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Breik L, Barker L, Bauer J, Davidson ZE. The effect of blended tube feeding compared to conventional formula on clinical outcomes in adults: A systematic review. Nutr Diet 2024. [PMID: 39450577 DOI: 10.1111/1747-0080.12912] [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: 03/24/2024] [Revised: 09/23/2024] [Accepted: 09/24/2024] [Indexed: 10/26/2024]
Abstract
AIM To explore the effect of blended tube feeding compared to conventional formulas on nutritional status, quality of life, anthropometry, diarrhoea and tube blockages in adults receiving tube feeding. METHODS The protocol was registered (PROSPERO CRD42022372443). Five databases (MEDLINE, EMBASE, CINAHL, Scopus, CENTRAL) were searched from commencement of database to 14th June 2023 to identify studies comparing blended tube feeding to conventional formulas in adults receiving tube feeding. Certainty assessment was conducted using the Cochrane Risk of Bias Tools and the Grading of Recommendations, Assessment, Development and Evaluations framework, and a narrative synthesis of results is provided. RESULTS From 4227 studies screened, eight were included (total n = 763 patients, 9-215 patients). Three studies were hospital-based and five were home-based with duration from 8 days-8 months. Blended tube feeding and conventional formulas were nutritionally equivalent in only three studies; energy and protein concentration of formulas ranged from 1.7-7.1 kJ/mL and 21-68.5 g/L for the blended tube feeding groups, and 4.2-6.7 kJ/mL and 39-100 g/L for the conventional groups. No studies assessed nutrition status or quality of life using validated measures. Blended tube feeding was associated with a clinically relevant reduction in diarrhoea with a low level of certainty. For remaining outcomes, there were inconclusive findings and an overall very low certainty of evidence for each. CONCLUSION The effect of blended tube feeding compared to conventional formulas on all outcomes remains uncertain. Blended tube feeding may reduce the incidence of diarrhoea. Future research using nutritionally equivalent comparisons and validated outcome measures is required.
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Affiliation(s)
- Lina Breik
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lisa Barker
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Judy Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Zoe E Davidson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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2
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Estrada-Restrepo A, Deossa-Restrepo GC, Benjumea-Rincón MV, Giraldo-Giraldo NA. [Sociodemographic and dietary factors and health conditions: determinants of malnutrition in the elderly in Colombia]. CAD SAUDE PUBLICA 2024; 40:e00189423. [PMID: 39319925 PMCID: PMC11423768 DOI: 10.1590/0102-311xes189423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 06/10/2024] [Indexed: 09/26/2024] Open
Abstract
This study aimed to estimate the prevalence of malnutrition using clustered anthropometric indicators and to describe the sociodemographic and dietary factors and health conditions that determine malnutrition in elderly Colombians. This was a secondary analysis of the study Health, Well-being and Ageing (SABE) Colombia, 2015. The survey included 23,694 people aged ≥ 60 years. Malnutrition excess was defined by clustering two indicators: body mass index (BMI) and waist circumference; weight deficit was defined by clustering BMI and arm and calf circumferences. The chi-square test was used to associate malnutrition with sociodemographic variables, dietary and health conditions, and to determine the heterogeneity of malnutrition, a latent class analysis was performed. Overweight was 31.9%, whereas underweight, according to BMI and calf circumference, was 7.9%, and increased to 18.8% when arm circumference was also taken into account. Five latent classes of malnutrition were generated - class 1: no overweight and deteriorated health conditions; class 2: no weight deficit and deteriorated health conditions; class 3: no malnutrition and deteriorated health conditions; class 4: overweight and multimorbidity; and class 5: low protein food intake without being underweight or overweight. It is concluded that a high prevalence of malnutrition in older adults exists, with excess rather than deficit. Sociodemographic and dietary factors and health conditions are associated differently with overweight and underweight.
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Affiliation(s)
- Alejandro Estrada-Restrepo
- Escuela de Nutrición y Dietética, Universidad de Antioquia, Medellín, Colombia
- Grupo de Investigación en Demografía y Salud, Universidad de Antioquia, Medellín, Colombia
| | - Gloria Cecilia Deossa-Restrepo
- Escuela de Nutrición y Dietética, Universidad de Antioquia, Medellín, Colombia
- Grupo de Investigación en Socioantropología de la Alimentación, Universidad de Antioquia, Medellín, Colombia
| | | | - Nubia Amparo Giraldo-Giraldo
- Escuela de Nutrición y Dietética, Universidad de Antioquia, Medellín, Colombia
- Grupo de Investigación en Alimentación y Nutrición Humana, Universidad de Antioquia, Medellín, Colombia
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3
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Nduba V, Njagi LN, Murithi W, Mwongera Z, Byers J, Logioia G, Peterson G, Segnitz RM, Fennelly K, Hawn TR, Horne DJ. Mycobacterium tuberculosis cough aerosol culture status associates with host characteristics and inflammatory profiles. Nat Commun 2024; 15:7604. [PMID: 39217183 PMCID: PMC11365933 DOI: 10.1038/s41467-024-52122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 08/27/2024] [Indexed: 09/04/2024] Open
Abstract
Interrupting transmission events is critical to tuberculosis control. Cough-generated aerosol cultures predict tuberculosis transmission better than microbiological or clinical markers. We hypothesize that highly infectious individuals with pulmonary tuberculosis (positive for cough aerosol cultures) have elevated inflammatory markers and unique transcriptional profiles compared to less infectious individuals. We performed a prospective, longitudinal study using cough aerosol sampling system. We enrolled 142 participants with treatment-naïve pulmonary tuberculosis in Kenya and assessed the association of clinical, microbiologic, and immunologic characteristics with Mycobacterium tuberculosis aerosolization and transmission in 129 household members. Contacts of the forty-three aerosol culture-positive participants (30%) are more likely to have a positive interferon-gamma release assay (85% vs 53%, P = 0.006) and higher median IFNγ level (P < 0.001, 4.28 IU/ml (1.77-5.91) vs. 0.71 (0.01-3.56)) compared to aerosol culture-negative individuals. We find that higher bacillary burden, younger age, larger mean upper arm circumference, and host inflammatory profiles, including elevated serum C-reactive protein and lower plasma TNF levels, associate with positive cough aerosol cultures. Notably, we find pre-treatment whole blood transcriptional profiles associate with aerosol culture status, independent of bacillary load. These findings suggest that tuberculosis infectiousness is associated with epidemiologic characteristics and inflammatory signatures and that these features may identify highly infectious persons.
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Affiliation(s)
- Videlis Nduba
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lilian N Njagi
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Wilfred Murithi
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Zipporah Mwongera
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jodi Byers
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Gisella Logioia
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Glenna Peterson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R Max Segnitz
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kevin Fennelly
- Division of Intramural Research, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
| | - Thomas R Hawn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - David J Horne
- Department of Global Health, University of Washington, Seattle, WA, USA.
- Department of Medicine, University of Washington, Seattle, WA, USA.
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4
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Wang L, Deng YY, Yu T, Lao XQ, Wong MCS. Associations of short-term changes in obesity indices with all-cause mortality and cardiovascular disease. Obesity (Silver Spring) 2024; 32:1568-1584. [PMID: 38924337 DOI: 10.1002/oby.24062] [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] [Received: 01/19/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE This study aimed to investigate how short-term changes (1-, 3-, and 5-year) in obesity measures affect mortality and cardiovascular disease (CVD) risk. METHODS We analyzed longitudinal data from the MJ Health Centre (n = 43,304 for the 1-year study; 24,295 for the 3-year study; 16,138 for the 5-year study) with median follow-up periods of 15.8, 13.9, and 12.3 years, respectively. Associations of short-term obesity indices changes with mortality and Framingham Risk Score changes were explored using time-dependent coefficient Cox regression models, restricted cubic splines, and multivariable linear regression models. RESULTS All-cause mortality was negatively associated with short-term weight and BMI changes, with greater reductions causing poorer outcomes. Compared with stable groups, short-term reduced weight and BMI were associated with greater risks of all-cause mortality and CVD-specific mortality (5-year study only). Also, either 1- and 3-year reduced or 3-year increased waist circumference and waist to height ratio were related to higher all-cause and CVD deaths than stable groups, respectively. Nonlinear relationships indicated lower cutoff values for short-term changes in obesity indices in predicting all-cause mortality. Decreased obesity indices significantly improved CVD profiles. CONCLUSIONS Short-term changes in obesity indices show complex mortality risks, urging personalized approaches beyond a simple weight loss focus.
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Affiliation(s)
- Lyu Wang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yun-Yang Deng
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Xiang-Qian Lao
- Department of Biomedical Science, City University of Hong Kong, Hong Kong, China
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Public Health, The Chinese Academy of Medical Sciences and the Peking Union Medical College, Beijing, China
- School of Public Health, Peking University, Beijing, China
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5
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Yang Y, Li Q, Qiu W, Zhang H, Qiu Y, Yuan J, Zha Y. Trajectory of mid-arm subcutaneous fat, muscle mass predicts mortality in hemodialysis patients independent of body mass index. Sci Rep 2024; 14:14005. [PMID: 38890351 PMCID: PMC11189518 DOI: 10.1038/s41598-024-64728-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
Although decreasing body mass index (BMI) is associated with higher mortality risk in patients undergoing hemodialysis (HD), BMI neither differentiates muscle and fat mass nor provides information about the variations of fat distribution. It remains unclear whether changes over time in fat and muscle mass are associated with mortality. We examined the prognostic significance of trajectory in the triceps skinfold (TSF) thickness and mid-upper arm circumference (MUAC). In this multicenter prospective cohort study, 972 outpatients (mean age, 54.5 years; 55.3% men) undergoing maintenance HD at 22 treatment centers were included. We calculated the relative change in TSF and MUAC over a 1-year period. The outcome was all-cause mortality. Kaplan-Meier, Cox proportional hazard analyses, restricted cubic splines, and Fine and Gray sub-distribution hazards models were performed to examine whether TSF and MUAC trajectories were associated with all-cause mortality. During follow-up (median, 48.0 months), 206 (21.2%) HD patients died. Compared with the lowest trajectory group, the highest trajectories of TSF and MUAC were independently associated with lower risk for all-cause mortality (HR = 0.405, 95% CI 0.257-0.640; HR = 0.537; 95% CI 0.345-0.837; respectively), even adjusting for BMI trajectory. Increasing TSF and MUAC over time, measured as continuous variables and expressed per 1-standard deviation decrease, were associated with a 55.7% (HR = 0.443, 95% CI 0.302-0.649), and 97.8% (HR = 0.022, 95% CI 0.005-0.102) decreased risk of all-cause mortality. Reduction of TSF and MUAC are independently associated with lower all-cause mortality, independent of change in BMI. Our study revealed that the trajectory of TSF thickness and MUAC provides additional prognostic information to the BMI trajectory in HD patients.
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Affiliation(s)
- Yuqi Yang
- School of Basic Medicine, Guangzhou Medical University, Guangzhou, China
- Department of Nephrology, Guizhou Provincial People's Hospital, Zhongshan East Road, Guiyang, China
| | - Qian Li
- Department of Nephrology, Guizhou Provincial People's Hospital, Zhongshan East Road, Guiyang, China
| | - Wanting Qiu
- School of Basic Medicine, Guangzhou Medical University, Guangzhou, China
| | - Helin Zhang
- School of Basic Medicine, Guangzhou Medical University, Guangzhou, China
| | - Yuyang Qiu
- School of Basic Medicine, Guangzhou Medical University, Guangzhou, China
| | - Jing Yuan
- Department of Nephrology, Guizhou Provincial People's Hospital, Zhongshan East Road, Guiyang, China
| | - Yan Zha
- Department of Nephrology, Guizhou Provincial People's Hospital, Zhongshan East Road, Guiyang, China.
