in the Quality Assessment of Diagnostic Accuracy Studies-2. DATA ANALYSIS A total of 45 studies, comprising 20 876 individuals evaluated for GLIM and 11 575 for PG-SGA, were included. The pooled sensitivity was 0.833 (95% CI 0.744 to 0.896) for GLIM and 0.874 (0.797 to 0.925) for PG-SGA, while the pooled specificity was 0.837 (0.780 to 0.882) for GLIM and 0.778 (0.707 to 0.836) for PG-SGA. GLIM showed slightly better performance than PG-SGA, with a higher diagnostic odds ratio (25.791 vs 24.396). The diagnostic performance of GLIM was most effective in non-cancer patients with an average body mass index (BMI) of <24 kg/m2, followed by non-cancer patients with an average age of ≥60 years. PG-SGA was most powerful in cancer patients with an average age of <60 years, followed by cancer patients with an average BMI of <24 kg/m2. CONCLUSION Both GLIM and PG-SGA had moderately high diagnostic capabilities. GLIM was most effective in non-cancer patients with a low BMI, while PG-SGA was more applicable in cancer patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration No. CRD42022380409.
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Affiliation(s)
- Tiantian Wu
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Mingming Zhou
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Kedi Xu
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Yuanlin Zou
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Shaobo Zhang
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Haoqing Cheng
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Pengxia Guo
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Chunhua Song
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
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Xu Y, Yan Z, Li K, Liu L, Xu L. Association between nutrition-related indicators with the risk of chronic obstructive pulmonary disease and all-cause mortality in the elderly population: evidence from NHANES. Front Nutr 2024; 11:1380791. [PMID: 39081677 PMCID: PMC11286481 DOI: 10.3389/fnut.2024.1380791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Background This study aims to use six nutrition-related indicators to assess the relationship between nutritional status and the risk of COPD as well as the all-cause mortality rate, and to determine the most reliable predictive indicators. Methods Data from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2013 to 2018 were extracted. Nutritional status was evaluated using Controlling nutritional status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), Advanced Lung Cancer Inflammation Index (ALI), Prognostic Nutritional Index (PNI), Triglycerides (TG) × Total Cholesterol (TC) × Body Weight (BW) Index (TCBI), and Albumin-to-Globulin Ratio (AGR) nutritional-related indicators. Multivariate weighted logistic and Cox regression models were employed to assess the correlation between the six nutritional-related indicators and the risk of COPD and as all-cause mortality. The restricted cubic spline tests were applied to explore potential nonlinear relationships, and ROC curves and C-index analyses were conducted to compare the predictive capabilities of different indicators. Stratified analysis and propensity score matching (PSM) to assess the robustness of the results. Results In this study, Lower ALI, lower GNRI, and higher CONUT scores were positively correlated with an increased risk of COPD (OR: 1.77, 95% CI: 1.10-2.84) (OR: 8.66, 95% CI: 2.95-25.5), and (OR: 5.11, 95% CI: 1.72-15.2), respectively. It was found that ALI and GNRI had a non-linear relationship with the risk of COPD. After propensity score matching (PSM), the associations between ALI, GNRI, CONUT scores, and COPD remained consistent. Lower ALI, PNI, and GNRI scores were positively associated with all-cause mortality in COPD patients (HR: 2.41, 95% CI: 1.10-5.27), (HR: 3.76, 95% CI: 1.89-7.48), and (HR: 4.55, 95% CI: 1.30-15.9), respectively, with GNRI displaying a non-linear relationship with all-cause mortality. ROC curve and C-index analyses indicated that ALI had the best predictive ability for both COPD risk and all-cause mortality. Conclusion ALI, GNRI, and CONUT scores are correlated with the risk of COPD, while ALI, PNI, and GNRI scores are associated with all-cause mortality in COPD patients. Compared to other nutritional scores, ALI may provide more effective predictive value for both risk and all-cause mortality.
