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Pournasiri Z, Bakhtiary M, Nikparast A, Hashemi SM, Narjes Ahmadizadeh S, Behzad A, Asghari G. The association between nutritional status measured by body mass index and outcomes in the pediatric intensive care unit. Front Pediatr 2024; 12:1421155. [PMID: 39355651 PMCID: PMC11443694 DOI: 10.3389/fped.2024.1421155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/30/2024] [Indexed: 10/03/2024] Open
Abstract
Aim/Introduction The relationship between nutritional status upon admission to a pediatric intensive care unit (PICU) and clinical outcomes remains unclear. We examined the relationship between nutrition status, as indicated by body mass index-for-age (BMI-for-age), and clinical outcomes in the PICU. Method In this retrospective study at a tertiary care center, records of 1,015 critically ill children and adolescents aged one month to 18 years old with available anthropometric parameters were included. The nutritional status upon admission was determined by calculating the BMI-for-age z-score using the WHO growth charts as the reference. The participants were categorized as underweight (BMI-for-age z-score < -2), normal weight (-2 ≤ BMI-for-age z-score ≤ +1), and overweight/obese (BMI-for-age z-score > +1). Multi-variate odds ratios (OR) with 95% confidence intervals (CI) were used to investigate the association between malnutrition (being underweight and overweight/obese) and odds of Prolonged PICU stay (≥7 days) and PICU mortality after controlling for descriptive characteristics, Glasgow Coma Scale score status, fluctuations in serum sodium, and acute kidney injury confounders. Results The proportions of patients in underweight, normal weight, and overweight/obese categories were 34.2%, 45.8%, and 20%, respectively. During the study period, 21.5% of patients had prolonged PICU stay, and 5.6% of patients in PICU died. Compared to normal-weight patients, underweight patients had higher odds of prolonged PICU stay (OR: 1.52; 95% CI: 1.05-2.22) and PICU mortality (OR: 2.12; 95% CI: 1.22-4.01). Age- and gender-stratified full-adjusted analysis showed that the increased odds of prolonged PICU stay remained significant among underweight boys and underweight individuals aged 5-19 years old. Furthermore, the increased odds of PICU mortality remained significant among underweight individuals aged 2-5 years old. However, being overweight or obese during PICU admission did not demonstrate a significant association with our outcomes in the total sample or subgroup analysis. Conclusion Our findings showed that PICU patients who were underweight had higher odds of prolonged PICU stay and PICU mortality than their normal-weight counterparts. This underscores the importance of closely monitoring underweight patients in the PICU upon admission in order to improve clinical outcomes.
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Affiliation(s)
- Zahra Pournasiri
- Pediatric Nehrology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Bakhtiary
- Pediatric Nephrology Research Center, Research Institute for Children's Health, Mofid Children's Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Ali Nikparast
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Masumeh Hashemi
- Pediatric Intensive Care Departmant, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Narjes Ahmadizadeh
- Pediatric Intensive Care Departmant, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Behzad
- Pediatric Intensive Care Departmant, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golaleh Asghari
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Leon S, Rouhi AD, Roberson JL, Shreve LA, Nadolski GJ, Williams NN, Dumon KR. Safety of elective enteral access in elderly patients: a comparative analysis of perioperative risk. J Gastrointest Surg 2024; 28:1472-1478. [PMID: 38878956 DOI: 10.1016/j.gassur.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Elderly patients can experience torpid hospitalization that is often characterized by malnutrition. In this setting, enteral feeding may facilitate improvement in nutritional status. This study aimed to compare the perioperative outcomes between elderly (age of ≥65 years old) and nonelderly (age of <65 years old) patients undergoing elective enteral access placement. METHODS Adult patients who underwent enteral access procedures between 2018 and 2020 at a tertiary care facility were retrospectively reviewed. Differences in baseline characteristics between nonelderly and elderly patients were adjusted using entropy-balanced weights. Subsequently, multivariate logistic and linear regression models were developed to evaluate the association between elderly status and outcomes of interest. RESULTS Overall, 914 patients with enteral access met the inclusion criteria, of whom 471 (51.5%) were elderly. Elderly patients more commonly received percutaneous gastrostomy and had a higher burden of comorbidities as measured using the Charlson Comorbidity Index than nonelderly patients. Multivariate risk adjustment generated a strongly balanced distribution of baseline covariates between patient groups. After adjustment, despite no significant association with inhospital mortality, reoperation, or time to feeding goals, elderly status was linked to an approximately 8-day reduction in length of stay (95% CI, -14.28 to -2.30; P = .007) and significantly lower odds of total parenteral nutrition (adjusted odds ratio [AOR], 0.59; 95% CI, 0.37-0.94; P = .026) and nonelective readmission (AOR, 0.65; 95% CI, 0.49-0.86; P = .003). In addition, elderly status was associated with significantly greater odds of nonhome discharge (AOR, 1.58; 95% CI, 1.17-2.13; P = .003). CONCLUSION Despite having more comorbidities than their nonelderly counterparts, elderly patients experienced favorable nutritional and perioperative outcomes after enteral access placement.
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Affiliation(s)
- Sebastian Leon
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Armaun D Rouhi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jeffrey L Roberson
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Lauren A Shreve
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Gregory J Nadolski
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Noel N Williams
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Kristoffel R Dumon
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
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Weijzen MEG, Kohlen M, Monsegue A, Houtvast DCJ, Nyakayiru J, Beijer S, Geerlings P, Verdijk LB, van Loon LJC. Access to a pre-sleep protein snack increases daily energy and protein intake in surgical hospitalized patients. Clin Nutr 2024; 43:1073-1078. [PMID: 38579369 DOI: 10.1016/j.clnu.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/19/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND & AIM In hospitalized patients, daily protein intake remains far below WHO requirements for healthy adults (0.8 g·kg-1·d-1) as well as ESPEN guidelines for patients (1.2-1.5 g·kg-1·d-1). Providing access to a pre-sleep protein dense snack between dinner and going to bed may serve as a great opportunity to increase daily energy and protein intake in hospitalized patients. However, it remains to be assessed whether protein provision prior to sleep effectively increases protein intake, or may reduce food intake throughout the remainder of the day(s). The present study evaluated the impact of giving access to a pre-sleep snack on daily energy and protein intake in patients throughout their hospitalization. METHODS Patients admitted to the surgical wards of the Maastricht University Medical Centre+ were randomly allocated to usual care (n = 51) or given access to a pre-sleep snack (n = 50). The pre-sleep snack consisted of 103 g cheese cubes (30 g protein) provided between 7:30 and 9:30 PM, prior to sleep. All food provided and all food consumed was weighed and recorded throughout (2-7 days) hospitalization. Daily energy and protein intake and distribution were calculated. Data were analyzed by independent T-Tests with P < 0.05 considered as statistically significant. RESULTS Daily energy intake was higher in the pre-sleep group (1353 ± 424 kcal d-1) when compared to the usual care group (1190 ± 402 kcal·d-1; P = 0.049). Providing patients access to a pre-sleep snack resulted in a 17% (11 ± 9 g) higher daily protein intake (0.81 ± 0.29 g·kg-1·d-1) when compared to the usual care group (0.69 ± 0.28 g·kg-1·d-1; P = 0.045). Protein intake at breakfast, lunch, and dinner did not differ between the pre-sleep and usual care groups (all P > 0.05). CONCLUSION Providing access to a pre-sleep protein snack, in the form of protein dense food items such as cheese, represents an effective dietary strategy to increase daily energy and protein intake in hospitalized patients. Patients consuming pre-sleep protein snacks do not compensate by lowering energy or protein intake throughout the remainder of the days. Pre-sleep protein dense food provision should be implemented in hospital food logistics to improve the nutritional intake of patients. TRIAL REGISTER NO NL8507 (https://trialsearch.who.int/).
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Affiliation(s)
- Michelle E G Weijzen
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, the Netherlands
| | - Maxime Kohlen
- Department of Dietetics, Maastricht University Medical Centre+, the Netherlands
| | - Alejandra Monsegue
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, the Netherlands
| | - Dion C J Houtvast
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, the Netherlands
| | | | - Sandra Beijer
- Department of Dietetics, Maastricht University Medical Centre+, the Netherlands
| | - Phil Geerlings
- Department of Dietetics, Maastricht University Medical Centre+, the Netherlands
| | - Lex B Verdijk
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, the Netherlands
| | - Luc J C van Loon
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, the Netherlands.
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Capurso C, Lo Buglio A, Bellanti F, Vendemiale G. Prognostic Nutritional Index and Instant Nutritional Assessement Are Associated with Clinical Outcomes in a Geriatric Cohort of Acutely Inpatients. Nutrients 2024; 16:1359. [PMID: 38732604 PMCID: PMC11085456 DOI: 10.3390/nu16091359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Among elderly inpatients, malnutrition is one of the most important predictive factors affecting length of stay (LOS), mortality, and risk of re-hospitalization. METHODS We conducted an observational, retrospective study on a cohort of 2206 acutely inpatients. Serum albumin and lymphocytes were evaluated. Instant Nutritional Assessment (INA) and the Prognostic Nutritional Index (PNI) were calculated to predict in-hospital mortality, LOS, and risk of rehospitalization. RESULTS An inverse relationship between LOS, serum albumin, and PNI were found. Deceased patients had lower albumin levels, lower PNI values, and third- and fourth-degree INA scores. An accurate predictor of mortality was PNI (AUC = 0.785) after ROC curve analysis; both lower PNI values (HR = 3.56) and third- and fourth-degree INA scores (HR = 3.12) could be independent risk factors for mortality during hospitalization after Cox regression analysis. Moreover, among 309 subjects with a lower PNI value or third- and fourth-class INA, hospitalization was re-hospitalization. CONCLUSIONS PNI and INA are two simple and quick-to-calculate tools that can help in classifying the condition of hospitalized elderly patients also based on their nutritional status, or in assessing their mortality risk. A poor nutritional status at the time of discharge may represent an important risk factor for rehospitalization in the following thirty days. This study confirms the importance of evaluating nutritional status at the time of hospitalization, especially in older patients. This study also confirms the importance for adequate training of doctors and nurses regarding the importance of maintaining a good nutritional status as an integral part of the therapeutic process of hospitalization in acute departments.
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Affiliation(s)
- Cristiano Capurso
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (A.L.B.); (F.B.); (G.V.)
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Domnicu AE, Boia ER, Mogoi M, Manea AM, Marcovici TM, Mărginean O, Boia M. The Neutrophil-to-Lymphocyte Ratio (NLR) Can Predict Sepsis's Presence and Severity in Malnourished Infants-A Single Center Experience. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1616. [PMID: 37892278 PMCID: PMC10605152 DOI: 10.3390/children10101616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
Sepsis represents one of the leading causes of death in newborns and infants, and prompt diagnosis is essential for achieving favorable outcomes. Regarding malnourished children with concurrent infection, most studies have focused, besides blood culture, on C-reactive protein and procalcitonin. Because malnutrition has a deleterious effect on cellular immune competence, the present study characterized the acute-phase response, including hematological indices, in response to sepsis. Among the examined laboratory biomarkers, procalcitonin and neutrophil-to-lymphocyte ratio were the most accurate discriminators between sepsis patients and those with bacterial infection. Moreover, these two parameters showed a gradual increase between sepsis, severe sepsis, and septic shock patients (p < 0.001). Subgroup analysis of the sepsis group revealed positive correlations of NLR with prolonged ICU stay (<0.001), acute organ dysfunction (0.038), mechanical ventilation (<0.001), and fatality (<0.001). In summary, our results suggest that the neutrophil-to-lymphocyte ratio can be used as an auxiliary diagnostic index in discriminating the presence and severity of bacterial sepsis in malnourished infants.
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Affiliation(s)
- Alina Emilia Domnicu
- Ph.D. School Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
- Clinical Section I Pediatrics—Nutritional Recovery, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania;
| | - Eugen Radu Boia
- Department IX Surgery I, Discipline ENT, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- ENT Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Mirela Mogoi
- Pediatric Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Aniko-Maria Manea
- Neonatology and Puericulture Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-M.M.); (M.B.)
- Neonatology and Preterm Department, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania
| | - Tamara Marcela Marcovici
- Clinical Section I Pediatrics—Nutritional Recovery, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania;
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Otilia Mărginean
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
- Department of Pediatrics I, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania
- Department XI Pediatrics, Discipline I Pediatrics, Disturbances of Growth and Development in Children—BELIVE, 300011 Timisoara, Romania
| | - Marioara Boia
- Neonatology and Puericulture Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-M.M.); (M.B.)
