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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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Iversen E, Strejby Christensen LW, Leegaard Andersen A, Nielsen RL, Damgaard M, Lund TM, Hornum M, Andersen O, Houlind MB. Choice of Estimated GFR Concept and Implications for Cystatin C to Creatinine Ratio Among Hospitalized Older Adults. Kidney Int Rep 2024; 9:2295-2298. [PMID: 39081739 PMCID: PMC11284434 DOI: 10.1016/j.ekir.2024.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 08/02/2024] Open
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Louise Westberg Strejby Christensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
| | - Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Morten Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Trine Meldgaard Lund
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Mads Hornum
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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3
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Andersen AL, Houlind MB, Nielsen RL, Jørgensen LM, Bengaard AK, Bornæs O, Juul-Larsen HG, Hansen NM, Brøchner LD, Hansen RG, Skovlund CAR, Pedersen AML, Beck AM, Pedersen MM, Petersen J, Andersen O. Effectiveness of a multidisciplinary and transitional nutritional intervention compared with standard care on health-related quality of life among acutely admitted medical patients aged ≥65 years with malnutrition or risk of malnutrition: A randomized controlled trial. Clin Nutr ESPEN 2024; 61:52-62. [PMID: 38777473 DOI: 10.1016/j.clnesp.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIM Malnutrition, risk of malnutrition, and risk factors for malnutrition are prevalent among acutely admitted medical patients aged ≥65 years and have significant health-related consequences. Consequently, we aimed to investigate the effectiveness of a multidisciplinary and transitional nutritional intervention on health-related quality of life compared with standard care. METHODS The study was a block randomized, observer-blinded clinical trial with two parallel arms. The Intervention Group was offered a multidisciplinary transitional nutritional intervention consisting of dietary counselling and six sub-interventions targeting individually assessed risk factors for malnutrition, while the Control Group received standard care. The inclusion criteria were a Mini Nutritional Assessment Short-Form score ≤11, age ≥65 years, and an acute admittance to the Emergency Department. Outcomes were assessed on admission and 8 and 16 weeks after hospital discharge. The primary outcome was the difference between groups in change in health-related quality of life (assessed by the EuroQol-5D-5L) from baseline to 16 weeks after discharge. The secondary outcomes were difference in intake of energy and protein, well-being, muscle strength, and body weight at all timepoints. RESULTS From October 2018 to April 2021, 130 participants were included. Sixteen weeks after discharge, 29% in the Intervention Group and 19% in the Control Group were lost to follow-up. Compliance varied between the sub-interventions targeting nutritional risk factors and was generally low after discharge, ranging from 0 to 61%. No difference was found between groups on change in health-related quality of life or on well-being, muscle strength, and body weight at any timepoint, neither using the intention-to-treat analysis nor the per-protocol analysis. The protein intake was higher in the Intervention Group during hospitalization (1.1 (Standard Deviation (SD) 0.4) vs 0.8 (SD 0.5) g/kg/day, p = 0.0092) and 8 weeks after discharge (1.2 (SD 0.5) vs 0.9 (0.4) g/kg/day, p = 0.0025). The percentual intake of calculated protein requirements (82% (SD 24) vs 61% (SD 32), p = 0.0021), but not of calculated energy requirements (89% (SD 23) vs 80% (SD 37), p = 0.2), was higher in the Intervention Group than in the Control Group during hospitalization. Additionally, the Intervention Group had a significantly higher percentual intake of calculated protein requirements (94% (SD 41) vs 74% (SD 30), p = 0.015) and calculated energy requirements (115% (SD 37) vs 94% (SD 31), p = 0.0070) 8 weeks after discharge. The intake of energy and protein was comparable between the groups 16 weeks after discharge. CONCLUSION We found no effect of a multidisciplinary and transitional nutritional intervention for acutely admitted medical patients aged ≥65 years with malnutrition or risk of malnutrition on our primary outcome, health-related quality of life 16 weeks after discharge. Nor did the intervention affect the secondary outcomes, well-being, muscle strength, and body weight from admission to 8 or 16 weeks after discharge. However, the intervention improved energy and protein intake during hospitalization and 8 weeks after discharge. Low compliance with the intervention after discharge may have compromised the effect of the intervention. The study is registered at ClinicalTrials.gov (identifier: NCT03741283).
