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Ayesh W, Ibrahim Hassan AA, Jaafar H, Khorshid O, Laviano A, Lovey J, Mahrous M, Mogawer E, Molla H, Morsy A, Ouaijan K. Unmet needs in cancer patients: Creating recommendations to overcome geographical disparities in economic growth. Clin Nutr ESPEN 2023; 55:267-276. [PMID: 37202056 DOI: 10.1016/j.clnesp.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 05/20/2023]
Abstract
Cancer is a major clinical, economic and societal challenge across different world regions. Effective anticancer therapies are now available, yet the impact of these treatments on the needs of patients with cancer remains questionable, since improved survival is not frequently associated with improved quality of life. In an effort to raise patients' needs at the core of anticancer therapies, the importance of nutritional support has become recognized by international scientific societies. It is recognized that the needs of patients with cancer are universal, yet the economic and societal status of any country influence the availability and implementation of nutritional care. The Middle East is a geographic area in which major differences in economic growth coexist. Consequently, it appears reasonable that international guidelines on nutritional care in oncology are reviewed to highlight those recommendations which could be universally adopted and those which may need a progressive implementation. To this end, a group of Middle East healthcare professionals working in cancer centers across the region gathered to develop a list of recommendations to be implemented in daily practice. This would translate in a likely better acceptance and delivery of nutritional care, aligning all Middle East cancer centers to the quality standards now available only in selected hospital across the region.
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Trujillo EB, Dixon SW, Claghorn K, Levin RM, Mills JB, Spees CK. Closing the Gap in Nutrition Care at Outpatient Cancer Centers: Ongoing Initiatives of the Oncology Nutrition Dietetic Practice Group. J Acad Nutr Diet 2019; 118:749-760. [PMID: 29576094 DOI: 10.1016/j.jand.2018.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Indexed: 12/16/2022]
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Nutritional status assessment of the elderly patients with congestive heart failure by mini nutritional assessment test. Res Cardiovasc Med 2017. [DOI: 10.5812/cardiovascmed.31898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Goates S, Du K, Braunschweig CA, Arensberg MB. Economic Burden of Disease-Associated Malnutrition at the State Level. PLoS One 2016; 11:e0161833. [PMID: 27655372 PMCID: PMC5031313 DOI: 10.1371/journal.pone.0161833] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 08/12/2016] [Indexed: 12/22/2022] Open
Abstract
Background Disease-associated malnutrition has been identified as a prevalent condition, particularly for the elderly, which has often been overlooked in the U.S. healthcare system. The state-level burden of community-based disease-associated malnutrition is unknown and there have been limited efforts by state policy makers to identify, quantify, and address malnutrition. The objective of this study was to examine and quantify the state-level economic burden of disease-associated malnutrition. Methods Direct medical costs of disease-associated malnutrition were calculated for 8 diseases: Stroke, Chronic Obstructive Pulmonary Disease, Coronary Heart Failure, Breast Cancer, Dementia, Musculoskeletal Disorders, Depression, and Colorectal Cancer. National disease and malnutrition prevalence rates were estimated for subgroups defined by age, race, and sex using the National Health and Nutrition Examination Survey and the National Health Interview Survey. State prevalence of disease-associated malnutrition was estimated by combining national prevalence estimates with states’ demographic data from the U.S. Census. Direct medical cost for each state was estimated as the increased expenditures incurred as a result of malnutrition. Principal Findings Direct medical costs attributable to disease-associated malnutrition vary among states from an annual cost of $36 per capita in Utah to $65 per capita in Washington, D.C. Nationally the annual cost of disease-associated malnutrition is over $15.5 billion. The elderly bear a disproportionate share of this cost on both the state and national level. Conclusions Additional action is needed to reduce the economic impact of disease-associated malnutrition, particularly at the state level. Nutrition may be a cost-effective way to help address high health care costs.
