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Melis GC, van Leeuwen PAM, von Blomberg-van der Flier BME, Goedhart-Hiddinga AC, Uitdehaag BMJ, Strack van Schijndel RJM, Wuisman PIJM, van Bokhorst-de van der Schueren MAE. A Carbohydrate-Rich Beverage Prior to Surgery Prevents Surgery-Induced Immunodepression: A Randomized, Controlled, Clinical Trial. JPEN J Parenter Enteral Nutr 2017; 30:21-6. [PMID: 16387895 DOI: 10.1177/014860710603000121] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fasting before surgery is still common care in a lot of western hospitals. Overnight fasting can induce postoperative insulin resistance. Insulin resistance has been shown to be related to infectious morbidity. It was shown that postoperative insulin resistance can be attenuated by preoperative intake of a clear carbohydrate-rich beverage. The aim of this study was to investigate whether preoperative intake of carbohydrate-rich beverages could postoperatively influence the immune system. METHODS In this randomized, controlled study, we investigated the effect of surgery on the postoperative immune response in 10 preoperatively fasted patients (control) and 2 groups of 10 patients receiving 2 different carbohydrate-rich beverages preoperatively, by measuring human leukocyte antigen (HLA)-DR expression on monocytes on the day before and on the day after surgery. Furthermore, we studied perioperative fluid homeostasis and preoperative well-being of the patients. RESULTS HLA-DR expression decreased significantly after surgery in the control group. Patients receiving any of the 2 carbohydrate-rich beverages did not show this postoperative decrease. Fluid homeostasis was not affected in any of the groups, and well-being tended to be better in patients receiving carbohydrate-rich beverages compared with controls. CONCLUSION This study suggests that preoperative intake of a carbohydrate-rich beverage can prevent surgery-induced immunodepression and thus might reduce the risk of infectious complications.
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Affiliation(s)
- Gerdien C Melis
- Department of Nutrition Science and Dietetics and Nutritional Team, VU University Medical Center, Amsterdam, The Netherlands.
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van Bokhorst-de van der Schueren MAE, Guaitoli PR, Jansma EP, de Vet HCW. Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr 2014; 33:39-58. [PMID: 23688831 DOI: 10.1016/j.clnu.2013.04.008] [Citation(s) in RCA: 309] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/04/2013] [Accepted: 04/06/2013] [Indexed: 01/04/2023]
Affiliation(s)
| | - Patrícia Realino Guaitoli
- Dept. of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Elise P Jansma
- Medical Library, VU Amsterdam University Library, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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van Bokhorst-de van der Schueren MAE, Guaitoli PR, Jansma EP, de Vet HCW. A systematic review of malnutrition screening tools for the nursing home setting. J Am Med Dir Assoc 2013; 15:171-184. [PMID: 24290910 DOI: 10.1016/j.jamda.2013.10.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [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: 06/24/2013] [Revised: 09/11/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE Malnutrition screening among nursing home residents is often performed with tools developed for use among older subjects, and sometimes with tools designed for an adult population. Only a few tools have been designed specifically for the nursing home setting. This systematic review assesses the criterion and predictive validity of malnutrition screening tools used in nursing homes. METHODS The databases MEDLINE, CINAHL, and EMBASE were searched on January 30, 2013, for manuscripts including search terms for malnutrition, screening or assessment tools, and setting. Articles were eligible for inclusion if they expressed criterion validity (how well can a tool assess nutritional status) or predictive validity (how well can a tool predict clinical outcome) of malnutrition screening tools in a nursing home population. Included were articles that had been published in the English, German, French, Dutch, Spanish, or Portuguese language. RESULTS The search yielded 8313 references. Of these, 24 met the inclusion criteria and were available; 2 extra manuscripts were retrieved by reference checking. Twenty tools were identified. Seventeen studies reported on criterion validity, and 9 on predictive validity. Four of the tools had been designed specifically for use in long term care. None of the tools, not even the ones specifically designed for the nursing home setting, performed (on average) better than "fair" in either assessing the residents' nutritional status or in predicting malnutrition-related outcomes. CONCLUSION The use of existing screening tools for the nursing home population carries limitations, as none performs better than "fair" in assessing nutritional status or in predicting outcome. Also, no superior tool can be pointed out. This systematic review implies that further considerations regarding malnutrition screening among nursing home residents are required.
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Affiliation(s)
- Marian A E van Bokhorst-de van der Schueren
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition, Sports, and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Patrícia Realino Guaitoli
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Elise P Jansma
- Medical Library, VU Amsterdam University Library, Amsterdam, The Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Wierdsma NJ, van Bokhorst-de van der Schueren MAE, Berkenpas M, Mulder CJJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients 2013; 5:3975-92. [PMID: 24084055 PMCID: PMC3820055 DOI: 10.3390/nu5103975] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/13/2013] [Accepted: 09/13/2013] [Indexed: 12/13/2022] Open
Abstract
Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years) and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B6, B12, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin were determined (before prescribing gluten free diet). Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B6 14.5%, folic acid 20%, and vitamin B12 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) < 18.5), and 29% of the patients were overweight (BMI > 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B12. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly “early diagnosed” CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.
