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Visser J, Cederholm T, Philips L, Blaauw R. Prevalence and related assessment practices of adult hospital malnutrition in Africa: A scoping review. Clin Nutr ESPEN 2024; 63:121-132. [PMID: 38943652 DOI: 10.1016/j.clnesp.2024.06.015] [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: 08/21/2023] [Revised: 05/15/2024] [Accepted: 06/13/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND AND AIMS Globally, hospital malnutrition prevalence is estimated at 20-50%, with little known about the situation in African hospitals. The aim of this scoping review was to appraise the current evidence base regarding the prevalence of adult hospital malnutrition and related assessment practices in an African context. METHODS A comprehensive and exhaustive search strategy was undertaken to search seven electronic bibliographic databases (including Africa-specific databases) from inception until August 2022 for articles/resources reporting on the prevalence of adult hospital malnutrition in an African setting. Two reviewers independently reviewed abstracts and full-text articles and data extraction was undertaken in duplicate. RESULTS We screened the titles and abstracts of 7537 records and included 28 studies. Most of the included studies were conducted in the East African region (n = 12), with ten studies from South Africa. Most studies were single-centre studies (n = 22; 79%), including 23 to 2126 participants across all studies. A variety of study populations were investigated with most described as medical and surgical populations (n = 14; 50%). Malnutrition risk prevalence was reported to be between 23% and 74%, using a variety of nutritional screening tools (including MNA-SF/LF, NRS-2002, MUST, NRI, GNRI). Malnutrition prevalence was reported to be between 8% and 85%, using a variety of tools and parameters, including ASPEN and ESPEN guidelines, SGA, MNA-SF/LF, anthropometric and biochemical indices, with one study using the GLIM criteria to diagnose malnutrition. CONCLUSIONS Both malnutrition risk and malnutrition prevalence are alarmingly high in African adult hospitalised patients. The prevalence of malnutrition differs significantly among studies, owing in part to the variety of tools used and variability in cut-offs for measurements, underscoring the importance of adopting a standardised approach. Realities in the African context include limited nutritional screening and assessment, poor referral practices, and a unique disease burden. General awareness is needed, and routine nutritional screening practices with appropriate nutrition support action should be implemented as a matter of urgency in African hospitals.
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Affiliation(s)
- Janicke Visser
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, South Africa.
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Renée Blaauw
- Division of Human Nutrition, Department of Global Health, Stellenbosch University, South Africa
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Filisa-Kaphamtengo F, Ngoma J, Mukhula V, Matemvu Z, Kapute D, Banda P, Phiri T, Mipando M, Hosseinipour MC, Katundu KGH. Prevalence, patterns and associated risk factors for dyslipidaemia among individuals attending the diabetes clinic at a tertiary hospital in Central Malawi. BMC Cardiovasc Disord 2023; 23:548. [PMID: 37946116 PMCID: PMC10636904 DOI: 10.1186/s12872-023-03589-x] [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: 08/15/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Dyslipidaemia among individuals with diabetes is a significant modifiable risk factor for atherosclerotic cardiovascular diseases (ASCVDs). ASCVDs are a major cause of mortality and morbidity globally, especially in people with diabetes. In Malawi, limited data exist on the prevalence and biochemical characteristics of diabetic dyslipidaemia. This study investigated the prevalence and biochemical characteristics of dyslipidaemia in individuals attending the diabetes clinic at Kamuzu Central Hospital, the largest tertiary referral hospital in Central Malawi. METHODS Using a cross-sectional design, sociodemographic, medical and anthropometric data were collected from 391 adult participants who were enrolled in the study. Blood samples were analysed for glycosylated haemoglobin (HBA1c) and fasting lipid profiles. The prevalence of dyslipidaemia was calculated, and the biochemical characteristics of the dyslipidaemia were defined. The associations between dyslipidaemia and risk factors such as sociodemographic characteristics, obesity, and HBA1c levels were evaluated using logistic regression analysis. RESULTS Prevalence of dyslipidaemia was observed in 71% of the participants, and elevated low-density lipoprotein cholesterol was the most frequent lipid abnormality among the study participants. None of the participants were receiving any lipid-lowering therapy. On bivariate analysis, dyslipidemia was positively associated with female sex [OR 1.65 (95% CI 1.05- 2.58); p = 0.09], age ≥ 30 years [OR 3.60 (95% CI 1.17-7.68); p = 0.001] and overweight and obesity [OR 2.11 (95% CI 1.33-3.34); p = 0.002]. On multivariate analysis, being overweight or obese was an independent predictor of dyslipidaemia [AOR 1.8;(95% CI 1.15- 3.37); p = 0.04]. CONCLUSION Dyslipidaemia was highly prevalent among individuals with diabetes in this study, and elevated low-density lipoprotein cholesterol was the most frequent lipid abnormality. Overweight and obesity were also highly prevalent and positively predicted dyslipidaemia. This study highlights the importance of appropriately addressing dyslipidaemia, overweight and obesity among individuals with diabetes in Malawi and other similar settings in Africa as one of the significant ways of reducing the risk of ASCVDs among this population.