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Affiliation(s)
- Aino L 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.
| | - Morten B Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark; Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen Ø, Denmark.
| | - Rikke L 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.
| | - Lillian M Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Anne K Bengaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, 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.
| | - Helle G Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Nikita M Hansen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Louise D Brøchner
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Randi G Hansen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Corneliah A R Skovlund
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
| | - Anne M L Pedersen
- Section of Oral Medicine, Oral Biology and Immunopathology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark.
| | - Anne M Beck
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 50, 2730 Herlev, Denmark.
| | - Mette M Pedersen
- 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.
| | - Janne Petersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark; Copenhagen Phase IV Unit (Phase4CPH), Center of Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, 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, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
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Li M, Li M, Mao E, Li M, Cui Y, Chen S. Prevalence and risk factors associated with dehydration of patients with dysphagia in eastern China: A cross-sectional study. Int J Nurs Pract 2024; 30:e13236. [PMID: 38238976 DOI: 10.1111/ijn.13236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/10/2023] [Accepted: 12/27/2023] [Indexed: 06/06/2024]
Abstract
AIMS Dehydration is one of the common complications of dysphagia and poses significant risks including hospitalization and mortality, but the relationship between dysphagia and dehydration has received little attention. This study aims to determine the prevalence and risk factors for dehydration of patients with dysphagia in eastern China, and to provide reference for early identification and prevention of dehydration. METHODS A descriptive, cross-sectional design was conducted. Three hundred and thirty-seven (n = 337) patients with dysphagia participated in the study between August and December 2022. Information relating to participants' demographic variables, nutrition, cognition, functional, hydration status and fluid intake was collected. Univariate analysis was used to examine related impact factors, and then binary logistic regression analysis was conducted to determine reliable impact factors. RESULTS Among 337 patients with dysphagia, the average age was 63.47 ± 16.96, most participants were male (72.1%) and married (91.7%). The prevalence of dehydration was calculated to be 43.9%, the mean plasma osmolality score was 293.53 mmol/L. Diseases with the highest prevalence were stroke (78.3%), followed by hypertension (63.5%). The risk for dehydration increased with older age, usage of more medicines such as diuretics and beta-blockers, worse functional status and lower fluid intake. CONCLUSION This study found a high percentage of dehydration in patients with dysphagia. Findings can provide a basis for targeted nursing interventions for clinical prevention and treatment of dehydration.
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Affiliation(s)
- Mengchao Li
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Mengru Li
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Erli Mao
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Li
- The Nanjing Zijin Hospital, Nanjing, China
| | - Yan Cui
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shen Chen
- School of Nursing, Nanjing Medical University, Nanjing, China
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Cortés-Aguilar R, Malih N, Abbate M, Fresneda S, Yañez A, Bennasar-Veny M. Validity of nutrition screening tools for risk of malnutrition among hospitalized adult patients: A systematic review and meta-analysis. Clin Nutr 2024; 43:1094-1116. [PMID: 38582013 DOI: 10.1016/j.clnu.2024.03.008] [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: 12/23/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUNDS & AIMS Malnutrition is prevalent among hospitalized patients in developed countries, contributing to negative health outcomes and increased healthcare costs. Timely identification and management of malnutrition are crucial. The lack of a universally accepted definition and standardized diagnostic criteria for malnutrition has led to the development of various screening tools, each with varying validity. This complicates early identification of malnutrition, hindering effective intervention strategies. This systematic review and meta-analysis aimed to identify the most valid and reliable nutritional screening tool for assessing the risk of malnutrition in hospitalized adults. METHODS A systematic literature search was conducted to identify validation studies published from inception to November 2023, in the Pubmed/MEDLINE, Embase, and CINAHL databases. This systematic review was registered in INPLASY (INPLASY202090028). The risk of bias and quality of included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2). Meta-analyses were performed for screening tools accuracy using the symmetric hierarchical summary receiver operative characteristics models. RESULTS Of the 1646 articles retrieved, 60 met the inclusion criteria and were included in the systematic review, and 21 were included in the meta-analysis. A total of 51 malnutrition risk screening tools and 9 reference standards were identified. The meta-analyses assessed four common malnutrition risk screening tools against two reference standards (Subjective Global Assessment [SGA] and European Society for Clinical Nutrition and Metabolism [ESPEN] criteria). The Malnutrition Universal Screening Tool (MUST) vs SGA had a sensitivity (95% Confidence Interval) of 0.84 (0.73-0.91), and specificity of 0.85 (0.75-0.91). The MUST vs ESPEN had a sensitivity of 0.97 (0.53-0.99) and specificity of 0.80 (0.50-0.94). The Malnutrition Screening Tool (MST) vs SGA had a sensitivity of 0.81 (0.67-0.90) and specificity of 0.79 (0.72-0.74). The Mini Nutritional Assessment-Short Form (MNA-SF) vs ESPEN had a sensitivity of 0.99 (0.41-0.99) and specificity of 0.60 (0.45-0.73). The Nutrition Universal Screening Tool-2002 (NRS-2002) vs SGA had a sensitivity of 0.76 (0.58-0.87) and specificity of 0.86 (0.76-0.93). CONCLUSIONS The MUST demonstrated high accuracy in detecting malnutrition risk in hospitalized adults. However, the quality of the studies included varied greatly, possibly introducing bias in the results. Future research should compare tools within a specific patient population using a valid and universal gold standard to ensure improved patient care and outcomes.
