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Arslan S, Dal N, Tari Selcuk K, Sahin K, Atan RM. Identifying malnutrition risk in hospitalized patients: an analysis of five tools in the light of GLIM criteria. Postgrad Med 2024:1-10. [PMID: 38819304 DOI: 10.1080/00325481.2024.2363169] [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: 01/06/2024] [Accepted: 05/30/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The prompt identification of malnutrition among hospitalized patients using the appropriate screening tool is paramount. The objective of our study is to compare the most recommended screening tools concerning the new GLIM criteria for malnutrition in hospitalized patients. METHODS In this cross-sectional study, we analyzed the data on 1,397 patients receiving inpatient treatment at Bandırma Training and Research Hospital between August 2022 and May 2023 to assess and compare malnutrition in them. Patients who received inpatient treatment in the internal and surgical clinics of Bandırma Training and Research Hospital. In addition to the GLIM criteria, we used nutritional screening and assessment tools such as NRS-2002, MST, GMS, MUST, and SNAQ. The GLIM criteria were considered the gold standard for the evaluation of sensitivity and specificity. Receiver operating characteristic (ROC) curves for the five screening tools were also used to assess the ability to distinguish malnutrition-risk patients accurately. RESULTS The comparison of the performances of different screening tools in detecting malnutrition demonstrated that while the GMS had the highest sensitivity (87.40%), the NRS-2002 had the highest specificity (91.70%). The area under the Curve (AUC) value indicated that the predictive values of the NRS-2002, MST, GMS, and SNAQ were excellent, and the predictive value of the MUST was good (p < 0.001). While the GLIM criteria in particular appear to be an effective tool for detecting malnutrition in hospitalized individuals, other screening tools are also useful in assessing their malnutrition risk. CONCLUSIONS We emphasized MST's alignment with GLIM criteria, underscoring the importance of a multidisciplinary approach for early malnutrition diagnosis. Patients at risk of malnutrition can be diagnosed more quickly and accurately with appropriate screening tools and the effectiveness of treatments can be increased.
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Affiliation(s)
- Sedat Arslan
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey
| | - Nursel Dal
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey
| | - Kevser Tari Selcuk
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey
| | - Kezban Sahin
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey
| | - Ramazan Mert Atan
- Department of Nutrition and Dietetics, Bandirma Onyedi Eylul University, Balikesir, Turkey
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Merchán-Chaverra RA, Acero-Alfonso DA, Cuellar-Fernandez YM, Medina-Parra J, Lloreda PS. Malnutrition screening tool and nutritional screening tool for classification of nutritional risk in patients with cancer upon hospital admission: Comparison of diagnostic performance using Global Leadership Initiative on malnutrition criteria as reference. Clin Nutr ESPEN 2024; 61:46-51. [PMID: 38777472 DOI: 10.1016/j.clnesp.2024.02.029] [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: 08/15/2023] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS Tools for screening of nutrition risk in patients with cancer are usually validated against other screening instruments. Here with the performance of Malnutrition Screening Tool (MST) and Nutritional Screening Tool (NUTRISCORE) to identify the risk of malnutrition was assessed. A full nutritional evaluation and diagnosis following criteria from the Global Leadership Initiative of Malnutrition (GLIM) was the reference standard for the classification of malnutrition. METHODS Diagnostic test prospective analysis of adult patients with a confirmed diagnosis of cancer. MST, NUTRISCORE and nutritional evaluation and diagnosis by GLIM criteria were independently performed within 24 h of admission to a 4th tier hospital in Bogotá, Colombia. RESULTS From 439 patients the sensitivity and specificity of MST was 75% and 94% and of NUTRISCORE 45% and 97% respectively. The area under receiver operating characteristic (ROC) curves were 0.90 for MST and 0.85 for NUTRISCORE (p = 0.003). CONCLUSION The MST showed a significantly better diagnostic performance over NUTRISCORE for detection of malnutrition risk at admission to hospital of patients with cancer.
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Affiliation(s)
- Ricardo Alfonso Merchán-Chaverra
- Grupo de Investigación de Nutrición Clínica y Rehabilitación, Fundación Universitaria Sanitas, Clínicas Colsanitas, Grupo Keralty, Bogotá, Colombia; Facultad de Medicina, Fundación Universitaria Sanitas, Bogotá, Colombia; Centro Latinoamericano de Nutrición (CELAN), Chía (Cundinamarca), Colombia; Vicepresidencia de innovación y Desarrollo Científico, Clínica Infantil Santa María del Lago, Clínica Reina Sofía Pediátrica y Mujer, Clínicas Colsanitas, Grupo Keralty, Bogotá, Colombia.
| | - Daniela Alejandra Acero-Alfonso
- Grupo de Investigación de Nutrición Clínica y Rehabilitación, Fundación Universitaria Sanitas, Clínicas Colsanitas, Grupo Keralty, Bogotá, Colombia; Clínica Universitaria Colombia, Clínicas Colsanitas, Grupo Keralty, Bogotá, Colombia
| | - Yeny Marjorie Cuellar-Fernandez
- Grupo de Investigación de Nutrición Clínica y Rehabilitación, Fundación Universitaria Sanitas, Clínicas Colsanitas, Grupo Keralty, Bogotá, Colombia; Facultad de Medicina, Fundación Universitaria Sanitas, Bogotá, Colombia; Centro Latinoamericano de Nutrición (CELAN), Chía (Cundinamarca), Colombia
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Bozzetti F. The role of the nutrition in malnourished cancer patients: Revisiting an old dilemma. Clin Nutr 2024; 43:1320-1328. [PMID: 38669764 DOI: 10.1016/j.clnu.2024.03.018] [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: 01/28/2024] [Revised: 03/10/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND & AIMS GLIM definition of malnutrition is recognised all over the world and, when is referring to cancer, it specifies that weight or muscle loss are associated with an inflammatory status. However, the real-world practice shows that GLIM definition cannot encompass all the wide and heterogenous clinical presentations of cancer patients with malnutrition, which involves many other drivers beyond inflammation. Moreover, placing an excessive emphasis on the inflammation can overshadow, in the clinical practice, the role of the nutritional support in malnourished cancer patients. The aim of this paper is not to criticize the rationale of the GLIM definition of cancer cachexia, but to show the complexity and heterogeneity of malnutrition of cancer patients and reasons why nutritional support should deserve such a better consideration among the oncologists. METHODS Literature pertinent to pathophysiology of malnutrition of cancer patients is scrutinised and reasons for the frequent underuse of nutritional support are critically analysed. RESULTS The appraisal of the literature shows that there are various pathophysiological patterns of malnutrition among cancer patients and inflammatory markers are not universally present in weight-losing cancer patients. Inflammation alone does not account for weight loss in all cancer patients and factors other than inflammation can drive hypophagia and weight loss, and hypophagia appears to be a primary catalyst for weight loss. Furthermore, malnutrition may be the consequence of the presence of several Nutrition Impact Symptoms or of the oncologic therapy. The nutritional support may fail to show benefits in malnourished cancer patients because the golden standard to validate a therapy relies on RCT, but it is ethically impossible to have an unfed control group of malnourished patients. Furthermore, nutritional interventions often fell short of the optimal standards, adherence to treatment plans was often poor, nutritional support was mainly reserved for very advanced patients and the primary endpoints of the studies on nutritional support were sometimes unrealistic. CONCLUSION There is a gap between the suggestion of the guidelines which advocate the use of nutritional support to improve the compliance of patients facing intensive oncologic treatments or to prevent an early demise when patients enter a chronic phase of slow nutritional deterioration, and the poor use of nutrition in the real-world practice. This requires a higher level of awareness of the oncologists concerning the reasons for the lacking evidence of efficacy of the nutritional support and an understanding of its potential contribute to improve the outcome of the patients. Finally, this paper calls for a change of the oncologist's approach to the cancer patient, from only focusing on the cure of the tumour to taking care of the patient as a whole.
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Wang Y, Liu Z, Zhang H, Wang Y, Chen X, Lu W, Fang Y, Peng Z, Liu W. Evaluation of different screening tools as the first step of the GLIM framework: A cross-sectional study of Chinese cancer patients in an outpatient setting. Nutr Clin Pract 2024; 39:702-713. [PMID: 38161144 DOI: 10.1002/ncp.11103] [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: 07/17/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Ambulatory cancer patients are at high risk of malnutrition. Multiple nutrition screening and assessment tools are used in the outpatient setting. This study aimed to evaluate the efficacy of different nutrition screening tools as the first step of the Global Leadership Initiative on Malnutrition (GLIM) framework in Chinese ambulatory cancer patients. METHODS A cross-sectional study was conducted in a tertiary hospital in China. Malnutrition diagnoses made by the GLIM framework using Malnutrition Screening Tool, Malnutrition Universal Screening Tool, Nutritional Risk Screening 2002, or short-form of Patient-Gernerated Subjective Global Assessment (PG-SGA) as the first step were compared with PG-SGA separately. RESULTS Of the 562 included patients, 31.0% were diagnosed with malnutrition (PG-SGA: B + C), and 12.6% were diagnosed with severe malnutrition (PG-SGA: C). As the screening tool in the first step of the GLIM framework, the short form of PG-SGA (PG-SGA SF) with a cutoff value of ≥2 performed best in diagnosing malnutrition, with good sensitivity (SE) (80.5% [73.6-85.9]) and specificity (SP) (98.4% [96.5-99.4]) and substantial accordance (κ = 0.826), whereas PG-SGA SF with a cutoff value of ≥4 performed best in diagnosing severe malnutrition, with fair SE (62.0% [49.6-73.0]), good SP (96.7% [94.6-98.1]) and moderate accordance (κ = 0.629). CONCLUSION Using PG-SGA as the standard, the GLIM framework using PG-SGA SF as the screening tool has good accordance with the PG-SGA regardless of severity grading. PG-SGA SF can be used as a valid screening tool in the GLIM framework.
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Affiliation(s)
- Yanfei Wang
- Department of Day Oncology Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Ziqi Liu
- Department of Nutrition, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Hong Zhang
- Department of Day Oncology Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Yunyi Wang
- Department of Supportive Care, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Xiaoyan Chen
- Department of Day Oncology Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Wenqi Lu
- School of Global Public Health, Public Health Nutrition, New York University, New York City, New York, USA
| | - Yu Fang
- Department of Nutrition, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Zhi Peng
- Department of Nutrition, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
| | - Wei Liu
- Department of Day Oncology Unit, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
- Department of Supportive Care, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital, Beijing, China
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Razzera EL, Milanez DSJ, Silva FM. A longitudinal study to determine if all critically ill patients should be considered at nutrition risk or is there a highly accurate screening tool to be adopted? Nutr Clin Pract 2024; 39:714-725. [PMID: 38282189 DOI: 10.1002/ncp.11118] [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: 07/12/2023] [Revised: 11/03/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Nutrition risk is prevalent in intensive care unit (ICU) settings and related to poor prognoses. We aimed to evaluate the concurrent and predictive validity of different nutrition risk screening tools in the ICU. METHODS Data were collected between 2019 and 2022 in six ICUs (n = 450). Nutrition risk was evaluated by modified Nutrition Risk in Critically ill (mNUTRIC), Nutritional Risk Screening (NRS-2002), Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), and Nutritional Risk in Emergency (NRE-2017). Accuracy and agreement of the tools were assessed; logistic regression was used to verify the association between nutrition risk and prolonged ICU stay; Cox regression was used for mortality in the ICU, both with adjustment for confounders. RESULTS NRS-2002 ≥5 showed the best accuracy (0.63 [95% CI, 0.58-0.69]) with mNUTRIC, and MST with NRS-2002 ≥5 (0.76 [95% CI, 0.71-0.80]). All tools had a poor/fair agreement with mNUTRIC (k = 0.019-0.268) and moderate agreement with NRS-2002 ≥5 (k = 0.474-0.503). MUST (2.26 [95% CI 1.40-3.63]) and MST (1.69 [95% CI, 1.09-2.60]) predicted death in the ICU, and the NRS-2002 ≥5 (1.56 [95% CI 1.02-2.40]) and mNUTRIC (1.86 [95% CI, 1.26-2.76]) predicted prolonged ICU stay. CONCLUSION No nutrition risk screening tool demonstrated a satisfactory concurrent validity; only the MUST and MST predicted ICU mortality and the NRS-2002 ≥5 and mNUTRIC predicted prolonged ICU stay, suggesting that it could be appropriate to adopt the ESPEN recommendation to assess nutrition status in patients with ≥48 h in the ICU.
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Affiliation(s)
- Elisa L Razzera
- Nutrition Science Graduate Program, Universidade, Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Danielle S J Milanez
- Nutrition Science Graduate Program, Universidade, Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Flávia M Silva
- Nutrition Department, Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Guan L, Tuttle CSL, Galkin F, Zhavoronkov A, Maier AB. Higher blood biochemistry-based biological age developed by advanced deep learning techniques is associated with frailty in geriatric rehabilitation inpatients: RESORT. Exp Gerontol 2024; 190:112421. [PMID: 38588752 DOI: 10.1016/j.exger.2024.112421] [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: 01/11/2024] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Accelerated biological ageing is a major underlying mechanism of frailty development. This study aimed to investigate if the biological age measured by a blood biochemistry-based ageing clock is associated with frailty in geriatric rehabilitation inpatients. METHODS Within the REStORing health of acutely unwell adulTs (RESORT) cohort, patients' biological age was measured by an ageing clock based on completed data of 30 routine blood test variables measured at rehabilitation admission. The delta of biological age minus chronological age (years) was calculated. Ordinal logistic regression and multinomial logistic regression were performed to evaluate the association of the delta of ages with frailty assessed by the Clinical Frailty Scale. Effect modification of Cumulative Illness Rating Scale (CIRS) score was tested. RESULTS A total of 1187 geriatric rehabilitation patients were included (median age: 83.4 years, IQR: 77.7-88.5; 57.4 % female). The biochemistry-based biological age was strongly correlated with chronological age (Spearman r = 0.883). After adjustment for age, sex and primary reasons for acute admission, higher biological age (per 1 year higher in delta of ages) was associated with more severe frailty at admission (OR: 1.053, 95 % CI:1.012-1.096) in patients who had a CIRS score of <12 not in patients with a CIRS score >12. The delta of ages was not associated with frailty change from admission to discharge. The specific frailty manifestations as cardiac, hematological, respiratory, renal, and endocrine conditions were associated with higher biological age. CONCLUSION Higher biological age was associated with severe frailty in geriatric rehabilitation inpatients with less comorbidity burden.
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Affiliation(s)
- Lihuan Guan
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
| | - Camilla S L Tuttle
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; Department of Surgery, St Vincent's Hospital, The University of Melbourne, Victoria, Australia.
| | | | - Alex Zhavoronkov
- Deep longevity, Hong Kong; Insilico Medicine, Hong Kong Science and Technology Park, Hong Kong; The Buck Institute for Research on Aging, Novato, CA, USA.
