1
|
Uchida S, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Yamashita M, Noda T, Ueno K, Hotta K, Maekawa E, Yamaoka-Tojo M, Matsunaga A, Ako J. Prognostic Utility of Skeletal Muscle Mass Metrics in Patients With Heart Failure. Can J Cardiol 2023; 39:1630-1637. [PMID: 37574130 DOI: 10.1016/j.cjca.2023.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Sarcopenia is associated with risks of various adverse outcomes, and the assessment of skeletal muscle mass is necessary for its diagnosis. However, heart failure (HF) is a syndrome characterised by fluid retention, which affects muscle mass measurements. Different measurement methods have been reported to have different prognostic implications. We investigated the association between skeletal muscle mass metrics measured with the use of bioelectrical impedance analysis (BIA) and anthropometric measures and prognosis in patients with HF. METHODS The findings of 869 consecutive patients with HF were reviewed. We investigated the skeletal muscle mass index (SMI) measured with the use of BIA, the mid-upper arm circumference (MUAC), the arm muscle circumference (AMC), and the calf circumference (CC), and the patients were divided into 3 groups according to the sex-specific tertiles of the skeletal muscle mass metrics. The end points were all-cause death and readmission due to HF. RESULTS The high MUAC and AMC groups showed significantly better prognoses than their respective low groups (combined events: high MUAC group hazard ratio [HR] 0.559, 95% confidence interval [CI] 0.395-0.789 [P < 0.01]; high AMC group HR 0.505, 95% CI 0.359-0.710 [P < 0.01]), although high SMI and high CC were not associated with better prognoses. CONCLUSIONS Among patients with HF, MUAC and AMC are more associated with prognosis than SMI and CC, which are recommended in preexisting sarcopenia guidelines. MUAC and AMC may also be useful measures in sarcopenia assessments.
Collapse
Affiliation(s)
- Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Division of Research, ARCE, Sagamihara, Kanagawa, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kensuke Ueno
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Kazuki Hotta
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| |
Collapse
|
2
|
Kushwaha NS, Rana DB, Singh A, Saxena S, Srivastava S, Sharma V. Assessment of Nutrition Status and Its Effect on Outcomes in Patients With Limb Injuries Using the Subjective Global Assessment as a Screening Tool. Cureus 2023; 15:e44953. [PMID: 37818498 PMCID: PMC10561698 DOI: 10.7759/cureus.44953] [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] [Accepted: 09/09/2023] [Indexed: 10/12/2023] Open
Abstract
Background Malnutrition in hospitalized patients is a significant problem. This study aimed to assess the utility of the Subjective Global Assessment (SGA) in predicting the association between serum biomarkers and malnutrition in patients with limb injuries as well as the impact of malnutrition on clinical and radiological bone healing. Methodology This prospective study included 93 patients with limb injuries. Basic demographic details, serum biomarker levels, nutritional status assessed using the SGA, and the correlation of the Radiological Union Shaft Tibia (RUST) score with nutrition status were assessed along with the secondary outcomes. Results According to the SGA, patients were classified into Group A (well-nourished), Group B (moderately malnourished), and Group C (severely malnourished). Serum biomarkers (albumin, hemoglobin, platelets, and total leucocyte count) were significantly higher in Group A than in Group B + C (p < 0.0001). The nutritional status of patients from admission up to six months in Group A was significantly higher (p < 0.0001) compared to Group B + C. The radiological healing according to the RUST score had a negative correlation with C-reactive protein and a positive correlation with various parameters at six months. Conclusions The serum biomarker levels and the clinical and radiological bone healing, as measured by the RUST scoring system, showed a positive correlation with the nutritional status of the patients. Malnutrition significantly increases the chance of developing complications such as wound infection, decubitus, and infected implants.
Collapse
Affiliation(s)
| | - Divya Bhanu Rana
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, IND
| | - Arpit Singh
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, IND
| | - Suraj Saxena
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, IND
| | - Shubham Srivastava
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, IND
| | - Vineet Sharma
- Department of Orthopaedic Surgery, King George's Medical University, Lucknow, IND
| |
Collapse
|
3
|
Nabarrete JM, Pereira AZ, Garófolo A, Seber A, Venancio AM, Grecco CES, Bonfim CMS, Nakamura CH, Fernandes D, Campos DJ, Oliveira FLC, Cousseiro FK, Rossi FFP, Gurmini J, Viani KHC, Guterres LF, Mantovani LFAL, Darrigo LG, Albuquerque MIBPE, Brumatti M, Neves MA, Duran N, Villela NC, Zecchin VG, Fernandes JF. Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: children and adolescents. EINSTEIN-SAO PAULO 2021; 19:eAE5254. [PMID: 34909973 PMCID: PMC8664291 DOI: 10.31744/einstein_journal/2021ae5254] [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: 06/30/2019] [Accepted: 12/10/2020] [Indexed: 11/28/2022] Open
Abstract
The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Children and Adolescents was developed by dietitians, physicians, and pediatric hematologists from 10 Brazilian reference centers in hematopoietic stem cell transplantation. The aim was to emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to patient´s nutritional assessment. This consensus is intended to improve and standardize nutrition therapy during hematopoietic stem cell transplantation. The consensus was approved by the Brazilian Society of Bone Marrow Transplantation.
Collapse
Affiliation(s)
- Juliana Moura Nabarrete
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Andrea Z Pereira
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Adriana Garófolo
- Universidade Federal de São PauloInstituto de Oncologia PediátricaSão PauloSPBrazilInstituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Adriana Seber
- Universidade Federal de São PauloSão PauloSPBrazilUniversidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Angela Mandelli Venancio
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Carlos Eduardo Setanni Grecco
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoHospital das ClínicasRibeirão PretoSPBrazilHospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Carmem Maria Sales Bonfim
- Universidade Federal do ParanáHospital de ClínicasCuritibaSPBrazilHospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Claudia Harumi Nakamura
- Universidade Federal de São PauloInstituto de Oncologia PediátricaSão PauloSPBrazilInstituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Daieni Fernandes
- Santa Casa de Misericórdia de Porto AlegrePorto AlegreRSBrazilSanta Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Denise Johnsson Campos
- Universidade Federal do ParanáHospital de ClínicasCuritibaSPBrazilHospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Fernanda Luisa Ceragioli Oliveira
- Universidade Federal de São PauloEscola Paulista de MedicinaSão PauloSPBrazilEscola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Flávia Krüger Cousseiro
- Santa Casa de Misericórdia de Porto AlegrePorto AlegreRSBrazilSanta Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Flávia Feijó Panico Rossi
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Jocemara Gurmini
- Universidade Federal do ParanáHospital de ClínicasCuritibaSPBrazilHospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Karina Helena Canton Viani
- Universidade de São PauloFaculdade de MedicinaHospital das ClínicasSão PauloSPBrazilInstituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Luciana Fernandes Guterres
- Santa Casa de Misericórdia de Porto AlegrePorto AlegreRSBrazilSanta Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
| | | | - Luiz Guilherme Darrigo
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoHospital das ClínicasRibeirão PretoSPBrazilHospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
| | - Maria Isabel Brandão Pires e Albuquerque
- Instituto Nacional de Câncer José Alencar Gomes da SilvaRio de JaneiroRJBrazilInstituto Nacional de Câncer José Alencar Gomes da Silva - INCA, Rio de Janeiro, RJ, Brazil.
| | - Melina Brumatti
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Mirella Aparecida Neves
- Universidade Federal do ParanáHospital de ClínicasCuritibaSPBrazilHospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Natália Duran
- Hospital de Câncer de BarretosBarretosSPBrazilHospital de Câncer de Barretos, Barretos, SP, Brazil.
| | - Neysimelia Costa Villela
- Hospital de Câncer de BarretosBarretosSPBrazilHospital de Câncer de Barretos, Barretos, SP, Brazil.
| | - Victor Gottardello Zecchin
- Universidade Federal de São PauloInstituto de Oncologia PediátricaSão PauloSPBrazilInstituto de Oncologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Juliana Folloni Fernandes
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| |
Collapse
|
4
|
Rakotondrainibe A, Rasoaherinomenjanahary F, Rakotomena SD, Randriamizao HMRR, Samison LH, Rakoto Ratsimba HN, Sztark F. Évaluation nutritionnelle préopératoire en chirurgie viscérale au CHU d’Antananarivo, intérêt du grade nutritionnel. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
5
|
Akhlaghi Z, Sharifipour F, Nematy M, Safarian M, Malekahmadi M, Barkhidarian B, Norouzy A. Assessment of nutritional status in maintenance hemodialysis patients: A multicenter cross-sectional study in Iran. Semin Dial 2020; 34:77-82. [PMID: 33058310 DOI: 10.1111/sdi.12917] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/24/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Protein-energy wasting (PEW) is common in hemodialysis patients and is linked with a high rate of morbidity and mortality. Regarding importance of nutrition in these patients, a recent study was administered to evaluate the nutritional status of hemodialysis patients. MATERIALS In this cross-sectional study 540 HD patients from 15 dialysis centers were evaluated. The nutritional status of the patients was determined by Subjective Global Assessment (SGA), Dialysis Malnutrition Score (DMS), and Malnutrition Inflammation Score (MIS). Their dietary intakes were assessed using a Food Frequency Questionnaire (FFQ). RESULT Based on DMS, 66.7% of HD patients were well nourished and the prevalence of mild-to-moderate and severe PEW were 32.4% and 0.9% in HD patients, respectively. Based on MIS, 65.2% of HD patients were well nourished and the prevalence of mild-to-moderate and severe PEW was 34.0%. The prevalence of mild-to-moderate and severe malnutrition based on SGA was 35.0% and 1.1%, respectively. Energy and protein intake in 85.6% and 80.6% of patients respectively were less than the minimum recommended amount. CONCLUSION HD patients are at risk of malnutrition and in this regard training the patient, periodic assessment of nutritional status, and referring them to a dietitian seems necessary.
