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Oberhoff G, Schooren L, Vondran F, Kroh A, Koch A, Bednarsch J, Neumann UP, Schmitz SM, Alizai PH. Impairment of Nutritional Status and Quality of Life Following Minimal-Invasive Esophagectomy-A Prospective Cohort Analysis. Cancers (Basel) 2024; 16:266. [PMID: 38254757 PMCID: PMC10814124 DOI: 10.3390/cancers16020266] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/25/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Minimal-invasive resection of the esophagus for esophageal cancer has led to a relevant decrease in postoperative morbidity. Postoperatively, patients still suffer from surgical and adjuvant therapy-related symptoms impairing nutrition and quality of life. The aim of this study was to evaluate the nutritional status and associated symptoms six months after esophagectomy. Patients who attended follow-up examination six months after minimal-invasive esophagectomy were included. Blood and fecal tests, quality of life surveys (QLQ-C30 and QLQ-OG25) and nutritional risk screening (NRS) were performed. Twenty-four patients participated. The mean weight loss was 11 kg. A significant decrease in vitamin B12 (737 to 467 pg/mL; p = 0.033), ferritin (302 to 126 ng/mL; p = 0.012) and haptoglobin (227 to 152 mg/dL; p = 0.025) was found. In total, 47% of the patients had an impaired pancreatic function (fecal elastase < 500 µg/g). Physical (72 to 58; p = 0.034) and social functioning (67 to 40; p = 0.022) was significantly diminished, while self-reported global health status remained stable (52 to 54). The number of patients screened and found to be in need of nutritional support according to NRS score decreased slightly (59% to 52%). After MIE, patients should be meticulously monitored for nutritional status after surgery.
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Affiliation(s)
- Grace Oberhoff
- Uniklinik Aachen, General-, Visceral- and Transplant Surgery, Pauwelsstr. 30, 52074 Aachen, Germany; (G.O.); (F.V.); (A.K.); (P.H.A.)
| | - Lena Schooren
- Uniklinik Aachen, General-, Visceral- and Transplant Surgery, Pauwelsstr. 30, 52074 Aachen, Germany; (G.O.); (F.V.); (A.K.); (P.H.A.)
| | - Florian Vondran
- Uniklinik Aachen, General-, Visceral- and Transplant Surgery, Pauwelsstr. 30, 52074 Aachen, Germany; (G.O.); (F.V.); (A.K.); (P.H.A.)
| | - Andreas Kroh
- Uniklinik Aachen, General-, Visceral- and Transplant Surgery, Pauwelsstr. 30, 52074 Aachen, Germany; (G.O.); (F.V.); (A.K.); (P.H.A.)
| | - Alexander Koch
- Uniklinik Aachen, Gastroenterology, Metabolic Diseases and Internal Intensive Care Medicine, Pauwelsstr. 30, 52074 Aachen, Germany;
| | - Jan Bednarsch
- Uniklinik Essen, General-, Visceral- and Transplant Surgery, Hufelandstr. 55, 45147 Essen, Germany; (J.B.); (U.P.N.)
| | - Ulf P. Neumann
- Uniklinik Essen, General-, Visceral- and Transplant Surgery, Hufelandstr. 55, 45147 Essen, Germany; (J.B.); (U.P.N.)
| | - Sophia M. Schmitz
- Uniklinik Aachen, General-, Visceral- and Transplant Surgery, Pauwelsstr. 30, 52074 Aachen, Germany; (G.O.); (F.V.); (A.K.); (P.H.A.)
- Uniklinik Essen, General-, Visceral- and Transplant Surgery, Hufelandstr. 55, 45147 Essen, Germany; (J.B.); (U.P.N.)
| | - Patrick H. Alizai
- Uniklinik Aachen, General-, Visceral- and Transplant Surgery, Pauwelsstr. 30, 52074 Aachen, Germany; (G.O.); (F.V.); (A.K.); (P.H.A.)