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Affiliation(s)
| | - Narges Malih
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, 07002 Palma, Spain.
| | - Manuela Abbate
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Sergio Fresneda
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Aina Yañez
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Miquel Bennasar-Veny
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain; Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
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Tesfaye BT, Yizengaw MA, Birhanu TE, Bosho DD. Nutritional status of hospitalized elderly patients in Ethiopia: a cross-sectional study of an important yet neglected problem in clinical practice. Front Nutr 2024; 10:1227840. [PMID: 38260070 PMCID: PMC10800825 DOI: 10.3389/fnut.2023.1227840] [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: 05/23/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Background Malnutrition is a common geriatric syndrome affecting approximately half of the older population with a more pronounced occurrence rate in those hospitalized. It affects the physiology, and results in poor humanistic and clinical outcomes. In Africa, particularly in Ethiopia, albeit multiple studies are available on malnutrition in non-hospitalized older population, similar studies in inpatient settings are scarce. Therefore, this study was conducted with the intention to quantify the prevalence of malnutrition in older patients on inpatient admission and determine its associated factors. Methods A total of 157 older inpatients aged 60 years and above were included in the present study. The data collection format was developed after an in-depth review of relevant literatures. The full Mini-Nutritional Assessment (MNA) tool was employed to assess the nutritional status on admission. Data completeness was checked thoroughly. Descriptive statistics and logistic regression analysis were conducted using STATA 15.0. The area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow test, and classification table were computed to evaluate the final model goodness-of-fit. Results Of the total study subjects, 81% were malnourished (MNA score <17) and 17% were at risk for malnutrition (MNA score of 17.5-23.5). However, upon review of the patients' medical charts, malnutrition diagnosis was recorded in only two patients. Rural residence (AOR = 2.823, 95%CI: 1.088, 7.324), self-reported financial dependence for expenses (AOR = 4.733, 95%CI: 1.011, 22.162), and partial dependence in functional autonomy on admission (AOR = 3.689, 95%CI: 1.190, 11.433) significantly increased the risk of malnutrition. The area under the ROC curve (0.754) and the Hosmer-Lemeshow test (p = 0.7564) indicated that the final model reasonably fits the data. The model`s sensitivity is 96.85%. Conclusion In the present study, an alarmingly high prevalence of malnutrition was identified older inpatients. The problem went undiagnosed in a similar percentage of patients. Several available literatures indicate the presence of an association between nutritional status and patient outcomes, thus strict nutritional screening at inpatient admission and intervention are recommended with special emphasis for those from rural areas, with financial dependence, and with functional impairment on admission.
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Affiliation(s)
- Behailu Terefe Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mengist Awoke Yizengaw
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tesema Etefa Birhanu
- Human Anatomy Unit, Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Dula Dessalegn Bosho
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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Nielsen RL, Andersen AL, Kallemose T, Damgaard M, Bornæs O, Juul-Larsen HG, Strejby Christensen LW, Jawad BN, Andersen O, Rasmussen HH, Munk T, Lund TM, Houlind MB. Evaluation of Multi-Frequency Bioelectrical Impedance Analysis against Dual-Energy X-ray Absorptiometry for Estimation of Low Muscle Mass in Older Hospitalized Patients. J Clin Med 2023; 13:196. [PMID: 38202202 PMCID: PMC10779600 DOI: 10.3390/jcm13010196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
The accuracy of multi-frequency (MF) bioelectrical impedance analysis (BIA) to estimate low muscle mass in older hospitalized patients remains unclear. This study aimed to describe the ability of MF-BIA to identify low muscle mass as proposed by The Global Leadership Initiative on Malnutrition (GLIM) and The European Working Group on Sarcopenia in Older People (EWGSOP-2) and examine the association between muscle mass, dehydration, malnutrition, and poor appetite in older hospitalized patients. In this prospective exploratory cohort study, low muscle mass was estimated with MF-BIA against dual-energy X-ray absorptiometry (DXA) in 42 older hospitalized adults (≥65 years). The primary variable for muscle mass was appendicular skeletal muscle mass (ASM), and secondary variables were appendicular skeletal muscle mass index (ASMI) and fat-free mass index (FFMI). Cut-off values for low muscle mass were based on recommendations by GLIM and EWGSOP-2. MF-BIA was evaluated against DXA on the ability to estimate absolute values of muscle mass by mean bias, limits of agreement (LOA), and accuracy (5% and 10% levels). Agreement between MF-BIA and DXA to identify low muscle mass was evaluated with sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). The association between muscle mass, dehydration, malnutrition, and poor appetite was visually examined with boxplots. MF-BIA overestimated absolute values of ASM with a mean bias of 0.63 kg (CI: -0.20:1.46, LOA: -4.61:5.87). Agreement between MF-BIA and DXA measures of ASM showed a sensitivity of 86%, specificity of 94%, PPV of 75% and NPV of 97%. Boxplots indicate that ASM is lower in patients with malnutrition. This was not observed in patients with poor appetite. We observed a tendency toward higher ASM in patients with dehydration. Estimation of absolute ASM values with MF-BIA should be interpreted with caution, but MF-BIA might identify low muscle mass in older hospitalized patients.
