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Kurik G, Kelly-Bissue C, Lõhmus A, Muhhamedjanov K, Ilves N, Forbes A. Standardising and simplifying the Global Leadership Initiative on Malnutrition (GLIM) for its more general application. Clin Nutr ESPEN 2024; 62:120-127. [PMID: 38901933 DOI: 10.1016/j.clnesp.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/27/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Malnutrition is present in 20-50% of hospital patients but its recognition is often neither timely nor complete. The Global Leadership Initiative on Malnutrition (GLIM) aims to improve this, but its successful implementation may be compromised by its dependence on (a choice of) prior screening tools and difficulties in consistent assessment of muscle mass. AIMS To explore different approaches to screening and muscle assessment in GLIM and to offer simpler choices for its more widespread application. METHODS (1) Data from 300 consenting in-patients provided Nutritional Risk Screening (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Subjective Global Assessment (SGA) scores. GLIM scoring was preceded by NRS-2002 or MUST (using threshold scores of 1 or 2 for MUST), or no prior screening. The results of GLIM scoring preceded by different screening approaches were compared with those of SGA. (2) The literature on mid-upper arm circumference (MUAC) and calf circumference (CC) as simple, non-invasive, objective methods of muscle assessment methods was reviewed (3) The cumulative times taken to obtain GLIM scores were measured and corrected for the different screening strategies. RESULTS (1) Participants' mean age was 60 years, 157 (52%) were female and mean BMI was 27.8 kg/m2. In comparison with SGA, GLIM with no prior screening had the highest sensitivity (65%) and negative predictive value (NPV) (76%), but the lowest specificity (90%) and positive predictive value (PPV) (84%). The equivalent figures for GLIM with prior MUST "1" were 62%, 75%, 93% and 88%; with prior NRS-2002, 55%∗, 73%, 98%∗ and 95%∗; and with prior MUST "2", 44%∗, 69%∗, 98%∗, 95%∗. The area under an ROC curve was the highest (0.78) when GLIM was performed without screening or with prior MUST "1". (2) Being less affected by oedema and gender differences than calf circumference, MUAC could serve as a standard globally accessible muscle mass assessment method which can be supplemented by technical approaches if available and deemed necessary. (3) The overall per-capita time requirement of GLIM was 240-245 s without prior screening, and was increased by 2-3% with prior MUST "1", by 27-29% with prior NRS-2002 and decreased by 8-9% with prior MUST "2". CONCLUSIONS Preceding GLIM by screening can decrease its sensitivity and increase overall time utilisation; "gold standard" muscle assessment is not globally accessible. Our results therefore support considering using GLIM as a combined screening and assessment tool, with MUAC as the method of muscle assessment which can be supplemented by technical approaches if available and deemed necessary. This could potentially both simplify the use of GLIM and improve the early detection of malnutrition. ∗Indicates statistically significant difference from use of GLIM without prior screening.
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Affiliation(s)
- G Kurik
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - C Kelly-Bissue
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - A Lõhmus
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - K Muhhamedjanov
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - N Ilves
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia
| | - A Forbes
- Institute of Clinical Medicine, University of Tartu, Puusepa 8, 50406, Tartu, Estonia.
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Tomasiewicz A, Polański J, Tański W. Advancing the Understanding of Malnutrition in the Elderly Population: Current Insights and Future Directions. Nutrients 2024; 16:2502. [PMID: 39125381 PMCID: PMC11314143 DOI: 10.3390/nu16152502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/27/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Malnutrition is a growing public health problem leading to increased morbidity and mortality worldwide. Up to 50% of elderly patients are hospitalized due to this condition. In this review, we focused on analyzing the current diagnostic criteria for malnutrition among the elderly population and proposing promising solutions. Currently used diagnostic methods such as BMI or serum albumin levels are not sufficient to indicate malnutrition, which is affected by many factors, including the number of chronic diseases, multiple medications taken, or physical condition. Moreover, current recommendations are inadequate because they fail to account for various factors such as chronic illnesses, multiple medications, and bodily changes that are crucial in diagnostic evaluations. There is a noticeable gap between these recommendations and actual clinical practice. Nevertheless, developing more precise, non-invasive biomarkers and personalized nutrition strategies has to be explored. One of these strategies we discuss in our review is multidisciplinary approaches that combine nutrition, physical activity, and psychosocial support. Addressing malnutrition among the elderly should rely on standardized protocols and personalized interventions to enhance their nutritional health and overall well-being.