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Affiliation(s)
- Florence Filisa-Kaphamtengo
- Kamuzu Central Hospital, Lilongwe, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Victoria Mukhula
- Malawi-Liverpool Wellcome Clinical Research Program, Blantyre, Malawi
- Blantyre to Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | - Peter Banda
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Tamara Phiri
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Mwapatsa Mipando
- Blantyre to Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Kondwani G H Katundu
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
- Malawi-Liverpool Wellcome Clinical Research Program, Blantyre, Malawi.
- Blantyre to Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre, Malawi.
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Filisa-Kaphamtengo F, Ngoma J, Mukhula V, Matemvu Z, Kapute D, Banda P, Phiri T, Mipando M, Hosseinipour MC, Katundu KGH. Prevalence, patterns and associated risk factors for dyslipidaemia among individuals attending the diabetes clinic at a tertiary hospital in Central Malawi. RESEARCH SQUARE 2023:rs.3.rs-3262287. [PMID: 37674703 PMCID: PMC10479448 DOI: 10.21203/rs.3.rs-3262287/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background Dyslipidaemia among individuals with diabetes is a significant modifiable risk factor for atherosclerotic cardiovascular diseases (ASCVDs). ASCVDs are a major cause of mortality and morbidity globally, especially in people with diabetes. In Malawi, limited data exist on the prevalence and biochemical characteristics of diabetic dyslipidaemia. This study investigated the prevalence and biochemical characteristics of dyslipidaemia in individuals attending the diabetes clinic at Kamuzu Central Hospital, the largest tertiary referral hospital in Central Malawi. Methods Using a cross-sectional design, sociodemographic, medical and anthropometric data were collected from 391 adult participants who were enrolled in the study. Blood samples were analysed for glycosylated haemoglobin (HBA1c) and fasting lipid profiles. The prevalence of dyslipidaemia was calculated, and the biochemical characteristics of the dyslipidaemia were defined. The associations between dyslipidaemia and risk factors such as sociodemographic characteristics, obesity, and HBA1c levels were evaluated using logistic regression analysis. Results Prevalence of dyslipidaemia was observed in 71% of the participants, and elevated low-density lipoprotein cholesterol was the most frequent lipid abnormality among the study participants. On bivariate analysis, dyslipidemia was positively associated with female sex [OR 1.65 (95% CI 1.05-2.58); p = 0.09], age ≥ 30 years [OR 3.60 (95% CI 1.17-7.68); p = 0.001] and overweight and obesity [OR 2.11 (95% CI 1.33-3.34); p = 0.002]. On multivariate analysis, being overweight or obese was an independent predictor of dyslipidaemia [AOR 1.8 ;( 95% CI 1.15-3.37); p = 0.04]. Conclusion Dyslipidaemia was highly prevalent among individuals with diabetes in this study, and elevated low-density lipoprotein cholesterol was the most frequent lipid abnormality. Overweight and obesity were also highly prevalent and positively predicted dyslipidaemia. This study highlights the importance of appropriately addressing dyslipidaemia, overweight and obesity among individuals with diabetes in Malawi and other similar settings in Africa as one of the significant ways of reducing the risk of ASCVDs among this population.
