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Goldfarb M, Marcano Y, Schafer D, Chronopoulos J, Hayman V, Trnkus A, Afilalo J. Dietary protein intake in older adults undergoing cardiac surgery. Nutr Metab Cardiovasc Dis 2019; 29:1095-1100. [PMID: 31362848 DOI: 10.1016/j.numecd.2019.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Older adults undergoing major surgery have increased protein requirements in the postoperative period, but there are limited data describing actual protein intake following cardiac surgery. METHODS AND RESULTS We performed a prospective sub-study within a registry of older adults ≥60 years of age undergoing cardiac surgery at a tertiary care centre. A dietician administered a food frequency questionnaire before surgery and 1-4 months after surgery. In-hospital food intake was recorded by direct observation for 3 days in the early postoperative period. Food intake was analyzed to calculate the protein intake per kilogram of body weight per day (g/kg/d) during the three phases of care, compared to the dietary reference intake. Frailty was measured by a questionnaire and physical performance tests before surgery. There were 22 patients (8 females, 14 males; 59% frail) enrolled in the study with a mean age of 72.0 ± 7.8 years. The mean protein intake was 1.3 ± 0.5 g/kg/d, 0.7 ± 0.3 g/kg/d, and 1.3 ± 0.6 g/kg/d in the preoperative, early postoperative, and postdischarge periods, respectively (P < 0.0001 for early postoperative compared to other periods). Compared to the targeted dietary reference intake of 1.5 g/kg/d, there was a mean protein deficit of 0.8 g/kg/d in the early postoperative period. Only one patient (5%) met the protein dietary reference intake in the early postoperative period. CONCLUSION In older adults undergoing cardiac surgery, dietary protein intake was substantially lower than the recommended target in the early postoperative period. Strategies to improve protein intake, particularly in frail older patients, may be considered as a therapeutic target.
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Affiliation(s)
- Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, Montreal, QC, Canada
| | - Yamileth Marcano
- Department of Clinical Nutrition, Jewish General Hospital, Montreal, QC, Canada
| | - Donna Schafer
- Department of Clinical Nutrition, Jewish General Hospital, Montreal, QC, Canada
| | - Julia Chronopoulos
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Victoria Hayman
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Amanda Trnkus
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Jonathan Afilalo
- Division of Cardiology, Jewish General Hospital, Montreal, QC, Canada; Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, QC, Canada.
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Determination of food intake and the factors affecting food intake in perioperative period in patients who undergo open heart surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:214-222. [PMID: 32082737 DOI: 10.5606/tgkdc.dergisi.2018.15787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/05/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the factors affecting food intake in perioperative period of patients who undergo open heart surgery and the effects of body weight, albumin and hemoglobin values, nausea, vomiting and constipation on food intake. Methods This cross-sectional study was conducted between 4 February 2015 and 4 May 2015 in a cardiovascular surgery clinic. A questionnaire including 25 questions was applied to a total of 86 volunteer participants (62 males, 24 females; mean age 61.3±10.8 years; range 38 to 82 years). Results Patients consumed 38% of the food one day before the surgery and 51% one day after, 47% three days after, and 52% five days after the surgery. Factors affecting food intake were the procedure of discontinuing food intake for pre-surgery anesthesia preparation (84.9%), nausea (31.4%) one day after surgery, and constipation three (26.5%) and five (33.7%) days after surgery. Albumin levels decreased significantly in days after surgery compared to the day before surgery (p<0.05). There was a significant positive correlation between food intake rates and albumin levels on the first, third and fifth days after surgery (r=0.354, r=0.353, and r=0.521, respectively; p<0.05). Conclusion Patients' body weight and albumin levels decreased in accordance with their nourishment status after surgery. Food intake was insufficient in the perioperative period.