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Affiliation(s)
- Yifeng Xu
- School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China
| | - Zhaoqi Yan
- School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China
| | - Keke Li
- School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China
| | - Liangji Liu
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
| | - Lei Xu
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
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Beichmann B, Henriksen C, Paur I, Paulsen MM. Barriers and facilitators of improved nutritional support for patients newly diagnosed with cancer: a pre-implementation study. BMC Health Serv Res 2024; 24:815. [PMID: 39010098 PMCID: PMC11251100 DOI: 10.1186/s12913-024-11288-2] [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: 08/15/2023] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Disease-related malnutrition affects a significant number of patients with cancer and poses a major social problem worldwide. Despite both global and national guidelines to prevent and treat malnutrition, the prevalence is high, ranging from 20 to 70% in all patients with cancer. This study aimed to explore the current practice of nutritional support for patients with cancer at a large university hospital in Norway and to explore potential barriers and facilitators of the intervention in the Green Approach to Improved Nutritional support for patients with cancer (GAIN), prior to implementation in a clinical setting. METHODS The study used individual interviews and a focus group discussion to collect data. Study participants included different healthcare professionals and patients with cancer treated at a nutrition outpatient clinic. The Consolidated Framework for Implementation Research (CFIR) was used to guide the thematic data analysis. RESULTS Barriers connected to the current nutritional support were limited resources and undefined roles concerning responsibility for providing nutritional support among healthcare professionals. Facilitators included a desire for change regarding the current nutritional practice. The GAIN intervention was perceived as feasible for patients and healthcare professionals. Potential barriers included limited knowledge of technology, lack of motivation among patients, and a potential added burden experienced by the participating patients. CONCLUSIONS The identification of the potential barriers and facilitators of the current nutritional support to patients with cancer will be used to plan the implementation of improved nutritional support in a randomized controlled trial for patients with cancer prior to clinical implementation. The current findings may be of value to others trying to implement either or both nutritional support and digital application tools in a clinical healthcare setting. TRIAL REGISTRATION The study was registered in the National Institutes of Health Clinical trials 08/09/22. The identification code is NCT05544318.
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Affiliation(s)
- Benedicte Beichmann
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1110, Blindern, Oslo, 0317, Norway.
- Section for Clinical Nutrition, Department of Clinical Services, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
| | - Christine Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1110, Blindern, Oslo, 0317, Norway
| | - Ingvild Paur
- Norwegian Advisory Unit on Disease-Related Undernutrition, Oslo, Norway
- Section for Clinical Nutrition, Department of Clinical Services, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Mari Mohn Paulsen
- Department of Food Safety, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Sustainable Diets, Norwegian Institute of Public Health, Oslo, Norway
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Xu X, Tian M, Ding CC, Xu H, Wang H, Jin X. Skeletal Muscle Index-Based Cachexia Index as a Predictor of Prognosis in Patients With Cancer: A Meta-Analysis and Systematic Review. Nutr Rev 2024:nuae094. [PMID: 39001797 DOI: 10.1093/nutrit/nuae094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2024] Open
Abstract
CONTEXT Cachexia is associated with poor survival rates. In the clinical setting, the diagnosis of cancer cachexia is challenging. The cachexia index (CXI), a new index for predicting survival time, is a promising tool for diagnosing cancer cachexia; however, its efficacy in predicting patient survival has not been validated. OBJECTIVE This meta-analysis and systematic review aimed to explore the CXI's prognostic value in patients with cancer. DATA SOURCES The PubMed, Embase, MEDLINE, and Cochrane Library databases were searched for relevant studies to determine the association between CXI findings and prognosis. DATA EXTRACTION The outcomes were overall survival (OS), progression-, disease-, and recurrence-free survival (PFS/DFS/RFS) rates, and the rate of complete response. DATA ANALYSIS The QUality In Prognostic Studies (QUIPS) tool was used to evaluate the quality of the included trials. This meta-analysis comprised 14 studies involving 2777 patients. A low CXI was associated with decreased OS (hazard ratio [HR] 2.34, 95% confidence interval [CI] 2.01-2.72; P < .001), PFS/DFS/RFS (HR 1.93, 95% CI 1.68-2.22; P < .001), and complete response (odds ratio [OR] 0.49, 95% CI 0.36-0.66; P < .001). Patients with a low CXI had a lower body mass index (mean difference [MD] -0.75, 95% CI -1.00 to 0.50; P < .001), skeletal muscle index (standardized MD -0.80, 95% CI -0.98 to -0.61; P < .001), and serum albumin level (MD -0.23, 95% CI -0.26 to -0.20; P < .001); and a higher neutrophil-lymphocyte ratio (MD 1.88, 95% CI 1.29-2.47; P < .001) and more advanced disease stages (OR 0.80, 95% CI 0.71-0.91; P = .001). CONCLUSION A low CXI was found to be associated with poor survival in patients with cancer. While the CXI is a promising marker for predicting cancer cachexia, further studies are required to verify its usefulness.
