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Zheng HL, Lin J, Shen LL, Yang HB, Xu BB, Xue Z, Wu D, Huang JB, Lin GS, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lu J, Huang CM. The GLIM criteria as an effective tool for survival prediction in gastric cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:964-973. [PMID: 36958948 DOI: 10.1016/j.ejso.2023.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/26/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition released a new version of the malnutrition criteria (GLIM criteria). To investigate the influence of the GLIM criteria on the long-term efficacy of radical gastric cancer surgery and establish a nomogram to predict the long-term prognosis of patients with gastric cancer. METHODS A retrospective analysis of 1121 patients with gastric cancer in our department from 2010 to 2013 was performed. A nomogram was established to predict overall survival (OS) based on the GLIM criteria. Patients were divided into the low-risk group (LRG) and high-risk group (HRG) based on the established nomogram. RESULTS Multivariate Cox regression analyses showed that GLIM criteria was an independent risk factor for the 5-year OS (HR = 1.768, Cl:1.341-2.329, p < 0.001). The C index, AUC and Time-ROC of the nomogram were significantly better than that of GLIM criteria and traditional criteria. The 5-year OS of patients receiving adjuvant chemotherapy in the high-risk group was significantly higher than that of patients without chemotherapy (45.77% vs. 24.73%,p < 0.001). CONCLUSIONS The GLIM criteria independently influence the long-term outcome of patients after radical gastric cancer surgery. The established nomogram can predict the long-term survival of patients with gastric cancer, and postoperative adjuvant chemotherapy for HRG can significantly improve the 5-year OS of patients.
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Affiliation(s)
- Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Li-Li Shen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hai-Bo Yang
- Department of General Surgery, People's Hospital of Guyuan City, Ningxia, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jiao-Bao Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Guo-Sheng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
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Wong HJ, Harith S, Lua PL, Ibrahim KA. Comparison of concurrent validity of different malnutrition screening tools with the Global Leadership Initiative on Malnutrition (GLIM) among stroke survivors in Malaysia. Sci Rep 2023; 13:5189. [PMID: 36997594 PMCID: PMC10063687 DOI: 10.1038/s41598-023-31006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/06/2023] [Indexed: 04/01/2023] Open
Abstract
Individuals with stroke are at high malnutrition risk in both the acute and chronic phases. This study aimed to assess the validity of different malnutrition screening tools for stroke patients in rehabilitation phase. Participants in this study were 304 stroke patients from three hospitals in the East-Coast region of Peninsular Malaysia from May-August 2019. The concurrent validity of the Malnutrition Risk Screening Tool-Hospital (MRST-H), Mini Nutritional Assessment-Short Form (MNA-SF), Malnutrition Screening Tool (MST), Malnutrition Universal Screening (MUST) and Nutritional Risk Screening (NRS-2002) was assessed with the diagnostic criteria for malnutrition proposed by the Global Leadership Initiative on Malnutrition (GLIM-DCM). Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the curve were computed. MUST and MRST-H demonstrated good validity regardless of different age groups (> 80% sensitivity and specificity); meanwhile, MST and MNA-SF had fair validity, yet NRS-2002 had poor to fair validity with GLIM-DCM. Only MRST-H and NRS-2002 were significantly correlated with all anthropometric indices, dietary energy intake, and health-related quality of life in both age groups. In conclusion, MRST-H and MUST showed good concurrent validity with GLIM-DCM and can be considered as appropriate malnutrition screening tool in discriminating malnutrition among stroke individuals attending rehabilitation centre in Malaysia regardless of their age groups.
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Affiliation(s)
- Hui Jie Wong
- Faculty of Health Sciences, School of Nutrition and Dietetics, Universiti Sultan Zainal Abidin, Gong Badak Campus, 21300, Kuala Nerus, Terengganu, Malaysia
- Dietetic Unit, Karak Health Clinic, Ministry of Health Malaysia, Jalan Besar Karak, 28600, Bentong, Pahang, Malaysia
| | - Sakinah Harith
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, 21300, Kuala Nerus, Terengganu, Malaysia.
| | - Pei Lin Lua
- Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut Campus, 22200, Besut, Terengganu, Malaysia
| | - Khairul Azmi Ibrahim
- Neurology Unit, Department of Medicine, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Jalan Sultan Mahmud, 20400, Kuala Nerus, Terengganu, Malaysia
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Factors associated with survival in older patients with stage I-III colorectal carcinoma who were not managed curatively in the Netherlands. J Geriatr Oncol 2022; 13:667-672. [PMID: 35304069 DOI: 10.1016/j.jgo.2022.02.010] [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: 04/21/2021] [Revised: 01/26/2022] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
Abstract
AIM Some patients with stage I-III colorectal cancer (CRC) do not undergo tumor resection. Little is known about survival of these non-curatively managed patients. The aim of this study is to report all-cause mortality and to identify which factors are associated with survival in these patients. METHODS A retrospective review of electronic medical records was performed in two hospitals in the Netherlands. Patients diagnosed with CRC without distant metastases (radiologically determined stage I-III) and managed without tumor resection between 2011 and 2017 were included. The primary outcome was all-cause mortality. The effect of several variables on survival was evaluated with a multivariate logistic regression. RESULTS Of the 107 patients with stage I-III CRC that did not undergo resection of the primary tumor, 80% died within two years; median survival time was 8.5 months (IQR 2.5-22 months). Malnutrition risk (OR 6.36 (CI 1.21-33.25); p = 0.03) and comorbidity burden (OR 1.51 (CI 1.05-2.18 p = 0.03) were significantly associated with decreased survival after two years in a multivariate model. Age and disease stage were not. When treatment decision was mainly patient driven instead of based on the multi-disciplinary tumor board's decision, survival was longer (mean overall survival 16 months vs 10 months, respectively) p < 0.05. CONCLUSION Survival of patients with radiologically determined stage I-III CRC who did not undergo surgical resection was approximately 20% at two years and associated with the number of comorbidities, malnutrition risk status and dependent living, but not with age or disease stage.
