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Cederholm T, Jensen GL, Ballesteros-Pomar MD, Blaauw R, Correia MITD, Cuerda C, Evans DC, Fukushima R, Ochoa Gautier JB, Gonzalez MC, van Gossum A, Gramlich L, Hartono J, Heymsfield SB, Jager-Wittenaar H, Jayatissa R, Keller H, Malone A, Manzanares W, McMahon MM, Mendez Y, Mogensen KM, Mori N, Muscaritoli M, Nogales GC, Nyulasi I, Phillips W, Pirlich M, Pisprasert V, Rothenberg E, de van der Schueren M, Shi HP, Steiber A, Winkler MF, Barazzoni R, Compher C. Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach. Clin Nutr 2024; 43:1025-1032. [PMID: 38238189 DOI: 10.1016/j.clnu.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND & AIMS The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation in support of the etiologic criterion for inflammation. METHODS A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified-Delphi review. A multi-round review and revision process served to develop seven guidance statements. RESULTS The final round of review was highly favorable with 99 % overall "agree" or "strongly agree" responses. The presence of acute or chronic disease, infection or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C-reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (mg/dL or mg/L) for the clinical laboratory that is being used. CONCLUSION Confirmation of inflammation should be guided by clinical judgement based upon underlying diagnosis or condition, clinical signs, or CRP.
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Affiliation(s)
- Tommy Cederholm
- Clinical Nutrition & Metabolism, Uppsala University, Sweden; Theme Inflammation & Ageing, Karolinska University Hospital, Stockholm, Sweden.
| | - Gordon L Jensen
- Deans Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
| | | | - Renee Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Isabel T D Correia
- Food Science Post Graduation Program, Surgery Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - David C Evans
- Trauma, Critical Care, General & Gastrointestinal Surgery, OhioHealth Grant Medical Center, Columbus, OH, USA.
| | - Ryoji Fukushima
- Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo Japan.
| | | | | | - Andre van Gossum
- Department of Gastroenterology and Clinical Nutrition, Hospital Universitaire de Bruxelles, Brussels, Belgium.
| | - Leah Gramlich
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Joseph Hartono
- Indonesian Central Army Gatot Soebroto Hospital, Jakarta, Indonesia.
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.
| | - Harriët Jager-Wittenaar
- Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands; Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Renuka Jayatissa
- Department of Nutrition and Food Science, International Institute of Health Sciences, Colobo, Sri Lanka.
| | - Heather Keller
- Schlegel-UW Research Institute for Aging and Department of Kinesiology and Health Sciences, University of Waterloo, Ontario, Canada.
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Columbus, OH, USA.
| | - William Manzanares
- Critical Care Medicine, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay.
| | - M Molly McMahon
- Division of Endocrinology, Metabolism, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA.
| | - Yolanda Mendez
- Internal Medicine, Clinical Nutrition, Colegio Mexicano de Nutrición Clínica y Terapia Nutricional, Mexico.
| | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, MA, USA.
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Japan.
| | | | | | - Ibolya Nyulasi
- Department of Medicine, Central Clinical School, Monash University, Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia.
| | | | - Matthias Pirlich
- Praxis Kaisereiche - Imperial Oak Outpatient Clinic, Berlin Germany; Endocrinology, Gastroenterology, Clinical Nutrition, Berlin, Germany.
| | - Veeradej Pisprasert
- Division of Clinical Nutrition, Department of Medicine, Khon Kaen University, Thailand.
| | | | - Marian de van der Schueren
- HAN University of Applied Sciences, School of Allied Health, Wageningen University, Division of Human Nutrition and Health, the Netherlands.
| | - Han Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, China.
| | | | - Marion F Winkler
- Alpert Medical School of Brown University, Rhode Island Hospital, Surgical Nutrition Service, Providence, RI, USA.
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing, and Clinical Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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Lew CCH, Lee ZY, Day AG, Jiang X, Bear D, Jensen GL, Ng PY, Tweel L, Parillo A, Heyland DK, Compher C. The Association Between Malnutrition and High Protein Treatment on Outcomes in Critically Ill Patients: A Post Hoc Analysis of the EFFORT Protein Randomized Trial. Chest 2024:S0012-3692(24)00154-5. [PMID: 38354904 DOI: 10.1016/j.chest.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Preexisting malnutrition in critically ill patients is associated with adverse clinical outcomes. Malnutrition can be diagnosed with the Global Leadership Initiative on Malnutrition using parameters such as weight loss, muscle wasting, and BMI. International critical care nutrition guidelines recommend high protein treatment to improve clinical outcomes in critically ill patients diagnosed with preexisting malnutrition. However, this recommendation is based on expert opinion. RESEARCH QUESTION In critically ill patients, what is the association between preexisting malnutrition and time to discharge alive (TTDA), and does high protein treatment modify this association? STUDY DESIGN AND METHODS This multicenter randomized controlled trial involving 16 countries was designed to investigate the effects of high vs usual protein treatment in 1,301 critically ill patients. The primary outcome was TTDA. Multivariable regression was used to identify if preexisting malnutrition was associated with TTDA and if protein delivery modified their association. RESULTS The prevalence of preexisting malnutrition was 43.8%, and the cumulative incidence of live hospital discharge by day 60 was 41.2% vs 52.9% in the groups with and without preexisting malnutrition, respectively. The average protein delivery in the high vs usual treatment groups was 1.6 g/kg per day vs 0.9 g/kg per day. Preexisting malnutrition was independently associated with slower TTDA (adjusted hazard ratio, 0.81; 95% CI, 0.67-0.98). However, high protein treatment in patients with and without preexisting malnutrition was not associated with TTDA (adjusted hazard ratios of 0.84 [95% CI, 0.63-1.11] and 0.97 [95% CI, 0.77-1.21]). Furthermore, no effect modification was observed (ratio of adjusted hazard ratio, 0.84; 95% CI, 0.58-1.20). INTERPRETATION Malnutrition was associated with slower TTDA, but high protein treatment did not modify the association. These findings challenge current international critical care nutrition guidelines. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT03160547; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Charles Chin Han Lew
- Department of Dietetics & Nutrition, Ng Teng Fong General Hospital, Singapore, Singapore; Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore
| | - Zheng-Yii Lee
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Cardiac Anesthesiology & Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Andrew G Day
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Xuran Jiang
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Danielle Bear
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gordon L Jensen
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Pauline Y Ng
- Critical Care Medicine Unit, School of Clinical Medicine, The University of Hong Kong, Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong
| | - Lauren Tweel
- Clinical and Preventive Nutrition Sciences, Rutgers University, School of Health Professions, New Brunswick, NJ; Foothills Medical Centre, Calgary, AB, Canada
| | - Angela Parillo
- Department of Clinical Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania, School of Nursing, Philadelphia, PA.
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Compher C, Jensen GL, Malone A, Morgan S, Becker S, Cresta L, Paul AM, Steiber A. Clinical Outcomes Associated With Malnutrition Diagnosed by the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Indicators of Malnutrition: A Systematic Review of Content Validity and Meta-Analysis of Predictive Validity. J Acad Nutr Diet 2024:S2212-2672(24)00052-2. [PMID: 38331188 DOI: 10.1016/j.jand.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/18/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Charlene Compher
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Gordon L Jensen
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland
| | - Sherry Morgan
- University of Pennsylvania Libraries, Philadelphia, Pennsylvania
| | - Saraelena Becker
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura Cresta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alex M Paul
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Jensen GL, Cederholm T, Ballesteros-Pomar MD, Blaauw R, Correia MITD, Cuerda C, Evans DC, Fukushima R, Gautier JBO, Gonzalez MC, van Gossum A, Gramlich L, Hartono J, Heymsfield SB, Jager-Wittenaar H, Jayatissa R, Keller H, Malone A, Manzanares W, McMahon MM, Mendez Y, Mogensen KM, Mori N, Muscaritoli M, Nogales GC, Nyulasi I, Phillips W, Pirlich M, Pisprasert V, Rothenberg E, de van der Schueren M, Shi HP, Steiber A, Winkler MF, Compher C, Barazzoni R. Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach. JPEN J Parenter Enteral Nutr 2024; 48:145-154. [PMID: 38221842 DOI: 10.1002/jpen.2590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation, and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation. METHODS A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified Delphi review. A multiround review and revision process served to develop seven guidance statements. RESULTS The final round of review was highly favorable, with 99% overall "agree" or "strongly agree" responses. The presence of acute or chronic disease, infection, or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C-reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (milligrams per deciliter or milligram per liter) for the clinical laboratory that is being used. CONCLUSION Confirmation of inflammation should be guided by clinical judgment based on underlying diagnosis or condition, clinical signs, or CRP.