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Bernal N, Olivera J, Suhrcke M. The effects of social pensions on nutrition-related health outcomes of the poor: Quasi-experimental evidence from Peru. HEALTH ECONOMICS 2024; 33:971-991. [PMID: 38282052 DOI: 10.1002/hec.4806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 12/04/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
This paper exploits the discontinuity around a welfare index of eligibility to assess the impact of Peru's social pension program Pension 65 on nutrition-related health outcomes among elderly poor individuals. Overall, we find evidence of how a relatively inexpensive program can produce improvements in anemia and nutrition-related mortality risk markers. The effects appear to be driven by plausible underlying mechanisms, including via improved nutritional quality as well as greater food expenditures and healthcare utilization. These positive effects are only modestly countered by tentative signs of an increased obesity risk among women in the short term (<2 years), but not beyond this term. As the program evolves further, policymakers need to confront the challenge of continuing to ensure the health benefits in terms of reducing nutritional deficits while avoiding potential undesirable side effects in terms of over-nutrition in Peru. The findings may serve to highlight the wider benefits of similar pension policies for the poor also in other middle income countries, well beyond the immediate economic welfare effects that the policies have primarily been designed for.
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Affiliation(s)
- Noelia Bernal
- Department of Economics, Universidad del Pacífico, Lima, Peru
- Netspar, Tilburg, Netherlands
| | - Javier Olivera
- Luxembourg Institute of Socio-Economic Research (LISER), Esch-sur-Alzette, Luxembourg
- Department of Economics, Pontificia Universidad Católica del Perú (PUCP), San Miguel, Peru
| | - Marc Suhrcke
- Luxembourg Institute of Socio-Economic Research (LISER), Esch-sur-Alzette, Luxembourg
- Centre for Health Economics, University of York, York, UK
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7
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Hou X, Hu J, Wang E, Guo Q, Zhang X, Yang M, Liu Z, Wang J, Song Z. The L-shaped association of mid-upper arm circumference with all-cause and cause-specific mortality in US adults: a population-based prospective cohort study. BMC Public Health 2023; 23:2297. [PMID: 37985990 PMCID: PMC10662296 DOI: 10.1186/s12889-023-17064-x] [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: 04/10/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The arm circumference is a feasible and reliable indicator in evaluating the nutritional status of children. However, its application in general adults has yet to be thoroughly investigated. OBJECTIVE This study aimed to evaluate the association between mid-upper arm circumferences (MUACs) and mortality in general adults. METHODS The nationally representative cohort from the National Health and Nutrition Examination Survey (1999-2018) was analyzed with mortality information obtained through linkage to the National Death Index. The baseline MUACs were collected as exposure. Survey-weighted Cox proportional hazard regressions were performed to estimate the hazard ratios (HRs) and 95% confidential intervals (CIs) of mortality risk for individuals with different MUACs. Restricted cubic spline analyses were performed to examine the nonlinear association of MUAC with all-cause and cause-specific mortality. RESULTS A total of 52,159 participants were included in this study. During a median follow-up time of 117 months, 7157 deaths were documented, with leading causes of cardiovascular disease (CVD), cancer, and respiratory disease. Individuals in the first quartile (Q1) of MUAC tended to have higher all-cause mortality risk than the rest after full adjustment. Similarly, CVD mortality risk in Q1 was higher than that in the second quartile (Q2) and the third quartile (Q3); respiratory mortality risk in Q1 was higher than in Q2. MUAC was non-linearly associated with all-cause mortality and CVD mortality. Individuals in Q1 MUAC (≤ 29.3) tended to have higher all-cause mortality risk, with HRs (95% CIs) estimated to be 0.76 (0.67-0.87) for Q2 (29.4, 32.5), 0.69 (0.59-0.81) for Q3 (32.6, 36.0), and 0.59 (0.46-0.75) for Q4 (≥ 36.1) after adjustment of demographic, lifestyle, and comorbidity covariates. Similarly, compared with Q1, HRs (95% CIs) for CVD mortality were estimated to be 0.73 (0.58-0.93) for Q2 and 0.57 (0.43-0.47) for Q3; HRs (95% CIs) for respiratory mortality was estimated to be 0.57 (95% CI, 0.37-0.87) for Q2 with other differences not significant. CONCLUSION The MUAC was inversely associated with long-term mortality in general adults in the United States and may serve as a valuable measurement in adult health evaluations.
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Affiliation(s)
- Xinran Hou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha, China
| | - Jie Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Qulian Guo
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Xian Zhang
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Minjing Yang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuoyi Liu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China
| | - Zongbin Song
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, Changsha, China.
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Huang L, Niannian F, Zhang Y, Shi Y, Gao X, Zhang L, Wu Y, Dai C, Huang Y, Cao Q, Zhou W, Jiang H, Jing X, Zhu W, Wang X. Rapid assessment of malnutrition based on GLIM diagnosis in Crohn's disease. Front Nutr 2023; 10:1236036. [PMID: 37736137 PMCID: PMC10510406 DOI: 10.3389/fnut.2023.1236036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023] Open
Abstract
Background and aims Malnutrition is strongly linked to adverse outcomes in patients with Crohn's disease (CD). In this study, our objective was to validate the Global Leadership Initiative on Malnutrition (GLIM) criteria and develop a fast and accurate diagnostic approach for identifying malnutrition in CD patients. Methods This study assessed 177 CD patients from four general hospitals. The efficacy of the GLIM criteria for the diagnosis of CD malnutrition was compared. By analyzing the independent factors, a nomogram model was derived and internally validated to predict the diagnosis of malnutrition in patients with CD. Model performance was assessed using discrimination and calibration, decision curves, and net benefit analyses. Results Compared with the SGA criteria, the GLIM criteria was consistent in sensitivity (88.89%) and specificity (78.43%) [AUC = 0.84; 95% Confidence Interval (CI): 0.77-0.89]. The Harvey-Bradshaw index(HBI) score (OR: 1.58; 95% CI: 1.15-2.18), body mass index (OR: 0.41; 95% CI: 0.27-0.64), and mid-upper arm circumference (OR: 0.68; 95% CI: 0.47-0.9) were independent factors associated with malnutrition. The nomogram was developed based on these indicators showing good discrimination in malnutrition diagnosis (AUC = 0.953; 95% CI: 0.922-0.984), with agreement after calibration curve and decision curve analysis. Conclusion The GLIM criteria are appropriate for diagnosing malnutrition in CD patients. The HBI score may be used to diagnose malnutrition in patients with CD and become a possible selection for the GLIM etiologic criteria of inflammation. The HBM nomogram could be a simple, rapid, and efficient method for diagnosing malnutrition in CD patients.
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Affiliation(s)
- Longchang Huang
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Fu Niannian
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yupeng Zhang
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yifan Shi
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xuejin Gao
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Li Zhang
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yan Wu
- Department of Pharmacy, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Cong Dai
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yuhong Huang
- Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, China
| | - Qian Cao
- Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Zhou
- Department of General Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Haitao Jiang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xue Jing
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Weiming Zhu
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xinying Wang
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Mossello E, Baccini M, Caramelli F, Biagini CA, Cester A, De Vreese LP, Darvo G, Vampini C, Gotti M, Fabbo A, Marengoni A, Cavallini MC, Gori G, Chattat R, Marini M, Ceron D, Lanzoni A, Pizziolo P, Mati A, Zilli I, Cantini C, Caleri V, Tonon E, Simoni D, Mecocci P, Ungar A, Masotti G. Italian guidance on Dementia Day Care Centres: A position paper. Aging Clin Exp Res 2023; 35:729-744. [PMID: 36795236 PMCID: PMC9933825 DOI: 10.1007/s40520-023-02356-4] [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: 11/04/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023]
Abstract
Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological symptoms (BPSD) in a semi-residential setting. According to available evidence, DDCCs may decrease BPSD, depressive symptoms and caregiver burden. The present position paper reports a consensus of Italian experts of different disciplines regarding DDCCs and includes recommendations about architectural features, requirements of personnel, psychosocial interventions, management of psychoactive drug treatment, prevention and care of geriatric syndromes, and support to family caregivers. DDCCs architectural features should follow specific criteria and address specific needs of people with dementia, supporting independence, safety, and comfort. Staffing should be adequate in size and competence and should be able to implement psychosocial interventions, especially focused on BPSD. Individualized care plan should include prevention and treatment of geriatric syndromes, a targeted vaccination plan for infectious diseases including COVID-19, and adjustment of psychotropic drug treatment, all in cooperation with the general practitioner. Informal caregivers should be involved in the focus of intervention, with the aim of reducing assistance burden and promoting the adaptation to the ever-changing relationship with the patient.
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Affiliation(s)
- Enrico Mossello
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Ageing, University of Florence, Florence, Italy.
| | | | - Francesca Caramelli
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Ageing, University of Florence, Florence, Italy
| | | | | | - Luc Pieter De Vreese
- Department of Mental Health and Addictions, Cognitive Clinic, Azienda USL Modena, Italy
| | - Gianluca Darvo
- Department of Architecture, University of Florence, Florence, Italy
| | - Claudio Vampini
- Psychiatric and Psychogeriatric Service, San Francesco Hospital, Garofalo Health Care, Verona, Italy
| | - Mabel Gotti
- Psychotherapist and Psychoanalyst, Italian Society of Interpersonal Psychoanalysis, Florence, Italy
| | - Andrea Fabbo
- Cognitive Disorders and Dementia Unit, Health Authority and Services of Modena, Modena, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Chiara Cavallini
- Continuity of Care Agency, Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Guido Gori
- Scientific Director, PAS Pubbliche Assistenze Foundation, Florence, Italy
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Monica Marini
- Staff Coordinator, Healthcare Executive, Tuscany Region, Italy
| | - Davide Ceron
- Opera Immacolata Concezione Foundation, Padua, Italy
| | - Alessandro Lanzoni
- Cognitive Disorders and Dementia Unit, Primary Care Department, Health District of Modena, Modena, Italy
| | | | | | | | | | | | | | - David Simoni
- Health Area Manager, Arnera Cooperativa Sociale, Pontedera, Italy
| | - Patrizia Mecocci
- Section of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Ageing, University of Florence, Florence, Italy
| | - Giulio Masotti
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Ageing, University of Florence, Florence, Italy
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10
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Alharbi TA, Ryan J, Freak-Poli R, Gasevic D, Scali J, Ritchie K, Ancelin ML, Owen AJ. The Association of Weight Loss, Weight Status, and Abdominal Obesity with All-Cause Mortality in Older Adults. Gerontology 2022; 68:1366-1374. [PMID: 35176746 PMCID: PMC9808634 DOI: 10.1159/000522040] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/08/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The objectives of this study were to examine whether weight loss, weight status (based on body mass index [BMI] categories), and abdominal obesity (based on waist circumference [WC]) were associated with a 17-year mortality risk in community-dwelling older adults. METHODS Participants were 2,017 community-dwelling adults aged 65 years or above in the longitudinal Enquête de Santé Psychologique-Risques, Incidence et Traitement study. Self-reported weight loss was collected at baseline during face-to-face interviews. Bodyweight (kg), height (m), and WC (cm) were independently measured at the baseline. BMI was categorized as follows: underweight (BMI <18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥30 kg/m2). Abdominal obesity was defined by a WC of ≥102 cm in men and ≥88 cm in women. Adjusted Cox proportional hazards models were used to examine associations of weight loss, weight status, and abdominal obesity with all-cause mortality. RESULTS Over 17 years of follow-up (median 15.5 years), 812 participants died. Abdominal obesity compared to nonabdominal obesity was associated with a 49% increased mortality risk (95% confidence interval (CI): 1.22-1.83). However, being overweight (but not obese) was associated with a 20% decreased risk (95% CI: 0.66-0.97) compared to a normal BMI. Gender did not affect these associations. In the whole cohort, self-reported weight loss at baseline was not associated with an increased mortality risk after adjusting for health and lifestyle factors. However, in men, a baseline self-reported recent weight loss of >3 kg was associated with a 52% increase in mortality risk (95% CI: 1.05-2.18) in a fully adjusted model. CONCLUSION In community-dwelling adults aged ≥65 years, abdominal obesity was strongly associated with increased mortality risk. Being overweight appeared, however, to be protective against mortality. Modest self-reported weight loss was not associated with all-cause mortality in community-dwelling older adults after adjusting for health and lifestyle factors. However, men reporting recent weight loss of more than 3 kg may be at increased risk. The findings of this study support the use of WC, rather than BMI, as a predictor of mortality risk in older adults.
