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Nielsen RL, Bornæs O, Iversen E, Strejby Christensen LW, Kallemose T, Jawad B, Rasmussen HH, Munk T, Lund TM, Andersen O, Houlind MB, Leegaard Andersen A, Tavenier J. Growth differentiation factor 15 (GDF15) levels are associated with malnutrition in acutely admitted older adults. Clin Nutr 2024; 43:1685-1693. [PMID: 38879915 DOI: 10.1016/j.clnu.2024.06.005] [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: 04/05/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND AIMS The aging process is often accompanied by high risk of malnutrition and elevated levels of growth differentiation factor 15 (GDF15). GDF15 is an increasingly recognized biomarker for regulation of metabolism, but few studies have investigated the connection between GDF15 and malnutrition in older age and how it relates to other features of aging such as decreased appetite and physical function. Therefore, we investigated the associations between GDF15 levels and nutritional status, appetite, and physical function in acutely admitted older adults. METHODS Plasma GDF15 levels were measured using immunoassays in 302 older adults (≥65 years) admitted to the emergency department (ED). Nutritional status was evaluated with the Mini Nutritional Assessment Short-Form (MNA®-SF), appetite was evaluated with the Simplified Nutritional Appetite Questionnaire (SNAQ), and physical function was evaluated with handgrip strength (HGS), 30-s chair stand test (30s-RSS), and gait speed (GS). Associations between GDF15 and each outcome was determined by logistic regression adjusted for age, sex, and C-reactive protein (CRP). RESULTS Each doubling in plasma GDF15 level was associated with an adjusted odds ratio (OR) (95% confidence interval) of 1.59 (1.10-2.29, P = 0.01) for risk of malnutrition compared to normal nutrition and 1.19 (0.85-1.69, P = 0.3)) for malnutrition compared to risk of malnutrition. Each doubling in GDF15 was associated with an adjusted OR of 1.63 (1.21-2.23)) for having poor appetite, 1.46 (1.07-1.99) for having low HGS, 1.74 (1.23-2.51) for having low 30s-RSS, and 1.99 (1.39-2.94) for having low GS. CONCLUSION Among older adults admitted to the ED, higher GDF15 levels were significantly associated with malnutrition, poor appetite, and low physical function independent of age, sex, and CRP.
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Affiliation(s)
- Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Olivia Bornæs
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Louise Westberg Strejby Christensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Baker Jawad
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Henrik Højgaard Rasmussen
- Center for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg University, 9220 Aalborg, Denmark; The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital-Herlev and Gentofte, 2100 Copenhagen, Denmark.
| | - Tina Munk
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital-Herlev and Gentofte, 2100 Copenhagen, Denmark.
| | - Trine Meldgaard Lund
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark.
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark.
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark; Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark.
| | - Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
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Wezeman J, Darvas M, Postupna N, Klug J, Mangalindan RS, Keely A, Nguyen K, Johnson C, Rosenfeld M, Ladiges W. A drug cocktail of rapamycin, acarbose, and phenylbutyrate enhances resilience to features of early-stage Alzheimer's disease in aging mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.26.577437. [PMID: 38352353 PMCID: PMC10862773 DOI: 10.1101/2024.01.26.577437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
The process of aging is defined by the breakdown of critical maintenance pathways leading to an accumulation of damage and its associated phenotypes. Aging affects many systems and is considered the greatest risk factor for a number of diseases. Therefore, interventions aimed at establishing resilience to aging should delay or prevent the onset of age-related diseases. Recent studies have shown a three-drug cocktail consisting of rapamycin, acarbose, and phenylbutyrate delayed the onset of physical, cognitive, and biological aging phenotypes in old mice. To test the ability of this drug cocktail to impact Alzheimer's disease (AD), an adeno-associated-viral vector model of AD was created. Mice were fed the drug cocktail 2 months prior to injection and allowed 3 months for phenotypic development. Cognitive phenotypes were evaluated through a spatial navigation learning task. To quantify neuropathology, immunohistochemistry was performed for AD proteins and pathways of aging. Results suggested the drug cocktail was able to increase resilience to cognitive impairment, inflammation, and AD protein aggregation while enhancing autophagy and synaptic integrity, preferentially in female cohorts. In conclusion, female mice were more susceptible to the development of early stage AD neuropathology and learning impairment, and more responsive to treatment with the drug cocktail in comparison to male mice. Translationally, a model of AD where females are more susceptible would have greater value as women have a greater burden and incidence of disease compared to men. These findings validate past results and provide the rationale for further investigations into enhancing resilience to early-stage AD by enhancing resilience to aging.
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Affiliation(s)
- Jackson Wezeman
- Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Martin Darvas
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA
| | - Nadia Postupna
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA
| | - Jenna Klug
- Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Ruby Sue Mangalindan
- Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Addison Keely
- Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Kathryn Nguyen
- Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Chloe Johnson
- Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Manuela Rosenfeld
- Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Warren Ladiges
- Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, WA
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Mosaffa-Jahromi M, Molavi Vardanjani H, Fuzimoto A, Hunter J, Lankarani KB, Pasalar M. Efficacy and safety of aniseed powder for treating gastrointestinal symptoms of COVID-19: a randomized, placebo-controlled trial. Front Pharmacol 2024; 15:1331177. [PMID: 38292939 PMCID: PMC10824915 DOI: 10.3389/fphar.2024.1331177] [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: 10/31/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Background: Gastrointestinal symptoms are prevalent amongst patients with a confirmed diagnosis of COVID-19 and may be associated with an increased risk of disease severity. This trial aimed to evaluate the efficacy and safety of aniseed (Pimpinella anisum L.) powder as an add-on therapy to standard care for treating gastrointestinal symptoms experienced by adults with an acute SARS-CoV-2 infection. Methods: The study was a randomized parallel-group double-blinded placebo-controlled add-on therapy trial. Adults with an acute SARS-CoV-2 infection who did not require hospitalization and reported at least one gastrointestinal symptom in the preceding 48 h were assigned to either the aniseed or placebo group in a 1:4 ratio. All 225 participants (45 in the aniseed group and 180 in the placebo group) were instructed to use 25 g of powdered aniseed or placebo twice daily for 2 weeks. The primary outcomes were the proportion of patients who experienced an improvement of at least one point in the symptom score after adjusting for age group, gender, and time. Backwards stepwise logistic regression was applied to calculate the risk ratios. The clinical symptoms and adverse events were assessed at the beginning, 1 week later, and at the end of the trial (week two). Results: Participants in the aniseed group were significantly more likely to report symptom improvement for abdominal pain [adjusted risk ratio (RR):0.55; 95% confidence interval (CI): 0.46-0.72], anorexia (RR:0.62; 95% CI: 0.47-0.82), and diarrhea (RR:0.19; 95% CI: 0.12-0.30), but not nausea/vomiting (RR:0.87; 95% CI: 0.71-1.08) or bloating (RR:0.87; 95% CI: 0.72-1.05). Two participants in the aniseed group and three participants in the placebo group reported mild to moderate adverse events. Conclusion: This study showed that 2 weeks of aniseed powder containing trans-anethole (87%-94%) may help improve abdominal pain, anorexia, and diarrhea in COVID-19 patients. The findings align with the known biological, multitargeted activity of P. anisum and trans-anethole, which includes inhibiting SARS-CoV-2 along with other anti-infective, anti-inflammatory, antioxidant, hepatoprotective, and anti-dysbiosis properties. Multicenter trials with larger sample sizes and longer follow-up are warranted to confirm these findings. Clinical Trial Registration: Iranian Registry of Clinical Trials (IRCT20120506009651N3).
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Affiliation(s)
- Maryam Mosaffa-Jahromi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Molavi Vardanjani
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | | | - Mehdi Pasalar
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Widhalm HK, Keintzel M, Ohrenberger G, Widhalm K. The Urgent Need for Nutritional Medical Care in Geriatric Patients-Malnutrition in Nursing Homes. Nutrients 2023; 15:4367. [PMID: 37892441 PMCID: PMC10610431 DOI: 10.3390/nu15204367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Patients aged 65 and over who are accommodated in hospitals and nursing homes are at high risk of malnutrition and often show signs of it. The future relevance of this problem becomes clear, especially in view of the demographic development of the coming years and decades. In this study, the correlation between malnutrition, hypoalbuminemia, anemia, elevated CRP, and low transferrin levels, as well as mortality in seniors between 65 and 100 years, should be revealed. Therefore, the prevalence of disease-specific malnutrition (DRM), according to the criteria of the guidelines of the German Society of Nutritional Medicine (DGEM), and the prevalence of hypoalbuminemia were presented based on the data of 120 residents who were inpatients in a large Viennese nursing home between 01/2017 and 08/2020. Moreover, 86 of the inpatient residents were women and 34 were men, with a mean age of 84 years (SD: 8.7). In this examination, more than one-third of nursing home residents were malnourished. More than half of the residents were found to have low serum albumin or low transferrin saturation. However, no correlation between elevated CRP, low transferrin, or low serum albumin values and malnutrition could be established. Residents with low serum albumin or low transferrin levels, however, had a higher mortality rate. This study supports the urgent relevance of closer and individually personalized medical nutritional interventions, especially concerning hypoalbuminemic seniors aged 65 years and older.
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Affiliation(s)
- Harald K. Widhalm
- Clinical Division of Traumatology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Maximilian Keintzel
- Clinical Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria;
- Austrian Academic Institute for Clinical Nutrition, 1090 Vienna, Austria;
| | | | - Kurt Widhalm
- Austrian Academic Institute for Clinical Nutrition, 1090 Vienna, Austria;
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Nguyen LHT, Dang AK, Tran TV, Phan HT, Doan DAT, Nguyen LBT, Tran AM, Do TD, Nguyen TB, Nguyen TT, Nguyen BH, Le HT. The role of nutritional risk evaluation in predicting adverse outcomes among patients with severe COVID-19 in Vietnam. Front Nutr 2023; 10:1245816. [PMID: 37867496 PMCID: PMC10585166 DOI: 10.3389/fnut.2023.1245816] [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: 06/23/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction As sufficient nutrition helps alleviate catabolic stress and modulate the systemic inflammatory response of the body, it plays an indispensable role in the good prognosis of critically ill patients. Thus, this study aimed to investigate the malnutrition of patients with severe COVID-19 and its association with adverse treatment outcomes. Methods We conducted a retrospective cross-sectional study in two provincial hospitals in Hanoi from February to April 2022. Participants were patients with severe COVID-19 admitted to the Intensive Care Unit (ICU). Malnutrition risk were evaluated by Nutritional Risk Screening-2002 (NRS), Global Leadership Initiative on Malnutrition (GLIM), Prognostic Nutritional Index (PNI), and the adverse prognosis was assessed by Acute Physiology and Chronic Health Evaluation II (APACHE II). The multivariate receiver-operating characteristic (ROC) curve was applied to estimate the predictive ability of those criteria regarding worse treatment results. Results The percentages of malnutrition measured by NRS, GLIM, PNI, and BMI were 62.6, 51.5, 42.9, and 16.6%, respectively. Patients with more severe malnutrition assessed by GLIM, PNI, and having above target fasting blood glucose (FBG) (≥10.0 mmol/L) were more likely to have higher APACHE scores. PNI had a better diagnostic performance than NRS and BMI (AUC = 0.84, 0.81, and 0.82, respectively). In addition, FBG revealed a good prognostic implication (AUC = 0.84). Conclusion A relatively high percentage of patients experienced moderate and severe malnutrition regardless of screening tools. Individuals at higher risk of malnutrition and high FBG were predicted to have more adverse treatment outcomes. It is recommended that nutritional screening should be conducted regularly, and personalizing nutritional care strategies is necessary to meet patients' nutrient demands and prevent other nutrition-related complications.