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Affiliation(s)
- Anna Tomasiewicz
- Student Research Club of Surgical Specialties, Faculty of Medicine, Wroclaw Medical University, 50-532 Wrocław, Poland
| | - Jacek Polański
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland;
| | - Wojciech Tański
- Faculty of Medicine, Wrocław University of Science and Technology, 50-376 Wrocław, Poland
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Zhang X, Ma N, Lin Q, Chen K, Zheng F, Wu J, Dong X, Niu W. Body Roundness Index and All-Cause Mortality Among US Adults. JAMA Netw Open 2024; 7:e2415051. [PMID: 38837158 PMCID: PMC11154161 DOI: 10.1001/jamanetworkopen.2024.15051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/03/2024] [Indexed: 06/06/2024] Open
Abstract
Importance Obesity, especially visceral obesity, is an established risk factor associated with all-cause mortality. However, the inadequacy of conventional anthropometric measures in assessing fat distribution necessitates a more comprehensive indicator, body roundness index (BRI), to decipher its population-based characteristics and potential association with mortality risk. Objective To evaluate the temporal trends of BRI among US noninstitutionalized civilian residents and explore its association with all-cause mortality. Design, Setting, and Participants For this cohort study, information on a nationally representative cohort of 32 995 US adults (age ≥20 years) was extracted from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 and NHANES Linked Mortality File, with mortality ascertained through December 31, 2019. Data were analyzed between April 1 and September 30, 2023. Exposures Biennial weighted percentage changes in BRI were calculated. Restricted cubic spline curve was used to determine optimal cutoff points for BRI. Main Outcome and Measures The survival outcome was all-cause mortality. Mortality data were obtained from the Centers for Disease Control and Prevention website and linked to the NHANES database using the unique subject identifier. Weibull regression model was adopted to quantify the association between BRI and all-cause mortality. Results Among 32 995 US adults, the mean (SD) age was 46.74 (16.92) years, and 16 529 (50.10%) were women. Mean BRI increased gradually from 4.80 (95% CI, 4.62-4.97) to 5.62 (95% CI, 5.37-5.86) from 1999 through 2018, with a biennial change of 0.95% (95% CI, 0.80%-1.09%; P < .001), and this increasing trend was more obvious among women, elderly individuals, and individuals who identified as Mexican American. After a median (IQR) follow-up of 9.98 (5.33-14.33) years, 3452 deaths (10.46% of participants) from all causes occurred. There was a U-shaped association between BRI and all-cause mortality, with the risk increased by 25% (hazard ratio, 1.25; 95% CI, 1.05-1.47) for adults with BRI less than 3.4 and by 49% (hazard ratio, 1.49; 95% CI, 1.31-1.70) for those with BRI of 6.9 or greater compared with the middle quintile of BRI of 4.5 to 5.5 after full adjustment. Conclusions and Relevance This national cohort study found an increasing trend of BRI during nearly 20-year period among US adults, and importantly, a U-shaped association between BRI and all-cause mortality. These findings provide evidence for proposing BRI as a noninvasive screening tool for mortality risk estimation, an innovative concept that could be incorporated into public health practice pending consistent validation in other independent cohorts.
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Affiliation(s)
- Xiaoqian Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Ning Ma
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Pediatrics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Qiushi Lin
- Sanofi Aventis, Cambridge, Massachusetts
| | - Kening Chen
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Fangjieyi Zheng
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
| | - Jing Wu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
| | - Xiaoqun Dong
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Wenquan Niu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
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Mazzini LR, Aquino JLBD, Camargo JGTD, Leandro-Merhi VA. IS CALF CIRCUMFERENCE ASSOCIATED WITH CLINICAL AND NUTRITIONAL OUTCOME IN OLDER PATIENTS? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1773. [PMID: 37971026 PMCID: PMC10642954 DOI: 10.1590/0102-672020230055e1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/02/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Previous studies have shown a relationship between calf circumference (CC) and outcomes in hospitalized patients. AIMS To investigate the relationship between CC and clinical and nutritional outcomes in older in-patients (OiP) in a surgery ward. METHODS This was a cross-sectional study with 417 OiP in a surgery ward. Clinical variables, anthropometry, and nutritional screening instruments such as subjective global assessment (SGA), mini nutritional assessment (MNA), and nutritional risk screening (NRS) were used in the investigation. The tests Pearson's chi-square, Mann-Whitney, Kruskal-Wallis, and Spearman's coefficient, and multiple linear regression analyses were used to review the factors associated with CC. RESULTS Lower CC values were found in the age group 80 years and over (p<0.0001), presence of complications (p=0.0269), NRS (p<0.0001), SGA (p<0.0001), and MNA (p<0.0001). Gender (p=0.0011; partial R2=0.01151), age (p=0.0002; partial R2=0.06032), body mass index (p≤0.0001; partial R2=0.40820), and arm circumference (p≤0.0001; partial R2=0.11890) are variables that together were associated with CC. There was also a relationship between SGA (p=0.0166; partial R2=0.00605) and absence of complications during hospitalization (p=0.0047; R2=0.01154) with CC. CONCLUSIONS Gender, age, body mass index, and arm circumference were jointly associated with CC, in addition to SGA and absence of complications. The CC is a relevant indicator for OiP in the clinical practice.
