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Geary R, Mantik J, Moore V, Schuller J, Fedoruk R, Atkins M, Chan CB. COMmunity-Based Nutrition RISK Screening in Older Adults Living Independently (COMRISK): Feasibility, Acceptability, and Appropriateness of Community Partnership Models in Alberta, Canada. Can J Aging 2024; 43:287-296. [PMID: 37811554 DOI: 10.1017/s0714980823000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
This feasibility study of routine nutrition risk screening in community-dwelling older adults using a partnership between health care and community-based organizations (CBO) aimed to (1) evaluate the ability of community-based partnerships to provide screening for nutrition risk, and appropriately refer at-risk individuals for follow-up care and (2) determine the barriers to and facilitators of screening. Adults 65 years of age and older were screened by staff in two primary care and one CBO setting using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN)-8 nutrition risk screening tool. Screeners, organization administrators, and registered dietitians responded to surveys regarding SCREEN-8 administration, referral processes, and partnership interactions. All found the SCREEN-8 initiative feasible, acceptable, and appropriate. Sustainability requires strengthening of community resources, referral processes, and telephone assessments. The partnership added value despite limitations in communications. We conclude that broader implementation of this program using community-based partnerships has the potential to aid in the prevention of malnutrition in older adults.
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Affiliation(s)
- Rebecca Geary
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Jessica Mantik
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Valerie Moore
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Jessica Schuller
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Rani Fedoruk
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Marlis Atkins
- Nutrition Services, Alberta Health Services, Edmonton, AB, Canada
| | - Catherine B Chan
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
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Krznarić Ž, Vranešić Bender D, Blaž Kovač M, Cuerda C, van Ginkel-Res A, Hiesmayr M, Marinho A, Mendive J, Monteiro I, Pirlich M, Musić Milanović S, Kozjek NR, Schneider S, Chourdakis M, Barazzoni R. Clinical nutrition in primary care: ESPEN position paper. Clin Nutr 2024; 43:1678-1683. [PMID: 38471980 DOI: 10.1016/j.clnu.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024]
Abstract
Primary care healthcare professionals (PCHPs) are pivotal in managing chronic diseases and present a unique opportunity for nutrition-related disease prevention. However, the active involvement of PCHPs in nutritional care is limited, influenced by factors like insufficient education, lack of resources, and time constraints. In this position paper The European Society for Clinical Nutrition and Metabolism (ESPEN) promotes the active engagement of PCHPs in nutritional care. We emphasize the importance of early detection of malnutrition by screening and diagnosis, particularly in all individuals presenting with risk factors such as older age, chronic disease, post-acute disease conditions and after hospitalization for any cause. ESPEN proposes a strategic roadmap to empower PCHPs in clinical nutrition, focusing on education, tools, and multidisciplinary collaboration. The aim is to integrate nutrition into medical curricula, provide simple screening tools for primary care, and establish referral pathways to address malnutrition systematically. In conclusion, we urge for collaboration with PCHP organizations to raise awareness, enhance nutrition skills, facilitate dietitian accessibility, establish multidisciplinary teams, and promote referral pathways, thereby addressing the underestimated clinical challenge of malnutrition in primary care.
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Affiliation(s)
- Željko Krznarić
- University of Zagreb, Zagreb School of Medicine, University Hospital Centre Zagreb, Department of Gastroenterology, Hepatology and Nutrition, Zagreb, Croatia.
| | - Darija Vranešić Bender
- University of Zagreb, Zagreb School of Medicine, University Hospital Centre Zagreb, Department of Gastroenterology, Hepatology and Nutrition, Zagreb, Croatia.
| | - Milena Blaž Kovač
- Community Health Centre Ljubljana, Ljubljana, Slovenia; Department of Family Medicine, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Annemieke van Ginkel-Res
- European Federation of Associations of Dietitians, Diëtheek The Netherlands, Organization of Primary Care Dietitians, The Netherlands
| | - Michael Hiesmayr
- Center for Medical Data Science, Medical University Vienna, Vienna, Austria
| | - Anibal Marinho
- Department of Intensive Care, Hospital Universitário de Santo António, Porto, Portugal
| | - Juan Mendive
- La Mina Primary Health Care Academic Centre, Catalan Health Institute, University of Barcelona, Barcelona, Spain
| | - Isabel Monteiro
- Department of Sciences, University Institute of Health Sciences, CESPU, Gandra, Portugal; 1H-TOXRUN - One Health Toxicology Research Unit, University Institute of Health Sciences, CESPU, 4585 -116 Gandra, Portugal
| | | | - Sanja Musić Milanović
- University of Zagreb, Zagreb School of Medicine, Division for Health Promotion, Croatian Institute of Public Health, Zagreb, Croatia
| | | | - Stephane Schneider
- Gastroenterology and Clinical Nutrition, Archet University Hospital, Université Côte d'AZUR, Nice, France
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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Qing H, Zhang XD, Yang E, Li HX, Wei YL, Chen W, Guo SY, Tang SF. Nutritional status and nutritional intervention of older inpatients in China. J Nutr Health Aging 2024; 28:100169. [PMID: 38308922 DOI: 10.1016/j.jnha.2024.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Malnutrition is a critical issue among older inpatients, yet limited large-scale research related to this issue has been conducted in China. This study aimed to examine the nutritional status and support of older inpatients in China, assess the associations between disease categories and malnutrition on admission, and explore effective nutritional intervention. METHODS A total of 24,139 older participants from the China Nutrition Fundamental Data 2020 Project were included. Malnutrition was measured by the Global Leadership Initiative on Malnutrition criteria. Adjusted odds ratios (aORs) were calculated using logistic analysis. RESULTS The overall frequency of malnutrition on admission was 18.9%. Participants with infections were more likely to have malnutrition (aOR = 1.929, 95% CI 1.486-2.504). Risks that were also noted for malnutrition included neoplasms (aOR = 1.822, 95% CI 1.697-1.957), hemic and lymphatic diseases (aOR = 1.671, 95% CI 1.361-2.051), nervous system diseases (aOR = 1.222, 95% CI 1.126-1.326), respiratory diseases (aOR = 1.613, 95% CI 1.490-1.746), and digestive system diseases (aOR = 1.462, 95% CI 1.357-1.577). Further, 32.26% inpatients with malnutrition during hospitalization didn't receive nutritional support. Oral nutrition supplements, enteral tube feeding, and parenteral nutrition were associated with stable or improved nutritional status. CONCLUSIONS Older inpatients were at a high risk for malnutrition but did not receive adequate nutritional intervention. More resources and attention need to be devoted to the nutritional status of older inpatients and targeted nutritional support.
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Affiliation(s)
- Hua Qing
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xu-Dong Zhang
- National Institute of Hospital Administration, National Health Commission, Beijing 100048, China
| | - En Yang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hui-Xin Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yi-Lin Wei
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Shu-Yan Guo
- National Institute of Hospital Administration, National Health Commission, Beijing 100048, China.
| | - Shang-Feng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Suárez D, Pascual E, Soravilla JR. [Long covid and disability]. Semergen 2024; 50:102189. [PMID: 38277734 DOI: 10.1016/j.semerg.2023.102189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 01/28/2024]
Abstract
Long covid is a health problem that will entail a high hidden cost attributable to the pandemic years after it because it affects the work capacity of many workers. Given the millions of covid-19 cases worldwide and current research showing that one in 7covid-19 patients remain symptomatic at 12 weeks, the number of long covid patients is likely to be substantial. Long covid is characterized by heterogeneous sequelae that often affect multiple systems, organs with an impact on the functioning and capacity of the worker. Workers with long covid symptoms can return to their occupation but this involves a complex individualized approach to the impact of symptoms on work, adjustments and modifications to the workplace. Patients with long covid typically report prolonged multisystem involvement and signicant disability. The psychological cost to the worker must also be addressed. A survey by the Community of Madrid (CCOO, SATSE, CSIF, AMYTS) in 2022 reveals that 24.5% of those affected by long covid were sick for more than 12 months; 30% of those affected by persistent covid need and adaption to their workplace. In Spain, more than 10million people infected with SARS-CoV-2 have been reported since the pandemic began, so it is estimated that there could be one million people with persistent covid. In 2021 alone there were more than 2.6 million sick leave due to covid-19 in Spain, the average duration of which was 10 days. One hundred million people around the world suffer from persistent covid, but few countries officially count them, nor do they help those affected with employment. In advanced countries, like the United States, long covid is treated as a disability,and the number of people with disabilities working or looking for work increased by 1.36 million, an increase of 23%, between January 2021 and January 2022. In the United Kingdom, some 200,000 people are not working or are not looking for work due to long-term health problems attributable to long covid, since the pandemic began.
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Affiliation(s)
- D Suárez
- Medicina de Familia, Centro de salud de Benejúzar, Alicante, España.
| | - E Pascual
- Medicina de Familia, Centro de salud de Pamplona, Pamplona, España
| | - J R Soravilla
- Medicina del Trabajo, Clínica Soravilla Los Sauces, Alicante, España
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Hegazi R, Miller A, Sauer A. Evolution of the diagnosis of malnutrition in adults: a primer for clinicians. Front Nutr 2024; 11:1169538. [PMID: 38379550 PMCID: PMC10876842 DOI: 10.3389/fnut.2024.1169538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 01/19/2024] [Indexed: 02/22/2024] Open
Abstract
During the last two decades, the definition, diagnosis, and management of malnutrition have significantly evolved. Malnutrition is generally defined as deficiencies, excesses, or imbalances in a person's intake of energy and/or nutrients. While malnutrition is associated with a significantly increased risk of morbidity, mortality, and healthcare cost, it is often underdiagnosed both in healthcare and community settings. One contributing factor is the lack of a consensus on its definition and appropriate diagnostic indicators. In the current article, we review the evolution of frameworks for the diagnosis of malnutrition. Recently published consensuses by prominent clinical nutrition societies have established a trajectory for the uniform global diagnosis of malnutrition. Limiting the use of body mass index (BMI) as a diagnostic criterion while emphasizing the use of muscle mass enables a more consistent and accurate diagnosis of malnutrition in the clinical setting. Guidance for the unified methodology and terminology for diagnosing malnutrition, such as the one proposed in the current article will enable policy makers to systematically address the two faces of malnutrition, starvation- and disease-related malnutrition applicable to both pediatric and adult populations. Policies and programs that could address issues of food insecurity and scarcity as well as early diagnosis and management of disease-related malnutrition will empower better care of community nutrition.
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Affiliation(s)
- Refaat Hegazi
- Department of Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, United States
| | - Anthony Miller
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Abby Sauer
- Department of Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, United States
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Álvarez-Hernández J, Matía-Martín P, Cáncer-Minchot E, Cuerda C. Long-term outcomes in critically ill patients who survived COVID-19: The NUTRICOVID observational cohort study. Clin Nutr 2023; 42:2029-2035. [PMID: 37659250 DOI: 10.1016/j.clnu.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/14/2023] [Accepted: 08/09/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND & AIMS Malnutrition and sarcopenia may last beyond hospital discharge, especially in patients admitted to intensive care units (ICU), having a negative impact on patient recovery and leading to disability, poor quality of life, and additional morbidity. No prior evidence is available for post-ICU management and follow-up of coronavirus disease 2019 (COVID-19) patients and their long-term evolution. This study reports on the one-year-long evolution of a cohort of COVID-19 survivors after ICU discharge, in terms of nutritional and functional status as well as health-related quality of life (HRQoL). METHODS A multicenter, ambispective, observational cohort study (NUTRICOVID study) was conducted in 16 public hospitals located in the Community of Madrid with COVID-19 survivors who were admitted to ICU during the first outbreak. Retrospective and prospective data were collected from hospital admission to one year after discharge. At hospital discharge and at 3, 6 and 12 months post-discharge, the following outcomes were recorded: weight, risk of malnutrition (MUST) and sarcopenia (SARC-F), medical nutrition therapy (MNT), functional status (Barthel index), and HRQoL (EQ-5D-5L). RESULTS A total of 199 patients (70.4% male, mean age [SD] of 60.7 [10.1]) were included in the study. At hospital discharge, mean weight loss was 16.4% (8.0%), whereas most patients gained weight after discharge with an increase of 16.5% (14.0%) at 12 months. The proportion of patients at high risk of malnutrition decreased from 83.2% at hospital discharge to 2.1% at 12 months. The proportion at risk of sarcopenia decreased from 86.9% at hospital discharge to 13.4% at 12 months. At hospital discharge, 69 patients received MNT by means of oral nutritional supplements (ONS) while two patients required enteral nutrition (EN). At 12 months, only 12 patients continued taking ONS, with no patients taking EN. Regarding functional status, 72.9% of patients were moderately or severely dependent at hospital discharge, whereas 87.2% showed low dependency or independency after 12 months. The EQ-VAS values increased from hospital discharge (39 [21.2]) to 6 months post-discharge and remained steady up to 12 months (72.7 [19.0]). The mean health value improved from hospital discharge (0.25 [0.41]) to 6 months post-discharge (0.80 [0.24]) and was maintained thereafter. CONCLUSIONS Patients' nutritional and functional impairment at hospital discharge was high, with high dependency status and low HRQoL; however, their situation improved progressively during the 12 months following hospital discharge. Nevertheless, there is a need to define early strategies to optimize the nutritional and functional recovery of COVID-19 patients.
