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Chang D, Gupta VK, Hur B, Cobo-López S, Cunningham KY, Han NS, Lee I, Kronzer VL, Teigen LM, Karnatovskaia LV, Longbrake EE, Davis JM, Nelson H, Sung J. Gut Microbiome Wellness Index 2 for Enhanced Health Status Prediction from Gut Microbiome Taxonomic Profiles. bioRxiv 2023:2023.09.30.560294. [PMID: 37873265 PMCID: PMC10592848 DOI: 10.1101/2023.09.30.560294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Recent advancements in human gut microbiome research have revealed its crucial role in shaping innovative predictive healthcare applications. We introduce Gut Microbiome Wellness Index 2 (GMWI2), an advanced iteration of our original GMWI prototype, designed as a robust, disease-agnostic health status indicator based on gut microbiome taxonomic profiles. Our analysis involved pooling existing 8069 stool shotgun metagenome data across a global demographic landscape to effectively capture biological signals linking gut taxonomies to health. GMWI2 achieves a cross-validation balanced accuracy of 80% in distinguishing healthy (no disease) from non-healthy (diseased) individuals and surpasses 90% accuracy for samples with higher confidence (i.e., outside the "reject option"). The enhanced classification accuracy of GMWI2 outperforms both the original GMWI model and traditional species-level α-diversity indices, suggesting a more reliable tool for differentiating between healthy and non-healthy phenotypes using gut microbiome data. Furthermore, by reevaluating and reinterpreting previously published data, GMWI2 provides fresh insights into the established understanding of how diet, antibiotic exposure, and fecal microbiota transplantation influence gut health. Looking ahead, GMWI2 represents a timely pivotal tool for evaluating health based on an individual's unique gut microbial composition, paving the way for the early screening of adverse gut health shifts. GMWI2 is offered as an open-source command-line tool, ensuring it is both accessible to and adaptable for researchers interested in the translational applications of human gut microbiome science.
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Affiliation(s)
- Daniel Chang
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Vinod K Gupta
- Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Division of Surgery Research, Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin Hur
- Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Division of Surgery Research, Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Sergio Cobo-López
- Viral Information Institute, San Diego State University, San Diego, CA 92182, USA
| | - Kevin Y Cunningham
- Bioinformatics and Computational Biology Program, University of Minnesota, Minneapolis, MN 55455, USA
| | - Nam Soo Han
- Brain Korea 21 Center for Bio-Health Industry, Department of Food Science and Biotechnology, Chungbuk National University, Cheongju, South Korea
| | - Insuk Lee
- Department of Biotechnology, Yonsei University, Seoul 03722, South Korea
| | - Vanessa L Kronzer
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Levi M Teigen
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN 55108, USA
| | | | - Erin E Longbrake
- Department of Neurology, Yale University, New Haven, CT 06510, USA
| | - John M Davis
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Heidi Nelson
- Emeritus, Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Jaeyun Sung
- Microbiome Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Division of Surgery Research, Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Thul J, Pruett TL, Teigen LM. CT-derived psoas muscle area and density are associated with length of stay and discharge disposition after liver transplantation. Clin Nutr ESPEN 2023; 55:434-439. [PMID: 37202080 DOI: 10.1016/j.clnesp.2023.04.028] [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: 04/18/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND & AIMS Prolonged length of stay (LOS) and discharge disposition following liver transplantation are associated with postoperative complications and increased healthcare utilization. This study evaluated the relationship between CT-derived psoas muscle measurements and hospital LOS, intensive care unit (ICU) LOS, and discharge disposition after liver transplant. The psoas muscle was chosen given its ease of measurement with any radiological software. A secondary analysis assessed the relationship between the American Society for Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics (ASPEN/AND) malnutrition diagnosis criteria and CT-derived psoas muscle measures. METHODS CT-derived measures of psoas muscle density (mHU) and cross-sectional area at the level of the third lumbar vertebrae were obtained from preoperative CT scans of liver transplant recipients. Cross-sectional area measures were corrected for body size to generate a psoas area index variable (cm2/m2; PAI). RESULTS Each 1-unit increase in PAI was associated with a reduced hospital LOS of 4 days (R2 = 0.07). Each 5-unit increase in mean Hounsfield units (mHU) was associated with a reduced hospital and ICU LOS of 5 and 1.6 days, respectively (R2 = 0.22 and 0.14, respectively). Mean PAI and mHU were higher in patients who discharged to home. PAI was reasonably identified through ASPEN/AND malnutrition criteria, but there was no difference in mHU between those with and without malnutrition. CONCLUSION Measures of psoas density were associated with both hospital and ICU LOS and discharge disposition. PAI was associated with hospital LOS and discharge disposition. CT-derived measures of psoas density may be a valuable complement to preoperative liver transplant nutrition assessment using traditional ASPEN/AND malnutrition criteria.