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Affiliation(s)
- Lan Huong Thi Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Department of Nutrition, Saint Paul General Hospital, Hanoi, Vietnam
| | - Anh Kim Dang
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, QLD, Australia
| | - Tien Viet Tran
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Hai Thanh Phan
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Dao Anh Thi Doan
- Department of Nutrition, Thanh Nhan General Hospital, Hanoi, Vietnam
| | - Lien Bao Thi Nguyen
- Intensive Care Unit and Poison Control, Saint Paul General Hospital, Hanoi, Vietnam
| | - Anh Minh Tran
- Department of Nutrition, Saint Paul General Hospital, Hanoi, Vietnam
| | | | - Thang Ba Nguyen
- Intensive Care Unit and Poison Control, Saint Paul General Hospital, Hanoi, Vietnam
| | - Tien Thanh Nguyen
- Department of Nutrition, Saint Paul General Hospital, Hanoi, Vietnam
| | - Binh Huy Nguyen
- Department of Physiology, Hanoi Medical University, Hanoi, Vietnam
| | - Huong Thi Le
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
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Vaudin A, Dean W, Chen J, Sahyoun NR. Service Awareness Among Older Adults Experiencing Barriers to Food and Eating. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:564-574. [PMID: 37389500 DOI: 10.1016/j.jneb.2023.04.005] [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: 08/04/2022] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To explore (1) the services older adults use to address the barriers to food access they face and (2) how they found out about these services. DESIGN Semistructured, basic descriptive qualitative in-person interviews. SETTING Senior center and participants' homes. PARTICIPANTS A convenience sample of 24 older adults recruited from suburban and urban settings. Primarily Black females, living alone, and able to leave home without help. PHENOMENON OF INTEREST Financial and nonfinancial barriers to food access, awareness of services available. ANALYSIS Codes were assigned to portions of the text in which participants described how they learned about a service. These codes were categorized into one of the 3 larger themes that emerged: (1) intentionally sought by the participant, (2) intentional outreach by the service, and (3) encounters in daily life and environment. RESULTS Most connections to services were made through encounters in participants' daily life and environment; for example, word of mouth from family, friends or neighbors; connection through other services; referral from health care professionals; and seeing the service in their neighborhood. CONCLUSIONS AND IMPLICATIONS Robust social networks, medical screening, and referral may promote awareness of food assistance services. Future research and outreach should target those who are most isolated.
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Affiliation(s)
- Anna Vaudin
- Department of Nutrition and Food Science, University of Maryland College Park, College Park, MD
| | - Wesley Dean
- Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland College Park, College Park, MD
| | - Nadine R Sahyoun
- Department of Nutrition and Food Science, University of Maryland College Park, College Park, MD.
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Blanquet M, Guiguet-Auclair C, Berland P, Ducher G, Sauvage A, Dadet S, Guiyedi V, Farigon N, Bohatier J, Gerbaud L, Boirie Y. Are Energy and Protein Intakes Lower Than Requirements in Older Adults? An Urgent Issue in Hospitals and Nursing Homes. Nutrients 2023; 15:3307. [PMID: 37571245 PMCID: PMC10421298 DOI: 10.3390/nu15153307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Energy and protein intakes lower than requirements are associated with worsening health outcomes. Here we set out to evaluate gaps between energy and protein intakes and requirements in older adults in hospitals and in nursing homes (NH). A cross-sectional study included 360 inpatients and residents aged 75 years and older in two acute care wards; i.e., a multidisciplinary care unit (MCU) and a geriatric care unit (GCU), a geriatric rehabilitation unit (GRU), and two NH. Intakes were measured for three days. Requirements were based on French National Health Authority recommendations. Energy and protein intakes were under the minimum requirement of 30 kcal/kg/day and 1.2 g/kg/day in 89.5% and 100% of MCU patients, respectively, 75.5% and 64.2% of GCU patients, 92.7% and 90.9% of GRU patients, and 83.8% and 83.8 of NH residents. Intake-to-requirement gaps were not significantly associated with malnutrition, except in the GCU group where non-malnourished patients had higher energy gaps than malnourished patients. Intakes fell dramatically short of requirements in older adults in both hospital and NH settings irrespective of malnutrition status. A new paradigm based on a patient-centered approach should be developed to adapt meals served in hospital and in NH.
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Affiliation(s)
- Marie Blanquet
- Unité de Recherche Clinique, CH Mauriac, 15200 Mauriac, France;
- CNRS, Institut Pascal, Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (C.G.-A.); (P.B.); (L.G.)
- Service de Santé Publique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Candy Guiguet-Auclair
- CNRS, Institut Pascal, Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (C.G.-A.); (P.B.); (L.G.)
- Service de Santé Publique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Pauline Berland
- CNRS, Institut Pascal, Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (C.G.-A.); (P.B.); (L.G.)
- Service de Santé Publique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | | | - Anaïs Sauvage
- Recherche et Développement, Nutriset, 76770 Malaunay, France;
| | | | - Vincent Guiyedi
- Unité de Recherche Clinique, CH Mauriac, 15200 Mauriac, France;
| | - Nicolas Farigon
- Nutrition Clinique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (N.F.); (Y.B.)
| | | | - Laurent Gerbaud
- CNRS, Institut Pascal, Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (C.G.-A.); (P.B.); (L.G.)
- Service de Santé Publique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Yves Boirie
- Nutrition Clinique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (N.F.); (Y.B.)
- Unité de Nutrition Humaine, Université Clermont Auvergne, INRA, UMR 1019, 63000 Clermont-Ferrand, France
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Pourhassan M, Cederholm T, Donini LM, Poggiogalle E, Schwab U, Nielsen RL, Andersen AL, Małgorzewicz S, Volkert D, Wirth R. Severity of Inflammation Is Associated with Food Intake in Hospitalized Geriatric Patients-A Merged Data Analysis. Nutrients 2023; 15:3079. [PMID: 37513497 PMCID: PMC10385000 DOI: 10.3390/nu15143079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
The extent to which inflammation impacts food intake remains unclear, serving as a key risk factor for malnutrition as defined by the Global Leadership Initiative on Malnutrition (GLIM). To address this, we analyzed a large, merged dataset of geriatric hospitalized patients across Europe. The study included 1650 consecutive patients aged ≥65 year from Germany, Italy, Finland, Denmark, and Poland. Nutritional intake was assessed using the first item of the Mini Nutritional Assessment Short Form; C-reactive protein (CRP) levels were measured using standard procedures. In total (age 79.6 ± 7.4 year, 1047 females), 23% exhibited moderate to severe inflammation, and 12% showed severe inflammation; 35% showed moderate reductions in food intake, and 28% were considered malnourished. Median CRP levels differed significantly between patients with severe, moderate, and no decrease in food intake. Among patients with a CRP level of 3.0-4.99 mg/dL, 19% experienced a severe decrease in food intake, while 66% experienced moderate to severe decreases. Regression analysis revealed that inflammation was the most prominent risk factor for low food intake and malnutrition, surpassing other factors such as age, gender, infection, and comorbidity. A CRP level of ≥3.0 mg/dL is associated with reduced food intake during last 3 months in two thirds of hospitalized geriatric patients and therefore indicative for a high risk of malnutrition.
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Affiliation(s)
- Maryam Pourhassan
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, 44625 Herne, Germany
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, 75122 Uppsala, Sweden
- Theme Inflammation & Aging, Karolinska University Hospital, 14186 Stockholm, Sweden
| | - Lorenzo M Donini
- Department of Experimental Medicine, University of Rome "Sapienza", 00185 Rome, Italy
| | - Eleonora Poggiogalle
- Department of Experimental Medicine, University of Rome "Sapienza", 00185 Rome, Italy
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, 70210 Kuopio, Finland
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, ACUTE-CAG, Copenhagen University Hospital, 2650 Hvidovre, Denmark
| | - Aino Leegaard Andersen
- Department of Clinical Research, ACUTE-CAG, Copenhagen University Hospital, 2650 Hvidovre, Denmark
| | - Sylwia Małgorzewicz
- Department of Clinical Nutrition, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90403 Nuremberg, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, 44625 Herne, Germany
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Nagururu NV, Bernstein IA, Voegtline K, Olson S, Agrawal Y, Rowan NR. The Association of Peripheral and Central Olfaction With Frailty in Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:1276-1283. [PMID: 36502375 PMCID: PMC10329228 DOI: 10.1093/gerona/glac237] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Olfactory impairment is increasingly recognized as a biomarker of frailty, but the relationship between olfactory subdomains that describe peripheral or central dysfunction and frailty remains unexplored. METHODS We examined 1 160 older adults from the National Social Life, Health, and Aging Project Wave 3. Olfactory identification (OI): the ability to identify an odorant; and olfactory sensitivity (OS): the ability to detect the presence of an odorant, were assessed using 5- and 6-point measures, respectively. Frailty was operationalized as both a 37-item frailty index (FI) and the 5-item Physical Frailty Phenotype (PFP). Mixed models were fit to examine the association between OI, OS, FI, and PFP, while adjusting for demographic and clinical covariates. RESULTS Participants in the most-frail PFP category had lower OI and OS scores (OI: 3.88 vs 4.19, p = .016; OS: 3.15 vs 3.47, p = .031), whereas participants in the most-frail FI category exhibited lower OI scores but not OS scores when compared to nonfrail participants (OI: 3.72 vs 4.27, p = .014; OS: 3.19 vs 3.43, p = .476). Adjusted mixed models showed that a point increase in OI was associated with a lower PFP score (β = -0.107, p = .006) and FI score (β = -0.009, p = .010). A point increase in OS was associated with a lower PFP score (β = -0.058, p = .016) but not FI score (β = -0.004, p = .064). CONCLUSION Both OS and OI, predominantly peripheral and central measures of olfaction, respectively, are associated with frailty implicating olfaction as a potential biomarker and risk factor for frailty.
