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Olpe T, Wunderle C, Bargetzi L, Tribolet P, Laviano A, Stanga Z, Prado CM, Mueller B, Schuetz P. Muscle matters: Prognostic implications of malnutrition and muscle health parameters in patients with cancer. A secondary analysis of a randomised trial. Clin Nutr 2024; 43:2255-2262. [PMID: 39181036 DOI: 10.1016/j.clnu.2024.07.020] [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: 03/28/2024] [Revised: 06/18/2024] [Accepted: 07/18/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Low muscle mass and malnutrition are independently associated with an increased risk of adverse outcomes in patients with cancer. However, it is not yet clear which parameter is most indicative of these risks. This study investigates the prognostic significance of different parameters reflecting malnutrition and muscle health in a well-characterised oncology population at nutritional risk. METHODS This preplanned secondary analysis included patients with cancer from a Swiss-wide, randomised-controlled nutritional trial. We investigated associations among malnutrition markers (i.e., malnutrition diagnosis based on modified Global Leadership Initiative on Malnutrition (GLIM) criteria, albumin concentration) and muscle health markers (i.e., hand grip strength, computed tomography (CT)-based muscle mass and radiodensity) with 180-day all-cause mortality (primary outcome). RESULTS We included 269 patients with a main admission diagnosis of cancer and available CT scans. In a mutually adjusted model, four parameters contributed to risk assessment including modified malnutrition diagnosis (GLIM) (HR 1.78 (95%CI 1.17 to 2.69), p = 0.007, AUC 0.58), low albumin concentration (HR 1.58 (95%CI 1.08 to 2.31), p = 0.019, AUC 0.62), low handgrip strength (HR 2.05 (95%CI 1.43 to 2.93), p = 0.001, AUC 0.62) and low muscle radiodensity (HR 1.39 (95%CI 0.90 to 2.16), p = 0.139, AUC 0.63). Combining these parameters resulted in a model with high prognostic power regarding 180-day mortality (overall AUC 0.71). CONCLUSIONS In this study of inpatients with cancer at nutritional risk, several malnutrition and muscle health parameters emerged as independent prognostic indicators for mortality. The use of these parameters may improve risk stratification and guide nutritional interventions in this vulnerable population. TRIAL REGISTRATION ClinicalTrials.gov, number NCT02517476.
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Affiliation(s)
- T Olpe
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - C Wunderle
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - L Bargetzi
- Medical Faculty of the University of Basel, Basel, Switzerland; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - P Tribolet
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Department of Nutritional Sciences and Research Platform Active Ageing, University of Vienna, Vienna, Austria
| | - A Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Z Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine & Metabolism, Bern University Hospital and University of Bern, Bern, Switzerland
| | - C M Prado
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - B Mueller
- Medical Faculty of the University of Basel, Basel, Switzerland; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - P Schuetz
- Medical Faculty of the University of Basel, Basel, Switzerland; Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
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Ma W, Cai B, Li HX, Tan X, Deng MJ, Jiang L, Sun MW, Jiang H. GLIM-defined malnutrition in patients with acute abdomen associated with poor prognosis and increased economic burden: A cross-sectional study. Nutr Clin Pract 2024. [PMID: 39189803 DOI: 10.1002/ncp.11202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/18/2024] [Accepted: 07/31/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) criteria have rapidly developed into a principal methodological framework for nutrition diagnosis. However, the applicability of the GLIM criteria in patients with acute abdomen has not been validated. METHODS This is a cross-sectional study conducted on patients diagnosed with acute abdomen and admitted to a tertiary hospital in southwest China. Nutrition risk screening was conducted using the Nutrition Risk Screening 2002, and patients identified with nutrition risk were assessed for malnutrition based on the GLIM criteria. RESULTS We enrolled a total of 440 patients with acute abdomen. The top three diagnoses of acute abdomen were intestinal obstruction (47.2%), acute appendicitis (23.1%), and digestive system perforation (8.8%). The prevalence of nutrition risk was 46.5%, with a malnutrition rate of 32.5% based on the GLIM. Patients with malnutrition according to the GLIM showed significantly higher rates of intensive care unit (ICU) admission (13.28% vs 7.07%; P = 0.003), increased hospitalization costs (median: 3315USD [interquartile range (IQR): 978-7852] vs 1641 [IQR: 816-3523] USD; P < 0.001), and longer length of hospital stay (LOS) (median: 8 [IQR: 5-13] vs 6 [IQR: 4-8] days; P < 0.001) compared with patients without malnutrition. Multivariate analysis indicated that GLIM-defined malnutrition was an independent predictor of hospitalization costs, and severe malnutrition was an independent predictor of ICU admission. CONCLUSION GLIM criteria are applicable for diagnosing malnutrition in patients with acute abdomen. The prevalence of malnutrition was high in patients with acute abdomen. Malnutrition was associated with increased ICU admission and LOS, along with higher economic burden.
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Affiliation(s)
- Wei Ma
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bin Cai
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Emergency Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Clinical Research Center for Emergency and Critical Care Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua-Xin Li
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Emergency Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Clinical Research Center for Emergency and Critical Care Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xin Tan
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Meng-Jie Deng
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Emergency Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Clinical Research Center for Emergency and Critical Care Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Jiang
- Department of General Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ming-Wei Sun
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Emergency Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Clinical Research Center for Emergency and Critical Care Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Emergency Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Clinical Research Center for Emergency and Critical Care Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Akazawa N, Funai K, Hino T, Tsuji R, Tamura W, Tamura K, Hioka A, Moriyama H. Change in body weight is positively related to the change in muscle mass of the quadriceps in older inpatients with severely low BMI according to the GLIM criteria. BMC Geriatr 2024; 24:711. [PMID: 39187769 PMCID: PMC11345986 DOI: 10.1186/s12877-024-05309-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/16/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND & AIMS Body weight is one of the essential indicators of nutritional status, and body weight management is vital in nutritional care. In addition, low body mass index (BMI) was included as a phenotypic criterion in the Global Leadership Initiative on Malnutrition (GLIM) criteria. Furthermore, low BMI has been used in grading the severity of malnutrition (moderate or severe malnutrition) in the GLIM criteria. A recent cross-sectional study reported that muscle mass of the quadriceps in older inpatients with severely low BMI is less than those of older inpatients with moderately low BMI and non-low BMI. However, the longitudinal relationship between body weight and muscle mass of the quadriceps in older inpatients in each BMI category according to the GLIM criteria remains unclear. This study aimed to examine the longitudinal relationship between body weight and muscle mass of the quadriceps in older inpatients in each BMI category according to the GLIM criteria. METHODS This retrospective cohort study included 179 older inpatients (aged ≥ 70 years) (median [IQR] age: 84.0 [79.0-89.0]). The period of this study was between January 2017 and March 2020. In accordance with the cut-off value of a low BMI for patients aged ≥ 70 years in the Asian population according to the GLIM criteria, the participants were divided into the following three groups: the severely low BMI group (< 17.8 kg/m2) (n = 47), moderately low BMI group (≥ 17.8 to < 20.0 kg/m2) (n = 38), and non-low BMI group (≥ 20.0 kg/m2) (n = 94). The medians (IQR) of the length of hospital stay of the severely low BMI, moderately low BMI, and non-low BMI groups were 71.0 (49.0-98.0) days, 71.0 (50.0-98.0) days, and 50.5 (36.5-103.0) days, respectively. The primary outcome was a change in muscle mass of the quadriceps. The muscle mass of the quadriceps was examined using ultrasound images (i.e., quadriceps thickness). The changes in quadriceps thickness and body weight were calculated by subtracting the quadriceps thickness and body weight at admission from those values at discharge. Multiple linear regression analysis adjusting for confounding factors was used to determine whether the change in body weight was independently and significantly related to the change in quadriceps thickness in the severely low BMI, moderately low BMI, and non-low BMI groups. RESULTS The means (SD) of the change in quadriceps thickness of the severely low BMI group, moderately low BMI group, and non-low BMI group were 0.0 ± 0.3 cm, 0.1 ± 0.3 cm, and 0.1 ± 0.5 cm, respectively. The means of the change in body weight in those groups were 0.4 ± 2.8 kg, - 1.1 ± 2.7 kg, and - 1.3 ± 4.3 kg, respectively. In the severely low BMI group, the change in body weight (β = 0.34, p = 0.006) and quadriceps thickness at admission (β = -0.62, p < 0.001) were significantly and independently related to the change in quadriceps thickness (R2 = 0.645, f2 = 1.817, statistical power = 1.000). In the moderately low BMI and non-low BMI groups, there were no factors that were significantly and independently related to the change in quadriceps thickness. CONCLUSIONS The results of this study suggest that change in body weight is positively related to the change in muscle mass of the quadriceps in older inpatients with severely low BMI according to the GLIM criteria. These results imply the importance of body weight management for older inpatients with severely low BMI perspective from the muscle mass of the quadriceps.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Hoji 180, Nishihama, Yamashiro-cho, Tokushima-city, Tokushima, 770-8514, Tokushima, Japan.
| | - Keita Funai
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Wataru Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Hoji 180, Nishihama, Yamashiro-cho, Tokushima-city, Tokushima, 770-8514, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Ljungqvist O, Weimann A, Sandini M, Baldini G, Gianotti L. Contemporary Perioperative Nutritional Care. Annu Rev Nutr 2024; 44:231-255. [PMID: 39207877 DOI: 10.1146/annurev-nutr-062222-021228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Over the last decades, surgical complication rates have fallen drastically. With the introduction of new surgical techniques coupled with specific evidence-based perioperative care protocols, patients today run half the risk of complications compared with traditional care. Many patients who in previous years needed weeks of hospital care now recover and can leave in days. These remarkable improvements are achieved by using nutritional stress-reducing care elements for the surgical patient that reduce metabolic stress and allow for the return of gut function. This new approach to nutritional care and how it is delivered as an integral part of enhancing recovery after surgery are outlined in this review. We also summarize the new and increased understanding of the effects of the routes of delivering nutrition and the role of the gut, as well as the current recommendations for artificial nutritional support.
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Affiliation(s)
- Olle Ljungqvist
- Department of Surgery, School of Medical Sciences, Orebro University Hospital and Orebro University, Orebro, Sweden;
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Arved Weimann
- Department of General, Visceral, and Oncologic Surgery, Saint George Hospital, Leipzig, Germany
| | - Marta Sandini
- Department of Medicine, Surgery, and Neuroscience and Unit of General and Oncologic Surgery, University of Siena, Siena, Italy
| | - Gabriele Baldini
- Section of Anesthesia and Critical Care, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- HPB Surgery, Foundation IRCCS San Gerardo Hospital, Monza, Italy
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Liu H, Song J, Wang Z, Wu S, Qiu S, Chen B, Rao Z, Jing X. Investigation of nutrition status and analysis of 180-day readmission factors in elderly hospitalized patients with COPD. Aging Clin Exp Res 2024; 36:155. [PMID: 39085739 PMCID: PMC11291564 DOI: 10.1007/s40520-024-02820-9] [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: 05/13/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Malnutrition is prevalent among elderly patients with COPD, who also experience a high rate of readmission. Therefore, it is imperative to investigate the nutrition status of these patients, identify risk factors for readmission, and offer insights for clinical management. To achieve this, a cross-sectional study was conducted to investigate factors influencing nutrition status using GLIM criteria and explore the 180-day readmission factors among hospitalized elderly COPD patients. METHORDS AND RESULTS The data were collected from a hospital in Southwest China, encompassing a cohort of 319 eligible patients. Among elderly hospitalized COPD patients, the prevalence of malnutrition was 49.53% (158/319). Multivariate logistic regression revealed malnutrition (OR = 3.184), very severe airway obstruction (OR = 3.735), and Number of comorbidities ≥ 3 (OR = 5.754) as significant risk factors for 180-day readmission. CONCLUSIONS These findings suggest that malnutrition is a prevalent issue among elderly hospitalized patients with COPD and constitutes one of the risk factors contributing to the 180-day readmission rate. Therefore, timely identification and treatment for malnourished patients are crucial.
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Affiliation(s)
- Huan Liu
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Jingsi Song
- Department of Clinical Nutrition, Chengdu Shang jin Nan fu Hospital, West China Hospital, Chengdu, China
| | - Zhiqiang Wang
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Songze Wu
- Department of Respiratory and Critical care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Qiu
- Department of Medical administration, West China Hospital, Sichuan University, Chengdu, China
| | - Benhui Chen
- Department of Integrated Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiyong Rao
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China.
| | - Xiaofan Jing
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China.
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He Y, Wang Z, Wu S, Li L, Li J, Zhang Y, Chen B, Sun X, Sun C, Wu L. Screening and assessment of malnutrition in patients with liver cirrhosis. Front Nutr 2024; 11:1398690. [PMID: 39091687 PMCID: PMC11292113 DOI: 10.3389/fnut.2024.1398690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 07/09/2024] [Indexed: 08/04/2024] Open
Abstract
The development and advancement of malnutrition is associated not only with the progression of hepatic dysfunction, but also with cirrhosis-related complications. However, the prevalence of malnutrition reported in different studies varies widely due to differences in diagnostic methods and patient investigation settings. Therefore, we need to identify malnourished patients promptly and accurately. The purpose of this review was to compare the validity and reliability of nutritional screening tools and to select the most appropriate nutritional risk screening for patients with cirrhosis. We compared nutritional risk screening tools such as the Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) and Liver Disease Undernutrition Screening Tool (LDUST). Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) is more feasible to screen cirrhotic patients for nutritional risk, and is highly reproducible, considering the impact of sodium and water retention; so it is practical to screen cirrhotic patients via RFH-NPT for nutritional risk, subsequently, to evaluate the nutritional status of patients with nutritional risk via the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria. L3-SMI (third lumbar-skeletal muscle index) can accurately define sarcopenia in cirrhotic patients and also be used for clinical nutritional status assessment.