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Affiliation(s)
- Lucas Rosasco Mazzini
- Pontificia Universidade Católica de Campinas, School of Medicine - Campinas (SP), Brazil
| | - José Luis Braga de Aquino
- Pontificia Universidade Católica de Campinas, School of Medicine - Campinas (SP), Brazil
- Pontificia Universidade Católica de Campinas, Postgraduate Program in Health Sciences - Campinas (SP), Brazil
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Bosnić Z, Babič F, Wittlinger T, Anderková V, Šahinović I, Majnarić LT. Influence of Age, Gender, Frailty, and Body Mass Index on Serum IL-17A Levels in Mature Type 2 Diabetic Patients. Med Sci Monit 2023; 29:e940128. [PMID: 37837182 PMCID: PMC10583604 DOI: 10.12659/msm.940128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/09/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The cytokine IL-17A is emerging as a marker of chronic inflammation in cardio-metabolic conditions. This study aimed to identify relevant factors that in older primary care patients with type 2 diabetes (T2D) could influence serum IL-17A concentrations. The results have a potential to improve risk stratification and therapy options for these patients. MATERIAL AND METHODS The study was conducted during a period of 4 months, in 2020, in the south-eastern region of Croatia. Patients from primary health care, diagnosed with T2D (N=170, M: F 75: 95, ≥50 years old), were recruited at their visits. Those with malignant diseases, on chemotherapy or biological therapy, with amputated legs, or at hemodialysis, were excluded. The multinomial regression models were used to determine independent associations of the groups of variables, indicating sociodemographic and clinical characteristics of these patients, with increasing values (quartiles) of serum IL-17A. RESULTS The regression models indicated the frailty index and sex bias are the key modifying factors in associations of other variables with IL-17A serum values. CONCLUSIONS Sex bias and the existence of different frailty phenotypes could be the essential determining factors of the serum IL-17A levels in community-dwelling patients with T2D age 50 years and older. The results support the concept of T2D as a complex disorder.
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Affiliation(s)
- Zvonimir Bosnić
- Department of Family Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - František Babič
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Košice, Slovakia
| | - Thomas Wittlinger
- Department of Cardiology, Asklepios Hospital, Goslar, Germany
- University of Göttingen, Göttingen, Germany
| | - Viera Anderková
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Košice, Slovakia
| | - Ines Šahinović
- Department of Clinical Laboratory Diagnostics, Osijek University Hospital, Osijek, Croatia
| | - Ljiljana Trtica Majnarić
- Department of Family Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Pathophysiology, Physiology and Immunology, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Leandro-Merhi VA, Dos Santos HAV, Almendra AAR, de Aquino JLB. Nutritional indicators' performance in malnutrition diagnosis of hospitalized elderly patients. Exp Gerontol 2023; 181:112286. [PMID: 37683730 DOI: 10.1016/j.exger.2023.112286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 05/29/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Several nutritional diagnosis methods and their relationship with clinical outcomes have been described. This study investigated malnutrition in hospitalized elderly patients (HEP) using different nutritional indicators and determined criteria to identify malnutrition and explore the variables that discriminate the risk of malnutrition. METHOD Cross-sectional study with 500 HEP; different methods of nutritional diagnosis, their relationship with clinical outcomes and criteria for defining malnutrition were investigated. The GLIM criteria for the diagnosis of malnutrition was applied in this study. In the statistical analysis, the Chi-square test, Fisher's exact test, Mann-Whitney test, univariate and multiple logistic regression and the ROC curve were used. RESULTS Patients aged 65-79 years, at nutritional risk or with malnutrition, had longer hospital stays (p = 0.0099; OR = 1.047; 95% CI = 1.011; 1.084) and lower body mass index (BMI) (p < 0.0001; OR = 0.867 (1153)); 95% CI = 0.813; 0.924 (1085; 1225). Patients aged ≥80 years had a lower BMI (p = 0.0053; OR = 0.779 (1284); 95% CI = 0.653; 0.928 (1078; 1531)). Accuracy was significant in both age groups for BMI (p < 0.0001; 65-79 years and p = 0.001; ≥80 years); for the lymphocyte count (p = 0.0167; 65-79 years and p = 0.0028; ≥80 years), and for the calf circumference (CC) (p < 0.0001; 65-79 years and p = 0.001; ≥80 years). Using the GLIM criteria, 27.78% of patients were considered malnourished. CC showed good accuracy, good specificity, but low sensitivity while BMI was more accurate to detect malnutrition in both age groups. CONCLUSION CC showed good accuracy, good specificity, but low sensitivity to detect malnutrition. BMI was more accurate in both age groups to detect malnutrition.