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Affiliation(s)
- Xintian Xu
- Department of Pharmacy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Mengxing Tian
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Chen Chen Ding
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Huiting Xu
- Department of Abdominal Oncology 1, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Huifen Wang
- Nursing Department, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
| | - Xin Jin
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430079, China
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McLay K, Stonewall N, Forbes L, Peters C. The association between malnutrition risk and revised Edmonton Symptom Assessment System (ESAS-r) scores in an adult outpatient oncology population: a cross-sectional study. J Patient Rep Outcomes 2024; 8:71. [PMID: 38995461 PMCID: PMC11245459 DOI: 10.1186/s41687-024-00750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 06/23/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Cancer-associated malnutrition is associated with worse symptom severity, functional status, quality of life, and overall survival. Malnutrition in cancer patients is often under-recognized and undertreated, emphasizing the need for standardized pathways for nutritional management in this population. The objectives of this study were to (1) investigate the relationship between malnutrition risk and self-reported symptom severity scores in an adult oncology outpatient population and (2) to identify whether a secondary screening tool for malnutrition risk (abPG-SGA) should be recommended for patients with a specific ESAS-r cut-off score or group of ESAS-r cut-off scores. METHODS A single-institution retrospective cross-sectional study was conducted. Malnutrition risk was measured using the Abridged Patient-Generated Subjective Global Assessment (abPG-SGA). Cancer symptom severity was measured using the Revised Edmonton Symptom Assessment System (ESAS-r). In accordance with standard institutional practice, patients completed both tools at first consult at the cancer centre. Adult patients who completed the ESAS-r and abPG-SGA on the same day between February 2017 and January 2020 were included. Spearman's correlation, Mann Whitney U tests, receiver operating characteristic curves, and binary logistic regression models were used for statistical analyses. RESULTS 2071 oncology outpatients met inclusion criteria (mean age 65.7), of which 33.6% were identified to be at risk for malnutrition. For all ESAS-r parameters (pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and wellbeing), patients at risk for malnutrition had significantly higher scores (P < 0.001). All ESAS-r parameters were positively correlated with abPG-SGA score (P < 0.01). The ESAS-r parameters that best predicted malnutrition risk status were total ESAS-r score, lack of appetite, tiredness, and wellbeing (area under the curve = 0.824, 0.812, 0.764, 0.761 respectively). Lack of appetite score ≥ 1 demonstrated a sensitivity of 77.4% and specificity of 77.0%. Combining lack of appetite score ≥ 1 with total ESAS score > 14 yielded a sensitivity of 87.9% and specificity of 62.8%. CONCLUSION Malnutrition risk as measured by the abPG-SGA and symptom severity scores as measured by the ESAS-r are positively and significantly correlated. Given the widespread use of the ESAS-r in cancer care, utilizing specific ESAS-r cut-offs to trigger malnutrition screening could be a viable way to identify cancer patients at risk for malnutrition.
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Affiliation(s)
- Katherine McLay
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.
| | - Nicole Stonewall
- Waterloo Wellington Regional Cancer Program, Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | - Laura Forbes
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Christine Peters
- Waterloo Wellington Regional Cancer Program, Grand River Regional Cancer Centre, Kitchener, ON, Canada
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Kuichanuan T, Kitisatorn T, Pongchaiyakul C. New Body Mass Index Cut-Off Point for Obesity Diagnosis in Young Thai Adults. Nutrients 2024; 16:2216. [PMID: 39064659 PMCID: PMC11279830 DOI: 10.3390/nu16142216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Obesity is a global health threat affecting people of all ages, especially young adults. Early diagnosis of obesity allows for effective treatments and the prevention of its consequences. This study aimed to determine the prevalence of obesity in Thai young adults, evaluate the extent to which BMI values indicate excess adiposity, and identify the most appropriate BMI diagnostic cut-point based on body fat percentage. The study included 186 young adults aged 20 to 35 years. The diagnosis of obesity using body mass index (BMI) was compared with dual-energy X-ray absorptiometry-derived body fat percentage, considered the gold standard. The appropriate BMI cut-point was established using ROC curve analysis and the Youden index. Obesity was more common in women and in urban areas. BMI and body fat were significantly correlated; however, there was a high rate of false-negative obesity diagnosis based on the conventional BMI cut-off, a condition known as normal weight obesity (NWO). The newly proposed BMI cut-off points that best correlated with body fat and corrected false negatives were 22.1 kg/m2 for men and 22.5 kg/m2 for women. These new BMI cut-points should be applied together with clinical evaluations for obesity assessment in this particularly high-risk group.