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Affiliation(s)
- Gordon L Jensen
- Deans Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Tommy Cederholm
- Clinical Nutrition & Metabolism, Uppsala University, Uppsala, Sweden
- Theme Inflammation & Ageing, Karolinska University Hospital, Stockholm, Sweden
| | | | - Renee Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Isabel T D Correia
- Food Science Post Graduation Program; Surgery Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David C Evans
- Trauma, Critical Care, General & Gastrointestinal Surgery, OhioHealth Grant Medical Center, Columbus, Ohio, USA
| | - Ryoji Fukushima
- Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan
| | | | | | - Andre van Gossum
- Department of Gastroenterology and Clinical Nutrition, Hospital Universitaire de Bruxelles, Brussels, Belgium
| | - Leah Gramlich
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Hartono
- Indonesian Central Army Gatot Soebroto Hospital, Jakarta, Indonesia
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Harriët Jager-Wittenaar
- Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Renuka Jayatissa
- Department of Nutrition and Food Science, International Institute of Health Sciences, Colobo, Sri Lanka
| | - Heather Keller
- Department of Kinesiology and Health Sciences, Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Columbus, Ohio, USA
| | - William Manzanares
- Critical Care Medicine, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
| | - M Molly McMahon
- Division of Endocrinology, Metabolism, Diabetes and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Yolanda Mendez
- Internal Medicine, Clinical Nutrition, Colegio Mexicano de Nutrición Clínica y Terapia Nutricional, Mexico City, Mexico
| | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | | | | | - Ibolya Nyulasi
- Department of Medicine, Central Clinical School, Monash University; Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Victoria, Australia
| | | | - Matthias Pirlich
- Departments of Endocrinology, Gastroenterology, and Clinical Nutrition, Imperial Oak Outpatient Clinic, Berlin, Germany
| | - Veeradej Pisprasert
- Division of Clinical Nutrition, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Marian de van der Schueren
- School of Allied Health, HAN University of Applied Sciences; Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Han Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Alison Steiber
- Academy of Nutrition and Dietetics, Cleveland, Ohio, USA
| | - Marion F Winkler
- Surgical Nutrition Service, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing and Clinical Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Flores AC, Jensen GL, Mitchell DC, Na M, Wood GC, Still CD, Gao X. Prospective Study of Diet Quality and the Risk of Dementia in the Oldest Old. Nutrients 2023; 15:nu15051282. [PMID: 36904280 PMCID: PMC10005581 DOI: 10.3390/nu15051282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
This study examined the associations between overall diet quality and the risk of dementia in a rural cohort among the oldest old. Included in this prospective cohort study were 2232 participants aged ≥ 80 years and dementia-free at the baseline according to the Geisinger Rural Aging Study (GRAS), a longitudinal cohort in rural Pennsylvania. In 2009, diet quality was assessed by a validated dietary screening tool (DST). Incident cases of dementia during 2009-2021 were identified using diagnosis codes. This approach was validated by a review of electronic health records. Associations between diet quality scores and the incidence of dementia were estimated using the Cox proportional hazards models, adjusted for potential confounders. Across a mean of 6.90 years of follow-up, we identified 408 incident cases of all-cause dementia. Having a higher diet quality was not significantly associated with a lower risk for incidents of all-cause dementia (adjusted HR for the highest compared with the lowest tertile: 1.01, 95% CI: 0.79, 1.29, P-trend = 0.95). Similarly, we did not observe a significant association between diet quality and altered risks of Alzheimer's disease and other forms of dementia. Overall, having a higher diet quality was not significantly associated with a lower risk of dementia among the oldest old during the full follow-up.
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Affiliation(s)
- Ashley C. Flores
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA 16801, USA
| | - Gordon L. Jensen
- Larner College of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Diane C. Mitchell
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA 16801, USA
| | - Muzi Na
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA 16801, USA
| | - G. Craig Wood
- Obesity Institute, Geisinger Health System, Danville, PA 17822, USA
| | | | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA 16801, USA
- School of Public Health, Institute of Nutrition, Fudan University, Shanghai 200437, China
- Correspondence:
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Heymsfield SB, Prado CM, Cristina Gonzalez M, Cederholm T, Jensen GL, Barazzoni R, Compher C. Author Response to LTE JPEN-2022-04-138. Reply to: Evans WJ. Lean body mass should not be used as a surrogate measurement of muscle mass in malnourished men and women: Comment on Compher et al. JPEN J Parenter Enteral Nutr. 2022 Apr 19. doi: 10.1002/jpen.2384. Epub ahead of print. PMID: 35437790. JPEN J Parenter Enteral Nutr 2022; 46:1500-1501. [PMID: 35633304 DOI: 10.1002/jpen.2414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022]
Abstract
Professor Evans comments (1) on our recent Global Leadership Initiative on Malnutrition (GLIM) Guidance published in the journal (2). In the title of his letter, Dr. Evans uses the term "lean body mass", an archaic body component description long abandoned by experts in the field. We believe this term is being used to refer to fat-free mass, the now accepted terminology for the component derived as the difference between body weight and fat mass This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - M Cristina Gonzalez
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Gordon L Jensen
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Barazzoni R, Jensen GL, Correia MITD, Gonzalez MC, Higashiguchi T, Shi HP, Bischoff SC, Boirie Y, Carrasco F, Cruz-Jentoft A, Fuchs-Tarlovsky V, Fukushima R, Heymsfield S, Mourtzakis M, Muscaritoli M, Norman K, Nyulasi I, Pisprasert V, Prado C, de van der Schuren M, Yoshida S, Yu Y, Cederholm T, Compher C. Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition. Clin Nutr 2022; 41:1425-1433. [PMID: 35450768 DOI: 10.1016/j.clnu.2022.02.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 01/02/2023]
Abstract
The Global Leadership Initiative on Malnutrition (GLIM) provides consensus criteria for the diagnosis of malnutrition that can be widely applied. The GLIM approach is based on the assessment of three phenotypic (weight loss, low body mass index, and low skeletal muscle mass) and two etiologic (low food intake and presence of disease with systemic inflammation) criteria, with diagnosis confirmed by any combination of one phenotypic and one etiologic criterion fulfilled. Assessment of muscle mass is less commonly performed than other phenotypic malnutrition criteria, and its interpretation may be less straightforward, particularly in settings that lack access to skilled clinical nutrition practitioners and/or to body composition methodologies. In order to promote the widespread assessment of skeletal muscle mass as an integral part of the GLIM diagnosis of malnutrition, the GLIM consortium appointed a working group to provide consensus-based guidance on assessment of skeletal muscle mass. When such methods and skills are available, quantitative assessment of muscle mass should be measured or estimated using dual-energy x-ray absorptiometry, computerized tomography, or bioelectrical impedance analysis. For settings where these resources are not available, then the use of anthropometric measures and physical examination are also endorsed. Validated ethnic- and sex-specific cutoff values for each measurement and tool are recommended when available. Measurement of skeletal muscle function is not advised as surrogate measurement of muscle mass. However, once malnutrition is diagnosed, skeletal muscle function should be investigated as a relevant component of sarcopenia and for complete nutrition assessment of persons with malnutrition.
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Affiliation(s)
- Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Gordon L Jensen
- Dean's Office, Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Maria Isabel T D Correia
- Department of Surgery, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Cristina Gonzalez
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Han Ping Shi
- Key Laboratory of Cancer FSMP for State Market Regulation, Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Stephan C Bischoff
- Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Yves Boirie
- Unité de Nutrition Humaine, Clinical Nutrition Department, INRAE, CHU Clermont-Ferrand, CRNH Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Fernando Carrasco
- Department of Nutrition, Faculty of Medicine, Nutrition and Bariatric Surgery Center, University of Chile, Clínica Las Condes, Santiago, Chile
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Ryoji Fukushima
- Department of Surgery Teikyo University School of Medicine/Health and Dietetics Teikyo Heisei University, Tokyo, Japan
| | - Steve Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Marina Mourtzakis
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Kristina Norman
- Department of Geriatrics and Medical Gerontology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Ibolya Nyulasi
- Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Dietetics, Nutrition and Sport, LaTrobe University, Bundoora, Victoria, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Veeradej Pisprasert
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Carla Prado
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Marian de van der Schuren
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands; Wageningen University & Research, Human Nutrition and Health, Wageningen, the Netherlands
| | - Sadao Yoshida
- Department of Rehabilitation, Chuzan Hospital, Okinawa-city, Okinawa Prefecture, Japan
| | - Yanchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Theme Inflammation & Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Liu YH, Gao X, Na M, Kris-Etherton PM, Mitchell DC, Jensen GL. Dietary Pattern, Diet Quality, and Dementia: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Alzheimers Dis 2021; 78:151-168. [PMID: 32955461 DOI: 10.3233/jad-200499] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Diet is an important lifestyle factor that may prevent or slow the onset and progression of neurodegeneration. Some, but not all, recent studies have suggested that adherence to a healthy dietary pattern may be associated with reduced risk of dementia. OBJECTIVE In this meta-analysis, we systematically examined the associations between overall dietary patterns, assessed a priori and a posteriori, and risk of dementia. METHODS We systematically searched PubMed, Web of Science, and the Cumulative Index for Nursing and Allied Health databases from January 1, 1981 to September 11, 2019. Prospective studies published in English were included. Random-effects model was used to calculate the pooled risk ratios and 95% confidence intervals (CIs). RESULTS Sixteen research articles were identified in the systematic review and 12 research articles including 66,930 participants were further included for the meta-analysis. Adherence to high diet quality or a healthy dietary pattern was significantly associated with lower risk of overall dementia (pooled risk ratio = 0.82; 95% CI: 0.70, 0.95; n = 12) and Alzheimer's disease (pooled risk ratio = 0.61; 95% CI: 0.47, 0.79; n = 6) relative to those with low diet quality or an unhealthy dietary pattern. Subgroup analyses stratified by age, sex, follow-up duration, diet quality assessment approach, study location, and study quality generated similar results. CONCLUSION Adherence to a healthy dietary pattern was associated with lower risk of overall dementia. Further randomized controlled trials are needed to provide additional evidence about the role of a healthy diet on the development and progression of dementia.
