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Griffiths CD, D'Souza D, Rodriguez F, Park LJ, Serrano PE. Quality of life following perioperative optimization with nutritional supplements in patients undergoing gastrointestinal surgery for cancer: A randomized, placebo-controlled feasibility clinical trial. J Surg Oncol 2024; 129:1289-1294. [PMID: 38504604 DOI: 10.1002/jso.27624] [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: 11/16/2023] [Revised: 02/22/2024] [Accepted: 03/09/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Up to two thirds of patients presenting for abdominal cancer surgery are malnourished pre-operatively. Perioperative nutritional supplementation has been proposed to improve surgical outcomes, though its effect on quality of life (QoL) is not yet understood. METHODS A randomized controlled feasibility trial for perioperative nutrition among patients undergoing major abdominal cancer surgery was conducted. Participants in the intervention group received supplements for 30 days before surgery. Participants completed two QoL questionnaires (EORTC-QLQ-C-30 and FACT-G) at baseline, then 4 and 12 weeks postoperatively. Participants were compared between and within groups at baseline, Weeks 4, and 12 using t tests. Minimal clinically important differences (MCIDs) were considered as a 10-point worsening from baseline. RESULTS Sixty-six participants were available for analysis in this study, including 33 in the intervention and 30 in the control arms. Baseline demographics were balanced between groups except for different rates of pancreas cancer (36% intervention vs. 9% control) and colorectal cancer (19% intervention vs. 34% control). At baseline, participants in the intervention group had lower overall QoL (59% vs. 77%, p = 0.01), role functioning (72% vs 88%, p = 0.045), and cognitive functioning (79% vs 90%, p = 0.047). Following surgery, role and physical functioning worsened in the control group, without significant differences between groups. Role functioning was persistently worsened at 12 weeks in the control group. The rates of MCIDs were similar between both intervention and control groups. DISCUSSION Perioperative nutrition was associated with preservation of QoL in the postoperative period following major abdominal cancer surgery compared to placebo. SUMMARY Among patients undergoing surgery for cancer, the majority present at high risk for malnutrition. In this placebo-controlled randomized trial among patients undergoing major abdominal surgery for cancer, preoperative nutrition supplementation was associated with the preservation of QoL in the postoperative period.
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Affiliation(s)
| | - Daniel D'Souza
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Felipe Rodriguez
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lily J Park
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Pablo E Serrano
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Parchure P, Besculides M, Zhan S, Cheng FY, Timsina P, Cheertirala SN, Kersch I, Wilson S, Freeman R, Reich D, Mazumdar M, Kia A. Malnutrition risk assessment using a machine learning-based screening tool: A multicentre retrospective cohort. J Hum Nutr Diet 2024; 37:622-632. [PMID: 38348579 DOI: 10.1111/jhn.13286] [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: 08/21/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Malnutrition is associated with increased morbidity, mortality, and healthcare costs. Early detection is important for timely intervention. This paper assesses the ability of a machine learning screening tool (MUST-Plus) implemented in registered dietitian (RD) workflow to identify malnourished patients early in the hospital stay and to improve the diagnosis and documentation rate of malnutrition. METHODS This retrospective cohort study was conducted in a large, urban health system in New York City comprising six hospitals serving a diverse patient population. The study included all patients aged ≥ 18 years, who were not admitted for COVID-19 and had a length of stay of ≤ 30 days. RESULTS Of the 7736 hospitalisations that met the inclusion criteria, 1947 (25.2%) were identified as being malnourished by MUST-Plus-assisted RD evaluations. The lag between admission and diagnosis improved with MUST-Plus implementation. The usability of the tool output by RDs exceeded 90%, showing good acceptance by users. When compared pre-/post-implementation, the rate of both diagnoses and documentation of malnutrition showed improvement. CONCLUSION MUST-Plus, a machine learning-based screening tool, shows great promise as a malnutrition screening tool for hospitalised patients when used in conjunction with adequate RD staffing and training about the tool. It performed well across multiple measures and settings. Other health systems can use their electronic health record data to develop, test and implement similar machine learning-based processes to improve malnutrition screening and facilitate timely intervention.
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Affiliation(s)
| | - Melanie Besculides
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Serena Zhan
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fu-Yuan Cheng
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Prem Timsina
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Ilana Kersch
- Clinical Nutrition, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara Wilson
- Clinical Nutrition, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert Freeman
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Hospital Administration, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Reich
- Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madhu Mazumdar
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arash Kia
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Jima LM, Atomsa GE, Allard JP, Nigatu YD. The effect of malnutrition on adult Covid-19 patient's ICU admission and mortality in Covid-19 isolation and treatment centers in Ethiopia: A prospective cohort study. PLoS One 2024; 19:e0298215. [PMID: 38507372 PMCID: PMC10954135 DOI: 10.1371/journal.pone.0298215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/20/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND A new coronavirus was first identified in Wuhan, China in December 2019. Since the times of the 1918 influenza pandemic, malnutrition has been known as a risk factor for severity and mortality from viral pneumonia. Similarly, the recently identified SARS-Cov2 infection (COVID-19) and related pneumonia may be closely linked to malnutrition. Therefore, this study will contribute to new knowledge and awareness of the recording and evaluation of each COVID-19 patient's nutritional status by assessing the effect of malnutrition on ICU admission and death of COVID-19 patients in developing countries. METHOD We conducted a prospective cohort study in adult COVID-19 patients admitted to selected COVID-19 Isolation and Treatment Centers, Addis Ababa, Ethiopia. Baseline data of the patients were collected using interviewer-administered structured questionnaire and data on the adverse outcomes of follow up were extracted from follow up chart. The main clinical outcomes (ICU admission and death) were captured every week of follow up. We ran a multivariate Cox's regression analysis to determine the relationship between malnutrition at admission and its effect on ICU admission and death. RESULTS A total of 581 COVID-19 patients were enrolled. From the total of recruited patients, 346 (59.6%) were males and 235 (40.4%) were females. The mean age of the respondents was 55 years (16.45) years. The Cox proportional hazard model controlled for sex, age group, number of co-morbidities, and number of medications found that malnutrition at admission was associated with ICU admission and death. When compared to well-nourished patients, the rate of ICU admission was significantly associated and found to be higher among underweight [(adjusted hazard ratio (AHR) = 10.02, 95% CI: (8.64-12.10)] and overweight [(AHR = 7.7, 95% CI: (6.41-9.62)] patients. The rate of survival probability was significantly associated and was found to be better among well-nourished patients (AHR = 0.06, 95% CI : (0.01-0.44) when compared with malnourished COVID-19 patients. CONCLUSION Malnutrition at the time of admission was shown to increase the risk of ICU admission and mortality among COVID-19 patients. Therefore, it is vital to evaluate patients' nutritional condition early in their admission and provide timely intervention to minimize the effects on patients and the healthcare system.