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Katundu KGH, Mukhula V, Phiri T, Phiri C, Filisa-Kaphamtengo F, Chipewa P, Chirambo G, Mipando M, Mwandumba HC, Muula AS, Kumwenda J. High prevalence of dyslipidaemia among persons with diabetes mellitus and hypertension at a tertiary hospital in Blantyre, Malawi. BMC Cardiovasc Disord 2022; 22:557. [PMID: 36544081 PMCID: PMC9771776 DOI: 10.1186/s12872-022-03011-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dyslipidaemia drives the process of atherosclerosis, and hence a significant modifiable risk factor complicating hypertension and diabetes. In Malawi, the prevalence, screening and management of dyslipidaemia among persons with diabetes mellitus have not been reported. This study aimed to investigate the prevalence, biochemical characteristics, screening and management practices for dyslipidaemia among persons with diabetes mellitus, hypertension, and diabetes mellitus and hypertension comorbidity at Queen Elizabeth Central hospital in Blantyre, Malawi. METHODS This was a cross-sectional study conducted in 2021. A total of 256 adult participants (diabetes mellitus = 100); hypertension = 100; both conditions = 56) were included. Medical data and anthropometric measurements were recorded. Blood samples were analysed for HbA1C and serum lipids. Associated risk factors for dyslipidaemia were also assessed. RESULTS Dyslipidaemia was prevalent in 58%, 55%, and 70% of participants with diabetes mellitus, hypertension, and both conditions. Low-density lipoprotein cholesterol (LDL-C) dyslipidaemia was the most common in all participant groups. Participants with both diabetes and hypertension had 2.4 times (95% CI 1.2-4.6) increased risk of LDL-C dyslipidaemia than those with diabetes alone (p < 0.02). Being overweight or obese and age over 30 years were risk factors for dyslipidaemia in participants with diabetes mellitus alone (OR 1.3 (95% CI 1.1-1.6), p < 0.04, and OR 2.2 (95% CI 1.2-4.7) (p < 0.01), respectively. Overweight and obesity predicted LDL-C dyslipidaemia in hypertensive patients (OR 3.5 (95% CI 1.2-9.9) p < 0.001). Poorly controlled hypertension and the use of beta-blockers and thiazide diuretics predicted dyslipidaemia among patients with both diabetes mellitus and hypertension (OR 6.50 CI 1.45-29.19; and OR 5.20 CI 1.16-23.36 respectively). None of the participants had a lipogram performed before the study or were on lipid-lowering therapy. CONCLUSIONS Dyslipidaemia with LDL-C derangement was highly prevalent, especially in individuals with both diabetes mellitus and hypertension, and there was absent use of lipid-lowering therapy. Screening and managing dyslipidaemia should be reinforced to reduce the risk of cardiovascular complications in this population at increased risk.
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Affiliation(s)
- Kondwani G H Katundu
- Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi.
- Malawi-Liverpool Wellcome Clinical Research Program, Kamuzu University of Health Sciences, Blantyre, Malawi.
