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Tanaka K, Kimura H, Ejiri H, Saito H, Watanabe K, Kazama S, Shimabukuro M, Asahi K, Watanabe T, Kazama JJ. Geriatric Nutritional Risk Index is associated with adverse outcomes in patients with hypertension: the Fukushima Cohort study. Hypertens Res 2024; 47:2041-2052. [PMID: 38769135 DOI: 10.1038/s41440-024-01716-5] [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: 01/12/2024] [Revised: 04/06/2024] [Accepted: 04/12/2024] [Indexed: 05/22/2024]
Abstract
Malnutrition is reportedly associated with adverse clinical outcomes in various populations. However, associations between nutritional status and adverse outcomes in patients with hypertension have not been sufficiently elucidated. We therefore aimed to investigate the impact of nutritional status as evaluated by the Geriatric Nutritional Risk Index (GNRI) on adverse outcomes in patients with hypertension. We conducted a retrospective cohort study of 1588 hypertensive patients enrolled in the Fukushima Cohort Study. Participants were categorized into tertiles (T1-T3) according to GNRI at baseline. The primary endpoint of the present study was a kidney event, defined as a combination of a 50% decline in eGFR from baseline and end-stage kidney disease requiring kidney replacement therapy. Associations between GNRI and kidney events were assessed using Kaplan-Meier curves and multivariate Cox regression analyses. Median age was 64 years, 55% were men, median eGFR was 63.1 mL/min/1.73 m2, and median GNRI was 101.3. The lower GNRI group (T1) showed an increased incidence of kidney events in the Kaplan-Meier curve analysis. Compared to the highest GNRI group (T3), lower GNRI carried a higher risk of kidney events for both T2 (hazard ratio [HR] 1.38, 95% confidence interval [CI] 0.71-2.68) and T1 (HR 3.59, 95%CI 1.96-6.63). Similar relationships were observed for risks of all-cause death and cardiovascular events. Lower GNRI was associated with kidney events, all-cause death, and cardiovascular events in patients with hypertension. Nutritional status as evaluated by GNRI could offer a simple and useful predictor of adverse outcomes in this population.
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Affiliation(s)
- Kenichi Tanaka
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan.
| | - Hiroshi Kimura
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
| | - Hiroki Ejiri
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Hirotaka Saito
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Kimio Watanabe
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Sakumi Kazama
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
| | - Michio Shimabukuro
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University, Fukushima, Japan
| | - Koichi Asahi
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
- Division of Nephrology and Hypertension, Iwate Medical University, Yahaba, Japan
| | - Tsuyoshi Watanabe
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
| | - Junichiro James Kazama
- Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan
- Division of Advanced Community Based Care for Lifestyle Related Diseases, Fukushima Medical University, Fukushima, Japan
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Hori S, Tomizawa M, Inoue K, Yoneda T, Onishi K, Morizawa Y, Gotoh D, Nakai Y, Miyake M, Torimoto K, Tanaka N, Fujimoto K. Prognostic role of nutritional and inflammatory indicators for patient survival and death with functional graft in living kidney transplant recipients. Clin Exp Nephrol 2024:10.1007/s10157-024-02524-4. [PMID: 39023822 DOI: 10.1007/s10157-024-02524-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 06/03/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND The clinical importance of nutrition and inflammation in patients with end-stage renal disease is well established. In this study, we investigated the role of nutritional and inflammatory indicators in the patient outcomes of living donor kidney transplant recipients. METHODS We included 204 consecutive patients who underwent kidney transplantation at our institute between 2003 and 2022. We retrospectively reviewed medical charts to obtain clinical information. Six nutritional indicators and two inflammatory indicators were assessed. Patient outcomes were investigated, and predictive factors were explored. RESULTS The median patient age and follow-up period were 48 years and 99 months, respectively. The cohort included patients with preoperative malnutrition and microinflammation. No significant differences in graft survival were identified according to nutritional and inflammatory indicators, whereas the survival index, controlled nutritional status, and C-reactive protein levels were associated with patient survival. The survival index was an independent indicator of survival and death in patients with functioning grafts (P = 0.047 and P = 0.013, respectively). Furthermore, the C-reactive protein level could distinguish between low and high mortality risks in patients with good nutrition (P = 0.019). CONCLUSIONS Our findings suggest that nutrition and inflammation indicators play important roles in predicting outcomes in living donor kidney transplantation recipients. Further research is warranted to establish optimal management strategies.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kuniaki Inoue
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kenta Onishi
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
- Department of Prostate Brachytherapy, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
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Pagano AP, Sicchieri JMF, Morgado ASDM, Meira Filho LF, Gonzalez MC, Prado CM, Elias Junior J, Teixeira AC, Chiarello PG. Phase Angle but Not Psoas Muscle Predicts Nutritional Risk and Prognosis in Males with Hepatocellular Carcinoma. Nutr Cancer 2024:1-11. [PMID: 39012155 DOI: 10.1080/01635581.2024.2378504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 07/05/2024] [Indexed: 07/17/2024]
Abstract
Despite those with hepatocellular carcinoma (HCC) being at increased risk of malnutrition, there is a notable absence of practical approaches for nutritional assessment in clinical practice. We investigated the usefulness of phase angle (PhA) and Total Psoas Area Index (TPAI) for indicating nutritional risk and HCC prognosis. Weight, height, body mass index (BMI), adductor pollicis muscle thickness (APMT), and handgrip strength (HGS) were assessed. The Nutritional Risk Index (NRI) was calculated. Body composition was assessed using bioimpedance spectroscopy and magnetic resonance imaging. The Child-Turcotte-Pugh (CTP) score and Barcelona-Clinic Liver Cancer (BCLC) classification determined the prognosis. Fifty-one males with HCC were enrolled (CTP C = 11.8%). PhA showed a moderate positive correlation with APMT (r = 0.450; p < 0.001) and HGS (r = 0.418; p = 0.002) and a weak positive correlation with TPAI (r = 0.332; p = 0.021). PhA had a strong positive correlation with NRI (r = 0.614; p < 0.001). Mean PhA values were significantly different according to disease severity (CTP C p = 0.001, and BCLC D p = 0.053). TPAI had no significant correlation with HGS, CTP, or BCLC. PhA was a superior approach for predicting nutritional risk and prognosis in HCC than TPAI. Lower PhA is associated with disease progression, lower muscle mass and function, greater severity of nutritional risk, and increased mortality in HCC.
