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Dagnelie PC, Willems PC, Jørgensen NR. Nutritional status as independent prognostic factor of outcome and mortality until five years after hip fracture: a comprehensive prospective study. Osteoporos Int 2024:10.1007/s00198-024-07088-3. [PMID: 38760504 DOI: 10.1007/s00198-024-07088-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/09/2024] [Indexed: 05/19/2024]
Abstract
We determined the prognostic value of nutritional status for outcome after hip fracture. Nutritional status was a strong independent prognostic factor for clinical outcome and 5-year mortality. Physical function showed incomplete recovery. Elderly care should focus on prevention already before hip fracture. PURPOSE To determine the prognostic value of nutritional status in hip fracture patients for multiple clinical and functional outcomes over 6 months, and for new fractures and survival over 5 years post-fracture. METHODS We included 152 well-characterized subjects (age 55+ years) with a hip fracture from a previously published randomized controlled trial. Nutritional status was appraised using the Mini Nutritional Assessment (MNA). Multivariable linear, logistic and Cox regression models were fitted, adjusted for age, sex, ASA score, group and additional prognostic covariates identified in backward regression models. RESULTS At baseline, impaired nutritional status was significantly associated with physical disability, depression, impaired cognition and lower quality of life. Prospective analyses showed that impaired baseline nutritional status was an independent prognostic factor for postoperative complications (OR 2.00, 95%CI 1.01-3.98, p = 0.047), discharge location from hospital (home vs. rehabilitation clinic, OR 0.41, 95%CI 0.18-0.98, p = 0.044), hospital readmission (OR 4.59, 95%CI 1.70-12.4, p = 0.003) and total length of hospital stay (HR of being discharged: 0.63, 96%CI 0.44-0.89, p = 0.008), as well as for 5-year mortality (HR 3.94, 95%CI 1.53-10.2, p = 0.005), but not for risk of new fractures (5y-HR 0.87, 95%CI 0.34-2.24, p = 0.769). Curves of physical disability over time showed that the three nutritional status categories followed almost parallel trajectories from baseline until 6 months after hip fracture, without complete recovery and even with further deterioration in malnourished subjects from 3 to 6 months post-fracture. CONCLUSION As baselline nutritional status is a strong independent prognostic factor for clinical outcome after hip fracture, affecting even five-year survival, elderly health care should focus on prevention and identification of at-risk individuals already before hip fracture.
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Affiliation(s)
- P C Dagnelie
- Department of Internal Medicine, CARIM, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - P C Willems
- Department of Orthopaedic Surgery, Maastricht University Medical Centre+, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - N R Jørgensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark.
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
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Chiavarini M, Ricciotti GM, Genga A, Faggi MI, Rinaldi A, Toscano OD, D’Errico MM, Barbadoro P. Malnutrition-Related Health Outcomes in Older Adults with Hip Fractures: A Systematic Review and Meta-Analysis. Nutrients 2024; 16:1069. [PMID: 38613102 PMCID: PMC11013126 DOI: 10.3390/nu16071069] [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: 03/01/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Hip fracture is a common condition in older adults, leading to disability and mortality. Several studies have demonstrated the association between nutritional status and the risk of a negative health outcome after fractures. In this systematic review, we evaluated the association between malnutrition and mortality, changes in mobility/living arrangements, and postoperative complications, such as delirium, in older patients with hip fractures. A literature search on the PubMed, Web of Science, and Scopus databases, up to September 2023, was conducted to identify all studies involving older subjects that reported an association between MNA/GNRI/PNI/CONUT and health outcome after hip fracture. Meta-analysis was performed by a random-effects model using risk values (RR, OR, and HR) extracted from the 14 eligible selected studies. Malnutrition significantly increased the risk of any analyzed adverse outcome by 70% at 1 month, and up to 250% at 1 year. Malnutrition significantly increased delirium risk by 275% (OR = 2.75; 95% CI 1.80-4.18; p ≤ 0.05), mortality risk by 342% (OR = 3.42; 95% CI 2.14-5.48; p ≤ 0.05), mortality hazard risk by 351% (HR = 3.51; 95% CI 1.63-7.55; p ≤ 0.05) at 1 month, and transfer-to-more-supported-living-arrangements risk by 218% (OR = 2.18; 95% CI 1.58-3.01; p ≤ 0.05), and declined mobility risk by 41% (OR = 1.41; 95% CI 1.14-1.75; p ≤ 0.05), mortality risk by 368% (OR = 3.68; 95% CI 3.00-4.52; p ≤ 0.05), and mortality hazard risk by 234% (HR = 2.34; 95% CI 1.91-2.87; p ≤ 0.05) at 1 year. Malnutrition of older patients increases the risk of death and worsens mobility and independence after hip fractures. The results of the present study highlight the importance of nutritional status evaluation of older subjects with hip fractures in order to prevent potential adverse outcomes (Registration No: CRD42023468751).