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Asma A, Tuncer Ö. Risks of undernutrition and depression in hospitalized patients: A cross-sectional study. Medicine (Baltimore) 2023; 102:e35133. [PMID: 37682139 PMCID: PMC10489483 DOI: 10.1097/md.0000000000035133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
Undernutrition in hospitalized patients is a significant healthcare burden worldwide. Depression is a major global health problem characterized by symptoms such as altered mood, loss of interest and pleasure, and impairment in cognitive and physical functions. Patients hospitalized for medical conditions have a higher risk of depression than the general population. The purpose of this study was to explore the relationship between undernutrition risk and depression risk in hospitalized patients. The design of this study was an observational cross-sectional analytic. A questionnaire form created by the investigator including sociodemographic data, dietary patterns, presence of chronic diseases and anthropometric measurements, Nutritional Risk Screening and Patient Health Questionnaire-2 were applied to the patients. All quantitative data were expressed as the median and interquartile range and qualitative data were expressed as numbers and percentage. Mann-Whitney U test and Kruskal-Wallis test were used to analyze nonparametric data; Chi-square and Fisher Exact test were used to analyze qualitative data. P < .05 was considered statistically significant. A total of 308 patients who met the criteria were reached. Undernutrition was detected in 28.6% of the participants, and depression was present in 37.3%. A statistically significant relationship was found between the risk of undernutrition and the risk of depression, with individuals without a risk of depression being found to have a lower risk of undernutrition. (P < .001). The risk of undernutrition was found to increase with advancing age. Moreover, individuals with higher values for arm muscle area, arm muscle circumference, mid-upper arm circumference, triceps skinfold thickness, calf circumference, and body mass index had a lower risk of undernutrition. No relationship was found between gender and the risk of depression. However, a statistically significant relationship was observed between age and the risk of depression, indicating that older patients had a higher risk of depression. In this study, a statistically significant relationship was found between the risk of undernutrition and the risk of depression in hospitalized patients. It was observed that the risk of undernutrition was lower in individuals without risk of depression.
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Affiliation(s)
- Ayça Asma
- Department of Family Medicine, The University of Health Sciences, Izmir Bozyaka Education and Training Hospital, Bozyaka, Izmir, Turkey
| | - Özge Tuncer
- Department of Family Medicine, The University of Health Sciences, Izmir Bozyaka Education and Training Hospital, Bozyaka, Izmir, Turkey
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Khan K, Wanjari A, Acharya S, Quazi S. Anthropometric Indices With Insulin Resistance in Obese Patients: A Literature Review. Cureus 2023; 15:e41881. [PMID: 37583730 PMCID: PMC10423844 DOI: 10.7759/cureus.41881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
The hormone insulin is responsible for regulating the metabolism of proteins, carbs, and lipids by promoting the absorption of molecules such as glucose from the bloodstream into fat, the liver, and skeletal muscle cells. Insulin resistance (IR) is considered to be a physiological response to obesity that inhibits fat from accumulating and supports weight stabilization. People with IR gain less weight than those with insulin sensitivity, and therefore IR individuals have a three-fold increased likelihood of losing more weight when compared with insulin-sensitive individuals. A person's health is jeopardized by obesity, which is defined as excessive or unusual storage of fat in adipose tissue. Early identification using different anthropometric measuring parameters and proper and suitable therapy is essential as the incidence of obesity cases is increasing as a result of sedentary lifestyles, bad eating habits, a lack of physical exercise, and a lack of knowledge among young adults. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, following which based on inclusion and exclusion criteria, eight articles were considered for the review. The analysis showed that all the parameters are easily accessible and hence can be used in daily practices. Due to being readily available, body mass index (BMI) and waist circumference (WC) constituted the most often employed anthropometric measures in everyday practices. In addition, variances in the values of the variables were seen due to differences in gender.
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Affiliation(s)
- Khalid Khan
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DMIHER), Wardha, IND
| | - Anil Wanjari
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DMIHER), Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DMIHER), Wardha, IND
| | - Sabiha Quazi
- Department of Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DMIHER), Wardha, IND
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Yang N, Zhuo J, Xie S, Qu Z, Li W, Li Z, Guo P, Gao M, Qin H, Han T. A Body Shape Index and Its Changes in Relation to All-Cause Mortality among the Chinese Elderly: A Retrospective Cohort Study. Nutrients 2023; 15:2943. [PMID: 37447269 DOI: 10.3390/nu15132943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/17/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Although recent evidence has revealed that a body shape index (ABSI) is correlated with the incidence of death among different ethnicities, there remains a paucity of studies investigating the impact of ABSI on mortality within the Chinese elderly. Our objective was to ascertain the link between ABSI, as well as its alterations over time, and all-cause mortality among Chinese aged 65 y and above. A total of 3789 participants were enrolled from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Cox regressions and restricted cubic splines were employed to assess the association of ABSI and relative changes with all-cause mortality. When nonlinearity was detected, a restricted cubic spline regression was subsequently conducted to compute hazard ratios and 95% confidence intervals. The median survival time was 46 months, and 1342 individuals (35.4%) were reported to have died. ABSI contributed independently to rising death rates among Chinese old populations according to univariate and multivariate Cox regressions. Statistically significant associations were also found stratified by age, sex, and lifestyle. A U-shaped association of ABSI changes with all-cause mortality (p = 0.027) was observed, indicating that old adults with stable ABSI during the follow-up period experienced the lowest risk of mortality. After multivariable adjustment, participants with a 10% reduction in ABSI changes had an increased 9.4% risk of death, while participants with a 10% rise in ABSI changes had an increased 1.9% risk. ABSI and its changes are predictors for all-cause mortality among the elderly Chinese population, which emphasizes the clinical importance of monitoring ABSI and keeping it stable over time.