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Yıldız E, Arslan Ş, Çölkesen F, Sadi Aykan F, Evcen R, Kılınç M, Aytekin G. Evaluation of malnutrition risk and nutrition status in adult patients with common variable immunodeficiency. Nutr Clin Pract 2022; 37:1206-1214. [PMID: 34989028 DOI: 10.1002/ncp.10806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The aim of this study is to determine the prevalence of malnutrition in outpatients with common variable immunodeficiency (CVID) and the utility of nutrition screening tools to detect malnutrition in these patients. METHODS Fifty outpatients with CVID were included in the study. Nutrition risk for each patient was evaluated using four nutrition screening tools: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Short Nutritional Assessment Questionnaire (SNAQ), and Nutritional Risk Screening 2002 (NRS-2002). RESULTS According to MUST, MST, SNAQ, and NRS-2002, malnutrition risk was determined to be 48% (n = 24), 26% (n = 13), 20% (n = 10), and 20% (n = 10), respectively. Malnutrition was detected in 54% (n = 27) of the patients. It was found that MUST showed a better correlation in detecting malnutrition in outpatients with CVID (κ = 0.482, P = 0.001). MUST has a higher positive and negative predictive value than other nutrition screening tools (79% and 70%, respectively). In the multivariate logistic regression analysis, it was found that low serum immunoglobulin A (IgA) levels at diagnosis increased the risk of malnutrition by ∼15 times, and low CD19+ B-cell counts increased the risk by approximately eight times. CONCLUSION The prevalence of malnutrition in patients with CVID was found to be quite high, and there was a strong correlation between malnutrition and low CD19+ B-cell counts and low serum IgA levels. Given the high rate of malnutrition in patients with CVID, nutrition assessment is recommended rather than starting with nutrition screening.
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Affiliation(s)
- Eray Yıldız
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Şevket Arslan
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Fatih Çölkesen
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Filiz Sadi Aykan
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Recep Evcen
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Kılınç
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gökhan Aytekin
- Deparment of Internal Medicine, Division of Allergy and Clinical Immunology, Konya City Hospital, Konya, Turkey
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Short Nutritional Assessment Questionnaire as a predictor of undernutrition in cancer patients receiving outpatient chemotherapy: A retrospective study. Eur J Oncol Nurs 2021; 54:102013. [PMID: 34500316 DOI: 10.1016/j.ejon.2021.102013] [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: 12/22/2020] [Revised: 07/06/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of this retrospective study was to verify whether the revised Short Nutritional Assessment Questionnaire© (SNAQ), a simplified nutritional assessment, could be comparable with serum albumin (ALB) levels as a predictor of undernutrition in cancer patients receiving outpatient chemotherapy. METHODS Of 111 patients, 79 patients with baseline ALB levels ≥3.5 g/dL were included in the analysis. Patients completed the revised SNAQ, which evaluated items including appetite loss, weight loss, nutritional supplement usage, age, and body mass index, using a maximum of 12 points (a score of ≥3 was marked as severe undernutrition). ALB levels were then monitored for 1 year using patient medical records. RESULTS There was a significant difference in event-free survival (EFS) when the SNAQ scores were classified into two groups [i.e., scores of ≤3 (SNAQ3) or scores of ≥4 (SNAQ4)]. The 150-day EFS rate was 86.8% and 57.6% for SNAQ3 and SNAQ4, respectively (hazard ratio: 2.92; 95% confidence interval: 1.31-6.51; p = 0.009). Based on the Cox proportional-hazards analysis, a higher risk of undernutrition was associated with SNAQ4 (compared with SNAQ3), C-reactive protein levels, and serum transthyretin levels. CONCLUSION The revised SNAQ is a predictor of undernutrition in cancer patients receiving outpatient chemotherapy. In particular, it is important that patients with a SNAQ score of ≥4 receive dietary guidance at an early stage as they are likely to become undernourished within a year.
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Pakai A, Havasi-Sántha E, Mák E, Máté O, Pusztai D, Fullér N, Zrínyi M, Oláh A. Influence of cognitive function and nurse support on malnutrition risk in nursing home residents. Nurs Open 2021; 8:1805-1811. [PMID: 33635604 PMCID: PMC8186720 DOI: 10.1002/nop2.824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/09/2020] [Accepted: 01/29/2021] [Indexed: 12/19/2022] Open
Abstract
Aim To predict malnutrition risk of older residents by cognitive function, nurse support and self‐care capacity as primary measures of interest. Design Cross‐sectional, correlation design with linear regression analysis. Methods Older residents over 60 years of age were randomly selected from nursing homes. Mini Mental State Exam and the Mini Nutritional Assessment were used were as main measures. Results Lower malnutrition risk was associated with better cognitive functioning. Improved independence of self‐feeding was also linked to reduced nutritional risk. Nurse support was positively related to BMI and cognitive impairment. General self‐care capacity and ‘appetite the week before’ were key predictors of malnutrition risk; 1‐point increase in both variables caused nutritional risk to decrease by 1.73 and 1.38 points, respectively. That is, a 1‐point increase in self‐care capacity and appetite would decrease malnutrition risk by 5.76% and 4.6%. The regression model explained significant amount (65.6%) of variance in malnutrition risk.
