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Yao J, Zhang Y, Gao B, Zhou M. Associations of Preoperative Nutritional Status and Sarcopenia With Mortality in Patients With Abdominal Aortic Aneurysm After Open and Endovascular Abdominal Aortic Aneurysm Repair: A Retrospective Study. J Cardiothorac Vasc Anesth 2024; 38:1337-1346. [PMID: 38521631 DOI: 10.1053/j.jvca.2024.02.041] [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: 12/17/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE The effect of preoperative malnutrition and sarcopenia on outcomes in patients with abdominal aortic aneurysm (AAA) after open surgical repair (OSR) and endovascular abdominal aortic aneurysm repair is undefined. The authors conducted the study to address this issue in this population. DESIGN A retrospective observational study. SETTING A large tertiary hospital. PARTICIPANTS Patients with AAA who underwent OSR and endovascular aneurysm repair (EVAR). INTERVENTIONS Evaluation of nutritional status (Nutritional Risk Screening 2002 [NRS 2002] and the Controlling Nutritional Status [CONUT] scores), muscle size (skeletal muscle index), and postoperative parameters. MEASUREMENTS AND MAIN RESULTS A total of 199 patients were reviewed from January 2020 to December 2022. Patients weew categorized into group A (CONUT <4) and group B (CONUT ≥4) based on whether their CONUT scores were less than 4. The mortality (p = 0.004) and the incidence of Clavien-Dindo class III complications (p = 0.007) in group B were higher than those in group A. CONUT score was an independent risk factor for midterm mortality (hazard ratio 1.329; 95% CI, 1.104-1.697; p = 0.002) and Clavien-Dindo class III complications (odds ratio 1.225; 95% CI, 1.012-1.482; p = 0.037) according to univariate and multivariate analyses, whereas NRS 2002 score and sarcopenia were not. Kaplan-Meier curves showed a lower midterm survival rate in group B (log-rank p < 0.001). CONCLUSION In patients with AAA undergoing OSR or EVAR, a CONUT score ≥4 was associated with increased Clavien-Dindo class III complications and mortality. Preoperative nutritional status should be evaluated and optimized in this high-risk population.
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Affiliation(s)
- Jiashu Yao
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yepeng Zhang
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bo Gao
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Min Zhou
- Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Cortés-Aguilar R, Malih N, Abbate M, Fresneda S, Yañez A, Bennasar-Veny M. Validity of nutrition screening tools for risk of malnutrition among hospitalized adult patients: A systematic review and meta-analysis. Clin Nutr 2024; 43:1094-1116. [PMID: 38582013 DOI: 10.1016/j.clnu.2024.03.008] [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: 12/23/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUNDS & AIMS Malnutrition is prevalent among hospitalized patients in developed countries, contributing to negative health outcomes and increased healthcare costs. Timely identification and management of malnutrition are crucial. The lack of a universally accepted definition and standardized diagnostic criteria for malnutrition has led to the development of various screening tools, each with varying validity. This complicates early identification of malnutrition, hindering effective intervention strategies. This systematic review and meta-analysis aimed to identify the most valid and reliable nutritional screening tool for assessing the risk of malnutrition in hospitalized adults. METHODS A systematic literature search was conducted to identify validation studies published from inception to November 2023, in the Pubmed/MEDLINE, Embase, and CINAHL databases. This systematic review was registered in INPLASY (INPLASY202090028). The risk of bias and quality of included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2). Meta-analyses were performed for screening tools accuracy using the symmetric hierarchical summary receiver operative characteristics models. RESULTS Of the 1646 articles retrieved, 60 met the inclusion criteria and were included in the systematic review, and 21 were included in the meta-analysis. A total of 51 malnutrition risk screening tools and 9 reference standards were identified. The meta-analyses assessed four common malnutrition risk screening tools against two reference standards (Subjective Global Assessment [SGA] and European Society for Clinical Nutrition and Metabolism [ESPEN] criteria). The Malnutrition Universal Screening Tool (MUST) vs SGA had a sensitivity (95% Confidence Interval) of 0.84 (0.73-0.91), and specificity of 0.85 (0.75-0.91). The MUST vs ESPEN had a sensitivity of 0.97 (0.53-0.99) and specificity of 0.80 (0.50-0.94). The Malnutrition Screening Tool (MST) vs SGA had a sensitivity of 0.81 (0.67-0.90) and specificity of 0.79 (0.72-0.74). The Mini Nutritional Assessment-Short Form (MNA-SF) vs ESPEN had a sensitivity of 0.99 (0.41-0.99) and specificity of 0.60 (0.45-0.73). The Nutrition Universal Screening Tool-2002 (NRS-2002) vs SGA had a sensitivity of 0.76 (0.58-0.87) and specificity of 0.86 (0.76-0.93). CONCLUSIONS The MUST demonstrated high accuracy in detecting malnutrition risk in hospitalized adults. However, the quality of the studies included varied greatly, possibly introducing bias in the results. Future research should compare tools within a specific patient population using a valid and universal gold standard to ensure improved patient care and outcomes.
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Affiliation(s)
| | - Narges Malih
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, 07002 Palma, Spain.
| | - Manuela Abbate
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Sergio Fresneda
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Aina Yañez
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Miquel Bennasar-Veny
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain; Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
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Cheung HHT, Joynt GM, Lee A. Diagnostic test accuracy of preoperative nutritional screening tools in adults for malnutrition: a systematic review and network meta-analysis. Int J Surg 2024; 110:1090-1098. [PMID: 37830947 PMCID: PMC10871615 DOI: 10.1097/js9.0000000000000845] [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: 08/08/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Good nutritional screening tests can triage malnourished patients for further assessment and management by dietitians before surgery to reduce the risk of postoperative complications. The authors assessed the diagnostic test accuracy of common nutritional screening tools for preoperative malnutrition in adults undergoing surgery and determined which test had the highest accuracy. METHODS MEDLINE, EMBASE, CINAHL, and Web of Science were searched for relevant titles with no language restriction from inception till 1 January 2023. Studies reporting on the diagnostic test accuracy of preoperative malnutrition in adults using one or more of the following index nutritional screening tools were included: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment (MNA), short-form Mini Nutritional Assessment (MNA-SF), Nutritional Risk Index (NRI), Nutrition Risk Screening Tool 2002 (NRS-2002), and Preoperative Nutrition Screening (PONS). The reference standard was the Subjective Global Assessment (SGA) before surgery. Random-effects bivariate binomial model meta-analyses, meta-regressions, and a network meta-analysis were used to estimate the pooled and relative sensitivities and specificities. RESULTS Of the 16 included studies (5695 participants with an 11 957 index and 11 957 SGA tests), all were conducted after hospital admission before surgery. Eleven studies ( n =3896) were at high risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool due to a lack of blinded assessments. MUST had the highest overall test accuracy performance (sensitivity 86%, 95% CI: 75-93%; specificity 89%, 95% CI: 83-93%). Network meta-analysis showed NRI had similar relative sensitivity (0.93, 95% CI: 0.77-1.13) but lower relative specificity (0.75, 95% CI: 0.61-0.92) than MUST. CONCLUSIONS Of all easy-to-use tests applicable at the bedside, MUST had the highest test accuracy performance for screening preoperative malnutrition. However, its predictive accuracy is likely insufficient to justify the application of nutritional optimization interventions without additional assessments.
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Affiliation(s)
| | | | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, People’s Republic of China
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Pradelli L, Zaniolo O, Sanfilippo A, Lezo A, Riso S, Zanetti M. Prevalence and economic cost of malnutrition in Italy: A systematic review and metanalysis from the Italian Society of Artificial Nutrition and Metabolism (SINPE). Nutrition 2023; 108:111943. [PMID: 36669368 DOI: 10.1016/j.nut.2022.111943] [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: 05/25/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Disease-related malnutrition (DRM) is a major public health issue with dramatic consequences on outcomes. However, in Italy a comprehensive and updated overview on national prevalence, in both the adult and pediatric populations, and its burden on the health care environment, is missing. The aim of this systematic literature review and meta-analysis was to identify and summarize the available evidence regarding the prevalence of DRM in Italy from pediatric to adult and older ages, and to project its global costs on the health care system. METHODS We performed a systematic literature search for articles on epidemiology of DRM in Italy published up to June 2021. Studies reporting data on the prevalence of DRM in community-dwelling individuals with chronic diseases, nursing home patients, and hospitalized patients (medical, surgery, and oncology patients), were selected for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria. An epidemiologic meta-analysis to obtain an aggregate estimate of prevalence of DRM was performed and a model for estimating the cost of illness, based on the application of epidemiologic results to official national hospitalization data, and attribution of relevant unit costs in the national context was constructed. RESULTS Sixty-seven studies reporting on the prevalence of DRM in Italian populations were included in the final selection; meta-analytical pooling yields mean prevalence estimates of about 50% and 30% in adult and pediatric hospitalized populations, respectively, with even higher findings for residents of long-term care facilities. Modeled projections of DRM-attributable yearly economic effects on the Italian health care system exceed 10 billion € in base case analysis, with the most optimistic estimate still exceeding 2.5 billion €. CONCLUSION Although comparable in magnitude to data from previous studies in analogous international settings, the diffusion and effects of DRM in the Italian setting is impressive. Increased awareness of these data and proactive fostering of clinical nutrition services are warranted, as prompt identification and treatment of malnutrition have been shown to effectively improve clinical and economic results.
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Affiliation(s)
| | | | | | - Antonella Lezo
- Clinical Nutrition Unit, Children's Hospital "Regina Margherita," AOU Città della Salute e della Scienza, Turin, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetic Unit - "Maggiore della Carità" University Hospital, Novara, Italy
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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Pereira Bertini de Oliveira AJ, Regina de Goes C, Gonçalo Domiciano C, Ferreira NL, Ferreira LG. The Mini Nutritional Assessment-Short Form is more effective in predicting clinical outcomes among hospitalised patients with overweight than the Nutritional Risk Screening-2002. NUTR BULL 2023; 48:179-189. [PMID: 36748546 DOI: 10.1111/nbu.12608] [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: 10/22/2022] [Revised: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 02/08/2023]
Abstract
Understanding of the association between nutritional risk and clinical outcomes in hospitalised patients with overweight is still at an early stage. Given the lack of specific tools for the patient with overweight, the objective of this study was to compare two of the main general screening instruments for assessing nutritional risk in predicting clinical outcomes in a population of hospitalised patients with overweight. A retrospective study was carried out in a medium-sized hospital in Brazil, with patients ≥20 years old admitted between July 2017 and December 2019. Patients who were overweight and had records of Nutritional Risk Screening-2002 (NRS-2002) and Mini-Nutritional Assessment-Short Form (MNA-SF) in their medical files were included in the study. Clinical outcomes data (longer length of stay, readmission during the study period and mortality before the end of study or during hospitalisation) were obtained. The Kappa coefficient assessed agreement between both tools, and their performance for predicting outcomes was analysed using characteristic receiver operating curves (ROC). Data were collected from 643 patients. The prevalence of nutritional risk was 17.7% and 36.1% according to the NRS-2002 and MNA-SF (k = 0.390; p < 0.001), respectively. According to both tools, all clinical outcomes were significantly more common among individuals at nutritional risk (p < 0.05). Only the MNA-SF showed a significant percentage of predictions for readmission (57.2%) and death during hospitalisation (65.7%). For mortality until the end of the study, the area under the ROC curve was similar for MNA-SF (60.5%) and NRS-2002 (60.7%; p = 0.057). The MNA-SF detected a greater proportion of nutritional risk among hospitalised patients with overweight and better predicted all clinical outcomes compared to the NRS-2002 and should be used to screen patients with overweight for nutritional risk.