- Neonatology and Preterm Department, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania
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Fontane L, Reig MH, Garcia-Ribera S, Herranz M, Miracle M, Chillaron JJ, Estepa A, Toro S, Ballesta S, Navarro H, Llaurado G, Pedro-Botet J, Benaiges D. Validity and Applicability of the Global Leadership Initiative on Malnutrition (GLIM) Criteria in Patients Hospitalized for Acute Medical Conditions. Nutrients 2023; 15:4012. [PMID: 37764796 PMCID: PMC10535463 DOI: 10.3390/nu15184012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: The objectives of this study were to evaluate the concurrent and predictive validity and the applicability of the global leadership initiative on malnutrition (GLIM) criteria in patients hospitalized for acute medical conditions. (2) Methods: prospective cohort study with patients hospitalized for acute medical conditions. For validation, the methodology proposed by the GLIM group of experts was used. Sensitivity and specificity values greater than 80% with respect to those for the subjective global assessment (SGA) were necessary for concurrent validation. The time necessary to complete each nutritional assessment test was determined. (3) Results: A total of 119 patients were evaluated. The SGA was applied to the entire cohort, but the GLIM criteria could not be applied to 3.4% of the patients. The sensitivity and specificity of the GLIM criteria with respect to those for the SGA to detect malnutrition were 78.0 and 86.2%, respectively. The GLIM predictive validity criterion was fulfilled because patients with malnutrition more frequently had a hospital stay >10 days (odds ratio of 2.98 (1.21-7.60)). The GLIM criteria required significantly more time for completion than did the SGA (p = 0.006). (4) Conclusion: The results of this study do not support the use of the GLIM criteria over the SGA for the diagnosis of malnutrition in patients hospitalized for acute medical conditions.
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Affiliation(s)
- Laia Fontane
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
| | - Maria Helena Reig
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
| | - Sonika Garcia-Ribera
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
| | - Miriam Herranz
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
| | - Mar Miracle
- Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Joan XXIII, 08028 Barcelona, Spain;
| | - Juan Jose Chillaron
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, 08002 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, 08003 Barcelona, Spain
| | - Araceli Estepa
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
| | - Silvia Toro
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
| | - Silvia Ballesta
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, 08003 Barcelona, Spain
| | - Humberto Navarro
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
- Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar., Dr. Aiguader, 80, 08003 Barcelona, Spain
| | - Gemma Llaurado
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, 08002 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, 08003 Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, 08003 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar., Dr. Aiguader, 80, 08003 Barcelona, Spain
| | - David Benaiges
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, 08002 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición, Monforte de Lemos Avenue, 3-5, Pavilion 11, Floor 0, 28029 Madrid, Spain
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Castro RJ, Gambetta-Tessini K, Clavijo I, Arthur RA, Maltz M, Giacaman RA. Caries Experience in Elderly People Consuming a Milk-Based Drink Nutritional Supplement: A Cross-Sectional Study. Caries Res 2023; 57:211-219. [PMID: 37315548 DOI: 10.1159/000531546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 06/08/2023] [Indexed: 06/16/2023] Open
Abstract
Nutritional supplements have been recommended to cope with malnutrition in elderly persons. In Chile, the Supplementary Nutrition Program for the Elderly (PACAM, for its Spanish acronym) consists in a monthly distribution of a low-fat-milk-based drink that contains 8% sucrose. The aim of this study was to determine whether older persons consuming the milk-based drink have a higher caries experience when compared to those not receiving the supplement. A cross-sectional study was conducted in the Maule Region in Chile. The representative sample comprised two groups: (a) PACAM consumers (CS) (n = 60) and (b) nonconsumers (NCS) (n = 60). Participants received intraoral examination and coronal (DMFT/DMFS) and root caries (RCI index) experience were recorded. Additionally, questionnaires regarding acceptability and consumption habits of PACAM and a 24-h diet recall were applied. The influence of predictors was calculated using binary logistic regression for a dichotomized DMFS and Poisson Regression for root caries lesions. A p value <0.05 was considered significant. No differences were detected in food consumption patterns between study groups (p > 0.05). CS participants had increased dairy product consumption. Higher DMFS mean value was observed in the CS (85.35 ± 39.0) compared with NCS (77.28 ± 28.9) (p = 0.043). The multivariate analysis showed nonconsumers of the milk-based product (β = -0.41, p = 0.02) are less likely to have root surfaces affected by caries. Additionally, CS show higher RCI, compared to nonconsumers (β = -0.17, p = 0.02). Daily consumption of a PACAM's milk-based drink supplement seems to increase coronal and root caries risk. Based on these results, composition modification of milk-based drinks with added sucrose appears mandatory.
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Affiliation(s)
- Ramiro J Castro
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Interuniversity Center on Healthy Aging, Talca, Chile
| | - Karla Gambetta-Tessini
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Ignacio Clavijo
- Master's Program in Geriatric Dentistry, Faculty of Dentistry, University of Talca, Talca, Chile
| | - Rodrigo A Arthur
- Preventive and Community Dentistry Department, Dental School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Marisa Maltz
- Preventive and Community Dentistry Department, Dental School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Dentistry, University of Talca, Talca, Chile
- Interuniversity Center on Healthy Aging, Talca, Chile
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R J M, A V, Chakraborthy A, B MK, Shetty A V, Badanthadka M. Protein malnutrition in BALB/C mice: A model mimicking clinical scenario of marasmic-kwashiorkor malnutrition. J Pharmacol Toxicol Methods 2023; 119:107231. [PMID: 36410663 DOI: 10.1016/j.vascn.2022.107231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/05/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
Protein malnutrition continues to be a major global issue. A stable animal model to address protein malnutrition and its effect on various disease conditions is necessary. In the present study, we have formulated and standardized a low protein diet (LPD) to develop a protein malnutrition model using Balb/C mice. Healthy male Balb/C mice were weaned and exposed to LPD combinations while another group exposed to normal diet (18% protein). Animal survival, change in body weight, body mass index (BMI), biochemical parameters, antioxidant status, and liver histopathology were used to confirm the development of malnourished mice model (marasmic-kwashiorkor). Mice receiving 10% protein diet showed moderate weight gain, higher BMI, and no mortality compared to the 6% protein group. The former group showed remarkable differences in BMI, biochemical and antioxidant parameters. Further, histopathological changes against the normal group at weeks 20 and 30 confirmed the development of protein malnutrition in mice on 10% protein diet. The study confirms the development of a stable, economical, reproducible, and clinically relevant protein malnutrition model using the formulated 10% protein diet. Further, the model can be used for short and long-term studies to investigate the pathophysiology of malnutrition in any disease/condition.
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Affiliation(s)
- Madhura R J
- Nitte (Deemed to be University), NGSM Institute of Pharmaceutical Sciences (NGSMIPS), Department of Nitte University Centre for Animal Research and Experimentation (NUCARE), Paneer campus, Deralakatte, Mangaluru 575 018, Karnataka, India
| | - Varsha A
- Nitte (Deemed to be University), NGSM Institute of Pharmaceutical Sciences (NGSMIPS), Department of Nitte University Centre for Animal Research and Experimentation (NUCARE), Paneer campus, Deralakatte, Mangaluru 575 018, Karnataka, India
| | - Anirban Chakraborthy
- Nitte (Deemed to be University), Nitte University Centre for Science Education and Research (NUCSER), Division of Molecular Genetics and Cancer, Kotekar-Beeri Road, Deralakatte, Mangaluru 575018, India
| | - Mohana Kumar B
- Nitte (Deemed to be University), K. S. Hegde Medical Academy, Nitte University Center for Stem Cell Research and Regenerative Medicine, Deralakatte, 575018 Mangaluru, India
| | - Veena Shetty A
- Nitte (Deemed to be University), K. S. Hegde Medical Academy, Department of Microbiology, Deralakatte, Mangaluru 575018, India
| | - Murali Badanthadka
- Nitte (Deemed to be University), NGSM Institute of Pharmaceutical Sciences (NGSMIPS), Department of Nitte University Centre for Animal Research and Experimentation (NUCARE), Paneer campus, Deralakatte, Mangaluru 575 018, Karnataka, India.
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9
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Dormal V, Pachikian B, Debock E, Buchet M, Copine S, Deldicque L. Evaluation of a Dietary Supplementation Combining Protein and a Pomegranate Extract in Older People: A Safety Study. Nutrients 2022; 14:nu14235182. [PMID: 36501211 PMCID: PMC9739468 DOI: 10.3390/nu14235182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Malnutrition is a highly prevalent condition in older adults. It is associated with low muscle mass and function and increased occurrence of health problems. Maintaining an adequate nutritional status as well as a sufficient nutrient intake in older people is therefore essential to address this public health problem. For this purpose, protein supplementation is known to prevent the loss of muscle mass during aging, and the consumption of various pomegranate extracts induces numerous health benefits, mainly through their antioxidant properties. However, to our knowledge, no study has to date investigated the impact of their combination on the level of malnutrition in older people. The objective of this preliminary study was thus to evaluate the safety of a combination of protein and a pomegranate extract in healthy subjects aged 65 years or more during a 21-day supplementation period. Thirty older participants were randomly assigned to receive protein and a pomegranate extract (Test group) or protein and maltodextrin (Control group) during a 21-day intervention period. The primary outcomes were the safety and tolerability of the supplementation defined as the occurrence of adverse events, and additional secondary outcomes included physical examination and hematological and biochemical parameters. No serious adverse events were reported in any group. Changes in physical, hematological, and biochemical parameters between the initial screening and the end of the study were equivalent in both groups, except for glutamate-pyruvate transaminase (GPT) and prealbumin, for which a decrease was observed only in the Test group. Our initial findings support the safety of the combination of protein and a pomegranate extract in healthy elderly people. Future clinical trials on a larger sample and a longer period are needed to determine the efficacy of this combination.
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Affiliation(s)
- Valérie Dormal
- Center of Investigation in Clinical Nutrition, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
- Institute of Neuroscience, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Barbara Pachikian
- Center of Investigation in Clinical Nutrition, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Elena Debock
- Center of Investigation in Clinical Nutrition, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Marine Buchet
- Center of Investigation in Clinical Nutrition, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Sylvie Copine
- Center of Investigation in Clinical Nutrition, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
| | - Louise Deldicque
- Center of Investigation in Clinical Nutrition, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
- Institute of Neuroscience, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium
- Correspondence:
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10
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Fukuuchi T, Itahashi I, Takayanagi F, Yamaoka N, Kaneko K. Determination of total purine and free purine content in milk, soymilk, and enteral nutritional supplements to assist nutritional therapy for hyperuricemia and gout. NUCLEOSIDES, NUCLEOTIDES & NUCLEIC ACIDS 2022; 41:1287-1295. [PMID: 35767334 DOI: 10.1080/15257770.2022.2093362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In this study, we determined the purine contents in milk and soymilk, as protein-rich drinks, and in enteral nutritional supplements employed to ameliorate protein malnutrition in the elderly. Milk consumption is known to lower serum uric acid levels and to promote uric acid excretion. However, discrepant results have been reported regarding the effect of soymilk on serum uric acid levels. The purpose of this study was to quantify and compare the total purine contents and the contents of individual purines and pyrimidines by molecular type (nucleotides, nucleosides, and bases).
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Affiliation(s)
- Tomoko Fukuuchi
- Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Itsuki Itahashi
- Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Fukue Takayanagi
- Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Noriko Yamaoka
- Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
| | - Kiyoko Kaneko
- Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan
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11
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Kapoor N, Bhattacharya S, Agarwal N, Das S, Bantwal G, Deshmukh V, Kalra S. Subclinical Kwashiorkor in Adults: A New Age Paradigm. Indian J Endocrinol Metab 2022; 26:213-222. [PMID: 36248046 PMCID: PMC9555378 DOI: 10.4103/ijem.ijem_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022] Open
Abstract
Childhood protein-energy undernutrition (PEU) is a well-recognized problem and therefore a lot of work has been done to identify and manage paediatric PEU. Though there have been several reports of low protein consumption in adults from developing countries, PEU and its subtle forms (subclinical PEU) are not yet recognized as adult disorders. Physicians and public perception do not favour easy recognition and action. In this review, the authors provide a scoping review of the existing literature on this entity providing insights into its recognition, pathogenesis and management. Adult subclinical PEU is an enormous under-recognized challenge that can have detrimental consequences if not recognized and corrected in time. PEU has grave health and economic impact on the patient and society. Therefore, it is important to recognize subclinical PEU and prevent its progression to full-blown form.