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Affiliation(s)
- Lencho Mekonnen Jima
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gudina Egeta Atomsa
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Johane P. Allard
- Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Yakob Desalegn Nigatu
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Mosquera C, Silva MM, Weyh AM, Malik MA, Fernandes R. Can the Malnutrition Universal Screening Tool (MUST) Predict Healing Complications Following Microvascular Reconstruction of the Head and Neck? Craniomaxillofac Trauma Reconstr 2024; 17:34-39. [PMID: 38371218 PMCID: PMC10874204 DOI: 10.1177/19433875231160346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Study Design Retrospective cohort study. Objective Malnutrition has been found to have negative effects on the immune system and inflammatory responses, impairing the wound healing process. Free flap failure is a serious complication in patients undergoing microvascular reconstruction, as it increases patient morbidity, length of stay in the hospital, patient, and hospital costs, as well as causes the need for further surgical interventions1. Malnutrition is estimated to be present in 35-50% of head and neck cancer patients with higher rates in those experiencing hypo-oropharyngeal disease. This is often caused by functional and pain limitations from due to disease burden causing odynophagia and dysphagia. The Malnutrition Universal Screening Tool (MUST) is recommended for risk screening and provides three scores for risk classification: high, intermediate, and low2. We argue that the use of MUST as a preoperative assessment tool is useful to predict postoperative surgical site infection and delayed wound healing in patients that will undergo reconstruction with free flaps for head and neck defects. Methods A retrospective cohort study was designed to include all subjects who underwent head and neck microvascular free tissue transfer at a single institution between 2013 and 2019. Primary and secondary reconstructions were included, for benign or malignant pathology, osteonecrosis, osteomyelitis, congenital defects, and trauma. The nutritional risk was evaluated using MUST, which analyzes body mass index, weight loss, and acute disease effect, to classify patients as low, intermediate, and high risk. We further divided the subjects into two comparison groups- low-intermediate and high risk. The primary outcome was surgical site complications and delayed wound healing. Data was analyzed as frequencies and means with standard deviations, as well as Fisher's exact test and t-test. P-values <0.05 were considered statistically significant. Analyses were done utilizing IBM SPSS Statistics Version 29. Results 131 subjects were included for data analysis, with 54 being considered low MUST risk, 12 intermediate risk (66 low-intermediate), and 65 were high risk. The mean BMI overall was 25.5 ±5.3, and 27.2 in the low-intermediate group, and 23.7 in the high-risk group. Eighty-two subjects experienced <5-pound weight loss in the preceding 6 months to surgery, while 17 lost between 5-10 pounds, and 23 lost 10< pounds. Cancer/osteonecrosis was the etiology for 54 (82%) subjects of the low-intermediate group, and 61 (92%) of the high-risk group (P = .089). The subjects classified in High-risk group according to the MUST score had 11% more surgical site complications (P = .120) and 13.7% more delayed wound healing and dehiscence(P = .09); only 3 subjects in the study presented total flap loss and they were all in the High-risk group. Surgical site complication, delayed wound healing rates and partial or total flap loss were not increased by any specific medical comorbidity or history such as radiation or chemotherapy. Conclusions In conclusion, Subjects with high MUST score had increased complications and poor wound healing, and subjects with acute disease effect that induces a phase of nil per os for > 5 day have higher risk of total flap loss and surgical site complication.
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Affiliation(s)
- Camilo Mosquera
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA
| | - Marina Morante Silva
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA
| | - Ashleigh M. Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA
| | - Michael A. Malik
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA
| | - Rui Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA
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Kao FC, Yen CM, Lin MC, Liao HY, Hsu HC, Lin YW. Acupoint catgut embedding attenuates fibromyalgia pain through attenuation of TRPV1 signaling pathway in mouse. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2024; 27:66-73. [PMID: 38164490 PMCID: PMC10722483 DOI: 10.22038/ijbms.2023.71431.15534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/23/2023] [Indexed: 01/03/2024]
Abstract
Objectives Chronic pain is considered as pain lasting for more than three months and has emerged as a global health problem affecting individuals and society. Chronic extensive pain is the main syndrome upsetting individuals with fibromyalgia (FM), accompanied by anxiety, obesity, sleep disturbances, and depression, Transient receptor potential vanilloid 1 (TRPV1) has been reported to transduce inflammatory and pain signals to the brain. Materials and Methods Acupoint catgut embedding (ACE) is a novel acupuncture technique that provides continuous effects and convenience. ACE was performed at the bilateral ST36 acupoint. Results We demonstrated similar pain levels among all groups at baseline. After cold stress, chronic mechanical or thermal nociception was induced (D14: mechanical: 1.85 ± 0.13 g; thermal: 4.85 ± 0.26 s) and reversed in ACE-treated mice (D14: mechanical: 3.99 ± 0.16 g; thermal: 7.42 ± 0.45 s) as well as Trpv1-/- group (Day 14, mechanical: 4.25 ± 0.2 g; thermal: 7.91 ± 0.21 s) mice. Inflammatory mediators were augmented in FM individuals and were abridged after ACE management and TRPV1 gene loss. TRPV1 and its linked mediators were increased in the thalamus (THA), somatosensory cortex (SSC), medial prefrontal cortex (mPFC), and anterior cingulate cortex (ACC) in FM mice. The up-regulation of these mediators was diminished in ACE and Trpv1-/- groups. Conclusion We suggest that chronic pain can be modulated by ACE or Trpv1-/-. ACE-induced analgesia via TRPV1 signaling pathways may be beneficial targets for FM treatment.
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Affiliation(s)
- Feng-Chen Kao
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- Department of Orthopedics, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chia-Ming Yen
- Department of Anesthesiology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-DA Hospital, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Hsien-Yin Liao
- College of Chinese Medicine, School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| | - Hsin-Cheng Hsu
- College of Chinese Medicine, School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| | - Yi-Wen Lin
- College of Chinese Medicine, Graduate Institute of Acupuncture Science, China Medical University, Taichung 404332, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung 40402, Taiwan
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Pawłowski P, Pawłowska P, Ziętara KJ, Samardakiewicz M. The Critical Exploration into Current Evidence behind the Role of the Nutritional Support in Adult Patients Who Undergo Haematogenic Stem Cell Transplantation. Nutrients 2023; 15:3558. [PMID: 37630748 PMCID: PMC10459351 DOI: 10.3390/nu15163558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Haematopoietic stem cell transplantation (HSCT) is a treatment option for many haematological conditions in patients of all ages. Nutritional support is important at each stage of treatment, but particular nutritional needs and dictated support occur during the preparatory (conditioning regimen) and post-transplant periods. Patients may require nutritional treatment by the enteral or parenteral route. The quantitative and qualitative composition of meals may change. Vitamin requirements, including vitamin D and vitamin C, might also be different. An adequately composed diet, adapted to the needs of the patient, may influence the occurrence of complications such as graft-versus-host disease (GvHD), gastrointestinal disorders, infections, and reduced survival time. Haematological diseases as well as transplantation can negatively affect the intestinal flora, with negative consequences in the form of mucosal inflammation and disorders of a functional nature. Currently, aspects related to nutrition are crucial in the care of patients after HSCT, and numerous studies, including randomized trials on these aspects, are being conducted. This study serves the critical analysis of current scientific evidence regarding nutritional support for patients after HSCT.
