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Ma JJ, Guo YJ, Li Z, Chen Y, He H, Li WM. Prevalence and prognostic significance of malnutrition risk in patients with pulmonary tuberculosis: A hospital-based cohort study. Front Public Health 2022; 10:1039661. [PMID: 36582380 PMCID: PMC9792975 DOI: 10.3389/fpubh.2022.1039661] [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: 09/08/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background The prevalence and prognostic significance of malnutrition risk remain unclear in Chinese patients with pulmonary tuberculosis. Therefore, we aimed to investigate the malnutrition risk in Chinese patients and explore the relationship between malnutrition risk and follow-up outcomes. Methods We conducted a hospital-based cohort study from January 2020 to December 2020. Malnutrition risks were evaluated using nutritional scales, including the Nutritional Risk Screening 2002 (NRS-2002), the controlling nutritional status score (CONUT), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index (PNI). The primary outcome was all-cause mortality at a one-year follow-up. Malnutrition risk was calculated, and the relationship between malnutrition and follow-up outcomes was analyzed. We assessed the performance of malnutrition risks to predict clinical outcomes in prognostic models. Results A total of 1,075 patients were included. According to NRS-2002, CONUT, GNRI, and PNI, 818 (76.09%), 954 (88.74%), 682 (63.44%), and 364 (33.86%) patients were at risk of malnutrition, respectively. Before 1-year follow-up, a total of 99 patients (9.2%) had died. After adjustment for risk factors, the association between severe malnutrition in CONUT (HR = 4.78, 95% CI: 1.14-20.11, P = 0.033), GNRI (HR = 3.53, 95% CI: 1.70-7.34, P = 0.001), or PNI (HR = 2.94, 95% CI: 1.76-4.88, P < 0.001) and death before 1-year follow-up remained significant. The addition of the nutritional scales to prognostic models improved death prediction, as validated by the integrated discrimination index (all P-values of <0.05). Conclusion Malnutrition in patients with pulmonary tuberculosis was associated with an increased risk of all-cause death in the long-term follow-up. Our findings provided evidence for the use of admission nutrition screening in patients with pulmonary tuberculosis.
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Affiliation(s)
- Jiao-Jie Ma
- Department of Nutrition, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yi-Jia Guo
- Beijing Chest Hospital, Capital Medical University, Beijing, China,Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Zhuo Li
- Department of Nutrition, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yang Chen
- Department of Nutrition, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Hong He
- Department of Nutrition, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Wei-Min Li
- Beijing Chest Hospital, Capital Medical University, Beijing, China,Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,National Tuberculosis Clinical Lab of China, Beijing Tuberculosis and Thoracic Tumor Research Institute and Beijing Key Laboratory in Drug Resistance Tuberculosis Research, Beijing, China,*Correspondence: Wei-Min Li
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Xie B, Sun Y, Sun J, Deng T, Jin B, Gao J. Applicability of five nutritional screening tools in Chinese patients undergoing colorectal cancer surgery: a cross-sectional study. BMJ Open 2022; 12:e057765. [PMID: 35623749 PMCID: PMC9150165 DOI: 10.1136/bmjopen-2021-057765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify the most appropriate nutritional risk screening tool for patients undergoing colorectal cancer surgery, five nutritional screening tools, including the Nutritional Risk Screening 2002 (NRS 2002), Short Form of Mini Nutritional Assessment (MNA-SF), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST) and Nutritional Risk Index (NRI), were employed to evaluate the nutritional risk at admission and short-term clinical outcome prediction. DESIGN A cross-sectional study. SETTING A comprehensive affiliated hospital of a university in Shenyang, Liaoning Province, China. PARTICIPANTS 301 patients diagnosed with colorectal cancer were continuously recruited to complete the study from October 2020 to May 2021. PRIMARY AND SECONDARY OUTCOME MEASURES Within 48 hours of hospital admission, five nutritional screening tools were used to measure the nutritional risk and to determine their relationship with postoperative short-term clinical outcomes. RESULTS The nutritional risk assesed by the five tools ranged from 25.2% to 46.2%. Taking the Subject Global Assessment as the diagnostic standard, MNA-SF had the best consistency (κ=0.570, p<0.001) and MST had the highest sensitivity (82.61%). Multivariate Logistic regression analysis after adjusting confounding factors showed that the NRS 2002 score ≥3 (OR 2.400, 95% CI 1.043 to 5.522) was an independent risk factor for postoperative complications and was the strongest predictor of postoperative complications (area under the curve 0.621, 95% CI 0.549 to 0.692). The scores of NRS 2002 (r=0.131, p<0.001), MNA-SF (r=0.115, p<0.05) and NRI (r=0.187, p<0.05) were poorly correlated with the length of stay. There was no correlation between the five nutritional screening tools and hospitalisation costs (p>0.05). CONCLUSIONS Compared with the other four nutritional screening tools, we found that NRS 2002 is the most appropriate nutritional screening tool for Chinese patients with colorectal cancer.