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Affiliation(s)
- Yi-Hsuan Liu
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Muzi Na
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Diane C Mitchell
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Gordon L Jensen
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
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9
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Jensen GL, Compher C, Malone A, Guenter P. Concurrent and Predictive Validity of AND-ASPEN Malnutrition Consensus Is Satisfactory in Hospitalized Patients: A Longitudinal Study. JPEN J Parenter Enteral Nutr 2021; 45:862-864. [PMID: 33990987 DOI: 10.1002/jpen.2187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Gordon L Jensen
- The Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Charlene Compher
- Penn Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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10
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Davis B, Liu YH, Stampley J, Wood GC, Mitchell DC, Jensen GL, Gao X, Glynn NW, Still CD, Irving BA. The Association between Poor Diet Quality, Physical Fatigability and Physical Function in the Oldest-Old from the Geisinger Rural Aging Study. Geriatrics (Basel) 2021; 6:geriatrics6020041. [PMID: 33920900 PMCID: PMC8167721 DOI: 10.3390/geriatrics6020041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 01/09/2023] Open
Abstract
More perceived physical fatigability and poor diet quality are associated with impairments in physical function in older adults. However, the degree to which more perceived fatigability explains the association between poor diet quality and low physical function is unknown. We examined this relationship in 122 (66F, 56M) of the oldest-old participants from the Geisinger Rural Aging Study (GRAS). We used 24-h dietary recalls to assess the Healthy Eating Index (HEI), the Pittsburgh Fatigability Scale (PFS, 0–50) to assess perceived physical fatigability, and the PROMIS Physical Function 20a* to assess physical function. We grouped participants into three age categories: 80–84 (n = 51), 85–89 (n = 51), and 90+ (n = 20) years. Multiple linear regression revealed that a lower HEI was associated with higher PFS Physical score after adjusting for age group, sex, body mass index, and the number of medical conditions (p = 0.001). Several macro- and micro-nutrient intakes were also lower in those reporting more (≥15) compared to less (<15) perceived physical fatigability. Mediation analysis revealed that PFS Physical scores explained ~65% (p = 0.001) of the association between HEI total score and PROMIS19 Physical Function score. Poor diet quality may contribute to more perceived physical fatigability, which could exacerbate impairments in the oldest-old’s physical function.
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Affiliation(s)
- Brett Davis
- Department of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA; (B.D.); (J.S.)
| | - Yi-Hsuan Liu
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA; (Y.-H.L.); (D.C.M.); (X.G.)
| | - James Stampley
- Department of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA; (B.D.); (J.S.)
| | - G. Craig Wood
- Geisinger Obesity Institute, Geisinger Health System, Danville, PA 17822, USA; (G.C.W.); (C.D.S.)
| | - Diane C. Mitchell
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA; (Y.-H.L.); (D.C.M.); (X.G.)
| | - Gordon L. Jensen
- Larner College of Medicine, University of Vermont, Burlington, VT 05401, USA;
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA; (Y.-H.L.); (D.C.M.); (X.G.)
| | - Nancy W. Glynn
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Christopher D. Still
- Geisinger Obesity Institute, Geisinger Health System, Danville, PA 17822, USA; (G.C.W.); (C.D.S.)
| | - Brian A. Irving
- Department of Kinesiology, Louisiana State University, Baton Rouge, LA 70803, USA; (B.D.); (J.S.)
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
- Correspondence: ; Tel.: +1-225-578-7179
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11
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Evans DC, Corkins MR, Malone A, Miller S, Mogensen KM, Guenter P, Jensen GL. The Use of Visceral Proteins as Nutrition Markers: An ASPEN Position Paper. Nutr Clin Pract 2020; 36:22-28. [PMID: 33125793 DOI: 10.1002/ncp.10588] [Citation(s) in RCA: 200] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/27/2020] [Accepted: 09/15/2020] [Indexed: 12/20/2022] Open
Abstract
Serum albumin and prealbumin, well-known visceral proteins, have traditionally been considered useful biochemical laboratory values in a nutrition assessment. However, recent literature disputes this contention. The aim of this document is to clarify that these proteins characterize inflammation rather than describe nutrition status or protein-energy malnutrition. Both critical illness and chronic illness are characterized by inflammation and, as such, hepatic reprioritization of protein synthesis occurs, resulting in lower serum concentrations of albumin and prealbumin. In addition, the redistribution of serum proteins occurs because of an increase in capillary permeability. There is an association between inflammation and malnutrition, however, not between malnutrition and visceral-protein levels. These proteins correlate well with patients' risk for adverse outcomes rather than with protein-energy malnutrition. Therefore, serum albumin and prealbumin should not serve as proxy measures of total body protein or total muscle mass and should not be used as nutrition markers. This paper has been approved by the American Society for Parenteral and Enteral Nutrition Board of Directors.
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Affiliation(s)
- David C Evans
- System Nutrition Support Team, OhioHealth Trauma and Surgical Services, Columbus, Ohio, USA
| | - Mark R Corkins
- Division of Pediatric Gastroenterology, Le Bonheur Children's Hospital, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ainsley Malone
- Nutrition Services, Mount Carmel East Hospital, Columbus, Ohio, USA.,American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Sarah Miller
- Providence Saint Patrick Hospital, University of Montana Skaggs School of Pharmacy, Missoula, Montana, USA
| | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Peggi Guenter
- Clinical Practice, Quality, and Advocacy, American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Gordon L Jensen
- Medicine and Nutrition, The Larner College of Medicine, University of Vermont, University of Vermont Health Network, Burlington, Vermont, USA
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- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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12
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Liu YH, Jensen GL, Na M, Mitchell DC, Wood GC, Still CD, Gao X. Diet Quality and Risk of Parkinson's Disease: A Prospective Study and Meta-Analysis. J Parkinsons Dis 2020; 11:337-347. [PMID: 33104042 DOI: 10.3233/jpd-202290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Several dietary components have been shown to be neuroprotective against risk of neurodegeneration. However, limited observational studies have examined the role of overall diet quality on risk of Parkinson's disease. OBJECTIVES We examined the associations between diet quality and risk of Parkinson's disease in a prospective cohort study and meta-analysis. METHODS Included in the cohort study were 3,653 participants (1,519 men and 2,134 women; mean age: 81.5 years) in the Geisinger Rural Aging Study longitudinal cohort in Pennsylvania. Diet quality was assessed using a validated dietary screening tool containing 25 food- and behavior-specific questions in 2009. Potential Parkinson's cases were identified using electronic health records based on ICD9 (332.*), ICD10 (G20), and Parkinson-related treatments. Hazard ratios (HRs) and 95% confidence intervals (CIs) across diet quality tertiles were calculated using Cox proportional hazards models after adjusting for potential confounders. We further performed a meta-analysis by pooling our study with four published papers on this topic. Random-effects model was utilized to calculate the pooled risk ratios and 95% CIs. RESULTS During a mean of 6.94 years of follow-up, 47 incident Parkinson's cases were documented. Having high diet quality at baseline was associated with lower Parkinson's disease risk (adjusted HR for the highest vs the lowest diet quality tertile = 0.39; 95% CI: 0.17, 0.89; p-trend = 0.02). The meta-analysis including 140,617 individuals also showed that adherence to high diet quality or a healthy dietary pattern was associated with lower risk of Parkinson's disease (pooled risk ratio = 0.64; 95% CI: 0.49, 0.83). CONCLUSION Having high diet quality or a healthy dietary pattern was associated with lower future risk of Parkinson's disease.
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Affiliation(s)
- Yi-Hsuan Liu
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Gordon L Jensen
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Muzi Na
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Diane C Mitchell
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - G Craig Wood
- Obesity Institute, Geisinger Health System, Danville, PA, USA
| | | | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
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13
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Keller H, van der Schueren MAE, Jensen GL, Barazzoni R, Compher C, Correia MITD, Gonzalez MC, Jager‐Wittenaar H, Pirlich M, Steiber A, Waitzberg D, Cederholm T. Global Leadership Initiative on Malnutrition (GLIM): Guidance on Validation of the Operational Criteria for the Diagnosis of Protein‐Energy Malnutrition in Adults. JPEN J Parenter Enteral Nutr 2020; 44:992-1003. [DOI: 10.1002/jpen.1806] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Heather Keller
- Schlegel‐University of Waterloo Research Institute for Aging Waterloo Ontario Canada
- Department of KinesiologyUniversity of Waterloo Waterloo Ontario Canada
| | - Marian A. E. van der Schueren
- Department of Nutrition and HealthSchool of Allied HealthHAN University of Applied Sciences Nijmegen the Netherlands
| | - Gordon L. Jensen
- The Larner College of MedicineUniversity of Vermont Burlington Vermont USA
| | - Rocco Barazzoni
- Department of MedicalSurgical and Health Sciences, University of Trieste Trieste Italy
| | - Charlene Compher
- Biobehavioral Health Sciences DepartmentSchool of NursingUniversity of Pennsylvania Philadelphia Pennsylvania USA
| | | | - M. Cristina Gonzalez
- Post‐Graduate Program in Health and BehaviourCatholic University of Pelotas Pelotas Rio Grande do Sul Brazil
- Post‐Graduate Program in Nutrition and FoodFederal University of Pelotas Pelotas Rio Grande do Sul Brazil
| | - Harriët Jager‐Wittenaar
- Research Group Healthy AgeingAllied Health Care and NursingHanze University of Applied Sciences Groningen the Netherlands
- Department of Maxillofacial SurgeryUniversity of Groningen, University Medical Center Groningen Groningen the Netherlands
| | - Matthias Pirlich
- Endocrinology, Gastroenterology, Clinical NutritionImperial Oak Outpatient Clinic (Kaisereiche) Berlin Germany
| | | | - Dan Waitzberg
- Department of GastroenterologySchool of MedicineUniversity of Sao Paulo Sao Paulo Brazil
| | - Tommy Cederholm
- Clinical Nutrition and MetabolismDepartment of Public Health and Caring SciencesUppsala University Uppsala Sweden
- Theme AgingKarolinska University Hospital Stockholm Sweden
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14
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Bresette W, Skulas-Ray AC, Tontsch C, Tomich T, Hudson O, Richter CK, Kris-Etherton PM, Jensen GL, Chilton F. In vivo
metabolomic and lipidomic response of healthy humans to intravenous lipopolysaccharide challenge. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.06746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Norris PC, Skulas-Ray AC, Riley I, Richter CK, Kris-Etherton PM, Jensen GL, Serhan CN, Maddipati KR. Author Correction: Identification of specialized pro-resolving mediator clusters from healthy adults after intravenous low-dose endotoxin and omega-3 supplementation: a methodological validation. Sci Rep 2019; 9:19816. [PMID: 31852986 PMCID: PMC6920359 DOI: 10.1038/s41598-019-56282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Paul C Norris
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Ann C Skulas-Ray
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Ian Riley
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Chesney K Richter
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, 16802, USA
| | - Gordon L Jensen
- Larner College of Medicine, University of Vermont, Burlington, VT, 05405, USA
| | - Charles N Serhan
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
| | - Krishna Rao Maddipati
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA.