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Affiliation(s)
- Tagrid Abdullah Alharbi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Karen Ritchie
- INM, Univ Montpellier, INSERM, Montpellier, France,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Alice J. Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,*Alice J. Owen,
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Wu XS, Miles A, Braakhuis A. Effects of hydrolysed meat on dietary intake and nutritional status in aged care residents requiring pureed diets: a crossover randomised controlled trial. BMC Geriatr 2022; 22:905. [PMID: 36434542 PMCID: PMC9700874 DOI: 10.1186/s12877-022-03622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As a result of the high prevalence of dysphagia in aged care facilities, demand for pureed diets is increasing. One of the biggest challenges for pureed diets is the reduced nutritional density due to the cooking process, such as when blending or softening with liquid. This study aimed to investigate the impact of innovative energy and protein-enriched meat puree on the nutrition intake and nutritional status of aged care residents requiring pureed diets. METHODS This is a single-blinded randomised controlled trial conducted in two aged care facilities using a crossover design. Twenty-two residents aged 83.2 ± 7.3 years participated in a 12-week study. Participants were blocked randomised into two groups and received a 6-week of either control (unaltered freshly made pureed diets by facilities) or intervention diet, followed by a 2-week washout and then 6-week of alternative treatment. During the intervention, freshly made meat pureed portions were swapped to hydrolysed meat, which contained 144 -392 kcal and 5.6-6.8 g more energy and protein per 100 g. Nutrition intake was collected using a validated visual estimation method over 24 h on two non-consecutive days during the control and intervention phases. A two-tailed t-test was used to compare the significance. RESULTS The intervention diet significantly increased energy (147 ± 285 kcal, p = .02), protein (4 ± 7 g, p = .04), and fat (3 ± 8 g, p = .07) intake in comparison to the control diet. Nutritional status was improved by the end of the intervention as evidenced by a higher nutritional assessment score using Mini-Nutritional Assessment - Short Form (9.1 ± 1.8) and a weight gain of 1.3 ± 1.7 g, p = .04. No significant differences were found in body composition using bioelectrical impedance analysis, calf circumference and mid-upper arm circumference. Though handgrip strength did not differ at the end of control and intervention, significance was found between the changes in control and intervention period. Plasma branched-chain amino acid increased significantly with hydrolysed meat consumption. CONCLUSIONS As a dietary enrichment, hydrolysed meat is a promising intervention for pureed diet consumers in aged care facilities, improving residents' dietary intake and reducing malnutrition risk. Future larger multicentre studies with longer intervention periods are required to confirm the effectiveness and residents' acceptance. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12622000888763).
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Affiliation(s)
- Xiaojing Sharon Wu
- grid.9654.e0000 0004 0372 3343Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1142 New Zealand
| | - Anna Miles
- grid.9654.e0000 0004 0372 3343Department of Speech Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | - Andrea Braakhuis
- grid.9654.e0000 0004 0372 3343Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1142 New Zealand
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12
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Qiu W, Chen H, Dincer AB, Lundberg S, Kaeberlein M, Lee SI. Interpretable machine learning prediction of all-cause mortality. COMMUNICATIONS MEDICINE 2022; 2:125. [PMID: 36204043 PMCID: PMC9530124 DOI: 10.1038/s43856-022-00180-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background Unlike linear models which are traditionally used to study all-cause mortality, complex machine learning models can capture non-linear interrelations and provide opportunities to identify unexplored risk factors. Explainable artificial intelligence can improve prediction accuracy over linear models and reveal great insights into outcomes like mortality. This paper comprehensively analyzes all-cause mortality by explaining complex machine learning models. Methods We propose the IMPACT framework that uses XAI technique to explain a state-of-the-art tree ensemble mortality prediction model. We apply IMPACT to understand all-cause mortality for 1-, 3-, 5-, and 10-year follow-up times within the NHANES dataset, which contains 47,261 samples and 151 features. Results We show that IMPACT models achieve higher accuracy than linear models and neural networks. Using IMPACT, we identify several overlooked risk factors and interaction effects. Furthermore, we identify relationships between laboratory features and mortality that may suggest adjusting established reference intervals. Finally, we develop highly accurate, efficient and interpretable mortality risk scores that can be used by medical professionals and individuals without medical expertise. We ensure generalizability by performing temporal validation of the mortality risk scores and external validation of important findings with the UK Biobank dataset. Conclusions IMPACT's unique strength is the explainable prediction, which provides insights into the complex, non-linear relationships between mortality and features, while maintaining high accuracy. Our explainable risk scores could help individuals improve self-awareness of their health status and help clinicians identify patients with high risk. IMPACT takes a consequential step towards bringing contemporary developments in XAI to epidemiology.
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Affiliation(s)
- Wei Qiu
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA USA
| | - Hugh Chen
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA USA
| | - Ayse Berceste Dincer
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA USA
| | | | - Matt Kaeberlein
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA USA
| | - Su-In Lee
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA USA
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13
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Dawed A, Mekonnen TC, Genetu M, Tadesse SE, Dewau R, Muche A, Zerga AA, Ayele FY, Gill TK. Comparing the validity of anthropometric measurements in identifying malnutrition status of older age people in Borena district, North Central Ethiopia: a cross_sectional study. BMC Geriatr 2022; 22:776. [PMID: 36192694 PMCID: PMC9528122 DOI: 10.1186/s12877-022-03467-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Malnutrition among older age people is becoming significantly higher in spite of improvements in the health care system. Life expectancy of Ethiopian elders is increasing; but reliable and valid tools for screening and diagnosis of malnutrition in this subgroup are limited. This study aimed to assess the validity of anthropometric measurements: Mid Upper Arm Circumference (MUAC), Body Mass Index (BMI), and Calf Circumference (CC) in detecting malnutrition status of older age people in Ethiopia. Methods A community based cross-sectional study was conducted in Borena District from January to March, 2020. A total of 421 participants aged were systematically included in the study. To test reliability and validity of the measurements,Cronbach’s α coefficient and Pearson’s correlations were used, respectively. The full Mini-Nutritional Assessment (MNA) tool was used to diagnosis malnutrition. Overall accuracy, sensitivity and specificity of BMI, MUAC and CC were estimated using Receiver Operating Characteristic curves. The Youden Index was used to determine the best cut-off point. Results The reliability of BMI, MUAC and CC by Cronbach’s alpha was found 0.847. Significant positive correlations between MNA, BMI(r = 0.56, p < 0.01); MNA, MUAC(r = 0.43, p < 0.01; and MNA, CC(r = 0.52, p < 0.01) revealed. The area under the curve (AUC) of BMI, MUAC and CC were found: 0.98(95% CI, 0.96–0.99, p < 0.001), 0.94(95% CI, 0.89–0.98, p < 0.001) and 0.96(95% CI, 0.94–0.98, p < 0.001) indicating the overall accuracy respectively. The sensitivity and specificity of BMI, MUAC and CC using established cut off points were found: 90%, 96%; 78%, 94% and 84%, 95% respectively. However, using the Youden index the best cut-off point, the sensitivity and specificity of MUAC and CC were 88%, 86%; 92% and 89% respectively and adjusted for age and sex. Conclusions The current study demonstrated that BMI was a reliable and valid method to identify the malnutrition status of older age people. A MUAC value of 19 cm and CC of 30 cm were simple and efficient cut-off points for the determination of malnutrition in the older age people. A future study is needed to validate the validity of BMI, MUAC and CC against biochemical tests as gold standard. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03467-9.
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Affiliation(s)
- Abdu Dawed
- Dessie Comprehensive Specialized Hospital, Dessie, North Eastern, Ethiopia
| | - Tefera Chane Mekonnen
- Human Nutrition and Dietetics Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Muluken Genetu
- Department of Health Service Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Sisay Eshete Tadesse
- Human Nutrition and Dietetics Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amare Muche
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Aregash Abebayehu Zerga
- Human Nutrition and Dietetics Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fanos Yeshanew Ayele
- Human Nutrition and Dietetics Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tiffany K Gill
- Adelaide Medical School, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide, South Australia, Australia
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Yeung SSY, Lee JSW, Kwok T. A Nutritionally Complete Oral Nutritional Supplement Powder Improved Nutritional Outcomes in Free-Living Adults at Risk of Malnutrition: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11354. [PMID: 36141627 PMCID: PMC9517313 DOI: 10.3390/ijerph191811354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This randomized controlled trial investigated the effectiveness of an oral nutritional supplement (ONS) on nutrition-related outcomes over 12 weeks in Chinese adults with or at risk of malnutrition. METHODS 88 Chinese adults ≥18 years living independently in Hong Kong with Mini Nutritional Assessment-Short Form (MNA-SF) score ≤11 were randomly assigned to (1) 2 servings/day of nutritionally complete ONS powder made with water (Fresubin® Powder (Fresubin Kabi Deutschland GmbH, Bad Homburg, Germany), 600 kcal, 22.4 g protein) for 12 weeks (intervention group) or (2) no treatment (control group). The primary outcome was increase in body weight (BW) over 12 weeks. Secondary outcomes included improvement in body mass index (BMI), mid-arm circumference (MAC), calf circumference, MNA-SF score, quality of life, self-rated health, frailty, and diet quality. RESULTS The intervention group showed a significantly higher mean increase in BW compared with the control group (1.381 kg, intervention vs control, p < 0.001). The intervention group also showed significantly higher mean increases in BMI, MAC, calf circumference, intake of energy, protein, vitamin D, and calcium compared with the control group. No group differences in the changes of other outcomes were observed. CONCLUSIONS For Chinese free-living adults at risk of malnutrition, daily consumption of a nutritionally complete ONS powder improved nutritional outcomes compared with the control group.
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Affiliation(s)
- Suey S. Y. Yeung
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jenny S. W. Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
- Department of Medicine and Geriatrics, To Po Hospital, Hong Kong, China
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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15
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Berry KM, Garcia S, Warren JR, Stokes AC. Association of Weight at Different Ages and All-Cause Mortality Among Older Adults in the US. J Aging Health 2022; 34:705-719. [PMID: 35220792 PMCID: PMC9411264 DOI: 10.1177/08982643211059717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Objective: Assess the association of BMI and BMI change with mortality. Methods: Using data from the Wisconsin Longitudinal Study (WLS) on participants born mainly in 1939 (n=4922), we investigated the associations between various measures of BMI across the life course (age 54 BMI; age 65 BMI; age 72 BMI; lifetime maximum BMI; BMI change between ages 54 and 65; BMI change between ages 65 and 72) and mortality. We also assessed whether these associations are mediated by late life health. Results: BMI at age 54 was more strongly associated with late life mortality than BMI at older ages. The association between BMI change and mortality varied based on the timing of weight change. Health at age 72, particularly self-rated health, diabetes, and physical functioning, mediated the observed associations. Conclusion: Knowing older people's weight at midlife and how their weight has changed may be more important in assessing late life mortality risk than their current weight.