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, the Netherlands.; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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Coltman A, Ojeda T, Ashafa M, Pertel D, McCauley S. The Global Malnutrition Composite Score: Impacting malnutrition care. Nutr Clin Pract 2024. [PMID: 38824274 DOI: 10.1002/ncp.11162] [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: 03/06/2024] [Revised: 05/03/2024] [Accepted: 05/10/2024] [Indexed: 06/03/2024] Open
Abstract
The presence and impact of malnutrition in adult hospitalized patients has been well documented by a significant body of literature. However, current malnutrition care practices often vary widely and frequently lack standardization. The Global Malnutrition Composite Score (GMCS), the first nutrition-related electronic clinical quality measure, is intended to evaluate the quality of malnutrition care provided to inpatient adults. This measure aims to aid in standardizing malnutrition care through performance measurement. The four components of the measure (nutrition screening, nutrition assessment, malnutrition diagnosis, and nutrition care plans) follow the well-established Nutrition Care Process and encourage the use of standardized terminology. Facilities with high-performance scores on the GMCS are likely to experience improved outcomes associated with high-quality malnutrition care.
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Affiliation(s)
- Anne Coltman
- Commission on Dietetic Registration, Chicago, Illinois, USA
| | - Tamaire Ojeda
- Commission on Dietetic Registration, Chicago, Illinois, USA
| | | | - Donna Pertel
- Commission on Dietetic Registration, Chicago, Illinois, USA
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Jack S, Andritsch E, Joaquim A, Kreissl M, Locati L, Netea-Maier R, Reverter J, Elisei R. Current landscape and support for practical initiation of oncological prehabilitation translatable to thyroid cancer: A position paper. Heliyon 2024; 10:e30723. [PMID: 38813200 PMCID: PMC11133508 DOI: 10.1016/j.heliyon.2024.e30723] [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: 06/12/2023] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
Despite a growing body of evidence for the effectiveness of prehabilitation, the uptake of prehabilitation in Europe remains low. Contributing factors range from limited awareness and understanding of prehabilitation to a lack of supporting infrastructure and reimbursement challenges. In this position paper, the authors propose a new comprehensive definition of prehabilitation and identify differentiated thyroid cancer as a type of cancer particularly well-suited for prehabilitation. To support clinicians with the implementation of prehabilitation programs in their clinics, the authors discuss the following practical solutions: a) find the most appropriate prehabilitation program for each patient; b) raise awareness among peers; c) develop evidence to demonstrate the effectiveness of prehabilitation; d) expand the interdisciplinary team; e) expand your network and make use of existing assets; f) utilize learnings from the COVID-19 pandemic.
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Affiliation(s)
- S. Jack
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - E. Andritsch
- Clinical Department of Oncology, University Medical Centre of Internal Medicine, Medical University of Graz, Auenbruggerpl. 2, 8036, Graz, Austria
| | - A. Joaquim
- ONCOMOVE®, Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), 4410-406, Vila Nova de Gaia, Portugal
| | - M.C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto von Guericke University, Universitatsplätz 2, 39106, Magdeburg, Germany
| | - L. Locati
- Department of Internal Medicine and Therapeutics, University of Pavia, S. da Nuova, 65, 27100, Pavia, PV, Italy
- Medical Oncology Unit, IRCCS ICS, Maugeri, Via Salvatore Maugeri, 10, 27100 Pavia PV, Italy
| | - R.T. Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Centre, Radboud Institute for Molecular Life Sciences, Geert Grooteplein Zuid 28, 6525, GA, Nijmegen, the Netherlands
| | - J.L. Reverter
- Endocrinology and Nutrition Department, Germans Trias i Pujol University Hospital, Universidad Autónoma de Barcelona, Placa Civica, 08193, Bellaterra, Barcelona, Spain
| | - R. Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126, Pisa, PI, Italy
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Javorszky SM, Palli C, Domkar S, Iglseder B. Combined systematic screening for malnutrition and dysphagia in hospitalized older adults: a scoping review. BMC Geriatr 2024; 24:445. [PMID: 38773449 PMCID: PMC11110417 DOI: 10.1186/s12877-024-05070-6] [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: 03/12/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Dysphagia affects about 40% of patients admitted to acute geriatric wards, as it is closely associated with diseases that rise in prevalence with advancing age, such as stroke, Parkinson's disease, and dementia. Malnutrition is a highly associated predictive factor of dysphagia as well as one of the most common symptoms caused by dysphagia. Thus, the two conditions may exist simultaneously but also influence each other negatively and quickly cause functional decline especially in older adults. The purpose of this review was to determine whether institutions have established a protocol combining screenings for dysphagia and malnutrition on a global scale. If combined screening protocols have been implemented, the respective derived measures will be reported. METHODS A scoping review was conducted. A systematic database search was carried out in January and February 2024. Studies were included that examined adult hospitalized patients who were systematically screened for dysphagia and malnutrition. The results were managed through the review software tool Covidence. The screening of titles and abstracts was handled independently by two reviewers; conflicts were discussed and resolved by consensus between three authors. This procedure was retained for full-text analysis and extraction. The extraction template was piloted and revised following feedback prior to extraction, which was carried out in February 2024. RESULTS A total of 2014 studies were found, 1075 of which were included for abstract screening, 80 for full text screening. In the end, 27 studies were extracted and reported following the reporting guideline PRISMA with the extension for Scoping Reviews. CONCLUSION Most of the studies considered the prevalence and association of dysphagia and malnutrition with varying outcomes such as nutritional status, pneumonia, oral nutrition, and swallowing function. Only two studies had implemented multi-professional nutrition teams.
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Affiliation(s)
- Susanne M Javorszky
- Institute of Nursing Science and Research, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
- FH Campus Wien, Department of Health Sciences, Favoritenstraße, 226, 1100, Vienna, Austria.
| | - Christoph Palli
- FH Joanneum, Institute of Health and Nursing, Alte Post Straße 149, 8020, Graz, Austria
| | - Susanne Domkar
- FH Campus Wien, Department of Health Sciences, Favoritenstraße, 226, 1100, Vienna, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian-Doppler-Klinik, Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria
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Hettiarachchi J, Verstraeten LMG, Pacifico J, Reijnierse EM, Meskers CGM, Maier AB. Body Weight and Composition Changes in Geriatric Rehabilitation Are Dependent on Sarcopenia and Malnutrition: RESORT. J Am Med Dir Assoc 2024:105030. [PMID: 38782039 DOI: 10.1016/j.jamda.2024.105030] [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: 09/15/2023] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Body weight and muscle mass loss following an acute hospitalization in older patients may be influenced by malnutrition and sarcopenia among other factors. This study aimed to assess the changes in body weight and composition from admission to discharge and the geriatric variables associated with the changes in geriatric rehabilitation inpatients. DESIGN RESORT is an observational, longitudinal cohort. SETTING AND PARTICIPANTS Geriatric rehabilitation inpatients admitted to geriatric rehabilitation wards at the xxx, Australia (N = 1006). METHODS Changes in body weight and body composition (fat mass [FM], appendicular lean mass [ALM]) from admission to discharge were analyzed using linear mixed models. Body mass index (BMI) categories, (risk of) malnutrition (Global Leadership Initiative on Malnutrition), sarcopenia (European Working Group on Sarcopenia in Older People), dependence in activities of daily living (ADL), multimorbidity, and cognitive impairment were tested as geriatric variables by which the changes in body weight and composition may differ. RESULTS A total of 1006 patients (median age: 83.2 [77.7-88.8] years, 58.5% female) were included. Body weight, FM (kg), and FM% decreased (0.30 kg, 0.43 kg, and 0.46%, respectively) and ALM (kg) and ALM% increased (0.17 kg and 0.33%, respectively) during geriatric rehabilitation. Body weight increased in patients with underweight; decreased in patients with normal/overweight, obesity, ADL dependence and in those without malnutrition and sarcopenia. ALM% and FM% decreased in patients with normal/overweight. ALM increased in patients without multimorbidity and in those with malnutrition and sarcopenia; ALM% increased in patients without multimorbidity and with sarcopenia. CONCLUSIONS AND IMPLICATIONS In geriatric rehabilitation, body weight increased in patients with underweight but decreased in patients with normal/overweight and obesity. ALM increased in patients with malnutrition and sarcopenia but not in patients without. This suggests the need for improved standard of care independent of patients' nutritional risk.
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Affiliation(s)
- Jeewanadee Hettiarachchi
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Laure M G Verstraeten
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jacob Pacifico
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; Centre of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, SM Amsterdam, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands; Healthy Longevity Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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Nissa C, Hanna L, Bauer J. Current Oncology Nutrition Care Practice in Southeast Asia: A Scoping Review. Nutrients 2024; 16:1427. [PMID: 38794665 PMCID: PMC11123819 DOI: 10.3390/nu16101427] [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: 04/03/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Although evidence-based nutrition care is recommended for patients with cancer, current nutrition care practices provided by nutritionists and dietitians in Southeast Asian countries are not clearly reported. The aim of this scoping review was to describe nutritionists' and dietitians' current oncology nutrition care practice within Southeast Asia by identifying access to dietetic services, tools or strategies used in providing care, and barriers and enablers to implementing nutrition care practices. Five databases (Ovid MEDLINE, Global Health, Embase, Cochrane Central Register of Controlled Trials, and Proquest) were searched through structured search strategies, in addition to strategic searching of grey literature. A total of 4261 sources of evidence were retrieved. After full-text screening, 18 studies from Southeast Asian countries met the inclusion criteria and were included in this review. The provision and reporting of nutrition care practices provided by nutritionists and dietitians were limited. Access to dietetic services, including nutritional screening tools and reason to be referred, were varied within studies. Barriers and enablers to nutrition care provision were unique and related to each country's specific resources and guidelines. In summary, there was varied reporting of nutrition care practices provided to patients with cancer in Southeast Asia and a lack of clarity on the actual standardized processes. Future research is warranted to further explore the barriers and enablers to providing nutrition care by local nutritionists and dietitians in Southeast Asia.
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Affiliation(s)
- Choirun Nissa
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC 3168, Australia; (C.N.); (L.H.)
- Department of Nutrition Science, Faculty of Medicine, Diponegoro University, Jl. Prof. Mr. Sunario, Tembalang, Semarang City 50275, Indonesia
| | - Lauren Hanna
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC 3168, Australia; (C.N.); (L.H.)
| | - Judy Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC 3168, Australia; (C.N.); (L.H.)
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12
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Wu T, Xu H, Li W, Zhou F, Guo Z, Wang K, Weng M, Zhou C, Liu M, Lin Y, Li S, He Y, Yao Q, Shi H, Song C. The potential of machine learning models to identify malnutrition diagnosed by GLIM combined with NRS-2002 in colorectal cancer patients without weight loss information. Clin Nutr 2024; 43:1151-1161. [PMID: 38603972 DOI: 10.1016/j.clnu.2024.04.001] [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: 03/08/2023] [Revised: 02/29/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS The key step of the Global Leadership Initiative on Malnutrition (GLIM) is nutritional risk screening, while the most appropriate screening tool for colorectal cancer (CRC) patients is yet unknown. The GLIM diagnosis relies on weight loss information, and bias or even failure to recall patients' historical weight can cause misestimates of malnutrition. We aimed to compare the suitability of several screening tools in GLIM diagnosis, and establish machine learning (ML) models to predict malnutrition in CRC patients without weight loss information. METHODS This multicenter cohort study enrolled 4487 CRC patients. The capability of GLIM diagnoses combined with four screening tools in predicting survival probability was compared by Kaplan-Meier curves, and the most accurate one was selected as the malnutrition reference standard. Participants were randomly assigned to a training cohort (n = 3365) and a validation cohort (n = 1122). Several ML approaches were adopted to establish models for predicting malnutrition without weight loss data. We estimated feature importance and reserved the top 30% of variables for retraining simplified models. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were calculated to assess and compare model performance. RESULTS NRS-2002 was the most suitable screening tool for GLIM diagnosis in CRC patients, with the highest hazard ratio (1.59; 95% CI, 1.43-1.77). A total of 2076 (46.3%) patients were malnourished diagnosed by GLIM combined with NRS-2002. The simplified random forest (RF) model outperformed other models with an AUC of 0.830 (95% CI, 0.805-0.854), and accuracy, sensitivity and specificity were 0.775, 0.835 and 0.742, respectively. We deployed an online application based on the simplified RF model to accurately estimate malnutrition probability in CRC patients without weight loss information (https://zzuwtt1998.shinyapps.io/dynnomapp/). CONCLUSIONS Nutrition Risk Screening 2002 was the optimal initial nutritional risk screening tool in the GLIM process. The RF model outperformed other models, and an online prediction tool was developed to properly identify patients at high risk of malnutrition.
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Affiliation(s)
- Tiantian Wu
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Hongxia Xu
- Department of Clinical Nutrition, Daping Hospital, Army Medical University, Chongqing, China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, China
| | - Fuxiang Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zengqing Guo
- Department of Medical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
| | - Kunhua Wang
- Department of Gastrointestinal Surgery, Institute of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Min Weng
- Department of Clinical Nutrition, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chunling Zhou
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ming Liu
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yuan Lin
- Department of Gastrointestinal Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Suyi Li
- Department of Nutrition and Metabolism of Oncology, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ying He
- Department of Clinical Nutrition, Chongqing General Hospital, Chongqing, China
| | - Qinghua Yao
- Department of Integrated Traditional Chinese and Western Medicine, Zhejiang Cancer Hospital and Key Laboratory of Traditional Chinese Medicine Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Chunhua Song
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
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13
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Cortés-Aguilar R, Malih N, Abbate M, Fresneda S, Yañez A, Bennasar-Veny M. Validity of nutrition screening tools for risk of malnutrition among hospitalized adult patients: A systematic review and meta-analysis. Clin Nutr 2024; 43:1094-1116. [PMID: 38582013 DOI: 10.1016/j.clnu.2024.03.008] [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: 12/23/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUNDS & AIMS Malnutrition is prevalent among hospitalized patients in developed countries, contributing to negative health outcomes and increased healthcare costs. Timely identification and management of malnutrition are crucial. The lack of a universally accepted definition and standardized diagnostic criteria for malnutrition has led to the development of various screening tools, each with varying validity. This complicates early identification of malnutrition, hindering effective intervention strategies. This systematic review and meta-analysis aimed to identify the most valid and reliable nutritional screening tool for assessing the risk of malnutrition in hospitalized adults. METHODS A systematic literature search was conducted to identify validation studies published from inception to November 2023, in the Pubmed/MEDLINE, Embase, and CINAHL databases. This systematic review was registered in INPLASY (INPLASY202090028). The risk of bias and quality of included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2). Meta-analyses were performed for screening tools accuracy using the symmetric hierarchical summary receiver operative characteristics models. RESULTS Of the 1646 articles retrieved, 60 met the inclusion criteria and were included in the systematic review, and 21 were included in the meta-analysis. A total of 51 malnutrition risk screening tools and 9 reference standards were identified. The meta-analyses assessed four common malnutrition risk screening tools against two reference standards (Subjective Global Assessment [SGA] and European Society for Clinical Nutrition and Metabolism [ESPEN] criteria). The Malnutrition Universal Screening Tool (MUST) vs SGA had a sensitivity (95% Confidence Interval) of 0.84 (0.73-0.91), and specificity of 0.85 (0.75-0.91). The MUST vs ESPEN had a sensitivity of 0.97 (0.53-0.99) and specificity of 0.80 (0.50-0.94). The Malnutrition Screening Tool (MST) vs SGA had a sensitivity of 0.81 (0.67-0.90) and specificity of 0.79 (0.72-0.74). The Mini Nutritional Assessment-Short Form (MNA-SF) vs ESPEN had a sensitivity of 0.99 (0.41-0.99) and specificity of 0.60 (0.45-0.73). The Nutrition Universal Screening Tool-2002 (NRS-2002) vs SGA had a sensitivity of 0.76 (0.58-0.87) and specificity of 0.86 (0.76-0.93). CONCLUSIONS The MUST demonstrated high accuracy in detecting malnutrition risk in hospitalized adults. However, the quality of the studies included varied greatly, possibly introducing bias in the results. Future research should compare tools within a specific patient population using a valid and universal gold standard to ensure improved patient care and outcomes.