| | - Victoria Mukhula
- Malawi-Liverpool Wellcome Clinical Research Program, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Tamara Phiri
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Chimota Phiri
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Pascal Chipewa
- Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - George Chirambo
- Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
- Blantyre to Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mwapatsa Mipando
- Department of Biomedical Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
- Blantyre to Blantyre Research Facility, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Henry C Mwandumba
- Malawi-Liverpool Wellcome Clinical Research Program, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Adamson S Muula
- Department of Community and Environmental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Johnstone Kumwenda
- Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
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Jones D, Knight SR, Sremanakova J, Lapitan MCM, Qureshi AU, Drake TM, Tabiri S, Ghosh D, Thomas M, Kingsley PA, Sundar S, Maimbo M, Yenli E, Shaw C, Valparaiso AP, Bhangu A, Magill L, Norrie J, Roberts TE, Theodoratou E, Weiser TG, Harrison EM, Burden ST. Malnutrition and nutritional screening in patients undergoing surgery in low and middle income countries: A systematic review. JCSM CLINICAL REPORTS 2022. [DOI: 10.1002/crt2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Debra Jones
- School of Health Sciences University of Manchester Manchester UK
| | - Stephen R. Knight
- Centre for Medical Informatics, Usher Institute University of Edinburgh Edinburgh UK
| | - Jana Sremanakova
- School of Health Sciences University of Manchester Manchester UK
| | - Marie Carmela M. Lapitan
- Department of Surgery, Institute of Clinical Epidemiology, National Institutes of Health University of the Philippines Manila Philippines
| | - Ahmad U. Qureshi
- Department of General Surgery Services Institute of Medical Sciences Lahore Pakistan
| | - Thomas M. Drake
- Centre for Medical Informatics, Usher Institute University of Edinburgh Edinburgh UK
| | - Stephen Tabiri
- Department of Surgery, School of Medicine University for Development Studies Tamale Ghana
| | - Dhruva Ghosh
- Department of Paediatric Surgery Christian Medical College Ludhiana India
| | - Maria Thomas
- Department of Paediatric Surgery Christian Medical College Ludhiana India
| | - Pamela A. Kingsley
- Department of Radiation Oncology Christian Medical College Ludhiana India
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
| | - Mayaba Maimbo
- Department of General Surgery Kitwe Teaching Hospital Kitwe Zambia
| | - Edwin Yenli
- Department of Surgery, School of Medicine University for Development Studies Tamale Ghana
| | - Catherine Shaw
- Centre for Medical Informatics, Usher Institute University of Edinburgh Edinburgh UK
| | - Apple P. Valparaiso
- Department of Surgery, Institute of Clinical Epidemiology, National Institutes of Health University of the Philippines Manila Philippines
| | - Aneel Bhangu
- Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
| | - Laura Magill
- Institute of Applied Health Research University of Birmingham Birmingham UK
| | - John Norrie
- Centre for Global Health, Usher Institute University of Edinburgh Edinburgh UK
| | - Tracey E. Roberts
- Institute of Applied Health Research University of Birmingham Birmingham UK
| | - Evropi Theodoratou
- Centre for Global Health, Usher Institute University of Edinburgh Edinburgh UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer University of Edinburgh Edinburgh UK
| | - Thomas G. Weiser
- Department of Surgery Stanford University Stanford CA USA
- Department of Clinical Surgery University of Edinburgh Edinburgh UK
| | - Ewen M. Harrison
- Centre for Medical Informatics, Usher Institute University of Edinburgh Edinburgh UK
| | - Sorrel T. Burden
- School of Health Sciences University of Manchester Manchester UK
- Intestinal Failure Unit Salford Royal NHS Foundation Trust Manchester UK
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6
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Manning Smith R, Cambiano V, Colbourn T, Collins JH, Graham M, Jewell B, Li Lin I, Mangal TD, Manthalu G, Mfutso-Bengo J, Mnjowe E, Mohan S, Ng'ambi W, Phillips AN, Revill P, She B, Sundet M, Tamuri A, Twea PD, Hallet TB. Estimating the health burden of road traffic injuries in Malawi using an individual-based model. Inj Epidemiol 2022; 9:21. [PMID: 35821170 PMCID: PMC9275162 DOI: 10.1186/s40621-022-00386-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Road traffic injuries are a significant cause of death and disability globally. However, in some countries the exact health burden caused by road traffic injuries is unknown. In Malawi, there is no central reporting mechanism for road traffic injuries and so the exact extent of the health burden caused by road traffic injuries is hard to determine. A limited number of models predict the incidence of mortality due to road traffic injury in Malawi. These estimates vary greatly, owing to differences in assumptions, and so the health burden caused on the population by road traffic injuries remains unclear. METHODS We use an individual-based model and combine an epidemiological model of road traffic injuries with a health seeking behaviour and health system model. We provide a detailed representation of road traffic injuries in Malawi, from the onset of the injury through to the final health outcome. We also investigate the effects of an assumption made by other models that multiple injuries do not contribute to health burden caused by road accidents. RESULTS Our model estimates an overall average incidence of mortality between 23.5 and 29.8 per 100,000 person years due to road traffic injuries and an average of 180,000 to 225,000 disability-adjusted life years (DALYs) per year between 2010 and 2020 in an estimated average population size of 1,364,000 over the 10-year period. Our estimated incidence of mortality falls within the range of other estimates currently available for Malawi, whereas our estimated number of DALYs is greater than the only other estimate available for Malawi, the GBD estimate predicting and average of 126,200 DALYs per year over the same time period. Our estimates, which account for multiple injuries, predict a 22-58% increase in overall health burden compared to the model ran as a single injury model. CONCLUSIONS Road traffic injuries are difficult to model with conventional modelling methods, owing to the numerous types of injuries that occur. Using an individual-based model framework, we can provide a detailed representation of road traffic injuries. Our results indicate a higher health burden caused by road traffic injuries than previously estimated.
