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Zeng Q, Chen XJ, He YT, Ma ZM, Wu YX, Lin K. Body composition and metabolic syndrome in patients with type 1 diabetes. World J Diabetes 2024; 15:81-91. [PMID: 36636484 PMCID: PMC10835494 DOI: 10.4239/wjd.v15.i1.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/19/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND In recent years, the prevalence of obesity and metabolic syndrome in type 1 diabetes (T1DM) patients has gradually increased. Insulin resistance in T1DM deserves attention. It is necessary to clarify the relationship between body composition, metabolic syndrome and insulin resistance in T1DM to guide clinical treatment and intervention. AIM To assess body composition (BC) in T1DM patients and evaluate the relationship between BC, metabolic syndrome (MS), and insulin resistance in these indi-viduals. METHODS A total of 101 subjects with T1DM, aged 10 years or older, and with a disease duration of over 1 year were included. Bioelectrical impedance analysis using the Tsinghua-Tongfang BC Analyzer BCA-1B was employed to measure various BC parameters. Clinical and laboratory data were collected, and insulin resistance was calculated using the estimated glucose disposal rate (eGDR). RESULTS MS was diagnosed in 16/101 patients (15.84%), overweight in 16/101 patients (15.84%), obesity in 4/101 (3.96%), hypertension in 34/101 (33.66%%) and dyslipidemia in 16/101 patients (15.84%). Visceral fat index (VFI) and trunk fat mass were significantly and negatively correlated with eGDR (both P < 0.001). Female patients exhibited higher body fat percentage and visceral fat ratio compared to male patients. Binary logistic regression analysis revealed that significant factors for MS included eGDR [P = 0.017, odds ratio (OR) = 0.109], VFI (P = 0.030, OR = 3.529), and a family history of diabetes (P = 0.004, OR = 0.228). Significant factors for hypertension included eGDR (P < 0.001, OR = 0.488) and skeletal muscle mass (P = 0.003, OR = 1.111). Significant factors for dyslipidemia included trunk fat mass (P = 0.033, OR = 1.202) and eGDR (P = 0.037, OR = 0.708). CONCLUSION Visceral fat was found to be a superior predictor of MS compared to conventional measures such as body mass index and waist-to-hip ratio in Chinese individuals with T1DM. BC analysis, specifically identifying visceral fat (trunk fat), may play an important role in identifying the increased risk of MS in non-obese patients with T1DM.
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Affiliation(s)
- Qiong Zeng
- Department of Neurology, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Xiao-Jing Chen
- Medical College, Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Yi-Ting He
- Medical College, Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Ze-Ming Ma
- Medical College, Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Yi-Xi Wu
- Department of Endocrinology, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Kun Lin
- Department of Endocrinology, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
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Branco MG, Mateus C, Capelas ML, Pimenta N, Santos T, Mäkitie A, Ganhão-Arranhado S, Trabulo C, Ravasco P. Bioelectrical Impedance Analysis (BIA) for the Assessment of Body Composition in Oncology: A Scoping Review. Nutrients 2023; 15:4792. [PMID: 38004186 PMCID: PMC10675768 DOI: 10.3390/nu15224792] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Bioelectrical Impedance Analysis (BIA) is a reliable, non-invasive, objective, and cost-effective body composition assessment method, with high reproducibility. This scoping review aims to evaluate the current scientific and clinical evidence on BIA for body composition assessment in oncology patients, under active treatment. Literature search was conducted through MEDLINE, CINAHL, Scopus and Web of Science databases, following PRISMA-ScR Guidelines. Inclusion criteria comprised studies reporting the use of BIA for body composition evaluation in adults with cancer diagnosis. Studies including non-cancer pathology or only assessing nutritional status were excluded. This scoping review comprised a total of 36 studies: 25 were original studies including 18 prospective studies, six cross-sectional studies and one retrospective study and 11 were systematic reviews. Population size for the included original articles ranged from 18 to 1217 participants, comprising a total of 3015 patients with cancer with a mean baseline Body Mass Index (BMI) ranging from 20.3 to 30.0 kg/m2 and mean age ranging between 47 and 70 years. Review articles included a total of 273 studies, with a total of 78,350 participants. The current review considered studies reporting patients with head and neck cancer (HNC) (n = 8), breast cancer (BC) (n = 4), esophageal cancer (EC) (n = 2), liver cancer (n = 2), pancreatic cancer (PC) (n = 3), gastric cancer (GC) (n = 3), colorectal cancer (CRC) (n = 8), lung cancer (LC) (n = 1), skin cancer (SK) (n = 1) and multiple cancer types (n = 6). BIA is a suitable and valid method for the assessment of body composition in oncology. BIA-derived measures have shown good potential and relevant clinical value in preoperative risk evaluation, in the reduction of postoperative complications and hospital stay and as an important prognostic indicator in persons with cancer. Future research on the diagnostic value and clinical applications of BIA and BIA-derived phase angle (PhA) should be conducted in order to predict its impact on patient survival and other clinical outcomes.
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Affiliation(s)
- Mariana Garcia Branco
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
- Nutrition and Dietetics, Hospital de Cascais Dr. José de Almeida, 2755-009 Alcabideche, Portugal
| | - Carlota Mateus
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
| | - Manuel Luís Capelas
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (T.S.); (C.T.); (P.R.)
| | - Nuno Pimenta
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
- Polytechnic Institute of Santarém, Sport Sciences School of Rio Maior, 2040-413 Rio Maior, Portugal
- Interdisciplinary Centre for the Study of Human Performance, Faculdade de Motricidade Humana, Universidade de Lisboa, 1495-751 Lisbon, Portugal
| | - Teresa Santos
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (T.S.); (C.T.); (P.R.)
- Universidade Europeia, 1500-210 Lisbon, Portugal
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland;
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska University Hospital, Karolinska Institute, 17176 Stockholm, Sweden
| | - Susana Ganhão-Arranhado
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (C.M.); (M.L.C.); (N.P.); (S.G.-A.)
- Atlântica, Instituto Universitário, Fábrica da Pólvora de Barcarena, 2730-036 Barcarena, Portugal
- CINTESIS, Centre for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Carolina Trabulo
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (T.S.); (C.T.); (P.R.)
- Medical Oncology, Centro Hospitalar Barreiro-Montijo, 2830-003 Barreiro, Portugal
| | - Paula Ravasco
- Faculty of Health Sciences and Nursing, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal; (T.S.); (C.T.); (P.R.)
- Católica Medical School, Universidade Católica Portuguesa, 2635-631 Rio de Mouro, Portugal
- Centre for Interdisciplinary Research in Health Egas Moniz (CiiEM), 2829-511 Almada, Portugal
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Agrawal V, Subitha L, Medha R, Deepanjali S. Impact of nutrition status and body mass index on mortality in hospitalized general medical patients: A prospective observational study. Nutr Clin Pract 2022; 37:1316-1325. [PMID: 35932259 DOI: 10.1002/ncp.10896] [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: 04/12/2022] [Revised: 06/03/2022] [Accepted: 06/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malnutrition and low body mass index (BMI) are risk factors for mortality in hospitalized patients. Data substantiating this are unavailable for hospitalized general medical patients in our setting. We studied the prevalence of malnutrition among patients admitted to general medical wards in a tertiary care hospital and its role as a risk factor for 1-month mortality. We also investigated the association of BMI with mortality. METHODS In this prospective observational study, nutrition assessment using Subjective Global Assessment (SGA) and anthropometric measurements was performed in 395 hospitalized general medical patients. Charlson Comorbidity Index (CCI) and Modified Early Warning System (MEWS) score were calculated. Clinical course and vital status at 1 month after discharge was noted. Factors associated with mortality were identified using logistic regression. RESULTS The mean age of the study population was 46.2 + 16.1 years; 247 (62.5%) were males. Of 395 patients, 129 (32.7%) belonged to SGA A, 155 (39.2%) to SGA B, and 111 (28.1%) to SGA C. Mean (±SD) BMI was 23.38 (±5.33); 141 (35.6%) were obese. Mortality was observed in 61 (15.4%) patients. Patients in the lowest BMI quartile had the lowest mortality. The adjusted regression analysis showed that higher age and MEWS scores were independently associated with mortality. Severe malnourishment (SGA C) was another important predictor. Further, the odds of death increased consistently across the consecutive BMI quartiles. CONCLUSION Higher age, higher MEWS scores, severe malnourishment, and higher BMI scores were independent risk factors for 1-month mortality in hospitalized general medical patients.
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Affiliation(s)
- Vineet Agrawal
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Lakshminarayanan Subitha
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Rajappa Medha
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Surendran Deepanjali
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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4
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Löser A, Avanesov M, Thieme A, Gargioni E, Baehr A, Hintelmann K, Tribius S, Krüll A, Petersen C. Nutritional Status Impacts Quality of Life in Head and Neck Cancer Patients Undergoing (Chemo)Radiotherapy: Results from the Prospective HEADNUT Trial. Nutr Cancer 2022; 74:2887-2895. [PMID: 35209777 DOI: 10.1080/01635581.2022.2042571] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Malnutrition negatively impacts quality of life (QoL) in patients with head and neck cancer (HNC). This is the first prospective study to assess the impact of malnutrition (defined by the bioelectrical impedance analysis (BIA)-derived fat-free mass index) on QoL in patients with HNC undergoing (chemo)radiotherapy. Between October 2018 and October 2020, 58 HNC patients prospectively completed the QoL-questionnaires EORTC-QLQ-C30 and EORTC-QLQ-H&N35 at the beginning (tb) and at the end of (chemo)radiotherapy (te) as well as during follow-up (tf). At these time points, nutritional risk assessment (MUST, NRS-2002, Nutriscore), BIA measurement and laboratory testing was performed by a permanent study team. Differences between malnourished (n = 14) and well-nourished patients (n = 44) were observed in UICC classification (P < 0.001) and HPV status (P = 0.03). Well-nourished patients showed higher baseline hemoglobin (P = 0.025) and albumin (P = 0.005), but lower c-reactive protein levels (P < 0.001). At tb, mostly malnourished patients presented with worse QoL. Multivariable analysis showed that MUST, NRS-2002, HPV status, and UICC classification were related to QoL. Nutritional status has a crucial impact on QoL. The nutritional screening protocols MUST and NRS-2002 are suitable for identifying patients at risk and predicting QoL in patients with HNC undergoing (chemo)radiotherapy.
