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Agarwal S, Sharma S, Grover I, Singh N, Ahmed S, Saraya A. Longitudinal changes in bone mineral density may be associated with long-term survival in patients with cirrhosis: A proof of concept of study. Indian J Gastroenterol 2024:10.1007/s12664-023-01504-y. [PMID: 38619809 DOI: 10.1007/s12664-023-01504-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/11/2023] [Indexed: 04/16/2024]
Abstract
INTRODUCTION The impact of longitudinal changes in different body components measured via body composition analysis (BCA) on liver-related outcomes in patients with cirrhosis is poorly understood. We evaluated the prognostic relevance of longitudinal changes in body composition over one year in patients with cirrhosis. METHODS This was a follow-up study of a randomized controlled trial evaluating changes in bone density measured via dual energy X-ray absorptiometry (DEXA) upon vitamin D supplementation. Patients with available anthropometric indices, fat mass (FM), fat-free mass (FFM), bone-density at lumbar spine (LD) and left femur-neck (FD) (assessed by T score) at two time points one year apart were assessed for outcomes. The prognostic relevance of change in parameters such as ΔFM, ΔFFM, ΔLD and ΔFD over one year was assessed and compared with baseline model for end-stage liver disease (MELD) score. RESULTS Patients with cirrhosis (n=112) (mean age 41.8±12 years, 58.5% males) were followed up for median duration of 5.7 years interquartile range [IQR 3.5-5.7], with five-year survival rate of 77%. On serial BCA, ΔLD (p=0.029) and ΔFD (p=0.003) emerged as significant predictors of survival, whereas ΔFM (p=0.479), ΔFFM (p=0.245) and ΔBMI (p=0.949) were not. The area under curve of ΔLD and MELD score for predicting survival was 0.636 (0.5-0.773) and 0.664 (0.555-0.773), respectively. ΔFD<0.1 over one year had sensitivity and specificity of 70.4% and 56.5% to predict poor survival. The combination of ΔFD, MELD and ascites predicted five-year survival with an optimism-corrected c-statistic of 0.785. CONCLUSION Among body composition parameters, changes in bone mineral density correlate best with survival and have prognostic relevance similar to that of ascites and MELD score.
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Affiliation(s)
- Samagra Agarwal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Sanchit Sharma
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Indu Grover
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Namrata Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Syed Ahmed
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Anoop Saraya
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India.
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Grover I, Gunjan D, Singh N, Gopi S, Sati HC, Sachdev V, Saraya A. Kitchen-based diet versus commercial polymeric formulation in acute pancreatitis: a pilot randomized comparative study. Eur J Clin Nutr 2024; 78:328-334. [PMID: 38243059 DOI: 10.1038/s41430-024-01400-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Nutrition plays an important role in management of acute pancreatitis (AP) and decreases its severity and infectious complications. Various formulations of enteral nutrition (EN) are available and are costly. For developing countries, cost and availability is a major issue and kitchen-based diet should be explored in patients with AP. AIM Comparison of kitchen-based diet with a commercially available polymeric formulation in terms of various outcomes in patients with AP within 14 days after the onset of pain. METHODS Sixty patients (39 male, mean age 36.1 ± 12.7 years) of moderately severe and severe AP of any etiology were randomized (30 in each group) to either kitchen-based diet or commercial polymeric formulation group. Outcome measures were refeeding pain, tolerability, infectious complications, mortality, total hospital/intensive care unit stay; and change in serum C-reactive protein (CRP), transferrin and pre albumin. RESULTS There was no significant difference in baseline demographic and biochemical parameters in both groups. No difference was observed in refeeding pain (7.1% vs 8%, p = 0.99), tolerability (28.6% vs 12%, p = 0.17), infectious complications (57.14% vs 36%, p = 0.12), mortality (31.7% vs 20%, p = 0.69), hospital stay (19.5 vs 23.5 days, p = 0.86), CRP (74.4 vs 59 mg/L, p = 0.97), transferrin levels (23.6 vs 25.6 mg/dL, p = 0.75) and pre albumin (9.45 vs 13.09 mg/dL, p = 0.68) in both groups. CONCLUSION Kitchen-based diet is comparable to commercial polymeric formulation for the early initiation of enteral nutrition in patients with severe or moderately severe acute pancreatitis. CLINICAL TRIAL REGISTRATION Trial registered with the Clinical Trials registry-India (CTRI/2018/01/011188).