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16
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Jensen GL, Malone A, Guenter P. The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Usability and Association With Outcomes-A Commentary. Nutr Clin Pract 2019; 34:655-656. [DOI: 10.1002/ncp.10380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Gordon L. Jensen
- The Larner College of Medicine; University of Vermont; Burlington Vermont USA
| | - Ainsley Malone
- Department of Pharmacy, Mount Carmel Grove City Hospital; Grove City Ohio USA
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition (ASPEN); Silver Spring Maryland USA
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17
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Liu YH, Gao X, Mitchell DC, Wood GC, Still CD, Jensen GL. Diet Quality Is Associated With Mortality in Adults Aged 80 Years and Older: A Prospective Study. J Am Geriatr Soc 2019; 67:2180-2185. [PMID: 31386173 DOI: 10.1111/jgs.16089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Diet quality has been associated with health outcomes and quality of life. However, the association between diet quality and mortality in older people, those aged 80 years and older, is understudied. Therefore, we conducted a prospective study to examine whether better diet quality, assessed by a validated dietary screening tool (DST), was associated with lower mortality in those aged 80 years and older. METHODS Our study included 1990 participants (812 men and 1178 women), with a mean age of 84.1 years at baseline (ranging from 80 to 102 years old), from the Geisinger Rural Aging Study longitudinal cohort in Pennsylvania. Baseline descriptive information was obtained in 2009, and the DST was administered via mailed survey. The DST is composed of 25 food- and behavior-specific questions associated with dietary intake that generate a diet quality score ranging from 0 (lowest) to 100 (highest). Death was identified using electronic medical record and the Social Security Death Index data. Hazard ratios (HRs) and 95% confidence intervals (CIs) across three diet quality categories were calculated by using Cox proportional hazards models after adjusting for potential confounders. RESULTS Over 8 years of follow-up (October 2009-February 2018), 931 deaths were documented. Higher diet quality was associated with lower mortality risk (P-trend = .04). Participants with high diet quality (defined as DST scores >75) had significantly lower risk of mortality compared with those with low diet quality (defined as DST scores <60) after adjusting for potential risk factors (adjusted HR = 0.76; 95% CI = 0.59-0.97). CONCLUSION Diet quality, assessed by DST, is significantly associated with risk of mortality in older adults aged 80 years and older in our prospective cohort. Our results indicate that nutrition may have an important role in healthy aging, and more studies are needed to develop appropriate dietary recommendations for older persons. J Am Geriatr Soc 67:2180-2185, 2019.
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Affiliation(s)
- Yi-Hsuan Liu
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania
| | - Diane C Mitchell
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania
| | - G Craig Wood
- Obesity Institute, Geisinger Health System, Danville, Pennsylvania
| | | | - Gordon L Jensen
- Larner College of Medicine, University of Vermont, Burlington, Vermont
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18
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Davis B, Stampley JE, Craig Wood G, Mitchell DC, Jensen GL, Liu YH, Gao X, Whilden B, Yohn M, Cunningham K, Lamotte M, Still CD, Irving BA. Association between Dietary Quality and Fatigability among the Elderly in the Geisinger Rural Aging Study. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561676.84118.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Stampley JE, Davis B, Craig Wood G, Mitchell DC, Jensen GL, Liu YH, Gao X, Whilden B, Yohn M, Cunningham K, Lemotte M, Still CD, Irving BA. Association between Fatigability and Physical Function among the Elderly in the Geisinger Rural Aging Study. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561678.68871.7c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Liu YH, Gao X, Mitchell DC, Wood GC, Bailey RK, Still CD, Jensen GL. Validation of a Diet Quality Screening Tool for Use in the Oldest Old .. J Nutr Gerontol Geriatr 2019; 38:196-204. [PMID: 31046651 DOI: 10.1080/21551197.2019.1601604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The oldest old (aged ≥80 years) are often the population subgroup at high nutritional risk due to age-related metabolic changes. We performed a validation analysis of a dietary screening tool (DST) which was developed for older adults among the oldest old. We examined dietary intakes using three 24-hour dietary recalls and the DST among 122 participants (aged 82-97) of the Geisinger Rural Aging Study. DST scores were compared with the Health Eating Index (HEI)-2015 scores, which were calculated based on three-day dietary recalls. Pearson correlations were used to characterize concurrent validity and Bland-Altman plots were used to identify potential bias. DST scores were significantly correlated with HEI scores (adjusted r = 0.68; p < 0.001) in an age- and sex-adjusted model. Those within the not-at-risk DST group had significantly higher HEI scores (adjusted means = 79.6 ± 3.68) compared with those who were in the at-risk (adjusted means = 51.2 ± 1.56) and the possibly-at-risk (adjusted means = 66.3 ± 1.79) groups (p-trend < 0.001). The DST appears to be a valid measure of diet quality in the oldest old when compared with the HEI and may be a potential tool to assess overall diet quality in this population.
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Affiliation(s)
- Yi-Hsuan Liu
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , PA , USA
| | - Xiang Gao
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , PA , USA
| | - Diane C Mitchell
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , PA , USA
| | - G Craig Wood
- b Department of Internal Medicine and The Obesity Institute , Geisinger Health System , Danville , PA , USA
| | - Regan K Bailey
- c Department of Nutrition Science , Purdue University , West Lafayette , IN , USA
| | - Christopher D Still
- b Department of Internal Medicine and The Obesity Institute , Geisinger Health System , Danville , PA , USA
| | - Gordon L Jensen
- d Larner College of Medicine , University of Vermont , Burlington , VT , USA
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21
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Cederholm T, Compher C, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, Van Gossum A, Jensen GL. Response to the letter: Comment on "GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community". Some considerations about the GLIM criteria - A consensus report for the diagnosis of malnutrition by Drs. LB da Silva Passos and DA De-Souza. Clin Nutr 2019; 38:1480-1481. [PMID: 30904187 DOI: 10.1016/j.clnu.2019.02.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Affiliation(s)
| | - C Compher
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - M I T D Correia
- Universidade Federal de Minas Gerais, Belo Horizante, Brazil
| | | | - R Fukushima
- Tokyo University School of Medicine, Tokyo, Japan
| | - T Higashiguchi
- Fujita Health University School of Medicine, Dengakugakubo, Kutsukake, Toyoake-City, Aichi, Japan
| | | | - G L Jensen
- University of Vermont, Burlington, VT, USA
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22
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Norris PC, Skulas-Ray AC, Riley I, Richter CK, Kris-Etherton PM, Jensen GL, Serhan CN, Maddipati KR. Identification of specialized pro-resolving mediator clusters from healthy adults after intravenous low-dose endotoxin and omega-3 supplementation: a methodological validation. Sci Rep 2018; 8:18050. [PMID: 30575798 PMCID: PMC6303400 DOI: 10.1038/s41598-018-36679-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/25/2018] [Indexed: 12/31/2022] Open
Abstract
Specialized pro-resolving mediator(s) (SPMs) are produced from the endogenous ω-3 polyunsaturated fatty acids (PUFA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and accelerate resolution of acute inflammation. We identified specific clusters of SPM in human plasma and serum using LC-MS/MS based lipid mediator (LM) metabololipidomics in two separate laboratories for inter-laboratory validation. The human plasma cluster consisted of resolvin (Rv)E1, RvD1, lipoxin (LX)B4, 18-HEPE, and 17-HDHA, and the human serum cluster consisted of RvE1, RvD1, AT-LXA4, 18-HEPE, and 17-HDHA. Human plasma and serum SPM clusters were increased after ω-3 supplementation (triglyceride dietary supplements or prescription ethyl esters) and low dose intravenous lipopolysaccharide (LPS) challenge. These results were corroborated by parallel determinations with the same coded samples in a second, separate laboratory using essentially identical metabololipidomic operational parameters. In these healthy subjects, two ω-3 supplementation protocols (Study A and Study B) temporally increased the SPM cluster throughout the endotoxin-challenge time course. Study A and Study B were randomized and Study B also had a crossover design with placebo and endotoxin challenge. Endotoxin challenge temporally regulated lipid mediator production in human serum, where pro-inflammatory eicosanoid (prostaglandins and thromboxane) concentrations peaked by 8 hours post-endotoxin and SPMs such as resolvins and lipoxins initially decreased by 2 h and were then elevated at 24 hours. In healthy adults given ω-3 supplementation, the plasma concentration of the SPM cluster (RvE1, RvD1, LXB4, 18-HEPE, and 17-HDHA) peaked at two hours post endotoxin challenge. These results from two separate laboratories with the same samples provide evidence for temporal production of specific pro-resolving mediators with ω-3 supplementation that together support the role of SPM in vivo in inflammation-resolution in humans.