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Affiliation(s)
| | - Narges Malih
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, 07002 Palma, Spain.
| | - Manuela Abbate
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Sergio Fresneda
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Aina Yañez
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Miquel Bennasar-Veny
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain; Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
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Botero L, Banks MD, Gordon EH, Bauer J, Young AM. Incidence and outcomes of in-hospital nutritional decline: A prospective observational cohort study in adult patients. Clin Nutr 2024; 43:1057-1064. [PMID: 38569329 DOI: 10.1016/j.clnu.2024.03.014] [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: 01/17/2024] [Revised: 03/07/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND AND AIMS Hospital malnutrition is associated with higher healthcare costs and worse outcomes. Only a few prospective studies have evaluated trends in nutritional status during an acute stay, but these studies were limited by the short timeframe between nutrition assessments. The aim of this study was to investigate changes in nutritional status, incidence of hospital-acquired malnutrition (HAM), and the associated risk factors and outcomes in acute adult patients admitted for >14 days. METHODS A prospective observational cohort study was conducted in two medical and two surgical wards in a tertiary hospital in Brisbane, Australia. Nutrition assessments were performed using the Subjective Global Assessment at baseline (day eight) and weekly until discharge. Nutritional decline was defined as a change from well-nourished to moderate/severe malnutrition (HAM) or from moderate to severe malnutrition (further decline) >14 days after admission. RESULTS One hundred and thirty patients were included in this study (58.5% male; median age 67.0 years (IQR 24.4), median length of stay 23.5 days (IQR 14)). At baseline, 70.8% (92/130) of patients were well-nourished. Nutritional decline occurred in 23.8% (31/130), with 28.3% (26/92) experiencing HAM. Of the patients with moderate malnutrition on admission (n = 30), 16% (5/30) continued to decline to severe malnutrition. Improvement in nutritional status from moderate and severe malnutrition to well-nourished was 18.4% (7/38). Not being prescribed the correct nutrition care plan within the first week of admission was an independent predictor of in-hospital nutritional decline or remaining malnourished (OR 2.3 (95% CI 1.0-5.1), p = 0.039). In-hospital nutritional decline was significantly associated with other hospital-acquired complications (OR 3.07 (95% CI 1.1-8.9), p = 0.04) and longer length of stay (HR 0.63 (95% CI 0.4-0.9), p = 0.044). CONCLUSION This study found a high rate of nutritional decline in acute patients, highlighting the importance of repeated nutrition screening and assessments during hospital admission and proactive interdisciplinary nutrition care to treat or prevent further nutritional decline.
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Affiliation(s)
- Liliana Botero
- School of Human Movement and Nutrition Science, The University of Queensland, Brisbane, Queensland, Australia.
| | - Merrilyn D Banks
- Department of Nutrition and Dietetics and Food Services, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Emily H Gordon
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Judy Bauer
- School of Human Movement and Nutrition Science, The University of Queensland, Brisbane, Queensland, Australia; Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Adrienne M Young
- Department of Nutrition and Dietetics and Food Services, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Capurso C, Lo Buglio A, Bellanti F, Vendemiale G. Prognostic Nutritional Index and Instant Nutritional Assessement Are Associated with Clinical Outcomes in a Geriatric Cohort of Acutely Inpatients. Nutrients 2024; 16:1359. [PMID: 38732604 PMCID: PMC11085456 DOI: 10.3390/nu16091359] [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: 02/26/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Among elderly inpatients, malnutrition is one of the most important predictive factors affecting length of stay (LOS), mortality, and risk of re-hospitalization. METHODS We conducted an observational, retrospective study on a cohort of 2206 acutely inpatients. Serum albumin and lymphocytes were evaluated. Instant Nutritional Assessment (INA) and the Prognostic Nutritional Index (PNI) were calculated to predict in-hospital mortality, LOS, and risk of rehospitalization. RESULTS An inverse relationship between LOS, serum albumin, and PNI were found. Deceased patients had lower albumin levels, lower PNI values, and third- and fourth-degree INA scores. An accurate predictor of mortality was PNI (AUC = 0.785) after ROC curve analysis; both lower PNI values (HR = 3.56) and third- and fourth-degree INA scores (HR = 3.12) could be independent risk factors for mortality during hospitalization after Cox regression analysis. Moreover, among 309 subjects with a lower PNI value or third- and fourth-class INA, hospitalization was re-hospitalization. CONCLUSIONS PNI and INA are two simple and quick-to-calculate tools that can help in classifying the condition of hospitalized elderly patients also based on their nutritional status, or in assessing their mortality risk. A poor nutritional status at the time of discharge may represent an important risk factor for rehospitalization in the following thirty days. This study confirms the importance of evaluating nutritional status at the time of hospitalization, especially in older patients. This study also confirms the importance for adequate training of doctors and nurses regarding the importance of maintaining a good nutritional status as an integral part of the therapeutic process of hospitalization in acute departments.
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Affiliation(s)
- Cristiano Capurso
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (A.L.B.); (F.B.); (G.V.)
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16
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Fujiyoshi A, Kohsaka S, Hata J, Hara M, Kai H, Masuda D, Miyamatsu N, Nishio Y, Ogura M, Sata M, Sekiguchi K, Takeya Y, Tamura K, Wakatsuki A, Yoshida H, Fujioka Y, Fukazawa R, Hamada O, Higashiyama A, Kabayama M, Kanaoka K, Kawaguchi K, Kosaka S, Kunimura A, Miyazaki A, Nii M, Sawano M, Terauchi M, Yagi S, Akasaka T, Minamino T, Miura K, Node K. JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease. Circ J 2024; 88:763-842. [PMID: 38479862 DOI: 10.1253/circj.cj-23-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Mitsuhiko Hara
- Department of Health and Nutrition, Wayo Women's University
| | - Hisashi Kai
- Department of Cardiology, Kurume Univeristy Medical Center
| | | | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
| | - Masatsune Ogura
- Department of General Medical Science, Chiba University School of Medicine
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Yasushi Takeya
- Division of Helath Science, Osaka University Gradiate School of Medicine
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | | | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Yoshio Fujioka
- Division of Clinical Nutrition, Faculty of Nutrition, Kobe Gakuin University
| | | | - Osamu Hamada
- Department of General Internal Medicine, Takatsuki General Hospital
| | | | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Kenjiro Kawaguchi
- Division of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University
| | | | | | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
- Yale New Haven Hospital Center for Outcomes Research and Evaluation
| | | | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Meidicine
| | - Katsuyuki Miura
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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Tangvik RJ, Skeie E, Haugen AS, Harthug S, Harris K. Is self-screening for 'at risk of malnutrition' feasible in a home setting? PLoS One 2024; 19:e0299305. [PMID: 38625912 PMCID: PMC11020964 DOI: 10.1371/journal.pone.0299305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/02/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION Despite malnutrition being established as a well-known risk for postoperative complications, the lack of screening for nutritional risk remains a challenge. The aim of this study was to investigate whether self-screening for nutritional risk prior to surgery is feasible in a home setting and if it will increase number of patients screened for nutritional risk, and secondly, to compare their screening results with the "in-hospital assessments" conducted by healthcare professionals. MATERIALS AND METHODS This was a prospective study involving patients from six randomly selected surgical wards at two Norwegian hospitals as a part of the "Feasibility study of implementing the surgical Patient Safety Checklist the (PASC)". This checklist included a self-reported screening tool based on the Nutritional Risk Screening tool (NRS 2002) to identify "at risk of malnutrition" in patients that will undergo surgery the next 3 months or less. The original screening tool (NRS 2002) was used as a standard routine to identify "at risk of malnutrition" by healthcare professionals at hospital. The interrater reliability between these results was investigated using Fleiss multi rater Kappa with overall agreement and reported with Landis and Koch's grading system (poor, slight, fair, moderate, substantial, and almost perfect). RESULTS Out of 215 surgical patients in the home setting, 164 (76.7%) patients completed the self-reported screening tool. A total of 123 (57.2%) patients were screened in-hospital, of whom 96 (44.7%) prior to surgery and 96 (44.7%) were screened both at hospital (pre- and post-surgery) and at home. Self-screening at home improved malnutrition screening participation by 71.9% compared to hospital screening prior to surgery (165 (76.7%) and 96 (44.7%), respectively) and by 34.1% compared to pre- and postoperative in-hospital screening, 165 (76.7%) and 123 (57.2%), respectively). The degree of agreement between patients identified to be "at risk of malnutrition" by the self-reported screening tool and healthcare professionals was poor (κ = - 0.04 (95% CI: -0.24, 0.16), however, the degrees of agreement between the patients and healthcare professionals answers to the initial NRS 2002 questions "low BMI", "weight loss", and "reduced food intake" were almost perfect (κ = 1.00 (95% CI: 0,82, 1.18)), moderate (κ = 0.55 (95% CI: 0.34, 0.75)), and slight (κ = 0.08 (95% CI: - 0.10, 0.25) respectively. CONCLUSIONS Three out of four patients completed the self-screening form and the preoperative screening rate improved with 70%. Preoperatively self-screening in a home setting may be a feasible method to increase the number of elective surgical patients screened for risk of malnutrition. TRIAL REGISTRATION The trial is registered in ClinicalTrials.gov ID NCT03105713. https://classic.clinicaltrials.gov/ct2/show/NCT03105713.
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Affiliation(s)
- Randi J. Tangvik
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Centre for Nutrition, University of Bergen, Bergen, Norway
| | - Eli Skeie
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Health and Social Services, Kvam Municipality, Norheimsund, Norway
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Faculty of Health Sciences, Department of Nursing and Health Promotion Acute and Critical Illness, OsloMet–Oslo Metropolitan University, Oslo, Norway
| | - Stig Harthug
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kristin Harris
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Roberts S, Marshall AP, Bromiley L, Hopper Z, Byrnes J, Ball L, Collins PF, Kelly J. Patient-Led, Technology-Assisted Malnutrition Risk Screening in Hospital: A Feasibility Study. Nutrients 2024; 16:1139. [PMID: 38674830 PMCID: PMC11055004 DOI: 10.3390/nu16081139] [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: 03/04/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Malnutrition risk screening is crucial to identify at-risk patients in hospitals; however, screening rates can be suboptimal. This study evaluated the feasibility, acceptability, and potential cost-effectiveness of patient-led, technology-assisted malnutrition risk screening. A prospective multi-methods study was conducted in a 750-bed public hospital in Australia. Patients were recruited from seven wards and asked to complete an electronic version of the Malnutrition Screening Tool (e-MST) on bedside computer screens. Data were collected on feasibility, acceptability, and cost. Feasibility data were compared to pre-determined criteria on recruitment (≥50% recruitment rate) and e-MST completion (≥75% completion rate). Quantitative acceptability (survey) data were analyzed descriptively. Patient interview data were analyzed thematically. The economic evaluation was from the perspective of the health service using a decision tree analytic model. Both feasibility criteria were met; the recruitment rate was 78% and all 121 participants (52% male, median age 59 [IQR 48-69] years) completed the e-MST. Patient acceptability was high. Patient-led e-MST was modeled to save $3.23 AUD per patient and yield 6.5 more true malnutrition cases (per 121 patients) with an incremental cost saving per additional malnutrition case of 0.50 AUD. Patient-led, technology-assisted malnutrition risk screening was found to be feasible, acceptable to patients, and cost-effective (higher malnutrition yield and less costly) compared to current practice at this hospital.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222, Australia;
- Allied Health Research, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Andrea P. Marshall
- School of Nursing and Midwifery, Griffith University, Southport, QLD 4222, Australia;
- Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia
| | - Leisa Bromiley
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia;
| | - Zane Hopper
- School of Health Sciences and Social Work, Griffith University, Southport, QLD 4222, Australia;
- Nutrition and Food Services, Gold Coast Hospital and Health Service, Southport, QLD 4215, Australia;
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Southport, QLD 4222, Australia;
- School of Medicine and Dentistry, Griffith University, Southport, QLD 4222, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, The University of Queensland, St Lucia, QLD 4072, Australia;
| | - Peter F. Collins
- Faculty of Medicine and Health, Sydney Nursing School/Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2006, Australia;
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Jaimon Kelly
- Centre for Online Health, The University of Queensland, Woolloongabba, QLD 4102, Australia;
- Centre for Health Services Research, The University of Queensland, Woolloongabba, QLD 4102, Australia
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19
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Lu JK, Guan L, Wang W, Rojer AGM, Galkin F, Goh J, Maier AB. The association between blood biological age at rehabilitation admission and physical activity during rehabilitation in geriatric inpatients: RESORT. GeroScience 2024:10.1007/s11357-024-01152-w. [PMID: 38589672 DOI: 10.1007/s11357-024-01152-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024] Open
Abstract
Geriatric rehabilitation inpatients have high levels of sedentary behaviour (SB) and low levels of physical activity (PA). Biological age predicted by blood biomarkers is indicative of adverse outcomes. The objective was to determine the association between blood biological age at rehabilitation admission and levels of SB and PA during rehabilitation in geriatric inpatients. Inpatients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital (Melbourne, Australia) from October 22, 2019, to March 29, 2020, in the REStORing health of acute unwell adulTs (RESORT) observational cohort were included. Blood biological age was predicted using SenoClock-BloodAge, a hematological ageing clock. Patients wore an inertial sensor to measure SB and PA. Logistic regression analyses were conducted. A total of 111 patients (57.7% female) with mean age 83.3 ± 7.5 years were included in the analysis. The mean blood biological age was 82.7 ± 8.4 years. Patients with 1-year higher blood biological age had higher odds of having high SB measured as non-upright time greater than 23 h/day (odds ratio (OR): 1.050, 95% confidence interval (CI): 1.000-1.102). Individuals having 1-year higher age deviation trended towards lower odds of having high levels of PA measured as stepping time greater than 7.4 min/day (OR: 0.916, CI: 0.836-1.005) and as greater than 19.5 sit-to-stand transitions/day (OR: 0.915, CI: 0.836-1.002). In conclusion, higher biological age was associated with higher levels of SB and trended towards lower PA. Incorporating blood biological age could facilitate resource allocation and the development of more tailored rehabilitation plans.