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Affiliation(s)
| | | | - Anita Genga
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, 60126 Ancona, Italy; (M.C.); (G.M.R.); (M.I.F.); (A.R.); (O.D.T.); (M.M.D.)
| | | | | | | | | | - Pamela Barbadoro
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of the Marche Region, 60126 Ancona, Italy; (M.C.); (G.M.R.); (M.I.F.); (A.R.); (O.D.T.); (M.M.D.)
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Maheshwari V, Choudhury AK, Yadav R, Dhingra M, Kant R, Kalia RB. Prevalence of Poor Nutrition in Knee Osteoarthritis Patients: A Hospital-Based Cohort Study in Indian Population. Indian J Orthop 2024; 58:298-307. [PMID: 38425822 PMCID: PMC10899134 DOI: 10.1007/s43465-023-01090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/25/2023] [Indexed: 03/02/2024]
Abstract
Purpose Malnourished adults with knee osteoarthritis (OA) have a lower propensity for physical activities, leading to post-surgical stress and poorer clinic-functional outcomes. The study is aimed to propose an integrative screening procedure for patients and to identify a subset of patients who are undernourished or at risk of undernutrition in the Indian population. Methods A hospital-based cross-sectional study was conducted at a tertiary care, a university-level teaching hospital for seven months, which included knee OA patients above the age of 45 years, and the following criteria were evaluated anthropometric measurement and blood biochemical parameters and nutritional scoring system. Results The current study reports a high prevalence of malnutrition (69.5%) in patients with knee OA in the Indian population based on blood biochemical levels, and late presenters are associated with poor nutritional status of an individual. A single gold standard blood biochemical test, serum albumin alone, reports many malnourished individuals in the population, and the remaining blood biochemical parameters may not yield any additional information. Mini nutritional assessment, mid-arm circumference, and mid-calf circumference are poor predictors of malnutrition, and we need a revised cut-off for our group of patients. Conclusion In the cohort of OA Knee, the prevalence of malnutrition is high (69.5%) in the Indian population. Serum Albumin is the best parameter to detect the presence of malnutrition preoperatively, and MNS is not applicable to detect malnutrition in our subset of patients. The study recommends routinely measuring serum albumin levels in all patients to correct the nutritional abnormality preoperatively, resulting in better surgical outcomes and reduced post-operatively complications. Level of evidence IV.
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Affiliation(s)
- Vikas Maheshwari
- Department of Orthopeaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Robin Yadav
- Department of Orthopeaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Mohit Dhingra
- Department of Orthopeaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Ravi Kant
- Department of Orthopeaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Roop Bhushan Kalia
- Department of Orthopeaedics, All India Institute of Medical Sciences, Rishikesh, India
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Hurtado Y, Hernández OA, De Leon DPA, Duque G. Challenges in Delivering Effective Care for Older Persons with Fragility Fractures. Clin Interv Aging 2024; 19:133-140. [PMID: 38283764 PMCID: PMC10822128 DOI: 10.2147/cia.s433999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
Fragility fractures occur because of low-impact trauma or even spontaneously in individuals with osteoporosis. Caring for older persons with fragility fractures can present several challenges due to the unique needs and vulnerabilities of this population. Older individuals commonly have multiple medical conditions, such as osteoporosis, arthritis, cardiovascular diseases, and diabetes. These comorbidities can complicate fracture management and increase the risk of complications. Fracture repair through surgery may be more complex in older patients due to poor bone quality, decreased tissue elasticity, and higher chances of anesthesia complications. In addition, mobility and functional limitations post-fracture are highly prevalent in this population, affecting their independence and increasing their risk of institutionalization. Addressing these challenges requires a multidisciplinary approach involving orthopedic surgeons, geriatricians, physical and rehabilitation physicians, physiotherapists, occupational therapists, dieticians, social workers, and caregivers. Preventive measures, such as fall prevention strategies and osteoporosis management, can also play a vital role in reducing the incidence of fragility fractures in older persons.