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Affiliation(s)
- Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
- Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Saptarshi Bhattacharya
- Consultant Endocrinologist, Apollo Centre for Obesity, Diabetes and Endocrinology (ACODE), Indraprastha Apollo Hospitals, New Delhi, India
| | - Navneet Agarwal
- Department of Diabetology, DNA Sugar Clinic, Gwalior, Madhya Pradesh, India
| | - Sambit Das
- Department of Endocrinology, Hi Tech Medical College and Hospital, Bhubaneshwar, Odisha, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St Johns Medical College and Hospital, Bengaluru, Karnataka, India
| | - Vaishali Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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12
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Huo Z, Chong F, Yin L, Lu Z, Liu J, Xu H. Accuracy of the GLIM criteria for diagnosing malnutrition: A systematic review and meta-analysis. Clin Nutr 2022; 41:1208-1217. [DOI: 10.1016/j.clnu.2022.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/04/2023]
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13
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Atuna RA, Amagloh FC, Denwar NN, Asase VR, Faisal S, Baako E, Koomson G, Gulkirpik E, Toc M, Donnelly A, Amagloh FK, Andrade Laborde JE. Filling the Protein Gap in Ghana: The Role of Soy. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2021.781571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The study assessed the nutrient value and desirability of eight improved soybean varieties, for use in soymilk, tofu and as an ingredient to enhance staple foods. The soymilk, tofu, and soybean residue (okara) yields were determined across all varieties. The okara was subsequently used in composite with cassava, as a recipe refinement of gari, a popular cassava-based ready-to-eat food. Multiple composite ratios were compared against a control of 100% cassava gari; 80% cassava: 20% okara, 70% cassava: 30% okara, and 50% cassava: 50% okara. The soymilk and tofu from the various varieties and okara enriched-gari were also evaluated for proximate and sensory qualities (n = 50) using standard protocols. No differences (p > 0.05) existed among soybean varieties in terms of soymilk (p = 0.55; 13.0–14.1 L), tofu (p = 0.05; 0.12–0.15 kg/L) or okara (p = 0.08; 3.17–3.97 kg) yields. The proximate parameters evaluated for soymilk did not vary significantly (p > 0.05) among varieties. However, for total solids (3.33–7.93°Brix; p < 0.01) there were significant differences. Generally, there was an increasing trend in the crude protein, moisture, crude fat and total ash contents for the okara-enriched gari as the okara inclusion increased from 20 to 50%. Thus, the crude protein content of the 50% okara-enriched gari, the formulation with the highest okara incorporation was almost 11-times higher than the 100% cassava gari. The swelling capacity of the okara-enriched gari ranged from 3.29–5.47 and for water holding capacity 439.7–482.1%. The okara-enriched gari was equally preferred by consumers, except for colour which consumers were mostly indifferent towards. The 50%-okara enriched gari composite was compared equally with 100% cassava gari control. The sensory data showed that the “Favour” soybean variety was desirable for soymilk production while Salintuya 1 was desirable for tofu production. Recipe refinements using the desired varieties and compositing okara with cassava may help fill the protein gap among the vulnerable group in Ghana by improving the protein quality of ready-to-eat foods such as gari.
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Albadi MS, Bookari K. Is Undernutrition Associated With Deterioration of Outcomes in the Pediatric Intensive Care Unit (PICU): Systematic and Meta-Analysis Review. Front Pediatr 2022; 10:769401. [PMID: 35601420 PMCID: PMC9114497 DOI: 10.3389/fped.2022.769401] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM Undernutrition (UN) may negatively impact clinical outcomes for hospitalized patients. The relationship between UN status at pediatric intensive care unit (PICU) admission and clinical outcomes is still not well-reported. This systematic meta-analysis review evaluated the impact of UN at admission to PICU on clinical outcomes, including mortality incidence, length of stay (LOS), and the need for and length of time on mechanical ventilation (MV). METHODS A search was conducted using relevant and multi-medical databases from inception until January 2022. We considered studies that examined the link between UN at PICU admission and clinical outcomes in patients aged 18 years or younger. Pooled risk difference estimates for the PICU outcomes were calculated using a random-effects model. RESULT There were a total of 10,638 patients included in 17 observational studies; 8,044 (75.61%) and 2,594 (24.38%) patients, respectively, were normal-nourished (NN) and undernourished (UN). In comparison to NN patients, UN patients had a slightly higher risk of mortality (RD = 0.02, P = 0.05), MV usage (RD = 0.05, P = 0.02), and PICU LOS (RD = 0.07, P = 0.007). While the duration of MV was significantly longer in UN than in NN (RD = 0.13, P < 0.0001). Sensitivity analysis of UN classification cohorts with a z-score < -2 or in the 5%, patetints age up to 18 years, and mixed diagnose for PICU admission demonstrated a 6-fold increase in the probability of PICU LOS in UN patients compared to NN patients (RD = 0.06, 95% CI = 0.01, 0.12). UN patients have a higher risk of MV usage RD = 0.07, 95% CI = 0.00, 0.14) in studies involving cohorts with a mixed primary diagnosis for PICU admission. CONCLUSION In PICU, UN is linked to mortality incidence, longer PICU stay, MV usage, and duration on MV. The primary diagnosis for PICU admission may also influence clinical outcomes. Determining the prevalence of UN in hospitalized patients, as well as the subgroups of patients diagnosed at the time of admission, requires more research. This may help explain the relationship between nutritional status and clinical outcomes in PICU patients.
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Affiliation(s)
- Maram S Albadi
- Clinical Nutrition Department, Maternity and Children Hospital, Medina, Saudi Arabia.,Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
| | - Khlood Bookari
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
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15
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Alonso A, Barat S, Kennedy H, Potter M, Alzahrani N, Morris D. Risk factors and clinical outcomes in patients undergoing cytoreductive surgery with concomitant ureteric reimplantation. Pleura Peritoneum 2021; 6:155-160. [PMID: 35071736 PMCID: PMC8719446 DOI: 10.1515/pp-2021-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
There are currently scarce data exploring ureteric reimplantation (UR) during cytoreductive surgery (CRS).
Methods
We identified patients undergoing CRS for peritoneal surface malignancies (PSM) of any origin at a single high-volume unit. UR was defined as ureteroureterostomy, transureterouretostomy, ureteroneocystostomy, ureterosigmoidostomy or ileal conduit performed during CRS. Peri-operative outcomes, long-term survival and risk factors for requiring UR were analysed.
Results
Seven hundred and sixty-seven CRSs were identified. Twenty-three (3.0%) procedures involved UR. Bladder resection and colorectal cancer (CRC) were associated with increased risk of UR (bladder resection: OR 12.90, 95% CI 4.91–33.90, p<0.001; CRC: OR 2.51, 95% CI 1.05–6.01, p=0.038). UR did not increase the risk of Grade III–IV morbidity or mortality. The rate of ureteric leak was 3/23 (13.0%) in the UR group. Mean survival was equivocal in patients with CRC (58.14 vs. 34.25 months, p=0.441) but significantly lower in those with high-grade appendiceal mucinous neoplasm (HAMN) undergoing UR (73.98 vs. 30.90 months, p=0.029).
Conclusions
UR during CRS does not increase major morbidity or mortality for carefully selected patients, and is associated with low rates of urologic complications. Whilst decreased survival was apparent in patients with HAMN undergoing UR, it is unclear whether this relationship is causal.
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Affiliation(s)
- Anais Alonso
- Liver and Peritonectomy Unit, St George Hospital , Kogarah , Australia
- St George and Sutherland Clinical School , University of New South Wales , Kogarah , Australia
| | - Shoma Barat
- Liver and Peritonectomy Unit, St George Hospital , Kogarah , Australia
- St George and Sutherland Clinical School , University of New South Wales , Kogarah , Australia
| | - Helen Kennedy
- Liver and Peritonectomy Unit, St George Hospital , Kogarah , Australia
| | - Meredith Potter
- Liver and Peritonectomy Unit, St George Hospital , Kogarah , Australia
| | - Nayef Alzahrani
- Liver and Peritonectomy Unit, St George Hospital , Kogarah , Australia
- College of Medicine , Al Imam Mohammad Ibn Saud Islamic University , Riyadh , Saudi Arabia
| | - David Morris
- Liver and Peritonectomy Unit, St George Hospital , Kogarah , Australia
- St George and Sutherland Clinical School , University of New South Wales , Kogarah , Australia
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Taib A, Ong T, Mulvaney E, Neale C, Strawther N, Peters C, Sahota A, Sahota O. Can an Ice-Cream Based Supplement Help Address Malnutrition in Orthogeriatric Patients? J Nutr Gerontol Geriatr 2021; 40:280-289. [PMID: 34635024 DOI: 10.1080/21551197.2021.1984365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Using a Plan-Do-Study-Act (PDSA) methodology, we describe our first cycle of a project using an ice-cream oral nutritional supplement (ONS ice-cream) to address malnutrition in older patients. A Scandishake-based® (Nutricia) vanilla flavored ice-cream was developed and piloted on a cohort of orthopedic patients over 3 days. All suitable patients were offered 100 g ice-cream portions (240 kcal/per portion). Acceptability and energy intake were our primary outcomes. Over 3 days, the ONS ice-cream was accepted in 77% (n = 27, median age, 75 years, IQR 12.5) of the times offered. Among these patients the average energy intake per day including the ONS ice-cream was 1006 kcal, a 41% increase in energy intake compared to an initial nutritional survey among the older orthopedic patients (714 kcal, p = 0.010). When surveyed 84% (n = 16) of patients stated they would have the ONS ice-cream again. An ONS ice-cream intervention to improve energy intake in older adults is feasible.
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Affiliation(s)
- Adnan Taib
- Specialty Trainee in General Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Terence Ong
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Emily Mulvaney
- Department of Trauma and Orthopedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Chris Neale
- Department of Catering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Strawther
- Dietetics and Nutrition, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Christina Peters
- Foundation Year Doctor 1, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Arun Sahota
- School of Medicine, University of Leicester, Leicester, UK
| | - Opinder Sahota
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Kassie Tesema A, Liyew AM, Alem AZ, Yeshaw Y, Tesema GA, Teshale AB. Spatial distribution and determinants of undernutrition among reproductive age women of Ethiopia: A multilevel analysis. PLoS One 2021; 16:e0257664. [PMID: 34543339 PMCID: PMC8452048 DOI: 10.1371/journal.pone.0257664] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 09/07/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Malnutrition is one of the most devastating problems in Ethiopia and is inextricably linked with poverty. Women in the reproductive age group and children are most vulnerable to malnutrition due to low dietary intakes, inequitable distribution of food within the household, improper food storage and preparation, dietary taboos, infectious diseases, and care. Therefore, this study aimed to assess the spatial distribution and determinants of undernutrition among reproductive age of Ethiopia. METHODS The study was based on the 2016 Ethiopian Demographic and Health Survey. The study included a total sampled weight of 15,139 women aged 15-49 years. The ArcGIS version 10.7 and SaTScan version 9.6 statistical software were used for exploring the spatial distribution of undernutrition. A multilevel logistic regression model was fitted to determine the individual and community level factors associated with women undernutrition. Finally, the factors which were significant at 95% confidence interval were reported. RESULT The spatial analysis revealed that women undernutrition was significantly varied across the country. The SaTScan analysis identified a total of 144 significant hotspot areas of maternal undernutrition with three significant spatial windows. Of these, 134 clusters were primary. The primary spatial window was identified in the southeast Tigray, northwest Afar, central and north Amhara regions (LLR = 57.48, P<0.01, RR = 1.51). Age at first marriage (AOR = 1.57: CI 1.33, 1.99), middle wealth index (AOR = 3.15: CI 1.4, 6.97), rural residence (AOR = 2.82: CI 1.22, 6.52), being in Afar region, Tigray region and Harari region (AOR = 4.88: CI 1.71, 13.91), (AOR = 4.17: CI 1.57, 11.06) and (AOR = 3.01: CI 1.05, 8.68) respectively were significantly associated with women undernutrition. CONCLUSION In Ethiopia, undernutrition had significant spatial variations across the country. Residence, age at first marriage, wealth index and region were significantly associated with undernutrition. Therefore, public health interventions that reduce reproductive age women undernutrition and enhance women awareness towards undernutrition in hotspot areas of undernutrition is crucial.