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Affiliation(s)
| | | | - Tim Colbourn
- University College London, Gower Street, London, WC1E 6BT, UK
| | | | - Matthew Graham
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Britta Jewell
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Ines Li Lin
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Tara D Mangal
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Gerald Manthalu
- Ministry of Health and Population, P.O. Box 30377, Lilongwe 3, Malawi
| | - Joseph Mfutso-Bengo
- Kamuzu University of Health Sciences, Mahatma Gandhi, 52X8+782, Blantyre, Malawi
| | | | | | | | | | | | - Bingling She
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Mads Sundet
- REMEDY-Center for treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Asif Tamuri
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Pakwanja D Twea
- Ministry of Health and Population, P.O. Box 30377, Lilongwe 3, Malawi
| | - Timothy B Hallet
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
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Djordjevic A, Deftereos I, Carter VM, Morris S, Shannon R, Kiss N, Yeung JMC. Ability of malnutrition screening and assessment tools to identify computed tomography defined low muscle mass in colorectal cancer surgery. Nutr Clin Pract 2022; 37:666-676. [DOI: 10.1002/ncp.10844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/23/2021] [Accepted: 01/01/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Aleksandra Djordjevic
- Department of Surgery, Western Precinct The University of Melbourne Melbourne Australia
- Department of General Internal Medicine Western Health Footscray Australia
| | - Irene Deftereos
- Department of Surgery, Western Precinct The University of Melbourne Melbourne Australia
- Department of Nutrition and Dietetics Western Health Footscray Australia
| | - Vanessa M. Carter
- Department of Nutrition and Dietetics Western Health Footscray Australia
| | - Stephanie Morris
- Department of Nutrition and Dietetics Western Health Footscray Australia
| | - Roland Shannon
- Department of Radiology and Medical Imaging Western Health Footscray Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition Deakin University Geelong Australia
- Department of Allied Health Peter MacCallum Cancer Centre Melbourne Australia
| | - Justin M. C. Yeung
- Department of Surgery, Western Precinct The University of Melbourne Melbourne Australia
- Department of Colorectal Surgery Western Health Footscray Australia
- Western Health Chronic Disease Alliance, Western Health Melbourne Australia
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Liu S, Zhang S, Li Z, Li M, Zhang Y, He M, Jin C, Gao C, Gong J. Insufficient Post-operative Energy Intake Is Associated With Failure of Enhanced Recovery Programs After Laparoscopic Colorectal Cancer Surgery: A Prospective Cohort Study. Front Nutr 2022; 8:768067. [PMID: 34993219 PMCID: PMC8724790 DOI: 10.3389/fnut.2021.768067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Although enhanced recovery after surgery (ERAS) has been proven to be beneficial after laparoscopic colorectal surgery, some of the patients may fail to complete the ERAS program during hospitalization. This prospective study aims to evaluate the risk factors associated with ERAS failure after laparoscopic colorectal cancer surgery. Methods: This is a prospective study from a single tertiary referral hospital. Patients diagnosed with colorectal cancer who met the inclusion criteria were included in this study. Demographic and clinicopathological characteristics were collected. Post-operative activity time and 6-min walking distance (6MWD) were measured. Patients were divided into ERAS failure group and ERAS success according to decreased post-operative activity and 6MWD. Factors associated with ERAS failure were investigated by univariate and multivariate analysis. Results: A total of 91 patients with colorectal cancer were included. The incidence of ERAS failure is 28.6% among all patients. Patients in ERAS failure group experienced higher rate of post-operative ileus and prolonged hospital stay (p < 0.001). Multivariate analysis revealed that older age (p = 0.006), body mass index ≥25.5 kg/m2 (p = 0.037), smoking (p = 0.002), operative time (p = 0.048), and post-operative energy intake <18.5 kcal/kg•d (p = 0.045) were independent risk factors of ERAS failure after laparoscopic colorectal surgery. Conclusions: Our findings indicated that a proportion of patients may fail the ERAS program after laparoscopic colorectal surgery. We for the first time showed that post-operative energy intake was an independent risk factor for ERAS failure. This may provide evidence for further investigation on precise measurement of nutritional status and selected high-risk patients for enhanced nutrition support.