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Affiliation(s)
- Anastassia Löser
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Hamburg, Germany.,Department of Oncology, Hematology and Bone Marrow Transplantation with the Section Pneumology, Centre for Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Thieme
- Department of Medicine & Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Elisabetta Gargioni
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Baehr
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Hamburg, Germany
| | - Katharina Hintelmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Hamburg, Germany
| | - Silke Tribius
- Asklepios Hospital St. Georg, Hermann Holthusen Institute for Radiation Oncology, Hamburg, Germany
| | - Andreas Krüll
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Hamburg, Germany.,Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cordula Petersen
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Hamburg, Germany.,Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Patient-Generated Subjective Global Assessment (PG-SGA) predicts length of hospital stay in lung adenocarcinoma patients. Br J Nutr 2021; 127:1543-1548. [PMID: 34503589 PMCID: PMC9044215 DOI: 10.1017/s0007114521003500] [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] [Indexed: 11/17/2022]
Abstract
The prevalence of malnutrition is high among oncology patients in Northern China. Malnutrition is related to the longer hospital stay, and it can be used to predict the prognostic outcome of patients. This work focused on investigating the relationship of nutritional condition with the length of hospital stay (LOS) in Northern Chinese patients with lung adenocarcinoma (LUAD). The Patient-Generated Subjective Global Assessment (PG-SGA), Nutritional Risk Screening 2002 (NRS 2002) score, recent weight loss and BMI were assessed in a probabilistic sample of 389 LUAD patients without epidermal growth factor receptor (EGFR) mutations. This study collected the demographic and clinical features of patients in a prospective manner. Then, we examined the association of nutritional status with LOS among the population developing LUAD. According to the PG-SGA, 63 (16·3 %), 174 (44·7 %) and 78 (20·1 %) patients were at risk for undernutrition, moderate undernutrition and severe undernutrition, respectively. Nutritional risk was found in 141 (36·2 %) patients based on the NRS 2002. The average LOS for tumour patients in Northern China was 12·5 d. At admission, a risk of undernutrition or undernutrition according to the PG-SGA (P < 0·001), NRS 2002 (P < 0·001) and latest weight loss (P < 0·001) predicted the longer LOS. LOS was related to nutritional status and hospitalisation expenses (P < 0·001). LUAD patients who stayed in the ICU had a poorer nutritional status and a longer LOS (P < 0·001). In Northern Chinese patients with LUAD, a risk for undernutrition evaluated by the PG-SGA, the NRS 2002 and recent weight loss, but not BMI, could predict a longer LOS.
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The incorporation of body composition assessments as part of routine clinical care in a tertiary hospital's dietetic department. JBI Evid Implement 2021; 20:21-32. [DOI: 10.1097/xeb.0000000000000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fayssoil A, Chaffaut C, Prigent H, Laforet P, Clair B, Orlikowski D, Ogna A, Chevret S, Meng P, Annane D, Lofaso F, Crenn P. Nutritional status, swallowing disorders, and respiratory prognosis in adult Duchenne muscular dystrophy patients. Pediatr Pulmonol 2021; 56:2146-2154. [PMID: 33939888 DOI: 10.1002/ppul.25430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 03/16/2021] [Accepted: 04/12/2021] [Indexed: 11/08/2022]
Abstract
Malnutrition and swallowing disorders are common in Duchenne muscular dystrophy (DMD) patients. We assessed, in adult DMD with home mechanical ventilation (HMV) and cough assist device, its prevalence and the relationships with respiratory muscle strength and long-term respiratory prognosis. We reviewed the patients (n = 117, age 18-39 years [median 24]), followed in a reference center, from 2006 to 2015, to obtain clinical baseline, nutritional status, vital capacity (VC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). The median body mass index (BMI) was low (15.6 kg/m²). Included patients had severe restrictive respiratory function with a median VC of 10.5% [7-17] of the predicted value. All patients were on HMV. Prevalence of malnutrition, swallowing disorders, and gastrostomy were respectively 62%, 34%, and 11%. BMI and serum albumin level were significantly associated with MIP, MEP, and VC. The 1-year/5-years cumulative incidences of respiratory events (pulmonary sepsis and acute respiratory distress) were, respectively, 20.7%/44.5%. Using univariate analysis, predictive factors for respiratory events were swallowing disorders (p = .001), transthyretinemia (p = .034), MIP (p = .039), and MEP (p = .03) but not BMI or albuminemia. Using multivariate analysis, only swallowing disorders remained significantly associated with respiratory events (OR = 4.2, IC 95% 1.31-12.2, p = .01). In conclusion, this study highlights the interrelationships between nutritional intake, swallowing function, airway clearance, and respiratory function in adult DMD. A multidisciplinary approach focusing on these previous factors is essential to optimize DMD patient health.
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Affiliation(s)
- Abdallah Fayssoil
- Service de Médecine intensive et Réanimation/Unité de ventilation à domicile, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,CRMR des maladies neuromusculaires Nord-Est-Ile de France, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,Service de cardiologie, Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Hôpital Ambroise Paré, AP-HP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Boulogne-Billancourt, France.,Centre d'Investigation clinique (CIC) 1429 INSERM, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France
| | - Cendrine Chaffaut
- Service de Biostatistiques et Information Médicale (SBIM), Hôpital Saint Louis, APHP, Université Paris, Paris, France
| | - Helene Prigent
- CRMR des maladies neuromusculaires Nord-Est-Ile de France, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,Centre d'Investigation clinique (CIC) 1429 INSERM, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,Service de Physiologie-Explorations fonctionnelles, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France
| | - Pascal Laforet
- CRMR des maladies neuromusculaires Nord-Est-Ile de France, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,Centre d'Investigation clinique (CIC) 1429 INSERM, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,Service de Neurologie/Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France
| | - Bernard Clair
- Service de Médecine intensive et Réanimation/Unité de ventilation à domicile, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,CRMR des maladies neuromusculaires Nord-Est-Ile de France, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France
| | - David Orlikowski
- Service de Médecine intensive et Réanimation/Unité de ventilation à domicile, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,CRMR des maladies neuromusculaires Nord-Est-Ile de France, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,Centre d'Investigation clinique (CIC) 1429 INSERM, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France
| | - Adam Ogna
- Service de Médecine intensive et Réanimation/Unité de ventilation à domicile, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France
| | - Sylvie Chevret
- Service de Biostatistiques et Information Médicale (SBIM), Hôpital Saint Louis, APHP, Université Paris, Paris, France
| | - Paris Meng
- Service de Médecine intensive et Réanimation/Unité de ventilation à domicile, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France
| | - Djillali Annane
- Service de Médecine intensive et Réanimation/Unité de ventilation à domicile, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,CRMR des maladies neuromusculaires Nord-Est-Ile de France, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,Centre d'Investigation clinique (CIC) 1429 INSERM, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France
| | - Frederic Lofaso
- CRMR des maladies neuromusculaires Nord-Est-Ile de France, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,Centre d'Investigation clinique (CIC) 1429 INSERM, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,Service de Physiologie-Explorations fonctionnelles, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France
| | - Pascal Crenn
- CRMR des maladies neuromusculaires Nord-Est-Ile de France, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,Centre d'Investigation clinique (CIC) 1429 INSERM, Hôpital Raymond Poincaré, APHP, Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France.,Unité de Nutrition clinique transversale, Hôpital Raymond Poincaré, APHP Université Paris Saclay/UFR Simone Veil-Santé-Université de Versailles Saint Quentin en Yvelines, Garches, France
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8
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Jobber CJD, Wilkinson SA, Hughes EK, Nave F, van der Meij BS. Using the theoretical domains framework to inform strategies to support dietitians undertaking body composition assessments in routine clinical care. BMC Health Serv Res 2021; 21:518. [PMID: 34049555 PMCID: PMC8161923 DOI: 10.1186/s12913-021-06375-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/08/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Malnutrition, sarcopenia and cachexia are clinical wasting syndromes characterised by muscle loss. Systematic monitoring by body composition assessment (BCA) is recommended for the diagnosis, treatment and monitoring of the syndrome(s). This study investigated practices, competency, and attitudes of Australian dietitians regarding BCA, to inform a local implementation process. METHODS Applying the Action cycle in the Knowledge to Action framework, surveys were distributed to the 26 dietitians of an 800-bed tertiary hospital. The survey assessed barriers and enablers to performing routine BCA in clinical care. Results were categorised using the Theoretical Domains Framework (TDF) and suitable interventions mapped using the Behaviour Change Wheel. RESULTS Twenty-two dietitians (84.6%) completed the survey. Barriers to BCA were identified in all TDF domains, particularly in Knowledge, Skills, Social/professional role and identity, Beliefs about capabilities, and Environmental context and resources. Enablers existed in domains of: Skills; Beliefs about consequences; Goals; Environmental context and resources; Social influences; Intentions; Optimism; Reinforcement. CONCLUSIONS This study showed that hospital dietitians experience individual, team, and organisational barriers to adopt BCAs in clinical practice. We were able to formulate targeted implementation strategies to overcome these barriers to assist BCA adoption into routine practice.
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Affiliation(s)
- Chloe J D Jobber
- Department of Dietetics & Foodservices, Mater Health, South Brisbane, Queensland, Australia
| | - Shelley A Wilkinson
- Department of Dietetics & Foodservices, Mater Health, South Brisbane, Queensland, Australia. .,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, 4072, Australia. .,Nutrition & Dietetics, Mater Research Institute - The University of Queensland, Brisbane, Queensland, Australia.
| | - Elyssa K Hughes
- Department of Dietetics & Foodservices, Mater Health, South Brisbane, Queensland, Australia.,Department of Nutrition and Dietetics, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Fiona Nave
- Department of Dietetics & Foodservices, Mater Health, South Brisbane, Queensland, Australia
| | - Barbara S van der Meij
- Department of Dietetics & Foodservices, Mater Health, South Brisbane, Queensland, Australia.,Nutrition & Dietetics, Mater Research Institute - The University of Queensland, Brisbane, Queensland, Australia.,Bond University Nutrition and Dietetics Research Group, Gold Coast, Queensland, Australia
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Matthews L, Bates A, Wootton SA, Levett D. The use of bioelectrical impedance analysis to predict post-operative complications in adult patients having surgery for cancer: A systematic review. Clin Nutr 2021; 40:2914-2922. [PMID: 33962360 DOI: 10.1016/j.clnu.2021.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients undergoing surgery for cancer are at particular risk of post-operative complications. The pre-operative period is an opportunity to identify and mitigate risk factors and improve outcome. Bioelectrical impedance analysis (BIA) may offer an additional means of identifying patients at risk of post-operative morbidity. AIMS The aim of this systematic review was to assess the use of measures and estimates of body composition determined by BIA as markers of peri-operative risk in adult patients undergoing elective surgery for cancer. METHODS This review was performed in accordance with the PRISMA guidelines. The electronic databases of MEDLINE, EMBASE, CINAHL, CENTRAL and the Web of Science were searched from inception. Studies of adult participants having elective surgery for cancer were included if participants underwent BIA in the peri-operative period and were assessed for post-operative complications. RESULTS 2578 studies were identified, of which 12 were eligible for inclusion. In total the studies report data from 1508 subjects. Five studies examined phase angle or standardized phase angle, six examined derived measures and one examined both. Eight of the 12 demonstrated an association between phase angle and/or body composition and an increased risk of post-operative complications. CONCLUSIONS Bioelectrical impedance analysis in the peri-operative period may be useful in predicting the risk of complications following elective cancer surgery. Phase angle more consistently demonstrates an association than derived estimates. Further high quality studies are needed and should report the raw impedance values, standardized phase angle and the equations used to derive body composition.