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Affiliation(s)
- Jessica K Lu
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
- Healthy Longevity Translational Research Program, @Age Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lihuan Guan
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
- Healthy Longevity Translational Research Program, @Age Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Weilan Wang
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
- Healthy Longevity Translational Research Program, @Age Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anna G M Rojer
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van Der Boechorstsraat 7, 1081 BT, Amsterdam, The Netherlands
| | | | - Jorming Goh
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
- Healthy Longevity Translational Research Program, @Age Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrea B Maier
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore.
- Healthy Longevity Translational Research Program, @Age Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van Der Boechorstsraat 7, 1081 BT, Amsterdam, The Netherlands.
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20
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Dos Santos JG, Saueressig C, Wolf R, Dos Santos JC, Silva FM, Franzosi OS, Alba VD. Identifying nutrition risk in emergency patients: What is the most appropriate screening tool? Nutr Clin Pract 2024. [PMID: 38575550 DOI: 10.1002/ncp.11147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The emergency department (ED) is the most frequent access route to the hospital. Nutrition risk (NR) screening allows the early identification of patients at risk of malnutrition. This study aimed to evaluate the feasibility and predictive validity of five different tools in EDs: Nutritional Risk Screening 2002 (NRS-2002), Nutritional Risk Emergency 2017 (NRE-2017), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), Malnutrition Universal Screening (MUST), and Malnutrition Screening Tool (MST). METHODS Patients with scores ≥3 according to the NRS-2002, ≥1.5 according to the NRE-2017, and ≥2 according to the MUST, RFH-NPT, or MST were classified with NR. Prolonged length of stay (LOS) and 1-year mortality were evaluated. RESULTS 431 patients were evaluated (57.31 ± 15.6 years of age; 54.4% women) in a public hospital in southern Brazil. The prevalence of NR was: 35% according to the NRS-2002, 43% according to the MST, 45% according to the NRE-2017 and MUST, and 49% according to the RFH-NPT. Patients with NR, had a greater risk of prolonged LOS (P < 0.001). The presence of NR was associated with an increased risk of 1-year mortality according to the NRS-2002 (hazard ratio [HR]: 4.04; 95% CI, 2.513-6.503), MST (HR: 2.60; 95% CI, 1.701-3.996), NRE-2017 (HR: 4.82; 95% CI, 2.753-8.443), MUST (HR: 4.00; 95% CI, 2.385-6.710), and RFH-NPT (HR: 5.43; 95% CI, 2.984-9.907). CONCLUSIONS NRE-2017 does not require objective data and presented predictive validity for all outcomes assessed, regardless of the severity of the disease, and thus appears to be the most appropriate tool for carrying out NR screening in the ED.
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Affiliation(s)
- Johnny Galhano Dos Santos
- Graduate Program in Food, Nutrition, and Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila Saueressig
- Graduate Program Sciences in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Renata Wolf
- Nutrition Course, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jéssica Correa Dos Santos
- Nutrition Course, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Graduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Oellen Stuani Franzosi
- Nutrition and Dietetics Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Valesca Dall' Alba
- Graduate Program in Food, Nutrition, and Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program Sciences in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Nutrition Course, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Nutrition and Dietetics Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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21
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García-Fuente I, Corral-Gudino L, Gabella-Martín M, Olivet-de-la-Fuente VE, Pérez-Nieto J, Miramontes-González P. How to detect non-institutionalized older patients at risk of malnutrition during their hospitalization? Comparison of 8 screening tools for malnutrition or nutritional risk. Rev Clin Esp 2024; 224:217-224. [PMID: 38490479 DOI: 10.1016/j.rceng.2024.03.003] [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: 01/02/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The prevalence of malnutrition is high among the elderly population. Hospital admission is a window of opportunity for its detection. OBJECTIVE To assess the concordance of different nutritional scales in hospitalized patients. METHODS Prospective study in non-institutionalized patients over 65 years of age admitted to an internal medicine department. Five malnutrition screening surveys (MNA, MST, MUST, NRS-2000 and CONUT) and three nutritional risk screening surveys (SCREEN 3, 8 and 14) were compared. As gold standard we use the Global Malnutrition Leadership Initiative for Malnutrition (GLIM) definition of malnutrition. RESULTS Eighty-five patients (37% female, median age 83 years) were included. Forty-eight percent (95% CI 38-59%) of patients were classified as malnourished according to GLIM criteria. The SCREEN 3 scale was the most sensitive (93%; 95% CI 87-98) and MUST the most specific (91%; CI 85-99). The most effective scale for excluding suspected malnutrition was SCREEN 3 (LR- 0.17; 95% CI 0.05-0.53) and the best for confirming it was MST (LR+ 7.08; 95% CI 3.06-16.39). Concordance between the different scales was low or very low with kappa indices between 0.082 and 0.465. CONCLUSIONS A comprehensive approach is needed to detect malnutrition in hospitalized patients. More sensitive scales are more useful in initial screening. Nutritional risk tools could be effective at this stage. In a second step, malnutrition should be confirmed according to established criteria such as GLIM.
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Affiliation(s)
- I García-Fuente
- Servicio de Medicina Interna, Hospital Universitario de Valladolid, Valladolid, Spain; Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain; IBioVALL (Instituto de Investigación Biosanitaria de Valladolid), Valladolid, Spain
| | - L Corral-Gudino
- Servicio de Medicina Interna, Hospital Universitario de Valladolid, Valladolid, Spain; Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain; IBioVALL (Instituto de Investigación Biosanitaria de Valladolid), Valladolid, Spain.
| | - M Gabella-Martín
- Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - J Pérez-Nieto
- Enfermería, Hospital Universitario Río Hortega, Valladolid, Spain
| | - P Miramontes-González
- Servicio de Medicina Interna, Hospital Universitario de Valladolid, Valladolid, Spain; Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain; IBioVALL (Instituto de Investigación Biosanitaria de Valladolid), Valladolid, Spain
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22
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Enge M, Peelen FO, Nielsen RL, Beck AM, Olin AÖ, Cederholm T, Boström AM, Paur I. Malnutrition prevalence according to GLIM and its feasibility in geriatric patients: a prospective cross-sectional study. Eur J Nutr 2024; 63:927-938. [PMID: 38240774 PMCID: PMC10948466 DOI: 10.1007/s00394-023-03323-5] [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: 08/28/2023] [Accepted: 12/29/2023] [Indexed: 03/19/2024]
Abstract
PURPOSE In 2019, the Global Leadership Initiative on Malnutrition (GLIM) suggested a 2-step diagnostic format for malnutrition including screening and diagnosis. Prospective validation and feasibility studies, using the complete set of the five GLIM criteria, are needed. The aims of this study were to determine the prevalence of malnutrition, and investigate how the prevalence varied with mode of screening. Furthermore, we assessed the feasibility of GLIM in geriatric patients. METHODS Consecutive patients from two acute geriatric wards were included. For screening risk of malnutrition, the Mini Nutritional Assessment-Short Form (MNA-SF) or Malnutrition Screening Tool (MST) were used. In accordance with GLIM, a combination of phenotypic and etiologic criteria were required for the diagnosis of malnutrition. Feasibility was determined based on % data completeness, and above 80% completeness was considered feasible. RESULTS One hundred patients (mean age 82 years, 58% women) were included. After screening with MNA-SF malnutrition was confirmed by GLIM in 51%, as compared with 35% after screening with MST (p = 0.039). Corresponding prevalence was 58% with no prior screening. Using hand grip strength as a supportive measure for reduced muscle mass, 69% of the patients were malnourished. Feasibility varied between 70 and 100% for the different GLIM criteria, with calf circumference as a proxy for reduced muscle mass having the lowest feasibility. CONCLUSION In acute geriatric patients, the prevalence of malnutrition according to GLIM varied depending on the screening tool used. In this setting, GLIM appears feasible, besides for the criterion of reduced muscle mass.
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Affiliation(s)
- Maria Enge
- Department of Geriatric Medicine, Jakobsbergsgeriatriken, Stockholm, Sweden
| | - Frida Ostonen Peelen
- Theme Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit EATEN, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Ann Ödlund Olin
- Department of Quality and Patient Safety, Karolinska University Hospital Stockholm, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Tommy Cederholm
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Huddinge, Sweden
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anne-Marie Boström
- Theme Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, Huddinge, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Stockholms Sjukhem, Research and Development Unit, Stockholm, Sweden
| | - Ingvild Paur
- Norwegian Advisory Unit On Disease-Related Undernutrition, Oslo, Norway.
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Nydalen, Postbox 4950, 0424, Oslo, Norway.
- Institute for Clinical Medicine, Clinical Nutrition Research Group, UiT the Arctic University of Norway, Tromsø, Norway.
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23
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Furness K, Huggins CE, Hanna L, Croagh D, Sarkies M, Haines TP. Comparison of Goal Achievement during an Early, Intensive Nutrition Intervention Delivered to People with Upper Gastrointestinal Cancer by Telephone Compared with Mobile Application. Int J Telemed Appl 2024; 2024:7841826. [PMID: 38567030 PMCID: PMC10987247 DOI: 10.1155/2024/7841826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/09/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Objective This study is aimed at exploring whether the mode of nutrition intervention delivery affected participant goal achievement in a three-arm randomised controlled trial of early and intensive nutrition intervention delivered to upper gastrointestinal cancer patients. Methods Newly diagnosed upper gastrointestinal cancer patients were recruited from four tertiary hospitals in Melbourne, Australia. Participants in the intervention groups received a regular nutrition intervention for 18 weeks from an experienced dietitian via telephone or mobile application (app) using behaviour change techniques to assist in goal achievement. Univariate and multiple regression models using STATA determined goal achievement, dose, and frequency of contact between groups. A p value <0.05 was considered statistically significant. Results The telephone group (n = 38) had 1.99 times greater frequency of contact with the research dietitian (95% CI: 1.67 to 2.36, p < 0.001) and 2.37 times higher frequency of goal achievement (95% CI: 1.1 to 5.11, p = 0.03) compared with the mobile app group (n = 36). The higher dose (RR 0.03) of intervention and more behaviour change techniques employed in the telephone group compared with the mobile app group increased participant goal achievement (95% CI: 0.01 to 0.04, p < 0.001). Discussion. Telephone nutrition intervention delivery led to a higher frequency of goal achievement compared to the mobile app intervention. There was also a higher number of behaviour change techniques employed which may have facilitated the greater goal achievement. Mobile app-based delivery may have poorer acceptance in this population with high levels of withdrawal. Practice Implications. We need to ensure that specifically designed technologies for our target populations are fit for purpose, efficacious, and acceptable to both patients and healthcare providers. This trial is registered with ACTRN12617000152325.
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Affiliation(s)
- Kate Furness
- Nutrition and Dietetics, Monash Health, Monash Medical Centre, Clayton, Victoria 3168, Australia
- Dietetics, Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199, Australia
| | - Catherine E. Huggins
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia
| | - Lauren Hanna
- Nutrition and Dietetics, Monash Health, Monash Medical Centre, Clayton, Victoria 3168, Australia
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia
| | - Daniel Croagh
- Upper Gastrointestinal and Hepatobiliary Surgery, Monash Medical Centre, Clayton, Victoria 3168, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia
| | - Mitchell Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Terry P. Haines
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199, Australia
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24
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Zhu XX, Yao KF, Huang HY, Wang LH. Associations between Geriatric Nutrition Risk Index, bone mineral density and body composition in type 2 diabetes patients. World J Diabetes 2024; 15:403-417. [PMID: 38591073 PMCID: PMC10999046 DOI: 10.4239/wjd.v15.i3.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/08/2023] [Accepted: 01/24/2024] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM), a fast-growing issue in public health, is one of the most common chronic metabolic disorders in older individuals. Osteoporosis and sarcopenia are highly prevalent in T2DM patients and may result in fractures and disabilities. In people with T2DM, the association between nutrition, sarcopenia, and osteoporosis has rarely been explored. AIM To evaluate the connections among nutrition, bone mineral density (BMD) and body composition in patients with T2DM. METHODS We enrolled 689 patients with T2DM for this cross-sectional study. All patients underwent dual energy X-ray absorptiometry (DXA) examination and were categorized according to baseline Geriatric Nutritional Risk Index (GNRI) values calculated from serum albumin levels and body weight. The GNRI was used to evaluate nutritional status, and DXA was used to investigate BMD and body composition. Multivariate forward linear regression analysis was used to identify the factors associated with BMD and skeletal muscle mass index. RESULTS Of the total patients, 394 were men and 295 were women. Compared with patients in tertile 1, those in tertile 3 who had a high GNRI tended to be younger and had lower HbA1c, higher BMD at all bone sites, and higher appendicular skeletal muscle index (ASMI). These important trends persisted even when the patients were divided into younger and older subgroups. The GNRI was positively related to ASMI (men: r = 0.644, P < 0.001; women: r = 0.649, P < 0.001), total body fat (men: r = 0.453, P < 0.001; women: r = 0.557, P < 0.001), BMD at all bone sites, lumbar spine (L1-L4) BMD (men: r = 0.110, P = 0.029; women: r = 0.256, P < 0.001), FN-BMD (men: r = 0.293, P < 0.001; women: r = 0.273, P < 0.001), and hip BMD (men: r = 0.358, P < 0.001; women: r = 0.377, P < 0.001). After adjustment for other clinical parameters, the GNRI was still significantly associated with BMD at the lumbar spine and femoral neck. Additionally, a low lean mass index and higher β-collagen special sequence were associated with low BMD at all bone sites. Age was negatively correlated with ASMI, whereas weight was positively correlated with ASMI. CONCLUSION Poor nutrition, as indicated by a low GNRI, was associated with low levels of ASMI and BMD at all bone sites in T2DM patients. Using the GNRI to evaluate nutritional status and using DXA to investigate body composition in patients with T2DM is of value in assessing bone health and physical performance.