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Affiliation(s)
- Rikke Lundsgaard Nielsen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Aino Leegaard Andersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
| | - Morten Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Olivia Bornæs
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
| | - Louise Westberg Strejby Christensen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
| | - Baker Nawfal Jawad
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, 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, 2100 Copenhagen, Denmark;
| | - Morten Baltzer Houlind
- Department of Clinical Research, Acute CAG, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark; (A.L.A.); (T.K.); (O.B.)
- The Capital Region Pharmacy, Marielundsvej 25, 2730 Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark;
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Iversen E, Bengaard AK, Leegaard Andersen A, Tavenier J, Nielsen RL, Juul-Larsen HG, Jørgensen LM, Bornæs O, Jawad BN, Aharaz A, Walls AB, Kallemose T, Dalhoff K, Nehlin JO, Hornum M, Feldt-Rasmussen B, Damgaard M, Andersen O, Houlind MB. Performance of Panel-Estimated GFR Among Hospitalized Older Adults. Am J Kidney Dis 2023; 82:715-724. [PMID: 37516299 DOI: 10.1053/j.ajkd.2023.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/16/2023] [Accepted: 05/10/2023] [Indexed: 07/31/2023]
Abstract
RATIONALE & OBJECTIVE Older adults represent nearly half of all hospitalized patients and are vulnerable to inappropriate dosing of medications eliminated through the kidneys. However, few studies in this population have evaluated the performance of equations for estimating the glomerular filtration rate (GFR)-particularly those that incorporate multiple filtration markers. STUDY DESIGN Cross-sectional diagnostic test substudy of a randomized clinical trial. SETTING & PARTICIPANTS Adults≥65 years of age presenting to the emergency department of Copenhagen University Hospital Amager and Hvidovre in Hvidovre, Denmark, between October 2018 and April 2021. TESTS COMPARED Measured GFR (mGFR) determined using 99mTc-DTPA plasma clearance compared with estimated GFR (eGFR) calculated using 6 different equations based on creatinine; 3 based on creatinine and cystatin C combined; and 2 based on panels of markers including creatinine, cystatin C, β-trace protein (BTP) and/or β2-microglobulin (B2M). OUTCOME The performance of each eGFR equation compared with mGFR with respect to bias, relative bias, inaccuracy (1-P30), and root mean squared error (RMSE). RESULTS We assessed eGFR performance for 106 patients (58% female, median age 78.3 years, median mGFR 62.9mL/min/1.73m2). Among the creatinine-based equations, the 2009 CKD-EPIcr equation yielded the smallest relative bias (+4.2%). Among the creatinine-cystatin C combination equations, the 2021 CKD-EPIcomb equation yielded the smallest relative bias (-3.4%), inaccuracy (3.8%), and RMSE (0.139). Compared with the 2021 CKD-EPIcomb, the CKD-EPIpanel equation yielded a smaller RMSE (0.136) but larger relative bias (-4.0%) and inaccuracy (5.7%). LIMITATIONS Only White patients were included; only a subset of patients from the original clinical trial underwent GFR measurement; and filtration marker concentration can be affected by subclinical changes in volume status. CONCLUSIONS The 2009 CKD-EPIcr, 2021 CKD-EPIcomb, and CKD-EPIpanel equations performed best and notably outperformed their respective full-age spectrum equations. The addition of cystatin C to creatinine-based equations improved performance, while the addition of BTP and/or B2M yielded minimal improvement. FUNDING Grants from public sector industry (Amgros I/S) and government (Capital Region of Denmark). TRIAL REGISTRATION Registered at ClinicalTrials.gov with registration number NCT03741283. PLAIN-LANGUAGE SUMMARY Inaccurate kidney function assessment can lead to medication errors, a common cause of hospitalization and early readmission among older adults. Several novel methods have been developed to estimate kidney function based on a panel of kidney function markers that can be measured from a single blood sample. We evaluated the accuracy of these new methods (relative to a gold standard method) among 106 hospitalized older adults. We found that kidney function estimates combining 2 markers (creatinine and cystatin C) were highly accurate and noticeably more accurate than estimates based on creatinine alone. Estimates incorporating additional markers such as β-trace protein and β2-microglobulin did not further improve accuracy.