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Affiliation(s)
- Ana Paula Pagano
- Hospital das Clínicas, Ribeirão Preto Medical School, Department of Health Sciences, Division of Nutrition and Metabolism, University of São Paulo, Ribeirão Preto, Brazil
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Juliana Maria Faccioli Sicchieri
- Hospital das Clínicas, Ribeirão Preto Medical School, Department of Health Sciences, Division of Nutrition and Metabolism, University of São Paulo, Ribeirão Preto, Brazil
| | - Alexandre Souto de Moraes Morgado
- Hospital das Clínicas, Ribeirão Preto Medical School, Department of Medical Images, Hematology, and Oncology, University of São Paulo, Ribeirão Preto, Brazil
| | - Luiz Fernando Meira Filho
- School of Economics, Business Administration and Accounting, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Jorge Elias Junior
- Hospital das Clínicas, Ribeirão Preto Medical School, Department of Medical Images, Hematology, and Oncology, University of São Paulo, Ribeirão Preto, Brazil
| | - Andreza Correa Teixeira
- Hospital das Clínicas, Ribeirão Preto Medical School, Department of Internal Medicine, Division of Gastroenterology, University of São Paulo, Ribeirão Preto, Brazil
| | - Paula Garcia Chiarello
- Hospital das Clínicas, Ribeirão Preto Medical School, Department of Health Sciences, Division of Nutrition and Metabolism, University of São Paulo, Ribeirão Preto, Brazil
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Yoon S, Ko NG, Lee YJ. Geriatric Nutritional Risk Index as a Possible Predictor of Decline in Kidney Function in Older People. Ann Geriatr Med Res 2024; 28:164-170. [PMID: 38419389 PMCID: PMC11217657 DOI: 10.4235/agmr.23.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/30/2024] [Accepted: 02/24/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The Geriatric Nutritional Risk Index (GNRI) is associated with morbidity and mortality in older individuals. Our study explored the relationship between GNRI, decline in kidney function, and all-cause mortality in older individuals. METHODS This retrospective cohort study analyzed data from participants aged ≥60 years who underwent a general health checkup between 2002 and 2018. The primary exposure was the GNRI, divided into quartiles. The primary and secondary outcomes were a decline in kidney function assessed using the 5-year estimated glomerular filtration rate (eGFR) and all-cause mortality, respectively. RESULTS The analysis included a total of 1,599 participants (median age, 63 years; interquartile range [IQR], 61-67; 54% males). The mean±standard deviation of GNRI was 114±7. Compared with the highest GNRI quartile, the lower GNRI quartiles were associated with steeper 5-year slopes in eGFR, with a fully adjusted beta coefficient and 95% confidence intervals (CIs) of -0.50 (-0.86, -0.14), -0.29 (-0.63, 0.05), and -0.19 (-0.53, 0.14) for the first, second, and third GNRI quartiles, respectively. The median follow-up duration was 7.4 years (IQR, 4.6-12.4). During this period, we identified 108 deaths (7.8 per 1,000 person-years). The first GNRI quartile was associated with all-cause mortality compared to the highest GNRI quartile (hazard ratio of 2.20; 95% CI 1.23, 3.95). CONCLUSION Nutritional status, as evaluated using the GNRI, was associated with 5-year changes in kidney function and all-cause mortality in older individuals.
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Affiliation(s)
- Sukmin Yoon
- Division of Nephrology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Nak Gyeong Ko
- Department of Research & Support, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Yu-Ji Lee
- Division of Nephrology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
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Yılmaz M, Atuk Kahraman T, Kurtbeyoğlu E, Konyalıgil Öztürk N, Gültekin M. The evaluation of the nutritional status in Parkinson's disease: geriatric nutritional risk index comparison with mini nutritional assessment questionnaire. Nutr Neurosci 2024; 27:66-73. [PMID: 36594568 DOI: 10.1080/1028415x.2022.2161129] [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] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The symptoms associated with Parkinson's disease may lead to reduced food consumption and in turn, malnutrition. It is therefore important to apply a reliable nutrition screening tool to evaluate the nutritional status of individuals with Parkinson's disease. This cross-sectional study aims to compare the Mini Nutritional Assessment (MNA) questionnaire and the Geriatric Nutrition Risk Index (GNRI) in the assessment of the nutritional status of individuals with Parkinson's disease, and to evaluate the usability of the GNRI in cases of Parkinson's disease. METHODS The study was conducted with 89 individuals over the age of 60 who were diagnosed with Parkinson's disease. Study data were collected using a questionnaire form administered through face-to-face interviews, the MNA-Long Form (MNA-LF), and the GNRI was calculated. RESULTS The mean GNRI scores were significantly lower in the participants with malnutrition (106.5 ± 19.4) than in the participants at risk of malnutrition (121.0 ± 10.3) and the participants with no malnutrition (125.3 ± 9.6) according to the MNA-LF (p < 0.001). Although there was a positive correlation between the MNA-LF and the GNRI scores, this correlation was not significant (p = 0.095). CONCLUSIONS This is the first study to research the nutritional status of individuals with Parkinson's disease using the GNRI. The malnutrition rate detected by GNRI was found to be lower than MNA in Parkinson's patients receiving outpatient treatment. Similar studies are recommended to determine the usability of GNRI on inpatients.
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Affiliation(s)
- Müge Yılmaz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Tutku Atuk Kahraman
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Emine Kurtbeyoğlu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
| | | | - Murat Gültekin
- Department of Neurology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
- Gevher Nesibe Hospital, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Ruperto M, Barril G. Clinical Significance of Nutritional Status, Inflammation, and Body Composition in Elderly Hemodialysis Patients-A Case-Control Study. Nutrients 2023; 15:5036. [PMID: 38140295 PMCID: PMC10745431 DOI: 10.3390/nu15245036] [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: 10/28/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Nutritional and inflammatory disorders are factors that increase the risk of adverse clinical outcomes and mortality in elderly hemodialysis (HD) patients. This study aimed to examine nutritional and inflammation status as well as body composition in older adults on HD compared to matched controls. A case-control study was conducted on 168 older participants (84 HD patients (cases) and 84 controls) age- and sex-matched. Demographic, clinical, anthropometric, and laboratory parameters were collected from medical records. The primary outcome was nutritional status assessment using a combination of nutritional and inflammatory markers along with the geriatric nutritional risk index (GNRI). Sarcopenic obesity (SO) was studied by the combined application of anthropometric measures. Body composition and hydration status were assessed by bioelectrical impedance analysis (BIA). Univariate and multivariate regression analyses were performed to identify nutritional and inflammatory independent risk indicators in elderly HD patients and controls. A significantly high prevalence of nutritional risk measured by the GNRI was found in HD patients (32.1%) compared to controls (6.0%) (p < 0.001). Elderly HD patients were overweight and had lower percent arm muscle circumference, phase angle (PA), serum albumin (s-albumin), as well as higher percent extracellular body water (ECW%) and serum C-reactive protein (s-CRP) than controls (all at least, p < 0.01). SO was higher in HD patients (15.50%) than in controls (14.30%). By multi-regression analyses, age < 75 years (OR: 0.119; 95%CI: 0.036 to 0.388), ECW% (OR: 1.162; 95%CI: 1.061 to 1.273), PA (OR: 0.099; 95%CI: 0.036 to 0.271), as well as BMI, s-albumin ≥ 3.8 g/dL, and lower s-CRP were independently related between cases and controls (all at least, p < 0.05). Elderly HD patients had increased nutritional risk, SO, inflammation, overhydration, and metabolic derangements compared to controls. This study highlights the importance of identifying nutritional risk along with inflammation profile and associated body composition disorders in the nutritional care of elderly HD patients. Further studies are needed to prevent nutritional disorders in elderly HD patients.
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Affiliation(s)
- Mar Ruperto
- Department of Pharmaceutical & Health Sciences, School of Pharmacy, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660 Alcorcón, Madrid, Spain
| | - Guillermina Barril
- Nephrology Department, Hospital Universitario La Princesa, C/Diego de León 62, 28006 Madrid, Spain
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Kim EJ, Cho A, Kim DH, Park HC, Yoon JY, Shon K, Kim E, Koo JR, Lee YK. Geriatric Nutritional Risk Index as a Prognostic Factor for Renal Progression in Patients with Type 2 Diabetes Mellitus. Nutrients 2023; 15:4636. [PMID: 37960289 PMCID: PMC10649929 DOI: 10.3390/nu15214636] [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: 10/03/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
The aim of this study was to evaluate whether the geriatric nutritional risk index (GNRI) is associated with chronic kidney disease (CKD) progression in patients with type 2 diabetes mellitus (DM). In total, 1100 patients with type 2 DM with a follow-up duration > 1 year were included in this longitudinal study. The risk of CKD progression was assessed according to GNRI quartiles. Patients in the lowest GNRI quartile exhibited a significantly lower estimated glomerular filtration rate (eGFR), compared with those in quartile four. Moreover, these patients had poorer glycemic control and lower hemoglobin levels, body mass index, and albumin levels. Additionally, they exhibited a greater annual decline in eGFR. Multivariate logistic regression analysis showed that old age (>60 years), baseline eGFR, the presence of proteinuria, the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and low GNRI were significantly associated with CKD progression. GNRI may serve as a valuable predictive tool for identifying the risk of adverse renal outcomes in patients with type 2 DM. It may potentially serve as a more feasible measure for assessing the nutritional status of these patients, as well as for predicting their clinical outcomes.