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Affiliation(s)
- Jessica Thul
- MHealth Fairview, University of Minnesota Medical Center, Minneapolis, MN, 55455, USA.
| | - Timothy L Pruett
- Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - Levi M Teigen
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN, 55108, USA.
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Grunvald E, Shah R, Hernaez R, Chandar AK, Pickett-Blakely O, Teigen LM, Harindhanavudhi T, Sultan S, Singh S, Davitkov P. AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity. Gastroenterology 2022; 163:1198-1225. [PMID: 36273831 DOI: 10.1053/j.gastro.2022.08.045] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND & AIMS Pharmacological management of obesity improves outcomes and decreases the risk of obesity-related complications. This American Gastroenterological Association guideline is intended to support practitioners in decisions about pharmacological interventions for overweight and obesity. METHODS A multidisciplinary panel of content experts and guideline methodologists used the Grading of Recommendations Assessment, Development and Evaluation framework to prioritize clinical questions, identify patient-centered outcomes, and conduct an evidence synthesis of the following agents: semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate extended-release (ER), naltrexone-bupropion ER, orlistat, phentermine, diethylpropion, and Gelesis100 oral superabsorbent hydrogel. The guideline panel used the evidence-to-decision framework to develop recommendations for the pharmacological management of obesity and provided implementation considerations for clinical practice. RESULTS The guideline panel made 9 recommendations. The panel strongly recommended the use of pharmacotherapy in addition to lifestyle intervention in adults with overweight and obesity (body mass index ≥30 kg/m2, or ≥27 kg/m2 with weight-related complications) who have an inadequate response to lifestyle interventions. The panel suggested the use of semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER (based on moderate certainty evidence), and phentermine and diethylpropion (based on low certainty evidence), for long-term management of overweight and obesity. The guideline panel suggested against the use of orlistat. The panel identified the use of Gelesis100 oral superabsorbent hydrogel as a knowledge gap. CONCLUSIONS In adults with overweight and obesity who have an inadequate response to lifestyle interventions alone, long-term pharmacological therapy is recommended, with multiple effective and safe treatment options.
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Affiliation(s)
- Eduardo Grunvald
- Department of Medicine, University of California San Diego, La Jolla, California.
| | - Raj Shah
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruben Hernaez
- Division of Gastroenterology and Hepatology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Division of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Octavia Pickett-Blakely
- Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Levi M Teigen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Tasma Harindhanavudhi
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Siddharth Singh
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Perica Davitkov
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Division of Gastroenterology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
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Nagel EM, Hickey M, Teigen LM, Kuchnia A, Schifsky H, Holm T, Earthman CP, Demerath E, Ramel SE. Ultrasound measurements of abdominal muscle thickness are associated with postmenstrual age at full oral feedings in preterm infants: A preliminary study. Nutr Clin Pract 2021; 36:1207-1214. [PMID: 34101241 DOI: 10.1002/ncp.10670] [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: 07/14/2020] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A premature infant's discharge from the neonatal intensive care unit (NICU) is dependent on factors such as respiratory stability, adequate growth, and the ability to consume oral feeds. Once infants have achieved respiratory stability, a tool that can better predict age at discharge is desirable. Thus, we conducted a secondary data analysis to assess the association between ultrasound measurements of abdominal muscle thickness and postmenstrual age (PMA) at full oral feedings. METHODS Forty-nine (n = 49) healthy, premature infants (mean gestational age = 32 weeks) were recruited from the NICU. Anthropometric measurements and ultrasound measurements of the rectus abdominis were conducted when infants were medically stable. Fat-free mass (FFM) was obtained using air displacement plethysmography. The relationship between ultrasound measurements of muscle thickness and PMA at full oral feedings was assessed using linear regression analysis. The relationship between FFM z-scores and PMA at full oral feedings was also assessed for comparison. RESULTS When adjusting for gestational age at birth, PMA at measurement, days of positive pressure respiratory support, weight, and length, ultrasound measurements of abdominal muscle thickness were independently, negatively associated with PMA at full oral feedings (β estimate: -0.71, P = .03). CONCLUSION Preliminary results suggest infants with greater abdominal muscle thickness may reach full oral feedings at an earlier PMA (nearly 1 week per millimeter). Thus, ultrasound measurements of abdominal muscle thickness may be helpful in assessing readiness for discharge in healthy preterm infants. Further research is needed for development and validation of a prediction equation.