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Ann DiMaria-Ghalili R. Development of an Integrated Theory of Surgical Recovery in Older Adults. J Nutr Gerontol Geriatr 2016; 35:1-14. [PMID: 26885942 DOI: 10.1080/21551197.2016.1140535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Experts argue the health care system is not prepared to meet the unique needs of older surgical patients, including how to provide the best care during the recovery phase. Nutrition plays a critical role in the recovery of surgical patients. Since older adults are at risk for malnutrition, examining the role of nutrition as a mediator for surgical recovery across the care continuum in older adults is critical. Presently there is a paucity of frameworks, models, and guidelines that integrate the role of nutrition on the trajectory of postoperative recovery in older surgical patients. The purpose of this article is to introduce the Integrated Theory of Surgical Recovery in Older Adults, an interdisciplinary middle-range theory, so that scholars, researchers, and clinicians can use this framework to promote recovery from surgery in older adults by considering the contribution of mediators of recovery (nutritional status, functional status, and frailty) unique to the older adults.
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Affiliation(s)
- Rose Ann DiMaria-Ghalili
- a Doctoral Nursing Department and Nutrition Sciences Department, College of Nursing and Health Professions , Drexel University , Philadelphia , Pennsylvania , USA
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Ringaitienė D, Gineitytė D, Vicka V, Žvirblis T, Šipylaitė J, Irnius A, Ivaškevičius J, Kačergius T. Impact of malnutrition on postoperative delirium development after on pump coronary artery bypass grafting. J Cardiothorac Surg 2015; 10:74. [PMID: 25990791 PMCID: PMC4449612 DOI: 10.1186/s13019-015-0278-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/01/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & AIMS Even though malnutrition is frequently observed in cardiac population outcome data after cardiac surgery in malnourished patients is very rare. No thorough research was done concerning the impact of malnutrition on neuropsychological outcomes after cardiac surgery. The aim of our study was to analyze the incidence of postoperative delirium development in malnourished patients undergoing on pump bypass grafting. METHODS We performed a cohort study of adults admitted to Vilnius University Hospital Santariskiu Clinics for elective coronary artery bypass grafting. The nutritional status of the patients was assessed by Nutritional Risk Screening 2002 (NRS-2002) questionnaire the day before surgery. Patients were considered as having no risk of malnutrition when NRS-2002 score was less than 3 and at risk of malnutrition when NRS-2002 score was ≥3. During ICU stay patients were screened for postoperative delirium development using the CAM-ICU method. and divided into two groups: delirium and non delirium. The statistical analysis was preformed to evaluate the differences between the two independent groups. The logistic regression model was used to evaluate the potential preoperative and intraoperative risk factors of postoperative delirium. RESULTS Ninety-nine patients were enrolled in the study. Preoperative risk of malnutrition was detected in 24 % (n = 24) of the patients. The incidence of early postoperative delirium in overall study population was 8.0 % (n = 8). The incidence of the patients at risk of malnutrition was significantly higher in the delirium group (5 (62.5 %) vs 19 (20.9 %), p <0.0191). In multivariate logistic regression analysis risk of malnutrition defined by NRS 2002 was an independent preoperative and intraoperative risk factor of postoperative delirium after coronary artery bypass grafting (OR: 6.316, 95 % CI: 1.384-28.819 p = 0.0173). CONCLUSIONS Preoperative malnutrition is common in patients undergoing elective coronary artery bypass grafting. Nutrition deprivation is associated with early postoperative delirium after on pump coronary artery bypass grafting.
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Affiliation(s)
- Donata Ringaitienė
- Clinic of Anesthesiology and Intensive care, Vilnius University, Faculty of medicine, Vilnius, Lithuania. .,Center of Anesthesia and Intensive care Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, Lt 08448, Lithuania.
| | - Dalia Gineitytė
- Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
| | - Vaidas Vicka
- Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
| | - Tadas Žvirblis
- Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
| | - Jūratė Šipylaitė
- Clinic of Anesthesiology and Intensive care, Vilnius University, Faculty of medicine, Vilnius, Lithuania. .,Center of Anesthesia and Intensive care Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, Vilnius, Lt 08448, Lithuania.
| | - Algimantas Irnius
- Hepatology and Gastroenterology Department, Vilnius University faculty of Medicine. Centre of Hepatology, Gastroenterology and Dietetics, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
| | - Juozas Ivaškevičius
- Clinic of Anesthesiology and Intensive care, Vilnius University, Faculty of medicine, Vilnius, Lithuania.
