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Chen J, Luo D, Sun C, Sun X, Dai C, Hu X, Wu L, Lei H, Ding F, Chen W, Li X. Predicting COVID-19 Re-Positive Cases in Malnourished Older Adults: A Clinical Model Development and Validation. Clin Interv Aging 2024; 19:421-437. [PMID: 38487375 PMCID: PMC10937181 DOI: 10.2147/cia.s449338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
Purpose Building and validating a clinical prediction model for novel coronavirus (COVID-19) re-positive cases in malnourished older adults. Patients and Methods Malnourished older adults from January to May 2023 were retrospectively collected from the Department of Geriatrics of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. They were divided into a "non-re-positive" group and a "re-positive" group based on the number of COVID-19 infections, and into a training set and a validation set at a 7:3 ratio. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to identify predictive factors for COVID-19 re-positivity in malnourished older adults, and a nomogram was constructed. Independent influencing factors were screened by multivariate logistic regression. The model's goodness-of-fit, discrimination, calibration, and clinical impact were assessed by Hosmer-Lemeshow test, area under the curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CIC), respectively. Results We included 347 cases, 243 in the training set, and 104 in the validation set. We screened 10 variables as factors influencing the outcome. By multivariate logistic regression analysis, preliminary identified protective factors, risk factors, and independent influencing factors that affect the re-positive outcome. We constructed a clinical prediction model for COVID-19 re-positivity in malnourished older adults. The Hosmer-Lemeshow test yielded χ2 =5.916, P =0.657; the AUC was 0.881; when the threshold probability was >8%, using this model to predict whether malnourished older adults were re-positive for COVID-19 was more beneficial than implementing intervention programs for all patients; when the threshold was >80%, the positive estimated value was closer to the actual number of cases. Conclusion This model can help identify the risk of COVID-19 re-positivity in malnourished older adults early, facilitate early clinical decision-making and intervention, and have important implications for improving patient outcomes. We also expect more large-scale, multicenter studies to further validate, refine, and update this model.
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Affiliation(s)
- Jiao Chen
- Geriatric Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Danmei Luo
- Geriatric Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Chengxia Sun
- Geriatric Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Xiaolan Sun
- Geriatric Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Changmao Dai
- Geriatric Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Xiaohong Hu
- Geriatric Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Liangqing Wu
- Geriatric Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Haiyan Lei
- Geriatric Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Fang Ding
- Geriatric Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Wei Chen
- Geriatric Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Xueping Li
- Geriatric Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
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Zhang L, Wang K, Kuang T, Deng W, Hu P, Wang W. Low geriatric nutritional risk index as a poor prognostic biomarker for immune checkpoint inhibitor treatment in solid cancer. Front Nutr 2023; 10:1286583. [PMID: 38024341 PMCID: PMC10646500 DOI: 10.3389/fnut.2023.1286583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Objective In this investigation, we focused on the geriatric nutritional risk index (GNRI), a comprehensive metric that takes into account the patient's ideal weight, actual weight, and serum albumin levels to measure malnutrition. Our primary objective was to examine the predictive value of GNRI-defined malnutrition in determining the response to immunotherapy among cancer patients. Methods Relevant articles for this study were systematically searched in PubMed, the Cochrane Library, EMBASE, and Google Scholar up to July 2023. Our analysis evaluated overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) as clinical outcomes. Results This analysis comprised a total of eleven articles encompassing 1,417 patients. The pooled results revealed that cancer patients with low GNRI levels exhibited shorter OS (HR: 2.64, 95% CI: 2.08-3.36, p < 0.001) and PFS (HR: 1.87, 95% CI: 1.46-2.41, p < 0.001), and lower ORR (OR: 0.46, 95% CI: 0.33-0.65, p < 0.001) and DCR (OR: 0.42, 95% CI: 0.29-0.61, p < 0.001). Sensitivity analyses confirmed that the above results were stable. Egger's and Begg's tests revealed that there was no publication bias in the above results. Conclusion Our results imply that the GNRI is a useful predictor of immunotherapy response in cancer patients.
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Affiliation(s)
- Lilong Zhang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Kunpeng Wang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Tianrui Kuang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Wenhong Deng
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Peng Hu
- Department of Emergency, Renmin Hospital of Wuhan University, Wuhan, China
| | - Weixing Wang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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Feliu J, Custodio AB, Pinto-Marín A, Higuera O, Pérez-González M, del Pino L, Ruiz-Jiménez L, Sánchez-Cabero D, Viera I, Jurado A, Espinosa E. Predicting Risk of Severe Toxicity and Early Death in Older Adult Patients Treated with Chemotherapy. Cancers (Basel) 2023; 15:4670. [PMID: 37760638 PMCID: PMC10526243 DOI: 10.3390/cancers15184670] [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: 07/18/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Determining the risk of grade 3-5 toxicity and early death (ED) is important to plan chemotherapy in older adult patients with cancer. Our objective was to identify factors predicting these complications at the time of treatment initiation. METHODS 234 patients aged ≥70 were subjected to a geriatric assessment and variables related to the tumor and the treatment were also collected. Logistic regression multivariable analysis was used to relate these factors with the appearance of grade 3-5 toxicity and ED. Predictive scores for both toxicity and ED were then developed. RESULTS Factors related to grade 3-5 toxicity were hemoglobin, MAX2 index, ADL, and the CONUT score. Factors related to ED were tumor stage and the GNRI score. Two predictive scores were developed using these variables. ROC curves for the prediction of toxicity and ED were 0.71 (95% CI: 0.64-0.78) and 0.73 (95% CI: 0.68-0.79), respectively. CONCLUSIONS Two simple and reliable scores were developed to predict grade 3-5 toxicity and ED in older adult patients with cancer. This may be helpful in treatment planning.
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Affiliation(s)
- Jaime Feliu
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
- Cátedra UAM-AMGEN de Oncología Médica y Medicina Paliativa, Facultad de Medicina, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red del Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ana Belén Custodio
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
- Centro de Investigación Biomédica en Red del Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alvaro Pinto-Marín
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Oliver Higuera
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Miriam Pérez-González
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Laura del Pino
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Leticia Ruiz-Jiménez
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Darío Sánchez-Cabero
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Isabel Viera
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Ana Jurado
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
| | - Enrique Espinosa
- Oncology Department, Hospital La Paz Institute for Health Research—IdiPAZ, Hospital Universitario La Paz, 28029 Madrid, Spain; (A.B.C.); (A.P.-M.); (O.H.); (M.P.-G.); (L.d.P.); (L.R.-J.); (D.S.-C.); (I.V.); (A.J.); (E.E.)
- Cátedra UAM-AMGEN de Oncología Médica y Medicina Paliativa, Facultad de Medicina, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red del Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Suzuki E, Kawata N, Shimada A, Sato H, Anazawa R, Suzuki M, Shiko Y, Yamamoto M, Ikari J, Tatsumi K, Suzuki T. Prognostic Nutritional Index (PNI) as a Potential Prognostic Tool for Exacerbation of COPD in Elderly Patients. Int J Chron Obstruct Pulmon Dis 2023; 18:1077-1090. [PMID: 37309393 PMCID: PMC10257926 DOI: 10.2147/copd.s385374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 04/28/2023] [Indexed: 06/14/2023] Open
Abstract
Purpose In COPD, exacerbation of the disorder causes a deterioration in the quality-of-life and worsens respiratory dysfunction, leading to a poor prognosis. In recent years, nutritional indices have been reported as significant prognostic factors in various chronic diseases. However, the relationship between nutritional indicators and prognosis in elderly subjects with COPD has not been investigated. Patients and methods We enrolled 91 subjects who received COPD assessment tests (CAT), spirometry, blood tests, and multidetector computed tomography (MDCT). We divided the subjects into two groups according to age (<75 years (n=57) and ≥ 75 years (n=34)). The prognostic nutritional index (PNI) was used to assess immune-nutritional status and was calculated as 10 x serum albumin + 0.005 x total lymphocyte count. We then examined the relationship between PNI and clinical parameters, including exacerbation events. Results There was no significant correlation between the PNI and CAT, the FEV1%pred, or low attenuation volume percentage (LAV%). In the elderly group, there were significant differences between the groups with or without exacerbation in the CAT and PNI (p=0.008, p=0.004, respectively). FEV1%pred, neutrophil-to-lymphocyte ratio (NLR) and LAV% did not differ between the two groups. The analytical model combining CAT and PNI improved the prediction of exacerbations in the elderly subjects (p=0.0068). Conclusion In elderly subjects with COPD, CAT were associated significantly with the risk of COPD exacerbation, with PNI also a potential predictor. The combined assessment of CAT and PNI may be a useful prognostic tool in subjects with COPD.
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Affiliation(s)
- Eiko Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
| | - Naoko Kawata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
| | - Ayako Shimada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
- Department of Respirology, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, 215-0026, Japan
| | - Hirotaka Sato
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
- Department of Radiology, Soka Municipal Hospital, Souka-shi, Saitama, 340-8560, Japan
| | - Rie Anazawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
- Department of Infectious Diseases, NTT Medical Center Tokyo, Tokyo, 141-8625, Japan
| | - Masaki Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
- Department of Respirology, Kashiwa Kousei General Hospital, Kashiwa-shi, Chiba-ken, 277-8551, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba-shi, 260-8670, Japan
| | - Mayumi Yamamoto
- Department of Palliative Care Medicine, Chiba Rosai Hospital, Chiba-shi, Chiba, 290-0003, Japan
| | - Jun Ikari
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
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Rau CS, Tsai CH, Chou SE, Su WT, Hsu SY, Hsieh CH. The Addition of the Geriatric Nutritional Risk Index to the Prognostic Scoring Systems Did Not Improve Mortality Prediction in Trauma Patients in the Intensive Care Unit. Emerg Med Int 2023; 2023:3768646. [PMID: 37293272 PMCID: PMC10247323 DOI: 10.1155/2023/3768646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/20/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
Background Malnutrition is prevalent among critically ill patients and has been associated with a poor prognosis. This study sought to determine whether the addition of a nutritional indicator to the various variables of prognostic scoring models can improve the prediction of mortality among trauma patients in the intensive care unit (ICU). Methods This study's cohort included 1,126 trauma patients hospitalized in the ICU between January 1, 2018, and December 31, 2021. Two nutritional indicators, the prognostic nutrition index (PNI), a calculation based on the serum albumin concentration and peripheral blood lymphocyte count, and the geriatric nutritional risk index (GNRI), a calculation based on the serum albumin concentration and the ratio of current body weight to ideal body weight, were examined for their association with the mortality outcome. The significant nutritional indicator was served as an additional variable in prognostic scoring models of the Trauma and Injury Severity Score (TRISS), the Acute Physiology and Chronic Health Evaluation (APACHE II), and the mortality prediction models (MPM II) at admission, 24, 48, and 72 h in the mortality outcome prediction. The predictive performance was determined by the area under the receiver operating characteristic curve. Results Multivariate logistic regression revealed that GNRI (OR, 0.97; 95% CI, 0.96-0.99; p=0.007), but not PNI (OR, 0.99; 95% CI, 0.97-1.02; p=0.518), was independent risk factor for mortality. However, none of these predictive scoring models showed a significant improvement in prediction when the GNRI variable is incorporated. Conclusions The addition of GNRI as a variable to the prognostic scoring models did not significantly enhance the performance of the predictors.