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Affiliation(s)
- Emily M Nagel
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA.,School of Public Health, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Marie Hickey
- Department of Pediatrics, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Levi M Teigen
- Department of Gastroenterology, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Adam Kuchnia
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Holly Schifsky
- Department of Pediatrics, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Tara Holm
- Department of Radiology, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Carrie P Earthman
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
| | - Ellen Demerath
- School of Public Health, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Sara E Ramel
- Department of Pediatrics, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
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5
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Muniraj T, Day LW, Teigen LM, Ho EY, Sultan S, Davitkov P, Shah R, Murad MH. AGA Clinical Practice Guidelines on Intragastric Balloons in the Management of Obesity. Gastroenterology 2021; 160:1799-1808. [PMID: 33832655 DOI: 10.1053/j.gastro.2021.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 12/13/2022]
Affiliation(s)
- Thiruvengadam Muniraj
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California
| | - Levi M Teigen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Edith Y Ho
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Perica Davitkov
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Veterans Affairs, Northeast Ohio Healthcare System, Cleveland, Ohio
| | - Raj Shah
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Veterans Affairs, Northeast Ohio Healthcare System, Cleveland, Ohio; University Hospitals Cleveland Medical Center Cleveland, Ohio
| | - M Hassan Murad
- Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
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Hurt RT, Ebbert JO, Croghan I, Nanda S, Schroeder DR, Teigen LM, Velapati SR, Mundi MS. The Comparison of Segmental Multifrequency Bioelectrical Impedance Analysis and Dual-Energy X-ray Absorptiometry for Estimating Fat Free Mass and Percentage Body Fat in an Ambulatory Population. JPEN J Parenter Enteral Nutr 2020; 45:1231-1238. [PMID: 32794583 DOI: 10.1002/jpen.1994] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 03/03/2020] [Accepted: 08/07/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite malnutrition being associated with increased mortality and morbidity, there continues to be great difficulty in defining criteria and implementing widespread screening. Tools used to diagnose decreased fat-free mass (FFM [sarcopenia]) should be easy to use, relatively inexpensive, and safe. Bioelectrical impedance analysis (BIA) has the potential to meet these criteria, but reliability across body mass index (BMI) classes is a concern. METHODS A total of 176 healthy ambulatory participants (aged 18-65 years) were recruited equally (n = 44) in 4 BMI categories: (1) 18.5-24.9, (2) 25.0-29.9, (3) 30-34.9, and (4) ≥35.0. Participants were fasting overnight and had S-MFBIA (InBody 770) measurements the next morning, with DXA being performed subsequently within 30 minutes. RESULTS The measurement (mean ± SD) for FFM with DXA was 52.8 ± 11.0, and BIA was 53.6 ± 11.0. Delta (S-MFBIA vs DXA) was 0.8 ± 2.2 (5% limits of agreement -3.5 to +5.2), and concordance correlation coefficient (CCC) was 0.98 (95% CI, 0.97-0.98). The measurements (mean ± SD) for PBF with DXA was 37.5 ± 10.6% and S-MFBIA was 36.6 ± 11.3%. Delta (S-MFBIA vs DXA) was -0.9 ± 2.6 (5% limits of agreement 6.0 to +4.2), and CCC was 0.97 (95% CI, 0.96-0.98). The CCC according to the 4 BMI groups for FFM and PBF was between 0.96-0.98 and 0.90-0.94, respectively. CONCLUSIONS FFM and PBF measured by S-MFBIA had good agreement with DXA across all BMI categories measured in the current study of ambulatory participants.