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Affiliation(s)
| | | | - Erzsébet Mák
- Department of Dietetics, Faculty of Health, Semmelweis University, Budapest, Hungary
| | - Orsolya Máté
- Faculty of Health, University of Pécs, Pécs, Hungary
| | | | - Noémi Fullér
- Faculty of Health, University of Pécs, Pécs, Hungary
| | - Miklós Zrínyi
- Faculty of Health, University of Pécs, Pécs, Hungary
| | - András Oláh
- Faculty of Health, University of Pécs, Pécs, Hungary
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Scored-GLIM as an effective tool to assess nutrition status and predict survival in patients with cancer. Clin Nutr 2021; 40:4225-4233. [PMID: 33579553 DOI: 10.1016/j.clnu.2021.01.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS The Global Leadership Initiative on Malnutrition (GLIM) released new universal criteria for diagnosing and grading malnutrition, and calls for further investigations not only in different clinical setting but also in GLIM itself including reference value, combination and weight of different GLIM criteria. This study aimed to weigh the GLIM criteria and develop a scored-GLIM system, and then validate as well as evaluate its application in nutritional assessment and survival prediction for patients with cancer. DESIGN A total of 3547 patients in the primary cohort and 415 patients in the validation cohort were included in the study. Patients' nutritional status were retrospectively assessed using the GLIM criteria. Kaplan-Meier survival curves and multivariate Cox regression analyses were performed to analyze the association between nutritional status and overall survival (OS). A nomogram was produced to quantify the GLIM criteria and develop the scored-GLIM system. C-index, receiver operating characteristic (ROC) curve and calibration curve analyses were performed to validate the predictive accuracy and discriminatory capacity of the scored-GLIM. Finally, a decision curve was applied to assess the clinical utility of the scored-GLIM system. RESULTS In the primary cohort, 70.3% of patients were diagnosed as malnutrition. The malnutrition severity grading according to the GLIM criteria were associated with the prognosis of patients with cancer (HR 1.42, 1.23 to 1.65 for moderate malnutrition; HR 1.80,1.84 to 2.09 for severe malnutrition). The weight of each GLIM criteria was calculated, and unintentional weight loss was the most determining factor acting upon mortality (HR 1.82, 1.64 to 2.10 for stage II and HR 1.50, 1.31 to 1.73 for stage I). A nomogram was constructed by four factors of GLIM to weigh the GLIM criteria. The areas under the ROC curve were 65.3 (1-year ROC) and 65.5 (3-year ROC), and the C-index was 0.62, and the calibration curves fitted well. Decision curve analysis demonstrated the clinical usefulness of the scored-GLIM system. CONCLUSION The accuracy and net clinical benefit of scored-GLIM system were similar to scored-PG-SGA but higher than GLIM both in nutrition assessment and in survival prediction for patients with cancer. These findings, along with its time-savings advantages over scored-PG-SGA, suggest scored-GLIM be a better nutritional assessment tool.
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Dijksterhuis WPM, Latenstein AEJ, van Kleef JJ, Verhoeven RHA, de Vries JHM, Slingerland M, Steenhagen E, Heisterkamp J, Timmermans LM, de van der Schueren MAE, van Oijen MGH, Beijer S, van Laarhoven HWM. Cachexia and Dietetic Interventions in Patients With Esophagogastric Cancer: A Multicenter Cohort Study. J Natl Compr Canc Netw 2021; 19:144-152. [PMID: 33418527 DOI: 10.6004/jnccn.2020.7615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cachexia is common in patients with esophagogastric cancer and is associated with increased mortality. Nutritional screening and dietetic interventions can be helpful in preventing evolvement of cachexia. Our aim was to study the real-world prevalence and prognostic value of pretreatment cachexia on overall survival (OS) using patient-reported weight loss, and to explore dietetic interventions in esophagogastric cancer. MATERIALS AND METHODS Patients with esophagogastric cancer (2015-2018), regardless of disease stage, who participated in the Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP) and completed patient-reported outcome measures were included. Data on weight loss and dietetic interventions were retrieved from questionnaires before start of treatment (baseline) and 3 months thereafter. Additional patient data were obtained from the Netherlands Cancer Registry. Cachexia was defined as self-reported >5% half-year body weight loss at baseline or >2% in patients with a body mass index (BMI) <20 kg/m2 according to the Fearon criteria. The association between cachexia and OS was analyzed using multivariable Cox proportional hazard analyses adjusted for sex, age, performance status, comorbidities, primary tumor location, disease stage, histology, and treatment strategy. RESULTS Of 406 included patients, 48% had pretreatment cachexia, of whom 65% were referred for dietetic consultation at baseline. The proportion of patients with cachexia was the highest among those who received palliative chemotherapy (59%) or best supportive care (67%). Cachexia was associated with decreased OS (hazard ratio, 1.52; 95% CI, 1.11-2.09). Median weight loss after 3-month follow-up was lower in patients with cachexia who were referred to a dietician at baseline compared with those who were not (0% vs 2%; P=.047). CONCLUSIONS Nearly half of patients with esophagogastric cancer have pretreatment cachexia. Dietetic consultation at baseline was not reported in more than one-third of the patients with cachexia. Because cachexia was independently associated with decreased survival, improving nutritional screening and referral for dietetic consultation are warranted to prevent further deterioration of malnutrition and mortality.
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Affiliation(s)
- Willemieke P M Dijksterhuis
- 1Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam.,2Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Amsterdam
| | - Anouk E J Latenstein
- 3Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam
| | - Jessy Joy van Kleef
- 1Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam
| | - Rob H A Verhoeven
- 2Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Amsterdam
| | | | - Marije Slingerland
- 5Department of Medical Oncology, Leiden University Medical Center, Leiden
| | - Elles Steenhagen
- 6Department of Dietetics, University Medical Center Utrecht, Utrecht
| | | | - Liesbeth M Timmermans
- 8Stichting voor Patiënten met Kanker aan het Spijsverteringskanaal, Utrecht.,9Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; and
| | | | - Martijn G H van Oijen
- 1Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam.,2Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Amsterdam
| | - Sandra Beijer
- 2Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Amsterdam
| | - Hanneke W M van Laarhoven
- 1Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam
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Yurut-Caloglu V, Caloglu M, Turkkan G. The importance of weight loss during definitive radiotherapy in patients with laryngeal carcinoma. J Cancer Res Ther 2021; 18:638-643. [DOI: 10.4103/jcrt.jcrt_727_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jayanth KS, Maroju NK. Utility of nutritional indices in preoperative assessment of cancer patients. Clin Nutr ESPEN 2020; 37:141-147. [PMID: 32359736 DOI: 10.1016/j.clnesp.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/15/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Malnutrition is an important but neglected predictor for outcomes and healthcare costs in cancer patients. A simple screening tool for detecting malnutrition may have clinical utility in their preoperative assessment. OBJECTIVES This study compared three validated indices, for their predictive ability for prolonged length of stay (LOS) and 30-day postsurgical complications in malignancies in a tertiary hospital in South India. METHODS 342 cancer patients admitted for elective surgery were stratified on their preoperative day using MUST - Malnutrition Universal Screening Tool, SGA - Subjective Global Assessment and NRI - Nutritional Risk Index. The postoperative LOS and 30-day morbidity as per Clavien-Dindo classification (CDC) were compared to calculate the predictive accuracy of the various nutritional indices. RESULTS In our study, 44% patients were classified as malnourished by SGA. SGA was found to have maximum correlation coefficient with LOS (σ = 0.410), followed by MUST (σ = 0.401) and NRI (σ = 0.36). On logistic regression, MUST, NRI and SGA were all found to be significant independent predictors of LOS and CDC class. Age, acute illness and comorbidities were found to have significant confounding effects. Sensitivity of MUST and SGA to predict prolonged LOS (>10 d) were. DISCUSSION Our study showed that surgical cancer population was at high risk for malnutrition. MUST and SGA were good risk-stratification tools with independent predictive ability for prolonged LOS and postoperative complications. Patients having higher MUST and SGA scores fared poorly postoperatively with significant prolongation of stay. MUST had 88% agreement with SGA, and took shorter time to administer in the in-patient setting. CONCLUSION Routine preoperative nutritional assessment is important in cancer patients. SGA and MUST were found to be reliable tools, with MUST being the simplest and quickest tool for preoperative nutritional assessment. Patients stratified to be at risk for malnutrition may benefit with nutritional therapy.