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Affiliation(s)
- Yumei He
- North Sichuan Medical College, Nanchong, China
- Department of Gastroenterology, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Zhiming Wang
- Department of Gastroenterology, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Shiyan Wu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lu Li
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jiazhen Li
- Department of Clinical Nutrition, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yexing Zhang
- Department of Gastroenterology, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Boshi Chen
- Department of Gastroenterology, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Xiaobin Sun
- Department of Gastroenterology, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Liping Wu
- Department of Gastroenterology, The Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
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Xu J, Hu Y, Wang L, Li P, Zhu M, Song J, Wei J. Albumin-dNLR score could be an etiological criterion to determine inflammation burden for GLIM in medical inpatients over 70 years old: A multicenter retrospective study. Heliyon 2024; 10:e34102. [PMID: 39091958 PMCID: PMC11292551 DOI: 10.1016/j.heliyon.2024.e34102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024] Open
Abstract
Aim To validate the role of the albumin-derived neutrophil-to-lymphocyte (ALB-dNLR) score in diagnosing malnutrition in medical inpatients over 70 years old. Methods This is a retrospective cross-sectional study involving 7 departments from 14 Chinese hospitals. The ALB-dNLR score was calculated, and outcomes between groups with positive and negative ALB-dNLR scores were compared after propensity score matching (PSM). Afterwards, the outcomes were compared between the groups receiving nutrition support and those not receiving support among malnourished patients diagnosed using the Global Leadership Initiative Malnutrition (GLIM) criteria after PSM. Results Out of 10,184 cases, 6165 were eligible. 2200 cases were in the positive ALB-dNLR score group. After PSM, 1458 pairs were analyzed, showing lower in-hospital mortality (0.8 % vs. 2.1 %, p = 0.005) and a lower nosocomial infection rate (5.9 % vs. 11.0 %, p < 0.001) in the negative ALB-dNLR score group. In malnourished patients, 259 pairs were analyzed after PSM. It showed better outcomes in mortality (0.8 % vs. 3.5 %, p = 0.033), nosocomial infection rate (5.4 % vs. 15.4 %, p < 0.001), length of stay (LOS) (13.8 ± 10.3 vs. 18.4 ± 14.1, p < 0.001), and total hospital cost (3315.3 ± 2946.4 vs. 4795.3 ± 4198.2, p < 0.001) in the support group. In malnourished patients with ALB-dNLR score as the sole etiological criterion, 94 pairs were calculated. It showed better outcomes in mortality (0.0 % vs. 6.4 %, p = 0.029), nosocomial infection rate (7.4 % vs. 18.1 %, p = 0.029), LOS (13.7 ± 8.3 vs. 19.8 ± 15.2, p = 0.001), and total hospital cost (3379.3 ± 2955.6 vs. 4471.2 ± 4782.4, p = 0.029) in the support group. Conclusions The ALB-dNLR score was validated to predict in-hospital mortality in medical inpatients over 70 years old. Malnutrition patients diagnosed by the GLIM criteria and using the ALB-dNLR score might benefit from nutrition support.
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Affiliation(s)
- Jingyong Xu
- Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital, Beijing, China
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yifu Hu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lijuan Wang
- Department of Clinical Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Pengxue Li
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingwei Zhu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinghai Song
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Junmin Wei
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Pumtako C, Dolan RD, McGovern J, McMillan DC. Routine assessment of nutritional, functional and inflammatory criteria in patients with cancer: A systematic review. Clin Nutr ESPEN 2024; 63:294-303. [PMID: 38980797 DOI: 10.1016/j.clnesp.2024.06.052] [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: 03/12/2024] [Revised: 06/19/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND The review discusses the significant impact of cancer on patients, particularly focusing on cachexia - a condition marked by weight and lean tissue loss. This condition critically affects the nutritional status, quality of life, and treatment outcomes of cancer patients. RESEARCH QUESTION The review seeks to understand the effectiveness and necessity of routine clinical monitoring of cancer cachexia, and how it can aid in better therapeutic interventions. METHODS The systematic review followed a pre-defined protocol based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)statement. A systematic search using specific keywords was conducted in PubMed and EMBASE databases on October 24, 2023, supplemented by citations from the original papers. The selection process involved screening titles and abstracts for relevance. RESULTS The review finds varying levels of effectiveness in the different measurement criteria used for monitoring cachexia. It highlights the potential of the Global Leadership Initiative on Malnutrition (GLIM) framework in defining and managing cancer cachexia, though noting some challenges in standardisation and implementation of measurements. CONCLUSION The present systematic review highlights the variability and lack of standardization in the application of GLIM criteria for monitoring cachexia in cancer patients. Despite these challenges, it will be important to determine the most efficacious clinically routine nutritional and inflammation assessments in the routine application of GLIM criteria assessment.
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Affiliation(s)
- Chattarin Pumtako
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK.
| | - Ross D Dolan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Josh McGovern
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, New Lister Building, Royal Infirmary, Glasgow, G31 2ER, UK
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Xie H, Wei L, Ruan G, Zhang H, Shi J, Lin S, Liu C, Liu X, Zheng X, Chen Y, Shi H. Performance of anthropometry-based and bio-electrical impedance-based muscle-mass indicators in the Global Leadership Initiative on Malnutrition criteria for predicting prognosis in patients with cancer. Clin Nutr 2024; 43:1791-1799. [PMID: 38865763 DOI: 10.1016/j.clnu.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Reduced muscle mass is a criterion for diagnosing malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria; however, the choice of muscle-mass indicators within the GLIM criteria remains contentious. This study aimed to establish muscle-measurement-based GLIM criteria using data from bio-electrical impedance analysis (BIA) and anthropometric evaluations and evaluate their ability to predict overall survival (OS), short-term outcomes, and healthcare burden in patients with cancer. METHODS This was a multicenter, prospective study that commenced in 2013 and enrolled participants from various clinical centers across China. We constructed GLIM criteria based on various muscle measurements, including fat-free mass index (FFMI), skeletal muscle index (SMI), calf circumference (CC), midarm circumference (MAC), midarm muscle circumference (MAMC), and midarm muscle area (MAMA). Survival was estimated using the Kaplan-Meier method and survival curves were compared using the log-rank test. Cox proportional hazards regression was used to assess the independent association between the GLIM criteria and OS. The discriminatory performance of different muscle-measurement-based GLIM criteria for mortality was evaluated using Harrell's concordance index (C-index). Logistic regression was used to evaluate the association of the GLIM criteria with short-term outcomes and healthcare burden. RESULTS A total of 4769 patients were included in the analysis, of whom 1659 (34.8%) died during the study period. The Kaplan-Meier curves demonstrated that all muscle-measurement-based GLIM criteria significantly predicted survival in patients with cancer (all p < 0.001). The survival rate of malnourished patients was approximately 10% lower than that of non-malnourished patients. Cox proportional hazards regression showed that all the muscle-measurement-based GLIM could independently predict the OS of patients (all p < 0.001). The prognostic discrimination was as follows: MAMC (Chi-square: 79.61) > MAMA (Chi-square: 79.10) > MAC (Chi-square: 64.09) > FFMI (Chi-square: 62.33) > CC (Chi-square: 58.62) > ASMI (Chi-square: 57.29). In comparison to the FFMI-based GLIM criteria, the ASMI-based criteria (-0.002, 95% CI: -0.006 to 0.002, p = 0.334) and CC-based criteria (-0.003, 95% CI: -0.007 to 0.002, p = 0.227) did not exhibit a significant advantage. However, the MAC-based criteria (0.001, 95% CI: -0.003 to 0.004, p = 0.776), MAMA-based criteria (0.004, 95% CI: 0.000-0.007, p = 0.035), and MAMC-based criteria (0.005, 95% CI: 0.000-0.007, p = 0.030) outperformed the FFMI-based GLIM criteria. Logistic regression showed that muscle measurement-based GLIM criteria predicted short-term outcomes and length of hospital stay in patients with cancer. CONCLUSION All muscle measurement-based GLIM criteria can effectively predict OS, short-term outcomes, and healthcare burden in patients with cancer. Anthropometric measurement-based GLIM criteria have potential for clinical application as an alternative to BIA-based measurement.
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Affiliation(s)
- Hailun Xie
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Lishuang Wei
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Guotian Ruan
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Heyang Zhang
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Jinyu Shi
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Shiqi Lin
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Chenan Liu
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Xiaoyue Liu
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Xin Zheng
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Yue Chen
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Hanping Shi
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China; Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
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10
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Shi Y, Sun Y, Shen X, Yang Z, Xu B, Bao C. Combination of handgrip strength and high-sensitivity modified Glasgow prognostic score predicts survival outcomes in patients with colon cancer. Front Nutr 2024; 11:1421560. [PMID: 39010859 PMCID: PMC11247022 DOI: 10.3389/fnut.2024.1421560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/17/2024] [Indexed: 07/17/2024] Open
Abstract
Objective Handgrip strength (HGS) and the high-sensitivity modified Glasgow prognostic score (HS-mGPS) are associated with the survival of patients with cancer. However, no studies have investigated the combined effect of HGS and HS-mGPS on the overall survival (OS) of patients with colon cancer. Methods Prospective follow-up data of colon cancer patients undergoing radical resection from April, 2016 to September, 2019 were retrospectively collected. We combined the HGS and HS-mGPS to create a new composite index, HGS-HS-mGPS. The hazard ratio (HR) and 95% confidence interval (CI) were calculated using Cox regression models to assess the association between variables and OS. Risk factors on OS rates were investigated by Cox analyses and the nomogram was constructed using significant predictors and HGS-HS-mGPS. The predictive performance of the nomogram was evaluated by receiver operating characteristic curve and calibration curve. Results This study included a total of 811 patients, of which 446 (55.0%) were male. The HGS optimal cut-off values of male and female patients were 28.8 and 19.72 kg, respectively. Multivariate analysis revealed that low HGS and high HS-mGPS were independent risk factors of colon cancer after adjusting confounders (adjusted HR = 3.20; 95% CI: 2.27-4.50; p < 0.001 and adjusted HR = 1.55; 95% CI: 1.12-2.14; p = 0.008 respectively). Patients with low HGS and high HS-mGPS had a 10.76-fold higher mortality risk than those with neither (adjusted HR = 10.76; 95% CI: 5.38-21.54; p < 0.001). A nomogram predicting 1-, 3-, and 5 year OS was constructed based on three clinicopathologic prognostic factors. Importantly, incorporating HGS-HS-mGPS into the nomogram model meaningfully improved the predictive performance. The decision curve analyses demonstrated the application value of the HGS-HS-mGPS nomogram for predicting OS of patients with colon cancer. Conclusion HGS-HS-mGPS is associated with the survival of patients with colon cancer. These findings indicate the usefulness of HGS and HS-mGPS measurements in clinical practice for improving patient assessment, cancer prognosis, and precise intervention.
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Affiliation(s)
- Yifan Shi
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yuting Sun
- Department of General Surgery, Jiangnan University Medical Center, Wuxi, China
| | - Xiaoming Shen
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Zenghui Yang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Binghua Xu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Chuanqing Bao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
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Xi Z, Jia-Xin H, Xi W, Meng T, Jin-Feng L, Wei W, Tao D, Chun-Hua S, Jiu-Wei C, Han-Ping S, Ming-Hua C. Association between GLIM-diagnosed malnutrition and quality of life in older patients with cancer. J Nutr Health Aging 2024; 28:100274. [PMID: 38810512 DOI: 10.1016/j.jnha.2024.100274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/24/2024] [Accepted: 05/18/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Older patients with cancer have a higher risk for malnutrition and impaired quality of life (QoL). The present study aimed to investigate the relationship between malnutrition diagnosed according to the Global Leadership Initiative Malnutrition (GLIM) criteria and QoL across various tumor types, and to evaluate the combined prognostic value of malnutrition and QoL in predicting survival among older patients with cancer. METHODS This multicenter, observational cohort study included 5310 older patients with cancer and 2184 with malnutrition (moderate stage, n = 1023; severe stage, n = 1161). An empirical cumulative distribution curve was performed to illustrate the correlation between malnutrition and QoL. The primary objective was to investigate the association between malnutrition and QoL using logistic regression analysis. Survival analyses were performed to assess the combined prognostic value of malnutrition and QoL. RESULTS The median age of the patients (66.9% male, 33.1% female) was 70 years (interquartile range [IQR] 67-74 years) years. The median QoL score was highest in patients without malnutrition (91.88 [IQR 84.44-97.44]), followed by those with moderate (86.15 [IQR 76.18-93.85) and severe (82.31 [IQR 69.87-91.11]) malnutrition. Logistics regression revealed that the risk for developing impaired QoL increased 1.98 (95% confidence interval [CI] 1.64-2.38; P < 0.001) and 2.33 (95% CI 1.93-2.81; P < 0.001) times in patients with moderate and severe malnutrition, respectively. Kaplan-Meier curves showed that QoL in combination with GLIM criteria demonstrated a significant discriminative performance for survival and served as an independent prognostic factor among older patients with cancer, especially for lung and gastric cancers. CONCLUSIONS Malnutrition diagnosed according to the GLIM criteria was a predictor of impaired QoL. Additionally, the combination of QoL and malnutrition demonstrated utility for predicting survival outcomes in older patients with cancer.
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Affiliation(s)
- Zhang Xi
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Huang Jia-Xin
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wu Xi
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tang Meng
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Liu Jin-Feng
- Department of Clinical Nutrition, Cancer Hospital of HuanXing ChaoYang District Beijing, Beijing, China
| | - Wei Wei
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Tao
- Taiyuan Second People's Hospital, Department of Intensive Care and Palliative Care, Tai Yuan, China
| | - Song Chun-Hua
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zheng Zhou, China
| | - Cui Jiu-Wei
- Cancer Center of the First Hospital of Jilin University, Changchun, 130021, China
| | - Shi Han-Ping
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China; Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Cong Ming-Hua
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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12
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Wang Y, Liu Z, Zhang H, Wang Y, Chen X, Lu W, Fang Y, Peng Z, Liu W. Evaluation of different screening tools as the first step of the GLIM framework: A cross-sectional study of Chinese cancer patients in an outpatient setting. Nutr Clin Pract 2024; 39:702-713. [PMID: 38161144 DOI: 10.1002/ncp.11103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Ambulatory cancer patients are at high risk of malnutrition. Multiple nutrition screening and assessment tools are used in the outpatient setting. This study aimed to evaluate the efficacy of different nutrition screening tools as the first step of the Global Leadership Initiative on Malnutrition (GLIM) framework in Chinese ambulatory cancer patients. METHODS A cross-sectional study was conducted in a tertiary hospital in China. Malnutrition diagnoses made by the GLIM framework using Malnutrition Screening Tool, Malnutrition Universal Screening Tool, Nutritional Risk Screening 2002, or short-form of Patient-Gernerated Subjective Global Assessment (PG-SGA) as the first step were compared with PG-SGA separately. RESULTS Of the 562 included patients, 31.0% were diagnosed with malnutrition (PG-SGA: B + C), and 12.6% were diagnosed with severe malnutrition (PG-SGA: C). As the screening tool in the first step of the GLIM framework, the short form of PG-SGA (PG-SGA SF) with a cutoff value of ≥2 performed best in diagnosing malnutrition, with good sensitivity (SE) (80.5% [73.6-85.9]) and specificity (SP) (98.4% [96.5-99.4]) and substantial accordance (κ = 0.826), whereas PG-SGA SF with a cutoff value of ≥4 performed best in diagnosing severe malnutrition, with fair SE (62.0% [49.6-73.0]), good SP (96.7% [94.6-98.1]) and moderate accordance (κ = 0.629). CONCLUSION Using PG-SGA as the standard, the GLIM framework using PG-SGA SF as the screening tool has good accordance with the PG-SGA regardless of severity grading. PG-SGA SF can be used as a valid screening tool in the GLIM framework.