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Affiliation(s)
- Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Deng M, Lu Y, Zhang Q, Bian Y, Zhou X, Hou G. Global prevalence of malnutrition in patients with chronic obstructive pulmonary disease: Systemic review and meta-analysis. Clin Nutr 2023; 42:848-858. [PMID: 37084471 DOI: 10.1016/j.clnu.2023.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/22/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Malnutrition is a significant comorbidity among chronic obstructive pulmonary disease (COPD), but it has been often ignored. To date, the prevalence of malnutrition and its association with clinical parameters in the patients with COPD have not been well described. We aimed to investigate the prevalence of malnutrition and the prevalence of at-risk for malnutrition among COPD and the clinical impact of malnutrition on patients with COPD in a systematic review and meta-analysis. METHODS PubMed, Embase, Cochrane Library, and Web of Science were searched for articles describing the prevalence of malnutrition and/or at-risk for malnutrition from January 2010 to December 2021. Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Meta-analyses were performed to determine the prevalence of malnutrition and at-risk for malnutrition and the clinical impact of malnutrition on patients with COPD. Meta-regression and subgroup analyses were performed to explore the sources of heterogeneity. Comparisons were made between individuals with and without malnutrition according to pulmonary function, degree of dyspnea, exercise capacity, and mortality risk. RESULTS Out of the 4156 references identified, 101 were read full-text, of which 36 studies were included. The total number of involved patients included in this meta-analysis was 5289. The prevalence of malnutrition was 30.0% (95% CI 20.3 to 40.6), compared with an at-risk prevalence of 50.0% (95% CI 40.8 to 59.2). Both prevalences were associated with regions and measurement tools. The prevalence of malnutrition was associated with COPD phase (acute exacerbations and stable). COPD with malnutrition showed lower forced expiratory volume 1 s % predicted (mean difference (MD) -7.19, 95% CI -11.86 to -2.52), higher modified Medical Research Council dyspnea scores (MD 0.38, 95% CI 0.12 to 0.64), poorer exercise tolerance (standardized mean difference -0.29, 95% CI -0.54 to -0.05), and higher mortality risk (hazard ratio 2.24, 95% CI 1.23 to 4.06) compared to COPD without malnutrition. CONCLUSION Malnutrition and at-risk for malnutrition are common among COPD. Malnutrition negatively impacts important clinical outcomes of COPD.
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Affiliation(s)
- Mingming Deng
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Ye Lu
- Department of Respiratory and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Qin Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Yiding Bian
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoming Zhou
- Respiratory Department, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.
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Peng JC, Zhu YW, Xing SP, Li W, Gao Y, Gong WW. Association of geriatric nutritional risk index with all-cause hospital mortality among elderly patients in intensive care unit. Front Nutr 2023; 10:1117054. [PMID: 37032766 PMCID: PMC10076778 DOI: 10.3389/fnut.2023.1117054] [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: 12/06/2022] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Background Malnutrition is associated with poor outcomes for geriatric patients in intensive care unit (ICU). It is important to identify patients at risk of malnutrition and provide individual nutrition support. The assessment of malnutrition risk is not easy for these patients due to their cognitive impairment. Geriatric nutrition risk index (GNRI) is a simple and objective scoring tool to evaluate the risk of malnutrition in elderly patients. In this study, we aimed to see whether GNRI score was appropriate to predict clinical outcomes among geriatric patients in the setting of ICU. Materials and methods Elderly patients with age ≥ 65 years were extracted from Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Categories based on GNRI were classified as major risk (GNRI <82), moderate risk (GNRI 82 to <92), low risk (GNRI 92 to ≤98), and no risk (GNRI >98). The primary outcome was all-cause hospital mortality. Multivariable Cox proportional hazards regression models and restricted cubic spline were used to investigate associations of GNRI with hospital mortality, respectively. A two-piecewise linear regression model was applied to examine the inflection point of GNRI on hospital mortality. To reduce selection bias, propensity score matching (PSM) was used in a 1:1 ratio. Results A total of 3,696 geriatric patients were finally included with median age 75 (69, 81) years. The prevalence of major risk was 28.6%. In the fully adjusted model, GNRI categories featured a negative trend with hospital mortality (p for trend = 0.037). Restricted cubic spline analysis demonstrated an L-shaped relationship between GNRI and hospital mortality before and after matching. The inflection point was 78.7. At the left side of inflection point, GNRI levels were significantly negatively associated with hospital mortality (HR = 0.96, 95% CI: 0.94-0.98; p < 0.001) and featured no significant relations at the right side. Multiple linear regression also showed that GNRI was negatively associated with length of stay in hospital. Conclusion The major risk of malnutrition defined by GNRI was able to predict poor prognosis for geriatric patients admitted to ICU.
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Affiliation(s)
- Jiang-Chen Peng
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Wei Zhu
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shun-Peng Xing
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Li
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Gao
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Wen Gong
- Department of Critical Care, Shanghai Baoshan Luodian Hospital, Shanghai, China
- *Correspondence: Wen-Wen Gong,
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The prognostic significance of Geriatric nutritional risk index in elderly patients with bladder cancer after radical cystectomy. Asian J Surg 2022; 46:2178-2179. [PMID: 36528529 DOI: 10.1016/j.asjsur.2022.11.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
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Mao Y, Lan J. Prognostic value of the geriatric nutritional index in colorectal cancer patients undergoing surgical intervention: A systematic review and meta-analysis. Front Oncol 2022; 12:1066417. [PMID: 36518324 PMCID: PMC9743169 DOI: 10.3389/fonc.2022.1066417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/08/2022] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND We reviewed the literature to assess the prognostic ability of the geriatric nutritional risk index (GNRI) for patients with colorectal cancer (CRC) undergoing curative surgery. METHODS The online databases of PubMed, CENTRAL, ScienceDirect, Embase, and Google Scholar were searched for articles reporting the relationship between GNRI and outcomes in CRC patients. English language studies were searched up to 28th April 2022. RESULTS Ten studies with 3802 patients were included. Meta-analysis indicated that patients with low GNRI had significantly poor overall survival (HR: 2.41 95% CI: 1.72, 3.41 I2 = 68%) and disease-free survival (HR: 1.92 95% CI: 1.47, 2.49 I2 = 49%) as compared to those with high GNRI. The meta-analysis also indicated a significantly higher risk of complications with low GNRI as compared to high GNRI (HR: 1.98 95% CI: 1.40, 2.82 I2 = 0%). The results did not change on subgroup analysis based on study location, age group, GNRI cut-off, and sample size. CONCLUSION Current evidence indicates that GNRI can be a valuable prognostic indicator for CRC patients undergoing surgical intervention. Patients with low GNRI have poor overall and disease-free survival and a higher incidence of complications. Clinicians could use this simple indicator to stratify patients and formulate personalized treatment plans. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier (CRD42022328374).
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Affiliation(s)
- Yiqing Mao
- Department of Gastrointestinal Surgery, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
| | - Jiarong Lan
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Medicine, Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Huzhou, China
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10
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Shen F, Ma Y, Guo W, Li F. Prognostic Value of Geriatric Nutritional Risk Index for Patients with Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Lung 2022; 200:661-669. [DOI: 10.1007/s00408-022-00567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/29/2022] [Indexed: 12/24/2022]
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11
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Wang J, Xing F, Sheng N, Xiang Z. Associations of the Geriatric Nutritional Risk Index With Femur Bone Mineral Density and Osteoporosis in American Postmenopausal Women: Data From the National Health and Nutrition Examination Survey. Front Nutr 2022; 9:860693. [PMID: 35656160 PMCID: PMC9152150 DOI: 10.3389/fnut.2022.860693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe geriatric nutritional risk index (GNRI) has been used as a significant tool to access the nutritional status of the elderly. However, the relationship between the GNRI and femur bone mineral density (BMD) and the risk of osteoporosis remains unclear in American postmenopausal women.ObjectivesWe aimed to explore associations between the GNRI with femur BMD and the risk of osteoporosis in American postmenopausal women.MethodsWe merged the continuous National Health and Nutrition Examination Survey (NHANES) 2005–2006, 2007–2008, 2009–2010, 2013–2014, and 2017–2018 to ensure a large and representative sample, including 3,152 participants. The linear relationship between the GNRI and femur BMD was assessed via a weighted multivariate linear regression model. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between the GNRI and the risk of osteoporosis were assessed by a weighted logistic regression model. Moreover, the nonlinear relationship was also characterized by smooth curve fitting (SCF) and a weighted generalized additive model (GAM).ResultsAfter adjusting for all covariates, the weighted multivariable linear regression models demonstrated that the GNRI was positively correlated with femur BMD. The weighted logistic regression models demonstrated that each unit of increased GNRI value was associated with a decreased risk of osteoporosis of 4.13%. When categorizing GNRI based on quartiles, ORs between the risk of osteoporosis and the GNRI across quintiles 2, 3, and 4 compared with quintile 1 were 0.5565 (95% CI: 0.4791, 0.6463; P < 0.000001), 0.5580 (95% CI: 0.4600, 0.6769; P < 0.000001), and 0.3475 (95% CI: 0.2681, 0.4505; P < 0.000001). The trends similar to the above were also observed in SCF and GAM.ConclusionThis study indicated that nutritional status, represented by the GNRI, was positively associated with femur BMD and negatively associated with the risk of osteoporosis in American postmenopausal women. The GNRI may be a good tool to identify American postmenopausal women who need further bone health nutritional support.