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Affiliation(s)
- L Matthews
- Department of Perioperative Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK; University of Southampton, Southampton, UK.
| | - A Bates
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S A Wootton
- University of Southampton, Southampton, UK; National Institute for Health Research Cancer and Nutrition Collaboration, UK
| | - D Levett
- Department of Perioperative Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK; University of Southampton, Southampton, UK
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van Vliet IMY, Gomes-Neto AW, de Jong MFC, Bakker SJL, Jager-Wittenaar H, Navis GJ. Malnutrition screening on hospital admission: impact of overweight and obesity on comparative performance of MUST and PG-SGA SF. Eur J Clin Nutr 2021; 75:1398-1406. [PMID: 33589809 PMCID: PMC8416656 DOI: 10.1038/s41430-020-00848-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Traditional malnutrition screening instruments, including the Malnutrition Universal Screening Tool (MUST), strongly rely on low body mass index (BMI) and weight loss. In overweight/obese patients, this may result in underdetection of malnutrition risk. Alternative instruments, like the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), include characteristics and risk factors irrespective of BMI. Therefore, we aimed to compare performance of MUST and PG-SGA SF in malnutrition risk evaluation in overweight/obese hospitalized patients. SUBJECTS/METHODS We assessed malnutrition risk using MUST (≥1 = increased risk) and PG-SGA SF (≥4 = increased risk) in adult patients at hospital admission in a university hospital. We compared results for patients with BMI < 25 kg/m2 vs. BMI ≥ 25 kg/m2. RESULTS Of 430 patients analyzed (58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m2), 35% were overweight and 25% obese. Malnutrition risk was present in 16% according to MUST and 42% according to PG-SGA SF. In patients with BMI < 25 kg/m2, MUST identified 31% as at risk vs. 52% by PG-SGA SF. In patients with BMI ≥ 25 kg/m2, MUST identified 5% as at risk vs. 36% by PG-SGA SF. Agreement between MUST and PG-SGA SF was low (к = 0.143). Of the overweight/obese patients at risk according to PG-SGA SF, 83/92 (90%) were categorized as low risk by MUST. CONCLUSIONS More than one-third of overweight/obese patients is at risk for malnutrition at hospital admission according to PG-SGA SF. Most of them are not identified by MUST. Awareness of BMI-dependency of malnutrition screening instruments and potential underestimation of malnutrition risk in overweight/obese patients by using these instruments is warranted.
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Affiliation(s)
- Iris M Y van Vliet
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Antonio W Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Margriet F C de Jong
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Theilla M, Rattanachaiwong S, Kagan I, Rigler M, Bendavid I, Singer P. Validation of GLIM malnutrition criteria for diagnosis of malnutrition in ICU patients: An observational study. Clin Nutr 2020; 40:3578-3584. [PMID: 33413910 DOI: 10.1016/j.clnu.2020.12.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/25/2020] [Accepted: 12/15/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Patients in the Intensive Care Unit (ICU) are at high risk of malnutrition. The only validated malnutrition assessment tool is the Subjective Global Assessment (SGA). The Global Leadership Initiative on Malnutrition (GLIM) is a new malnutrition assessment tool. The present study compares the nutrition-related parameters of the following tools: GLIM tool, SGA, Phase Angle (PA), Low Fat-Free Mass Index (FFMI), and Patient- and Nutrition-Derived Outcome Risk Assessment score (PANDORA), in an attempt to validate an objective tool. METHODS Eighty-four ICU patients were included. The tools mentioned above were assessed for their validity in diagnosing malnutrition. All patients were defined as suffering from acute disease and received medical nutrition therapy. To evaluate whether there is a correlation between the GLIM criteria, SGA, PA, and low FFMI, we compared the SGA, PA, and low FFMI to the GLIM criteria using Spearman correlation coefficients and a Chi-square test. Also, a Mann-Whitney U test was used to test the mean differences between the GLIM criteria and the PANDORA. The area under the curve (AUC) of the proposed parameters was evaluated for diagnosis of malnutrition to seek cutoff points that yield good sensitivity and specificity. RESULTS Mean age was 50 ± 20 years, BMI 25.3 ± 5.1 kg/m2, APACHE II 20.5 ± 7.7, PANDORA score 32 ± 8.5. GLIM malnutrition criteria were significantly correlated with the gold standard SGA assessment and with low FFMI, with PA (Phase Angle), and with the PANDORA score. The area under the curve, by using the ROC curve analysis for GLIM criteria stratified by the SGA results, was 0.85 (P < 0.001). Sensitivity was 85%, and specificity 79%. However, when comparing the low FFMI, PA, and PANDORA to the GLIM criteria, the ROC curve analysis results were considered poor rank. CONCLUSIONS The SGA malnutrition assessment highly validated the GLIM criteria framework combined with the two-criteria diagnosis of malnutrition with a high level of precision. The GLIM malnutrition assessment seems to be acceptable in the ICU setting.
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Affiliation(s)
- Miriam Theilla
- Department of General Intensive Care and Institute for Nutrition Research, Israel; Nutrition Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Steyer School of Health Professions, Nursing Department, Sackler School of Medicine, Tel Aviv University, Israel.
| | - Sornwichate Rattanachaiwong
- Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Israel; Nutrition Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Merav Rigler
- Department of General Intensive Care and Institute for Nutrition Research, Israel; Nutrition Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Itai Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Israel; Nutrition Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Israel; Nutrition Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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12
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Dusseaux MM, Antoun S, Grigioni S, Béduneau G, Carpentier D, Girault C, Grange S, Tamion F. Skeletal muscle mass and adipose tissue alteration in critically ill patients. PLoS One 2019; 14:e0216991. [PMID: 31194755 PMCID: PMC6563951 DOI: 10.1371/journal.pone.0216991] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/02/2019] [Indexed: 12/13/2022] Open
Abstract
Background Increasing numbers of studies in chronic diseases have been published showing the relationship between body composition (BC) parameters (i.e. skeletal muscle mass (SMM) and adipose tissue (AT)) and outcomes. For patients admitted to intensive care unit (ICU), BC parameters have rarely been described as a prognostic marker of outcome. The primary objective was to evaluate the relationship between body composition at ICU admission and major clinical outcomes. Secondary objectives were to assess the relationship between BC parameters and other parameters (systemic inflammatory markers, Sequential Organ Failure Assessment (SOFA) score, albumin level) at ICU admission, and between BC alterations during ICU stay and outcomes. Patients and methods This retrospective study enrolled 25 adult patients who had two abdominal CT scans for clinical indication: first, within 48 hours of ICU admission (initial assessment), and second, 7 to 14 days later (late assessment). Skeletal Muscle radiodensity (SMD), cross-sectional area of SMM, Visceral Adipose Tissue (VAT) and Subcutaneous Adipose Tissue (SAT) were measured at the third lumbar vertebra. Cox regression analysis was used to determine the association between these parameters and mortality. Results Patients’ mean age was 64.6 years. Their mean BMI was 27.7 kg/m2 (SD = 6.0). ICU mortality was 36%. There was no correlation between BC parameters at initial assessment and ICU outcomes. We observed a negative correlation between SMM index and SOFA score at initial assessment (r = -0.458, p = 0.037). There was a significant loss of VAT between two CT assessments which was associated with mortality (-22.34cm2 / m2 in non-survivors versus -6.22 cm2 / m2 in survivors, p = 0.039). Loss of SMD was greater with the occurrence of an infection than without (Delta SMD = -5.642 vs +1.957, p = 0.04). Conclusions Our results show alterations in body composition during ICU stay with a loss of muscle quality (decreased SMD) and adipose tissue. These findings require confirmation in future studies but already show that BC assessments at ICU admission and BC alterations during ICU stay are important factors for outcome in critically ill patients.
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Affiliation(s)
| | - Sami Antoun
- Gustave Roussy Institute, Emergency Unit, Villejuif, France
| | - Sébastien Grigioni
- Normandie University, UNIROUEN, Inserm U 1073, Rouen University Hospital, Rouen, France
| | - Gaétan Béduneau
- Department of Intensive Care, Rouen University Hospital, Rouen, France
| | | | | | - Steven Grange
- Department of Intensive Care, Rouen University Hospital, Rouen, France
| | - Fabienne Tamion
- Normandie University, UNIROUEN, Inserm U 1096, Rouen University Hospital, Rouen, France
- * E-mail:
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Charette N, Vandeputte C, Ameye L, Bogaert CV, Krygier J, Guiot T, Deleporte A, Delaunoit T, Geboes K, Van Laethem JL, Peeters M, Demolin G, Holbrechts S, Flamen P, Paesmans M, Hendlisz A. Prognostic value of adipose tissue and muscle mass in advanced colorectal cancer: a post hoc analysis of two non-randomized phase II trials. BMC Cancer 2019; 19:134. [PMID: 30744591 PMCID: PMC6371452 DOI: 10.1186/s12885-019-5319-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/24/2019] [Indexed: 12/21/2022] Open
Abstract
Background The prognostic value of body composition in cancer patients has been widely studied during the last decade. The main finding of these studies is that sarcopenia, or skeletal muscle depletion, assessed by CT imaging correlates with a reduced overall survival (OS). By contrast, the prognostic value of fat mass remains ill-defined. This study aims to analyze the influence of body composition including both muscle mass and adipose tissue on OS in a homogeneous population of advanced colorectal cancer (CRC) patients. Methods Among 235 patients with chemorefractory advanced CRC included in the SoMore and RegARd-C trials, body composition was assessed in 217 patients on baseline CT images. The relationship between body composition (sarcopenia, muscle density, subcutaneous and visceral fat index and density), body mass index (BMI) and OS were evaluated. Results Patients with a higher BMI had a better OS (≥30 versus < 30, HR: 0.50; 0.33–0.76). Those with low muscle index and muscle density had an increased mortality (HR: 2.06; 1.45–2.93 and HR: 1.54; 1.09–2.18, respectively). Likewise, low subcutaneous and visceral fat index were associated with an increased risk of dying (HR: 1.63; 1.23–2.17 and 1.48; 1.09–2.02 respectively), as were a high subcutaneous and visceral adipose tissue density (HR: 1.93; 1.44–2.57 and 2.40; 1.79–3.20 respectively). In multivariate analysis, a high visceral fat density was the main predictor of poor survival. Conclusions Our results confirm the protective role of obesity in CRC patients at an advanced stage, as well as the negative prognostic impact of muscle depletion on survival. More importantly, our data show for the first time that visceral adipose tissue density is an important prognostic factor in metastatic CRC. Trial registration NCT01290926, 07/02/2011 and NCT01929616, 28/08/2013.