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Affiliation(s)
- Yanfei Wang
- Department of Day Oncology Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Ziqi Liu
- Department of Nutrition, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Hong Zhang
- Department of Day Oncology Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Yunyi Wang
- Department of Supportive Care, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Xiaoyan Chen
- Department of Day Oncology Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Wenqi Lu
- School of Global Public Health, Public Health Nutrition, New York University, New York City, New York, USA
| | - Yu Fang
- Department of Nutrition, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Zhi Peng
- Department of Nutrition, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Wei Liu
- Department of Day Oncology Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
- Department of Supportive Care, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
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Yamanaka M, Wakabayashi H, Nishioka S, Momosaki R. Malnutrition and cachexia may affect death but not functional improvement in patients with sarcopenic dysphagia. Eur Geriatr Med 2024; 15:777-785. [PMID: 38739334 DOI: 10.1007/s41999-024-00984-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To investigate whether two factors, malnutrition and cachexia, affect swallowing function, activities of daily living (ADL), and death in sarcopenic dysphagia. METHODS Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia Database, 271 met the study eligibility criteria in a retrospective cohort study. Patients were divided into four groups based on whether they had cachexia according to the Asian Working Group for Cachexia (AWGC) criteria and malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Multivariate analyses were performed to investigate the differences in changes in the Food Intake LEVEL Scale (FILS) and Barthel Index (BI) and death after follow-up between the malnutrition and cachexia group and the other groups. RESULTS The mean age was 83.7 ± 8.3 years, 119 (44%) were men and 152 (56%) were women. The median FILS at baseline was 7 and the median BI was 25. A total of 120 (44%) had malnutrition only, 54 (20%) had neither cachexia nor malnutrition, 12 (4%) had cachexia only, and 85 (31%) had both cachexia and malnutrition. Multivariate analyses showed no significant difference between the change in BI (P = 0.688) and the change in FILS (P = 0.928) between the malnutrition and cachexia group and the other groups; however, death increased significantly (P = 0.010). CONCLUSION Some patients diagnosed with cachexia were not malnourished, although many patients with cachexia were malnourished. While patients with both cachexia and malnutrition did not show significant improvement in ADL and swallowing function compared with patients without both conditions, the number of deaths increased significantly.
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Affiliation(s)
- Mai Yamanaka
- School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan.
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
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Yao J, Zhang Y, Gao B, Zhou M. Associations of Preoperative Nutritional Status and Sarcopenia With Mortality in Patients With Abdominal Aortic Aneurysm After Open and Endovascular Abdominal Aortic Aneurysm Repair: A Retrospective Study. J Cardiothorac Vasc Anesth 2024; 38:1337-1346. [PMID: 38521631 DOI: 10.1053/j.jvca.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE The effect of preoperative malnutrition and sarcopenia on outcomes in patients with abdominal aortic aneurysm (AAA) after open surgical repair (OSR) and endovascular abdominal aortic aneurysm repair is undefined. The authors conducted the study to address this issue in this population. DESIGN A retrospective observational study. SETTING A large tertiary hospital. PARTICIPANTS Patients with AAA who underwent OSR and endovascular aneurysm repair (EVAR). INTERVENTIONS Evaluation of nutritional status (Nutritional Risk Screening 2002 [NRS 2002] and the Controlling Nutritional Status [CONUT] scores), muscle size (skeletal muscle index), and postoperative parameters. MEASUREMENTS AND MAIN RESULTS A total of 199 patients were reviewed from January 2020 to December 2022. Patients weew categorized into group A (CONUT <4) and group B (CONUT ≥4) based on whether their CONUT scores were less than 4. The mortality (p = 0.004) and the incidence of Clavien-Dindo class III complications (p = 0.007) in group B were higher than those in group A. CONUT score was an independent risk factor for midterm mortality (hazard ratio 1.329; 95% CI, 1.104-1.697; p = 0.002) and Clavien-Dindo class III complications (odds ratio 1.225; 95% CI, 1.012-1.482; p = 0.037) according to univariate and multivariate analyses, whereas NRS 2002 score and sarcopenia were not. Kaplan-Meier curves showed a lower midterm survival rate in group B (log-rank p < 0.001). CONCLUSION In patients with AAA undergoing OSR or EVAR, a CONUT score ≥4 was associated with increased Clavien-Dindo class III complications and mortality. Preoperative nutritional status should be evaluated and optimized in this high-risk population.
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Affiliation(s)
- Jiashu Yao
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yepeng Zhang
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bo Gao
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Min Zhou
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Li N, Xue D, Men K, Li L, Yang J, Jiang H, Meng Q, Zhang S. Influence of malnutrition according to the glim criteria on the chemotherapy toxicities in patients with advanced lung cancer. Support Care Cancer 2024; 32:358. [PMID: 38750262 DOI: 10.1007/s00520-024-08556-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/07/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Cancer-associated malnutrition is highly prevalent in advanced lung cancer, and 50% of global cancer-related deaths are attributed to cancer-associated malnutrition. Platinum-containing chemotherapy is the standard treatment for advanced lung cancer. Unfortunately, it can cause exacerbated toxicities, which can also have a negative impact on patient's prognosis and quality of life. The Global Leadership Initiative on Malnutrition (GLIM) criteria have been proposed as the world's first accepted diagnostic criteria for malnutrition. However, the effectiveness of GLIM criteria in predicting chemotherapy toxicities in patients with advanced lung cancer is unclear. The aim of this study was to apply the GLIM criteria to assess the prevalence of pre-treatment diagnosis of malnutrition in patients with advanced non-small cell lung cancer (NSCLC) and to determine the impact of nutritional status on patient's chemotherapy toxicity. METHODS We conducted a study of hospitalized patients with pathologically and clinically diagnosed advanced NSCLC who presented to our hospital from May 2021 to January 2022. Initially, the Nutritional Risk Screening-2002 (NRS-2002) was used for nutritional risk screening, and nutritional status was assessed using the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and GLIM criteria. Chemotherapy toxicity was assessed and graded according to CTCAE5.0, and chemotherapy efficacy was assessed according to RECIST1.1. Kappa test was used to analyze the agreement between PG-SGA and GLIM criteria. Univariate and multivariate logistic regression analyses were used to determine the relationship between malnutrition and chemotherapy toxicity. RESULTS A total of 215 patients with advanced NSCLC were evaluated for nutritional status. Most of the patients had normal BMI (61.86%) before the start of treatment, 40% were well-nourished as assessed by the PG-SGA tool, and 51.17% were well-nourished as assessed by GLIM criteria. Consistency analysis showed moderate agreement (Kappa = 0.463, P < 0.001) and their correlation was also moderate (Spearman, rs = 0.475, P < 0.001). The objective response rate (ORR) (P = 0.040) and disease control rate (DCR) (P < 0.001) were significantly lower in malnourished patients diagnosed according to GLIM criteria than in well-nourished patients. Multivariate analysis showed that malnutrition (OR = 1.531,95%CI 0.757-3.009; OR = 6.623,95%CI 1.390-31.567, P = 0.046) diagnosed by GLIM criteria was an independent predictor of chemotherapy toxicity. Conclusions Malnutrition diagnosed by GLIM criteria better predicts toxicity during chemotherapy, determines the degree of clinical benefit of chemotherapy, and may affect patient prognosis.
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Affiliation(s)
- Ning Li
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Dinglong Xue
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Kaiya Men
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lijun Li
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jiaxin Yang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hao Jiang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qingwei Meng
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
| | - Shuai Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
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Yang B, Wang L, Yu K, Shi H. Three-Stage Nutrition Diagnosis for surgical patients at the perioperative period. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106759. [PMID: 36335078 DOI: 10.1016/j.ejso.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Medical nutrition therapy has been widely applied in various diseases as a fundamental or even a first-line treatment. Patient who undergoes a disease state especially at the perioperative period can be much improved with the help of nutrition therapy. Precise nutrition diagnosis should be conducted before applying any nutrition therapy. Traditional malnutrition diagnostic process, however, is a two-stage process (nutrition screening and nutrition assessment) which cannot precisely assess nutritional status of surgical patients or the consequences of being malnourished. This article systematically introduced a new nutrition diagnostic process - Three-Stage Diagnosis (nutrition screening, nutrition assessment, and comprehensive evaluation) and discussed its applications during perioperative period.
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Affiliation(s)
- Bohan Yang
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Lin Wang
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Kaiying Yu
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Hanping Shi
- Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
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Lin N, Zhou X, Chen W, He C, Wang X, Wei Y, Long Z, Shen T, Zhong L, Yang C, Dai T, Zhang H, Shi H, Ma X. Development and validation of a point-of-care nursing mobile tool to guide the diagnosis of malnutrition in hospitalized adult patients: a multicenter, prospective cohort study. MedComm (Beijing) 2024; 5:e526. [PMID: 38606361 PMCID: PMC11006711 DOI: 10.1002/mco2.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 04/13/2024] Open
Abstract
Malnutrition is a prevalent and severe issue in hospitalized patients with chronic diseases. However, malnutrition screening is often overlooked or inaccurate due to lack of awareness and experience among health care providers. This study aimed to develop and validate a novel digital smartphone-based self-administered tool that uses facial features, especially the ocular area, as indicators of malnutrition in inpatient patients with chronic diseases. Facial photographs and malnutrition screening scales were collected from 619 patients in four different hospitals. A machine learning model based on back propagation neural network was trained, validated, and tested using these data. The model showed a significant correlation (p < 0.05) and a high accuracy (area under the curve 0.834-0.927) in different patient groups. The point-of-care mobile tool can be used to screen malnutrition with good accuracy and accessibility, showing its potential for screening malnutrition in patients with chronic diseases.
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Affiliation(s)
- Nan Lin
- Department of BiotherapyCancer CenterWest China Hospital, Sichuan UniversityChengduChina
| | - Xueyan Zhou
- Department of BiotherapyState Key Laboratory of Biotherapy, Frontiers Science Center for Disease‐related Molecular Network, West China Hospital, and Key Laboratory of Bio‐Resource and Eco‐Environment of Ministry of Education, College of Life Sciences, Sichuan UniversityChengduSichuanChina
| | - Weichang Chen
- State Key Laboratory of Oral DiseasesNational Clinical Research Center for Oral Diseases, Sichuan UniversityChengduChina
| | | | - Xiaoxuan Wang
- Department of BiotherapyCancer CenterWest China Hospital, Sichuan UniversityChengduChina
| | - Yuhao Wei
- Department of BiotherapyCancer CenterWest China Hospital, Sichuan UniversityChengduChina
| | | | - Tao Shen
- Department of Colorectal SurgeryThe Third Affiliated Hospital of Kunming Medical University/Yunnan Tumor HospitalKunmingChina
| | - Lingyu Zhong
- Department of Clinical NutritionHospital of Chengdu Office of People’s Government of Tibetan Autonomous RegionChengduChina
| | - Chan Yang
- Division of Endocrinology and MetabolismState Key Laboratory of Biotherapy, West China Hospital, Sichuan UniversityChengduChina
| | - Tingting Dai
- Department of Clinical NutritionWest China Hospital, Sichuan UniversityChengduChina
| | - Hao Zhang
- Division of Pancreatic SurgeryDepartment of General SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Hubing Shi
- Laboratory of Integrative MedicineClinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation CenterChengduSichuanChina
| | - Xuelei Ma
- Department of BiotherapyCancer CenterWest China Hospital, Sichuan UniversityChengduChina
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18
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Chen W, Yu D, Ren Q, Shen Z, Huang G, Chen X, Dong Q, Yu Z. Predictive value of Global Leadership Initiative on Malnutrition criteria combined with handgrip strength for postoperative outcomes in overweight colorectal cancer patients. J Gastroenterol Hepatol 2024; 39:716-724. [PMID: 38212102 DOI: 10.1111/jgh.16481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND AND AIM The Global Leadership Initiative on Malnutrition (GLIM) criteria are increasingly used to assess the nutritional status of hospitalized patients and predict the prognosis of patients with malignant tumors; however, malnutrition is often overlooked in overweight individuals, such as colorectal cancer patients. This study aimed to investigate the predictive value of the GLIM criteria combined with handgrip strength (HGS) in overweight colorectal cancer patients. METHODS This retrospective study enrolled overweight patients who underwent radical resection for colorectal cancer at two centers between 2015 and 2021. Malnutrition was diagnosed based on the GLIM criteria. Skeletal muscle mass was assessed using the skeletal muscle index, and skeletal muscle function was assessed using the HGS test. The risk factors for complications and survival were also evaluated. RESULTS A total of 850 patients were enrolled in the study. The incidence of malnutrition in the GLIM and HGS-GLIM groups was 12.4% and 6.4%, respectively. The incidence of total complications in both the malnutrition groups was significantly higher than that in the control group. Patients in the HGS-GLIM-malnutrition group had worse overall survival and disease-free survival. HGS-GLIM was independently associated with postoperative complications (P = 0.046), overall survival (P = 0.037), and disease-free survival (P = 0.047). CONCLUSION The GLIM criteria combined with the HGS test is an effective tool for diagnosing malnutrition. Particularly, these modalities are applicable in overweight colorectal cancer patients. Compared with the standard GLIM criteria, this tool has a better predictive value for postoperative complications and long-term survival.