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Affiliation(s)
- Ryan T Hurt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jon O Ebbert
- Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ivana Croghan
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjeev Nanda
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Levi M Teigen
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Saketh R Velapati
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
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Teigen LM, Johnson AJ, Shmidt E, Vaughn BP. Use of Exclusive Enteral Formula Diet as Adjunctive Therapy for Treatment of a Crohn's Disease Flare. Crohns Colitis 360 2020; 2:otaa006. [PMID: 36798884 PMCID: PMC9927819 DOI: 10.1093/crocol/otaa006] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction We report the case of an adult patient who achieved remission of a Crohn's disease flare after treatment with exclusive enteral nutrition as adjunctive therapy to medication. Case Report A 46-year-old man with severe, stricturing Crohn's presented for severe abdominal pain and weight loss; estimated Crohn's Disease Activity Index score greater than 300. Antibiotics, vedolizumab, budesonide, and exclusive enteral nutrition diet were instituted. Approximately 30 days later, his Crohn's Disease Activity Index score improved to 170. Discussion This case illustrates the possible utility of an exclusive enteral formula diet as an adjunct to medication to induce remission of a Crohn's disease flare.
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Affiliation(s)
- Levi M Teigen
- Address correspondence to: Levi M. Teigen, PhD, RD, 420 Delaware St SE, MMC 36, Minneapolis, MN 55455 ()
| | - Abigail J Johnson
- BioTechnology Institute, University of Minnesota, St. Paul, Minnesota, USA
| | - Eugenia Shmidt
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Byron P Vaughn
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
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8
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McCarter SJ, Teigen LM, McCarter AR, Benarroch EE, St Louis EK, Savica R. Low Vitamin B12 and Parkinson Disease: Potential Link to Reduced Cholinergic Transmission and Severity of Disease. Mayo Clin Proc 2019; 94:757-762. [PMID: 31054604 DOI: 10.1016/j.mayocp.2019.01.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/07/2018] [Accepted: 01/23/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Stuart J McCarter
- Mayo Clinic Department of Neurology, Rochester, MN; Mayo Clinic Department of Sleep Medicine, Rochester, MN.
| | - Levi M Teigen
- Mayo Clinic Department of Nutrition, Rochester, MN; Department of Medicine, Minneapolis, MN
| | - Allison R McCarter
- Mayo Clinic Department of Sleep Medicine, Rochester, MN; University of Minnesota Medical School, Minneapolis, MN
| | | | - Erik K St Louis
- Mayo Clinic Department of Neurology, Rochester, MN; Mayo Clinic Department of Sleep Medicine, Rochester, MN; Mayo Clinic Department of Medicine, Rochester, MN
| | - Rodolfo Savica
- Mayo Clinic Department of Neurology, Rochester, MN; Mayo Clinic Department of Health Sciences Research, Rochester, MN
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Teigen LM, Kuchnia AJ, Nagel EM, Price KL, Hurt RT, Earthman CP. Diagnosing clinical malnutrition: Perspectives from the past and implications for the future. Clin Nutr ESPEN 2018; 26:13-20. [PMID: 29908677 DOI: 10.1016/j.clnesp.2018.05.006] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/30/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022]
Abstract
This review, intended for both researchers and clinicians, provides a history of the definition of clinical malnutrition. Despite global efforts, we remain without one clear, objective, internationally accepted definition; clarity in this regard will ultimately improve our evaluation and monitoring of nutritional status to achieve optimal patient outcomes. In this review we explore the development of the term malnutrition and its diagnosis and application in the setting of acute and chronic disease. We begin in the second century A.D. with the work of the Greek physician Galen who is credited as the first to apply the term marasmus to characterize three categories of malnutrition, which are surprisingly similar to components of current international definitions. We then highlight significant developments over the next 2000 years culminating in our current application of the clinical diagnosis of malnutrition. A perspective on historical practices may inform current efforts toward a global definition and diagnosis of malnutrition.