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Affiliation(s)
- Nicolas Charette
- Gastroenterology Department, Hôpital Civil Marie Curie, Charleroi, Belgium. .,Department of Gastroenterology, CHU de Charleroi, Hôpital Civil Marie Curie, Chaussée de Bruxelles, 140, 6042, Lodelinsart, Belgium.
| | - Caroline Vandeputte
- Gastro-Oncology translational laboratory, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lieveke Ameye
- Data centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Camille Van Bogaert
- Medical Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jonathan Krygier
- Medical Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thomas Guiot
- Nuclear Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Amélie Deleporte
- Medical Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Karen Geboes
- Service of digestive oncology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Jean-Luc Van Laethem
- Gastroenterology Medico-Surgical Department, Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marc Peeters
- Oncology department, Universitair Ziekenhuis Antwerpen, Antwerpen, Belgium
| | - Gauthier Demolin
- Gastroenterology Department, Centre Hospitalier Chrétien St-Joseph, Liège, Belgium
| | | | - Patrick Flamen
- Nuclear Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marianne Paesmans
- Data centre, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alain Hendlisz
- Medical Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
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14
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Bioelectrical impedance vector analysis as a useful predictor of nutritional status in patients with short bowel syndrome. Clin Nutr 2017; 36:1117-1121. [DOI: 10.1016/j.clnu.2016.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/15/2016] [Accepted: 07/19/2016] [Indexed: 01/19/2023]
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Sarangi SC, Tripathi M, Kakkar AK, Gupta YK. Comparison of body composition in persons with epilepsy on conventional & new antiepileptic drugs. Indian J Med Res 2017; 143:323-30. [PMID: 27241646 PMCID: PMC4892079 DOI: 10.4103/0971-5916.182623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND & OBJECTIVES Certain antiepileptic drugs (AEDs) such as valproic acid (VPA) are known to affect body weight, and lipid profile. However, evidences regarding effects of AEDs on the body composition are deficient. This cross-sectional study compared the body composition and lipid profile among patients with epilepsy on newer and conventional AEDs. METHODS The patients with epilepsy (n=109) on treatment with conventional and newer AEDs (levetiracetam, lamotrigine and clobazam) for > 6 months were enrolled. Of these, 70 were on monotherapy: levetiracetam (n=12), VPA (n=16), carbamazepine (n=20) and phenytoin (n=22) and the remaining on polytherapy. Their body composition [body fat mass, lean dry mass (LDM), total body water (TBW), intracellular water (ICW), extracellular water (ECW) and basal metabolic rate (BMR) was estimated and biochemical parameters were assessed. RESULTS Levetiracetam group had no significant difference with VPA, carbamazepine, phenytoin and control groups, except low LDM (17.8±2.4) than VPA groups (20.2±2.7, p<0.05). In comparison with control, AEDs monotherapy groups had no significant difference, except higher LDM and ECW in VPA group. Among groups based on conventional and newer AEDs, there was no significant difference in body composition parameters except for higher LDM (as % of BW) in conventional AEDs only treated group than control (p<0.01). INTERPRETATION & CONCLUSIONS The alterations observed in body composition with valproic acid in contrast to other AEDs like levetiracetam, carbamazepine and phenytoin could affect treatment response in epilepsy especially in subjects with already altered body composition status like obese and thin frail patients, which needs to be established by prospective studies (CTRI/2013/05/003701).
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Affiliation(s)
- Sudhir Chandra Sarangi
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi; Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Kumar Kakkar
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi; Department of Pharmacology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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Kyle UG, Earthman CP, Pichard C, Coss-Bu JA. Body composition during growth in children: limitations and perspectives of bioelectrical impedance analysis. Eur J Clin Nutr 2015; 69:1298-305. [DOI: 10.1038/ejcn.2015.86] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 02/13/2015] [Accepted: 03/16/2015] [Indexed: 01/10/2023]
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Cloetens L, Johansson-Persson A, Helgegren H, Landin-Olsson M, Uusitupa M, Åkesson B, Önning G. Assessment of body composition in subjects with metabolic syndrome comparing single-frequency bioelectrical impedance analysis and bioelectrical spectroscopy. Metab Syndr Relat Disord 2014; 13:91-8. [PMID: 25545543 DOI: 10.1089/met.2014.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the agreement between body composition measurements made with two methods-single-frequency bioelectrical impedance analysis (SF-BIA) and bioelectrical impedance spectroscopy (BIS). METHODS The body composition measurements using SF-BIA and BIS were performed seven times during 6 months on 41 patients (13 men and 28 women) with metabolic syndrome who were taking part in a dietary intervention study. RESULTS The mean [standard deviation (SD)] fat mass (FM) and median [interquartile range (IQR)] FM% measured with SF-BIA were 32.7 (6.7) kg and 36.3 (30.3-39.3)%, respectively, compared with 38.2 (8.7) kg and 40.9 (35.5-45.6)%, respectively, using BIS. The median (IQR) fat-free mass (FFM) was 60.0 (53.3-73.5) kg according to SF-BIA and 55.4 (48.8-66.5) kg according to BIS. These results obtained with the two methods were significantly different (P<0.001). Still highly significant correlations were found between the results obtained with SF-BIA and BIS for FM and FFM (all r≥0.89, P<0.001). Using Bland-Altman analysis, the bias was found to be -5.4 (4.1) kg for FM, -5.5 (3.7)% for FM%, and 5.4 (4.1) kg for FFM. Rather wide limits of agreement were found for FM, FM%, and FFM. CONCLUSION Body composition data obtained using SF-BIA and BIS in subjects with metabolic syndrome were highly correlated but not interchangeable. FM was systematically lower when using SF-BIA than when using BIS.
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Affiliation(s)
- Lieselotte Cloetens
- 1 Biomedical Nutrition, Department of Pure and Applied Biochemistry, Centre for Applied Life Sciences, Lund University , Lund, Sweden
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Body fat composition impacts the hematologic toxicities and pharmacokinetics of doxorubicin in Asian breast cancer patients. Breast Cancer Res Treat 2014; 144:143-52. [DOI: 10.1007/s10549-014-2843-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 01/15/2014] [Indexed: 01/01/2023]
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Matthie JR. Bioimpedance measurements of human body composition: critical analysis and outlook. Expert Rev Med Devices 2014; 5:239-61. [DOI: 10.1586/17434440.5.2.239] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Berstad P, Haugum B, Helgeland M, Bukholm I, Almendingen K. Preoperative body size and composition, habitual diet, and post-operative complications in elective colorectal cancer patients in Norway. J Hum Nutr Diet 2012. [PMID: 23190256 DOI: 10.1111/jhn.12002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Both malnutrition and obesity are related to worsened post-operative outcomes after colorectal surgery. Obese cancer patients may be malnourished as a result of short-term weight loss. The present study aimed to evaluate preoperative nutritional status, body composition and dietary intake related to post-operative complications (POC) and post-operative hospital days (POHD) in elective colorectal cancer (CRC) patients. METHODS Anthropometry, body composition measured by bioelectric spectroscopy and dietary habits assessed by a validated food-frequency questionnaire were examined in 100 newly-diagnosed CRC patients. Data from 30-day POC and POHD were collected from medical records. Nonparametric and chi-squared tests and logistic regression were used to analyse associations between body and dietary variables and post-operative outcome. RESULTS Twenty-nine patients had at least one POC. The median POHD was six. Body size and composition measures and short-term weight loss were no different between patients with and without POC, or between patients with POHD <7 and ≥7. Dietary variables were otherwise no different between patients with and without POC, although the median intake of marine n-3 polyunsaturated fatty acids (PUFA, the sum of eicosapentaenoic and docosahexaenoic acids) was significantly lower in patients with versus without POC (0.7 versus 1.2 g day(-1) , P = 0.04). CONCLUSIONS We found that preoperative body size, body composition and short-term weight loss were not related to 30-day post-operative outcomes in CRC patients. A high content of marine n-3 PUFA in preoperative habitual diets may protect against POC after CRC surgery.
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Affiliation(s)
- P Berstad
- Research Centre, Akershus University Hospital, Lørenskog, Norway.
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Abstract
Nutritional evaluation may predict clinical outcomes, such as hospital length of stay (LOS). We aimed to assess the value of nutritional risk and status methods, and to test standard anthropometry percentilesv.the 50th percentile threshold in predicting LOS, and to determine nutritional status changes during hospitalisation and their relation with LOS. In this longitudinal prospective study, 298 surgical patients were evaluated at admission and discharge. At admission, nutritional risk was assessed by Nutritional Risk Screening-2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST) and nutritional status by Subjective Global Assessment (SGA), involuntary % weight loss in the previous 6 months and anthropometric parameters; % weight loss and anthropometry were reassessed at discharge. At admission, risk/undernutrition results by NRS-2002 (P< 0·001), MUST (P< 0·001), % weight loss (P< 0·001) and SGA (P< 0·001) were predictive of longer LOS. A mid-arm circumference (MAC) or a mid-arm muscle circumference (MAMA) under the 15th and the 50th percentile, which was considered indicative of undernutrition, did predict longer LOS (P< 0·001); conversely, there was no association between depleted triceps skinfold (TSF) and longer LOS. In-hospital, there was a high prevalence of weight, muscle and fat losses, associated with longer LOS. At discharge, patients with a simultaneous negative variation in TSF+MAC+MAMA (n158, 53 %) had longer LOS than patients with a TSF+MAC+MAMA positive variation (11 (8–15)v.8 (7–12) d,P< 0·001). We concluded that at risk or undernutrition evaluated by all methods, except TSF and BMI, predicted a longer LOS. Moreover, MAC and MAMA measurements and their classification according to the 50th percentile threshold seem reliable undernutrition indicators.