Collapse
Affiliation(s)
- Zahra Akhlaghi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzaneh Sharifipour
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Nematy
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Safarian
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Malekahmadi
- Research Center for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Barkhidarian
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolreza Norouzy
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
6
|
Dijkink S, Meier K, Krijnen P, Yeh DD, Velmahos GC, Arbous MS, Salim A, Hoogendoorn JM, Schipper IB. The malnutrition in polytrauma patients (MaPP) study: Research protocol. Nutr Health 2019; 25:291-301. [PMID: 31456469 PMCID: PMC6900577 DOI: 10.1177/0260106019868884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Polytrauma patients are at risk of considerable harm from malnutrition due to the metabolic response to trauma. However, there is little knowledge of (the risk of) malnutrition and its consequences in these patients. Recognition of sub-optimally nourished polytrauma patients and their nutritional needs is crucial to prevent complications and optimize their clinical outcomes. AIM The primary objective is to investigate whether polytrauma patients admitted to the Intensive Care Unit (ICU) who have or develop malnutrition have a higher complication rate than patients who are and remain well nourished. Secondary objectives are to determine the prevalence of pre-existent and in-hospital acquired malnutrition in these patients, to assess the association between malnutrition and long-term outcomes, and to determine the association between serum biomarkers (albumin and pre-albumin) and malnutrition. METHODS This international observational prospective cohort study will be performed at three Level-1 trauma centers in the United States and two Level-1 centers in the Netherlands. Adult polytrauma patients (Injury Severity Score ≥16) admitted to the ICU of one of the participating centers directly from the Emergency Department are eligible for inclusion. Nutritional status and risk of malnutrition will be assessed using the Subjective Global Assessment (SGA) scale and Nutritional Risk in Critically Ill (NUTRIC) score, respectively. Nutritional intake, biomarkers and complications will be collected daily. Patients will be followed up to one year after discharge for long-term outcomes. CONCLUSIONS This international prospective cohort study aims to gain more insight into the effect and consequences of malnutrition in polytrauma patients admitted to the ICU.
Collapse
Affiliation(s)
- Suzan Dijkink
- Department of Surgery, Leiden University Medical Center, The
Netherlands
- Contributed equally to this manuscript and therefore share first
authorship
| | - Karien Meier
- Department of Surgery, Leiden University Medical Center, The
Netherlands
- Contributed equally to this manuscript and therefore share first
authorship
| | - Pieta Krijnen
- Department of Surgery, Leiden University Medical Center, The
Netherlands
| | - D Dante Yeh
- Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery,
University of Miami Miller School of Medicine, Florida, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care,
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - M Sesmu Arbous
- Department of Intensive Care, Leiden University Medical Center Leiden, The
Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, The
Netherlands
| | - Ali Salim
- Department of Surgery, Division of Trauma, Burn and Surgical Critical Care,
Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jochem M Hoogendoorn
- Department of General Surgery, Haaglanden Medical Center Westeinde, The
Hague, The Netherlands
| | - Inger B Schipper
- Department of Surgery, Leiden University Medical Center, The
Netherlands
| |
Collapse
|
7
|
Luong R, Kim M, Lee A, Carey S. Assessing nutritional status in a cohort of liver cirrhosis outpatients: A prospective cross-sectional study. Nutr Health 2019; 26:19-25. [PMID: 31779515 DOI: 10.1177/0260106019888362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Malnutrition impairs prognosis in patients with liver cirrhosis (LC). There is limited research exploring the prevalence of malnutrition in patients with LC in an Australian population and in outpatient settings. AIMS One aim of this study was to investigate the prevalence of malnutrition in patients with LC in an outpatient liver clinic at a tertiary metropolitan hospital in Sydney, Australia, and explore other factors that may be associated with malnutrition. The second aim was to compare different versions of Subjective Global Assessment (SGA). METHODS This cross-sectional study evaluated the nutritional status of 42 prospectively recruited participants by SGA, SGA modified for liver disease (SGA-LD) and patient-generated SGA (PG-SGA). Anthropometric measures and handgrip strength (HGS) were also measured for comparison. Clinical and demographic data were compared with nutritional status. RESULTS SGA, SGA-LD and PG-SGA yielded the same prevalence of malnutrition of 40% with very good agreement (kappa value = 1.00). Malnourished patients had a lower median HGS% of normal than those who were well-nourished. Malnourished patients also had anthropometric measurements trending towards the lower percentiles of a healthy population. Nutritional status was significantly associated with ethnicity (p = 0.02) and PG-SGA score (p < 0.0001). CONCLUSION The present study showed that nearly half of our study population were malnourished (40%). Thus, nutrition intervention in terms of nutrition support could improve patient outcomes. It appears that the standard SGA is suitable to assess nutritional status in patients in the early stages of LC compared to more time-consuming SGA versions.
Collapse
Affiliation(s)
- Rebecca Luong
- Molecular Bioscience, University of Sydney, Australia
| | - Marcellinus Kim
- Nutrition and Dietetics Department, Concord Repatriation General Hospital, Australia
| | - Alice Lee
- Gastroenterology and Hepatology Department, Concord Repatriation General Hospital, Australia
| | - Sharon Carey
- Nutrition and Dietetics Department, Royal Prince Alfred Hospital, Australia
| |
Collapse
|
8
|
Hao X, Li D, Zhang N. Geriatric Nutritional Risk Index as a predictor for mortality: a meta-analysis of observational studies. Nutr Res 2019; 71:8-20. [DOI: 10.1016/j.nutres.2019.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022]
|
9
|
Özdemir U, Özdemir M, Aygencel G, Kaya B, Türkoğlu M. The role of maximum compressed thickness of the quadriceps femoris muscle measured by ultrasonography in assessing nutritional risk in critically-ill patients with different volume statuses. Rev Assoc Med Bras (1992) 2019; 65:952-958. [DOI: 10.1590/1806-9282.65.7.952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 04/19/2019] [Indexed: 11/22/2022] Open
Abstract
SUMMARY PURPOSE In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status. METHODS 55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected. RESULTS There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04). CONCLUSION Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.
Collapse
|
10
|
Pena NF, Mauricio SF, Rodrigues AMS, Carmo AS, Coury NC, Correia MITD, Generoso SV. Association Between Standardized Phase Angle, Nutrition Status, and Clinical Outcomes in Surgical Cancer Patients. Nutr Clin Pract 2018; 34:381-386. [PMID: 29870080 DOI: 10.1002/ncp.10110] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Different nutrition assessment tools in surgical cancer patients are used in clinical practice, which results in different prevalence rates of malnutrition. This may impact the interpretation of the association between nutrition status and clinical outcomes. Reduced standardized phase angle (SPA) values are associated with adverse outcomes in patients with cancer. Thus, it is important to assess the association of SPA with nutrition status and relate it to postoperative clinical outcomes. METHODS This prospective observational study included 121 surgical cancer patients. Bioelectrical impedance analysis, subjective global assessment (SGA), anthropometric measurements, and assessment of muscle strength were used to provide nutrition diagnosis 1 day before surgery. The patients were followed for infectious and noninfectious postoperative complications from the first day after the operation until discharge or death. RESULTS The prevalence of malnutrition was higher according to SGA (63.6%). Patients with an SPA < -1.65 had a greater chance of being diagnosed as malnourished according to the SGA (3.66 [1.35-9.90]), midarm circumference (OR 4.24; CI95%; 1.72-10.43), midarm muscle area (OR 4.38; CI95%; 1.68-11.42), and low handgrip strength (3.84 [1.31-11.25]). Patients with an SPA < -1.65 presented with more infectious complications (OR 4.19; CI95%; 1.52-11.53), but there was no association between SPA and other outcomes or death. SPA was the only significant predictor of infectious complications (AUC, 0.61; 95% CI, 0.51-0.71). CONCLUSION SPA was associated with different nutrition status parameters, and it was able to predict postoperative infectious complications.