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Affiliation(s)
- Nimesh V Nagururu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Isaac A Bernstein
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kristin Voegtline
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Biostatistics, Epidemiology, and Data Management (BEAD) Core, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Olson
- Biostatistics, Epidemiology, and Data Management (BEAD) Core, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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10
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Liu CA, Liu T, Li HC, Song MM, Ge YZ, Ruan GT, Deng L, Zhang Q, Xie HL, Lin SQ, Shi JY, Shi HP. Nutrition impact symptoms: Noteworthy prognostic indicators for lung cancer. Clin Nutr 2023; 42:550-558. [PMID: 36863291 DOI: 10.1016/j.clnu.2023.02.021] [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: 10/25/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Nutrition impact symptoms (NIS) in head and neck cancer are well-studied and are found to be heavy contributors of poor outcome. However, the prevalence and role of NIS in other cancer are less addressed. In this study, we investigated the incidence and prognostic role of NIS in patients with lung cancer. METHODS NIS, evaluated by patient-generated subjective global assessment (PG-SGA) in a multicenter real-world prospective study, included loss of appetite, nausea, vomiting, mouth ulcer, constipation, diarrhea, dry mouth, taste change, altered smell, dysphagia, early satiety, and pain. The endpoints were the patients' overall survival (OS) and quality of life (QoL). The COX analysis was used to investigate the relationship between NIS and OS. Interaction analysis and mediation analysis were performed to determine the modifiers and mediator. RESULTS 3634 patients with lung cancer were enrolled in this study, of which 1533 patients had NIS. During the average follow-up of 22.65 months, 1875 deaths occurred. The OS of patients with lung cancer with NIS was lower than that of patients without NIS. NIS (HR, 1.181, 95% CI, 1.073-1.748), loss of appetite (HR, 1.266, 95% CI, 1.137-1.409), vomiting (HR, 1.282, 95% CI, 1.053-1.561), and dysphagia (HR, 1.401, 95% CI, 1.079-1.819) were independent prognostic factors in patients with lung cancer. There were interactions between chemotherapy and primary tumor on NIS . In the relationship between different types of NIS (NIS, loss of appetite, vomiting, dysphagia) and prognosis, the mediating effects of inflammation accounted for 15.76%, 16.49%, 26.32%, and 18.13%, respectively. Meanwhile, these three NIS were closely associated with the occurrence of severe malnutrition and cancer cachexia. CONCLUSIONS 42% patients with lung cancer experienced different types of NIS. NIS were independent indicators of malnutrition, cancer cachexia and shorter OS, and closely related to QoL. NIS management is of clinical significance.
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Affiliation(s)
- Chen-An Liu
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
| | - Tong Liu
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
| | - Hui-Chen Li
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China; Tianjin Institute of Coloproctology, Tianjin, 300121, China
| | - Meng-Meng Song
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
| | - Yi-Zhong Ge
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
| | - Guo-Tian Ruan
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
| | - Li Deng
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
| | - Qi Zhang
- Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China; Department of Colorectal Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, 310022, China
| | - Hai-Lun Xie
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
| | - Shi-Qi Lin
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
| | - Jin-Yu Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China
| | - Han-Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, 100038, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, China.
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11
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Krogdahl Å, Dhanasiri AKS, Krasnov A, Aru V, Chikwati EM, Berge GM, Engelsen SB, Kortner TM. Effects of functional ingredients on gut inflammation in Atlantic salmon (Salmo salar L). FISH & SHELLFISH IMMUNOLOGY 2023; 134:108618. [PMID: 36801242 DOI: 10.1016/j.fsi.2023.108618] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
Functional feed ingredients are frequently used in feeds for Atlantic salmon, often claimed to improve immune functions in the intestine and reduce severity of gut inflammation. However, documentation of such effects is, in most cases, only indicative. In the present study effects of two packages of functional feed ingredients commonly used in salmon production, were evaluated employing two inflammation models. One model employed soybean meal (SBM) as inducer of a severe inflammation, the other a mixture of corn gluten and pea meal (CoPea) inducing mild inflammation. The first model was used to evaluate effects of two packages of functional ingredients: P1 containing butyrate and arginine, and P2 containing β-glucan, butyrate, and nucleotides. In the second model only the P2 package was tested. A high marine diet was included in the study as a control (Contr). The six diets were fed to salmon (average weight of 177g) in saltwater tanks (57 fish per tank), in triplicate, for 69 days (754 ddg). Feed intake was recorded. The growth rate of the fish was high, highest for the Contr (TGC: 3.9), lowest for SBM fed fish (TGC: 3.4). Fish fed the SBM diet showed severe symptoms of inflammation in the distal intestine as indicated by histological, biochemical, molecular, and physiological biomarkers. The number of differently expressed genes (DEG) between the SBM and Contr fed fish was 849 and comprised genes indicating alteration in immune functions, cellular and oxidative stress, and nutrient digestion, and transport functions. Neither P1 nor P2 altered the histological and functional symptoms of inflammation in the SBM fed fish importantly. Inclusion of P1 altered expression of 81 genes, inclusion of P2 altered 121 genes. Fish fed the CoPea diet showed minor signs of inflammation. Supplementation with P2 did not change these signs. Regarding composition of the microbiota in digesta from the distal intestine, clear differences regarding beta-diversity and taxonomy between Contr, SBM, and CoPea fed fish were observed. In the mucosa the microbiota differences were less clear. The two packages of functional ingredients altered microbiota composition of fish fed the SBM and the CoPea diet towards that of fish fed the Contr diet.
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Affiliation(s)
- Åshild Krogdahl
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine, Department of Paraclinical Sciences, Ås, Norway.
| | - Anusha K S Dhanasiri
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine, Department of Paraclinical Sciences, Ås, Norway
| | | | - Violetta Aru
- Department of Food Science, University of Copenhagen, Frederiksberg, Denmark
| | | | | | | | - Trond M Kortner
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine, Department of Paraclinical Sciences, Ås, Norway
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12
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Sánchez-Sánchez JL, Guyonnet S, Lucas A, Parini A, Rolland Y, de Souto Barreto P. Plasma Inflammatory Biomarkers and Anorexia of Ageing among Community-Dwelling Older Adults: An Exploratory Analysis of the MAPT Study. J Nutr Health Aging 2023; 27:1127-1131. [PMID: 37997735 DOI: 10.1007/s12603-023-2024-8] [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: 09/12/2023] [Accepted: 10/22/2023] [Indexed: 11/25/2023]
Abstract
Anorexia of aging and biological aging might share physiological underpinnings. The aim of this secondary analysis was to investigate the associations between circulating inflammation-related markers and anorexia of aging in community-dwelling older adults. C-reactive protein (CRP), tumor necrosis factor receptor-1 (TNFR-1), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1) and growth/differentiation factor-15 (GDF-15) were measured in plasma. Anorexia of aging was defined by the response "severe/moderate decrease in food intake" to the first item of the Mini-Nutritional Assessment. We included 463 subjects (median age=74y, IQR=71-78; 63.1% women). 33 subjects (7.1%) presented with anorexia at baseline, whereas 25 out of 363 (6.9%) developed it along 1-year follow-up. We found that TNFR1 (OR=1.74, 95%CI=1.27-2.39) and GDF-15 (OR=1.38, 95%CI=1.01-1.89) were associated with a significant increase in the odds of presenting with anorexia of aging cross-sectionally. No further significant associations were found. Biological aging mechanisms might be involved in the pathogenesis of anorexia of aging.
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Affiliation(s)
- J L Sánchez-Sánchez
- Juan Luis Sánchez-Sánchez, CHU Toulouse Gérontopôle: Centre Hospitalier Universitaire de Toulouse Gerontopole, France,
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13
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Picca A, Calvani R, Coelho-Júnior HJ, Landi F, Marzetti E. Anorexia of Aging: Metabolic Changes and Biomarker Discovery. Clin Interv Aging 2022; 17:1761-1767. [PMID: 36483084 PMCID: PMC9726216 DOI: 10.2147/cia.s325008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/24/2022] [Indexed: 08/04/2023] Open
Abstract
The age-associated decrease in appetite and food intake is referred to as "anorexia of aging". Older adults with anorexia show changes in the quantity/quality of energy supplied to the organism which eventually may cause a mismatch between ingested calories and physiological energy demands. Therefore, a state of malnutrition and impaired metabolism may ensue which renders older people more vulnerable to stressors and more prone to incur negative health outcomes. These latter cover a wide range of conditions including sarcopenia, low engagement in physical activity, and more severe consequences such as disability, loss of independence, hospitalization, nursing home placement, and mortality. Malnutrition has been recognized by the European Society of Clinical Nutrition (ESPEN) among the chief risk factors for the development of frailty. Frailty refers to a state of increased vulnerability to stressors stemming from reduced physiologic reserve, and according to ESPEN, is also nutrition-based. Alike frailty, anorexia is highly prevalent among older adults, and its multifactorial nature includes metabolic changes that develop in older age and possibly underly the condition. Circulating factors, including hormones (eg, cholecystokinin, ghrelin, leptin, and inflammatory and microbial mediators of gut dysbiosis), have been proposed as biomarkers for this condition to support early identification and develop personalized nutritional interventions. Additional studies are needed to untangle the interrelationship between gut microbiota and appetite regulation in older adults operating through brain-gut crosstalk. Furthermore, the contribution of the genetic background to appetite regulation and specific nutritional needs warrants investigation. Here, we provide an overview on anorexia of aging in the context of age-related metabolic changes. A special focus is placed on candidate biomarkers that may be used to assist in the early identification of anorexia of aging and in the development of personalized nutritional counseling.