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Affiliation(s)
- Yesid Hurtado
- Division of Endocrinology, Hospital San José, Bogotá, Colombia
| | | | | | - Gustavo Duque
- Bone, Muscle & Geroscience Research Group, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
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Yamamoto M, Nozoe M, Ikeji R, Seike H, Yoshida Y, Shomoto K. Anorexia assessment using the Simplified Nutritional Appetite Questionnaire and its association with activities of daily living in patients with stroke. Nutrition 2024; 117:112238. [PMID: 37924625 DOI: 10.1016/j.nut.2023.112238] [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: 04/29/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE This study aimed to validate the assessment of anorexia in patients with acute stroke using the Simplified Nutritional Appetite Questionnaire. METHODS This cross-sectional observational study assessed appetite using the Simplified Nutritional Appetite Questionnaire in patients with acute stroke at discharge from an acute care hospital. Additionally, the relationship between the Simplified Nutritional Appetite Questionnaire and Mini Nutritional Assessment, Mini Nutritional Assessment - Short Form scores, skeletal muscle mass, muscle strength, and activities of daily living measured using the Functional Independence Measures for the motor domain was investigated. A multiple regression analysis was conducted with the Functional Independence Measure for the motor domain as the dependent variable and the Simplified Nutritional Appetite Questionnaire and other confounding factors as explanatory variables to evaluate the association between the Simplified Nutritional Appetite Questionnaire and functional outcomes. RESULTS Among the 234 patients with stroke analyzed in this study, the median Simplified Nutritional Appetite Questionnaire score was 15 (IQR = 13-16) points. The Simplified Nutritional Appetite Questionnaire score significantly correlated with weight change, Functional Independence Measure for the motor domain, nutritional assessment index, and energy and protein intake. However, no significant differences in body mass index, muscle mass, or muscle strength were observed. In the multiple regression analysis adjusted for confounders, the Simplified Nutritional Appetite Questionnaire score (β = 0.106; P = 0.007) was independently associated with the Functional Independence Measure for the motor domain (adjusted R2 = 0.662). CONCLUSIONS This study's results found a significant correlation between Simplified Nutritional Appetite Questionnaire scores and nutritional status as well as an independent association with functional outcomes in patients with stroke. These findings suggest that the Simplified Nutritional Appetite Questionnaire can be a valuable tool for evaluating anorexia in this patient population.
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Affiliation(s)
- Miho Yamamoto
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan; Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Masafumi Nozoe
- Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan.
| | - Rio Ikeji
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Haruka Seike
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Yosuke Yoshida
- Department of Rehabilitation, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Koji Shomoto
- Graduate School of Health Sciences, Kio University, Nara, Japan
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Zink TM, Kent SE, Choudhary AN, Kavolus JJ. Nutrition in Surgery: An Orthopaedic Perspective. J Bone Joint Surg Am 2023; 105:1897-1906. [PMID: 37856576 DOI: 10.2106/jbjs.23.00259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
➤ Malnutrition is common among subsets of patients undergoing orthopaedic surgery and is associated with an increased risk of postoperative complications.➤ Serum proteins, in particular, albumin, may be used in the evaluation of nutritional status.➤ Anthropometric measurements and surveys also play a role in the evaluation of nutritional status.➤ Increased energy and nutrient requirements due to surgical procedures necessitate increased caloric and protein intake in the perioperative period, which may be achieved through diet or supplementation.➤ Evidence supports the use of protein-calorie, amino acid, and immunonutrition supplements. Vitamin D supplementation is an area of further consideration.➤ Diet restriction, activity alterations, pharmacotherapy, and bariatric surgery are all safe, effective approaches to weight loss, although the optimal timing and magnitude of preoperative weight loss require further investigation.
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Affiliation(s)
- Thomas M Zink
- Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Suzanne E Kent
- Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | | | - Joseph J Kavolus
- Tufts University School of Medicine, Boston, Massachusetts
- Newton-Wellesley Orthopedic Associates, Newton, Massachusetts
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Thuayngam Y, Komolsuradej N, Buathong N, Srikrajang S. Use of Mindex and Demiquet for assessing nutritional status in older adults. Fam Pract 2023:7174233. [PMID: 37208307 DOI: 10.1093/fampra/cmad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND The Mini Nutritional Assessment (MNA) is a validated questionnaire that estimates nutritional status. Given that this questionnaire uses stature measurement, which are unreliable in older adults, Mindex and Demiquet are alternatives to BMI for assessing malnutrition risk. However, the correlation of Mindex and Demiquet values with MNA scores has not been investigated. OBJECTIVES This cross-sectional study examined the correlation of Mindex and Demiquet with nutritional status and blood parameters in older adults in Thailand. METHODS The correlation of Mindex and Demiquet with MNA scores and body mass index (BMI), as well as blood parameters, was evaluated. Sociodemographic characteristics, anthropometric measurements, and blood test results were collected from 347 participants aged 60 years and older (mean ± SD, 66.4 ± 5.3 years). Spearman's rank correlation coefficient and multiple logistic regression analyses were used in statistical analyses. RESULTS MNA scores were significantly correlated with Mindex (P < 0.001) and Demiquet (P = 0.001), and BMI was related to Mindex and Demiquet (P < 0.001). Low-density lipoprotein cholesterol (LDL-C) predicted MNA scores (P = 0.048) in males but not females. CONCLUSIONS Mindex and Demiquet values were positively correlated with MNA scores and BMI. In addition, LDL-C predicted MNA scores in male older adults.