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Affiliation(s)
- Weizhe Chen
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dingye Yu
- Department of General Surgery, Shanghai Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Qi Ren
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zile Shen
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guowei Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaolei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiantong Dong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhen Yu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Gil-Andrés D, Cabañas-Alite L. A Narrative Review Comparing Nutritional Screening Tools in Outpatient Management of Cancer Patients. Nutrients 2024; 16:752. [PMID: 38474880 DOI: 10.3390/nu16050752] [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: 02/19/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Malnutrition during cancer has a negative impact on prognosis and quality of life. Therefore, it is important to identify those patients at higher nutritional risk to prevent its development. There are nutritional screening tools, such as MUST and NRS-2002, that focus on the patient on admission to hospital. However, most patients will develop malnutrition in the outpatient or ambulatory setting. This study aims to determine which nutritional screening tool is most effective in assessing nutritional risk in the outpatient oncology patient, highlighting the parameters analysed by these tools. Seventeen articles were reviewed, with the most important variables being tumour location, tumour stage, age, and gender, as well as recent weight loss, dietary intake, and digestive disorders. The Nutriscore, NRS-2002, and MUST tools are considered suitable, but the choice varies depending on these parameters. MNA is suitable for elderly patients, while SNAQ was not considered reliable in this population. In conclusion, MUST, NRS-2002, and Nutriscore are suitable tools, but their choice depends on specific characteristics. There is currently no universal tool for nutritional risk assessment in outpatients.
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Affiliation(s)
- Delia Gil-Andrés
- Internal Medicine Department, Manises' Hospital, Av. De la Generalitat Valenciana, 50, 46940 Manises, Spain
| | - Luis Cabañas-Alite
- Faculty of Health Sciences, Miguel de Cervantes European University, C. del Padre Julio Chevalier, 2, 47012 Valladolid, Spain
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20
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Dos Santos ALS, Santos BC, Frazão LN, Miranda AL, Fayh APT, Silva FM, Gonzalez MC, Correia MITD, Souza NC, Anastácio LR, Maurício SF. Validity of the GLIM criteria for the diagnosis of malnutrition in patients with colorectal cancer: A multicenter study on the diagnostic performance of different indicators of reduced muscle mass and disease severity. Nutrition 2024; 119:112324. [PMID: 38215671 DOI: 10.1016/j.nut.2023.112324] [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: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVES To assess the concurrent and predictive validity of different combinations of Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with colorectal cancer considering different indicators of reduced muscle mass (MM) and the effects of the disease. METHODS A secondary analysis with patients with colorectal cancer. The reduced MM was assessed by arm muscle area, arm muscle circumference, calf circumference, fat-free mass index, skeletal muscle index (SMI) and skeletal muscle. Cancer diagnosis or disease staging (TNM) was considered for the etiologic criterion referred to as the effect of the disease. The other phenotypic and etiologic criteria were also evaluated, and we analyzed 13 GLIM combinations. Concurrent validity between GLIM criteria and Patient-Generated Subjective Global Assessment was evaluated. Logistic and Cox regression were used in the predictive validation. RESULTS For concurrent validity (n = 208), most GLIM combinations (n = 6; 54.5%) presented a moderate agreement with Patient-Generated Subjective Global Assessment and none showed satisfactory sensitivity and specificity (>80%). Reduced MM evaluated by SMI and SMI were present in the GLIM combinations associated with postoperative complications (odds ratio, ≥2.0), independent of other phenotypic and etiologic criteria. The combinations with reduced MM considering any method and fixed phenotypic criteria and TNM were associated with mortality (hazard ratio, ≥2.0). CONCLUSIONS Satisfactory concurrent validity was not verified. The GLIM diagnosis of malnutrition was associated with postoperative complications and mortality.
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Affiliation(s)
| | - Bárbara Chaves Santos
- Universidade Federal de Minas Gerais, Postgraduate Program in Food Science, Belo Horizonte, Brazil
| | | | - Ana Lúcia Miranda
- Universidade Federal do Rio Grande do Norte, Postgraduate Program in Health Sciences, Health Sciences Center, Natal, Brazil
| | - Ana Paula Trussardi Fayh
- Universidade Federal do Rio Grande do Norte, Postgraduate Program in Health Sciences, Health Sciences Center, Natal, Brazil
| | - Flávia Moraes Silva
- Universidade Federal de Ciências da Saúde de Porto Alegre, Department of Nutrition, Porto Alegre, Brazil
| | - Maria Cristina Gonzalez
- Postgraduate Program in Food and Nutrition, Federal University of Pelotas, Rio Grande do Sul, Pelotas, Brazil
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21
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Li ZZ, Yan XL, Zhang Z, Chen JL, Li JY, Bao JX, Ru JT, Wang JX, Chen XL, Shen X, Huang DD. Prognostic value of GLIM-defined malnutrition in combination with hand-grip strength or gait speed for the prediction of postoperative outcomes in gastric cancer patients with cachexia. BMC Cancer 2024; 24:253. [PMID: 38395798 PMCID: PMC10885679 DOI: 10.1186/s12885-024-11880-z] [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: 04/02/2023] [Accepted: 01/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Cancer cachexia is associated with impaired functional and nutritional status and worse clinical outcomes. Global Leadership Initiative in Malnutrition (GLIM) consensus recommended the application of GLIM criteria to diagnose malnutrition in patients with cachexia. However, few previous study has applied the GLIM criteria in patients with cancer cachexia. METHODS From July 2014 to May 2019, patients who were diagnosed with cancer cachexia and underwent radical gastrectomy for gastric cancer were included in this study. Malnutrition was diagnosed using the GLIM criteria. Skeletal muscle index was measured using abdominal computed tomography (CT) images at the third lumbar vertebra (L3) level. Hand-grip strength and 6-meters gait speed were measured before surgery. RESULTS A total of 356 patients with cancer cachexia were included in the present study, in which 269 (75.56%) were identified as having malnutrition based on the GLIM criteria. GLIM-defined malnutrition alone did not show significant association with short-term postoperative outcomes, including complications, costs or length of postoperative hospital stays. The combination of low hand-grip strength or low gait speed with GLIM-defined malnutrition led to a significant predictive value for these outcomes. Moreover, low hand-grip strength plus GLIM-defined malnutrition was independently associated with postoperative complications (OR 1.912, 95% CI 1.151-3.178, P = 0.012). GLIM-defined malnutrition was an independent predictive factor for worse OS (HR 2.310, 95% CI 1.421-3.754, P = 0.001) and DFS (HR 1.815, 95% CI 1.186-2.779, P = 0.006) after surgery. The addition of low hand-grip strength or low gait speed to GLIM-defined malnutrition did not increase its predictive value for survival. CONCLUSION GLIM-defined malnutrition predicted worse long-term survival in gastric cancer patients with cachexia. Gait speed and hand-grip strength added prognostic value to GLIM-defined malnutrition for the prediction of short-term postoperative outcomes, which could be incorporated into preoperative assessment protocols in patients with cancer cachexia.
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Affiliation(s)
- Zong-Ze Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, 325000, Wenzhou, Zhejiang, China
| | - Xia-Lin Yan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, 325000, Wenzhou, Zhejiang, China
| | - Zhao Zhang
- Radiology Imaging Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiong-Lai Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, 325000, Wenzhou, Zhejiang, China
| | - Jiang-Yuan Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, 325000, Wenzhou, Zhejiang, China
| | - Jing-Xia Bao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, 325000, Wenzhou, Zhejiang, China
| | - Jia-Tong Ru
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, 325000, Wenzhou, Zhejiang, China
| | - Jia-Xin Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, 325000, Wenzhou, Zhejiang, China
| | - Xiao-Lei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, 325000, Wenzhou, Zhejiang, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, 325000, Wenzhou, Zhejiang, China.
| | - Dong-Dong Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, 2 Fuxue Lane, 325000, Wenzhou, Zhejiang, China.
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Tan S, Jiang J, Qiu L, Liang Y, Meng J, Tan N, Xiang B. Prevalence of Malnutrition in Patients with Hepatocellular Carcinoma: A Comparative Study of GLIM Criteria, NRS2002, and PG-SGA, and Identification of Independent Risk Factors. Nutr Cancer 2024; 76:335-344. [PMID: 38379140 DOI: 10.1080/01635581.2024.2314317] [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: 06/20/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
AIM Malnutrition is prevalent in hepatocellular carcinoma (HCC) patients, linked to poor outcomes, necessitating early intervention. This study aimed to investigate malnutrition in HCC patients, assess Nutrition Risk Screening 2002 (NRS-2002) and Patient-Generated Subjective Global Assessment (PG-SGA) vs. Global Leadership Initiative on Malnutrition (GLIM) criteria, and identify independent risk factors. METHOD A cross-sectional retrospective study was conducted on 207 patients with HCC. Nutritional screening/assessment results and blood samples were collected within 72 h of admission. This study assessed the prevalence of malnutrition using the NRS-2002 and PG-SGA and retrospectively using the GLIM criteria. The performance of the screening tools was evaluated using kappa (K) values. Logistic regression analyses were performed to determine whether laboratory parameters were associated with malnutrition as identified by the GLIM criteria. RESULTS Of the participants, 30.4% were at risk of malnutrition according to NRS-2002. The agreement between the NRS-2002 and GLIM criteria was substantial. The GLIM criteria and PG-SGA diagnosed malnutrition in 43 and 54.6% of the participants, respectively. Age, anemia, and ascites correlated with malnutrition in regression. CONCLUSION The GLIM criteria, along with NRS-2002 and PG-SGA, aid in diagnosing malnutrition in HCC patients. Recognizing risk factors improves accuracy, enabling timely interventions for better outcomes.
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Affiliation(s)
- Shengqiang Tan
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
- Department of Hepatobiliary Surgery, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Jie Jiang
- Department of Clinical Nutrition, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Liulin Qiu
- Department of Clinical Nutrition, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Yaohao Liang
- Department of Hepatobiliary Surgery, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Jianyi Meng
- Department of Hepatobiliary Surgery, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Ning Tan
- College of Basic Medical Sciences, Guilin Medical University, Guilin, China
| | - Bangde Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
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Wu W, Guo Z, Gu Z, Mao Y, She C, Gu J, Lv B, Xu W, Li L. GLIM criteria represent a more suitable tool to evaluate the nutritional status and predict postoperative motor functional recovery of older patients with hip fracture: A retrospective study. Medicine (Baltimore) 2024; 103:e37128. [PMID: 38335434 PMCID: PMC10860930 DOI: 10.1097/md.0000000000037128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 02/12/2024] Open
Abstract
Early recognition of malnutrition is essential to improve the prognosis of older patients with hip fracture. The Nutritional Risk Screening 2002 (NRS-2002), the Short-Form Mini Nutritional Assessment (MNA-SF) and the Global Leadership Initiative on Malnutrition (GLIM) are widely used in malnutrition diagnosis. However, criteria for predicting postoperative hip joint motor function in older patients with hip fractures are still necessary. The objective of this study was to select the most appropriate criteria from the NRS-2002, the MNA-SF and the GLIM in predicting the postoperative hip joint motor function recovery 1 year after surgery. This retrospective observational study included 161 patients aged ≥ 65 years with hip fractures. The nutritional status of patients was determined by the NRS-2002, MNA-SF and GLIM. The Harris hip joint score (HHS), the primary outcome of this study, was used to evaluate hip joint motor function. HHS was classified as excellent (HHS > 75) or non-excellent outcomes (HHS ≤ 75). Logistic regression models for hip joint motor function recovery were constructed. Both the receiver operating characteristic curve and the decision curve analysis were used to select the most predictive criteria. The overall mean age of the 161 patients was 77.90 ± 8.17. As a result, NRS-2002 (OR:0.06, 95%CI [0.01, 0.17]), MNA-SF (OR:0.05, 95%CI [0.00, 0.23]) and GLIM (OR of moderate: 0.03, 95%CI [0.01, 0.11]; OR of severe: 0.02 [0.00, 0.07]) were predictive for recovery of hip joint motor function. Additionally, both the area under curve of the receiver operating characteristic curve (NRS-2002: 81.2 [73.8, 88.6], MNA-SF: 76.3 [68.5, 84.2], GLIM: 86.2 [79.6,92.8]) and the decision curve analysis showed the GLIM was better than others. Compared with NRS-2002 and MNA-SF, GLIM was a more suitable nutritional assessment criteria to predict the postoperative recovery of hip joint motor function for older patients with hip fracture 1 year after surgery.
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Affiliation(s)
- Weicheng Wu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhening Guo
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zenghui Gu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongtao Mao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang She
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Gu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Bo Lv
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Xu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Liubing Li
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China
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Hou J, Tan G, Hua S, Zhang H, Wang J, Xia N, Zhou S, An D. Development of high internal phase Pickering emulsions stabilized by egg yolk and carboxymethylcellulose complexes to improve β-carotene bioaccessibility for the elderly. Food Res Int 2024; 177:113835. [PMID: 38225112 DOI: 10.1016/j.foodres.2023.113835] [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: 08/11/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/17/2024]
Abstract
The work aimed to develop the multi-protein mixture of egg yolk as natural particles to stabilize high internal phase Pickering emulsions (HIPPEs) to improve the bioaccessibility of β-carotene in the elderly. The results showed that the depletion attraction drove the adsorption of egg yolk protein particles at the oil-water interface and the formation of osmotic droplet clusters due to the attachment of particle-coated droplets in the dispersed phase, leading to kinetic blocking and stable gelation of HIPPEs. Rheological measurements showed that HIPPEs had shear thinning, low shear stress, viscoelastic properties, and structural recovery properties, which facilitated easy consumption for the elderly. The stability of HIPPEs was verified by ionic and centrifugal stability tests, demonstrating their potential for application to complex gastric environments. HIPPEs have been applied to the International Dysphagia Dietary Standardization Initiative (IDDSI) test and simulated in vitro digestion in older adults, demonstrating their safe swallowability and high β-carotene bioaccessibility. Our findings suggest solutions for food practitioners facing the aging problem and provide new insights for preparing age-friendly foods.