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Lunardi AC, Miranda CS, Silva KM, Cecconello I, Carvalho CRF. Weakness of expiratory muscles and pulmonary complications in malnourished patients undergoing upper abdominal surgery. Respirology 2012; 17:108-13. [PMID: 21883675 DOI: 10.1111/j.1440-1843.2011.02049.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Malnutrition is prevalent in hospitalized patients and causes systemic damage including effects on the respiratory and immune systems, as well as predisposing to infection and increasing postoperative complications and mortality. This study aimed to assess the impact of malnutrition on the rate of postoperative pulmonary complications, respiratory muscle strength and chest wall expansion in patients undergoing elective upper abdominal surgery. METHODS Seventy-five consecutive candidates for upper abdominal surgery (39 in the malnourished group (MNG) and 36 in the control group (CG)) were enrolled in this prospective controlled cohort study. All patients were evaluated for nutritional status, respiratory muscle strength, chest wall expansion and lung function before surgery. Postoperative pulmonary complications (pneumonia, tracheobronchitis, atelectasis and acute respiratory failure) before discharge from hospital were also evaluated. RESULTS The MNG showed expiratory muscle weakness (MNG 65 ± 24 vs CG 82 ± 22 cm H(2) O; P < 0.001) and decreased chest wall expansion (P < 0.001), whereas inspiratory muscle strength and lung function were preserved (P > 0.05). The MNG also had a higher incidence of postoperative pulmonary complications compared with the CG (31% and 11%, respectively; P = 0.05). In addition, expiratory muscle weakness was correlated with BMI in the MNG (r = 0.43; P < 0.01). The association between malnutrition and expiratory muscle weakness increased the likelihood of postoperative pulmonary complications after upper abdominal surgery (P = 0.02). CONCLUSIONS These results show that malnutrition is associated with weakness of the expiratory muscles, decreased chest wall expansion and increased incidence of pulmonary complications in patients undergoing elective upper abdominal surgery.
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Affiliation(s)
- Adriana C Lunardi
- Department of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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Thibault R, Genton L, Pichard C. Body composition: why, when and for who? Clin Nutr 2012; 31:435-47. [PMID: 22296871 DOI: 10.1016/j.clnu.2011.12.011] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/21/2011] [Accepted: 12/19/2011] [Indexed: 12/22/2022]
Abstract
Body composition reflects nutritional intakes, losses and needs over time. Undernutrition, i.e. fat-free mass (FFM) loss, is associated with decreased survival, worse clinical outcome and quality of life, as well as increased therapy toxicity in cancer patients. In numerous clinical situations, such as sarcopenic obesity and chronic diseases, the measurement of body composition with available methods, such as dual-X ray absorptiometry, computerized tomography and bioelectrical impedance analysis, quantifies the loss of FFM, whereas body weight loss and body mass index only inconstantly reflect FFM loss. The measurement of body composition allows documenting the efficiency of nutrition support, tailoring the choice of disease-specific and nutritional therapies and evaluating their efficacy and putative toxicity. Easy-to-use body composition methods integrated to the routine of care allow sequential measurements for an initial nutritional assessment and objective patients follow-up. By allowing an earlier and objective management of undernutrition, body composition assessment could contribute to reduce undernutrition-induced morbidity, worsening of quality of life, and global health care costs by a timely nutrition intervention.
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Affiliation(s)
- Ronan Thibault
- Nutrition Unit, Geneva University Hospital, Geneva, Switzerland.
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Thibault R, Pichard C. The evaluation of body composition: a useful tool for clinical practice. ANNALS OF NUTRITION AND METABOLISM 2011; 60:6-16. [PMID: 22179189 DOI: 10.1159/000334879] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 11/07/2011] [Indexed: 12/22/2022]
Abstract
Undernutrition is insufficiently detected in in- and outpatients, and this is likely to worsen during the next decades. The increased prevalence of obesity together with chronic illnesses associated with fat-free mass (FFM) loss will result in an increased prevalence of sarcopenic obesity. In patients with sarcopenic obesity, weight loss and the body mass index lack accuracy to detect FFM loss. FFM loss is related to increasing mortality, worse clinical outcomes, and impaired quality of life. In sarcopenic obesity and chronic diseases, body composition measurement with dual-energy X-ray absorptiometry, bioelectrical impedance analysis, or computerized tomography quantifies the loss of FFM. It allows tailored nutritional support and disease-specific therapy and reduces the risk of drug toxicity. Body composition evaluation should be integrated into routine clinical practice for the initial assessment and sequential follow-up of nutritional status. It could allow objective, systematic, and early screening of undernutrition and promote the rational and early initiation of optimal nutritional support, thereby contributing to reducing malnutrition-induced morbidity, mortality, worsening of the quality of life, and global health care costs.
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Affiliation(s)
- Ronan Thibault
- Centre de Recherche en Nutrition Humaine Auvergne, UMR 1019 Nutrition Humaine, INRA, Clermont Université, Service de Nutrition Clinique, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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Body fat and fat-free mass measured by bioelectric impedance spectroscopy and dual-energy X-ray absorptiometry in obese and non-obese adults. Br J Nutr 2011; 107:1192-200. [PMID: 21878141 DOI: 10.1017/s000711451100417x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of the present study was to compare body fat mass (FM) and fat-free mass (FFM) estimates by bioelectric impedance spectroscopy (BIS), with respective estimates by dual-energy X-ray absorptiometry (DXA), in obese and non-obese subjects. Body composition was measured in ninety-three obese and non-obese men and women by BIS device, BodyScout (Fresenius Kabi, Bad Homburg, Germany) and DXA device, Lunar iDXA (GE Healthcare, Madison, WI, USA). Mean difference between the methods was analysed by t tests, and Bland-Altman plots were generated to further examine the differences between the methods. Mean difference between the estimates by DXA and BIS (ΔDXA - BIS and Bland-Altman 95 % limits of agreement) were as follows: FM 4·1 ( - 2·9, 11·2) kg and 4·5 ( - 2·9, 11·8) %, FFM - 4·1 ( - 11·2, 2·9) kg and - 4·5 ( - 11·9, 2·9) %, indicating large inter-individual variation and statistically significant underestimation of FM and overestimation of FFM by BIS, as compared to DXA. The underestimation of FMkg (FM measured in kg) and overestimation of FFMkg (FFM measured in kg) were more pronounced in men than in women, and the underestimation of FM% (FM measured in percent) and overestimation of FFM% (FFM measured in percent) were more pronounced in normal weight (BMI = 20·0-24·9 kg/m2) than in overweight and obese (BMI ≥ 25·0 kg/m2) subjects. BIS may be suitable for classification of a population into groups according to FM and FFM. However, the large inter-individual variation suggests that this BIS device with the proprietary software is insufficient for estimation of single individual body FM and FFM.
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Graf CE, Zekry D, Giannelli S, Michel JP, Chevalley T. Efficiency and applicability of comprehensive geriatric assessment in the emergency department: a systematic review. Aging Clin Exp Res 2011; 23:244-54. [PMID: 20930499 DOI: 10.1007/bf03337751] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Comprehensive geriatric assessment (CGA) may benefit frail or chronically ill patients in the emergency department (ED), but take too much time to be performed routinely in ED. An alternative approach is to use first a screening tool to detect high-risk patients and then perform CGA in these patients only. This systematic review focuses on the use and value of CGA in ED for evaluation of older patients and its influence on adverse outcomes. This approach is compared with an alternative one using existing screening tools, validated in ED, to detect high-risk patients needing subsequent CGA. This review ends by suggesting a short assessment of CGA to be used in ED and ways to improve home discharge management from ED. METHODS A systematic English Medline literature search was conducted in December 2009, with no date limit with the following Medical Subject Heading (MeSH) terms: "Frail Elderly", "Health Services for Aged", "Community Health Nursing", "Emergency Service, Hospital", "Geriatric Assessment", "Patient Discharge", "Risk Assessment" and "Triage". RESULTS We selected 8 studies on CGA efficiency and 14 on screening tools. CGA in ED is efficient for decreasing functional decline, ED readmission and possibly nursing home admission in high-risk patients. As CGA takes too much time to be performed routinely in ED, validated screening tools can be applied to detect high-risk patients who will benefit most from CGA. CONCLUSIONS The selected studies demonstrated that screening of high-risk patients is more efficient than age-based screening, and that CGA performed in ED, followed by appropriate interventions, improves outcomes.
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Affiliation(s)
- Christophe E Graf
- Rehabilitation and Geriatrics Department, Geneva University Hospitals, 3, chemin du Pont-Bochet, Thônex, Switzerland.
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Kim CH, Chung S, Kim H, Park JH, Park SH, Ji JW, Han SW, Lee JC, Kim JH, Park YB, Nam HS, Kim C. Norm references of fat-free mass index and fat mass index and subtypes of obesity based on the combined FFMI–%BF indices in the Korean adults aged 18–89yr. Obes Res Clin Pract 2011; 5:e169-266. [DOI: 10.1016/j.orcp.2011.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 01/25/2011] [Accepted: 01/25/2011] [Indexed: 10/18/2022]
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Guest JF, Panca M, Baeyens JP, de Man F, Ljungqvist O, Pichard C, Wait S, Wilson L. Health economic impact of managing patients following a community-based diagnosis of malnutrition in the UK. Clin Nutr 2011; 30:422-9. [PMID: 21406315 DOI: 10.1016/j.clnu.2011.02.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 02/04/2011] [Accepted: 02/09/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS To examine the effect of malnutrition on clinical outcomes and healthcare resource use from initial diagnosis by a general practitioner (GP) in the UK. METHODS 1000 records of malnourished patients were randomly selected from The Health Improvement Network database and matched with a sample of 996 patients' records with no previous history of malnutrition. Patients' outcomes and resource use were quantified for six months following diagnosis. RESULTS Malnourished patients utilised significantly more healthcare resources (e.g. 18.90 versus 9.12 GP consultations; p < 0.001, and 13% versus 5% were hospitalised; p < 0.05). The six-monthly cost of managing the malnourished and non-malnourished group was £1753 and £750 per patient respectively, generating an incremental cost of care following a diagnosis of malnutrition of £1003 per patient. Thirteen percent and 2% of patients died in the malnourished and non-malnourished group respectively (p < 0.001). Independent predictors of mortality were: malnutrition (OR: 7.70); age (per 10 years) (OR: 10.46); and the Charlson Comorbidity Index Score (per unit score) (OR: 1.24). CONCLUSION The healthcare cost of managing malnourished patients was more than twice that of managing non-malnourished patients, due to increased use of healthcare resources. After adjusting for age and comorbidity, malnutrition remained an independent predictor of mortality.