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Affiliation(s)
- Indu Grover
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Srikanth Gopi
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Hem Chandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Sachdev
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Saraya
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.
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Grover I, Singh N, Gunjan D, Benjamin J, Ramakrishnan L, Pandey R, Sati HC, Saraya A. Vitamin D status & bone health in patients with liver cirrhosis. Indian J Med Res 2023; 158:284-291. [PMID: 37815065 PMCID: PMC10720958 DOI: 10.4103/ijmr.ijmr_1144_20] [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: 04/11/2020] [Indexed: 10/11/2023] Open
Abstract
Background & objectives Vitamin D plays an important role in bone metabolism, and liver is the intermediary site of vitamin D metabolism. The purpose of this study was to study the prevalence of vitamin D deficiency and bone health in patients with cirrhosis. Methods Prospectively, serum 25-hydroxy vitamin D [25(OH)D] level were assessed in cirrhotics by chemiluminescence method. Endocrine Society Clinical practice guideline was used to define deficiency and insufficiency of vitamin D. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry and the World Health Organization criteria was used to define osteoporosis and osteopenia. The lowest T score at the left hip neck or lumbar spine was taken as osteoporosis or osteopenia. The Child-Turcotte-Pugh score was used to assess the severity of cirrhosis. Results Cirrhotics (n=350, male: 278, compensated: 210) were included. Mean serum 25(OH)D level was 8.75 ng/ml. The prevalence of vitamin D deficiency (VDD) and low-BMD (osteopenia and osteoporosis) was 89.4 and 86 per cent, respectively. VDD, insufficiency and osteoporosis was found in 86.7, 11.9 and 33.8 per cent, respectively, in patients with compensated cirrhosis; and 93.6, 3.6 and 40 per cent, respectively, in patients with decompensated cirrhosis. Body mass index of >25 kg/m2 was protective for bone health. Interpretation & conclusions VDD and low-BMD is prevalent in Indian patients with cirrhosis and should be looked for in patients with cirrhosis for its prevention.
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Affiliation(s)
- Indu Grover
- Department of Gastroenterology & Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Singh
- Department of Gastroenterology & Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology & Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Jaya Benjamin
- Department of Clinical Nutrition, Institute of liver & Biliary Sciences, New Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - R.M. Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Hem Chandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Saraya
- Department of Gastroenterology & Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
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Grover I, Gunjan D, Singh N, Saraya A. Response to Medda et al. Am J Gastroenterol 2022; 117:814. [PMID: 35311798 DOI: 10.14309/ajg.0000000000001715] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Indu Grover
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
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Grover I, Singh N, Gunjan D, Pandey RM, Chandra Sati H, Saraya A. Comparison of Anthropometry, Bioelectrical Impedance, and Dual-energy X-ray Absorptiometry for Body Composition in Cirrhosis. J Clin Exp Hepatol 2022; 12:467-474. [PMID: 35535105 PMCID: PMC9077186 DOI: 10.1016/j.jceh.2021.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/29/2021] [Indexed: 12/12/2022] Open
Abstract
Background & aims This study was planned to evaluate triceps skinfold thickness (TSFT), mid-arm muscle circumference (MAMC) and bioelectrical impedance analysis (BIA) for assessing body composition using dual-energy X-ray absorptiometry (DEXA) (reference) and to predict fat mass (FM) and fat-free mass (FFM) in patients with cirrhosis. Methods FM and FFM were assessed by using DEXA and BIA. Skin-fold calliper was used for measuring TSFT, and MAMC was calculated. Bland-Altman plot was used to determine agreement and linear regression analysis for obtaining equations to predict FM and FFM. Results Patients with cirrhosis (n = 302, 241 male, age 43.7 ± 12.0 years) were included. Bland-Altman plot showed very good agreement between BIA and DEXA for the estimation of FM and FFM. Majority of patients were within the limit of agreement: FM (98%) and FFM (96.4%). BIA shows a positive correlation with DEXA:FM (r = 0.73, P ≤ 0.001) and FFM (r = 0.86, P ≤ 0.001). DEXA (FM and FFM) shows a positive correlation with TSFT (r = 0.69, P ≤ 0.01) and MAMC (r = 0.61, P ≤ 0.01). The mean difference between the observed and predicted value of FM and FFM by BIA in the developmental set was 0.01 and 0.05, respectively; whereas in the validation set, it was -0.13 and 0.86, respectively. The mean difference between the observed and predicted value of TSFT and MAMC in the developmental set was 0.43 and 0.07; whereas, in the validation set, it was 0.16 and 0.48, respectively. Conclusion Anthropometry (TSFT and MAMC) and BIA are simple and easy to use and can be a substitute of DEXA for FM and FFM assessment in routine clinical settings in patients with cirrhosis.