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Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre.
| | - Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Clinical Medicine, University of Copenhagen, Copenhagen; Capital Region Pharmacy, Herlev, Denmark
| | - Aino Leegaard Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Juliette Tavenier
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | | | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Lillian Mørch Jørgensen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Olivia Bornæs
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Baker Nawfal Jawad
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Anissa Aharaz
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Capital Region Pharmacy, Herlev, Denmark
| | - Anne Byriel Walls
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen; Capital Region Pharmacy, Herlev, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Jan Olof Nehlin
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Mads Hornum
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Morten Damgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre; Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen; Capital Region Pharmacy, Herlev, Denmark
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9
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Iversen E, Andersen O, Houlind MB. Discordance in Estimated GFR Among Hospitalized Older Adults. Kidney Med 2023; 5:100743. [PMID: 38116165 PMCID: PMC10728693 DOI: 10.1016/j.xkme.2023.100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Affiliation(s)
- Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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10
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Ng DHL, Koh FHX, Yeong HEL, Huey TCW, Chue KM, Foo FJ, Chew STH. Nutrition Care after Hospital Discharge in Singapore: Evidence-Based Best-Practice Recommendations. Nutrients 2023; 15:4492. [PMID: 37960145 PMCID: PMC10650134 DOI: 10.3390/nu15214492] [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] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
The nutritional status of hospitalised patients is often at risk or compromised and predisposed to further deterioration after discharge, leading to poor clinical outcomes, high healthcare costs, and poor quality of life. This paper aims to provide evidence-based best-practice recommendations to address this, supported by a national survey of healthcare professionals in Singapore and reviewed by a multidisciplinary expert panel under the Sarcopenia Interest Group of Society of Parenteral and Enteral Nutrition Singapore (SingSPEN). We advocate screening all patients with a validated tool which includes a disease activity/burden component, an easily accessible dietitian referral pathway for patients at risk of malnutrition, and an individualised nutrition care plan formulated and delivered using a multidisciplinary team approach for patients at risk or with malnutrition. A comprehensive team would include not only dietitians but also physicians, nurses, physiotherapists, speech therapists, and medical social workers working together towards a common goal. Information on why nutrition is important for good health and how it can be achieved should also be provided to all patients and their caregivers before and after hospital discharge. With the above recommendations, we seek to improve upon the current nutrition care processes at discharge for healthcare institutions in Singapore.
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Affiliation(s)
- Doris Hui Lan Ng
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
| | - Frederick Hong Xiang Koh
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Hazel Ee Ling Yeong
- Department of Nutrition and Dietetics, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore;
| | - Terence Cheong Wei Huey
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
| | - Koy Min Chue
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Fung Joon Foo
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Samuel Teong Huang Chew
- Department of Geriatric Medicine, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore;
- SingHealth Duke-NUS Medicine Academic Clinical Programme, 8 College Road, Singapore 169857, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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11
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Leandro-Merhi VA, Dos Santos HAV, Almendra AAR, de Aquino JLB. Nutritional indicators' performance in malnutrition diagnosis of hospitalized elderly patients. Exp Gerontol 2023; 181:112286. [PMID: 37683730 DOI: 10.1016/j.exger.2023.112286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 05/29/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Several nutritional diagnosis methods and their relationship with clinical outcomes have been described. This study investigated malnutrition in hospitalized elderly patients (HEP) using different nutritional indicators and determined criteria to identify malnutrition and explore the variables that discriminate the risk of malnutrition. METHOD Cross-sectional study with 500 HEP; different methods of nutritional diagnosis, their relationship with clinical outcomes and criteria for defining malnutrition were investigated. The GLIM criteria for the diagnosis of malnutrition was applied in this study. In the statistical analysis, the Chi-square test, Fisher's exact test, Mann-Whitney test, univariate and multiple logistic regression and the ROC curve were used. RESULTS Patients aged 65-79 years, at nutritional risk or with malnutrition, had longer hospital stays (p = 0.0099; OR = 1.047; 95% CI = 1.011; 1.084) and lower body mass index (BMI) (p < 0.0001; OR = 0.867 (1153)); 95% CI = 0.813; 0.924 (1085; 1225). Patients aged ≥80 years had a lower BMI (p = 0.0053; OR = 0.779 (1284); 95% CI = 0.653; 0.928 (1078; 1531)). Accuracy was significant in both age groups for BMI (p < 0.0001; 65-79 years and p = 0.001; ≥80 years); for the lymphocyte count (p = 0.0167; 65-79 years and p = 0.0028; ≥80 years), and for the calf circumference (CC) (p < 0.0001; 65-79 years and p = 0.001; ≥80 years). Using the GLIM criteria, 27.78% of patients were considered malnourished. CC showed good accuracy, good specificity, but low sensitivity while BMI was more accurate to detect malnutrition in both age groups. CONCLUSION CC showed good accuracy, good specificity, but low sensitivity to detect malnutrition. BMI was more accurate in both age groups to detect malnutrition.