| | - Tomas Kačergius
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
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Kulik A, Ruel M, Jneid H, Ferguson TB, Hiratzka LF, Ikonomidis JS, Lopez-Jimenez F, McNallan SM, Patel M, Roger VL, Sellke FW, Sica DA, Zimmerman L. Secondary Prevention After Coronary Artery Bypass Graft Surgery. Circulation 2015; 131:927-64. [DOI: 10.1161/cir.0000000000000182] [Citation(s) in RCA: 260] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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DiMaria-Ghalili RA. Integrating Nutrition in the Comprehensive Geriatric Assessment. Nutr Clin Pract 2014; 29:420-427. [DOI: 10.1177/0884533614537076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Abstract
Nutrition and hydration are vital components of critical care nursing. However, meeting the nutrition and hydration needs of the critically ill older adult is often complex, because of preexisting risk factors (malnutrition, unintentional weight loss, frailty, and dehydration); as well as intensive care unit-related challenges (catabolism, eating and feeding, end-of-life care). This article highlights the challenges of managing nutrition and hydration in the critically ill older adult, reviews assessment principles, and offers strategies for optimizing nutrition and hydration.
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DiMaria-Ghalili RA, Sullivan-Marx EM, Compher C. Inflammation, Functional Status, and Weight Loss During Recovery From Cardiac Surgery in Older Adults. Biol Res Nurs 2013; 16:344-52. [DOI: 10.1177/1099800413503489] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To determine the nutritional, inflammatory, and functional aspects of unintentional weight loss after cardiac surgery that warrant further investigation. Research Methods and Procedures: Twenty community-dwelling adults > 65 years old undergoing cardiac surgery (coronary artery bypass graft [CABG] or CABG + valve) were recruited for this prospective longitudinal (preoperative and 4–6 weeks postdischarge) pilot study. Anthropometrics (weight, standing height, and mid-arm and calf circumference), nutritional status (Mini-Nutritional Assessment™ [MNA]), appetite, physical performance (timed chair stand), muscle strength (hand grip) and functional status (basic and instrumental activities of daily living), and inflammatory markers (plasma leptin, ghrelin, interleukin [IL]-6, high-sensitivity[hs] C-reactive protein, and serum albumin and prealbumin) were measured. Results: Participants who completed the study ( n = 11 males, n = 3 females) had a mean age 70.21 ± 4.02 years. Of these, 12 lost 3.66 ± 1.44 kg over the study period. Weight, BMI, activities of daily living, and leptin decreased over time ( p < .05). IL-6 increased over time ( p < .05). Ghrelin, hs-CRP, and timed chair stand increased over time in those who underwent combined procedures ( p < .05). Grip strength decreased in those who developed complications ( p = .004). Complications, readmission status, and lowered grip strength were found in those with low preoperative MNA scores ( p < .05). Conclusion: After cardiac surgery, postdischarge weight loss occurs during a continued inflammatory response accompanied by decreased physical functioning and may not be a positive outcome. The impacts of weight loss, functional impairment, and inflammation during recovery on disability and frailty warrant further study.