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Affiliation(s)
| | - P Matía-Martín
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | | | - C Cuerda
- Hospital Universitario Gregorio Marañón, Madrid, Spain
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7
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Wang J, He C, Long Z. Establishing a machine learning model for predicting nutritional risk through facial feature recognition. Front Nutr 2023; 10:1219193. [PMID: 37781131 PMCID: PMC10540841 DOI: 10.3389/fnut.2023.1219193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Background Malnutrition affects many worldwide, necessitating accurate and timely nutritional risk assessment. This study aims to develop and validate a machine learning model using facial feature recognition for predicting nutritional risk. This innovative approach seeks to offer a non-invasive, efficient method for early identification and intervention, ultimately improving health outcomes. Methods We gathered medical examination data and facial images from 949 patients across multiple hospitals to predict nutritional status. In this multicenter investigation, facial images underwent preprocessing via face alignment and cropping. Orbital fat pads were isolated using the U-net model, with the histogram of oriented gradient (HOG) method employed for feature extraction. Standardized HOG features were subjected to principal component analysis (PCA) for dimensionality reduction. A support vector machine (SVM) classification model was utilized for NRS-2002 detection. Our approach established a non-linear mapping between facial features and NRS-2002 nutritional risk scores, providing an innovative method for evaluating patient nutritional status. Results In context of orbital fat pad area segmentation with U-net model, the averaged dice coefficient is 88.3%. Our experimental results show that the proposed method to predict NRS-2002 scores achieves an accuracy of 73.1%. We also grouped the samples by gender, age, and the location of the hospital where the data were collected to evaluate the classification accuracy in different subsets. The classification accuracy rate for the elderly group was 85%, while the non-elderly group exhibited a classification accuracy rate of 71.1%; Furthermore, the classification accuracy rate for males and females were 69.2 and 78.6%, respectively. Hospitals located in remote areas, such as Tibet and Yunnan, yielded a classification accuracy rate of 76.5% for collected patient samples, whereas hospitals in non-remote areas achieved a classification accuracy rate of 71.1%. Conclusion The attained accuracy rate of 73.1% holds significant implications for the feasibility of the method. While not impeccable, this level of accuracy highlights the potential for further improvements. The development of this algorithm has the potential to revolutionize nutritional risk assessment by providing healthcare professionals and individuals with a non-invasive, cost-effective, and easily accessible tool.
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Affiliation(s)
- Jingmin Wang
- College of International Engineering, Xi’an University of Technology, Xi’an, China
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8
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Gómez-Sánchez L, Tamayo-Morales O, Suárez-Moreno N, Bermejo-Martín JF, Domínguez-Martín A, Martín-Oterino JA, Martín-González JI, González-Calle D, García-García Á, Lugones-Sánchez C, González-Sánchez S, Jiménez-Gómez R, García-Ortiz L, Gómez-Marcos MA, Navarro-Matías E. Relationship between the structure, function and endothelial damage, and vascular ageing and the biopsychological situation in adults diagnosed with persistent COVID (BioICOPER study). A research protocol of a cross-sectional study. Front Physiol 2023; 14:1236430. [PMID: 37772064 PMCID: PMC10523018 DOI: 10.3389/fphys.2023.1236430] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/17/2023] [Indexed: 09/30/2023] Open
Abstract
Background: SARS-CoV-2 infection affects the vascular endothelium, which mediates the inflammatory and thrombotic cascade. Moreover, alterations in the endothelium are related to arterial stiffness, which has been established as a marker of cardiovascular disease. The objective of this study is to analyse how the structure, vascular function, vascular ageing and endothelial damage are related to the biopsychological situation in adults diagnosed with persistent COVID and the differences by gender. Methods: This cross-sectional, descriptive, observational study will be carried out in the Primary Care Research Unit of Salamanca (APISAL) and in the BioSepsis laboratory of the University of Salamanca. The sample will be selected from the persistent COVID monographic office at the Internal Medicine Service of the University Hospital of Salamanca, and from the population of subjects diagnosed with persistent COVID in the clinical history of Primary Care. Through consecutive sampling, the study will include 300 individuals diagnosed with persistent COVID who meet the diagnosis criteria established by the WHO, after they sign the informed consent. Endothelial damage biomarkers will be measured using ELLA-SimplePlexTM technology (Biotechne). Their vascular structure and function will be analysed by measuring the carotid intima-media thickness (Sonosite Micromax); the pulse wave and carotid-femoral pulse wave velocity (cfPWV) will be recorded with Sphygmocor System®. Cardio Ankle Vascular Index (CAVI), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index will be analysed with Vasera VS-2000®. The integral assessment of the subjects with persistent COVID will be conducted with different scales that evaluate fatigue, sleep, dyspnea, quality of life, attention, nutrition state, and fragility. We will also evaluate their lifestyles (diet, physical activity, smoking habits and alcohol consumption), psychological factors, and cognitive deterioration, which will be gathered through validated questionnaires; moreover, physical activity will be objectively measured using a pedometer for 7 days. Body composition will be measured through impedance using an Inbody 230. Vascular ageing will be calculated with 10 and 90 percentiles of cfPWV and baPWV. Furthermore, we will analyse the presence of vascular injury in the retina, heart, kidneys and brain, as well as cardiovascular risk. Demographic and analytical variables will also be gathered. Discussion: Arterial stiffness reflects the mechanic and functional properties of the arterial wall, showing the changes in arterial pressure, blood flow, and vascular diameter that occur with each heartbeat. SARS-CoV-2 affects the endothelial cells that are infected with this virus, increasing the production of pro-inflammatory cytokines and pro-thrombotic factors, which can cause early vascular ageing and an increase of arterial stiffness. Persistent COVID is a complex heterogeneous disorder that affects the lives of millions of people worldwide. The identifications of potential risk factors to better understand who is at risk of developing persistent COVID is important, since this would enable early and appropriate clinical support. It is unknown whether vascular alterations caused by COVID-19 resolve after acute infection or remain over time, favouring the increase of arterial stiffness and early vascular ageing. Therefore, it is necessary to propose studies that analyse the evolution of persistent COVID in this group of patients, as well as the possible variables that influence it. Clinical Trial registration: ClinicalTrials.gov, identifier NCT05819840.
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Affiliation(s)
- Leticia Gómez-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Salamanca, Spain
- Hospital de la Paz de Madrid, Servicio de Urgencias, Madrid, Spain
| | - Olaya Tamayo-Morales
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
| | - Nuria Suárez-Moreno
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Castilla and León Health Service–SACYL, Gerencia Regional de Salud, Valladolid, Spain
| | - Jesus F. Bermejo-Martín
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea Domínguez-Martín
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Castilla and León Health Service–SACYL, Gerencia Regional de Salud, Valladolid, Spain
| | - José A. Martín-Oterino
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Castilla and León Health Service–SACYL, Gerencia Regional de Salud, Valladolid, Spain
- Hospital Universitario de Salamanca, Internal Medicine Department, Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - José I. Martín-González
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Castilla and León Health Service–SACYL, Gerencia Regional de Salud, Valladolid, Spain
- Hospital Universitario de Salamanca, Internal Medicine Department, Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - David González-Calle
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Castilla and León Health Service–SACYL, Gerencia Regional de Salud, Valladolid, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
- Hospital Universitario de Salamanca, Cardiology Department, Salamanca, Spain
| | - Ángel García-García
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Castilla and León Health Service–SACYL, Gerencia Regional de Salud, Valladolid, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
- Hospital Universitario de Salamanca, Emergency Department, Salamanca, Spain
| | - Cristina Lugones-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
| | - Susana González-Sánchez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
| | - Raquel Jiménez-Gómez
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Castilla and León Health Service–SACYL, Gerencia Regional de Salud, Valladolid, Spain
| | - Luis García-Ortiz
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
- Castilla and León Health Service–SACYL, Gerencia Regional de Salud, Valladolid, Spain
- Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Manuel A. Gómez-Marcos
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Salamanca, Spain
- Castilla and León Health Service–SACYL, Gerencia Regional de Salud, Valladolid, Spain
- Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Elena Navarro-Matías
- Primary Care Research Unit of Salamanca (APISAL), Salamanca Primary Care Management, Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Castilla and León Health Service–SACYL, Gerencia Regional de Salud, Valladolid, Spain
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Marino LV, Fandinga C, Barratt J, Brady I, Denton SA, Fitzgerald K, Mills T, Palframan K, Phillips S, Rees L, Scanlan N, Ashton JJ, Beattie RM. Pedi-R-MAPP | the development, testing, validation, and refinement of a digital nutrition awareness tool. Clin Nutr 2023; 42:1701-1710. [PMID: 37531806 DOI: 10.1016/j.clnu.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND & AIMS The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments and provide practical guidance for nutritional care. R-MAPP was adapted into Pediatric Remote Malnutrition Application (Pedi-R-MAPP) using a modified Delphi consensus, with the goal of providing a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. The aim of this study was to develop and validate a digital version of Pedi-R-MAPP using the IDEAS framework (Integrate, Design, Assess and Share). METHODS A ten-step process was completed using the IDEAS framework. This involved the four concept processes; Stage-1, Integrate (Step 1-3) identify the problem, specify the goal, and use an evidence-based approach. Stage-2, (Step 4-7) design iteratively and rapidly with user feedback. Stage 3, (Step 8-9) Assess rigorously, and Stage 4 (Step 9-10) publish and launch of the tool. RESULTS Stage 1:Evidence-based development, Pedi-R-MAPP was developed using Delphi consensus methodology. Stage 2:Iteration & design, HCPs (n = 22) from UK, Europe, South Africa, and North America were involved four workshops to further develop a paper prototype of the tool and complete small-scale testing of a beta version of the tool which resulted in eight iterations. Stage 3:Assess rigorously, Small scale retrospective testing of the tool on children with congenital heart disease (n = 80) was completed by a single researcher, with iterative changes made to improve agreement with summary advice. Large scale testing amongst (n = 745) children in different settings was completed by specialist paediatric dietitians (n = 15) advice who recorded agreement with the summary advice compared with their own clinical assessment. Paediatric dietitians were in overall agreement with the summary advice in the tool 86% (n = 640), compared to their own clinical practice. The main reasons for disagreement were i) frequency of planned review 57.1% (n = 60/105), ii) need for ongoing dietetic review due to chronic condition 20.0% (n = 21/105), iii) disagreement with recommendation for discharge 16.2% (n = 17/105) and iv) concerns with faltering growth and/or need for condition specific growth charts 6.7% (7/105). Iterative changes were made to the algorithm, leading to an improvement in agreement of the summary advice on re-evaluation to 98% (p=<0.0001). CONCLUSION A digital version of the Pedi-R-MAPP nutrition awareness tool was developed using the IDEAS framework. The summary advice provided by the tool achieved a high level of agreement when compared to paediatric dietetic assessment, by providing a structured approach to completing a remote nutrition focused assessment, along with identifying the frequency of follow-up or an in-person assessment.
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Affiliation(s)
- L V Marino
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Health Science, University of Southampton, Southampton, UK.
| | - C Fandinga
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Barratt
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - I Brady
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S A Denton
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Fitzgerald
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - T Mills
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Palframan
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Phillips
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - L Rees
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - N Scanlan
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J J Ashton
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Medicine, University of Southampton, Southampton, UK
| | - R M Beattie
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Medicine, University of Southampton, Southampton, UK
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10
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Massimino E, Izzo A, Castaldo C, Ferretti E, Rivellese AA, Della Pepa G. Risk of Sarcopenia and Associated Factors in Older Adults with Type 2 Diabetes: An Exploratory Cross-Sectional Study. Healthcare (Basel) 2023; 11:2081. [PMID: 37510524 PMCID: PMC10380017 DOI: 10.3390/healthcare11142081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Evidence on the risk of sarcopenia and associated factors in older adults with type 2 diabetes (T2D) is lacking. We evaluate (1) the proportion of patients at risk of sarcopenia in older adults with T2D; and (2) the factors associated with the risk of sarcopenia. METHODS We conducted a cross-sectional study on T2D patients over 65 years referred to our outpatient clinic and who carried out the yearly complication assessment visit. Eligible patients were administered questionnaires during phone interviews for the risk evaluation of sarcopenia (SARC-F), the risk evaluation of malnutrition (Mini Nutritional Assessment Short Form (MNA®-SF)), the adherence to the Mediterranean diet (MEDI-quest), and the evaluation of physical activity (the International Physical Activity Questionnaire short form). RESULTS A total of 138 patients were included in the study, and 12 patients (8.7% (95% CI 4.6-14.7)) were at risk of sarcopenia. The mean SARC-F score was significantly higher in women compared with men (2.1 ± 1.8 vs. 0.9 ± 1.4, respectively; p < 0.001). The majority of patients identified at risk of sarcopenia compared with those not at risk were women (75% vs. 30%, respectively; p = 0.003), had a higher proportion of neuropathy (50% vs. 19%, respectively; p = 0.027), a lower mean MNA®-SF score (11.6 ± 1.5 vs. 13.0 ± 1.4, respectively; p = 0.001), a lower mean MEDI-quest score (5.2 ± 1.5 vs. 5.9 ± 1, respectively; p = 0.037), and were more inactive (92% vs. 61%, respectively; p = 0.032). CONCLUSIONS In a sample of older adults with T2D, the risk of sarcopenia was identified in 8.7% (95% CI: 4.6-14.7) of the sample, and the main factors associated were female gender, neuropathy, a lower MNA®-SF score, low adherence to the Mediterranean diet, and low physical activity.