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Affiliation(s)
| | - Cassiana Regina de Goes
- Institute of Biological and Health Sciences, Universidade Federal Viçosa, Rio Paranaíba, Brazil
| | | | | | - Lívia Garcia Ferreira
- Program in Nutrition and Health, Department of Nutrition, Universidade Federal de Lavras, Lavras, Brazil
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Deligöz Ö, Ekinci O. Prediction of Prognosis in Geriatric Palliative Care Patients with Diagnosed Malnutrition: A Comparison of Nutritional Assessment Parameters. Clin Interv Aging 2022; 17:1893-1900. [PMID: 36597427 PMCID: PMC9805734 DOI: 10.2147/cia.s380536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022] Open
Abstract
Objective Malnutrition is very commonly encountered in palliative care centers (PCC), especially in geriatric patients. It is known that development of malnutrition increases morbidity and mortality. In this study, we aimed to investigate the effectiveness of commonly used nutritional assessment parameters in predicting prognosis in geriatric patients diagnosed in PCC with malnutrition. Methods Our study included 1451 patients aged ≥65 years, who were diagnosed with malnutrition in PCC between 2016-2020 and did not yet start receiving nutritional support. Demographic data, comorbidities, The Nutritional Risk Screening 2002 (NRS-2002), body mass index (BMI), albumin, prealbumin and C-reactive protein (CRP) values of the patients were recorded. Prognostic course was evaluated by dividing the patients into 3 groups, namely mortal patients during PCC follow-up, patients transferred from PCC to Intensive Care (ICU) and patients discharged to home from PCC. Results Logistic Regression analysis showed that low albumin levels affected transfer to ICU (P<0.05). Elevated NRS-2002 and low albumin and prealbumin levels were found to be factors affecting mortality (P<0.05). Areas under the ROC Curve were calculated to attain patients' differential diagnosis. The area under the ROC Curve of low albumin in patients transferred to ICU was found to be significant (P<0.05). In the differential diagnosis of patients with mortal course, the area under the ROC Curve of low albumin and prealbumin and high CRP was found to be significant (P<0.05). Conclusion We found that BMI had no prognostic predictive effects in geriatric PCC patients with malnutrition. We concluded that NRS-2002 and high CRP and low albumin and prealbumin can be used to predict mortality. In addition, we found that low albumin indicates a poor prognosis and predicts patients to be transferred to ICU.
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Affiliation(s)
- Özlem Deligöz
- University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey,Correspondence: Özlem Deligöz, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey, Email
| | - Osman Ekinci
- University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
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Totland TH, Krogh HW, Smedshaug GB, Tornes RA, Bye A, Paur I. Harmonization and standardization of malnutrition screening for all adults - A systematic review initiated by the Norwegian Directorate of Health. Clin Nutr ESPEN 2022; 52:32-49. [PMID: 36513471 DOI: 10.1016/j.clnesp.2022.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND & AIMS The Norwegian Directorate of Health has identified a need to harmonize and standardize the malnutrition screening practice in Norwegian hospitals and primary health care settings, in order to provide a seamless communication of malnutrition screening along the patient pathway. Our aim was to perform a systematic review of the validity and reliability of screening tools used to identify risk of malnutrition across health care settings, diagnoses or conditions and adult age groups, as a first step towards a national recommendation of one screening tool. METHODS A systematic literature search for articles evaluating validity, agreement, and reliability of malnutrition screening tools, published up to August 2020, was conducted in: MEDLINE, Embase, APA PsycInfo, Cinahl, Cochrane Databases, Web of Science, Epistemonikos, SveMed+, and Norart. The systematic review was registered in PROSPERO (CRD42022300558). For critical appraisal of each included article, the Quality Criteria Checklist by The Academy of Nutrition and Dietetics was used. RESULTS The review identified 105 articles that fulfilled the inclusion and exclusion criteria. The most frequently validated tools were Mini Nutritional Assessment short form (MNA), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and Nutritional Risk Screening 2002 (NRS-2002). MNA, MST and NRS-2002 displayed overall moderate validity, and MUST low validity. All four tools displayed low agreement. MST and MUST were validated across health care settings and age groups. In general, data on reliability was limited. CONCLUSIONS The screening tools MST and NRS-2002 displayed moderate validity for the identification of malnutrition in adults, of which MST is validated across health care settings. In addition, MNA has moderate validity for the identification of malnutrition in adults 65 years or older.
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Affiliation(s)
- Torunn Holm Totland
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway; Department of Physical Health and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Henriette Walaas Krogh
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway
| | - Guro Berge Smedshaug
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway
| | | | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway; European Palliative Care Research Centre (PRC), Dept. of Oncology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Paur
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway; Norwegian Advisory Unit on Disease-related Undernutrition, Oslo University Hospital, Oslo, Norway; Dept. of Clinical Services, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
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Muacevic A, Adler JR, Konanur Srinivasa NK, Gande A, Anusha M, Dar H. Nutrition Care in Cancer Surgery Patients: A Narrative Review of Nutritional Screening and Assessment Methods and Nutritional Considerations. Cureus 2022; 14:e33094. [PMID: 36721576 PMCID: PMC9884126 DOI: 10.7759/cureus.33094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 12/30/2022] Open
Abstract
Malignancy is a catabolic state, which is precipitated with surgical intervention. Malnutrition is one of the main risk factors for poor outcomes of cancer surgery. We need to screen oncological patients for malnutrition using standardized screening tools, by which patients found to be at nutritional risk are then referred to a registered dietitian for further management. A detailed assessment is required in such patients, which helps in categorizing the patients based on the severity and rendering proper care. Preoperative nutrition care is often overlooked because of the urgency of operating on a cancer patient. Still, studies have shown preoperative nutritional building gives better surgical outcomes and good postoperative quality of life. Preoperative nutrition care includes both early and late preoperative care. For efficient preoperative nutrition care publishing, standard operating procedures at every healthcare center are recommended. Postoperative nutrition care is given to build the patient tackle the surgical trauma, and their diet mainly includes protein to minimize catabolism. Regardless of the route of nutrition delivery, providing appropriate nutrition care in the postoperative period improves cancer patients' condition drastically. Early postoperative nutrition is studied in different cancer surgeries and is considered ideal in cancer surgical patients. There is a need for consensus on the composition of postoperative nutrition. The diet of a cancer patient should include micronutrients like vitamins D and B and minerals along with the usual nutrition care. The use of special diets like branched-chain amino acids and immune nutrition is to be considered on a case-by-case basis and introducing them into the routine care of a patient needs to be studied extensively.
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Two Distinct Nutritional Assessment Tools Have Dissimilar Outcomes in a Sample of Older Adult Patients With Cancer. FORUM OF CLINICAL ONCOLOGY 2022. [DOI: 10.2478/fco-2021-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Introduction
Malnutrition is strongly associated with negative outcomes in aged populations with cancer. Several studies have compared the outcomes of nutritional-screening tools, but knowledge specifically covering older adult patients with cancer remains limited. The aim of this study was to compare the outcomes of two tools, the Patient-Generated Subjective Global Assessment (PG-SGA) versus the Mini Nutritional Assessment (MNA) for this population.
Method
Cross-sectional study with 432 participants who consented to participate and were enrolled at admission to medical and surgical wards of a tertiary referral hospital. The participants’ nutritional statuses were simultaneously assessed using the PG-SGA and the MNA, and the outcomes compared using the kappa statistical test. The Receiver Operating Characteristic Curve (ROC) was employed to calculate the MNA sensitivity, specificity, positive and negative predictive values, and was compared with PG-SGA.
Results
Prevalence of good nourishment was observed in 62.5% and 61.1% of the participants, as detected by PG-SGA and MNA, respectively. Both tools concurred moderately (kappa = 0.453). Importantly, there were significant differences in the diagnosis of malnutrition (7.6% vs. 4.6%, p = 0.000). The MNA showed sensitivity of 72.2% and specificity of 75.9% in detecting good nourishment for the population investigated.
Conclusion
The MNA may not present greater sensitivity, possibly due to a lack of coverage of gastrointestinal symptoms. It is a quick and efficient tool for nutritional assessment of older adult patients with cancer, but as it is more specific than sensitive, caution is recommended when identifying borderline or early malnourished individuals of this population.
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Eslamian G, Sali S, Babaei M, Parastouei K, Moghadam DA. Association of nutrition risk screening 2002 and Malnutrition Universal Screening Tool with COVID-19 severity in hospitalized patients in Iran. Acute Crit Care 2022; 37:332-338. [PMID: 35791649 PMCID: PMC9475157 DOI: 10.4266/acc.2021.01830] [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: 12/30/2021] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Malnutrition affects normal body function and is associated with disease severity and mortality. Due to the high prevalence of malnutrition reported in patients with coronavirus disease 2019 (COVID-19), the current study examined the association between malnutrition and disease severity in hospitalized adult patients with COVID-19 in Iran.Methods: In this prospective observational study, 203 adult patients with COVID-19 verified by real-time polymerase chain reaction test and chest computed tomography were recruited from those admitted to a university hospital in Iran. To determine COVID-19 intensity, patients were categorized into four groups. Malnutrition assessment was based on the Malnutrition Universal Screening Tool (MUST) and nutrition risk screening score (NRS-2002). An ordinal regression model was run to assess the association between malnutrition and disease severity.Results: In the studies sample of Iranian patients with COVID-19, 38.3% of patients had severe COVID-19. According to NRS-2002, 12.9% of patients were malnourished. Based on MUST, 2% of patients were at medium, and 13.4% of patients were at high risk of malnutrition. Malnutrition was associated with a higher odds of extremely severe COVID-19 according to NRS-2002 (odds ratio, 1.38; 95% confidence interval, 0.21–2.56; P=0.021).Conclusions: Malnutrition was not prevalent in the studies sample of Iranian patients with COVID-19; however, it was associated with a higher odds of extremely severe COVID-19.
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Suryawanshi V, Phalnikar R. Analysis of nutritional risk tools to identify essential parameters in assessing nutritional risk in elderly patients. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2022. [DOI: 10.3233/mnm-220045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The nutrition screening tool determines whether or not a patient is at risk of malnutrition. Many organizations contributed to the form’s design by researching various nutritional screening tools. OBJECTIVE: The purpose of this study is to analyse the different screening forms for the hospitalised geriatric patients to understand the nutritional status as well as the comorbidities. In addition, the study intends to identify the essential parameters from three nutrition screening forms-MUST,NRS-2002,MNA. The primary outcome is to identify the essential parameters from the screening form and calculating the nutrition risk score is considered a secondary outcome. METHODS: The research was done on geriatric patients who were admitted to the hospital from November 2019 to March 2020, suffering from comorbidities. The study comprises 192 hospitalized patients with an average age of 74 years including both genders. The patients’ data was collected by a certified dietician to understand the essential parameters of these nutrition screening forms. The Pearson correlation test is used to find the correlation value between the screening form parameters. Based on the analysis, features with a correlation value greater than 0.5 with the nutrition score are considered a significant parameter for the research. RESULTS: The analysis of the nutrition screening strategy demonstrates the different significant parameters of the above three screening forms. The experimentation shows, the significant parameters are the Body Mass Index, impaired nutrition status, the severity of disease, mobility, mode of feeding, nutritional status, and weight loss score. CONCLUSIONS: The research is performed to understand the correlation between the screening form parameters MNA, MUST, NRS2002 using a non-invasive method and analyze the score in patients to improve health rates by using nutritional risk therapy and nutritional care for such patients. Nutrition therapy can be applied to patients suffering from malnutrition and at risk of malnutrition to improve the health of the patient.
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Affiliation(s)
| | - Rashmi Phalnikar
- School of Computer Engineering and Technology, MIT-WPU, Pune, India
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Amasene M, Medrano M, Echeverria I, Urquiza M, Rodriguez-Larrad A, Diez A, Labayen I, Ariadna BB. Malnutrition and Poor Physical Function Are Associated With Higher Comorbidity Index in Hospitalized Older Adults. Front Nutr 2022; 9:920485. [PMID: 35811947 PMCID: PMC9263978 DOI: 10.3389/fnut.2022.920485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background The Charlson Comorbidity Index (CCI) is the most widely used method to measure comorbidity and predict mortality. There is no evidence whether malnutrition and/or poor physical function are associated with higher CCI in hospitalized patients. Therefore, this study aimed to (i) analyze the association between the CCI with nutritional status and with physical function of hospitalized older adults and (ii) examine the individual and combined associations of nutritional status and physical function of older inpatients with comorbidity risk. Methods A total of 597 hospitalized older adults (84.3 ± 6.8 years, 50.3% women) were assessed for CCI, nutritional status (the Mini Nutritional Assessment-Short Form [MNA-SF]), and physical function (handgrip strength and the Short Physical Performance Battery [SPPB]). Results Better nutritional status (p < 0.05) and performance with handgrip strength and the SPPB were significantly associated with lower CCI scores among both men (p < 0.005) and women (p < 0.001). Patients with malnutrition or risk of malnutrition (OR: 2.165, 95% CI: 1.408–3.331, p < 0.001) as well as frailty (OR: 3.918, 95% CI: 2.326–6.600, p < 0.001) had significantly increased the risk for being at severe risk of comorbidity. Patients at risk of malnutrition or that are malnourished had higher CCI scores regardless of being fit or unfit according to handgrip strength (p for trend < 0.05), and patients classified as frail had higher CCI despite their nutritional status (p for trend < 0.001). Conclusions The current study reinforces the use of the MNA-SF and the SPPB in geriatric hospital patients as they might help to predict poor clinical outcomes and thus indirectly predict post-discharge mortality risk.