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Affiliation(s)
- Scott Goates
- Abbott Nutrition, Research & Development, Columbus, Ohio, United States of America
| | - Kristy Du
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
- Abbott Nutrition, Research Park at the University of Illinois, Champaign, Illinois, United States of America
| | - Carol A. Braunschweig
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Mary Beth Arensberg
- Abbott Nutrition Products Division of Abbott, Columbus, Ohio, United States of America
- * E-mail:
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Abizanda P, Sinclair A, Barcons N, Lizán L, Rodríguez-Mañas L. Costs of Malnutrition in Institutionalized and Community-Dwelling Older Adults: A Systematic Review. J Am Med Dir Assoc 2016; 17:17-23. [DOI: 10.1016/j.jamda.2015.07.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 07/04/2015] [Accepted: 07/06/2015] [Indexed: 11/26/2022]
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Why the oncologist should consider the nutritional status of the elderly cancer patient. Nutrition 2015; 31:590-3. [DOI: 10.1016/j.nut.2014.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Couch ME, Dittus K, Toth MJ, Willis MS, Guttridge DC, George JR, Barnes CA, Gourin CG, Der-Torossian H. Cancer cachexia update in head and neck cancer: Definitions and diagnostic features. Head Neck 2014; 37:594-604. [DOI: 10.1002/hed.23599] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/21/2013] [Accepted: 01/07/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Marion E. Couch
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; Vermont Cancer Center; University of Vermont, College of Medicine; Burlington Vermont
| | - Kim Dittus
- Division of Hematology - Oncology; Department of Medicine; Vermont Cancer Center; University of Vermont, College of Medicine; Burlington Vermont
| | - Michael J. Toth
- Department of Molecular Physiology and Biophysics; University of Vermont, College of Medicine; Burlington Vermont
| | - Monte S. Willis
- Department of Pathology and Laboratory Medicine; McAllister Heart Institute; University of North Carolina; Chapel Hill North Carolina
| | - Denis C. Guttridge
- Department of Molecular Virology; Immunology; and Medical Genetics; Ohio State University; Columbus Ohio
| | - Jonathan R. George
- Department of Otolaryngology - Head and Neck Surgery; University of California; San Francisco California
| | - Christie A. Barnes
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; Vermont Cancer Center; University of Vermont, College of Medicine; Burlington Vermont
| | - Christine G. Gourin
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - Hirak Der-Torossian
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; Vermont Cancer Center; University of Vermont, College of Medicine; Burlington Vermont
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Henry L. Effect of Malnutrition on Cancer Patients. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bozzetti F. Nutritional support of the oncology patient. Crit Rev Oncol Hematol 2013; 87:172-200. [DOI: 10.1016/j.critrevonc.2013.03.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 01/28/2013] [Accepted: 03/06/2013] [Indexed: 01/06/2023] Open
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Abstract
Cancer patients receiving chemotherapy have a high risk of malnutrition secondary to the disease and treatment, and 40–80 % of cancer patients suffer from different degrees of malnutrition, depending on tumour subtype, location, staging and treatment strategy. Malnutrition in cancer patients affects the patient's overall condition, and it increases the number of complications, the adverse effects of chemotherapy and reduces the quality of life. The aim of the present study was to evaluate weight-loss prevalence depending on the tumour site and the gastrointestinal (GI) symptoms of oncology patients receiving chemotherapy. We included 191 cancer patients receiving chemotherapy. Files of all patients were reviewed to identify symptoms that might potentially influence weight loss. The nutritional status of all patients was also determined. The cancer sites in the patients were as follows: breast (31·9 %); non-colorectal GI (18·3 %); colorectal (10·4 %); lung (5·8 %); haematological (13·1 %); others (20·5 %). Of these patients, 58 % experienced some degree of weight loss, and its prevalence was higher among the non-colorectal GI and lung cancer patients. Common symptoms included nausea (59·6 %), anorexia (46 %) and constipation (31·9 %). A higher proportion of patients with ≥ 5 % weight loss experienced anorexia, nausea and vomiting (OR 9·5, 2·15 and 6·1, respectively). In conclusion, these results indicate that GI symptoms can influence weight loss in cancer patients, and they should be included in early nutritional evaluations.