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Affiliation(s)
- Ayenew Kassie Tesema
- Department of Health Education and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mathewson SL, Azevedo PS, Gordon AL, Phillips BE, Greig CA. Overcoming protein-energy malnutrition in older adults in the residential care setting: A narrative review of causes and interventions. Ageing Res Rev 2021; 70:101401. [PMID: 34237434 DOI: 10.1016/j.arr.2021.101401] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/10/2021] [Accepted: 07/02/2021] [Indexed: 01/06/2023]
Abstract
Malnutrition, in particular protein-energy malnutrition, is a highly prevalent condition in older adults, and is associated with low muscle mass and function, and increased prevalence of physical frailty. Malnutrition is often exacerbated in the residential care setting due to factors including lack of dentition and appetite, and increased prevalence of dementia and dysphagia. This review aims to provide an overview of the available literature in older adults in the residential care setting regarding the following: links between sarcopenia, frailty, and malnutrition (in particular, protein-energy malnutrition (PEM)), recognition and diagnosis of malnutrition, factors contributing to PEM, and the effectiveness of different forms of protein supplementation (in particular, oral nutritional supplementation (ONS) and protein-fortified foods (PFF)) to target PEM. This review found a lack of consensus on effective malnutrition diagnostic tools and lack of universal requirement for malnutrition screening in the residential care setting, making identifying and treating malnutrition in this population a challenge. When assessing the use of protein supplementation in the residential care setting, the two primary forms of supplementation were ONS and PFF. There is evidence that ONS and PFF increase protein and energy intakes in residential care setting, yet compliance with supplementation and their impact on functional status is unclear and conflicting. Further research comparing the use of ONS and PFF is needed to fully determine feasibility and efficacy of protein supplementation in the residential care setting.
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19
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Chen L, Huang Z, Lu J, Yang Y, Pan Y, Bao K, Wang J, Chen W, Liu J, Liu Y, Chen K, Li W, Chen S. Impact of the Malnutrition on Mortality in Elderly Patients Undergoing Percutaneous Coronary Intervention. Clin Interv Aging 2021; 16:1347-1356. [PMID: 34290497 PMCID: PMC8286965 DOI: 10.2147/cia.s308569] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Malnutrition has been shown to be related to adverse clinical outcomes in patients with heart failure, hypertension, atrial fibrillation and other cardiovascular diseases. However, in the patients with coronary artery disease (CAD) undergoing percutaneous coronary interventions (PCI), especially in the elderly, the association of nutritional state and all-cause mortality remains unknown. We aimed to investigate the association of malnutrition with all-cause mortality in the elder patients undergoing PCI. Patients and Methods Based on the largest retrospective and observational cohort study from January 2007 to December 2017, the Controlling Nutritional Status (CONUT) score was applied to 21,479 consecutive patients with age ≥60 who undergoing PCI for nutritional assessment. Participants were classified as absent, mild, moderate and severe malnutrition by CONUT score. The Kaplan-Meier method was used to compare all-cause mortality among the above four groups. Multivariable Cox proportional hazard regression analyses were performed to examine the association of malnutrition with all-cause mortality. Results According to the CONUT score, 48.19%, 15.08% and 0.94% patients were mildly, moderately and severely malnourished, respectively. During a median follow-up of 5.16 years (interquartile range: 3.02 to 7.89 years), 3173 (14.77%) patients died. Kaplan-Meier analysis showed that the risk of all-cause mortality was significantly higher in patients with a worse nutritional status. Compared with normal nutritional state, malnutrition was associated with significantly increased risk for all-cause mortality (adjusted hazard ratio for mild, moderate and severe degrees of malnutrition, respectively: 1.20 [95% confidence interval (CI): 1.09 to 1.33], 1.32 [95% CI: 1.17 to 1.49] and 1.76 [95% CI: 1.33 to 2.33]). Conclusion Malnutrition is prevalent among elderly patients with CAD undergoing PCI, and is strongly related to the all-cause mortality increasing. For elderly patients with CAD undergoing PCI, it is necessary to assess the status of nutrition, and evaluate the efficacy of nutritional interventions.
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Affiliation(s)
- Liling Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, People's Republic of China
| | - Zhidong Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Jin Lu
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, People's Republic of China
| | - Yanfang Yang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, People's Republic of China
| | - Yuxiong Pan
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, People's Republic of China
| | - Kunming Bao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, People's Republic of China
| | - Junjie Wang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, People's Republic of China
| | - Weihua Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, People's Republic of China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Kaihong Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, People's Republic of China
| | - Weiguo Li
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, 364000, People's Republic of China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
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Hirsch KR, Wolfe RR, Ferrando AA. Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery. Nutrients 2021; 13:nu13051675. [PMID: 34063333 PMCID: PMC8156786 DOI: 10.3390/nu13051675] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022] Open
Abstract
Nutritional status is a strong predictor of postoperative outcomes and is recognized as an important component of surgical recovery programs. Adequate nutritional consumption is essential for addressing the surgical stress response and mitigating the loss of muscle mass, strength, and functionality. Especially in older patients, inadequate protein can lead to significant muscle atrophy, leading to a loss of independence and increased mortality risk. Current nutritional recommendations for surgery primarily focus on screening and prevention of malnutrition, pre-surgical fasting protocols, and combating post-surgical insulin resistance, while recommendations regarding macronutrient composition and timing around surgery are less established. The goal of this review is to highlight oral nutrition strategies that can be implemented leading up to and following major surgery to minimize atrophy and the resultant loss of functionality. The role of carbohydrate and especially protein/essential amino acids in combating the surgical stress cascade and supporting recovery are discussed. Practical considerations for nutrient timing to maximize oral nutritional intake, especially during the immediate pre- and post- surgical periods, are also be discussed.
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21
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Toh S, Ong C, Sultana R, Kirk AHP, Koh JC, Lee JH. Association between admission body mass index and outcomes in critically ill children: A systematic review and meta-analysis. Clin Nutr 2021; 40:2772-2783. [PMID: 33933743 DOI: 10.1016/j.clnu.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/23/2021] [Accepted: 04/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND & AIMS The association between nutritional status at pediatric intensive care unit (PICU) admission with clinical outcomes remains unclear. We conducted this systematic review to summarize the overall impact of PICU admission body mass index (BMI) on clinical outcomes. METHODS We searched the following medical databases from inception through May 2020: PubMed, Excerpta Medica database (Embase), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Web of Science. We included studies on patients ≤18 years old admitted to a PICU that investigated the effect of BMI on mortality, PICU or hospital length of stay (LOS), or duration of mechanical ventilation (MV). Classification of underweight, overweight, and obese were based on each study's criteria. RESULTS There was a total of 21,558 patients from 20 included studies. 12,936 (60.0%), 2965 (13.8%), 2182 (10.1%), 3348 (15.5%) were normal weight, underweight, overweight, and obese patients, respectively. Relative to normal weight patients, underweight (OR 1.32, 95% CI 0.89-1.98; p = 0.171) and overweight/obese patients (OR 1.10, 95% CI 0.86-1.42; p = 0.446) did not have an increase risk in mortality. There was also no difference in duration of MV, PICU and hospital LOS between all three weight categories. Included studies were heterogeneous and lacked standardized nutritional categorization. Sensitivity analysis including only studies that used BMI z-scores as nutritional classification (n = 5) revealed that underweight patients had higher odds of mortality compared to patients with normal weight (OR 1.61, 95% CI 1.35-1.92; p < 0.001); studies that used percentiles as classification did not reveal any differences in mortality. Sensitivity analysis including only studies containing mixed PICU cohorts (i.e., excluding specialized cohorts e.g., congenital heart surgeries, burns) revealed higher mortality odds in underweight patients (OR 1.53, 95% CI 1.25-1.87; p < 0.001) and overweight/obese patients (OR 1.51, 95% CI 1.14-2.01; p = 0.004) relative to normal weight patients. CONCLUSIONS Our systematic review did not reveal any association between PICU admission BMI status and outcomes in critically ill children. Further investigation with standardized nutrition status classification on admission, stratified by patient subgroups, is needed to clarify the association between nutritional status and clinical outcomes of PICU patients.
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Affiliation(s)
- Samantha Toh
- Duke-NUS Medical School, 8 College Rd, 169857, Singapore
| | - Chengsi Ong
- Department of Nutrition and Dietetics, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899, Singapore
| | - Rehena Sultana
- Duke-NUS Medical School, 8 College Rd, 169857, Singapore
| | - Angela Hui Ping Kirk
- Children's Intensive Care Unit, Division of Nursing, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899, Singapore
| | - Janine Cynthia Koh
- Department of Paediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899, Singapore
| | - Jan Hau Lee
- Duke-NUS Medical School, 8 College Rd, 169857, Singapore; Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Rd, 229899, Singapore.
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Taghizadeh S, Mahmoudinezhad M, Farazkhah T, Barari paein lamouki E, Kavyani M, Rashidi N, valiei F, Abbasalizad-Farhangi M. Neck circumference as a predictor of metabolic disorders and renal diseases in hospitalized patients. CLINICAL NUTRITION OPEN SCIENCE 2021. [DOI: 10.1016/j.nutos.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Richardson DP, Lovegrove JA. Nutritional status of micronutrients as a possible and modifiable risk factor for COVID-19: a UK perspective. Br J Nutr 2021; 125:678-684. [PMID: 32815493 PMCID: PMC7492581 DOI: 10.1017/s000711452000330x] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022]
Abstract
Recent scientific evidence has indicated that the elderly have increased risk of COVID-19 infections, with over 70s and 80s being hardest hit - especially residents of care homes and in clinical settings, ethnic minorities, people who work indoors and those who are overweight and obese. Other potential risk factors include lack of exposure to sunlight, darker skin pigmentation, co-morbidities, poor diet, certain medications, disadvantaged social and economic status, and lifestyle factors such as smoking and excessive consumption of alcohol. A key question is to understand how and why certain groups of people are more susceptible to COVID-19, whether they have weakened immune systems and what the roles of good nutrition and specific micronutrients are in supporting immune functions. A varied and balanced diet with an abundance of fruits and vegetables and the essential nutrients like vitamin D, vitamin A, B vitamins (folate, vitamin B6 and vitamin B12), vitamin C and the minerals, Fe, Cu, Se and Zn are all known to contribute to the normal functions of the immune system. Avoidance of deficiencies and identification of suboptimal intakes of these micronutrients in targeted groups of patients and in distinct and highly sensitive populations could help to strengthen the resilience of people to the COVID-19 pandemic. It is important to highlight evidence-based public health messages, to prevent false and misleading claims about the benefits of foods and food supplements and to communicate clearly that the extent of knowledge between micronutrients and COVID-19 infection is still being explored and that no diet will prevent or cure COVID-19 infection. Frequent handwashing and social distancing will be critical to reduce transmission.
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Affiliation(s)
- David P. Richardson
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, ReadingRG6 6AP, UK
| | - Julie A. Lovegrove
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, ReadingRG6 6AP, UK
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24
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Effect of malnutrition on length of hospital stay in children. Turk Arch Pediatr 2021; 56:37-43. [PMID: 34013228 DOI: 10.14744/turkpediatriars.2020.46354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/20/2020] [Indexed: 11/20/2022]
Abstract
Objective To determine the prevalence of malnutrition in hospitalized pediatric patients, to provide a classification of patients with malnutrition, and to evaluate the effect of malnutrition on length of hospital stay. Material and Methods The study included patients aged 5 months to 18 years who were hospitalized in the Department of Pediatrics of the Adana City Training and Research Hospital between May 1st, 2018, and December 31st, 2018. Bodyweight, height, mid-upper arm circumference, and triceps skinfold thickness were measured at the time of hospitalization, and age, sex, diagnosis, comorbid conditions, and length of stay for treatment were recorded. Results Of 1009 patients, 44% were female and 56% were male, and the mean age was 59.9±58.6 (median age 32) months. The mean length of stay was 6.83±4.48 days. Malnutrition was determined in 46.9% of the patients according to the Gomez classification. The mean length of stay in patients without malnutrition was 6.31±3.86 days, compared with 7.39±5.04 days in patients with malnutrition (p<0.001). The length of stay increased with increasing degrees of malnutrition (p<0.001). Conclusion Malnutrition is often overlooked in hospitalized patients. Studies conducted in different years that reported similar malnutrition rates indicated that this condition still existed as a significant health problem. In the evaluation of nutritional status in hospitalized patients, paying attention to malnutrition while addressing the main reason of hospitalization and incorporating nutritional support into the treatment plan will decrease the length of stay and also reduce the rate of complications.