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Affiliation(s)
- Elena Massimino
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Anna Izzo
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Carmen Castaldo
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Erica Ferretti
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Angela Albarosa Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
- Cardiometabolic Risk Unit, Institute of Clinical Physiology, National Research Council-CNR, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
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11
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Prado CM, Ford KL, Gonzalez MC, Murnane LC, Gillis C, Wischmeyer PE, Morrison CA, Lobo DN. Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient. JPEN J Parenter Enteral Nutr 2023; 47 Suppl 1:S54-S68. [PMID: 36468288 PMCID: PMC9905223 DOI: 10.1002/jpen.2420] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 12/11/2022]
Abstract
Preoperative nutrition status is an important determinant of surgical outcomes, yet malnutrition assessment is not integrated into all surgical pathways. Given its importance and the high prevalence of malnutrition in patients undergoing surgical procedures, preoperative nutrition screening, assessment, and intervention are needed to improve postoperative outcomes. This narrative review discusses novel methods to assess malnutrition and frailty in the surgical patient. The Global Leadership Initiative for Malnutrition (GLIM) criteria are increasingly used in surgical settings although further spread and implementation are strongly encouraged to help standardize the diagnosis of malnutrition. The use of body composition (ie, reduced muscle mass) as a phenotypic criterion in GLIM may lead to a greater number of patients identified as having malnutrition, which may otherwise be undetected if screened by other diagnostic tools. Skeletal muscle loss is a defining criterion of malnutrition and frailty. Novel direct and indirect approaches to assess muscle mass in clinical settings may facilitate the identification of patients with or at risk for malnutrition. Selected imaging techniques have the additional advantage of identifying myosteatosis (an independent predictor of morbidity and mortality for surgical patients). Feasible pathways for screening and assessing frailty exist and may determine the cost/benefit of surgery, long-term independence and productivity, and the value of undertaking targeted interventions. Finally, the evaluation of nutrition risk and status is essential to predict and mitigate surgical outcomes. Nascent to novel approaches are the future of objectively identifying patients at perioperative nutrition risk and guiding therapy toward optimal perioperative standards of care.
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Affiliation(s)
- Carla M. Prado
- Department of Agricultural, Food & Nutritional ScienceUniversity of AlbertaEdmontonAlbertaCanada
| | - Katherine L. Ford
- Department of Agricultural, Food & Nutritional ScienceUniversity of AlbertaEdmontonAlbertaCanada
| | - M. Cristina Gonzalez
- Postgraduate Program in Health and BehaviorCatholic University of PelotasPelotasBrazil
| | - Lisa C. Murnane
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
- Department of Nutrition and DieteticsAlfred HealthMelbourneVictoriaAustralia
| | - Chelsia Gillis
- School of Human NutritionMcGill UniversityMontrealQuebecCanada
| | - Paul E. Wischmeyer
- Departments of Anesthesiology and SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Chet A. Morrison
- Department of SurgeryCentral Michigan UniversitySaginawMichiganUSA
| | - Dileep N. Lobo
- Gastrointestinal SurgeryNottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical CentreNottinghamUK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life SciencesUniversity of Nottingham, Queen's Medical CentreNottinghamUK
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12
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Rodríguez-Mañas L, Murray R, Glencorse C, Sulo S. Good nutrition across the lifespan is foundational for healthy aging and sustainable development. Front Nutr 2023; 9:1113060. [PMID: 36761990 PMCID: PMC9902887 DOI: 10.3389/fnut.2022.1113060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023] Open
Abstract
Ensuring healthy lives and promoting wellbeing across the age spectrum are essential to sustainable development. Nutrition is at the heart of the World Health Organization (WHO) Sustainable Development Goals, particularly for Sustainable Development Goal 2/Subgoal 2, which is to End all forms of malnutrition by 2030. This subgoal addresses people of all ages, including targeted groups like young children and older adults. In recent decades, there have been marked advances in the tools and methods used to screen for risk of malnutrition and to conduct nutritional assessments. There have also been innovations in nutritional interventions and outcome measures related to malnutrition. What has been less common is research on how nutritional interventions can impact healthy aging. Our Perspective article thus takes a life-course approach to consider what is needed to address risk of malnutrition and why, and to examine how good nutrition across the lifespan can contribute to healthy aging. We discuss broad-ranging yet interdependent ways to improve nutritional status worldwide-development of nutritional programs and policies, incorporation of the best nutrition-care tools and methods into practice, provision of professional training for quality nutritional care, and monitoring health and economic benefits of such changes. Taken together, our Perspective aims to (i) identify current challenges to meeting these ideals of nutritional care, and to (ii) discover enabling strategies for the improvement of nutrition care across the lifespan. In harmony with the WHO goal of sustainable development, we underscore roles of nutrition to foster healthy human development and healthy aging worldwide.
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Affiliation(s)
- Leocadio Rodríguez-Mañas
- Service of Geriatrics, Getafe University Hospital and CIBER on Frailty and Healthy Aging (CIBERFES), Getafe, Spain,*Correspondence: Leocadio Rodríguez-Mañas,
| | - Robert Murray
- Department of Pediatrics, Emeritus, The Ohio State University College of Medicine, Columbus, OH, United States
| | | | - Suela Sulo
- Abbott Laboratories, Abbott Park, IL, United States
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13
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Muscaritoli M, Bar-Sela G, Battisti NML, Belev B, Contreras-Martínez J, Cortesi E, de Brito-Ashurst I, Prado CM, Ravasco P, Yalcin S. Oncology-Led Early Identification of Nutritional Risk: A Pragmatic, Evidence-Based Protocol (PRONTO). Cancers (Basel) 2023; 15:cancers15020380. [PMID: 36672329 PMCID: PMC9856655 DOI: 10.3390/cancers15020380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/22/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023] Open
Abstract
Nutritional issues, including malnutrition, low muscle mass, sarcopenia (i.e., low muscle mass and strength), and cachexia (i.e., weight loss characterized by a continuous decline in skeletal muscle mass, with or without fat loss), are commonly experienced by patients with cancer at all stages of disease. Cancer cachexia may be associated with poor nutritional status and can compromise a patient's ability to tolerate antineoplastic therapy, increase the likelihood of post-surgical complications, and impact long-term outcomes including survival, quality of life, and function. One of the primary nutritional problems these patients experience is malnutrition, of which muscle depletion represents a clinically relevant feature. There have been recent calls for nutritional screening, assessment, treatment, and monitoring as a consistent component of care for all patients diagnosed with cancer. To achieve this, there is a need for a standardized approach to enable oncologists to identify patients commencing and undergoing antineoplastic therapy who are or who may be at risk of malnutrition and/or muscle depletion. This approach should not replace existing tools used in the dietitian's role, but rather give the oncologist a simple nutritional protocol for optimization of the patient care pathway where this is needed. Given the considerable time constraints in day-to-day oncology practice, any such approach must be simple and quick to implement so that oncologists can flag individual patients for further evaluation and follow-up with appropriate members of the multidisciplinary care team. To enable the rapid and routine identification of patients with or at risk of malnutrition and/or muscle depletion, an expert panel of nutrition specialists and practicing oncologists developed the PROtocol for NuTritional risk in Oncology (PRONTO). The protocol enables the rapid identification of patients with or at risk of malnutrition and/or muscle depletion and provides guidance on next steps. The protocol is adaptable to multiple settings and countries, which makes implementation feasible by oncologists and may optimize patient outcomes. We advise the use of this protocol in countries/clinical scenarios where a specialized approach to nutrition assessment and care is not available.
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Affiliation(s)
- Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
| | - Gil Bar-Sela
- Oncology Department, Emek Medical Center, Afula 1834111, Israel
| | - Nicolo Matteo Luca Battisti
- The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
- Breast Cancer Research Division, The Institute of Cancer Research, London SW3 6JJ, UK
| | - Borislav Belev
- Clinical Hospital Center Zagreb, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Enrico Cortesi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Carla M. Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Paula Ravasco
- Faculty of Medicine and Centre for Interdisciplinary Research in Health (CIIS-UCP), Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
- Centre for Interdisciplinary Research Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, 2829-511 Almada, Portugal
| | - Suayib Yalcin
- Department of Medical Oncology, Institute of Cancer, Hacettepe University, Ankara 06800, Turkey
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14
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Frenzel AP, Bielemann RM, Barbosa-Silva TG, Gonzalez MC. Applicability of the SARC-F questionnaire by remote interview. Nutrition 2023; 105:111871. [PMID: 36413820 DOI: 10.1016/j.nut.2022.111871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/10/2022] [Accepted: 10/08/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to assess the applicability of the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire by telephone to identify sarcopenia risk (SR; SARC-F ≥6) and low muscle function risk (LMFR; SARC-F ≥ 4) and their associated risk factors in a cohort of community-dwelling older adults in southern Brazil. METHODS A longitudinal study was carried out with community-dwelling older individuals from COMO VAI? STUDY Sociodemographic, behavioral, and health-related information were collected at baseline, and, in the second assessment, the SARC-F questionnaire was applied by phone or in-person interviews. Older adults identified with sarcopenia at the baseline assessment were excluded. Adjusted analysis by Poisson regression according to hierarchical levels was performed. RESULTS Of the 1451 participants interviewed at baseline, only 951 participated in the second assessment. During the second assessment, 732 adults (77%) were interviewed by phone and 219 (23%) in person. There was no statistically significant difference for the SR (9.1 versus 9.7%, P = 0.802) and LMFR (22.4 versus 20.0%, P = 0.435) prevalence when the SARC-F questionnaire was administered in person or by phone, respectively. Age ≥80 y, presence of depressive symptoms, multimorbidity, dependence to perform one or more daily activities, and polypharmacy were factors associated with a higher risk for poor outcomes in older adults interviewed by phone. CONCLUSIONS The similar prevalence between in-person and remote assessments suggests the feasibility of using the SARC-F questionnaire by phone interview as a reliable alternative for sarcopenia and low muscle function risk assessment without the requirement of face-to-face evaluations.
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Affiliation(s)
- Aline P Frenzel
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | - Renata M Bielemann
- Postgraduate Program in Nutrition and Foods, Federal University of Pelotas (UFPel), Pelotas, Brazil
| | | | - Maria Cristina Gonzalez
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil; Postgraduate Program in Nutrition and Foods, Federal University of Pelotas (UFPel), Pelotas, Brazil.
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15
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[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and concurrent pathologies]. NUTR HOSP 2022; 39:1-8. [PMID: 36546334 DOI: 10.20960/nh.04505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction Type 2 diabetes mellitus is a highly prevalent disease worldwide, generating an increasing clinical and economic burden due to its micro- and macrovascular complications. Frequently, people with diabetes are hospitalized for various pathologies. These patients generally have higher risk of complications, prolonged hospitalizations and mortality. An additional factor that worsens the prognosis in these patients is the concurrence of malnutrition, especially in elderly people. All this makes the management of these patients challenging and requires a specific nutritional approach, whose purpose is to cover the nutritional requirements while always maintaining glycemic control. The purpose of this work is to provide, based on the evidence available in the literature and clinical experience, consensus recommendations by eighteen experts in Endocrinology and Nutrition on the nutritional approach of hospitalized patients with diabetes/ hyperglycemia and compare the optimal management, based on these recommendations with bedside usual care according to a panel of Spanish doctors surveyed about their daily clinical practice. This first article of this extraordinary issue of the journal Nutrición Hospitalaria describes the methodology of the study and the results obtained regarding common issues for all pathologies.
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16
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Impact of COVID-19 in nutritional and functional status of survivors admitted in intensive care units during the first outbreak. Preliminary results of the NUTRICOVID study. Clin Nutr 2022; 41:2934-2939. [PMID: 34893357 PMCID: PMC8609675 DOI: 10.1016/j.clnu.2021.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS COVID-19 patients present a high hospitalization rate with a high mortality risk for those requiring intensive care. When these patients have other comorbid conditions and older age, the risk for severe disease and poor outcomes after ICU admission are increased. The present work aims to describe the preliminary results of the ongoing NUTRICOVID study about the nutritional and functional status and the quality of life of adult COVID-19 survivors after ICU discharge, emphasizing the in-hospital and discharge situation of this population. METHODS A multicenter, ambispective, observational cohort study was conducted in 16 public hospitals of the Community of Madrid with COVID-19 survivors who were admitted to the ICU during the first outbreak. Preliminary results of this study include data retrospectively collected. Malnutrition and sarcopenia were screened at discharge using MUST and SARC-F; the use of healthcare resources was measured as the length of hospital stay and requirement of respiratory support and tracheostomy during hospitalization; other study variables were the need for medical nutrition therapy (MNT); and patients' functional status (Barthel index) and health-related quality of life (EQ-5D-5L). RESULTS A total of 176 patients were included in this preliminary analysis. Most patients were male and older than 60 years, who suffered an average (SD) weight loss of 16.6% (8.3%) during the hospital stay, with a median length of stay of 53 (27-89.5) days and a median ICU stay of 24.5 (11-43.5) days. At discharge, 83.5% and 86.9% of the patients were at risk of malnutrition and sarcopenia, respectively, but only 38% were prescribed MNT. In addition, more than 70% of patients had significant impairment of their mobility and to conduct their usual activities at hospital discharge. CONCLUSIONS This preliminary analysis evidences the high nutritional and functional impairment of COVID-19 survivors at hospital discharge and highlights the need for guidelines and systematic protocols, together with appropriate rehabilitation programs, to optimize the nutritional management of these patients after discharge.
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Barazzoni R, Bischoff SC, Busetto L, Cederholm T, Chourdakis M, Cuerda C, Delzenne N, Genton L, Schneider S, Singer P, Boirie Y. Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance. Clin Nutr 2022; 41:2869-2886. [PMID: 34140163 PMCID: PMC8110326 DOI: 10.1016/j.clnu.2021.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 01/27/2023]
Abstract
The COVID-19 pandemics has created unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favoring the onset of COVID-19 complications. In addition, patients with obesity may be at risk for loss of skeletal muscle mass, reflecting a state of hidden malnutrition with a strong negative health impact in all clinical settings. Also importantly, obesity is commonly associated with micronutrient deficiencies that directly influence immune function and infection risk. Finally, the pandemic-related lockdown, deleterious lifestyle changes and other numerous psychosocial consequences may worsen eating behaviors, sedentarity, body weight regulation, ultimately leading to further increments of obesity-associated metabolic complications with loss of skeletal muscle mass and higher non-communicable disease risk. Therefore, prevention, diagnosis and treatment of malnutrition and micronutrient deficiencies should be routinely included in the management of COVID-19 patients in the presence of obesity; lockdown-induced health risks should also be specifically monitored and prevented in this population. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing clinical practice guidance for nutritional management of COVID-19 patients with obesity in various clinical settings.