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12
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Zhou J, Fang P, Li X, Luan S, Xiao X, Gu Y, Shang Q, Zhang H, Yang Y, Zeng X, Yuan Y. Prognostic Value of Geriatric Nutritional Risk Index in Esophageal Carcinoma: A Systematic Review and Meta-Analysis. Front Nutr 2022; 9:831283. [PMID: 35399659 PMCID: PMC8990286 DOI: 10.3389/fnut.2022.831283] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/17/2022] [Indexed: 02/05/2023] Open
Abstract
Esophageal cancer (EC) is one of the most common cancers worldwide. Malnutrition often leads to poor prognosis of patients with EC. Geriatric nutritional risk index (GNRI) was reported as an objective nutrition-related risk index. We intend to comprehensively review evidence of GNRI in predicting EC prognosis. To explore the influence of GNRI on the long-term survival outcome of patients with EC, a meta-analysis was needed. We searched the Web of Science, Medline, Embase, and the Cochrane Library databases. The association between prognosis of patients with EC and GNRI was evaluated by pooling hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs). The fixed model or random model method was chosen according to the heterogeneity among the studies. Totally, 11 studies with 1785 patients who met the inclusion criteria were eventually included in our meta-analysis. Comparing the lower level GNRI group and the higher level GNRI group, the pooled results showed that lower GNRI had a negative impact on overall survival (OS) (HR: 1.75, 95% CI: 1.45–2.10, P < 0.01) and cancer-specific survival (CSS) (HR: 1.77, 95% CI: 1.19–2.62, P < 0.01), indicating that lower GNRI significantly predicted poor OS. In conclusion, lower GNRI could predict the poor prognosis of patients with EC. Meanwhile, more well-designed randomized controlled trials (RCTs) are needed to confirm the findings.
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Affiliation(s)
- Jianfeng Zhou
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Pinhao Fang
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Xiaokun Li
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Siyuan Luan
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Xin Xiao
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Yinmin Gu
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Qixin Shang
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Hanlu Zhang
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Yushang Yang
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
| | - Xiaoxi Zeng
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Yuan
- Department of Thoracic Surgery, Westchina Hospital, Sichuan University, Chengdu, China
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13
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Matsuura S, Shibazaki K, Uchida R, Imai Y, Mukoyama T, Shibata S, Morita H. Sarcopenia is associated with the Geriatric Nutritional Risk Index in elderly patients with poorly controlled type-2 diabetic mellitus. J Diabetes Investig 2022; 13:1366-1373. [PMID: 35290727 PMCID: PMC9340875 DOI: 10.1111/jdi.13792] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/06/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022] Open
Abstract
Aims/Introduction Diabetes and sarcopenia have a two‐way relationship with each other with advanced age. Additionally, malnutrition is correlated with a higher risk of sarcopenia in elderly patients. This study evaluated the association between sarcopenia and geriatric nutritional risk index (GNRI) in elderly patients with type 2 diabetes mellitus. Materials and Methods Patients with type 2 diabetes mellitus aged ≥60 years were recruited from June 2018 to August 2020. This study analyzed 234 patients, who completed a physical performance test required for the diagnosis of sarcopenia. To investigate the effect of GNRI on sarcopenia, logistic regression analyses was used. Results Patients with sarcopenia were significantly older with a lower body mass index (BMI) and GNRI compared with normal patients. The GNRI showed a positive correlation with the skeletal muscle index (SMI) and handgrip strength (SMI: R = 0.486, P < 0.001 for male; R = 0.589, P < 0.001 for female, handgrip strength: R = 0.470, P < 0.001 for male, R = 0.364, P < 0.001 for female). In the multivariate logistic regression model, a higher GNRI was associated with a lower risk of sarcopenia in older men and women with diabetes (adjusted odds ratio [OR], 0.892; 95% confidence interval [CI], 0.839–0.948 for male; adjusted OR, 0.928; 95% CI, 0.876–0.982 for female). One year of diabetes treatment improved the GNRI in the sarcopenia group with type 2 diabetes mellitus. Conclusions A low GNRI was associated with an increased risk of sarcopenia in elderly patients with type 2 diabetes mellitus. Treatment with glucose‐lowering drugs improved the GNRI in the sarcopenia group.
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Affiliation(s)
- Shun Matsuura
- Division of Diabetes Endocrinology medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka, 426-8677, Japan.,Division of Respiratory Internal medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka, 426-8677, Japan
| | - Koji Shibazaki
- Division of Diabetes Endocrinology medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka, 426-8677, Japan
| | - Reiko Uchida
- Division of Diabetes Endocrinology medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka, 426-8677, Japan
| | - Yukiko Imai
- Division of Diabetes Endocrinology medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka, 426-8677, Japan
| | - Takuya Mukoyama
- Division of Diabetes Endocrinology medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka, 426-8677, Japan
| | - Shoko Shibata
- Division of Diabetes Endocrinology medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka, 426-8677, Japan
| | - Hiroshi Morita
- Division of Diabetes Endocrinology medicine, Fujieda Municipal General Hospital, 4-1-11, Surugadai, Fujieda, Shizuoka, 426-8677, Japan
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14
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Doi S, Migita K, Ueno M, Yasuda S, Aoki S, Fujimoto K, Ishikawa H. The Prognostic Significance of the Geriatric Nutritional Risk Index in Colorectal Cancer Patients. Nutr Cancer 2022; 74:2838-2845. [DOI: 10.1080/01635581.2022.2036768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Shunsuke Doi
- Department of Surgery, Nara Prefectural Seiwa Medical Center, Ikoma, Nara, Japan
| | - Kazuhiro Migita
- Department of Surgery, Nara Prefectural Seiwa Medical Center, Ikoma, Nara, Japan
| | - Masato Ueno
- Department of Surgery, Nara Prefectural Seiwa Medical Center, Ikoma, Nara, Japan
| | - Satoshi Yasuda
- Department of Surgery, Nara Prefectural Seiwa Medical Center, Ikoma, Nara, Japan
| | - Satoko Aoki
- Department of Surgery, Nara Prefectural Seiwa Medical Center, Ikoma, Nara, Japan
| | - Kosuke Fujimoto
- Department of Surgery, Nara Prefectural Seiwa Medical Center, Ikoma, Nara, Japan
| | - Hirofumi Ishikawa
- Department of Surgery, Nara Prefectural Seiwa Medical Center, Ikoma, Nara, Japan
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Karayama M, Inoue Y, Yoshimura K, Hozumi H, Suzuki Y, Furuhashi K, Fujisawa T, Enomoto N, Nakamura Y, Inui N, Suda T. Association of the Geriatric Nutritional Risk Index With the Survival of Patients With Non-Small Cell Lung Cancer After Nivolumab Therapy. J Immunother 2022; 45:125-131. [PMID: 34653100 PMCID: PMC8806036 DOI: 10.1097/cji.0000000000000396] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Abstract
The nutritional status has the potential to affect cancer immunity. We evaluated the relationship between the nutritional status and the efficacy of nivolumab in patients with non-small cell lung cancer (NSCLC). This study was a post hoc analysis of a prospective, multicenter cohort study conducted at 14 institutions in Japan between July 2016 and December 2018. The Geriatric Nutritional Risk Index (GNRI), calculated from body weight and serum albumin, was evaluated in 158 patients with NSCLC who received nivolumab. GNRI was graded as low, moderate, and high. Low GNRI was associated with significantly shorter progression-free survival [median, 1.9 mo; 95% confidence interval (CI)=0.6-3.3 mo] than moderate (median, 4.0 mo; 95% CI=2.3-5.8 mo; P=0.017) and high GNRI (median, 3.0 mo; 95% CI=1.9-7.2 mo; P=0.014). Low GNRI was also linked to significantly shorter overall survival (OS) (median, 7.8 mo; 95% CI=2.6-12.0 mo) than moderate (median, 13.0 mo; 95% CI=9.6-15.2 mo; P=0.006) and high GNRI (median, 20.6 mo; 95% CI=15.6 mo-not reached; P<0.001). High GNRI was associated with significantly longer OS than moderate GNRI (P=0.015). In multivariate Cox proportional hazard analyses, increased GNRI was predictive of longer progression-free survival and OS, similarly as tumor programmed cell death-ligand 1 expression. In patients with NSCLC receiving nivolumab. GNRI was predictive of survival and may be useful for predicting the efficacy of immune checkpoint inhibitor therapy.
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Affiliation(s)
- Masato Karayama
- Departments of Chemotherapy
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan
| | - Yusuke Inoue
- Clinical Pharmacology and Therapeutics
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan
| | - Katsuhiro Yoshimura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan
| | | | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan
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16
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Karayama M, Inoue Y, Yasui H, Hozumi H, Suzuki Y, Furuhashi K, Fujisawa T, Enomoto N, Nakamura Y, Inui N, Suda T. Association of the Geriatric Nutritional Risk Index with the survival of patients with non-small-cell lung cancer after platinum-based chemotherapy. BMC Pulm Med 2021; 21:409. [PMID: 34895201 PMCID: PMC8665565 DOI: 10.1186/s12890-021-01782-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
Background The nutritional status can potentially affect the efficacy of cancer therapy. The Geriatric Nutritional Risk Index (GNRI), a simple index for evaluating nutritional status calculated from body weight and serum albumin levels, has been reported to be associated with the prognosis of various diseases. However, the relationships between GNRI and the efficacy of platinum-based chemotherapy in patients with non-small-cell lung cancer (NSCLC) are unknown. Methods The pretreatment levels of GNRI were retrospectively evaluated in 148 chemo-naïve patients with advanced NSCLC who received first-line platinum-based chemotherapy and scored as low or high. Results Patients with a high GNRI had a significantly higher overall response rate (ORR; 44.5% [95% confidence interval {CI} = 35.6%–53.9%] vs. 15.8% [95% CI = 7.4%–30.4%, p = 0.002), longer median progression-free survival (PFS; 6.3 months [95% CI = 5.6–7.2 months] vs. 3.8 months [95% CI = 2.5–4.7 months], p < 0.001), and longer median overall survival (OS; 22.8 months [95% CI = 16.7–27.2 months] vs. 8.5 months [95% CI = 5.4–16.0 months], p < 0.001) than those with low GNRI. High GNRI was independently predictive of better ORR in multivariate logistic regression analysis and longer PFS and OS in multivariate Cox proportional hazard analyses. In 71 patients who received second-line non-platinum chemotherapy, patients with high GNRI exhibited significantly longer PFS and OS than those with low GNRI (both p < 0.001). Conclusions GNRI was predictive of prolonged survival in patients with NSCLC who received first-line platinum-based chemotherapy and second-line non-platinum chemotherapy. Assessment of the nutritional status may be useful for predicting the efficacy of chemotherapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01782-2.