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Affiliation(s)
- Kaitlyn M. Berry
- University of Minnesota School of Public Health, Minneapolis, MN, USA
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16
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Camargo Pereira C, Pagotto V, de Oliveira C, Silveira EA. Low muscle mass and mortality risk later in life: A 10-year follow-up study. PLoS One 2022; 17:e0271579. [PMID: 35901119 PMCID: PMC9333286 DOI: 10.1371/journal.pone.0271579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Little is known about the impact of low muscle mass (MM) assessed by calf circumference (CC), arm circumference (AC), arm muscle circumference (AMC), and corrected arm muscle circumference (CAMC)—on mortality risk later in life. We aimed to investigate the impact of low MM assessed by CC, AC, AMC and, CAMC on all-cause, cardiovascular, and cancer mortality risk. Methods Data came from 418 older adults who participated in a 10-year follow-up prospective cohort study. Low MM was defined as a CC < 33 cm for women and < 34 cm for men and by the lowest tertile of AC, AMC, and CAMC stratified by sex. The log rank test, Kaplan-Meier curves, and Cox regression were used. Results There were 147 deaths: 49 related to CVD and 22 to cancer. A small CC (HR = 1.57, 95% CI, 1.12–2.20), AMC (HR = 1.61, 95% CI, 1.13–2.30) and CAMC (HR = 1.45, 95% CI, 1.03–2.04) were associated with all-cause mortality. A small CAMC was a protective factor for CVD mortality (HR = 0.46, 95% CI, 0.22–0.98). In the Kaplan-Meier analysis, older adults with LMM presented low all-cause mortality survival, with AC (p < 0.05), AMC (p < 0.005), CAMC (p < 0.002), and CC (p < 0.001). Cancer mortality was associated with low CAMC (p < 0.020). Conclusions Low MM assessed by anthropometric measures (AC, AMC, CAMC and CC) increased the all-cause mortality risk. A small CAMC decreased the CVD mortality.
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Affiliation(s)
- Cristina Camargo Pereira
- Postgraduate Program in Health Sciences, Medical School, Federal University of Goiás (UFG), Goiania, Brazil
| | - Valéria Pagotto
- Faculty of Nursing, Postgraduate Program in Nursing, Federal University of Goiás (UFG), Goiania, Brazil
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, Medical School, Federal University of Goiás (UFG), Goiania, Brazil
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
- * E-mail:
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17
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Zhuang CL, Zhang FM, Xu HX, Weng M, Yao Y, Zhou FX, Li ZN, Guo ZQ, Li T, Li W, Shi HP. Reference values of low body mass index, mid-upper arm circumference, and calf circumference in cancer patients: a national-wide multi-center observational study. Nutrition 2022; 99-100:111688. [DOI: 10.1016/j.nut.2022.111688] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/26/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022]
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Martinez-Arnau FM, Buigues C, Fonfría-Vivas R, Cauli O. Respiratory function correlates with fat mass index and blood triglycerides in institutionalized older individuals. Endocr Metab Immune Disord Drug Targets 2022; 22:1029-1039. [PMID: 35352657 DOI: 10.2174/1871530322666220329150813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/09/2022] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND We investigated the relationship between respiratory function measured by spirometry analysis and anthropometric variables (skeletal and fat mass) and nutritional status in the institutionalized elderly, particularly at high risk of adverse outcomes after respiratory infections and malnutrition. DESIGN A multicenter cross-sectional study with quantitative approach among older people institutionalized living in nursing homes. METHODS Respiratory function was assessed by measuring the forced vital capacity, forced expiratory volume in the first second, the ratio between FEV1 and FVC (FEV1/FVC), and peak expiratory flow in percentage by means of spirometric analysis (values of the forced expiratory volume measured during the first second of the forced breath (FEV1) and forced vital capacity (FVC)). Nutritional assessment and anthropometry analysis were done to evaluate under or over nutrition/weight. RESULTS There was a significant (p<0.05) and positive correlation between FEV1 and skeletal muscle mass index, whereas fat mass index correlated significantly (p<0.01) with the FEV1/FVC index. FEV1/FVC values were both significantly (p<0.05) associated with high body mass index and triglyceride levels in blood. The prevalence of individuals with ventilator restrictive pattern (FEV1/FVC>70% with FEV1 and FVC<80%) was 27.6% and 12 individuals (21.1%) receive daily bronchodilators as part of the pharmacological treatment for respiratory disorders. A logistic regression was performed to identify predictors of restrictive respiratory pattern. The following variables were entered into the model: age group, female gender, Charlson comorbidity index, body-mass index (BMI), fat mass index, skeletal muscle mass index, total cholesterol and triglycerides concentration. The model was statistically significant (p < 0.05; R2 = 0.39), correctly classifying 70.0% of cases, with a sensitivity of 89.3% and a specificity of 50.0%. Area under curve was 0.71 (IC95% 0.54-0.88; p=0.023). The highest OR for restrictive respiratory pattern were for BMI (OR=5.09) and triglycerides concentration in blood (>150 mg/dl) (OR=5.59). CONCLUSION The relationship between a restrictive pattern of respiratory function and fat mass which deserves future investigation to manage these parameters as possible modifiable factor of altered respiratory function in overweight institutionalized older individuals.
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Affiliation(s)
- Francisco Miguel Martinez-Arnau
- Department of Physiotherapy, University of Valencia, Valencia, Spain
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, Valencia, Spain
| | - Cristina Buigues
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, Valencia, Spain
- Department of Medicine and Nursing, University of Valencia, Spain
| | - Rosa Fonfría-Vivas
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, Valencia, Spain
- Department of Medicine and Nursing, University of Valencia, Spain
| | - Omar Cauli
- Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, Valencia, Spain
- Department of Medicine and Nursing, University of Valencia, Spain
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Razon AH, Haque M, Ahmed M, Ahmad T. Assessment of dietary habits, nutritional status and common health complications of older people living in rural areas of Bangladesh. Heliyon 2022; 8:e08947. [PMID: 35243069 PMCID: PMC8857427 DOI: 10.1016/j.heliyon.2022.e08947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/09/2021] [Accepted: 02/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background Old age is one of the vulnerable and prone stages in terms of health status. So this study aimed to assess the nutritional status and common health complications of older people. Methods Simplified Nutritional Appetite Questionnaire (SNAQ), Anthropometric measurements, Diet History Method, and Mini Nutritional Assessment (MNA) tools were used to measure the nutritional status. Data were analyzed by using Statistical Package for Social Science (SPSS) version 16. Results Out of the total 320 elderly participants the mean ± SD value for the age of male and female was 67.25 ± 6.5 and 67.32 ± 7.7 years respectively. According to BMI classification, it was noticed that with advancing age the percentage of underweight was also increased such as for 60–75 years old age group the underweight percentage was 30.0% where for 76 to 85 and >85 years old age group the underweight percentage was 45.0% and 60.0% respectively. According to the MNA score, 97 elderly respondents were malnourished and a total of 172 respondents had SNAQ scores below 14. This study found a statistically significant (P < 0.05) correlations among various health complications with nutritional status according to MNA score. In addition 56.6% (OR = 1.24, 95% CI = .799–1.939), 63.8% (OR = 1.18, 95% CI = .745–1.857) and 64.7% (OR = 1.14, 95% CI = .720–1.804) respondents had diabetes mellitus, hypertension and cardiovascular disease respectively. The risk of musculoskeletal pain (OR = 1.073, 95% CI = .684–1.681), bedsore (OR = 1.884, 95% CI = .903–3.934) and decreased sense of thirst (OR = 1.278, 95% CI = .821–1.991) were higher among females than males. A little number of the elderly used to take milk, meat, and fish daily. Conclusion During this cross-sectional study, significant correlations among nutritional changes with health complications were determined. To prevent malnutrition among the elderly a proper health policy as well as periodical nutritional screening should be conducted.
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de Freitas JS, de Oliveira Pedron ÉL, de Lima E Silva Aliprandi J, Laurentino GC, Gatti AL, Forones NM, de Cássia de Aquino R. The effect of chemotherapy on dietary intake and nutritional status in patients with colorectal neoplasms and the importance of nutritional counseling. Support Care Cancer 2022; 30:3885-3891. [PMID: 35043217 DOI: 10.1007/s00520-022-06794-0] [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: 06/06/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed at assessing the effect of chemotherapy on dietary intake and nutritional status of patients with colorectal cancer undergoing chemotherapy. METHODS Observational, cross-sectional study conducted with 35 patients of both sexes, aged 50 years or older. Dietary intake was assessed four times: before (T0), twice during (T1 and T2), and after (TF) chemotherapy. Data on energy, macronutrients, and micronutrients were used for assessing dietary intake. Nutritional status was assessed on the first day and at the end of the chemotherapy cycle. The data were treated statistically using a 5% significance level. RESULTS The intake of energy, carbohydrates, lipids, selenium, and iron was lower after chemotherapy infusion (p < 0.05). Energy consumption decreased when comparing T0 (1419.8 ± 527.1 kcal) with T1 (1181.9 ± 423.2 kcal). Regarding macronutrients, carbohydrates and lipids showed a drop (p < 0.05), but there were no differences in protein intake, and it was observed that the consumption of food sources such as dairy was prioritized. In the analysis of vitamins and minerals, vitamins dropped but without a significant difference. There were significant differences between T1 and TF for iron (9.7 mg ± 4.5 mg and 12.0 ± 4.0 mg) and selenium (77.4 ± 29.7 µg and 93.6 ± 37.8 µg). There was no change in body composition and nutritional status between chemotherapy cycles. CONCLUSION The treatment reduced patients' food consumption after the chemotherapy session and impacted dietary intake, which demonstrates the importance of nutritional counseling and intervention, especially on energy consumption.
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Affiliation(s)
- Jessica Sillas de Freitas
- Graduate Program in the Science of Aging,, Universidade São Judas Tadeu (USJT) and Anima Institute, São Paulo, Brazil.
| | - Érica Line de Oliveira Pedron
- Graduate Program in the Science of Aging,, Universidade São Judas Tadeu (USJT) and Anima Institute, São Paulo, Brazil
| | | | - Gilberto Cândido Laurentino
- Graduate Program in the Science of Aging,, Universidade São Judas Tadeu (USJT) and Anima Institute, São Paulo, Brazil
| | - Ana Lucia Gatti
- Graduate Program in the Science of Aging,, Universidade São Judas Tadeu (USJT) and Anima Institute, São Paulo, Brazil
| | - Nora Manoukian Forones
- Oncology Division, Gastroenterology Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Rita de Cássia de Aquino
- Graduate Program in the Science of Aging,, Universidade São Judas Tadeu (USJT) and Anima Institute, São Paulo, Brazil
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21
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Wang J, He L, Yang N, Li Z, Xu L, Li W, Ping F, Zhang H, Li Y. Large mid-upper arm circumference is associated with reduced insulin resistance independent of BMI and waist circumference: A cross-sectional study in the Chinese population. Front Endocrinol (Lausanne) 2022; 13:1054671. [PMID: 36619554 PMCID: PMC9816137 DOI: 10.3389/fendo.2022.1054671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Body mass index (BMI) is a common indicator in clinical practice, but it is not sufficient to predict insulin resistance (IR). Other anthropometric methods supplement BMI in the assessment of body composition, which can be predicted more accurately. This cross-sectional study aimed to evaluate the association between mid-upper arm circumference (MUAC), triceps skinfold (TSF) thickness, mid-arm muscle circumference (MAMC) and IR in Chinese adults. METHODS This cross-sectional study analyzed data from the 2009 China Health and Nutrition Survey database. The study population was divided into four groups according to the MUAC quartiles, and the homeostasis mode assessment was used to evaluate the degree of IR. Logistic regression analysis was performed to calculate odds ratios (ORs) with 95% confidence intervals (CIs), with adjustments for multiple covariates. Subgroup analyses stratified by age, sex, BMI, waist circumference (WC), smoking status, and alcohol consumption were performed. RESULTS In total, 8,070 participants were included in the analysis. As MUAC increased, BMI, TSF thickness, MAMC, and the proportion of IR tended to increase. However, we found that there was a significant negative association between MUAC and MAMC and IR in the logistic regression analysis, independent of BMI and WC, the ORs for the highest quartiles compared with the lowest quartiles were 0.662 (95%CI: 0.540-0.811) and 0.723 (95%CI: 0.609-0.860), respectively. There was no significant association was observed between the TSF thickness and IR (OR=1.035 [95%CI: 0.870-1.231]). The inverse associations were more pronounced among participants with lower BMI and WC. No significant age-specific differences were observed (P-heterogeneity > 0.05). CONCLUSIONS After adjusting for BMI and WC, MUAC was negatively associated with IR in Chinese adults, and the association between MUAC and IR was derived from arm muscle instead of subcutaneous fat. MUAC could be an additional predictor of IR besides BMI and WC in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yuxiu Li
- *Correspondence: Huabing Zhang, ; Yuxiu Li,
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22
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Araujo TAD, Corona LP, Andrade FCD, Roediger MDA, Duarte YADO. Factors associated with body mass index changes among older adults: a ten-year follow-up. CAD SAUDE PUBLICA 2021; 37:e00081320. [PMID: 34909928 DOI: 10.1590/0102-311x00081320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 03/02/2021] [Indexed: 11/22/2022] Open
Abstract
To examine changes in body mass index (BMI) among older Brazilian adults and associated factors. Longitudinal, population-based study, conducted in São Paulo, Brazil. Adults aged 60 years or over (n = 1,796) from the first wave of data collection from the Health, Well-Being, and Aging Study (SABE Project) conducted from 2000 to 2010. Repeated mixed-effects linear regression was used to analyze longitudinal changes in BMI and to examine whether sociodemographic characteristics, health conditions, and social behaviors were associated with these changes. Mean BMI decreased after 70 years. Men had lower BMI than women (β = -1.86, 95%CI: -2.35; -1.37). Older adults who consumed alcohol (β = 0.30, 95%CI: 0.06; 0.54), had more than one chronic disease (β = 0.19, 95%CI: 0.26; 0.72) and who did not perform physical activity (β = 0.56, 95%CI: 0.38; 0.74) had higher BMI. Subjects who smoked (β = -0.40, 95%CI: -0.76; -0.04) and who reported having eaten less food in recent months (β = -0.48, 95%CI: -0.71; -0.24) had lower BMI. In older Brazilians, several sociodemographic characteristics, health conditions, and behaviors predict BMI. Increasing prevalence of chronic diseases and growing sedentary behaviors in Brazil may have detrimental effects on BMI at older ages.