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Affiliation(s)
- Anna Picca
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | | | - Francesco Landi
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica Del Sacro Cuore, Rome, Italy
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14
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Zhang M, Guo Y, Zhang X, Zhang Y, Fan Y, Liu Y, Zhao K, Fan R, Lu P. Nutritional risk screening in malignant tumors: a study of 375 cancer inpatients. Support Care Cancer 2022; 30:8333-8337. [PMID: 35864360 DOI: 10.1007/s00520-022-07242-9] [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: 04/30/2021] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
Malnutrition is a common complication in cancer patients. It often accelerates disease progression and affects treatment outcomes. Thus, in the early census of cancer patients, examination for possible nutritional risks and correcting potential causes of malnutrition are needed to improve patients' quality of life. Our study included 375 patients diagnosed with cancer in Henan province and analyzed the relationship between nutritional risk and indicators like age, serum albumin, serum prealbumin, serum hemoglobin, tumor stage, tumor type, and inflammatory factors. We found that age, hemoglobin, and presence of gastrointestinal tumors were independent risk factors for nutritional risk. We also found significant correlation between inflammatory factors and nutritional risk in cancer patients, so as to provide new prediction indexes for clinical management of nutritional risk and dynamic changes of nutritional status.
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Affiliation(s)
- Min Zhang
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China
- Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China
| | - Yuying Guo
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China
| | - Xiaodi Zhang
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China
| | - Yu Zhang
- Internal Medicine Comprehensive Ward, Shangqiu, Third People's Hospital, Shangqiu, Henan Province, 476000, People's Republic of China
| | - Yuanyuan Fan
- Department of Oncology and Hematology, Yanshi City People's Hospital, 2#, Shangdu Dong Road, Luoyang, Henan, 471900, People's Republic of China
| | - Yanting Liu
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China.
- Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China.
| | - Kelei Zhao
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China
| | - Ruijuan Fan
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China
| | - Ping Lu
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, No. 88, Jiankang Road, Weihui, Henan Province, 453100, People's Republic of China.
- Life Science Research Center, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province, 453100, People's Republic of China.
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15
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Salmi A, Komulainen K, Nihtilä A, Tiihonen M, Nykänen I, Hartikainen S, Suominen AL. Eating problems among old home care clients. Clin Exp Dent Res 2022; 8:959-968. [PMID: 35527353 PMCID: PMC9382049 DOI: 10.1002/cre2.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
Aims The purpose was to examine the prevalence and determinants of self‐reported eating problems in old home care clients, screened separately by a clinical nutritionist and a dental hygienist. Methods and Results The data came from the Nutrition, Oral Health and Medication (NutOrMed) study, the participants of which were ≥75‐year‐old home care clients living in Finland. The structured interviews were conducted at the participants' (n = 250) homes. Of the participants, 29% reported poor appetite, 20% had problems with chewing, and 14% had problems with swallowing when asked by a clinical nutritionist. Additionally, 18% reported oral health‐related eating problems when asked by a dental hygienist. Participants with continuous xerostomia (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.0–9.0) or poor self‐reported oral health (OR: 4.3, 95% CI: 1.4–13.0) had a higher risk for problems with chewing when asked by a clinical nutritionist. Edentulous participants (OR: 3.5, 95% CI: 1.2–10.9) and participants with toothache or problems with dentures (OR: 10.3, 95% CI: 4.0–26.0) had a higher risk for oral health‐related eating problems when asked by a dental hygienist. Conclusion Eating problems are common in older adults, and interprofessional collaboration is required for their identification and alleviation.
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Affiliation(s)
- Annina Salmi
- Institute of Dentistry, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kaija Komulainen
- Institute of Dentistry, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Annamari Nihtilä
- Institute of Dentistry, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Social and Health Services, City of Espoo, Espoo, Finland
| | - Miia Tiihonen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Irma Nykänen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna L Suominen
- Institute of Dentistry, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Surgery, University Hospital Kuopio, Kuopio, Finland
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Chareh N, Kiesswetter E, Kob R, Hannink A, Brandl B, Skurk T, Hauner H, Sieber CC, Volkert D. Association Between Inflammation and Appetite in Healthy Community-Dwelling Older Adults—An enable Study. FRONTIERS IN AGING 2022; 3:826816. [PMID: 35821805 PMCID: PMC9261305 DOI: 10.3389/fragi.2022.826816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022]
Abstract
Aging is associated with reduced appetite as well as a slight increase in pro-inflammatory status, which both might contribute to the development of malnutrition. We aimed to evaluate the association between inflammation based on serum C-reactive protein (CRP), and appetite in healthy community-dwelling older adults. In this cross-sectional study of 158 healthy and non-smoking persons (aged 75–85 years), appetite was assessed in personal interviews by a single question with five answer categories. As nobody reported (very) poor appetite, the remaining three categories were dichotomised into “(very) good” and “moderate” appetite. Fasting serum CRP was analysed according to standard procedures, values ≥ 5.0 mg/L were considered as inflammation. The association between inflammation and appetite was examined by binary logistic regression, unadjusted and adjusted for age, sex, waist circumference, leptin, depressive mood, number of medications, interleukin-6 and tumor necrosis factor-α. Appetite was very good in 27.8%, good in 58.9%, and moderate in 13.3% of participants. Inflammation was present in 10.8% overall, in 8.8% of those with (very) good and in 23.8% of those with moderate appetite (p = 0.038). In the unadjusted model, participants with inflammation were 3.2 times more likely to have moderate appetite (95%CI: 1.01–10.44, p = 0.047). In the adjusted model, the odds of having moderate appetite was 3.7 times higher in participants with inflammation, but no longer significant (95%CI: 0.77–18.55, p = 0.102). In healthy older people, we found hints for a potential association between increased levels of CRP and a slightly reduced appetite. More studies in larger samples are needed.
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Affiliation(s)
- Neshat Chareh
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
- *Correspondence: Neshat Chareh,
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Anne Hannink
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Beate Brandl
- ZIEL–Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Thomas Skurk
- ZIEL–Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Hans Hauner
- ZIEL–Institute for Food and Health, Technical University of Munich, Freising, Germany
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Cornel C. Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
- Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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17
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Abstract
Objective COVID-19 may cause an anorexic situation. This in turn leads to underfeeding, puts the patient in an energy protein malnutrition state, develops the hyperinflammation, weakens the immunity, and makes COVID-19 conditions more dangerous. Meanwhile, the more severe inflammation conditions in the body, the more severe the anorexia, which in turn affect the disease severity. Studies evaluating appetite in COVID-19 patients are very rare; therefore, we evaluated anorexia and analyzed the related factors in patients with COVID-19. Material and methods In this cross sectional study, adult patients’ ≥18 years old with the positive real-time fluorescence polymerase chain reaction for COVID-19 were included. The patients were classified as mild, moderate, and severe based on the WHO classification. We measured the appetite score, weight, height, body mass index (BMI), depression and anxiety score, at admission for every patient. Results A total of 301 patients participated in the study. The prevalence of admission anorexia was 58%, and this rate was significantly more in the severe group compared to the mild and moderate groups (P < 0.001). Comorbidities, depression and anxiety were independently correlated with anorexia risk [(OR = 3.6, 95% CI 1.68–7.70, P = 0.001), (OR = 1.23, 95% CI 1.16–1.30, P < 0001), and (OR = 1.24, 95% CI 1.17–1.31, P < 0001)], respectively. This correlation was adherence to a U-shape association for BMI, which means BMI < 18.5 (OR = 3.35, 95% CI 1.8–10.42, P < 0001) and BMI ≥30 (OR = 2.45, 95% CI 1.02–6.53, P = 0.048) were related to higher risk of anorexia. Conclusion We reported a high prevalence of anorexia (58%) in COVID-19 patients, which was positively correlated with disease severity. Furthermore, any factor worsening inflammatory state, including underweight, obesity, comorbidities, depression and anxiety can exacerbate anorexia in these patients.
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Masaki S, Kawamoto T. Nutritional and prognostic significance of abdominal wall thickness measured during percutaneous endoscopic gastrostomy in older individuals with dysphagia. Clin Nutr ESPEN 2021; 46:216-222. [PMID: 34857200 DOI: 10.1016/j.clnesp.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND & AIMS The significance of abdominal wall thickness (AWT) for nutritional assessment remains unclear. This study aimed to evaluate the nutritional and prognostic significance of AWT measured during percutaneous endoscopic gastrostomy (PEG) in older patients with dysphagia. METHODS This single-center retrospective cohort study enrolled older adults with dysphagia who underwent PEG for enteral nutrition using the introducer technique between February 2010 and January 2019. We examined the association between AWT measured during PEG and nutritional status items, including body mass index (BMI), serum albumin (Alb), total lymphocyte count (TLC), total cholesterol (TC), hemoglobin (Hb), and C-reactive protein (CRP). The shaft length of the PEG tube inserted, which is an approximation value of the AWT, was used for statistical analysis. Patients were divided into three groups: low-AWT group (shaft length ≤2.5 cm), medium-AWT group (shaft length 3.0-3.5 cm), and high-AWT group (shaft length ≥4.0 cm). We performed the Kruskal-Wallis test and multiple linear regression analysis with multiple imputation. We performed survival analysis using the Kaplan-Meier method, log-rank test, and Cox regression analysis. RESULTS A total of 520 patients were identified: 115, 258, and 147 patients in the low-AWT, medium-AWT, and high-AWT groups, respectively. Higher AWT was significantly associated with higher BMI, Alb, TLC, TC, Hb, and lower CRP levels. Multiple linear regression analysis revealed that BMI and TLC were significant predictors of AWT (BMI: coefficient 1.16E-01, 95% confidence interval [CI], 9.77E-02-1.33E-01, P < 0.001; TLC: coefficient 1.18E-04, 95% CI, 2.72E-05-2.09E-04, P = 0.011). The median survival time was the longest in the high-AWT group (low-AWT, 359 days; medium-AWT, 851 days; high-AWT, 1662 days; P < 0.001). The hazard ratio for the high-AWT group relative to the medium-AWT group was 0.59 (95% CI, 0.41-0.85, P = 0.004), and that relative to the low-AWT group was 0.34 (95% CI, 0.24-0.51, P < 0.001). CONCLUSIONS Higher AWT was associated with better nutritional status and survival. AWT may help assess nutritional status and predict survival in older dysphagic patients with PEG.
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Affiliation(s)
- Shigenori Masaki
- Department of Surgery and Gastroenterology, Miyanomori Memorial Hospital, Sapporo 064-0953, Hokkaido, Japan.
| | - Takashi Kawamoto
- Department of Neurosurgery, Miyanomori Memorial Hospital, Sapporo 064-0953, Hokkaido, Japan.