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Affiliation(s)
- Kalkunte Sriram Jayanth
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
| | - Nanda Kishore Maroju
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
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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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Spooren CEGM, Wintjens DSJ, de Jong MJ, van der Meulen-de Jong AE, Romberg-Camps MJ, Becx MC, Maljaars JP, van Bodegraven AA, Mahmmod N, Markus T, Hameeteman WM, Masclee AAM, Winkens B, Jonkers DMAE, Pierik MJ. Risk of impaired nutritional status and flare occurrence in IBD outpatients. Dig Liver Dis 2019; 51:1265-1269. [PMID: 31213405 DOI: 10.1016/j.dld.2019.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) patients are at risk of an impaired nutritional status. The impact thereof on the IBD relapse risk is clinically relevant, though sparsely investigated. AIM The aim was to explore the association between an impaired nutritional status risk and the occurrence of disease flares in IBD outpatients participating in a longitudinal telemedicine study. METHODS IBD outpatients were recruited from the myIBDcoach study cohort, with one year clinical follow-up. Through myIBDcoach, a telemedicine tool, patients reported on disease activity and risk of impaired nutritional status (i.e. Short Nutritional Assessment Questionnaire >1 and/or BMI < 18.5 kg/m2) every one to three months. Data was analysed by generalized estimating equation modelling. RESULTS In total, 417 patients were included. During follow-up, 49 patients (11.8%) flared after initial clinical remission and 53 patients (12.7%) showed an increased risk of impaired nutritional status. The risk of impaired nutritional status was associated with flare occurrence (OR 2.61 (95% CI 1.02-6.69)). CONCLUSIONS The risk of an impaired nutritional status was associated with subsequent flares in IBD outpatients. This emphasizes the importance of monitoring disease activity in IBD patients at risk of impaired nutritional status.
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Affiliation(s)
- Corinne E G M Spooren
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, The Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Dion S J Wintjens
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, The Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marin J de Jong
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, The Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Mariëlle J Romberg-Camps
- Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine (Co-MIK), Zuyderland Medical Centre, Sittard-Geleen-Heerlen, The Netherlands
| | - Marco C Becx
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jeroen P Maljaars
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ad A van Bodegraven
- Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine (Co-MIK), Zuyderland Medical Centre, Sittard-Geleen-Heerlen, The Netherlands
| | - Nofel Mahmmod
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Tineke Markus
- CCUVN, Dutch IBD Patients Organization, Woerden, Netherlands
| | - Wim M Hameeteman
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ad A M Masclee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, The Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Daisy M A E Jonkers
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, The Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marie J Pierik
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, The Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
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Validity of Nutritional Screening Tools for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2019; 20:1351.e13-1351.e25. [PMID: 31409560 DOI: 10.1016/j.jamda.2019.06.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/23/2019] [Accepted: 06/24/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this systematic review was to summarize the validity of nutritional screening tools to detect the risk of malnutrition in community-dwelling older adults. DESIGN A systematic review and meta-analysis. The protocol for this systematic review was registered in the PROSPERO database (CRD42017072703). SETTING AND PARTICIPANTS A literature search was performed in PubMed, EMBASE, CINAHL, and Cochrane using the combined terms "malnutrition," "aged," "community-dwelling," and "screening." The time frame of the literature reviewed was from January 1, 2001, to May 18, 2018. Older community-dwellers were defined as follows: individuals with a mean/median age of >65 years who were community-dwellers or attended hospital outpatient clinics and day hospitals. All nutritional screening tools that were validated in community-dwelling older adults against a reference standard to detect the risk of malnutrition, or with malnutrition, were included. MEASURES Meta-analyses were performed on the diagnostic accuracy of identified nutritional screening tools validated against the Mini Nutritional Assessment-Long Form (MNA-LF). The symmetric hierarchical summary receiver operating characteristic models were used to estimate test performance. RESULTS Of 7713 articles, 35 articles were included in the systematic review, and 9 articles were included in the meta-analysis. Seventeen nutritional screening tools and 10 reference standards were identified. The meta-analyses showed average sensitivities and specificities of 0.95 (95% confidence interval [CI] 0.75-0.99) and 0.95 (95% CI 0.85-0.99) for the Mini Nutritional Assessment-Short Form (MNA-SF; cutoff point ≤11), 0.85 (95% CI 0.80-0.89) and 0.87 (95% CI 0.86-0.89) for the MNA-SF-V1 (MNA-SF using body mass index, cutoff point ≤11), 0.85 (95% CI 0.77-0.89) and 0.84 (95% CI 0.79-0.87) for the MNA-SF-V2 (MNA-SF using calf circumference instead of body mass, cutoff point ≤11), respectively, using MNA-LF as the reference standard. CONCLUSIONS AND IMPLICATIONS The MNA-SF, MNA-SF-V1, and MNA-SF-V2 showed good sensitivity and specificity to detect community-dwelling older adults at risk of malnutrition validated against the MNA-LF. Clinicians should consider the use of the cutoff point ≤11 on the MNA-SF, MNA-SF-V1, and MNA-SF-V2 to identify community-dwelling older adults at risk of malnutrition.