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Affiliation(s)
- Tânia Aparecida de Araujo
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.,Centro Universitário de Patos de Minas, Pato de Minas, Brasil
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23
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Masaki S, Kawamoto T. Nutritional and prognostic significance of abdominal wall thickness measured during percutaneous endoscopic gastrostomy in older individuals with dysphagia. Clin Nutr ESPEN 2021; 46:216-222. [PMID: 34857200 DOI: 10.1016/j.clnesp.2021.10.005] [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: 08/26/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND & AIMS The significance of abdominal wall thickness (AWT) for nutritional assessment remains unclear. This study aimed to evaluate the nutritional and prognostic significance of AWT measured during percutaneous endoscopic gastrostomy (PEG) in older patients with dysphagia. METHODS This single-center retrospective cohort study enrolled older adults with dysphagia who underwent PEG for enteral nutrition using the introducer technique between February 2010 and January 2019. We examined the association between AWT measured during PEG and nutritional status items, including body mass index (BMI), serum albumin (Alb), total lymphocyte count (TLC), total cholesterol (TC), hemoglobin (Hb), and C-reactive protein (CRP). The shaft length of the PEG tube inserted, which is an approximation value of the AWT, was used for statistical analysis. Patients were divided into three groups: low-AWT group (shaft length ≤2.5 cm), medium-AWT group (shaft length 3.0-3.5 cm), and high-AWT group (shaft length ≥4.0 cm). We performed the Kruskal-Wallis test and multiple linear regression analysis with multiple imputation. We performed survival analysis using the Kaplan-Meier method, log-rank test, and Cox regression analysis. RESULTS A total of 520 patients were identified: 115, 258, and 147 patients in the low-AWT, medium-AWT, and high-AWT groups, respectively. Higher AWT was significantly associated with higher BMI, Alb, TLC, TC, Hb, and lower CRP levels. Multiple linear regression analysis revealed that BMI and TLC were significant predictors of AWT (BMI: coefficient 1.16E-01, 95% confidence interval [CI], 9.77E-02-1.33E-01, P < 0.001; TLC: coefficient 1.18E-04, 95% CI, 2.72E-05-2.09E-04, P = 0.011). The median survival time was the longest in the high-AWT group (low-AWT, 359 days; medium-AWT, 851 days; high-AWT, 1662 days; P < 0.001). The hazard ratio for the high-AWT group relative to the medium-AWT group was 0.59 (95% CI, 0.41-0.85, P = 0.004), and that relative to the low-AWT group was 0.34 (95% CI, 0.24-0.51, P < 0.001). CONCLUSIONS Higher AWT was associated with better nutritional status and survival. AWT may help assess nutritional status and predict survival in older dysphagic patients with PEG.
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Affiliation(s)
- Shigenori Masaki
- Department of Surgery and Gastroenterology, Miyanomori Memorial Hospital, Sapporo 064-0953, Hokkaido, Japan.
| | - Takashi Kawamoto
- Department of Neurosurgery, Miyanomori Memorial Hospital, Sapporo 064-0953, Hokkaido, Japan.
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24
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Dahl H, Sandblost SRT, Welland NL, Sandnes K, Sekse I, Sæle K, Marti HP, Holst L, Dierkes J. Medication Prescription, Common Side-effects, and Nutritional Status are Associated in Patients With Chronic Kidney Disease. J Ren Nutr 2021; 32:520-528. [PMID: 34922813 DOI: 10.1053/j.jrn.2021.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/17/2021] [Accepted: 10/17/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Chronic kidney disease (CKD) is associated with metabolic, nutritional, and extra-renal changes, as well as a high rate of comorbidities, which necessitates the prescription of numerous medications. Patients with CKD often experience poor nutritional status related to disease severity and prescribed medication; however, this association has not been investigated in depth. Therefore, this study aimed at investigating the association between prescribed medication and nutritional status in patients with CKD. METHODS Assessment of nutritional status was performed using anthropometric and functional measurements and by biochemical measures. Patient history and the number and type of currently prescribed medications were collected from patients' records. We evaluated the total number and the number of specific medicines with common or very common side-effects of nausea or xerostomia. RESULTS Two hundred seventeen patients with CKD were included in this cross-sectional study (n = 112 with pre-dialysis CKD stages 3-5, n = 33 with hemodialysis, and n = 72 with kidney transplant). On average, patients were prescribed nine medications concurrently. The number of prescribed medications was inversely associated with mid-upper arm circumference, skinfold thickness triceps, handgrip strength, serum albumin, and hemoglobin after adjustment for age, sex, and kidney function. Prescription of medications with nausea as a side-effect showed similar associations, whereas prescription of medications with xerostomia as a side-effect was associated with lower handgrip strength. CONCLUSION Medication prescription was associated with poor nutritional status in patients with CKD, and monitoring of nutritional status in patients with CKD with long medication lists is warranted to identify and treat patients with poor nutritional status.
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Affiliation(s)
- Helene Dahl
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | - Natasha L Welland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kristina Sandnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingegjerd Sekse
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kristin Sæle
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Hans-Peter Marti
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Lone Holst
- Centre for Pharmacy, University of Bergen, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jutta Dierkes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
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25
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Gainey M, Qu K, Garbern SC, Barry MA, Lee JA, Nasrin S, Monjory M, Nelson EJ, Rosen R, Alam NH, Schmid CH, Levine AC. Assessing the performance of clinical diagnostic models for dehydration among patients with cholera and undernutrition in Bangladesh. Trop Med Int Health 2021; 26:1512-1525. [PMID: 34469615 PMCID: PMC9118139 DOI: 10.1111/tmi.13675] [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] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Accurately assessing dehydration severity is a critical step in reducing mortality from diarrhoea, but is complicated by cholera and undernutrition. This study seeks to assess the accuracy of two clinical diagnostic models for dehydration among patients over five years with cholera and undernutrition and compare their respective performance to the World Health Organization (WHO) algorithm. METHODS In this secondary analysis of data collected from the NIRUDAK study, accuracy of the full and simplified NIRUDAK models for predicting severe and any dehydration was measured using the area under the Receiver Operator Characteristic curve (AUC) among patients over five with/without cholera and with/without wasting. Bootstrap with 1000 iterations was used to compare the m-index for each NIRUDAK model to that of the WHO algorithm. RESULTS A total of 2,139 and 2,108 patients were included in the nutrition and cholera subgroups respectively with an overall median age of 35 years (IQR = 42) and 49.6% female. All subgroups had acceptable discrimination in diagnosing severe or any dehydration (AUC > 0.60); though the full NIRUDAK model performed best among patients without cholera, with an AUC of 0.82 (95%CI:0.79, 0.85) and among patients without wasting, with an AUC of 0.79 (95%CI:0.76, 0.81). Compared with the WHO's algorithm, both the full and simplified NIRUDAK models performed significantly better in terms of their m-index (p < 0.001) for all comparisons, except for the simplified NIRUDAK model in the wasting group. CONCLUSIONS Both the full and simplified NIRUDAK models performed less well in patients over five years with cholera and/or wasting; however, both performed better than the WHO algorithm.
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Affiliation(s)
| | - Kexin Qu
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Stephanie C. Garbern
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - Meagan A. Barry
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - John Austin Lee
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
| | - Sabiha Nasrin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mahmuda Monjory
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Eric J. Nelson
- Departments of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Rochelle Rosen
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Nur H. Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Christopher H. Schmid
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Adam C. Levine
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
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26
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Validating mid-upper arm circumference (MUAC) cut off points as an indicator of nutritional status among nine tribal populations of India. ANTHROPOLOGICAL REVIEW 2021. [DOI: 10.2478/anre-2021-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Mid-upper arm circumference (MUAC) is an alternative anthropometric measurement to assess undernutrition but a universally accepted cut-off is yet to be established. The objectives of the present study are to determine whether the proposed sex-specific global cut-offs are suitable across several tribes in India. This cross-sectional study was conducted among nine tribal populations in India (1046 males, 1087 females). Weight, height and MUAC values were obtained, and body mass index (BMI) was calculated. The BMI cut-off (<18.5 kg/m2) was used to determine chronic energy deficiency (CED). The ROC Curve analyses of binomial logistic regression for MUAC versus CED revealed optimal cut-off point of MUAC as 23.8 cm (in males) and 21.8 cm (in females). MUAC cut-offs were similar in females, relative to males, in all tribes. Males with MUAC<24cm and females with MUAC<22 encompassed significantly higher numbers of CED than those with MUAC≥24 and ≥22 cm, respectively (χ2-value males: 254.9, p<0.001; females: 493.60, p<0.01). A single cut off point of MUAC may not be universally applicable for diverse populations and both sexes as well. It seemed that there is no alternative than to undertake further validation studies in various populations before using the MUAC cut off to identify undernourished or CED condition.