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Affiliation(s)
- Julian F Guest
- Catalyst Health Economics Consultants, Northwood, Middlesex, UK.
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Bouillanne O, Hay P, Liabaud B, Duché C, Cynober L, Aussel C. Evidence that albumin is not a suitable marker of body composition-related nutritional status in elderly patients. Nutrition 2011; 27:165-9. [DOI: 10.1016/j.nut.2009.12.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 12/23/2009] [Accepted: 12/23/2009] [Indexed: 11/26/2022]
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Jager-Wittenaar H, Dijkstra PU, Vissink A, Langendijk JA, van der Laan BFAM, Pruim J, Roodenburg JLN. Changes in nutritional status and dietary intake during and after head and neck cancer treatment. Head Neck 2010; 33:863-70. [PMID: 20737491 DOI: 10.1002/hed.21546] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2010] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to test whether nutritional status of patients with head and neck cancer changes during and after treatment. METHODS Nutritional status (including body weight, lean mass, and fat mass) and dietary intake were assessed in 29 patients with head and neck cancer. Patients were assessed 1 week before, and 1 and 4 months after treatment (radiotherapy, either alone or combined with chemotherapy or surgery). RESULTS During treatment, body weight (-3.6 ± 5.3 kg; p = .019) and lean mass (-2.43 ± 2.81 kg; p = .001) significantly declined. Patients with sufficient intake (≥35 kcal and ≥1.5 grams protein/kg body weight) lost less body weight and lean mass than patients with insufficient intake (mean difference, -4.0 ± 1.9 kg; p = 0.048 and -2.1 ± 1.0 kg; p = .054, respectively). After treatment, only patients with sufficient intake gained body weight (2.3 ± 2.3 kg) and lean mass (1.2 ± 1.3 kg). CONCLUSION Patients with head and neck cancer fail to maintain or improve nutritional status during treatment, despite sufficient intake.
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Affiliation(s)
- Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Post Office Box 30001, 9700 RB Groningen, The Netherlands.
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Heersink JT, Brown CJ, Dimaria-Ghalili RA, Locher JL. Undernutrition in hospitalized older adults: patterns and correlates, outcomes, and opportunities for intervention with a focus on processes of care. ACTA ACUST UNITED AC 2010; 29:4-41. [PMID: 20391041 DOI: 10.1080/01639360903574585] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Undernutrition in hospitalized older adults is increasingly being recognized as a serious problem with implications for both patient care and outcomes and health service utilization and costs. This article presents an overview of research that has been conducted examining undernutrition in hospitalized older adults. First, findings from observational studies examining patterns and predictors of undernutrition in hospitalized older adults will be described, with a focus on methodological challenges. Second, clinical outcomes and costs associated with undernutrition in hospitalized older adults will be presented, both while in the hospital and subsequent to discharge. Third, a description of interventions that have already been implemented in hospitalized older adults will be described. Finally, future areas of inquiry and opportunities for evidence-based nutritional interventions targeted at older adults during and following hospitalization will be suggested. The emphasis of the discussion on interventions will focus on processes of care and the hospital environment.
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Affiliation(s)
- Juanita Titrud Heersink
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-2041, USA
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Peterson SJ, Tsai AA, Scala CM, Sowa DC, Sheean PM, Braunschweig CL. Adequacy of oral intake in critically ill patients 1 week after extubation. ACTA ACUST UNITED AC 2010; 110:427-33. [PMID: 20184993 DOI: 10.1016/j.jada.2009.11.020] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 09/04/2009] [Indexed: 01/08/2023]
Abstract
Hospital malnutrition is associated with increased morbidity and mortality, particularly among patients admitted to intensive care units (ICUs). The purpose of this observational study (August to November 2007) was to examine the adequacy of oral intake and to identify predictors of oral intake after ICU patients were removed from invasive mechanical ventilation. Patients aged > or = 18 years who required mechanical ventilation for at least 24 hours, advanced to an oral diet postextubation, and did not require supplemental enteral or parenteral nutrition were included. The first 7 days of oral intake after extubation were assessed via modified multiple-pass 24-hour recall and the numbers of days on therapeutic diets and reasons for decreased intake were collected. Oral intake <75% of daily requirements was considered inadequate. Descriptive statistics, chi2, Student t tests, and logistic regression analyses were conducted. Of the 64 patients who met eligibility criteria, 50 were included. Of these 50 patients, 54% were women and intubated for 5.2 days, with a mean age of 59.1 years, body mass index of 28.7, and Acute Physiology and Chronic Health Evaluation II score of 21.9. Subjective Global Assessment determined 44% were malnourished upon admission to the ICU. The average daily energy and protein intake failed to exceed 50% of daily requirements on all 7 days for the entire population. The majority of patients who consumed <75% of daily requirements were prescribed a therapeutic diet and/or identified "no appetite" and nausea/vomiting as the barriers to eating. Although more research is needed, these data call into question the use of restrictive oral diets and suggest that alternative medical nutrition therapies are needed to optimize nutrient intake in this unique patient population.
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Carlsson M, Gustafson Y, Eriksson S, Håglin L. Body composition in Swedish old people aged 65–99 years, living in residential care facilities. Arch Gerontol Geriatr 2009; 49:98-107. [DOI: 10.1016/j.archger.2008.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Revised: 05/22/2008] [Accepted: 05/26/2008] [Indexed: 12/20/2022]
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How important is malnutrition? A prospective study in internal medicine. Eur J Clin Nutr 2007; 63:430-6. [PMID: 17987052 DOI: 10.1038/sj.ejcn.1602948] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND/OBJECTIVE Data about the prevalence of malnutrition on hospital admission vary and follow-up data are scarce. We assessed the nutritional status of unselected patients on admission and discharge. SUBJECTS/METHODS A total of 430 consecutively admitted patients were assessed and 168 patients hospitalized > or =6 days were reassessed on discharge. Assessment was carried out by the Mini Nutritional Assessment (MNA), weight and anthropometric measurements, bioelectrical impedance analysis, biochemical markers and a subjective clinical assessment by the physicians in charge. RESULTS On admission, 47% of all patients were overweight (body mass index, BMI >25 kg m(-2)) and 8% underweight (BMI<18.5 kg m(-2)). In terms of the MNA 70% were adequately nourished, 20% were at risk for malnutrition and 10% were malnourished. By clinical judgment alone 18 (4.3%) malnourished patients according to MNA were missed. The 44 malnourished patients according to the MNA had significantly lower values for BMI, fat-free mass, fat mass, waist circumference, triceps skinfold thickness, hemoglobin, albumin, prealbumin, total cholesterol but higher values for C-reactive protein. Of the 168 patients staying > or =6 days in hospital, 57% lost and 39% gained weight. Only 1.9% of all patients (8 of 430) were malnourished and lost further weight during hospitalization. CONCLUSIONS We found a low prevalence (10%) of malnourished patients on admission. Clinical judgment and to some extent anthropometrical measurement were helpful for assessing the nutritional status, laboratory values were not.
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Yucel O, Erol N. Preoperative nutritional parameters in children with congenital heart diseases under two years of age. Ann Saudi Med 2007; 27:461-2. [PMID: 18059125 PMCID: PMC6074164 DOI: 10.5144/0256-4947.2007.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Oya Yucel
- School of Health Sciences, Sakarya University, Sakarya, Turkey
| | - Nurdan Erol
- Haydarpaþa Numune Training and Research Hospital, Istanbul, Turkey
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Kyle UG, Kossovsky MP, Genton L, Pichard C. Overweight and obesity in a Swiss city: 10-year trends. Public Health Nutr 2007; 10:914-9. [PMID: 17381938 DOI: 10.1017/s136898000765798x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractBackgroundIncreased rates of overweight/obesity have been reported in recent years in developed countries. This population study of healthy subjects evaluated the changes in overweight/obesity prevalence in 2003, compared with 1993, and determined the association of age, sex and leisure-time activity with body mass index (BMI), fat-free mass index (FFMI) and fat mass index (FMI).DesignTwo transversal samples of convenience.ParticipantsHealthy volunteers (1993, n = 802; 2003, n = 1631).MethodsFat-free mass was determined using the bioelectrical impedance multiple regression equation. Multivariable linear regression, including confounding variables (age, sex, leisure-time activity), was used to model the body composition evolution between the 1993 and the 2003 subjects.ResultsBMI and FMI were higher in 2003 than in 1993, P < 0.001. FFMI was not higher in 2003 than in 1993, P = 0.38. More subjects were overweight/obese in 2003 than in 1993 (27.5 versus 17.2%, chi-square P < 0.001), and had a high FFMI (30.2 versus 21.8%, chi-square P < 0.001) and high FMI (28.0 versus 20.3%, chi-square P < 0.001). Multivariate linear regressions showed that leisure-time activity was negatively, and sex, age and inclusion year were positively associated with BMI, FFMI and FMI (the exception was a negative association with sex) (P < 0.001).ConclusionOverweight prevalence increased between 1993 and 2003 in a Swiss city, and was associated with a higher fat mass. This observation remained statistically significant after adjustment for age, sex and leisure-time activity.
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Affiliation(s)
- Ursula G Kyle
- Clinical Nutrition, Geneva University Hospital, 1211 Geneva, Switzerland
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Suesada MM, Martins MA, Carvalho CRF. Effect of short-term hospitalization on functional capacity in patients not restricted to bed. Am J Phys Med Rehabil 2007; 86:455-62. [PMID: 17515684 DOI: 10.1097/phm.0b013e31805b7566] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE It has been suggested that long-term bed rest induces significant changes in most organ systems. However, few studies have focused on the effect of short-term hospitalization. The aim of the present study was to evaluate the effect of short-term hospitalization on functional capacity in patients not restricted to bed. DESIGN We evaluated 78 patients before and after a 5-day hospitalization. RESULTS The following differences were observed between pre- and post-hospitalization outcomes: upper-limb muscle strength, 30 +/- 7.9 vs. 28.4 +/- 7.7 kg (P < 0.001); maximal inspiratory pressure, -83.3 +/- 25.0 vs. -70.9 +/- 23.1 cm H2O (P < 0.001); distance covered in the 6-min walk test, 476.2 +/- 93.1 vs. 437.7 +/- 89.5 m (P < 0.001); forced vital capacity, 3.25 +/- 0.95 vs. 2.95 +/- 0.93 liters (P < 0.001); spinal mobility, 4.3 +/- 0.9 vs. 3.7 +/- 0.9 cm (P < 0.001); and trunk mobility, 8.1 +/- 1.9 vs. 7.3 +/- 1.6 cm (P < 0.001). None of the anthropometric or clinical data collected at admission were predictive of these losses. CONCLUSION Our results suggest that short-term hospitalization reduces functional capacity, even in patients who are not restricted to bed, regardless of age or initial functional status.