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Affiliation(s)
- Maria Amasene
- Department of Pharmacy and Food Science, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - María Medrano
- Institute on Innovation and Sustainable Development in Food Chain (IS-FOOD), Public University of Navarre (UPNA), Pamplona, Spain
| | - Iñaki Echeverria
- Department of Physiology, University of the Basque Country, UPV/EHU, Leioa, Spain
- Department of Physical Education and Sport, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - Miriam Urquiza
- Department of Physiology, University of the Basque Country, UPV/EHU, Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Ana Rodriguez-Larrad
- Department of Physiology, University of the Basque Country, UPV/EHU, Leioa, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Amaia Diez
- Nurse Supervisor, Bioaraba Research Institute, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Idoia Labayen
- Institute on Innovation and Sustainable Development in Food Chain (IS-FOOD), Public University of Navarre (UPNA), Pamplona, Spain
| | - Besga-Basterra Ariadna
- Ageing and Frailty Research Group, Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
- Internal Medicine Department, Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
- *Correspondence: Besga-Basterra Ariadna
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13
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Malnutrition Screening and Assessment. Nutrients 2022; 14:nu14122392. [PMID: 35745121 PMCID: PMC9228435 DOI: 10.3390/nu14122392] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023] Open
Abstract
Malnutrition is a serious problem with a negative impact on the quality of life and the evolution of patients, contributing to an increase in morbidity, length of hospital stay, mortality, and health spending. Early identification is fundamental to implement the necessary therapeutic actions, involving adequate nutritional support to prevent or reverse malnutrition. This review presents two complementary methods of fighting malnutrition: nutritional screening and nutritional assessment. Nutritional risk screening is conducted using simple, quick-to-perform tools, and is the first line of action in detecting at-risk patients. It should be implemented systematically and periodically on admission to hospital or residential care, as well as on an outpatient basis for patients with chronic conditions. Once patients with a nutritional risk are detected, they should undergo a more detailed nutritional assessment to identify and quantify the type and degree of malnutrition. This should include health history and clinical examination, dietary history, anthropometric measurements, evaluation of the degree of aggression determined by the disease, functional assessment, and, whenever possible, some method of measuring body composition.
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14
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Ramsey KA, Meskers CGM, Trappenburg MC, Bacalini MG, Delledonne M, Garagnani P, Greig C, Kallen V, van Meeteren N, van Riel N, Correia Santos N, Sipilä S, Thompson JL, Whittaker AC, Maier AB. The Physical Activity and Nutritional INfluences in Ageing (PANINI) Toolkit: A Standardized Approach towards Physical Activity and Nutritional Assessment of Older Adults. Healthcare (Basel) 2022; 10:healthcare10061017. [PMID: 35742068 PMCID: PMC9222478 DOI: 10.3390/healthcare10061017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Assessing multiple domains of health in older adults requires multidimensional and large datasets. Consensus on definitions, measurement protocols and outcome measures is a prerequisite. The Physical Activity and Nutritional INfluences In Ageing (PANINI) Toolkit aims to provide a standardized toolkit of best-practice measures for assessing health domains of older adults with an emphasis on nutrition and physical activity. The toolkit was drafted by consensus of multidisciplinary and pan-European experts on ageing to standardize research initiatives in diverse populations within the PANINI consortium. Domains within the PANINI Toolkit include socio-demographics, general health, nutrition, physical activity and physical performance and psychological and cognitive health. Implementation across various countries, settings and ageing populations has proven the feasibility of its use in research. This multidimensional and standardized approach supports interoperability and re-use of data, which is needed to optimize the coordination of research efforts, increase generalizability of findings and ultimately address the challenges of ageing.
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Affiliation(s)
- Keenan A. Ramsey
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; (K.A.R.); (C.G.M.M.)
| | - Carel G. M. Meskers
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; (K.A.R.); (C.G.M.M.)
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Marijke C. Trappenburg
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Amsterdam University Medical Center, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands;
- Department of Internal Medicine, Amstelland Hospital, Laan van de Helende Meesters 8, 1186 AM Amstelveen, The Netherlands
| | - Maria Giulia Bacalini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Padiglione G, Via Altura, 3, 40139 Bologna, Italy;
| | - Massimo Delledonne
- Department of Biotechnology, University of Verona, Strada Le Grazie 15, 37134 Verona, Italy;
| | - Paolo Garagnani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Zamboni 33, 40126 Bologna, Italy;
- Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Alfred Nobels allé 8 141 52 Huddinge, 10316 Stockholm, Sweden
- Personal Genomics S.r.l., Via Roveggia, 43B, 37136 Verona, Italy
| | - Carolyn Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (C.G.); (J.L.T.); (A.C.W.)
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Copeman House, St Mary’s Court, St Mary’s Gate, Chesterfield S41 7TD, UK
| | - Victor Kallen
- Department of Microbiology and System Biology, The Netherlands Organization for Applied Scientific Research, Utrechtseweg 48, 3704 HE Zeist, The Netherlands;
| | - Nico van Meeteren
- Top Sector Life Sciences & Health (Health~Holland), Wilhelmina van Pruisenweg 104, 2595 AN The Hague, The Netherlands;
- Department of Anesthesiology, Erasmus Medical Center, Dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Natal van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, Postbus 513, 5600 MB Eindhoven, The Netherlands;
| | - Nadine Correia Santos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal;
- ICVS/3B’s, PT Government Associate Laboratory, AvePark, Zona Industrial da Gandra S. Claudio do Barco Caldas das Taipas, 4806-909 Guimarães, Portugal
| | - Sarianna Sipilä
- Faculty of Sport and Health Sciences, University of Jyväskylä, Building Viveca (Viv), Rautpohjankatu 8, 40700 Jyväskylä, Finland;
| | - Janice L. Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (C.G.); (J.L.T.); (A.C.W.)
| | - Anna C. Whittaker
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (C.G.); (J.L.T.); (A.C.W.)
- Sport, Health & Exercise Research & Education (SpHERE), Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - Andrea B. Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; (K.A.R.); (C.G.M.M.)
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, 300 Grattan Street, Parkville, VIC 3052, Australia
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, 10 Medical Drive, Singapore 117597, Singapore
- Correspondence: ; Tel.: +31-20-59-82000l
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Comparison of nutrition screening tools and calf circumference in estimating the preoperative prevalence of malnutrition among patients with aerodigestive tract cancers-a prospective observational cohort study. Support Care Cancer 2022; 30:6603-6612. [PMID: 35486230 DOI: 10.1007/s00520-022-07092-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE There is paucity of data on the prevalence of malnutrition among cancer patients in India and a brief tool to identify the same would be an asset. Our aim was to evaluate two nutrition screening tools and calf circumference (CC) with the European Society for Clinical Nutrition and Metabolism (ESPEN) consensus guidelines for malnutrition among patients with head and neck (H&N) and gastrointestinal (GI) cancers. METHODS Nutritional evaluation was performed preoperatively using Malnutrition Universal Screening Tool (MUST), Short Form of Mini Nutritional Assessment (MNA-SF), and calf circumference (CC) in 206 patients. The diagnostic accuracy of these tools was compared with the ESPEN criteria for malnutrition. Patients evaluated were grouped as normal or malnourished. The incidence of infection, antibiotic days, antibiotic escalation, and length of stay was compared among the groups. Clavien-Dindo score at discharge, 30-day readmission, and mortality were also examined. RESULTS A total of 28.6% were malnourished as per ESPEN criteria and 25.2% had CC less than the cut-off. With respect to ESPEN criteria, MUST and MNA-SF had 100% sensitivity and negative predictive value. CC had the highest specificity and positive predictive value for the total population (91.16%, 75% respectively). The agreement between the tools was acceptable except in MNA-SF (MNA-SF-ESPEN κ = 0.228, MUST-ESPEN κ = 0.565, CC-ESPEN κ = 0.594). There was no difference in postoperative outcomes between the malnourished and normal. CONCLUSION Thus, more than a quarter of patients with H&N and GI cancers are malnourished preoperatively. As the best agreement between the screening tools was for MUST-ESPEN and CC-ESPEN, either of them can be used to identify malnutrition at admission.
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16
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Chen Z, Jiang H, He W, Li D, Lin M, Wang M, Shang M, Zhang W. The Association of Nutritional Risk Screening 2002 With 1-Year Re-hospitalization and the Length of Initial Hospital Stay in Patients With Heart Failure. Front Nutr 2022; 9:849034. [PMID: 35571880 PMCID: PMC9103872 DOI: 10.3389/fnut.2022.849034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Backgrounds and AimsNutritional Risk Screening 2002 (NRS-2002) has been widely recommended for identifying the nutritional risk. However, the association between NRS-2002 and the prognosis of heart failure has not been fully addressed. This study aimed to explore the association of NRS-2002 with 1-year re-hospitalization and the length of initial hospital stay in heart failure patients.MethodsThis retrospective study included 2,830 heart failure patients. The primary endpoint was 1-year re-hospitalization for heart failure. The secondary endpoint was the length of initial hospital stay. The Log-binomial regression analysis was performed to determine the association between NRS-2002 and re-hospitalization. The Cox regression model was fitted to estimate hazard of discharge. The cumulative incidence curves of discharge were plotted using Kaplan–Meier method and log-rank test was performed. Exploratory analysis was also conducted according to the classification of heart failure and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) fold-elevation.ResultsAmong 2,830 heart failure patients, the mean age was 64.3 years and 66.4% were male. A total of 122 (4.3%) patients were considered at high nutritional risk. Log-binomial regression analysis demonstrated that higher NRS-2002 score was an independent risk factor of re-hospitalization ([1 vs. 0]: relative risks [RR] = 1.383, 95% CI = 1.152 to 1.660; [2 vs. 0]: RR = 1.425, 95% CI = 1.108 to 1.832; [3–7 vs. 0]: RR = 1.770, 95% CI = 1.310 to 2.393). Kaplan–Meier curve showed that the cumulative incidence of discharge was lower in high nutritional risk group (Log rank p < 0.001). Cox regression analysis also found that higher NRS-2002 score (2 or ≥3) was strongly associated with longer length of initial hospital stay ([2 vs. 0]: Hazard ratios [HR] = 0.854, 95% CI = 0.748 to 0.976; [3–7 vs. 0]: HR = 0.609, 95% CI = 0.503 to 0.737). Exploratory analysis showed that such association still remained irrespective of NT-proBNP fold-elevation, but only existed in patients with heart failure with preserved ejection fraction (HFpEF).ConclusionIn patients with heart failure, high NRS-2002 score was strongly and independently associated with the incidence of 1-year re-hospitalization and the length of initial hospital stay.