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Affiliation(s)
- Shuang Liu
- Department of Gastrointestinal Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Zhang
- Department of Gastrointestinal Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zike Li
- Department of Gastrointestinal Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Li
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yujie Zhang
- Department of Gastrointestinal Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Min He
- Department of Gastrointestinal Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Chengcheng Jin
- Department of Gastrointestinal Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Gao
- Department of Gastrointestinal Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jianping Gong
- Department of Gastrointestinal Surgery, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Lee DU, Hastie DJ, Fan GH, Addonizio EA, Lee KJ, Han J, Karagozian R. Effect of malnutrition on the postoperative outcomes of patients undergoing pancreatectomy for pancreatic cancer: Propensity score-matched analysis of 2011-2017 US hospitals. Nutr Clin Pract 2022; 37:117-129. [PMID: 34994482 DOI: 10.1002/ncp.10816] [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: 12/20/2022] Open
Abstract
BACKGROUND Patients with pancreatic cancer suffer from metabolic dysregulation, which can manifest in clinical malnutrition. Because a portion of these patients require cancer-resective surgery, we evaluate the impact of malnutrition in patients undergoing pancreatic resection using a national database. METHODS The 2011-2017 National Inpatient Sample was used to isolate cases of pancreatic resection (partial/total pancreatectomy and radical pancreaticoduodenectomy), which were stratified using malnutrition. A 1:1 nearest-neighbor propensity-score matching was applied to match the controls to the malnutrition cohort. End points include mortality, length of stay (LOS), hospitalization costs, and postoperative complications. RESULTS Following the match, there were 2108 with malnutrition and an equal number without; from this, those with malnutrition had higher mortality (4.7% vs 3.04%; P = 0.007; odds ratio [OR], 1.57; 95% CI, 1.14-2.17), longer LOS, and higher costs. Regarding complications, malnourished patients had higher bleeding (5.41% vs 2.99%; P < 0.001; OR, 1.86; 95% CI, 1.36-2.54), wound complications (3.75% vs 1.57%; P < 0.001; OR, 2.45; 95% CI, 1.62-3.69), infection (7.83% vs 3.13%; P < 0.001; OR, 2.63; 95% CI, 1.96-3.52), and respiratory failure (7.45% vs 3.56%; P < 0.001; OR, 2.18; 95% CI, 1.65-2.89). In multivariate analyses, those with malnutrition had higher mortality (P = 0.008; adjust OR, 1.55; 95% CI, 1.12-2.14). CONCLUSION Those with malnutrition had higher mortality and complications following pancreatic resection; given these findings, it is important that preoperative nutrition therapy is provided to minimize the surgical risks.