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Affiliation(s)
- Masato Karayama
- Department of Chemotherapy, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan. .,Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
| | - Yusuke Inoue
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.,Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
| | - Naoki Inui
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
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17
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Kataoka M, Hirano Y, Ishii T, Ishikawa S, Kataoka A, Fujii T, Shimamura S. Prognostic Utility of Geriatric Nutritional Risk Index After Curative Resection of Colorectal Cancer: A Propensity Score-matched Study. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:479-484. [PMID: 35403165 PMCID: PMC8962875 DOI: 10.21873/cdp.10064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/12/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND/AIM The geriatric nutrition risk index (GNRI) is a presumptive prognosticator in a variety of carcinomas. We investigated whether it similarly predicts outcomes of elderly patients with colorectal cancer (CRC). PATIENTS AND METHODS A total of 904 older adults (≥65 years) undergoing radical resections of CRC between April 2011 and December 2015 proved eligible for study. Each was grouped by preoperative status (cut-off point, 98) as low-level or normal GNRI, using propensity score matching to compare rates of complications, disease-free survival (DFS), and overall survival (OS). RESULTS After matching (n=127, each group), those with low-level (vs. normal) GNRI values experienced significantly more complications (p=0.001), and 5-year survival was significantly poorer (DFS: p=0.006; OS: p=0.002). CONCLUSION In elderly patients with resected CRC, preoperative GNRI may have significant prognostic merit.
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Affiliation(s)
- Masahiro Kataoka
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasumitsu Hirano
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshimasa Ishii
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shintaro Ishikawa
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Atsuko Kataoka
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takatsugu Fujii
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Satoshi Shimamura
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
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18
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Nouri A, Mansour-Ghanaei R, Esmaeilpour-Bandboni M, Gholami Chaboki B. Geriatric nutritional risk index in prediction of muscular strength of elderly patients undergoing hemodialysis. Int Urol Nephrol 2021; 54:1575-1581. [PMID: 34674148 DOI: 10.1007/s11255-021-03034-y] [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: 02/28/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Geriatric nutritional risk index (GNRI) is one of the new tools to determine nutritional status in the elderly. This study assessed the association between GNRI and muscular strength through handgrip strength (HGS) in patients undergoing hemodialysis. METHODS This cross-sectional analytical study assessed 110 hemodialysis patients at Guilan, North of Iran, (mean age of 70.3 ± 6.93), 57 men and 53 women through simple random sampling. Demographic characteristics, GNRI, and HGS of patients were determined. Data were analyzed using descriptive and inferential statistics, including independent t test, AVOVA, Pearson correlation, and linear multiple regression tests. RESULTS The mean values of the GNRI and HGS were 93.90 ± 11.06 and 14.82 ± 3.72, respectively. Finally, it was identified that there is a direct and significant association between GNRI and HGS (p = 0.001, r = 0.734). Linear multiple regression showed that GNRI is an independent predictor of HGS (Adj.R2 = 0.67, βGNRI = 8.13). CONCLUSION GNRI can be used as a predictor of muscular strength in hemodialysis patients.
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Affiliation(s)
- Ali Nouri
- Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Roya Mansour-Ghanaei
- Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. .,Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
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Does the geriatric nutrition risk index predict the prognosis of patients with oral squamous cell carcinoma? Br J Oral Maxillofac Surg 2021; 60:475-481. [DOI: 10.1016/j.bjoms.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/05/2021] [Indexed: 11/18/2022]
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20
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Matsuura S, Morikawa K, Ito Y, Kubota T, Ichijo K, Mochizuki E, Akiyama N, Uehara M, Harada M, Tsukui M, Koshimizu N. The Geriatric Nutritional Risk Index and Prognostic Nutritional Index Predict the Overall Survival of Advanced Non-Small Cell Lung Cancer Patients. Nutr Cancer 2021; 74:1606-1613. [PMID: 34431441 DOI: 10.1080/01635581.2021.1960387] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We aimed to assess the prognostic and predictive significance of pretreatment Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) measurements on advanced non-small cell lung cancer (NSCLC) patients treated with first-line therapy. Patients with advanced NSCLC treated between February 2014 and August 2020 were retrospectively analyzed. The optimal cutoff points for GNRI and PNI were measured with receiver operating characteristic (ROC) curve analysis according to overall survival (OS). The predictive factors for progression-free survival (PFS) and OS were evaluated with univariate and multivariate analyses via the Cox hazards regression. A total of 160 patients were included in the study. Significant differences between the low and high-GNRI or PNI groups were found regarding ECOG-PS. The low-GNRI and low-PNI groups had significantly shorter PFS and OS than the high-GNRI and high-PNI groups. A multivariate analysis using a Cox regression model revealed that the high-GNRI group was an independent prognostic factor of OS and PFS, and the PNI group was an independent prognostic factor of OS. Pretreatment GNRI and PNI may therefore be a potential effective predictor of the survival of advanced NSCLC patients undergoing first-line treatment.
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Affiliation(s)
- Shun Matsuura
- Division of Respiratory Internal Medicine, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Keisuke Morikawa
- Division of Respiratory Internal Medicine, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Yutaro Ito
- Division of Respiratory Internal Medicine, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Tsutomu Kubota
- Division of Respiratory Internal Medicine, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Koshiro Ichijo
- Division of Respiratory Internal Medicine, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Eisuke Mochizuki
- Division of Respiratory Internal Medicine, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Norimichi Akiyama
- Division of Respiratory Internal Medicine, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Masahiro Uehara
- Division of Respiratory Internal Medicine, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Masanori Harada
- Division of Respiratory Internal Medicine, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Masaru Tsukui
- Division of Respiratory Internal Medicine, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Naoki Koshimizu
- Division of Respiratory Internal Medicine, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
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Su WT, Tsai CH, Huang CY, Chou SE, Li C, Hsu SY, Hsieh CH. Geriatric Nutritional Risk Index as a Prognostic Factor for Mortality in Elderly Patients with Moderate to Severe Traumatic Brain Injuries. Risk Manag Healthc Policy 2021; 14:2465-2474. [PMID: 34140818 PMCID: PMC8203299 DOI: 10.2147/rmhp.s314487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background The Geriatric Nutritional Risk Index (GNRI) is a simple and objective screening tool for clinicians to screen patients’ nutritional status based on serum albumin level and their weight and height. The original study had divided patients based on GNRI into quartiles of nutritional risk for death: a no-risk group (GNRI >98), a low-risk group (GNRI 92–98), a moderate-risk group (GNRI 82 to <92), and a major-risk group (GNRI <82). Given that the patients generally sustained traumatic brain injury (TBI) in an acute condition, the study aimed to explore whether GNRI presents a prognostic value for the mortality outcome of these patients. Methods From January 1, 2009, to December 31, 2019, 581 elderly patients with moderate to severe TBI, which was defined as sustaining a head Abbreviated Injury Scale ≥3, was included in the study population. The collected data included age, sex, body mass index, serum albumin levels at admission, preexisting comorbidities, Glasgow Coma Scale, and Injury Severity Score. The primary outcome in the comparison was in-hospital mortality. Results Multivariate logistic regression analysis revealed that GNRI, ESRD, and ISS were significant independent risk factors for mortality in patients with moderate to severe TBI. When subgrouping the study population into four nutritional risk categories according to the quartile deviation as Q1 (GNRI <85, n = 145), Q2 (GNRI 85 to <93.8 n = 145), Q3 (GNRI 93.8 to 103, n = 145), and Q4 (GNRI >103, n = 146), Q1 patients had a significantly longer LOS in hospital (25.2 days vs 18.6 days, respectively; p = 0.004) and higher mortality rate (28.3% vs 11.7%, respectively; p < 0.001) than Q4 patients. The mortality rate was significantly higher in Q1 patients than in Q4 patients (OR, 2.8; 95% CI, 1.14–6.78; p = 0.021). Conclusion This study revealed that the GNRI is a significant independent risk factor and a promising simple assessment tool for mortality in elderly patients with moderate to severe TBI.
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Affiliation(s)
- Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Ying Huang
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi Li
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Łukaszyk E, Bień-Barkowska K, Bień B. Identification of Mortality Risks in the Advancement of Old Age: Application of Proportional Hazard Models Based on the Stepwise Variable Selection and the Bayesian Model Averaging Approach. Nutrients 2021; 13:nu13041098. [PMID: 33801694 PMCID: PMC8066062 DOI: 10.3390/nu13041098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023] Open
Abstract
Identifying factors that affect mortality requires a robust statistical approach. This study’s objective is to assess an optimal set of variables that are independently associated with the mortality risk of 433 older comorbid adults that have been discharged from the geriatric ward. We used both the stepwise backward variable selection and the iterative Bayesian model averaging (BMA) approaches to the Cox proportional hazards models. Potential predictors of the mortality rate were based on a broad range of clinical data; functional and laboratory tests, including geriatric nutritional risk index (GNRI); lymphocyte count; vitamin D, and the age-weighted Charlson comorbidity index. The results of the multivariable analysis identified seven explanatory variables that are independently associated with the length of survival. The mortality rate was higher in males than in females; it increased with the comorbidity level and C-reactive proteins plasma level but was negatively affected by a person’s mobility, GNRI and lymphocyte count, as well as the vitamin D plasma level.