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25
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Flint K, Matthews-Rensch K, Flaws D, Mudge A, Young A. Mealtime care and dietary intake in older psychiatric hospital inpatient: A multiple case study. J Adv Nurs 2020; 77:1490-1500. [PMID: 33326632 DOI: 10.1111/jan.14728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/24/2020] [Accepted: 11/23/2020] [Indexed: 12/29/2022]
Abstract
AIMS To investigate the energy and protein adequacy of meals and dietary intake of older psychiatric inpatients and describe patient and mealtime factors potentially influencing intake. DESIGN Multiple case studies. METHODS Psychiatric inpatients aged 65 years and older, admitted to a single mental health ward during the 6-week study period (April-May 2019) were eligible for inclusion. Dietary intake was observed for two consecutive days each week (minimum four observation days). Visual plate waste methods were used to estimate patients' dietary intake at mealtimes, with energy and protein intake calculated using known food composition data and compared with estimated requirements. Medical records were reviewed weekly to collect information on potential factors related to intake and mealtime care. Data from all sources were first summarized in a case record for within-case analysis using descriptive statistics, followed by cross-case analysis. RESULTS Eight participants (five men, age 67-90 years, two underweight and one overweight, and four requiring some mealtime assistance) had 5-12 days of observation data recorded. Three met their estimated daily energy and protein requirements throughout the study period, while the remaining five participants did not. The main barriers identified as contributing to insufficient energy and protein intake were as follows: missing meals (asleep and treatment); inadequate food provided (insufficiency of the standard hospital menu); and need for increased mealtime assistance. CONCLUSION Poor dietary intake may be common among older psychiatric patients, suggesting that they may also need nursing and multidisciplinary nutrition care interventions shown to effectively prevent and treat malnutrition in other older inpatient groups. IMPACT Older psychiatric patients experience similar nutrition and mealtime issues to other older inpatients. This study highlights the need for nurses and the multidisciplinary team to ensure patients order and receive adequate food, especially when they miss meals and that they receive proactive mealtime assistance.
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Affiliation(s)
- Kate Flint
- School of Human Movement and Nutrition, University of Queensland, Brisbane, Qld, Australia
| | - Kylie Matthews-Rensch
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Dylan Flaws
- Department of Mental Health, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia
| | - Alison Mudge
- Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.,School of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Adrienne Young
- School of Human Movement and Nutrition, University of Queensland, Brisbane, Qld, Australia.,Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
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26
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Mezemir Y, Egata G, Geset D, Lambebo A. Nutritional Status and Associated Factors Among the Community-Dwelling Elderly Population in Debre Berhan Town, North Shewa Zone, Ethiopia. NUTRITION AND DIETARY SUPPLEMENTS 2020. [DOI: 10.2147/nds.s280589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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27
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Clark AB, Reijnierse EM, Lim WK, Maier AB. Prevalence of malnutrition comparing the GLIM criteria, ESPEN definition and MST malnutrition risk in geriatric rehabilitation patients: RESORT. Clin Nutr 2020; 39:3504-3511. [DOI: 10.1016/j.clnu.2020.03.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 01/28/2020] [Accepted: 03/17/2020] [Indexed: 01/10/2023]
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28
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Castro R, Maltz M, Arthur R, Giacaman R. Anti-caries effect of fluoridated milk-based drink consumed by older adults on an in vitro root caries experimental model. Arch Oral Biol 2020; 118:104878. [DOI: 10.1016/j.archoralbio.2020.104878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/15/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
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29
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Weijzen MEG, Kouw IWK, Geerlings P, Verdijk LB, van Loon LJC. During Hospitalization, Older Patients at Risk for Malnutrition Consume <0.65 Grams of Protein per Kilogram Body Weight per Day. Nutr Clin Pract 2020; 35:655-663. [PMID: 32578906 PMCID: PMC7384011 DOI: 10.1002/ncp.10542] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Malnutrition is prevalent in hospitalized patients. To support muscle maintenance in older and chronically ill patients, a protein intake of 1.2-1.5 g/kg/d has been recommended during hospitalization. We assessed daily protein intake levels and distribution in older patients at risk for malnutrition during hospitalization. METHODS In this prospective, observational study, we measured actual food and food supplement consumption in patients (n = 102; age, 68 ± 14 years; hospital stay, 14 [8-28] days) at risk of malnutrition during hospitalization. Food provided by hospital meals, ONS, and snacks and the actual amount of food (not) consumed were weighed and recorded for all patients. RESULTS Hospital meals provided 1.03 [0.77-1.26] protein, whereas actual protein consumption was only 0.65 [0.37-0.93] g/kg/d. Protein intake at breakfast, lunch, and dinner was 10 [6-15], 9 [5-14], and 13 [9-18] g, respectively. The use of ONS (n = 62) resulted in greater energy (1.26 [0.40-1.79] MJ/d, 300 [100-430] kcal/d) and protein intake levels (11 [4-16] g/d), without changing the macronutrient composition of the diet. CONCLUSION Despite protein provision of ∼1.0 g/kg/d, protein intake remains well below these values (∼0.65 g/kg/d), as 30%-40% of the provided food and supplements is not consumed. Provision of ONS may increase energy and protein intake but does not change the macronutrient composition of the diet. Current nutrition strategies to achieve the recommended daily protein intake in older patients during their hospitalization are not as effective as generally assumed.
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Affiliation(s)
- Michelle E. G. Weijzen
- Department of Human BiologySchool of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+Maastrichtthe Netherlands
| | - Imre W. K. Kouw
- Department of Human BiologySchool of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+Maastrichtthe Netherlands
| | - Phil Geerlings
- Department of DieteticsMaastricht University Medical Centre+Maastrichtthe Netherlands
| | - Lex B. Verdijk
- Department of Human BiologySchool of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+Maastrichtthe Netherlands
| | - Luc J. C. van Loon
- Department of Human BiologySchool of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+Maastrichtthe Netherlands
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Judd S, Khedr M, Milan AM, Davison AS, Hughes AT, Needham A, Psarelli EE, Shenkin A, Ranganath LR. The nutritional status of people with alkaptonuria: An exploratory analysis suggests a protein/energy dilemma. JIMD Rep 2020; 53:45-60. [PMID: 32395409 PMCID: PMC7203650 DOI: 10.1002/jmd2.12084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/16/2019] [Accepted: 10/29/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Alkaptonuria (AKU) is a disorder of tyrosine/protein metabolism leading to accumulation of homogentisic acid. Clinical management historically recommended reducing dietary protein intake, especially in childhood, which has since been discredited in the literature. For the first time, analysis of baseline cross-sectional nutritional surveillance data from a large cohort of AKU patients is presented, which has clinical implications in all aspects of treatment planning. METHOD Seventy-four patients (mean 55 years) admitted to the National Alkaptonuria Centre (NAC), underwent a global nutritional assessment, which included objective anthropometry, bioimpedance measures, habitual nutritional intake using a 7-day food diary and key nutritional biomarkers, including 24 hours urinary nitrogen, serum albumin, total protein and total 25-hydroxy vitamin D. All data was compared with cohort norms or recommended nutrient intakes for health (RNI). The potential beneficial impact of protein and anti-inflammatory nutrients such as vitamin C, selenium, and zinc were statistically interrogated against the AKU severity score index (AKUSSI)-a validated measure of disease progression stratified by age. RESULTS Fifty percent of AKU patients reported some level of protein restriction at some point in their lives. In comparison with national data sets, AKU patients present with significantly lower than predicted mid-upper arm circumference, grip strength, BMI, total energy and protein intake, and higher than predicted percentage body fat. They therefore meet the ESPEN criteria as "clinically undernourished." Severity fluctuates over the life course. No statistical association is identified between protein intake, expressed as %RNI or g/kg, or anti-inflammatory nutrients, including vitamin C as a high dose supplement on the severity of the disease, when correlated against the validated AKUSSI score. CONCLUSION AKU patients are at risk of protein depletion associated with a "perfect storm" of risk factors: historical, poorly evidenced recommendations to reduce total protein intake; limited mobility as the condition progresses, compromising muscle integrity; frequent hospital admissions for major surgery associated with multiple joint replacements, creating pinch points of high metabolic demand and the potential impact of the disease itself. As this is the first time this risk has been identified, the authors consider the dietetic implications of nitisinone treatment, which requires dietary protein control to manage the acquired tyrosinaemia. The lack of statistically significant evidence to support dietary manipulation of any kind to impede disease progression in AKU is demonstrated.
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Affiliation(s)
- Shirley Judd
- Department of Nutrition and DieteticsRoyal Liverpool University HospitalLiverpoolUK
| | - Milad Khedr
- Department of Clinical Biochemistry and Metabolic MedicineLiverpool Clinical Laboratories, Royal Liverpool University HospitalLiverpoolUK
| | - Anna M. Milan
- Department of Clinical Biochemistry and Metabolic MedicineLiverpool Clinical Laboratories, Royal Liverpool University HospitalLiverpoolUK
| | - Andrew S. Davison
- Department of Clinical Biochemistry and Metabolic MedicineLiverpool Clinical Laboratories, Royal Liverpool University HospitalLiverpoolUK
| | - Andrew T. Hughes
- Department of Clinical Biochemistry and Metabolic MedicineLiverpool Clinical Laboratories, Royal Liverpool University HospitalLiverpoolUK
| | - Alexander Needham
- Liverpool Cancer Trials UnitUniversity of Liverpool, Block C, Waterhouse BuildingLiverpoolUK
| | - Eftychia E. Psarelli
- Liverpool Cancer Trials UnitUniversity of Liverpool, Block C, Waterhouse BuildingLiverpoolUK
| | - Alan Shenkin
- Department of Clinical Biochemistry and Metabolic MedicineLiverpool Clinical Laboratories, Royal Liverpool University HospitalLiverpoolUK
| | - Lakshiminaryan R. Ranganath
- Department of Clinical Biochemistry and Metabolic MedicineLiverpool Clinical Laboratories, Royal Liverpool University HospitalLiverpoolUK
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Assessment of nutritional status of older patients attending a tertiary hospital in Middle Eastern country. Clin Nutr ESPEN 2019; 33:105-110. [PMID: 31451245 DOI: 10.1016/j.clnesp.2019.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/16/2019] [Accepted: 06/22/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE In hospitals, poor nutritional status could be associated with a higher incidence of nosocomial infections, postoperative complications and mortality. Subsequently the costs of providing health care and social services will increase. Malnutrition has often been described as the skeleton in the hospital closet, as it is often ignored, undiagnosed and untreated. Our study aimed to describe the nutritional status of hospitalized patients aged 60 years or more and to evaluate the associated risk factors. MATERIALS AND METHODS This was an observational cross-sectional study conducted at a major tertiary teaching hospital in Beirut city. During a 7 months period, patients aged 60 and over and admitted in the medical and surgical units of the hospital were invited to participate in the study. Data were collected by means of a questionnaire including sociodemographic and medical characteristics, the Arabic version of the Mini Nutritional Assessment (MNA), the Activity of Daily Living (ADL) scale, and the American Society of Anesthesiologists (ASA) score. RESULTS 171 participants aged 73.15 ± 8.06 years were included in the study. 52% of them were at risk of malnutrition and 13.5% were malnourished. Prevalence of malnutrition was higher in medical compared to surgical departments (16.2% vs. 10.5%, p = 0.003). Moreover, malnutrition was significantly associated with low level of education, high age, prolonged hospital stay, high number of medical comorbidities, polymedication, high ASA score and low ADL score (p < 0.05). CONCLUSIONS Malnutrition or risk of malnutrition are found in 2 out of 3 hospitalized patients aged 60 years or more, and is associated with several specific risk factors. Screening and management of malnutrition should be considered a priority in order to improve the overall medical status of older people, reduce hospital stay and improve outcome and quality of life.
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Jung MK. [Nutritional Support for Patients with Pancreatic Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 74:87-94. [PMID: 31438660 DOI: 10.4166/kjg.2019.74.2.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 02/04/2023]
Abstract
Pancreatic cancer is the ninth common malignancy in South Korea. It has a dismal prognosis with a 5-year overall survival rate of less than 10%, and pancreatic cancer is associated with cancer cachexia, which is defined as the loss of muscle mass that is not reversible by conventional nutritional support. Cachexia is noted in over 85% of all pancreatic cancer patients and it is strongly related with the disease's mortality. Nearly 30% of pancreatic cancer deaths are due to cachexia rather than being due to the tumor burden. Therefore, it is crucial to discover the mechanisms behind the development of muscle wasting in pancreatic cancer patients and find novel therapeutics for targeting cachexia. This review deals with the current understanding about the development of cachexia and nutritional support in those patients suffering with pancreatic cancer.