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Affiliation(s)
- Paul C Norris
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Ann C Skulas-Ray
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Ian Riley
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Chesney K Richter
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, 16802, USA
| | - Gordon L Jensen
- Larner College of Medicine, University of Vermont, Burlington, VT, 05405, USA
| | - Charles N Serhan
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine and Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
| | - Krishna Rao Maddipati
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA.
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Affiliation(s)
- Gordon L Jensen
- Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Aging, Karolinska University Hospital, Stockholm, Sweden
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Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, Baptista G, Barazzoni R, Blaauw R, Coats A, Crivelli A, Evans DC, Gramlich L, Fuchs-Tarlovsky V, Keller H, Llido L, Malone A, Mogensen KM, Morley JE, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, de van der Schueren MAE, Siltharm S, Singer P, Tappenden K, Velasco N, Waitzberg D, Yamwong P, Yu J, Van Gossum A, Compher C, Cederholm T, Van Gossum A, Correia MIT, Gonzalez MC, Fukushima R, Higashiguchi T, Baptista G, Barazzoni R, Blaauw R, Coats A, Crivelli A, Evans D, Gramlich L, Fuchs V, Keller H, Llido L, Malone A, Mogensen K, Morley J, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, de van der Schueren M, Siltharm S, Singer P, Tappenden K, Velasco N, Waitzberg D, Yamwong P, Yu J. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clin Nutr 2018; 38:1-9. [PMID: 30181091 DOI: 10.1016/j.clnu.2018.08.002] [Citation(s) in RCA: 1200] [Impact Index Per Article: 200.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 12/12/2022]
Abstract
RATIONALE This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. METHODS In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. RESULTS A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify "at risk" status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. CONCLUSION A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re-considered every 3-5 years.
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Affiliation(s)
- T Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden; Theme Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - G L Jensen
- Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - M I T D Correia
- Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizante, Brazil
| | - M C Gonzalez
- Post-graduate Program in Health and Behavior, Catholic University of Pelotas, RS, Brazil
| | - R Fukushima
- Department of Medicine, Department of Surgery, Tokyo University School of Medicine, Tokyo, Japan
| | - T Higashiguchi
- Department of Surgery and Palliative Medicine, Fujita Health University School of Medicine, Dengakugakubo, Kutsukake, Toyoake-City, Aichi, Japan
| | - G Baptista
- Medicine Faculty Central University of Venezuela, Universitary Hospital of Caracas, Chief Nutritional Support Unit Hospital Universitary/Academic of Caracas, University Central of Venezuela, Venezuela
| | - R Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - R Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Coats
- Monash University, Australia; University of Warwick, Warwick, UK
| | - A Crivelli
- Hospital HIGA San Martín, Unit of Nutrition Support and Malabsorptive Diseases, Buenos Aires, Argentina
| | - D C Evans
- Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - L Gramlich
- University of Alberta, Edmonton, Alberta, Canada
| | - V Fuchs-Tarlovsky
- Clinical Nutrition Department, Hospital General de México, Mexico City, Mexico
| | - H Keller
- Schlegel-UW Research Institute for Aging and Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - L Llido
- Clinical Nutrition Service, St. Luke's Medical Center-Quezon City, Metro-Manila, Quezon City, Philippines
| | - A Malone
- The American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA; Mt. Carmel West Hospital, Columbus, OH, USA
| | - K M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, MA, USA
| | - J E Morley
- Division of Geriatrics, Saint Louis University Hospital, St. Louis, MO, USA
| | - M Muscaritoli
- Department of Clinical Medicine, Sapienza University of Rome, Italy
| | - I Nyulasi
- Department of Nutrition, Alfred Health and Professor of Dietetic Practice, Department of Rehabilitation, Nutrition and Sport, Latrobe University; Department of Medicine, Central Clinical School, Monash University, Australia
| | - M Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany
| | - V Pisprasert
- Department of Medicine, Khon Kaen University College of Medicine, Khon Kaen, Thailand
| | - M A E de van der Schueren
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Nutrition and Dietetics, Amsterdam, the Netherlands; HAN University of Applied Sciences, Faculty of Health and Social Studies, Department of Nutrition and Dietetics, Nijmegen, the Netherlands
| | - S Siltharm
- Ministry of Science and Technology, Bangkok, Thailand
| | - P Singer
- Department of General Intensive Care, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - K Tappenden
- Department of Kinesiology and Nutrition, University of Illinois-Chicago, Chicago, IL, USA
| | - N Velasco
- Department of Nutrition, Diabetes and Metabolismo, School of Medicine, Pontificia Universidad Catolica de Chile, Chile
| | - D Waitzberg
- Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - P Yamwong
- Department of Medicine, Siriaj Hospital, Bangkok, Thailand
| | - J Yu
- GI Surgery and Nutrition Metabolic Division, Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - A Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - C Compher
- Biobehavioral Health Sciences Department and Nutrition Programs, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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25
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Jensen GL, Cederholm T, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, de Baptista GA, Barazzoni R, Blaauw R, Coats AJS, Crivelli A, Evans DC, Gramlich L, Fuchs-Tarlovsky V, Keller H, Llido L, Malone A, Mogensen KM, Morley JE, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, de van der Schueren M, Siltharm S, Singer P, Tappenden KA, Velasco N, Waitzberg DL, Yamwong P, Yu J, Compher C, Van Gossum A. GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community. JPEN J Parenter Enteral Nutr 2018; 43:32-40. [PMID: 30175461 DOI: 10.1002/jpen.1440] [Citation(s) in RCA: 310] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND This initiative aims to build a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. METHODS The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. RESULTS A 2-step approach for the malnutrition diagnosis was selected, that is, first screening to identify at risk status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among GLIM participants that selected 3 phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and 2 etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least 1 phenotypic criterion and 1 etiologic criterion should be present. Phenotypic metrics for grading severity are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. CONCLUSIONS A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The construct should be re-considered every 3-5 years.
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Affiliation(s)
- Gordon L Jensen
- Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | | | - M Christina Gonzalez
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, RS, Brazil
| | - Ryoji Fukushima
- Department of Medicine, Department of Surgery, Tokyo University School of Medicine, Tokyo
| | - Takashi Higashiguchi
- Department of Surgery and Palliative Medicine, Fujita Health University School of Medicine, Dengakugakubo, Kutsukake, Toyoake-City, Aichi, Japan
| | - Gertrudis Adrianza de Baptista
- Medicine Faculty Central University of Venezuela, University Hospital of Caracas, Chief Nutritional Support Unit Hospital Universitary/Academic of Caracas, University Central of Venezuela
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Renée Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andrew J S Coats
- Monash University Australia and University of Warwick, Warwick, UK; Member Board of Directors Society on Sarcopenia, Cachexia and Wasting Disorders
| | - Adriana Crivelli
- Nutritional Support Unit, San Martín Hospital, La Plata, Argentina
| | - David C Evans
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | | | | | - Heather Keller
- Schlegel-UW Research Institute for Aging and Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - Luisito Llido
- Clinical Nutrition Service, St. Luke's Medical Center-Quezon City, Metro-Manila, Phillippines, Quezon City, Philippines
| | - Ainsley Malone
- The American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, and Mt. Carmel West Hospital, Columbus, Ohio, USA
| | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John E Morley
- Division of Geriatrics, Saint Louis University Hospital, St. Louis, Missouri, U.S.A. Member Board of Directors Society on Sarcopenia, Cachexia and Wasting Disorders
| | | | - Ibolya Nyulasi
- Department of Nutrition, Alfred Health and Professor of Dietetic Practice, Department of Rehabilitation, Nutrition and Sport, Latrobe University, Department of Medicine, Central Clinical School, Monash University
| | - Matthias Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany
| | - Veeradej Pisprasert
- Department of Medicine, Khon Kaen University College of Medicine, Khon Kaen, Thailand
| | - Marian de van der Schueren
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Nutrition and Dietetics, Amsterdam, the Netherlands; HAN University of Applied Sciences, Faculty of Health and Social studies, Department of Nutrition and Dietetics, Nijmegen, the Netherlands
| | | | - Pierre Singer
- Department of General Intensive Care, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Israel
| | - Kelly A Tappenden
- Department of Kinesiology and Nutrition, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Nicolas Velasco
- Department of Nutrition, Diabetes and Metabolismo. School of Medicine, Pontificia Universidad Catolica de Chile
| | - Dan L Waitzberg
- Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Jianchun Yu
- GI Surgery and Nutrition Metabolic Division, Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Charlene Compher
- Biobehavioral Health Sciences Department and Nutrition Programs, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Andre Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
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Abstract
The explanation for reduced mortality among older persons with overweight or class I obesity compared to those of desirable weight remains unclear. Our objective was to investigate the joint effects of body mass index (BMI) and metabolic health status on all-cause mortality in a cohort of advanced age. Adults aged 74 ± 4.7 (mean ± SD) years at baseline (n = 4551) were categorized according to BMI (18.5-24.9, 25.0-29.9, 30.0-34.9, and ≥35.0 kg/m(2)) and the presence or absence of a metabolically healthy phenotype (i.e., 0 or 1 risk factors based on a modified Adult Treatment Panel III). Metabolically unhealthy was ≥2 risk factors. There were 2294 deaths over a mean 10.9 years of follow up. Relative to metabolically healthy desirable weight, metabolically healthy overweight or class I obesity was not associated with a greater mortality risk (HR 0.90; 95 CI% 0.73-1.13 and HR 0.58; 95 CI% 0.42-0.80, respectively) (P-interaction <0.001). Results remained consistent in rigorous sensitivity analyses. The "obesity paradox" may be partially explained by the inclusion of metabolically healthy overweight and obese older persons, who do not have elevated mortality risk, in population studies of BMI and mortality.