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Power L, Mullally D, Gibney ER, Clarke M, Visser M, Volkert D, Bardon L, de van der Schueren MAE, Corish CA. A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study. Clin Nutr ESPEN 2019; 24:1-13. [PMID: 29576345 DOI: 10.1016/j.clnesp.2018.02.005] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Older adults are at increased risk of malnutrition compared to their younger counterparts. Malnutrition screening should be conducted using a valid malnutrition screening tool. An aim of the Healthy Diet for a Healthy Life (HDHL) Joint Programming Initiative (JPI) 'Malnutrition in the Elderly Knowledge Hub' (MaNuEL) was to review the reported validity of existing malnutrition screening tools used in older adults. METHODS A literature search was conducted to identify validation studies of malnutrition screening tools in older populations in community, rehabilitation, residential care and hospital settings. A database of screening tools was created containing information on how each tool was validated. RESULTS Seventy-four articles containing 119 validation studies of 34 malnutrition screening tools used in older adults were identified across the settings. Twenty-three of these tools were designed for older adults. Sensitivity and specificity ranged from 6 to 100% and 12-100% respectively. Seventeen different reference standards were used in criterion validation studies. Acceptable reference standards were used in 68 studies; 38 compared the tool against the Mini Nutritional Assessment-Full Form (MNA-FF), 16 used clinical assessment by a nutrition-trained professional and 14 used the Subjective Global Assessment (SGA). Twenty-five studies used inappropriate reference standards. Predictive validity was measured in 14 studies and was weak across all settings. CONCLUSIONS Validation results differed significantly between tools, and also between studies using the same tool in different settings. Many studies have not been appropriately conducted, leaving the true validity of some tools unclear. Certain tools appear to be more valid for use in specific settings.
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Affiliation(s)
- Lauren Power
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Deirdre Mullally
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Michelle Clarke
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marjolein Visser
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands.
| | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Laura Bardon
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marian A E de van der Schueren
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
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Hung Y, Wijnhoven HAH, Visser M, Verbeke W. Appetite and Protein Intake Strata of Older Adults in the European Union: Socio-Demographic and Health Characteristics, Diet-Related and Physical Activity Behaviours. Nutrients 2019; 11:nu11040777. [PMID: 30987278 PMCID: PMC6521269 DOI: 10.3390/nu11040777] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/24/2019] [Accepted: 03/28/2019] [Indexed: 12/25/2022] Open
Abstract
Considerable efforts have been directed towards stimulating healthy ageing regarding protein intake and malnutrition, yet large-scale consumer studies are scarce and fragmented. This study aims to profile older adults in the European Union (EU) according to appetite (poor/good) and protein intake (lower/higher) strata, and to identify dietary and physical activity behaviours. A survey with older (aged 65 years or above) adults (n = 1825) in five EU countries (Netherlands, United Kingdom, Finland, Spain and Poland) was conducted in June 2017. Four appetite and protein intake strata were identified based on simplified nutritional appetite questionnaire (SNAQ) scores (≤14 versus >14) and the probability of a protein intake below 1.0 g/kg adjusted BW/day (≥0.3 versus <0.3) based on the 14-item Pro55+ screener: "appi"-Poor appetite and lower level of protein intake (12.2%); "APpi"-Good appetite but lower level of protein intake (25.5%); "apPI"-Poor appetite but higher level of protein intake (14.8%); and "APPI"-Good appetite and higher level of protein intake (47.5%). The stratum of older adults with a poor appetite and lower level of protein intake (12.2%) is characterized by a larger share of people aged 70 years or above, living in the UK or Finland, having an education below tertiary level, who reported some or severe financial difficulties, having less knowledge about dietary protein and being fussier about food. This stratum also tends to have a higher risk of malnutrition in general, oral-health related problems, experience more difficulties in mobility and meal preparation, lower confidence in their ability to engage in physical activities in difficult situations, and a lower readiness to follow dietary advice. Two multivariate linear regression models were used to identify the behavioural determinants that might explain the probability of lower protein intake, stratified by appetite status. This study provides an overview and highlights the similarities and differences in the strata profiles. Recommendations for optimal dietary and physical activity strategies to prevent protein malnutrition were derived, discussed and tailored according to older adults' profiles.
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Affiliation(s)
- Yung Hung
- Department of Agricultural Economics, Ghent University, Coupure links 653, 9000 Ghent, Belgium.
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
| | - Wim Verbeke
- Department of Agricultural Economics, Ghent University, Coupure links 653, 9000 Ghent, Belgium.
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16
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Miller J, Wells L, Nwulu U, Currow D, Johnson MJ, Skipworth RJE. Validated screening tools for the assessment of cachexia, sarcopenia, and malnutrition: a systematic review. Am J Clin Nutr 2018; 108:1196-1208. [PMID: 30541096 DOI: 10.1093/ajcn/nqy244] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/17/2018] [Indexed: 11/13/2022] Open
Abstract
Background There is great overlap between the presentation of cachexia, sarcopenia, and malnutrition. Distinguishing between these conditions would allow for better targeted treatment for patients. Objectives The aim was to systematically review validated screening tools for cachexia, sarcopenia, and malnutrition in adults and, if a combined tool is absent, make suggestions for the generation of a novel screening tool. Design A systematic search was performed in Ovid Medline, EMBASE, CINAHL, and Web of Science. Two reviewers performed data extraction independently. Each tool was judged for validity against a reference method. Psychometric evaluation was performed as was appraisal of the tools' ability to assess the patient against consensus definitions. Results Thirty-eight studies described 22 validated screening tools. The Cachexia score (CASCO) was the only validated screening tool for cachexia and performed well against the consensus definition. Two tools assessed sarcopenia [the Short Portable Sarcopenia Measure (SPSM) and the SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls)] and scored well against the 1998 Baumgartner definition. The SPSM required large amounts of equipment, and the SARC-F had a low sensitivity. Nineteen tools screened for malnutrition. The 3-Minute Nutrition Score performed best, meeting consensus definition criteria (European Society for Clinical Nutrition and Metabolism) and having a sensitivity and specificity of >80%. No tool contained all of the currently accepted components to screen for all 3 conditions. Only 3 tools were validated against cross-sectional imaging, a clinical tool that is gaining wider interest in body-composition analysis. Conclusions No single validated screening tool can be implemented for the simultaneous assessment of cachexia, sarcopenia, and malnutrition. The development of a tool that encompasses consensus definition criteria and directs clinicians toward the underlying diagnosis would be optimal to target treatment and improve outcomes. We propose that tool should incorporate a stepwise assessment of nutritional status, oral intake, disease status, age, muscle mass and function, and metabolic derangement.