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Affiliation(s)
- Min Kyu Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
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33
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[Factors related to the presence of hospital malnutrition in patients under five years old in a third level unit]. NUTR HOSP 2019; 36:563-570. [PMID: 31033333 DOI: 10.20960/nh.02490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Objective: to identify the factors related to the presence of hospital malnutrition (HM) in patients under five years of age hospitalized in a third level care unit. Material and methods: cohort study. Patients under five years of age hospitalized were included. The record identified age, sex, pathological history, reason for admission and nutritional status by calculating weight/age (W/A), height/age (H/A) and weight/height (W/H). The entire somatometry intake process was performed upon admission, and was repeated on days 2, 4 and 7 of follow-up. The HM was defined as a decrease of more than 0.25 standard deviations in the W/H after seven days of hospitalization. Results: eighty-three patients were identified. The reason for admission was non-surgical pathology in 77% (n = 64). Seventy per cent (n = 58) had underlying disease. At the time of admission, 66% (n = 55) presented malnutrition. A progressive decrease in the Z score of W/H was observed as hospitalization progressed (p < 0.001). An incidence of 67.5% of HM was identified. It was shown that the presence of malnutrition at admission of hospitalization increased the risk of HM (OR 2.9, 95% CI 1.05 to 8.10, p = 0.03). In patients with malnutrition from admission, an age younger than two years decreased the risk of HM (OR 0.093, 95% CI 0.009 to 0.959, p = 0.046), while the underlying disease increased the risk (OR 6.34, 95% CI 1.009 to 39.89, p = 0.049). Conclusions: the presence of malnutrition and underlying disease prior to admission were risk factors to present HM.
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Wang Q, Guo BY, Zhao QC, Yan ZD, Shang LF, Yu J, Ji G. Safety of early oral feeding after total laparoscopic radical gastrectomy for gastric cancer (SOFTLY): Study protocol for a randomized controlled trial. Trials 2019; 20:384. [PMID: 31242936 PMCID: PMC6595557 DOI: 10.1186/s13063-019-3493-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 06/05/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gastric cancer is the third most common cause of cancer-related deaths and has the fifth highest incidence worldwide, especially in eastern Asia, central and Eastern Europe, and South America. Currently, surgery is the only curative treatment for gastric cancer; however, there is an increasing trend toward laparoscopic radical gastrectomy. Early oral feeding (EOF) has been shown to benefit clinical outcomes compared with open gastrectomy under conditions of enhanced recovery after surgery. There are a lack of guidelines and evidence for the safety and feasibility of EOF in patients undergoing laparoscopic radical gastrectomy. Thus, a prospective randomized trial is warranted. METHODS/DESIGN The EOF after total laparoscopic radical gastrectomy (SOFTLY) study is a single-center, parallel-arm, non-inferiority randomized controlled trial which will enroll 200 patients who are pathologically diagnosed with gastric cancer and undergo laparoscopic radical gastrectomy. The primary endpoint, incidence of anastomotic leakage, is based on 1.9% in the control group in the CLASS-01 study. The patients will be randomized (1:1) into two groups: the EOF group will receive a clear liquid diet on post-operative day 1 (POD1) and the delayed oral feeding (DOF) group will receive a clear liquid diet on post-operative day 4 (POD4). The demographic and pathologic characteristics will be recorded. Total and oral nutritional intake, general data, total serum protein, serum albumin, blood glucose, and temperature will be recorded before surgery and at the time of hospitalization. Adverse events will also be recorded. The occurrence of post-operative fistulas, including anastomotic leakage, will be recorded as the main severe post-operative adverse event and represent the primary endpoint. DISCUSSION The safety and feasibility of EOF after gastrectomy has not been established. The SOFTLY trial will be the first randomized controlled trial involving total laparoscopic radical gastrectomy, in which the EOF group (POD1) will be compared with the DOF group (POD4). The results of the SOFTLY trial will provide data on the safety and feasibility of EOF after total laparoscopic radical gastrectomy. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IOR-15007660 . Registered on 28 December 2015. The study has full ethical and institutional approval.
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Affiliation(s)
- Quan Wang
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China
| | - Bo-Yang Guo
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China
| | - Qing-Chuan Zhao
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China
| | - Zun-Dong Yan
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China
| | - Li-Feng Shang
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China
| | - Juan Yu
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China
| | - Gang Ji
- Xijing Hospital of Digestive Disease, Xijing Hospital, The fourth Military Medical University, Xi'an, 710032, China.
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Suárez-Llanos JP, Rosat-Rodrigo A, García-Niebla J, Vallejo-Torres L, Delgado-Brito I, García-Bello MA, Pereyra-García-Castro F, Barrera-Gómez MA. Comparison of Clinical Outcomes in Surgical Patients Subjected to CIPA Nutrition Screening and Treatment versus Standard Care. Nutrients 2019; 11:E889. [PMID: 31010007 PMCID: PMC6520912 DOI: 10.3390/nu11040889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 12/20/2022] Open
Abstract
Malnutrition is prevalent in surgical patients and leads to comorbidities and a poorer postoperative course. There are no studies that compare the clinical outcomes of implementing a nutrition screening tool in surgical patients with standard clinical practice. An open, non-randomized, controlled study was conducted in general and digestive surgical hospitalized patients, who were either assigned to standard clinical care or to nutrition screening using the Control of Food Intake, Protein, and Anthropometry (CIPA) tool and an associated treatment protocol (n = 210 and 202, respectively). Length of stay, mortality, readmissions, in-hospital complications, transfers to critical care units, and reinterventions were evaluated. Patients in the CIPA group had a higher Charlson index on admission and underwent more oncological and hepatobiliary-pancreatic surgeries. Although not significant, a shorter mean length of stay was observed in the CIPA group (-1.48 days; p < 0.246). There were also fewer cases of exitus (seven vs. one) and fewer transfers to critical care units in this group (p = 0.068 for both). No differences were detected in other clinical variables. In conclusion, patients subjected to CIPA nutrition screening and treatment showed better clinical outcomes than those receiving usual clinical care. The results were not statistically significant, possibly due to the heterogeneity across patient groups.
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Affiliation(s)
- José Pablo Suárez-Llanos
- Endocrinology and Nutrition Department, University Hospital Nuestra Señora de Candelaria (HUNSC), 38010 Santa Cruz de Tenerife, Spain.
| | - Adriá Rosat-Rodrigo
- General and Digestive Surgery Department, HUNSC, 38010 Santa Cruz de Tenerife, Spain.
| | | | - Laura Vallejo-Torres
- Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain.
- Canary Islands Foundation for Health Research (FUNCANIS), 38109 Santa Cruz de Tenerife, Spain.
- Health Services Research on Chronic Patients Network (REDISSEC), 38010 Santa Cruz de Tenerife, Spain.
| | - Irina Delgado-Brito
- Canary Islands Cancer Research Institute (FICIC), 38204 Santa Cruz de Tenerife, Spain.
| | - Miguel A García-Bello
- Department of Clinical Epidemiology and Biostatistics, HUNSC; Primary Care Management, 38010 Santa Cruz de Tenerife, Spain.
| | - Francisca Pereyra-García-Castro
- Endocrinology and Nutrition Department, University Hospital Nuestra Señora de Candelaria (HUNSC), 38010 Santa Cruz de Tenerife, Spain.
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Differences in Respiratory Muscle Strength Measures in Well-Nourished and Malnourished Hospitalized Patients. J Acad Nutr Diet 2019; 119:831-839. [PMID: 30862483 DOI: 10.1016/j.jand.2019.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 01/04/2019] [Accepted: 01/04/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Objective indicators of nutritional status are essential for accurate identification of malnutrition. Previous research has indicated an association between measures of respiratory muscle strength (RMS) and nutritional status. Measurement of RMS-including maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP)-may provide evidence to support the assessment of nutritional status in hospitalized patients. OBJECTIVE The purpose of this study was to determine whether there was a difference in MIP, MEP, and SNIP between well-nourished and malnourished hospitalized patients. DESIGN A cross-sectional study was conducted. PARTICIPANTS/SETTING Patients were screened for eligibility criteria on admission by means of electronic medical records in general medical or surgical units at a tertiary care hospital in Chicago, IL, from January 2016 to January 2017. A total of 140 patients were included for analysis. MAIN OUTCOMES MEASURED The primary outcome was detection of differences in measures of RMS between malnourished and well-nourished hospitalized patients. Nutritional status was assessed using subjective global assessment and Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (Academy/ASPEN) criteria recommended to identify malnutrition. The MIP, MEP, and SNIP measures were obtained and reported as absolute values (expressed in centimeters of water) and percent of predicted values. STATISTICAL ANALYSIS Independent t tests or Mann-Whitney U tests were used to determine differences in RMS measures between patients assessed as well nourished and those assessed as malnourished, depending on normality. RESULTS Compared with well-nourished patients, malnourished patients identified by subjective global assessment criteria had significantly lower absolute SNIP (73.7±28.7 vs 59.5±27.1 cm H2O, P=0.004) and percent of predicted SNIP (78.6%±26.3% vs 64.8%± 30.0% predicted, P=0.006). Similarly, compared with well-nourished patients when Academy/ASPEN guidelines were used, malnourished individuals had significantly lower absolute SNIP (76.5±28.6 vs 58.3±26.3 cm H2O, P<0.001), percent of predicted SNIP (81.4%±26.4% vs 63.5%±28.7% predicted, P<0.001), absolute MIP (83.5±34.6 vs 71.1±33.6 cm H2O, P=0.05), and absolute MEP (108.7±36.6 vs 94.2±39.9 cm H2O, P=0.04). CONCLUSION Differences in RMS between well-nourished and malnourished patients were observed when SNIP measures were used. However, there were no differences in MIP and MEP measures. Further research is needed to build on the findings from this study.
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Metin S, Demirci H, Metin AT. Effect of health literacy of caregivers on survival rates of patients under palliative care. Scand J Caring Sci 2019; 33:669-676. [PMID: 30735265 DOI: 10.1111/scs.12662] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/07/2019] [Indexed: 01/03/2023]
Abstract
AIM In this study, we aimed to investigate the effect of health literacy of the patient caregiver on the care results of palliative care patients. METHODS Two hundred and forty-two patients who were hospitalised in palliative care units of seven hospitals in the city in January 2018 were involved in the study. Mortality of the patients was checked 3 months later. A survey interrogating the sociodemographic characteristics of the patients and Turkish translation of Health Literacy Survey - European Union to measure the health literacy level of the caregivers were used. RESULTS About 19.50% of the patient caregivers are in adequate (sufficient/perfect) HL group in term of general HL. Caregivers had difficulty to access information/knowledge of what to do in case of emergency. Prevalence of bedsore occurrence in patients whose caregiver has 'inadequate' HL is higher than patients whose caregiver has 'adequate' HL. Rate of 'inadequate HL' of the caregiver is higher in dead group. As the length of hospitalisation variable value increases 1 unit, risk of mortality decreases 2%. CONCLUSIONS Health literacy levels of the individuals dealing with the care of palliative unit patients hospitalised in our region are low. Amelioration of health literacy of the caregivers will have a direct effect on patient health and prevention of complications. Improving health literacy must be a priority target for a more quality patient care and less complication. The issues that caregivers felt themselves insufficient should be addressed and necessary actions should be taken in the identified issues.
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Affiliation(s)
- Salih Metin
- Department of Family Medicine, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Hakan Demirci
- Department of Family Medicine, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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McCarthy A, Delvin E, Marcil V, Belanger V, Marchand V, Boctor D, Rashid M, Noble A, Davidson B, Groleau V, Spahis S, Roy C, Levy E. Prevalence of Malnutrition in Pediatric Hospitals in Developed and In-Transition Countries: The Impact of Hospital Practices. Nutrients 2019; 11:nu11020236. [PMID: 30678232 PMCID: PMC6412458 DOI: 10.3390/nu11020236] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/02/2019] [Accepted: 01/13/2019] [Indexed: 01/04/2023] Open
Abstract
Presently, undernutrition still goes undetected in pediatric hospitals despite its association with poor clinical outcomes and increased annual hospital costs, thus affecting both the patient and the health care system. The reported prevalence of undernutrition in pediatric patients seeking care or hospitalized varies considerably, ranging from 2.5 to 51%. This disparity is mostly due to the diversity of the origin of populations studied, methods used to detect and assess nutritional status, as well as the lack of consensus for defining pediatric undernutrition. The prevalence among inpatients is likely to be higher than that observed for the community at large, since malnourished children are likely to have a pre-existent disease or to develop medical complications. Meanwhile, growing evidence indicates that the nutritional status of sick children deteriorates during the course of hospitalization. Moreover, the absence of systematic nutritional screening in this environment may lead to an underestimation of this condition. The present review aims to critically discuss studies documenting the prevalence of malnutrition in pediatric hospitals in developed and in-transition countries and identifying hospital practices that may jeopardize the nutritional status of hospitalized children.