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Affiliation(s)
- Ning Yang
- Department of Clinical Nutrition, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
- Shanghai Clinical Nutrition Quality Control Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
| | - Jialu Zhuo
- Department of Clinical Nutrition, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
- Shanghai Clinical Nutrition Quality Control Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
| | - Suyi Xie
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Laboratory for Heart Failure + Circulation Research, Li Ka Shing Institute of Health Sciences, Gerald Choa Cardiac Research Centre, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Zhihua Qu
- Department of Clinical Nutrition, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
- Shanghai Clinical Nutrition Quality Control Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
| | - Wei Li
- Department of Clinical Nutrition, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
- Shanghai Clinical Nutrition Quality Control Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
| | - Zixiang Li
- Department of Clinical Nutrition, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
- Shanghai Clinical Nutrition Quality Control Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
| | - Panpan Guo
- Department of Clinical Nutrition, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
- Shanghai Clinical Nutrition Quality Control Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
| | - Mingbo Gao
- Department of Clinical Nutrition, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
- Shanghai Clinical Nutrition Quality Control Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
| | - Huanlong Qin
- Shanghai Clinical Nutrition Quality Control Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
| | - Ting Han
- Department of Clinical Nutrition, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
- Shanghai Clinical Nutrition Quality Control Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, 301 Yanchang Road, Shanghai 200072, China
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Bhagwasia M, Rao AR, Banerjee J, Bajpai S, Raman AV, Talukdar A, Jain A, Rajguru C, Sankhe L, Goswami D, Shanthi GS, Kumar G, Varghese M, Dhar M, Gupta M, A-Koul P, Mohanty RR, Chakrabarti SS, Yadati SR, Dey S, Dey AB. Association Between Cognitive Performance and Nutritional Status: Analysis From LASI-DAD. Gerontol Geriatr Med 2023; 9:23337214231194965. [PMID: 37743872 PMCID: PMC10515514 DOI: 10.1177/23337214231194965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 09/26/2023] Open
Abstract
Malnutrition in low- and middle-income countries causes cognitive decline and other health problems. Harmonized Diagnostic Assessment of Dementia for Longitudinal Aging Study in India (LASI DAD) is an extensive study on late-life cognition and dementia. This study examines the link between nutrition and cognitive abilities in older adults using data from the LASI DAD. We conducted descriptive statistics on nutritional parameters (body-mass index, waist-hip ratio, and Mini-Nutritional Assessment), cognitive functions, and socio-demographic variables in 2,892 adults aged ≥60 years. Cognitive domains assessed included delayed recall, orientation, language, executive function, abstract reasoning, and attention. Cognitive impairment was defined as impaired performance in two or more domains. Mean age was 69.3 ± 7.1 years, 52.9% were female, and 57.5% were illiterate. Low body-mass index (adjusted OR: 1.88, p < .001), at risk of malnutrition (adjusted OR: 1.89, p < .001) and malnourished (adjusted OR: 2.86, p < .001) on Mini-Nutritional Assessment were associated with the presence of cognitive impairment. Better cognitive performance was associated with increased body mass index (adjusted OR: 0.74, p-.03), hemoglobin (adjusted OR: 0.91, p-.006), and serum albumin (adjusted OR: 0.38, p < .001). This study shows that nutritional status assessed by anthropometric measures and blood markers is strongly linked to cognitive performance in older adults.