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Affiliation(s)
- Ewelina Łukaszyk
- Department of Geriatrics, Medical University of Bialystok, Fabryczna 27, 15-471 Bialystok, Poland;
- Geriatric Ward, Hospital of the Ministry of the Interior and Administration in Bialystok, 15-471 Białystok, Poland
- Correspondence: ; Tel.: +48-47-710-40-23
| | - Katarzyna Bień-Barkowska
- Institute of Econometrics, Warsaw School of Economics, Madalińskiego 6/8, 02-513 Warsaw, Poland;
| | - Barbara Bień
- Department of Geriatrics, Medical University of Bialystok, Fabryczna 27, 15-471 Bialystok, Poland;
- Geriatric Ward, Hospital of the Ministry of the Interior and Administration in Bialystok, 15-471 Białystok, Poland
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Han BG, Han J, Lee KH. Association of impedance ratio with corrected Geriatric Nutritional Risk Index in older patients with nondialysis chronic kidney disease stage 5. JPEN J Parenter Enteral Nutr 2021; 46:93-103. [PMID: 33586150 DOI: 10.1002/jpen.2089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND The usual calculation of body mass index (BMI) can be misleading in patients with advanced chronic kidney disease (CKD) because their altered fluid balances may not be reflected. We obtained corrected BMI (cBMI) and corrected Geriatric Nutritional Risk Index (cGNRI) values and investigated whether the impedance ratio (IR) of 200/5 kHz, measured using bioimpedance spectroscopy, was associated with cGNRI in older patients with nondialysis CKD stage 5 (CKD5-ND). METHODS Patients over 65 years old (n = 118) were divided into groups by cGNRI tertiles. The differences between the correlations were tested using Steiger's z-test. The IR and cBMI were used as both continuous and categorical variables in the regression analyses to determine the factors that were independently associated with the cGNRI. RESULTS Patients in the third cGNRI tertile had a significantly lower mean IR than those in the other 2 tertiles (P < .001). Across the 3 cGNRI tertile groups, the IR was incrementally lower in the higher cGNRI tertiles (P for trend < .001). The Steiger's z-test showed that the IR had a significantly stronger correlation with cGNRI than cBMI had with cGNRI. In the multivariable linear regression analyses, the IR was independently associated with the cGNRI, after adjusting for various confounders. CONCLUSION The current results revealed that the IR was a more sensitive indicator of nutrition risk than BMI and was independently associated with cGNRI in older patients with CKD5-ND. Our study suggests that the IR is an appropriate tool for nutrition risk screening.
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Affiliation(s)
- Byoung-Geun Han
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea
| | - Jihye Han
- Politics and International Relations, London School of Economics and Political Science, London, United Kingdom.,United Nations Development Programme Seoul Policy Center, Seoul, Korea
| | - Kwang Hoon Lee
- Dr. Lee's Medical Clinic and Hemodialysis Center, Wonju, Kang-won, Korea
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Hsieh CH, Liu YW, Tsai CH, Chou SE, Su WT, Li C, Hsu SY. Geriatric nutritional risk index in screening malnutrition among young adult and elderly trauma patients. FORMOSAN JOURNAL OF SURGERY 2021. [DOI: 10.4103/fjs.fjs_44_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yeh CH, Wu SC, Chou SE, Su WT, Tsai CH, Li C, Hsu SY, Hsieh CH. Geriatric Nutritional Risk Index as a Tool to Evaluate Impact of Malnutrition Risk on Mortality in Adult Patients with Polytrauma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249233. [PMID: 33321867 PMCID: PMC7764093 DOI: 10.3390/ijerph17249233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Identification of malnutrition is especially important in severely injured patients, in whom hypermetabolism and protein catabolism following traumatic injury worsen their nutritional condition. The geriatric nutritional risk index (GNRI), based on serum albumin level and the current body weight/ideal body weight ratio, is useful for identifying patients with malnutrition in many clinical conditions. This study aimed to explore the association between admission GNRI and mortality outcomes of adult patients with polytrauma. METHODS From 1 January 2009 to 31 December 2019, a total of 348 adult patients with polytrauma, registered in the trauma database of a level I trauma center, were recognized and categorized into groups of death (n = 71) or survival (n = 277) and into four nutritional risk groups: a high-risk group (GNRI < 82, n = 87), a moderate-risk group (GNRI 82 to <92, n = 144), a low-risk group (GNRI 92-98, n = 59), and a no-risk group (GNRI > 98, n = 58). Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for mortality. The mortality outcomes of patients at various nutritional risks were compared to those of patients in the no-risk group. RESULTS The comparison between the death group (n = 71) and the survival group (n = 277) revealed that there was no significant difference in gender predominance, age, pre-existing comorbidities, injury mechanism, systolic blood pressure, and respiratory rate upon arrival at the emergency room. A significantly lower GNRI and Glasgow Coma Scale score but higher injury severity score (ISS) was observed in the death group than in the survival group. Multivariate logistic regression analysis revealed that Glasgow Coma Scale (GCS), odds ratio (OR), 0.88; 95% confidence interval (CI), 0.83-0.95; p < 0.001), ISS (OR, 1.07; 95% CI, 1.04-1.11; p < 0.001), and GNRI (OR, 0.94; 95% CI, 0.91-0.97; p < 0.001) were significant independent risk factors for mortality in these patients. The mortality rates for the high-risk, moderate-risk, low-risk, and no-risk groups were 34.5%, 20.1%, 8.5%, and 12.1%, respectively. Unlike patients in the moderate-risk and low-risk groups, patients in the high-risk group had a significantly higher death rate than that of those in the no-risk group. CONCLUSIONS This study revealed that the GNRI may serve as a simple, promising screening tool to identify the high risk of malnutrition for mortality in adult patients with polytrauma.
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Affiliation(s)
- Cheng-Hsi Yeh
- Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan;
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan;
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan; (S.-E.C.); (W.-T.S.); (C.-H.T.); (C.L.); (S.-Y.H.)
| | - Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan; (S.-E.C.); (W.-T.S.); (C.-H.T.); (C.L.); (S.-Y.H.)
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan; (S.-E.C.); (W.-T.S.); (C.-H.T.); (C.L.); (S.-Y.H.)
| | - Chi Li
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan; (S.-E.C.); (W.-T.S.); (C.-H.T.); (C.L.); (S.-Y.H.)
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan; (S.-E.C.); (W.-T.S.); (C.-H.T.); (C.L.); (S.-Y.H.)
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan
- Correspondence: ; Tel.: +886-7-7327476
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Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures-A Retrospective Study in a Level I Trauma Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238920. [PMID: 33266264 PMCID: PMC7729938 DOI: 10.3390/ijerph17238920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/13/2020] [Accepted: 11/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Malnutrition is frequently underdiagnosed in geriatric patients and is considered to be a contributing factor for worse outcomes during hospitalization. In addition, elderly patients who undergo trauma are often malnourished at the time of incurring fractures. The geriatric nutritional risk index (GNRI), calculated based on the serum albumin level and the ratio of present body weight to ideal body weight, was proposed for the assessment of the nutritional status of elderly patients with various illnesses. This study aimed to investigate whether the GNRI has a prognostic value that links the nutritional status and mortality outcomes of elderly patients who have previously undergone trauma with femoral fractures. METHODS From January 1, 2009 to December 31, 2019, a total of 678 elderly patients with femoral fractures were categorized into four nutritional risk groups: a major-risk group (GNRI <82; group 1, n = 127), moderate-risk group (GNRI 82- <92; group 2, n = 179), low-risk group (GNRI 92-98; group 3, n = 123), and no-risk group (GNRI >98; group 4, n = 249). To minimize the confounding effects of sex, age, preexisting comorbidities, and injury severity of patients on outcome measurements, propensity score-matched patient cohorts were created to assess the impact of patients being in different nutritional risk groups on the in-hospital mortality outcomes against the no-risk group. RESULTS The patients in groups 1-3 were significantly older and presented a significantly lower body mass index and lower serum albumin levels than those in group 4. Compared with patients in group 4 (3.6%), a significantly higher mortality rate was found in the patients in group 1 (17.3%, p < 0.001), but not in those in group 2 (6.7%) or group 3 (2.4%). The study of propensity score-matched patient cohorts provided similar results; group 1 patients had significantly higher odds of mortality than group 4 patients (odds ratio, 6.3; 95% confidence interval, 1.34-29.37; p = 0.009), but there were no significant differences in mortality risks among patients in groups 2 and 3 compared with those in group 4. CONCLUSIONS This preliminary study suggested that the GNRI may be used as a screening tool to identify patients with malnutrition at a high risk of mortality among elderly patients with femoral fractures. A prospective study is needed to validate the suggestion.