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Affiliation(s)
- Zhezhe Chen
- Department of Cardiology, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Hangpan Jiang
- Department of Cardiology, College of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, China
| | - Wujian He
- Department of Cardiology, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Duanbin Li
- Department of Cardiology, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Maoning Lin
- Department of Cardiology, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Min Wang
- Department of Cardiology, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
| | - Min Shang
- Department of Cardiology, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
- Min Shang
| | - Wenbin Zhang
- Department of Cardiology, College of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, China
- *Correspondence: Wenbin Zhang
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17
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Pizzorni N, Ciammola A, Casazza G, Ginocchio D, Bianchi F, Feroldi S, Poletti B, Nanetti L, Mariotti C, Mora G, Schindler A. Predictors of malnutrition risk in neurodegenerative diseases: the role of swallowing function. Eur J Neurol 2022; 29:2493-2498. [PMID: 35384164 PMCID: PMC9540307 DOI: 10.1111/ene.15345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia is generally recognized to increase the risk of malnutrition, however, its role in patients with neurodegenerative disease has still to be determined. The cross-sectional study aimed to investigate the impact of swallowing function on malnutrition risk in patients with neurodegenerative diseases. METHODS Patients with oral nutrition and diagnosis of Huntington's disease (HD), Parkinson's disease (PD), or Amyotrophic Lateral Sclerosis (ALS) were recruited. Demographic and clinical data were collected. The swallowing assessment included a fiberoptic endoscopic evaluation of swallowing, an oral phase assessment, and a meal observation scored with the Mealtime Assessment Scale (MAS). Malnutrition risk was assessed with the Mini Nutritional Assessment (MNA®). RESULTS Overall, 148 patients were recruited (54 HD, 33 PD, and 61 ALS). One-hundred (67.6%) patients were considered at risk of malnutrition. At the multivariate analysis, age ≥65 (OR 3.16, p=0.014), disease severity (moderate vs mild OR 3.89, severe vs mild OR 9.71, p=0.003), number of masticatory cycles (OR 1.03, p=0.044), and MAS safety (OR 1.44, p=0.016) were significantly associated with malnutrition risk. CONCLUSION Prolonged oral phase and signs of impaired swallowing safety during meals, together with older age and disease severity, are independent predictors of malnutrition risk in neurodegenerative diseases. The study broadens the focus on dysphagia, stressing the importance of an early detection not only of pharyngeal signs, but also of oral phase impairment and meal difficulties through a multidimensional swallowing assessment.
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Affiliation(s)
- Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Giovanni Casazza
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Daniela Ginocchio
- ALS Center, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Federica Bianchi
- ALS Center, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Sarah Feroldi
- ALS Center, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.,Ph.D. Program in Neuroscience, School of Medicine and Surgery, University Milano-Bicocca, Monza, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Lorenzo Nanetti
- Department of Diagnostics and Technology, Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Caterina Mariotti
- Department of Diagnostics and Technology, Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gabriele Mora
- ALS Center, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
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Boutata FZ, Bencharif M, Abdessemed D. Validity of four nutritional screening tools against subjective global assessment for inpatients with non communicable diseases (Algeria, 2020). NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Sahin N, Tek NA. Validity of the Graz Malnutrition Screening as an indicator of malnutrition in hospitalized patients. Nutr Clin Pract 2022; 37:1336-1347. [DOI: 10.1002/ncp.10825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Nursel Sahin
- Department of Nutrition and Dietetic Bandirma Onyedi Eylul University Balikesir Turkey
| | - Nilufer Acar Tek
- Department of Nutrition and Dietetic Gazi University Ankara Turkey
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20
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Malnutrition Among Hospitalized Adult Patients. TOP CLIN NUTR 2022. [DOI: 10.1097/tin.0000000000000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Kate V, Raghuraman H, Kavyashree M, Balakrishnan G, Elamurugan TP, Shankar G, Nanda N, Thulasingam M. Comparison of Nutrition Risk Screening 2002 and Subjective Global Assessment for predicting postoperative complications among patients undergoing elective abdominal surgery. INTERNATIONAL JOURNAL OF ADVANCED MEDICAL AND HEALTH RESEARCH 2022. [DOI: 10.4103/ijamr.ijamr_239_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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22
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Youssef N, Elbadry M, Al Shafie A, Abdalazeem A, Hasan S, Tahoon M, Omran D, El Kassas M. Nutritional Status Associated with Clinical Outcomes among Patients Hospitalized with COVID-19: A Multicenter Prospective Study in Egypt. Nurs Health Sci 2021; 24:204-213. [PMID: 34918872 DOI: 10.1111/nhs.12913] [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: 07/15/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 01/08/2023]
Abstract
Few studies have addressed the relationship between the nutritional status of patients with COVID-19 and their disease course. This multicenter prospective study aimed to evaluate the nutritional status of patients hospitalized with COVID-19 and its association with their clinical outcomes. Sociodemographic, physical, clinical, and nutritional data of 121 patients with confirmed COVID-19 were collected upon admission and at discharge from three COVID-19 quarantine hospitals in Egypt via a questionnaire and a standardized scale. The majority (73.6%) of the patients had a reduced dietary intake over the last week before admission, and 57% were severely ill. Overall, 14% had a high risk of malnutrition on admission, increased to 26.3% at discharge. Malnutrition was present in most (85.7%) of intensive care unit patients, and deaths, compared with recovered patients (14%). We concluded that malnutrition might worsen the clinical outcomes and increase the morbidity and mortality of COVID-19 patients. A multidisciplinary approach is recommended to manage patients with Covid-19, considering their nutritional status before and during infection, with early detection of high-risk patients in order to design and provide the appropriate nutritional support. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Naglaa Youssef
- Medical-Surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt.,Medical-Surgical Nursing Department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mohamed Elbadry
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmad Al Shafie
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Amr Abdalazeem
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Salwa Hasan
- Clinical Pharmacology Department, Aswan Specialized Hospital, Aswan, Egypt
| | - Marwa Tahoon
- Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia university, Menoufia, Egypt
| | - Dalia Omran
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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23
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Screening Nutritional Status of Hospitalized Patients with Nutritional Risk Screening 2002 and Subjective Global Assessment Tools. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.975869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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24
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Amasene M, Besga A, Medrano M, Urquiza M, Rodriguez-Larrad A, Tobalina I, Barroso J, Irazusta J, Labayen I. Nutritional status and physical performance using handgrip and SPPB tests in hospitalized older adults. Clin Nutr 2021; 40:5547-5555. [PMID: 34656951 DOI: 10.1016/j.clnu.2021.09.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 07/09/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND & AIMS Malnutrition and poor physical performance are highly prevalent within hospitalized older adults, and both have in common the loss of muscle mass. Likewise, there is growing interest in identifying markers of physical performance, other than just measuring muscle mass, that might be useful for managing malnutrition. This study aimed to (i) characterize the physical condition of hospitalized older adults in comparison to previously published reference percentile values of same age adults and (ii) to examine the association between the nutritional status and physical performance of older inpatients. METHODS A total of 604 inpatients (age 84.3 ± 6.8 years, 50.3% women) participated in this cross-sectional study. Patients were assessed for nutritional status (Mini Nutritional Assessment-Short Form (MNA-SF)) and physical performance (handgrip strength and the Short Physical Performance Battery (SPPB)). RESULTS During hospitalization, 65.7% of the inpatients were at risk of malnutrition or malnourished. More than a half of the older inpatients were unfit (≤P25) for handgrip strength (52.0%) and SPPB total score (86.3%) as well as for two of its subtests, gait speed (86.7%) and 5 times sit-to-stand (91.1%) tests. Patients' nutritional status was significantly associated with better physical performance within all tests (all p < 0.001), as their nutritional status improved so did their physical performance (all p for trend <0.001). Hence, being at risk of malnutrition or malnourished significantly increased the likelihood for being classified as unfit according to handgrip strength (OR: 1.466, 95% CI: 1.045-2.056), SPPB total score (OR: 2.553, 95% CI: 1.592-4.094) and 4-m walking test (OR: 4.049, 95% CI: 2.469-6.640) (all p < 0.05), and as frail (OR: 4.675, 95% CI: 2.812-7.772) according to the SPPB frailty threshold (p < 0.001). CONCLUSIONS This study reinforces the use of handgrip strength and SPPB, as well as its subtests (gait speed and 5 times sit-to-stand tests), in hospitalized older adults as alternative measures of muscle mass for malnutrition management. Hence, it seems that risk of malnutrition or malnutrition assessed by MNA-SF might help to predict poor physical performance in older inpatients.
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Affiliation(s)
- Maria Amasene
- Department of Pharmacy and Food Science, University of the Basque Country UPV/EHU, 01006, Vitoria-Gasteiz, Spain.
| | - Ariadna Besga
- Department of Internal Medicine, Araba University Hospital, OSI Araba, Bioaraba Research Institute, CIBERSAM, University of the Basque Country, UPV/EHU, 01004, Vitoria-Gasteiz, Spain.
| | - María Medrano
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, 31006, Pamplona, Spain.
| | - Miriam Urquiza
- Department of Physiology, University of the Basque Country UPV/EHU, 48940, Leioa, Spain.
| | - Ana Rodriguez-Larrad
- Department of Physiology, University of the Basque Country UPV/EHU, 48940, Leioa, Spain.
| | - Ignacio Tobalina
- Department of Nuclear Medicine, Araba University Hospital, 01004, Vitoria-Gasteiz, Spain; Department of Surgery Radiology and Physical Medicine, Faculty of Medicine, University of the Basque Country, UPV/EHU, 01009, Vitoria-Gasteiz, Spain.
| | - Julia Barroso
- Department of Internal Medicine, Araba University Hospital, OSI Araba, Bioaraba Research Institute, CIBERSAM, University of the Basque Country, UPV/EHU, 01004, Vitoria-Gasteiz, Spain.
| | - Jon Irazusta
- Department of Physiology, University of the Basque Country UPV/EHU, 48940, Leioa, Spain.
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, 31006, Pamplona, Spain.
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Chahrour MA, Kharroubi H, Al Tannir AH, Assi S, Habib JR, Hoballah JJ. Hypoalbuminemia is Associated with Mortality in Patients Undergoing Lower Extremity Amputation. Ann Vasc Surg 2021; 77:138-145. [PMID: 34428438 DOI: 10.1016/j.avsg.2021.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/07/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Poor nutritional status is common among patients undergoing lower extremity amputation (LEA). In this study, the association between preoperative hypoalbuminemia, a marker for malnutrition, and postoperative mortality in patients undergoing LEA was explored. METHODS Data on patients undergoing LEA between 2005 and 2017 were retrospectively analyzed from the prospectively collected American College of Surgeons National Surgical Quality Improvement Program database. Patients were divided into clinically relevant categories based on their serum albumin level (<2.5, 2.5-3.39, ≥3.4 g/dl) and were further stratified according to amputation level. Operative death was compared across groups and multivariable logistic regression was performed to estimate risk-adjusted odds ratio (AOR). RESULTS In 35,383 patients, the rate of 30-day postoperative mortality was 7.6% (n = 2693). Mortality rate was highest in patients with very low albumin levels (11%) as compared to low (6.8%) and normal levels (3.9%). On multivariable analysis, lower albumin levels emerged as a risk-adjusted independent predictor of mortality. After risk-adjustment, patients with very low albumin levels (AOR [95% CI]: 2.25 [1.969-2.56], P < 0.001) and low albumin levels (AOR [95% CI]: 1.42 [1.239-1.616], P < 0.001) had higher odds of mortality when compared to patients with normal albumin levels. On sensitivity analysis, a similar trend was seen in patients undergoing above knee amputation but not in patients undergoing minor amputations. CONCLUSIONS In patients undergoing major LEA, hypoalbuminemia is associated with an increased risk of postoperative mortality in a dose response manner, specifically in above knee amputations. Monitoring and optimizing patients' nutritional status before surgery, when possible, may be warranted and should be further explored.
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Affiliation(s)
- Mohamad A Chahrour
- Division of Vascular and Endovascular Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Sahar Assi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Joseph R Habib
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Jamal J Hoballah
- Division of Vascular and Endovascular Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Andersen AL, Nielsen RL, Houlind MB, Tavenier J, Rasmussen LJH, Jørgensen LM, Treldal C, Beck AM, Pedersen MM, Andersen O, Petersen J. Risk of Malnutrition upon Admission and after Discharge in Acutely Admitted Older Medical Patients: A Prospective Observational Study. Nutrients 2021; 13:nu13082757. [PMID: 34444917 PMCID: PMC8398199 DOI: 10.3390/nu13082757] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022] Open
Abstract
There is a lack of knowledge about malnutrition and risk of malnutrition upon admission and after discharge in older medical patients. This study aimed to describe prevalence, risk factors, and screening tools for malnutrition in older medical patients. In a prospective observational study, malnutrition was evaluated in 128 older medical patients (≥65 years) using the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment-Short Form (MNA-SF) and the Eating Validation Scheme (EVS). The European Society of Clinical Nutrition (ESPEN) diagnostic criteria from 2015 were applied for diagnosis. Agreement between the screening tools was evaluated by kappa statistics. Risk factors for malnutrition included polypharmacy, dysphagia, depression, low functional capacity, eating-related problems and lowered cognitive function. Malnutrition or risk of malnutrition were prevalent at baseline (59-98%) and follow-up (30-88%). The baseline, follow-up and transitional agreements ranged from slight to moderate. NRS-2002 and MNA-SF yielded the highest agreement (kappa: 0.31 (95% Confidence Interval (CI) 0.18-0.44) to 0.57 (95%CI 0.42-0.72)). Prevalence of risk factors ranged from 17-68%. Applying ESPEN 2015 diagnostic criteria, 15% had malnutrition at baseline and 13% at follow-up. In conclusion, malnutrition, risk of malnutrition and risk factors hereof are prevalent in older medical patients. MNA-SF and NRS-2002 showed the highest agreement at baseline, follow-up, and transitionally.