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Affiliation(s)
- Bingxin Xie
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yefei Sun
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jian Sun
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tingting Deng
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Baodi Jin
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jia Gao
- Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Hussein Z. Pulmonary tuberculosis: Impact of clinical and radiological presentations on mortality. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_48_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sharma V, Sharma V, Khan A, Wassmer DJ, Schoenholtz MD, Hontecillas R, Bassaganya-Riera J, Zand R, Abedi V. Malnutrition, Health and the Role of Machine Learning in Clinical Setting. Front Nutr 2020; 7:44. [PMID: 32351968 PMCID: PMC7174626 DOI: 10.3389/fnut.2020.00044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/23/2020] [Indexed: 12/16/2022] Open
Abstract
Nutrition plays a vital role in health and the recovery process. Deficiencies in macronutrients and micronutrients can impact the development and progression of various disorders. However, malnutrition screening tools and their utility in the clinical setting remain largely understudied. In this study, we summarize the importance of nutritional adequacy and its association with neurological, cardiovascular, and immune-related disorders. We also examine general and specific malnutrition assessment tools utilized in healthcare settings. Since the implementation of the screening process in 2016, malnutrition data from hospitalized patients in the Geisinger Health System is presented and discussed as a case study. Clinical data from five Geisinger hospitals shows that ~10% of all admitted patients are acknowledged for having some form of nutritional deficiency, from which about 60-80% of the patients are targeted for a more comprehensive assessment. Finally, we conclude that with a reflection on how technological advances, specifically machine learning-based algorithms, can be integrated into electronic health records to provide decision support system to care providers in the identification and management of patients at higher risk of malnutrition.
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Affiliation(s)
- Vaibhav Sharma
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Vishakha Sharma
- Geisinger Commonwealth School of Medicine, Scranton, PA, United States
| | - Ayesha Khan
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States
| | - David J. Wassmer
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States
| | | | | | | | - Ramin Zand
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, United States
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Muñoz-Torrico M, Cid-Juárez S, Galicia-Amor S, Troosters T, Spanevello A. Tuberculosis sequelae assessment and rehabilitation. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10022317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Maia I, Xará S, Vaz D, Shiang T, Amaral T. Undernutrition risk at hospital admission and length of stay among pulmonology inpatients. Pulmonology 2018; 24:330-336. [DOI: 10.1016/j.pulmoe.2018.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/21/2017] [Accepted: 01/13/2018] [Indexed: 12/13/2022] Open
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Lazzari TK, Forte GC, Silva DR. Nutrition Status Among HIV-Positive and HIV-Negative Inpatients with Pulmonary Tuberculosis. Nutr Clin Pract 2018; 33:858-864. [PMID: 29397039 DOI: 10.1002/ncp.10006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/09/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The association between tuberculosis (TB) and malnutrition is well recognized. Considering the risk of mortality due to malnutrition in patients with TB, it is necessary to conduct a thorough nutrition assessment to identify individuals at nutrition risk. The study objective was to assess the nutrition status of hospitalized patients with TB, co-infected or not by human immunodeficiency virus (HIV). METHODS Patients with confirmed diagnosis of TB were included using a cross-sectional design. Nutrition assessment parameters included: body mass index (BMI), triceps skin-fold thickness (TSF), bioelectrical impedance analysis (BIA), mid-upper-arm circumference (MUAC), mid-arm muscle circumference (MAMC), food frequency questionnaire, Malnutrition Screening Tool (MST), Subjective Global Assessment (SGA), and serum levels of hemoglobin. RESULTS A total 108 patients completed the study. Forty-four patients (40.7%) were HIV positive. Considering the BMI, 36.1% of the patients met the criteria for nutrition deficiency. Body fat percentage was low in 27.8% of patients. In addition, more than half of the participants met criteria for malnutrition according to MUAC, MAMC, TSF, SGA, or MST. Malnutrition measured by MAMC was more frequent in HIV-positive patients (n=33, 75.0%) than in HIV-negative patients (n=31, 48.4%) (P = 0.010). Regarding the components of diet, selenium and vitamin C intake among HIV-positive patients was significantly lower than in HIV-negative patients. CONCLUSIONS We identified a high prevalence of malnutrition in hospitalized patients with pulmonary TB, regardless of the method used to assess nutrition status. In HIV-positive patients, malnutrition measured by MAMC was more frequent than in HIV-negative patients.