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27
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Elgazzar K, Hassan AA. Autoaugmentation Brachioplasty: An Arm Contouring Method in Women with Massive Weight Loss. Aesthetic Plast Surg 2021; 45:2233-2241. [PMID: 33580276 DOI: 10.1007/s00266-021-02138-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Brachioplasty of deflated arms following massive weight loss (MWL) often results in too slim arms. These slimmer arms lack the natural proportion and contour. This study presents a novel method for such arms through standard skin excision and autoaugmentation by dermofat flap. PATIENTS During a period of 2 years, 21 women complaining of severe deflation deformity of upper arms following MWL were operated. At time of surgery, the BMI ranged from 20.5 to 33. 4 with a mean of 26.2 kg/m2. The mean value of weight loss was 47.8 kg over a mean period of 18 months. METHODS A de-epithelialized dermofat flap was preserved underneath the dissected and advanced anterior and posterior arm skin flaps. The bulk of the flap was tailored as to give an appropriate girth with balanced proportion and contour of the upper arm. RESULTS During 14 months of follow-up, all patients reported a high satisfaction. Objective evaluation was based on measurement of the mid-upper arm circumferences (MUAC) and its ratio with the mid-forearm circumferences (MFAC) which was compared with those of arms of healthy volunteers with normal BMIs. CONCLUSION Augmentation of the upper arm by autologous dermofat flap provides a well arm contour in appropriate balance with the forearm in women having severe arm deflation deformity following MWL. The findings were supported by the objective anthropometric measurements of the MUAC/MFAC of a normal weight healthy women which reached to a mean value of 1.366. The normal girth of upper arm should equal 1[Formula: see text] that of the forearm. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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28
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High Prevalence of Overweight and Its Association with Mid-Upper Arm Circumference among Female and Male Farmers in Tanzania and Mozambique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179128. [PMID: 34501716 PMCID: PMC8431514 DOI: 10.3390/ijerph18179128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022]
Abstract
The increasing prevalence of overweight/obesity may already have reached the farmers in Tanzania and Mozambique. Here, the measurement of the mid-upper-arm-circumference (MUAC) could become a simple and sensitive tool for early detection of at-risk groups of overweight as well as underweight. Body Mass Index (BMI) and MUAC of female and male farmers (n = 2106) from different regions of Tanzania and the Zambézia province, Mozambique, were analyzed by region, sex, age, and correlates. MUAC cut-offs, calculated via BMI cut-offs (<18.5, ≥25, and ≥30 kg/m2), and multiple linear regression (MLR), compared to those selected by highest Youden’s index (YI) value, were assessed. The study showed an overall higher prevalence of overweight (19%) than underweight (10%) due to the high number of overweight female farmers (up to 35%) in southern Tanzania. BMI, which was mainly and positively predicted by MUAC, was higher in Tanzania and among female farmers, and decreased significantly from the age of ≥65 years. MUAC cut-offs of <24 cm and ≥30.5 cm, calculated by MLR, detected 55% of farmers being underweight and 74% being overweight, with a specificity of 96%; the higher cut-off <25 cm and lower cut-off ≥29 cm, each selected according to YI, consequently detected more underweight (80%) and overweight farmers (91%), but on the basis of a lower specificity (87–88%). Overweight was evident among female farmers in East Africa. MUAC cut-offs, whether defined via linear regression or Youden’s Index, could prove to be easy-to-use tools for large-scale screenings of both underweight and overweight.
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He L, Yang N, Wang J, Huang J, Li W, Xu L, Ping F, Li Y, Zhang H. Mid-Arm Muscle and Subcutaneous Fat Associated with All-Cause Mortality Independent of BMI: A Prospective Cohort Study. Obesity (Silver Spring) 2021; 29:1203-1214. [PMID: 34021531 DOI: 10.1002/oby.23179] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study aimed to systematically evaluate the association between triceps skinfold (TSF) thickness (which indicates subcutaneous fat) mid-arm muscle circumference (MAMC; which reflects muscle mass), mid-upper arm circumference (MUAC), and all-cause mortality. METHODS A total of 17,717 adults from the China Health and Nutrition Survey (1993-2015) were included. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. The joint effect of TSF thickness and MAMC was examined, and planned subgroup analyses were performed. RESULTS The highest quartiles of TSF thickness, MAMC, and MUAC were significantly associated with low all-cause mortality, independent of BMI (TSF thickness: HR = 0.704 [95% CI: 0.575-0.862]; MAMC: HR = 0.729 [95% CI: 0.607-0.876]; MUAC: HR = 0.713 [95% CI: 0.583-0.872]). A 1-SD increase showed comparable risk reductions for TSF thickness and MAMC (14.6% and 14.0%), with 16.1% risk reductions in MUAC. There were positive additive interactions between TSF thickness and MAMC. The inverse association existed in young, middle-aged, and elderly participants (P-heterogeneity > 0.05). CONCLUSIONS Mid-arm muscle and subcutaneous fat were inversely associated with all-cause mortality, independent of BMI, beyond the elderly population. Mid-arm muscle and subcutaneous fat made comparable contributions to and had positive joint effects on all-cause mortality.
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Affiliation(s)
- Liyun He
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Na Yang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jialu Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingyue Huang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lingling Xu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fan Ping
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huabing Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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30
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Dahl H, Warz SI, Welland NL, Arnesen I, Marti HP, Dierkes J. Factors associated with nutritional risk in patients receiving haemodialysis assessed by Nutritional Risk Screening 2002 (NRS2002). J Ren Care 2021; 48:112-118. [PMID: 33977653 DOI: 10.1111/jorc.12374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/19/2021] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nutritional Risk Screening 2002 is recommended as a screening tool to identify patients at risk of undernutrition for all patients in hospitals by the European Society of Clinical Nutrition and Metabolism. Nutritional risk is associated with increased morbidity and mortality in patients, and it is common among patients on haemodialysis. Factors associated with nutritional risk that could facilitate the screening/diagnostic procedures are warranted. OBJECTIVES Identification of factors that are associated with nutritional risk in patients with end-stage renal disease treated with haemodialysis. DESIGN AND PARTICIPANTS Single-centre, cross-sectional study in patients receiving haemodialysis (n = 53) were screened for nutritional risk using Nutritional Risk Screening 2002. Associations were made with data on dietary intake by 24-h dietary recall, and measurement of body composition, anthropometric measurements and biochemical variables. RESULTS Nutritional risk was common among patients on haemodialysis (26%), and was associated with low energy and protein intake, and low pre-albumin concentrations also after adjustments for age and sex. Nutritional risk was neither associated with diabetes nor duration of dialysis treatment. CONCLUSION Measurement of pre-albumin and dietary assessment using a 24-h dietary recall can support the identification of patients receiving haemodialysis at nutritional risk.
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Affiliation(s)
- Helene Dahl
- Department of Clinical Medicine, Centre for Nutrition, University of Bergen, Bergen, Norway
| | - Sina-Isabel Warz
- Department of Clinical Medicine, Centre for Nutrition, University of Bergen, Bergen, Norway
| | - Natasha L Welland
- Department of Clinical Medicine, Centre for Nutrition, University of Bergen, Bergen, Norway
| | - Iselin Arnesen
- Department of Clinical Medicine, Centre for Nutrition, University of Bergen, Bergen, Norway
| | - Hans-Peter Marti
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Nephrology, Haukeland University Hospital, Bergen, Norway
| | - Jutta Dierkes
- Department of Clinical Medicine, Centre for Nutrition, University of Bergen, Bergen, Norway.,Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.,Mohn Nutrition Research Laboratory, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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31
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Alharbi TA, Paudel S, Gasevic D, Ryan J, Freak-Poli R, Owen AJ. The association of weight change and all-cause mortality in older adults: a systematic review and meta-analysis. Age Ageing 2021; 50:697-704. [PMID: 33161429 DOI: 10.1093/ageing/afaa231] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE there may be age-related differences in the impact of weight change on health. This study systematically reviewed the evidence on the relationship between weight change and all-cause mortality in adults aged 65 years and older. METHODS MEDLINE, EMBASE and CINAHL were searched from inception to 11 June 2020, PROSPERO CRD 42019142268. We included observational studies reporting on the association between weight change and all-cause mortality in older community-dwelling adults. A random-effects meta-analysis was performed to calculate pooled hazard ratios and scored based on the Agency for Healthcare Research and Quality guidelines. RESULTS a total of 30 studies, including 1,219,279 participants with 69,255 deaths, demonstrated that weight loss was associated with a 59% increase in mortality risk (hazard ratio (HR): 1.59; 95% confidence interval (CI): 1.45-1.74; P < 0.001). Twenty-seven studies that reported outcomes for weight gain (1,210,116 participants with 65,481 deaths) indicated that weight gain was associated with a 10% increase in all-cause mortality (HR: 1.10; 95%CI: 1.02, 1.17; P = 0.01). Four studies investigated weight fluctuation (2,283 events among 6,901 participants), which was associated with a 63% increased mortality risk (HR: 1.66; 95%CI: 1.28, 2.15). No evidence of publication bias was observed (all P > 0.05). CONCLUSION for community-dwelling older adults, weight changes (weight loss, gain or weight fluctuation) are associated with an increased risk of all-cause mortality risk relative to stable weight. Further research is needed to determine whether these associations vary depending upon initial weight, and whether or not the weight loss/gain was intentional.
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Affiliation(s)
- Tagrid A Alharbi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Susan Paudel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- PSNREC, INSERM, University of Montpellier, Montpellier 34000, France
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Olive oil-based lipid emulsion is noninferior to soybean oil-based lipid emulsion in the acute care setting: A double-blind randomized controlled trial. Nutrition 2021; 89:111283. [PMID: 34090216 DOI: 10.1016/j.nut.2021.111283] [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: 11/04/2020] [Revised: 04/05/2021] [Accepted: 04/10/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Olive oil (OO)-based intravenous lipid emulsion (IVLE) may have biological advantages for nutrition and inflammation status compared with soybean oil (SO)-based IVLE. We aimed to compare prealbumin levels during infusion of OO- or SO-based IVLE in patients receiving parenteral nutrition in the acute-care setting. METHODS In this prospective, noninferiority, double blind randomized controlled efficacy trial, patients received either OO-based or SO-based IVLE after providing consent. Biochemical and nutrition parameters were collected at baseline and at 7 to 10 d after initiation of parenteral nutrition. Results are expressed as means (standard deviations). RESULTS A total of 210 patients completed the study: 102 patients in the SO-based IVLE group and 108 patients in the OO-based IVLE group. Both groups had a significant increase in prealbumin levels from baseline (SO: 0.10 [0.06] versus 0.15 [0.08] g/L; P < 0.0001; OO: 0.11 [0.06] versus 0.16 [0.08] g/L; P < 0.0001), but mean changes between groups were not different (P = 0.53). OO-based IVLE was noninferior to SO-based IVLE in maintaining or increasing serum prealbumin levels, with 20% as the noninferiority margin at follow-up (least square geometric mean ratio [95% CI], 1.10 [0.83,1.47]; P = 0.50). There was a significant improvement in C-reactive protein levels from baseline within each group (SO: 83.24 [69.72] versus 53.4 [59.78] mg/dL; P < 0.0001; OO: 85.13 [68.14] versus 58.75 [60.11] mg/dL; P = 0.004), but mean changes between the groups were not different (P = 0.836). Mortality, length of stay, and infection rates were not different for both groups. CONCLUSIONS In this study, OO-based IVLE was not inferior to SO-based IVLE in maintaining or increasing the prealbumin level. The improvement of C-reactive protein levels and other clinical outcomes were not different for both groups.
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Guzmán-Mercado E, Vásquez-Garibay EM, Sánchez Ramírez CA, Muñoz-Esparza NC, Larrosa-Haro A, Meza Arreola PL. Full Breastfeeding Modifies Anthropometric and Body Composition Indicators in Nursing Mothers. Breastfeed Med 2021; 16:264-271. [PMID: 33179962 DOI: 10.1089/bfm.2020.0144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: It has been observed that breastfeeding mobilizes the deposits of fat that accumulate during pregnancy and promotes weight loss through energy expenditure. The purpose of this study was to demonstrate that full breastfeeding (FBF) reduces anthropometric and body composition indicators in women between the 8th and the 16th week postpartum. Methods: In a nonrandom cohort study, 170 mothers at the Hospital Civil de Guadalajara, Guadalajara, México, were enrolled: FBF 74, partial breastfeeding (PBF) 57, and human milk substitutes (HMS) 39. Anthropometric indicators and body composition were measured at the 8th and 16th week postpartum. We performed analysis of variance to compare body composition according to the type of feeding and paired Student's t-test to compare the changes from the 8th to 16th week postpartum. Results: We found that FBF mothers had a trend to lower arm fat area and triceps skinfold than PBF and HMS mothers at 8 and 16 weeks postpartum. We observed a decrease in weight (p = 0.004), weight/age index (p = 0.003), body mass index (p = 0.003), hip circumference (p = 0.037), and lean mass (p = 0.003) from 8 to 16 weeks postpartum in mothers who offered FBF. The mid-upper arm circumference, the arm total area, and their z-score increased in the three feeding groups. Conclusions: Our results show that FBF mothers had some lower adiposity from 8 to 16 weeks postpartum compared with the result observed among PBF mothers and those who utilized HMS.