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Etani T, Naiki T, Sugiyama Y, Nagai T, Iida K, Noda Y, Shimizu N, Tasaki Y, Mimura Y, Okada T, Banno R, Kubota H, Hamamoto S, Ando R, Kawai N, Yasui T. Low Geriatric Nutritional Risk Index as a Poor Prognostic Marker for Second-Line Pembrolizumab Treatment in Patients with Metastatic Urothelial Carcinoma: A Retrospective Multicenter Analysis. Oncology 2020; 98:876-883. [PMID: 32862183 DOI: 10.1159/000508923] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/25/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND We evaluated the prognostic efficacy of the Geriatric Nutritional Risk Index (GNRI) in second-line pembrolizumab (PEM) therapy for patients with metastatic urothelial carcinoma (mUC). PATIENTS AND METHODS From January 2018 to October 2019, 52 mUC patients, treated previously with platinum-based chemotherapy, underwent second-line PEM therapy. Peripheral blood parameters were measured at the start of treatment: serum neutrophil-to-lymphocyte ratio (NLR), serum albumin, serum C-reactive protein (CRP), and body height and weight. PEM was intravenously administered (200 mg every 3 weeks). The patients were organized into two groups based on their GNRI (<92 [low GNRI] and ≥92 [high GNRI]), and the data were retrospectively analyzed. Adverse events (AEs) were evaluated and imaging studies assessed for all patients. Analyses of survival and recurrence were performed using Kaplan-Meier curves. Potential prognostic factors affecting cancer-specific survival (CSS) were assessed by univariate and multivariate Cox regression analyses. RESULTS patients' baseline characteristics, except for their BMI and objective response rate, did not significantly differ between the two groups. The median total number of cycles of PEM therapy was significantly higher for the high-GNRI group (n [range]: 6 [2-20] vs. 3 [1-6]). The median CSS with second-line PEM therapy was 3.6 months (95% confidence interval [CI]: 2.5-6.1) and 11.8 months (95% CI: 6.2-NA) in the low-GNRI and the high-GNRI group (p < 0.01), respectively. Significant differences in CSS between the low- and high-CRP or -NRL groups were not found. Multivariate Cox proportional-hazards regression analysis revealed that a poor Eastern Cooperative Oncology Group performance status, visceral metastasis, and a low GNRI were significant prognostic factors for short CSS (95% CI: 1.62-6.10, HR: 3.14; 95% CI: 1.13-8.11, HR: 3.03; 95% CI: 1.32-8.02, HR: 3.25, respectively). Of the AEs, fatigue showed a significantly higher incidence in the low-GNRI group. CONCLUSIONS For mUC patients receiving second-line PEM therapy, the GNRI is a useful predictive biomarker for survival outcome.
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Affiliation(s)
- Toshiki Etani
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Taku Naiki
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan,
| | - Yosuke Sugiyama
- Department of Pharmacy, Nagoya City University Hospital, Nagoya, Japan
| | - Takashi Nagai
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Keitaro Iida
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Noda
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.,Department of Urology, Toyota Kosei Hospital, Toyota, Japan
| | - Nobuhiko Shimizu
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshihiko Tasaki
- Department of Pharmacy, Nagoya City University Hospital, Nagoya, Japan
| | - Yoshihisa Mimura
- Department of Pharmacy, Nagoya City University Hospital, Nagoya, Japan
| | - Tomoki Okada
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.,Department of Urology, Konan Kosei Hospital, Konan, Japan
| | - Rika Banno
- Department of Urology, Konan Kosei Hospital, Konan, Japan
| | - Hiroki Kubota
- Department of Urology, Kainan Hospital, Yatomi, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Noriyasu Kawai
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
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The Geriatric Nutritional Risk Index predicts postoperative complications and prognosis in elderly patients with colorectal cancer after curative surgery. Sci Rep 2020; 10:10744. [PMID: 32612136 PMCID: PMC7329855 DOI: 10.1038/s41598-020-67285-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
Malnutrition has been considered to be associated with the prognosis of cancer. The Geriatric Nutritional Risk Index (GNRI), based on serum albumin levels, present body weight, and ideal body weight, is a simple screening tool to predict the risk of nutrition-related morbidity and mortality in elderly patients. We aimed to evaluate whether preoperative GNRI was associated with postoperative complications and prognosis in elderly patients with colorectal cancer (CRC). We retrospectively enrolled 313 CRC patients aged ≥65 years after curative surgery and classified them into an all-risk GNRI (≤98) group and a no-risk GNRI (>98) group. Kaplan-Meier analysis showed overall survival was significantly worse in the all-risk GNRI group than in the no-risk GNRI group (P = 0.009). Multivariable analyses showed low GNRI (≤98) was an independent risk factor for postoperative complications (P = 0.048) and overall survival (P = 0.001) in the patients. Among the complications, the incidence of surgical site infection, in particular, was significantly higher in the all-risk GNRI group (P = 0.008). In conclusion, low preoperative GNRI (≤98) was associated with increased postoperative complications and poor prognosis. Preoperative GNRI can be used as an identifier for potential high-risk group of morbidity and mortality in elderly CRC patients.
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Hirahara N, Matsubara T, Fujii Y, Kaji S, Hyakudomi R, Yamamoto T, Uchida Y, Miyazaki Y, Ishitobi K, Kawabata Y, Tajima Y. Preoperative geriatric nutritional risk index is a useful prognostic indicator in elderly patients with gastric cancer. Oncotarget 2020; 11:2345-2356. [PMID: 32595832 PMCID: PMC7299529 DOI: 10.18632/oncotarget.27635] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/25/2020] [Indexed: 12/28/2022] Open
Abstract
Background: The geriatric nutritional risk index (GNRI) was developed to evaluate the prognosis in elderly hospitalized patients at risk of malnutrition and related morbidity and mortality. This study aimed to evaluate the relationship between preoperative GNRI and long-term outcomes in elderly gastric cancer patients. Materials and Methods: We retrospectively reviewed 297 consecutive patients aged ≥ 65 years who underwent laparoscopic gastrectomy with R0 resection and evaluated their overall survival (OS) and cancer-specific survival (CSS). Results: In the univariate analyses, OS was significantly associated with the American Society of Anesthesiologists Physical Status (ASA-PS), tumor size, tumor differentiation, pathological stage, carcinoembryonic antigen (CEA), C-reactive protein, postoperative complications, and GNRI, whereas in the univariate analyses of CSS, ASA-PS, tumor size, tumor differentiation, pathological stage, CEA, postoperative adjuvant chemotherapy, and GNRI were significantly associated with poor prognosis. In the multivariate analysis, ASA-PS, tumor differentiation, pathological stage, and GNRI were significant independent prognostic factors of OS, whereas ASA-PS, pathological stage, and CEA were significant independent prognostic factors of CSS. Conclusions: GNRI is significantly associated with OS and CSS in elderly gastric cancer patients and is an independent predictor of OS. It is a simple, cost-effective, and promising nutritional index for predicting OS in elderly patients.
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Affiliation(s)
- Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Takeshi Matsubara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yusuke Fujii
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Shunsuke Kaji
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yuki Uchida
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshiko Miyazaki
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kazunari Ishitobi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yasunari Kawabata
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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Lidoriki I, Schizas D, Frountzas M, Machairas N, Prodromidou A, Kapelouzou A, Karavokyros I, Pikoulis E, Kales SN, Liakakos T. GNRI as a Prognostic Factor for Outcomes in Cancer Patients: A Systematic Review of the Literature. Nutr Cancer 2020; 73:391-403. [PMID: 32321298 DOI: 10.1080/01635581.2020.1756350] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Oncologic patients often suffer from malnutrition which in turn, might have negative impact on treatment outcomes. The Geriatric Nutritional Risk Index (GNRI), as an index of impaired nutritional status, has emerged as a significant prognostic factor for short-and long-term outcomes in cancer patients. The aim of the current systematic review is to determine whether the GNRI is an independent prognostic factor of postoperative complications and survival in cancer patients. A systematic search was conducted to identify studies, published from 2005 to 2019, which assessed associations between GNRI and short- and long-term outcomes in cancer patients. Eighteen studies fulfilled the eligibility criteria and were included in the analysis. Low scores of GNRI were associated with increased risk for developing postoperative complications and impaired survival of cancer patients in most studies. Our findings support the use of the GNRI in the clinical practice, since it is a simple and reliable tool for assessing nutritional status in oncologic patients. More prospective, multi-centered studies are warranted to confirm the current results, as well as the role of nutritional support in improving the prognosis of cancer patients.
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Affiliation(s)
- Irene Lidoriki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maximos Frountzas
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Machairas
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | | | - Alkistis Kapelouzou
- Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Emmanouil Pikoulis
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Stefanos N Kales
- Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Theodoros Liakakos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients. Surg Endosc 2020; 35:1202-1209. [PMID: 32152675 DOI: 10.1007/s00464-020-07487-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Preoperative nutritional assessment of cancer patients is important to reduce postoperative complications. Several studies have reported the Geriatric Nutritional Risk Index (GNRI) to be useful in assessing underlying diseases and long-term outcomes of hospitalized patients. The present study aimed to evaluate the impact of preoperative GNRI on short- and long-term outcomes in elderly gastric cancer patients who underwent laparoscopic gastrectomy. METHODS We retrospectively reviewed consecutive patients aged ≥ 65 years who underwent laparoscopy-assisted gastrectomy and had R0 resection for histologically confirmed gastric adenocarcinoma. The cutoff value for preoperative GNRI was determined to be 85.7 based on the incidence of postoperative complications. Patients were categorized into two groups: low GNRI group and normal GNRI group. RESULTS Univariate analyses of the 303 patients revealed that the incidence of postoperative complications was significantly associated with the American Society of Anesthesiologists Physical Status classification (ASA-PS), C-reactive protein (CRP), GNRI (p < 0.001), and operative procedure. Multivariate analyses revealed that preoperative GNRI (odds ratio [OR] 2.716; 95% confidence interval [CI] 1.166-6.328; p = 0.021) and operative procedure (OR 2.459; 95% CI 1.378-4.390; p = 0.002) were independently associated with the incidence of postoperative complications. Univariate analyses showed that overall survival (OS) was significantly associated with ASA-PS, tumor size, tumor differentiation, pathological tumor node metastasis (TNM) stage, carcinoembryonic antigen (CEA), CRP, GNRI, and postoperative complications. Multivariate analysis demonstrated that ASA-PS (hazard ratio [HR], 3.755; 95% CI 2.141-6.585; p < 0.001), tumor differentiation (HR 1.898; 95% CI 1.191-3.025; p = 0.007), CEA (HR 1.645; 95% CI 1.024-2.643; p = 0.040), and GNRI (HR 2.093; 95% CI 1.105-3.963; p = 0.023) independently predicted OS. CONCLUSION GNRI is an important predictor of postoperative complications and overall survival in elderly gastric cancer patients. It is a reliable and cost-effective prognostic indicator that should be routinely evaluated.