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Affiliation(s)
- Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- Correspondence: ; Tel.: +45-24-61-61-08
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
| | - Line J. H. Rasmussen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Psychology & Neuroscience, Duke University, 2020 W Main St., Suite 201, Durham, NC 27707, USA
| | - Lillian Mørch Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Charlotte Treldal
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark;
- Dietetic and Nutritional Research Unit, Herlev-Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730 Herlev, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark; (R.L.N.); (M.B.H.); (J.T.); (L.J.H.R.); (L.M.J.); (C.T.); (M.M.P.); (O.A.); (J.P.)
- Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark
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Clinical nutrition as part of the treatment pathway of pancreatic cancer patients: an expert consensus. Clin Transl Oncol 2021; 24:112-126. [PMID: 34363594 PMCID: PMC8732873 DOI: 10.1007/s12094-021-02674-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/20/2021] [Indexed: 12/24/2022]
Abstract
Purpose Malnutrition is a common problem among pancreatic cancer (PC) patients that negatively impacts on their quality of life (QoL) and clinical outcomes. The main objective of this consensus is to address the role of Medical Nutrition Therapy (MNT) into the comprehensive therapeutic management of PC patients. Methods A Spanish multidisciplinary group of specialists from the areas of Medical Oncology; Radiation Oncology; Endocrinology and Nutrition; and General Surgery agreed to assess the role of MNT as part of the best therapeutic management of PC patients. Results The panel established different recommendations focused on nutritional screening and nutritional screening tools, MNT strategies according to PC status, and MNT in palliative treatment. Conclusions There is an unmet need to integrate nutritional therapy as a crucial part of the multimodal care process in PC patients. Health authorities, health care professionals, cancer patients, and their families should be aware of the relevance of nutritional status and MNT on clinical outcomes and QoL of PC patients.
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Gillis C, Hasil L, Kasvis P, Bibby N, Davies SJ, Prado CM, West MA, Shaw C. Nutrition Care Process Model Approach to Surgical Prehabilitation in Oncology. Front Nutr 2021; 8:644706. [PMID: 34249985 PMCID: PMC8264148 DOI: 10.3389/fnut.2021.644706] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/26/2021] [Indexed: 12/21/2022] Open
Abstract
The nutrition care process is a standardized and systematic method used by nutrition professionals to assess, diagnose, treat, and monitor patients. Using the nutrition care process model, we demonstrate how nutrition prehabilitation can be applied to the pre-surgical oncology patient.
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Affiliation(s)
- Chelsia Gillis
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Leslee Hasil
- Department of Nutrition Services, Alberta Health Services, Calgary, AB, Canada
| | - Popi Kasvis
- Department of Nutrition, McGill University Health Center, Montreal, QC, Canada
| | - Neil Bibby
- Manchester Royal Infirmary, Dietetics Department, Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Sarah J Davies
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Malcolm A West
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom.,Anaesthesia, Perioperative and Critical Care Research Group, National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospital Southampton National Health Service (NHS) Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Clare Shaw
- Department of Nutrition and Dietetics, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
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SeDREno study - prevalence of hospital malnutrition according to GLIM criteria, ten years after the PREDyCES study. NUTR HOSP 2021; 38:1016-1025. [PMID: 34157845 DOI: 10.20960/nh.03638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND & AIMS the last large multicenter study on disease-related malnutrition (DRM) in Spain (the PREDyCES study) showed a 23.7 % prevalence of malnutrition, according to the Nutritional Risk Screening (NRS-2002) tool. The main objective of the SeDREno study was to assess the prevalence of hospital malnutrition upon admission, according to GLIM criteria, ten years later. METHODS a cross-sectional, observational, multicenter study in standard clinical practice, conducted in 17 hospitals during a period of five to seven days. Patients were initially screened using the Malnutrition Universal Screening Tool (MUST), and then assessed using the GLIM criteria for diagnosis and severity grading. RESULTS a total of 2,185 patients, 54.8 % males, mean age 67.1 (17.0) years (50.2 % aged ≥ 70 years), were evaluated. Malnutrition was observed in 29.7 % of patients according to GLIM criteria (12.5 % severe, 17.2 % moderate). In patients ≥ 70 years malnutrition was observed in 34.8 %. The clinical conditions significantly associated with a higher prevalence of malnutrition were dysphagia (47.6 %), cognitive impairment (43.4 %), cancer (39.1 %), gastrointestinal disease (37.7 %), diabetes (34.8 %), and cardiovascular disease (33.4 %). The multivariate analysis revealed that gender, BMI, diabetes, cancer, gastrointestinal disorders, and polypharmacy were the main independent factors associated with DRM. Malnutrition was associated with an increase in length of hospital stay and death (p < 0.001). CONCLUSIONS DRM in admitted patients has increased in Spain in the last 10 years paralleling ageing of the population. In the SeDREno study almost one in three patients are malnourished. A systematic assessment of nutritional status allows early detection and implementation of nutritional interventions to achieve a better clinical outcome.
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Abulmeaty MMA, Aljuraiban GS, Shaikh SM, ALEid NE, Mazrou LRA, Turjoman AA, Aldosari MS, Razak S, El-Sayed MM, Areabi TM, Alsalafi RM, Al-Helio YS, Almutairy AB, Molla HN. The Efficacy of Antioxidant Oral Supplements on the Progression of COVID-19 in Non-Critically Ill Patients: A Randomized Controlled Trial. Antioxidants (Basel) 2021; 10:804. [PMID: 34069549 PMCID: PMC8160844 DOI: 10.3390/antiox10050804] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
Modulation of cytokine production using immunonutrition is a relatively novel concept to improve outcomes among patients with SARS-CoV-2 infection and is now hypothesized to help manage COVID-19, however, clinical evidence is lacking. This prospective, double-blinded, randomized parallel-controlled interventional clinical trial investigated the effect of antioxidant supplements on inflammatory cytokines and disease progression in non-critically ill patients. A total of 87 hospitalized COVID-19 patients were randomized using computer-generated-randomization into the supplement group (n = 18) and the placebo group (n = 16) for 10 days. Baseline and final nutritional screening via nutrition risk screening (NRS-2002) and subjective global assessment (SGA), as well as the recording of anthropometric, clinical, biochemical, and functional parameters, were done. Serum ferritin level, cytokine storm parameters such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein 1(MCP-1), C-reactive protein, total leukocyte count, lymphocytic count, and neutrophil-to-lymphocyte ratio were measured. Anthropometric and clinical parameters showed nonsignificant differences between groups. The hematology profile showed improvement in lymphocyte count in the supplement group. However, levels of alkaline phosphatase, IL-6, TNF-α, and MCP-1 were significantly lower in the supplement group. In conclusion, antioxidant oral supplementation significantly reduced the cytokine storm and led to partial improvements in clinical parameters among patients with non-critical COVID-19.
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Affiliation(s)
- Mahmoud M. A. Abulmeaty
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (G.S.A.); (S.R.)
| | - Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (G.S.A.); (S.R.)
| | - Sumaya M. Shaikh
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Naif E. ALEid
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Lulwa R. Al Mazrou
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Abdullah A. Turjoman
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Mona S. Aldosari
- Clinical Nutrition Department, King Saud University Medical City, Riyadh 11472, Saudi Arabia; (M.S.A.); (H.N.M.)
| | - Suhail Razak
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Saudi Arabia; (G.S.A.); (S.R.)
| | - Mervat M. El-Sayed
- College of Food Sciences and Agriculture, King Saud University, Riyadh 11362, Saudi Arabia;
| | - Tahani M. Areabi
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Rokia M. Alsalafi
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Yasser S. Al-Helio
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Abdulrhman B. Almutairy
- Prince Mohamed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia; (S.M.S.); (N.E.A.); (L.R.A.M.); (A.A.T.); (T.M.A.); (R.M.A.); (Y.S.A.-H.); (A.B.A.)
| | - Haneen N. Molla
- Clinical Nutrition Department, King Saud University Medical City, Riyadh 11472, Saudi Arabia; (M.S.A.); (H.N.M.)
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Nigatu YD, Gebreyesus SH, Allard JP, Endris BS. The effect of malnutrition at admission on length of hospital stay among adult patients in developing country: A prospective cohort study. Clin Nutr ESPEN 2021; 41:217-224. [PMID: 33487267 DOI: 10.1016/j.clnesp.2020.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/10/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Malnutrition in hospitalized adults is a highly prevalent problem. During hospital admission, nutritional care and nutritional screenings are often overlooked components of the health care facilities in developing countries. Identifying patients who are at risk of malnutrition at admission are vital to ameliorate clinical outcomes. Therefore, the present study was aimed at assessing the magnitude of hospital malnutrition at the time of admission and evaluates its effect on the length of hospital stay among adult patients. METHOD We conducted a prospective cohort study in patients ≥18 years admitted in Tikur Anbessa Specialized hospital in Ethiopia. At admission, patient's nutritional status was assessed within 48 h using the Subjective Global Assessment (SGA). The main clinical outcome, length of stay in hospital (LOS) was captured for patients in days. We ran a multivariate Cox's regression analysis to determine the relationship between malnutrition at admission and its effect on LOS. RESULT Four hundred seventeen patients were enrolled. Based on Subjective Global Assessment (SGA), 62.1% were malnourished. The mean (SD) length of hospital stay for all patients admitted was 13.84 days ± 7.53, with a significant difference (p < 0.01) in length of stay between malnourished patients and well-nourished patients. Malnourished patients had significantly longer hospital stays (17.2 ± 6.8 days) than well-nourished patients (8.3 ± 4.9 days) during 30 days observations. The multivariate Cox's regression model controlled for age, sex, living conditions, number of medications, and number of diagnostic categories, disease severity score, number of comorbidities and presence of cancer found that malnutrition at admission was independently associated with prolonged LOS (adjusted hazard ratio (AHR), 0.29; 95% CI, 0.22,0.38). CONCLUSION Malnutrition at admission was highly prevalent and was highly associated with prolonged length of hospital stay. Therefore, it is essential to assess the nutritional status of patients early in admission and to institute appropriate nutritional therapy.
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Affiliation(s)
- Yakob Desalegn Nigatu
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Ethiopia.
| | - Seifu Hagos Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Ethiopia
| | - Johane P Allard
- Department of Medicine, University Health Network, University of Toronto, Ethiopia
| | - Bilal Shikur Endris
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Ethiopia
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GÜZEL S, KESER A, KEPENEKCİ BAYRAM İ. Risk of malnutrition in general surgical patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.823458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Comparison of Nutrition Risk Screening 2002 and Subjective Global Assessment Form as Short Nutrition Assessment Tools in Older Hospitalized Adults. Nutrients 2021; 13:nu13010225. [PMID: 33466724 PMCID: PMC7828813 DOI: 10.3390/nu13010225] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to compare two widely recommended short nutrition assessment tools—Nutrition Risk Screening 2002 (NRS-2002) and Subjective Global Assessment Form (SGA)—with other Comprehensive Geriatric Assessment (CGA) measurements. The study included 622 consecutively hospitalized older subjects, aged 81.7 ± 7.8 years. The criteria to participate were the ability to communicate and given consent. Both NRS-2002 and SGA were inversely related to anthropometric measurements, functional assessment tests, Mini-Mental State Examination (MMSE) and positively associated with the Vulnerable Elders Survey-13 (VES-13) score. Results of SGA and NRS-2002 were not related to sex and 15-item Geriatric Depression Scale (GDS) score. Comparison of well-nourished subjects and patients with suggested problems with nutrition according to NRS-2002 (0–2 vs. 3–7) and SGA (A vs. B + C) gave comparable results. Both nutritional scales at given cut-off points similarly discriminated anthropometric data and other CGA tools in the populations of well-nourished vs. malnourished hospitalized older subjects. In conclusion, we can recommend using both NRS-2002 and SGA to detect malnutrition or risk of malnutrition in a routine clinical practice of the geriatric department ward.