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Affiliation(s)
- Janice Miller
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Liz Wells
- Diabetes, Endocrinology, and Metabolism, Hull Royal Infirmary, Hull, United Kingdom
| | - Ugochinyere Nwulu
- Wolfson Palliative Care Research Center, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - David Currow
- Wolfson Palliative Care Research Center, Hull York Medical School, University of Hull, Hull, United Kingdom.,Improving Palliative Care through Clinical Trials (IMPACCT), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Miriam J Johnson
- Wolfson Palliative Care Research Center, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Richard J E Skipworth
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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17
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Souwer ETD, Hultink D, Bastiaannet E, Hamaker ME, Schiphorst A, Pronk A, van der Bol JM, Steup WH, Dekker JWT, Portielje JEA, van den Bos F. The Prognostic Value of a Geriatric Risk Score for Older Patients with Colorectal Cancer. Ann Surg Oncol 2018; 26:71-78. [PMID: 30362061 PMCID: PMC6338720 DOI: 10.1245/s10434-018-6867-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION VMS is a Dutch risk assessment tool for hospitalized older adults that includes a short evaluation of four geriatric domains: risk for delirium, risk for undernutrition, risk for physical impairments, and fall risk. We investigated whether the information derived from this tool has prognostic value for outcomes of colorectal surgery. METHODS All consecutive patients over age 70 years who underwent elective colorectal cancer surgery in three Dutch hospitals (2014-2016) were studied. The presence of risk was scored prior to surgery and per geriatric domain as either 0 (risk absent) or 1 (risk present). The total number of geriatric risk factors was summed. The primary outcome was long-term survival. Secondary outcomes were postoperative complications, including delirium. Cox proportional hazards models were used to evaluate the sumscore and risk factors associated with overall survival. RESULTS Five hundred fifty patients were included. Median age was 76.5 years, and median follow-up was 870 days. Patients with intermediate (1-2) or high (3-4) sumscore were independently associated with lower overall survival, with hazard ratio (HR) of 1.9 [95% confidence interval (CI) 1.1-3.5; p = 0.03] and 8.7 (95% CI 4.0-19.2; p < 0.001), respectively. Sumscores were also associated with postoperative complications (intermediate sumscore OR 1.8; 95% CI 1.2-2.7; high sumscore OR 2.4; 95% CI 1.02-5.5). CONCLUSIONS This easy-to-use geriatric sumscore has strong associations with long-term outcome and morbidity after colorectal cancer surgery. This information may be included in risk models for morbidity and mortality and can be used in shared decision-making.
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Affiliation(s)
- E T D Souwer
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.
| | - D Hultink
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands
| | - E Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M E Hamaker
- Department of Geriatrics, Diakonessenhuis, Utrecht, The Netherlands
| | - A Schiphorst
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - A Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - J M van der Bol
- Department of Geriatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - W H Steup
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - J E A Portielje
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - F van den Bos
- Department of Internal Medicine, Haga Hospital, PO Box 40551, 2504 LN, The Hague, The Netherlands.,Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Abstract
Screening and assessment imply different processes, with the former indicating risk factors for a deprived nutrition condition and the latter providing the nutrition diagnosis. Both should be routinely performed at hospital admission according to recommended guidelines; however, this is not the reality worldwide, and undernutrition remains highly prevalent in the hospital setting. Therefore, the objective of the current review is to delve into the principles leading to nutrition status deficiencies and how they should be addressed by screening and assessment. A critical appraisal for the reasons associated with the misunderstanding between screening and assessing is proposed without further discussing the many available screening tools while approaching some of the assessment instruments.
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Affiliation(s)
- Maria Isabel Toulson Davisson Correia
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Nutritional Therapy Team, Instituto Alfa de Gastroenterologia, Hospital das Clínicas-Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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19
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Malnutrition and sarcopenia in a large cohort of patients with systemic sclerosis. Clin Rheumatol 2017; 37:987-997. [PMID: 29196890 DOI: 10.1007/s10067-017-3932-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/20/2017] [Accepted: 11/24/2017] [Indexed: 12/13/2022]
Abstract
Systemic sclerosis (SSc) is an autoimmune disease which may lead to malnutrition. Previous studies have defined it with different criteria. No thorough evaluations of sarcopenia in SSc are available. The aim of the present study was to assess the prevalence and the potential association of malnutrition and sarcopenia in a large cohort of SSc cases. A total of 141 SSc consecutive outpatients were enrolled. Body composition was analyzed by densitometry. Malnutrition was defined according to recently published ESPEN criteria, whereas sarcopenia was diagnosed in patients with reduced skeletal muscle index. Malnutrition was diagnosed in 9.2% of patients (95% CI, 4.4-14.0%). Malnourished patients had worse gastrointestinal symptoms according to UCLA SCTC GIT 2.0 questionnaire (p = 0.007), lower physical activity (p = 0.028), longer disease duration (p = 0.019), worse predicted DLCO/VA and FVC (p = 0.009, respectively), worse disease severity according to Medsger severity score (p < 0.001), lower hemoglobin (p = 0.023), and fat-free mass (p < 0.001) and were more often sarcopenic (p < 0.001). In multivariate analysis, only FVC (p = 0.006) and disease severity (p = 0.003), in particular for the lungs (p = 0.013), were confirmed to be worse in malnourished patients. Sarcopenia was diagnosed in 29\140 patients (20.7%; 95% CI, 14.0-27.4%); 11\29 were also malnourished. In multivariate analysis, sarcopenic patients had longer disease duration (p = 0.049), worse DLCO/VA (p = 0.002), and lung (p = 0.006) and skin (p = 0.014) involvement. In SSc, malnutrition defined with ESPEN criteria was found to be lower than previously reported. Sarcopenia was found to be somewhat common. Lung involvement was significantly associated with nutritional status and may not be explained only by muscle weakness.