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Affiliation(s)
- Levi M Teigen
- Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA; Department of Clinical Dietetics, Mayo Clinic, Rochester, MN, USA.
| | - Adam J Kuchnia
- Department of Nutritional Science, University of Wisconsin-Madison, Madison, WI, USA
| | - Emily M Nagel
- Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - Kathleen L Price
- Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - Ryan T Hurt
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Carrie P Earthman
- Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
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10
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Teigen LM, Kuchnia AJ, Nagel E, Deuth C, Vock DM, Mulasi U, Earthman CP. Impact of Software Selection and ImageJ Tutorial Corrigendum on Skeletal Muscle Measures at the Third Lumbar Vertebra on Computed Tomography Scans in Clinical Populations. JPEN J Parenter Enteral Nutr 2017; 42:933-941. [DOI: 10.1002/jpen.1036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/11/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Levi M. Teigen
- Department of Food Science and Nutrition; University of Minnesota-Twin Cities; Minneapolis Minnesota USA
| | - Adam J. Kuchnia
- Department of Food Science and Nutrition; University of Minnesota-Twin Cities; Minneapolis Minnesota USA
| | - Emily Nagel
- Department of Food Science and Nutrition; University of Minnesota-Twin Cities; Minneapolis Minnesota USA
| | - Christopher Deuth
- Department of Food Science and Nutrition; University of Minnesota-Twin Cities; Minneapolis Minnesota USA
| | - David M. Vock
- Division of Biostatistics; University of Minnesota-Twin Cities; Minneapolis Minnesota USA
| | - Urvashi Mulasi
- Department of Family and Consumer Sciences (Nutrition and Food/Dietetics); California State University; Sacramento California USA
| | - Carrie P. Earthman
- Department of Food Science and Nutrition; University of Minnesota-Twin Cities; Minneapolis Minnesota USA
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11
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Teigen LM, John R, Kuchnia AJ, Nagel EM, Earthman CP, Kealhofer J, Martin C, Cogswell R. Preoperative Pectoralis Muscle Quantity and Attenuation by Computed Tomography Are Novel and Powerful Predictors of Mortality After Left Ventricular Assist Device Implantation. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004069. [PMID: 28912261 DOI: 10.1161/circheartfailure.117.004069] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [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: 05/05/2017] [Accepted: 08/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Skeletal muscle mass decreases in end-stage heart failure and is predictive of clinical outcomes in several disease states. Skeletal muscle attenuation and quantity as quantified on preoperative chest computed tomographic scans may be predictive of mortality after continuous flow (CF) left ventricular assist device (LVAD) implantation. METHODS AND RESULTS A single-center continuous flow-LVAD database (n=354) was used to identify patients with chest computed tomographies performed in the 3 months before LVAD implantation (n=143). Among patients with computed tomography data available, unilateral pectoralis muscle mass indexed to body surface area and attenuation (approximated by mean Hounsfield units [PHUm]) were measured in each patient with a high intrarater and inter-rater reliability (intraclass correlation coefficients 0.98 and 0.97, respectively). Multivariate Cox regression analyses were performed, censoring at cardiac transplantation, to assess the impact of preoperative pectoralis muscle index and pectoralis muscle mean Hounsfield unit on survival after LVAD implantation. Each unit increase in pectoralis muscle index was associated with a 27% reduction in the hazard of death after LVAD (adjusted hazard ratio, 0.73; 95% confidence interval, 0.58-0.92; P=0.007). Each 5-U increase in pectoralis muscle mean Hounsfield unit was associated with a 22% reduction in the hazard of death after LVAD (adjusted hazard ratio, 0.78; 95% confidence interval, 0.68-0.89; P<0.0001). Pectoralis muscle index and pectoralis muscle mean Hounsfield unit outperformed other traditional measures in the data set, including the HeartMate II risk score. CONCLUSIONS Pectoralis muscle size and attenuation were powerful predictors of outcomes after LVAD implantation in this data set. This one time, repeatable, internal assessment of patient substrate added valuable prognostic information that was not available on standard preoperative testing.