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Abstract
The global COVID-19 (coronavirus disease 2019) pandemic has become a complex problem that overlaps with a growing public health problem, obesity. Obesity alters different components of the innate and adaptive immune responses, creating a chronic and low-grade state of inflammation. Nutritional status is closely related to a better or worse prognosis of viral infections. Excess weight has been recognised as a risk factor for COVID-19 complications. In addition to the direct risk, obesity triggers other diseases such as diabetes and hypertension, increasing the risk of severe COVID-19. The present review explains the diets that induce obesity and the importance of different foods in this process. We also review tissue disruption in obesity, leading to impaired immune responses and the possible mechanisms by which obesity and its co-morbidities increase COVID-19 morbidity and mortality. Nutritional strategies that support the immune system in patients with obesity and with COVID-19 are also discussed in light of the available data, considering the severity of the infection. The discussions held may contribute to combating this global emergency and planning specific public health policy.
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20
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Factors Related to Oral Intake of Food by Hospitalized Patients with Malnutrition under the Care of a Nutrition Support Team. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111725. [PMID: 34770239 PMCID: PMC8583554 DOI: 10.3390/ijerph182111725] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 01/16/2023]
Abstract
This study aimed to evaluate the role of the general condition and oral health status in determining the primary nutritional route and suitable food form for oral ingestion among malnourished inpatients. This cross-sectional study included 255 inpatients referred to a nutrition support team (NST), which included dental professionals, at an acute care hospital. We assessed the participants’ basic information, and Dysphagia Severity Scale (DSS) and Oral Health Assessment Tool (OHAT) scores. The nutritional intake mode was evaluated based on the Functional Oral Intake Scale scores at the initial NST consultation (FOIS-I), and then revised by the NST based on the participants’ general condition and oral health (FOIS-R). There was a divergence between FOIS-I and FOIS-R, with FOIS-R being significantly higher than FOIS-I (p < 0.001). Logistic regression analysis of FOIS-R identified that consciousness level (odds ratio (OR): 0.448; 95% confidence interval (CI): 0.214–0.935) and DSS (OR: 3.521; 95% CI: 2.574–4.815) significantly affected the oral nutrition intake. Among participants who could ingest orally (FOIS-R ≥ 3; n = 126), FOIS score had significant negative and positive associations with the OHAT and DSS scores, respectively. These findings suggest that appropriate assessment of oral health status, including swallowing function, might contribute to high-quality nutrition management.
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21
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Zeng Q, Cao H, Ma Q, Chen J, Shi H, Li J. Appetite loss, death anxiety and medical coping modes in COVID-19 patients: a cross-sectional study. Nurs Open 2021; 8:3242-3250. [PMID: 34463433 PMCID: PMC8510753 DOI: 10.1002/nop2.1037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/27/2021] [Accepted: 07/25/2021] [Indexed: 12/14/2022] Open
Abstract
AIM This study aims to explore the current level and associated factors of appetite and death anxiety amongst COVID-19 patients and also to identify correlation between the two variables. DESIGN A cross-sectional study. METHODS Demographic and characteristic questionnaires, templer death anxiety scale, council on nutrition of appetite questionnaire and medical coping modes questionnaire were utilized. RESULTS The average scores of appetite and death anxiety were 19.46 (4.09) and 6.58, (3.21) respectively. 76 patients (100%) suffered from appetite loss, whilst 27 (35.50%) patients suffered from severe death anxiety. Marital status, COVID-19 disease condition ranks, educational level and death anxiety were explained 55.20% of the total variance in the appetite regression model (F = 31.83, p < .001), whilst the gender, avoidance coping strategy and appetite level were explained 49.80% of the total variance in death anxiety model (F = 17.80, p < .001). A moderate negative correlation between appetite and death anxiety was also confirmed (r=-.55, p < .001).
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Affiliation(s)
- Qiuxuan Zeng
- Guangzhou Institute of Respiratory HealthThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Huangliang Cao
- Guangzhou Eighth People's Hospital, Guangzhou Medical UniversityGuangzhouChina
| | - Qing Ma
- School of NursingGuangzhou University of Chinese MedicineGuangzhouChina
| | - Jieya Chen
- Guangzhou Institute of Respiratory HealthThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Haixia Shi
- Guangzhou Institute of Respiratory HealthThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Jiaying Li
- School of Nursing, Li Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina
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22
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Endocrinological and Nutritional Implications of Anorexia of Aging. ENDOCRINES 2021. [DOI: 10.3390/endocrines2040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Poor appetite—known as anorexia—is a common condition in aging and is associated with poor outcomes, including reduced survival and impaired quality of life. The anorexia of aging is mainly the result of several complex endocrinological, metabolic, and nutritional changes occurring with later age. The modulation of different peptides and hormones has been identified as an important determinant for the development of low appetite; in particular, an altered imbalance of plasma ghrelin, leptin, and cholecystokinin and increased inflammatory markers are implicated in its pathophysiology, and robust evidence of their involvement in anorexia of aging has been produced in the clinical setting. More recently, researchers identified that the gut microbiome composition significantly varies according to the appetite status. Other important clinical factors may worsen the symptoms of the anorexia in the elderly, in particular the potential concomitant presence of chronic catabolic comorbidities. Importantly, data indicate that anorexia is prevalent in frail older adults, negatively impacting body composition and specifically in altering muscle mass and function. For all these reasons, a prompt and early diagnosis of anorexia in the elderly is crucial to implement personalized metabolic and nutrition interventions to improve the outcomes and ameliorate quality of life.
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23
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Malnutrition-sarcopenia syndrome and all-cause mortality in hospitalized older people. Clin Nutr 2021; 40:5475-5481. [PMID: 34656028 DOI: 10.1016/j.clnu.2021.09.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/24/2021] [Accepted: 09/17/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Malnutrition-sarcopenia syndrome (MSS) describes the presence of sarcopenia and malnutrition together. This study aims to evaluate the relationship between MSS and all-cause mortality at two years in hospitalised older Turkish people. METHODS This is a bi-centered prospective cohort study conducted in older individuals in hospital settings (University hospital and research, research and training hospital). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle mass was measured by bioelectrical impedance analysis. Malnutrition (MN) was assessed by the Mini Nutritional Assessment. Six study groups were formed according to sarcopenia and MN status; MSS, sarcopenia with malnutrition risk (MNR), sarcopenia, MN, MNR, and normal nutrition. The relationship between MSS and other study groups with mortality was assessed by Cox regression model. Survival curves were estimated using the Kaplan-Meier method. RESULTS 350 hospitalised older people participated (mean age: 77.2 ± 7.6, 56% female). During the 2-year follow-up, 98 (28%) of the participants died. MSS, sarcopenia, sarcopenia with MNR and MN groups were independently associated with all-cause mortality at two years. MSS group had the highest hazard ratio (HR:19.8). Survival curves of MSS sarcopenia, sarcopenia with MNR, and MN groups were significantly different from MNR and normal nutrition groups. MSS had the worst survival curve. CONCLUSIONS Hospitalised older people should be evaluated for the presence of both sarcopenia and MN because of increased mortality. Preventive measures are needed for both conditions to decrease adverse health outcomes such as mortality.
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Persistent level of mental distress in PTSD patients is not reflected in cytokine levels 1 year after the treatment. Acta Neuropsychiatr 2021; 33:254-260. [PMID: 33902770 DOI: 10.1017/neu.2021.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Cross-sectional data show that post-traumatic stress disorder (PTSD) patients often have increased levels of circulating inflammatory markers. There is, however, still a paucity of longitudinal studies with long follow-up times on levels of cytokines in such patients. The current study assesses patients with and without PTSD diagnosis 1 year after discharge from inpatient treatment. METHODS Patients in treatment for serious non-psychotic mental disorders were recruited at the beginning of their treatment stay at a psychiatric centre in Norway. Ninety patients submitted serum samples and filled out the Hopkins Symptom Checklist-90 Revised Global Severity Index (HSCL-90R GSI) questionnaire during their mainstay and at a follow-up stay 1 year after discharge. Of these patients, 33 were diagnosed with PTSD, 48 with anxiety, depression, or eating disorder, while 9 patients had missing data. The patients were diagnosed using the Mini-International Neuropsychiatric Interview (MINI). RESULTS At the follow-up stay (T3), PTSD patients had higher levels of GSI scores than non-PTSD patients (p = 0.048). These levels were unchanged from the year before (T2) in both groups. The levels of circulating cytokines/chemokine did not differ between the PTSD and non-PTSD patients at T3. At T2, however, the PTSD and non-PTSD groups exhibited different levels of interleukin 1β (IL-1β) (p = 0.053), IL-1RA (p = 0.042), and TNF-α (p = 0.037), with the PTSD patients having the higher levels. CONCLUSION Despite exhibiting different mental distress scores, the PTSD and non-PTSD patients did not differ regarding levels of circulating inflammatory markers at 1-year follow-up.
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25
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Kamugisha JGK, Lanyero B, Nabukeera-Barungi N, Ritz C, Mølgaard C, Michaelsen KF, Briend A, Mupere E, Friis H, Grenov B. Weight-for-Height Z-score Gain during Inpatient Treatment and Subsequent Linear Growth during Outpatient Treatment of Young Children with Severe Acute Malnutrition: A Prospective Study from Uganda. Curr Dev Nutr 2021; 5:nzab118. [PMID: 34712895 PMCID: PMC8546154 DOI: 10.1093/cdn/nzab118] [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: 05/20/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Linear catch-up growth after treatment of severe acute malnutrition (SAM) is low, and little is known about the association between ponderal and subsequent linear growth. OBJECTIVE The study assessed the association of weight-for-height z-score (WHZ) gain with subsequent linear growth during SAM treatment and examined its modifiers. METHODS This was a prospective study, nested in a trial (ISRCTN16454889), among 6-59-mo-old children treated for SAM in Uganda. Weight, total length (TL), and knee-heel length (KHL) were measured at admission, weekly during inpatient therapeutic care (ITC), at discharge, and fortnightly during outpatient therapeutic care (OTC) for 8 wk. Linear regression was used to assess the association between WHZ gain during ITC and linear growth during OTC. RESULTS Of 400 children, 327 were discharged to OTC and 290 were followed up for 8 wk. Mean WHZ gains were 0.45 in ITC and 1.24 in OTC, whereas mean height-for-age z-score (HAZ) declined by 0.41 during ITC and increased by 0.14 during OTC. WHZ gain during ITC was positively associated with HAZ, TL, and KHL gains during OTC [regression coefficients (β) (95% CI): 0.12 (0.09, 0.15) z-score; 3.1 (2.4, 3.8) mm and 0.5 (0.1, 0.7) mm, respectively]. The regression coefficients were highest for the middle tertile of WHZ gain with respect to HAZ and TL. Admission diarrhea and low plasma citrulline reduced the association between WHZ gain during ITC and HAZ and TL gain during OTC (P < 0.001). In contrast, pneumonia (P = 0.051) and elevated plasma C-reactive protein (P < 0.001) increased the association with TL gain, but reduced the association with KHL gain (P < 0.001). CONCLUSIONS Among children admitted with SAM, considerable WHZ gain during ITC was followed by very modest linear catch-up growth during OTC, with no indication of a WHZ gain threshold, above which linear growth was higher. To optimize linear growth in these children, early treatment of infections and conditions affecting the gut may be necessary.