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Affiliation(s)
- Yanisa Thuayngam
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Narucha Komolsuradej
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Napakkawat Buathong
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Siwaluk Srikrajang
- Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Thailand
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Khan AA, AbuAlrob H, Al-Alwani H, Ali DS, Almonaei K, Alsarraf F, Bogoch E, Dandurand K, Gazendam A, Juby AG, Mansoor W, Marr S, Morgante E, Myslik F, Schemitsch E, Schneider P, Thain J, Papaioannou A, Zalzal P. Post hip fracture orthogeriatric care-a Canadian position paper addressing challenges in care and strategies to meet quality indicators. Osteoporos Int 2023; 34:1011-1035. [PMID: 37014390 DOI: 10.1007/s00198-022-06640-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/12/2022] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Osteoporosis is a major disease state associated with significant morbidity, mortality, and health care costs. Less than half of the individuals sustaining a low energy hip fracture are diagnosed and treated for the underlying osteoporosis. OBJECTIVE A multidisciplinary Canadian hip fracture working group has developed practical recommendations to meet Canadian quality indicators in post hip fracture care. METHODS A comprehensive narrative review was conducted to identify and synthesize key articles on post hip fracture orthogeriatric care for each of the individual sections and develop recommendations. These recommendations are based on the best evidence available today. CONCLUSION Recommendations are anticipated to reduce recurrent fractures, improve mobility and healthcare outcomes post hip fracture, and reduce healthcare costs. Key messages to enhance postoperative care are also provided.
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Affiliation(s)
- Aliya A Khan
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada.
| | - Hajar AbuAlrob
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Hatim Al-Alwani
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Dalal S Ali
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Khulod Almonaei
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Farah Alsarraf
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Earl Bogoch
- Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Karel Dandurand
- Department of Medicine, Division of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Aaron Gazendam
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Angela G Juby
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - Wasim Mansoor
- Trillium Health Partners, University of Toronto, Toronto, ON, Canada
| | - Sharon Marr
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Emmett Morgante
- Bone Research and Education Center Patient Support Program and Education Coordinator, Oakville, ON, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Western University, London, ON, Canada
| | - Emil Schemitsch
- Department of Surgery, Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Prism Schneider
- Department of Surgery, Division of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | - Jenny Thain
- Department of Medicine, Division of Geriatric Medicine, Western University, London, ON, Canada
| | - Alexandra Papaioannou
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON, Canada
| | - Paul Zalzal
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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Zhang D, Zhang X. Effect of serologic malnutrition on postoperative wound infection problems after total joint arthroplasty: A meta-analysis. Int Wound J 2022; 20:261-268. [PMID: 35833263 PMCID: PMC9885483 DOI: 10.1111/iwj.13869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 05/29/2022] [Accepted: 06/04/2022] [Indexed: 02/03/2023] Open
Abstract
We performed a meta-analysis to evaluate the effect of serologic malnutrition on postoperative wound infection problems after total joint arthroplasty. A systematic literature search up to April 2022, was performed and 446 501 subjects with total joint arthroplasty at the baseline of the studies; 200 433 of them were confirmed serologic malnutrition, and 246 068 were confirmed normal nutrition. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated to assess the effect of serologic malnutrition on postoperative wound infection problems after total joint arthroplasty using the dichotomous method with a random or fixed-effect model. The serologic malnutrition subjects had a significantly higher wound disruption (OR, 1.97; 95% CI, 1.53-2.53, P < 0.001), higher superficial incisional surgical site infection (OR, 2.89; 95% CI, 1.67-5.01, P < 0.001), higher deep incisional surgical site infection (OR, 3.06; 95% CI, 2.36-3.96, P < 0.001), and higher organ space surgical site infection (OR, 3.15; 95% CI, 2.34-4.24, P < 0.001) in subjects after total joint arthroplasty compared with normal nutrition. The serologic malnutrition subjects had a significantly higher wound disruption, superficial incisional surgical site infection, deep incisional surgical site infection, and organ space surgical site infection in subjects after total joint arthroplasty compared with normal nutrition. The analysis of outcomes should be with caution because of the low number of studies in certain comparisons.