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Affiliation(s)
- Elizabeth Guzmán-Mercado
- Instituto de Nutrición Humana, Universidad de Guadalajara, Guadalajara, Mexico.,Doctorado en Ciencias Médicas, Universidad de Colima, Colima, Mexico
| | - Edgar M Vásquez-Garibay
- Instituto de Nutrición Humana, Universidad de Guadalajara, Guadalajara, Mexico.,División de Pediatría, Nuevo Hospital Civil de Guadalajara Dr. Juan I. Menchaca, Guadalajara, Mexico
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Ling CHY, Meskers CGM, Maier AB. Can anthropometric measures be used as proxies for body composition and physical function in geriatric outpatients? Arch Gerontol Geriatr 2021; 94:104379. [PMID: 33610124 DOI: 10.1016/j.archger.2021.104379] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The study aimed to evaluate the associations between anthropometric measures with body composition, in particular skeletal muscle mass, and with physical function in a cohort of geriatric outpatients. METHODS We included 572 outpatients who attended geriatric clinics at Amsterdam UMC, location VUmc, Netherlands from January 2014 to December 2015. Anthropometric measures (height, weight, body circumferences, body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR)), and physical function measures (handgrip strength (HGS), Short Physical Performance Battery (SPPB) and Timed Up and Go test (TUG)) were obtained. Body composition was analysed using bioimpedance analysis (BIA) in a subgroup of 78 patients. Gender-stratified regression analyses were performed to test associations between anthropometric measures with body composition and physical function, adjusted for age. RESULTS In females, BMI, WHtR and all measured body circumferences were positively associated with body fat mass (BFM) (all β≥0.64, all p≤0.001). BMI and mid-upper arm circumference were also associated with fat-free mass (FFM) (β=0.49, p=0.001; β=0.53, p=0.01), skeletal muscle mass (SMM) (β=0.39, p=0.01; β=0.44, p=0.02) and skeletal muscle index (SMI) (β=0.44, p=0.003; β=0.44, p=0.02). In males, BMI, WHR, WHtR and waist circumference were positively associated with BFM (all β≥0.54, all p≤0.02). Calf circumference was associated with FFM (β=0.46, p=0.01), SMM (β=0.47, p=0.01) and SMI (β=0.50, p=0.01). BMI and central fat anthropometric measures were inversely associated with physical function. CONCLUSIONS Mid-upper arm circumference and calf circumference could serve as practical proxy measures for skeletal muscle mass in geriatric outpatient setting, but their associations with physical function were weak.
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Affiliation(s)
- Carolina H Y Ling
- Internal Medicine Department, The Prince Charles Hospital, Queensland, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Carel G M Meskers
- Amsterdam UMC, Department of Rehabilitation medicine, VU University, Amsterdam Movement Sciences, @AgeAmsterdam, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
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Phong RY, Taylor SL, Robinson BA, Jhawar S, Nandalike K. Utility of Mid-Upper Arm Circumference in Diagnosing Malnutrition in Children With Cystic Fibrosis. Nutr Clin Pract 2020; 35:1094-1100. [PMID: 33078441 DOI: 10.1002/ncp.10593] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Standardized diagnostic indicators for malnutrition using growth percentile z-scores (weight for length or body mass index [BMI]) and mid-upper arm circumference (MUAC) z-scores are being used in clinical practice; however, their application to the pediatric cystic fibrosis (CF) population is not well described. In this study, we aim to compare growth percentile z-scores and MUAC z-scores in diagnosing and classifying malnutrition in children with CF and assess the relationship between their degree of malnourishment and corresponding pulmonary function tests (PFTs). METHODS In this retrospective observational outpatient study of 49 pediatric CF patients, data were collected on baseline characteristics, anthropometrics, and PFTs over 12 months. Agreement in malnutrition diagnoses was quantified by Cohen κ statistics. Pearson test assessed the correlation between MUAC and BMI z-scores as well as PFTs and anthropometrics. Serial anthropometrics and PFTs were obtained and compared for a subset of patients (n = 28). RESULTS Growth percentile and MUAC z-scores were positively correlated in diagnosing malnutrition (Pearson correlation r = 0.87), but MUAC z-scores identified more patients as malnourished compared with growth percentile z-scores (49% vs 12%, Cohen κ of 0.22 [95% CI, 0.04-0.40]). There was no significant relationship between anthropometrics and PFTs. MUAC z-scores increased significantly over time, but BMI z-scores did not show this trend. CONCLUSIONS Our small-scale data suggest a promising role for MUAC z-scores in classifying malnutrition and in measuring changes in nutrition status over time in pediatric CF.
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Affiliation(s)
- Rachel Y Phong
- Department of Food and Nutrition Services, University of California Davis Health, Sacramento, California, USA
| | - Sandra L Taylor
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Sacramento, California, USA
| | - Brandt A Robinson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California Davis Health, Sacramento, California, USA
| | - Sanjay Jhawar
- Division of Pulmonary Medicine, Department of Pediatrics, University of California Davis Health, Sacramento, California, USA
| | - Kiran Nandalike
- Division of Pulmonary Medicine, Department of Pediatrics, University of California Davis Health, Sacramento, California, USA
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Javed AA, Aljied R, Allison DJ, Anderson LN, Ma J, Raina P. Body mass index and all-cause mortality in older adults: A scoping review of observational studies. Obes Rev 2020; 21:e13035. [PMID: 32319198 DOI: 10.1111/obr.13035] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 12/17/2022]
Abstract
In older age, body composition changes as fat mass increases and redistributes. Therefore, the current body mass index (BMI) classification may not accurately reflect risk in older adults (65+). This study aimed to review the evidence on the association between BMI and all-cause mortality in older adults and specifically, the findings regarding overweight and obese BMI. A systematic search of the OVID MEDLINE and Embase databases was conducted between 2013 and September 2018. Observational studies examining the association between BMI and all-cause mortality within a community-dwelling population aged 65+ were included. Seventy-one articles were included. Studies operationalized BMI categorically (n = 60), continuously (n = 8) or as a numerical change/group transition (n = 7). Reduced risk of mortality was observed for the overweight BMI class compared with the normal BMI class (hazard ratios [HR] ranged 0.41-0.96) and for class 1 or 2 obesity in some studies. Among studies examining BMI change, increases in BMI demonstrated lower mortality risks compared with decreases in BMI (HR: 0.83-0.95). Overweight BMI classification or a higher BMI value may be protective with regard to all-cause mortality, relative to normal BMI, in older adults. These findings demonstrate the potential need for age-specific BMI cut-points in older adults.
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Affiliation(s)
- Ayesha A Javed
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Rumaisa Aljied
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - David J Allison
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Kinesiology, McMaster University, Hamilton, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,McMaster Institute for Research on Aging, Hamilton, Canada.,Labarge Centre for Mobility in Aging, Hamilton, Canada
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Thorup L, Hamann SA, Kallestrup P, Hjortdal VE, Tripathee A, Neupane D, Patsche CB. Mid-upper arm circumference as an indicator of underweight in adults: a cross-sectional study from Nepal. BMC Public Health 2020; 20:1187. [PMID: 32727437 PMCID: PMC7391598 DOI: 10.1186/s12889-020-09294-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/23/2020] [Indexed: 12/31/2022] Open
Abstract
Background Undernourished people have an increased risk of premature mortality from both infectious and non-communicable diseases. Aside from screening purposes, assessment of nutritional status is a useful tool in management and evaluation of various chronic diseases. Body-Mass-Index (BMI) is today the most commonly used marker of nutritional status however, this method presents a challenge in many low resource settings and immobile patients. Mid-upper arm circumference (MUAC) is another anthropometric measure that requires minimal equipment and little training. So far, MUAC cutoffs for undernutrition are well established in children < 5 years but there is still no consensus for a specific cutoff in adults. The objective of this study was to compare MUAC with BMI and suggest a MUAC cut-off corresponding to a BMI of 18.5 kg/m2 to identify underweight in adults. Methods A cross-sectional study was conducted at two urban public hospitals in Nepal. The following variables where collected: MUAC, weight, height, sex, age and self-reported medical history. Exclusion criteria: < 19 years of age, pregnancy and oedema. Sensitivity and specificity for a MUAC value corresponding to BMI < 18.5 was calculated. ROC analysis was performed for male and female as well as Pearson’s correlation of MUAC and BMI. Results A total of 302 people between 18 and 86 years of age, 197 women and 105 men, were included. Of these, 90 people suffered from rheumatic heart disease. MUAC was highly correlated with BMI in both women r = 0.889 and men r = 0.846. Best statistically derived MUAC cutoff corresponding to a BMI < 18.5 kg/m2 was 24.5 cm (Youdens Index = 0.75; sensitivity 92.86; specificity 82.48), with high predictive value (AUROCC> 0.9). The setting based optimal MUAC cutoff was also 24.5 cm. No considerable variation was found in sex- and disease specific subgroups. Conclusion MUAC is strongly correlated with BMI in adults in Nepal. For simplicity, a MUAC of 24.5 cm is the optimal statistically and setting based cutoff in both women and men to identify underweight (BMI < 18.5 kg/m2).
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Affiliation(s)
- Lene Thorup
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Aarhus N, Denmark. .,Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Sophie Amalie Hamann
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Per Kallestrup
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Vibeke Elisabeth Hjortdal
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ashish Tripathee
- Western Regional Hospital, Pokhara Academy of Health Sciences, Pokhara, Nepal
| | - Dinesh Neupane
- Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Nepal Development Society, Bharatpur, Chitwan, Nepal
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Shi J, Yang Z, Niu Y, Zhang W, Li X, Zhang H, Lin N, Gu H, Wen J, Ning G, Qin L, Su Q. Large mid-upper arm circumference is associated with metabolic syndrome in middle-aged and elderly individuals: a community-based study. BMC Endocr Disord 2020; 20:78. [PMID: 32493449 PMCID: PMC7268597 DOI: 10.1186/s12902-020-00559-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The mid-upper arm circumference (MUAC) is a proxy for subcutaneous fat in the upper body and is a reliable screening measure for identifying individuals with abnormal regional fat distribution. The purpose of this study was to evaluate the association between MUAC and metabolic syndrome (MetS) in middle-aged and elderly individuals. METHODS We measured the MUAC in a cross-sectional sample with a total of 9787 subjects aged 40 years and older. The measurement of MUAC is performed on the right arm using a non-elastic tape held midway between the acromion and the olecranon processes in duplicate, with the arm hanging loosely at the side of the body. The MetS was defined according to the Joint Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention. RESULTS MUAC was positively correlated with waist circumference (r = 0.437, P < 0.001), BMI (r = 0.334, P < 0.001), fasting insulin (r = 0.348, P < 0.001), HOMA-IR (r = 0.134, P < 0.001), triglycerides (r = 0.138, P < 0.001), SBP (r = 0.124, P < 0.001), and DBP (r = 0.123, P < 0.001), and inversely correlated with adiponectin (r = - 0.147, P < 0.001) and HDL-cholesterol (r = - 0.176, P < 0.001) after adjusting for age and gender. Compared with the lowest quartile group, the odds ratios were substantially higher for MetS (OR 1.77; 95% CI 1.51-2.09, P for trend< 0.001) in the highest MUAC quartile group after adjustment for potential cofounder. CONCLUSION Large mid-upper arm circumference is significantly associated with metabolic syndrome in middle-aged and elderly individuals.
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Affiliation(s)
- Jie Shi
- Department of Endocrinology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, 25 Nanmen Road, Shanghai, 202150, China
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Zhen Yang
- Department of Endocrinology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, 25 Nanmen Road, Shanghai, 202150, China.
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.
| | - Yixin Niu
- Department of Endocrinology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, 25 Nanmen Road, Shanghai, 202150, China
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Weiwei Zhang
- Department of Endocrinology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, 25 Nanmen Road, Shanghai, 202150, China
| | - Xiaoyong Li
- Department of Endocrinology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, 25 Nanmen Road, Shanghai, 202150, China
| | - Hongmei Zhang
- Department of Endocrinology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, 25 Nanmen Road, Shanghai, 202150, China
| | - Ning Lin
- Department of Endocrinology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, 25 Nanmen Road, Shanghai, 202150, China
| | - Hongxia Gu
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Jie Wen
- Institute of Endocrinology and Diabetes, Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Guang Ning
- Shanghai Institute of Endocrinology and Metabolism, Department of Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Li Qin
- Department of Endocrinology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, 25 Nanmen Road, Shanghai, 202150, China.