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20
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Leipold CE, Bertino SB, L'Huillier HM, Howell PM, Rosenkotter M. Validation of the Malnutrition Screening Tool for use in a Community Rehabilitation Program. Nutr Diet 2017; 75:117-122. [PMID: 29411490 DOI: 10.1111/1747-0080.12365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 04/28/2017] [Accepted: 05/31/2017] [Indexed: 12/01/2022]
Abstract
AIM The aim of the present study was to determine if the Malnutrition Screening Tool (MST) is valid for use within the Community Rehabilitation Program (CRP) setting. Secondary outcome measures were to assess malnutrition prevalence in the CRP population and to determine trends between malnutrition and age, body mass index (BMI) and falls history. METHODS This study used a cross-sectional design. All clients admitted to a Melbourne metropolitan CRP during the study period had the MST completed at intake. A total of 160 participants were then selected at random and a Subjective Global Assessment (SGA) was completed by an experienced dietitian. Participants were classified as well nourished or malnourished, and this result was compared to their MST score. Data analysis was completed to determine the predictive value of the MST compared to SGA, which was expressed using sensitivity, specificity, positive and negative predictive values. RESULTS Out of the 160 participants, 34.0% were identified as malnourished. The MST achieved a sensitivity of 72.2% and a specificity of 83.8% with positive predictive value of 69.6% and negative predictive value of 85.4% compared to the SGA. Participants in the malnourished group were older and had a lower BMI (P < 0.05). CONCLUSIONS Considering the demographics and needs of the CRP population group and the predictive value of the MST compared to SGA, it can be concluded that the MST is a valid screening tool for use in this population and has relatively low burden to complete. Consequently, the MST could be included in the client initial needs identification to be completed when admitted to the program.
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Affiliation(s)
- Claire E Leipold
- Angliss Hospital Community Rehabilitation Program, Eastern Health, Melbourne, Victoria, Australia
| | - Shaylyn B Bertino
- Yarra Ranges Health Community Rehabilitation Program, Eastern Health, Melbourne, Victoria, Australia
| | - Heather M L'Huillier
- Wantirna Health Community Rehabilitation Program, Eastern Health, Melbourne, Victoria, Australia.,Outer East Aged Care Assessment Service, Eastern Health, Melbourne, Victoria, Australia
| | - Paula M Howell
- Peter James Centre Community Rehabilitation Program, Eastern Health, Melbourne, Victoria, Australia
| | - Michelina Rosenkotter
- Wantirna Health Community Rehabilitation Program, Eastern Health, Melbourne, Victoria, Australia
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Ballyuzek MF, Mashkova MV, Arutjunyan AV, Duke VA. Melatonin as a marker of severity of cardiac disorders in developing cachexia syndrome among cancer patients of different age groups. ADVANCES IN GERONTOLOGY 2017. [DOI: 10.1134/s2079057017030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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22
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Analysis of Outcomes of the NRS 2002 in Patients Hospitalized in Nephrology Wards. Nutrients 2017; 9:nu9030287. [PMID: 28300757 PMCID: PMC5372950 DOI: 10.3390/nu9030287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/25/2017] [Accepted: 03/06/2017] [Indexed: 01/04/2023] Open
Abstract
Introduction: Malnutrition is a common problem among hospitalized patients. In chronic kidney disease, it affects up to 50% of the population. Undernourishment has an adverse effect on prognosis and prolongs convalescence. The aim of the study was to test the effectiveness of NRS (Nutrition Risk Screening) -2002 in the assessment of risk of malnutrition for patients hospitalized in nephrology wards. The aim was to develop clinical characteristics of malnourished patients and to assess the relationship between nutritional status and patient outcome. Methods: The analysis included 292 patients, consecutively admitted to nephrology wards. NRS-2002 was assessed in comparison to subjective global assessment. Associations with patient characteristics and outcome were evaluated. Results: Out of all the respondents, 119 patients (40%) suffered from malnutrition. The NRS-2002 showed a very strong relationship with Subjective Global Assessment (SGA) (p < 0.0001). Malnourished patients were older, were characterized by a significantly lower body mass index (BMI), and had a much longer hospitalization duration. In multiple regression analysis, the presence of malnutrition proved to be an independent predictor of the duration of hospital stay. CONCLUSIONS: Malnutrition is highly prevalent among patients hospitalized in nephrology wards, and it affects the length of hospitalization. Identification of malnourished patients and patients at serious risk of malnutrition progression allows the implementation of appropriate nutritional intervention.
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23
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Harada K, Ochi K, Taguchi T, Nakamura T, Kanazawa M, Yoshida N, Neriya H, Okagaki M, Nishida N, Takishita Y, Yamamoto Y, Wada S, Kuwahata M, Yokota I, Sekido K, Higashi A. Validity of the Short Nutritional Assessment Questionnaire for Japanese Patients with Cancer Undergoing Outpatient Chemotherapy. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 64:117-121. [PMID: 28373607 DOI: 10.2152/jmi.64.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kiyomi Harada
- School of Nursing, Kyoto Prefectural University of Medicine
| | - Kiyo Ochi
- Department of Nursing, University Hospital, Kyoto Prefectural University of Medicine
| | - Tetsuya Taguchi
- Department of Endocrine and Breast Surgery, Kyoto Prefectural University of Medicine Graduate School of Medical Science
| | - Terukazu Nakamura
- Department of Urology, Imperial Gift Foundation, Saiseikai Suita Hospital
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Motohiro Kanazawa
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science
| | - Hiroko Neriya
- Department of Clinical Nutrition, University Hospital, Kyoto Prefectural University of Medicine
| | - Masami Okagaki
- Department of Clinical Nutrition, University Hospital, Kyoto Prefectural University of Medicine
| | - Naoko Nishida
- Faculty of Health and Medical Sciences, Kyoto Gakuen University
| | | | - Yoko Yamamoto
- School of Nursing, Kyoto Prefectural University of Medicine
| | - Sayori Wada
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University
| | - Masashi Kuwahata
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Keiko Sekido
- School of Nursing, Kyoto Prefectural University of Medicine
| | - Akane Higashi
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University
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The prevalence of malnutrition according to the new ESPEN definition in four diverse populations. Clin Nutr 2016; 35:758-62. [DOI: 10.1016/j.clnu.2015.06.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/14/2015] [Accepted: 06/15/2015] [Indexed: 11/19/2022]
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Mulder CJJ, Wanten GJA, Semrad CE, Jeppesen PB, Kruizenga HM, Wierdsma NJ, Grasman ME, van Bodegraven AA. Clinical nutrition in the hepatogastroenterology curriculum. World J Gastroenterol 2016; 22:1729-1735. [PMID: 26855532 PMCID: PMC4724604 DOI: 10.3748/wjg.v22.i5.1729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/29/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
Gastroenterology (GE) used to be considered a subspecialty of internal medicine. Today, GE is generally recognized as a wide-ranging specialty incorporating capacities, such as hepatology, oncology and interventional endoscopy, necessitating GE-expert differentiation. Although the European Board of Gastroenterology and Hepatology has defined specific expertise areas in Advanced endoscopy, hepatology, digestive oncology and clinical nutrition, training for the latter topic is lacking in the current hepatogastroenterology (HGE) curriculum. Given its relevance for HGE practice, and being at the core of gastrointestinal functioning, there is an obvious need for training in nutrition and related issues including the treatment of disease-related malnutrition and obesity and its associated metabolic derangements. This document aims to be a starting point for the integration of nutritional expertise in the HGE curriculum, allowing a central role in the management of malnutrition and obesity. We suggest minimum endpoints for nutritional knowledge and expertise in the standard curriculum and recommend a focus period of training in nutrition issues in order to produce well-trained HGE specialists. This article provides a road map for the organization of such a training program. We would highly welcome the World Gastroenterology Organisation, the European Board of Gastroenterology and Hepatology, the American Gastroenterology Association and other (inter)national Gastroenterology societies support the necessary certifications for this item in the HGE-curriculum.