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Weight loss in cancer patients: a plea for a better awareness of the issue. Support Care Cancer 2011; 20:301-9. [DOI: 10.1007/s00520-010-1075-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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Teh R, Wham C, Kerse N, Robinson E, Doughty RN. How is the risk of undernutrition associated with cardiovascular disease among individuals of advanced age? J Nutr Health Aging 2010; 14:737-43. [PMID: 21085902 DOI: 10.1007/s12603-010-0120-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The oldest old (85+) are the fastest growing population segment in New Zealand. Cardiovascular disease (CVD) is the main cause of death and is associated with various risk factors including risk of undernutrition. OBJECTIVES To determine if there is an association between CVD and nutrition risk in advanced age. SETTING Three North Island locations (rural and urban areas) in New Zealand. PARTICIPANTS 108 participants aged 85 years (75-79 for Maori). MEASUREMENTS Comprehensive health assessments were undertaken. Clinically manifest CVD was pre-defined and ascertained from interviews and hospitalisation records. Nutrition risk was assessed using a validated questionnaire-Seniors in the Community: Risk evaluation for eating and nutrition, Version II (SCREEN II). RESULTS 72 participants (67%) had CVD (49% men); 52% of participants had a SCREEN II score < 50. Those with CVD had lower HDL level [median(IQR)] [1.4(0.7) vs. 1.6(0.6)] (p=0.041), and higher waist circumference [97.5(19.1) vs. 89.3(20.6)] (p=0.043) compared to those without CVD. Those with CVD were at no greater nutrition risk than those without CVD (SCREEN II score: [49(7) vs. 51(10)] (p=0.365). Using logistic regression controlling for confounders, SCREEN II scores trended towards an inverse association with CVD (p=0.10). CONCLUSION Two thirds of the study participants had CVD and half were at risk of undernutrition. Nutrition risk was mildly associated with CVD. This study provides further evidence that those in advanced age are at risk of undernutrition. Further research is needed to establish how the causes and consequences of CVD are related to nutrition risk.
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Affiliation(s)
- R Teh
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
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Bozzetti F, Arends J, Lundholm K, Micklewright A, Zurcher G, Muscaritoli M. ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology. Clin Nutr 2009; 28:445-54. [PMID: 19477052 DOI: 10.1016/j.clnu.2009.04.011] [Citation(s) in RCA: 308] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 04/14/2009] [Indexed: 12/29/2022]
Abstract
Parenteral nutrition offers the possibility of increasing or ensuring nutrient intake in patients in whom normal food intake is inadequate and enteral nutrition is not feasible, is contraindicated or is not accepted by the patient. These guidelines are intended to provide evidence-based recommendations for the use of parenteral nutrition in cancer patients. They were developed by an interdisciplinary expert group in accordance with accepted standards, are based on the most relevant publications of the last 30 years and share many of the conclusions of the ESPEN guidelines on enteral nutrition in oncology. Under-nutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis and, per se, responsible for excess morbidity and mortality. Many indications for parenteral nutrition parallel those for enteral nutrition (weight loss or reduction in food intake for more than 7-10 days), but only those who, for whatever reason cannot be fed orally or enterally, are candidates to receive parenteral nutrition. A standard nutritional regimen may be recommended for short-term parenteral nutrition, while in cachectic patients receiving intravenous feeding for several weeks a high fat-to-glucose ratio may be advised because these patients maintain a high capacity to metabolize fats. The limited nutritional response to the parenteral nutrition reflects more the presence of metabolic derangements which are characteristic of the cachexia syndrome (or merely the short duration of the nutritional support) rather than the inadequacy of the nutritional regimen. Perioperative parenteral nutrition is only recommended in malnourished patients if enteral nutrition is not feasible. In non-surgical well-nourished oncologic patients routine parenteral nutrition is not recommended because it has proved to offer no advantage and is associated with increased morbidity. A benefit, however, is reported in patients undergoing hematopoietic stem cell transplantation. Short-term parenteral nutrition is however commonly accepted in patients with acute gastrointestinal complications from chemotherapy and radiotherapy, and long-term (home) parenteral nutrition will sometimes be a life-saving maneuver in patients with sub acute/chronic radiation enteropathy. In incurable cancer patients home parenteral nutrition may be recommended in hypophagic/(sub)obstructed patients (if there is an acceptable performance status) if they are expected to die from starvation/under nutrition prior to tumor spread.