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Affiliation(s)
- Rose Ann DiMaria-Ghalili
- Doctoral Nursing Department and Nutrition Sciences Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | | | - Charlene Compher
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Attitudes, Perceptions, and Knowledge Among Hospital Staff Concerning Postdischarge Nutritional Follow-up. TOP CLIN NUTR 2013. [DOI: 10.1097/tin.0b013e31829df124] [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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van Venrooij LMW, Verberne HJ, de Vos R, Borgmeijer-Hoelen MMMJ, van Leeuwen PAM, de Mol BAJM. Postoperative loss of skeletal muscle mass, complications and quality of life in patients undergoing cardiac surgery. Nutrition 2011; 28:40-5. [PMID: 21621393 DOI: 10.1016/j.nut.2011.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 12/20/2010] [Accepted: 02/12/2011] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The objective of this study was to describe postoperative undernutrition in terms of postoperative losses of appendicular skeletal muscle mass (ASMM) with respect to complications, quality of life, readmission, and 1-y mortality after cardiac surgery. METHODS Patients undergoing cardiac surgery were prospectively followed. ASMM was measured 2 wk before and 2 mo after surgery using dual-energy X-ray absorptiometry. ASMM consists of arm skeletal muscle mass (SMM) and leg SMM. The association between ≥5% of ASMM decrease and postoperative outcome was analyzed using the chi-square test. A similar approach was used to analyze arm SMM and leg SMM decreases separately. RESULTS Twenty-nine patients were included (23 male, 34.5% ≥65 y old). Postoperatively, seven patients (24.1%) lost ≥5% ASMM. When analyzed separately, a ≥5% decrease in leg SMM was associated with a decrease in experienced vitality (odds ratio 13.0, 95% confidence interval 1.32-128.11, P = 0.03). In contrast, a ≥5% loss of arm SMM was associated with fewer in-hospital complications (odds ratio 0.20, 95% confidence interval 0.04-0.98, P = 0.04). These patients were characterized by a higher preoperative fat-free mass index (kilograms per meter squared; P = 0.01). CONCLUSIONS The results suggest that a preoperatively higher fat-free mass index indicates better ability to cope with operative stress, resulting in fewer complications. In addition, postoperative loss of muscle mass was associated with decreased vitality. We advocate further research investigating the effect of preoperative and postoperative nutritional intervention combined with physical exercise programs to increase lean body mass and thereby improve postoperative recovery after cardiac surgery.
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Affiliation(s)
- Lenny M W van Venrooij
- Department of Dietetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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DiMaria-Ghalili RA. Nutrition Risk Factors in Older Coronary Artery Bypass Graft Patients. Nutr Clin Pract 2008; 23:494-500. [DOI: 10.1177/0884533608323428] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yukawa M, Weigle DS, Davis CD, Marck BT, Wolden-Hanson T. Peripheral ghrelin treatment stabilizes body weights of senescent male Brown Norway rats at baseline and after surgery. Am J Physiol Regul Integr Comp Physiol 2008; 294:R1453-60. [DOI: 10.1152/ajpregu.00035.2008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Unintentional weight loss may occur spontaneously in older humans and animals. Further weight losses after surgery or illness in the older patients result in increased morbidity, mortality, and hospital readmission rate. A growing body of work has shown increased appetite and weight gain in response to administration of ghrelin, the “hunger hormone.” We conducted two studies in senescent male Brown Norway rats to assess the ability of peripheral administration of ghrelin to increase body weight and food intake. One study assessed the effect of 2 wk of daily subcutaneous ghrelin administration (1 mg·kg−1·day−1) to senescent rats in a baseline condition; a second study used the same administration protocol in an interventional experiment with aged rats subjected to a surgery with 10–15% blood loss as a model of elective surgery. In both studies, animals receiving ghrelin maintained their body weights, whereas control animals lost weight. Body weight stability was achieved in ghrelin-treated animals despite a lack of increase in daily or cumulative food intake in both experiments. Hormone and proinflammatory cytokine levels were measured before surgery and after 14 days of treatment. Ghrelin treatment appeared to blunt declining ghrelin levels and also to blunt cytokine increases seen in the surgical control group. The ability of peripheral ghrelin treatment to maintain body weights of senescent rats without concomitant increases in food intake may be due to its known ability to decrease sympathetic activity and metabolic rate, perhaps by limiting cytokine-driven inflammation.
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Abstract
Both physiologic and psychosocial changes affect the nutritional status of adults over the age of 65. Malnutrition is, in fact, a greater threat to this population than obesity. This article reviews the intake requirements of older adults and discusses the risk factors that can lead to malnutrition, including diet, limited income, isolation, chronic illness, and physiologic changes. Assessment and nursing interventions are also addressed.
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Affiliation(s)
- Rose Ann DiMaria-Ghalili
- School of Nursing, West Virginia University, Charleston Division, and Charleston Area Medical Center, Charleston, WV, USA.
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