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Affiliation(s)
- Piotr Pawłowski
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Paulina Pawłowska
- The Critical Care Unit, The Royal Marsden Hospital, London SW3 6JJ, UK;
| | - Karolina Joanna Ziętara
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Marzena Samardakiewicz
- Department of Psychology, Psychosocial Aspects of Medicine, Medical University of Lublin, 20-081 Lublin, Poland;
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Arthur PS. Desenvolvimento de Suplementos Artesanais, Análise e Comparação com Suplementos Industriais para Pacientes em Estado de Caquexia do Câncer. REVISTA BRASILEIRA DE CANCEROLOGIA 2023. [DOI: 10.32635/2176-9745.rbc.2023v69n2.3855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Introdução: Um desfecho clínico que pode afetar cerca de 80% dos pacientes com câncer é a caquexia, condição caracterizada pela perda de massa muscular ou de peso, anorexia e perda ou diminuição da força física. Uma estratégia para preservar a via de alimentação oral é a suplementação nutricional. Objetivo: Elaborar suplementos nutricionais artesanais orais cujos macronutrientes sejam similares aos industrializados e comparar as formulações propostas com suplementos industriais em relação à composição nutricional e aos aspectos econômicos. Método: A composição nutricional foi calculada a partir das fichas técnicas, com auxílio da tabela de composição química dos alimentos da Escola Paulista de Medicina e da Tabela Brasileira de Composição de Alimentos. O preço médio dos suplementos industriais foi calculado com base nos valores praticados no mês de dezembro de 2022, consultados na ferramenta Google Shopping. Os ingredientes usados nos suplementos artesanais foram adquiridos em Piracicaba, SP. Resultados: Foram desenvolvidas cinco formulações artesanais comparáveis às formulações industriais em densidade calórica, energética e proteica. Todas utilizam predominantemente lácteos como fonte de proteína e ácido graxo monoinsaturado oleico como fonte lipídica. Os suplementos caseiros priorizam carboidratos naturalmente contidos nos alimentos. Conclusão: Os suplementos alimentares artesanais são alternativas economicamente viáveis e de perfil macronutricional similar aos industriais.
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Fumagalli Romario U, de Pascale S, Colombo S, Attanasio A, Sabbatini A, Sandrin F. Esophagectomy-prevention of complications-tips and tricks for the preoperative, intraoperative and postoperative stage. Updates Surg 2023; 75:343-355. [PMID: 35851675 DOI: 10.1007/s13304-022-01332-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/06/2022] [Indexed: 01/24/2023]
Abstract
Esophagectomy still remains the mainstay of treatment for localized esophageal cancer. Many progresses have been made in the technique of esophagectomy in the last decades but the overall morbidity for this operation remains formidable. Postoperative complication and mortality rate after esophagectomy are significant; anastomotic leak has an incidence of 11,4%. The occurrence of a complication is a significant negative prognostic factor for long term survival and is also linked to longer postoperative stay, a lower quality of life, increased hospital costs. Preventing the occurrence of postoperative morbidity and reducing associated postoperative mortality rate is a major goal for surgeons experienced in resective esophageal surgery. Many details of pre, intra and postoperative care for patients undergoing esophagectomy need to be shared among the professionals taking care of these patients (oncologists, dieticians, physiotherapists, surgeons, nurses, anesthesiologists, gastroenterologists) in order to improve the short and long term clinical results.
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Loss of Appetite in Adult Patients: Effectiveness and Safety of an Appetite Stimulating Medication in an Open-Label, Investigator-Initiated Study in India. J Nutr Metab 2022; 2022:2661912. [PMID: 35036004 PMCID: PMC8759923 DOI: 10.1155/2022/2661912] [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: 10/27/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/24/2022] Open
Abstract
Loss of appetite (LOA) may have a negative impact on a patient's well-being owing to loss of nutrition and associated conditions. The current study assessed the effects of an appetite-stimulating medication containing multivitamins, lysine, and zinc in Indian patients with a history of LOA. Using an investigator-initiated, single-center, open-label, single-arm design, we evaluated the effectiveness and safety of the appetite-stimulating medication (15 mL) in 50 male or female patients (18–55 years old) attending the outpatient department, with a confirmed diagnosis of LOA after two weeks of therapy and assessed the change in Council on Nutrition Appetite Questionnaire (CNAQ) score and safety of the medication after two weeks of treatment. CNAQ scores were presented as mean (standard deviation (SD)). The mean age of patients was 42.1 years, with the majority (66%) being males. At weeks 1 and 2, a statistically significant improvement was observed in the mean CNAQ scores of 25.48 (5.10) and 25.48 (4.29), respectively, vs. baseline (22.08 (2.76); P ≤ 0.0001 both). Majority of the patients had CNAQ appetite scores of 17–28 at baseline (94%), week 1 (66%), and week 2 (78%) of treatment. For patients with acute and chronic illness, a statistically significant improvement was observed in the mean CNAQ score at week 1 (26.75 (3.69), P = 0.0256; 25.24 (5.33), P = 0.0004) and at week 2 (26.63 (3.46), P = 0.0027; 25.26 (4.43), P ≤ 0.0001) from baseline (21.88 (3.31) and 22.12 (2.69), respectively). No serious adverse events were reported during the study. The study findings suggest that appetite-stimulating medication containing multivitamins, lysine, and zinc could be a suitable treatment option for the management of LOA with no significant safety concerns.
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Muralidharan S, Acharya A, Mallaiah P, Babu BA. A systematic review on the guidelines for nutritional assessment for head and neck cancer patients managed by surgery. J Oral Maxillofac Pathol 2021; 25:370. [PMID: 34703139 PMCID: PMC8491340 DOI: 10.4103/0973-029x.325255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022] Open
Abstract
There are a number of guidelines to assess the nutrition status of cancer cases. None of these guidelines are specifically head and neck cancer related; except for the European guidelines. This article reviews the different guidelines in nutrition for cancer cases and also their drawbacks.
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Affiliation(s)
| | - Arunkumar Acharya
- Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Pramila Mallaiah
- Department of Public Health Dentistry, MR Ambedkar Dental College and Hospital, Karnataka, India
| | - B Anil Babu
- Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
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Xu R, Chen XD, Ding Z. Perioperative nutrition management for gastric cancer. Nutrition 2021; 93:111492. [PMID: 34655954 DOI: 10.1016/j.nut.2021.111492] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 08/29/2021] [Accepted: 09/08/2021] [Indexed: 12/24/2022]
Abstract
Gastric cancer is one of the most frequently diagnosed and the leading cause of cancer death worldwide. Malnutrition is a substantial problem in patients with gastric cancer, associated with poor treatment tolerance and increased morbidity. It has also been recognized as an independent prognostic factor in individuals with cancer. Early detection of malnutrition and effective perioperative nutrition intervention play an important role in the treatment of gastric cancer. Nutrition screening and assessment are the first steps in nutrition management and provide a basis for further nutrition support. Several tools, including the Nutrition Risk Screening-2002 and Patient-Generated Subjective Global Assessment, have been developed for nutrition screening and assessment. Effective nutrition support can significantly improve nutritional and immune status, reduce the incidence of postoperative complications, and accelerate recovery. The aim of this review was to focus on preoperative nutrition risk screening and assessment, and perioperative nutrition support, which may serve as a framework of perioperative nutrition management for gastric cancer.
