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Wang X, Li Y, Ye J, Jiang F, Cheng Y, Chen X. The Prognostic Value of Johns Hopkins Hospital Nutrition Support Score in Older Patients Undergoing Cardiovascular Surgery. J Cardiothorac Vasc Anesth 2023; 37:1959-1966. [PMID: 37516594 DOI: 10.1053/j.jvca.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES Clarify the prognostic value of the Johns Hopkins Hospital Nutrition Support (JHHNS) score on clinical outcomes in older patients undergoing cardiovascular surgery with cardiopulmonary bypass (CPB). DESIGN A retrospective observational study. SETTING A teaching and university hospital and tertiary referral center. PARTICIPANTS The authors analyzed 328 older patients aged ≥65 who underwent cardiovascular surgery with CPB in 2020. INTERVENTIONS Malnutrition risk was identified by the JHHNS score calculated based on specific preoperative and intraoperative objective parameters. Patients were divided into low- and high-JHHNS groups. Early morbidity, including pneumonia, bacteremia, wound infection, cerebrovascular accident, gastrointestinal bleeding, acute kidney injury, delirium, requirement for extracorporeal membrane oxygenation, and readmission to the intensive care unit (ICU), were the primary outcome; whereas in-hospital mortality, length of ICU and hospital stay, duration of mechanical ventilation and short-term mortality were secondary outcomes. The independent risk factors for postoperative complications were analyzed by logistic regression analyses. MEASUREMENTS AND MAIN RESULTS The JHHNS score identified 21.0% of patients at risk for malnutrition. Patients in the high-JHHNS group had prolonged median length hospital stay (21 v 24 days, p = 0.002) and mechanical ventilation (13.0 v 16.0 hours, p = 0.038), and more patients in this subgroup stayed longer than 3 days in ICU (30.1% v 43.5%, p = 0.036). Besides, they experienced more postoperative complications (11.2% v 39.1%, p < 0.001). Furthermore, multivariate logistic regression analysis demonstrated that the JHHNS score independently predicted the risk of postoperative complications. No significant intergroup difference was observed for the short-term mortality. CONCLUSIONS The JHHNS score was an independent predictor for postoperative complications but did not significantly affect short-term mortality in older patients undergoing cardiovascular surgery with CPB.
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Affiliation(s)
- Xiaoqian Wang
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Yuan Li
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Jiaxin Ye
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Fengjuan Jiang
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Yongqing Cheng
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Xiaotian Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
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Chen X, Han P, Zhu X, Song P, Zhao Y, Zhang H, Yu C, Niu J, Ding W, Zhao J, Zhang L, Qi H, Zhang S, Guo Q. Comparison of three nutritional screening tools for detecting sarcopenia in patients with maintenance hemodialysis. Front Public Health 2022; 10:996447. [PMID: 36353286 PMCID: PMC9637894 DOI: 10.3389/fpubh.2022.996447] [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] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/26/2022] [Indexed: 01/26/2023] Open
Abstract
Background Malnutrition, dynapenia, and sarcopenia are prevalent conditions among patients with maintenance hemodialysis (MHD). They are related to numerous adverse health outcomes. The aim of this study was to compare the effect of three nutritional screening tools on predicting the risk of dynapenia and sarcopenia in patients with MHD. Methods From July 2020 to April 2021, a total of 849 patients with MHD were enrolled at seven different healthcare facilities in Shanghai, China in this multi-center cross-sectional study. Geriatric nutritional risk index (GNRI), malnutrition inflammation score (MIS), and creatinine (Cr) index were used for nutritional assessment. The cutoff values of muscle mass and strength to define dynapenia, pre-sarcopenia, and sarcopenia were based on the consensus by the Asia Working Group of Sarcopenia in 2019. Results Among 849, almost 60% were malnourished with the majority suffering from dynapenia (27.7%), followed by sarcopenia (22.7%), and pre-sarcopenia (6.2%).The area under the receiver-operating characteristic curve for GNRI was 0.722 [95% confidence interval (CI) = 0.684-0.760] and 0.723 (95% CI = 0.663-0.783) in predicting sarcopenia and pre-sarcopenia. The GNRI [odds ratio (OR) =6.28, 95% CI: 4.05-9.73], MIS (OR =1.91, 95% CI: 1.31-2.78), and the Cr index (OR =2.73, 95% CI: 1.71-4.34) were all significantly associated with the risk of sarcopenia. More importantly, the sarcopenia predictability of the GNRI appears greater than the MIS and Cr index, while MIS was similar to the Cr index. Similarly, the superiority of GNRI prediction was also found in pre-sarcopenia, but not in dynapenia. Conclusion All the three nutritional screening tools were significantly associated with an increased risk of sarcopenia. The sarcopenia predictability of the GNRI was greater than the MIS and Cr index.