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Affiliation(s)
- Nicolette J. Wierdsma
- Department of Nutrition and Dietetics, VU University Medical Centre, P.O. Box 7057, Amsterdam 1007 MB, The Netherlands; E-Mails: (M.A.E.B.S.); (M.B.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +31-20-444-3410; Fax: +31-20-444-4143
| | | | - Marijke Berkenpas
- Department of Nutrition and Dietetics, VU University Medical Centre, P.O. Box 7057, Amsterdam 1007 MB, The Netherlands; E-Mails: (M.A.E.B.S.); (M.B.)
| | - Chris J. J. Mulder
- Department of Gastroenterology, Celiac Centre Amsterdam, VU University Medical Centre, Amsterdam 1007 MB, The Netherlands; E-Mails: (C.J.J.M.); (A.A.B.)
| | - Ad A. van Bodegraven
- Department of Gastroenterology, Celiac Centre Amsterdam, VU University Medical Centre, Amsterdam 1007 MB, The Netherlands; E-Mails: (C.J.J.M.); (A.A.B.)
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van Bokhorst-de van der Schueren MAE, Guaitoli PR, Jansma EP, de Vet HCW. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr 2013. [PMID: 23688831 DOI: 10.1016/j.clnu.2013.04.008.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Numerous nutrition screening tools for the hospital setting have been developed. The aim of this systematic review is to study construct or criterion validity and predictive validity of nutrition screening tools for the general hospital setting. METHODS A systematic review of English, French, German, Spanish, Portuguese and Dutch articles identified via MEDLINE, Cinahl and EMBASE (from inception to the 2nd of February 2012). Additional studies were identified by checking reference lists of identified manuscripts. Search terms included key words for malnutrition, screening or assessment instruments, and terms for hospital setting and adults. Data were extracted independently by 2 authors. Only studies expressing the (construct, criterion or predictive) validity of a tool were included. RESULTS 83 studies (32 screening tools) were identified: 42 studies on construct or criterion validity versus a reference method and 51 studies on predictive validity on outcome (i.e. length of stay, mortality or complications). None of the tools performed consistently well to establish the patients' nutritional status. For the elderly, MNA performed fair to good, for the adults MUST performed fair to good. SGA, NRS-2002 and MUST performed well in predicting outcome in approximately half of the studies reviewed in adults, but not in older patients. CONCLUSIONS Not one single screening or assessment tool is capable of adequate nutrition screening as well as predicting poor nutrition related outcome. Development of new tools seems redundant and will most probably not lead to new insights. New studies comparing different tools within one patient population are required.
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Affiliation(s)
| | - Patrícia Realino Guaitoli
- Dept. of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Elise P Jansma
- Medical Library, VU Amsterdam University Library, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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van Bokhorst-de van der Schueren MAE, Lonterman-Monasch S, de Vries OJ, Danner SA, Kramer MHH, Muller M. Prevalence and determinants for malnutrition in geriatric outpatients. Clin Nutr 2013; 32:1007-11. [PMID: 23755842 DOI: 10.1016/j.clnu.2013.05.007] [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] [Received: 02/13/2013] [Revised: 04/18/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND & AIMS Few data is available on the nutritional status of geriatric outpatients. The aim of this study is to describe the nutritional status and its clinical correlates of independently living geriatric older individuals visiting a geriatric outpatient department. METHODS From 2005 to 2010, all consecutive patients visiting a geriatric outpatient department in the Netherlands were screened for malnutrition. Nutritional status was assessed by the Mini Nutritional Assessment (MNA). Determinants of malnutrition were categorized into somatic factors (medicine use, comorbidity, walking aid, falls, urinary incontinence), psychological factors (GDS-15 depression scale, MMSE cognition scale), functional status (Activities of Daily Life (ADL), Instrumental ADL (IADL)), social factors (children, marital status), and life style factors (smoking, alcohol use). Univariate and multivariate logistic regression analyses, adjusted for age and sex and all other risk factors were performed to identify correlates of malnutrition (MNA < 17). RESULTS Included were 448 outpatients, mean (SD) age was 80 (7) years and 38% was men. Prevalence of malnutrition and risk for malnutrition were 17% and 58%. Depression, being IADL dependent, and smoking were independently associated with an increased risk of malnutrition with OR's (95%CI) of 2.6 (1.3-5.3), 2.8 (1.3-6.4), 5.5 (1.9-16.4) respectively. Alcohol use was associated with a decreased risk (OR 0.4 (0.2-0.9)). CONCLUSION Malnutrition is highly prevalent among geriatric outpatients and is independently associated with depressive symptoms, poor functional status, and life style factors. Our results emphasize the importance of integrating nutritional assessment within a comprehensive geriatric assessment. Future longitudinal studies should be performed to examine the effects of causal relationships and multifactorial interventions.