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Affiliation(s)
- Xiao-Xiao Zhu
- Department of Pediatrics, The Second Affiliated Hospital of Nantong University, First People’s Hospital of Nantong City, Nantong 226001, Jiangsu Province, China
| | - Kai-Feng Yao
- Department of Nursing, The Second Affiliated Hospital of Nantong University, First People’s Hospital of Nantong City, Nantong 226001, Jiangsu Province, China
| | - Hai-Yan Huang
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, First People’s Hospital of Nantong City, Nantong 226001, Jiangsu Province, China
| | - Li-Hua Wang
- Department of Nursing, The Second Affiliated Hospital of Nantong University, First People’s Hospital of Nantong City, Nantong 226001, Jiangsu Province, China
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25
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Schlake K, Teller J, Hinken L, Laser H, Lichtinghagen R, Schäfer A, Fegbeutel C, Weissenborn K, Jung C, Worthmann H, Gabriel MM. Butyrylcholinesterase activity in patients with postoperative delirium after cardiothoracic surgery or percutaneous valve replacement- an observational interdisciplinary cohort study. BMC Neurol 2024; 24:80. [PMID: 38424490 PMCID: PMC10905803 DOI: 10.1186/s12883-024-03580-9] [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: 10/06/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Postoperative delirium is a frequent and severe complication after cardiac surgery. Activity of butyrylcholinesterase (BChE) has been discussed controversially regarding a possible role in its development. This study aimed to investigate the relevance of BChE activity as a biomarker for postoperative delirium after cardiac surgery or percutaneous valve replacement. METHODS A total of 237 patients who received elective cardiothoracic surgery or percutaneous valve replacement at a tertiary care centre were admitted preoperatively. These patients were tested with the Montreal Cognitive Assessment investigating cognitive deficits, and assessed for postoperative delirium twice daily for three days via the 3D-CAM or the CAM-ICU, depending on their level of consciousness. BChE activity was measured at three defined time points before and after surgery. RESULTS Postoperative delirium occurred in 39.7% of patients (n = 94). Univariate analysis showed an association of pre- and postoperative BChE activity with its occurrence (p = 0.037, p = 0.001). There was no association of postoperative delirium and the decline in BChE activity (pre- to postoperative, p = 0.327). Multivariable analysis including either preoperative or postoperative BChE activity as well as age, MoCA, type 2 diabetes mellitus, coronary heart disease, type of surgery and intraoperative administration of red-cell concentrates was performed. Neither preoperative nor postoperative BChE activity was independently associated with the occurrence of postoperative delirium (p = 0.086, p = 0.484). Preoperative BChE activity was lower in older patients (B = -12.38 (95% CI: -21.94 to -2.83), p = 0.011), and in those with a history of stroke (B = -516.173 (95% CI: -893.927 to -138.420), p = 0.008) or alcohol abuse (B = -451.47 (95% CI: -868.38 to -34.55), p = 0.034). Lower postoperative BChE activity was independently associated with longer procedures (B = -461.90 (95% CI: -166.34 to -757.46), p = 0.002), use of cardiopulmonary bypass (B = -262.04 (95% CI: -485.68 to -38.39), p = 0.022), the number of administered red cell-concentrates (B = -40.99 (95% CI: -67.86 to -14.12), p = 0.003) and older age (B = -9.35 (95% CI: -16.04 to -2.66), p = 0.006). CONCLUSION BChE activity is not independently associated with the occurrence of postoperative delirium. Preoperative BChE values are related to patients' morbidity and vulnerability, while postoperative activities reflect the severity, length and complications of surgery.
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Affiliation(s)
- Konstantin Schlake
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Johannes Teller
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lukas Hinken
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hans Laser
- Department for Educational and Scientific IT Systems, Hannover Medical School, MHH Information Technology, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Andreas Schäfer
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christine Fegbeutel
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Carolin Jung
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Maria Magdalena Gabriel
- Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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26
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Jimenez EY, Lamers-Johnson E, Long JM, McCabe G, Ma X, Woodcock L, Bliss C, Abram JK, Steiber AL. Predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition indicators to diagnose malnutrition tool in hospitalized adults: a cohort study. Am J Clin Nutr 2024; 119:779-787. [PMID: 38432715 DOI: 10.1016/j.ajcnut.2023.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The lack of a widely accepted, broadly validated tool for diagnosing malnutrition in hospitalized patients limits the ability to assess the integral role of nutrition as an input and outcome of health, disease, and treatment. OBJECTIVES This study aimed to evaluate the predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (ASPEN) indicators to diagnose malnutrition (AAIM) tool and determine if it can be simplified. METHODS A prospective cohort study was conducted from August 2019 to September 2022 with 32 hospitals in United States. At baseline, 290 adult patients were evaluated for a diagnosis of malnutrition using the AAIM tool, which assesses weight loss, inadequate energy intake, subcutaneous fat and muscle loss, edema, and hand grip strength. Healthcare outcomes were extracted from the medical record: composite incidence of emergency department (ED) visits and hospital readmissions within 90 d postdischarge; length of hospital stay (LOS); and Medicare Severity Disease Related Group (MS-DRG) relative weight (i.e., healthcare resource utilization). We used multilevel, multivariable negative binomial or generalized linear regression models to evaluate relationships between malnutrition diagnosis and healthcare outcomes. RESULTS After adjusting for disease severity and acuity and sociodemographic characteristics, individuals diagnosed with severe malnutrition had a higher incidence rate of ED visits and hospital readmissions (incidence rate ratio: 1.89; 95% CI: 1.14, 3.13; P = 0.01), and individuals diagnosed with moderate malnutrition had a 25.2% longer LOS (95% CI: 2.0%, 53.7%; P = 0.03) and 15.1% greater healthcare resource utilization (95% CI: 1.6%, 31.9%; P = 0.03) compared with individuals with no malnutrition diagnosis. Observed relationships remained consistent when only considering malnutrition diagnoses supported by at least 2 of these indicators: weight loss, subcutaneous fat loss, muscle wasting, and inadequate energy intake. CONCLUSIONS Findings from this multihospital study confirm the predictive validity of the original or simplified AAIM tool and support its routine use for hospitalized adult patients. This trial was registered at clinicaltrials.gov as NCT03928548 (https://classic. CLINICALTRIALS gov/ct2/show/NCT03928548).
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Affiliation(s)
- Elizabeth Yakes Jimenez
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States; Department of Pediatrics, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, United States; Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, United States; College of Population Health, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Erin Lamers-Johnson
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Julie M Long
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - George McCabe
- Department of Statistics, Purdue University, West Lafayette, IN, United States
| | - Xingya Ma
- Department of Pediatrics, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, United States
| | - Lindsay Woodcock
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Courtney Bliss
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Jenica K Abram
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Alison L Steiber
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States.
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O'Shea MC, Barrett C, Corones-Watkins K, Foo J, Maloney S, Bauer J, Palermo C, Kellett U, Williams LT. Dietetics student contribution to addressing malnutrition in residential aged care facilities. Nutr Diet 2024. [PMID: 38409632 DOI: 10.1111/1747-0080.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/17/2023] [Accepted: 12/30/2023] [Indexed: 02/28/2024]
Abstract
AIMS To test a model of malnutrition screening and assessment conducted by dietetics students on placement in residential aged care facilities. The secondary aim was to identify possible facilitators and barriers to the implementation of the model. METHOD The type 1 hybrid effectiveness-implementation trial study design and reporting outcomes were developed using the Consolidated Framework for Implementation Research. An innovative placement model was developed, where students on voluntary placement visited three residential aged care facilities to identify residents at risk of malnutrition using currently available screening tools for older people. Students completed malnutrition assessments for all residents using the subjective global assessment tool. RESULTS Thirty-two students participated; 31 completed all three sessions, with malnutrition screening completed for 207 residents and malnutrition assessment for 187 residents (July and September 2022). Based on the subjective global assessment, 31% (n = 57) of residents were mildly/moderately malnourished, and 3% (n = 5) were severely malnourished. The Innovation Domain of the Framework was the most important consideration before implementation. CONCLUSION Whilst previous research documented student learning opportunities in residential aged care facilities, this study provides the first available evidence of the direct contribution students can make to the health of aged care residents through malnutrition screening and assessment. The model enables students to conduct malnutrition screening and assessment feasibly and efficiently in facilities that do not routinely collate and act on these data. With a limited nursing aged care workforce to undertake this vital task, the potential role of student dietitians to fulfil this role must be considered.
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Affiliation(s)
- Marie-Claire O'Shea
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Clare Barrett
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
| | | | - Jonathan Foo
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Stephen Maloney
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Judy Bauer
- School of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Claire Palermo
- School of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Ursula Kellett
- School of Nursing & Midwifery, Griffith University, Queensland, Australia
| | - Lauren T Williams
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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Jimenez EY, Lamers-Johnson E, Long JM, Mordarski BA, Ma X, Steiber A. Completion of a Nutrition-Focused Physical Exam with hospitalized adults and pediatric patients: Secondary analysis of a prospective cohort study. Nutr Clin Pract 2024. [PMID: 38372592 DOI: 10.1002/ncp.11137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/22/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Nutrition-Focused Physical Exam (NFPE) feasibility is not well-studied. We describe registered dietitian nutritionist (RDN)-reported NFPE completion for hospitalized adult and pediatric patients overall and by assessment parameters. METHODS Trained RDNs systematically conducted NFPEs for hospitalized adult and pediatric patients during the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Indicators to diagnose Malnutrition multisite cohort study (ClinicalTrials.gov: NCT03928548). RDNs reported their ability to evaluate assessment sites for subcutaneous fat and muscle loss, fluid accumulation, and micronutrient status and to complete handgrip strength (adults and children ≥6 years) and mid-upper arm circumference measurements (children). RDNs noted if they could complete the full NFPE; if not, they noted challenges. We descriptively summarized results and used multilevel logistic regression models to examine relationships between patient characteristics and NFPE completion. RESULTS RDNs from 39 adult and 29 pediatric US hospitals conducted NFPEs for 327 adults and 214 children aged 1 month to 17.9 years. RDNs reported completing the examination for 44% (n = 145) of adults and 15% (n = 33) of children. They successfully evaluated 25 of 27 and 19 of 26 unique NFPE components in >80% of adults and children, respectively. Common reasons the full NFPE was not completed were limited mobility in adults and patient refusal in children. RDNs had lower odds of completing NFPEs in adults with lower vs higher education levels or higher vs lower nutrition complexity and in younger vs older children. CONCLUSION RDNs evaluated NFPE components for a high proportion (>80%) of hospitalized patients.
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Affiliation(s)
- Elizabeth Yakes Jimenez
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Erin Lamers-Johnson
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Julie M Long
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Beth A Mordarski
- Lifelong Learning and Engagement, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Xingya Ma
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Alison Steiber
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
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Forero-Rodríguez J, Zimmermann J, Taubenheim J, Arias-Rodríguez N, Caicedo-Narvaez JD, Best L, Mendieta CV, López-Castiblanco J, Gómez-Muñoz LA, Gonzalez-Santos J, Arboleda H, Fernandez W, Kaleta C, Pinzón A. Changes in Bacterial Gut Composition in Parkinson's Disease and Their Metabolic Contribution to Disease Development: A Gut Community Reconstruction Approach. Microorganisms 2024; 12:325. [PMID: 38399728 PMCID: PMC10893096 DOI: 10.3390/microorganisms12020325] [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: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/25/2024] Open
Abstract
Parkinson's disease (PD) is a chronic and progressive neurodegenerative disease with the major symptoms comprising loss of movement coordination (motor dysfunction) and non-motor dysfunction, including gastrointestinal symptoms. Alterations in the gut microbiota composition have been reported in PD patients vs. controls. However, it is still unclear how these compositional changes contribute to disease etiology and progression. Furthermore, most of the available studies have focused on European, Asian, and North American cohorts, but the microbiomes of PD patients in Latin America have not been characterized. To address this problem, we obtained fecal samples from Colombian participants (n = 25 controls, n = 25 PD idiopathic cases) to characterize the taxonomical community changes during disease via 16S rRNA gene sequencing. An analysis of differential composition, diversity, and personalized computational modeling was carried out, given the fecal bacterial composition and diet of each participant. We found three metabolites that differed in dietary habits between PD patients and controls: carbohydrates, trans fatty acids, and potassium. We identified six genera that changed significantly in their relative abundance between PD patients and controls, belonging to the families Lachnospiraceae, Lactobacillaceae, Verrucomicrobioaceae, Peptostreptococcaceae, and Streptococcaceae. Furthermore, personalized metabolic modeling of the gut microbiome revealed changes in the predicted production of seven metabolites (Indole, tryptophan, fructose, phenylacetic acid, myristic acid, 3-Methyl-2-oxovaleric acid, and N-Acetylneuraminic acid). These metabolites are associated with the metabolism of aromatic amino acids and their consumption in the diet. Therefore, this research suggests that each individual's diet and intestinal composition could affect host metabolism. Furthermore, these findings open the door to the study of microbiome-host interactions and allow us to contribute to personalized medicine.
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Affiliation(s)
- Johanna Forero-Rodríguez
- Bioinformatics and Systems Biology Research Group, Genetic Institute, Universidad Nacional de Colombia, Bogotá 111321, Colombia; (J.F.-R.); (J.D.C.-N.); (J.L.-C.)
- Medical Systems Biology Research Group, Institute of Experimental Medicine, Christian-Albrechts-Universität zu Kiel, 24118 Kiel, Germany (J.T.)
| | - Johannes Zimmermann
- Medical Systems Biology Research Group, Institute of Experimental Medicine, Christian-Albrechts-Universität zu Kiel, 24118 Kiel, Germany (J.T.)
| | - Jan Taubenheim
- Medical Systems Biology Research Group, Institute of Experimental Medicine, Christian-Albrechts-Universität zu Kiel, 24118 Kiel, Germany (J.T.)
| | - Natalia Arias-Rodríguez
- Bioinformatics and Systems Biology Research Group, Genetic Institute, Universidad Nacional de Colombia, Bogotá 111321, Colombia; (J.F.-R.); (J.D.C.-N.); (J.L.-C.)
| | - Juan David Caicedo-Narvaez
- Bioinformatics and Systems Biology Research Group, Genetic Institute, Universidad Nacional de Colombia, Bogotá 111321, Colombia; (J.F.-R.); (J.D.C.-N.); (J.L.-C.)