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Affiliation(s)
| | | | | | - Swati Bajpai
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Arvind Jain
- Dr S. N. Medical College, Jodhpur, Rajasthan, India
| | - Chhaya Rajguru
- Grant Medical College and J.J. Hospital, Mumbai, Maharashtra, India
| | - Lalit Sankhe
- Grant Medical College and J.J. Hospital, Mumbai, Maharashtra, India
| | | | | | - Govind Kumar
- Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Mathew Varghese
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Minakshi Dhar
- All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Monica Gupta
- Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Parvaiz A-Koul
- Sher-e-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | | | | | | | - Sharmistha Dey
- All India Institute of Medical Sciences, New Delhi, India
| | - Aparajit Ballav Dey
- All India Institute of Medical Sciences, New Delhi, India
- Venu Geriatric Institute, New Delhi, India
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11
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Ding J, Chen X, Shi Z, Bai K, Shi S. Association of body roundness index and its trajectories with all-cause and cardiovascular mortality among a Chinese middle-aged and older population: A retrospective cohort study. Front Public Health 2023; 11:1107158. [PMID: 37033022 PMCID: PMC10076882 DOI: 10.3389/fpubh.2023.1107158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Objectives The body roundness index (BRI) is a novel anthropometric index that is a better indicator for predicting fat distribution than the body mass index (BMI). The longitudinal study can repeatedly collect measured results for the variables to be studied and then consider the potential effects of intraindividual changes in measurement. However, few population-based, longitudinal studies of BRI have been conducted, especially among the Chinese population. The study aimed to investigate the association of BRI and its longitudinal trajectories with all-cause and cardiovascular mortality. Methods A total of 71,166 participants with four times BRI measurements between January 2010 and December 2019 were included in this longitudinal study, with a median follow-up was 7.93 years, and 11,538 deaths were recorded, of which 5,892 deaths were due to cardiovascular disease (CVD). A latent class growth mixture modeling (LCGMM) was used to identify BRI trajectories. Cox proportional hazard models were used to estimate associations between BRI trajectories and the risk of all-cause and cardiovascular mortality. Results In the restricted cubic spline regression models, a U-shaped relationship between BRI and all-cause and cardiovascular mortality was observed. Three BRI longitudinal trajectories of low-stable (mean BRI = 2.59), moderate-stable (mean BRI = 3.30), and high-stable (mean BRI = 3.65) were identified by LCGMM. After being adjusted for potential confounders, the HRs for all-cause mortality were 1.18 (1.13-1.24) for the moderate-stable group and 1.74 (1.66-1.82) for the high-stable group compared to the low-stable group. The HRs for cardiovascular mortality were 1.12 (1.05-1.18) for the moderate-stable group and 1.64 (1.53-1.75) for the high-stable group compared to the low-stable group. Conclusion A nonlinear association of BRI with all-cause and cardiovascular mortality was observed, and participants in the higher BRI longitudinal trajectory group were significantly associated with an increased risk of all-cause and cardiovascular mortality.
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Affiliation(s)
- Jiacheng Ding
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xuejiao Chen
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhan Shi
- Department of Pharmacy, Zhengzhou People’s Hospital, Zhengzhou, Henan, China
| | - Kaizhi Bai
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Songhe Shi
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- *Correspondence: Songhe Shi,
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12
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El Osta N, Wehbe A, Sleiman N, Drancourt N, El Osta L, Hennequin M. Dental Criteria Could Alert for Malnutrition Risk and Inappropriate Choice of Food Texture in Older Subjects with Dementia: An Analytical Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15086. [PMID: 36429816 PMCID: PMC9690132 DOI: 10.3390/ijerph192215086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Oral health indicators are usually collected to alert for the presence of infectious diseases, but the impact of poor oral health on the nutritional status of older people with dementia is often neglected. This study aims to explore the relationship between the number of posterior dental functional units (PFUs) and the anthropometric measure of malnutrition, the mid-upper arm circumference (MUAC), in older people with dementia while controlling for other variables, and to analyze whether the number of PFUs is considered when adjusting the texture of the food provided at mealtimes. A total of 103 individuals who were 70 years or older with dementia were recruited from seven institutions. Cognitive impairment was assessed using the Mini Mental State Examination. Data were collected from medical records (sociodemographic characteristics, presence of chronic diseases, prescribed medications, results of serum albumin level), as well as questionnaires (type of feeding routes, type of food texture, supplements intake, Activity of Daily Living index), clinical examinations (MUAC), and oral health parameters (PFUs, oral dryness, oral hygiene). MUAC was the dependent outcome variable. MUAC was associated with the number of PFUs (p = 0.032); participants with PFU ≤ 4 were 7.5 times more likely to have MUAC < 21 cm than others. Other associations were found between MUAC and albumin level (OR = 12.5; p = 0.001), modified food texture (OR = 4.2; p = 0.035), and length of institutional stay (OR = 5.2; p = 0.033); however, the type of oral feeding was not significantly related to the number of PFUs (p = 0.487) so there is an inadequate correlation between food texture and oral health status. Similar to MUAC, the number of PFUs could be an oral anthropometric criterion that is recorded during routine hygiene care to alert for the risk of malnutrition and the inappropriate choice of food texture in older individuals with dementia.