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Konijn NPC, van Tuyl LHD, Bultink IEM, Lems WF, van Bokhorst-de van der Schueren MAE. Body Mass Index Measurements Have Limited Value for the Assessment of Body Composition in Rheumatoid Arthritis: Comment on the Article by Wolfe and Michaud. Arthritis Care Res (Hoboken) 2013; 65:833-4. [DOI: 10.1002/acr.21909] [Citation(s) in RCA: 4] [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: 11/08/2022]
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van Bokhorst-de van der Schueren MAE, Konijn NPC, Bultink IEM, Lems WF, Earthman CP, van Tuyl LHD. Relevance of the new pre-cachexia and cachexia definitions for patients with rheumatoid arthritis. Clin Nutr 2012; 31:1008-10. [PMID: 22695407 DOI: 10.1016/j.clnu.2012.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 05/15/2012] [Accepted: 05/17/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND & AIMS The recently proposed definitions of 'pre-cachexia' and 'cachexia' might offer new possibilities for the detection of malnutrition in patients with rheumatoid arthritis (RA). METHODS The prevalence of different components of nutritional status and the compiled definitions of 'precachexia' and 'cachexia' were measured in a cohort of 103 patients with moderately active RA. Nutritional status was determined by measuring unintentional weight loss, BMI, and muscle strength. Bio-electrical Impedance Analysis (BIA) was used to determine fat free mass index (FFMI) and fat mass index. In addition, appetite, pain, fatigue, and inflammatory activity were assessed. The prevalence of 'pre-cachexia' and 'cachexia' was calculated from different combinations of these parameters. RESULTS 20% of the study population had a low FFMI (<10th percentile), and 95% had a decreased muscle strength ( < lowest tertile). Weight loss and loss of appetite, both essential elements in the newly proposed (pre-)cachexia definitions, were uncommon. The prevalence of 'pre-cachexia' and 'cachexia' was both 1% (n = 1). CONCLUSIONS In spite of altered body composition and impaired body function, the recently proposed definitions of both 'pre-cachexia' and 'cachexia' were unable to identify and diagnose impaired nutritional status in RA patients mainly because of low prevalences of weight loss and decreased appetite.
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Neelemaat F, van Bokhorst-de van der Schueren MAE, Thijs A, Seidell JC, Weijs PJM. Resting energy expenditure in malnourished older patients at hospital admission and three months after discharge: predictive equations versus measurements. Clin Nutr 2012; 31:958-66. [PMID: 22658444 DOI: 10.1016/j.clnu.2012.04.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 04/12/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Predicting resting energy expenditure (REE) in malnourished hospitalized older patients is important for establishing optimal goals for nutritional intake. Measuring REE by indirect calorimetry is hardly feasible in most clinical settings. OBJECTIVE To study the most accurate and precise REE predictive equation for malnourished older patients at hospital admission and again three months after discharge. DESIGN Twenty-three equations based on weight, height, gender, age, fat free mass (FFM) and/or fat mass (FM) and eleven fixed factors of kcal/kg were compared to measured REE. REE was measured by indirect calorimetry. Accuracy of REE equations was evaluated by the percentage patients predicted within 10% of REE measured, the mean percentage difference between predicted and measured values (bias) and the Root Mean Squared prediction Error (RMSE). RESULTS REE was measured in 194 patients at hospital admission (mean 1473 kcal/d) and again three months after hospital discharge in 107 patients (mean 1448 kcal/d). The best equations predicted 40% accuracy at hospital admission (Lazzer, FAO/WHO-wh and Owen) and 63% three months after discharge (FAO/WHO-wh). Equations combined with FFM, height or illness factor predicted slightly better. Fixed factors produce large RMSE's. All predictive equations showed proportional bias, with overestimation of low REE values and underestimation of high REE values. Correction by regression analysis did not improve results. CONCLUSIONS The REE predictive equations are not adequate to predict REE in malnourished hospitalized older patients. There is an urgent need for either a new accurate REE predictive equation, or accurate easy-to-use equipment to measure REE in clinical practice.
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Affiliation(s)
- Floor Neelemaat
- Department of Nutrition, Internal Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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van Asselt DZB, van Bokhorst-de van der Schueren MAE, van der Cammen TJM, Disselhorst LGM, Janse A, Lonterman-Monasch S, Maas HAAM, Popescu ME, Schölzel-Dorenbos CJM, Sipers WMWH, Veldhoven CMM, Wijnen HH, Olde Rikkert MGM. Assessment and treatment of malnutrition in Dutch geriatric practice: consensus through a modified Delphi study. Age Ageing 2012; 41:399-404. [PMID: 22334385 DOI: 10.1093/ageing/afs005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE scientific evidence regarding the optimal management of malnutrition in geriatric patients is scarce. Our aim was to develop a consensus statement for geriatric hospital practice concerning six elements: (i) definition of malnutrition, (ii) screening and assessment, (iii) treatment and monitoring, (iv) roles and responsibilities of involved health care professionals, (v) communication and coordination of care between hospital and community health care professionals, (vi) quality indicators for malnutrition management. DESIGN a modified Delphi study. METHODS eleven geriatricians with special interest in malnutrition participated. In four rounds the experts rated the relevance of 204 statements, which were based on a literature review, on a five-point Likert scale. From the responses, means and 95% CIs were calculated. Consensus was defined as a lower 95% confidence limit ≥4.0. RESULTS the panel reached consensus that malnutrition should be considered a geriatric syndrome. The nutritional status should be assessed using the Mini Nutritional Assessment combined with comprehensive geriatric assessment. Nutritional interventions should be combined with interventions targeting underlying factors. Specific goals for nutritional therapy and ways to achieve them were agreed upon. According to the experts, malnutrition is best managed by a multidisciplinary team for whom roles and responsibilities were specified. At discharge written information about the nutritional problem, treatment plan and goals should be provided to the patient, caregiver and community health care professionals. CONCLUSION this study shows that a qualitative study based on a modified Delphi technique can result in national consensus on essential ingredients for a practical malnutrition guideline for geriatric patients.