- Neurosciences Research Group, Genetic Institute, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Lena Best
- Medical Systems Biology Research Group, Institute of Experimental Medicine, Christian-Albrechts-Universität zu Kiel, 24118 Kiel, Germany (J.T.)
| | - Cindy V. Mendieta
- PhD Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá 110231, Colombia;
- Department of Nutrition and Biochemistry, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
| | - Julieth López-Castiblanco
- Bioinformatics and Systems Biology Research Group, Genetic Institute, Universidad Nacional de Colombia, Bogotá 111321, Colombia; (J.F.-R.); (J.D.C.-N.); (J.L.-C.)
| | - Laura Alejandra Gómez-Muñoz
- Neurosciences Research Group, Genetic Institute, Universidad Nacional de Colombia, Bogotá 111321, Colombia
- Cell Death Research Group, Medical School and Genetic Institute, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Janneth Gonzalez-Santos
- Structural Biochemistry and Bioinformatics Laboratory, Pontificia Universidad Javeriana, Bogotá 110231, Colombia
| | - Humberto Arboleda
- Cell Death Research Group, Medical School and Genetic Institute, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - William Fernandez
- Neurosciences Research Group, Genetic Institute, Universidad Nacional de Colombia, Bogotá 111321, Colombia
- Cell Death Research Group, Medical School and Genetic Institute, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Christoph Kaleta
- Medical Systems Biology Research Group, Institute of Experimental Medicine, Christian-Albrechts-Universität zu Kiel, 24118 Kiel, Germany (J.T.)
| | - Andrés Pinzón
- Bioinformatics and Systems Biology Research Group, Genetic Institute, Universidad Nacional de Colombia, Bogotá 111321, Colombia; (J.F.-R.); (J.D.C.-N.); (J.L.-C.)
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Cheung HHT, Joynt GM, Lee A. Diagnostic test accuracy of preoperative nutritional screening tools in adults for malnutrition: a systematic review and network meta-analysis. Int J Surg 2024; 110:1090-1098. [PMID: 37830947 PMCID: PMC10871615 DOI: 10.1097/js9.0000000000000845] [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: 08/08/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Good nutritional screening tests can triage malnourished patients for further assessment and management by dietitians before surgery to reduce the risk of postoperative complications. The authors assessed the diagnostic test accuracy of common nutritional screening tools for preoperative malnutrition in adults undergoing surgery and determined which test had the highest accuracy. METHODS MEDLINE, EMBASE, CINAHL, and Web of Science were searched for relevant titles with no language restriction from inception till 1 January 2023. Studies reporting on the diagnostic test accuracy of preoperative malnutrition in adults using one or more of the following index nutritional screening tools were included: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment (MNA), short-form Mini Nutritional Assessment (MNA-SF), Nutritional Risk Index (NRI), Nutrition Risk Screening Tool 2002 (NRS-2002), and Preoperative Nutrition Screening (PONS). The reference standard was the Subjective Global Assessment (SGA) before surgery. Random-effects bivariate binomial model meta-analyses, meta-regressions, and a network meta-analysis were used to estimate the pooled and relative sensitivities and specificities. RESULTS Of the 16 included studies (5695 participants with an 11 957 index and 11 957 SGA tests), all were conducted after hospital admission before surgery. Eleven studies ( n =3896) were at high risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool due to a lack of blinded assessments. MUST had the highest overall test accuracy performance (sensitivity 86%, 95% CI: 75-93%; specificity 89%, 95% CI: 83-93%). Network meta-analysis showed NRI had similar relative sensitivity (0.93, 95% CI: 0.77-1.13) but lower relative specificity (0.75, 95% CI: 0.61-0.92) than MUST. CONCLUSIONS Of all easy-to-use tests applicable at the bedside, MUST had the highest test accuracy performance for screening preoperative malnutrition. However, its predictive accuracy is likely insufficient to justify the application of nutritional optimization interventions without additional assessments.
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Affiliation(s)
| | | | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, People’s Republic of China
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Yaceczko S, Baltz J. Evaluation of nutrition components within prehabilitation programs in gastrointestinal cancers: Is prehab worth the hype? Nutr Clin Pract 2024; 39:117-128. [PMID: 37772471 DOI: 10.1002/ncp.11079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/01/2023] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
Nutrition impact symptoms and unintended weight loss are prevalent in patients with gastrointestinal cancers, especially during the perioperative period or while prescribed anticancer treatments. Because patients may experience loss of lean body mass and malnutrition, aggressive nutrition intervention prior to surgery should be considered. Cancer prehabilitation is a process spanning the care continuum from diagnosis to the time of surgery encompassing nutrition support, psychological and physical assessment, and targeted interventions. Thirteen studies published between 2013 and 2023 were included in this review and evaluated prehabilitation programs' impact on postoperative outcomes in patients with gastrointestinal cancers. Literature continues to emerge supporting the integration of nutrition into a prehabilitation program because of its potential to contribute to improved clinical outcomes, quality of life, and cost-effectiveness, but considerable variation exists with respect to the specific recommendations provided by current prehabilitation programs.
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Affiliation(s)
- Shelby Yaceczko
- UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Jami Baltz
- Stanford Health Care, Comprehensive Cancer Center, Stanford, California, USA
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Baguley BJ, Benna-Doyle S, Drake S, Curtis A, Stewart J, Loeliger J. Access to nutrition services and information after active cancer treatment: a mixed methods study. J Cancer Surviv 2024; 18:176-185. [PMID: 36823493 PMCID: PMC10866769 DOI: 10.1007/s11764-023-01352-x] [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: 12/19/2022] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Evidence-based guidelines for cancer strongly support nutrition and dietetic services for people with cancer and carers in order to improve patient-centred and health service outcomes. Access to nutrition services and information after completing active cancer treatment is relatively unknown in Australia. This study aimed to determine the availability, accessibility, barriers, and preferences to nutrition services and information after cancer treatment in Australia. METHODS Utilising mixed methods, people with cancer and carers completed a cross-sectional survey, and a sub-group of participants completed a semi-structured interview. The survey evaluated the availability of nutrition services, nutrition information searched, barriers, and preferences for nutrition information. Semi-structured interviews explored participant experience with nutrition services and information. RESULTS The 149 participants (including 10 carers) were predominately male and with a diagnosis of prostate cancer (63%). Overall, 23% of participants received nutrition information from a dietitian after cancer treatment. Participants (78%) indicated that accessing a nutrition specialist is the main barrier to receiving nutrition care after treatment. Most searched nutrition information on the internet (55%) and found the information easy to understand (89%), but conflicting (52%). Thematic analysis of interviews in fourteen cancer patients revealed three key themes pertaining to (1) preferred referral and timing of nutrition services, (2) lack of confidence in publicly available nutrition information, and (3) streamlining nutrition services for greater access. CONCLUSION Access to a dietitian and evidence-based information after cancer treatment is limited for people with cancer and carers in Australia, despite the high interest and need for ongoing nutrition care. IMPLICATIONS FOR CANCER SURVIVORS Models of care evaluating the provision of appropriate nutrition care and information provision after cancer treatment are needed to address this unmet survivorship need.
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Affiliation(s)
- Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, VIC, 3220, Geelong, Australia.
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, VIC, 3125, Burwood, Australia.
| | - Sarah Benna-Doyle
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, VIC, 3125, Burwood, Australia
| | - Shani Drake
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Annie Curtis
- Institute for Physical Activity and Nutrition, Deakin University, VIC, 3220, Geelong, Australia
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, VIC, 3125, Burwood, Australia
| | - Jane Stewart
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Jenelle Loeliger
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, VIC, 3125, Burwood, Australia
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
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Ojeda T, Ashafa M, Pertel D, McCauley S, Coltman A. The Updated Global Malnutrition Composite Score Clinical Quality Measure: Its Relevance to Improving Inpatient Clinical Outcomes and Health Equity. J Acad Nutr Diet 2024; 124:249-256. [PMID: 37939845 DOI: 10.1016/j.jand.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
Quality improvement has existed in health care for centuries with a dramatic transformation over time, largely motivated by the academic health quality movement. Throughout this evolution, the Centers for Medicare and Medicaid Services have been at the forefront of the development and provision of quality measures for health care in a variety of settings, including acute care. Quality initiatives aid in the evaluation of patient care to encourage quality improvement efforts, determine pay-for-performance rates, and help patients and consumers evaluate their care providers. The addition of the Global Malnutrition Composite Score as an electronic Clinical Quality Measure in 2022 highlights the key role nutrition plays in outcomes and quality of hospitalized patients. With this, credentialed nutrition and dietetics practitioners lie front and center for the development of quality improvement processes to help promote high quality standards of nutrition care, improve length of stay, and reduce health care costs and readmissions while addressing malnutrition, health equity, and nutrition care as a human right. As the Global Malnutrition Composite Score steward, it is the obligation of the Academy of Nutrition and Dietetics and the Commission on Dietetic Registration to promote the measure and support credentialed nutrition and dietetics practitioners in advocating for the implementation of this measure. Therefore, the purpose of this practice update is to provide necessary information to credentialed nutrition and dietetics practitioners and other health care leaders related to the history and implementation of the Global Malnutrition Composite Score, along with relevant updates to the measure and practice implications.
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Affiliation(s)
- Tamaire Ojeda
- Commission on Dietetic Registration, Chicago, Illinois
| | | | - Donna Pertel
- Commission on Dietetic Registration, Chicago, Illinois
| | | | - Anne Coltman
- Commission on Dietetic Registration, Chicago, Illinois
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Peniamina R, McLean RM. Experiences of healthcare practitioners providing nutrition care to people with cancer in New Zealand: A qualitative study. Nutr Health 2024:2601060231207439. [PMID: 38280228 DOI: 10.1177/02601060231207439] [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: 01/29/2024]
Abstract
Aim: To explore the perspectives and experiences of healthcare practitioners in providing nutrition care to people with cancer in New Zealand. Methods: Semi-structured interviews were conducted with 16 New Zealand healthcare professionals (HCPs) practicing in specialist secondary and tertiary cancer care (both public and private) who had previously completed an online survey about nutrition in cancer care. Interviews were recorded and transcribed verbatim, and thematic analysis was undertaken. Results: Participants identified nutrition as important in cancer care, from diagnosis to survivorship, in order to maximise recovery and ongoing health. While participants reported that the best person to provide high-quality individualised nutrition care is a dietitian, other HCPs also have a role in nutrition care. Limited nutrition care is currently available, especially for those in rural areas, which impacts health and equity in cancer care. Participants identified a need for increased dietitian capacity in the workforce as well as a need for nutrition resources that were accessible and appropriate. Conclusion: The perspective of participants was that more must be done to provide nutrition care as part of cancer care in New Zealand to improve health and wellbeing among people with cancer.
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Affiliation(s)
- Rana Peniamina
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rachael Mira McLean
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Wong HMK, Qi D, Ma BHM, Hou PY, Kwong CKW, Lee A. Multidisciplinary prehabilitation to improve frailty and functional capacity in high-risk elective surgical patients: a retrospective pilot study. Perioper Med (Lond) 2024; 13:6. [PMID: 38263053 PMCID: PMC10807111 DOI: 10.1186/s13741-024-00359-x] [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: 05/12/2023] [Accepted: 01/01/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Frailty is associated with worse outcomes and higher healthcare costs. The long waiting time for surgery is a potential 'teachable' moment. We examined the feasibility and safety of a pilot prehabilitation programme on high-risk frail patients undergoing major elective surgery. METHODS A single-centre, retrospective pilot study (Dec 2020-Nov 2021) on a one-stop prehabilitation programme (structured exercise training, nutritional counselling/therapy, and psychological support) in collaboration with geriatricians and allied health professionals. At least 4 weeks before surgery, patients at high risk of frailty or malnutrition, or undergoing major hepatectomy, esophagectomy, pancreaticoduodenectomy, or radical cystectomy, were referred for prehabilitation (2-3 sessions/week). The primary outcomes were the feasibility and safety of prehabilitation. The secondary outcomes were changes in functional, emotional, and nutritional status and days alive and at home within 30 days after surgery (DAH30) associated with prehabilitation. RESULTS Over a 12-month period, 72 out of 111 patients (64.9%) from the Perioperative Medicine Clinic were eligible for prehabilitation, of which 54 (75%) were recruited. The mean (standard deviation) age was 71.9 (6.9) years. The adherence rate to 3 weeks of prehabilitation was high in 52 (96.3%) participants. Prehabilitation improved exercise capacity (P = 0.08), enhanced some functional mobility measures (P = 0.02), and increased nutritional energy (P = 0.04) and protein intakes (P < 0.01). However, prehabilitation-related changes in muscle strength, cognitive function, and emotional resilience were minimal. The median (interquatile range) DAH30 was 19 (14-23) days. No adverse events were reported. CONCLUSIONS This outpatient-based, one-stop multidisciplinary prehabilitation programme was feasible, safe, and improved several measures of patient's physiological reserve and functional capacity. CLINICAL TRIAL REGISTRATION NCT05668221.
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Affiliation(s)
- Henry Man Kin Wong
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong.
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, New Territories, Hong Kong.
| | - Ding Qi
- Department of Medicine and Geriatrics, Shatin Hospital, New Territories, Hong Kong
| | - Bosco Hon Ming Ma
- Department of Medicine and Geriatrics, Shatin Hospital, New Territories, Hong Kong
| | - Pik Yi Hou
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Calvin Ka Woon Kwong
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, New Territories, Hong Kong
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Mohammed HO, Hassan AM, Mostafa A, Khater MS, Aboelfotoh A, Abd Elaziz KM. Geriatric nutritional risk index and adverse medical outcomes among Egyptian patients admitted to a geriatric hospital: a prospective cohort study. BMC Geriatr 2024; 24:62. [PMID: 38225577 PMCID: PMC10789057 DOI: 10.1186/s12877-024-04671-5] [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: 07/20/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Elderly are one of the most heterogeneous and vulnerable groups who have a higher risk of nutritional problems. Malnutrition is prevalent among hospitalized elderly but underdiagnosed and almost undistinguishable from the changes in the aging process. The Geriatric Nutritional Risk Index (GNRI) is a tool created to predict nutrition-related complications in hospitalized patients. This study aims to measure the prevalence of nutritional risk using the GNRI among hospitalized elderly Egyptian inpatients and to determine the association between the GNRI and selected adverse clinical outcomes. METHODS A hospital-based prospective cohort study was conducted among 334 elderly patients admitted to a tertiary specialized geriatric university hospital in Cairo, Egypt from August 2021 to June 2022. Within 48 hours after hospital admission, socio-demographic characteristics, blood biomarkers, anthropometric measurements, and nutritional risk assessment by the GNRI score were obtained. Patients were divided into three groups based on their GNRI: high, low, and no nutritional risk (GNRI<92, 92-98, and >98) respectively. Patients were followed up for the occurrence of adverse outcomes during hospital stay (bed sores, Healthcare-Associated Infections (HAIs), hospital Length of Stay (LOS), and hospital mortality) and three months after discharge (non-improvement medical status, appearance of new medical conditions, hospital readmission and 90-day mortality). Multivariable regression and survival analysis were conducted. RESULTS The prevalence of high-nutritional risk was 45.5% (95% CI, 40%-51%). Patients with high risk had significantly longer LOS than those with no risk. The high-nutritional risk was significantly associated with the development of bed sores (Adjusted Odds Ratio (AOR) 4.89; 95% CI, 1.37-17.45), HAIs (AOR: 3.18; 95% CI, 1.48-6.83), and hospital mortality (AOR: 4.41; 95% CI, 1.04-18.59). The overall survival rate was significantly lower among patients with high-nutritional risk compared to those with no risk. CONCLUSION GNRI is a simple and easily applicable objective nutritional screening tool with high prognostic value in this Egyptian sample of patients. The findings of this study signal the initiation of the application of this tool to all geriatric hospitals in Egypt.