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Affiliation(s)
- Feon W Cheng
- a Department of Nutritional Sciences , Pennsylvania State University , University Park , Pennsylvania , USA
| | - Xiang Gao
- a Department of Nutritional Sciences , Pennsylvania State University , University Park , Pennsylvania , USA
| | - Diane C Mitchell
- a Department of Nutritional Sciences , Pennsylvania State University , University Park , Pennsylvania , USA
| | - Craig Wood
- b Obesity Institute , Geisinger Health System , Danville , Pennsylvania , USA
| | - David D K Rolston
- b Obesity Institute , Geisinger Health System , Danville , Pennsylvania , USA.,c Department of Internal Medicine, Geisinger Health System , Danville , Pennsylvania , USA
| | - Christopher D Still
- b Obesity Institute , Geisinger Health System , Danville , Pennsylvania , USA
| | - Gordon L Jensen
- a Department of Nutritional Sciences , Pennsylvania State University , University Park , Pennsylvania , USA.,d Dean's Office and Department of Medicine , University of Vermont College of Medicine , Burlington , Vermont , USA
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Cheng FW, Gao X, Bao L, Mitchell DC, Wood C, Sliwinski MJ, Smiciklas-Wright H, Still CD, Rolston DDK, Jensen GL. Obesity as a risk factor for developing functional limitation among older adults: A conditional inference tree analysis. Obesity (Silver Spring) 2017; 25:1263-1269. [PMID: 28544480 DOI: 10.1002/oby.21861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/17/2017] [Accepted: 03/28/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the risk factors of developing functional decline and make probabilistic predictions by using a tree-based method that allows higher order polynomials and interactions of the risk factors. METHODS The conditional inference tree analysis, a data mining approach, was used to construct a risk stratification algorithm for developing functional limitation based on BMI and other potential risk factors for disability in 1,951 older adults without functional limitations at baseline (baseline age 73.1 ± 4.2 y). We also analyzed the data with multivariate stepwise logistic regression and compared the two approaches (e.g., cross-validation). Over a mean of 9.2 ± 1.7 years of follow-up, 221 individuals developed functional limitation. RESULTS Higher BMI, age, and comorbidity were consistently identified as significant risk factors for functional decline using both methods. Based on these factors, individuals were stratified into four risk groups via the conditional inference tree analysis. Compared to the low-risk group, all other groups had a significantly higher risk of developing functional limitation. The odds ratio comparing two extreme categories was 9.09 (95% confidence interval: 4.68, 17.6). CONCLUSIONS Higher BMI, age, and comorbid disease were consistently identified as significant risk factors for functional decline among older individuals across all approaches and analyses.
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Affiliation(s)
- Feon W Cheng
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Le Bao
- Department of Statistics, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Diane C Mitchell
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Craig Wood
- Obesity Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Martin J Sliwinski
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Helen Smiciklas-Wright
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Christopher D Still
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
| | - David D K Rolston
- Department of Internal Medicine, Geisinger Health System, Danville, Pennsylvania, USA
| | - Gordon L Jensen
- University of Vermont College of Medicine, Burlington, Vermont, USA
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Compher C, Higashiguchi T, Yu J, Jensen GL. Does Low Body Mass Index Predict the Hospital Mortality of Adult Western or Asian Patients? JPEN J Parenter Enteral Nutr 2017. [DOI: 10.1177/0148607117713182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Charlene Compher
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Takashi Higashiguchi
- Department of Surgery and Palliative Medicine, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Gordon L. Jensen
- College of Medicine, University of Vermont, Burlington, Vermont, USA
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Jensen GL, Cederholm T. Global Leadership Initiative on Malnutrition: Progress Report From ASPEN Clinical Nutrition Week 2017. JPEN J Parenter Enteral Nutr 2017; 42:266-267. [DOI: 10.1177/0148607117707761] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/10/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Gordon L. Jensen
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Tommy Cederholm
- Department of Geriatric Medicine, Uppsala University Hospital, and Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Affiliation(s)
- Tommy Cederholm
- Departments of Geriatric Medicine, Uppsala University Hospital and Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Gordon L. Jensen
- The Dean’s Office and Department of Medicine, The University of Vermont College of Medicine, Burlington, Vermont, USA
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Cederholm T, Jensen GL. To create a consensus on malnutrition diagnostic criteria: A report from the Global Leadership Initiative on Malnutrition (GLIM) meeting at the ESPEN Congress 2016. Clin Nutr 2017; 36:7-10. [DOI: 10.1016/j.clnu.2016.12.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 12/14/2022]
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Binkley JF, Mills B, Roy MA, Diaz JJ, Jensen GL. Spurious Laboratory Values From Improper Sampling of Blood Containing Parenteral Nutrition. Nutr Clin Pract 2017; 19:540-1. [PMID: 16215151 DOI: 10.1177/0115426504019005540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Shlisky J, Bloom DE, Beaudreault AR, Tucker KL, Keller HH, Freund-Levi Y, Fielding RA, Cheng FW, Jensen GL, Wu D, Meydani SN. Nutritional Considerations for Healthy Aging and Reduction in Age-Related Chronic Disease. Adv Nutr 2017; 8:17-26. [PMID: 28096124 PMCID: PMC5227979 DOI: 10.3945/an.116.013474] [Citation(s) in RCA: 219] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A projected doubling in the global population of people aged ≥60 y by the year 2050 has major health and economic implications, especially in developing regions. Burdens of unhealthy aging associated with chronic noncommunicable and other age-related diseases may be largely preventable with lifestyle modification, including diet. However, as adults age they become at risk of "nutritional frailty," which can compromise their ability to meet nutritional requirements at a time when specific nutrient needs may be high. This review highlights the role of nutrition science in promoting healthy aging and in improving the prognosis in cases of age-related diseases. It serves to identify key knowledge gaps and implementation challenges to support adequate nutrition for healthy aging, including applicability of metrics used in body-composition and diet adequacy for older adults and mechanisms to reduce nutritional frailty and to promote diet resilience. This review also discusses management recommendations for several leading chronic conditions common in aging populations, including cognitive decline and dementia, sarcopenia, and compromised immunity to infectious disease. The role of health systems in incorporating nutrition care routinely for those aged ≥60 y and living independently and current actions to address nutritional status before hospitalization and the development of disease are discussed.
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Affiliation(s)
- Julie Shlisky
- The Sackler Institute for Nutrition Science at the New York Academy of Sciences, New York, NY;
| | - David E Bloom
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA
| | | | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Heather H Keller
- Schlegel-UW Research Institute for Aging, Applied Health Sciences, University of Waterloo, Ontario, Canada
| | - Yvonne Freund-Levi
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
- Department of Geriatrics, Karolinska University Hospital, Huddinge, Sweden
- Department of Psychiatry, Tiohundra Hospital, Stockholm, Sweden
| | | | - Feon W Cheng
- The Pennsylvania State University, University Park, PA; and
| | | | - Dayong Wu
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
| | - Simin N Meydani
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
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Cheng FW, Gao X, Mitchell DC, Wood C, Still CD, Rolston D, Jensen GL. Body mass index and all-cause mortality among older adults. Obesity (Silver Spring) 2016; 24:2232-9. [PMID: 27570944 DOI: 10.1002/oby.21612] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/06/2016] [Accepted: 06/13/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the association between baseline body mass index (BMI, kg/m(2) ) and all-cause mortality in a well-characterized cohort of older persons. METHODS The association between BMI (both as a categorical and continuous variable) and all-cause mortality was investigated using 4,565 Geisinger Rural Aging Study participants with baseline age 74.0 ± 4.7 years (mean ± SD) and BMI 29.5 ± 5.3 kg/m(2) over a mean of 10.9 ± 3.8 years of follow-up. RESULTS The relationship between BMI (as a continuous variable) and all-cause mortality was found to be U-shaped (P nonlinearity <0.001). Controlling for age, sex, smoking, alcohol, laboratory values, medications, and comorbidity status, underweight (BMI <18.5 kg/m(2) ) individuals had significantly greater adjusted risk of all-cause mortality than persons of BMI 18.5 to 24.9 kg/m(2) (reference range). Participants with overweight (BMI 25.0-29.9 kg/m(2) ) and class I obesity (BMI 30.0-34.9 kg/m(2) ) had significantly lower adjusted-risk of all-cause mortality. Those with classes II/III obesity (BMI ≥ 35.0 kg/m(2) ) did not have significantly greater adjusted-risk of all-cause mortality. Findings were consistent using propensity score weights and among never-smokers with 2- and 5-year lag analysis and among those with no identified chronic disease. CONCLUSIONS A U-shaped association was observed between BMI and all-cause mortality with lower risk among older persons with overweight and class I obesity in comparison with those with BMI 18.5 to 24.9 kg/m(2) .