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Affiliation(s)
- Eun Jung Kim
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si 18450, Republic of Korea; (E.J.K.); (J.-R.K.)
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Graduate School of Kangwon National University, Kangwon 24341, Republic of Korea
| | - Ajin Cho
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Do Hyoung Kim
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Hayne Cho Park
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Joo Yeon Yoon
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Kyungjun Shon
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Eunji Kim
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Ja-Ryong Koo
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si 18450, Republic of Korea; (E.J.K.); (J.-R.K.)
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
| | - Young-Ki Lee
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
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Rau CS, Tsai CH, Chou SE, Su WT, Hsu SY, Hsieh CH. The Addition of the Geriatric Nutritional Risk Index to the Prognostic Scoring Systems Did Not Improve Mortality Prediction in Trauma Patients in the Intensive Care Unit. Emerg Med Int 2023; 2023:3768646. [PMID: 37293272 PMCID: PMC10247323 DOI: 10.1155/2023/3768646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/20/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
Background Malnutrition is prevalent among critically ill patients and has been associated with a poor prognosis. This study sought to determine whether the addition of a nutritional indicator to the various variables of prognostic scoring models can improve the prediction of mortality among trauma patients in the intensive care unit (ICU). Methods This study's cohort included 1,126 trauma patients hospitalized in the ICU between January 1, 2018, and December 31, 2021. Two nutritional indicators, the prognostic nutrition index (PNI), a calculation based on the serum albumin concentration and peripheral blood lymphocyte count, and the geriatric nutritional risk index (GNRI), a calculation based on the serum albumin concentration and the ratio of current body weight to ideal body weight, were examined for their association with the mortality outcome. The significant nutritional indicator was served as an additional variable in prognostic scoring models of the Trauma and Injury Severity Score (TRISS), the Acute Physiology and Chronic Health Evaluation (APACHE II), and the mortality prediction models (MPM II) at admission, 24, 48, and 72 h in the mortality outcome prediction. The predictive performance was determined by the area under the receiver operating characteristic curve. Results Multivariate logistic regression revealed that GNRI (OR, 0.97; 95% CI, 0.96-0.99; p=0.007), but not PNI (OR, 0.99; 95% CI, 0.97-1.02; p=0.518), was independent risk factor for mortality. However, none of these predictive scoring models showed a significant improvement in prediction when the GNRI variable is incorporated. Conclusions The addition of GNRI as a variable to the prognostic scoring models did not significantly enhance the performance of the predictors.
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Affiliation(s)
- Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Tsuda S, Nakayama M, Tanaka S, Haruyama N, Yoshitomi R, Fukui A, Tsuruya K, Nakano T, Kitazono T. The Association of Controlling Nutritional Status Score and Prognostic Nutritional Index with Cardiovascular Diseases: the Fukuoka Kidney Disease Registry Study. J Atheroscler Thromb 2022; 30:390-407. [PMID: 35811136 PMCID: PMC10067341 DOI: 10.5551/jat.63501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI) reflect the immunonutritional status of patients. However, the associations of these two indices with cardiovascular disease (CVD) have not been characterized in patients with chronic kidney disease (CKD). Therefore, the current study aimed to determine whether the CONUT score or PNI was associated with prior CVD in patients with CKD. METHODS A cross-sectional study of 2,751 patients with CKD who were not on dialysis was performed. The patients were grouped into tertiles (T1-T3) of PNI and placed into three groups following their CONUT score: low- (CONUT score, 0), mild- (CONUT score, 1-2), and moderate-to-high- (CONUT score, ≥ 3) risk groups. RESULTS Prior CVD was present in 655 (24%) of the participants. Multivariable logistic regression analyses, with adjustment for potential confounders, showed that high CONUT score was associated with prior CVD than the low score (mild-risk group: odds ratio [OR]=1.35, 95% confidence interval [CI]=1.04-1.76; moderate-to-high-risk group: OR=1.66, 95% CI=1.19-2.30). In addition, the lower PNI tertiles were independently associated with prior CVD compared with T3 of PNI (T1: OR=1.45, 95% CI=1.09-1.92; T2: OR=1.32, 95% CI=1.01-1.72). CONCLUSIONS Both CONUT score and PNI were found to be independently associated with prior CVD in patients with CKD in the present cross-sectional study. A longitudinal study is needed to elucidate whether these two indices are associated with subsequent cardiovascular events.
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Affiliation(s)
- Susumu Tsuda
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | - Masaru Nakayama
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Naoki Haruyama
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | - Ryota Yoshitomi
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | - Akiko Fukui
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Hospital Organization Kyushu Medical Center
| | | | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
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Wang J, Xing F, Sheng N, Xiang Z. Associations of the Geriatric Nutritional Risk Index With Femur Bone Mineral Density and Osteoporosis in American Postmenopausal Women: Data From the National Health and Nutrition Examination Survey. Front Nutr 2022; 9:860693. [PMID: 35656160 PMCID: PMC9152150 DOI: 10.3389/fnut.2022.860693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe geriatric nutritional risk index (GNRI) has been used as a significant tool to access the nutritional status of the elderly. However, the relationship between the GNRI and femur bone mineral density (BMD) and the risk of osteoporosis remains unclear in American postmenopausal women.ObjectivesWe aimed to explore associations between the GNRI with femur BMD and the risk of osteoporosis in American postmenopausal women.MethodsWe merged the continuous National Health and Nutrition Examination Survey (NHANES) 2005–2006, 2007–2008, 2009–2010, 2013–2014, and 2017–2018 to ensure a large and representative sample, including 3,152 participants. The linear relationship between the GNRI and femur BMD was assessed via a weighted multivariate linear regression model. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between the GNRI and the risk of osteoporosis were assessed by a weighted logistic regression model. Moreover, the nonlinear relationship was also characterized by smooth curve fitting (SCF) and a weighted generalized additive model (GAM).ResultsAfter adjusting for all covariates, the weighted multivariable linear regression models demonstrated that the GNRI was positively correlated with femur BMD. The weighted logistic regression models demonstrated that each unit of increased GNRI value was associated with a decreased risk of osteoporosis of 4.13%. When categorizing GNRI based on quartiles, ORs between the risk of osteoporosis and the GNRI across quintiles 2, 3, and 4 compared with quintile 1 were 0.5565 (95% CI: 0.4791, 0.6463; P < 0.000001), 0.5580 (95% CI: 0.4600, 0.6769; P < 0.000001), and 0.3475 (95% CI: 0.2681, 0.4505; P < 0.000001). The trends similar to the above were also observed in SCF and GAM.ConclusionThis study indicated that nutritional status, represented by the GNRI, was positively associated with femur BMD and negatively associated with the risk of osteoporosis in American postmenopausal women. The GNRI may be a good tool to identify American postmenopausal women who need further bone health nutritional support.
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Nouri A, Mansour-Ghanaei R, Esmaeilpour-Bandboni M, Gholami Chaboki B. Geriatric nutritional risk index in prediction of muscular strength of elderly patients undergoing hemodialysis. Int Urol Nephrol 2021; 54:1575-1581. [PMID: 34674148 DOI: 10.1007/s11255-021-03034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Geriatric nutritional risk index (GNRI) is one of the new tools to determine nutritional status in the elderly. This study assessed the association between GNRI and muscular strength through handgrip strength (HGS) in patients undergoing hemodialysis. METHODS This cross-sectional analytical study assessed 110 hemodialysis patients at Guilan, North of Iran, (mean age of 70.3 ± 6.93), 57 men and 53 women through simple random sampling. Demographic characteristics, GNRI, and HGS of patients were determined. Data were analyzed using descriptive and inferential statistics, including independent t test, AVOVA, Pearson correlation, and linear multiple regression tests. RESULTS The mean values of the GNRI and HGS were 93.90 ± 11.06 and 14.82 ± 3.72, respectively. Finally, it was identified that there is a direct and significant association between GNRI and HGS (p = 0.001, r = 0.734). Linear multiple regression showed that GNRI is an independent predictor of HGS (Adj.R2 = 0.67, βGNRI = 8.13). CONCLUSION GNRI can be used as a predictor of muscular strength in hemodialysis patients.