Collapse
Affiliation(s)
- Natália F Pena
- Nursing School, Departament of Nutrition, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Sílvia F Mauricio
- Medicine Faculty, Departament of Surgery, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana M S Rodrigues
- Pharmacy Faculty, Departament of foods, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ariene S Carmo
- Medicine Faculty, Departament of Pediatric, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Nayara C Coury
- Nursing School, Departament of Nutrition, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria I T D Correia
- Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Simone V Generoso
- Nursing School, Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
11
|
Hoffer LJ. High-Protein Hypocaloric Nutrition for Non-Obese Critically Ill Patients. Nutr Clin Pract 2018; 33:325-332. [PMID: 29701916 DOI: 10.1002/ncp.10091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
High-protein hypocaloric nutrition, tailored to each patient's muscle mass, protein-catabolic severity, and exogenous energy tolerance, is the most plausible nutrition therapy in protein-catabolic critical illness. Sufficient protein provision could mitigate the rapid muscle atrophy characteristic of this disease while providing urgently needed amino acids to the central protein compartment and sites of tissue injury. The protein dose may range from 1.5 to 2.5 g protein (1.8-3.0 g free amino acids)/kg dry body weight per day. Nutrition should be low in energy (≈70% of energy expenditure or ≈15 kcal/kg dry body weight per day) because efforts to match energy provision to energy expenditure are physiologically irrational, risk toxic energy overfeeding, and have repeatedly failed in large clinical trials to demonstrate clinical benefit. The American Society for Parenteral and Enteral Nutrition currently suggests high-protein hypocaloric nutrition for obese critically ill patients. Short-term high-protein hypocaloric nutrition is physiologically and clinically sensible for most protein-catabolic critically ill patients, whether obese or not.
Collapse
Affiliation(s)
- L John Hoffer
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC, Canada
| |
Collapse
|
12
|
Abstract
Recent studies have suggested that undernutrition as defined using multidimensional nutritional evaluation tools may affect clinical outcomes in heart failure (HF). The evidence supporting this correlation is unclear. Therefore, we conducted this systematic review to critically appraise the use of multidimensional evaluation tools in the prediction of clinical outcomes in HF. We performed descriptive analyses of all identified articles involving qualitative analyses. We used STATA to conduct meta-analyses when at least three studies that tested the same type of nutritional assessment or screening tools and used the same outcome were identified. Sensitivity analyses were conducted to validate our positive results. We identified 17 articles with qualitative analyses and 11 with quantitative analysis after comprehensive literature searching and screening. We determined that the prevalence of malnutrition is high in HF (range 16-90 %), particularly in advanced and acute decompensated HF (approximate range 75-90 %). Undernutrition as identified by multidimensional evaluation tools may be significantly associated with hospitalization, length of stay and complications and is particularly strongly associated with high mortality. The meta-analysis revealed that compared with other tools, Mini Nutritional Assessment (MNA) scores were the strongest predictors of mortality in HF [HR (4.32, 95 % CI 2.30-8.11)]. Our results remained reliable after conducting sensitivity analyses. The prevalence of malnutrition is high in HF, particularly in advanced and acute decompensated HF. Moreover, undernutrition as identified by multidimensional evaluation tools is significantly associated with unfavourable prognoses and high mortality in HF.
Collapse
|
13
|
Orlandoni P, Venturini C, Jukic Peladic N, Costantini A, Di Rosa M, Cola C, Giorgini N, Basile R, Fagnani D, Sparvoli D, David S. Malnutrition upon Hospital Admission in Geriatric Patients: Why Assess It? Front Nutr 2017; 4:50. [PMID: 29164125 PMCID: PMC5670098 DOI: 10.3389/fnut.2017.00050] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/05/2017] [Indexed: 01/04/2023] Open
Abstract
Objective To assess the prevalence of malnutrition according to the new ESPEN definition in a population of geriatric hospital patients and to determine how malnutrition affects the length of hospital stay (LOS) and hospital mortality. Design A retrospective analysis of data gathered during nutritional screening surveys carried out three consecutive years, from 2012 to 2014, in an Italian geriatric research hospital (INRCA, Ancona) was performed. On the day of the study, demographic data, data on clinical conditions and the nutritional status of newly admitted patients were collected. Patients were screened for malnutrition risk using the Malnutrition Universal Screening Tool (MUST). Subsequently, malnutrition was diagnosed, for subjects at high risk, following the criteria suggested by the European Association for Clinical Nutrition and Metabolism [body mass index (BMI) < 18.5 kg/m2 or different combinations of unintentional weight loss over time and BMI values]. Sensitivity, specificity, positive and negative predictive value of MUST compared to ESPEN criteria were assessed. The characteristics of patients with a diagnosis of malnutrition were compared to those of non-malnourished patients. The impact of malnutrition on LOS and hospital mortality was investigated through logistic and linear regression models. Setting The study was performed in an Italian geriatric research hospital (INRCA, Ancona). Subjects Two hundred eighty-four newly hospitalized geriatric patients from acute care wards (mean age 82.8 ± 8.7 years), who gave their written consent to participate in the study, were enrolled. Results According to the MUST, high risk of malnutrition at hospitalization was found in 28.2% of patients. Malnutrition was diagnosed in 24.6% of subjects. The malnutrition was an independent predictor of both the LOS and hospital mortality. The multivariate analyses—linear and logistic regression—were performed considering different potential confounders contemporarily. The results showed that the malnutrition is an independent predictor of LOS and hospital mortality. Malnourished subjects were hospitalized almost 3 days longer compared to non-malnourished patients (p = 0.047; CI 0.04–5.80). The risk of death during hospitalization was 55% higher for malnourished patients (p = 0.037; CI 0.21–0.95). Conclusion A new ESPEN consensus of malnutrition was easily applicable in a population of geriatric hospital patients. Given that the nutritional status of geriatric patients was strongly correlated with the LOS and hospital mortality, the use of this simple and non-time consuming tool is highly recommended in clinical practice.
Collapse
Affiliation(s)
- Paolo Orlandoni
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Claudia Venturini
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Nikolina Jukic Peladic
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Annarita Costantini
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Mirko Di Rosa
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Claudia Cola
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Natascia Giorgini
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Redenta Basile
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Donata Fagnani
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Debora Sparvoli
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Serenella David
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| |
Collapse
|
14
|
Quality Improvement Interventions for Nutritional Assessment among Pregnant Mothers in Northeastern Uganda. BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28638835 PMCID: PMC5468564 DOI: 10.1155/2017/8036535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction Assessment of pregnant mothers for nutritional status is a neglected intervention. In Kaabong Hospital, nutritional status of pregnant mothers was not assessed during antenatal care (ANC) visits. A quality improvement (QI) project was initiated to increase nutritional assessment using midupper arm circumference (MUAC) among pregnant mothers during ANC visits from 0 to 90% between April and September 2015. Method Baylor-Uganda formed ANC Work Improvement Team (WIT) that reviewed ANC register, identified gaps in quality of care, analyzed root causes using cause-effect diagram, developed solutions, and tested and implemented the solution using Plan-Do-Study-Act cycles. Planned and tested changes included the provision of anthropometric tools, integrated ANC register, and data use. Result In April 2015 (baseline), none (0/235) of the pregnant women were assessed for nutritional status using MUAC. Following QI interventions, nutritional assessment improved to 79% (200/252) in May 2015 and to 100% (241/241) in June 2015. The 100% performance was sustained until August 2016. Overall, 39 cases of malnutrition—1 (2.6%) severe (MUAC < 19.0 cm) and 38 (97.4%) moderate acute malnutrition (MUAC 19–22.0 cm)—were identified and linked to nutritional rehabilitation program. Conclusion QI interventions are critical in achieving high rates of nutritional status assessment and identifying malnourished pregnant women during ANC visits.
Collapse
|
15
|
Kamimura MA, Majchrzak KM, Cuppari L, Pupim LB. Protein and Energy Depletion in Chronic Hemodialysis Patients: Clinical Applicability of Diagnostic Tools. Nutr Clin Pract 2017; 20:162-75. [PMID: 16207654 DOI: 10.1177/0115426505020002162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Protein and energy depletion states are common and associated with increased morbidity and mortality in chronic hemodialysis (CHD) patients. Therefore, proper use of diagnostic tools to assess depleted states in CHD patients is critical. Assessment of protein and energy status can be done by an array of methodologies that include simple estimates of the visceral and somatic pools of protein to more refined techniques to measure protein and energy balance. The nutritional and metabolic derangements in the CHD population are highly complex and can be confounded by multiple comorbidities and fluid shifts between body compartments. Therefore, assessment of protein and energy status in CHD patients requires a wide range of methodologies that not only identify depleted states but also monitor nutrition therapy and predict clinical outcome. Most important, these methods require cautious and individualized interpretation in order to minimize the interference of comorbid conditions frequently observed in the CHD population. Currently, there is not a single method that can be considered the gold standard for assessment of protein and energy status in CHD patients. Therefore, a combination of methods is recommended. In this review, we describe available methods to assess protein and energy status, with special considerations pertaining to CHD patients.