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Affiliation(s)
- Feon W Cheng
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA.
| | - Diane C Mitchell
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Craig Wood
- Department of Internal Medicine & the Obesity Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Christopher D Still
- Department of Internal Medicine & the Obesity Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - David Rolston
- Department of Internal Medicine & the Obesity Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Gordon L Jensen
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
- Dean's Office and Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont, USA
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Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, Compher C, Correia I, Higashiguchi T, Holst M, Jensen GL, Malone A, Muscaritoli M, Nyulasi I, Pirlich M, Rothenberg E, Schindler K, Schneider SM, de van der Schueren MAE, Sieber C, Valentini L, Yu JC, Van Gossum A, Singer P. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2016; 36:49-64. [PMID: 27642056 DOI: 10.1016/j.clnu.2016.09.004] [Citation(s) in RCA: 1161] [Impact Index Per Article: 145.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/09/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research. OBJECTIVE This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures. METHODS The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round. RESULTS Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery. CONCLUSION An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.
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Affiliation(s)
- T Cederholm
- Departments of Geriatric Medicine, Uppsala University Hospital and Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - P Austin
- Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, United Kingdom; Pharmacy Department, University Hospital Southampton NHS Foundation Trust, United Kingdom.
| | - P Ballmer
- Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland.
| | - G Biolo
- Institute of Clinical Medicine, University of Trieste, Trieste, Italy.
| | - S C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - C Compher
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
| | - I Correia
- Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | - T Higashiguchi
- Department of Surgery and Palliative Medicine, Fujita Health University, School of Medicine, Toyoake, Japan.
| | - M Holst
- Center for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
| | - G L Jensen
- The Dean's Office and Department of Medicine, The University of Vermont College of Medicine, Burlington, VT, USA.
| | - A Malone
- Pharmacy Department, Mount Carmel West Hospital, Columbus, OH, USA.
| | - M Muscaritoli
- Department of Clinical Medicine, Sapienza University of Rome, Italy.
| | - I Nyulasi
- Nutrition and Dietetics, Alfred Health, Melbourne, Australia.
| | - M Pirlich
- Department of Internal Medicine, Elisabeth Protestant Hospital, Berlin, Germany.
| | - E Rothenberg
- Department of Food and Meal Science, Kristianstad University, Kristianstad, Sweden.
| | - K Schindler
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University Vienna, Vienna, Austria.
| | - S M Schneider
- Department of Gastroenterology and Clinical Nutrition, Archet Hospital, University of Nice Sophia Antipolis, Nice, France.
| | - M A E de van der Schueren
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition, Sports and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - C Sieber
- Institute for Biomedicine of Ageing, Friedrich-Alexander University Erlangen-Nürnberg, Hospital St. John of Lord, Regensburg, Germany.
| | - L Valentini
- Department of Agriculture and Food Sciences, Section of Dietetics, University of Applied Sciences, Neubrandenburg, Germany.
| | - J C Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - A Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium.
| | - P Singer
- Department of Critical Care, Institute for Nutrition Research, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 49100 Israel.
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Mitchell DC, Cheng FW, Still CD, Jensen GL. A Validation of Automated Self‐Administered 24‐Hour Dietary Recalls(ASA24) Relative to Interviewer‐Administered Recalls using the Nutrition Data System for Research (NDSR). FASEB J 2016. [DOI: 10.1096/fasebj.30.1_supplement.43.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Feon W Cheng
- Nutritional SciencesPenn State UniversityUniversity ParkPA
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Cheng FW, Gao X, Mitchell DC, Wood C, Still C, Jensen GL. Impact of Body Mass Index and Metabolic Health Status on All‐Cause Mortality Risk among Older Adults. FASEB J 2016. [DOI: 10.1096/fasebj.30.1_supplement.417.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Feon W. Cheng
- Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPA
| | - Xiang Gao
- Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPA
| | - Diane C. Mitchell
- Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPA
| | | | | | - Gordon L. Jensen
- Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkPA
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Affiliation(s)
- Gordon L. Jensen
- University of Vermont College of Medicine, Burlington, Vermont, USA
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Ford DW, Hartman TJ, Still C, Wood C, Mitchell DC, Erickson P, Bailey R, Smiciklas-Wright H, Coffman DL, Jensen GL. Body mass index, poor diet quality, and health-related quality of life are associated with mortality in rural older adults. J Nutr Gerontol Geriatr 2015; 33:23-34. [PMID: 24597994 DOI: 10.1080/21551197.2014.875819] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In an aging population, potentially modifiable factors impacting mortality such as diet quality, body mass index (BMI), and health-related quality of life (HRQOL) are of interest. Surviving members of the Geisinger Rural Aging Study (GRAS) (n = 5,993; aged ?74 years) were contacted in the fall of 2009. Participants in the present study were the 2,995 (1,267 male, 1,728 female; mean age 81.4 ± 4.4 years) who completed dietary and demographic questionnaires and were enrolled in the Geisinger Health Plan over follow-up (mean = 3.1 years). Cox proportional hazards multivariate regression models were used to examine the associations between all-cause mortality and BMI, diet quality, and HRQOL. Compared to GRAS participants with BMIs in the normal range, a BMI < 18.5 was associated with increased mortality (HR 1.85 95%CI 1.09, 3.14, P = 0.02), while a BMI of 25-29.9 was associated with decreased risk of mortality (HR 0.71 95%CI 0.55, 0.91, P =0.007). Poor diet quality increased risk for mortality (HR 1.53 95%CI 1.06, 2.22, P = 0.02). Finally, favorable health-related quality of life was inversely associated with mortality (HR 0.09 95%CI 0.06, 0.13, P < 0.0001). Higher diet quality and HALex scores, and overweight status, were associated with reduced all-cause mortality in a cohort of advanced age. While underweight (BMI < 18.5) increased risk of all-cause mortality, no association was found between obesity and all-cause mortality in this aged cohort.
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Affiliation(s)
- Dara W Ford
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , Pennsylvania , USA
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Abstract
This meta-analysis of observational cohort studies examined the association between weight change (weight loss, weight gain, and weight fluctuation) and all-cause mortality among older adults. We used Pub Med (MEDLINE), Web of Science, and Cochrane Library to identify prospective studies published in English from inception to November 2014. Seventeen prospective studies met the inclusion criteria and were included in this meta-analysis. Higher all-cause mortality risks were noted with weight change: weight loss (pooled RR, 1.67; 95% CI, 1.51-1.85; p < 0.001 for heterogeneity), weight gain (pooled RR, 1.21; 95% CI, 1.09-1.33; p = 0.03 for heterogeneity), and weight fluctuation (pooled RR, 1.53; 95% CI, 1.36-1.72; p = 0.43 for heterogeneity). Similar results were observed with stricter criteria for sensitivity analyses. None of the study characteristics had statistically significant effects on the pooled RR, except for study quality on weight loss. Weight change is associated with higher mortality risk among community-dwelling adults 60 years and older.
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Affiliation(s)
- Feon W Cheng
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , Pennsylvania , USA
| | - Xiang Gao
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , Pennsylvania , USA
| | - Gordon L Jensen
- a Department of Nutritional Sciences , The Pennsylvania State University , University Park , Pennsylvania , USA
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Ford DW, Hartman TJ, Still C, Wood C, Mitchell DC, Bailey R, Smiciklas-Wright H, Coffman DL, Jensen GL. Diet quality and body mass index are associated with health care resource use in rural older adults. J Acad Nutr Diet 2014; 114:1932-8. [PMID: 24746773 PMCID: PMC4568998 DOI: 10.1016/j.jand.2014.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
Abstract
Health care resource consumption is a growing concern. The aim of this study was to examine the associations between diet quality and body mass index with health care resource use (HRU) in a cohort of advanced age. Participants in the Geisinger Rural Aging Study (n=5,993) were mailed demographic and dietary questionnaires in 2009. Of those eligible, 2,995 (50%; 1,267 male, 1,728 female; mean age 81.4±4.4 years) provided completed surveys. Multivariate negative binomial models were used to estimate relative risk and 95% CI of HRU outcomes with diet quality as assessed by the Dietary Screening Tool score and body mass index determined from self-reported height and weight. Poor diet quality was associated with a 20% increased risk for emergency room (ER) visits. Fruit and vegetable consumption was grouped into quintiles of intake, with the highest quintile serving as the reference group in analyses. The three lowest fruit and vegetable quintiles were associated with increased risk for ER visits (23% to 31%); the lowest quintile increased risk for inpatient visits (27%). Obesity increased risk of outpatient visits; however, individuals with class I obesity were less likely than normal-weight individuals to have ER visits (relative risk=0.84; 95% CI 0.70 to 0.99). Diets of greater quality, particularly with greater fruit and vegetable intake, are associated with favorable effects on HRU outcomes among older adults. Overweight and obesity are associated with increased outpatient HRU and, among obese individuals, with decreased ER visits. These findings suggest that BMI and diet quality beyond age 74 years continue to affect HRU measures.