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Key Words
- ALP, alkaline phosphatise
- ALT, alanine aminotransferase
- ANA, anti-nuclear antibody
- ASMA, anti-smooth muscle antibody
- AST, aspartate aminotransferase
- BIA, bioelectrical impedance analysis
- BMC, bone mineral content
- BMI, body mass index
- CTP, Child–Turcotte–Pugh score
- DEXA, dual-energy X-ray absorptiometry
- FFM, fat-free mass
- FM, fat mass
- HBsAg, hepatitis B surface antigen
- MAMC, mid-arm muscle circumference
- TSFT, triceps skinfold thickness
- anthropometric measurements
- anti-HCV, anti-hepatitis C virus
- anti-LKM1, anti-liver kidney microsomal antibody type 1
- bioelectrical impedance analysis
- cirrhosis
- dual-energy X-ray absorptiometry
- nutritional assessment
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Affiliation(s)
- Indu Grover
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, N. Delhi, India
| | - Namrata Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, N. Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, N. Delhi, India
| | - Ravindra M. Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, N. Delhi, India
| | - Hem Chandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, N. Delhi, India
| | - Anoop Saraya
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, N. Delhi, India,Address for correspondence: Anoop Saraya, Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, N. Delhi, India.
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Affiliation(s)
- Renu Kumari
- Department of Home Science Extension Education, College of Home Science, CCS, Haryana Agricultural University , Hisar 125 004, Haryana, India
| | - Indu Grover
- Department of Home Science Extension Education, College of Home Science, CCS, Haryana Agricultural University , Hisar 125 004, Haryana, India
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Grover I, Reed W, Neuman T. The SANDHOG criteria and its validation for the diagnosis of DCS arising from bounce diving. Undersea Hyperb Med 2007; 34:199-210. [PMID: 17672176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE A three-point scale, the SANDHOG (SAN Diego Diving and Hyperbaric Organizations) criteria, was developed to diagnose DCS (decompression sickness), and then it was validated against a known database of diving related injuries. INTRODUCTION There are currently no universally accepted diagnostic criteria for the diagnosis of DCS. The SANDHOG criteria were developed to address the need for a case definition of DCS. METHODS A point scale and entrance criteria were developed for the diagnosis of DCS. Once the entrance criterion had been met, points were awarded based upon the diver's symptoms and their time of onset. The point system and time limits (SANDHOG criteria) were determined based upon US Navy and Royal Canadian diving reports. The SANDHOG criteria were then applied on a post hoc basis to the Duke Hyperbaric database of diving injuries. Sensitivity and specificity were then calculated using three points as the cut off. The ROC (receiver operating characteristic) analysis was performed to determine the area under the curve (AUC). RESULTS The three point SANDHOG criteria had a specificity of 90.3% and a sensitivity of 52.7%. ROC analysis of the original SANDHOG criteria gave an AUC of 0.72. Using different point values for the diagnosis of DCS will subsequently affect the sensitivity and specificity of the SANDHOG criteria. CONCLUSIONS The specificity of the SANDHOG criteria is good, and demonstrates that the SANDHOG criteria are a useful tool for the diagnosis of DCS.
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Affiliation(s)
- I Grover
- Hyperbaric Medicine Department, UCSD Medical Center, San Diego, CA 92103, USA
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Abstract
Part one of this two-part review described the advantages and limitations of quantitative structure-property relationships (QSPR), and offered an overview of the components involved in the development of correlations1. Part two provides a discussion of a few notable examples of relationships with organoleptic, physicochemical and pharmaceutical properties.
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Affiliation(s)
- I Grover
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh 160 014, India
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Sethi S, Mehta U, Grover I. Perception of nutritional constraints and correlates by rural Haryana women. Ecol Food Nutr 1992. [DOI: 10.1080/03670244.1992.9991273] [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: 10/19/2022]
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