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12
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Bech CB, Svendsen JA, Knudsen AW, Munk T, Beck AM. The association between malnutrition and dehydration in older adults admitted to a geriatric unit: An observational study. Clin Nutr ESPEN 2023; 57:598-605. [PMID: 37739711 DOI: 10.1016/j.clnesp.2023.08.011] [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: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIM There is an overlap between the risk factors causing low intake of water and low intake of nutrients, respectively. This study aims to explore the agreement between the assessment of malnutrition and the outcome of low-intake dehydration in a population of older hospitalized patients. METHODS Patients ≥65 years old and hospitalized at the geriatric hospital ward were screened for eligibility within 96 h of admission. Dehydration was assessed with the calculated serum osmolarity ≥295 mmol/L (1.86 × (Na+ + K+) + 1.15 × glucose + urea + 14), and (risk of) malnutrition was assessed with NRS-2002 ≥ 3 points, MNA-SF ≤ 7 points, MNA-LF < 17, MUST ≥ 2 points, and GLIM after screening with NRS-2002 and MNA-LF. Follow-up data regarding exercise rehabilitation, readmissions, and mortality was collected 30 days after discharge. Statistics used were the Chi-squared test, Fishers-exact test, and Wilcoxon signed rank test. RESULTS A total of 114 patients (57% females) were included. Median age 85.5 (IQR 80; 89.25) years. A total of 49 (43%) were dehydrated. Fewer females were dehydrated (F: 42.9% vs. M: 67.7%, p = 0.013). The patients with osmolarity ≥295 mmol/L had a higher median weight (68.3 (IQR 58.5; 78.4) vs. 62 (IQR 51.8; 72.1), p = 0.021) and mid-up-arm circumference (27 (IQR 26; 30) vs. 25.5 (IQR 22.9; 28.3), p = 0.004). No significant difference was found in the prevalence of malnutrition between those with or without dehydration (NRS-2002; 70% vs. 81%, p = 0.174; MNA-SF: 23.1 vs. 23.2%, p = 1.0; MNA-LF: 37.1 vs. 30.2%, p = 0.644; MUST: 24.5 vs. 33.8%, p = 0.308; GLIM after screening with NRS-2002: 84.4 vs. 74.5%, p = 0.405, GLIM after screening with MNA-LF: 74.1 vs. 75.6%, p = 0.438). Kappa values varied around 0 and reflected low agreement. There were no differences in the follow-up data, between those who were normohydrated and those who were dehydrated. CONCLUSION We found low agreement between the assessment of malnutrition and low-intake dehydration in a population of older hospitalized patients. All geriatric patients should therefore be assessed for both conditions.
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Affiliation(s)
- Camilla Balle Bech
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | | | - Anne Wilkens Knudsen
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | - Tina Munk
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark.