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Affiliation(s)
- Milena M Suesada
- Department of Physical Therapy, University of Sao Paulo School of Medicine, Av. Dr. Arnaldo 455, 01256-903 Sao Paulo, SP, Brazil
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Hassen TA, Pearson S, Cowled PA, Fitridge RA. Preoperative Nutritional Status Predicts the Severity of the Systemic Inflammatory Response Syndrome (SIRS) Following Major Vascular Surgery. Eur J Vasc Endovasc Surg 2007; 33:696-702. [PMID: 17276097 DOI: 10.1016/j.ejvs.2006.12.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 12/03/2006] [Indexed: 01/19/2023]
Abstract
OBJECTIVES This study examined the relationship between pre-operative nutritional status and systemic inflammatory response syndrome (SIRS) or sepsis following major vascular surgery. DESIGN AND METHODS Subjects undergoing open AAA repair, EVAR or lower limb revascularisation were studied prospectively. Pre-operative nutrition was assessed clinically using Mini-Nutritional Assessment (MNA) and body composition was measured by dual energy X-ray absorptiometry (DEXA) scanning. SIRS severity was assessed for 5 post-operative days and sepsis noted within 30 days of surgery. RESULTS Using MNA, neither SIRS severity nor sepsis occurrence differed significantly between 'well-nourished' subjects and those 'at risk of malnutrition'. Using DEXA, negative associations existed between body mass index and both SIRS score and SIRS duration. Fat free mass (FFM) was negatively associated with SIRS score and duration. Negative associations also existed between skeletal muscle mass (SMM) and SIRS score and duration. SMM was also negatively correlated with post-operative length of stay in hospital. There were no significant correlations between sepsis and any nutritional indices. CONCLUSIONS Lower pre-operative nutritional indices, indicating protein energy malnutrition, were associated with more severe systemic inflammatory responses following major vascular surgery.
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Affiliation(s)
- T A Hassen
- Discipline of Surgery, School of Medicine, The University of Adelaide, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
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Alemán-Mateo H, Huerta RH, Esparza-Romero J, Méndez RO, Urquidez R, Valencia ME. Body composition by the four-compartment model: validity of the BOD POD for assessing body fat in mexican elderly. Eur J Clin Nutr 2007; 61:830-6. [PMID: 17228350 DOI: 10.1038/sj.ejcn.1602597] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aims of this study were to validate BOD POD in a wide sample of healthy and independent Mexican elderly men and women subjects using the 4 compartment (4C) model as the reference method, and to evaluate the assumptions of the densitometric two-compartment (2C) model. DESIGN Cross-sectional study designed to assess body composition and validation of a method based on 2C model (BOD POD). SETTING Urban and rural regions of Sonora, Mexico. SUBJECTS Two hundred and two free-living subjects >or=60 years old were completed in this study. METHODS Body density and body fat were measured by the BOD POD, total body water by deuterium dilution and total body bone ash by dual energy X-ray absorptiometry. Body composition was determined using Baumgartner's equation. RESULTS Percent body fat by the 4C model was 31.2 and 42.5% in men and women, respectively (P<0.001). Group mean accuracy of body fat by BOD POD against that of the 4C model showed an effect of sex (P<0.001), but not the method (P=0.27). Results of individual accuracy showed no significant difference with the identity line and the slope was significantly different from zero or a slope similar to one. Precision assessed by model R (2) was high for all subjects and for men and women by separate. The standard error of the estimate was low for all and for men and women by separate. Bland and Altman analysis showed no significant bias. CONCLUSION The BOD POD technique is a valid and reliable method compared to the 4C model and it could be applied in subjects with similar physical and anthropometric characteristics to subjects of this study.
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Affiliation(s)
- H Alemán-Mateo
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, A C, Hermosillo, Sonora, México.
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Cosquéric G, Sebag A, Ducolombier C, Thomas C, Piette F, Weill-Engerer S. Sarcopenia is predictive of nosocomial infection in care of the elderly. Br J Nutr 2007; 96:895-901. [PMID: 17092379 DOI: 10.1017/bjn20061943] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Protein-energy malnutrition and nosocomial infection (NI) are frequent in elderly patients, and a causal link between the two has often been suggested. The aim of the present study was to identify the nutritional parameters predictive of NI in elderly patients. We assessed on admission 101 patients (sixty-six women, thirty-five men, aged over 65 years) admitted to an acute care of the elderly department. Sarcopenia was detected by dual-energy X-ray absorptiometry, with appendicular skeletal muscle mass expressed with respect to body area. Weight, BMI, albuminaemia, serum transthyretin and C-reactive protein values were also determined on admission, and known risk factors, such as functional dependence and invasive biomedical material, were also evaluated. After up to 3 weeks of hospitalisation, patients were classified according to whether they had developed an NI. After 3 weeks of hospitalisation, we found that twenty-nine patients had suffered an NI, occurring after a mean of 16.1 d. Patients who were sarcopenic on admission had a significantly higher risk of contracting an NI (relative risk 2.1, 95 % CI 1.1, 3.8). None of the other morphometric or biological parameters differed significantly between the two groups of patients on admission. Patients who experienced an NI were also more likely, on admission, to have a medical device (P=0.02 to P=0.001 depending on the device), to have swallowing problems (P=0.002) or to have restricted autonomy (P<0.01). Sarcopenia on admission to an acute care of the elderly unit, as measured by X-ray absorptiometry, was therefore associated with a doubled risk of NI during the first 3 weeks of hospitalisation.
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Affiliation(s)
- Gaëlle Cosquéric
- Service de Gériatrie, Hôpital Rothschild, Assistance Publique - Hôpitaux de Paris, Paris, France
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Itobi E, Stroud M, Elia M. Impact of oedema on recovery after major abdominal surgery and potential value of multifrequency bioimpedance measurements. Br J Surg 2006; 93:354-61. [PMID: 16463271 DOI: 10.1002/bjs.5259] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abstract
Background
The consequences of generalized oedema following major abdominal surgery are under-recognized, and its causes are poorly understood.
Methods
Thirty-eight patients (21 men and 17 women) were observed for the occurrence of oedema after major abdominal surgery. Oedema formation was related to fluid balance, changes in whole-body bioimpedance (Z) measured at four frequencies (5, 50, 100 and 200 kHz), and clinical outcome.
Results
The 20 patients who developed oedema were older than those who did not (mean(s.d.) 73(9) versus 63(14) years; P = 0·007). Fluid intake over the first 5 days after surgery was similar in both groups, but those with oedema excreted less total fluid (16·9(2·4) versus 19·7(3·5) litres; P = 0·022). Oedema was associated with a delay in tolerating solid food (P = 0·001) and opening bowels (P = 0·020), a prolonged hospital stay (median 17 (range 8–59) versus 9 (range 4–27) days; P = 0·001) and more postoperative complications (13 of 20 versus four of 18 patients; P = 0·011). The preoperative ratio of whole-body impedance at 200 kHz to that at 5 kHz was higher in those who subsequently developed oedema (0·81(0·03) versus 0·78(0·02); P = 0·015).
Conclusion
The development of oedema after major abdominal surgery is associated with increased morbidity. Age and reduced ability to excrete administered fluid load are significant aetiological factors and bioimpedance analysis can potentially identify patients at risk.
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Affiliation(s)
- E Itobi
- Department of Surgery, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
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Martín Peña G, Gómez Candela C, de Cos Blanco AI, Cabré Gelada E. Valoración nutricional de los pacientes ingresados en hospitales de España. Med Clin (Barc) 2005; 125:534-42. [PMID: 16266638 DOI: 10.1157/13080459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Gonzalo Martín Peña
- Junta Directiva de la Sociedad Española de Nutrición Básica y Aplicada, Spain.
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Kyle UG, Pirlich M, Lochs H, Schuetz T, Pichard C. Increased length of hospital stay in underweight and overweight patients at hospital admission: a controlled population study. Clin Nutr 2005; 24:133-42. [PMID: 15681111 DOI: 10.1016/j.clnu.2004.08.012] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2004] [Accepted: 08/16/2004] [Indexed: 01/15/2023]
Abstract
BACKGROUND Reduced lean tissue as well as high fat mass may be independent nutritional risk factors resulting in increased length of hospital stay (LOS). This controlled population study (1707 patients, 1707 volunteers) aimed to evaluate the association between LOS in Geneva and Berlin patients at hospital admission and high fat mass index (FMI, kg/m2) and low fat-free mass index (FFMI, kg/m2), and the respective value of body mass index (BMI) and of FFMI and FMI for nutritional assessment. METHODS Patients (891 men, 816 women) were prospectively recruited at hospital admission and compared to gender-, age- and height-matched healthy volunteers. Fat-free mass and fat mass, determined at admission by 50 kHz-bioelectrical impedance analysis, were expressed as indices (FFMI and FMI-kg/m2) to normalize for height. Patients were classified in four groups: normal, low FFMI, high FMI, or low FFMI and high FMI. Logistic regressions were used to determine the association between body composition and LOS. RESULTS Higher FMI and lower FFMI were found in patients at hospital admission than in sex- and age-matched healthy volunteers. Low FFMI, high FMI, and low FFMI/high FMI combined, adjusted for age, were all significantly associated with longer LOS (high FFMI: 1-5 days OR 2.4, CI 2.0-2.9; 6-10 days OR 2.3, CI 1.8-3.0; 11 days OR 2.8, CI 2.2-3.5); low FMI: 1-5 days OR 1.9, CI 1.6-2.2; 6-10 days OR 2.7, CI 2.0-3.5, 11 days OR 2.1, CI 1.7-2.7; low FFMI/high FMI: 1-5 days OR 7.8, CI 5.3-11.4; 6-10 days OR 13.6, CI 7.8-23.5, 11 days OR 11.8, CI 7.0-19.8). CONCLUSION Increased LOS is associated with adiposity (high FMI) and low muscle mass (low FFMI). The current study shows that both depletion of lean tissue and excess of fat mass negatively affect the LOS. Finally, we found that excess fat mass reduces the sensitivity of BMI to detect nutritional depletion.