Collapse
Affiliation(s)
- M A Kamimura
- Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | |
Collapse
|
16
|
Sharma Y, Thompson C, Shari R, Hakendorf P, Miller M. Malnutrition in Acutely Unwell Hospitalized Elderly - "The Skeletons Are Still Rattling in the Hospital Closet". J Nutr Health Aging 2017; 21:1210-1215. [PMID: 29188881 DOI: 10.1007/s12603-017-0903-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Malnutrition is common in hospitalized patients with prevalence rates of up to 30% in Australian hospitals with adverse consequences for both the patients and health care services. Despite formulation of nutritional screening protocols, not all hospitalized patients get nutritional screening. Real life screening rates of hospitalized elderly patients are unknown. AIM The present study explored nutrition screening rate in acutely unwell elderly patients admitted in a large tertiary hospital and how these patients fared depending upon their nutrition status. METHODS A prospective cross-sectional study involving 205 general medical patients ≥60years recruited between November 2014 and November 2015. The number of patients who missed nutrition screening were noted and all patients underwent nutritional assessment by a qualified dietitian using PG-SGA and quality of life was measured using EQ-5D 5L. A survival curve was plotted and multivariate cox proportional hazard model was used to adjust for confounders. RESULTS Only 99 (49.7%) patients underwent nutritional screening. One hundred and six (53.5%) patients were confirmed as malnourished by PG-SGA. Malnourished patients had significantly longer length of hospital stay and had worse quality of life. Mortality was significantly higher in malnourished patients at one year (23 (21.7%) vs 4 (4.3%); p<0.001) and cox proportional hazard model suggests that malnutrition significantly affects survival even after adjustment for confounders like age, sex, Charlson index and polypharmacy. CONCLUSION This study confirms that nutrition screening is still suboptimal in elderly hospitalized patients with adverse consequences and suggests need for review of policies to improve screening practices.
Collapse
Affiliation(s)
- Y Sharma
- Michelle Miller, Flinders University, Australia,
| | | | | | | | | |
Collapse
|
17
|
Bector S, Vagianos K, Suh M, Duerksen DR. Does the Subjective Global Assessment Predict Outcome in Critically Ill Medical Patients? J Intensive Care Med 2016; 31:485-9. [DOI: 10.1177/0885066615596325] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/28/2015] [Indexed: 12/18/2022]
Abstract
Background: The Subjective Global Assessment (SGA) is a validated nutrition assessment tool that is not commonly used to evaluate the nutritional status of patients admitted to the intensive care unit (ICU). Objectives: The aims of this study were to determine the prevalence of malnutrition in critically ill medical patients using the SGA and to determine whether the SGA was predictive of patient outcome. Materials and Methods: A retrospective chart review was performed on 57 consecutive patients admitted to a single tertiary care medical ICU and requiring mechanical ventilation over a 6-month time period. All SGA assessments were performed by a single dietitian trained in this assessment technique. Multiple factors including patient demographics, severity of illness, length of mechanical ventilation, length of ICU stay, and mortality were abstracted from the charts. Results: The prevalence of malnutrition on admission as assessed by the SGA was 35%. Severity of illness as determined by Acute Physiology and Chronic Health Evaluation II (APACHE II) score was not different between the SGA groups. Mortality rates were significantly higher in the moderately (45.5%) and severely malnourished (55.6%) groups than in the well-nourished group (10.8%; P = .004). Conclusion: Malnutrition on admission is common in critically ill medical patients. Malnutrition, as assessed by SGA at admission to ICU, is associated with increased mortality and thus can serve as a valuable prognostic tool in the assessment of critically ill patients. Given that that the SGA is a simple bedside assessment, it should be considered for routine use in assessing critically ill patients.
Collapse
Affiliation(s)
- Savita Bector
- Department of Nutrition and Food Services, Health Science Centre, Winnipeg Manitoba, Canada
| | - Kathy Vagianos
- Department of Nutrition and Food Services, Health Science Centre, Winnipeg Manitoba, Canada
| | - Miyoung Suh
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Donald R. Duerksen
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
18
|
Hailemariam H, Singh P, Fekadu T. Evaluation of mini nutrition assessment (MNA) tool among community dwelling elderly in urban community of Hawassa city, Southern Ethiopia. BMC Nutr 2016. [DOI: 10.1186/s40795-016-0050-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
19
|
Role of nutrition on anemia in elderly. Clin Nutr ESPEN 2015; 11:e1-e11. [PMID: 28531420 DOI: 10.1016/j.clnesp.2015.09.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 07/08/2015] [Accepted: 09/30/2015] [Indexed: 12/15/2022]
Abstract
Anemia in elderly population have a great incidence and is related to increased mortality risk. The incidence of nutrition in anemia is about one third of the total. Caloric and protein restriction, iron, vitamin B12, folic deficiency are the causes of nutritional anemia. Protein and energy malnutrition stimulate an increased cytokines production with induction of inflammation, immunodeficiency and anemia. Anorexia and obesity can be associated with anemia due to increased cytokines and hepdicin serum level. Macrophages activity is inhibited and a decrease in red blood cells (RBC), hemoglobin (Hb) concentration due to ineffective erythropoiesis is observed. An adequate energy and protein diet is necessary to reduce inflammation and increase iron absorption. A minimum of 1700 kcal/day and 1.7 gr/kg/day of protein intake are necessary to maintain anabolism in chronic patients to prevent and treat anemia. Iron supplementation by intravenous injection is safe and effective to correct severe iron deficiency. The supplementation of vitamins and oligomineral are useful to reduce oxidative stress and improve RBC longevity. Anemia in elderly could be prevented by an adequate nutrition, a simple and not expensive intervention, and associated to physical exercise reduce the incidence of mortality rate.
Collapse
|
20
|
Fruchtenicht AVG, Poziomyck AK, Kabke GB, Loss SH, Antoniazzi JL, Steemburgo T, Moreira LF. Nutritional risk assessment in critically ill cancer patients: systematic review. Rev Bras Ter Intensiva 2015; 27:274-83. [PMID: 26270855 PMCID: PMC4592123 DOI: 10.5935/0103-507x.20150032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/08/2015] [Indexed: 01/10/2023] Open
Abstract
Objective To systematically review the main methods for nutritional risk assessment used in
critically ill cancer patients and present the methods that better assess risks
and predict relevant clinical outcomes in this group of patients, as well as to
discuss the pros and cons of these methods according to the current
literature. Methods The study consisted of a systematic review based on analysis of manuscripts
retrieved from the PubMed, LILACS and SciELO databases by searching for the key
words “nutritional risk assessment”, “critically ill” and “cancer”. Results Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and
were selected for the review. The main outcomes of these studies were that resting
energy expenditure was associated with undernourishment and overfeeding. The high
Patient-Generated Subjective Global Assessment score was significantly associated
with low food intake, weight loss and malnutrition. In terms of biochemical
markers, higher levels of creatinine, albumin and urea were significantly
associated with lower mortality. The worst survival was found for patients with
worse Eastern Cooperative Oncologic Group - performance status, high Glasgow
Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment
score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index
values < 87 were significantly associated with mortality. A high Prognostic
Inflammatory and Nutritional Index score was associated with abnormal nutritional
status in critically ill cancer patients. Among the reviewed studies that examined
weight and body mass index alone, no significant clinical outcome was found. Conclusion None of the methods reviewed helped to define risk among these patients.
Therefore, assessment by a combination of weight loss and serum measurements,
preferably in combination with other methods using scores such as Eastern
Cooperative Oncologic Group - performance status, Glasgow Prognostic Score and
Patient-Generated Subjective Global Assessment, is suggested given that their use
is simple, feasible and useful in such cases.
Collapse
Affiliation(s)
- Ana Valéria Gonçalves Fruchtenicht
- Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| | - Aline Kirjner Poziomyck
- Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| | - Geórgia Brum Kabke
- Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| | - Sérgio Henrique Loss
- Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, BR
| | - Jorge Luiz Antoniazzi
- Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| | - Thais Steemburgo
- Departamento de Nutrição, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| | - Luis Fernando Moreira
- Programa de Pós-Graduação em Medicina: Ciências Cirúrgicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| |
Collapse
|
21
|
Zhou J, Wang M, Wang H, Chi Q. Comparison of two nutrition assessment tools in surgical elderly inpatients in Northern China. Nutr J 2015; 14:68. [PMID: 26170020 PMCID: PMC4499876 DOI: 10.1186/s12937-015-0054-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/29/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND & OBJECTIVE Nutrition assessment enables early identification of malnourished patients and those at risk of malnutrition. To determine the prevalence of malnutrition, to analyze the correlation between short-form Mini Nutritional Assessment (MNA-SF) and Nutritional Risk Screening 2002 (NRS2002) with classical nutritional markers among elderly hospitalized patients in surgery departments, with a view to improving nutrition advice for these patients. METHODS A total of 142 elderly patients admitted for surgery were enrolled in the study. Within 48 hours of admission, MNA-SF and NRS2002 scale, anthropometric measures and biochemical tests were carried out to assess the nutritional status of each patient. RESULTS The prevalence of malnutrition classified by MNA-SF, NRS2002, BMI, serum albumin, hemoglobin, total lymphocyte count, handgrip strength, calf circumference and mid-arm circumference were 45%, 38%, 17%, 22%, 24%, 71%, 36%, 12 % and 15 %, respectively. As the nutritional status classified by both MNA-SF and NRS2002 deteriorated, BMI, serum albumin, hemoglobin, handgrip strength, mid-arm circumference and calf circumference of patients with malnutrition were lower (P < 0.05). MNA-SF and NRS2002 had a unanimous correlation with classical nutritional markers (P < 0.05) except total lymphocyte count (P > 0.05). MNA-SF results showed a moderate agreement (P < 0.001) with NRS2002. Malnourished patients were older than well-nourished patients with NRS2002 (P < 0.05). Digestive disease patients tend to suffer from malnutrition, evaluated by MNA-SF (P < 0.05). CONCLUSIONS The results show a relatively high prevalence of malnutrition among elderly patients in our general surgery department, especially in patients with digestive disease. NRS2002 and MNA-SF on elderly patients showed great consistency but significant difference in elderly patients with digestive disease. Both MNA-SF and NRS2002 correlated with each other and with BMI, serum albumin, hemoglobin, handgrip strength, calf circumference and mid-arm circumference. MNA-SF may be a more suitable tool for the nutrition assessment of surgical elderly inpatients.