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Affiliation(s)
- Jolly G K Kamugisha
- Mwanamugimu Nutrition Unit, Department of Pediatrics, Mulago National Referral Hospital, Kampala, Uganda
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Betty Lanyero
- World Health Organization, Ethiopia Country Office, UNECA Compound, Addis Ababa, Ethiopia
| | | | - Christian Ritz
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - André Briend
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ezekiel Mupere
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henrik Friis
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Benedikte Grenov
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg C, Denmark
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Pourhassan M, Babel N, Sieske L, Westhoff TH, Wirth R. Longitudinal Changes of Cytokines and Appetite in Older Hospitalized Patients. Nutrients 2021; 13:nu13082508. [PMID: 34444668 PMCID: PMC8400156 DOI: 10.3390/nu13082508] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
There are few data on the longitudinal association of cytokine and appetite among older hospitalized patients. We aimed to investigate the impact of the changes of inflammatory cytokines on appetite in older hospitalized patients. A total of 191 patients (mean age 81.3 ± 6.6 years, 64% women) participated in this prospective longitudinal observational study. Appetite was evaluated using the Edmonton Symptom Assessment System on admission and after seven days. Serum cytokines such as IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-17, IL-18, IL-23 and IL-33, IFN-α2, IFN-γ, TNF-α and MCP-1 were measured both times. No significant differences in the mean serum levels of all the cytokines could be detected overtime in relation to appetite changes, except for IL-18. Appetite significantly deteriorated overtime in patients with increasing IL-18 levels and improved in those without significant changes in IL-18 levels. In a stepwise regression analysis, changes of IL-18 levels were the major independent predictor for the changes of patients' appetite and explained 4% of the variance, whereas other cytokines and variables, such as age, sex, infection and disease, did not show any impact on appetite changes. We conclude that IL-18 seems to exert a significant impact on appetite in acutely ill older hospitalized patients and should, therefore, be considered as a potential target in the diagnosis, prevention and treatment of malnutrition.
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Affiliation(s)
- Maryam Pourhassan
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40D, 44625 Herne, Germany; (L.S.); (R.W.)
- Correspondence: ; Tel.: +49-2323-499-2416; Fax: +49-2323-499-2417
| | - Nina Babel
- Medical Department I, General Internal Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, 44625 Herne, Germany; (N.B.); (T.H.W.)
| | - Lars Sieske
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40D, 44625 Herne, Germany; (L.S.); (R.W.)
| | - Timm Henning Westhoff
- Medical Department I, General Internal Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, 44625 Herne, Germany; (N.B.); (T.H.W.)
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40D, 44625 Herne, Germany; (L.S.); (R.W.)
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27
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Pourhassan M, Cederholm T, Trampisch U, Volkert D, Wirth R. Inflammation as a diagnostic criterion in the GLIM definition of malnutrition-what CRP-threshold relates to reduced food intake in older patients with acute disease? Eur J Clin Nutr 2021; 76:397-400. [PMID: 34282291 PMCID: PMC8907075 DOI: 10.1038/s41430-021-00977-4] [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: 03/30/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022]
Abstract
Background/objectives In the recently introduced GLIM diagnosis of malnutrition (Global Leadership Initiative on Malnutrition), details of how to classify inflammation as an etiologic criterion are lacking. This study aimed to determine at what level of serum C-reactive protein (CRP) the risk of low food intake increases in acutely ill older hospitalized patients. Subjects/methods A total of 377 patients, who were consecutively admitted to a geriatric acute care ward, were analyzed. Nutritional intake was determined using the food intake item of Nutritional Risk Screening and the plate diagram method and patients were grouped into three categories as >75%, 50–75% and ≤50% of requirements. CRP was analyzed according to standard procedures and patients were classified into different CRP groups as follows: 0.0–0.99 mg/dl, 1.0–1.99 mg/dl, 2.0–2.99 mg/dl, 3.0–4.99 mg/dl, 5.0–9.99 mg/dl and ≥10.0 mg/dl. Results Of the total population (mean age of 82.2 ± 6.6 years; 241 females), 82 (22%) had intake <50% of requirements and 126 (33%) demonstrated moderate to severe inflammation. Patients with food intake <50% of requirements had a significantly higher median CRP level compared to patients with food intake >75% of requirements (P < 0.001). The group with serum-CRP levels above 3.0 mg/dl had a markedly higher proportion of patients with low food intake; i.e., <50% and <75% of the requirements. Conclusion A serum-CRP of 3.0 mg/dl appears to be a reasonable threshold of acute inflammation leading to reduced food intake to serve as an orientation with regard to the inflammation criterion of the GLIM diagnosis in acutely ill older patients.
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Affiliation(s)
- Maryam Pourhassan
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Bochum, Germany.
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Ulrike Trampisch
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Bochum, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Bochum, Germany
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28
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Shelton C, Demidowich AP, Motevalli M, Sokolinsky S, MacKay P, Tucker C, Abundo C, Peters E, Gooding R, Hackett M, Wedler J, Alexander LA, Barry L, Flynn M, Rios P, Fulda CL, Young MF, Kahl B, Pummer E, Mathioudakis NN, Sidhaye A, Howell EE, Rotello L, Zilbermint M. Retrospective Quality Improvement Study of Insulin-Induced Hypoglycemia and Implementation of Hospital-Wide Initiatives. J Diabetes Sci Technol 2021; 15:733-740. [PMID: 33880952 PMCID: PMC8258511 DOI: 10.1177/19322968211008513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hospitalized patients who are receiving antihyperglycemic agents are at increased risk for hypoglycemia. Inpatient hypoglycemia may lead to increased risk for morbidity, mortality, prolonged hospitalization, and readmission within 30 days of discharge, which in turn may lead to increased costs. Hospital-wide initiatives targeting hypoglycemia are known to be beneficial; however, their impact on patient care and economic measures in community nonteaching hospitals are unknown. METHODS This retrospective quality improvement study examined the effects of hospital-wide hypoglycemia initiatives on the rates of insulin-induced hypoglycemia in a community hospital setting from January 1, 2016, until September 30, 2019. The potential cost of care savings has been calculated. RESULTS Among 49 315 total patient days, 2682 days had an instance of hypoglycemia (5.4%). Mean ± SD hypoglycemic patient days/month was 59.6 ± 16.0. The frequency of hypoglycemia significantly decreased from 7.5% in January 2016 to 3.9% in September 2019 (P = .001). Patients with type 2 diabetes demonstrated a significant decrease in the frequency of hypoglycemia (7.4%-3.8%; P < .0001), while among patients with type 1 diabetes the frequency trended downwards but did not reach statistical significance (18.5%-18.0%; P = 0.08). Based on the reduction of hypoglycemia rates, the hospital had an estimated cost of care savings of $98 635 during the study period. CONCLUSIONS In a community hospital setting, implementation of hospital-wide initiatives targeting hypoglycemia resulted in a significant and sustainable decrease in the rate of insulin-induced hypoglycemia. These high-leverage risk reduction strategies may be translated into considerable cost savings and could be implemented at other community hospitals.
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Affiliation(s)
- Carter Shelton
- Ambulatory Services, Medical University of South Carolina, Charleston, SC, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew P. Demidowich
- Division of Hospital Medicine, Johns Hopkins Community Physicians at Howard County General Hospital, Columbia, MD, USA
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mahsa Motevalli
- Division of Hospital Medicine, Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD, USA
| | - Sam Sokolinsky
- JHHS Quality and Clinical Analytics, Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Periwinkle MacKay
- Department of Nursing Education, Suburban Hospital, Bethesda, MD, USA
| | - Cynthia Tucker
- Department of Nursing Education, Suburban Hospital, Bethesda, MD, USA
| | - Cora Abundo
- Readmission Department, Suburban Hospital, Bethesda, MD, USA
| | - Eileen Peters
- Readmission Department, Suburban Hospital, Bethesda, MD, USA
| | | | | | - Joyce Wedler
- Department of Information Systems, Suburban Hospital, Bethesda, MD, USA
| | | | - Luvenia Barry
- Community Health and Wellness, Suburban Hospital, Bethesda, MD, USA
| | - Mary Flynn
- Community Health and Wellness, Suburban Hospital, Bethesda, MD, USA
| | - Patricia Rios
- Community Health and Wellness, Suburban Hospital, Bethesda, MD, USA
| | | | - Michelle F. Young
- Department of Food and Nutrition, Suburban Hospital, Bethesda, MD, USA
| | - Barbara Kahl
- Patient and Family Advisory Council, Suburban Hospital, Bethesda, MD, USA
| | - Eileen Pummer
- Department of Quality, Safety, and Performance Improvement, Suburban Hospital, Bethesda, MD, USA
| | - Nestoras N. Mathioudakis
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aniket Sidhaye
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Leo Rotello
- Division of Hospital Medicine, Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD, USA
| | - Mihail Zilbermint
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Hospital Medicine, Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD, USA
- Mihail Zilbermint, MD, FACE, Division of Hospital Medicine, Johns Hopkins Community Physicians at Suburban Hospital, 8600 Old Georgetown Road, 6th Floor Endocrinology Office, Bethesda, MD 20814, USA. Twitter: @Zilbermint; LinkedIn: https://www.linkedin.com/in/mishazilbermint/
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Pourhassan M, Babel N, Sieske L, Westhoff TH, Wirth R. Inflammatory cytokines and appetite in older hospitalized patients. Appetite 2021; 166:105470. [PMID: 34139296 DOI: 10.1016/j.appet.2021.105470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022]
Abstract
It has already been confirmed that the decline in appetite during disease is a common issue and the biologic players of inflammation such as cytokines may serve as mediators of this effect. This study aimed to investigate the association of appetite with individual cytokines that could be involved in the inflammation-associated loss of appetite in acutely ill older hospitalized patients. 191 patients (mean age 81.3 ± 6.6 years, 64% women) participated in this prospective observational study. Risk of malnutrition and patient's appetite were evaluated using the Mini Nutritional Assessment Short Form and the Simplified Nutritional Appetite Questionnaire on admission, respectively. Serum C-reactive protein (CRP) and serum cytokines such as Interleukin 1 beta (IL-1β), IL-6, IL-8, IL-10, IL-12p70, IL-17, IL-18, IL-23 and IL-33, interferon alpha-2, interferon gamma, tumor necrosis factor alpha and monocyte chemoattractant protein-1 (MCP-1) were measured. Of total population, 30% had CRP>3.0 (mg/dL), 31% were malnourished and 31% demonstrated poor and very poor appetite. There were significant differences in the mean concentrations of a number of cytokines including IL-1β, MCP-1, IL-6, IL-10, IL-12p70, IL-18 and IL-23 across the appetite scores. In a regression analysis, an increased IL-18 level (P = 0.049) was the most prominent biomarker for poor appetite. No other significant associations between appetite and circulating levels of other cytokines were found in the regression analysis, except for IL-6 and IL-33, which were only significantly associated in the unadjusted model. The association of IL-18 with decreased appetite was independent from the severity of CRP-level and infections. In this study, certain cytokines, in particular IL-18 were associated with poor appetite in acutely diseased patients and should therefore be considered as a potential target of the prevention and treatment of malnutrition.