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Affiliation(s)
- F Bozzetti
- Department of Surgery, General Hospital of Prato, Prato, Italy
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Supplement use contributes to meeting recommended dietary intakes for calcium, magnesium, and vitamin C in four ethnicities of middle-aged and older Americans: the Multi-Ethnic Study of Atherosclerosis. ACTA ACUST UNITED AC 2009; 109:422-9. [PMID: 19248857 DOI: 10.1016/j.jada.2008.11.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 08/22/2008] [Accepted: 08/22/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Low intake of nutrients is associated with poor health outcomes. We examined the contribution of dietary supplementation to meeting recommended dietary intakes of calcium, magnesium, potassium, and vitamin C in participants of the Multi-Ethnic Study of Atherosclerosis, a cohort of white, African-American, Hispanic, and Chinese-American participants ages 45 to 84 years. We also assessed the prevalence of intakes above Tolerable Upper Intake Levels (ULs). METHODS At the baseline exam in 2000-2001, 2,938 men and 3,299 women completed food frequency questionnaires and provided information about dietary supplementation. We used relative risk regression to estimate the probability of meeting Recommended Dietary Allowances (RDAs) or Adequate Intakes (AIs) in supplement users vs nonusers and Fisher's exact tests to compare the proportion of those exceeding ULs between the two groups. RDAs, AIs, and ULs were defined by the National Academy of Sciences Food and Nutrition Board's Dietary Reference Intakes (DRIs). RESULTS After adjustment for age and education, the relative risk of meeting RDAs or AIs in supplement-users vs nonusers ranged from 1.9 (1.6, 2.3) in white men to 5.7 (4.1, 8.0) in African-American women for calcium, from 2.5 (1.9, 3.3) in Hispanic men to 5.2 (2.4, 11.2) in Chinese men for magnesium, and from 1.4 (1.3, 1.5) in African-American women to 2.0 (1.7, 2.2) in Chinese men for vitamin C. The relative risks for meeting RDAs for calcium differed significantly by ethnicity (P<0.001) and sex (P<0.001), and by ethnicity for magnesium (P=0.01). The relative risk for each sex/ethnicity strata was close to 1 and did not reach statistical significance at alpha=.05 for potassium. For calcium, 15% of high-dose supplement users exceeded the UL compared with only 2.1% of nonusers. For vitamin C, the percentages were 6.6% and 0%, and for magnesium, 35.3% and 0% (P<0.001 for all). CONCLUSIONS Although supplement use is associated with meeting DRI guidelines for calcium, vitamin C and magnesium, many adults are not meeting the DRI guidelines even with the help of dietary supplements, and the effect of supplementation can vary according to ethnicity and sex. However, supplementation was not significantly associated with meeting DRIs for potassium. Also, high-dose supplement use is associated with intakes above ULs for calcium, magnesium, and vitamin C.