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Affiliation(s)
- Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy,Azienda sanitaria universitaria Giuliano Isontina (ASUGI), Cattinara Hospital, Trieste, Italy,Corresponding author. Department of Medical, Surgical and Health Sciences and Azienda sanitaria universitaria Giuliano Isontina (ASUGI), Cattinara University Hospital, Strada di Fiume 447, Trieste, Italy
| | - Stephan C. Bischoff
- Department of Nutritional Medicine and Prevention, University of Hohenheim, Stuttgart, Germany
| | - Luca Busetto
- Department of Medicine, University of Padova, Italy
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Laurence Genton
- Clinical Nutrition, Geneva University Hospitals, Geneva, Switzerland
| | - Stephane Schneider
- Gastroenterology and Nutrition, Nice University Hospital, Université Côte d’Azur, Nice, France
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Israel
| | - Yves Boirie
- Department of Clinical Nutrition, CHU Clermont-Ferrand, University of Clermont Auvergne, Human Nutrition Unit, CRNH Auvergne, F-63000, Clermont-Ferrand, France
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Barazzoni R, Breda J, Cuerda C, Schneider S, Deutz NE, Wickramasinghe K, Abbasoglu O, Meijerink JB, Bischoff S, Pelaez RB, Cardenas D, Cederholm T, Cereda E, Chourdakis M, Toulson Davisson Correia MI, Schuren MDVD, Delzenne N, Frias-Toral E, Genton L, Cappellari GG, Cakir BK, Klek S, Krznaric Z, Laviano A, Lobo D, Muscaritoli M, Ockenga J, Pirlich M, Serlie MJM, Shi HP, Singer P, Soop M, Walrand S, Weimann A. COVID-19: Lessons on malnutrition, nutritional care and public health from the ESPEN-WHO Europe call for papers. Clin Nutr 2022; 41:2858-2868. [PMID: 36075815 PMCID: PMC9365508 DOI: 10.1016/j.clnu.2022.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 01/27/2023]
Abstract
With prolonged pandemic conditions, and emerging evidence but persisting low awareness of the importance of nutritional derangements, ESPEN has promoted in close collaboration with World Health Organization-Europe a call for papers on all aspects relating COVID-19 and nutrition as well as nutritional care, in the Society Journals Clinical Nutrition and Clinical Nutrition ESPEN. Although more COVID-related papers are being submitted and continue to be evaluated, ESPEN and WHO present the current editorial to summarize the many published findings supporting major interactions between nutritional status and COVID-19. These include 1) high risk of developing the disease and high risk of severe disease in the presence of pre-existing undernutrition (malnutrition) including micronutrient deficiencies; 2) high risk of developing malnutrition during the course of COVID-19, with substantial impact on long-term sequelae and risk of long COVID; 3) persons with obesity are also prone to develop or worsen malnutrition and its negative consequences during the course of COVID-19; 4) malnutrition screening and implementation of nutritional care may improve disease outcomes; 5) social and public health determinants contribute to the interaction between nutritional status and COVID-19, including negative impact of lockdown and social limitations on nutrition quality and nutritional status. We believe the evidence supports the need to consider COVID-19 as (also) a case of malnutrition-enhanced disease and disease-related malnutrition, with added risk for persons both with and without obesity. Similarities with many other disease conditions further support recommendations to implement standard nutritional screening and care in COVID-19 patients, and they underscore the relevance of appropriate nutritional and lifestyle prevention policies to limit infection risk and mitigate the negative health impact of acute pandemic bouts.
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Affiliation(s)
- Rocco Barazzoni
- Corresponding author. Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, Strada di Fiume 447, 34149 Trieste, Italy
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19
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Ballesteros-Pomar MD, Blay Cortés G, Botella Romero F, Fernández García JM, Pita Gutiérrez F, Ramírez Arroyo V, Bretón Lesmes I. Continuity of care in disease-related malnutrition and nutritional medical treatment. ENDOCRINOL DIAB NUTR 2022; 69:897-909. [PMID: 36443194 DOI: 10.1016/j.endien.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Disease-related malnutrition (DRM) continues to be a very significant healthcare problem, both in our hospitals and in the community. It is often not properly diagnosed or treated, despite a growing body of evidence highlighting its clinical and economic consequences. The transition between clinical care in the hospital and community services (Primary Care (PC) and Nursing Homes) is a key element in the prevention, detection and treatment of DRM. In October 2020, the Spanish Society of Endocrinology and Nutrition (SEEN) and the main societies of PC physicians in our country (SEMERGEN, SEMFYC and SEMG) met for the first time within the virtual NutriSEEN forum. From that moment on, a joint working group was created for this issue. This document tries to establish joint lines of work between the Clinical Nutrition and Dietetic Units (UNCyD) and the Primary Care teams to improve the detection and treatment of DRM. The clinical consequences and costs associated with DRE, nutritional risk screening, assessment and medical nutritional treatment are considered in a coordinated way between the PC teams and the UNCyD, as well as future proposals to improve the management of DRM.
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Affiliation(s)
- María D Ballesteros-Pomar
- Area de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain; Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, Spain.
| | - Guadalupe Blay Cortés
- Grupo de Endocrinología, Metabolismo y Nutrición, Sociedad Española de Médicos Generales y de Familia (SEMG), Spain
| | - Francisco Botella Romero
- Area de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain; Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - José Manuel Fernández García
- Grupo de trabajo de Nutrición, Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud de Valga, Pontevedra, Spain
| | - Francisco Pita Gutiérrez
- Area de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain; Endocrinología y Nutrición, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Violeta Ramírez Arroyo
- Grupo de Trabajo de Alimentación y Nutrición, Sociedad Española de Medicina de Familia y Comunitaria (SEMFYC), Hospital Comarcal de Inca de las Islas Baleares, Mallorca, Spain
| | - Irene Bretón Lesmes
- Area de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain; Fundación de la Sociedad Española de Endocrinología y Nutrición (SEEN), Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IsSGM), Madrid, Spain
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20
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Long Z, Huang S, Zhang J, Zhang D, Yin J, He C, Zhang Q, Xu H, He H, Sun HC, Xie K. A Digital Smartphone-Based Self-administered Tool (R+ Dietitian) for Nutritional Risk Screening and Dietary Assessment in Hospitalized Patients With Cancer: Evaluation and Diagnostic Accuracy Study. JMIR Form Res 2022; 6:e40316. [PMID: 36287601 PMCID: PMC9647468 DOI: 10.2196/40316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Malnutrition is a common and severe problem in patients with cancer that directly increases the incidence of complications and significantly deteriorates quality of life. Nutritional risk screening and dietary assessment are critical because they are the basis for providing personalized nutritional support. No digital smartphone-based self-administered tool for nutritional risk screening and dietary assessment among hospitalized patients with cancer has been developed and evaluated. OBJECTIVE This study aims to develop a digital smartphone-based self-administered mini program for nutritional risk screening and dietary assessment for hospitalized patients with cancer and to evaluate the validity of the mini program. METHODS We have developed the R+ Dietitian mini program, which consists of 3 parts: (1) collection of basic information of patients, (2) nutritional risk screening, and (3) dietary energy and protein assessment. The face-to-face paper-based Nutritional Risk Screening (NRS-2002), the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), and 3 days of 24-hour dietary recall (3d-24HRs) questionnaires were administered according to standard procedure by 2 trained dietitians as the reference methods. Sensitivity, specificity, positive predictive value, negative predictive value, κ value, and correlation coefficients (CCs) of nutritional risk screened in R+ Dietitian against the reference methods, as well as the difference and CCs of estimated dietary energy and protein intakes between R+ Dietitian and 3d-24HRs were calculated to evaluate the validity of R+ Dietitian. RESULTS A total of 244 hospitalized patients with cancer were recruited to evaluate the validity of R+ Dietitian. The NRS-2002 and PG-SGA-SF tools in R+ Dietitian showed high accuracy, sensitivity, and specificity (77.5%, 81.0%, and 76.7% and 69.3%, 84.5%, and 64.5%, respectively), and fair agreement (κ=0.42 and 0.37, respectively; CC 0.62 and 0.56, respectively) with the NRS-2002 and PG-SGA-SF tools administered by dietitians. The estimated intakes of dietary energy and protein were significantly higher (P<.001 for both) in R+ Dietitian (mean difference of energy intake: 144.2 kcal, SD 454.8; median difference of protein intake: 10.7 g, IQR 9.5-39.8), and showed fair agreement (CC 0.59 and 0.47, respectively), compared with 3d-24HRs performed by dietitians. CONCLUSIONS The identified nutritional risk and assessment of dietary intakes of energy and protein in R+ Dietitian displayed a fair agreement with the screening and assessment conducted by dietitians. R+ Dietitian has the potential to be a tool for nutritional risk screening and dietary intake assessment among hospitalized patients with cancer. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900026324; https://www.chictr.org.cn/showprojen.aspx?proj=41528.
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Affiliation(s)
| | - Shan Huang
- Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Zhang
- Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Deng Zhang
- Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Jun Yin
- Recovery Plus Clinic, Chengdu, China
| | | | - Qinqiu Zhang
- Recovery Plus Clinic, Chengdu, China
- College of Food Science, Sichuan Agricultural University, Ya'an, China
| | - Huilin Xu
- Recovery Plus Clinic, Chengdu, China
| | - Huimin He
- Recovery Plus Clinic, Chengdu, China
| | | | - Ke Xie
- Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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21
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Aguiar GBD, Dourado KF, Andrade MISD, Domingos Júnior IR, Barros-Neto JA, Vasconcelos SML, Petribú MDMV, Santos CMD, Moura MWSD, Aguiar CBD, Campos MIX, Santiago ERC, Silva JHLD, Simões SKDS, Rodrigues ACDM, França Filho JCDD, Souza NMMD, Santos TM. Frequency and factors associated with sarcopenia prediction in adult and elderly patients hospitalized for COVID-19. Exp Gerontol 2022; 168:111945. [PMID: 36064158 PMCID: PMC9443615 DOI: 10.1016/j.exger.2022.111945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/20/2022] [Accepted: 08/27/2022] [Indexed: 01/08/2023]
Abstract
Patients with COVID-19 may develop symptoms that interfere with food intake. Systemic inflammatory response associated with physical inactivity and/or immobilization during hospital stay can induce weight and muscle loss leading to sarcopenia and worsening the clinical condition of these patients. The present study identifies the frequency and factors associated with sarcopenia prediction in adult and elderly patients hospitalized for COVID-19. It is a cohort-nested cross-sectional study on adult and elderly patients admitted to wards and intensive care units (ICUs) of 8 hospitals in a northeastern Brazilian state. The study was conducted from June 2020 to June 2021. Sociodemographic, economic, lifestyle, and current and past clinical history variables were collected. Sarcopenia prediction was determined by the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire compiled in the Remote-Malnutrition APP (R-MAPP). Patients were diagnosed with sarcopenia when the final score ≥ 4 points. The study included 214 patients with a mean age of 61.76 ± 16.91 years, of which 52.3 % were female and 57.5 % elderly. Sarcopenia prevailed in 40.7 % of the sample. Univariate analysis showed greater probability of sarcopenia in elderly individuals, nonpractitioners of physical activities, hypertensive patients, diabetic patients, and those hospitalized in the ICU. In the multivariate model, the type of hospital admission remained associated with sarcopenia prediction, where patients admitted to the ICU were 1.43 (95 % CI: 1.04; 1.97) more likely to have sarcopenia than those undergoing clinical treatment. Sarcopenia prediction was not associated with patient outcome (discharge, transfer, or death) (p = 0.332). The study highlighted an important percentage of sarcopenia prediction in patients with COVID-19, especially those admitted to the ICU. Additional investigations should be carried out to better understand and develop early diagnostic strategies to assist in the management of sarcopenic patients with COVID-19.