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Affiliation(s)
- Nada El Osta
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, 63000 Clermont-Ferrand, France
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 111, Lebanon
| | - Amine Wehbe
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 111, Lebanon
| | - Nelly Sleiman
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 111, Lebanon
| | - Noemie Drancourt
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, 63000 Clermont-Ferrand, France
- CHU of Clermont-Ferrand, Service d’Odontologie, 63003 Clermont-Ferrand, France
| | - Lana El Osta
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 111, Lebanon
| | - Martine Hennequin
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, 63000 Clermont-Ferrand, France
- CHU of Clermont-Ferrand, Service d’Odontologie, 63003 Clermont-Ferrand, France
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13
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A nonlinear association between body roundness index and all-cause mortality and cardiovascular mortality in general population. Public Health Nutr 2022; 25:3008-3015. [PMID: 35983642 PMCID: PMC9991644 DOI: 10.1017/s1368980022001768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the association between body roundness index (BRI) and all-cause mortality and cardiovascular mortality in general population. DESIGN A retrospective cohort study. SETTING The status of cardiovascular mortality and all-cause mortality of participants were followed through 31 December 2015. Multivariate adjusted Cox restricted cubic spline regression models and Kaplan-Meier survival curves were used to evaluate the relationship between BRI and cardiovascular mortality and all-cause mortality. PARTICIPANTS A sample of 47 356 participants from the National Health and Nutrition Examination Surveys 1999-2014 with aged ≥18 years. RESULTS Mean age was 47 years and female were 49·9 %. During a median follow-up of 92 months, 4715 participants died from any cause, with 985 died of CVD. In multivariate adjusted Cox regression, compared with the lowest quartile of Body roundness index (BRI), the hazard ratios (HR) for all-cause mortality from other quartiles were 0·83, 95 % CI (0·75, 0·92), 0·73, 95 % CI (0·65, 0·81) and 0·80, 95 % CI (0·72, 0·89), respectively (Pfor trend < 0·05) and the HR for cardiovascular mortality from other quartiles were 0·79, 95 % CI (0·62, 1·00), 0·78, 95 % CI (0·62, 0·99) and 0·79, 95 % CI (0·62, 1·01), respectively (P for trend > 0·05). In the restricted cubic spline regression models, the relationship was showed U-shaped between BRI and all-cause mortality and cardiovascular mortality. In Kaplan-Meier survival curves, the lowest cumulative survival rate of cardiovascular mortality and all-cause mortality was recorded in the highest BRI quartile. CONCLUSIONS The U-shaped association between BRI and all-cause mortality and cardiovascular mortality in a large population-based cohort was observed.
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14
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Dawed A, Mekonnen TC, Genetu M, Tadesse SE, Dewau R, Muche A, Zerga AA, Ayele FY, Gill TK. Comparing the validity of anthropometric measurements in identifying malnutrition status of older age people in Borena district, North Central Ethiopia: a cross_sectional study. BMC Geriatr 2022; 22:776. [PMID: 36192694 PMCID: PMC9528122 DOI: 10.1186/s12877-022-03467-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Malnutrition among older age people is becoming significantly higher in spite of improvements in the health care system. Life expectancy of Ethiopian elders is increasing; but reliable and valid tools for screening and diagnosis of malnutrition in this subgroup are limited. This study aimed to assess the validity of anthropometric measurements: Mid Upper Arm Circumference (MUAC), Body Mass Index (BMI), and Calf Circumference (CC) in detecting malnutrition status of older age people in Ethiopia. Methods A community based cross-sectional study was conducted in Borena District from January to March, 2020. A total of 421 participants aged were systematically included in the study. To test reliability and validity of the measurements,Cronbach’s α coefficient and Pearson’s correlations were used, respectively. The full Mini-Nutritional Assessment (MNA) tool was used to diagnosis malnutrition. Overall accuracy, sensitivity and specificity of BMI, MUAC and CC were estimated using Receiver Operating Characteristic curves. The Youden Index was used to determine the best cut-off point. Results The reliability of BMI, MUAC and CC by Cronbach’s alpha was found 0.847. Significant positive correlations between MNA, BMI(r = 0.56, p < 0.01); MNA, MUAC(r = 0.43, p < 0.01; and MNA, CC(r = 0.52, p < 0.01) revealed. The area under the curve (AUC) of BMI, MUAC and CC were found: 0.98(95% CI, 0.96–0.99, p < 0.001), 0.94(95% CI, 0.89–0.98, p < 0.001) and 0.96(95% CI, 0.94–0.98, p < 0.001) indicating the overall accuracy respectively. The sensitivity and specificity of BMI, MUAC and CC using established cut off points were found: 90%, 96%; 78%, 94% and 84%, 95% respectively. However, using the Youden index the best cut-off point, the sensitivity and specificity of MUAC and CC were 88%, 86%; 92% and 89% respectively and adjusted for age and sex. Conclusions The current study demonstrated that BMI was a reliable and valid method to identify the malnutrition status of older age people. A MUAC value of 19 cm and CC of 30 cm were simple and efficient cut-off points for the determination of malnutrition in the older age people. A future study is needed to validate the validity of BMI, MUAC and CC against biochemical tests as gold standard. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03467-9.