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Affiliation(s)
- Dahua Zhang
- Department of OrthopedicsThe First Affiliated Hospital of Xi'an Medical UniversityXi'anChina
| | - Xiang Zhang
- Department of OrthopedicsThe First Affiliated Hospital of Xi'an Medical UniversityXi'anChina
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Frederiksen AK, Beck AM, Luiking YC, Hofstede JM, Knudsen AW, Munk T. Protein intake in hospitalized older patients after hip fracture: Pilot feasibility study evaluating ESPEN guidelines for geriatrics. CLINICAL NUTRITION OPEN SCIENCE 2022. [DOI: 10.1016/j.nutos.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Soloff MA, Vargas MV, Wei C, Ohnona A, Tyan P, Gu A, Georgakopoulos B, Thomas CA, Quan T, Barishansky S, Moawad G. Malnutrition is Associated with Poor Postoperative Outcomes Following Laparoscopic Hysterectomy. JSLS 2021; 25:JSLS.2020.00084. [PMID: 33879999 PMCID: PMC8035827 DOI: 10.4293/jsls.2020.00084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Malnutrition continues to be pervasive among the general population, with rates as high as 50% of patients undergoing surgical procedures. Data is limited about women undergoing surgery for non-malignant gynecologic indications (generally elective laparoscopic hysterectomies, after failed conservative measures). With the significant increase in benign gynecologic surgery, it is of the upmost importance that surgeons optimize modifiable risk factors for patients undergoing laparoscopic hysterectomy. The purpose of this study is to identify the impact of malnutrition on postoperative outcomes in patients undergoing laparoscopic hysterectomy for benign conditions. Methods: A retrospective cohort study was conducted utilizing data that was collected through the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP) Database. All patients that underwent laparoscopic hysterectomy for benign indications were identified. Patients with malnutrition were identified by either low albumin (≤ 3.5 g/dL), low body mass index (≤ 18.5), or 10% weight loss within 6 months. The frequency of postoperative complications was evaluated with univariate and multivariate analyses where appropriate. Results: Following adjustment, multivariate analysis illustrated pre-operative malnutrition to be a risk factor for the following complications: any complication, death, bleeding requiring transfusion, wound, cardiac, pulmonary, renal, thromboembolic, sepsis complications, extended length of stay, and reoperation (p ≤ 0.05 for all). Conclusion: Malnourished patients were at significantly higher risk of developing postoperative complications during the acute postoperative period. With elective laparoscopic hysterectomies, pre-operative evaluation and intervention for malnutrition should be considered to improve nutritional status.
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Affiliation(s)
- Michelle A Soloff
- Department of Obstetrics and Gynecology, North Shore University Hospital and Long Island Jewish Medical Center, Manhasset, NY
| | - Maria V Vargas
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Chapman Wei
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ashley Ohnona
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Paul Tyan
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Alex Gu
- Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Caroline A Thomas
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Theodore Quan
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Seth Barishansky
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC
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Home-Delivered Meals: Characterization of Food Intake in Elderly Beneficiaries. Nutrients 2021; 13:nu13062064. [PMID: 34208726 PMCID: PMC8234175 DOI: 10.3390/nu13062064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
Objective. In this study, we focus on elderly people (≥70 years old) benefiting from a home delivery meal service as part of a social welfare program. We aimed to: (i) assess the gap between the recommended and actual nutritional intake in this population and (ii) study the relationship between the intake of nutrients and the variables characterizing the participants’ health and nutritional status. Design. A dietary survey (24-hour record) was conducted during a home interview, with 64 people receiving a home delivery meal service (75% women; 70–97 years old). At the same time, the participants answered questionnaires assessing their nutritional and health status. Results. Our data showed that the consumption of 70 to 80% participants was not sufficient for reaching the nutritional recommendations for energy and macronutrients. Additionally, the data showed that the lower the energy and protein intakes, the higher the risk of malnutrition. In addition, one third of the participants were both overweight or obese and at risk of undernutrition or undernourished. Our study demonstrated that the heavier the person, the more difficult it was for them to meet the nutritional recommendations based on kilograms of body weight. Finally, individuals receiving two to three delivered meals per day had higher energy and protein intakes than those receiving a single meal. Conclusion. These results suggest that it is important that home meal delivery companies improve the quality of their meals and service so that their recipients can better meet nutritional recommendations.