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Neelemaat F, Lips P, Bosmans JE, Thijs A, Seidell JC, van Bokhorst-de van der Schueren MAE. Short-Term Oral Nutritional Intervention with Protein and Vitamin D Decreases Falls in Malnourished Older Adults. J Am Geriatr Soc 2012; 60:691-9. [DOI: 10.1111/j.1532-5415.2011.03888.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | | | | | - Abel Thijs
- Department of Internal Medicine, VU University Medical Center
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Wijnhoven HAH, Schilp J, van Bokhorst-de van der Schueren MAE, de Vet HCW, Kruizenga HM, Deeg DJH, Ferrucci L, Visser M. Development and validation of criteria for determining undernutrition in community-dwelling older men and women: The Short Nutritional Assessment Questionnaire 65+. Clin Nutr 2011; 31:351-8. [PMID: 22119209 DOI: 10.1016/j.clnu.2011.10.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 09/26/2011] [Accepted: 10/27/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND & AIMS There is no valid, fast and easy-to-apply set of criteria to determine (risk of) undernutrition in community-dwelling older persons. The aim of this study was to develop and validate such criteria. METHODS Selection of potential anthropometric and undernutrition-related items was based on consensus literature. The criteria were developed using 15-year mortality in community-dwelling older persons ≥ 65 years (Longitudinal Aging Study Amsterdam, n = 1687) and validated in an independent sample (InCHIANTI, n = 1142). RESULTS Groups distinguished were: (1) undernutrition (mid-upper arm circumference <25 cm or involuntary weight loss ≥4 kg/6 months); (2) risk of undernutrition (poor appetite and difficulties climbing staircase); and (3) no undernutrition (others). Respective hazard ratio's for 15-year mortality were: (1) 2.22 (95% CI 1.83-2.69); and (2) 1.57 (1.22-2.01) ((3) = reference). The area under the curve (AUC) was 0.55. Comparable results were found stratified by sex, excluding cancer/obstructive lung disease/(past) smoking, using 6-year mortality, and applying results to the InCHIANTI study (hazard ratio's 2.12 and 2.46, AUC 0.59). CONCLUSIONS The developed set of criteria (SNAQ⁶⁵⁺) for determining (risk of) undernutrition in community-dwelling older persons shows good face validity and moderate predictive validity based on the consistent association with mortality in a second independent study sample.
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Affiliation(s)
- Hanneke A H Wijnhoven
- Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.
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van der Meij BS, van Bokhorst-de van der Schueren MAE, Langius JAE, Brouwer IA, van Leeuwen PAM. n-3 PUFAs in cancer, surgery, and critical care: a systematic review on clinical effects, incorporation, and washout of oral or enteral compared with parenteral supplementation. Am J Clin Nutr 2011; 94:1248-65. [PMID: 21940600 DOI: 10.3945/ajcn.110.007377] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND n-3 (omega-3) Fatty acids (FAs) may have beneficial effects in patients with cancer or in patients who undergo surgery or critical care. OBJECTIVE Our aim was to systematically review the effects of oral or enteral and parenteral n-3 FA supplementation on clinical outcomes and to describe the incorporation of n-3 FAs into phospholipids of plasma, blood cells, and mucosal tissue and the subsequent washout in these patients. DESIGN We investigated the supplementation of n-3 FAs in these patients by using a systematic literature review. RESULTS In cancer, the oral or enteral supplementation of n-3 FAs contributed to the maintenance of body weight and quality of life but not to survival. We did not find any studies on parenteral supplementation of n-3 FAs in cancer. In surgical oncology, we did not find any studies on enteral supplementation of n-3 FAs. However, postoperative parenteral supplementation in surgical oncology may reduce the length of a hospital stay. For general surgery, we did not find any studies on enteral supplementation of n-3 FAs, and evidence on parenteral supplementation was insufficient. In critical care, enteral supplementation of n-3 FAs had beneficial effects on clinical outcomes; evidence on parenteral supplementation in critical care was inconsistent. The incorporation of n-3 FAs in plasma and blood cells was slower with enteral supplementation (4-7 d) than with parenteral supplementation (1-3 d). The washout was 5-7 d. CONCLUSIONS This review shows the beneficial effects of n-3 FA supplementation in cancer, surgical oncology, and critical care patients. Supplementation in these specific patient populations could be considered with the route of administration taken into account.
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Affiliation(s)
- Barbara S van der Meij
- Department of Nutrition and Dietetics, VU University Medical Center Amsterdam, Netherlands
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14
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Wijnhoven HAH, Snijder MB, van Bokhorst-de van der Schueren MAE, Deeg DJH, Visser M. Region-specific fat mass and muscle mass and mortality in community-dwelling older men and women. Gerontology 2011; 58:32-40. [PMID: 21358171 DOI: 10.1159/000324027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 01/04/2011] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Increased mortality risk at low body mass index values is well established for older persons. It is, however, unclear how the underlying body mass components (fat and muscle mass - FM and MM, respectively) are associated with mortality in old age. OBJECTIVE This study aimed to examine the mortality risk of four body composition measures (appendicular skeletal MM, leg, arm and trunk FM) with 12-year mortality in community-dwelling older men and women. As a secondary objective, the influence of cancer, obstructive lung disease, smoking and previous weight loss on these associations was examined. METHODS Data were used from the Longitudinal Aging Study Amsterdam, a random population-based cohort study (55-85 years) in the Netherlands. Body composition was determined in 1995-1996 by dual energy X-ray absorptiometry. The present study included 477 community-dwelling persons aged ≥65 years who were followed until 2007 for their vital status. RESULTS Twelve-year mortality rates were 133/242 (55%) in men and 92/235 (39%) in women. Since most associations were U- or J-shaped, only observations below the sample mean were included to calculate hazard ratios (HRs) per one SD lower value. Adjusted for height, age and each other, lower appendicular skeletal MM [HR 1.59 (95% CI: 1.04-2.42)] and lower leg FM [1.68 (1.04-2.72)] in men and lower trunk FM [1.61 (1.02-2.53)] in women were associated with an increased mortality risk. Associations attenuated and became statistically nonsignificant in men after adjustment for cancer, obstructive pulmonary disease and smoking and in women after additional adjustment for previous 3-year weight change. CONCLUSIONS In older men, lower MM and lower leg FM are associated with an increased mortality risk, while in older women only lower trunk FM is associated with an increased risk. The causality of these associations is debated. Suggested sex differences deserve further study.