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Wobith M, Hill A, Fischer M, Weimann A. Nutritional Prehabilitation in Patients Undergoing Abdominal Surgery-A Narrative Review. Nutrients 2024; 16:2235. [PMID: 39064678 PMCID: PMC11280454 DOI: 10.3390/nu16142235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/25/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
Malnutrition plays a crucial role as a risk factor in patients undergoing major abdominal surgery. To mitigate the risk of complications, nutritional prehabilitation has been recommended for malnourished patients and those at severe metabolic risk. Various approaches have been devised, ranging from traditional short-term conditioning lasting 7-14 days to longer periods integrated into a comprehensive multimodal prehabilitation program. However, a significant challenge is the considerable heterogeneity of nutritional interventions, leading to a lack of clear, synthesizable evidence for specific dietary recommendations. This narrative review aims to outline the concept of nutritional prehabilitation, offers practical recommendations for clinical implementation, and also highlights the barriers and facilitators involved.
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Affiliation(s)
- Maria Wobith
- Department for General, Visceral, and Oncological Surgery, Klinikum St. Georg, 04129 Leipzig, Germany; (M.W.); (M.F.)
| | - Aileen Hill
- Department for Operative Intensive Care and Intermediate Care, University Hospital RWTH Aachen, 52074 Aachen, Germany;
- Department for Anaesthesiology, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Martin Fischer
- Department for General, Visceral, and Oncological Surgery, Klinikum St. Georg, 04129 Leipzig, Germany; (M.W.); (M.F.)
| | - Arved Weimann
- Department for General, Visceral, and Oncological Surgery, Klinikum St. Georg, 04129 Leipzig, Germany; (M.W.); (M.F.)
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Cederholm T, Bosaeus I. Malnutrition in Adults. N Engl J Med 2024; 391:155-165. [PMID: 38986059 DOI: 10.1056/nejmra2212159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Affiliation(s)
- Tommy Cederholm
- From Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala (T.C.), Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm (T.C.), Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Stockholm (T.C.), and the Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, and the Clinical Nutrition Unit, Sahlgrenska University Hospital, Gothenburg (I.B.) - all in Sweden
| | - Ingvar Bosaeus
- From Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala (T.C.), Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm (T.C.), Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Stockholm (T.C.), and the Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, and the Clinical Nutrition Unit, Sahlgrenska University Hospital, Gothenburg (I.B.) - all in Sweden
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Celik HI, Koc F, Siyasal K, Ay B, Ilter NB, Celik OM. Exploring the complex associations among risks of malnutrition, sarcopenia, and frailty in community-dwelling older adults. Eur Rev Aging Phys Act 2024; 21:18. [PMID: 38982337 PMCID: PMC11232342 DOI: 10.1186/s11556-024-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 07/04/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Malnutrition, sarcopenia, and frailty are age-related conditions that are associated with multiple health-related negative outcomes. However, the complex associations between them remain to be elucidated. The aims of the study were to explore: (1) whether the risk of sarcopenia has a mediator effect on the association between risks of malnutrition and frailty; and (2) whether physical activity (PA) level modulates this mediator effect in community-dwelling older adults. METHODS This cross-sectional study involved 593 older adults (62.73% female; mean age = 71.35 ± 5.86 years). The Mini Nutritional Assessment-Short Form (MNA-SF), the SARC-F Questionnaire, and the FRAIL Questionnaire were used to assess the risks of malnutrition, sarcopenia, and frailty, respectively. The International Physical Activity Questionnaire Short Form (IPAQ-SF) was employed to assess PA level. Using the Hayes PROCESS macro (Models 4 and 7), mediation and moderated mediation analyses were performed. RESULTS The mediation analysis demonstrated that the MNA-SF had a significant effect on the SARC-F (B=-0.325; p < 0.001) and the SARC-F, in turn, had a significant effect on the FRAIL (B = 0.341; p < 0.001). The total (B=-0.171; p < 