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Affiliation(s)
- Hebatullah O Mohammed
- Department of community, environmental and occupational medicine. Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt.
| | - Azza M Hassan
- Department of community, environmental and occupational medicine. Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt
| | - Aya Mostafa
- Department of community, environmental and occupational medicine. Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt
| | - Mohamed S Khater
- Department of geriatrics and gerontology. Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt
| | - Aisha Aboelfotoh
- Department of community, environmental and occupational medicine. Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt
| | - Khaled M Abd Elaziz
- Department of community, environmental and occupational medicine. Faculty of medicine, Ain Shams University, Cairo, 11566, Egypt
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Golder JE, Bauer JD, Barker LA, Lemoh CN, Gibson SJ, Davidson ZE. Prevalence, risk factors, and clinical outcomes of vitamin C deficiency in adult hospitalized patients in high-income countries: a scoping review. Nutr Rev 2024:nuad157. [PMID: 38219216 DOI: 10.1093/nutrit/nuad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Assessment for vitamin C deficiency (VCD) is rarely undertaken in an acute hospital setting in high-income countries. However, with growing interest in VCD in community settings, there is emerging evidence investigating the prevalence and impact of VCD during hospitalization. OBJECTIVES In this scoping review, the prevalence of VCD in adult hospitalized patients is explored, patient characteristics are described, and risk factors and clinical outcomes associated with VCD are identified. METHODS A systematic scoping review was conducted in accordance with the PRISMA-ScR framework. The Ovid MEDLINE, Ovid Embase, Scopus, CINAHL Plus, Allied and Complementary Medicine Database, and the Cochrane Library databases were searched for interventional, comparative, and case-series studies that met eligibility criteria, including adult hospital inpatients in high-income countries, as defined by the Organization for Economic Co-operation and Development, that reported VCD prevalence using World Health Organization reference standards. These standards define VCD deficiency as plasma or serum vitamin C level <11.4 µmol/L, wholeblood level <17 µmol/L, or leukocytes <57 nmol/108 cells. RESULTS Twenty-three articles were included, representing 22 studies. The cumulative prevalence of VCD was 27.7% (n = 2494; 95% confidence interval [CI], 21.3-34.0). High prevalence of VCD was observed in patients with severe acute illness and poor nutritional status. Scurvy was present in 48% to 62% of patients with VCD assessed in 2 studies (n = 71). Being retired (P = 0.015) and using excessive amounts of alcohol and tobacco (P = 0.0003) were independent risk factors for VCD (n = 184). Age was not conclusively associated with VCD (n = 631). Two studies examined nutrition associations (n = 309); results were inconsistent. Clinical outcomes for VCD included increased risk of frailty (adjusted odds ratio, 4.3; 95%CI, 1.33-13.86; P = 0.015) and cognitive impairment (adjusted odds ratio, 2.93; 95%CI, 1.05-8.19, P = 0.031) (n = 160). CONCLUSIONS VCD is a nutritional challenge facing the healthcare systems of high-income countries. Research focused on early identification and treatment of patients with VCD is warranted. SYSTEMATIC REVIEW REGISTRATION Open Science Framework ( https://doi.org/10.17605/OSF.IO/AJGHX ).
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Affiliation(s)
- Janet E Golder
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Nutrition and Dietetics Department, Allied Health, Monash Health, Melbourne, Victoria, Australia
| | - Judith D Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lisa A Barker
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Christopher N Lemoh
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, Melbourne, Victoria, Australia
| | - Simone J Gibson
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Zoe E Davidson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Galvin A, Soubeyran P, Brain E, Cheung KL, Hamaker ME, Kanesvaran R, Mauer M, Mohile S, Montroni I, Puts M, Rostoft S, Wildiers H, Mathoulin-Pélissier S, Bellera C. Assessing patient-reported outcomes (PROs) and patient-related outcomes in randomized cancer clinical trials for older adults: Results of DATECAN-ELDERLY initiative. J Geriatr Oncol 2024; 15:101611. [PMID: 37679204 DOI: 10.1016/j.jgo.2023.101611] [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: 03/06/2023] [Revised: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
As older adults with cancer are underrepresented in randomized clinical trials (RCT), there is limited evidence on which to rely for treatment decisions for this population. Commonly used RCT endpoints for the assessment of treatment efficacy are more often tumor-centered (e.g., progression-free survival). These endpoints may not be as relevant for the older patients who present more often with comorbidities, non-cancer-related deaths, and treatment toxicity. Moreover, their expectation and preferences are likely to differ from younger adults. The DATECAN-ELDERLY initiative combines a broad expertise, in geriatric oncology and clinical research, with interest in cancer RCT that include older patients with cancer. In order to guide researchers and clinicians coordinating cancer RCT involving older patients with cancer, the experts reviewed the literature on relevant domains to assess using patient-reported outcomes (PRO) and patient-related outcomes, as well as available tools related to these domains. Domains considered relevant by the panel of experts when assessing treatment efficacy in RCT for older patients with cancer included functional autonomy, cognition, depression and nutrition. These were based on published guidelines from international societies and from regulatory authorities as well as minimum datasets recommended to collect in RCT including older adults with cancer. In addition, health-related quality of life, patients' symptoms, and satisfaction were also considered by the panel. With regards to tools for the assessment of these domains, we highlighted that each tool has its own strengths and limitations, and very few had been validated in older adults with cancer. Further studies are thus needed to validate these tools in this specific population and define the minimum clinically important difference to use when developing RCTs in this population. The selection of the most relevant tool should thus be guided by the RCT research question, together with the specific properties of the tool.
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Affiliation(s)
- Angéline Galvin
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France
| | - Pierre Soubeyran
- Univ. Bordeaux, Inserm, UMR 1312, SIRIC BRIO, France; Department of medical oncology, Bergonie Institute, Comprehensive Cancer Center, Bordeaux, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Saint-Cloud, France
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht/ Zeist/Doorn, Zeist, the Netherlands
| | | | - Murielle Mauer
- Statistics Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Supriya Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Isacco Montroni
- Division of Colorectal Surgery, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Belgium
| | - Simone Mathoulin-Pélissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France
| | - Carine Bellera
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, Bordeaux, France; INSERM CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, F-33000 Bordeaux, France.
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Razzera EL, Milanez DSJ, Silva FM. Derivation of the Screening of Nutritional Risk in Intensive Care risk prediction score: A secondary analysis of a prospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:82-92. [PMID: 37855263 DOI: 10.1002/jpen.2569] [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: 07/10/2023] [Revised: 09/14/2023] [Accepted: 10/13/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND For patients who are critically ill, the recommended nutrition risk screening tools are the Nutrition Risk in the Critically Ill (NUTRIC) and the Nutritional Risk Screening 2002 (NRS-2002) have limitations. OBJECTIVE To develop a new screening tool, the Screening of Nutritional Risk in Intensive Care (SCREENIC score), and assess its predictive validity. METHODS A secondary analysis of a prospective cohort study was conducted. Variables from several nutritional screening and assessment tools were considered. The high nutrition risk cutoff point was defined using mNUTRIC as a reference. Predictive validity was evaluated using logistic regression and Cox regression. RESULTS The study included 450 patients (64 [54-71] years, 52.2% men). The SCREENIC score comprised six questions: (1) does the patient have ≥2 comorbidities (1.3 points); (2) was the patient hospitalized for ≥2 days before intensive care unit (ICU) admission (0.9 points); (3) does the patient have sepsis (1.0 point); (4) was the patient on mechanical ventilation upon ICU admission (1.2 points); (5) is the patient aged >65 years (1.2 points); and (6) does the patient exhibit signs of moderate/severe muscle mass loss according to the physical exam (0.6 points). The high nutrition risk cutoff point was set at 4.0. SCREENIC demonstrated moderate agreement (κ = 0.564) and high accuracy (0.896 [95% CI, 0.867-0.925]) with mNUTRIC. It predicted prolonged ICU (odds ratio [OR] = 1.81 [95% CI, 1.14-2.85]) and hospital stay (OR = 2.15 [95% CI, 1.37-3.38]). CONCLUSION The SCREENIC score comprises questions with variables that do not require nutrition history. Further evaluation of its applicability, reproducibility, and validity in guiding nutrition therapy is needed using large external cohorts.
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Affiliation(s)
- Elisa Loch Razzera
- Nutrition Department, Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Danielle Silla Jobim Milanez
- Nutrition Department, Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Li ZZ, Yan XL, Jiang HJ, Ke HW, Chen ZT, Chen DH, Xu JY, Liu XC, Shen X, Huang DD. Sarcopenia predicts postoperative complications and survival in colorectal cancer patients with GLIM-defined malnutrition: Analysis from a prospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107295. [PMID: 38016248 DOI: 10.1016/j.ejso.2023.107295] [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: 06/20/2023] [Revised: 10/08/2023] [Accepted: 11/18/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To investigate whether sarcopenia could predict postoperative outcomes in patients with colorectal cancer with Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition. METHODS Clinical data of patients who underwent radical resection for colorectal cancer were prospectively collected. Sarcopenia was diagnosed by the combination of low handgrip strength and low muscle quantity or quality as measured by abdominal computed tomography (CT) images. Logistic regression analysis and Cox proportional hazards regression analysis were performed to identify independent predictors for postoperative complications and survival, respectively. RESULTS A total of 310 patients with colorectal cancer with GLIM-defined malnutrition were included, of which 145 (46.77%) were identified with sarcopenia. Malnutritional patients with sarcopenia had significantly higher incidences of total complications (34.5% versus 15.8%), severe complications (9.7% versus 1.8%), longer lengths of postoperative hospital stay (median, 14 days versus 12 days), and more costs (median, 56,257 RMB versus 49,024 RMB) than those without sarcopenia. Sarcopenia was an independent predictive factor for postoperative complications (OR 2.531, 95% CI 1.451-4.415), overall survival (HR 1.519, 95% CI 1.026-2.248), and disease-free survival (HR 1.847, 95% CI 1.324-2.576). Patients with severe sarcopenia had a higher incidence of severe complications but not total complications or survival than those with not-severe sarcopenia. Moreover, the predictive value of sarcopenia for postoperative complications was attributed to muscle strength and quality but not muscle quantity. CONCLUSION Sarcopenia predicts postoperative complications and survival in patients with colorectal cancer with GLIM-defined malnutrition. Preoperative assessment of sarcopenia is still necessary when nutritional assessment has been well performed.
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Affiliation(s)
- Zong-Ze Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xia-Lin Yan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao-Jie Jiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao-Wen Ke
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Zhang-Tao Chen
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Ding-Hao Chen
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Jia-Yi Xu
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xue-Chun Liu
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Dong-Dong Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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van Dronkelaar C, Tieland M, Cederholm T, Reijnierse EM, Weijs PJM, Kruizenga H. Malnutrition Screening Tools Are Not Sensitive Enough to Identify Older Hospital Patients with Malnutrition. Nutrients 2023; 15:5126. [PMID: 38140387 PMCID: PMC10745606 DOI: 10.3390/nu15245126] [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: 11/08/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
This study evaluates the concurrent validity of five malnutrition screening tools to identify older hospitalized patients against the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria as limited evidence is available. The screening tools Short Nutritional Assessment Questionnaire (SNAQ), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Mini Nutritional Assessment-Short Form (MNA-SF), and the Patient-Generated Subjective Global Assessment-Short Form (PG-SGA-SF) with cut-offs for both malnutrition (conservative) and moderate malnutrition or risk of malnutrition (liberal) were used. The concurrent validity was determined by the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the level of agreement by Cohen's kappa. In total, 356 patients were included in the analyses (median age 70 y (IQR 63-77); 54% male). The prevalence of malnutrition according to the GLIM criteria without prior screening was 42%. The conservative cut-offs showed a low-to-moderate sensitivity (32-68%) and moderate-to-high specificity (61-98%). The PPV and NPV ranged from 59 to 94% and 67-86%, respectively. The Cohen's kappa showed poor agreement (k = 0.21-0.59). The liberal cut-offs displayed a moderate-to-high sensitivity (66-89%) and a low-to-high specificity (46-95%). The agreement was fair to good (k = 0.33-0.75). The currently used screening tools vary in their capacity to identify hospitalized older patients with malnutrition. The screening process in the GLIM framework requires further consideration.
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Affiliation(s)
- Carliene van Dronkelaar
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (E.M.R.); (P.J.M.W.); (H.K.)
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, 1081 HV Amsterdam, The Netherlands
| | - Michael Tieland
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (E.M.R.); (P.J.M.W.); (H.K.)
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Uppsala University, 751 22 Uppsala, Sweden;
- Theme Ageing, Karolinska University Hospital, 14186 Stockholm, Sweden
| | - Esmee M. Reijnierse
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (E.M.R.); (P.J.M.W.); (H.K.)
- Amsterdam Movement Sciences, Ageing & Vitality, 1081 HZ Amsterdam, The Netherlands
| | - Peter J. M. Weijs
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (E.M.R.); (P.J.M.W.); (H.K.)
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, 1081 HV Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, 1081 HZ Amsterdam, The Netherlands
| | - Hinke Kruizenga
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (E.M.R.); (P.J.M.W.); (H.K.)
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, 1081 HV Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, 1081 HZ Amsterdam, The Netherlands
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Escobar Y, Ramchandani A, Salgado M, Castillo-Trujillo A, Martínez de Castro E, Diaz de Corcuera I, Vera R, Lacalle A, Torres I, Pérez Segura P, Hierro C, Soto de Prado D, Cotes A, Marín Zafra G, Marsé Fabregat R, Virizuela J, Villa JC, Borrega P, Jimenez-Fonseca P. What do patients and oncologists think about the evaluation and management of cancer-related anorexia-cachexia? The Quasar_SEOM study. Clin Transl Oncol 2023; 25:3479-3491. [PMID: 37289352 DOI: 10.1007/s12094-023-03212-7] [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: 02/08/2023] [Accepted: 04/29/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Cancer patients often suffer from malnutrition and early detection and raising awareness of nutritional issues is crucial in this population. METHODS The Spanish Oncology Society (SEOM) conducted the Quasar_SEOM study to investigate the current impact of the Anorexia-Cachexia Syndrome (ACS). The study employed questionnaires and the Delphi method to gather input from both cancer patients and oncologists on key issues related to early detection and treatment of ACS. A total of 134 patients and 34 medical oncologists were surveyed about their experiences with ACS. The Delphi methodology was used to evaluate oncologists' perspectives of ACS management, ultimately leading to a consensus on the most critical issues. RESULTS Despite widespread acknowledgement of malnutrition in cancer as a significant issue by 94% of oncologists, the study revealed deficiencies in knowledge and protocol implementation. A mere 65% of physicians reported being trained to identify and treat these patients, with 53% failing to address ACS in a timely manner, 30% not monitoring weight, and 59% not adhering to any clinical guidelines. The lack of experience was identified as the primary hindrance to the use of orexigens in 18% of cases. Furthermore, patients reported concerns and a perception of inadequate attention to malnutrition-related issues from their physicians. CONCLUSION The results of this study point to a gap in the care of this syndrome and a need to improve education and follow-up of cancer patients with anorexia-cachexia.