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Affiliation(s)
- Jingjie Hou
- College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang, 150030, China
| | - Guixin Tan
- College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang, 150030, China
| | - Shihui Hua
- College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang, 150030, China
| | - Huajiang Zhang
- College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang, 150030, China
| | - Jing Wang
- College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang, 150030, China.
| | - Ning Xia
- College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang, 150030, China
| | - Sijie Zhou
- College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang, 150030, China
| | - Dong An
- College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang, 150030, China
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25
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Kim Y, Kim SR, Kim K, Yu SJ. Demographic, clinical and psychological predictors of malnutrition among people with liver cancer. Eur J Oncol Nurs 2024; 68:102497. [PMID: 38199088 DOI: 10.1016/j.ejon.2023.102497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 12/10/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE This study aimed to explore the nutritional status and examine the demographic, clinical, nutritional, and psychosocial characteristics associated with malnutrition among people with liver cancer. METHODS A descriptive cross-sectional design was used. Data were collected from a convenience sample of 162 liver cancer outpatients at a tertiary university hospital. Nutritional status was evaluated using the Patient-Generated Subjective Global Assessment (PG-SGA). Self-administered structured questionnaires were administered, and medical records were reviewed for demographic, clinical, nutritional, and psychosocial characteristics. RESULTS Based on PG-SGA scores, 27 patients (16.7%) were classified into the malnutrition group. The stages of liver cancer, chemotherapy, physical and psychological symptom distress, global distress index, levels of alpha-fetoprotein and protein induced by vitamin K absence or antagonists, body mass index, appetite, hemoglobin and albumin levels, and depression were statistically significantly associated with malnutrition. Logistic regression model revealed that physical symptom distress, liver cancer stage, depression, and body mass index influenced statistically significantly malnutrition. CONCLUSIONS In this study, clinical, nutritional, and psychosocial characteristics predicted malnutrition among people with liver cancer. Nurses should consider these characteristics when evaluating the nutritional status of people with liver cancer.
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Affiliation(s)
- Yumi Kim
- Department of Nursing, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Sung Reul Kim
- College of Nursing, Institute of Nursing Research, Korea University, Republic of Korea.
| | - Kyounghae Kim
- College of Nursing, Institute of Nursing Research, and Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, Republic of Korea.
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Jiang M, Chen J, Wu M, Wu J, Xu X, Li J, Liu C, Zhao Y, Hua X, Meng Q. Application of Global Leadership Initiative on Malnutrition criteria in patients with liver cirrhosis. Chin Med J (Engl) 2024; 137:97-104. [PMID: 38073306 PMCID: PMC10766297 DOI: 10.1097/cm9.0000000000002937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) criteria were published to build a global consensus on nutritional diagnosis. Reduced muscle mass is a phenotypic criterion with strong evidence to support its inclusion in the GLIM consensus criteria. However, there is no consensus regarding how to accurately measure and define reduced muscle mass in clinical settings. This study aimed to investigate the optimal reference values of skeletal muscle mass index for diagnosing sarcopenia and GLIM-defined malnutrition, as well as the prevalence of GLIM-defined malnutrition in hospitalized cirrhotic patients. METHODS This retrospective study was conducted on 1002 adult patients with liver cirrhosis between January 1, 2018, and February 28, 2022, at Beijing You-An Hospital, Capital Medical University. Adult patients with a clinical diagnosis of liver cirrhosis and who underwent an abdominal computed tomography (CT) examination during hospitalization were included in the study. These patients were randomly divided into a modeling group (cohort 1, 667 patients) and a validation group (cohort 2, 335 patients). In cohort 1, optimal cut-off values of skeletal muscle index at the third lumbar skeletal muscle index (L3-SMI) were determined using receiver operating characteristic analyses against in-hospital mortality in different gender groups. Next, patients in cohort 2 were screened for nutritional risk using the Nutritional Risk Screening 2002 (NRS-2002), and malnutrition was diagnosed by GLIM criteria. Additionally, the reference values of reduced muscle mass in GLIM criteria were derived from the L3-SMI values from cohort 1. Multivariate logistic regression analysis was used to analyze the association between GLIM-defined malnutrition and clinical outcomes. RESULTS The optimal cut-off values of L3-SMI were 39.50 cm 2 /m 2 for male patients and 33.06 cm 2 /m 2 for female patients. Based on the cut-off values, 31.63% (68/215) of the male patients and 23.3% (28/120) of the female patients had CT-determined sarcopenia in cohort 2. The prevalence of GLIM-defined malnutrition in cirrhotic patients was 34.3% (115/335) and GLIM-defined malnutrition was an independent risk factor for in-hospital mortality in patients with liver cirrhosis ( Wald = 6.347, P = 0.012). CONCLUSIONS This study provided reference values for skeletal muscle mass index and the prevalence of GLIM-defined malnutrition in hospitalized patients with liver cirrhosis. These reference values will contribute to applying the GLIM criteria in cirrhotic patients.
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Affiliation(s)
- Minjie Jiang
- Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
- Beijing Institute of Hepatology, Beijing 100069, China
| | - Juan Chen
- Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Muchen Wu
- Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Jing Wu
- Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Xiaotong Xu
- Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Juan Li
- Department of Medical Oncology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Can Liu
- Department of Nutrition, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Yaping Zhao
- Department of Nutrition, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Xin Hua
- Department of Nutrition, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
| | - Qinghua Meng
- Department of Hepatology, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
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27
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Galvin A, Soubeyran P, Brain E, Cheung KL, Hamaker ME, Kanesvaran R, Mauer M, Mohile S, Montroni I, Puts M, Rostoft S, Wildiers H, Mathoulin-Pélissier S, Bellera C. Assessing patient-reported outcomes (PROs) and patient-related outcomes in randomized cancer clinical trials for older adults: Results of DATECAN-ELDERLY initiative. J Geriatr Oncol 2024; 15:101611. [PMID: 37679204 DOI: 10.1016/j.jgo.2023.101611] [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: 03/06/2023] [Revised: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
As older adults with cancer are underrepresented in randomized clinical trials (RCT), there is limited evidence on which to rely for treatment decisions for this population. Commonly used RCT endpoints for the assessment of treatment efficacy are more often tumor-centered (e.g., progression-free survival). These endpoints may not be as relevant for the older patients who present more often with comorbidities, non-cancer-related deaths, and treatment toxicity. Moreover, their expectation and preferences are likely to differ from younger adults. The DATECAN-ELDERLY initiative combines a broad expertise, in geriatric oncology and clinical research, with interest in cancer RCT that include older patients with cancer. In order to guide researchers and clinicians coordinating cancer RCT involving older patients with cancer, the experts reviewed the literature on relevant domains to assess using patient-reported outcomes (PRO) and patient-related outcomes, as well as available tools related to these domains. Domains considered relevant by the panel of experts when assessing treatment efficacy in RCT for older patients with cancer included functional autonomy, cognition, depression and nutrition. These were based on published guidelines from international societies and from regulatory authorities as well as minimum datasets recommended to collect in RCT including older adults with cancer. In addition, health-related quality of life, patients' symptoms, and satisfaction were also considered by the panel. With regards to tools for the assessment of these domains, we highlighted that each tool has its own strengths and limitations, and very few had been validated in older adults with cancer. Further studies are thus needed to validate these tools in this specific population and define the minimum clinically important difference to use when developing RCTs in this population. The selection of the most relevant tool should thus be guided by the RCT research question, together with the specific properties of the tool.
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Affiliation(s)
- Angéline Galvin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France
| | - Pierre Soubeyran
- Univ. Bordeaux, Inserm, UMR 1312, SIRIC BRIO, France; Department of medical oncology, Bergonie Institute, Comprehensive Cancer Center, Bordeaux, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Saint-Cloud, France
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht/ Zeist/Doorn, Zeist, the Netherlands
| | | | - Murielle Mauer
- Statistics Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Supriya Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Isacco Montroni
- Division of Colorectal Surgery, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Belgium
| | - Simone Mathoulin-Pélissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Carine Bellera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France.
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28
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Li ZZ, Yan XL, Jiang HJ, Ke HW, Chen ZT, Chen DH, Xu JY, Liu XC, Shen X, Huang DD. Sarcopenia predicts postoperative complications and survival in colorectal cancer patients with GLIM-defined malnutrition: Analysis from a prospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107295. [PMID: 38016248 DOI: 10.1016/j.ejso.2023.107295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/08/2023] [Accepted: 11/18/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To investigate whether sarcopenia could predict postoperative outcomes in patients with colorectal cancer with Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition. METHODS Clinical data of patients who underwent radical resection for colorectal cancer were prospectively collected. Sarcopenia was diagnosed by the combination of low handgrip strength and low muscle quantity or quality as measured by abdominal computed tomography (CT) images. Logistic regression analysis and Cox proportional hazards regression analysis were performed to identify independent predictors for postoperative complications and survival, respectively. RESULTS A total of 310 patients with colorectal cancer with GLIM-defined malnutrition were included, of which 145 (46.77%) were identified with sarcopenia. Malnutritional patients with sarcopenia had significantly higher incidences of total complications (34.5% versus 15.8%), severe complications (9.7% versus 1.8%), longer lengths of postoperative hospital stay (median, 14 days versus 12 days), and more costs (median, 56,257 RMB versus 49,024 RMB) than those without sarcopenia. Sarcopenia was an independent predictive factor for postoperative complications (OR 2.531, 95% CI 1.451-4.415), overall survival (HR 1.519, 95% CI 1.026-2.248), and disease-free survival (HR 1.847, 95% CI 1.324-2.576). Patients with severe sarcopenia had a higher incidence of severe complications but not total complications or survival than those with not-severe sarcopenia. Moreover, the predictive value of sarcopenia for postoperative complications was attributed to muscle strength and quality but not muscle quantity. CONCLUSION Sarcopenia predicts postoperative complications and survival in patients with colorectal cancer with GLIM-defined malnutrition. Preoperative assessment of sarcopenia is still necessary when nutritional assessment has been well performed.
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Affiliation(s)
- Zong-Ze Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xia-Lin Yan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao-Jie Jiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao-Wen Ke
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Zhang-Tao Chen
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Ding-Hao Chen
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Jia-Yi Xu
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xue-Chun Liu
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Dong-Dong Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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29
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Huang JX, Zhang X, Tang M, Zhang Q, Deng L, Song CH, Li W, Yang M, Shi HP, Cong MH. Association between a novel nutrition-inflammation prognostic grading system and overall survival in hospitalized adults with cancer: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:108-119. [PMID: 37855392 DOI: 10.1002/jpen.2565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/31/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Malnutrition and increased systemic inflammatory responses are highly prevalent in patients with cancer and they have a negative effect on prognosis. We aimed to develop a nutrition-inflammation prognostic grading system (NIPGS) for patients with cancer, which incorporates the Nutritional Risk Screening 2002 (NRS 2002) and C-reactive protein (CRP) levels. METHODS This multicenter retrospective cohort study totally included 6891 patients diagnosed with cancer. A 4 × 4 matrix incorporating the four NRS 2002 categories within each of the four CRP categories was constructed. Groups with approximate hazard ratios (HRs) were clustered into one grade. The NIPGS consists of four grades, with the survival rate gradually decreasing from Grades 1 to 4. The primary outcome was overall survival (OS) and comprehensive survival analyses were performed. RESULTS During a median follow-up of 18.70 months, 2818 death cases occurred. Kaplan-Meier curve showed the survival rate decreased from Grades 1 to 4 of NIPGS (P < 0.001). The NIPGS was an independent risk factor associated with OS adjusting for confounders, with HRs increasing from 1.22 (95% confidence interval [CI], 1.09-1.36; P < 0.001) in Grade 2, 1.58 (95% CI, 1.39-1.80; P < 0.001) in Grade 3 to 1.92 (95% CI, 1.73-2.13; P < 0.001) in Grade 4. A high NIPGS grade was also associated with an increased risk of short-term mortality, poor quality of life, and longer hospital stay and expenses. Two internal validation cohorts confirmed the results of our study. CONCLUSION The NIPGS could be an effective prognostic tool for patients with cancer.
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Affiliation(s)
- Jia-Xin Huang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Cancer Center of the First Hospital of Jilin University, Changchun, China
| | - Xi Zhang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Meng Tang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Qi Zhang
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Department of Gastrointestinal Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Li Deng
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chun-Hua Song
- Department of Epidemiology, Zhengzhou University, Zhengzhou, China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University, Changchun, China
| | - Min Yang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han-Ping Shi
- Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
- Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ming-Hua Cong
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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30
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Garutti M, Noto C, Pastò B, Cucciniello L, Alajmo M, Casirati A, Pedrazzoli P, Caccialanza R, Puglisi F. Nutritional Management of Oncological Symptoms: A Comprehensive Review. Nutrients 2023; 15:5068. [PMID: 38140327 PMCID: PMC10745914 DOI: 10.3390/nu15245068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Throughout their experience of illness and during the course of treatment, a substantial proportion of cancer patients are prone to develop nutritional and/or metabolic disturbances. Additionally, cancer patients often encounter long-term side effects from therapies, which may lead to impaired digestion, nutrient absorption or bowel motility. Therefore, the preservation and maintenance of an optimal and balanced nutritional status are pivotal to achieving a better prognosis, increasing the tolerance and adherence to cancer therapies and improving the overall quality of life. In this context, personalized nutritional programs are essential for addressing conditions predisposing to weight loss, feeding difficulties, digestion problems and intestinal irregularity, with the goal of promoting adequate nutrient absorption and minimizing the detrimental effects of treatment regimens. The focus of this research is to examine the most common clinical conditions and metabolic changes that cancer patients may experience, including stomatitis, xerostomia, diarrhea, nausea, vomiting, dysphagia, sub-occlusion, dysgeusia, dysosmia, anorexia, and cachexia. Furthermore, we present a pragmatic example of a multidisciplinary workflow that incorporates customized recipes tailored to individual clinical scenarios, all while maintaining the hedonic value of the meals.
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Affiliation(s)
- Mattia Garutti
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
| | - Claudia Noto
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Brenno Pastò
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Linda Cucciniello
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | | | - Amanda Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paolo Pedrazzoli
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Fabio Puglisi
- CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy
- Department of Medicine, University of Udine, 33100 Udine, Italy
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31
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Dingemans AM, van Walree N, Schramel F, Soud MYE, Baltruškevičienė E, Lybaert W, Veldhorst M, van den Berg CA, Kaasa S. High Protein Oral Nutritional Supplements Enable the Majority of Cancer Patients to Meet Protein Intake Recommendations during Systemic Anti-Cancer Treatment: A Randomised Controlled Parallel-Group Study. Nutrients 2023; 15:5030. [PMID: 38140289 PMCID: PMC10745925 DOI: 10.3390/nu15245030] [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: 09/29/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
ESPEN guidelines recommend a minimum protein intake of 1.0 g/kg body weight (BW) per day to maintain or restore lean body mass in patients with cancer. During anti-cancer treatment, optimal protein intake is difficult to achieve. We investigated whether a high-protein, low-volume oral nutritional supplement (ONS) supports patients in meeting recommendations. A multi-centre, randomised, controlled, open-label, parallel-group study was carried out in nine hospitals (five countries) between January 2019 and July 2021 in colorectal and lung cancer patients undergoing first-line systemic treatment with chemo(radio-) or immunotherapy. Subjects were randomised (2:1) to receive Fortimel Compact Protein® or standard care. Protein intake was assessed with a 3-day food diary (primary outcome). BW was a secondary outcome. Due to challenges in recruitment, the study was terminated prematurely with 42 patients randomised (intervention group (IG) 28; control group (CG) 14). At T1 and T2, protein intake was statistically significantly higher in the IG compared to the CG (1.40 vs. 1.07 g/kg/day at T1, p = 0.008; 1.32 vs. 0.94 g/kg/day at T2, p = 0.002). At baseline, only 65% (IG) and 45% (CG) of patients met ESPEN minimum protein intake recommendations. However, at T1 and T2 in the IG, a higher proportion of patients met recommendations than in the CG (88% vs. 55% and 40%). No statistically significant difference between study groups was observed for BW. Mean compliance to the ONS was 73.4%. A high-protein, low-volume ONS consumed twice daily enables the majority of patients to reach minimal ESPEN protein recommendations.