Collapse
Affiliation(s)
- JunDe Zhou
- Department of General Surgery, The Second Affiliated Hospital, Harbin Medical University, 148, Bao Jian Road, Harbin, 150081, China
| | - Miao Wang
- Center for Animal Disease Control of Heilongjiang Province, Harbin, 150069, China
| | - HaiKuan Wang
- Department of General Surgery, The Second Affiliated Hospital, Harbin Medical University, 148, Bao Jian Road, Harbin, 150081, China
| | - Qiang Chi
- Department of General Surgery, The Second Affiliated Hospital, Harbin Medical University, 148, Bao Jian Road, Harbin, 150081, China.
| |
Collapse
|
22
|
Yi PH, Frank RM, Vann E, Sonn KA, Moric M, Della Valle CJ. Is potential malnutrition associated with septic failure and acute infection after revision total joint arthroplasty? Clin Orthop Relat Res 2015; 473:175-82. [PMID: 24867449 PMCID: PMC4390916 DOI: 10.1007/s11999-014-3685-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although malnutrition has been hypothesized to increase the risk of periprosthetic joint infection (PJI), strong evidence linking the two is lacking. QUESTIONS/PURPOSES The purposes of this study were to determine (1) if one or more laboratory values suggestive of malnutrition is independently associated with being revised for an infected joint arthroplasty as opposed to for an aseptic failure; (2) the relationship between laboratory parameters suggestive of malnutrition and obesity; and (3) if one or more laboratory parameters suggestive of malnutrition is independently associated with acute PJI complicating an aseptic revision procedure. METHODS Between 2002 and 2010, one surgeon performed 600 revision total joint arthroplasties in 547 patients; during that time, nutritional parameters (including serum albumin, total lymphocyte count, and transferrin) were routinely obtained preoperatively; complete data sets were available on 454 patients (501 procedures [84%]). We compared the frequency of having one or more laboratory parameters suggestive of malnutrition between patients undergoing a revision for septic reasons and aseptic reasons as well as between obese and nonobese patients. The 375 aseptic revisions were then assessed for the incidence of acute postoperative infection (within 90 days, diagnosed with Musculoskeletal Infection Society criteria). Multivariate logistic regression modeling was used to evaluate factors independently associated with (1) a septic as opposed to an aseptic mode of failure; and (2) acute postoperative infection after an aseptic revision. RESULTS Patients in 67 of 126 (53%) revisions for PJI had one or more laboratory parameters suggestive of malnutrition compared with 123 of 375 (33%) undergoing revision for a noninfectious etiology (odds ratio [OR], 2.3 [95% confidence interval, 1.5-3.5]; p<0.001). Patients who were of normal weight at the time of revision had the highest frequency of laboratory parameters suggestive of malnutrition (42 of 82 [51%]), although this was common in obese patients as well (76 of 238 [32%]) (p=0.002). Among the 375 aseptic revisions, 12 developed an acute postoperative infection (3%). The frequency of infection was nine of 123 in the group having one or more laboratory parameters suggestive of malnutrition and three of 252 in the group not having such laboratory parameters (7% versus 1%; p=0.003). Multivariate regression revealed that having laboratory parameters suggestive of malnutrition is independently associated with both chronic PJI (p=0.003; OR, 2.1) and an acute postoperative infection complicating an aseptic revision arthroplasty (p=0.02; OR, 5.9). CONCLUSIONS Having one or more laboratory parameters suggestive of malnutrition is common among patients undergoing revision arthroplasty and is independently associated with both chronic septic failure and acute postoperative infection complicating a revision performed for a noninfectious etiology. Future studies should assess the impact of a standardized screening protocol with subsequent correction of abnormal laboratory parameters suggestive of malnutrition on the risk of PJI to determine a potential causal relationship between the two. LEVEL OF EVIDENCE Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Paul H. Yi
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Rachel M. Frank
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Elliott Vann
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Kevin A. Sonn
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Mario Moric
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Craig J. Della Valle
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison Street, Suite 300, Chicago, IL 60612 USA
| |
Collapse
|
23
|
Ikizler TA. Using and Interpreting Serum Albumin and Prealbumin as Nutritional Markers in Patients on Chronic Dialysis. Semin Dial 2014; 27:590-2. [DOI: 10.1111/sdi.12288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- T. Alp Ikizler
- Division of Nephrology; Department of Medicine; Vanderbilt School of Medicine; Nashville Tennessee
| |
Collapse
|
24
|
Shaw C, Fleuret C, Pickard JM, Mohammed K, Black G, Wedlake L. Comparison of a novel, simple nutrition screening tool for adult oncology inpatients and the Malnutrition Screening Tool (MST) against the Patient-Generated Subjective Global Assessment (PG-SGA). Support Care Cancer 2014; 23:47-54. [PMID: 24947056 DOI: 10.1007/s00520-014-2319-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/08/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Oncology inpatients are at high risk of malnutrition. Identification of at risk patients by nutrition screening requires a practical and easy to use tool. In this study, we have compared a simple, novel nutrition screening tool designed for an oncology inpatient setting and the Malnutrition Screening Tool (MST) against the Patient-Generated Subjective Global Assessment (PG-SGA). METHODS This was an observational study to compare assessment of nutritional status by PG-SGA with nutrition screening using the Royal Marsden Nutrition Screening Tool (RMNST) and the MST. Patients were recruited from a single tertiary cancer centre. RESULTS One hundred and twenty-six oncology inpatients underwent a full nutritional assessment and nutrition screening. The PG-SGA tool identified 90 (71%) patients as malnourished or at risk and 36 (29%) patients as well-nourished. The RMNST had a sensitivity of 93% and a specificity of 53%, and the MST had a sensitivity of 66% and a specificity of 83 %. Predictive value (ROC AUC) of both screening tools was excellent at 0.84 and 0.83 for RMNST and MST, respectively. CONCLUSIONS This study identified a high prevalence of malnutrition in the population with 71% of patients being identified as malnourished or at risk of malnutrition. The RMNST had an excellent sensitivity for identifying patients who were malnourished or at risk of malnutrition in the inpatient setting although it had a poor specificity. The MST had a poorer sensitivity of 66 %. We would recommend that the RMNST is trialled in other oncology inpatient settings and also in the outpatient setting.
Collapse
Affiliation(s)
- Clare Shaw
- Department of Nutrition and Dietetics, The Royal Marsden NHS Foundation Trust, London, Sutton, UK,
| | | | | | | | | | | |
Collapse
|
25
|
Yao ZH, Tian GY, Yang SX, Wan YY, Kang YM, Liu QH, Yao F, Lin DJ. Serum albumin as a significant prognostic factor in patients with malignant pleural mesothelioma. Tumour Biol 2014; 35:6839-45. [PMID: 25051913 DOI: 10.1007/s13277-014-1938-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 04/03/2014] [Indexed: 12/27/2022] Open
Abstract
Our aim was to evaluate the prognostic role of the pretreatment serum albumin level in patients with malignant pleural mesothelioma (MPM) receiving platinum-based systemic chemotherapy. From 1995 to 2013, a total of 97 patients receiving platinum-based systemic chemotherapy for newly diagnosed MPM were enrolled. All clinical information and laboratory results were retrospectively collected from the medical records. The Kaplan-Meier method was used to calculate survival. The Cox proportional hazards model was used to identify significant independent prognostic factors for predicting survival. In total, 34 of the 97 patients (35.1 %) had hypoalbuminaemia (albumin ≤ 35 g/l). The 1-year overall survival rate was 44.1 % for patients with hypoalbuminaemia and 72.0 % for patients with a normal albumin level. Multivariate analysis indicated that pretreatment albumin was an independent prognostic factor in MPM. Patients with hypoalbuminaemia had a greater risk of death than those with a normal albumin level [hazard ratio (HR) 1.778; 95 % confidence interval (CI) 1.504-2.998; P = 0.031]. When albumin was entered as a continuous variable in the Cox regression model, the HR of death was significantly decreased by 9.8 % (95 % CI 0.851-0.956) for each 1-g/l increment. The pretreatment serum albumin level is a simple, inexpensive and easily measurable marker with prognostic significance in MPM patients treated with platinum-based systemic chemotherapy.