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Dwyer JT, Gahche JJ, Weiler M, Arensberg MB. Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps. J Community Health 2021; 45:640-660. [PMID: 31571022 PMCID: PMC7188699 DOI: 10.1007/s10900-019-00739-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.
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Affiliation(s)
- Johanna T Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, 02111, USA
- Department of Medicine and Community Health, School of Medicine and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
| | - Jaime J Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
| | - Mary Weiler
- Abbott Nutrition Division of Abbott, Columbus, OH, 43219, USA
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Mendoza-Garcés L, Velázquez-Alva MC, Cabrer-Rosales MF, Arrieta-Cruz I, Gutiérrez-Juárez R, Irigoyen-Camacho ME. Vitamin D Deficiency is Associated with Handgrip Strength, Nutritional Status and T2DM in Community-Dwelling Older Mexican Women: A Cross-Sectional Study. Nutrients 2021; 13:736. [PMID: 33652581 PMCID: PMC7996586 DOI: 10.3390/nu13030736] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to evaluate the association between handgrip strength, nutritional status and vitamin D deficiency in Mexican community-dwelling older women. A cross sectional study in women ≥ 60 years-old was performed. Plasma 25-hydroxyvitamin D (25(OH)D) concentrations were measured by a quantitative immunoassay technique. Handgrip strength was assessed using a dynamometer, while nutritional status was assessed through the Full Mini Nutritional Assessment (Full-MNA). A total of 116 women participated in the study, their mean age was 70.3 ± 5.8 years; 49.1% of the study group had plasma 25(OH)D levels lower than 40 nmol/L [16 ng/mL]. Meanwhile, 28.45% of participants had low handgrip strength (<16 kg), and 23.1% were identified at risk of malnutrition/malnourished according with Full-MNA score. Women with 25(OH)D deficiency (<40 nmol/L [16 ng/mL]) were more likely to have low handgrip strength (OR = 2.64, p = 0.025) compared with those with higher 25(OH)D values. Additionally, being malnourished or at risk of malnutrition (OR = 2.53, p = 0.045) or having type 2 diabetes mellitus (T2DM) (OR = 2.92, p = 0.044) was also associated with low 25(OH)D. The prevalence of low plasma 25(OH)D concentrations was high among Mexican active older women. Low handgrip strength, being at risk of malnutrition/malnourished, or diagnosed with T2DM was also associated with Vitamin D deficiency.
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Affiliation(s)
| | - María Consuelo Velázquez-Alva
- Health Care Department, Metropolitan Autonomous University, Unit Xochimilco, Mexico City 04960, Mexico; (M.C.V.-A.); (M.F.C.-R.)
| | - María Fernanda Cabrer-Rosales
- Health Care Department, Metropolitan Autonomous University, Unit Xochimilco, Mexico City 04960, Mexico; (M.C.V.-A.); (M.F.C.-R.)
| | - Isabel Arrieta-Cruz
- National Institute of Geriatrics, Ministry of Health, Mexico City 10200, Mexico;
| | - Roger Gutiérrez-Juárez
- Department of Biomedical Sciences, School of Medicine, Faculty of Higher Studies Zaragoza, National Autonomous University of Mexico, Mexico City 09230, Mexico;
| | - María Esther Irigoyen-Camacho
- Health Care Department, Metropolitan Autonomous University, Unit Xochimilco, Mexico City 04960, Mexico; (M.C.V.-A.); (M.F.C.-R.)