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13
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Everink IHJ, Grund S, Benzinger P, de Vries A, Gordon AL, van Wijngaarden JP, Bauer JM, Schols JMGA. Nutritional Care Practices in Geriatric Rehabilitation Facilities across Europe: A Cross-Sectional Study. J Clin Med 2023; 12:jcm12082918. [PMID: 37109255 PMCID: PMC10142565 DOI: 10.3390/jcm12082918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Many patients in geriatric rehabilitation (GR) are physically frail at the time of admission and suffer from malnutrition and sarcopenia, which may worsen rehabilitation outcomes. This study aims to obtain insight into the current nutritional care practices in GR facilities across Europe. METHODS In this cross-sectional study, a questionnaire focused on nutritional care practices in GR was distributed across experts in EUGMS member countries. Data were analyzed by using descriptive statistics. RESULTS In total, 109 respondents working in 25 European countries participated, and the results showed that not all GR patients were screened and treated for malnutrition, and not all participants used (inter)national guidelines when performing nutritional care. The results also showed variations across European geographical areas related to screening and treatment of malnutrition, sarcopenia, and frailty. Even though the participants underlined the importance of dedicating time to nutritional care, they experienced barriers in its implementation, which were mostly due to a lack of resources. CONCLUSION As malnutrition, sarcopenia, and frailty are often present in patients admitted to GR, in addition to being interrelated, it is recommended to develop an integrated approach to screening and treatment of all three clinical problems.
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Affiliation(s)
- Irma H J Everink
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Stefan Grund
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69126 Heidelberg, Germany
| | - Petra Benzinger
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69126 Heidelberg, Germany
- Institute for Health and Generations, University of Applied Sciences Kempten, 87435 Kempten, Germany
| | - Anne de Vries
- Danone Trading Medical B.V., 2132 LS Hoofddorp, The Netherlands
| | - Adam L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham DE22 3NE, UK
| | | | - Jürgen M Bauer
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69126 Heidelberg, Germany
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands
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14
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Gregori P, Franceschetti E, Basciani S, Impieri L, Zampogna B, Matano A, Manzi C, Carbone L, Marano L, Papalia R. Immunonutrition in Orthopedic and Traumatic Patients. Nutrients 2023; 15:nu15030537. [PMID: 36771245 PMCID: PMC9919811 DOI: 10.3390/nu15030537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
The role of nutrition intervention in surgical settings is constantly developing and evolving. Immunonutrition represents a viable option to reduce perioperative and postoperative complications in surgical oncology. However, as far as we know, little research has been conducted in the orthopedic field. With this review, we aim to summarize the state of the art in the application of immune-enhanced compounds to surgical, orthopedic, and traumatic patients. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were adopted. A comprehensive search was carried out using the PubMed (MEDLINE), EMBASE, and Cochrane Library databases. All the studies dealing with immunonutrition fed to traumatic and orthopedic patients were pooled, the data were extracted, and the studies were discussed. A total of eight studies were included: six focused on trauma surgery and two on elective orthopedic surgery. The epidemiological characteristics of participants and the assessment of results were reported. Data were analyzed using R software (2020; R Core Team). Based on the current available literature, a positive impact of immunonutrition in orthopedic and trauma surgical settings was registered. All studies analyzed showed the favorable impact of the immunonutrition diet on clinical outcomes. The full effect of this type of nutrition and its different applications in the orthopedic and traumatic fields should be critically investigated through more extensive randomized controlled trials.
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Affiliation(s)
- Pietro Gregori
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, 00128 Rome, Italy
| | - Edoardo Franceschetti
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, 00128 Rome, Italy
| | - Susanna Basciani
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, 00128 Rome, Italy
| | - Lorenzo Impieri
- Residency Program in Orthopedics and Traumatology, University of Milan, 20122 Milan, Italy
| | - Biagio Zampogna
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, 00128 Rome, Italy
| | - Alfredo Matano
- Health Service Management Board, Azienda Ospedaliera di Caserta Sant’Anna e San Sebastiano, 81100 Caserta, Italy
| | - Carlo Manzi
- Health Service Management Board, Azienda Sanitaria Locale Caserta, 81100 Caserta, Italy
| | - Ludovico Carbone
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Luigi Marano
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
- Correspondence:
| | - Rocco Papalia
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, 00128 Rome, Italy
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15
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Søe Jensen P, Nørholm V, Poulsen I, Vendel Petersen H. Dialogue is a prerequisite for the nurse-patient relationship in nutritional care: A secondary analysis using the fundamentals of care framework. Scand J Caring Sci 2022; 36:1206-1216. [PMID: 35778822 PMCID: PMC9795910 DOI: 10.1111/scs.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/01/2022] [Accepted: 05/13/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Providing good nutritional care is complex as it goes beyond assessing and ensuring the patients' dietary needs. So far, nutritional research has mainly focused on establishing evidence for the nutritional treatment, while less attention has been on the complexity of providing nutritional care. The Fundamentals of Care (FoC) describes five elements (focus, knowledge, anticipate, evaluate and trust) essential for establishing a nurse-patient relationship as a foundation for quality care. By studying how these elements shape nutritional care and dialogue, we can explore and describe the complexity of nutritional care. AIM By using the FoC framework as an analytic framework, this study explores how the nurse-patient relationship shapes the nutritional care of orthopaedic patients. METHOD This study is a secondary analysis using deductive content analysis of interviews with patients undergoing major orthopaedic surgery, nursing staff and observations of interactions between nursing staff and patients. The core dimension of the FoC framework, 'Establishment of relationship,' was used as an analytic framework. RESULT The nurses perceived serving meals and providing nutritional supplements as an essential part of the nutritional care. Still, the nutritional care was organised as a routine task to be less time-consuming. Appropriate care was initiated when the nursing staff explored patients´ food preferences. When the nursing staff failed to familiarise themselves with the patient's preferences, the patients interpreted nutritional care as unrelated to their needs, resulting in a lack of trust. CONCLUSION The need for efficiency within nutritional care must not compromise the patients' need for dialogue with the nurse. Establishing a trusting relationship between nurses and patients prevents nutritional care from becoming a routine task unrelated to the patients' needs.