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Nakayama M, Gosho M, Adachi M, Ii R, Matsumoto S, Miyamoto H, Hirose Y, Nishimura B, Tanaka S, Wada T, Tabuchi K. The Geriatric Nutritional Risk Index as a Prognostic Factor in Patients with Advanced Head and Neck Cancer. Laryngoscope 2020; 131:E151-E156. [PMID: 32083731 DOI: 10.1002/lary.28587] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The Geriatric Nutritional Risk Index (GNRI) is a simple and well-established nutritional assessment tool and is a significant prognostic factor in various cancers. However, the role of the GNRI in predicting clinical outcomes in patients with advanced head and neck cancer (AHNC) has not been investigated. The aim of the present study was to examine the association between the GNRI and prognosis in patients with AHNC. STUDY DESIGN Retrospective cohort study. METHODS Data collected between 2002 and 2013 from Tsukuba University Hospital were reviewed. The GNRI was calculated according to the equation, 1.489 × serum albumin (g/l) + 41.7 × (body weight/ideal body weight). Characteristics and prognosis were compared among three risk groups: high (GNRI <82); intermediate (GNRI 82-98); and normal (GNRI >98). The primary endpoint was overall survival. RESULTS A total of 248 AHNC patients were enrolled, among whom 134 (54%) exhibited no nutritional risk, 53 (21%) had an intermediate risk for malnutrition, and 61 (25%) exhibited a high risk for malnutrition. Three-year survival rates according to the three-group GNRI scores for normal, intermediate, and high risk were 76.6%, 56.3%, and 19.5%, respectively. As the three-group GNRI score increased, the risk for mortality significantly increased (adjusted hazard ratio [HR] for intermediate to normal, 1.73 [95% CI, 1.02-2.92]; adjusted HR for high to normal, 4.31 [95% CI, 2.71-6.84]). CONCLUSIONS The GNRI could be considered a useful prognostic factor in patients with AHNC. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E151-E156, 2021.
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Affiliation(s)
- Masahiro Nakayama
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Masahiko Gosho
- Department of Biostatistics , Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Adachi
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Rieko Ii
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Shin Matsumoto
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Hidetaka Miyamoto
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Yuki Hirose
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Bungo Nishimura
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Shuho Tanaka
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Tetsuro Wada
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Keiji Tabuchi
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
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Tang S, Xie H, Kuang J, Gao F, Gan J, Ou H. The Value of Geriatric Nutritional Risk Index in Evaluating Postoperative Complication Risk and Long-Term Prognosis in Elderly Colorectal Cancer Patients. Cancer Manag Res 2020; 12:165-175. [PMID: 32021433 PMCID: PMC6957008 DOI: 10.2147/cmar.s234688] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/11/2019] [Indexed: 12/29/2022] Open
Abstract
Purpose The geriatric nutritional risk index (GNRI) has been reported as a useful tool for predicting the prognosis of many diseases; however, there is currently little research on the relationship between GNRI and outcomes in elderly colorectal cancer (CRC) patients. This study aimed to explore the value of GNRI in evaluating postoperative complication risk and long-term prognosis in elderly CRC patients. Patients and Methods The medical records of 230 CRC patients aged≥65 years who underwent surgery between January 2012 and December 2014 were retrospectively analyzed. Patients were divided into abnormal and normal GNRI groups by modified binary classification. Logistic regression analysis was used to evaluate the correlation between GNRI and complication risk. The Kaplan–Meier method with log-rank test was used to construct survival curves. The Cox proportional hazard model was used for univariate, multivariate and subgroup survival analyses to assess the relationship between GNRI and long-term prognosis. Results Multivariate logistic regression analysis showed that GNRI (p = 0.009, HR 2.280, 95% CI: 1.224–4.247) was an independent risk factor for postoperative complications in elderly CRC patients. Kaplan–Meier survival curves revealed that the abnormal GNRI group had significantly lower disease-free survival (DFS; p = 0.005) and overall survival (OS; p=0.007) than the normal GNRI group had, especially in TNM I stage. In multivariate survival analysis, GNRI was an independent prognostic factor for DFS (p = 0.003, HR 1.842, 95% CI: 1.229–2.760) and OS (p = 0.003, HR 1.852, 95% CI: 1.231–2.787). Conclusion GNRI is a simple and effective tool for predicting the risk of postoperative complications and the long-term prognosis of postoperative elderly CRC patients and can provide a scientific basis for early nutrition interventions in elderly CRC patients.
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Affiliation(s)
- Shuangyi Tang
- Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Hailun Xie
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Jiaan Kuang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Feng Gao
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Jialiang Gan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Hesheng Ou
- Pharmaceutical College, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
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Evaluation of objective nutritional indexes as predictors of one-year outcomes after transcatheter aortic valve implantation. J Cardiol 2019; 74:34-39. [DOI: 10.1016/j.jjcc.2019.02.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/04/2019] [Accepted: 02/28/2019] [Indexed: 11/23/2022]
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Tanaka T, Nishiyama K, Yamamura O, Watase H, Yokoyama Y, Horiguchi T, Konishi T, Hayashi H. Geriatric Nutritional Risk Index for independent walking function in maintenance hemodialysis patients: A single-facility retrospective cohort study. Geriatr Gerontol Int 2018; 18:1556-1561. [PMID: 30311409 DOI: 10.1111/ggi.13524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/06/2018] [Accepted: 07/30/2018] [Indexed: 12/16/2022]
Abstract
AIM The target Geriatric Nutritional Risk Index (GNRI) for patients on chronic maintenance hemodialysis is unclear. We aimed to determine the relationship between the GNRI and independent walking ability in such patients. METHODS In the present retrospective cohort study, 90 patients receiving chronic maintenance hemodialysis were included. Logistic regression analyses were carried out to evaluate the relationship between the GNRI and independent walking ability. Receiver operating characteristic curve analysis was carried out to determine the cut-off GNRI for predicting independent walking ability. RESULTS Multivariate logistic regression analysis showed significant differences in age (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.6-0.9), creatinine generation rate percentage (OR 1.1, 95% CI 1.0-1.2), GNRI (OR 1.4, 95% CI 1.1-1.8; P < 0.01) and urea removal rate (OR 0.3, 95% CI 0.1-0.9; P < 0.05). The cut-off GNRI for independent walking ability was 86.7 (area under the curve 0.80, sensitivity 92.1%, specificity 66.7%, positive hit ratio 86.6%, negative hit ratio 78.3%). The factors correlated with survival in the univariate analysis were the GNRI, equilibrated Kt/V, urea removal rate, clear space rate, salt intake amount (P < 0.01), number of days of hospitalization and %creatinine generation rate (P < 0.05). The Cox proportional hazard regression model showed an OR of 0.77 (95% CI 0.32-1.8) at a GNRI <86/GNRI ≥86. In the multivariate survival analysis, we observed no significant differences in any of the factors. CONCLUSIONS GNRI was correlated with walking ability, which indicated that GNRI might predict future walking ability; also, a GNRI of 87 might be the target for maintaining walking ability. Geriatr Gerontol Int 2018; 18: 1556-1561.
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Affiliation(s)
- Tokuharu Tanaka
- Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Japan
| | - Kei Nishiyama
- Critical Care Center, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
| | - Osamu Yamamura
- Department of Community Medicine, Regional Medicine Promotion Course, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroko Watase
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Yoshinari Yokoyama
- Department of Nephrology, Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Japan
| | - Takayasu Horiguchi
- Department of Nephrology, Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Japan
| | - Takashi Konishi
- Department of Internal Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Japan
| | - Hiroyuki Hayashi
- Department of Emergency and General Medicine, University of Fukui Hospital, Fukui, Japan
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Migita K, Matsumoto S, Wakatsuki K, Ito M, Kunishige T, Nakade H, Sho M. The Prognostic Significance of the Geriatric Nutritional Risk Index in Patients with Esophageal Squamous Cell Carcinoma. Nutr Cancer 2018; 70:1237-1245. [PMID: 30235009 DOI: 10.1080/01635581.2018.1512640] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim of this study was to investigate the impact of the geriatric nutritional risk index (GNRI) on the long-term outcomes in 137 esophageal squamous cell carcinoma (ESCC) patients who underwent curative esophagectomy. The GNRI was calculated from the serum albumin value and the body weight. The cutoff value of the GNRI was set at 98. A multivariate analysis was performed to identify prognostic factors for the overall survival (OS). The mean preoperative GNRI was 99.9 ± 7.8. Forty-five (32.8%) patients had a GNRI of <98. The GNRI was significantly associated with the tumor depth (p = 0.001), level of carcinoembryonic antigen (CEA; p = 0.009) and level of C-reactive protein (CRP; p = 0.028). The GRNI was significantly associated with the OS (p < 0.001). The multivariate analysis identified the GNRI as an independent predictor for the OS. Death due to EC was more frequent in the patients with a low GNRI than in the patients with a high GNRI (p = 0.004). Our results suggest that the GRNI is a simple and reliable predictor of the postoperative survival in ESCC patients. A low preoperative GNRI may indicate a higher risk of EC death.
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Affiliation(s)
- Kazuhiro Migita
- a Department of Surgery , Nara Medical University , Kashihara , Japan
| | - Sohei Matsumoto
- a Department of Surgery , Nara Medical University , Kashihara , Japan
| | - Kohei Wakatsuki
- a Department of Surgery , Nara Medical University , Kashihara , Japan
| | - Masahiro Ito
- a Department of Surgery , Nara Medical University , Kashihara , Japan
| | | | - Hiroshi Nakade
- a Department of Surgery , Nara Medical University , Kashihara , Japan
| | - Masayuki Sho
- a Department of Surgery , Nara Medical University , Kashihara , Japan
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Geriatric nutritional risk index predicts surgical site infection after pancreaticoduodenectomy. Mol Clin Oncol 2018; 9:274-278. [PMID: 30155249 DOI: 10.3892/mco.2018.1671] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/10/2018] [Indexed: 01/20/2023] Open
Abstract
Surgical site infections (SSIs) are a well-known potential complication of surgery. They are assocaited with preoperative malnutrition and lead to increased medical costs and longer hospital stays. Therefore, surgeons should appropriately identify patients who are at a high risk. The geriatric nutritional risk index (GNRI) is a tool, increasingly utilized to assess the degree of malnutrition, particularly in elderly patients. Therefore, the present study attempted to validate whether GNRI could predict the risk of SSI in patients following pancreaticoduodenectomy (PD). A cohort study was retrospectively conducted on 106 patients in the Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Japan from January 2007 to December 2017. All patients were subjected to nutritional screening using GNRI and followed up for the occurrence of postoperative complications, including SSI post PD. Additionally, risk factors for developing SSI, and the patient's height, body mass index and preoperative laboratory values were documented. Patients were divided into SSI (n=15) and non-SSI (n=91) groups with a determined incidence of 14.2% (15/106) for SSI. The results revealed that the SSI group had GNRI values that were significantly reduced compared with the non-SSI group (P<0.001). Receiver operating characteristic curve analysis was performed to determine the cut-off value of GNRI that conferred an increased risk of SSI; it was determined as 94 (sensitivity 80.0%, specificity 83.5%). Univariate analysis confirmed that a GNRI <94 was significantly associated with SSI (P<0.001), whereas multivariate logistic regression analysis revealed that a GNRI <94 was independently associated with SSI following PD (relative risk=1.73, 95% confidence interval=1.23-2.43; P<0.001). Therefore, a GNRI <94 is a potential predictive marker for SSI risk following PD.