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Affiliation(s)
- Ali Nouri
- Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Roya Mansour-Ghanaei
- Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. .,Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
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Utility of Geriatric Nutritional Risk Index in Patients with Chronic Kidney Disease: A Mini-Review. Nutrients 2021; 13:nu13113688. [PMID: 34835944 PMCID: PMC8624060 DOI: 10.3390/nu13113688] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/01/2022] Open
Abstract
Chronic kidney disease (CKD) is one of the most significant risk factors for cardiovasculardisese. Malnutrition has been recognized as a significant risk factor for cardiovascular disease in patients with CKD, including those on chronic dialysis. Current studies showed higher all-cause and cardiovascular mortality rates in patients with CKD and malnutrition. Geriatric nutritional risk index (GNRI), a simple and validated nutritional screening measure for both elderly people and patients on dialysis, is based only on three objective parameters: body weight, height, and serum albumin level. Recently, we demonstrated that the cutoff GNRI for predicting all-cause and cardiovascular mortality was 96 in patients on hemodialysis. Moreover, together with left ventricular hypertrophy and low estimated glomerular filtration rate, the utility of GNRI as a significant determinant of cardiovascular events was demonstrated in non-dialysis-dependent patients with CKD. In the present review, we summarize available evidence regarding the relationship of GNRI with all-cause and cardiovascular mortality in patients with CKD including those on dialysis.
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Su WT, Tsai CH, Huang CY, Chou SE, Li C, Hsu SY, Hsieh CH. Geriatric Nutritional Risk Index as a Prognostic Factor for Mortality in Elderly Patients with Moderate to Severe Traumatic Brain Injuries. Risk Manag Healthc Policy 2021; 14:2465-2474. [PMID: 34140818 PMCID: PMC8203299 DOI: 10.2147/rmhp.s314487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background The Geriatric Nutritional Risk Index (GNRI) is a simple and objective screening tool for clinicians to screen patients’ nutritional status based on serum albumin level and their weight and height. The original study had divided patients based on GNRI into quartiles of nutritional risk for death: a no-risk group (GNRI >98), a low-risk group (GNRI 92–98), a moderate-risk group (GNRI 82 to <92), and a major-risk group (GNRI <82). Given that the patients generally sustained traumatic brain injury (TBI) in an acute condition, the study aimed to explore whether GNRI presents a prognostic value for the mortality outcome of these patients. Methods From January 1, 2009, to December 31, 2019, 581 elderly patients with moderate to severe TBI, which was defined as sustaining a head Abbreviated Injury Scale ≥3, was included in the study population. The collected data included age, sex, body mass index, serum albumin levels at admission, preexisting comorbidities, Glasgow Coma Scale, and Injury Severity Score. The primary outcome in the comparison was in-hospital mortality. Results Multivariate logistic regression analysis revealed that GNRI, ESRD, and ISS were significant independent risk factors for mortality in patients with moderate to severe TBI. When subgrouping the study population into four nutritional risk categories according to the quartile deviation as Q1 (GNRI <85, n = 145), Q2 (GNRI 85 to <93.8 n = 145), Q3 (GNRI 93.8 to 103, n = 145), and Q4 (GNRI >103, n = 146), Q1 patients had a significantly longer LOS in hospital (25.2 days vs 18.6 days, respectively; p = 0.004) and higher mortality rate (28.3% vs 11.7%, respectively; p < 0.001) than Q4 patients. The mortality rate was significantly higher in Q1 patients than in Q4 patients (OR, 2.8; 95% CI, 1.14–6.78; p = 0.021). Conclusion This study revealed that the GNRI is a significant independent risk factor and a promising simple assessment tool for mortality in elderly patients with moderate to severe TBI.
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Affiliation(s)
- Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Ying Huang
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi Li
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Huang SW, Yin SM, Hsieh CH. Association of a Low Geriatric Nutritional Risk Index with Higher Adverse Outcome in the Elderly Patients with Fall Injuries: Analysis of a Propensity Score-Matched Population. Risk Manag Healthc Policy 2021; 14:1353-1361. [PMID: 33833598 PMCID: PMC8023402 DOI: 10.2147/rmhp.s298959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose We evaluate the association of Geriatric Nutritional Risk Index (GNRI) and the adverse outcome in elderly patients (≥65 years old) with fall injuries. Patients and Methods Total 1071 elderly patients with fall injuries were enrolled. Patients were divided into four groups: high risk, moderate risk, low risk and no risk (GNRI: <82, 82 to <92, 92 to ≤98 and >98) for patient demography, comorbidities, and adverse outcomes analysis. Results After 1:1 propensity score-matched analysis, 97 patients in high-risk group, 144 patients in moderate-risk group, and 114 patients in low-risk group were compared to no risk group. High-risk group patients had a 5.7-fold higher risk of mortality (p = 0.003) and prolong hospital stay (18.0 vs 12.3 days; p = 0.016) when compared to no-risk group patients. Significantly prolong hospital stay were also found in low-risk and moderate-risk group when compared to no risk group. Conclusion A lower GNRI is associated with prolonged hospital stay in the elderly patients with fall injuries. High nutritional risk (GNRI < 82) is associated with an increased in-hospital mortality rate.
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Affiliation(s)
- Szu-Wei Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Shih-Min Yin
- Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan
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Association between geriatric nutrition risk index and bone mineral density in elderly Chinese people. Arch Osteoporos 2021; 16:55. [PMID: 33709189 DOI: 10.1007/s11657-020-00862-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Malnutrition contributes to the occurrence of osteoporosis. This study showed that participants with higher GNRI values had higher levels of BMD. GNRIs were positively correlated with BMD and independently associated with total hip T-score. GNRIs may be a good indicator for identifying elderly who need further bone health nutritional support. PURPOSE To evaluate the relationship between geriatric nutrition risk index (GNRI) and bone mineral density (BMD) in elderly Chinese people. METHODS We recruited 1130 older adults (60-89 years old) between May 2018 and December 2019. Participants underwent clinical, laboratory, and densitometry examinations. Dual-energy x-ray absorptiometry densitometers and corresponding software were used to assess the BMD and T-scores of participants. Differences between study groups were assessed using one-way analysis of variance (ANOVA) for continuous variables and the chi-square test for categorical variables. Pearson's correlation coefficient was used to assess the correlation between two variables. Multivariate linear regressions with or without adjustments were constructed to explore the possible confounding variables. RESULTS Individuals with higher GNRI values had higher total hip and lumbar spine T-scores (P < 0.001, P = 0.029, respectively). Pearson's correlation demonstrated that GNRIs were positively correlated with BMD at different anatomical sites, in both sexes but especially in women. A multiple regression demonstrated that GNRIs were independently associated with total hip T-score in both sexes (β = 0.111 for men and 0.174 for women; P = 0.034 and 0.008, respectively). CONCLUSIONS Elderly people with higher GNRI values had higher total hip and lumbar spine T-scores, which suggested that GNRI is closely related to BMD. This relationship is maintained at the total hip, even after fully adjusting for possible confounding variables, and consequently, it may be a good indicator for identifying older people who need further bone health nutritional support.