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Affiliation(s)
- Rui Xu
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiao-Dong Chen
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Zhi Ding
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Nakyeyune R, Ruan X, Shen Y, Shao Y, Niu C, Zang Z, Liu F. Diagnostic Performance of SGA, PG-SGA and MUST for Malnutrition Assessment in Adult Cancer Patients: A Systematic Literature Review and Hierarchical Bayesian Meta-Analysis. Nutr Cancer 2021; 74:903-915. [PMID: 34187251 DOI: 10.1080/01635581.2021.1942080] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Because cancer-associated malnutrition is a major health complication, timely nutritional screening is of utmost importance. The aim of this study was to conduct a systematic literature review and meta-analysis of three tools in order to identify the method with the best diagnostic performance. PubMed, EMBASE and Cochrane central register of controlled trials were searched for articles published from database inception to January 2021. Studies that assessed the diagnostic accuracy of the SGA, PG-SGA or MUST in adult cancer patients were included. In order to evaluate the quality of each included study, the QUADAS-2 tool was used after which a meta-analysis was conducted using the hierarchical bivariate model. This model accounts for both within and between study variability. 16 studies (18 datasets) were included to evaluate these tools. The overall sensitivity and specificity for SGA was 0.69 and 0.80, 0.95 and 0.81 for PG-SGA, along with 0.83 and 0.83 for MUST respectively. An assessment of the likelihood ratios showed that PG-SGA had the highest LR + and the lowest LR-, it therefore has the best diagnostic performance to confirm malnutrition in adult cancer patients.
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Affiliation(s)
- Rena Nakyeyune
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xiaoli Ruan
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Yi Shen
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Yi Shao
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Chen Niu
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Zhaoping Zang
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Fen Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
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Hsueh SW, Liu KH, Hung CY, Tsai CY, Hsu JT, Tsang NM, Hsueh WH, Yang C, Chou WC. Predicting Postoperative Events in Patients With Gastric Cancer: A Comparison of Five Nutrition Assessment Tools. In Vivo 2021; 34:2803-2809. [PMID: 32871818 DOI: 10.21873/invivo.12106] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND/AIM We compared the adequacy of five nutrition assessment tools with respect to their predictive value in patients with locally advanced gastric cancer (GC) receiving radical surgery. PATIENTS AND METHODS Five nutrition assessment tools-Glasgow prognostic score (GPS), malnutritional universal screening tool (MUST), nutritional risk screening, patient generated subjective global assessment (PG-SGA), and prognostic nutritional index (PNI)-were assessed preoperatively for stage III GC patients. The correlation between postoperative events and nutritional status was further analyzed. RESULTS Most of the nutritional tools accurately predicted length of hospital stay and grade 3 or higher surgical complications, while only the GPS correlated with 30-day readmission and surgical complications. The PG-SGA performed the poorest among the five tools and failed to predict any postoperative event. CONCLUSION The application of GPS is recommended as a prognostic index for patients with locally advanced GC prior to radical surgery.
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Affiliation(s)
- Shun-Wen Hsueh
- Department of Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan, R.O.C
| | - Keng-Hao Liu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Chia-Yen Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.,Division of Hema-oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
| | - Chun-Yi Tsai
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Jun-Te Hsu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | | | - Chieh Yang
- Department of Internal Medicine, En-Hua Hospital, New Taipei City, Taiwan, R.O.C
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.
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Başıbüyük GÖ, Ayremlou P, Saeidlou SN, Ay F, Dalkıran A, Simzari W, Vitályos GÁ, Bektaş Y. A comparison of the different anthropometric indices for assessing malnutrition among older people in Turkey: a large population-based screening. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:13. [PMID: 33785057 PMCID: PMC8011074 DOI: 10.1186/s41043-021-00228-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Due to an increase in aging worldwide, assessment of the nutritional status of older people becomes an important matter. Malnutrition in older people increases the risk of infections, disease period and hospitalization rates. This study aimed to compare the different anthropometric indices for detecting malnutrition among older people and comparing these indices among males and females to explain the possible differences. METHODS In this cross-sectional study, 2721 aged 65 years and older in Turkey were enrolled. Anthropometric measurements weight, height, hip circumference (HC), and waist circumference (WC), abdominal circumference (AC), mid-upper arm circumference (MUAC), triceps skinfold thickness (TST), calf circumference (CC)) were measured. Body mass index (BMI), abdominal volume index (AVI), body roundness index (BRI) and body adiposity index (BAI), and waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) indices were calculated using standardized formulas. The receiver operator characteristic curves (ROCs) were conducted in detecting the best anthropometric parameters. Adjusted odds ratios (OR) (stratified by sex) calculated for each anthropometric index. RESULTS Participants with both BMI < 18.5 (1.1%) and BMI > 25 (80%) defined as the malnourished group and BMI of 18.5-24.99 (18.9%) defined as the normal group. In both sexes, the area under the curve (AUC) was > 0.7 for all anthropometric indices except WHR in females (AUC 0.66). BRI, WHR, WHtR, and AVI indices strongly predict the risk of malnutrition among both sexes. In males, the ORs were for BRI (6.83, 95% CI 5.39-8.66), WHR (6.43, 95% CI 5.9-6.9), AVI (2.02, 95% CI 1.86-2.12). In females, the ORs were for BRI (3.72, 95% CI 3.09-4.48), WtHR (2.63, 95% CI 1.3-3.5), and WHR (2.45, 95% CI 1.9-3.06). DISCUSSION The presence of a large AUC in almost all anthropometric indices suggests that they can be used to assess the risk of malnutrition among older persons in both sexes.