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Affiliation(s)
- Gisele Barbosa de Aguiar
- Residency Program in Clinical Nutrition, Hospital Barão de Lucena, Academic Center of Vitória de Santo Antão, Federal University of Pernambuco (CAV/UFPE), Recife, Pernambuco, Brazil.
| | - Keila Fernandes Dourado
- Residency Program in Clinical Nutrition, Hospital Barão de Lucena, Academic Center of Vitória de Santo Antão, Federal University of Pernambuco (CAV/UFPE), Recife, Pernambuco, Brazil
| | | | | | | | | | | | - Cláudia Mota Dos Santos
- Residency Program in Clinical Nutrition, Hospital Barão de Lucena, Academic Center of Vitória de Santo Antão, Federal University of Pernambuco (CAV/UFPE), Recife, Pernambuco, Brazil
| | - Mayana Wanessa Santos de Moura
- Residency Program in Clinical Nutrition, Hospital Barão de Lucena, Academic Center of Vitória de Santo Antão, Federal University of Pernambuco (CAV/UFPE), Recife, Pernambuco, Brazil
| | - Claudiane Barbosa de Aguiar
- Postgraduate Program in Morphotechnology, Department of Histology and Embryology, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | | | - José Hélio Luna da Silva
- Postgraduate Program in Nutrition, Physical Activity and Phenotypic Plasticity (PPGNAFPF), Federal University of Pernambuco, Academic Center of Vitória de Santo Antão, Vitória de Santo Antão, Pernambuco, Brazil
| | | | | | | | | | - Thayná Menezes Santos
- Postgraduate Program in Nutrition, Physical Activity and Phenotypic Plasticity (PPGNAFPF), Federal University of Pernambuco, Academic Center of Vitória de Santo Antão, Vitória de Santo Antão, Pernambuco, Brazil
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22
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Corriveau J, Alavifard D, Gillis C. Demystifying Malnutrition to Improve Nutrition Screening and Assessment in Oncology. Semin Oncol Nurs 2022; 38:151336. [PMID: 35995630 DOI: 10.1016/j.soncn.2022.151336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Patients with cancer and malnutrition are more likely to experience poor treatment tolerance, prolonged length of hospital stay, and decreased quality of life. Early and sustained nutrition risk screening is the first step to tackling this patient and health care burden. Yet, malnutrition remains largely overlooked and undertreated. Malnutrition mismanagement could be indicative of a systemic misunderstanding. With this narrative review, we aimed to (1) define malnutrition, (2) address common malnutrition misconceptions, and (3) summarize nutrition recommendations for patients with cancer. DATA SOURCES PubMed and international clinical practice guidelines were used. CONCLUSION Malnutrition represents an unbalanced nutritional state that alters body composition and diminishes function. Malnutrition is not always physically obvious, and albumin is not a reliable marker of nutritional status; therefore, systematically screening all patients with a validated nutrition risk screening tool at time of cancer diagnosis, and periodically throughout treatment, is necessary to provide optimal, equitable care. Nutrition risk screening takes less than 1 minute to complete and can be completed by any health care professional. Patients that screen positive for nutrition risk should be referred to a registered nutritionist or dietitian for comprehensive nutritional assessment, diagnosis, and treatment. IMPLICATIONS FOR NURSING PRACTICE All health care professionals can and should be responsible for preventing and treating malnutrition. Registered nurses can actively participate in improving patient outcomes by screening patients for nutrition risk, weighing patients at every visit, referring patients to dietitians for nutrition treatment, and providing supportive medical management of nutrition impact symptoms such as nausea.
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Affiliation(s)
- Jade Corriveau
- Department of Nutrition, McGill University Health Centre, Montreal, QC, Canada
| | - Dorsa Alavifard
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Chelsia Gillis
- Department of Anesthesia, McGill University, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; School of Human Nutrition, McGill University, McGill University, Montreal, QC, Canada.
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23
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Prado CM, Landi F, Chew STH, Atherton PJ, Molinger J, Ruck T, Gonzalez MC. Advances in Muscle Health and Nutrition: A Toolkit for Healthcare Professionals. Clin Nutr 2022; 41:2244-2263. [DOI: 10.1016/j.clnu.2022.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/03/2022] [Accepted: 07/31/2022] [Indexed: 11/03/2022]
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24
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Guasti L, Dilaveris P, Mamas MA, Richter D, Christodorescu R, Lumens J, Schuuring MJ, Carugo S, Afilalo J, Ferrini M, Asteggiano R, Cowie MR. Digital health in older adults for the prevention and management of cardiovascular diseases and frailty. A clinical consensus statement from the ESC Council for Cardiology Practice/Taskforce on Geriatric Cardiology, the ESC Digital Health Committee and the ESC Working Group on e-Cardiology. ESC Heart Fail 2022; 9:2808-2822. [PMID: 35818770 DOI: 10.1002/ehf2.14022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/04/2022] [Accepted: 06/03/2022] [Indexed: 12/14/2022] Open
Abstract
Digital health technology is receiving increasing attention in cardiology. The rise of accessibility of digital health tools including wearable technologies and smart phone applications used in medical practice has created a new era in healthcare. The coronavirus pandemic has provided a new impetus for changes in delivering medical assistance across the world. This Consensus document discusses the potential implementation of digital health technology in older adults, suggesting a practical approach to general cardiologists working in an ambulatory outpatient clinic, highlighting the potential benefit and challenges of digital health in older patients with, or at risk of, cardiovascular disease. Advancing age may lead to a progressive loss of independence, to frailty, and to increasing degrees of disability. In geriatric cardiology, digital health technology may serve as an additional tool both in cardiovascular prevention and treatment that may help by (i) supporting self-caring patients with cardiovascular disease to maintain their independence and improve the management of their cardiovascular disease and (ii) improving the prevention, detection, and management of frailty and supporting collaboration with caregivers. Digital health technology has the potential to be useful for every field of cardiology, but notably in an office-based setting with frequent contact with ambulatory older adults who may be pre-frail or frail but who are still able to live at home. Cardiologists and other healthcare professionals should increase their digital health skills and learn how best to apply and integrate new technologies into daily practice and how to engage older people and their caregivers in a tailored programme of care.
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Affiliation(s)
- Luigina Guasti
- University of Insubria - Department of Medicine and Surgery; ASST-settelaghi, Varese, Italy
| | - Polychronis Dilaveris
- First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
| | | | | | - Joost Lumens
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mark J Schuuring
- Department of Cardiology, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefano Carugo
- University of Milan, Cardiology, Policlinico di Milano, Milan, Italy
| | - Jonathan Afilalo
- Division of Experimental Medicine, McGill University; Centre for Clinical Epidemiology, Jewish General Hospital; Division of Cardiology, Jewish General Hospital, McGill University; Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Riccardo Asteggiano
- University of Insubria - Department of Medicine and Surgery; ASST-settelaghi, Varese, Italy.,LARC (Laboratorio Analisi e Ricerca Clinica), Turin, Italy
| | - Martin R Cowie
- Royal Brompton Hospital (Guy's& St Thomas' NHS Foundation Trust) & Faculty of Lifesciences & Medicine, King's College London, London, UK
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25
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Landi F, Martone AM, Ciciarello F, Galluzzo V, Savera G, Calvani R, Picca A, Marzetti E, Tosato M. Effects of a New Multicomponent Nutritional Supplement on Muscle Mass and Physical Performance in Adult and Old Patients Recovered from COVID-19: A Pilot Observational Case-Control Study. Nutrients 2022; 14:nu14112316. [PMID: 35684113 PMCID: PMC9182906 DOI: 10.3390/nu14112316] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 12/10/2022] Open
Abstract
Objective: The purpose of the present study was to assess the effect of a specific oral nutritional supplement among patients recovered from COVID-19 but suffering symptoms of fatigue. Methods: This is an observational case–control study involving a sample of 66 COVID-19 survivors divided in two groups, 33 subjects in the intervention group who received the nutritional supplement and 33 subjects in the control group. The nutritional supplement received by subjects in the active group was based on amino acids; vitamin B6 and B1; and malic, succinic and citric acids. After an 8-week follow-up, the main outcomes considered were skeletal muscle index (measured by bioelectrical impedance analysis), physical performance measures (handgrip strength, one-minute chair–stand test, six-minute walking test), and quality of life (using EuroQol visual analogue scale). Results: All the considered areas increased significantly in the subjects receiving the active treatment with oral nutritional supplement in comparison with the baseline values. After adjusting for age, gender, and baseline values, skeletal muscle index, handgrip strength test, the one-minute chair–stand test, and six-minute walking test values were higher among participants in the treatment group compared with subjects in control group. The oral nutritional supplement significantly improved the handgrip strength; similarly, participants in the active group showed a higher improvement in skeletal muscle index, the one-minute chair–stand test, the six-minute walking test, and in quality of life. Conclusion: The nutritional supplement containing nine essential amino acids plus cysteine; vitamin B6 and B1; and malic, succinic and citric acids had a positive effect on nutritional status, functional recovery, and quality of life in COVID-19 survivors still suffering from fatigue. Additional controlled clinical trials are required to corroborate these results.
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26
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S M, M M, M S, M C, S B, S S. Host‐related factors and cancer: malnutrition and Non‐Hodgkin Lymphoma. Hematol Oncol 2022; 40:320-331. [PMID: 35398917 PMCID: PMC9544175 DOI: 10.1002/hon.3002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 04/05/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Mancuso S
- Department of Health Promotion Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) Hematology Unit University of Palermo via del vespro 12990127 Palermo Italy
| | - Mattana M
- Hematology Unit University Hospital “Paolo Giaccone” via del vespro 12990127 Palermo Italy
| | - Santoro M
- Department of Health Promotion Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) Hematology Unit University of Palermo via del vespro 12990127 Palermo Italy
| | - Carlisi M
- Hematology Unit University Hospital “Paolo Giaccone” via del vespro 12990127 Palermo Italy
| | - Buscemi S
- Department of Health Promotion Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) Hematology Unit University of Palermo via del vespro 12990127 Palermo Italy
| | - Siragusa S
- Department of Health Promotion Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) Hematology Unit University of Palermo via del vespro 12990127 Palermo Italy
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27
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Burgos R, García-Almeida JM, Matía-Martín P, Palma S, Sanz-Paris A, Zugasti A, Alfaro JJ, Fullana AA, Continente AC, Chicetru MJ, Malpartida KG, Faes ÁG, Sánchez VG, López ML, Ortega AJM, Roldán JO, Moreno CS, Llanos PS. Malnutrition management of hospitalized patients with diabetes/hyperglycemia and COVID-19 infection. Rev Endocr Metab Disord 2022; 23:205-213. [PMID: 35244834 PMCID: PMC8895363 DOI: 10.1007/s11154-022-09714-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 01/08/2023]
Abstract
Diabetes mellitus and/or hyperglycemia are highly prevalent medical conditions in patients hospitalized for coronavirus disease 2019 (COVID-19) and are associated with adverse outcomes. In addition, COVID-19 itself can provoke fluctuating and high glucose levels that can be difficult to manage upon hospitalization. Hospitalized patients with COVID-19 are at high risk of malnutrition due to an increase in nutritional requirements and a severe acute inflammatory response. The management of patients with diabetes/hyperglycemia and COVID-19 is challenging and requires a specific nutritional approach, the purpose of which is to fulfill the nutritional requirements while maintaining an optimal glycemic control. In this study, an expert group of nutritional endocrinologists carried out a qualitative literature review and provided recommendations based on evidence and guidelines, when available, or on their own experience. The optimal care based on these recommendations was compared with the routine bedside care as reported by a panel of physicians (mainly, endocrinologists, geriatricians, and internists) treating patients with diabetes/hyperglycemia and COVID-19 in their daily practice. Early screening and diagnosis, a diabetes-specific therapeutic approach, and a close malnutrition monitoring are essential to improve the clinical outcomes of these patients. In conclusion, the proposed recommendations are intended to provide a useful guide on the clinical management of malnutrition in patients with COVID-19 and diabetes/hyperglycemia, in order to improve their outcomes and accelerate their recovery. The comparison of the recommended optimal care with routine clinical practice could aid to identify gaps in knowledge, implementation difficulties, and areas for improvement in the management of malnutrition in this population.
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Affiliation(s)
- Rosa Burgos
- Unidad de Soporte Nutricional, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Pilar Matía-Martín
- Departamento de Endocrinología Y Nutrición, Hospital Clínico San Carlos, Madrid, Spain
| | - Samara Palma
- Unidad de Nutrición Clínica Y Dietética, Hospital Universitario de La Paz, Madrid, Spain
| | - Alejandro Sanz-Paris
- Nutrition Department, Miguel Servet University Hospital, 50009, Zaragoza, Spain.
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009, Zaragoza, Spain.
| | - Ana Zugasti
- Unidad de Nutrición Clínica, Hospital Universitario de Navarra, 31008, Pamplona, Spain
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28
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[Approaching the new patient and innovations]. NUTR HOSP 2022; 38:26-30. [PMID: 35137594 DOI: 10.20960/nh.04066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The SARS-CoV-2 pandemic has accelerated the process of healthcare digitalization. This paradigm shift is a challenge for both healthcare professionals and patients. This article discusses the opinions of patients with different levels of familiarity with new technologies, as well as the perspective of healthcare professionals on new patients and technological innovations.
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Mori N, Maeda K, Fukami Y, Matsuyama R, Nonogaki T, Kato R, Ishida Y, Shimizu A, Ueshima J, Nagano A. High SARC-F score predicts poor survival of patients with cancer receiving palliative care. Support Care Cancer 2022; 30:4065-4072. [PMID: 35064824 DOI: 10.1007/s00520-022-06845-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/18/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE A high score determined by SARC-F, a simple screening questionnaire for sarcopenia, has been reportedly associated with worse medical outcomes. However, information regarding whether high SARC-F scores are associated with a poor prognosis in patients with advanced cancer remains limited. We clarified whether a SARC-F score ≥ 4 predicts poor prognosis in patients with cancer receiving palliative care. METHODS We conducted a retrospective cohort study of patients with cancer who received palliative care at a university hospital between May 2019 and April 2020. Patient characteristics including age, sex, height, weight, cancer type, serum albumin level, C-reactive protein level, presence of edema, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS), SARC-F score, history of anticancer therapy, and clinical outcomes were collected from electronic medical records. RESULTS Of 304 patients, 188 had a SARC-F score < 4, and 116 patients had a SARC-F score ≥ 4. The overall survival of patients with a SARC-F score ≥ 4 was 40 days (95% CI 29-47), which was significantly worse than 121 days (95% CI 95-156) for patients with a SARC-F score < 4 (p < 0.001). SARC-F score ≥ 4 (hazard ratio: HR 1.56), edema (HR 1.94), head and neck cancer (HR 0.51), C-reactive protein (HR 1.05), ECOG-PS ≥ 3 (HR 1.47), and radiotherapy (HR 0.52) were associated with overall survival. The ability to climb stairs was a SARC-F sub-item significantly associated with mortality (HR 1.59). CONCLUSION The SARC-F questionnaire is a useful predictor of prognosis for patients with cancer receiving palliative care because a SARC-F ≥ 4 score predicts worse overall survival.