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Han BG, Han J, Lee KH. Association of impedance ratio with corrected Geriatric Nutritional Risk Index in older patients with nondialysis chronic kidney disease stage 5. JPEN J Parenter Enteral Nutr 2021; 46:93-103. [PMID: 33586150 DOI: 10.1002/jpen.2089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND The usual calculation of body mass index (BMI) can be misleading in patients with advanced chronic kidney disease (CKD) because their altered fluid balances may not be reflected. We obtained corrected BMI (cBMI) and corrected Geriatric Nutritional Risk Index (cGNRI) values and investigated whether the impedance ratio (IR) of 200/5 kHz, measured using bioimpedance spectroscopy, was associated with cGNRI in older patients with nondialysis CKD stage 5 (CKD5-ND). METHODS Patients over 65 years old (n = 118) were divided into groups by cGNRI tertiles. The differences between the correlations were tested using Steiger's z-test. The IR and cBMI were used as both continuous and categorical variables in the regression analyses to determine the factors that were independently associated with the cGNRI. RESULTS Patients in the third cGNRI tertile had a significantly lower mean IR than those in the other 2 tertiles (P < .001). Across the 3 cGNRI tertile groups, the IR was incrementally lower in the higher cGNRI tertiles (P for trend < .001). The Steiger's z-test showed that the IR had a significantly stronger correlation with cGNRI than cBMI had with cGNRI. In the multivariable linear regression analyses, the IR was independently associated with the cGNRI, after adjusting for various confounders. CONCLUSION The current results revealed that the IR was a more sensitive indicator of nutrition risk than BMI and was independently associated with cGNRI in older patients with CKD5-ND. Our study suggests that the IR is an appropriate tool for nutrition risk screening.
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Affiliation(s)
- Byoung-Geun Han
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won, Korea
| | - Jihye Han
- Politics and International Relations, London School of Economics and Political Science, London, United Kingdom.,United Nations Development Programme Seoul Policy Center, Seoul, Korea
| | - Kwang Hoon Lee
- Dr. Lee's Medical Clinic and Hemodialysis Center, Wonju, Kang-won, Korea
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Dong CH, Chen SY, Zeng HL, Yang B, Pan J. Geriatric nutritional risk index predicts all-cause mortality in patients with heart failure: A systematic review and meta-analysis. Clinics (Sao Paulo) 2021; 76:e2258. [PMID: 33787674 PMCID: PMC7955148 DOI: 10.6061/clinics/2021/e2258] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 01/27/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Geriatric nutritional risk index (GNRI) might predict the all-cause mortality in patients with heart failure (HF). We performed a meta-analysis to evaluate the correlation between GNRI and all-cause mortality in patients with HF. METHODS We searched the PubMed, Medline, Cochrane Library, and Embase databases for clinical trials investigating the association between GNRI and all-cause mortality in patients with HF, having the primary endpoint as all-cause mortality. RESULTS In total, nine studies involving 7,659 subjects were included in the systematic review and meta-analysis. The results indicated that major risk and moderate risk GNRI (GNRI<92) was associated with an increased risk of all-cause mortality in elderly patients with HF (hazard ratios [HR] 1.59, 95% confidence intervals [CI] 1.37-1.85). Low risk GNRI (GNRI<98) group predicted all-cause mortality in elderly HF patients (HR 1.56, 95%CI 1.12-2.18) when compared with the high GNRI value group. A subgroup analysis indicated that the relationship between GNRI and HF might differ based on the subtype of heart failure. CONCLUSIONS GNRI is a simple and well-established nutritional assessment tool to predict all-cause mortality in patients with HF.
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Affiliation(s)
- Chao-hui Dong
- Department of Health Management Center, Affiliated Hospital of Chengdu University, Jinniu district, Chengdu City, Sichuan Province, China
| | - Si-yu Chen
- Department of Vascular Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Qingyang district, Chengdu City, Sichuan Province, China
- *Corresponding author. E-mail:
| | - Hong-lian Zeng
- Department of Health Management Center, Affiliated Hospital of Chengdu University, Jinniu district, Chengdu City, Sichuan Province, China
| | - Bo Yang
- Department of Health Management Center, Affiliated Hospital of Chengdu University, Jinniu district, Chengdu City, Sichuan Province, China
| | - Jia Pan
- Department of Health Management Center, Affiliated Hospital of Chengdu University, Jinniu district, Chengdu City, Sichuan Province, China
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Hsieh CH, Liu YW, Tsai CH, Chou SE, Su WT, Li C, Hsu SY. Geriatric nutritional risk index in screening malnutrition among young adult and elderly trauma patients. FORMOSAN JOURNAL OF SURGERY 2021. [DOI: 10.4103/fjs.fjs_44_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yeh CH, Wu SC, Chou SE, Su WT, Tsai CH, Li C, Hsu SY, Hsieh CH. Geriatric Nutritional Risk Index as a Tool to Evaluate Impact of Malnutrition Risk on Mortality in Adult Patients with Polytrauma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249233. [PMID: 33321867 PMCID: PMC7764093 DOI: 10.3390/ijerph17249233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Identification of malnutrition is especially important in severely injured patients, in whom hypermetabolism and protein catabolism following traumatic injury worsen their nutritional condition. The geriatric nutritional risk index (GNRI), based on serum albumin level and the current body weight/ideal body weight ratio, is useful for identifying patients with malnutrition in many clinical conditions. This study aimed to explore the association between admission GNRI and mortality outcomes of adult patients with polytrauma. METHODS From 1 January 2009 to 31 December 2019, a total of 348 adult patients with polytrauma, registered in the trauma database of a level I trauma center, were recognized and categorized into groups of death (n = 71) or survival (n = 277) and into four nutritional risk groups: a high-risk group (GNRI < 82, n = 87), a moderate-risk group (GNRI 82 to <92, n = 144), a low-risk group (GNRI 92-98, n = 59), and a no-risk group (GNRI > 98, n = 58). Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for mortality. The mortality outcomes of patients at various nutritional risks were compared to those of patients in the no-risk group. RESULTS The comparison between the death group (n = 71) and the survival group (n = 277) revealed that there was no significant difference in gender predominance, age, pre-existing comorbidities, injury mechanism, systolic blood pressure, and respiratory rate upon arrival at the emergency room. A significantly lower GNRI and Glasgow Coma Scale score but higher injury severity score (ISS) was observed in the death group than in the survival group. Multivariate logistic regression analysis revealed that Glasgow Coma Scale (GCS), odds ratio (OR), 0.88; 95% confidence interval (CI), 0.83-0.95; p < 0.001), ISS (OR, 1.07; 95% CI, 1.04-1.11; p < 0.001), and GNRI (OR, 0.94; 95% CI, 0.91-0.97; p < 0.001) were significant independent risk factors for mortality in these patients. The mortality rates for the high-risk, moderate-risk, low-risk, and no-risk groups were 34.5%, 20.1%, 8.5%, and 12.1%, respectively. Unlike patients in the moderate-risk and low-risk groups, patients in the high-risk group had a significantly higher death rate than that of those in the no-risk group. CONCLUSIONS This study revealed that the GNRI may serve as a simple, promising screening tool to identify the high risk of malnutrition for mortality in adult patients with polytrauma.
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Affiliation(s)
- Cheng-Hsi Yeh
- Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan;
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan;
| | - Sheng-En Chou
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan; (S.-E.C.); (W.-T.S.); (C.-H.T.); (C.L.); (S.-Y.H.)
| | - Wei-Ti Su
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan; (S.-E.C.); (W.-T.S.); (C.-H.T.); (C.L.); (S.-Y.H.)
| | - Ching-Hua Tsai
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan; (S.-E.C.); (W.-T.S.); (C.-H.T.); (C.L.); (S.-Y.H.)
| | - Chi Li
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan; (S.-E.C.); (W.-T.S.); (C.-H.T.); (C.L.); (S.-Y.H.)
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan; (S.-E.C.); (W.-T.S.); (C.-H.T.); (C.L.); (S.-Y.H.)