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Affiliation(s)
| | - Parvin Ayremlou
- Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Sakineh Nouri Saeidlou
- Food and Beverages Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran.
| | - Faruk Ay
- Department of Anthropology, Faculty of Literature, Sivas Cumhuriyet University, Sivas, Turkey
| | - Akgül Dalkıran
- Department of Anthropology, Faculty of Literature, Sivas Cumhuriyet University, Sivas, Turkey
| | - Wida Simzari
- Department of Nutrition and Dietetic, School of Health Sciences, Coppadocia University, Nevşehir, Turkey
| | - Gábor Áron Vitályos
- Department of Natural Sciences, Faculty of Primary and Pre-School Education, Eötvös Loránd University, Budapest, Hungary
| | - Yener Bektaş
- Department of Archaeology, Faculty of Arts and Sciences, Nevşehir Hacı Bektaş Veli University, Nevşehir, Turkey
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16
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[Nutritional screening in hospitalized patients with vascular disease - The relationship of nutritional risk with clinical and economic outcomes in a surgery department]. NUTR HOSP 2021; 38:252-532. [PMID: 33813834 DOI: 10.20960/nh.03386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: disease-related malnutrition has a negative impact on the outcome in surgical patients. Our objective was to assess the prevalence of nutritional risk in the field of vascular surgery, as well as its consequences on patient outcome and health expenditure. Patients and methods: this is a prospective, observational study conducted during 6 months in a vascular surgery ward at the University Hospital of León, Spain. The Malnutrition Universal Screening Tool was used to obtain data on admission and then every 7 days until hospital discharge. Clinical variables, surgical intervention performed, medical-surgical complications, hospital stay, healthcare costs, and early readmissions were studied. Results: a total of 104 patients, 84.6 % males, with a mean age of 69 (SD: 13) years were enrolled. Of these, 46.2 % were admitted due to peripheral arterial disease; 10.6 % had a positive MUST at the time of admission and 19.2 % at discharge; 100 % of malnourished patients at admission remained in the same situation at discharge. During hospitalization, in 29 patients (27.9 %) the nutritional situation worsened. In all, 81.25 % of patients who experienced worsening of their MUST score had been admitted urgently (p < 0.05). Patients who required urgent surgery significantly worsened in terms of their nutritional status (p < 0.001). Patients with worsening nutritional status obtained higher rates for: surgical reintervention (p < 0.05), pharmaceutical expense (p = 0.017), total hospital expense (€1,000/patient/admission), transfers to chronic care centers (p = 0.0002), and number of early readmissions (p = 0.017). Conclusion: patients with nutritional risk suffered an increase in medical-surgical complications, hospital stay, healthcare costs, and re-admission rates. Therefore, we consider that an implementation of screening procedures and the development of further studies in the vascular surgery setting are necessary.
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Ferrari F, Forte S, Sbalzer N, Zizioli V, Mauri M, Maggi C, Sartori E, Odicino F. Validation of an enhanced recovery after surgery protocol in gynecologic surgery: an Italian randomized study. Am J Obstet Gynecol 2020; 223:543.e1-543.e14. [PMID: 32652064 DOI: 10.1016/j.ajog.2020.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The enhanced recovery after surgery concept, which was introduced 20 years ago, is based on a multimodal approach to improve the functional rehabilitation of patients after surgery. OBJECTIVE This study aimed to validate an enhanced recovery after surgery protocol in gynecologic surgery for both benign and malignant diseases (endometrial cancer and advanced ovarian cancer) and to measure the adherence to the enhanced recovery after surgery protocol items in a randomized trial setting. STUDY DESIGN In this trial (NCT03347409), we randomly assigned patients to undergo standard perioperative care or enhanced recovery after surgery protocol. The primary outcome is a shorter length of stay in favor of the enhanced recovery after surgery protocol. Secondary outcomes include measurement of adherence to the enhanced recovery after surgery protocol items: comparison of postoperative pain, vomiting, and nausea; anesthesiologic and surgical complications up to 30 days after surgery; rate of readmissions; the time to event in hours for bowel movements, flatus, drinking, hunger, eating, and walking; and the quality of recovery using a validated questionnaire (QoR-15). Finally, we explored the length of stay in the prespecified subgroups at randomization, based on the type of surgical access and gynecologic disease. RESULTS A total of 168 women were available for analysis: 85 women (50.6%) were assigned to the standard perioperative care group, and 83 women (49.4%) were assigned to the enhanced recovery after surgery protocol group. The 2 groups were similar for age, body mass index, comorbidities, anesthesiological risk, smoking habits, surgical access, and complexity of surgical procedures. Seventy-two patients (42.9%) underwent surgery for benign disease, 48 (28.6%) for endometrial cancer, and 48 (28.6%) for ovarian cancer. Women in the enhanced recovery after surgery protocol group had a shorter length of stay (median: 2 [interquartile range, 2-3] vs 4 [interquartile range, 4-7] days; P<.001). A decreased rate of postoperative complications was noted for the enhanced recovery after surgery protocol group, as well as an earlier time to occur for all the events. Mean adherence to protocol items was 84.8% (95% confidence interval, 79.7-89.8), and we registered a better satisfaction in the enhanced recovery after surgery protocol group. The shortening of the length of stay was confirmed also in the prespecified subgroup analysis. CONCLUSION Application of the enhanced recovery after surgery protocol in gynecologic surgery translated to a shorter length of stay regardless of surgical access and type of gynecologic disease. Adherence to the enhanced recovery after surgery protocol items in the setting of a randomized trial was high.
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Aktary ML, Caron-Roy S, Sajobi T, O'Hara H, Leblanc P, Dunn S, McCormack GR, Timmins D, Ball K, Downs S, Minaker LM, Nykiforuk CI, Godley J, Milaney K, Lashewicz B, Fournier B, Elliott C, Raine KD, Prowse RJ, Olstad DL. Impact of a farmers' market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation. BMJ Open 2020; 10:e035143. [PMID: 32371514 PMCID: PMC7228519 DOI: 10.1136/bmjopen-2019-035143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/19/2020] [Accepted: 04/02/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers' market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers' Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers' markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts. METHODS AND ANALYSIS In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10-15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers' markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25-30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants' experiences with and perceived outcomes from the programme. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03952338.
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Affiliation(s)
- Michelle L Aktary
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Tolulope Sajobi
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Heather O'Hara
- British Columbia Association of Farmers' Markets, Vancouver, British Columbia, Canada
| | - Peter Leblanc
- British Columbia Association of Farmers' Markets, Vancouver, British Columbia, Canada
| | - Sharlette Dunn
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Gavin R McCormack
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- School of Architecture, Planning and Landscape, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Timmins
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
| | - Shauna Downs
- School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Leia M Minaker
- School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Jenny Godley
- Department of Sociology, University of Calgary, Calgary, Alberta, Canada
| | - Katrina Milaney
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bonnie Fournier
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Charlene Elliott
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Communication Media and Film, University of Calgary, Calgary, Alberta, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel Jl Prowse
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dana Lee Olstad
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
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John AA, Naresh KC, Ranganath V, Subramaniam MR, Patil AS, Jumani PN. Relationship between the nutritional status and antimicrobial protein levels with the periodontal condition in untreated head and neck cancer patients. J Family Med Prim Care 2019; 8:3325-3333. [PMID: 31742163 PMCID: PMC6857423 DOI: 10.4103/jfmpc.jfmpc_658_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 08/20/2019] [Accepted: 09/03/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Chronic periodontitis might be associated with oral premalignant lesions, tongue cancers, and other oral neoplasms, which is a foremost public health problem throughout the world. The nutritional status of the patient with cancer becomes very important for tolerating the treatment course as most of the newly diagnosed patients with head and neck cancer are malnourished before treatment begins. Antimicrobial proteins are also essential contributors to maintaining the balance between health and disease in this complex environment. Therefore the aim of this study was to determine whether an association exists between the measures of nutritional status and the levels of antimicrobial proteins with the periodontal condition in newly diagnosed, untreated head and neck cancer patients. Materials and Methods: A total of 50 patients newly diagnosed with head and neck carcinoma were included. Saliva and plasma samples were collected, together with clinical periodontal recordings. Nutritional status parameters consisted of body mass index, serum albumin, hemoglobin, and total lymphocyte count. Cystatin C and lysozyme were the antimicrobial proteins. Results: A logistic regression model showed that periodontal parameters were inversely related to their nutritional status; however, antimicrobial protein levels showed to be directly related to periodontal condition. Conclusion: This study suggests an association between periodontal disease, nutritional status parameters, and antimicrobial protein levels.