Collapse
Affiliation(s)
- Zhou-Hong Yao
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, No. 324 Jingwuweiqi Road, Jinan, Shandong Province, 250021, People's Republic of China
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Fontes D, Generoso SDV, Toulson Davisson Correia MI. Subjective global assessment: A reliable nutritional assessment tool to predict outcomes in critically ill patients. Clin Nutr 2014; 33:291-5. [DOI: 10.1016/j.clnu.2013.05.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 03/28/2013] [Accepted: 05/03/2013] [Indexed: 01/12/2023]
|
27
|
Abstract
The ideal set of variables for nutritional monitoring that may correlate with patient outcomes has not been identified. This is particularly difficult in the PICU patient because many of the standard modes of nutritional monitoring, although well described and available, are fraught with difficulties. Thus, repeated anthropometric and laboratory markers must be jointly analyzed but individually interpreted according to disease and metabolic changes, in order to modify and monitor the nutritional treatment. In addition, isotope techniques are neither clinically feasible nor compatible with the multiple measurements needed to follow progression. On the other hand, indirect alternatives exist but may have pitfalls, of which the clinician must be aware. Risks exist for both overfeeding and underfeeding of PICU patients so that an accurate monitoring of energy expenditure, using targeted indirect calorimetry, is necessary to avoid either extreme. This is very important, since the monitoring of the nutritional status of the critically ill child serves as a guide to early and effective nutritional intervention.
Collapse
|
28
|
Gabrielson DK, Scaffidi D, Leung E, Stoyanoff L, Robinson J, Nisenbaum R, Brezden-Masley C, Darling PB. Use of an abridged scored Patient-Generated Subjective Global Assessment (abPG-SGA) as a nutritional screening tool for cancer patients in an outpatient setting. Nutr Cancer 2013; 65:234-9. [PMID: 23441610 DOI: 10.1080/01635581.2013.755554] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The scored Patient-Generated Subjective Global Assessment tool (PG-SGA), regarded as the most appropriate means of identifying malnutrition in cancer patients, is often challenging to implement in a busy outpatient setting. We assessed the validity of an abridged version of the PG-SGA (abPG-SGA), which forgoes the physical examination, and compared its usefulness in discerning malnutrition to the full PG-SGA and Malnutrition Screening Tool (MST). The nutritional status of 90 oncology outpatients receiving chemotherapy was assessed according to SGA global rating, PG-SGA, and MST. Receiver operating characteristic (ROC) curves were generated to estimate the sensitivity and specificity of various cut-off scores for malnutrition. Thirty-six percent of patients were malnourished (SGA). The abPG-SGA yielded 94% sensitivity and 78% specificity and area under the curve (AUC) = 0.956, which was slightly lower than PG-SGA (97% sensitivity, 86% specificity, AUC = 0.967) and higher than MST (81% sensitivity, 72% specificity, AUC = 0.823). Patient reported symptoms included loss of appetite (30%), altered taste (31%), fatigue (30%), and decreased ability to perform activities of daily living (53%). In conclusion, the abPG-SGA is a practical, informative and valid tool for detecting malnutrition in the outpatient oncology setting.
Collapse
Affiliation(s)
- Denise K Gabrielson
- Department of Hematology-Oncology, St. Michael's Hospital, Toronto, ON, Canada
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: A narrative review. Maturitas 2013; 76:296-302. [DOI: 10.1016/j.maturitas.2013.07.013] [Citation(s) in RCA: 305] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 07/25/2013] [Indexed: 01/04/2023]
|
30
|
Moy FM, Darus A, Hairi NN. Predictors of Handgrip Strength Among Adults of a Rural Community in Malaysia. Asia Pac J Public Health 2013; 27:176-84. [DOI: 10.1177/1010539513510555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Handgrip strength is useful for screening the nutritional status of adult population as it is strongly associated with physical disabilities and mortality. Therefore, we aimed to determine the predictors of handgrip strength among adults of a rural community in Malaysia using a cross-sectional study design with multistage sampling. All adults aged 30 years and older from 1250 households were invited to our study. Structured questionnaire on sociodemographic characteristics, medical history, occupation history, lifestyle practices, and measurements, including anthropometry and handgrip strength were taken. There were 2199 respondents with 55.2% females and majority were of Malay ethnicity. Their mean (standard deviation) age was 53.4 (13.2) years. The response rate for handgrip strength was 94.2%. Females had significantly lower handgrip strength than males ( P < .05). In the multiple linear regression models, significant predictors of handgrip strength for males were age, height, job groups, and diabetes, while for females, the significant predictors were age, weight, height, and diabetes.
Collapse
Affiliation(s)
| | - Azlan Darus
- University of Malaya, Kuala Lumpur, Malaysia
| | | |
Collapse
|
31
|
Kuyumcu M, Yeşil Y, Oztürk Z, Halil M, Ulger Z, Yavuz B, Cankurtaran M, Güngör E, Erdoğan G, Besler T, Arıoğul S. Challenges in nutritional evaluation of hospitalized elderly; always with mini-nutritional assessment? Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
32
|
Abstract
Protein energy wasting is common in patients with CKD and ESRD and is associated with adverse clinical outcomes, such as increased rates of hospitalization and death, in these patients. A multitude of factors can affect the nutritional and metabolic status of patients with CKD, including decreased dietary nutrient intake, catabolic effects of renal replacement therapy, systemic inflammation, metabolic and hormonal derangements, and comorbid conditions (such as diabetes and depression). Unique aspects of CKD also confound reliable assessment of nutritional status, further complicating management of this comorbid condition. In patients in whom preventive measures and oral dietary intake from regular meals cannot help them maintain adequate nutritional status, nutritional supplementation, administered orally, enterally, or parenterally, is effective in replenishing protein and energy stores. The advantages of oral nutritional supplements include proven efficacy, safety, and compliance. Anabolic steroids and exercise, with nutritional supplementation or alone, improve protein stores and represent potential additional approaches for the treatment of PEW. There are several emerging novel therapies, such as appetite stimulants, anti-inflammatory interventions, and anabolic agents.
Collapse
Affiliation(s)
- T Alp Ikizler
- Department of Medicine, Division of Nephrology, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
33
|
Tomstad ST, Söderhamn U, Espnes GA, Söderhamn O. Nutritional self-care in two older Norwegian males: a case study. Clin Interv Aging 2013; 8:609-20. [PMID: 23807843 PMCID: PMC3686329 DOI: 10.2147/cia.s45458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Knowledge about how to support nutritional self-care in the vulnerable elderly living in their own homes is an important area for health care professionals. The aim of this case study was to evaluate the effects of nutritional intervention by comparing perceived health, sense of coherence, self-care ability, and nutritional risk in two older home-dwelling individuals before, during, and after intervention and to describe their experiences of nutritional self-care before and after intervention. METHODS A study circle was established to support nutritional self-care in two older home-dwelling individuals (≥65 years of age), who participated in three meetings arranged by health professionals over a period of six months. The effects of this study circle were evaluated using the Nutritional Form For the Elderly, the Self-care Ability Scale for the Elderly (SASE), the Appraisal of Self-care Agency scale, the Sense of Coherence (SOC) scale, and responses to a number of health-related questions. Qualitative interviews were performed before and after intervention to interpret the changes that occurred during intervention. RESULTS A reduced risk of undernutrition was found for both participants. A higher total score on the SASE was obtained for one participant, along with a slightly stronger preference for self-care to maintain sufficient food intake, was evident. For the other participant, total score on the SASE decreased, but the SOC score improved after intervention. Decreased mobility was reported, but this did not influence his food intake. The study circle was an opportunity to express personal views and opinions about food intake and meals. CONCLUSION An organized meeting place for dialogue between older home-dwelling individuals and health care professionals can stimulate the older person's engagement, consciousness, and learning about nutritional self-care, and thereby be of importance in reducing the risk of undernutrition.
Collapse
Affiliation(s)
- Solveig T Tomstad
- Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | | | | |
Collapse
|
34
|
Radman M, Mack R, Barnoya J, Castañeda A, Rosales M, Azakie A, Mehta N, Keller R, Datar S, Oishi P, Fineman J. The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). J Thorac Cardiovasc Surg 2013; 147:442-50. [PMID: 23583172 DOI: 10.1016/j.jtcvs.2013.03.023] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/31/2012] [Accepted: 03/15/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of this study was to determine the association between preoperative nutritional status and postoperative outcomes in children undergoing surgery for congenital heart defects (CHD). METHODS Seventy-one patients with CHD were enrolled in a prospective, 2-center cohort study. We adjusted for baseline risk differences using a standardized risk adjustment score for surgery for CHD. We assigned a World Health Organization z score for each subject's preoperative triceps skin-fold measurement, an assessment of total body fat mass. We obtained preoperative plasma concentrations of markers of nutritional status (prealbumin, albumin) and myocardial stress (B-type natriuretic peptide [BNP]). Associations between indices of preoperative nutritional status and clinical outcomes were sought. RESULTS Subjects had a median (interquartile range [IQR]) age of 10.2 (33) months. In the University of California at San Francisco (UCSF) cohort, duration of mechanical ventilation (median, 19 hours; IQR, 29 hours), length of intensive care unit stay (median, 5 days; IQR 5 days), duration of any continuous inotropic infusion (median, 66 hours; IQR 72 hours), and preoperative BNP levels (median, 30 pg/mL; IQR, 75 pg/mL) were associated with a lower preoperative triceps skin-fold z score (P < .05). Longer duration of any continuous inotropic infusion and higher preoperative BNP levels were also associated with lower preoperative prealbumin (12.1 ± 0.5 mg/dL) and albumin (3.2 ± 0.1; P < .05) levels. CONCLUSIONS Lower total body fat mass and acute and chronic malnourishment are associated with worse clinical outcomes in children undergoing surgery for CHD at UCSF, a resource-abundant institution. There is an inverse correlation between total body fat mass and BNP levels. Duration of inotropic support and BNP increase concomitantly as measures of nutritional status decrease, supporting the hypothesis that malnourishment is associated with decreased myocardial function.