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Affiliation(s)
- Maryam Pourhassan
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany.
| | - Nina Babel
- Medical Department I, General Internal Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany
| | - Lars Sieske
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany
| | - Timm Henning Westhoff
- Medical Department I, General Internal Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, Germany
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Nicolau J, Ayala L, Sanchís P, Olivares J, Dotres K, Soler AG, Rodríguez I, Gómez LA, Masmiquel L. Influence of nutritional status on clinical outcomes among hospitalized patients with COVID-19. Clin Nutr ESPEN 2021; 43:223-229. [PMID: 34024518 PMCID: PMC8084279 DOI: 10.1016/j.clnesp.2021.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Several factors that worsen the prognosis of the new coronavirus SARS-CoV-2 have been identified, such as obesity or diabetes. However, despite that nutrition may change in a lockdown situation, little is known about the influence of malnutrition among subjects hospitalized due to COVID-19. Our study aimed to assess whether the presence of malnutrition among patients admitted due to COVID-19 had any impact on clinical outcomes compared with patients with the same condition but well nourished. METHODS 75 patients admitted to hospital due to COVID-19 were analyzed cross-sectionally. Subjective Global Assessment (SGA) was completed by phone interview. Clinical parameters included were extracted from the electronic medical record. RESULTS According to the SGA, 27 admitted due to a COVID-19 infection had malnutrition. Patients not well nourished were older than patients with a SGA grade A (65 ± 14.1 vs 49 ± 15.1 years; p < 0.0001). Length of hospital stay among poorly nourished patients was significantly higher (18.4 ± 15.6 vs 8.5 ± 7.7 days; p = 0.001). Mortality rates and admission to ICU were greater among subjects with any degree of malnutrition compared with well-nourished patients (7.4% vs 0%; p = 0.05 and 44.4% vs 6.3%; p < 0.0001). CRP (120.9 ± 106.2 vs 60.8 ± 62.9 mg/l; p = 0.03), D-dimer (1516.9 ± 1466.9 vs 461.1 ± 353.7 ng/mL; p < 0.0001) and ferritin (847.8 ± 741.1 vs 617.8 ± 598.7mcg/l; p = 0.03) were higher in the group with malnutrition. Haemoglobin (11.6 ± 2.1 vs 13.6 ± 1.5 g/dl; p < 0.0001) and albumin 3.2 ± 0.7 vs 4.1 ± 0.5 g/dl; p < 0.0001) were lower in patients with any degree of malnutrition. CONCLUSIONS The presence of a poor nutritional status is related to a longer stay in hospital, a greater admission in the ICU and a higher mortality.
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Affiliation(s)
- Joana Nicolau
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain.
| | - Luisa Ayala
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Pilar Sanchís
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Josefina Olivares
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Keyla Dotres
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Ana-Gloria Soler
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Irene Rodríguez
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Luis-Alberto Gómez
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
| | - Lluís Masmiquel
- Endocrinology and Nutrition Department, Hospital Universitario Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Ctra Manacor km 4, 07198 Palma de Mallorca, Baleares, Spain
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Song F, Ma H, Wang S, Qin T, Xu Q, Yuan H, Li F, Wang Z, Liao Y, Tan X, Song X, Zhang Q, Huang D. Nutritional screening based on objective indices at admission predicts in-hospital mortality in patients with COVID-19. Nutr J 2021; 20:46. [PMID: 34034769 PMCID: PMC8145188 DOI: 10.1186/s12937-021-00702-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Could nutritional status serve as prognostic factors for coronavirus disease 2019 (COVID-19)? The present study evaluated the clinical and nutritional characteristics of COVID-19 patients and explored the relationship between risk for malnutrition at admission and in-hospital mortality. METHODS A retrospective, observational study was conducted in two hospitals in Hubei, China. Confirmed cases of COVID-19 were typed as mild/moderate, severe, or critically ill. Clinical data and in-hospital death were collected. The risk for malnutrition was assessed using the geriatric nutritional risk index (GNRI), the prognostic nutritional index (PNI), and the Controlling Nutritional Status (CONUT) via objective parameters at admission. RESULTS Two hundred ninety-five patients were enrolled, including 66 severe patients and 41 critically ill patients. Twenty-five deaths were observed, making 8.47% in the whole population and 37.88% in the critically ill subgroup. Patients had significant differences in nutrition-related parameters and inflammatory biomarkers among three types of disease severity. Patients with lower GNRI and PNI, as well as higher CONUT scores, had a higher risk of in-hospital mortality. The receiver operating characteristic curves demonstrated the good prognostic implication of GNRI and CONUT score. The multivariate logistic regression showed that baseline nutritional status, assessed by GNRI, PNI, or CONUT score, was a prognostic indicator for in-hospital mortality. CONCLUSIONS Despite variant screening tools, poor nutritional status was associated with in-hospital death in patients infected with COVID-19. This study highlighted the importance of nutritional screening at admission and the new insight of nutritional monitoring or therapy.
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Affiliation(s)
- Feier Song
- Department of Emergency and Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080 China
| | - Huan Ma
- Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Cardiovascular Institute, Guangzhou, 510080 China
| | - Shouhong Wang
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| | - Tiehe Qin
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| | - Qing Xu
- Department of Emergency Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233 China
| | - Huiqing Yuan
- Department of Respiratory and Critical Care Medicine, the First People’s Hospital of Shaoguan, Shaoguan, 512000 China
| | - Fei Li
- Department of Emergency, the First Affiliated Hospital of Jingzhou, Jingzhou, 434000 China
| | - Zhonghua Wang
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| | - Youwan Liao
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
| | - Xiaoping Tan
- Department of Gastroenterology, the First Affiliated Hospital of Yangtze University, Jingzhou, 434000 China
| | - Xiuchan Song
- Department of Critical Care Medicine, Dongguan Eighth People’s Hospital, Dongguan Children’s Hospital, Dongguan, 523000 China
| | - Qing Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Yangtze University, Jingzhou, 434000 China
| | - Daozheng Huang
- Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080 China
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Rothenberg E. Coronavirus Disease 19 from the Perspective of Ageing with Focus on Nutritional Status and Nutrition Management-A Narrative Review. Nutrients 2021; 13:nu13041294. [PMID: 33919840 PMCID: PMC8070771 DOI: 10.3390/nu13041294] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/04/2021] [Accepted: 04/11/2021] [Indexed: 12/18/2022] Open
Abstract
The novel severe acute respiratory syndrome coronavirus (COVID-19) has hit older adults harder due to a combination of age-related immunological and metabolic alterations. The aim of this review was to analyze the COVID-19 literature with respect to nutritional status and nutrition management in older adults. No studies only on people aged 65+ years were found, and documentation on those 80+ was rare. Age was found to be strongly associated with worse outcomes, and with poor nutritional status. Prevalence of malnutrition was high among severely and critically ill patients. The studies found a need for nutrition screening and management, and for nutrition support as part of follow-up after a hospital stay. Most tested screening tools showed high sensitivity in identifying nutritional risk, but none were recognized as best for screening older adults with COVID-19. For diagnosing malnutrition, the Global Leadership Initiative on Malnutrition (GLIM) criteria are recommended but were not used in the studies found. Documentation of olfactory and gustatory dysfunction in relation to nutritional status is missing in older adults. Other COVID-19-associated factors with a possible impact on nutritional status are poor appetite and gastrointestinal symptoms. Vitamin D is the nutrient that has attracted the most interest. However, evidence for supplementation of COVID-19 patients is still limited and inconclusive.
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Affiliation(s)
- Elisabet Rothenberg
- Faculty of Health Science, Kristianstad University, 291 88 Kristianstad, Sweden
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Wirth R, Becker C, Djukic M, Drebenstedt C, Heppner HJ, Jacobs AH, Meisel M, Michels G, Nau R, Pantel J, Bauer JM. [COVID-19 in old age-The geriatric perspective]. Z Gerontol Geriatr 2021; 54:152-160. [PMID: 33595696 PMCID: PMC7887547 DOI: 10.1007/s00391-021-01864-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/02/2021] [Indexed: 01/16/2023]
Abstract
Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons.
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Affiliation(s)
- R Wirth
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland.