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Affiliation(s)
- David Uihwan Lee
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA
| | - David Jeffrey Hastie
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gregory Hongyuan Fan
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Elyse Ann Addonizio
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ki Jung Lee
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - John Han
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Raffi Karagozian
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
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Nkomani S, Ausman LM, Marino-Costello E, Chimera B, Kalimbira A, Mwangwela A, Uebele-Harrigan M, Phuka J, Ghosh S. Nutrition Capacity Building to Meet National Priorities: Lessons Learned in Developing and Implementing Malawi's First Dietetics Program. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:928-935. [PMID: 34933987 PMCID: PMC8691871 DOI: 10.9745/ghsp-d-20-00687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/09/2021] [Indexed: 11/15/2022]
Abstract
We describe the lessons learned in building nutrition capacity through the development and implementation of the first dietetics training program in Malawi. The current nutrition situation in Malawi, characterized by high rates of malnutrition in communities and hospitals and a rapidly increasing burden of overweight/obesity and diet-related noncommunicable diseases, highlights the urgent need for registered dietitians, who have a proven track record in the prevention and management of all forms of malnutrition and improving patient outcomes. However, dietetics practice has been described as underdeveloped and fragmented in many parts of Africa, exacerbated by a severe and chronic shortage of dietetics professionals and a lack of nutrition and dietetic education programs in most African countries. We share early lessons learned in the development and implementation of the first dietetics program in Malawi. Within 6 years, the program produced 10 graduate dietitians who have filled the first clinical dietitian posts in Malawian public hospitals. This early success can be attributed to the model used to develop and implement the program, which included early stakeholder engagement to define the priority skills and competencies of a Malawian dietitian, the use of internationally recognized training standards, and the development of strategic institutional partnerships that brought together complementary skills and expertise. Furthermore, using existing resources and recruiting students with a nutrition and health background accelerated implementation. The current dietetics curriculum responds to the national nutrition and health policy direction and strategic objectives. Early and sustained government engagement was crucial in creating demand and securing career prospects for graduates. Although still in its infancy, dietitians in Malawi are poised to contribute significantly to alleviating the country's complex nutrition challenges.
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Affiliation(s)
| | | | | | - Bernadette Chimera
- Tufts University, Boston, MA, USA
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Agnes Mwangwela
- Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | | | - John Phuka
- Kamuzu University of Health Sciences, Blantyre, Malawi
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Soloff MA, Vargas MV, Wei C, Ohnona A, Tyan P, Gu A, Georgakopoulos B, Thomas CA, Quan T, Barishansky S, Moawad G. Malnutrition is Associated with Poor Postoperative Outcomes Following Laparoscopic Hysterectomy. JSLS 2021; 25:JSLS.2020.00084. [PMID: 33879999 PMCID: PMC8035827 DOI: 10.4293/jsls.2020.00084] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Malnutrition continues to be pervasive among the general population, with rates as high as 50% of patients undergoing surgical procedures. Data is limited about women undergoing surgery for non-malignant gynecologic indications (generally elective laparoscopic hysterectomies, after failed conservative measures). With the significant increase in benign gynecologic surgery, it is of the upmost importance that surgeons optimize modifiable risk factors for patients undergoing laparoscopic hysterectomy. The purpose of this study is to identify the impact of malnutrition on postoperative outcomes in patients undergoing laparoscopic hysterectomy for benign conditions. Methods: A retrospective cohort study was conducted utilizing data that was collected through the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP) Database. All patients that underwent laparoscopic hysterectomy for benign indications were identified. Patients with malnutrition were identified by either low albumin (≤ 3.5 g/dL), low body mass index (≤ 18.5), or 10% weight loss within 6 months. The frequency of postoperative complications was evaluated with univariate and multivariate analyses where appropriate. Results: Following adjustment, multivariate analysis illustrated pre-operative malnutrition to be a risk factor for the following complications: any complication, death, bleeding requiring transfusion, wound, cardiac, pulmonary, renal, thromboembolic, sepsis complications, extended length of stay, and reoperation (p ≤ 0.05 for all). Conclusion: Malnourished patients were at significantly higher risk of developing postoperative complications during the acute postoperative period. With elective laparoscopic hysterectomies, pre-operative evaluation and intervention for malnutrition should be considered to improve nutritional status.