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Guigoz Y, Vellas B. Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next? J Nutr Health Aging 2021; 25:528-583. [PMID: 33786572 DOI: 10.1007/s12603-021-1601-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.
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Affiliation(s)
- Y Guigoz
- Yves Guigoz, Chemin du Raidillon, CH-1066 Epalinges, Switzerland.
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Pavičić Žeželj S, Malec D, Janko-Labinac D, Šoić Vranić T, Mičetić Balog G, Schnurrer-Luke-Vrbanić T, Čaljkušić Mance T, Kovačević D, Cvijanović Peloza O. NUTRITIONAL RISK SCREENING IN GASTROENTEROLOGICAL PATIENTS AT THE RIJEKA UNIVERSITY HOSPITAL CENTRE. Acta Clin Croat 2020; 59:632-640. [PMID: 34285434 PMCID: PMC8253059 DOI: 10.20471/acc.2020.59.04.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/27/2019] [Indexed: 11/25/2022] Open
Abstract
Malnutrition is usually related to some diseases such as inflammatory bowel disease, chronic pancreatitis, chronic liver disease and malignant tumors. It is characterized by weight loss, protein deficiency, and deficit of specific nutrients. The aim was to estimate the prevalence of nutritional risk among 160 gastrointestinal patients by use of the Nutritional Risk Screening (NRS-2002) score at hospital admission and discharge. The patients stayed in the hospital between 5 and 15 days or longer. Results showed that 40% of patients at admission and 36.2% at discharge were malnourished. There were 53.1% of patients with recognized malnutrition at admission that received nutritional support, whereas at discharge 34.4% of patients at risk were not dietary supported. Malnourished patients were significantly older, had lower body mass index, longer hospital stay and higher rate of malignant diseases than properly nourished patients. Regular screening for malnutrition should be conveyed in hospitals as to provide appropriate dietary support for all patients at risk.
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Affiliation(s)
| | - Danijela Malec
- 1Department of Health Ecology, University of Rijeka, School of Medicine, Rijeka, Croatia; 2Department of Internal Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 3Department of Neurology, Pula General Hospital, Pula, Croatia; 4Department of Anatomy, University of Rijeka, School of Medicine, Rijeka, Croatia; 5Health Centre of Primorje-Gorski Kotar County, Rijeka, Croatia; 6Department of Physical and Rehabilitation Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 7Department of Ophthalmology, Rijeka University Hospital Centre, Rijeka, Croatia
| | - Dolores Janko-Labinac
- 1Department of Health Ecology, University of Rijeka, School of Medicine, Rijeka, Croatia; 2Department of Internal Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 3Department of Neurology, Pula General Hospital, Pula, Croatia; 4Department of Anatomy, University of Rijeka, School of Medicine, Rijeka, Croatia; 5Health Centre of Primorje-Gorski Kotar County, Rijeka, Croatia; 6Department of Physical and Rehabilitation Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 7Department of Ophthalmology, Rijeka University Hospital Centre, Rijeka, Croatia
| | - Tamara Šoić Vranić
- 1Department of Health Ecology, University of Rijeka, School of Medicine, Rijeka, Croatia; 2Department of Internal Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 3Department of Neurology, Pula General Hospital, Pula, Croatia; 4Department of Anatomy, University of Rijeka, School of Medicine, Rijeka, Croatia; 5Health Centre of Primorje-Gorski Kotar County, Rijeka, Croatia; 6Department of Physical and Rehabilitation Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 7Department of Ophthalmology, Rijeka University Hospital Centre, Rijeka, Croatia
| | - Gordana Mičetić Balog
- 1Department of Health Ecology, University of Rijeka, School of Medicine, Rijeka, Croatia; 2Department of Internal Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 3Department of Neurology, Pula General Hospital, Pula, Croatia; 4Department of Anatomy, University of Rijeka, School of Medicine, Rijeka, Croatia; 5Health Centre of Primorje-Gorski Kotar County, Rijeka, Croatia; 6Department of Physical and Rehabilitation Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 7Department of Ophthalmology, Rijeka University Hospital Centre, Rijeka, Croatia
| | - Tea Schnurrer-Luke-Vrbanić
- 1Department of Health Ecology, University of Rijeka, School of Medicine, Rijeka, Croatia; 2Department of Internal Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 3Department of Neurology, Pula General Hospital, Pula, Croatia; 4Department of Anatomy, University of Rijeka, School of Medicine, Rijeka, Croatia; 5Health Centre of Primorje-Gorski Kotar County, Rijeka, Croatia; 6Department of Physical and Rehabilitation Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 7Department of Ophthalmology, Rijeka University Hospital Centre, Rijeka, Croatia
| | - Tea Čaljkušić Mance
- 1Department of Health Ecology, University of Rijeka, School of Medicine, Rijeka, Croatia; 2Department of Internal Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 3Department of Neurology, Pula General Hospital, Pula, Croatia; 4Department of Anatomy, University of Rijeka, School of Medicine, Rijeka, Croatia; 5Health Centre of Primorje-Gorski Kotar County, Rijeka, Croatia; 6Department of Physical and Rehabilitation Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 7Department of Ophthalmology, Rijeka University Hospital Centre, Rijeka, Croatia
| | - Damir Kovačević
- 1Department of Health Ecology, University of Rijeka, School of Medicine, Rijeka, Croatia; 2Department of Internal Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 3Department of Neurology, Pula General Hospital, Pula, Croatia; 4Department of Anatomy, University of Rijeka, School of Medicine, Rijeka, Croatia; 5Health Centre of Primorje-Gorski Kotar County, Rijeka, Croatia; 6Department of Physical and Rehabilitation Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 7Department of Ophthalmology, Rijeka University Hospital Centre, Rijeka, Croatia
| | - Olga Cvijanović Peloza
- 1Department of Health Ecology, University of Rijeka, School of Medicine, Rijeka, Croatia; 2Department of Internal Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 3Department of Neurology, Pula General Hospital, Pula, Croatia; 4Department of Anatomy, University of Rijeka, School of Medicine, Rijeka, Croatia; 5Health Centre of Primorje-Gorski Kotar County, Rijeka, Croatia; 6Department of Physical and Rehabilitation Medicine, Rijeka University Hospital Centre, Rijeka, Croatia; 7Department of Ophthalmology, Rijeka University Hospital Centre, Rijeka, Croatia
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Ishida Y, Maeda K, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, Kato R, Ueshima J, Mori N. Determining the optimal value of the Geriatric Nutritional Risk Index to screen older patients with malnutrition risk: A study at a university hospital in Japan. Geriatr Gerontol Int 2020; 20:811-816. [PMID: 33058420 DOI: 10.1111/ggi.13976] [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: 03/17/2020] [Revised: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Abstract
AIM The Geriatric Nutritional Risk Index (GNRI) can predict nutritional risk. However, just a few studies have validated the optimal cut-off value of GNRI for nutrition screening in older patients. Hence, this study aimed to determine the optimal value of GNRI to screen the risk of malnutrition among older patients. METHODS This retrospective cross-sectional study was carried out with 5867 consecutive older adult patients who were admitted to an academic hospital in Japan. Receiver operating characteristic curve analyses were carried out to obtain the optimal cut-off value of GNRI, and the results were compared against the Mini Nutritional Assessment - Short Form and Malnutrition Universal Screening Tool. The validation of the obtained cut-off value was examined on the concordance rate of malnutrition diagnosis based on the European Society of Clinical Nutrition and Metabolism criteria. RESULTS The mean age of the patients was 76.0 ± 7.0 years. The optimal cut-off value of GNRI for Mini Nutritional Assessment - Short Form ≤11 points was 95.92 (area under the curve 0.827 [0.817-0.838], P < 0.001), and that for Malnutrition Universal Screening Tool ≥1 point was 95.95 (area under the curve 0.788 [0.776-0.799], P < 0.001). By adapting GNRI <96 points as an initial screening cut-off in the European Society of Clinical Nutrition and Metabolism-defined malnutrition process, the concordance rates of comparisons were 98.5% and 98.5% for Mini Nutritional Assessment - Short Form-based and MUST-based diagnosis, respectively. CONCLUSIONS The study showed GNRI <96 points as the optimal cut-off value for nutritional screening. GNRI might be one of the easy-to-use tools for nutritional screening and for diagnosing malnutrition in older adults. Geriatr Gerontol Int 2020; 20: 811-816.
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Affiliation(s)
- Yuria Ishida
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Tomoyuki Nonogaki
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Yosuke Yamanaka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Remi Matsuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Ryoko Kato
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Tokyo, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
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Vidal-Casariego A, Amigo-Otero E, Pita-Gutiérrez F, Lugo-Rodríguez G, Almeida-Seoane C, Martínez-Ramonde T. Comparison of MUST and Nutriscore for the Screening of Malnutrition in Hospitalized Oncology Patients. Nutr Cancer 2020; 73:1941-1946. [PMID: 32896165 DOI: 10.1080/01635581.2020.1817952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Nutriscore is a malnutrition screening tool designed specifically for cancer patients. Our objective was to assess its performance in hospitalized cancer patients. PATIENTS AND METHODS Adult patients diagnosed with any solid neoplasm hospitalized in Medical Oncology were included. In the first 24-48 h, of admission they were screened with Nutriscore and Malnutrition universal screening tool (MUST). Both tests were compared using chi-square, kappa index and ROC curve. Nutriscore sensitivity (S), specificity (Sp) and predictive values (PV) were calculated using MUST as a reference. RESULTS A total of 93 patients were included. The most frequent tumors were lung (36.6%), colorectal (24.8%) and breast (8.6%). MUST identified 69.9% of the patients at nutritional risk, and Nutriscore 44.1% (p < 0.001), with a low kappa index [k = 0.38 (95% CI 0.23 to 0.54)]. The AUC of the ROC curve for Nutriscore with respect to the MUST was 0.739. Nutriscore showed S = 58.6 (95% CI 45.7 to 71.2), Sp = 89.3% (95% CI 76.0 to 100.0%), VP + = 92.7% (95% CI 83.5 at 100.0%) and VP- = 48.1% (95% CI 33.5 to 62.6). CONCLUSIONS Nutriscore did not provided better screening results in hospitalized cancer patients than a validated tool such as MUST.
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Affiliation(s)
| | - Emilio Amigo-Otero
- Department of Endocrinology and Nutrition, University Hospital of A Coruña, A Coruña, Spain
| | | | - Gloria Lugo-Rodríguez
- Department of Endocrinology and Nutrition, University Hospital of A Coruña, A Coruña, Spain
| | - Carmen Almeida-Seoane
- Department of Endocrinology and Nutrition, University Hospital of A Coruña, A Coruña, Spain
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Yang L, Guo Z, Qi S, Fang T, Zhu H, Santos HO, Khani V, Wong CH, Qiu Z. Walnut intake may increase circulating adiponectin and leptin levels but does not improve glycemic biomarkers: A systematic review and meta-analysis of randomized clinical trials. Complement Ther Med 2020; 52:102505. [PMID: 32951753 DOI: 10.1016/j.ctim.2020.102505] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND & OBJECTIVE Walnut intake is considered a healthy dietary approach worldwide, particularly as a nutritional tool for the management of obesity and cardiometabolic disorders. Among these lines, leptin and adiponectin, as well as glycemic biomarkers, deserve further attention. We aimed to examine the impact of walnut intake on circulation levels of leptin and adiponectin through a systematic review and meta-analysis of randomized clinical trials (RCTs); secondarily, assessing the glycemic profile as well. METHODS The literature search was implemented in four following databases: Web of Science, Scopus, PubMed/Medline, and Google Scholar, thus, determining studies that measured the effects of walnut consumption on adiponectin, leptin, and glycemic biomarkers levels from 2004 up to December 2019. RESULTS Fourteen trials were include in the meta-analysis, with an intervention period ranging from 5 weeks to 12 months.Walnut intake increased leptin (weighted mean difference (WMD): 2.502 ng/mL; 95 % CI: 2.147-2.856, p < 0.001) and adiponectin (WMD: 0.440 ng/mL; 95 % CI: 0.323 to 0.557, p < 0.001) levels. Pertaining to glycemic biomarkers, neither overall analyses nor sub-analyses corroborated with changes in fasting blood glucose (WMD: 0.500 mg/dL, 95 % CI: -0.596, 1.596, p = 0.371), insulin (WMD: -0.21 mg/dL, 95 % CI: -0.67, 0.24, p = 0.367), and glycated hemoglobin (WMD: 0.004 mg/dL, 95 % CI: -0.041, 0.049, p = 0.870) concentrations. CONCLUSION Walnut intake may increase leptin and adiponectin levels but does not improve glycemic biomarkers.