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Affiliation(s)
- Tássia Kirchmann Lazzari
- Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Gabriele Carra Forte
- Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Denise Rossato Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
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Quality Improvement in Clinical Nutrition: Screening and Mealtime Protection for the Hospitalized Patient. CLIN NURSE SPEC 2017; 31:149-156. [PMID: 28383333 DOI: 10.1097/nur.0000000000000292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of the quality improvement project was to (1) enhance awareness, accuracy, and use of the validated nutrition screening tool by the nurse and (2) improve compliance to the nutrition care plan that included increasing patient meal intake percentage. DESCRIPTION OF THE PROJECT Nurses were provided with an in-depth educational program focused on the implementation of the nutrition screening tool on patient admission to the clinical site. Second, a unit-level patient protected mealtime program was implemented in an effort to decrease unnecessary mealtime interruptions and promote nurses and nursing assistants to assist with meals during mealtime to improve patient meal intake percentage and, finally, to encourage collaboration between the clinical nurse specialist, unit level nurses, and registered dietitians to improve patient nutritional care. OUTCOME The results indicate that the quality improvement strategies were successful in promoting the patient protected mealtime program and use of the nutrition screening tool. CONCLUSIONS The clinical nurse specialist plays a valuable role in program development, implementation, and evaluation to achieve quality healthcare through interdisciplinary collaboration. Adhering to nutrition guidelines for the hospitalized adult patient improves nutrition care plan guidance and meal intake.
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Maia I, Peleteiro B, Xará S, Amaral TF. Undernutrition Risk and Undernutrition in Pulmonology Department Inpatients: A Systematic Review and Meta-Analysis. J Am Coll Nutr 2017; 36:137-147. [DOI: 10.1080/07315724.2016.1209728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Isabel Maia
- ISPUP-EPIUnit, Universidade do Porto, Porto, PORTUGAL
| | - Bárbara Peleteiro
- ISPUP-EPIUnit, Universidade do Porto, Porto, PORTUGAL
- Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina, Universidade do Porto, Porto, PORTUGAL
| | - Sónia Xará
- Servi¸o de Nutri¸ão e Dietética, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PORTUGAL
| | - Teresa F. Amaral
- Faculdade de Ciências da Nutri¸ão e Alimenta¸ão, Universidade do Porto, Porto, PORTUGAL
- UISPA-IDMEC, Faculdade de Engenharia, Universidade do Porto, Porto, PORTUGAL
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Maia I, Xará S, Dias I, Parente B, Amaral TF. Nutritional Screening of Pulmonology Department Inpatients. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014; 20:293-8. [DOI: 10.1016/j.rppneu.2014.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/04/2014] [Indexed: 12/20/2022] Open
Affiliation(s)
- Isabel Maia
- Serviço de Nutrição e Dietética, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal.
| | - Sónia Xará
- Serviço de Nutrição e Dietética, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal
| | - Isabel Dias
- Serviço de Nutrição e Dietética, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal
| | - Bárbara Parente
- Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal
| | - Teresa F Amaral
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
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