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Affiliation(s)
- Hanneke A H Wijnhoven
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands.
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Buijs N, van Bokhorst-de van der Schueren MAE, Langius JAE, Leemans CR, Kuik DJ, Vermeulen MAR, van Leeuwen PAM. Perioperative arginine-supplemented nutrition in malnourished patients with head and neck cancer improves long-term survival. Am J Clin Nutr 2010; 92:1151-6. [PMID: 20881073 DOI: 10.3945/ajcn.2010.29532] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Plasma arginine concentrations are lower in patients with cancer, which indicates that arginine metabolism may be disturbed in these patients. Arginine supplementation has been associated with positive effects on antitumor mechanisms and has been shown to reduce tumor growth and to prolong survival. Furthermore, the prognosis of patients with head and neck cancer remains disappointing. Insufficient intake frequently leads to malnutrition, which contributes to high morbidity and mortality rates. OBJECTIVE The aim of this study was to assess the long-term effects of perioperative arginine supplementation in severely malnourished patients with head and neck cancer. DESIGN In this double-blind, randomized, controlled trial, we randomly assigned 32 severely malnourished patients with head and neck cancer to receive 1) standard perioperative enteral nutrition (n = 15) or 2) arginine-supplemented perioperative enteral nutrition (n = 17). The primary outcome was long-term (≥10 y) survival. Secondary outcomes included the long-term appearance of locoregional recurrence, distant metastases, and second primary tumors. RESULTS No significant differences in baseline characteristics were observed between groups. The group receiving arginine-enriched nutrition had a significantly better overall survival (P = 0.019) and better disease-specific survival (P = 0.022). Furthermore, the arginine-supplemented group had a significantly better locoregional recurrence-free survival (P = 0.027). No significant difference in the occurrence of distant metastases or occurrence of a second primary tumor was observed between the groups. CONCLUSION Perioperative arginine-enriched enteral nutrition significantly improved the long-term overall survival and long-term disease-specific survival in malnourished patients with head and neck cancer.
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Affiliation(s)
- Nikki Buijs
- Department of Surgery, VU University Medical Center, MB Amsterdam, Netherlands
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Wijnhoven HAH, van Bokhorst-de van der Schueren MAE, Heymans MW, de Vet HCW, Kruizenga HM, Twisk JW, Visser M. Low mid-upper arm circumference, calf circumference, and body mass index and mortality in older persons. J Gerontol A Biol Sci Med Sci 2010; 65:1107-14. [PMID: 20547497 PMCID: PMC3304296 DOI: 10.1093/gerona/glq100] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [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] [Indexed: 01/25/2023] Open
Abstract
Background. Low body mass index is a general measure of thinness. However, its measurement can be cumbersome in older persons and other simple anthropometric measures may be more strongly associated with mortality. Therefore, associations of low mid-upper arm circumference, calf circumference, and body mass index with mortality were examined in older persons. Methods. Data of the Longitudinal Aging Study Amsterdam, a population-based cohort study in the Netherlands, were used. The present study included community-dwelling persons 65 years and older in 1992–1993 (n = 1,667), who were followed until 2007 for their vital status. Associations between anthropometric measures and 15-year mortality were examined by spline regression models and, below the nadir, Cox regression models, transforming all measures to sex-specific Z scores. Results. Mortality rates were 599 of 826 (73%) in men and 479 of 841 (57%) in women. Below the nadir, the hazard ratio of mortality per 1 standard deviation lower mid-upper arm circumference was 1.79 (95% confidence interval, 1.48–2.16) in men and 2.26 (1.71–3.00) in women. For calf circumference, the hazard ratio was 1.45 (1.22–1.71) in men and 1.30 (1.15–1.48) in women and for body mass index 1.38 (1.17–1.61) in men and 1.56 (1.10–2.21) in women. Excluding deaths within the first 3 years after baseline did not change these associations. Excluding those with a smoking history, obstructive lung disease, or cancer attenuated the associations of calf circumference (men) and body mass index (women). Conclusions. Based on the stronger association with mortality and given a more easy assessment in older persons, mid-upper arm circumference seems a more feasible and valid anthropometric measure of thinness than body mass index in older men and women.
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Affiliation(s)
- Hanneke A H Wijnhoven
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, the Netherlands.