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.
| | - Qing Su
- Department of Endocrinology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, 25 Nanmen Road, Shanghai, 202150, China.
- Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.
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Brown T, Zelig R, Radler DR. Clinical Outcomes Associated With Commercial and Homemade Blenderized Tube Feedings: A Literature Review. Nutr Clin Pract 2020; 35:442-453. [PMID: 32319708 DOI: 10.1002/ncp.10487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
There is emerging evidence in the pediatric population that blenderized tube feeding (BTF) may improve gastrointestinal intolerance; however, not much is known about the impact of BTF on clinical outcomes in adults. This article presents a review of the literature published in the past 10 years that explored the impact of BTF on nutrition status (ie, weight status, body mass index, and upper-arm circumference) and nutrition adequacy in adults. The results indicate that BTF, compared with commercial enteral formula (CEF), may be inadequate in calories, macronutrients, and some micronutrients, given variability in BTF formula composition. As a result, BTF may result in significantly more weight loss than CEF. Thus, BTF may not be appropriate for adult patients who are malnourished or are at risk for malnutrition due to the potential worsening of clinical outcomes.
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Affiliation(s)
- Terry Brown
- HealthTrust Supply Chain, Coppell, Texas, USA.,Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Jersey, USA
| | - Rena Zelig
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Jersey, USA
| | - Diane Rigassio Radler
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Jersey, USA
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Previtali P, Fiore M, Colombo J, Arendar I, Fumagalli L, Pizzocri M, Colombo C, Rampello NN, Mariani L, Gronchi A, Codazzi D. Malnutrition and Perioperative Nutritional Support in Retroperitoneal Sarcoma Patients: Results from a Prospective Study. Ann Surg Oncol 2019; 27:2025-2032. [PMID: 31848820 DOI: 10.1245/s10434-019-08121-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Retroperitoneal soft tissue sarcomas (RPSs) are mesenchymal neoplasms. The prevalence of protein energetic malnutrition (PEM) and its impact in RPS patients who were candidates for surgery is unknown. MATERIALS AND METHODS A prospective feasibility study enrolled 35 patients with primary RPS who were candidates for extended multivisceral resection. PEM was screened at enrollment. Preoperative high protein β-hydroxy-β-methyl butyrate oral nutritional support (ONS) was provided according to the degree of PEM. After surgery, nutritional support followed standard practice, targeting at least 1 g/kg/day protein and 20 kcal/kg/day caloric intake within the third postoperative day (POD). PEM was re-evaluated before surgery on POD 10, and at 4 and 12 months after surgery. Primary outcomes were the patient's compliance to preoperative ONS and the physician's compliance to postoperative nutritional targets. RESULTS PEM was documented in 46% of patients at baseline; ONS met a 91% adherence (overall well tolerated). After ONS, PEM reduced to 38% (p = 0.45). The postoperative caloric target was reached on day 4.1 (standard error ± 2.7), with a protocol adherence rate of 52%. On POD 10, 91% of patients experienced PEM, the worsening of which was greater after resection of four or more organs (p = 0.06). At 4 and 12 months after surgery, almost all patients had fully recovered. A significant correlation between PEM at surgery and postoperative complications was found (p = 0.04). CONCLUSIONS Relevant PEM prevalence in RPS is documented for the first time. PEM correlates with greater morbidity. In this setting, preoperative ONS was feasible and well-tolerated. Disease-related factors for PEM and the ideal perioperative caloric target in the context of extended multivisceral resection need to be further investigated. Nutritional support should be included in enhanced recovery after surgery programs for RPS. TRIAL REGISTRY ClinicalTrials.gov identifier: NCT03877588.
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Affiliation(s)
- Paola Previtali
- Department of Anesthesiology Intensive and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. .,Department of Anesthesiology and Resuscitation, Niguarda Hospital, Milan, Italy.
| | - Marco Fiore
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jacopo Colombo
- Cardiothoracic Anesthesiology and Critical Care Unit, Niguarda Hospital, Milan, Italy
| | - Irina Arendar
- Department of Anesthesiology Intensive and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Fumagalli
- Department of Anesthesiology Intensive and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Pizzocri
- Department of Anesthesiology Intensive and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Colombo
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicolò N Rampello
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Mariani
- Medical Statistics, Biometry and Bioinformatics, Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniela Codazzi
- Department of Anesthesiology Intensive and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Impact of the antifermentative diet during radiotherapy for prostate cancer in elderly, SÃO Paulo, Brazil. Support Care Cancer 2019; 28:2969-2975. [PMID: 31773273 DOI: 10.1007/s00520-019-05187-0] [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: 08/23/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Assess the impact of the antifermentative diet on the dietary intake and body composition of elderly prostate cancer patients in radiotherapy. METHODS Observational and prospective study involving 45 men aged 60 years or older, receiving radiotherapy for prostate cancer treatment. The dietary intake was assessed at four times during radiotherapy: onset (TPre), between the 11th and 16th day (T1), between the 24th and 28th day (T2), and on the last day (TLast). The body composition was assessed before and on the last day of radiotherapy, by means of the body weight and height, mid-arm circumference, triceps and subscapular skin folds, phase angle, resistance, and reactance. The data were statistically treated, considering a 5% significance level. RESULTS The intake of energy, dietary fibers, and some nutrients decreased during the radiotherapy (p < 0.05). The intake of vitamins E, B1, B2, and folate, of the minerals calcium, magnesium, potassium, sodium, and phosphorus, and of the amino acid leucine dropped when the four assessment times were compared (p < 0.05). As regards the body composition, an impact was observed at the end of the radiotherapy, with lower body weight, arm circumference, subscapular cutaneous fold, phase angle and reactance (p < 0.05). CONCLUSION The antifermentative diet negatively influenced the food consumption and body composition of elderly patients submitted to radiotherapy for prostate cancer.
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Gottschall C, Tarnowski M, Machado P, Raupp D, Marcadenti A, Rabito EI, Silva FM. Predictive and concurrent validity of the Malnutrition Universal Screening Tool using mid-upper arm circumference instead of body mass index. J Hum Nutr Diet 2019; 32:775-780. [PMID: 31067603 DOI: 10.1111/jhn.12665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Considering the difficulty in obtaining weight and height measurements of patients at hospital admission, the Malnutrition Universal Screening Tool (MUST) proposes the use of mid-upper arm circumference (MUAC) instead of body mass index (BMI) as an alternative for screening of malnutrition risk. The present study aimed to evaluate the performance of MUST with MUAC in place of BMI to identify nutritional risk and predict prolonged hospitalisation and mortality in hospitalised patients. METHODS The prospective cohort study involved ambulant patients aged ≥18 years who were admitted to the emergency department of a public hospital. A questionnaire concerning clinical and socio-demographic data was applied and anthropometric measurements were performed (weight, height, BMI and MUAC). Nutritional risk screening was performed using the original MUST (BMI) and MUST-MUAC tools. The outcomes were length of hospital stay and death. RESULTS Seven hundred and fifty-two patients were included and followed-up for 13.5 (interquartile range 3.00-19.00) days. The frequency of patients at nutritional risk was higher according to MUST-MUAC (48.9%) compared to the original MUST (37.1%). MUST-MUAC showed concurrent validity, demonstrating good agreement with the original MUST (k = 0.690), high sensitivity (95.3%) and accuracy (area under the curve = 0.868; 95% confidence interval = 0.841-0.895) with respect to identifying nutritional risk. The presence of nutritional risk detected by the MUST-MUAC increased the chance of prolonged hospital stay by 1.9 (95% CI. 1.4-2.7)-fold and mortality by 3.2 (95% CI. 1.1-9.4)-fold. CONCLUSIONS MUST-MUAC showed satisfactory concurrent and predictive validity. Considering that MUAC measurement is easier to perform than BMI, the MUST-MUAC should be used for screening of nutritional risk in hospitalised patients.
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Affiliation(s)
- C Gottschall
- Nutrition Science Post-graduation Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - M Tarnowski
- Nutrition Science Post-graduation Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - P Machado
- Nutrition Science Post-graduation Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - D Raupp
- Nutrition Science Post-graduation Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - A Marcadenti
- Nutrition Science Post-graduation Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Institute of Research of the Heart Hospital (IP-HCOR), São Paulo, Brazil.,Health Science, Cardiology, Institute of Cardiology/University Foundation of Cardiology (IC/FUC), Porto Alegre, Brazil
| | - E I Rabito
- Food and Nutrition Post-graduation Program, Federal University of Paraná, Curitiba, Brazil
| | - F M Silva
- Nutrition Science Post-graduation Program, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Dodos J, Altare C, Altmann M. Letter to the editor regarding the comment by Gupta and Goswami about our article "individual and household risk factors of severe acute malnutrition among under-five children in Mao, Chad: a matched case-control study". Arch Public Health 2019; 77:18. [PMID: 30962930 PMCID: PMC6437975 DOI: 10.1186/s13690-019-0344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/04/2019] [Indexed: 11/10/2022] Open
Abstract
We would like to thank the authors Sunanda Gupta and Kiran Goswami for their interest in our article "Individual and household risk factors of severe acute malnutrition among under-five children in Mao, Chad: a matched case-control study". In this response we aim to address their criticisms.
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Affiliation(s)
- Jovana Dodos
- Action contre la Faim, 14/16 Boulevard Douaumont - CS 80060, 75854 Paris, CEDEX 17 France
| | - Chiara Altare
- Action contre la Faim, 14/16 Boulevard Douaumont - CS 80060, 75854 Paris, CEDEX 17 France
| | - Mathias Altmann
- Action contre la Faim, 14/16 Boulevard Douaumont - CS 80060, 75854 Paris, CEDEX 17 France
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Nakamura T, Kamiya K, Matsunaga A, Hamazaki N, Matsuzawa R, Nozaki K, Tanaka S, Yamashita M, Maekawa E, Noda C, Yamaoka-Tojo M, Masuda T, Ako J. Prognostic usefulness of arm circumference and nutritional screening tools in older patients with cardiovascular disease. Nutr Metab Cardiovasc Dis 2018; 28:743-748. [PMID: 29650296 DOI: 10.1016/j.numecd.2018.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Arm circumference (AC) and nutritional screening tools have been shown to have prognostic capability in patients with cardiovascular disease (CVD). This study aimed to compare the prognostic predictive capabilities of AC and nutritional screening tools in older patients with CVD. METHODS AND RESULTS The study population consisted of 949 admitted patients ≥60 years old with CVD. Patients underwent AC measurement and nutritional screening before hospital discharge. We used the controlling nutritional status index (CONUT), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index (PNI) as nutritional screening tools. The end point of the study was all-cause mortality. The mean age of the study population was 72.3 ± 7.2 years, and 68.2% of the patients were male. A total of 130 deaths occurred over a median follow-up period of 2.2 years (interquartile range, 1.1-3.8 years). After adjusting for other prognostic factors, AC (hazard ratio [HR]: 0.59; p < 0.001), CONUT (HR: 0.82; p = 0.016), GNRI (HR: 0.77; p = 0.040), and PNI (HR: 0.80; p = 0.014) were significant predictors of mortality. However, adding AC to the multivariate-adjusted model (0.739 vs. 0.714, respectively; p = 0.037), but not CONUT, GNRI, or PNI (0.724, 0.717, and 0.723 vs. 0.714; p = 0.072, p = 0.306, and p = 0.127, respectively), significantly increased the area under the curve on receiver operating characteristic curve. CONCLUSIONS AC, but not nutritional screening tools, plays a complementary role to preexisting prognostic factors for predicting prognosis in older patients with CVD.
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Affiliation(s)
- T Nakamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - K Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan.
| | - A Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - N Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - R Matsuzawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - K Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - S Tanaka
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - M Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - E Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - C Noda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - M Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - T Masuda
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - J Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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