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Affiliation(s)
| | - Kumar C Naresh
- Department of Periodontology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
| | - V Ranganath
- Department of Periodontology, AECS Maaruti Dental College and Hospital, Bangalore, Karnataka, India
| | - M Rao Subramaniam
- Department of Periodontology, P.M. Nadagouda Memorial Dental College and Hospital, Bagalkot, Karnataka, India
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Schneider SM, Correia MITD. Epidemiology of weight loss, malnutrition and sarcopenia: A transatlantic view. Nutrition 2019; 69:110581. [PMID: 31622908 DOI: 10.1016/j.nut.2019.110581] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Malnutrition is a common comorbidity in patients with cancer, with determinants linked to the patients, the tumor, and the treatment. Cancer malnutrition, also called cachexia, represents the chronic form of disease-related malnutrition with chronic inflammation, and strongly impairs the prognosis. Reduced muscle mass, otherwise called sarcopenia in these patients, is a feature of malnutrition and thus of cancer cachexia that may appear before weight loss, and has a strong negative effect on prognosis, as well. The reported global prevalence of loss of muscle mass is 39%, whereas the prevalence of malnutrition in important cohorts varies from 25% to 70%. This is mostly due to the very different screening and diagnostic tools used throughout the world. The recent Global Leadership Initiative on Malnutrition has become a consensus alternative to standardize how malnutrition may be diagnosed based on etiologic and phenotypic criteria available everywhere, from rich to poor countries. This will lead to an easier diagnosis of cancer malnutrition that itself will help us speak the same language worldwide.
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Affiliation(s)
- Stéphane M Schneider
- Centre Hospitalier Universitaire de Nice, and Université Côte d'Azur, Nice, France.
| | - M Isabel T D Correia
- Medical School, Universidade Federal de Minas Gerais, and Eterna - Nutrition Therapy Team, Rede Mater Dei, Belo Horizonte, MG, Brazil
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Abstract
PURPOSE OF REVIEW Malnutrition is a common and under-recognized geriatric condition in older adults with cancer. This review describes the public health burden, malnutrition prevention, and the relationship among cancer cachexia, malnutrition, and sarcopenia. Finally, clinical practice recommendations on malnutrition and prevention are presented. RECENT FINDINGS Advanced age and cancer stage, frailty, dementia, major depression, functional impairment, and physical performance are important risk factors for malnutrition in older adults with cancer. The Mini Nutrition Assessment (MNA), Malnutrition Universal Screening Tool (MUST), and Patient Generated Subjective Global Assessment (PG-SGA) are the most commonly used assessment tools in older adults with cancer. In addition, malnutrition is independently associated with poor overall survival and quality of life, longer hospital stays, greater hospital cost, and hospital readmission. Comprehensive malnutrition prevention is required for improving the nutrition status among older adults with cancer.
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Seghiri R, Essamri A. Ethno-nutraceutical survey of dietary seaweeds used in unconventional therapy in Morocco. An emerging practice for a renovated pharmacopeia. Heliyon 2019; 5:e01559. [PMID: 31183427 PMCID: PMC6488537 DOI: 10.1016/j.heliyon.2019.e01559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/20/2019] [Accepted: 04/18/2019] [Indexed: 01/07/2023] Open
Abstract
In Morocco, like in many developing countries, people usually tend to turn to unconventional therapies. An ethnophycological survey was realized to inventory seaweeds used in complementary Moroccan medicine. One hundred ninety-one (191) consumers and thirty-one (31) traditional healers were interviewed on seaweed food-related diseases using standardized questionnaires. The survey was conducted in some cities in Morocco. After gathering all the information, the data obtained were analyzed and summarized. The investigation has displayed emerging phycotherapy in Morocco. Consumers' knowledge about seaweeds is complex and various. Yet, most of them are convinced of their nutraceutical benefits for a healthy lifestyle. The healers strongly support the reliability of their recommendations in treating health problems according to what the literature shows. The present study has made a contribution in giving a clear picture of the status quo of dietary seaweeds therapies in Morocco, which is revealed as an emerging practice needed to renovate pharmacopeia. Therefore, it has allowed us to list some seaweeds that haven't been considered in any scientific investigation before, which will be subject afterward to pharmacological tests to prove the claimed uses.
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Affiliation(s)
- R Seghiri
- Laboratory of Agro Resources Polymers and Process Engineering (LAR2PE), Team of Agro Resources and Process Engineering, Department of Chemistry, Faculty of Sciences, Ibn Tofail University, BP 133, 14000, Kenitra, Morocco
| | - A Essamri
- Laboratory of Agro Resources Polymers and Process Engineering (LAR2PE), Team of Agro Resources and Process Engineering, Department of Chemistry, Faculty of Sciences, Ibn Tofail University, BP 133, 14000, Kenitra, Morocco
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Mahdavi-Roshan M, Salari A, Hasandokht T, Rahbar-Taramsari M. Malnutrition Status and Associated Factors in Cardiac Patients Admitted to Heart Hospital, in the North of Iran. Hosp Top 2019; 97:60-65. [PMID: 31050309 DOI: 10.1080/00185868.2019.1605864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The objective of study was to evaluate the prevalence of malnutrition and associated factors in cardiac patients in the north of Iran. This cross-sectional study was done on 430 cardiac patients, who were admitted to the only heart hospital in the north of Iran. The malnutrition status was assessed based on "Malnutrition Universal Screening Tool" (MUST). The data was analyzed using SPSS software. The mean age of patients was 63.5 ± 12.67 years. The commonest cause of hospitalization was acute coronary syndrome. 31.4% patients had history of admission in the past 12 months. The prevalence of malnutrition was 14%, 7.7%, and 6.3% had medium and high risk of malnutrition, respectively. Patients with history of one time admission were 2.7 times more likely to be malnourished. The odds ratio for more than one time of hospital admission was 3.54. Malnutrition is likely to be present when the cardiac patients are admitted to hospital in Gilan province, in northern Iran.