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Langius JAE, Doornaert P, Spreeuwenberg MD, Langendijk JA, Leemans CR, van Bokhorst-de van der Schueren MAE. Radiotherapy on the neck nodes predicts severe weight loss in patients with early stage laryngeal cancer. Radiother Oncol 2010; 97:80-5. [PMID: 20223540 DOI: 10.1016/j.radonc.2010.02.017] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 02/15/2010] [Accepted: 02/17/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Although patients with early stage (T1/T2) laryngeal cancer (LC) are thought to have a low incidence of malnutrition, severe weight loss is observed in a subgroup of these patients during radiotherapy (RT). The objective of this study was to evaluate weight loss and nutrition-related symptoms in patients with T1/T2 LC during RT and to select predictive factors for early identification of malnourished patients. METHODS Of all patients with T1/T2 LC, who received primary RT between 1999 and 2007, the following characteristics were recorded: sex, age, TNM classification, tumour location, radiation schedule, performance status, quality of life, weight loss, and nutrition-related symptoms. The association between baseline characteristics and malnutrition (>5% weight loss during RT) was investigated by Cox regression analysis. RESULTS The study population consisted of 238 patients. During RT, 44% of patients developed malnutrition. Tumour location, TNM classification, RT on the neck nodes, RT dose, nausea/vomiting, pain, swallowing, senses problems, trouble with social eating, dry mouth and the use of painkillers were all significantly associated with malnutrition. In the multivariate analysis, RTs on both the neck nodes (HR 4.16, 95% CI 2.62-6.60) and dry mouth (HR 1.72, 95% CI 1.14-2.60) remained predictive. Nevertheless, RT on the neck nodes alone resulted in the best predictive model for malnutrition scores. CONCLUSIONS Patients with early stage laryngeal cancer are at risk of malnutrition during radiotherapy. Radiotherapy on the neck nodes is the best predictor of malnutrition during radiotherapy. Therefore, we suggest to offer nutritional counselling to all the patients who receive nodal irradiation.
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Wierdsma NJ, van Bodegraven AA, Uitdehaag BMJ, Arjaans W, Savelkoul PHM, Kruizenga HM, van Bokhorst-de van der Schueren MAE. Fructo-oligosaccharides and fibre in enteral nutrition has a beneficial influence on microbiota and gastrointestinal quality of life. Scand J Gastroenterol 2010; 44:804-12. [PMID: 19347770 DOI: 10.1080/00365520902839675] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Intestinal microbiota is important in health and disease. The aim of this study was to evaluate the effect of fructo-oligosaccharides (FOS) and fibre-enriched tube feeding on quality of life and intestinal microbiota (faecal Bifidobacteria). MATERIAL AND METHODS Nineteen out of 59 home-living, tube-feeding-dependent, adult patients and matched healthy controls were included in this randomized, double-blind study. After a washout period, patients received either no residue tube feeding (non-FOS group) or FOS and fibre-enriched tube feeding (FOS group). Quality of life as defined by the Gastrointestinal Quality of Life Index (GIQLI) and quantification of faecal Bifidobacteria were determined. RESULTS At baseline, GIQLI scores in controls and patients were 88+/-12 and 67+/-14, respectively (p=0.001). Following 6 weeks' intervention, GIQLI scores remained stable (65+/-14 versus 67+/-17) in the FOS group, whereas the non-FOS group values decreased (68+/-17 versus 64+/-19). Baseline faecal samples contained 2. 1x 10(7)+/-3.5 x 10(7) and 2.1 x 10(6)+/-5.6 x10(6)Bifidobacteria (p=0.002) in controls and patients, respectively, with no differences between patient groups. During the intervention, this number remained stable in the FOS group (0.7 x 10(6)+/-1.3 x 10(6) versus 1.0 x 10(6)+/-1.3 x 10(6) baseline versus end-point), but decreased in the non-FOS group (3.6 x1 0(6)+/-8.0 x 10(6) versus 2.5 x 10(4)+/-4.0 x 10(4)). GIQLI scores were correlated with the number of faecal Bifidobacteria (r=0.41, p=0.007). CONCLUSIONS The GIQL score for the tube-fed patients increased with the number of faecal Bifidobacteria, although in a non-linear way, and addition of FOS increased the number of Bifidobacteria. This suggests that prebiotic tube feeding may lead to a change in intestinal microbiota that could induce an increased quality of life in these patients.
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Affiliation(s)
- Nicolette J Wierdsma
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands.