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Affiliation(s)
- Andrea McCarthy
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Edgard Delvin
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Biochemistry, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Valerie Marcil
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Veronique Belanger
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Valerie Marchand
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Pediatrics, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Dana Boctor
- Pediatric Gastroenterology, Alberta Children's Hospital, University of Calgary, Calgary, AL T2N 1N4, Canada.
| | - Mohsin Rashid
- Dalhousie University and IWK Health Center, Halifax, NS B3H 1S6, Canada.
| | - Angela Noble
- Dalhousie University and IWK Health Center, Halifax, NS B3H 1S6, Canada.
| | | | - Veronique Groleau
- Departments of Pediatrics, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Schohraya Spahis
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Claude Roy
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Pediatrics, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Emile Levy
- Research Centre, CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada.
- Departments of Nutrition, University of Montreal, Montreal, QC H3C 3J7, Canada.
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Weijzen MEG, Kouw IWK, Verschuren AAJ, Muyters R, Geurts JA, Emans PJ, Geerlings P, Verdijk LB, van Loon LJC. Protein Intake Falls below 0.6 g•kg-1•d-1 in Healthy, Older Patients Admitted for Elective Hip or Knee Arthroplasty. J Nutr Health Aging 2019; 23:299-305. [PMID: 30820520 PMCID: PMC6399806 DOI: 10.1007/s12603-019-1157-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/07/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Hospitalization is generally accompanied by changes in food intake. Patients typically receive hospital meals upon personal preference within the framework of the food administration services of the hospital. In the present study, we assessed food provision and actual food and snack consumption in older patients admitted for elective hip or knee arthroplasty. DESIGN A prospective observational study. SETTING Orthopedic nursing ward of the Maastricht University Medical Centre+. PARTICIPANTS In the present study, n=101 patients (age: 67±10 y; hospital stay: 6.1±1.8 d) were monitored during hospitalization following elective hip or knee arthroplasty. MEASUREMENTS Energy and protein provided by self-selected hospital meals and snacks, and actual energy and protein (amount, distribution, and source) consumed by patients was weighed and recorded throughout 1-6 days. RESULTS Self-selected meals provided 6.5±1.5 MJ•d-1, with 16, 48, and 34 En% provided as protein, carbohydrate, and fat, respectively. Self-selected hospital meals provided 0.75±0.16 and 0.79±0.21 g•kg-1•d-1 protein in males and females, respectively. Actual protein consumption averaged merely 0.59±0.18 and 0.50±0.21 g•kg-1•d-1, respectively. Protein consumption at breakfast, lunch, and dinner averaged 16±8, 18±9, and 20±6 g per meal, respectively. CONCLUSIONS Though self-selected hospital meals provide patients with ~0.8 g•kg-1•d-1 protein during short-term hospitalization, actual protein consumption falls well below 0.6 g•kg-1•d-1 with a large proportion (~32%) of the provided food being discarded. Alternative strategies are required to ensure maintenance of habitual protein intake in older patients admitted for elective orthopedic surgery.
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Affiliation(s)
- M E G Weijzen
- Prof. L.J.C. van Loon, Ph.D., Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, the Netherlands, E-mail: , Tel: +31 43 388 1397, Fax: +31 43 367 0976
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Hettiarachchi J, Madubhashini P, Miller M. Agreement between the Malnutrition Universal Screening Tool and the Patient-Generated Subjective Global Assessment for Cancer Outpatients Receiving Chemotherapy: A Cross-Sectional Study. Nutr Cancer 2018; 70:1275-1282. [PMID: 30596277 DOI: 10.1080/01635581.2018.1539186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Malnutrition is a common occurrence in cancer. Early detection of malnutrition is imperative but often overlooked in busy clinical routine. This study aimed to assess the agreement between malnutrition universal screening tool (MUST) and the patient-generated subjective global assessment (PG-SGA) to detect risk of malnutrition in a medical oncology outpatient setting. A cross-sectional study was conducted with 100 adult patients with cancer receiving chemotherapy. Nutrition screening and assessment were performed using MUST and PG-SGA, respectively. Sensitivity, specificity, predictive values, kappa agreement, and receiver operating characteristics (ROC) curve were used to compare MUST with PG-SGA. Prevalence of malnutrition or risk of malnutrition among subjects was 45% according to the MUST. Body mass index (BMI) against PG-SGA indicated a low capacity to detect malnutrition with 28.9% sensitivity and 96.4% specificity. Unintentional weight loss in the last 3-6 mo against PG-SGA resulted in 55.6% sensitivity and 98.2% specificity. MUST against PG-SGA resulted in 86.7% sensitivity and 94.5% specificity. MUST indicated a perfect agreement with PG-SGA (Kappa = 0.81; P < 0.05) and highest area under the ROC curve (AUC ROC = 0.91). MUST has high level of agreement with PG-SGA to detect chemotherapy outpatients at risk of malnutrition.
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Affiliation(s)
- Jeewanadee Hettiarachchi
- a Department Applied Nutrition Faculty of Livestock Fisheries and Nutrition , Wayamba University of Sri Lanka , Makandura , Gonawila , Sri Lanka
| | - Prabodha Madubhashini
- a Department Applied Nutrition Faculty of Livestock Fisheries and Nutrition , Wayamba University of Sri Lanka , Makandura , Gonawila , Sri Lanka
| | - Michelle Miller
- b Nutrition and Dietetics Department , Flinders University , Adelaide , South Australia , Australia
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Abstract
Older adults are at risk of protein-energy malnutrition (PEM). PEM detrimentally impacts on health, cognitive and physical functioning and quality of life. Given these negative health outcomes in the context of an ageing global population, the Healthy Diet for a Healthy Life Joint Programming Initiative Malnutrition in the Elderly (MaNuEL) sought to create a knowledge hub on malnutrition in older adults. This review summarises the findings related to the screening and determinants of malnutrition. Based on a scoring system that incorporated validity, parameters used and practicability, recommendations on setting-specific screening tools for use with older adults were made. These are: DETERMINE your health checklist for the community, Nutritional Form for the Elderly for rehabilitation, Short Nutritional Assessment Questionnaire-Residential Care for residential care and Malnutrition Screening Tool or Mini Nutritional Assessment-Short Form for hospitals. A meta-analysis was conducted on six longitudinal studies from MaNuEL partner countries to identify the determinants of malnutrition. Increasing age, unmarried/separated/divorced status (vs. married but not widowed), difficulties walking 100 m or climbing stairs and hospitalisation in the year prior to baseline or during follow-up predicted malnutrition. The sex-specific predictors of malnutrition were explored within The Irish Longitudinal Study of Ageing dataset. For females, cognitive impairment or receiving social support predicted malnutrition. The predictors for males were falling in the previous 2 years, hospitalisation in the past year and self-reported difficulties in climbing stairs. Incorporation of these findings into public health policy and clinical practice would support the early identification and management of malnutrition.
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Gómez-Campos R, Andruske CL, de Arruda M, Sulla-Torres J, Pacheco-Carrillo J, Urra-Albornoz C, Cossio-Bolaños M. Normative data for handgrip strength in children and adolescents in the Maule Region, Chile: Evaluation based on chronological and biological age. PLoS One 2018; 13:e0201033. [PMID: 30091984 PMCID: PMC6084899 DOI: 10.1371/journal.pone.0201033] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/06/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hand grip strength (HGS) is associated with a number of causes resulting in cardiovascular death, in addition to bone fragility, and the presence of sarcopenia. The goal of our study was to analyze HGS of students based on chronological and biological age and propose normative standards for children and adolescents from Chile. METHODS We studied 4604 school children of both sexes between the ages of 6.0 and 17.9 years of age. Weight, standing height, sitting height, and hand grip strength (HGS- right and left) were measured. The Body Mass Index (BMI) was calculated, and the biological age was calculated by using age at peak height velocity (APHV). RESULTS When arranged by chronological age, no significant differences occurred in HGS between both sexes of school children from age 6 to 12 years of age. However, from ages 13 to 17, males showed greater HGS than females. Significant differences also emerged between both sexes and at all levels for biological age (APHV). For males, chronological age explained the HGS occurring between 0.74 to 0.75% and for females between 0.54 to 0.59%. For males, biological age explained the HGS for the range of 0.79 to 0.80% and 0.62 to 0.67% for females. The normative data for HGS for both sexes is expressed in percentiles. CONCLUSIONS HGS during childhood and adolescence needs be analyzed and interpreted in terms of biological age rather than chronological age. The normative data to evaluate the HGS are a tool that can help professionals working in clinical and epidemiological contexts.
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Affiliation(s)
- Rossana Gómez-Campos
- Universidad Autónoma de Chile, Talca, Chile
- Faculty of Physical Education, State University of Campinas, Sao Paulo, Brazil
- Universidad Nacional de San Agustín, Arequipa, Perú
| | - Cynthia Lee Andruske
- Centro de Investigación Especializado en Ciencias de la Educación, Salud y Deporte, CINEMAROS, Arequipa, Perú
| | - Miguel de Arruda
- Faculty of Physical Education, State University of Campinas, Sao Paulo, Brazil
| | - Jose Sulla-Torres
- Universidad Nacional de San Agustín, Arequipa, Perú
- Universidad Católica de Santa María, Arequipa, Perú
| | | | - Camilo Urra-Albornoz
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
| | - Marco Cossio-Bolaños
- Faculty of Physical Education, State University of Campinas, Sao Paulo, Brazil
- Universidad Nacional de San Agustín, Arequipa, Perú
- Departamento de Ciencias de la Actividad Física, Universidad Católica del Maule, Talca, Chile
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Determination of food intake and the factors affecting food intake in perioperative period in patients who undergo open heart surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:214-222. [PMID: 32082737 DOI: 10.5606/tgkdc.dergisi.2018.15787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/05/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the factors affecting food intake in perioperative period of patients who undergo open heart surgery and the effects of body weight, albumin and hemoglobin values, nausea, vomiting and constipation on food intake. Methods This cross-sectional study was conducted between 4 February 2015 and 4 May 2015 in a cardiovascular surgery clinic. A questionnaire including 25 questions was applied to a total of 86 volunteer participants (62 males, 24 females; mean age 61.3±10.8 years; range 38 to 82 years). Results Patients consumed 38% of the food one day before the surgery and 51% one day after, 47% three days after, and 52% five days after the surgery. Factors affecting food intake were the procedure of discontinuing food intake for pre-surgery anesthesia preparation (84.9%), nausea (31.4%) one day after surgery, and constipation three (26.5%) and five (33.7%) days after surgery. Albumin levels decreased significantly in days after surgery compared to the day before surgery (p<0.05). There was a significant positive correlation between food intake rates and albumin levels on the first, third and fifth days after surgery (r=0.354, r=0.353, and r=0.521, respectively; p<0.05). Conclusion Patients' body weight and albumin levels decreased in accordance with their nourishment status after surgery. Food intake was insufficient in the perioperative period.
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Arensberg MB. Population aging: opportunity for business expansion, an invitational paper presented at the Asia-Pacific Economic Cooperation (APEC) International Workshop on Adaptation to Population Aging Issues, July 17, 2017, Ha Noi, Viet Nam. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:7. [PMID: 29636085 PMCID: PMC5894246 DOI: 10.1186/s41043-018-0138-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
A longer life brings opportunities for older adults and their families as well as for their communities. Commercial businesses can be successful in innovating on these opportunities and achieving business expansion when they better understand the market dynamics and spectrum of older adults as consumers and view them more as assets rather than as burdens to society. While there is no "typical" older adult consumer, some traits, characteristics, and physical realities may be more common, including those related to family and community, the shopping experience, brand marketing and packaging, food and nutrition, and health. The opportunities of longer life are impacted by health and underscore the importance of positive, healthy aging-related behaviors like good nutrition and active lifestyles. Healthy aging also requires a sustained commitment and action from country leaders to formulate evidence-based polices--like systematic nutrition screening and intervention-and healthcare workforce training and education that can strengthen and support an active aging population. In addition, governments should consider engaging commercial businesses to help set sustainable policies that can advance products for older adults. Finally, governments should set national and local goals to incentivize commercial business development and investment in public-private partnerships to improve quality of care, promote healthy aging, and impact outcomes for noncommunicable diseases, ultimately benefitting population health for Asia-Pacific Economic Cooperation (APEC) countries.