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Affiliation(s)
- Michelle A Soloff
- Department of Obstetrics and Gynecology, North Shore University Hospital and Long Island Jewish Medical Center, Manhasset, NY
| | - Maria V Vargas
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Chapman Wei
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ashley Ohnona
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Paul Tyan
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Alex Gu
- Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Caroline A Thomas
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Theodore Quan
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Seth Barishansky
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC
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Isaacson G, Doyle W, Summer D. Reducing Surgical Site Infections During Otolaryngology Surgical Missions. Laryngoscope 2019; 130:1388-1395. [PMID: 31755991 DOI: 10.1002/lary.28418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine what measures an otolaryngology-head and neck surgery team might adopt to decrease the incidence of surgical site infection (SSI) on a short-term surgical mission. Despite concerns about safety and efficacy, short-term surgical missions remain the predominant structure for humanitarian surgical care in low- and middle-income countries (LMIC). Hospitals in high-income countries strive to improve surgical outcomes through implementation of World Health Organization (WHO) safe surgery guidelines. Reduction of SSI risk is a key part of this effort. METHODS Literature review and practical experience. RESULTS WHO recommendations for reducing SSI are based largely on research done in the North America and Europe. LMIC populations are younger; comorbidities are fewer; infectious disease and trauma are prevalent; and delays in access to care are common. SSI are much more frequent in resource-limited settings. Recommendations regarding preoperative assessment, operating room environment, instrument sterilization, surgical antibiotic prophylaxis, surgical site preparation, gloving, draping, and postsurgical care are reviewed in the context of a surgical mission at a typical LMIC government hospital. CONCLUSION Many of the WHO guidelines on reduction of SSI are logical and applicable to the short-term surgical missions; others may need to be modified. Careful prospective data collection and clinical trials are needed to learn which interventions are valid and which should be changed. LEVEL OF EVIDENCE 5 Laryngoscope, 130:1388-1395, 2020.
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Affiliation(s)
- Glenn Isaacson
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Winifred Doyle
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Deborah Summer
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
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Daniel AI, Chatenga H, Chimera B, Mbale E, Chisala M, Borgstein E, Langton J, Gonzalez C, Bandsma RHJ, Vresk L. The introduction of a paediatric nutrition support program led by a clinical dietitian at a low-resource hospital setting in Malawi. Glob Health Action 2019; 12:1656452. [PMID: 31512960 PMCID: PMC6746265 DOI: 10.1080/16549716.2019.1656452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/08/2019] [Indexed: 11/25/2022] Open
Abstract
In low- and middle-income countries, nutrition support strategies are often suboptimal or non-existent in hospital settings. This is further compounded by high rates of malnutrition in these countries. The first four dietitians graduated in Malawi in 2017 providing a new opportunity to build capacity to introduce nutrition support in an acute care setting. A paediatric nutrition support program was implemented at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi including the hiring of a local dietitian. This capacity building paper explains the development and introduction of the nutrition support program including a description of perceptions of health professionals at QECH working alongside the dietitian. In the first four months of the program at QECH, the dietitian provided nutrition support to 183 different patients across paediatric wards. Nutritional interventions predominantly included infant formula and breastmilk fortification, provision of therapeutic feeds orally or via nasogastric tubes, increased dietary protein intake for children identified to be at high risk, and nutritional counselling to caregivers. More complex nutritional interventions were also given such as the insertion of gastrostomy tubes to deliver nutrition directly to the stomach. Following the introduction of the program, qualitative interviews were done with health professionals at QECH including nurses (n = 5) and physicians (n = 11). All participants emphasized the importance and impact of the nutrition support program in enhancing the care of hospitalized children, therefore improving outcomes such as tolerability of clinical interventions, decreased duration of stay, and reduced risk of hospital readmission. In conclusion, there is a need for nutrition support provided by a dietitian for different paediatric patients which was corroborated by positive feedback from health professionals at QECH. Integration of dietitians into the healthcare system by respective Ministries of Health will require advocacy around the potential for nutrition support to strengthen the quality of care of vulnerable children. A Chichewa abstract for this paper is available in a supplementary file.
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Affiliation(s)
- Allison I. Daniel
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Humphrey Chatenga
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Bernadette Chimera
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Emmie Mbale
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Mphatso Chisala
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Eric Borgstein
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Department of Surgery, College of Medicine, Blantyre, Malawi
| | - Josephine Langton
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Carmen Gonzalez
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Robert H. J. Bandsma
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Laura Vresk
- Department of Clinical Dietetics, Hospital for Sick Children, Toronto, Ontario, Canada
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