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
| | - C Becker
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Deutschland
| | - M Djukic
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Deutschland
- Abteilung für Neuropathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - C Drebenstedt
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Innere Medizin und Geriatrie, St.-Marien-Hospital Friesoythe, Friesoythe, Deutschland
| | - H J Heppner
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie, Helios Klinikum Schwelm, Lehrstuhl für Geriatrie, Universität Witten-Herdecke, Schwelm, Deutschland
| | - A H Jacobs
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie mit Neurologie, Johanniter Krankenhaus Bonn, Bonn, Deutschland
- CIO, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
- EIMI, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - M Meisel
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Innere Medizin und Geriatrie, Diakonissenkrankenhaus Dessau, Dessau, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - R Nau
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Deutschland
- Abteilung für Neuropathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - J Pantel
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Institut für Allgemeinmedizin, Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - J M Bauer
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum und Netzwerk Altersmedizin, Agaplesion Bethanien Krankenhaus Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
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Li Q. The association between sleep duration and excess body weight of the American adult population: a cross-sectional study of the national health and nutrition examination survey 2015-2016. BMC Public Health 2021; 21:335. [PMID: 33573618 PMCID: PMC7879643 DOI: 10.1186/s12889-021-10369-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We intend to explore whether sleep duration is associated with overweight and obesity among the adult American population. Furthermore, we stratified the study population by age and sex in the subgroup analysis to investigate the potential disparities between adults and older adults, and men and women. METHODS In total, 2459 individuals from the 2015-2016 National Health and Nutrition Examination Survey cycle were included for analysis in this study. Sleep duration was assessed by the Sleep Disorders Questionnaire. Classification of the short-sleep, normal-sleep, and long-sleep group was based on the recommendation of the National Sleep Foundation. Bodyweight was measured during the physical examination. Multivariate logistic regression models were implemented. RESULTS We observed a significantly higher overweight incidence in the short-sleep group compared to the normal-sleep group (OR = 1.825, 95%CI: 1.251-2.661, P = 0.004). Short-sleep (OR = 1.832, 95%CI: 1.215-2.762, P = 0.007) duration and long-sleep duration (OR = 1.370, 95%CI: 1.043-1.800, P = 0.027) were associated with higher prevalence of obesity. When stratified by age, short-sleep also increased the overweight and obese incidence 1.951 and 1.475 times in the adult group. In the sex-stratified subgroup analysis, the short-sleep group showed 2.49 times higher overweight incidence among females. The prevalence of obesity was 2.59 times higher in the short-sleep group and 1.698 times higher in the long-sleep group in the female population. CONCLUSIONS Sleep duration is associated with the occurrence of overweight and obesity, with sleep duration less than 7 h increase the overweight and obesity rate nearly 2 folds comparing to sleep 7-9 h.
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Affiliation(s)
- Qing Li
- School of Humanities and Social Sciences, Guangxi Medical University, No. 336 Wuming Street, Wuhua Road, Wuming District, Nanning, Guangxi, 530100, P.R. China.
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Okamoto N, Hoshikawa T, Ikenouchi A, Yoshimura R. Comparison of psychiatric symptoms between patients with major depression with higher and lower levels of high-sensitivity C-reactive protein in the serum: a preliminary study. Ther Adv Psychopharmacol 2021; 11:20451253211060228. [PMID: 34925758 PMCID: PMC8679054 DOI: 10.1177/20451253211060228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/28/2021] [Indexed: 01/31/2023] Open
Affiliation(s)
- Naomichi Okamoto
- Medical Center for Dementia, University Hospital, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Takashi Hoshikawa
- Department of Psychiatry, University Hospital, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Atsuko Ikenouchi
- Medical Center for Dementia, University Hospital, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Reiji Yoshimura
- Department of Psychiatry, University Hospital, University of Occupational and Environmental Health, Japan, Kitakyushu 8078555, Fukuoka, Japan
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Guigoz Y, Vellas B. Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next? J Nutr Health Aging 2021; 25:528-583. [PMID: 33786572 DOI: 10.1007/s12603-021-1601-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.
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Affiliation(s)
- Y Guigoz
- Yves Guigoz, Chemin du Raidillon, CH-1066 Epalinges, Switzerland.
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Zhao X, Li Y, Ge Y, Shi Y, Lv P, Zhang J, Fu G, Zhou Y, Jiang K, Lin N, Bai T, Jin R, Wu Y, Yang X, Li X. Evaluation of Nutrition Risk and Its Association With Mortality Risk in Severely and Critically Ill COVID-19 Patients. JPEN J Parenter Enteral Nutr 2020; 45:32-42. [PMID: 32613660 PMCID: PMC7361906 DOI: 10.1002/jpen.1953] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The nutrition status of coronavirus disease 2019 patients is unknown. This study evaluates clinical and nutrition characteristics of severely and critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and investigates the relationship between nutrition risk and clinical outcomes. METHODS A retrospective, observational study was conducted at West Campus of Union Hospital in Wuhan. Patients confirmed with SARS-CoV-2 infection by a nucleic acid-positive test and identified as severely or critically ill were enrolled in this study. Clinical data and outcomes information were collected and nutrition risk was assessed using Nutritional Risk Screening 2002 (NRS). RESULTS In total, 413 patients were enrolled in this study, including 346 severely and 67 critically ill patients. Most patients, especially critically ill patients, had significant changes in nutrition-related parameters and inflammatory markers. As for nutrition risk, the critically ill patients had significantly higher proportion of high NRS scores (P < .001), which were correlated with inflammatory and nutrition-related markers. Among 342 patients with NRS score ≥3, only 84 (of 342, 25%) received nutrition support. Critically ill patients and those with higher NRS score had a higher risk of mortality and longer stay in hospital. In logistic regression models, 1-unit increase in NRS score was associated with the risk of mortality increasing by 1.23 times (adjusted odds ratio, 2.23; 95% CI, 1.10-4.51; P = .026). CONCLUSIONS Most severely and critically ill patients infected with SARS-CoV-2 are at nutrition risk. The patients with higher nutrition risk have worse outcome and require nutrition therapy.
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Affiliation(s)
- Xiaobo Zhao
- Department of Paediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China
| | - Yan Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Yanyan Ge
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Yuxin Shi
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Ping Lv
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Jianchu Zhang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China
| | - Gui Fu
- Department of Paediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China
| | - Yanfen Zhou
- Department of Paediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China
| | - Ke Jiang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China
| | - Nengxing Lin
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China
| | - Tao Bai
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China
| | - Runming Jin
- Department of Paediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China
| | - Yuanjue Wu
- Department of Clinical Nutrition, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Xin Li
- Department of Paediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Moriyama H. Using GLIM criteria, cutoff value for low BMI in Asian populations discriminates high or low muscle mass: A cross-sectional study. Nutrition 2020; 81:110928. [PMID: 32739660 DOI: 10.1016/j.nut.2020.110928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/12/2020] [Accepted: 06/21/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim of this study was to examine whether differences in muscle mass and intramuscular adipose tissue are present between patients with a moderately and severely low body mass index (BMI) as discriminated by the cutoff value for a low BMI among patients ≥70 y of age in Asian populations according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. METHODS This cross-sectional study included 345 inpatients ≥70 y of age. The participants were placed into one of the following three groups: severely low BMI (<17.8 kg/m2; n = 96), moderately low BMI (≥17.8 to <20 kg/m2; n = 81), and normal BMI (≥20 kg/m2; n = 168). Ultrasound images were obtained with B-mode ultrasound imaging. Muscle mass and intramuscular adipose tissue of the quadriceps were assessed based on the muscle thickness and echo intensity, respectively. Analysis of covariance was used to examine the differences in the quadriceps thickness and echo intensity among the three groups. RESULTS The quadriceps thickness and echo intensity in the severely low, moderately low, and normal BMI groups were 0.9 ± 0.3, 1.1 ± 0.4, and 1.4 ± 0.5 cm and 93.3 ± 20.8, 91.3 ± 19.3, 80.1 ± 21.6, respectively. The quadriceps thickness in the severely low BMI group was statistically significantly lower than that in the moderately low BMI (P < 0.001) and normal BMI (P < 0.001) groups, and the quadriceps thickness in the moderately low BMI group was also statistically significantly lower than that in the normal BMI group (P < 0.001). The quadriceps echo intensity showed no significant differences among the three groups. CONCLUSIONS The cutoff value for a low BMI discriminates high or low muscle mass. Results of this study supported the validity of 17.8 kg/m2 as the cutoff value for a low BMI with which to grade the severity of malnutrition in Asian populations ≥70 y of age according to the GLIM criteria from the perspective of muscle mass.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan.
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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Abstract
The present study aimed to investigate the effect of acute changes in serum C-reactive protein (CRP) on appetite and food intake among older hospitalised patients. A total of 200 patients (age range 65-94 years, 62·5 % women) participated in this prospective longitudinal observational study. Risk of malnutrition was measured according to the Mini Nutritional Assessment Short Form. The Simplified Nutritional Appetite Questionnaire (SNAQ) and Edmonton Symptom Assessment System (ESAS) were used to evaluate patients' appetite at the time of hospital admission (baseline) and after 7 d (follow-up). Food intake was measured according to the plate diagram and serum CRP was analysed at baseline and follow-up. At baseline, 30·5 % of the patients had moderate to severe inflammation, 31·0 % were malnourished and 48·0 % had food intake <75 % of the meals offered. Also, 32·5 and 23·5 % reported poor and very poor appetite or severe loss of appetite according to the SNAQ and ESAS, respectively. Of the patients, 40 % displayed a pronounced reduction in median CRP levels by -1·2 mg/dl and 19 % demonstrated an increase in median CRP levels by +1·2 mg/dl. Appetite significantly improved (P = 0·006) in patients with a decrease in CRP level and deteriorated in those with an increase in CRP level (P = 0·032). Changes in CRP levels did not show any significant impact on food intake. In a regression analysis, changes of inflammation were the major independent predictor for changes of patients' appetite. We conclude that inflammation has a significant impact on appetite and should therefore be considered in the diagnosis and treatment of malnutrition.
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Heidenblut S, Zank S. Screening for Depression in Old Age With Very Short Instruments: The DIA-S4 Compared to the GDS5 and GDS4. Gerontol Geriatr Med 2020; 6:2333721420981328. [PMID: 33354593 PMCID: PMC7734509 DOI: 10.1177/2333721420981328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/07/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose of the Study: This article presents a short form of the Depression in old Age Scale with four items (DIA-S4). The diagnostic accuracy of the DIA-S4 was tested and compared to short forms of the Geriatric Depression Scale (GDS5, GDS4). Methods: Using the Montgomery and Asberg Depression Rating Scale (MADRS) as gold standard, the scales were validated with a sample of N = 331 geriatric inpatients. Results: The DIA-S4 had an internal consistency of .70, the GDS5 of .55, and the GDS4 of .58. The test efficiency considering ROC analyses for the DIAS-4 was AUC = .86, for the GDS5 AUC = .78, and for the GDS4 AUC = .74. The best cut-off score for the DIA-S4 was 1.5 with a sensitivity of 87% and a specificity of 68%, for the GDS4 1.5 with a sensitivity of 58% and a specificity of 81%, and for the GDS5 1.5 with a sensitivity of 88% and a specificity of 49%. Conclusion: Based on the data of this study, the DIA-S4 shows better psychometrical qualities than the GDS5 and the GDS4. It can be used as a very short screening scale for depression in old age in research and clinical practice.
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Affiliation(s)
- Sonja Heidenblut
- Chair of Rehabilitative Gerontology, University of Cologne, Cologne, Germany
| | - Susanne Zank
- Chair of Rehabilitative Gerontology, University of Cologne, Cologne, Germany
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