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 83301, Taiwan
- Correspondence: ; Tel.: +886-7-7327476
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Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures-A Retrospective Study in a Level I Trauma Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238920. [PMID: 33266264 PMCID: PMC7729938 DOI: 10.3390/ijerph17238920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/13/2020] [Accepted: 11/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Malnutrition is frequently underdiagnosed in geriatric patients and is considered to be a contributing factor for worse outcomes during hospitalization. In addition, elderly patients who undergo trauma are often malnourished at the time of incurring fractures. The geriatric nutritional risk index (GNRI), calculated based on the serum albumin level and the ratio of present body weight to ideal body weight, was proposed for the assessment of the nutritional status of elderly patients with various illnesses. This study aimed to investigate whether the GNRI has a prognostic value that links the nutritional status and mortality outcomes of elderly patients who have previously undergone trauma with femoral fractures. METHODS From January 1, 2009 to December 31, 2019, a total of 678 elderly patients with femoral fractures were categorized into four nutritional risk groups: a major-risk group (GNRI <82; group 1, n = 127), moderate-risk group (GNRI 82- <92; group 2, n = 179), low-risk group (GNRI 92-98; group 3, n = 123), and no-risk group (GNRI >98; group 4, n = 249). To minimize the confounding effects of sex, age, preexisting comorbidities, and injury severity of patients on outcome measurements, propensity score-matched patient cohorts were created to assess the impact of patients being in different nutritional risk groups on the in-hospital mortality outcomes against the no-risk group. RESULTS The patients in groups 1-3 were significantly older and presented a significantly lower body mass index and lower serum albumin levels than those in group 4. Compared with patients in group 4 (3.6%), a significantly higher mortality rate was found in the patients in group 1 (17.3%, p < 0.001), but not in those in group 2 (6.7%) or group 3 (2.4%). The study of propensity score-matched patient cohorts provided similar results; group 1 patients had significantly higher odds of mortality than group 4 patients (odds ratio, 6.3; 95% confidence interval, 1.34-29.37; p = 0.009), but there were no significant differences in mortality risks among patients in groups 2 and 3 compared with those in group 4. CONCLUSIONS This preliminary study suggested that the GNRI may be used as a screening tool to identify patients with malnutrition at a high risk of mortality among elderly patients with femoral fractures. A prospective study is needed to validate the suggestion.
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Yoo JW, Ju S, Lee SJ, Cho YJ, Lee JD, Kim HC. Geriatric nutritional risk index is associated with 30-day mortality in patients with acute respiratory distress syndrome. Medicine (Baltimore) 2020; 99:e20671. [PMID: 32569197 PMCID: PMC7310893 DOI: 10.1097/md.0000000000020671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The clinical effect of the geriatric nutritional risk index (GNRI) on patients with acute respiratory distress syndrome (ARDS) remains unclear. The aim of this study was to evaluate the association between the GNRI on admission and 30-day mortality in patients with ARDS. From January 2014 to May 2019, we retrospectively reviewed medical records for patients with ARDS admitted to a medical intensive care unit, who met for the Berlin definition. The GNRI was calculated as follows: 1.519 × serum albumin, (g/L) + (41.7 × present weight, kg/ideal body weight, kg). Clinical data of 224 patients were analyzed. Median age was 72 years old and 71.4% was men. ARDS was mostly of pulmonary origin (94.2%). 30-day mortality was 61.6% (138/224). APACHE II and SOFA scores and the frequency of septic shock and acute kidney injury, were significantly higher in non-survivors. The median GNRI score was higher in survivors than in non-survivors (86.9 vs 79.8, P = .001). In multivariate analysis, GNRI scores were associated with 30-day mortality (hazard ratio, 0.978; 95% confidence interval 0.966-0.990, P = .001). The GNRI on admission was associated with 30-day mortality and may be useful index to assess mortality in patients with ARDS.
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Affiliation(s)
- Jung-Wan Yoo
- Department of Internal Medicine, Gyeongsang National University Hospital
| | - Sunmi Ju
- Department of Internal Medicine, Gyeongsang National University Hospital
| | - Seung Jun Lee
- Department of Internal Medicine, Gyeongsang National University Hospital
- Gyeongsang National University College of Medicine
| | - Yu Ji Cho
- Department of Internal Medicine, Gyeongsang National University Hospital
- Gyeongsang National University College of Medicine
| | - Jong Deog Lee
- Department of Internal Medicine, Gyeongsang National University Hospital
- Gyeongsang National University College of Medicine
| | - Ho Cheol Kim
- Gyeongsang National University College of Medicine
- Gyeongsang National University Changwon Hospital, Jinju, South Korea
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Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients. Surg Endosc 2020; 35:1202-1209. [PMID: 32152675 DOI: 10.1007/s00464-020-07487-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Preoperative nutritional assessment of cancer patients is important to reduce postoperative complications. Several studies have reported the Geriatric Nutritional Risk Index (GNRI) to be useful in assessing underlying diseases and long-term outcomes of hospitalized patients. The present study aimed to evaluate the impact of preoperative GNRI on short- and long-term outcomes in elderly gastric cancer patients who underwent laparoscopic gastrectomy. METHODS We retrospectively reviewed consecutive patients aged ≥ 65 years who underwent laparoscopy-assisted gastrectomy and had R0 resection for histologically confirmed gastric adenocarcinoma. The cutoff value for preoperative GNRI was determined to be 85.7 based on the incidence of postoperative complications. Patients were categorized into two groups: low GNRI group and normal GNRI group. RESULTS Univariate analyses of the 303 patients revealed that the incidence of postoperative complications was significantly associated with the American Society of Anesthesiologists Physical Status classification (ASA-PS), C-reactive protein (CRP), GNRI (p < 0.001), and operative procedure. Multivariate analyses revealed that preoperative GNRI (odds ratio [OR] 2.716; 95% confidence interval [CI] 1.166-6.328; p = 0.021) and operative procedure (OR 2.459; 95% CI 1.378-4.390; p = 0.002) were independently associated with the incidence of postoperative complications. Univariate analyses showed that overall survival (OS) was significantly associated with ASA-PS, tumor size, tumor differentiation, pathological tumor node metastasis (TNM) stage, carcinoembryonic antigen (CEA), CRP, GNRI, and postoperative complications. Multivariate analysis demonstrated that ASA-PS (hazard ratio [HR], 3.755; 95% CI 2.141-6.585; p < 0.001), tumor differentiation (HR 1.898; 95% CI 1.191-3.025; p = 0.007), CEA (HR 1.645; 95% CI 1.024-2.643; p = 0.040), and GNRI (HR 2.093; 95% CI 1.105-3.963; p = 0.023) independently predicted OS. CONCLUSION GNRI is an important predictor of postoperative complications and overall survival in elderly gastric cancer patients. It is a reliable and cost-effective prognostic indicator that should be routinely evaluated.