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Affiliation(s)
- Pia Søe Jensen
- Department of Clinical ResearchCopenhagen University HospitalHvidovreDenmark,Department of Orthopaedic SurgeryCopenhagen University HospitalHvidovreDenmark,Research Unit of Nursing and Health CareHealth, Aarhus UniversityAarhusDenmark
| | - Vibeke Nørholm
- Department of Clinical ResearchCopenhagen University HospitalHvidovreDenmark
| | - Ingrid Poulsen
- Department of Clinical ResearchCopenhagen University HospitalHvidovreDenmark,Research Unit of Nursing and Health CareHealth, Aarhus UniversityAarhusDenmark,Department of Brain InjuryCopenhagen University HospitalRigshospitaletCopenhagenDenmark
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16
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Mild Cognitive Impairment Is Associated with Poorer Nutritional Status on Hospital Admission and after Discharge in Acutely Hospitalized Older Patients. Geriatrics (Basel) 2022; 7:geriatrics7050095. [PMID: 36136804 PMCID: PMC9498394 DOI: 10.3390/geriatrics7050095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
In acutely hospitalized older patients (≥65 years), the association between mild cognitive impairment (MCI) and malnutrition is poorly described. We hypothesized that (1) MCI is associated with nutritional status on admission and after discharge; (2) MCI is associated with a change in nutritional status; and (3) a potential association is partly explained by frailty, comorbidity, medication use, and age. We combined data from a randomized controlled trial (control group data) and a prospective cohort study (ClinicalTrials.gov: NCT01964482 and NCT03052192). Nutritional status was assessed on admission and follow-up using the Mini Nutritional Assessment—Short Form. MCI or intact cognition (noMCI) was classified by three cognitive performance tests at follow-up. Data on frailty, comorbidity, medication use, and age were drawn from patient journals. MCI (n = 42) compared to noMCI (n = 47) was associated with poorer nutritional status with an average difference of −1.29 points (CI: −2.30; −0.28) on admission and −1.64 points (CI: −2.57; −0.70) at 4-week follow-up. Only age influenced the estimates of −0.85 (CI: −1.86; 0.17) and −1.29 (CI: −2.25; −0.34), respectively. In acutely hospitalized older patients, there is an association between MCI and poorer nutritional status upon admission and four weeks after discharge. The association is partly explained by higher age.
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Bellanti F, lo Buglio A, Quiete S, Vendemiale G. Malnutrition in Hospitalized Old Patients: Screening and Diagnosis, Clinical Outcomes, and Management. Nutrients 2022; 14:nu14040910. [PMID: 35215559 PMCID: PMC8880030 DOI: 10.3390/nu14040910] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 02/05/2023] Open
Abstract
Malnutrition in hospitalized patients heavily affects several clinical outcomes. The prevalence of malnutrition increases with age, comorbidities, and intensity of care in up to 90% of old populations. However, malnutrition frequently remains underdiagnosed and undertreated in the hospital. Thus, an accurate screening to identify patients at risk of malnutrition or malnourishment is determinant to elaborate a personal nutritional intervention. Several definitions of malnutrition were proposed in the last years, affecting the real frequency of nutritional disorders and the timing of intervention. Diagnosis of malnutrition needs a complete nutritional assessment, which is often challenging to perform during a hospital stay. For this purpose, various screening tools were proposed, allowing patients to be stratified according to the risk of malnutrition. The present review aims to summarize the actual evidence in terms of diagnosis, association with clinical outcomes, and management of malnutrition in a hospital setting.
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