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Affiliation(s)
- Marjan Mahdavi-Roshan
- a Cardiovascular Diseases Research Center, Faculty of Medicine , Guilan University of Medical Sciences , Rasht , Iran
- b Department of Community Medicine, School of Medicine , Guilan University of Medical Sciences , Rasht , Iran
| | - Arsalan Salari
- a Cardiovascular Diseases Research Center, Faculty of Medicine , Guilan University of Medical Sciences , Rasht , Iran
| | - Tolou Hasandokht
- a Cardiovascular Diseases Research Center, Faculty of Medicine , Guilan University of Medical Sciences , Rasht , Iran
- b Department of Community Medicine, School of Medicine , Guilan University of Medical Sciences , Rasht , Iran
| | - Morteza Rahbar-Taramsari
- c Department of Forensic Medicine , School of Medicine, Razi Teaching Hospital, Guilan University of Medical Sciences , Rasht , Iran
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Shin JC, Chang SH, Hwang SW, Lee JJ. The Nutritional Status and the Clinical Outcomes of Patients With a Spinal Cord Injury Using Nutritional Screening Tools. Ann Rehabil Med 2018; 42:591-600. [PMID: 30180529 PMCID: PMC6129714 DOI: 10.5535/arm.2018.42.4.591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/13/2017] [Indexed: 01/04/2023] Open
Abstract
Objective To assess the nutritional status of Korean patients with spinal cord injury (SCI), identify the predictors of undernutrition, and investigate the relationship between undernutrition and clinical outcomes. Methods A retrospective study design was used to determine the nutritional status of 130 patients over 19 years old admitted to the rehabilitation hospital of Yonsei University Health System between June 2015 and February 2017. The nutritional status was assessed using the malnutrition universal screening tool (MUST) and the spinal nutrition screening tool (SNST). The relationship between undernutrition and clinical outcomes was examined by comparing a low-risk group with an at-risk group using a t-test. Results Among the SCI patients, 70 (50.8%) were confirmed with undernutrition based on the MUST scores, while 60 (46.2%) had undernutrition based on the SNST scores. It was found that undernutrition has an effect on functional outcomes. Conclusion We assessed the undernutrition risk in Korean SCI patients, and found that approximately 50% of the patients were at risk of undernutrition. We also found that undernutrition can affect functional recovery.
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Affiliation(s)
- Ji Cheol Shin
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin Hye Chang
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Won Hwang
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Joong Lee
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
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Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, Woo J, Dong B, de la Vega S, Hua Poi PJ, Kamaruzzaman SBB, Won C, Chen LK, Rockwood K, Arai H, Rodriguez-Mañas L, Cao L, Cesari M, Chan P, Leung E, Landi F, Fried LP, Morley JE, Vellas B, Flicker L. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc 2018. [PMID: 28648901 DOI: 10.1016/j.jamda.2017.04.018] [Citation(s) in RCA: 352] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. METHODS An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation. RECOMMENDATIONS Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan. CONCLUSIONS The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.
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Affiliation(s)
- Elsa Dent
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Australia.
| | - Christopher Lien
- Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Chin Wong
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Tze Pin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jean Woo
- The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Birong Dong
- Geriatrics Center Huaxi Hospital, Sichuan University, Chengdu, China
| | - Shelley de la Vega
- University of the Philippines College of Medicine, Manila, Philippines; Institute on Aging, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Philip Jun Hua Poi
- Division of Geriatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | - Chang Won
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Li Cao
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Piu Chan
- Department of Geriatrics, Neurology, and Neurobiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Edward Leung
- Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | | | - Linda P Fried
- Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University, St. Louis, MO
| | | | - Leon Flicker
- Western Australia Center for Health and Aging, University of Western Australia, Perth, Australia
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26
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Kostyukevich OI, Sviridov SV, Rylova AK, Rylova NV, Korsunskaya MI, Kolesnikova EA. [Malnutrition: from pathogenesis to current methods for diagnosis and treatment]. TERAPEVT ARKH 2018; 89:216-225. [PMID: 29488484 DOI: 10.17116/terarkh20178912216-225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Progressive weight loss is a frequent companion to somatic pathology. The risk of death is known to increase dramatically among those with a body mass index of less than 19 kg/m2. Even mild weight loss in the presence of severe diseases can have a substantial impact on the course of the disease. The paper presents current views on malnutrition, its prevalence in the presence of various somatic diseases, and clinical significance. It describes the basic pathogenetic components of weight loss and the possible ways of correcting nutritional status. Particular emphasis is placed on the methods of nutritional support that is currently regarded as one of the most important components of a comprehensive approach to treating patients with chronic diseases. The authors give recommendations for the assessment of the nutritional status of patients in clinical practice and algorithms for their malnutrition management.
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Affiliation(s)
- O I Kostyukevich
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - S V Sviridov
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - A K Rylova
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - N V Rylova
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - M I Korsunskaya
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - E A Kolesnikova
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
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27
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Lai SW, Lin CL, Liao KF. Tamoxifen Use Correlates with Increased Risk of the First Episode of Ischemic Cerebrovascular Disease in Older Women with Breast Cancer: A Case-Control Study in Taiwan. Front Pharmacol 2017; 8:742. [PMID: 29089895 PMCID: PMC5651079 DOI: 10.3389/fphar.2017.00742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives: There are inconsistent results about the association between ischemic cerebrovascular disease and tamoxifen use in women with breast cancer. The study aimed to evaluate the association between the risk of ischemic cerebrovascular disease and tamoxifen use in older women with breast cancer in Taiwan. Methods: We designed a retrospective, nationwide, case-control study using the database of the Taiwan National Health Insurance Program. A total of 800 female subjects with breast cancer aged ≥65 years with the first episode of ischemic cerebrovascular disease from 2000 to 2011 were identified as the cases. Additionally, 2,876 female subjects with breast cancer aged ≥65 years without any type of cerebrovascular diseases were selected as the control subjects. The cases and the control subjects were matched with age and comorbidities. Ever use of tamoxifen was defined as a subject who had at least a prescription for tamoxifen before the index date. Never use of tamoxifen was defined as a subject who never had a prescription for tamoxifen before the index date. We used the multivariable logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) for ischemic cerebrovascular disease associated with tamoxifen use. Results: After adjusting for confounding variables, the adjusted OR of ischemic cerebrovascular disease was 2.5 for subjects with ever use of tamoxifen (95% CI 2.10, 2.97), compared with never use of tamoxifen. In addition, the adjusted OR of ischemic cerebrovascular disease was 1.15 (95% CI 1.10, 1.21) in subjects with ever use of tamoxifen as increase in use duration per 1 year. The adjusted OR of ischemic cerebrovascular disease was 2.54 (95% CI 2.03, 3.17) in subjects with ever use of tamoxifen as increase in dosage per 1 mg. Conclusions: Tamoxifen use is significantly associated with 2.5-fold increased odds of ischemic cerebrovascular disease among older women with breast cancer in Taiwan. There are duration-dependent and dose-dependent effects of tamoxifen use on the risk of ischemic cerebrovascular disease.