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Li Y, Spence JD, Wang X, Huo Y, Xu X, Qin X. Effect of Vitamin B12 Levels on the Association Between Folic Acid Treatment and CKD Progression: A Post Hoc Analysis of a Folic Acid Interventional Trial. Am J Kidney Dis 2020; 75:325-332. [DOI: 10.1053/j.ajkd.2019.07.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/13/2019] [Indexed: 02/08/2023]
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24
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Pagano AP, Sicchieri JMF, Schiavoni IL, Barbeiro D, Manca CS, da Silva BR, Bezerra AE, Pinto LCM, Araújo RC, Teixeira AC, Chiarello PG. Phase angle as a severity indicator for liver diseases. Nutrition 2020; 70:110607. [DOI: 10.1016/j.nut.2019.110607] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/08/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022]
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Geriatric nutrition risk index is associated with renal progression, cardiovascular events and all-cause mortality in chronic kidney disease. J Nephrol 2019; 33:783-793. [PMID: 31773640 DOI: 10.1007/s40620-019-00676-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/18/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Malnutrition is common and associated with poor outcomes in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Recently, the geriatric nutritional risk index (GNRI) was reported as a novel tool for evaluating nutritional status. However, the association between GNRI and renal outcome, cardiovascular (CVD) events, and mortality in patients with CKD remains unclear. METHODS A prospective cohort study with adult patients with CKD stages 1-4 was conducted at 39 centers around China starting in 2011. Patients were divided into quartiles (Q1, Q2, Q3, and Q4) according to their GNRI category. RESULTS A total of 2791 CKD patients within a median follow-up of 4.38 years were included. A low GNRI quartile was independently associated with progression to ESRD, CVD events, and overall mortality. Compared to that in the Q1 group (the reference group), belonging to a higher GNRI quartile significantly reduced the risk of progression to ESRD in the crude and multivariate-adjusted models. Moreover, a significant inverse association was found between those in the high GNRI quartiles and overall mortality among patients with CKD (HR 0.25; 95% CI 0.15-0.43; p = 0.0007, Q4 vs. Q1) after multivariate adjustment. In addition, there was also a significant association between GNRI and CVD events (HR 0.57; 95% CI 0.39-0.84; p = 0.005, Q4 vs. Q1). Moreover, after adjusting for other confounders, only the Q3 group remained significantly fewer CVD events (HR 0.44; 95% CI 0.19-0.98; p = 0.04). CONCLUSIONS These findings suggest that GNRI might be a useful prognostic tool for patients with CKD.
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Geriatric Nutritional Risk Index Is Associated with Unique Health Conditions and Clinical Outcomes in Chronic Kidney Disease Patients. Nutrients 2019; 11:nu11112769. [PMID: 31739530 PMCID: PMC6893606 DOI: 10.3390/nu11112769] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/02/2019] [Accepted: 11/11/2019] [Indexed: 12/19/2022] Open
Abstract
Malnutrition is prevalent in patients with chronic kidney disease (CKD). However, current nutrition screening tools are not specific to the CKD population. In the present study, we aimed to investigate whether the geriatric nutritional risk index (GNRI), a simple tool designed for assessing nutrition-related risks in the elderly population, is associated with unique aspects of CKD such as fluid status, residual renal function, proteinuria, and inflammation, and whether it predicts clinical outcomes. The GNRI was calculated by incorporating serum albumin and anthropometric measurements in 326 patients with nondialysis stage 3–5 CKD who were followed up from September 2011 to March 2017 for end-stage renal disease (ESRD) and the composite outcome of all-cause death and cardiovascular events. Patients were stratified into tertiles according to baseline GNRI levels. Patients in the lowest GNRI tertile were more likely to have significantly higher levels of overhydration, proteinuria, and serum inflammatory markers and tended to have lower lean body mass and estimated glomerular filtration rate when compared with patients in the middle and upper GNRI tertiles. In multivariate linear regression analyses, the GNRI was independently associated with overhydration, proteinuria, and interleukin-6. During a median follow-up of 4.9 years, 101 patients developed ESRD; 40 deaths, and 68 cardiovascular events occurred. Patients in the lowest GNRI tertile had significantly increased risks of ESRD (hazard ratio (HR): 3.15, 95% confidence interval (CI): 1.95–5.07, p < 0.001) and the composite outcome (HR: 1.79, 95% CI: 1.10–2.92, p = 0.019) in fully adjusted models (reference: middle and upper GNRI tertiles). The GNRI takes CKD-specific health conditions into account. In addition, CKD patients with lower GNRI scores had a significantly higher risk of adverse clinical outcomes. Our findings suggest that the GNRI is an appropriate tool for nutrition screening and a prognostic predictor among patients with nondialysis stage 3–5 CKD.
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Sagou K, Ozeki K, Ukai S, Adachi Y, Fukushima N, Kohno A. Impact of a Nutritional Risk Index on Clinical Outcomes after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:2287-2296. [DOI: 10.1016/j.bbmt.2019.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/10/2019] [Accepted: 07/02/2019] [Indexed: 02/03/2023]
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Hori S, Ichikawa K, Morizawa Y, Gotoh D, Itami Y, Nakai Y, Miyake M, Yoneda T, Tanaka N, Yoshida K, Fujimoto K. Clinical Significance of Postoperative Nutritional Status as a Prognostic Factor in Kidney Transplant Recipients. Transplant Proc 2019; 51:1763-1772. [PMID: 31255359 DOI: 10.1016/j.transproceed.2019.04.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite advancements in the management of kidney transplantation (KT), kidney transplant recipients (KTRs) have a higher risk of mortality than the age-matched general population. Improvement of long-term graft and patient survival is a significant issue. Therefore we investigated the effects of postoperative nutritional status on graft and patient survival and explored the predictive factors involved in nutritional status. METHODS Our retrospective study included 118 KTRs who underwent KT at our hospital. Clinical and laboratory data were obtained from medical charts. The prognostic nutritional index (PNI) was used to assess nutritional status. Changes in nutritional status after KT were monitored and the effect of nutritional status on graft and patient survival was investigated. The variables involved in nutritional status were also explored. RESULTS The KTRs in this cohort comprised 66 men and 52 women with a median age of 47 years at KT. There were 16, 32, and 22 cases of cadaveric, preemptive, and ABO-incompatible KTs, respectively. Postoperative PNI gradually improved and was stable from 6 months after KT. Although graft survival was regulated by ABO-compatibility, independent predictors for patient survival were history of dialysis, PNI, and serum-corrected calcium levels. Preemptive KT and inflammatory status contributed to PNI. CONCLUSIONS Nutritional status of KTRs improved over time after KT and could contribute to patient survival. Optimal nutritional educational programs and interventions can lead to better outcomes in KTRs. Further studies are needed to validate our results and develop appropriate nutritional educational programs, interventions, and exercise programs.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, Nara, Japan
| | | | | | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Yasushi Nakai
- Department of Urology, Nara Medical University, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Nara, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Nara, Japan
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Yoshitomi R, Nakayama M, Sakoh T, Fukui A, Katafuchi E, Seki M, Tsuda S, Nakano T, Tsuruya K, Kitazono T. High neutrophil/lymphocyte ratio is associated with poor renal outcomes in Japanese patients with chronic kidney disease. Ren Fail 2019; 41:238-243. [PMID: 30942116 PMCID: PMC6450582 DOI: 10.1080/0886022x.2019.1595645] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Several studies have shown that the neutrophil/lymphocyte ratio (NLR) is a marker that reflects the state of systemic inflammation. A high NLR was reported to be associated with cardiovascular events and mortality. However, little is known about the association between NLR and kidney disease progression in patients with chronic kidney disease (CKD). Therefore, the aim of the present study was to determine whether NLR is associated with renal outcomes in CKD patients. Methods: This prospective observational study included 350 consecutive patients with stage 1–4 CKD treated between June 2009 and November 2016. Data were collected until June 2017. The endpoint was the composite of end-stage renal disease requiring dialysis or death. Subjects were divided into two groups according to high and low NLR levels. A Cox proportional hazards model was used to determine the risk factors for composite outcomes. Results: The composite endpoint was observed in 83 patients during the median follow-up period of 31.8 months: 29 in the low NLR group and 54 in the high NLR group. Multivariable analysis showed that the high NLR group had a significant increase in the hazard ratio (HR) for composite outcomes (HR 1.67, 95% confidence interval 1.02–2.77) compared with the low NLR group. Conclusion: The present study demonstrated that a high NLR was associated with poor renal outcomes, suggesting that NLR may be a useful marker for prognostic prediction in patients with CKD.