- Gemeinschaftskrankenhaus Bonn, General- and Visceral Surgery, Prinz-Albert-Str. 40, 53113 Bonn, Germany
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Siegwart J, Spennato U, Lerjen N, Mueller B, Schuetz P, Koch D, Struja T. Prediction of In-Hospital Falls Using NRS, PACD Score and FallRS: A Retrospective Cohort Study. Geriatrics (Basel) 2023; 8:60. [PMID: 37367092 DOI: 10.3390/geriatrics8030060] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Harmful in-hospital falls with subsequent injuries often cause longer stays and subsequently higher costs. Early identification of fall risk may help in establishing preventive strategies. OBJECTIVE To assess the predictive ability of different clinical scores including the Post-acute care discharge (PACD) score and nutritional risk screening score (NRS), and to develop a new fall risk score (FallRS). METHODS A retrospective cohort study of medical in-patients of a Swiss tertiary care hospital from January 2016 to March 2022. We tested the ability of the PACD score, NRS and FallRS to predict a fall by using the area under curve (AUC). Adult patients with a length of stay of ≥ 2 days were eligible. RESULTS We included 19,270 admissions (43% females; median age, 71) of which 528 admissions (2.74%) had at least one fall during the hospital stay. The AUC varied between 0.61 (95% confidence interval (CI), 0.55-0.66) for the NRS and 0.69 (95% CI, 0.64-0.75) for the PACD score. The combined FallRS score had a slightly better AUC of 0.70 (95% CI, 0.65-0.75) but was more laborious to compute than the two other scores. At a cutoff of 13 points, the FallRS had a specificity of 77% and a sensitivity of 49% in predicting falls. CONCLUSIONS We found that the scores focusing on different aspects of clinical care predicted the risk of falls with fair accuracy. A reliable score with which to predict falls could help in establishing preventive strategies for reducing in-hospital falls. Whether or not the scores presented have better predictive ability than more specific fall scores do will need to be validated in a prospective study.
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Affiliation(s)
- Jennifer Siegwart
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Umberto Spennato
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Nathalie Lerjen
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Beat Mueller
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Philipp Schuetz
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Daniel Koch
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Tristan Struja
- Medical University Clinic, Kantonsspital Aarau, 5001 Aarau, Switzerland
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Del Giorno R, Quarenghi M, Stefanelli K, Capelli S, Giagulli A, Quarleri L, Stehrenberger D, Ossola N, Monotti R, Gabutti L. Nutritional Risk Screening and Body Composition in COVID-19 Patients Hospitalized in an Internal Medicine Ward. Int J Gen Med 2020; 13:1643-1651. [PMID: 33380822 PMCID: PMC7767704 DOI: 10.2147/ijgm.s286484] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Malnutrition in patients hospitalized in internal medicine wards is highly prevalent and represents a prognostic factor of worse outcomes. Previous evidence suggested the prognostic role of the nutritional status in patients affected by the coronavirus disease 2019 (COVID-19). We aim to investigate the nutritional risk in patients with COVID-19 hospitalized in an internal medicine ward and their clinical outcomes using the Nutritional Risk Screening 2002 (NRS-2002) and parameters derived from bioelectrical impedance analysis (BIA). METHODS Retrospective analysis of patients with COVID-19 aimed at exploring: 1) the prevalence of nutritional risk with NRS-2002 and BIA; 2) the relationship between NRS-2002, BIA parameters and selected outcomes: length of hospital stay (LOS); death and need of intensive care unit (ICU); prolonged LOS; and loss of appetite. RESULTS Data of 90 patients were analyzed. Patients at nutritional risk were 92% with NRS-2002, with BIA-derived parameters: 88% by phase angle; 86% by body cell mass; 84% by fat-free mass and 84% by fat mass (p-value ≤0.001). In ROC analysis, NRS had the maximum sensitivity in predicting the risk of death and need of ICU and a prolonged hospitalization showing moderate-low specificity; phase angle showed a good predictive power in terms of AUC. NRS-2002 was significantly associated with LOS (β 12.62, SE 5.79). In a multivariate analysis, blood glucose level and the early warning score are independent predictors of death and need of ICU (OR 2.79, p ≤0.001; 1.59, p-0.029, respectively). CONCLUSION Present findings confirm the clinical utility of NRS-2002 to assess nutritional risk in patients with COVID-19 at hospital admission and in predicting LOS, and that bioimpedance does not seem to add further predictive value. An early detection of nutritional risk has to be systematically included in the management of COVID-19 patients hospitalized in internal medicine wards.