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Neelemaat F, Thijs A, Seidell JC, Bosmans JE, van Bokhorst-de van der Schueren MAE. Study protocol: cost-effectiveness of transmural nutritional support in malnourished elderly patients in comparison with usual care. Nutr J 2010; 9:6. [PMID: 20146794 PMCID: PMC2829481 DOI: 10.1186/1475-2891-9-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 02/10/2010] [Indexed: 11/29/2022] Open
Abstract
Background Malnutrition is a common consequence of disease in older patients. Both in hospital setting and in community setting oral nutritional support has proven to be effective. However, cost-effectiveness studies are scarce. Therefore, the aim of our study is to investigate the effectiveness and cost-effectiveness of transmural nutritional support in malnourished elderly patients, starting at hospital admission until three months after discharge. Methods This study is a randomized controlled trial. Patients are included at hospital admission and followed until three months after discharge. Patients are eligible to be included when they are ≥ 60 years old and malnourished according to the following objective standards: Body Mass Index (BMI in kg/m2) < 20 and/or ≥ 5% unintentional weight loss in the previous month and/or ≥ 10% unintentional weight loss in the previous six months. We will compare usual nutritional care with transmural nutritional support (energy and protein enriched diet, two additional servings of an oral nutritional supplement, vitamin D and calcium supplementation, and consultations by a dietitian). Each study arm will consist of 100 patients. The primary outcome parameters will be changes in activities of daily living (determined as functional limitations and physical activity) between intervention and control group. Secondary outcomes will be changes in body weight, body composition, quality of life, and muscle strength. An economic evaluation from a societal perspective will be conducted alongside the randomised trial to evaluate the cost-effectiveness of the intervention in comparison with usual care. Conclusion In this randomized controlled trial we will evaluate the effect of transmural nutritional support in malnourished elderly patients after hospital discharge, compared to usual care. Primary endpoints of the study are changes in activities of daily living, body weight, body composition, quality of life, and muscle strength. An economic evaluation will be performed to evaluate the cost-effectiveness of the intervention in comparison with usual care. Trial registration Netherlands Trial Register (ISRCTN29617677, registered 14-Sep-2005)
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Affiliation(s)
- Floor Neelemaat
- Departments of Nutrition and Dietetics, Internal Medicine and EMGO+ institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Meijers JMM, van Bokhorst-de van der Schueren MAE, Schols JMGA, Soeters PB, Halfens RJG. Defining malnutrition: mission or mission impossible? Nutrition 2009; 26:432-40. [PMID: 19954929 DOI: 10.1016/j.nut.2009.06.012] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 03/04/2009] [Accepted: 06/19/2009] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Although screening for malnutrition in health care has expanded enormously, a gold standard for the optimal definition and operationalism of malnutrition is still lacking. This report reflects expert opinions on the elements of the definition and operationalism of malnutrition and is meant to trigger further debate within the nutritional societies. METHODS A Delphi study was performed consisting of three phases. After a literature review (phase 1), questions for a semistructured interviews (phase 2) were formulated. Subsequently, the results of these semistructured interviews were used to develop the final list of elements (for defining and operationalism of malnutrition). In phase 3 (final phase), experts were asked to provide written feedback regarding the ranking of elements concerning the importance of these elements. RESULTS Twenty-two experts (response 73.3%) were included in the final phase of this Delphi study. No overall agreement could be reached. The elements deficiencies of energy or protein and decrease in fat-free mass were most often mentioned to be particularly important in defining malnutrition. Elements mentioned to be important in operationalism of malnutrition were involuntary weight loss, body mass index, and no nutritional intake. Opinions on cutoff points regarding these elements differed strongly among experts. CONCLUSION This study shows that there is no full agreement among experts on the elements defining and operationalism of malnutrition. The results of this study may fuel the discussion within the nutritional societies, which will most ideally lead to an international consensus on a definition and operationalism of malnutrition.
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Affiliation(s)
- Judith M M Meijers
- Faculty of Health, Medicine and Life Sciences, Department of Health Care and Nursing Science, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
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Leistra E, Neelemaat F, Evers AM, van Zandvoort MHWM, Weijs PJM, van Bokhorst-de van der Schueren MAE, Visser M, Kruizenga HM. Prevalence of undernutrition in Dutch hospital outpatients. Eur J Intern Med 2009; 20:509-13. [PMID: 19712855 DOI: 10.1016/j.ejim.2009.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [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: 10/14/2008] [Revised: 03/06/2009] [Accepted: 03/23/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prevalence of undernutrition in hospital inpatients is high. Earlier detection and treatment in the hospital outpatient clinic may help to reduce these numbers. The purpose of this study was to assess the prevalence of undernutrition in hospital outpatients in the Netherlands, to determine high risk departments, and to determine the percentage of patients receiving dietetic treatment. METHODS This cross-sectional multicenter study was conducted in nine hospitals. Patients who visited the outpatient clinic on one of the screening days in the period March-May 2008 received a short questionnaire and were weighed. Patients were classified as severely undernourished, moderately undernourished or not undernourished. RESULTS 2288 patients were included in the study, of which 5% were severely undernourished and 2% were moderately undernourished. The prevalence of severe undernutrition was highest in the outpatient departments of oral maxillofacial surgery (17%), oncology (10%), rehabilitation (8%), gastroenterology (7%) and pulmonology (7%). Only 17% of all severely undernourished and 4% of all moderately undernourished patients reported to receive dietetic treatment. CONCLUSION The prevalence of undernutrition in hospital outpatients is generally low but largely undertreated. Future screening should focus on high risk departments.
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Affiliation(s)
- Eva Leistra
- Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands.
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Meijers JMM, Candel MJMM, Schols JMGA, van Bokhorst-de van der Schueren MAE, Halfens RJG. Decreasing trends in malnutrition prevalence rates explained by regular audits and feedback. J Nutr 2009; 139:1381-6. [PMID: 19494024 DOI: 10.3945/jn.108.102608] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
To our knowledge, no studies have analyzed the influence of annual audit and feedback on the prevalence rates of malnutrition. This study analyzes the trend of malnutrition prevalence rates between 2004 and 2007 and the effects of previous audits and feedback from the annual Dutch National Prevalence Measurement of Care Problems (LPZ) and the effect of the participation in Dutch national improvement programs. From 2004 to 2007, an annual multicenter study was performed in Dutch hospitals, nursing homes, and home care organizations using a standardized questionnaire involving measurements at institutional, ward, and patient levels. The data were analyzed by logistic multilevel analysis. Nutritional status was assessed by BMI, undesired weight loss, and nutritional intake. In total, 80 hospitals, 141 nursing homes, and 48 home care organizations participated. The prevalence of malnutrition tended to decrease in hospitals and home care over the years. In nursing homes, prevalence rates were stable. Furthermore, the more often hospitals and home care organizations participated in the annual LPZ audits, the lower the prevalence rate of malnutrition (P < 0.001). Participation in national improvement programs also resulted in lower prevalence rates (P = 0.027). In conclusion, malnutrition prevalence rates have decreased over the last 4 y in hospitals and home care in The Netherlands. Participation in the LPZ and involvement in national improvement programs positively influenced these malnutrition prevalence rates, possibly indicating that increasing awareness and actively working toward improvement could be important in lowering these rates.