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Affiliation(s)
- Anne-Marie Dingemans
- Department of Pulmonology, Erasmus Medical Center Cancer Institute, 3015 CN Rotterdam, The Netherlands
| | - Nico van Walree
- Department of Pulmonary Diseases, Amphia Hospital, 4818 CK Breda, The Netherlands;
| | - Franz Schramel
- Department of Pulmonary Diseases, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | | | | | - Willem Lybaert
- Department of Medical Oncology, VITAZ, 9100 Sint-Niklaas, Belgium;
| | - Margriet Veldhorst
- Nutricia Research, 3584 CT Utrecht, The Netherlands; (M.V.); (C.A.v.d.B.)
| | | | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, 0379 Oslo, Norway;
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Shao X, Zhang H, Xu Z, Lang X. Prognostic value of TCBI for short-term outcomes in ATAD patients undergoing surgery. Gen Thorac Cardiovasc Surg 2023; 71:685-691. [PMID: 37338794 DOI: 10.1007/s11748-023-01949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Nutritional status has been reported to be associated with the prognosis of cardiovascular diseases. The study aimed to investigate the prognostic value of Triglycerides-total Cholesterol-Body weight-Index (TCBI) for short-term mortality in acute type A aortic dissection (ATAD) patients undergoing surgery. METHODS AND RESULTS Totally, the data of 290 ATAD patients undergone surgery were, retrospectively, analyzed. After logistic regression analysis, TCBI was identified as an independent predictor of short-term mortality in ATAD surgery. The development of receive operating characteristic (ROC) curve demonstrated that TCBI (AUC = 0.745, P < 0.001) could provide well prognostic value for short-term mortality. Accordingly, the optimal cut-off value was identified as 883.5 and patients were divided into high TCBI (> 883.5) and low TCBI (≤ 883.5) groups. Furthermore, Kaplan-Meier analysis illustrated that short-term mortality increased significantly in the low TCBI group than in the high TCBI group (P < 0.0001). In addition, the incidence of postoperative renal failure was also elevated in the low TCBI group (P = 0.0011). CONCLUSION Malnutrition by preoperative TCBI presented strong prognostic value for patients following ATAD surgery. And TCBI could be applied for risk stratification and therapeutic strategy-making in ATAD.
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Affiliation(s)
- Xin Shao
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Zhang
- Department of Cardiovascular Surgery, Changhai Hospital, The Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, The Naval Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Xilong Lang
- Department of Cardiovascular Surgery, Changhai Hospital, The Naval Medical University, 168 Changhai Road, Shanghai, 200433, China.
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Omiya S, Urade T, Komatsu S, Kido M, Kuramitsu K, Yanagimoto H, Toyama H, Fukumoto T. Impact of GLIM criteria-based malnutrition diagnosis on outcomes following liver resection for hepatocellular carcinoma. HPB (Oxford) 2023; 25:1555-1565. [PMID: 37684130 DOI: 10.1016/j.hpb.2023.08.012] [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: 01/30/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM), comprising several of the major global clinical nutrition societies, suggested the world's first criteria for diagnosis of the severity of malnutrition. However, the impact of the resulting diagnosis on patient outcomes for those with hepatocellular carcinoma (HCC) following liver resection (LR) has not been investigated. METHODS A retrospective analysis of 293 patients with HCC who underwent LR between January 2011 and December 2018 was performed. We compared overall survival (OS) and recurrence-free survival (RFS) and evaluated prognostic factors after LR using Cox proportional hazards regression models. RESULTS Preoperative patient nutritional status, n (%), was classified as follows: normal, 130 (44%), moderate malnutrition, 116 (40%), and severe malnutrition, 47 (16%). The median OS (129 vs. 43 months, p < 0.001) and median RFS (54 vs. 20 months, p = 0.001) were significantly greater in the normal group than in the severe malnutrition group. Multivariate analysis showed that severe malnutrition was a significant risk factor for OS (p = 0.006) and RFS (p = 0.010) after initial LR. CONCLUSION Severe malnutrition, as diagnosed by the GLIM criteria, is a significant prognostic factor for survival and recurrence in patients with HCC after LR.
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Affiliation(s)
- Satoshi Omiya
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takeshi Urade
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Shohei Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masahiro Kido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kaori Kuramitsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroaki Yanagimoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hirochika Toyama
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Amiri Khosroshahi R, Barkhordar M, Talebi S, Imani H, Sadeghi E, Mousavi SA, Mohammadi H. The impact of malnutrition on mortality and complications of hematopoietic stem cell transplantation in patients with acute leukemia. Clin Nutr 2023; 42:2520-2527. [PMID: 37925779 DOI: 10.1016/j.clnu.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND & AIMS Malnutrition is common in hematopoietic stem cell transplantation (HSCT) patients. However, there are few studies on the association between malnutrition and post-transplant outcomes, with inconsistent results. No standard screening tool has been established for malnutrition in these patients. Previous research suggests the Global Leadership Initiative on Malnutrition (GLIM) criteria is effective in predicting outcomes in other cancers. This study investigates the link between malnutrition based on the GLIM criteria with mortality and complications following allogeneic HSCT. METHODS This single-center, observational, longitudinal, and prospective study of 98 adult leukemia patients at the Hematology Center of Shariati Hospital in Tehran, Iran, monitored patients before transplantation until 100 days after the procedure, focusing on overall survival and mortality as a primary outcome, and secondary endpoints including oral mucositis, acute GVHD, infection during hospitalization, and readmission rates. RESULTS This study involved 98 allogeneic HSCT patients with a median age of 38 years old, 64.3 % with acute myeloid leukemia (AML), and 35.7 % with acute lymphoblastic leukemia (ALL). Among them, 26.5 % were categorized as malnourished based on GLIM criteria. During 100 days of follow-up, 13 patients died, but there was no significant difference in overall survival and mortality between malnourished and well-nourished patients. Malnourished patients demonstrated a noticeable upward trend in the incidence of oral mucositis, hospital readmission, and infection during their hospitalization. It is important to highlight that although this observed trend is discernible, it did not attain statistical significance in statistical analyses (P > 0.05). CONCLUSION The current study determined that, when assessed using the GLIM criteria, malnutrition did not exert a statistically significant influence on survival, mortality, or complications within the specified age range of 18-55 years, underscoring its limited impact on this cohort of younger patients.
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Affiliation(s)
- Reza Amiri Khosroshahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Barkhordar
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran; Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepide Talebi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Imani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Sadeghi
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Asadollah Mousavi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran; Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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35
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Ozorio GA, Ribeiro LMK, Santos BC, Bruzaca WFDS, Rocha GDGVD, Marchi LMDF, Santos FM, Alves de Almeida MMF, Kulcsar MAV, Junior UR, Correia MITD, Waitzberg DL. Exploring the use of the GLIM criteria to diagnose malnutrition in cancer inpatients. Nutrition 2023; 116:112195. [PMID: 37678014 DOI: 10.1016/j.nut.2023.112195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/05/2023] [Accepted: 08/12/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES The Global Leadership Initiative on Malnutrition (GLIM) criteria establish a diagnosis of malnutrition based on the presence of at least one phenotypic and one etiologic criterion. This study aimed to assess the concurrent and predictive validity of the GLIM criteria in hospitalized cancer patients. METHODS This is an observational retrospective study, including 885 cancer patients, ages >18 y, admitted to a medical oncology inpatient unit between 2019 and 2020. All patients at risk for malnutrition according to the Nutritional Risk Screening 2002 score were assessed by the subjective global assessment (SGA) and 14 different combinations of the GLIM criteria. The SGA was considered the gold standard for assessing the concurrent validity of the GLIM combinations. For a subsample of patients with data available on inflammatory markers (n = 198), the serum albumin and C-reactive protein were included in the combinations as etiologic criteria. The predictive validity of the different combinations was tested using the occurrence of surgical complications as the clinical outcome. The sensitivity and specificity values were calculated to assess the concurrent validity, univariate and multivariate logistic regression models were used to test predictive validity. Adequate concurrent and predictive validity were determined as sensitivity and specificity values >80% and odds ratio values ≥2.0, respectively. RESULTS The median age of the patients was 61.0 y (interquartile range = 51.0-70.0). Head and neck cancer was the prevailing diagnosis and 375 patients were at nutritional risk. According to the SGA, 173 (26.1%) patients were malnourished (SGA categories B or C) and the prevalence of malnutrition ranged from 3.9% to 30.0%, according to the GLIM combinations. None of the tested combinations reached adequate concurrent validity; however, the presence of malnutrition according to four combinations independently predicted surgical complications. CONCLUSIONS The predictive validity of the GLIM was satisfactory in surgical cancer patients.
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Affiliation(s)
| | - Lia Mara Kauchi Ribeiro
- Nutrition and Dietetics Service, Cancer Institute of the State of São Paulo, São Paulo, Brazil
| | - Bárbara Chaves Santos
- Graduate Program in Food Science, Federal University of Minas Gerais, Minas Gerais, Brazil
| | | | | | - Luani Maria da Fonseca Marchi
- Multiprofessional Residency Program in Adult Oncology Care, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Fernando Magri Santos
- Multiprofessional Residency Program in Adult Oncology Care, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | | | - Ulysses Ribeiro Junior
- Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Dan Linetzky Waitzberg
- Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Wang P, Soh KL, Ying Y, Liao J, Huang X, Zhao H, Pan X, Deng L, Yu X. Risk factors for malnutrition in patients with nasopharyngeal carcinoma. Support Care Cancer 2023; 31:723. [PMID: 38008866 DOI: 10.1007/s00520-023-08166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 11/07/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Malnutrition is a common complication in patients with nasopharyngeal carcinoma (NPC). However, there are few studies on risk factors for malnutrition in NPC patients. Our aims were to identify the risk factors for malnutrition in NPC patients. METHODS NPC patients were recruited in this cross-sectional study, and they were divided into well-nourished and malnourished groups according to the Global Leadership Initiative on Malnutrition (GLIM). Potential risk factors were initially screened using univariate analysis (p < 0.1), and the selected ones were analyzed by logistic regression analysis (p < 0.05) to identify the risk factors for malnutrition in NPC patients. RESULTS In total, 305 NPC patients meeting eligibility criteria were enrolled. Multivariate logistic regression analysis revealed that low body mass index (BMI) (OR = 0.596, 95% CI 0.520-0.683, p < 0.001), the high total radiation dose received (OR = 1.046, 95% CI 1.023-1.069, p < 0.001), appetite loss (OR = 2.839, 95% CI 1.269-6.353, p = 0.011), and low PA (OR = 0.993, 95% CI 0.988-0.998, p = 0.008) were risk factors for malnutrition in NPC patients. CONCLUSIONS The low BMI, the high total radiation dose received, appetite loss, and low prealbumin were risk factors for malnutrition in NPC patients.
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Affiliation(s)
- Pengpeng Wang
- Department of Nursing, Universiti Putra Malaysia, Selangor, Serdang, Malaysia
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Kim Lam Soh
- Department of Nursing, Universiti Putra Malaysia, Selangor, Serdang, Malaysia.
| | - Yanping Ying
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jinlian Liao
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xueling Huang
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Huihan Zhao
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao Pan
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Lan Deng
- Department of Nursing, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoxia Yu
- Faculty of Languages and Linguistics, University Malaya, Wilayah Persekutuan Kuala Lumpur, Malaysia
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Liu Y, Liu X, Duan L, Zhao Y, He Y, Li W, Cui J. Prognostic value of the combined effect of nutritional status and body water component in patients with colorectal cancer. Sci Rep 2023; 13:17570. [PMID: 37845294 PMCID: PMC10579348 DOI: 10.1038/s41598-023-43736-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023] Open
Abstract
The aim of this study was to explore the impact of Geriatric Nutritional Risk Index (GNRI) and body water component (BWC) on the survival of colorectal cancer (CRC) patients and whether the combined effect had a potential prognostic and predictive efficacy. We evaluated the accuracy of GNRI for malnutrition and estimated the predictive capacity of BWC for survival. Kaplan-Meier survival curves and cox regression analyses were used to examine the prognostic effects. A nutrition-water score (NWS) model was developed and evaluated the survival predictive power. GNRI and extracellular water-to-intracellular water ratio (ECW/ICW) were integrated, with the cut-off values of 103.5 and 63.7%. Lower GNRI and higher ECW/ICW were independent risk factors for poor prognosis in CRC patients. The combination of the two into the NWS model demonstrated a higher risk of death for patients with NWS ≥ 1 compared to those with NWS of 0. NWS showed a better predictive capability compared to GNRI and ECW/ICW, with the concordance index of 0.681. Our study demonstrates GNRI and ECW/ICW's prognostic utility in CRC, with their combination improving survival prediction to help guide patient-centered treatment.
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Affiliation(s)
- Yining Liu
- Center of Cancer, The First Hospital of Jilin University, Changchun, 130021, China
| | - Xiangliang Liu
- Center of Cancer, The First Hospital of Jilin University, Changchun, 130021, China
| | - Linnan Duan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Yixin Zhao
- Center of Cancer, The First Hospital of Jilin University, Changchun, 130021, China
| | - Yuwei He
- Center of Cancer, The First Hospital of Jilin University, Changchun, 130021, China
| | - Wei Li
- Center of Cancer, The First Hospital of Jilin University, Changchun, 130021, China.
| | - Jiuwei Cui
- Center of Cancer, The First Hospital of Jilin University, Changchun, 130021, China.