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Affiliation(s)
- Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Yasuyuki Fukami
- Department of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Remi Matsuyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tomoyuki Nonogaki
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Ryoko Kato
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Yuria Ishida
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Nutrition, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Akio Shimizu
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Clinical Nutrition and Food Services, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan
| | - Ayano Nagano
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
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Pedi-R-MAPP: The development of a nutritional awareness tool for use in remote paediatric consultations using a modified Delphi consensus. Clin Nutr 2022; 41:661-672. [PMID: 35149245 DOI: 10.1016/j.clnu.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIMS The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments, and provide practical guidance for nutritional care. The aim of this study was to modify the R-MAPP into a version suitable for children, Pediatric Remote Malnutrition Application (Pedi-R-MAPP), and provide a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. METHODS A ten-step process was completed: 1) permission to modify adult R-MAPP, 2) literature search to inform the Pedi-R-MAPP content, 3) Pedi-R-MAPP draft, 4) international survey of HCP practice using TECS, 5) nutrition experts invited to participate in a modified Delphi process, 6) first stakeholder meeting to agree purpose/draft of the tool, 7) round-one online survey, 8) statements with consensus removed from survey, 9) round-two online survey for statements with no consensus and 10) second stakeholder meeting with finalisation of the Pedi-R-MAPP nutrition awareness tool. RESULTS The international survey completed by 463 HCPs, 55% paediatricians, 38% dietitians, 7% nurses/others. When HCPs were asked to look back over the last 12 months, dietitians (n = 110) reported that 5.7 ± 10.6 out of every 10 appointments were completed in person; compared to paediatricians (n = 182) who reported 7.5 ± 7.0 out of every 10 appointments to be in person (p < 0.0001), with the remainder completed as TECS consultations. Overall, 74 articles were identified and used to develop the Pedi-R-MAPP which included colour-coded advice using a traffic light system; green, amber, red and purple. Eighteen participants agreed to participate in the Delphi consensus and completed both rounds of the modified Delphi survey. Agreement was reached at the first meeting on the purpose and draft sections of the proposed tool. In round-one of the online survey, 86% (n = 89/104) of statements reached consensus, whereas in round-two 12.5% (n = 13/104) of statements reached no consensus. At the second expert meeting, contested statements were discussed until agreement was reached and the Pedi-R-MAPP could be finalised. CONCLUSION The Pedi-R-MAPP nutrition awareness tool was developed using a modified Delphi consensus. This tool aims to support the technological transformation fast-tracked by the COVID-19 pandemic by providing a structured approach to completing a remote nutrition focused assessment, as well as identifying the frequency of follow up along with those children who may require in-person assessment.
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Silva J, Giglio BM, Lobo PC, Araújo VA, Pimentel GD. Neutrophil-to-lymphocyte ratio is not associated with risk of sarcopenia in elderly COVID-19 patients. Rev Esp Geriatr Gerontol 2022; 57:325-329. [PMID: 36357231 PMCID: PMC9537255 DOI: 10.1016/j.regg.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/16/2022] [Accepted: 09/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND To assess the existence of association between neutrophil to lymphocyte ratio (NLR) and the risk of sarcopenia in COVID-19 patients. METHODS A retrospective cross-sectional study was conducted in a university hospital with patients with an active COVID-19 infection admitted to the nursing ward or intensive care unit (ICU) between September to December 2020. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs and Falls (SARC-F). Biochemical analyses were assessed by circulating of C-reactive protein, D-dimer, neutrophils, lymphocytes count and NLR. Sixty-eight patients were evaluated and divided into tertiles of NLR values and the association between NLR and sarcopenia risk were tested using the linear regression analyses and p<0.05 were considered as significant. RESULTS Sixty-eight patients were evaluated and divided in NLR tertiles being the 1st (men=52.2%; 71.1±9.0 y; NLR: 1.1-3.85), 2nd (women=78.3%; 73.2±9.1 y; NLR: 3.9-6.0) and 3rd (men=72.7%; 71.7±10.4 y; NLR: 6.5-20.0). There was a difference between the tertiles in relation to the first to the biochemical parameters of total neutrophils count (p=0.001), C-reactive protein (p=0.012), and D-dimer (p=0.012). However, no difference was found in linear regression analysis between tertiles of NLR and SARC-F, if in total sample (p=0.054) or divided by sex, if men (p=0.369) or women (p=0.064). CONCLUSION In elderly patients hospitalized with COVID-19, we do not find an association between the risk of sarcopenia and NLR.
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Youssef N, Elbadry M, Al Shafie A, Abdalazeem A, Hasan S, Tahoon M, Omran D, El Kassas M. Nutritional Status Associated with Clinical Outcomes among Patients Hospitalized with COVID-19: A Multicenter Prospective Study in Egypt. Nurs Health Sci 2021; 24:204-213. [PMID: 34918872 DOI: 10.1111/nhs.12913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 01/08/2023]
Abstract
Few studies have addressed the relationship between the nutritional status of patients with COVID-19 and their disease course. This multicenter prospective study aimed to evaluate the nutritional status of patients hospitalized with COVID-19 and its association with their clinical outcomes. Sociodemographic, physical, clinical, and nutritional data of 121 patients with confirmed COVID-19 were collected upon admission and at discharge from three COVID-19 quarantine hospitals in Egypt via a questionnaire and a standardized scale. The majority (73.6%) of the patients had a reduced dietary intake over the last week before admission, and 57% were severely ill. Overall, 14% had a high risk of malnutrition on admission, increased to 26.3% at discharge. Malnutrition was present in most (85.7%) of intensive care unit patients, and deaths, compared with recovered patients (14%). We concluded that malnutrition might worsen the clinical outcomes and increase the morbidity and mortality of COVID-19 patients. A multidisciplinary approach is recommended to manage patients with Covid-19, considering their nutritional status before and during infection, with early detection of high-risk patients in order to design and provide the appropriate nutritional support. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Naglaa Youssef
- Medical-Surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt.,Medical-Surgical Nursing Department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mohamed Elbadry
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmad Al Shafie
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Amr Abdalazeem
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Salwa Hasan
- Clinical Pharmacology Department, Aswan Specialized Hospital, Aswan, Egypt
| | - Marwa Tahoon
- Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia university, Menoufia, Egypt
| | - Dalia Omran
- Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed El Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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Jones S, Archer E, Ongan D, Morais C, Speer R, Tsagari A, Jager-Wittenaar H, Ruperto M. Nutritional interventions in older people with COVID-19: an overview of the evidence. Nurs Older People 2021; 34:e1368. [PMID: 34877834 DOI: 10.7748/nop.2021.e1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/09/2022]
Abstract
Older people are a high-risk group for coronavirus disease 2019 (COVID-19) because of a range of factors, including age-related changes in anatomical pulmonary and muscle function, decreased immunity and increased inflammation. These factors partly explain why older people with COVID-19 experience more severe symptoms and higher mortality than younger adults and are more likely to require nutritional support. Furthermore, there is an association between suboptimal nutritional status and poorer recovery from COVID-19. Therefore, nutritional interventions are an important aspect of care for older people with COVID-19. All members of the multidisciplinary team, including dietitians and nurses, need to assess, treat and prevent nutritional deficiencies in older people with COVID-19. This literature review provides an overview of the evidence regarding the role of nutritional interventions in the treatment of, and recovery from, COVID-19 in older people.
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Affiliation(s)
- Stacey Jones
- dietetics, Coventry University, Coventry, England
| | - Elizabeth Archer
- mental health services for older people, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, England
| | - Dilek Ongan
- department of nutrition and dietetics, Izmir Kâtip Çelebi University, Izmir, Turkey
| | - Cecilia Morais
- faculty of nutrition and food sciences, University of Porto, Porto, Portugal
| | - Robert Speer
- department of geriatrics, Paracelsus Medical University, Nuremberg, Germany
| | - Amalia Tsagari
- department of clinical nutrition, KAT Hospital, Athens, Greece
| | - Harriët Jager-Wittenaar
- research group healthy ageing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Mar Ruperto
- faculty of pharmacy and health sciences, CEU San Pablo University, Madrid, Spain. On behalf of the European Specialist Dietetic Network for Older Adults of the European Federation of the Associations of Dietitians
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Ballesteros-Pomar MD, Blay Cortés G, Botella Romero F, Fernández García JM, Pita Gutiérrez F, Ramírez Arroyo V, Bretón Lesmes I. Continuidad asistencial en desnutrición relacionada con la enfermedad y tratamiento médico nutricional. ENDOCRINOL DIAB NUTR 2021. [DOI: 10.1016/j.endinu.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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De Vera K, Challa P, Liu RH, Fuller K, Feroz AS, Gamble A, Leung E, Seto E. Virtual Primary Care Implementation During COVID-19 in High-Income Countries: A Scoping Review. TELEMEDICINE JOURNAL AND E-HEALTH : THE OFFICIAL JOURNAL OF THE AMERICAN TELEMEDICINE ASSOCIATION 2021; 28:920-931. [PMID: 34847758 DOI: 10.1089/tmj.2021.0377] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The purpose of this scoping review was to map the challenges, strategies, and lessons learned from high-income countries that can be mobilized to inform decision-makers on how to best implement virtual primary care services during and after the COVID-19 pandemic. Findings of our scoping review identified the barriers and strategies within the Quadruple Aim components, which may prove to be an effective implementation strategy for virtual care adoption in primary care settings. Materials and Methods: The two concepts of virtual care and COVID-19 were searched in MEDLINE, EMBASE, and CINAHL on August 10, 2020, and Scopus was searched on August 15, 2020. The database searches returned 10,549 citations and an additional 766 citations were retrieved from searching the citations from the reference lists of articles that met all inclusion criteria. A total of 1,260 full-text articles were reviewed of which 38 articles met the eligibility criteria for inclusion in the review. Results: Seven key barriers and strategies were identified for the implementation of virtual primary care. Of the 38 articles included, the key barriers identified were equitable access to care (n = 20; 53%), lack of funding for virtual care (n = 14; 37%), negative patient and clinician perception (n = 11, 29%), lack of regulatory policies (n = 10, 26%), inadequate clinical workflows (n = 9, 21), lack of virtual care infrastructure (n = 8, 21%), and insufficient virtual care training and education (n = 5, 13%). Strategies included the following: increased funding (n = 15, 39%), improving clinical workflows (n = 13, 34%), appropriate education and training (n = 11, 29%), improving virtual care infrastructure and patient equity (n = 7, 18%), establishing regulatory policies (n = 5, 13%), and improving patient and clinician perceptions (n = 3, 7%). Conclusions: As many countries enter potential subsequent waves of the COVID-19 pandemic, applying early lessons learned to mitigate implementation barriers can help with the transition to equitable and appropriate virtual primary care services.
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Affiliation(s)
- Kristina De Vera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Priyanka Challa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Rebecca H Liu
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Canada
| | - Kaitlin Fuller
- University of Toronto Libraries, University of Toronto, Toronto, Canada
| | - Anam Shahil Feroz
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Anissa Gamble
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Eunice Leung
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Center for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, Canada
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Akbulut G, Yesildemir O. Overview of nutritional approach in hematopoietic stem cell transplantation: COVID-19 update. World J Stem Cells 2021; 13:1530-1548. [PMID: 34786156 PMCID: PMC8567455 DOI: 10.4252/wjsc.v13.i10.1530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/27/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) is caused by the newly discovered SARS-CoV-2. Hematopoietic stem cell transplantation (HSCT) is a high-risk procedure. The novelty of COVID-19 has created more uncertainty during all phases of HSCT. It is thought that HSCT patients taking immunosuppressive agents are more likely to contract COVID-19 than healthy individuals are. Appropriate care precautions should be taken with patients undergoing HSCT to minimize the risk of COVID-19, and appropriate treatment methods must be followed in patients infected with COVID-19. Malnutrition has become a significant problem in HSCT patients during the COVID-19 pandemic. The causes of malnutrition in HSCT patients are multifactorial. However, the most important reason is the decrease in energy and nutrient intake. The HSCT procedure can lead to many complications such as dysgeusia, mucositis, diarrhea, constipation, xerostomia and vomiting/nausea. Improving the nutritional status of HSCT patients by managing each of these special complications with an appropriate nutritional approach is essential for successful engraftment. This review aims to provide a comprehensive overview of the specific complications affecting the nutritional status of HSCT patients and their nutritional approach during the challenging COVID-19 pandemic.