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Affiliation(s)
- Xiaoyu Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Peipei Han
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xiaoyan Zhu
- Department of Rehabilitation Medicine, Shanghai Herson Rehabilitation Hospital, Shanghai, China
| | - Peiyu Song
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Sciences Affiliated First Rehabilitation Hospital, Shanghai, China
| | - Yinjiao Zhao
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Sciences Affiliated First Rehabilitation Hospital, Shanghai, China
| | - Hui Zhang
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Sciences Affiliated First Rehabilitation Hospital, Shanghai, China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jianying Niu
- Department of Nephrology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wei Ding
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junli Zhao
- Department of Nephrology, Shanghai University of Medicine and Health Science Affiliated Zhoupu Hospital, Shanghai, China
| | - Liming Zhang
- Department of Nephrology, Zhabei Central Hospital of Jing'an District of Shanghai, Shanghai, China
| | - Hualin Qi
- Department of Nephrology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Suhua Zhang
- Department of Nephrology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China,*Correspondence: Qi Guo
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Fiorindi C, Dragoni G, Scaringi S, Staderini F, Nannoni A, Ficari F, Giudici F. Relationship between Nutritional Screening Tools and GLIM in Complicated IBD Requiring Surgery. Nutrients 2021; 13:3899. [PMID: 34836154 PMCID: PMC8623109 DOI: 10.3390/nu13113899] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/14/2021] [Accepted: 10/29/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Accurate identification of malnutrition and preoperative nutritional care in Inflammatory Bowel Disease (IBD) surgery is mandatory. There is no validated nutritional screening tool for IBD patients. We developed a novel nutritional screening tool for IBD patients requiring surgery and compared it with other tools. METHODS we included 62 consecutive patients scheduled for elective surgery. The IBD Nutritional Screening tool (NS-IBD) was developed to screen patients for further comprehensive assessment. NRS-2002, MUST, MST, MIRT, SaskIBD-NR are compared with the new test. All screening tests were subsequently related to new GLIM criteria. RESULTS according to GLIM criteria, 25 (40%) IBD patients were malnourished (15 CD and 10 UC, 33% vs. 63%, p = 0.036). Stage 1 malnutrition was reported in ten patients, while stage 2 was detected in 15 patients. The comparison of each nutritional risk tool with GLIM criteria showed sensitivity of 0.52, 0.6, 0.6, 0.84, 0.84 and 0.92 for SASKIBD-NR, MUST, MST, NRS-2002, MIRT, and the new NS-IBD, respectively. CONCLUSIONS in IBD, currently adopted nutritional screening tools are characterized by a low sensitivity when malnutrition diagnosis is performed with recent GLIM criteria. Our proposed tool to detect malnutrition performed the best in detecting patients that may require nutritional assessment and preoperative intervention.
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Affiliation(s)
- Camilla Fiorindi
- Department of Health Science, Careggi University Hospital, 50134 Florence, Italy; (C.F.); (A.N.)
| | - Gabriele Dragoni
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy;
| | - Stefano Scaringi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (S.S.); (F.S.); (F.F.)
| | - Fabio Staderini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (S.S.); (F.S.); (F.F.)
| | - Anita Nannoni
- Department of Health Science, Careggi University Hospital, 50134 Florence, Italy; (C.F.); (A.N.)
| | - Ferdinando Ficari
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (S.S.); (F.S.); (F.F.)