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Affiliation(s)
- Mary Beth Arensberg
- Abbott Nutrition Division of Abbott, 3300 Stelzer Road, Columbus, OH, 43219, USA.
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McCullough J, Keller H. The My Meal Intake Tool (M-MIT): Validity of a Patient Self- Assessment for Food and Fluid Intake at a Single Meal. J Nutr Health Aging 2018; 22:30-37. [PMID: 29300419 DOI: 10.1007/s12603-016-0859-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Hospital malnutrition is an under-recognized issue that leads to a variety of adverse outcomes, especially for older adults. Food/fluid intake (FFI) monitoring in hospital can be used to identify those who are improving and those who need further treatment. Current monitoring practices such as calorie counts are impractical for all patients and a patient-completed tool, if valid, could support routine FFI monitoring. The aim of this research was to determine whether the patient-completed My Meal Intake Tool (M-MIT) can accurately represent FFI at a single meal. DESIGN Cross-sectional, multi-site. SETTING Four acute care hospitals in Canada. PARTICIPANTS 120 patients (65+ yrs, adequate cognition). MEASUREMENTS Participants completed M-MIT for a single meal. Food and fluid waste was visually estimated by a research dietitian at each hospital. Sensitivity (Se), specificity (Sp) and overall agreement were calculated for both food and fluid intake by comparing M-MIT and dietitian estimations to determine criterion validity of M-MIT. Patient and research dietitian comments were used to make revisions to the M-MIT. RESULTS Using a cut-point of ≤50% intake, Se was 76.2% and 61.9% and Sp was 74.0% and 80.5% for solid and fluids respectively (p<0.001). M-MIT identified a greater proportion of participants (37.2%) as having low FFI (≤50%) than dietitians (25.0%), as well as a greater proportion identified with low fluid intake (28.3% vs. 24.6%). Modest revisions were made to improve the tool. CONCLUSION This study has demonstrated initial validity of M-MIT for use in older patients with adequate cognition. Use of M-MIT could promote FFI monitoring as a routine practice to make clinical decisions about care.
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Affiliation(s)
- J McCullough
- H. Keller, Schlegel Research Chair Nutrition and Aging, Schlegel-University of Waterloo Research Institute for Aging and University of Waterloo, Dept Kinesiology, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada, mobile: 519 497 7868,
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Kimura D, Murata M, Kimura Y, Nunotani M, Hayashi Y, Abe K. Nutritional status and management of risks due to physical therapy in patients hospitalized for long periods. J Phys Ther Sci 2017; 29:1910-1913. [PMID: 29200622 PMCID: PMC5702812 DOI: 10.1589/jpts.29.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/01/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to understand the nutritional status of patients hospitalized
for long periods and the risk of physical therapy (PT) for such patients. [Subjects and
Methods] Participants were selected from patients who were hospitalized at a designated
medical long-term care sanatorium. The participants were divided into 5 groups (A–E)
depending on their mode of energy intake and ambulatory ability during PT. The serum
albumin level, energy intake, total daily energy expenditure, and total daily energy
expenditure per session of PT (EEPT) were evaluated for each group. [Results]
Protein-energy malnutrition was observed in 69.6% of the participants. No significant
association was identified between the serum albumin level and body mass index. Energy
intake was significantly higher in Groups D and E, whose energy intake was via ingestion,
than in Groups A and B, whose intake was via tube feeding. EEPT was highest in patients of
Group E who had gait independence different from the ability of those in groups A–D.
[Conclusion] The actual energy intake is lower with tube feeding than with ingestion. Risk
management and energy intake should be revisited in elderly patients who have been
hospitalized for long periods and subsequently obtain gait independence.
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Affiliation(s)
- Daisuke Kimura
- Department of Rehabilitation, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki City 701-0193, Okayama, Japan
| | | | - Yuko Kimura
- Department of Rehabilitation, Kousyokai Aino Hospital, Japan
| | | | - Yoshitaka Hayashi
- Graduate School of Health Sports Sciences, Mukogawa Women's University, Japan
| | - Kazuo Abe
- Department of Community Health Care Medicine, Hyogo College of Medicine, Japan
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Abd Aziz NAS, Teng NIMF, Abdul Hamid MR, Ismail NH. Assessing the nutritional status of hospitalized elderly. Clin Interv Aging 2017; 12:1615-1625. [PMID: 29042762 PMCID: PMC5634387 DOI: 10.2147/cia.s140859] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose The increasing number of elderly people worldwide throughout the years is concerning due to the health problems often faced by this population. This review aims to summarize the nutritional status among hospitalized elderly and the role of the nutritional assessment tools in this issue. Methods A literature search was performed on six databases using the terms “malnutrition”, “hospitalised elderly”, “nutritional assessment”, “Mini Nutritional Assessment (MNA)”, “Geriatric Nutrition Risk Index (GNRI)”, and “Subjective Global Assessment (SGA)”. Results According to the previous studies, the prevalence of malnutrition among hospitalized elderly shows an increasing trend not only locally but also across the world. Under-recognition of malnutrition causes the number of malnourished hospitalized elderly to remain high throughout the years. Thus, the development of nutritional screening and assessment tools has been widely studied, and these tools are readily available nowadays. SGA, MNA, and GNRI are the nutritional assessment tools developed specifically for the elderly and are well validated in most countries. However, to date, there is no single tool that can be considered as the universal gold standard for the diagnosis of nutritional status in hospitalized patients. Conclusion It is important to identify which nutritional assessment tool is suitable to be used in this group to ensure that a structured assessment and documentation of nutritional status can be established. An early and accurate identification of the appropriate treatment of malnutrition can be done as soon as possible, and thus, the malnutrition rate among this group can be minimized in the future.
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Affiliation(s)
- Nur Adilah Shuhada Abd Aziz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Nur Islami Mohd Fahmi Teng
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Mohd Ramadan Abdul Hamid
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Nazrul Hadi Ismail
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
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Laur C, Valaitis R, Bell J, Keller H. Changing nutrition care practices in hospital: a thematic analysis of hospital staff perspectives. BMC Health Serv Res 2017; 17:498. [PMID: 28724373 PMCID: PMC5518103 DOI: 10.1186/s12913-017-2409-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 06/27/2017] [Indexed: 12/31/2022] Open
Abstract
Background Many patients are admitted to hospital and are already malnourished. Gaps in practice have identified that care processes for these patients can be improved. Hospital staff, including management, needs to work towards optimizing nutrition care in hospitals to improve the prevention, detection and treatment of malnutrition. The objective of this study was to understand how staff members perceived and described the necessary ingredients to support change efforts required to improve nutrition care in their hospital. Methods A qualitative study was conducted using purposive sampling techniques to recruit participants for focus groups (FG) (n = 11) and key informant interviews (n = 40) with a variety of hospital staff and management. Discussions based on a semi-structured schedule were conducted at five diverse hospitals from four provinces in Canada as part of the More-2-Eat implementation project. One researcher conducted 2-day site visits over a two-month period to complete all interviews and FGs. Interviews were transcribed verbatim while key points and quotes were taken from FGs. Transcripts were coded line-by-line with initial thematic analysis completed by the primary author. Other authors (n = 3) confirmed the themes by reviewing a subset of transcripts and the draft themes. Themes were then refined and further detailed. Member checking of site summaries was completed with site champions. Results Participants (n = 133) included nurses, physicians, food service workers, dietitians, and hospital management, among others. Discussion regarding ways to improve nutrition care in each specific site facilitated the thought process during FG and interviews. Five main themes were identified: building a reason to change; involving relevant people in the change process; embedding change into current practice; accounting for climate; and building strong relationships within the hospital team. Conclusions Hospital staff need a reason to change their nutrition care practices and a significant change driver is perceived and experienced benefit to the patient. Participants described key ingredients to support successful change and specifically engaging the interdisciplinary team to effect sustainable improvements in nutrition care. Trial registration Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304, June 7, 2016.
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Affiliation(s)
- Celia Laur
- Department of Applied Health Science, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada
| | - Renata Valaitis
- Department of Applied Health Science, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada
| | - Jack Bell
- School of Human Movement and Nutrition Sciences, The University of Queensland &, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
| | - Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada. .,Department of Kinesiology University of Waterloo, 200 University Ave, Waterloo, N2L 3G1, ON, Canada.
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Theilla M, Cohen J, Kagan I, Attal-Singer J, Lev S, Singer P. Home parenteral nutrition for advanced cancer patients: Contributes to survival? Nutrition 2017; 54:197-200. [PMID: 28571682 DOI: 10.1016/j.nut.2017.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/06/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Patients with advanced cancer often suffer from severe malnutrition and gastrointestinal obstruction. This population could benefit from home parenteral nutrition (HPN). The aim of this study was to observe the outcome of patients with advanced cancer patients who were eligible for HPN. METHODS All patients in the nutrition clinic who received HPN over the past 7 y were included in the present study. We compared patients with advanced cancer with the noncancer population in terms of hospitalization rate and mortality. RESULTS Of 221 advanced cancer patients, 153 who had no oral/enteral intake and who received HPN survived. Of these, 35% survived for 6 mo, 27% for 1 y, 18.9% survived 2 y, and 3.9% survived for the 7 y of the follow-up. Hospitalization rate was not significantly different from the noncancer population. CONCLUSION These results show that HPN is a relevant palliative therapy for patients with advanced cancer patients without oral or enteral feeding access.
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Affiliation(s)
- Miriam Theilla
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel; Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Israel
| | - Johnathan Cohen
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Ilia Kagan
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Joelle Attal-Singer
- Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel; Institute of Endocrinology, Diabetes Services, Sackler School of Medicine, Tel Aviv University, Israel
| | - Shaul Lev
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel
| | - Pierre Singer
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
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Gilliland TM, Villafane-Ferriol N, Shah KP, Shah RM, Tran Cao HS, Massarweh NN, Silberfein EJ, Choi EA, Hsu C, McElhany AL, Barakat O, Fisher W, Van Buren G. Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection. Nutrients 2017; 9:nu9030243. [PMID: 28272344 PMCID: PMC5372906 DOI: 10.3390/nu9030243] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/20/2017] [Accepted: 02/28/2017] [Indexed: 12/15/2022] Open
Abstract
Pancreatic cancer is an aggressive malignancy with a poor prognosis. The disease and its treatment can cause significant nutritional impairments that often adversely impact patient quality of life (QOL). The pancreas has both exocrine and endocrine functions and, in the setting of cancer, both systems may be affected. Pancreatic exocrine insufficiency (PEI) manifests as weight loss and steatorrhea, while endocrine insufficiency may result in diabetes mellitus. Surgical resection, a central component of pancreatic cancer treatment, may induce or exacerbate these dysfunctions. Nutritional and metabolic dysfunctions in patients with pancreatic cancer lack characterization, and few guidelines exist for nutritional support in patients after surgical resection. We reviewed publications from the past two decades (1995–2016) addressing the nutritional and metabolic status of patients with pancreatic cancer, grouping them into status at the time of diagnosis, status at the time of resection, and status of nutritional support throughout the diagnosis and treatment of pancreatic cancer. Here, we summarize the results of these investigations and evaluate the effectiveness of various types of nutritional support in patients after pancreatectomy for pancreatic adenocarcinoma (PDAC). We outline the following conservative perioperative strategies to optimize patient outcomes and guide the care of these patients: (1) patients with albumin < 2.5 mg/dL or weight loss > 10% should postpone surgery and begin aggressive nutrition supplementation; (2) patients with albumin < 3 mg/dL or weight loss between 5% and 10% should have nutrition supplementation prior to surgery; (3) enteral nutrition (EN) should be preferred as a nutritional intervention over total parenteral nutrition (TPN) postoperatively; and, (4) a multidisciplinary approach should be used to allow for early detection of symptoms of endocrine and exocrine pancreatic insufficiency alongside implementation of appropriate treatment to improve the patient’s quality of life.
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Affiliation(s)
- Taylor M Gilliland
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Nicole Villafane-Ferriol
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Kevin P Shah
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Rohan M Shah
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Hop S Tran Cao
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Nader N Massarweh
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Eric J Silberfein
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Eugene A Choi
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Cary Hsu
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Amy L McElhany
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Omar Barakat
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - William Fisher
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
| | - George Van Buren
- The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.
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