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Affiliation(s)
- Ryota Yoshitomi
- a Department of Medicine and Clinical Science, Graduate School of Medical Sciences , Kyushu University , Higashi-ku , Japan.,b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Masaru Nakayama
- b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Teppei Sakoh
- b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Akiko Fukui
- b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Eisuke Katafuchi
- b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Makiko Seki
- b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Susumu Tsuda
- b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Toshiaki Nakano
- a Department of Medicine and Clinical Science, Graduate School of Medical Sciences , Kyushu University , Higashi-ku , Japan
| | - Kazuhiko Tsuruya
- c Division of Nephrology , Nara Medical University , Kashihara , Japan
| | - Takanari Kitazono
- a Department of Medicine and Clinical Science, Graduate School of Medical Sciences , Kyushu University , Higashi-ku , Japan
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Spatola L, Finazzi S, Santostasi S, Angelini C, Badalamenti S. Geriatric Nutritional Risk Index Is Predictive of Subjective Global Assessment and Dialysis Malnutrition Scores in Elderly Patients on Hemodialysis. J Ren Nutr 2019; 29:438-443. [PMID: 30853327 DOI: 10.1053/j.jrn.2019.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/02/2018] [Accepted: 01/21/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Malnutrition is a frequent complication in patients on hemodialysis (HD), even if its adequate appraisal remains one of the most complicated challenges in the HD scenario because of the limits of current malnutrition biomarkers. The aim of our study was to assess the relation of subjective nutritional tools Subjective Global Assessment (SGA) and Dialysis Malnutrition Score (DMS) with the objective malnutrition tool Geriatric Nutritional Risk Index (GNRI) in elderly patients on HD. METHODS This is a cross-sectional study involving 71 patients on maintenance HD. Mann-Whitney U and chi-square tests were used to compare data of male and female patients on HD. Linear and logistic regression models were used to assess the variables tested in all patients. RESULTS GNRI was not different between male and female patients on HD, and it was negatively related to SGA and DMS: B, -0.05 (95% confidence interval, -0.08 to -0.02) P = 0.00 and B, -0.30 (95% confidence interval, -0.47 to -0.14) P = .00, respectively. Both continuous and categorical GNRI data were predictive of SGA = 3: Odds Ratio (OR), 0.74 (0.63 to 0.87) P = 0.00 and OR, 6.74 (1.54 to 29.45) P = 0.01, respectively. Similarly, GNRI data were related to DMS > 13: OR, 0.85 (0.76 to 0.85) P = 0.00 and 3.29 (1.08 to 10.05) P = 0.03, respectively. Continuous GNRI data remained significant in both male and female patients separately, whereas categorical GNRI data, only in male patients. CONCLUSIONS GNRI is a reliable nutritional tool predictive of subjective malnutrition scores SGA and DMS, pointing out a relation between objective and subjective malnutrition indexes in both genders.
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Affiliation(s)
- Leonardo Spatola
- Division of Nephrology and Hemodialysis, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; Division of Nephrology, Dialysis and Renal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Silvia Finazzi
- Division of Nephrology and Hemodialysis, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Silvia Santostasi
- Division of Nephrology and Hemodialysis, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Claudio Angelini
- Division of Nephrology and Hemodialysis, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Salvatore Badalamenti
- Division of Nephrology and Hemodialysis, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
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Associations among Geriatric Nutrition Risk Index, bone mineral density, body composition and handgrip strength in patients receiving hemodialysis. Nutrition 2019; 65:6-12. [PMID: 31029923 DOI: 10.1016/j.nut.2019.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Malnutrition occurs as a complication of hemodialysis (HD) and has been identified as a risk factor for osteoporosis, sarcopenia, and low physical performance. The aim of this study was to assess the associations among nutrition, bone mineral density (BMD), body composition, and handgrip strength (HGS) in patients receiving HD. METHODS We enrolled 164 patients receiving HD who have undergone the dual energy x-ray absorptiometry (DXA) examination, categorized according to baseline Geriatric Nutritional Risk Index (GNRI) values calculated by serum albumin levels and body weight index. GNRI was used to evaluate nutritional status, and DXA to investigate BMD and body composition. Additionally, HGS test was performed. Multiple stepwise linear regression analysis was used to identify the factors associated with BMD, T-score, and HGS. RESULTS Compared with patients with tertile 1 of GNRI, those with tertile 3 of GNRI tend to have higher lumbar spine BMD and T-score, higher femoral neck BMD, higher total hip BMD, higher left distal mid-third radius BMD and T-score, higher fat mass index, higher android-to-gynoid ratio, higher lean mass index, and higher HGS. An increase in GNRI tertile was associated with an increase of BMD and a decrease of osteoporosis prevalence. The GNRI was positively correlated with BMD and T-score, body composition, and HGS. Low lean mass index and high parathyroid hormone were significantly associated with low BMD and T-score. Additionally, high GNRI and high left distal mid-third radius BMD were significantly associated with high HGS. CONCLUSIONS The present study demonstrated that good nutrition, indicated as high GNRI, resulted in higher BMD and T-score, lean mass index, and HGS in patients receiving HD. Using GNRI to evaluate nutritional status and using DXA to investigate BMD and body composition in patients receiving HD is important to bone health and physical performance.
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Geriatric Nutritional Risk Index, a Simplified Nutritional Screening Index, Is a Strong Predictor of Handgrip Strength in Renal Transplant Recipients. Transplant Proc 2018; 50:2509-2514. [DOI: 10.1016/j.transproceed.2018.03.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/02/2018] [Indexed: 02/08/2023]
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Subjective Global Assessment-Dialysis Malnutrition Score and cardiovascular risk in hemodialysis patients: an observational cohort study. J Nephrol 2018; 31:757-765. [PMID: 29936648 DOI: 10.1007/s40620-018-0505-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/08/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Malnutrition is an important risk factor for cardiovascular mortality in hemodialysis (HD) patients. However, current malnutrition biomarkers seem unable to accurately estimate the role of malnutrition in predicting cardiovascular risk. Our aim was to investigate the role of the Subjective Global Assessment-Dialysis Malnutrition Score (SGA-DMS) compared to two well-recognized comorbidity scores-Charlson Comorbidity Index (CCI) and modified CCI (excluding age-factor) (mCCI)-in predicting cardiovascular events in HD patients. METHODS In 86 maintenance HD patients followed from June 2015 to June 2017, we analyzed biohumoral data and clinical scores as risk factors for cardiovascular events (acute heart failure, acute coronary syndrome and stroke). Their impact on outcome was investigated by linear regression, Cox regression models and ROC analysis. RESULTS Cardiovascular events occurred in 26/86 (30%) patients during the 2-year follow-up. Linear regression showed only age and dialysis vintage to be positively related to SGA-DMS: B 0.21 (95% CI 0.01; 0.30) p 0.05, and B 0.24 (0.09; 0.34) p 0.02, respectively, while serum albumin, normalized protein catabolic rate (nPCR) and dialysis dose (Kt/V) were negatively related to SGA-DMS: B - 1.29 (- 3.29; - 0.81) p 0.02; B - 0.08 (- 1.52; - 0.35) p 0.04 and B - 2.63 (- 5.25; - 0.22) p 0.03, respectively. At Cox regression analysis, SGA-DMS was not a risk predictor for cardiovascular events: HR 1.09 (0.9; 1.22), while both CCI and mCCI were significant predictors: HR 1.43 (1.13; 1.87) and HR 1.57 (1.20; 2.06) also in Cox adjusted models. ROC analysis reported similar AUCs for CCI and mCCI: 0.72 (0.60; 0.89) p 0.00 and 0.70 (0.58; 0.82) p 0.00, respectively, compared to SGA-DMS 0.56 (0.49; 0.72) p 0.14. CONCLUSIONS SGA-DMS is not a superior and significant prognostic tool compared to CCI and mCCI in assessing cardiovascular risk in HD patients, even it allows to appraise both malnutrition and comorbidity status.
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