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Affiliation(s)
- Levi M Teigen
- From the Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis (L.T., A.J.K., E.M.N., C.P.E.); and Department of Cardiothoracic Surgery, Division of Surgery (R.J.) and Department of Medicine, Division of Cardiology (J.K., C.M., R.C.), University of Minnesota, Minneapolis
| | - Ranjit John
- From the Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis (L.T., A.J.K., E.M.N., C.P.E.); and Department of Cardiothoracic Surgery, Division of Surgery (R.J.) and Department of Medicine, Division of Cardiology (J.K., C.M., R.C.), University of Minnesota, Minneapolis
| | - Adam J Kuchnia
- From the Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis (L.T., A.J.K., E.M.N., C.P.E.); and Department of Cardiothoracic Surgery, Division of Surgery (R.J.) and Department of Medicine, Division of Cardiology (J.K., C.M., R.C.), University of Minnesota, Minneapolis
| | - Emily M Nagel
- From the Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis (L.T., A.J.K., E.M.N., C.P.E.); and Department of Cardiothoracic Surgery, Division of Surgery (R.J.) and Department of Medicine, Division of Cardiology (J.K., C.M., R.C.), University of Minnesota, Minneapolis
| | - Carrie P Earthman
- From the Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis (L.T., A.J.K., E.M.N., C.P.E.); and Department of Cardiothoracic Surgery, Division of Surgery (R.J.) and Department of Medicine, Division of Cardiology (J.K., C.M., R.C.), University of Minnesota, Minneapolis
| | - Jessica Kealhofer
- From the Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis (L.T., A.J.K., E.M.N., C.P.E.); and Department of Cardiothoracic Surgery, Division of Surgery (R.J.) and Department of Medicine, Division of Cardiology (J.K., C.M., R.C.), University of Minnesota, Minneapolis
| | - Cindy Martin
- From the Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis (L.T., A.J.K., E.M.N., C.P.E.); and Department of Cardiothoracic Surgery, Division of Surgery (R.J.) and Department of Medicine, Division of Cardiology (J.K., C.M., R.C.), University of Minnesota, Minneapolis
| | - Rebecca Cogswell
- From the Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis (L.T., A.J.K., E.M.N., C.P.E.); and Department of Cardiothoracic Surgery, Division of Surgery (R.J.) and Department of Medicine, Division of Cardiology (J.K., C.M., R.C.), University of Minnesota, Minneapolis.
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Johnson AJ, Matthie JR, Kuchnia A, Teigen LM, Beckman LM, Mager JR, Nicklay SA, Mulasi U, Sibley SD, Nagel E, Earthman CP. Evaluation of Advanced Bioimpedance Spectroscopy Models for Measuring Body Composition in Healthy Adults (NHANES 1999-2004) and Those Undergoing Massive Weight Loss Following Roux-en-Y Gastric Bypass Surgery. BRASPEN J 2017; 32:193-202. [PMID: 31396584 PMCID: PMC6687078] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Bioimpedance spectroscopy (BIS) devices utilize biophysical modeling to generate body composition data. The addition of body mass index (BMI) to modified Xitron-Hanai-based mixture equations improved BIS estimates of intracellular water (ICW), particularly at the extremes of BMI. A 3-compartment model for distinguishing excess fluid (ExF) from normally hydrated lean (NHLT) and adipose tissue may further improve BIS estimates. OBJECTIVE We aimed to validate a BIS approach based on the Chamney model for determining fat mass (FM) in healthy individuals (NHANES) and for measuring FM changes in individuals undergoing massive weight loss. METHODS Using adult NHANES 1999-2004 (2821 female, 3063 male) and longitudinal pre-to-post-RYGB (15F) data, we compared dual-energy-X-ray absorptiometry (DXA) and BIS for FM. We applied BIS adiposity-corrected values to Chamney equations for normally hydrated lean and adipose tissue (NHLT, NHAT) and FM. Method agreement was evaluated by correlations, paired t-tests, root mean square error (RMSE), Bland-Altman (B-A) analysis, and concordance correlation coefficients (CCC). RESULTS Method agreement between BIS and DXAFM was good in healthy adults (r=0.96, CCC=0.93, p<.0001), and pre-to-post-RYGB (r=0.93-0.98, CCC=0.81-0.86, p<.001). Although cross-sectional FM measures differed, FM change measures post-RYGB did not (35.6±8.9 vs. 35.2±9.2 kg, BIS vs. DXA) and agreed well (r=0.84, p<.0001). The 15 subjects with follow-up measurements at 1 year lost 11.5±9.8 kg FFM by DXA, but only 1.3±2.5 kg of NHLT by BIS, suggesting that the FFM loss may have been mostly adipose tissue water. CONCLUSIONS Incorporation of the Chamney model into BIS algorithms is a major conceptual advancement for assessing and monitoring body composition. Its ability to differentiate ICW and extracellular water (ECW) in NHLT and NHAT, as well as excess ECW is promising, and would facilitate lean tissue monitoring in obesity and acute/chronic disease.