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Xie H, Yuan K, Ruan G, Wei L, Zhang H, Ge Y, Lin S, Song M, Wang Z, Liu C, Shi J, Liu X, Yang M, Zheng X, Chen Y, Zhang X, Shi H. Improving the assessment of malnutrition in cancer: Using systemic inflammation markers as a supplement to the inflammation items of the GLIM criteria. Clin Nutr 2023; 42:2036-2044. [PMID: 37672850 DOI: 10.1016/j.clnu.2023.08.020] [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: 03/27/2023] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND & AIMS Systemic inflammation is a key pathogenic criterion for diagnosing malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Although cancer is commonly considered as a chronic inflammation-related disease, the inflammatory burden may vary depending on the type and stage of cancer. Therefore, a more precise definition of inflammation criteria could facilitate the identification of malnutrition in cancer. METHODS This prospective multicenter study included 1683 cancer patients screened via NRS2002 for malnutrition risk. The inflammatory burden index (IBI), C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), and albumin (ALB) level were used to assess the inflammatory burden. Kaplan-Meier and Cox regression analyses were used to determine the relationship between the GLIM criteria and overall survival. Harrell's concordance index (C-index) was used to compare the discriminative performance of the original, IBI-based, CRP-based, NLR-based, and ALB-based GLIM criteria for survival. Logistic regression models were used to assess the association between GLIM criteria and short-term outcomes, length of hospital stay, and hospitalization costs. RESULTS Compared to the original GLIM criteria, the IBI/CRP/NLR/ALB-based GLIM criteria better predicted the long-term outcomes of patients with cancer (chi-square: 1.316 vs. 78.321 vs. 74.740 vs. 88.719 vs. 100.921). The C-index revealed that the inflammation marker-based GLIM criteria showed significantly better prognostic accuracy than the original GLIM criteria. The ALB-based GLIM criteria exhibited the best prognostic accuracy. The inflammation marker-based GLIM criteria were independent predictive factors for the long-term prognosis of cancer. Patients with malnutrition had a 45% higher risk of adverse long-term prognoses than those without malnutrition. The inflammation marker-based GLIM criteria had good prognostic ability to predict outcomes at 3, 6, and 12 months. The stepwise effect of the grading of severity via the IBI-based GLIM criteria and CRP-based GLIM criteria was notable. The inflammation marker-based GLIM criteria are useful for predicting short-term outcomes, length of hospitalization, and hospitalization costs. CONCLUSION The inflammation marker-based GLIM criteria have a stronger predictive value than the original GLIM criteria in evaluating both the short- and long-term prognoses of cancer patients. It is recommended to use the inflammation marker-based GLIM criteria for nutritional evaluation of cancer patients.
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Affiliation(s)
- Hailun Xie
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Kaitao Yuan
- Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Guotian Ruan
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Lishuang Wei
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, 100020, Beijing, China
| | - Heyang Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Yizhong Ge
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Shiqi Lin
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Mengmeng Song
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Ziwen Wang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Chenan Liu
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Jinyu Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xiaoyue Liu
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Ming Yang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xin Zheng
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Yue Chen
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Xiaowei Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China.
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Wang W, Dai L, Ma J, Gu L, Xie H, Fu J. Malnutrition accelerates the occurrence of infectious complications in patients with chronic kidney disease: A cross-sectional survey of 682 patients with chronic kidney disease. Nutr Clin Pract 2023; 38:1167-1174. [PMID: 37461335 DOI: 10.1002/ncp.11040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/12/2023] [Accepted: 06/11/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND To investigate the influencing factors of infectious complications in patients with chronic kidney disease (CKD) and provide a basis for clinical diagnosis and prognosis evaluation of CKD. METHODS A total of 682 patients with CKD were selected and divided into CKD stage 1-5 subgroups according to their glomerular filtration rate. Infectious complications, length of hospital stay, and total cost of hospitalization were recorded. The Global Leadership Initiative on Malnutrition (GLIM) diagnostic tool was used to assess the detection rate of malnutrition among patients. Univariate and multivariate analyses were performed in patients with and without infectious complications. RESULTS The incidence rates of infectious complications in CKD stages 1-5 were 45.6%, 22.7%, 28.3%, 30.8%, and 40.4%, respectively. The overall detection rate of malnutrition among patients based on the GLIM criteria was 16.7%. The total detection rate of severe malnutrition was 14.2%, with all patients with severe malnutrition in CKD stages 3-5. The incidences of infectious complications in patients with and without malnutrition were 62.3% and 29%, respectively. Binary multivariate logistic regression analysis shows that malnutrition is a risk factor for infectious complications in patients with CKD, who are at 2.41 times higher risk than patients without malnutrition. There were significant differences in length of hospital stay and hospitalization costs between the patients with CKD with and without infectious complications (P < 0.01). CONCLUSION Infectious complications are relatively common in patients with CKD. As CKD advances, the incidence of infectious complications increases. Moreover, malnutrition accelerates the occurrence of infectious complications in patients with CKD.
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Affiliation(s)
- Weihong Wang
- Department of Urology & Nephrology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Lili Dai
- Department of Urology & Nephrology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Jianwei Ma
- Department of Urology & Nephrology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Lingna Gu
- Department of Urology & Nephrology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Haofen Xie
- Department of Nursing, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Jianfei Fu
- Department of Medical Records and Statistics, The First Affiliated Hospital of Ningbo University, Ningbo, China
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Su H, Luo Q, Wang X, Yan W. Frailty combined with nutritional risk score in predicting postoperative complications of elderly patients with gastrointestinal malignancies. Asian J Surg 2023; 46:4240-4244. [PMID: 36653293 DOI: 10.1016/j.asjsur.2023.01.003] [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: 09/06/2022] [Revised: 11/28/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Exploring the predictive power of frailty combined with nutritional risk on postoperative complications in elderly gastrointestinal malignancies patients. METHODS Elderly patients who underwent gastrointestinal cancer surgery at Gastrointestinal Surgery Department of the Affiliated Hospital of Binzhou Medical University from August 2021 to June 2022 were selected as the research subjects. The patients' frailty and nutritional status were assessed using the Fried Frailty Scale and the NRS2002 Nutritional Risk Scale within 24 h of admission. Observing and recording the diagnosis and treatment of postoperative complications during the hospitalization. RESULTS 202 patients were enrolled, including 119 patients (58.91%) with nutritional risk and 89 patients (44.06%) with frailty. Frailty was an independent risk factor for postoperative complications [OR = 5.904, 95%CI (3.103, 11.233)]. The AUC value of frailty assessment was 0.780, which was greater than the AUC value of NRS2002 score of 0.705 (P < 0.01). The AUC value of frailty assessment combined with NRS-2002 score was 0.844, which was significantly higher than that alone (P < 0.01). CONCLUSIONS The ability of frailty to predict postoperative complications is better than the NRS-2002 score. Frailty combined with nutritional risk assessment can increase the predictive power of postoperative complications in elderly gastrointestinal malignancies patients.
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Affiliation(s)
- Hongxia Su
- Binzhou Medical University, 256603, Binzhou, China
| | - Qianqian Luo
- Binzhou Medical University, 256603, Binzhou, China
| | - Xiuzhen Wang
- Department of Gastrointestinal Surgery, Binzhou Medical University Hospital, 256603, Binzhou, China
| | - Wanhua Yan
- Binzhou Medical University, 256603, Binzhou, 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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Stefani GP, Crestani MS, Scott LM, Soares CH, Steemburgo T. Complementarity of nutritional assessment tools to predict prolonged hospital stay and readmission in older patients with solid tumors: A secondary analysis of a cohort study. Nutrition 2023; 113:112089. [PMID: 37354653 DOI: 10.1016/j.nut.2023.112089] [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: 03/10/2023] [Revised: 04/06/2023] [Accepted: 05/19/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the complementarity of five nutritional risk screening tools (Nutritional Risk Screening 2002 [NRS-2002], Malnutrition Screening Tool [MST], Malnutrition Universal Screening Tool [MUST], Mini-Nutritional Assessment-Short Form [MNA-SF], and Patient-Generated Subjective Global Assessment SF [PG-SGA SF]) combined with three malnutrition diagnostic tools (SGA, PG-SGA, and Global Leadership Initiative on Malnutrition [GLIM]) and their ability to predict poor clinical outcomes in older patients with cancer. METHODS Using data collected within 48 h of hospital admission, we conducted a prospective cohort study on nutritional risk (NRS-2002, MST, MUST, MNA-SF, and PG-SGA SF) and the presence of malnutrition (SGA, PG-SGA, and GLIM). Patients were grouped according to their nutritional risk and malnutrition status. Accuracy tests and logistic regression analysis were used to evaluate the ability of the combined tools to predict hospital length of stay and readmission. We evaluated 248 older patients (69.7 ± 7.2 y of age, 59.7% men; 27.4% with gastrointestinal tumors). The median length of stay was 4 d (3-9 d), and 65.3% of patients remained hospitalized for ≥ 4 d. RESULTS The NRS-2002 combined with SGA and MST combined with SGA and GLIM had the highest specificity (> 80%) for predicting hospitalization. Nutritional risk assessed by MNA-SF and malnutrition assessed by PG-SGA were associated with 2.48- and 6.04-fold increased likelihood of hospitalization (≥ 4 d) and readmission (60 d), respectively. CONCLUSION Concomitant application of MNA-SF (specific for older patients) with PG-SGA (specific for patients with cancer) might enhance the ability to predict length of stay and readmission in hospitalized older patients with solid tumors.
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Affiliation(s)
- Giovanna Potrick Stefani
- Postgraduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto, Alegre, Brazil
| | - Mariana Scortegagna Crestani
- Postgraduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto, Alegre, Brazil
| | - Laura Machado Scott
- Hospital de Clínicas de Porto Alegre, Porto, Alegre, Brazil; Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Camilla Horn Soares
- Hospital de Clínicas de Porto Alegre, Porto, Alegre, Brazil; Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Thais Steemburgo
- Postgraduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto, Alegre, Brazil; Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Muscaritoli M, Imbimbo G, Jager-Wittenaar H, Cederholm T, Rothenberg E, di Girolamo FG, Amabile MI, Sealy M, Schneider S, Barazzoni R, Biolo G, Molfino A. Disease-related malnutrition with inflammation and cachexia. Clin Nutr 2023; 42:1475-1479. [PMID: 37302879 DOI: 10.1016/j.clnu.2023.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
In 2010, the definition of cachexia was jointly developed by the European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Groups (SIG) "Cachexia-anorexia in chronic wasting diseases" and "Nutrition in geriatrics". Cachexia was considered as a synonym of disease-related malnutrition (DRM) with inflammation by the ESPEN guidelines on definitions and terminology of clinical nutrition. Starting from these concepts and taking into account the available evidence the SIG "Cachexia-anorexia in chronic wasting diseases" conducted several meetings throughout 2020-2022 to discuss the similarities and differences between cachexia and DRM, the role of inflammation in DRM, and how it can be assessed. Moreover, in line with the Global Leadership Initiative on Malnutrition (GLIM) framework, in the future the SIG proposes to develop a prediction score to quantify the individual and combined effect(s) of multiple muscle and fat catabolic mechanisms, reduced food intake or assimilation and inflammation, which variably contribute to the cachectic/malnourished phenotype. This DRM/cachexia risk prediction score could consider the factors related to the direct mechanisms of muscle catabolism separately from those related to the reduction of nutrient intake and assimilation. Novel perspectives in the field of DRM with inflammation and cachexia were identified and described in the report.
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Affiliation(s)
- Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - Giovanni Imbimbo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands; Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Research Unit Experimental Anatomy, Faculty of Physical Education and Physiotherapy, Department of Physiotherapy and Human Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Uppsala University, Sweden; Theme Inflammation & Aging, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Maria Ida Amabile
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Martine Sealy
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Stéphane Schneider
- Gastroenterology and Nutrition, Nice University Hospital, Université Côte d'Azur, Nice, France
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Gianni Biolo
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
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Mękal D, Sobocki J, Badowska-Kozakiewicz A, Sygit K, Cipora E, Bandurska E, Czerw A, Deptała A. Evaluation of Nutritional Status and the Impact of Nutritional Treatment in Patients with Pancreatic Cancer. Cancers (Basel) 2023; 15:3816. [PMID: 37568634 PMCID: PMC10417457 DOI: 10.3390/cancers15153816] [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: 06/14/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Patients with pancreatic cancer who develop irreversible cancer cachexia have a life expectancy of less than 3 months. Therefore, it is extremely important to evaluate the patient's nutritional status as early as possible and to implement an appropriate nutritional intervention in order to reduce the risk of further weight loss and/or muscle loss, which affect the outcomes of cancer treatment and the correct nutritional treatment in patients with pancreatic cancer. A literature review was performed by using the PubMed and Cochrane quick search methodology. The main purpose of this review was to present the current approach to nutritional treatment in pancreatic cancer. The review included publications, most of which concerned clinical nutrition as part of the phase of treatment of patients with pancreatic cancer, nutritional and metabolic disorders in pancreatic cancer, and the period after pancreatic resection. Some of the publications concerned various nutritional interventions in patients with pancreatic cancer undergoing chemotherapy or surgical treatment (nutritional support before surgery, after surgery, or during palliative treatment). There is an unmet need for integrated nutritional therapy as a key part of the comprehensive care process for PC patients. Nutritional counseling is the first line of nutritional treatment for malnourished cancer patients, but pancreatic enzyme replacement therapy also constitutes the cornerstone of nutritional treatment for relieving symptoms of indigestion and maintaining or improving nutritional status.
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Affiliation(s)
- Dominika Mękal
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.B.-K.); (A.D.)
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre for Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Anna Badowska-Kozakiewicz
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.B.-K.); (A.D.)
| | - Katarzyna Sygit
- Faculty of Health Sciences, Calisia University, 62-800 Kalisz, Poland;
| | - Elżbieta Cipora
- Medical Institute, Jan Grodek State University, 38-500 Sanok, Poland;
| | - Ewa Bandurska
- Center for Competence Development, Integrated Care and e-Health, Medical University of Gdansk, 80-204 Gdansk, Poland;
| | - Aleksandra Czerw
- Department of Health Economics and Medical Law, Medical University of Warsaw, 01-445 Warsaw, Poland;
- Department of Economic and System Analyses, National Institute of Public Health NIH-National Research Institute, 00-791 Warsaw, Poland
| | - Andrzej Deptała
- Department of Oncology Propaedeutics, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.B.-K.); (A.D.)