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Affiliation(s)
- Gamze Akbulut
- Department of Nutrition and Dietetics, Gazi University, Faculty of Health Sciences, Ankara 06490, Turkey.
| | - Ozge Yesildemir
- Department of Nutrition and Dietetics, Gazi University, Faculty of Health Sciences, Ankara 06490, Turkey
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Quilliot D, Gérard M, Bonsack O, Malgras A, Vaillant MF, Di Patrizio P, Jaussaud R, Ziegler O, Nguyen-Thi PL. Impact of severe SARS-CoV-2 infection on nutritional status and subjective functional loss in a prospective cohort of COVID-19 survivors. BMJ Open 2021; 11:e048948. [PMID: 34261689 PMCID: PMC8282420 DOI: 10.1136/bmjopen-2021-048948] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
UNLABELLED The nutritional sequelae of COVID-19 have not been explored in a large cohort study. OBJECTIVES To identify factors associated with the change in nutritional status between discharge and 30 days post-discharge (D30). Secondary objectives were to determine the prevalence of subjective functional loss and severe disability at D30 and their associated factors. METHODS Collected data included symptoms, nutritional status, self-evaluation of food intake, Performance Status (PS) Scale, Asthenia Scale, self-evaluation of strength (SES) for arms and legs at discharge and at D30. An SES <7 was used to determine subjective functional loss. A composite criteria for severe disability was elaborated combining malnutrition, subjective functional loss and PS >2. Patients were classified into three groups according to change in nutritional status between discharge and D30 (persistent malnutrition, correction of malnutrition and the absence of malnutrition). RESULTS Of 549 consecutive patients hospitalised for COVID-19 between 1 March and 29 April 2020, 130 died including 17 after discharge (23.7%). At D30, 312 patients were at home, 288 (92.3%) of whom were interviewed. Of the latter, 33.3% were malnourished at discharge and still malnourished at D30, while 23.2% were malnourished at discharge but no longer malnourished at D30. The highest predictive factors of persistent malnutrition were intensive care unit (ICU) stay (OR=3.42, 95% CI: 2.04 to 5.75), subjective functional loss at discharge (OR=3.26, 95% CI: 1.75 to 6.08) and male sex (OR=2.39, 95% CI: 1.44 to 3.97). Subjective functional loss at discharge (76.8%) was the main predictive factor of subjective functional loss at D30 (26.3%) (OR=32.6, 95% CI: 4.36 to 244.0). Lastly, 8.3% had a severe disability, with a higher risk in patients requiring an ICU stay (OR=3.39, 95% CI: 1.43 to 8.06). CONCLUSION Patients who survived a severe form of COVID-19 had a high risk of persistent malnutrition, functional loss and severe disability at D30. We believe that nutritional support and rehabilitation should be strengthened, particularly for male patients who were admitted in ICU and had subjective functional loss at discharge. TRIAL REGISTRATION NUMBER NCT04451694.
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Affiliation(s)
- Didier Quilliot
- Unité Transversale de Nutrition, CHRU de Nancy, Nancy, France
| | - Marine Gérard
- Unité Transversale de Nutrition, CHRU de Nancy, Nancy, France
| | - Olivier Bonsack
- Unité Transversale de Nutrition, CHRU de Nancy, Nancy, France
| | - Aurélie Malgras
- Unité Transversale de Nutrition, CHRU de Nancy, Nancy, France
| | | | | | - Roland Jaussaud
- Internal Medicine and Clinical Immunology Department, CHRU de Nancy, Nancy, France
| | - Olivier Ziegler
- Endocrinology Diabetology and Nutrition Department, CHRU de Nancy, Nancy, France
| | - Phi-Linh Nguyen-Thi
- Medical Evaluation Department, Department of Clinical Research Support PARC, University of Lorraine, CHRU de Nancy, Nancy, France
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Silverio R, Gonçalves DC, Andrade MF, Seelaender M. Coronavirus Disease 2019 (COVID-19) and Nutritional Status: The Missing Link? Adv Nutr 2021; 12:682-692. [PMID: 32975565 PMCID: PMC7543263 DOI: 10.1093/advances/nmaa125] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging disease that has reached pandemic status by rapidly spreading worldwide. Elderly individuals and patients with comorbidities such as obesity, diabetes, and hypertension show a higher risk of hospitalization, severe disease, and mortality by acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These patients frequently show exacerbated secretion of proinflammatory cytokines associated with an overreaction of the immune system, the so-called cytokine storm. Host nutritional status plays a pivotal role in the outcome of a variety of different infectious diseases. It is known that the immune system is highly affected by malnutrition, leading to decreased immune responses with consequent augmented risk of infection and disease severity. Body composition, especially low lean mass and high adiposity, has consistently been linked to worsened prognosis in many different diseases. In this review, evidence concerning the impact of nutritional status on viral infection outcomes is discussed.
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Affiliation(s)
- Renata Silverio
- Cancer Metabolism Research Group, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Multicenter Graduate Program in Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Daniela Caetano Gonçalves
- Cancer Metabolism Research Group, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Biosciences Department, Universidade Federal de São Paulo (UNIFESP), Campus Baixada Santista, Santos, Brazil
| | - Márcia Fábia Andrade
- Cancer Metabolism Research Group, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Marilia Seelaender
- Cancer Metabolism Research Group, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Department of Clinical Surgery, LIM 26-HC, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
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Ali AM, Kunugi H. Screening for Sarcopenia (Physical Frailty) in the COVID-19 Era. Int J Endocrinol 2021; 2021:5563960. [PMID: 34113379 PMCID: PMC8152925 DOI: 10.1155/2021/5563960] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/22/2021] [Accepted: 04/30/2021] [Indexed: 01/08/2023] Open
Abstract
Although the numbers of aged populations have risen considerably in the last few decades, the current coronavirus disease 2019 (COVID-19) has revealed an extensive vulnerability among these populations. Sarcopenia is an age-related disorder that increases hospitalization, dependencies, and mortality in older adults. It starts to develop in midlife or even earlier as a result of unbalanced diet/poor nutrition and low levels of physical activity, in addition to chronic disorders such as obesity and diabetes mellitus. Given that social isolation is adopted as the most protective measure against COVID-19, the level of physical activity and the intake of adequate diet have considerably declined, especially among older adults-denoting an increased possibility for developing sarcopenia. Research also shows a higher vulnerability of sarcopenic people to COVID-19 as well as the development of wasting disorders such as sarcopenia and cachexia in a considerable proportion of symptomatic and recovering COVID-19 patients. Muscular wasting in COVID-19 is associated with poor prognosis. Accordingly, early detection and proper management of sarcopenia and wasting conditions in older adults and COVID-19 patients may minimize morbidity and mortality during the current COVID-19 crisis. This review explored different aspects of screening for sarcopenia, stressing their relevance to the detection of altered muscular structure and performance in patients with COVID-19. Current guidelines recommend prior evaluation of muscle strength by simple measures such as grip strength to identify individuals with proven weakness who then would be screened for muscle mass loss. The latter is best measured by MRI and CT. However, due to the high cost and radiation risk entailed by these techniques, other simpler and cheaper techniques such as DXA and ultrasound are given preference. Muscle loss in COVID-19 patients was measured during the acute phase by CT scanning of the pectoralis muscle simultaneously during a routine check for lung fibrosis, which seems to be an efficient evaluation of sarcopenia among those patients with no additional cost. In recovering patients, muscle strength and physical performance have been evaluated by electromyography and traditional tests such as the six-minute walk test. Effective preventive and therapeutic interventions are necessary in order to prevent muscle loss and associated physical decline in COVID-19 patients.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
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Spolidoro GCI, Azzolino D, Shamir R, Cesari M, Agostoni C. Joint Effort towards Preventing Nutritional Deficiencies at the Extremes of Life during COVID-19. Nutrients 2021; 13:1616. [PMID: 34065864 PMCID: PMC8150599 DOI: 10.3390/nu13051616] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 (Coronavirus disease 2019) pandemic is posing a threat to communities and healthcare systems worldwide. Malnutrition, in all its forms, may negatively impact the susceptibility and severity of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection in both children and older adults. Both undernutrition and obesity have been evoked as conditions associated with a higher susceptibility to the infection and poor prognosis. In turn, the COVID-19 infection may worsen the nutritional status through highly catabolic conditions, exposing individuals to the risk of malnutrition, muscle wasting, and nutritional deficiencies. Accordingly, the relationship between malnutrition and COVID-19 is likely to be bidirectional. Furthermore, the modification of nutritional behaviors and physical activity, required to limit the spread of the virus, are posing a challenge to health at both the extremes of life. Thus far, even the most advanced healthcare systems have failed to address the alarming consequences of malnutrition posed by this pandemic. If not properly addressed, we may run the risk that new and old generations will experience the consequences of COVID-19 related malnutrition.
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Affiliation(s)
- Giulia C. I. Spolidoro
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (G.C.I.S.); (D.A.); (M.C.)
| | - Domenico Azzolino
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (G.C.I.S.); (D.A.); (M.C.)
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
| | - Raanan Shamir
- Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Sackler Faculty of Medicine, Institute of Gastroenterology, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (G.C.I.S.); (D.A.); (M.C.)
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (G.C.I.S.); (D.A.); (M.C.)
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Abstract
PURPOSE OF REVIEW This manuscript reviews evidence collected during COVID-19 pandemic and provides information on the impact of body composition on severity and outcomes of the disease, analysing methods used for body composition assessment. Malnutrition-screening tools will also be discussed to screen and diagnose the patients at higher risk of COVID-19 severity and related worse outcomes. RECENT FINDINGS COVID-19 can occur in a wide range of presentation, from asymptomatic to severe forms. Among the major risk factors for worse severity, overnutrition, undernutrition and body composition play a role in the ability to respond to SARS-CoV-2 infection. Excess fat accumulation (i.e. obesity) or lean mass loss and functionality (i.e. sarcopenia) or a combination of both (i.e. sarcopenic obesity) can affect whole-body functioning. These body composition alterations in the short-term can influence susceptibility and immunological responses to the virus, inflammatory reaction, metabolic and respiratory distress, while in the long-term can modulate disease outcomes, namely length of stay, time required for recovery, risk of ICU-acquired weakness and long-term disabilities, and potentially increase the risk of death. SUMMARY Individuals with malnutrition, sarcopenia, obesity, sarcopenic obesity and older adults with abnormal body composition or malnutrition risk may require tailored medical nutrition therapy to improve short and long-term COVID-19 outcomes.
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Affiliation(s)
- Edda Cava
- Unit of Dietetic and Clinical Nutrition, University Hospital "Maggiore della Carità", Novara, Italy
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States of America; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
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The Role of Nutrition in the COVID-19 Pandemic. Nutrients 2021; 13:nu13041093. [PMID: 33801645 PMCID: PMC8066707 DOI: 10.3390/nu13041093] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/14/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2, the cause of the COVID-19 disease, is posing unprecedent challenges. In the literature, increasing evidence highlights how malnutrition negatively affects the immune system functionality, impairing protection from infections. The current review aims to summarize the complex relationship between SARS-CoV-2 infection and nutritional status and the effects of malnutrition in terms of disease severity, patients' recovery time, incidence of complications and mortality rate. Current studies evaluating the possibility of modulating nutrition and supplementation in combination with pharmacological treatments in the clinical setting to prevent, support, and overcome infection are also described. The discussion of the most recent pertinent literature aims to lay the foundations for making reasonable assumptions and evaluations for a nutritional "best practice" against COVID-19 pandemic and for the definition of sound cost-effective strategies to assist healthcare systems in managing patients and individuals in their recovery from COVID-19.
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Ali AM, Kunugi H. Approaches to Nutritional Screening in Patients with Coronavirus Disease 2019 (COVID-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2772. [PMID: 33803339 PMCID: PMC7967488 DOI: 10.3390/ijerph18052772] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
Malnutrition is common among severe patients with coronavirus disease 2019 (COVID-19), mainly elderly adults and patients with comorbidities. It is also associated with atypical presentation of the disease. Despite the possible contribution of malnutrition to the acquisition and severity of COVID-19, it is not clear which nutritional screening measures may best diagnose malnutrition in these patients at early stages. This is of crucial importance given the urgency and rapid progression of the disease in vulnerable groups. Accordingly, this review examines the available literature for different nutritional screening approaches implemented among COVID-19 patients, with a special focus on elderly adults. After a literature search, we selected and scrutinized 14 studies assessing malnutrition among COVID-19 patients. The Nutrition Risk Screening 2002 (NRS-2002) has demonstrated superior sensitivity to other traditional screening measures. The controlling nutritional status (CONUT) score, which comprises serum albumin level, cholesterol level, and lymphocytes count, as well as a combined CONUT-lactate dehydrogenase-C-reactive protein score expressed a predictive capacity even superior to that of NRS-2002 (0.81% and 0.92% vs. 0.79%) in midlife and elder COVID-19 patients. Therefore, simple measures based on routinely conducted laboratory investigations such as the CONUT score may be timely, cheap, and valuable alternatives for identifying COVID-19 patients with high nutritional risk. Mini Nutritional Assessment (MNA) was the only measure used to detect residual malnutrition and high malnutrition risk in remitting patients-MNA scores correlated with hypoalbuminemia, hypercytokinemia, and weight loss. Older males with severe inflammation, gastrointestinal symptoms, and pre-existing comorbidities (diabetes, obesity, or hypertension) are more prone to malnutrition and subsequently poor COVID-19 prognosis both during the acute phase and during convalescence. Thus, they are in need of frequent nutritional monitoring and support while detecting and treating malnutrition in the general public might be necessary to increase resilience against COVID-19.
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Affiliation(s)
- Amira Mohammed Ali
- National Center of Neurology and Psychiatry, Department of Mental Disorder Research, National Institute of Neuroscience, Tokyo 187-0031, Japan;
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 21527, Egypt
| | - Hiroshi Kunugi
- National Center of Neurology and Psychiatry, Department of Mental Disorder Research, National Institute of Neuroscience, Tokyo 187-0031, Japan;
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo 173-8605, Japan
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Zmora N, Elinav E. Harnessing SmartPhones to Personalize Nutrition in a Time of Global Pandemic. Nutrients 2021; 13:nu13020422. [PMID: 33525593 PMCID: PMC7911023 DOI: 10.3390/nu13020422] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 01/10/2023] Open
Abstract
The soar in COVID-19 cases around the globe has forced many to adapt to social distancing and self-isolation. In order to reduce contact with healthcare facilities and other patients, the CDC has advocated the use of telemedicine, i.e., electronic information and telecommunication technology. While these changes may disrupt normal behaviors and routines and induce anxiety, resulting in decreased vigilance to healthy diet and physical activity and reluctance to seek medical attention, they may just as well be circumvented using modern technology. Indeed, as the beginning of the pandemic a plethora of alternatives to conventional physical interactions were introduced. In this Perspective, we portray the role of SmartPhone applications (apps) in monitoring healthy nutrition, from their basic functionality as food diaries required for simple decision-making and nutritional interventions, through more advanced purposes, such as multi-dimensional data-mining and development of machine learning algorithms. Finally, we will delineate the emerging field of personalized nutrition and introduce pioneering technologies and concepts yet to be incorporated in SmartPhone-based dietary surveillance.