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Affiliation(s)
- Ursula G Kyle
- Clinical Nutrition, Geneva University Hospital, 1211 Geneva, Switzerland
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Rapp-Kesek D, Ståhle E, Karlsson TT. Body mass index and albumin in the preoperative evaluation of cardiac surgery patients. Clin Nutr 2004; 23:1398-404. [PMID: 15556262 DOI: 10.1016/j.clnu.2004.06.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Accepted: 06/11/2004] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS An increasing proportion of cardiac surgery is performed in the elderly where nutritional status is an important predictor of outcome. Our aim was to evaluate serum albumin concentration (S-albumin) and body mass index (BMI) as markers of malnutrition in relation to outcome measured as mortality and frequency of infections. PATIENTS AND METHODS We studied 886 consecutive patients who underwent cardiac surgery with extra-corporeal circulation for valve procedures, coronary artery bypass grafting or a combination of those. Preoperative assessment included age, gender, BMI, smoking habits, diabetes, left-ventricular function, S-albumin and C-reactive protein. Postoperative data was type of surgery, in-hospital stay, signs of infections and mortality. Risk factors for mortality were identified using the Cox proportional hazard model and risk factors for infections by using the logistic-regression model. RESULTS The patients (age 67+/-9.5 years) were followed for 22+/-6 months. In an univariate analysis low BMI and low S-albumin increased relative hazard for death and risk for infection. In a multivariate analysis low BMI, but not S-albumin, increased relative hazard for death and low S-albumin, but not BMI, increased risk for infection. Age, diabetes and longer bypass time increased the risk for infection. CONCLUSION In cardiac surgery patients a low BMI increased the relative hazard for death and low S-albumin increased the risk for infection. We suggest that these parameters provide useful information in the preoperative evaluation.
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Affiliation(s)
- Doris Rapp-Kesek
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, University Hospital, Uppsala, Sweden.
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Genton L, Dupertuis YM, Romand JA, Simonet ML, Jolliet P, Huber O, Kudsk KA, Pichard C. Higher calorie prescription improves nutrient delivery during the first 5 days of enteral nutrition. Clin Nutr 2004; 23:307-15. [PMID: 15158293 DOI: 10.1016/j.clnu.2003.07.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2002] [Accepted: 07/17/2003] [Indexed: 01/03/2023]
Abstract
AIMS It is unclear whether prescribing a higher amount of calories by enteral nutrition (EN) increases actual delivery. This prospective controlled study aimed at comparing the progression of EN of two study populations with different levels of calorie prescriptions, during the first 5 days of EN. METHODS The daily calorie prescription of group 1 (n=346) was 25 and 20 kcal/kg body weight for women <60 and > or =60 years, respectively, and 30 and 25 kcal/kg body weight for men <60 and > or =60 years, respectively. The prescription of group 2 (n=148) was 5 kcal/kg body weight higher than in group 1. Calorie intakes were expressed as percentage of resting energy expenditure (REE) and protein intakes as percentage of requirements estimated as 1.2 g/kg body weight/day. Patients were classified as <60 and > or =60 years and as medical or surgical patients. Statistical analysis was performed with ANOVA for repeated measures. RESULTS Calorie and protein deliveries increased in both groups independently of age and ward categories (P< or =0.0001). Group 2 showed faster progressions of calorie and protein intakes than group 1 in patients altogether (P< or =0.002), > or =60 years (P< or =0.01) and in surgical patients (P< or =0.02). Differences of calorie and protein intakes between day 1 and day 5 were significantly higher in group 2 than group 1 for patients altogether (75+/-61 vs. 56+/-54% of REE; 41+/-30 vs. 31+/-/-27% of protein requirements), those over 60 years (76+/-67 of REE vs. 52+/-59 of protein requirements) and surgical patients (81+/-52 vs. 58+/-57% of REE; 44+/-27 vs. 33+/-29% of protein requirements). CONCLUSIONS Increasing the levels of EN prescriptions improved calorie and protein deliveries. While the mean energy delivery over 5 days was sufficient to cover requirements, the protein delivery by EN was insufficient, despite our nutritional support team.
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Affiliation(s)
- Laurence Genton
- Clinical Nutrition, Geneva University Hospital, Geneva 1211, Switzerland
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Carlsson E, Bosaeus I, Nordgren S. Body composition in patients with short bowel syndrome: An assessment by bioelectric impedance spectroscopy (BIS) and dual–energy absorptiometry (DXA). Eur J Clin Nutr 2004; 58:853-9. [PMID: 15164105 DOI: 10.1038/sj.ejcn.1601886] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe body composition in patients with short bowel syndrome (SBS) by using bioelectric impedance spectroscopy (BIS), dual-energy X-ray absorptiometry (DXA) measurements and anthropometrical-derived estimates. SUBJECTS In all, 19 patients were included, mean age 54 y, range 36-77 (F/M=11/8). Mean BMI was 21.5 kg/m(2). Eight patients were on home parenteral nutrition (HPN). METHODS Total body water (TBW), intracellular water and extracellular water were assessed by BIS. TBW were derived from DXA. Fat-free mass (FFM) was assessed by BIS and DXA. TBW and FFM were predicted according to an empirical formula. Differences were analysed using the Bland-Altman method. RESULTS The mean difference between TBW (DXA) and TBW (BIS) was -1.1 l in women and -1.8 l in men. For FFM, the mean difference between FFM (DXA) and FFM (BIS) was -1.7 kg in women and -2.5 kg in men. The mean difference between TBW (DXA) and TBW (BIS) for all patients was -1.2 l and limits of agreement were (-7.80-5.40). Hydration of FFM assessed by BIS gave a mean of 0.75 (0.08). CONCLUSION The limits of agreement (Bland-Altman) between DXA and BIS were wide, indicating that methods are not interchangeable, which limits its clinical utility. Most of our patients with SBS were maintained in a stable clinical condition within normal limits of body weight and BMI. FFM and TBW did not appear to be altered in ileostomates or those on HPN.
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Affiliation(s)
- E Carlsson
- Department of Surgery, University of Göteborg, Sweden.
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Pichard C, Kyle UG, Morabia A, Perrier A, Vermeulen B, Unger P. Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay. Am J Clin Nutr 2004; 79:613-8. [PMID: 15051605 DOI: 10.1093/ajcn/79.4.613] [Citation(s) in RCA: 257] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Low fat-free mass may be an independent risk factor for malnutrition that results in an increased length of hospital stay (LOS). OBJECTIVES The objectives were to compare differences in fat-free mass and fat mass at hospital admission between patients and healthy control subjects and to determine the association between these differences and the LOS. DESIGN Patients (525 men, 470 women) were prospectively recruited at hospital admission. Height-corrected fat-free mass and fat mass (fat-free-mass index or fat-mass index; in kg/m2) were determined in patients at admission by bioelectrical impedance analysis and were compared with values for sex-, age-, and height-matched control subjects. Patients were classified as well-nourished, moderately depleted, or severely depleted on the basis of a Subjective Global Assessment questionnaire and a body mass index (in kg/m2) < or > 20. RESULTS Low fat-free mass was noted in 37% and 55.6% of patients hospitalized 1-2 d and > 12 d, respectively. The odds ratios were significant for fat-free-mass index and were higher in patients with a LOS of > 12 d [men (odds ratio: 5.6; 95% CI: 3.1, 10.4), women (4.4; 2.3, 8.7)] than in those with a LOS of 1-2 d [men (3.3; 2.2, 5.0), women (2.2; 1.6, 3.1)]. Severe nutritional depletion was significantly associated only with a LOS > 12 d. CONCLUSION Fat-free mass and fat-free-mass index were significantly lower in patients than in control subjects. Because the fat-free-mass index is significantly associated with an increased LOS, provides nutritional assessment information that complements that from a Subjective Global Assessment questionnaire, and is a more sensitive determinant of the association of fat-free mass with LOS than is a weight loss > 10% or a body mass index < 20, it should be used to evaluate nutritional status.
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Affiliation(s)
- Claude Pichard
- Clinical Nutrition department, Geneva University Hospital, Geneva, Switzerland.
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Maisonneuve N, Genton L, Karsegard V, Kyle U, Dupertuis Y, Pichard C. Place de l'impédancemétrie dans le dépistage de la dénutrition à l'hôpital. NUTR CLIN METAB 2003. [DOI: 10.1016/j.nupar.2003.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kyle UG, Schutz Y, Dupertuis YM, Pichard C. Body composition interpretation. Contributions of the fat-free mass index and the body fat mass index. Nutrition 2003; 19:597-604. [PMID: 12831945 DOI: 10.1016/s0899-9007(03)00061-3] [Citation(s) in RCA: 291] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Low and high body mass index (BMI) values have been shown to increase health risks and mortality and result in variations in fat-free mass (FFM) and body fat mass (BF). Currently, there are no published ranges for a fat-free mass index (FFMI; kg/m(2)), a body fat mass index (BFMI; kg/m(2)), and percentage of body fat (%BF). The purpose of this population study was to determine predicted FFMI and BFMI values in subjects with low, normal, overweight, and obese BMI. METHODS FFM and BF were determined in 2986 healthy white men and 2649 white women, age 15 to 98 y, by a previously validated 50-kHz bioelectrical impedance analysis equation. FFMI, BFMI, and %BF were calculated. RESULTS FFMI values were 16.7 to 19.8 kg/m(2) for men and 14.6 to 16.8 kg/m(2) for women within the normal BMI ranges. BFMI values were 1.8 to 5.2 kg/m(2) for men and 3.9 to 8.2 kg/m(2) for women within the normal BMI ranges. BFMI values were 8.3 and 11.8 kg/m(2) in men and women, respectively, for obese BMI (>30 kg/m(2)). Normal ranges for %BF were 13.4 to 21.7 and 24.6 to 33.2 for men and women, respectively. CONCLUSION BMI alone cannot provide information about the respective contribution of FFM or fat mass to body weight. This study presents FFMI and BFMI values that correspond to low, normal, overweight, and obese BMIs. FFMI and BFMI provide information about body compartments, regardless of height.
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Affiliation(s)
- Ursula G Kyle
- Department of Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland
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