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Bozzetti F. Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients. Support Care Cancer 2008; 17:279-84. [DOI: 10.1007/s00520-008-0476-3] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 05/29/2008] [Indexed: 12/22/2022]
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Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008; 27:5-15. [PMID: 18061312 DOI: 10.1016/j.clnu.2007.10.007] [Citation(s) in RCA: 867] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 06/21/2007] [Accepted: 10/12/2007] [Indexed: 12/15/2022]
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Lou MF, Dai YT, Huang GS, Yu PJ. Nutritional status and health outcomes for older people with dementia living in institutions. J Adv Nurs 2007; 60:470-7. [DOI: 10.1111/j.1365-2648.2007.04442.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Campillo B, Paillaud E, Uzan I, Merlier I, Abdellaoui M, Perennec J, Louarn F, Bories PN. Value of body mass index in the detection of severe malnutrition: influence of the pathology and changes in anthropometric parameters. Clin Nutr 2005; 23:551-9. [PMID: 15297091 DOI: 10.1016/j.clnu.2003.10.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2003] [Accepted: 10/07/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND & AIMS We have estimated the prevalence of severe malnutrition in groups of patients hospitalized for different medical causes and assessed the sensitivity of BMI in the diagnosis of severe malnutrition. DESIGN A prospective study enrolled 1052 patients: 396 patients with liver cirrhosis including 165 non-ascitic patients (NAP), 124 patients with mild ascites (MAP), 107 patients with tense ascites (TAP), 251 patients after cardiac surgery (SCP), 81 patients with cardiac diseases (MCP), 85 patients with stroke (SP), 36 patients with degenerative neurological diseases (DNP), 68 patients after surgery of a hip fracture (HFP), 91 patients with palliative care for cancer (CP) and 44 elderly patients with medical affections (EP). BMI, mid-arm muscular circumference (MAMC) and triceps skinfold thickness (TST) were measured within 48 h after admission. Patients with MAMC and TST below the 5th percentile of a reference population when aged < or = 74 or the 10th percentile when aged > or = 75 were defined as severely malnourished. Sensitivity of BMI < 20 to detect malnutrition was assessed. RESULTS The prevalence of severe malnutrition was the highest in TAP (39.1%) HFP (25.6%) and MAP (24.3%) and the lowest in SCP (4%), SP (4.8%), DNP (5.7%) and MCP (7.4%) (P < 10(-4)). In multivariate analysis, low TST was associated with female gender (P < 10(-4)) mild and tense ascites (P = 0.038, P = 0.0004), low MAMC with male gender (P < 10(-4)), low BMI with female gender (P = 0.0082), hip fracture (P = 0.0407) and cancer (P = 0.0059). The sensitivity of BMI to detect severe malnutrition was the highest in HFP, CP and EP (100%, 80% and 100% respectively) and the lowest in TAP, MCP and SP (40%, 33.3% and 50% respectively). After exclusion of TAP, sensitivity of BMI to detect malnutrition correlated significantly with the coefficient of correlation between MAMC and TST observed in each group (r = 0.821, P = 0.0066). CONCLUSION Ascitic cirrhotic patients and elderly patients after surgery of hip fracture had the highest prevalence of severe malnutrition. BMI had the highest sensitivity when both TST and MAMC were damaged to the same extent. BMI < 20 has a high sensitivity in the diagnosis of severe malnutrition in elderly and cancer patients but not in cirrhotic patients with tense ascites, cardiovascular and neurological patients.
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Affiliation(s)
- B Campillo
- Service de Rééducation Digestive, Hôpital Albert Chenevier, 40 rue de Mesly, 94010 Créteil Cedex, France.
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Edington J, Barnes R, Bryan F, Dupree E, Frost G, Hickson M, Lancaster J, Mongia S, Smith J, Torrance A, West R, Pang F, Coles SJ. A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: clinical and health economic outcomes. Clin Nutr 2004; 23:195-204. [PMID: 15030959 DOI: 10.1016/s0261-5614(03)00107-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2003] [Accepted: 06/17/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND & AIMS Malnutrition is common in sick elderly people on admission to hospital and in the community. We conducted a randomised controlled trial to determine if nutritional supplementation after discharge from hospital improved nutritional status and functional outcomes, or reduced health-care costs. METHODS Elderly malnourished subjects were randomised to 8 weeks of supplementation or no supplementation post discharge, and followed up for 24 weeks. Weight, body mass index, anthropometrics, handgrip strength, quality of life and requirements for health-care professionals' services and social services were measured throughout the study. RESULTS Nutritional status improved significantly from baseline to week 24 in the intervention group (P<0.05), but not in the control group. There was no significant difference in nutritional status between groups at week 24. Handgrip strength improved significantly in the intervention group during supplementation, and was significantly different from that of the control group at week 8, but decreased thereafter. There was no significant difference in quality of life or health economic outcomes between groups at week 24. CONCLUSIONS In already malnourished elderly subjects, it may be too late to expect to improve function or quality of life or to reduce health-care costs simply by providing nutritional supplements after hospitalisation. Prevention is key. All elderly patients should be nutritionally assessed as part of their routine care, and appropriate intervention initiated early.