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Affiliation(s)
- Ling Yang
- Departmentof Endocrinology, Shangrao People's Hospital, No.86 Shuyuan Road, Shangrao, Jiangxi, 334000, China
| | - Zhiyang Guo
- Internal Medicine, Ji'an Detachment Health Team, Chinese Pepople's Armed Police Force, Ji'an, 343000, China
| | - Shuwen Qi
- Internal Medicine, Mobile Detachment Medical Team of Jiangxi Provincial General Corps, Chinese Pepople's Armed Police Force, Anyi, 330500, China
| | - Tao Fang
- Department of Emergency, Guangfeng People's Hospital, Yongfeng South Street, Shangrao, Jiangxi, 334600, China
| | - Hongyan Zhu
- Departmentof Endocrinology, Shangrao People's Hospital, No.86 Shuyuan Road, Shangrao, Jiangxi, 334000, China
| | - Heitor O Santos
- School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil
| | - Vahid Khani
- Department of Radiology, Taleghani Hospital, Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Chun Hoong Wong
- Department of Pharmacy, Serdang Hospital, Selangor, Malaysia
| | - Zhiyun Qiu
- Department of Emergency, Minhang Hospital, Fudan University, No. 170 Xinsong Road, Minhang District, Shanghai, 201199, China.
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Chohan K, Park J, Dales S, Varughese R, Wickerson L, Singer LG, Stewart B, Rozenberg D. Evaluation of Malnutrition Risk in Lung Transplant Candidates Using the Nutritional Risk Index. Transplant Direct 2020; 6:e574. [PMID: 32766429 PMCID: PMC7339342 DOI: 10.1097/txd.0000000000001028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Malnutrition in lung transplant (LTx) candidates is an important risk factor for adverse outcomes. We sought to evaluate the Nutritional Risk Index (NRI) in LTx candidates, a validated measure of malnutrition risk in chronic disease. We aimed to characterize malnutrition risk using NRI, evaluate change in body weight between nutritional risk groups, and assess association of malnutrition risk with pretransplant and posttransplant outcomes. METHODS Retrospective, single-center cohort study of LTx candidates (2014-2015) evaluated by a dietitian before listing. Nutritional parameters, weight change pretransplant and posttransplant, and clinical outcomes were abstracted up to 1-year posttransplant. NRI was calculated as follows: (1.519 × albumin) + (41.7 × current weight/ideal weight) with high malnutrition risk defined as the lowest quartile of NRI for cystic fibrosis (CF) and non-CF patients. RESULTS The cohort comprises 247 LTx candidates (57% male; median age 59 y; non-CF 88%). Non-CF candidates had a greater mean NRI compared with CF patients (109 ± 11 versus 95 ± 12; P < 0.0001). 86% with high malnutrition risk maintained/gained weight (≥5%) pretransplant. In 196 LTx recipients, malnutrition risk was not associated with hospital stay, discharge disposition, or 1-year mortality. The median percent weight gain for LTx recipients in the first year was 10.5% (4.0-20.1), with high malnutrition risk recipients having comparable or greater weight gain to the low-risk group (mean difference for non CF: 6.8%; P = 0.02 and CF: -3.8%; P = 0.65). CONCLUSIONS Malnutrition risk assessed with NRI was not prognostic of posttransplant outcomes in this retrospective cohort. LTx candidates with high malnutrition risk were able to maintain their weight pretransplant and demonstrated considerable weight gain in the first-year posttransplant.
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Affiliation(s)
- Karan Chohan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jeff Park
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Dales
- Soham and Shaila Ajmera Family Transplant Centre, Nutrition, University Health Network, Toronto, ON, Canada
| | - Rhea Varughese
- Division of Pulmonary Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lisa Wickerson
- Toronto Lung Transplant Program, Soham and Shaila Ajmera Family Transplant Centre, University Health Network, Toronto, ON, Canada
| | - Lianne G. Singer
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Soham and Shaila Ajmera Family Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Respirology, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
| | - Brooke Stewart
- Soham and Shaila Ajmera Family Transplant Centre, Nutrition, University Health Network, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Lung Transplant Program, Soham and Shaila Ajmera Family Transplant Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Respirology, Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
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Ramsey KA, Meskers CGM, Trappenburg MC, Verlaan S, Reijnierse EM, Whittaker AC, Maier AB. Malnutrition is associated with dynamic physical performance. Aging Clin Exp Res 2020; 32:1085-1092. [PMID: 31429000 PMCID: PMC7260152 DOI: 10.1007/s40520-019-01295-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/25/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and poor physical performance are both conditions that increase in prevalence with age; however, their interrelation in a clinically relevant population has not been thoroughly studied. AIMS This study aimed to determine the strength of the association between malnutrition and measures of both static and dynamic physical performance in a cohort of geriatric outpatients. METHODS This cross-sectional study included 286 older adults (mean age 81.8, SD 7.2 years, and 40.6% male) who were referred to geriatric outpatient mobility clinics. The presence of malnutrition was determined using the Short Nutritional Assessment Questionnaire (SNAQ, cut-off ≥ 2 points). Measures of dynamic physical performance included timed up and go (TUG), 4-m walk test, and chair stand test (CST). Static performance encompassed balance tests and hand grip strength (HGS). Physical performance was standardized into sex-specific Z-scores. The association between malnutrition and each individual measure of physical performance was assessed using linear regression analysis. RESULTS 19.9% of the cohort was identified as malnourished. Malnutrition was most strongly associated with CST and gait speed; less strong but significant associations were found between malnutrition and TUG. There was no significant association between malnutrition and HGS or balance. DISCUSSION Physical performance was associated with malnutrition, specifically, dynamic rather than static measures. This may reflect muscle power being more impacted by nutritional status than muscle strength; however, this needs to be further addressed. CONCLUSIONS Malnutrition is associated with dynamic physical performance in geriatric outpatients, which should inform diagnosis and treatment/prevention strategies.
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Affiliation(s)
- Keenan A Ramsey
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carel G M Meskers
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marijke C Trappenburg
- Department of Internal Medicine, Section of Gerontology and Geriatrics, VU University Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Internal Medicine, Amstelland Hospital, Amstelveen, The Netherlands
| | - Sjors Verlaan
- Department of Internal Medicine, Amstelland Hospital, Amstelveen, The Netherlands
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne Health, City Campus, Level 6 North, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Anna C Whittaker
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne Health, City Campus, Level 6 North, 300 Grattan Street, Parkville, VIC, 3050, Australia.
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Skipper A, Coltman A, Tomesko J, Charney P, Porcari J, Piemonte TA, Handu D, Cheng FW. Adult Malnutrition (Undernutrition) Screening: An Evidence Analysis Center Systematic Review. J Acad Nutr Diet 2020; 120:669-708. [DOI: 10.1016/j.jand.2019.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 01/09/2023]
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Chávez-Tostado M, Cervantes-Guevara G, López-Alvarado SE, Cervantes-Pérez G, Barbosa-Camacho FJ, Fuentes-Orozco C, Hernández-Corona DM, González-Heredia T, Cervantes-Cardona GA, González-Ojeda A. Comparison of nutritional screening tools to assess nutritional risk and predict clinical outcomes in Mexican patients with digestive diseases. BMC Gastroenterol 2020; 20:79. [PMID: 32216787 PMCID: PMC7098076 DOI: 10.1186/s12876-020-01214-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/04/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The prevalence of malnutrition remains high in hospitals but no "gold standard" has been established to identify nutritional risks adequately. The Nutrition Risk Screening-2002 (NRS-2002), Subjective Global Assessment (SGA), and Controlling Nutritional Status Index (CONUT) are widely used screening tools, but their efficacy has not yet been compared in Mexican patients. Here, we aimed to compare the efficacy of these tools in identifying nutritional risks within the first 48 h of admission in a group of patients with gastrointestinal diseases. METHODS This was a cross-sectional study of 196 patients. The results of the screening tools, length of hospital stay, serum albumin and cholesterol concentrations, lymphocyte counts, age, body mass index (BMI), complications, and mortality were analyzed. Kappa (κ) statistics were applied to determine the degree of agreement between tools. The performances of the screening tools in predicting complications and mortality were assessed using binary logistic regression. RESULTS The NRS-2002, SGA, and CONUT tools identified nutritional risk in 67, 74, and 51% of the patients, respectively. The observed agreements between tools were: NRS2002/SGA, κ = 0.53; CONUT/NRS-2002, κ = 0.42; and SGA/CONUT, κ = 0.36. Within age groups, the best agreement was found in those aged 51-65 years (κ = 0.68). CONUT and length of stay were both predictive for the number of complications. The number of complications and serum cholesterol concentrations were predictive for mortality. CONCLUSIONS The proportion of patients identified as having nutritional risk was high using all three screening tools. SGA, NRS-2002, and CONUT had similar capacities for screening risk, but the best agreement was observed between NRS-2002 and SGA. Only CONUT predicted complications, but none of these tools performed well in predicting mortality.
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Affiliation(s)
- Mariana Chávez-Tostado
- Departamento de Clínicas de la Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 44340, Guadalajara, Jalisco, Mexico
| | - Gabino Cervantes-Guevara
- Department of Welfare and Sustainable Development, University Center of the North, University of Guadalajara, 46200, Colotlan, Jalisco, Mexico
| | - Sandra Estefanía López-Alvarado
- Department of Biomedical Sciences, Health Sciences Division, Tonala University Campus, University of Guadalajara, 45425, Guadalajara, Jalisco, Mexico
| | - Gabino Cervantes-Pérez
- Department of Welfare and Sustainable Development, University Center of the North, University of Guadalajara, 46200, Colotlan, Jalisco, Mexico
| | - Francisco José Barbosa-Camacho
- Biomedical Research Unit 02, Western National Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez # 1000, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Western National Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez # 1000, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico
| | - Diana Mercedes Hernández-Corona
- Department of Biomedical Sciences, Health Sciences Division, Tonala University Campus, University of Guadalajara, 45425, Guadalajara, Jalisco, Mexico
| | - Tonatiuh González-Heredia
- Department of Biomedical Sciences, Health Sciences Division, Tonala University Campus, University of Guadalajara, 45425, Guadalajara, Jalisco, Mexico
| | - Guillermo Alonso Cervantes-Cardona
- Department of Philosophical, Methodological and Instrumental Disciplines, Health Sciences University Center, University of Guadalajara, 44340, Guadalajara, Jalisco, Mexico
| | - Alejandro González-Ojeda
- Biomedical Research Unit 02, Western National Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez # 1000, Col. Independencia, 44340, Guadalajara, Jalisco, Mexico.
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Association between separate items of the Mini Nutritional Assessment instrument and mortality among older adults: A prospective cohort study introducing a trimmed MNA version. Clin Nutr 2019; 39:2255-2264. [PMID: 31703950 DOI: 10.1016/j.clnu.2019.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 08/26/2019] [Accepted: 10/07/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND & AIMS The predictive ability of the separate items of the full Mini Nutritional Assessment (MNA-F) instrument in relation to all-cause mortality (ACM) in older adults is unclear. The present study aimed to examine the magnitudes of the independent associations between separate MNA-F items and ACM among people aged ≥65 years old admitted to hospital. A secondary aim was to construct a trimmed MNA instrument (MNA-T) consisting of MNA-F items that contributed independently to predicting ACM, and compare its predictive ability with that of MNA-F and MNA short forms (MNA-SF). METHODS This prospective cohort study included 1768 individuals aged ≥65 years old admitted to a Swedish hospital who answered MNA-F in 2008. They were followed-up for ACM after two years using national registers. Associations with ACM were calculated using Cox regression analysis. Predictive abilities for ACM were calculated using an R2-type measure. RESULTS After a mean follow-up time of 1.7 years (3006 person-years), 455 (25.7%) participants had died. In adjusted analyses, nine MNA-F items contributed independently to predicting ACM (P < 0.20) and were included in MNA-T. Five items (food intake, independent living, > 3 prescription drugs, fluid intake, self-assessed health status) had significant contributions (P < 0.05). MNA-T had a better predictive ability for ACM than MNA-F and MNA-SF. CONCLUSIONS MNA-F could possibly benefit from excluding less important and more time-consuming items when used for predicting the ultimate consequence of malnutrition, an early death. MNA-T should be a more reliable instrument to use for this purpose.