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Affiliation(s)
- Dara W. Ford
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802
| | - Terryl J. Hartman
- 1518 Clifton Road NE, CNR #3035, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Christopher Still
- 100 N Academy Ave, Geisinger Obesity Institute, Geisinger Health System, Danville, PA 17882
| | - Craig Wood
- 100 N Academy Ave, Geisinger Obesity Institute, Geisinger Health System, Danville, PA 17882
| | - Diane C. Mitchell
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802
| | - Regan Bailey
- Office of Dietary Supplements, NIH, Rockville, MD 20892
| | - Helen Smiciklas-Wright
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802
| | - Donna L. Coffman
- The Methodology Center, The Pennsylvania State University, 204 E. Calder Way, Ste. 400, State College, PA 16801
| | - Gordon L. Jensen
- 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802
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Corkins MR, Guenter P, DiMaria-Ghalili RA, Jensen GL, Malone A, Miller S, Patel V, Plogsted S, Resnick HE. A.S.P.E.N. data brief 2014: use of enteral and parenteral nutrition in hospitalized patients with a diagnosis of malnutrition: United States, 2010. Nutr Clin Pract 2014; 29:698-700. [PMID: 25135335 DOI: 10.1177/0884533614543834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Mark R Corkins
- University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland
| | | | - Gordon L Jensen
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
| | | | - Sarah Miller
- Skaggs College of Pharmacy, University of Montana, Missoula, Montana
| | - Vihas Patel
- Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Helaine E Resnick
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland
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Affiliation(s)
- Gordon L. Jensen
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania
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Hsiao PY, Mitchell DC, Wood GC, Jensen GL, Still CD, Hartman TJ. The association of dietary patterns and weight change in rural older adults 75 years and older. J Nutr Gerontol Geriatr 2014; 33:357-375. [PMID: 25424511 DOI: 10.1080/21551197.2014.959681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Little is known about the relationship between weight change and dietary patterns (DP) in older adults, especially in those of advanced age (≥ 75 years). We examined the association of DP with obesity and five-year weight change in community-dwelling older adults (n = 270; mean ± SD age: 78.6 ± 3.9 years). Dietary data were collected from four, random, 24-hour dietary recalls over a 10-month period. Weight change was examined as: (1) 10-pound weight loss; (2) 10-pound weight gain; (3) 10% weight loss; and (4) 10% weight gain. Cluster analysis was used to derive 3 DP ("Health-conscious," "Sweets and dairy," and "Western"). Kaplan-Meier plots and Cox proportional hazards regression models were used. About 39% of participants lost at least 10 pounds during follow up. In the unadjusted model, five-year weight loss was not associated with dietary pattern. However, when stratified by gender, females who were characterized by the Sweets and Dairy and the Western DP were three and two times more likely to lose 10 pounds, respectively, compared to those in the Health-conscious DP (P < 0.05). These observations suggest that it is appropriate to recommend a Health-conscious DP for women 75 years and older who may be at risk for weight loss.
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Affiliation(s)
- Pao Ying Hsiao
- a Department of Food and Nutrition , Indiana University of Pennsylvania , Indiana , Pennsylvania , USA
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Ford DW, Jensen GL, Still C, Wood C, Mitchell DC, Erickson P, Bailey R, Smiciklas-Wright H, Coffman DL, Hartman TJ. The associations between diet quality, Body Mass Index (BMI) and Health and Activity Limitation Index (HALex) in the Geisinger Rural Aging Study (GRAS). J Nutr Health Aging 2014; 18:167-70. [PMID: 24522469 PMCID: PMC4550808 DOI: 10.1007/s12603-014-0016-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the associations between diet quality, body mass index (BMI), and health-related quality of life (HRQOL) as assessed by the health and activity limitation index (HALex) in older adults. DESIGN Multivariate linear regression models were used to analyze associations between Dietary Screening Tool (DST) scores, BMI and HALex score, after controlling for gender, age, education, living situation, smoking, disease burden and self-vs. proxy reporting. SETTING Geisinger Rural Aging Study, Pennsylvania. PARTICIPANTS 5,993 GRAS participants were mailed HRQOL and DST questionnaires with 4,009 (1,722 male, 2,287 female; mean age 81.5 ± 4.4) providing complete data. RESULTS HALex scores were significantly lower for participants with dietary intakes categorized as unhealthy (<60) (0.70, 95% CI 0.69, 0.72, p<0.05) or borderline (60-75) (0.71, 95% CI 0.70, 0.73, p<0.05) compared to those scoring in the healthy range (>75) (0.75, 95% CI 0.73, 0.77) based on DST scores. HALex scores were significantly lower for underweight (0.67, 95% CI 0.63, 0.72, p<0.05), obese class II (0.68, 95% CI 0.66, 0.71, p<0.05) and class III participants (0.62 95% CI 0.57, 0.67, p<0.05) compared to those with BMI 18.5-24.9. CONCLUSIONS Poor diet quality, as assessed by the DST, is associated with lower HRQOL in adults ≥ 74 years of age.
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Affiliation(s)
- D W Ford
- Dara W. Ford, 110 Chandlee Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania 16802, USA,
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Nicolo M, Compher CW, Still C, Huseini M, Dayton S, Jensen GL. Feasibility of Accessing Data in Hospitalized Patients to Support Diagnosis of Malnutrition by the Academy-A.S.P.E.N. Malnutrition Consensus Recommended Clinical Characteristics. JPEN J Parenter Enteral Nutr 2013; 38:954-9. [DOI: 10.1177/0148607113514613] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Michele Nicolo
- Hospital of the University of Pennsylvania, Philadelphia
| | - Charlene W. Compher
- Hospital of the University of Pennsylvania, Philadelphia
- University of Pennsylvania, Philadelphia
| | | | | | - Sarah Dayton
- Geisinger Medical Center, Danville, Pennsylvania
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Ford DW, Jensen GL, Hartman TJ, Wray L, Smiciklas-Wright H. Association between dietary quality and mortality in older adults: a review of the epidemiological evidence. J Nutr Gerontol Geriatr 2013; 32:85-105. [PMID: 23663210 DOI: 10.1080/21551197.2013.779622] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The population is aging worldwide. Delayed mortality is associated with an increased burden of chronic health conditions, many of which have a dietary component. A literature search was conducted to retrieve and review relevant articles considering quality of diets in association with mortality in older adults aged 60 years and older. In the studies we reviewed, diet quality defined using either a priori methods, which characterize dietary patterns based on existing dietary guidelines, or a posteriori methods, which define dietary patterns through statistical methods met review criteria. Sixteen articles met criteria for review. Generally, dietary patterns that demonstrated greater adherence to diets that emphasized whole fruits and vegetables, whole grains, low-fat dairy, lean meats, and legumes and nuts were inversely associated with mortality. However, a priori methods have not yet demonstrated associations between diet and mortality in older adults in the United States. Development of new methods based on regional variations in dietary intake may offer the best approach to assess associations with mortality.
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Affiliation(s)
- Dara Wheeler Ford
- Department of Nutritional Science, The Pennsylvania State University, University Park, PA 16802, USA.
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Corkins MR, Guenter P, DiMaria-Ghalili RA, Jensen GL, Malone A, Miller S, Patel V, Plogsted S, Resnick HE. Malnutrition diagnoses in hospitalized patients: United States, 2010. JPEN J Parenter Enteral Nutr 2013; 38:186-95. [PMID: 24247093 DOI: 10.1177/0148607113512154] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Malnutrition is common among hospitalized patients in the United States, and its coded prevalence is increasing. Malnutrition is known to be associated with increased morbidity, mortality and healthcare costs. Although national data indicate that the number of malnutrition diagnoses among hospital discharges has been steadily rising, an in-depth examination of the demographic and clinical characteristics of these patients has not been conducted. We examined data from the 2010 Healthcare Cost and Utilization Project (HCUP), the most recent nationally-representative data describing U.S. hospital discharges. Using ICD-9 codes, we constructed a composite variable indicating a diagnosis of malnutrition. Based on our definition, 3.2% of all U.S. hospital discharges in 2010 had this diagnosis. Relative to patients without a malnutrition diagnosis, those with the diagnosis were older, had longer lengths of stay and incurred higher costs. These patients were more likely to have 27 of 29 comorbidities assessed in HCUP. Finally, discharge to home care was twice as common among malnourished patients, and a discharge of death was more than 5 times as common among patients with a malnutrition diagnosis. Taken together, these nationally representative, cross-sectional data indicate that hospitalized patients discharged with a diagnosis of malnutrition are older and sicker and their inpatient care is more expensive than their counterparts without this diagnosis.
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Affiliation(s)
- Mark R Corkins
- University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, Tennessee
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Jensen GL, Compher C, Sullivan DH, Mullin GE. Recognizing malnutrition in adults: definitions and characteristics, screening, assessment, and team approach. JPEN J Parenter Enteral Nutr 2013; 37:802-7. [PMID: 23969411 DOI: 10.1177/0148607113492338] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Appropriate recognition of malnutrition in adults requires knowledge of screening and assessment methodologies. An appreciation for the contributions of inflammation has resulted in a new etiology-based approach to defining malnutrition syndromes. The Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) have published a consensus document that extends this approach to describe characteristics for the identification and documentation of malnutrition in adults. Nutrition screening tools are used to identify patients at nutrition risk and those who are likely to benefit from further assessment and intervention. Nutrition assessment serves to guide appropriate intervention. A systematic approach to nutrition assessment that supports the new diagnostic scheme and criteria from the Academy and A.S.P.E.N. has recently been presented. Since screening delays and failures in the diagnosis and management of malnutrition are all too common, a multidisciplinary team approach is recommended to promote improved communication and quality of care.
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Affiliation(s)
- Gordon L Jensen
- Department of Nutritional Sciences, Pennsylvania State University, University Park
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