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Affiliation(s)
- Abdu Dawed
- Dessie Comprehensive Specialized Hospital, Dessie, North Eastern, Ethiopia
| | - Tefera Chane Mekonnen
- Human Nutrition and Dietetics Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Muluken Genetu
- Department of Health Service Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Sisay Eshete Tadesse
- Human Nutrition and Dietetics Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amare Muche
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Aregash Abebayehu Zerga
- Human Nutrition and Dietetics Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fanos Yeshanew Ayele
- Human Nutrition and Dietetics Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tiffany K Gill
- Adelaide Medical School, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide, South Australia, Australia
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15
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Li X, Lang X, Peng S, Ding L, Li S, Li Y, Yin L, Liu X. Calf Circumference and All-Cause Mortality: A Systematic Review and Meta-Analysis Based on Trend Estimation Approaches. J Nutr Health Aging 2022; 26:826-838. [PMID: 36156674 DOI: 10.1007/s12603-022-1838-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To perform a systematic review and meta-analysis and quantify the associations of total mortality with calf circumference (CC) in adults 18 years and older via combining various analyses based on empirical dichotomic CC, continuous CC, and dose-response CC. METHODS We conducted a systematic search of relevant studies in PubMed, EMBASE, Cochrane Library, and Web of Science published through April 12, 2022. This systematic review includes longitudinal observational studies reporting the relationships of total mortality with CC. We calculated the pooled relative risk (RR) and 95% confidence interval (CI) of total mortality with CC per 1 cm for each study and combined the values using standard meta-analysis approaches. Newcastle-Ottawa scale (NOS), Grading of Recommendations, Assessment, Development and Evaluations approach (GRADE), and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) were assessed for meta-analyses. RESULTS Our analysis included a total of 37 cohort studies involving 62,736 participants, across which moderate heterogeneity was observed (I2=75.7%, P<0.001), but no publication bias was found. Study quality scores ranged from 6 to 9 (mean 7.7), with only three studies awarded a score of 6 (fair quality). We observed an inverse trend between total death risk and CC per 1 cm increase (RR, 0.95, 95% CI, 0.94-0.96; P<0.001; GRADE quality=high). Only a very slight difference was found among residents of nursing homes (6.9% mortality risk reduction per one cm CC increase), community-dwellers (5.4%), and those living in hospitals (4.8%), respectively (P for meta-regression=0.617). Low credible subgroup difference was found based on the ICEMAN tool. CONCLUSIONS Calf circumference is a valid anthropometric measure for mortality risk prediction in a community, nursing home, or hospital.
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Affiliation(s)
- X Li
- Lu Yin, Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing 102300, China. E-mail: ; Xiaomei Liu, Department of Emergency, Zhongshan Hospital of Xiamen University, Xiamen, China. Tel:
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Sahin Kaya A, Bora S, Yetisyigit T. Evaluation of the Effect of Nutritional Status in Patients with Cancer Receiving Chemotherapy on Anthropometric Measurements and Quality of Life. Nutr Cancer 2021; 74:1994-2002. [PMID: 34590508 DOI: 10.1080/01635581.2021.1984541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study is to determine the nutritional status, anthropometric measurements and quality of life of adult patients with cancer receiving chemotherapy, and to evaluate their interactions. In this retrospective cross sectional study, information about the patients' demographic characteristics, anthropometric measurements, nutritional status, hand grip strengths which were measured with a portable digital hand dynamometer, and the quality of life scores were obtained from the patient files. According to NRS-2002, 16.3% of the patients were at the risk of malnutrition. The body weight, body mass index, waist circumference, hip circumference, mid-upper arm circumference, hand grip strength values of the individuals who had three or higher scores from NRS-2002 were significantly lower (p < 0.05). Considering the evaluation of the quality of life scores based on their nutritional status, the functional and general health score was significantly lower in patients at the risk of malnutrition and their symptom score was significantly higher (p < 0.05). The presence of nutritional risk in cancer patients is related to the quality of life. In conclusion, the nutritional status of patients with cancer should be evaluated regularly, and early intervention regarding this is important to increase the quality of life.
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Affiliation(s)
- Aysel Sahin Kaya
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Antalya Bilim University, Antalya, Turkey
| | - Sumeyye Bora
- Faculty of Health Sciences, Department of Nutrition and Diet, Haliç University, Istanbul, Turkey
| | - Tarkan Yetisyigit
- Department of Medical Oncology, King Hamad University Hospital, Muharraq Governorate, Bahrain
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