0.001), direct (B=-0.061; p = 0.001), and indirect (B=-0.111; bootstrap CI did not include zero, which indicates a significant effect) effects of MNA-SF on FRAIL were significant, showing that 65% of the association between the MNA-SF and FRAIL was explained by the SARC-F acting as a mediator. The moderated mediation analysis demonstrated that the association between MNA and SARC-F was moderated by the PA level (B = 0.253; p = 0.016). The SARC-F mediated and relatively enhanced the association between MNA-SF and FRAIL only in older adults with a moderate PA level (B=-0.120; CI: -0.154 to -0.085). CONCLUSIONS The SARC-F partially mediates the association between the MNA-SF and the FRAIL, indicating that malnutrition affects frailty through an indirect path via sarcopenia. Furthermore, the PA level moderates this mediator effect, with sarcopenia serving as a mediator in older adults with moderate a PA level but not in those with a low PA level. These findings reveal that it may be beneficial to consider PA level in combination with malnutrition and sarcopenia in the management and prevention of frailty in community-dwelling older adults.
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Affiliation(s)
- Halil Ibrahim Celik
- Bilge Çocuk Special Education and Rehabilitation Center, Beysukent, Çankaya, Ankara, s06800, Turkey.
| | - Ferda Koc
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of Health Sciences, Ankara, Turkey
| | - Kübra Siyasal
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of Health Sciences, Ankara, Turkey
| | - Büsra Ay
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of Health Sciences, Ankara, Turkey
| | - Nazlı Bengu Ilter
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of Health Sciences, Ankara, Turkey
| | - Ozge Mengi Celik
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of Health Sciences, Ankara, Turkey
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Chen Q, Li K, Liu Y, Yu X, Ou F. Association of body composition indicators with colorectal cancer: a hospital-based case-control study. J Cancer Res Clin Oncol 2024; 150:344. [PMID: 38981909 PMCID: PMC11233301 DOI: 10.1007/s00432-024-05866-4] [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: 04/17/2024] [Accepted: 06/25/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Colorectal cancer (CRC) is a common malignancy that affects adults worldwide, causing a high disease burden. Few studies have examined the relationship between body composition (BC) measures and the prevalence of CRC. Our purpose was to investigate the relationship between pertinent BC indicators and CRC. METHODS Bioelectrical impedance analysis, laboratory test results, face-to-face questionnaire investigation, and nutritional risk assessment (Nutritional Risk Screening 2002 and Patient-Generated Subjective Global Assessment) were used in this case-control study. Bioelectrical impedance analysis in the case group was performed prior to antitumor therapy/surgery. RESULTS From June 2018 to January 2019, a total of 303 cases and 286 controls were included. The results showed that low body fat percentage (BFP) and high visceral adiposity index (VAI) groups had a higher risk of developing CRC in comparison to the normal BFP and normal VAI groups. The risk of CRC decreased with the increase of BFP. The group with a normal BC had a lower risk of developing CRC compared to those with a greater VAI and a lower BFP, as indicated by the results of the pairwise and total combinations of VAI, fat-free mass index (FFMI), and BFP. Additionally, FFMI and VAI had positive correlations with prealbumin, serum albumin, and nutritional risk scores. CONCLUSION Low BFP and high VAI are associated with higher CRC risk. FFMI and VAI are positively correlated with prealbumin, serum albumin, and nutritional risk scores in CRC patients.
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Affiliation(s)
- Qiujin Chen
- Department of Clinical Nutrition, The First Hospital of China Medical University, Shenyang, 110001, China
- Department of Immunization, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, Wuxi, 214023, China
| | - Kai Li
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Yang Liu
- Department of Clinical Nutrition, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Xiaozhai Yu
- Department of Clinical Nutrition, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Fengrong Ou
- Department of Clinical Nutrition, The First Hospital of China Medical University, Shenyang, 110001, China.
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