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Affiliation(s)
- J Edington
- Abbott Laboratories, Medical Division, Abbott House, Norden Road, Maidenhead, Berkshire SL6 4XE, UK.
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Paillaud E, Bories PN, Aita SL, Scherman E, Jeanfaivre V, Lejonc JL, Campillo B. Prognostic value of dietary intake and inflammation on survival in patients with advanced cancer: relationship with performance status, pain, and digestive disorders. Nutr Cancer 2003; 45:30-5. [PMID: 12791502 DOI: 10.1207/s15327914nc4501_4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Elena Paillaud
- Service de medecine interne Hopital Albert Chenevier, Assistance Publique Hopitaux de Paris, 40 Rue Mesly 94010 Creteil Cedex, France.
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van Binsbergen JJ, Drenthen AJM. Patient information letters on nutrition: development and implementation. Am J Clin Nutr 2003; 77:1035S-1038S. [PMID: 12663314 DOI: 10.1093/ajcn/77.4.1035s] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 1998 the Dutch College of General Practitioners (NHG) began developing patient information letters (PILs), based on the practice guidelines for family physicians (FPs) (NHG standards). Five nutritional guidance letters have since been developed with the Dutch Nutrition Center. METHODS In August-September 2001 a survey was done among a random sample of 200 FPs who subscribe to the PILs. They received a questionnaire about the use and implementation of the PILs in general, and about the nutrition letters specifically. RESULTS Responses were received from 133 FPs (67%). Of these FPs, 89% use the PILs in their practice. Only 5% of FPs say that they use the PILs on nutrition sufficiently; 32% think they should use them a bit more, whereas 63% make much too little use of the nutrition letters. The most important barriers for using the letters are that FPs do not think about them at the right moment (66%), do not know the content enough (32%), find that using them is too time-consuming (29%), have computer problems (17%), and have too little knowledge about nutritional advice (11%); only 6% do not see dietary advice as an FP's task. The most important reason for not using the nutrition letters is the fact that the letters are not integrated into their FP information system (23%). CONCLUSIONS Implementation of PILs takes time, and there are great advantages to integrating them into the existing Family Practice Information Systems.
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Affiliation(s)
- Jaap J van Binsbergen
- Department of Family Medicine, University Medical Center Nijmegen, Nijmegen, The Netherlands
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Gale CR, Edington J, Coles SJ, Martyn CN. Patterns of prescribing of nutritional supplements in the United Kingdom. Clin Nutr 2001; 20:333-7. [PMID: 11478831 DOI: 10.1054/clnu.2001.0396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS A large number of prescriptions are issued for nutritional supplements under British National Formulary classifications 9.4.1 (foods for special diets) and 9.4.2 (enteral feeds), but little is known about the characteristics of the patients who receive them. We used the General Practice Research Database to examine patterns of prescribing of these supplements. METHODS We selected patients who had been prescribed supplements under classifications 9.4.1 and 9.4.2 during 1996-1997. Descriptive statistics were used to examine how prescribing varied. RESULTS 28644 patients received prescriptions during 1996-1997. Among the 27413 (96%) patients prescribed supplements for oral use, 14750 received supplements for enteral nutrition alone, 8122 received supplements for special diets alone and 4541 had both types of supplement. 51% of patients receiving supplements for special diets were <18 years. The commonest diagnoses among such children were milk intolerance (24%) and malnutrition (17%). 94% of patients receiving supplements for enteral nutrition were adult, 52% of whom had cancer or cardiovascular disease. Only 4% of patients had weight and height recorded prior to first prescription. CONCLUSIONS The GPRD provides valuable information on the characteristics of patients prescribed nutritional supplements. But because only limited data are available on their nutritional status prior to supplementation, it is hard to assess whether general practitioners are prescribing these supplements appropriately.
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Affiliation(s)
- C R Gale
- MRC Environmental Epidemiology Unit (University of Southampton), Southampton General Hospital, Southampton, Hampshire, UK
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