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Affiliation(s)
- Abigail J. Johnson
- PhD, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | | | - Adam Kuchnia
- MS, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Levi M. Teigen
- RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Lauren M. Beckman
- PhD, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Jennifer R. Mager
- PhD, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Sarah A. Nicklay
- MS, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Urvashi Mulasi
- PhD, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Shalamar D. Sibley
- MD, MPH. University of Minnesota-Twin Cities, Department of Medicine, Minneapolis, MN, USA
| | - Emily Nagel
- MS, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
| | - Carrie P. Earthman
- PhD, RD. University of Minnesota-Twin Cities, Department of Food Science and Nutrition, St. Paul, MN, USA
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Teigen LM, Kuchnia AJ, Mourtzakis M, Earthman CP. The Use of Technology for Estimating Body Composition Strengths and Weaknesses of Common Modalities in a Clinical Setting [Formula: see text]. Nutr Clin Pract 2016; 32:20-29. [PMID: 27834282 DOI: 10.1177/0884533616676264] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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: 12/18/2022] Open
Abstract
Assessment of body composition, both at single time points and longitudinally, is particularly important in clinical nutrition practice. It provides a means for the clinician to characterize nutrition status at a single time point, aiding in the identification and diagnosis of malnutrition, and to monitor changes over time by providing real-time information on the adequacy of nutrition interventions. Objective body composition measurement tools are available clinically but are often underused in nutrition care, particularly in the United States. This is, in part, due to a number of factors concerning their use in a clinical context: cost and accessibility of equipment, as well as interpretability of the results. This article focuses on the factors influencing interpretation of results in a clinical setting. Body composition assessment, regardless of the method, is inherently limited by its indirect nature. Therefore, an understanding of the strengths and limitations of any method is essential for meaningful interpretation of its results. This review provides an overview of body composition technologies available clinically (computed tomography, dual-energy x-ray absorptiometry, bioimpedance, ultrasound) and discusses the strengths and limitations of each device.