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Bian W, Li Y, Wang Y, Chang L, Deng L, Li Y, Jiang H, Zhou P. Prevalence of malnutrition based on global leadership initiative in malnutrition criteria for completeness of diagnosis and future risk of malnutrition based on current malnutrition diagnosis: systematic review and meta-analysis. Front Nutr 2023; 10:1174945. [PMID: 37469547 PMCID: PMC10352804 DOI: 10.3389/fnut.2023.1174945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Background The proposal of the global leadership initiative in malnutrition (GLIM) criteria has received great attention from clinicians. The criteria are mainly used in the research environment and have the potential to be widely used in the clinic in the future. However, the prevalence of malnutrition and risk of future malnutrition based on a current diagnosis of malnutrition are worth exploring. Methods A systematic search of PubMed, Embase, and the Cochrane Library was performed from the earliest available date to 1 February 2023. According to the diagnostic criteria of the GLIM, we analysed the prevalence of malnutrition by directly adopting the GLIM criteria for diagnosis without a previous nutritional risk screening (one-step approach) and by adopting the GLIM criteria for diagnosis after a nutritional risk screening (two-step approach). The main outcome was the prevalence of malnutrition based on the one-and two-step approaches. Secondary outcomes were the future risk of malnutrition based on the GLIM diagnosis, including mortality within and beyond 1 year. primary outcomes were pooled using random-effects models, and secondary outcomes are presented as hazard ratios (HRs) and 95% confidence intervals (CIs). Results A total of 64 articles were included in the study, including a total of 47,654 adult hospitalized patients and 15,089 malnourished patients based on the GLIM criteria. Malnutrition was diagnosed by the one-step approach in 18 studies and by the two-step approach in 46 studies. The prevalence of malnutrition diagnosed by the one-and two-step approaches was 53% (95% CI, 42%-64%) and 39% (95% CI, 0.35%-0.43%), respectively. The prevalence of malnutrition diagnosed by the GLIM criteria after a nutritional risk screening was quite different; the prevalence of malnutrition diagnosed by the Nutritional Risk Screening 2002 (NRS2002) GLIM tool was 35% (95% CI, 29%-40%); however, the prevalence of malnutrition diagnosed by the Mini Nutrition Assessment (MNA) GLIM tool was 48% (95% CI, 35%-62%). Among the disease types, the prevalence of malnutrition in cancer patients was 44% (95% CI, 36%-52%), while that in acute and critically ill patients was 44% (95% CI, 33%-56%). The prevalence in patients in internal medicine wards was 40% (95% CI, 34%-45%), while that in patients in surgical wards was 47% (95% CI, 30%-64%). In addition, the mortality risk within 1 year (HR, 2.62; 95% CI, 1.95-3.52; I2 = 77.1%) and beyond 1 year (HR, 2.04; 95% CI, 1.70-2.45; I2 = 59.9%) of patients diagnosed with malnutrition by the GLIM criteria was double that of patients with normal nutrition. Conclusion The prevalence of malnutrition diagnosed by the GLIM criteria after a nutritional risk screening was significantly lower than the prevalence of malnutrition diagnosed directly by the GLIM criteria. In addition, the mortality risk was significantly greater among malnourished patients assessed by the GLIM criteria.Systematic review registration: identifier CRD42023398454.
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Affiliation(s)
- Wentao Bian
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi Li
- Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yu Wang
- Institute of Emergency and Disaster Medicine, Provincial People’s Hospital, Chengdu, China
| | - Li Chang
- Sichuan Provincial People’s Hospital, Chengdu, China
| | - Lei Deng
- Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yulian Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hua Jiang
- Institute of Emergency and Disaster Medicine, Provincial People’s Hospital, Chengdu, China
| | - Ping Zhou
- Sichuan Provincial People’s Hospital, Chengdu, China
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Zheng HL, Lin J, Shen LL, Yang HB, Xu BB, Xue Z, Wu D, Huang JB, Lin GS, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lu J, Huang CM. The GLIM criteria as an effective tool for survival prediction in gastric cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:964-973. [PMID: 36958948 DOI: 10.1016/j.ejso.2023.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/26/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition released a new version of the malnutrition criteria (GLIM criteria). To investigate the influence of the GLIM criteria on the long-term efficacy of radical gastric cancer surgery and establish a nomogram to predict the long-term prognosis of patients with gastric cancer. METHODS A retrospective analysis of 1121 patients with gastric cancer in our department from 2010 to 2013 was performed. A nomogram was established to predict overall survival (OS) based on the GLIM criteria. Patients were divided into the low-risk group (LRG) and high-risk group (HRG) based on the established nomogram. RESULTS Multivariate Cox regression analyses showed that GLIM criteria was an independent risk factor for the 5-year OS (HR = 1.768, Cl:1.341-2.329, p < 0.001). The C index, AUC and Time-ROC of the nomogram were significantly better than that of GLIM criteria and traditional criteria. The 5-year OS of patients receiving adjuvant chemotherapy in the high-risk group was significantly higher than that of patients without chemotherapy (45.77% vs. 24.73%,p < 0.001). CONCLUSIONS The GLIM criteria independently influence the long-term outcome of patients after radical gastric cancer surgery. The established nomogram can predict the long-term survival of patients with gastric cancer, and postoperative adjuvant chemotherapy for HRG can significantly improve the 5-year OS of patients.
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Affiliation(s)
- Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Li-Li Shen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hai-Bo Yang
- Department of General Surgery, People's Hospital of Guyuan City, Ningxia, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jiao-Bao Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Guo-Sheng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
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Sánchez-Rodríguez D, De Meester D, Minon L, Claessens M, Gümüs N, Lieten S, Benoit F, Surquin M, Marco E. Association between Malnutrition Assessed by the Global Leadership Initiative on Malnutrition Criteria and Mortality in Older People: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5320. [PMID: 37047936 PMCID: PMC10094645 DOI: 10.3390/ijerph20075320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/06/2023] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
The Global Leadership Initiative on Malnutrition (GLIM) criteria were introduced in 2018 for the diagnosis of malnutrition in adults. This review was aimed at gathering the evidence about the association between malnutrition according to the GLIM criteria and mortality in older people, an emerging and clinically meaningful topic in the implementation of the GLIM criteria in geriatric healthcare settings. This scoping review considered meta-analyses, systematic reviews, cohort studies, and cross-sectional studies published in PubMed, Scopus, and the Cochrane Database for Systematic Reviews from the development of the GLIM criteria in 2018 to January 2023. Seventeen articles (15 cohort and 2 cross-sectional studies) were included. The association between GLIM criteria and mortality had been assessed in hospitalized (11 over the 17 articles) and community-dwelling older populations, and those in nursing homes. The review found a strong association between malnutrition according to GLIM criteria and mortality in hospitalized (1.2-fold to 7-fold higher mortality) and community-dwelling older people (1.6-fold to 4-fold higher mortality). These findings highlight the prognostic value of the GLIM criteria and support strategies towards the implementation of malnutrition evaluation according to the GLIM, in order to optimize comprehensive geriatric assessment and provide older people with the highest quality of nutritional care. Studies in nursing home populations were very scarce and may be urgently required.
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Affiliation(s)
- Dolores Sánchez-Rodríguez
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Dr. Aiguader, 88, 08003 Barcelona, Spain
- Geriatric Department, Centre Fòrum-Hospital del Mar, Parc de Salut Mar, Llull, 410, 08029 Barcelona, Spain
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, 4000 Liège, Belgium
| | - Dorien De Meester
- Department of Geriatrics, Onze Lieve Vrouw Ziekehuis (OLV) Aalst, Moorselbaan 164, 9300 Aalst, Belgium
| | - Léa Minon
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
| | - Marie Claessens
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
| | - Neslian Gümüs
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
| | - Siddhartha Lieten
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette, 1090 Brussels, Belgium
| | - Florence Benoit
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
| | - Murielle Surquin
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
| | - Ester Marco
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM), Dr. Aiguader, 88, 08003 Barcelona, Spain
- Physical Medicine and Rehabilitation Department, Hospital del Mar-Hospital de L’Esperança, Parc de Salut Mar, Pg. Marítim de la Barceloneta, 25-29, 08003 Barcelona, Spain
- School of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, 08002 Barcelona, Spain
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Jiang X, Xu X, Ding L, Lu J, Xu H, Chen L, Xu Q. Preoperative low absolute and relative handgrip strength as predictors of postoperative short-term outcomes: a prospective study based on patients aged 60 years and older with gastric cancer. Eur Geriatr Med 2023; 14:251-262. [PMID: 36949226 DOI: 10.1007/s41999-023-00768-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/08/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE This study aimed to determine the association of absolute and relative HGS indicators with postoperative short-term outcomes in older patients with gastric cancer. METHODS The prospective, single-center, observational study involved 230 patients (age ≥ 60 years) who underwent radical gastrectomy. Absolute HGS was directly obtained from results measured by a hand dynamometer, while relative HGS was calculated as the value of absolute HGS divided by body mass index (BMI), appendicular skeletal muscle mass index (ASMI) and age, respectively. Low absolute HGS was defined according to the criterion in AWGS 2019 consensus and the first gender-specific quartile. Low relative handgrip strength was defined if it was below the first gender-specific quartile of the distribution. Postoperative outcomes included total complications, malnutrition and length of hospital stay. Univariate and multivariate regression models were performed to investigate and compare the predictive values of different HGS indicators. RESULTS For the five HGS indicators, multivariate analyses showed that low absolute HGS (AWGS consensus), low HGS/BMI and HGS/age were independent risk factors for both postoperative total complications (absolute HGS(AWGS consensus): OR 2.03, 95%CI:1.05-3.93; HGS/BMI: OR 2.12, 95%CI 1.05-4.28; HGS/age: OR 2.79, 95%CI 1.40-5.54) and malnutrition (absolute HGS(AWGS consensus): OR 2.01, 95%CI 1.10-3.67; HGS/BMI: OR 2.28, 95%CI 1.20-4.33; HGS/age: OR 2.70, 95%CI 1.42-5.14). Low absolute HGS (quartile) was an independent risk factor for malnutrition (OR 1.96, 95%CI 1.04-3.71). Moreover, Low HGS/age was associated with lengthened postoperative hospital stay (OR 2.07, 95%CI 1.12-3.85). CONCLUSIONS Except HGS/ASMI, both absolute and relative HGS indicators were associated with postoperative short-term outcomes. Particularly, HGS/age revealed relatively better predictive value for the studied outcomes.
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Affiliation(s)
- Xiaoman Jiang
- School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China
| | - Xinyi Xu
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Lingyu Ding
- School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China
| | - Jinling Lu
- Department of Gastric Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Xu
- Department of Gastric Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Chen
- Department of Gastric Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China.
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Wang X, Yang F, Zhu M, Cui H, Wei J, Li J, Chen W. Development and Assessment of Assisted Diagnosis Models Using Machine Learning for Identifying Elderly Patients With Malnutrition: Cohort Study. J Med Internet Res 2023; 25:e42435. [PMID: 36917167 PMCID: PMC10131894 DOI: 10.2196/42435] [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: 09/04/2022] [Revised: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Older patients are at an increased risk of malnutrition due to many factors related to poor clinical outcomes. OBJECTIVE This study aims to develop an assisted diagnosis model using machine learning (ML) for identifying older patients with malnutrition and providing the focus of individualized treatment. METHODS We reanalyzed a multicenter, observational cohort study including 2660 older patients. Baseline malnutrition was defined using the global leadership initiative on malnutrition (GLIM) criteria, and the study population was randomly divided into a derivation group (2128/2660, 80%) and a validation group (532/2660, 20%). We applied 5 ML algorithms and further explored the relationship between features and the risk of malnutrition by using the Shapley additive explanations visualization method. RESULTS The proposed ML models were capable to identify older patients with malnutrition. In the external validation cohort, the top 3 models by the area under the receiver operating characteristic curve were light gradient boosting machine (92.1%), extreme gradient boosting (91.9%), and the random forest model (91.5%). Additionally, the analysis of the importance of features revealed that BMI, weight loss, and calf circumference were the strongest predictors to affect GLIM. A BMI of below 21 kg/m2 was associated with a higher risk of GLIM in older people. CONCLUSIONS We developed ML models for assisting diagnosis of malnutrition based on the GLIM criteria. The cutoff values of laboratory tests generated by Shapley additive explanations could provide references for the identification of malnutrition. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-EPC-14005253; https://www.chictr.org.cn/showproj.aspx?proj=9542.
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Affiliation(s)
- Xue Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengchun Yang
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingwei Zhu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Hongyuan Cui
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Junmin Wei
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jiao Li
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Matsuda A, Yamada T, Ohta R, Sonoda H, Shinji S, Iwai T, Takeda K, Yonaga K, Ueda K, Kuriyama S, Miyasaka T, Yoshida H. Surgical Site Infections in Gastroenterological Surgery. J NIPPON MED SCH 2023; 90:2-10. [PMID: 35644555 DOI: 10.1272/jnms.jnms.2023_90-102] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Surgical site infections (SSIs) remain one of the most common serious surgical complications and are the second most frequent healthcare-associated infection. Patients with SSIs have a significantly increased postoperative length of hospital stay, hospital expenses, and mortality risk compared with patients without SSIs. The prevention of SSI requires the integration of a range of perioperative measures, and approximately 50% of SSIs are preventable through the implementation of evidence-based preventative strategies. Several international guidelines for SSI prevention are currently available worldwide. However, there is an urgent need for SSI prevention guidelines specific to Japan because of the differences in the healthcare systems of Japan versus western countries. In 2018, the Japan Society for Surgical Infection published SSI prevention guidelines for gastroenterological surgery. Although evidence-based SSI prevention guidelines are now available, it is important to consider the appropriateness of these guidelines depending on the actual conditions in each facility. A systemic inflammatory host response is a hallmark of bacterial infection, including SSI. Therefore, blood inflammatory markers are potentially useful in SSI diagnosis, outcome prediction, and termination of therapeutic intervention. In this review, we describe the current guideline-based perioperative management strategies for SSI prevention, focusing on gastroenterological surgery and the supplemental utility of blood inflammatory markers.
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Affiliation(s)
- Akihisa Matsuda
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Takeshi Yamada
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Ryo Ohta
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Hiromichi Sonoda
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Seiichi Shinji
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Takuma Iwai
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Kohki Takeda
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Kazuhide Yonaga
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Koji Ueda
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Sho Kuriyama
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Toshimitsu Miyasaka
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Hiroshi Yoshida
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
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