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Affiliation(s)
- Yolanda Escobar
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | | | - Alfredo Castillo-Trujillo
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Avenida de Roma s/n, Oviedo, Spain
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIBAL, Santander, Spain
| | | | - Ruth Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Irene Torres
- Medical Oncology Department, Hospital Clínico Universitario Lozano Bleza, Zaragoza, Spain
| | - Pedro Pérez Segura
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Cinta Hierro
- Medical Oncology Department, Instituto Catalán de Oncología (ICO), Badalona, Spain
| | - Diego Soto de Prado
- Medical Oncology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Almudena Cotes
- Medical Oncology Department, Hospital Universitario de Elda, Elda, Spain
| | - Gema Marín Zafra
- Medical Oncology Department, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | | | - Juan Virizuela
- Medical Oncology Department, Hospital Universitario Virgen de La Macarena, Sevilla, Spain
| | - Jose Carlos Villa
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Pablo Borrega
- Medical Oncology Department, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Avenida de Roma s/n, Oviedo, Spain.
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Viser AC, Cooke AR, Herfarth HH, Anderson C, Proch C, Peery AF. Inflammatory Bowel Disease Patients in the Ambulatory Setting Commonly Screen Positive for Malnutrition. GASTRO HEP ADVANCES 2023; 3:181-183. [PMID: 38468710 PMCID: PMC10927263 DOI: 10.1016/j.gastha.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Aaron C Viser
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Adelaide R Cooke
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Hans H Herfarth
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Chelsea Anderson
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Christina Proch
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Anne F Peery
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Tang H, Yang M. Nutritional Assessment in Patients with Chronic Diseases: Tools, Challenges, and Future Directions. Nutrients 2023; 15:4794. [PMID: 38004188 PMCID: PMC10674779 DOI: 10.3390/nu15224794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Chronic diseases, such as cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases, are leading causes of morbidity and mortality worldwide [...].
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Affiliation(s)
- Huiyu Tang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ming Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China
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45
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Briguglio M, Wainwright TW, Lombardi G. Definition of malnutrition from routinely-collected data for orthopedic surgery research: the global leadership initiative on malnutrition (GLIM) tool and others. Front Nutr 2023; 10:1200049. [PMID: 38024369 PMCID: PMC10665468 DOI: 10.3389/fnut.2023.1200049] [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: 04/19/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
The correct identification of malnourished patients in the context of hip, knee, or spine surgery research would enhance the quality of analytical studies investigating the prediction potential of preoperative nutritional disorders on postoperative recovery. However, accurate malnutrition screening and diagnostic assessment rely on parameters that were not routinely collected in routine practice until a few years ago. The authors of this article present substitute literature-based equations that can be built up using historical routinely collected data to classify patients that had been at risk of malnutrition or malnourished. For what concerns the risk screening, several methods are available to identify patients at risk of over- or undernutrition, encompassing the BWd (body weight difference from the ideal weight), GNRI (geriatric nutritional risk index), INA (instant nutritional assessment), LxA (combination of lymphocyte count and albumin), PMA (protein malnutrition with acute inflammation), PMAC (protein malnutrition with acute and chronic inflammation), IDM (iron deficit malnutrition), and VBD (vitamin B deficit malnutrition). Conversely, the GLIM (global leadership initiative on malnutrition) criteria can be used to assess malnutrition and diagnose subclasses of undernutrition. Rational use of these tools can facilitate the conduction of efficient prospective studies in the future, as well as bespoke retrospective cohort studies and database research.
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Affiliation(s)
- Matteo Briguglio
- Laboratory of Nutritional Sciences, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom
- University Hospitals Dorset, NHS Foundation Trust, Poole, United Kingdom
| | - Giovanni Lombardi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
- Department of Athletics, Strength and Conditioning, Poznań University of Physical Education, Poznań, Poland
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Roberts S, Gomes K, Rattray M. Dietitians' perceptions of identifying and managing malnutrition and frailty in the community: A mixed-methods study. Nutr Diet 2023; 80:511-520. [PMID: 36843203 DOI: 10.1111/1747-0080.12799] [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: 09/15/2022] [Revised: 01/08/2023] [Accepted: 01/15/2023] [Indexed: 02/28/2023]
Abstract
AIM This study aimed to explore dietitians' perceptions of their current practice for identifying and managing malnutrition/frailty in the community, to fill an evidence gap. METHODS This mixed-methods study involved an online survey distributed to dietitians practising in Australia and New Zealand, and semi-structured interviews with a subset of survey participants. The 34-item survey and interviews explored dietitians' practices for identifying/managing malnutrition and frailty, focusing on the community setting. Survey data were analysed descriptively and some simple association tests were conducted using statistical software. Interview data were analysed thematically. RESULTS Of the 186 survey respondents, 18 also participated in an interview. Screening and assessment for malnutrition varied in the community and occurred rarely for frailty. Dietitians reported practising person-centred care by involving clients/carers/family in setting goals and selecting nutrition interventions. Key barriers to providing nutrition care to community-dwelling adults included a lack of awareness/understanding of nutrition by clients and other health professionals (leading to them not participating in or valuing nutrition care), lack of time and resources in the community, and client access to foods/supplements. Enablers included engaging family members/carers and coordinating with other health professionals in nutrition care planning. CONCLUSION Reported practices for identifying malnutrition and frailty vary in the community, suggesting guidance may be needed for health professionals in this setting. Dietitians reported using person-centred care with malnourished and frail clients but encountered barriers in community settings. Engaging family members/carers and multidisciplinary colleagues may help overcome some of these barriers.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Allied Health Research, Gold Coast Hospital and Health Service, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Kristin Gomes
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Megan Rattray
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Diep-Pham HT, Donald N, Wall CL. Malnutrition screening tool use in a New Zealand hospital: Reliability and rates of malnutrition screening on admission. Nutr Diet 2023; 80:530-537. [PMID: 37614059 DOI: 10.1111/1747-0080.12838] [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: 01/28/2023] [Revised: 07/07/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023]
Abstract
AIMS This research aimed to assess the rate and reliability of routine nurse-completed malnutrition screening and report the prevalence of malnutrition risk on admission to Christchurch Hospital. METHODS Student dietitians administered the Malnutrition Screening Tool to patients in three speciality wards within 48 h of admission. Student dietitians' Malnutrition Screening Tool scores were compared against documented nurse-completed Malnutrition Screening Tool scores. Data were analysed using descriptive statistics, Fisher's exact test, and Cohen's kappa tests (interrater reliability ⱪ). A p-value <0.05 was considered statistically significant. RESULTS Student dietitians, using the Malnutrition Screening Tool, screened 360 (96%) of 377 eligible patients while nurses screened 332 (88%) patients. Student dietitians and nurses screened 119 patients (33%) and 63 patients (18%) respectively at risk of malnutrition. There was fair agreement (ⱪ = 0.311) in Malnutrition Screening Tool total scores between nurses and student dietitians. There was a significant difference in the proportion of patients screened at risk of malnutrition between nurses and student dietitians (p < 0.0001). CONCLUSION Malnutrition risk remains high in acute care settings. Nurses were less likely to screen patients as at risk of malnutrition than student dietitians. Regular support and training in using Malnutrition Screening Tool may help improve the rate and reliability of routine malnutrition screening.
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Affiliation(s)
| | - Natasha Donald
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Catherine L Wall
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Teasdale SB, Tripodi E, Harman A, Plain J, Burrows TL. Exploring the role of dietitians in mental health services and the perceived barriers and enablers to service delivery: A cross-sectional study. J Hum Nutr Diet 2023; 36:1771-1781. [PMID: 37438941 PMCID: PMC10946798 DOI: 10.1111/jhn.13203] [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: 10/21/2022] [Accepted: 06/14/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Mental health is a rapidly evolving area of practice for dietitians. The role of dietitians in supporting the physical health of consumers experiencing mental illness is becoming more widely recognised given the importance of lifestyle interventions for physical health. The present study aimed to explore the dietitian role in mental health services as well as identify barriers and enablers to service delivery. METHODS This was a cross-sectional survey of dietitians currently employed in any capacity in public and private mental health services. An online survey comprised of questions pertaining to four domains, including demographics, role and service provision, experience and supervision, barriers/challenges and drivers/enablers was completed and included closed and open-ended responses. RESULTS In total, 48 responses were included. The mean ± SD age of respondents was 36.1 ± 10.9 years (range 23-67 years) with the majority working in inpatient settings. The top three tasks respondents reported conducting were individual consultations (n = 47; 98%), group programs (n = 23; 48%) and multidisciplinary team meetings. Barriers included a lack of awareness from others regarding a dietitian's role in mental health, and a lack of specific tools for nutrition screening. More training, resources and increased evidence base to guide practice would enable better service provision. CONCLUSIONS The present study provides insights regarding the possible drivers and barriers to effective service provision for dietitians working in mental health services focusing on the local contexts of respondents. The findings highlight the importance and value of working collaboratively within a multidisciplinary team.
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Affiliation(s)
- Scott B. Teasdale
- Mindgardens Neuroscience NetworkKensingtonNSWAustralia
- Discipline of Psychiatry and Mental Health, Faculty of MedicineUniversity of New South WalesKensingtonNSWAustralia
| | - Elise Tripodi
- Justice Health and Forensic Mental Health NetworkMalabarNSWAustralia
| | - Alexandra Harman
- Department of Nutrition and DieteticsIllawarra Shoalhaven Local Health DistrictWollongongNSWAustralia
| | | | - Tracy L. Burrows
- School of Health Sciences, College of Health, Medicine and WellbeingUniversity of NewcastleNewcastleNSWAustralia
- Food and Nutrition ProgramHunter Medical Research InstituteNew LambtonNSWAustralia
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Chen JJ, Zhu ZY, Bian JJ, Lin F. Nutrition-associated health levels in persons with cancer: item response modelling based on the International Classification of Functioning, Disability and Health. Eur J Phys Rehabil Med 2023; 59:593-604. [PMID: 37733333 PMCID: PMC10664767 DOI: 10.23736/s1973-9087.23.07987-x] [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: 03/25/2023] [Revised: 06/06/2023] [Accepted: 07/21/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The nutritional status of individuals with cancer is a crucial determinant of their health and well-being, and addressing nutrition-related functioning conditions is essential for maintaining physical activity levels and participating in daily activities. AIM This study aims to identify an evidence-based International Classification of Functioning, Disability and Health (ICF) scale using item response theory for nutrition conditions in patients with cancer, which can differentiate and assess nutrition-related functioning conditions of cancer survivors. DESIGN Cross-sectional study. SETTING Sir Run Run Hospital, Nanjing Medical University. POPULATION One hundred cancer patients were enrolled. METHODS Via convenience sampling, the study administered a questionnaire consisting of 89 ICF items to participants. The original five-point rating system was binarized (1 = no problem, 0 = problem). Through data shaping, non-parametric IRT analysis and parametric IRT analysis, psychometric properties of nutritional ICF scale were calculated using R software. RESULTS The study extracted a unidimensional scale with 32 items and constructed 2-parameter logistic model with good fitness, whose root mean square error approximation (RMSEA) = 0.0759, Tucker-Lewis Index (TLI) = 0.9655, and Comparative Fit Index (CFI) = 0.9677. The model demonstrated high reliability, as indicated by a Cronbach's α of 0.95, Guttman λ2 of 0.95, Molenaar Sijtsma statistic of 0.96 and a latent class reliability coefficient (LCRC) of 0.98. Besides, there was a strong correlation between the total score of 32 ICF items and the score of Patient-Generated Subjective Global Assessment (PG-SGA, P<0.001, r=-0.77) and Mini Nutritional Assessment (MNA, P<0.001, r=0.76), suggesting the 32-item scale had high validity. CONCLUSIONS The study constructed an evidence-based ICF scale for nutrition conditions in patients with cancer with 32-item and 2PLM for evaluating nutrition-associated health level in persons with cancer, including high validity and reliability. CLINICAL REHABILITATION IMPACT The IRT model based on ICF provided a promising assessment tool to discriminate nutrition-associated health level of persons with cancer, and offered an auxiliary method for selecting rehabilitation intervention targets. This has the potential to lead to improved outcomes in cancer treatment and increased quality of life for cancer survivors.
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Affiliation(s)
- Jin-Jin Chen
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zi-Yan Zhu
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jia-Jia Bian
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Feng Lin
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China -
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Reece L, Moran B, Ferrie S, Ansari N, Koh C, Allman-Farinelli M, Carey S. A global analysis of nutrition support practices in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancy. Clin Nutr ESPEN 2023; 57:297-304. [PMID: 37739672 DOI: 10.1016/j.clnesp.2023.07.012] [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: 05/05/2023] [Accepted: 07/10/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Perioperative nutritional care has been identified as an important factor in the management of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Nevertheless, there is no published consensus on best practice for nutritional management specific to this patient group. The purpose of this study was to identify the current nutrition care practices among international centres performing CRS and HIPEC for patients with peritoneal malignancy. METHODS An online survey was developed and sent to experienced CRS and HIPEC centres. The survey questions covered clinician and institution demographics, formal nutrition care pathways, pre-operative nutrition care, post-operative nutrition support and post-discharge nutritional follow-up. RESULTS Eighty-two centres were contacted, and 42 responses were received. Respondents were from 20 different countries and were mostly dietitians (71%). Nutrition assessments were frequently completed (52% pre-operatively and 86% post-operatively) and most centres used a validated nutrition screening or assessment tool (79%). Perioperative nutrition support with respect to the use of enteral nutrition, parenteral nutrition and enhanced recovery after surgery varied widely between centres. The use of routine parenteral and enteral nutrition was significantly higher in Europe compared with other locations (p = 0.028). CONCLUSIONS Nutrition care is pivotal and has been positively integrated into the complex management of patients undergoing CRS and HIPEC globally, however variation in practice is evident. The findings highlight a unique opportunity to collaboratively investigate the role nutrition plays in determining outcomes and to identify the most appropriate nutrition support methods to achieve improved clinical outcomes for these high-risk patients.
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Affiliation(s)
- Lauren Reece
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia.
| | - Brendan Moran
- Peritoneal Malignancy Institute, Hampshire Hospital Foundation Trust, Basingstoke, United Kingdom
| | - Suzie Ferrie
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW, Australia
| | - Margaret Allman-Farinelli
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Sharon Carey
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW, Australia
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