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Affiliation(s)
- Rosaria Del Giorno
- Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
| | - Massimo Quarenghi
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Kevyn Stefanelli
- Department of Social Sciences and Economics, Sapienza University of Rome, Rome, Italy
| | - Silvia Capelli
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Antonella Giagulli
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Lara Quarleri
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Daniela Stehrenberger
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Nicola Ossola
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland
| | - Rita Monotti
- Department of Internal Medicine, Ospedale La Carità, Locarno, Switzerland
| | - Luca Gabutti
- Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
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Abstract
BACKGROUND Malnutrition is frequent among patients with malignancies and associated with impaired function, reduced quality of life and increased mortality. Few data are available in patients with neuroendocrine tumors (NET) on nutritional status, nutritional risk, and nutrition impact symptoms (NIS). We aimed to assess nutritional status (NS) and risk, level of function and associations with NIS in NET patients. METHODS In a cross-sectional study of NET patients, we measured body mass index (BMI) and handgrip strength (HGS) as markers of NS and muscle function assessed by HGS. The nutritional risk score (NRS) was determined by NRS-2002. NIS was assessed by the eating symptoms questionnaire (ESQ), and disease-related appetite questionnaire (DRAQ). RESULTS We included 186 patients (51% women), median age 66 years. We observed low BMI (<20.5 kg/m2) in 12%, low HGS in 25%, and impaired level of function in 43% of the patients. About 38% were at nutritional risk, more frequent in patients with residual disease (45% versus 29%, p < .05). Both low HGS, impaired level of function and being at nutritional risk were associated with the NIS: Nausea, vomiting, stomach ache and dry mouth (p < .05) whereas poor appetite and early satiety were only associated with being at nutritional risk and having impaired level of function (p < .05, all). CONCLUSIONS Almost 40% of NET patients were at nutritional risk; and 25% had impaired HGS associated with specific NIS that preclude food intake. We recommend that NET outpatients are screened with NRS-2002 and that HGS and NIS are determined if NET patients need nutritional therapy.
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Affiliation(s)
- Mette Borre
- a Department of Hepatology and Gastroenterology , Aarhus University Hospital ENETS Centre of Excellence, Aarhus University Hospital , Aarhus , Denmark
| | - Gitte Aarøe Dam
- a Department of Hepatology and Gastroenterology , Aarhus University Hospital ENETS Centre of Excellence, Aarhus University Hospital , Aarhus , Denmark
| | - Anne Wilkens Knudsen
- b Medical Division, and Medical Unit, Nutritional Division , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Henning Grønbaek
- a Department of Hepatology and Gastroenterology , Aarhus University Hospital ENETS Centre of Excellence, Aarhus University Hospital , Aarhus , Denmark
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Abstract
Obesity affects one in three American adult women and is associated with overall mortality and major morbidities. A composite diet index to evaluate total diet quality may better assess the complex relationship between diet and obesity, providing insights for nutrition interventions. The purpose of the present investigation was to determine whether diet quality, defined according to the previously validated Framingham nutritional risk score (FNRS), was associated with the development of overweight or obesity in women. Over 16 years, we followed 590 normal-weight women (BMI < 25 kg/m2), aged 25 to 71 years, of the Framingham Offspring and Spouse Study who presented without CVD, cancer or diabetes at baseline. The nineteen-nutrient FNRS derived from mean ranks of nutrient intakes from 3 d dietary records was used to assess nutritional risk. The outcome was development of overweight or obesity (BMI > or = 25 kg/m2) during follow-up. In a stepwise multiple logistic regression model adjusted for age, physical activity and smoking status, the FNRS was directly related to overweight or obesity (P for trend = 0.009). Women with lower diet quality (i.e. higher nutritional risk scores) were significantly more likely to become overweight or obese (OR 1.76; 95 % CI 1.16, 2.69) compared with those with higher diet quality. Diet quality, assessed using a comprehensive composite nutritional risk score, predicted development of overweight or obesity. This finding suggests that overall diet quality be considered a key component in planning and implementing programmes for obesity risk reduction and treatment recommendations.
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Affiliation(s)
- Dolores M. Wolongevicz
- Department of Family Medicine and the Graduate Medical Sciences Division, Boston University School of Medicine, Boston, MA, USA
| | - Lei Zhu
- Department of Mathematics, Boston University, Boston, MA, USA
| | | | - Ruth W. Kimokoti
- Department of Family Medicine and the Graduate Medical Sciences Division, Boston University School of Medicine, Boston, MA, USA
| | - P. K. Newby
- Departments of Pediatrics and Epidemiology, Boston University Schools of Medicine and Public Health, Boston, MA, USA
| | | | - Barbara E. Millen
- Department of Family Medicine and the Graduate Medical Sciences Division, Boston University School of Medicine, Boston, MA, USA
- Boston Nutrition Foundation, Inc., Westwood, MA, USA
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