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Williams DGA, Ohnuma T, Haines KL, Krishnamoorthy V, Raghunathan K, Sulo S, Cassady BA, Hegazi R, Wischmeyer PE. Association between early postoperative nutritional supplement utilisation and length of stay in malnourished hip fracture patients. Br J Anaesth 2021; 126:730-737. [PMID: 33516455 DOI: 10.1016/j.bja.2020.12.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/05/2020] [Accepted: 12/12/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Malnutrition in older hip fracture patients is associated with increased complication rates and mortality. As postoperative nutrition delivery is essential to surgical recovery, postoperative nutritional supplements including oral nutritional supplements or tube feeding formulas can improve postoperative outcomes in malnourished hip/femur fracture patients. The association between early postoperative nutritional supplements utilisation and hospital length of stay was assessed in malnourished hip/femur fracture patients. METHODS This is a retrospective cohort study of malnourished hip/femur fracture patients undergoing surgery from 2008 to 2018. Patients were identified through International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes and nutritional supplement utilisation via hospital charge codes. The primary outcome was hospital length of stay. Secondary outcomes included infectious complications, hospital mortality, ICU admission, and costs. Propensity matching (1:1) and univariable analysis were performed. RESULTS Overall, 160 151 hip/femur fracture surgeries were identified with a coded-malnutrition prevalence of 8.7%. Early postoperative nutritional supplementation (by hospital day 1) occurred in 1.9% of all patients and only 4.9% of malnourished patients. Propensity score matching demonstrated early nutritional supplements were associated with significantly shorter length of stay (5.8 [6.6] days vs 7.6 [5.8] days; P<0.001) without increasing hospital costs. No association was observed between early nutritional supplementation and secondary outcomes. CONCLUSION Malnutrition is underdiagnosed in hip/femur fracture patients, and nutritional supplementation is underutilised. Early nutritional supplementation was associated with a significantly shorter hospital stay without an increase in costs. Nutritional supplementation in malnourished hip/femur fracture patients could serve as a key target for perioperative quality improvement.
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Affiliation(s)
- David G A Williams
- CAPER Unit, Department of Anesthesiology, USA; Duke Clinical Research Institute, Durham, NC, USA
| | | | - Krista L Haines
- Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | | | | | | | | | - Paul E Wischmeyer
- CAPER Unit, Department of Anesthesiology, USA; Duke Clinical Research Institute, Durham, NC, USA.
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Comparison of Nutrition Risk Screening 2002 and Subjective Global Assessment Form as Short Nutrition Assessment Tools in Older Hospitalized Adults. Nutrients 2021; 13:nu13010225. [PMID: 33466724 PMCID: PMC7828813 DOI: 10.3390/nu13010225] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to compare two widely recommended short nutrition assessment tools—Nutrition Risk Screening 2002 (NRS-2002) and Subjective Global Assessment Form (SGA)—with other Comprehensive Geriatric Assessment (CGA) measurements. The study included 622 consecutively hospitalized older subjects, aged 81.7 ± 7.8 years. The criteria to participate were the ability to communicate and given consent. Both NRS-2002 and SGA were inversely related to anthropometric measurements, functional assessment tests, Mini-Mental State Examination (MMSE) and positively associated with the Vulnerable Elders Survey-13 (VES-13) score. Results of SGA and NRS-2002 were not related to sex and 15-item Geriatric Depression Scale (GDS) score. Comparison of well-nourished subjects and patients with suggested problems with nutrition according to NRS-2002 (0–2 vs. 3–7) and SGA (A vs. B + C) gave comparable results. Both nutritional scales at given cut-off points similarly discriminated anthropometric data and other CGA tools in the populations of well-nourished vs. malnourished hospitalized older subjects. In conclusion, we can recommend using both NRS-2002 and SGA to detect malnutrition or risk of malnutrition in a routine clinical practice of the geriatric department ward.
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Guigoz Y, Vellas B. Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next? J Nutr Health Aging 2021; 25:528-583. [PMID: 33786572 DOI: 10.1007/s12603-021-1601-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.
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Affiliation(s)
- Y Guigoz
- Yves Guigoz, Chemin du Raidillon, CH-1066 Epalinges, Switzerland.
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Matsuo M, Muramatsu K, Matsuda S, Fushimi K, Kaizuka Y, Kamochi M. Age-dependent influence of premorbid underweight status on mortality in severe burn patients: An administrative database study. Burns 2020; 47:1314-1321. [PMID: 33358396 DOI: 10.1016/j.burns.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/24/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the associations between premorbid nutritional status and in-hospital mortality in severe burn patients according to age in Japan. METHODS We retrospectively extracted the data of 14,345 patients aged 18-84 years admitted for burns from April 1, 2014, to March 31, 2018, using the Japanese Diagnosis Procedure Combination database. The exclusion criteria were out-of-hospital cardiac arrest, death in the emergency room, readmission, and planned admission. We collected data on age, sex, height, weight, comorbidities, burn index, and mechanical ventilation use and performed age-stratified multilevel logistic regression analyses to estimate associations between premorbid body mass index (BMI) and in-hospital mortality. RESULTS We analyzed 2968 patients with a burn index ≥10, including 831 elderly aged 75-84 years. In patients aged 18-74 years, being underweight (BMI < 18.5) significantly decreased mortality (0.34 [0.15-0.77]; P = 0.010). In contrast, in patients aged 75-84 years, being underweight significantly increased mortality (2.11 [1.05-4.25]; P = 0.036). Being overweight (BMI >25) increased mortality in both age groups, but not significantly. CONCLUSIONS The results suggest that pre-morbidly underweight elderly patients aged 75-84 years with severe burns have high mortality risks. Further research is needed to identify optimal care strategies for this population.