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García-Peris P, Velasco Gimeno C, Frías Soriano L, Higuera Pulgar I, Bretón Lesmes I, Camblor Álvarez M, Motilla de la Cámara M, Cuerda Compés C. Protocolo de implantación de un cribado para la detección precoz del riesgo nutricional en un hospital universitario. ENDOCRINOL DIAB NUTR 2019; 66:555-562. [DOI: 10.1016/j.endinu.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 01/04/2023]
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Blaauw R, Achar E, Dolman RC, Harbron J, Moens M, Munyi F, Nyatefe D, Visser J. The Problem of Hospital Malnutrition in the African Continent. Nutrients 2019; 11:E2028. [PMID: 31480222 PMCID: PMC6769751 DOI: 10.3390/nu11092028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/17/2019] [Accepted: 08/23/2019] [Indexed: 01/04/2023] Open
Abstract
This study aims to determine the prevalence of risk of malnutrition on admission and discharge in African hospitals, and to identify the association with selected indicators. In this multi-center prospective cohort study, adult patients from hospitals in South Africa, Kenya, and Ghana were screened on admission and discharge and contacted 3 months post-discharge. Relevant morbidity and mortality outcomes were assessed. At risk of malnutrition was indicated if NRS-2002 score ≥3. Adult patients (n = 2126; 43.11 years, IQR: 31.95-55.60; 52.2% female) were screened on admission and 61% were identified as at risk of malnutrition. The proportion of at-risk patients for the three hospitals in Kenya and Ghana (66.2%) were significantly higher than that of the three South African hospitals (53.7%) (Chi2 = 31.0; p < 0.001). Discharge risk of malnutrition was 71.2% (n = 394). Mean length of stay (LOS) was 6.46 ± 5.63 days. During hospitalization, 20.6% lost ≥5% body weight, 18.8% were referred for nutrition support, and discharge BMI (23.87 ± 7.38 kg/m2) was significantly lower than admission BMI (24.3 ± 7.3 kg/m2) (p < 0.001). Admission nutrition risk was associated with lower admission and discharge BMI (p < 0.001), longer LOS (p < 0.001), increased 3-month re-admission rates (Chi2 = 1.35; p = 0.245) and increased mortality (Chi2 = 21.68; p < 0.001). Nearly two-thirds of patients were at risk of malnutrition on admission. This was associated with longer LOS and greater hospital mortality. The nutritional status of patients deteriorated during hospitalization. Routine screening practices with appropriate nutrition support action should be implemented as a matter of urgency.
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Affiliation(s)
- Renée Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa.
| | - Esther Achar
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
| | - Robin C Dolman
- Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, Potchefstroom 2520, South Africa
| | - Janetta Harbron
- Division of Human Nutrition, Faculty of Health Sciences, University of Cape Town, Cape Town 8000, South Africa
| | - Merel Moens
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
| | - Faith Munyi
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
| | - Dzifa Nyatefe
- Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, Potchefstroom 2520, South Africa
| | - Janicke Visser
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
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Westfall JC, Cheng TW, Farber A, Jones DW, Eslami MH, Kalish JA, Rybin D, Siracuse JJ. Hypoalbuminemia Predicts Increased Readmission and Emergency Department Visits After Lower Extremity Bypass. Vasc Endovascular Surg 2019; 53:629-635. [PMID: 31416401 DOI: 10.1177/1538574419868869] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Preoperative hypoalbuminemia is associated with poor outcomes across many surgical fields. However, the effects on outcomes after lower extremity bypass (LEB), particularly over the 90-day global surgical period, are unclear. Our goal was to analyze the effect of hypoalbuminemia within 90 days after LE bypass. METHODS We performed a single-center retrospective review of all infrainguinal LEBs from 2007 to 2017. Patients were categorized into 3 preoperative albumin groups: severe hypoalbuminemia (SH; albumin ≤2.8g/dL), mild-moderate hypoalbuminemia (MH; albumin >2.8-3.5g/dL), and normal albumin (albumin >3.5g/dL). Patient and procedural details were recorded. Outcomes analyzed included wound infection, myocardial infarction (MI), pulmonary complications, early graft occlusion (≤30 days), mortality, and emergency department (ED) presentation and readmissions within 30 and 90 days. Multivariable analysis was performed. RESULTS We identified 313 patients undergoing LEB-45 (14.4%) with SH, 133 (42.5%) with MH, and 135 (43.1%) with normal albumin. Overall, the mean age was 65.7 years, and 63.3% were male. The SH group more frequently had tissue loss, diabetes, hypertension, end-stage renal disease, preoperative hematocrit <30%, and patients admitted preoperatively (all P < .05). There were no significant differences in wound complications, MI, pulmonary complications, early graft occlusion, 30-day or 90-day mortality, and 30-day ED presentation. Severe hypoalbuminemia compared to MH and normal albumin, respectively, had significantly higher rates of 30-day readmission (40% vs 30.8% vs 17.8%, P = .005), 90-day ED presentation (55.6% vs 33.8% vs 29.6%, P = .006), and 90-day readmission (66.7% vs 48.9% vs 35.6%, P = .001). Multivariable analysis showed that SH was independently associated with 90-day ED presentation (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.23-6.36, P = .014) and 90-day readmission (OR: 2.63, 95% CI: 1.21-5.71, P = .015). CONCLUSION Our study suggests that patients with SH undergoing LEB had similar perioperative complication rates compared to normal albumin and MH groups, and SH was independently associated with 90-day ED presentation and readmission. Further studies are needed to assess other factors associated with ED visits and readmission.
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Affiliation(s)
- John C Westfall
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Thomas W Cheng
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Douglas W Jones
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Mohammad H Eslami
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey A Kalish
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Denis Rybin
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Ishida Y, Maeda K, Nonogaki T, Shimizu A, Yamanaka Y, Matsuyama R, Kato R, Mori N. Impact of edema on length of calf circumference in older adults. Geriatr Gerontol Int 2019; 19:993-998. [DOI: 10.1111/ggi.13756] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/13/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Yuria Ishida
- Department of NutritionAichi Medical University Hospital Nagakute Aichi Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive MedicineGraduate School of Medicine, Aichi Medical University Nagakute Aichi Japan
- Nutritional Therapy Support CenterAichi Medical University Hospital Nagakute Aichi Japan
| | - Tomoyuki Nonogaki
- Department of PharmacyAichi Medical University Hospital Nagakute Aichi Japan
| | - Akio Shimizu
- Department of NutritionHamamatsu City Rehabilitation Hospital Hamamatsu Shizuoka Japan
| | - Yosuke Yamanaka
- Department of Oral and Maxillofacial SurgeryGraduate School of Medicine, Aichi Medical University Nagakute Aichi Japan
| | - Remi Matsuyama
- Department of Oral and Maxillofacial SurgeryGraduate School of Medicine, Aichi Medical University Nagakute Aichi Japan
| | - Ryoko Kato
- Department of PharmacyAichi Medical University Hospital Nagakute Aichi Japan
| | - Naoharu Mori
- Department of Palliative and Supportive MedicineGraduate School of Medicine, Aichi Medical University Nagakute Aichi Japan
- Nutritional Therapy Support CenterAichi Medical University Hospital Nagakute Aichi Japan
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Kim JH, Lee H, Choi HH, Min SK, Lee HK. Nutritional risk factors are associated with postoperative complications after pancreaticoduodenectomy. Ann Surg Treat Res 2019; 96:201-207. [PMID: 30941324 PMCID: PMC6444046 DOI: 10.4174/astr.2019.96.4.201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/20/2018] [Accepted: 12/11/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose The purpose of this study was to investigate whether the indicators of nutritional risk screening tool are associated with postoperative complications following pancreaticoduodenectomy (PD). Methods We investigated whether nutritional risk is associated with postoperative complications based on the medical records of 128 patients who underwent PD from 2010. The tool was composed of 6 risk factors: albumin, total lymphocyte count, body mass index, weight loss, dietary intake loss, and nutritional symptoms. The patients were divided into 2 groups: a nutritional risk group and a nonrisk group. The rates of general complications and postoperative pancreatic fistula (POPF) were investigated according to this nutritional status. Results There were 65 patients who did not have any risk factors. However, 63 patients had one risk factor or more. In the nonrisk group, the overall complication rate and serious complication rate were 30.8% and 15.4%, respectively. If there were one or more risk factors, the overall and serious complication rates were 59.5% and 41.3%, respectively (P = 0.001 and P = 0.001, respectively). The rate of clinically relevant POPF (grade B or C) was 9.2% in the nonrisk group. However, this rate was 23.8% in the NRS risk group (P = 0.029). In multivariate analysis, the NRS risk group was a significant factor of clinically relevant POPF (odds ratio, 9.878; 95% confidence interval, 1.527–63.914; P = 0.016). Conclusion There were statistically significant associations between complications and nutritional indicators. A comprehensive analysis of nutritional parameters will help predict postoperative complications.
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Affiliation(s)
- Jong Hun Kim
- Division of HBP surgery, Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Huisong Lee
- Division of HBP surgery, Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyun Hwa Choi
- Division of HBP surgery, Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seog Ki Min
- Division of HBP surgery, Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyeon Kook Lee
- Division of HBP surgery, Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
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Rozich NS, Jones CE, Morris KT. Malnutrition, frailty, and sarcopenia in pancreatic cancer patients: assessments and interventions for the pancreatic surgeon. ACTA ACUST UNITED AC 2019; 2. [PMID: 33554109 DOI: 10.21037/apc.2019.02.01] [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] [Indexed: 12/15/2022]
Abstract
The objective of this article is to review the available literature examining the impact of malnutrition, frailty, and sarcopenia on surgical morbidity among pancreatic cancer patients. We examine definitions used to diagnose and quantify these conditions and review the differences between them with regards to preoperative assessment and postoperative outcomes. The most relevant scoring systems are summarized. Lastly, we summarize current knowledge regarding effectiveness of specific interventions aimed at malnutrition, frailty, and sarcopenia for patients undergoing pancreatic cancer surgery.
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Affiliation(s)
- Noah S Rozich
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Caitlin E Jones
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Katherine T Morris
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Evaluation of Nutrition Risk Screening Score 2002 (NRS) assessment in hospitalized chronic kidney disease patient. PLoS One 2019; 14:e0211200. [PMID: 30677081 PMCID: PMC6345448 DOI: 10.1371/journal.pone.0211200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/08/2019] [Indexed: 12/21/2022] Open
Abstract
Background Although chronic kidney disease (CKD) patients are particularly prone to malnutrition, systematic nutritional screening is rarely routinely performed during hospitalization. The primary aim of this study was to determine the prevalence of malnutrition (as captured by the nutritional screening score NRS) in hospitalized CKD patients and explore the impact of malnutrition on hospital mortality. Methods All patients admitted to the tertiary nephrology department of the University hospital of Bern Inselspital over a period of 12 months were included in this observational study. The risk for malnutrition was assessed within 24h of admission by the NRS. Demographic, clinical, and outcome data were extracted from the patient database. The primary outcome was in-hospital mortality. The secondary outcomes were length of hospitalization and hospitalization costs. Multilevel mixed-effect logistic regression model analysis was performed to determine the association of in-hospital mortality and risk of malnutrition (NRS score≥3). Results We included 696 eligible hospitalizations of 489 CKD patients. Hospitalized patients had a median age of 64 years (interquartile range (IQR), 52–72), 35.6% were at risk of malnutrition (NRS≥3). After adjustment for the identified confounders (Case weight, Barthel index, and CKD stage) multivariate analysis confirmed an independent and significant association between higher in-hospital mortality with NRS≥3 [OR 2.92 (95% CI: 1.33–6.39), P<0.001]. Furthermore, in multivariate analysis the risk of malnutrition was associated with longer length of hospitalization [Geometric mean ratio: 1.8 (95% CI: 1.5–2.0), p<0.001] and with increased hospitalization costs [Geometric mean ratio: 1.7 (95% CI: 1.5–1.9), p<0.001]). Conclusions Malnutrition in CKD patients, as captured by NRS>3, is highly prevalent among hospitalized CKD patient and associated with prolonged hospital stay and increased in-hospital mortality.
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