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Affiliation(s)
- Levi M Teigen
- 1 Food Science and Nutrition, University of Minnesota-Twin Cities, Minnesota, USA
| | - Adam J Kuchnia
- 1 Food Science and Nutrition, University of Minnesota-Twin Cities, Minnesota, USA
| | | | - Carrie P Earthman
- 1 Food Science and Nutrition, University of Minnesota-Twin Cities, Minnesota, USA
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14
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Kuchnia AJ, Teigen LM, Cole AJ, Mulasi U, Gonzalez MC, Heymsfield SB, Vock DM, Earthman CP. Phase Angle and Impedance Ratio: Reference Cut-Points From the United States National Health and Nutrition Examination Survey 1999-2004 From Bioimpedance Spectroscopy Data. JPEN J Parenter Enteral Nutr 2016; 41:1310-1315. [PMID: 27670250 DOI: 10.1177/0148607116670378] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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
BACKGROUND Raw bioimpedance parameters (eg, 50-kHz phase angle [PA] and 200-kHz/5-kHz impedance ratio [IR]) have been investigated as predictors of nutrition status and/or clinical outcomes. However, their validity as prognostic measures depends on the availability of appropriate reference data. Using a large and ethnically diverse data set, we aimed to determine if ethnicity influences these measures and provide expanded bioimpedance reference data for the U.S. POPULATION METHODS The National Health and Nutrition Examination Survey (NHANES) is an ongoing compilation of studies conducted by the U.S. Centers for Disease Control and Prevention designed to monitor nutrition status of the U.S. POPULATION The NHANES data sets analyzed were from the years 1999-2000, 2001-2002, and 2003-2004. RESULTS Multivariate analysis showed that PA and IR differed by body mass index (BMI), age, sex, and ethnicity (n = 6237; R2 = 41.2%, P < .0001). Suggested reference cut-points for PA stratified by age decade, ethnicity, and sex are provided. CONCLUSION Ethnicity is an important variable that should be accounted for when determining population reference values for PA and IR. We have provided sex-, ethnicity-, and age decade-specific reference values from PA for use by future studies in U.S. POPULATIONS Interdevice differences are likely to be important contributors to variability across published population-specific reference data and, where possible, should be evaluated in future research. Ultimately, further validation with physiologically relevant reference measures (eg, dual-energy x-ray absorptiometry) is necessary to determine if PA/IR are appropriate bedside tools for the assessment of nutrition status in a clinical population.
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Affiliation(s)
- Adam J Kuchnia
- 1 Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota, USA
| | - Levi M Teigen
- 1 Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota, USA
| | - Abigail J Cole
- 1 Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota, USA
| | - Urvashi Mulasi
- 1 Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota, USA
| | - M Cristina Gonzalez
- 2 Post-graduate Program on Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | - Steven B Heymsfield
- 3 Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - David M Vock
- 4 School of Public Health, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Carrie P Earthman
- 1 Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Saint Paul, Minnesota, USA
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Cole AJ, Teigen LM, Jahansouz C, Earthman CP, Sibley SD. The Influence of Bariatric Surgery on Serum Bile Acids in Humans and Potential Metabolic and Hormonal Implications: a Systematic Review. Curr Obes Rep 2015; 4:441-50. [PMID: 26335653 DOI: 10.1007/s13679-015-0171-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent research suggests a mechanistic role for bile acids (BA) in the metabolic improvement following bariatric surgery. It is believed that the hormonal and metabolic effects associated with changes in systemic BAs may be related to the farnesoid X receptor (FXR) and a G-protein coupled receptor (TGR5). This systematic review examines changes in systemic BAs following bariatric procedures. Studies were included if they reported the measurement of systemic BAs in humans at at least one time point after bariatric surgery. Eleven papers were identified that met the inclusion criteria. Seven studies reported the effect of Roux-en-Y gastric bypass (RYGB) on fasting BAs. The majority (6/7) reported that fasting BAs increased after RYGB. Data regarding fasting BAs after vertical sleeve gastrectomy (VSG) and laparoscopic gastric banding (LAGB) are inconsistent. Data regarding post-prandial BA changes after RYGB, VSG, and LAGB are also inconsistent. More research is needed to investigate the connection between BAs and the metabolic improvement seen after bariatric surgery.
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Affiliation(s)
- Abigail J Cole
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, 1334 Eckles Avenue, Saint Paul, MN, 55108, USA.
| | - Levi M Teigen
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, 1334 Eckles Avenue, Saint Paul, MN, 55108, USA.
| | - Cyrus Jahansouz
- Medical School, Department of Surgery, University of Minnesota-Twin Cities, 420 Delaware Street SE, Minneapolis, MN, 55404, USA.
| | - Carrie P Earthman
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, 1334 Eckles Avenue, Saint Paul, MN, 55108, USA.
| | - Shalamar D Sibley
- Department of Medicine, Division of Endocrinology, University of Minnesota-Twin Cities, 516 Delaware St. SE, Minneapolis, MN, 55455, USA.
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