Collapse
Affiliation(s)
- Monique Radman
- Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif
| | - Ricardo Mack
- Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala
| | - Joaquin Barnoya
- Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala; Surgery, Washington University, St. Louis, Mo; Division of Public Health Sciences, Washington University, St. Louis, Mo
| | - Aldo Castañeda
- Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala
| | - Monica Rosales
- Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala
| | | | - Nilesh Mehta
- Pediatrics, Boston Children's Hospital, Boston, Mass
| | - Roberta Keller
- Pediatrics, University of California, San Francisco, Calif
| | - Sanjeev Datar
- Pediatrics, University of California, San Francisco, Calif
| | - Peter Oishi
- Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif
| | - Jeffrey Fineman
- Pediatrics, University of California, San Francisco, Calif; Cardiovascular Research Institute, University of California, San Francisco, Calif.
| |
Collapse
|
35
|
Bhatia A, Pal R. Impact of Antarctica winters on vital parameters and anthropometric variables. Travel Med Infect Dis 2013; 11:170-7. [PMID: 23523509 DOI: 10.1016/j.tmaid.2013.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 02/22/2013] [Accepted: 02/25/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We studied the variations in vital parameters and anthropometric variables in Antarctica to identify the effect of extreme weather and isolation on the vital parameters and adipose tissue distribution in humans. METHODS A descriptive observational cohort study on three vital parameters and nine anthropometric measurements was conducted among the 26 winter team members of the 27th Indian Scientific Expedition to Antarctica. The parameters were evaluated in March, May and July 2008. The data was analyzed for: (1) undivided team, (2) groups based on physical activity levels, and (3) groups based on age. Intergroup variations were analyzed. RESULTS The diastolic blood pressure of the undivided team fell significantly during the study. The systolic and diastolic blood pressure of non-convoy team decreased but the systolic blood pressure of the convoy team increased. The pulse rate of the two physical activity groups increased. No significant changes were observed in rest of the vital parameters and any of the anthropometric variables. CONCLUSION The blood pressure of the expedition members may show unpredictable changes. But in a modern day Antarctic station, no significant variations in body fat are observed. Though the stress factors have been mitigated in Antarctica to a large extent, they might still be substantial. Quantification of the impact of such factors is difficult.
Collapse
Affiliation(s)
- Abhijeet Bhatia
- National Centre for Antarctic and Ocean Research, Vasco-da-Gama, Goa, India.
| | | |
Collapse
|
36
|
Hoffer LJ, Bistrian BR. Why critically ill patients are protein deprived. JPEN J Parenter Enteral Nutr 2013; 37:300-9. [PMID: 23459750 DOI: 10.1177/0148607113478192] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Critical illness dramatically increases muscle proteolysis and more than doubles the dietary protein requirement. Yet surprisingly, most critically ill patients receive less than half the recommended amount of protein during their stay in a modern intensive care unit. What could explain the wide gap between the recommendations in clinical care guidelines and actual clinical practice? We suggest that an important aspect of the problem is the failure of guidelines to explain the pathophysiology of protein-energy malnutrition and the ways critical illness modifies protein metabolism. The difficulty created by the lack of a framework for reasoning about appropriate protein provision in critical illness is compounded by the many ambiguous and often contradictory ways the word malnutrition is used in the critical care literature. Failing to elucidate these matters, the recommendations for protein provision in the guidelines are incoherent, unconvincing, and easy to ignore.
Collapse
Affiliation(s)
- L John Hoffer
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | | |
Collapse
|
37
|
Ikizler TA. Optimal nutrition in hemodialysis patients. Adv Chronic Kidney Dis 2013; 20:181-9. [PMID: 23439378 DOI: 10.1053/j.ackd.2012.12.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 12/03/2012] [Accepted: 12/06/2012] [Indexed: 11/11/2022]
Abstract
Protein-energy wasting (PEW) is highly prevalent in patients undergoing maintenance hemodialysis (MHD). It is important to note that there is a robust association between the extent of PEW and the risk of hospitalization and death in these patients, regardless of the nutritional marker used. The multiple etiologies of PEW in advanced kidney disease are still being elucidated. Apart from the multiple mechanisms that might lead to PEW, it appears that the common pathway for all of the derangements is related to exaggerated protein degradation along with decreased protein synthesis. The hemodialysis procedure per se is an important contributor to this process. Metabolic and hormonal derangements such as acidosis, inflammation, and resistance to anabolic properties of insulin resistance and growth hormone are all implicated for the development of PEW in MHD patients. Appropriate management of MHD patients at risk for PEW requires a comprehensive combination of strategies to diminish protein and energy depletion and to institute therapies that will avoid further losses. The mainstay of nutritional treatment in MHD patients is provision of an adequate amount of protein and energy, using oral supplementation as needed. Intradialytic parenteral nutrition should be attempted in patients who cannot efficiently use the gastrointestinal tract. Other anabolic strategies such as exercise, anabolic hormones, anti-inflammatory therapies, and appetite stimulants can be considered as complementary therapies in suitable patients.
Collapse
|
38
|
Akbulut G, Sanlıer N, Inal S, Tek NA, Oneç K, Erten Y. Daily dietary energy and macronutrient intake and anthropometric measurements of the peritoneal dialysis patients. Ren Fail 2012; 35:56-61. [PMID: 23101754 DOI: 10.3109/0886022x.2012.734768] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION This study was planned to investigate the relation between dietary macronutrient status and anthropometric measurements in peritoneal dialysis (PD) patients. MATERIALS AND METHODS A total of 28 clinically stable patients were enrolled in this study. All patients were taken a dietary therapy according to the guidelines of the American Journal of Kidney Foundation for 12 weeks. The anthropometric measurements were taken by bioelectrical impedance analyzer. The daily macronutrient intakes of the patients were calculated by the food consumption records. RESULTS The mean age was 48.3 ± 13.10 years [56.3 ± 7.41 years for males (n = 14) and 40.3 ± 12.84 years for females (n = 14)]. There were significant changes in fat percentage (%), total body water (TBW; %, L), extracellular water (ECW; %, L), basal metabolic rate over body weight (BMR/BW), and body fat mass index (BMFI) in males (p < 0.05), but there was no change in females (p > 0.05). The daily dietary energy and protein intakes were under the recommended level in the study period. CONCLUSION Patients undergoing PD frequently have low intakes of protein and energy. It is recommended that individuals undergoing PD periodically maintain 3-day dietary records followed by dietary interviews conducted by a dietitian.
Collapse
Affiliation(s)
- Gamze Akbulut
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
39
|
Ikizler TA. The use and misuse of serum albumin as a nutritional marker in kidney disease. Clin J Am Soc Nephrol 2012; 7:1375-7. [PMID: 22904120 DOI: 10.2215/cjn.07580712] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
40
|
Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr 2012; 31:345-50. [DOI: 10.1016/j.clnu.2011.11.001] [Citation(s) in RCA: 545] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/04/2011] [Accepted: 11/03/2011] [Indexed: 01/15/2023]
|
41
|
Affiliation(s)
- Talat Alp Ikizler
- Department of Medicine, Division of Nephrology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2372, USA.
| |
Collapse
|
42
|
Vilaça KHC, Ferriolli E, Lima NKDC, Paula FJAD, Marchini JS, Moriguti JC. Força muscular e densidade mineral óssea em idosos eutróficos e desnutridos. REV NUTR 2011. [DOI: 10.1590/s1415-52732011000600005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Este estudo teve como objetivo avaliar a associação do estado nutricional com a força muscular de preensão manual e a densidade mineral óssea em idosos do sexo masculino. MÉTODOS: Participaram do estudo 41 idosos do sexo masculino, sendo 20 eutróficos (peso: M=69,6, DP=8,4; índice de massa corporal: M=25,7, DP=2,2) e 21 desnutridos (peso: M=50,9, DP=6,1; índice de massa corporal: M=18,7, DP=1,8), classificados subjetivamente segundo a Mini Avaliação Nutricional. A avaliação antropométrica incluiu peso corporal, altura, circunferência do braço e da panturrilha. A composição corporal foi avaliada pelo método de absorciometria por dupla emissão de Raios X, e a ocorrência de osteoporose foi definida de acordo com os critérios estabelecidos pela Organização Mundial da Saúde. A força muscular foi avaliada pelo dinamômetro de mão. RESULTADOS: O grupo desnutrido apresentou valores expressivamente menores dos parâmetros antropométricos e de com-posição corporal em relação ao grupo eutrófico (p<0,005). Além disso, a ocorrência de osteoporose foi signifi-cativamente maior (p<0,01) no grupo desnutrido em todas as regiões estudadas: colo do fêmur, quadril total e coluna. A força muscular de preensão manual dos idosos desnutridos foi significativamente menor que a dos idosos eutróficos (M=23,1, DP=6,8 e M=30,3, DP=8,4, respectivamente; p<0,005). CONCLUSÃO: A desnutrição está associada à menor força muscular e à diminuição da densidade mineral óssea em idosos do sexo masculino.