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (S.S.); (F.S.); (F.F.)
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Brglez M, Plazar N, Poklar Vatovec T, Meulenberg CJW. Health concerns regarding malnutrition among the older populations: considerations from a Slovenian perspective. Health Promot Int 2021; 37:6310297. [PMID: 34179974 DOI: 10.1093/heapro/daab097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Diet is an important factor in a healthy lifestyle for all age groups. However, with aging it is important to be aware that the diet, due to changed physiology, needs an accordingly adjusted and balanced daily regime. This article reviews the field of older population's nutrition and presents: the most common nutritional disorders, causes, demographics and malnutrition measurement tools. Relevant scientific literature as well as professional Slovenian papers were identified through specific searches with topic-related keywords in EBSCO, PubMed, Web of Science and COBISS databases. The results of the identified papers are subsequently discussed in a descriptive narrative. The reviewed literature shows noticeable trends of high proportions of malnutrition among older persons, both globally and in Slovenia: predominantly observed are overnutrition like overweight and obese, but as well, and often unnoticed, undernutrition. The latter is more worrying, as inadequate knowledge in health care institutions regarding nutritional screening tools and measures to prevent drastic forms of undernutrition, seem to facilitate these trends. Though there are many reasons for insufficient food intake in older people, the article formulates considerations that can feed appropriate education and awareness programs, and through correct screening point to timely identification of malnourished individuals and those with risk of malnutrition. The promotion and implementation of such considerations could prevent malnutrition among the older population, reduce the frequency of nutritional disorders and co-morbidities, and generally improve the nutritional status of the older population, thus, provide better quality of health later in life.
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Affiliation(s)
- Monika Brglez
- Alma Mater Europaea, European Centre, Maribor, Slovenia
| | - Nadja Plazar
- Alma Mater Europaea, European Centre, Maribor, Slovenia
| | | | - Cécil J W Meulenberg
- Institute for Kinesiology Research, Science and Research Centre, Koper, Slovenia
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Marderfeld L, Rub G, Hodik G, Poraz I, Hartman C, Ashkenazi S, Shamir R. Validation and impact of paediatric malnutrition screening tool in hospitalised children on awareness of medical staff and health-related outcomes. Nutr Diet 2019; 76:574-579. [PMID: 31012267 DOI: 10.1111/1747-0080.12529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/17/2019] [Accepted: 02/20/2019] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to evaluate the use of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) among children admitted in a paediatric hospital, and assess its impact on the nutritional status awareness among the medical staff and on health outcomes at discharge. METHODS STAMP performed by nurses on admission was compared with full nutritional assessment performed by a dietitian. Area under the receiving operating characteristic (AUROC) curve was used to evaluate validity of the tool. To assess how the tool affected awareness among the staff, information on nutritional status was compared prior to and following the intervention period. Therewith, health outcomes at discharge were compared for the children who had been screened by STAMP and the children who had not. RESULTS The analysis was performed for a total of 60 children (38 boys, 63%). The mean age was 7.8 ± 4.7 years. Malnutrition was found in 16% of patients, segregating equally between acute and chronic malnutrition. Sensitivity, specificity, positive predictive value and negative predictive value were 95.7% (95% confidence interval, CI = 85.75-98.83%), 76.9% (95% CI = 49.74-91.82%), 93.7 and 83.3, respectively. AUROC was 0.863 (95% CI = 0.72-1). There was no difference either in malnutrition awareness among the medical staff before and after the intervention period or in health outcomes at discharge. CONCLUSIONS STAMP is a valid tool for malnutrition screening in hospitalised children; however, its use does not influence admitted patients' nutritional status awareness among the medical staff nor their outcomes at discharge.
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Affiliation(s)
- Luba Marderfeld
- Nutrition and Dietetics Department, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel.,Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel
| | - Gal Rub
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel
| | - Gavriel Hodik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Epidemiology & Database Research Department, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Irit Poraz
- Nutrition and Dietetics Department, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel.,National Management Office, Clalit Health Services, Tel Aviv, Israel
| | - Corina Hartman
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Ashkenazi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Internal Department A, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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