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Affiliation(s)
- Judith M M Meijers
- Department of Health Care and Nursing Science, Maastricht 6200 MD, The Netherlands.
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Soeters PB, Reijven PLM, van Bokhorst-de van der Schueren MAE, Schols JMGA, Halfens RJG, Meijers JMM, van Gemert WG. A rational approach to nutritional assessment. Clin Nutr 2008; 27:706-16. [PMID: 18783855 DOI: 10.1016/j.clnu.2008.07.009] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 07/18/2008] [Accepted: 07/23/2008] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Consensus regarding definitions of malnutrition and methods to assess nutritional state is lacking. We propose a definition and its operationalization. METHODS A definition was formulated on the basis of the pathophysiology of malnutrition, while reviewing the metabolic and physiological characteristics of different populations, considered to be malnourished. The definition was operationalized to yield measures to perform nutritional assessment. RESULTS Malnutrition was defined as "a subacute or chronic state of nutrition in which a combination of varying degrees of over- or undernutrition and inflammatory activity has led to a change in body composition and diminished function". Its operationalization led to four elements that may serve as the basis of nutritional assessment: (1) measurement of nutrient balance, (2) measurement of body composition, (3) measurement of inflammatory activity, and (4) measurement of muscle, immune and cognitive function. Most elements measured should be validated with gold standards; normal values should be obtained in different populations. Values obtained in people considered to be at nutritional risk should be related to outcome. CONCLUSION A definition is proposed that reflects the pathophysiology of malnutrition and that, when operationalized, will lead to measures reflecting this pathophysiology. Such an approach may yield comparable and reproducible rates and degrees of malnutrition in populations as well as in individuals.
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Affiliation(s)
- Peter B Soeters
- Faculty of Health, Medicine and Life Sciences, Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
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Abstract
A large body of evidence exists, which demonstrates the importance of nutritional support in cancer. The nutritional needs of patients with cancer may differ from those of the healthy population due to hypermetabolism, impaired organ function, increased nutrient losses and therapy-related malnutrition. Patients with cancer often have increased requirements for both macro- and micronutrients due to long periods of undernutrition prior to diagnosis. The aim of nutritional support should be the prevention or reversal of malnutrition, and this should be initiated as early as possible to improve outcomes. Oral supplementation is a simple, non-invasive method of increasing the nutrient intake of those patients who are unable to meet nutritional requirements, despite dietary counselling. Enteral tube feeding is indicated for patients who are unable to meet their nutritional needs by oral intake alone, and has been shown to improve clinical outcomes. Novel approaches in oral supplementation include the use of eicosapentaenoic acid (EPA), a compound under investigation for its role in preventing and treating cancer-associated malnutrition. Individual studies suggest that EPA attenuates cancer-associated wasting and improves immune function. In addition, it has been shown to have anti-tumour effects and improve clinical outcomes. However, results are not consistent for all patient groups and further research is required.
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van der Kuip M, Oosterveld MJS, van Bokhorst-de van der Schueren MAE, de Meer K, Lafeber HN, Gemke RJBJ. Nutritional support in 111 pediatric intensive care units: a European survey. Intensive Care Med 2004; 30:1807-13. [PMID: 15197431 DOI: 10.1007/s00134-004-2356-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Accepted: 05/21/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To study current strategies in nutritional management of pediatric intensive care units (PICUs) in Europe, focusing on energy requirements. DESIGN AND SETTING Survey by a 35-item questionnaire sent to representatives of 242 PICUs in 28 countries. Addresses were obtained from national PICU associations and the members' list of the European Society of Pediatric and Neonatal Intensive Care. PARTICIPANTS Staff members of 111 European PICUs (46%) from 24 countries. MEASUREMENTS AND RESULTS Predominantly physicians were reported to be responsible for nutritional support. In 73% of PICUs a multidisciplinary nutritional team was available. In most PICUs daily energy requirements were estimated using weight, age, predictive equations and correction factors. In 17% of PICUs energy expenditure was regularly measured by indirect calorimetry. Nutritional status was mostly assessed by weight, physical examination, and a wide range of biochemical blood parameters. Approximately 70% of PICUs used dedicated software for nutritional support. A similar percentage of PICUs regarded "nutrition" as a research topic and part of the residents' training program. CONCLUSIONS Most European PICUs regard nutritional support as an important aspect of patient care, as shown by the presence of nutritional teams, software, research, and education. However, energy requirements of pediatric intensive care patient were based predominantly on estimations rather than on measurements.
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Affiliation(s)
- Martijn van der Kuip
- Department of Pediatrics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
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van Bokhorst-de van der Schueren MAE, van Leeuwen PAM, Kuik DJ, Klop WMC, Sauerwein HP, Snow GB, Quak JJ. The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 1999. [DOI: 10.1002/(sici)1097-0142(19990801)86:3<519::aid-cncr22>3.0.co;2-s] [Citation(s) in RCA: 213] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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