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Association between Bone Mineral Density of Femoral Neck and Geriatric Nutritional Risk Index in Rheumatoid Arthritis Patients Treated with Biological Disease-Modifying Anti-Rheumatic Drugs. Nutrients 2018; 10:nu10020234. [PMID: 29463015 PMCID: PMC5852810 DOI: 10.3390/nu10020234] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 02/07/2023] Open
Abstract
Treatment of rheumatoid arthritis (RA) with biological disease-modifying anti-rheumatic drugs (bDMARDs) induces rapid remission. However, osteoporosis and its management remains a problem. The Geriatric Nutritional Risk Index (GNRI) evaluates the risk of malnutrition-related complications in elderly patients and has been shown to be a significant predictor of many diseases. We evaluated the correlation between GNRI and RA activity. In addition, risk factors for femoral neck bone loss were evaluated in RA patients treated with bDMARDs. We retrospectively examined the medical records of 146 patients with RA, collecting and recording the patients’ demographic and clinical characteristics. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Inverse correlations were observed between GNRI and disease duration, disease activity score-28 joint count serum C-reactive protein (CRP), simple disease activity index, modified health assessment questionnaire score and CRP. GNRI showed correlation with femoral neck BMD and femoral neck BMD ≤ 70% of young adult men (YAM). Multiple regression analysis showed that female sex, increased age and lower GNRI were risk factors for lower BMD of the femoral neck. Multivariate binomial logistic regression analysis showed that female sex (odd ratio: 3.67) and lower GNRI (odd ratio: 0.87) were risk factors for BMD ≤ 70% of YAM. Because the GNRI is a simple method, it might be a simple predictor for RA activity and BMD status in RA patients. Complementary nutritional therapies might improve RA activity and osteoporosis in RA patients who have undergone treatment with bDMARDs.
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Kanemasa Y, Shimoyama T, Sasaki Y, Hishima T, Omuro Y. Geriatric nutritional risk index as a prognostic factor in patients with diffuse large B cell lymphoma. Ann Hematol 2018; 97:999-1007. [PMID: 29427185 DOI: 10.1007/s00277-018-3273-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/31/2018] [Indexed: 01/14/2023]
Abstract
The geriatric nutritional risk index (GNRI) is a simple and well-established nutritional assessment tool that is a significant prognostic factor for various cancers. However, the role of the GNRI in predicting clinical outcomes of diffuse large B cell lymphoma (DLBCL) patients has not been investigated. To address this issue, we retrospectively analyzed a total of 476 patients with newly diagnosed de novo DLBCL. We defined the best cutoff value of the GNRI as 96.8 using a receiver operating characteristic curve. Patients with a GNRI < 96.8 had significantly lower overall survival (OS) and progression-free survival (PFS) than those with a GNRI ≥ 96.8 (5-year OS, 61.2 vs. 84.4%, P < 0.001; 5-year PFS, 53.7 vs. 75.8%, P < 0.001). Multivariate analysis showed that performance status, Ann Arbor stage, serum lactate dehydrogenase, and GNRI were independent prognostic factors for OS. Among patients with high-intermediate and high-risk by National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI), the 5-year OS was significantly lower in patients with a GNRI < 96.8 than in those with a GNRI ≥ 96.8 (high-intermediate risk, 59.5 vs. 75.2%, P = 0.006; high risk, 37.4 vs. 64.9%, P = 0.033). In the present study, we demonstrated that the GNRI was an independent prognostic factor in DLBCL patients. The GNRI could identify a population of poor-risk patients among those with high-intermediate and high-risk by NCCN-IPI.
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Affiliation(s)
- Yusuke Kanemasa
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan.
| | - Tatsu Shimoyama
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
| | - Yuki Sasaki
- Department of Clinical Research Support, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tsunekazu Hishima
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yasushi Omuro
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
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Shoji F, Miura N, Matsubara T, Akamine T, Kozuma Y, Haratake N, Takamori S, Katsura M, Takada K, Toyokawa G, Takenaka T, Yamazaki K, Okamoto T, Takeo S, Maehara Y. Prognostic significance of immune-nutritional parameters for surgically resected elderly lung cancer patients: a multicentre retrospective study. Interact Cardiovasc Thorac Surg 2017; 26:389-394. [DOI: 10.1093/icvts/ivx337] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/17/2017] [Indexed: 01/29/2023] Open
Affiliation(s)
- Fumihiro Shoji
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoko Miura
- Department of Thoracic Surgery, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Taichi Matsubara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takaki Akamine
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuka Kozuma
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoki Haratake
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinkichi Takamori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masakazu Katsura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuki Takada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Gouji Toyokawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyoshi Takenaka
- Department of Thoracic Surgery, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Koji Yamazaki
- Department of Thoracic Surgery, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Tatsuro Okamoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sadanori Takeo
- Department of Thoracic Surgery, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abd Aziz NAS, Teng NIMF, Abdul Hamid MR, Ismail NH. Assessing the nutritional status of hospitalized elderly. Clin Interv Aging 2017; 12:1615-1625. [PMID: 29042762 PMCID: PMC5634387 DOI: 10.2147/cia.s140859] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose The increasing number of elderly people worldwide throughout the years is concerning due to the health problems often faced by this population. This review aims to summarize the nutritional status among hospitalized elderly and the role of the nutritional assessment tools in this issue. Methods A literature search was performed on six databases using the terms “malnutrition”, “hospitalised elderly”, “nutritional assessment”, “Mini Nutritional Assessment (MNA)”, “Geriatric Nutrition Risk Index (GNRI)”, and “Subjective Global Assessment (SGA)”. Results According to the previous studies, the prevalence of malnutrition among hospitalized elderly shows an increasing trend not only locally but also across the world. Under-recognition of malnutrition causes the number of malnourished hospitalized elderly to remain high throughout the years. Thus, the development of nutritional screening and assessment tools has been widely studied, and these tools are readily available nowadays. SGA, MNA, and GNRI are the nutritional assessment tools developed specifically for the elderly and are well validated in most countries. However, to date, there is no single tool that can be considered as the universal gold standard for the diagnosis of nutritional status in hospitalized patients. Conclusion It is important to identify which nutritional assessment tool is suitable to be used in this group to ensure that a structured assessment and documentation of nutritional status can be established. An early and accurate identification of the appropriate treatment of malnutrition can be done as soon as possible, and thus, the malnutrition rate among this group can be minimized in the future.
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Affiliation(s)
- Nur Adilah Shuhada Abd Aziz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Nur Islami Mohd Fahmi Teng
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Mohd Ramadan Abdul Hamid
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Nazrul Hadi Ismail
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
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Bo Y, Wang K, Liu Y, You J, Cui H, Zhu Y, Lu Q, Yuan L. The Geriatric Nutritional Risk Index Predicts Survival in Elderly Esophageal Squamous Cell Carcinoma Patients with Radiotherapy. PLoS One 2016; 11:e0155903. [PMID: 27196126 PMCID: PMC4873221 DOI: 10.1371/journal.pone.0155903] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/05/2016] [Indexed: 11/19/2022] Open
Abstract
The impact of nutritional status on survival among elderly esophageal squamous cell carcinoma (ESCC) patients undergoing radiotherapy is unclear. In this study, we aimed at validating the performance of the geriatric nutritional risk index (GNRI) in predicting overall survival time in elderly ESCC patients with radiotherapy. A retrospective cohort study was conducted on 239 ESCC patients aged 60 and over admitted consecutively from January 2008 to November 2014 in the Department of Radiotherapy, Henan Tumor Hospital (Affiliated Tumor Hospital of Zhengzhou University), Zhengzhou, Henan, China. All patients were subjected to nutritional screening using GNRI, and were followed for the occurrence of lymphatic node metastasis, radiation complication and mortality. The Kaplan-Meier method with Log-rank test was used to estimate survival curves. Univariable Cox regression analysis was used to identify variables associated with overall survival time. Among the 239 patients, 184 patients (76.9%) took no nutritional risk, 32 patients (13.4%) took moderate risk of malnutrition, and 23 patients (9.7%) took a high risk of malnutrition. Univariable Cox regression showed that both high nutritional risk group and moderate nutritional risk group were significantly less likely to survive than no nutritional risk patients (hazard ratio (HR) = 1.688, 95% confidence interval (CI) = 1.019-2.798 for moderate risk group, and HR = 2.699, 95% CI = 1.512-4.819 for high risk group, respectively). The GNRI is an independent prognostic factor for overall survival time in elderly ESCC patients with radiotherapy. A GNRI ≤98 can be suggested as an indicator of surviving less.
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Affiliation(s)
- Yacong Bo
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of radiotherapy, Henan Tumor Hospital, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Kunlun Wang
- Department of radiotherapy, Henan Tumor Hospital, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Liu
- Department of radiotherapy, Henan Tumor Hospital, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie You
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Han Cui
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yiwei Zhu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Quanjun Lu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
- * E-mail: (QJL); (LY)
| | - Ling Yuan
- Department of radiotherapy, Henan Tumor Hospital, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
- * E-mail: (QJL); (LY)
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