Collapse
|
43
|
Preoperative Nutritional Status and Post-Operative Infection in Total Knee Replacements: A Prospective Study of 213 Patients. Int J Artif Organs 2011; 34:876-81. [DOI: 10.5301/ijao.5000025] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2011] [Indexed: 11/20/2022]
Abstract
Purpose To assess the potential relationship between preoperative nutritional status, including anthropometric parameters, and infection following total knee replacement surgery. Methods A total of 213 patients undergoing total knee replacement between December 2007 and May 2008 were prospectively studied. Patients with rheumatoid arthritis were excluded. For each patient we pre-operatively checked biochemical and anthropometric parameters of nutrition information about co-morbidities such as diabetes and high blood pressure, ASA score, age, and gender. Information about early infections, both superficial and deep, was collected. A descriptive statistical analysis and univariate/multivariate logistic regression model for risk factors were performed. Results Eleven patients (5.16%) had an infection, 5 deep and 6 superficial. Neither co-morbidities nor preoperatively biochemical parameters were associated with infection. However, in the univariate logistic regression model there was an inversely proportional relationship between triceps skinfold (TSF) and infection. After adjusting for age, ASA score and gender (multivariate logistic regression), TSF remained significantly associated with infection. Conclusion There was a statistically significant association between TSF and post-operative infection risk after TKR. Level of evidence Level I (Prospective prognostic study).
Collapse
|
44
|
de Oliveira CMC, Kubrusly M, Mota RS, Choukroun G, Neto JB, da Silva CAB. Adductor pollicis muscle thickness: a promising anthropometric parameter for patients with chronic renal failure. J Ren Nutr 2011; 22:307-16. [PMID: 22056150 DOI: 10.1053/j.jrn.2011.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 07/16/2011] [Accepted: 07/18/2011] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Protein-calorie malnutrition is a prevalent disorder in chronic renal failure (CRF) and a major risk factor for increased mortality in hemodialysis (HD) patients. Although many methods have been used to assess malnutrition in CRF, the role of adductor pollicis muscle thickness (APMt) is not established yet. AIMS This study aimed to analyze the APMt in HD patients and to investigate the correlation between APMt and conventional anthropometric, laboratory, and bioelectrical impedance markers, as well as its association with mortality/morbidity in a period of 12 months of follow-up. SUBJECTS AND METHODS The study included 143 HD patients from a single facility. After dialysis, the dry weight, height, mid-arm circumference, triceps skinfold thickness, and APMt were measured. Subsequently, the body mass index, percentage of standard body weight, the mid-arm muscle circumference, and the mid-arm muscle area were calculated. Blood counts were performed for hemoglobin, creatinine, and albumin. Patients were also submitted to a single-frequency tetrapolar bioimpedance test for measuring resistance, reactance, phase angle, and percentage of body cell mass. The correlation between APMt and anthropometric, laboratory, and bioelectrical impedance parameters was calculated using Pearson's linear correlation. Multiple linear regression analysis was used to select independent risk factors to death and hospitalizations in 6 and 12 months of follow-up, among parameters selected by univariate analysis. RESULTS Patients were aged 52.2 ± 16.6 years (20 to 83 years) on average, 58% were men, and mean dialysis vintage was 5.27 ± 5.12 years. APMt was 11.85 ± 1.63 mm (men, 12.34 ± 1.53; women, 11.19 ± 1.51; P < .0001). APMt was positively correlated with body mass index (r = 0.37; P < .0001), mid-arm circumference (r = 0.437; P < .0001), mid-arm muscle circumference (r = 0.494; P < .0001), mid-arm muscle area (r = 0.449; P < .0001), percentage of standard body weight (r = 0.355; P = .000), creatinine (r = 0.230; P = .006), albumin (r = 0.207; P = .013), percentage of body cell mass (r = 0.293; P = .000), and phase angle (r = 0.402; P < .0001), and negatively correlated with resistance (r = -0.403; P < .0001). The APMt ≤10.6 mm was associated with a 3.3 times greater risk of hospitalization within 6 months of follow-up (OR = 3.3, 95% CI: 1.13 to 9.66; P = .029) compared with patients with an APMt >10.6 mm. The APMt was not associated with risk of death at 6 and 12 months or hospitalization within 12 months of follow-up. CONCLUSION This is the first study testing APMt as an anthropometric marker in HD patients. The parameter is easy to measure and does not seem to be significantly affected by variations in hydration status. The parameter was significantly correlated with markers reflecting the condition of the muscle compartment, but not with parameters estimating the fat mass. The determination of an APMt cutoff point for malnutrition in patients with CRF and its correlation with morbidity and mortality will require further investigation in clinical studies.
Collapse
|
45
|
Sheard JM, Ash S, Silburn PA, Kerr GK. Prevalence of malnutrition in Parkinson's disease: a systematic review. Nutr Rev 2011; 69:520-32. [DOI: 10.1111/j.1753-4887.2011.00413.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
46
|
Leroy S, Perez T, Neviere R, Aguilaniu B, Wallaert B. Determinants of dyspnea and alveolar hypoventilation during exercise in cystic fibrosis: Impact of inspiratory muscle endurance. J Cyst Fibros 2011; 10:159-65. [DOI: 10.1016/j.jcf.2010.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 12/15/2010] [Accepted: 12/16/2010] [Indexed: 11/30/2022]
|
47
|
Hill N, Fallowfield J, Price S, Wilson D. Military nutrition: maintaining health and rebuilding injured tissue. Philos Trans R Soc Lond B Biol Sci 2011; 366:231-40. [PMID: 21149358 DOI: 10.1098/rstb.2010.0213] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Food and nutrition are fundamental to military capability. Historical examples demonstrate that a failure to supply adequate nutrition to armies inevitably leads to disaster; however, innovative measures to overcome difficulties in feeding reap benefits, and save lives. In barracks, UK Armed Forces are currently fed according to the relatively new Pay As You Dine policy, which has attracted criticism from some quarters. The recently introduced Multi-Climate Ration has been developed specifically to deal with issues arising from Iraq and the current conflict in Afghanistan. Severely wounded military personnel are likely to lose a significant amount of their muscle mass, in spite of the best medical care. Nutritional support is unable to prevent this, but can ameliorate the effects of the catabolic process. Measuring and quantifying nutritional status during critical illness is difficult. A consensus is beginning to emerge from studies investigating the effects of nutritional interventions on how, what and when to feed patients with critical illness. The Ministry of Defence is currently undertaking research to address specific concerns related to nutrition as well as seeking to promote healthy eating in military personnel.
Collapse
Affiliation(s)
- Neil Hill
- Section of Investigative Medicine, Imperial College London, London, UK
| | | | | | | |
Collapse
|
48
|
Abstract
About 20%-50% of patients in hospitals are undernourished. The number varies depending on the screening tool amended and clinical setting. A large number of these patients are undernourished when admitted to the hospital, and in most of these patients, undernutrition develops further during hospital stay. The nutrition course of the patient starts by nutritional screening and is linked to the prescription of a nutrition plan and monitoring. The purpose of nutritional screening is to predict the probability of a better or worse outcome due to nutritional factors and whether nutritional treatment is likely to influence this. Most screening tools address four basic questions: recent weight loss, recent food intake, current body mass index, and disease severity. Some screening tools, moreover, include other measurements for predicting the risk of malnutrition. The usefulness of screening methods recommended is based on the aspects of predictive validity, content validity, reliability, and practicability. Various tools are recommended depending on the setting, ie, in the community, in the hospital, and among elderly in institutions. The Nutrition Risk Screening (NRS) 2002 seems to be the best validated screening tool, in terms of predictive validity ie, the clinical outcome improves when patients identified to be at risk are treated. For adult patients in hospital, thus, the NRS 2002 is recommended.
Collapse
Affiliation(s)
- Henrik H Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Medical Gastroenterology, Aarhus University Hospital, Aalborg, Denmark
| | | | | |
Collapse
|
49
|
Habek M, Hojsak I, Brinar VV. Nutrition in multiple sclerosis. Clin Neurol Neurosurg 2010; 112:616-20. [DOI: 10.1016/j.clineuro.2010.03.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 03/28/2010] [Accepted: 03/29/2010] [Indexed: 12/22/2022]
|
50
|
Malafaia G. A desnutrição energético-proteica: uma séria enfermidade que ainda assombra o contexto hospitalar. REVISTA PAULISTA DE PEDIATRIA 2010. [DOI: 10.1590/s0103-05822010000300020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|