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Hanna KL, Glen KD, Lau BT, Tran CQ, Truong NT, Gallegos D. Relationship between malnutrition and selected risk factors in two hospitals in Vietnam. Nutr Diet 2015. [DOI: 10.1111/1747-0080.12240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Katherine L. Hanna
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Brisbane Queensland Australia
| | - Kate D. Glen
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Brisbane Queensland Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Bonnie T. Lau
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Brisbane Queensland Australia
- Department of Dietetics; Singapore General Hospital; Singapore
| | - Cuong Q. Tran
- Ho Chi Minh City Nutrition Centre; Ho Chi Minh City Vietnam
| | - Nam T. Truong
- Can Tho University of Medicine and Pharmacy; Can Tho Vietnam
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Brisbane Queensland Australia
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Leistra E, Eerenstein SEJ, van Aken LH, Jansen F, de van der Schueren MAE, Twisk JWR, Visser M, Langius JAE. Effect of Early Individualized Dietary Counseling on Weight Loss, Complications, and Length of Hospital Stay in Patients With Head and Neck Cancer: A Comparative Study. Nutr Cancer 2015; 67:1093-103. [PMID: 26317372 DOI: 10.1080/01635581.2015.1073755] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients with head and neck cancer (HNC) are at risk for undernutrition. Dietary counseling during treatment has positive effects on nutritional status and quality of life, however, the effects of dietary counseling started before initiation of treatment are currently unknown. Therefore we assessed the effect of early individualized dietary counseling (DC) on weight loss, major complications, and length of hospital stay (LOS) in patients with HNC. Ninety-five newly diagnosed HNC patients with (risk of) undernutrition receiving DC were compared to 95 matched HNC patients receiving usual nutritional care (UC). Difference in weight change over time was analyzed by generalized estimating equations (GEE). Differences in complications and LOS were studied by Pearson chi-squared and student's t-tests. Weight change between diagnosis and end of treatment was -6.0 ± 6.9% (DC) and -5.4 ± 5.7% (UC; GEE: -0.4kg, 95% confidence interval: -1.2 to 0.5; P = 0.44). Less DC patients experienced overall postoperative complications (44%/70%, P = 0.04). No effect on major postoperative or (chemo)radiotherapy complications or LOS was found. This study showed a lower prevalence of overall postoperative complications in HNC patients receiving DC but could not demonstrate an effect on weight loss, other complications, and LOS.
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Affiliation(s)
- Eva Leistra
- a Department of Nutrition and Dietetics, Internal Medicine , VU University Medical Center , Amsterdam , The Netherlands.,b Department of Nutrition and Dietetics, School of Sports and Nutrition , Amsterdam University of Applied Sciences , Amsterdam , The Netherlands
| | - Simone E J Eerenstein
- c Department of Otolaryngology/Head and Neck Surgery , VU University Medical Center , Amsterdam , The Netherlands
| | - Loes H van Aken
- a Department of Nutrition and Dietetics, Internal Medicine , VU University Medical Center , Amsterdam , The Netherlands
| | - Femke Jansen
- c Department of Otolaryngology/Head and Neck Surgery , VU University Medical Center , Amsterdam , The Netherlands
| | - Marian A E de van der Schueren
- a Department of Nutrition and Dietetics, Internal Medicine , VU University Medical Center , Amsterdam , The Netherlands.,d Department of Nutrition, Sports, and Health , HAN University of Applied Sciences , Nijmegen , The Netherlands
| | - Jos W R Twisk
- e Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research , VU University Medical Center , Amsterdam , The Netherlands
| | - Marjolein Visser
- e Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research , VU University Medical Center , Amsterdam , The Netherlands.,f Department of Health Sciences, Faculty of Earth and Life Sciences , VU University , Amsterdam , The Netherlands
| | - Jacqueline A E Langius
- a Department of Nutrition and Dietetics, Internal Medicine , VU University Medical Center , Amsterdam , The Netherlands.,g Academy of Health , The Hague University of Applied Sciences , The Hague , The Netherlands
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de van der Schueren M, Elia M, Gramlich L, Johnson MP, Lim SL, Philipson T, Jaferi A, Prado CM. Clinical and economic outcomes of nutrition interventions across the continuum of care. Ann N Y Acad Sci 2014; 1321:20-40. [PMID: 25123208 DOI: 10.1111/nyas.12498] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Optimal nutrition across the continuum of care plays a key role in the short- and long-term clinical and economic outcomes of patients. Worldwide, an estimated one-quarter to one-half of patients admitted to hospitals each year are malnourished. Malnutrition can increase healthcare costs by delaying patient recovery and rehabilitation and increasing the risk of medical complications. Nutrition interventions have the potential to provide cost-effective preventive care and treatment measures. However, limited data exist on the economics and impact evaluations of these interventions. In this report, nutrition and health system researchers, clinicians, economists, and policymakers discuss emerging global research on nutrition health economics, the role of nutrition interventions across the continuum of care, and how nutrition can affect healthcare costs in the context of hospital malnutrition.
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