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Affiliation(s)
- Shih-Wei Lai
- Department of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Department of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- Department of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan
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28
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Lai SW, Lin CL, Liao KF. Use of Oral Corticosteroids and Risk of Hip Fracture in the Elderly in a Case-Control Study. Front Pharmacol 2017; 8:625. [PMID: 28955230 PMCID: PMC5600992 DOI: 10.3389/fphar.2017.00625] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/25/2017] [Indexed: 12/15/2022] Open
Abstract
Aim: Little is known regarding the relationship between use of oral corticosteroids and hip fracture in the elderly in Taiwan. The aim of the study was to examine this issue. Methods: A retrospective population-based case-control study using the database of the Taiwan National Health Insurance Program (2000–2013) was conducted. We identified 4538 individuals aged ≥ 65 years with newly diagnosed hip fracture as the cases. We randomly selected 4538 individuals without hip fracture as the control subjects. The cases and the control subjects were matched with sex, age, comorbidities, and the year of index date. Individuals who never had a prescription for oral corticosteroids were defined as never use. Individuals who ever had at least one prescription for oral corticosteroids were defined as ever use. The odds ratio (OR) and 95% confidence interval (CI) of hip fracture associated with oral corticosteroids use was estimated by a multivariable unconditional logistic regression analysis. Results: After adjustments for potential confounding factors, the multivariable logistic regression model showed that the adjusted OR of hip fracture was 1.17 for individuals with ever use of oral corticosteroids (95%CI 1.08, 1.28), compared to those with never use of oral corticosteroids. An sub-analysis showed that for every 1-mg increase in cumulative dose of oral corticosteroids, the adjusted OR of hip fracture was 1.01 (95% CI 1.01, 1.02). The adjusted ORs were 1.31 (95% CI 1.17, 1.47) for cumulative exposure to oral corticosteroids ≥ 3 months and 1.09 (95% CI 0.98, 1.20) for cumulative exposure < 3 months. Conclusion: We conclude that oral corticosteroids use is associated with a trivial but statistically significant increase in risk of hip fracture in Taiwan. Additionally, the results suggest that there are dose-response and duration-response effects of oral corticosteroids on the risk of hip fracture. The results confirm our understanding of oral corticosteroid-associated hip fracture in the elderly.
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Affiliation(s)
- Shih-Wei Lai
- College of Medicine, China Medical UniversityTaichung, Taiwan.,Department of Family Medicine, China Medical University HospitalTaichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical UniversityTaichung, Taiwan.,Management Office for Health Data, China Medical University HospitalTaichung, Taiwan
| | - Kuan-Fu Liao
- Graduate Institute of Integrated Medicine, China Medical UniversityTaichung, Taiwan.,College of Medicine, Tzu Chi UniversityHualien, Taiwan.,Department of Internal Medicine, Taichung Tzu Chi General HospitalTaichung, Taiwan
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29
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Cheng KC, Liao KF, Lin CL, Lai SW. Correlation of Proton Pump Inhibitors with Pulmonary Tuberculosis: A Case-Control Study in Taiwan. Front Pharmacol 2017; 8:481. [PMID: 28769810 PMCID: PMC5515903 DOI: 10.3389/fphar.2017.00481] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/04/2017] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives: Although the relationship between the use of proton pump inhibitors (PPIs) and pulmonary tuberculosis (TB) in Taiwan published in 2014. Due to just only one article and not enough comprehensively, we explore this issue. Methods: We conducted a population-based case-control study to identify 9,422 subjects aged 20 years or older with newly diagnosed pulmonary TB in 2000–2013 as test cases. We then randomly selected 9,422 subjects aged 20 years or older without pulmonary TB as controls. Both cases and controls were matched in terms of sex, age, and comorbidities. Use of PPIs were defined as subjects who had had at least one prescription for these medications before the index date. No use was defined as subjects who had never had a prescription for PPIs before the index date. The odds ratio (OR) and 95% confidence interval (CI) for pulmonary TB associated with PPI use was estimated using the logistic regression model. Results: The OR of pulmonary TB was 1.31 for subjects who had used PPIs (95% CI 1.22, 1.41) compared with those with no use of the medications. Sub-analysis revealed the OR of pulmonary TB in subjects using PPI per increasing microgram was 1.25 (95% CI 1.19, 1.30). Conclusions: PPI use is associated with a 1.3-fold increase in odds of developing pulmonary TB in Taiwan. There is a dose-related response between PPI use and pulmonary TB.
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Affiliation(s)
- Kao-Chi Cheng
- College of Medicine, China Medical UniversityTaichung, Taiwan.,Department of Family Medicine, China Medical University HospitalTaichung, Taiwan
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General HospitalTaichung, Taiwan.,College of Medicine, Tzu Chi UniversityHualien, Taiwan.,Graduate Institute of Integrated Medicine, China Medical UniversityTaichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical UniversityTaichung, Taiwan.,Management Office for Health Data, China Medical University HospitalTaichung, Taiwan
| | - Shih-Wei Lai
- College of Medicine, China Medical UniversityTaichung, Taiwan.,Department of Family Medicine, China Medical University HospitalTaichung, Taiwan
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30
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Cheng KC, Liao KF, Lin CL, Lai SW. Increased Risk of Pulmonary Tuberculosis in Patients with Depression: A Cohort Study in Taiwan. Front Psychiatry 2017; 8:235. [PMID: 29180971 PMCID: PMC5694036 DOI: 10.3389/fpsyt.2017.00235] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/31/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/OBJECTIVE Tuberculosis (TB) and depression were major public health issues worldwide and the mutual causative relationships between them were not exhaustive. This study was performed to explore the association between depression, comorbidities, and the risk of pulmonary TB in Taiwan. METHODS The cohort study used the database of the Taiwan National Health Insurance Program. The depression group included 34,765 subjects aged 20-84 years with newly diagnosed depression from 2000 to 2012, and the non-depression group included 138,187 randomly selected subjects without depression. Both depression and non-depression groups were matched with respect to sex, age, and comorbidities. We explored the incidence of pulmonary TB at the end of 2013 in both the groups and used multivariable Cox proportional hazards regression model to explore the hazard ratio (HR) and 95% confidence interval (CI) for the risk of pulmonary TB associated with depression. RESULTS The overall incidence of pulmonary TB was 1.16-fold greater in the depression group than that in the non-depression group (1.52 vs. 1.31 per 1,000 person-years, 95% CI 1.12, 1.21). The multivariable Cox proportional hazards regression analysis revealed that the adjusted HR of pulmonary TB was 1.15 for the depression group (95% CI 1.03, 1.28), compared with the non-depression group. CONCLUSION Depression is associated with 1.15-fold increased hazard of pulmonary TB in Taiwan.
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Affiliation(s)
- Kao-Chi Cheng
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wei Lai
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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