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Affiliation(s)
- Niv Zmora
- Immunology Department, Weizmann Institute of Science, Rehovot 7610001, Israel;
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- The Research Center for Digestive Tract and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Eran Elinav
- Immunology Department, Weizmann Institute of Science, Rehovot 7610001, Israel;
- Division of Cancer-Microbiome Research, DKFZ, 69120 Heidelberg, Germany
- Correspondence: or
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Viana Bagni U, da Silva Ribeiro KD, Soares Bezerra D, Cavalcante de Barros D, de Magalhães Fittipaldi AL, Pimenta da Silva Araújo RG, Alves Ferreira A. Anthropometric assessment in ambulatory nutrition amid the COVID-19 pandemic: Possibilities for the remote and in-person care. Clin Nutr ESPEN 2020; 41:186-192. [PMID: 33487263 PMCID: PMC7831722 DOI: 10.1016/j.clnesp.2020.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 02/08/2023]
Abstract
Background and aims The COVID-19 pandemic has caused many changes in the nutritional care process as a result of the social distancing measures imposed, especially in the assessment of nutritional status, in which obtaining anthropometric measures is necessary. Methods Critical review of the international anthropometry literature, in the light of the recent scientific evidence of COVID-19. Results This paper presents recommendations for anthropometric assessment of the nutritional status of people in ambulatory settings for both remote and in-person assessment. The most appropriate measures to the current pandemic scenario are also discussed, in order to contribute to the monitoring of nutritional status and to minimize health impacts.results Conclusion When sanitary conditions cannot be guaranteed during in-person encounters or when the person cannot attend the office of the professional, the remote anthropometric assessment can be a useful strategy to nutritional surveillance.conclusions
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Affiliation(s)
- Ursula Viana Bagni
- Universidade Federal Fluminense, Rua Mário Santos Braga nº 30, 4º Andar, Campus Do Valonguinho, Centro. Niterói/RJ, CEP: 24020-140, Brazil.
| | - Karla Danielly da Silva Ribeiro
- Universidade Federal Do Rio Grande Do Norte, Avenida Senador Salgado Filho nº 3.000, Campus Universitário, Lagoa Nova. Natal/RN, CEP: 59058-970, Brazil
| | - Danielle Soares Bezerra
- Universidade Federal Do Rio Grande Do Norte, Avenida Senador Salgado Filho nº 3.000, Campus Universitário, Lagoa Nova. Natal/RN, CEP: 59058-970, Brazil
| | - Denise Cavalcante de Barros
- Fundação Oswaldo Cruz. Rua Leopoldo Bulhões nº 1480, Escola Nacional de Saúde Pública Sérgio Arouca, Sala I, Manguinhos. Rio de Janeiro/RJ, CEP 21041-210, Brazil
| | - Ana Lúcia de Magalhães Fittipaldi
- Fundação Oswaldo Cruz. Rua Leopoldo Bulhões nº 1480, Escola Nacional de Saúde Pública Sérgio Arouca, Sala I, Manguinhos. Rio de Janeiro/RJ, CEP 21041-210, Brazil
| | - Roberta Gabriela Pimenta da Silva Araújo
- Fundação Oswaldo Cruz. Rua Leopoldo Bulhões nº 1480, Escola Nacional de Saúde Pública Sérgio Arouca, Sala I, Manguinhos. Rio de Janeiro/RJ, CEP 21041-210, Brazil
| | - Aline Alves Ferreira
- Universidade Federal Do Rio de Janeiro. Avenida Carlos Chagas Filho nº 373, Bloco J, 2º Andar, Cidade Universitária, Ilha Do Fundão. Rio de Janeiro/RJ, CEP 21941-902, Brazil
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46
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Farid D. COVID-19 and Telenutrition: Remote Consultation in Clinical Nutrition Practice. Curr Dev Nutr 2020; 4:nzaa124. [PMID: 33409442 PMCID: PMC7772096 DOI: 10.1093/cdn/nzaa124] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 12/20/2022] Open
Abstract
During the coronavirus disease 2019 pandemic, clinical dietitians, as other clinicians, have had to shift their elective in-person clinical encounters to online consultations. Adequate planning and use of tools are essential to minimize delay in delivering medical nutrition therapy to existing and new clients. This article describes the steps required to launch a successful e-nutrition clinic during these times of crisis. During Covid-19 pandemic, clinical dietitians have had to shift their elective in-person clinical encounters to online consultations. This article describes the steps required to launch a successful telenutrition clinic.
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Affiliation(s)
- Doaa Farid
- Department of Family Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
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47
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Nutrición y pandemia de la COVID-19. MEDICINE - PROGRAMA DE FORMACIÓN MÉDICA CONTINUADA ACREDITADO 2020; 13:1311-1321. [PMID: 33519030 PMCID: PMC7837011 DOI: 10.1016/j.med.2020.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
La pandemia de la COVID 19 está suponiendo un importante desafío a los sistemas de salud de todo el mundo. La obesidad y la desnutrición, dos pandemias silenciosas preexistentes a la llegada de la infección por SARS-CoV-2, condicionan el riesgo de agravamiento de los pacientes infectados. Los pacientes con esta dolencia presentan un alto riesgo de desnutrición relacionada con la enfermedad (DRE) y sarcopenia por síntomas derivados de la propia infección, la inflamación aguda, el encamamiento prolongado y las terapias de soporte utilizadas. Hoy por hoy, junto al soporte respiratorio, el soporte nutricional resulta imprescindible en la base de toda atención al paciente con infección por este coronavirus a lo largo de su evolución. El abordaje nutricional es un proceso dinámico que incluye el refuerzo en la dieta natural y el tratamiento nutricional especializado (TNE) con la utilización de suplementos orales, nutrición enteral o nutrición parenteral según los requerimientos y necesidades de cada paciente. En esta actualización, repasamos los aspectos relacionados con la estrecha relación entre alimentación, nutrición e inmunidad, su impacto en la evolución de la infección por SARS-Cov-2 y las estrategias terapéuticas propuestas por consenso de expertos de distintas sociedades científicas.
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48
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Mechanick JI, Carbone S, Dickerson RN, Hernandez BJD, Hurt RT, Irving SY, Li DY, McCarthy MS, Mogensen KM, Gautier JBO, Patel JJ, Prewitt TE, Rosenthal M, Warren M, Winkler MF, McKeever L. Clinical Nutrition Research and the COVID-19 Pandemic: A Scoping Review of the ASPEN COVID-19 Task Force on Nutrition Research. JPEN J Parenter Enteral Nutr 2020; 45:13-31. [PMID: 33094848 DOI: 10.1002/jpen.2036] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
The purpose of this scoping review by the American Society for Parenteral and Enteral Nutrition (ASPEN) Coronavirus Disease 2019 (COVID-19) Nutrition Task Force was to examine nutrition research applicable to the COVID-19 pandemic. The rapid pace of emerging scientific information has prompted this activity to discover research/knowledge gaps. This methodology adhered with recommendations from the Joanna Briggs Institute. There were 2301 citations imported. Of these, there were 439 articles fully abstracted, with 23 main topic areas identified across 24 article types and sourced across 61 countries and 51 specialties in 8 settings and among 14 populations. Epidemiological/mechanistic relationships between nutrition and COVID-19 were reviewed and results mapped to the Population, Intervention, Comparator, Outcome, and Time (PICO-T) questions. The aggregated data were analyzed by clinical stage: pre-COVID-19, acute COVID-19, and chronic/post-COVID-19. Research gaps were discovered for all PICO-T questions. Nutrition topics meriting urgent research included food insecurity/societal infrastructure and transcultural factors (pre-COVID-19); cardiometabolic-based chronic disease, pediatrics, nutrition support, and hospital infrastructure (acute COVID-19); registered dietitian nutritionist counseling (chronic/post-COVID-19); and malnutrition and management (all stages). The paucity of randomized controlled trials (RCTs) was particularly glaring. Knowledge gaps were discovered for PICO-T questions on pediatrics, micronutrients, bariatric surgery, and transcultural factors (pre-COVID-19); enteral nutrition, protein-energy requirements, and glycemic control with nutrition (acute COVID-19); and home enteral and parenteral nutrition support (chronic/post-COVID-19). In conclusion, multiple critical areas for urgent nutrition research were identified, particularly using RCT design, to improve nutrition care for patients before, during, and after COVID-19.
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Affiliation(s)
- Jeffrey I Mechanick
- Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and, Metabolic Support, Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roland N Dickerson
- Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Clinical Coordinator and Clinical Pharmacy Specialist, Nutrition Support Service, Regional One Health, Memphis, Tennessee, USA
| | | | - Ryan T Hurt
- Divisions of Gastroenterology and Hepatology, and Endocrinology, Diabetes, Metabolism, Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Sharon Y Irving
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Ding-You Li
- Gastroenterology and Nutrition, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Kris M Mogensen
- Department of Nutrition, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | | | - Jayshil J Patel
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - T Elaine Prewitt
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Martin Rosenthal
- Acute Care Surgery Team, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Malissa Warren
- VA Portland HealthCare System, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Marion F Winkler
- Department of Surgery and Nutritional Support Service, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island, USA
| | - Liam McKeever
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Nonalcoholic Fatty Liver Disease and Sarcopenia: Where Do We Stand? Can J Gastroenterol Hepatol 2020; 2020:8859719. [PMID: 33204675 PMCID: PMC7652636 DOI: 10.1155/2020/8859719] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/04/2020] [Indexed: 12/13/2022] Open
Abstract
The link between metabolic syndrome (MetS) and sarcopenia has not been extensively studied, but it is evident that they share several common features. Crucial mechanisms involved in sarcopenia-nonalcoholic fatty liver disease (NAFLD) interplay are based on effects of insulin resistance, chronic inflammation, oxidative stress, and crosstalk between organs by secretion of cytokines (hepatokines, adipokines, and myokines). Currently, published studies confirm the association of sarcopenia with the degree of NAFLD defined by liver histology. However, prospective studies that will give us information regarding the causal effect of NAFLD and sarcopenia are still needed. Furthermore, there is a need for a patient-friendly, noninvasive, low-cost method for detection of loss of skeletal muscle mass, strength, and physical performance in the context of NAFLD. Moreover, potential treatment strategies such as physical exercise and nutritional supplementation, that are usually a part of management of sarcopenia, should also be investigated in NAFLD patients, especially given the fact that for now, we do not have a good treatment option for NAFLD. Therefore, future investigations should combine studies on NAFLD and sarcopenia in terms of physical activity and nutritional interventions such as vitamin D supplementation. This review aims to report recent evidence concerning the links between sarcopenia and NAFLD and methods to assess sarcopenia.
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50
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Di Filippo L, De Lorenzo R, D'Amico M, Sofia V, Roveri L, Mele R, Saibene A, Rovere-Querini P, Conte C. COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: A post-hoc analysis of a prospective cohort study. Clin Nutr 2020; 40:2420-2426. [PMID: 33160700 PMCID: PMC7598735 DOI: 10.1016/j.clnu.2020.10.043] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Coronavirus disease 2019 (COVID-19) may associate with clinical manifestations, ranging from alterations in smell and taste to severe respiratory distress requiring intensive care, that might associate with weight loss and malnutrition. We aimed to assess the incidence of unintentional weight loss and malnutrition in COVID-19 survivors. METHODS In this post-hoc analysis of a prospective observational cohort study, we enrolled all adult (age ≥18 years) patients with a confirmed diagnosis of COVID-19 who had been discharged home from either a medical ward or the Emergency Department of San Raffaele University Hospital, and were re-evaluated after remission at the Outpatient COVID-19 Follow-Up Clinic of the same Institution from April 7, 2020, to May 11, 2020. Demographic, anthropometric, clinical and biochemical parameters upon admission were prospectively collected. At follow-up, anthropometrics, the mini nutritional assessment screening and a visual analogue scale for appetite were assessed. RESULTS A total of 213 patients were included in the analysis (33% females, median age 59.0 [49.5-67.9] years, 70% overweight/obese upon initial assessment, 73% hospitalised). Sixty-one patients (29% of the total, and 31% of hospitalised patients vs. 21% of patients managed at home, p = 0.14) had lost >5% of initial body weight (median weight loss 6.5 [5.0-9.0] kg, or 8.1 [6.1-10.9]%). Patients who lost weight had greater systemic inflammation (C-reactive protein 62.9 [29.0-129.5] vs.48.7 [16.1-96.3] mg/dL; p = 0.02), impaired renal function (23.7% vs. 8.7% of patients; p = 0.003) and longer disease duration (32 [27-41] vs. 24 [21-30] days; p = 0.047) as compared with those who did not lose weight. At multivariate logistic regression analysis, only disease duration independently predicted weight loss (OR 1.05 [1.01-1.10] p = 0.022). CONCLUSIONS COVID-19 might negatively impact body weight and nutritional status. In COVID-19 patients, nutritional evaluation, counselling and treatment should be implemented at initial assessment, throughout the course of disease, and after clinical remission. CLINICALTRIALS. GOV REGISTRATION NCT04318366.
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Affiliation(s)
- Luigi Di Filippo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Marta D'Amico
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Valentina Sofia
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Luisa Roveri
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Mele
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Patrizia Rovere-Querini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
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