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Affiliation(s)
- Mizue Matsuo
- Department of Intensive Care Medicine, University Hospital of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8556, Japan.
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan.
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan; Occupational Health Data Science Center, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan.
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Yasuo Kaizuka
- Department of Emergency and ICU, Steel Memorial Yawata Hospital, 1-1-1 Harunomachi, Yahatahigashi-ku, Kitakyushu, Fukuoka 805-8508, Japan.
| | - Masayuki Kamochi
- Department of Intensive Care Medicine, University Hospital of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8556, Japan.
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Han TS, Lisk R, Osmani A, Sharmin R, El Gammel S, Yeong K, Fluck D, Fry CH. Increased Association With Malnutrition and Malnourishment in Older Adults Admitted With Hip Fractures Who Have Cognitive Impairment and Delirium, as Assessed by 4AT. Nutr Clin Pract 2020; 36:1053-1058. [PMID: 33368631 DOI: 10.1002/ncp.10614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/16/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The Royal College of Physicians recently introduced the 4AT (Alertness, Abbreviated Mental Test-4, Attention, and Acute change or fluctuating course) for screening cognitive impairment and delirium. Here, we examined the association of the 4AT with nutrition status in patients admitted to a hospital with hip fractures between January 1, 2016, and June 6, 2019. METHODS Nutrition status was assessed using the Malnutrition Universal Screening Tool, and the 4AT was assessed within 1 day after hip surgery. χ2 Tests and logistic regression were conducted to assess the association of nutrition status with 4AT scores, adjusted for age and sex. RESULTS From 1082 patients aged 60-103 years, categorized into 4AT scores of 0, 1-3, or ≥4, the prevalence of malnutrition risk was 15.5%, 27.3%, and 39.6% and malnourishment was 4.1%, 13.2%, and 11.3%, respectively. Compared with the 4AT = 0 cohort, a 4AT score = 1-3 was associated with an increased malnutrition risk (odds ratio [OR], 2.3; 95% CI, 1.6-3.1) or malnourishment (OR, 3.6; 95% CI, 2.1-6.3). For a 4AT score ≥4, corresponding ORs were 4.0 (95% CI, 2.8-5.9) and 3.6 (95% CI, 1.9-6.8). Overall, there was a significant positive association: as 4AT scores increased, so did malnutrition risk. CONCLUSIONS Among older adults admitted with hip fractures, high 4AT scores, which are suggestive of cognitive impairment and delirium, identified patients at increased malnutrition risk. These findings lend further support for the use of 4AT to identify patients who are at increased health risk.
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Affiliation(s)
- Thang S Han
- Institute of Cardiovascular, Research, Royal Holloway, University of London, Egham, Surrey, UK
| | - Radcliffe Lisk
- Department of Orthogeriatrics, Ashford and St Peter's NHS Foundation Trust, Chertsey, Surrey, UK
| | - Ahmad Osmani
- Department of Orthogeriatrics, Ashford and St Peter's NHS Foundation Trust, Chertsey, Surrey, UK
| | - Rifat Sharmin
- Department of Orthogeriatrics, Ashford and St Peter's NHS Foundation Trust, Chertsey, Surrey, UK
| | - Sarah El Gammel
- Department of Orthogeriatrics, Ashford and St Peter's NHS Foundation Trust, Chertsey, Surrey, UK
| | - Keefai Yeong
- Department of Orthogeriatrics, Ashford and St Peter's NHS Foundation Trust, Chertsey, Surrey, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, Surrey, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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Portugal-Nunes C, Castanho TC, Amorim L, Moreira PS, Mariz J, Marques F, Sousa N, Santos NC, Palha JA. Iron Status is Associated with Mood, Cognition, and Functional Ability in Older Adults: A Cross-Sectional Study. Nutrients 2020; 12:E3594. [PMID: 33238615 PMCID: PMC7700455 DOI: 10.3390/nu12113594] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/02/2020] [Accepted: 11/19/2020] [Indexed: 01/04/2023] Open
Abstract
Several conditions are risk factors for iron deficiency (ID), some of which are highly prevalent in older individuals. Despite the amount of evidence pointing for a role of ID in cognition, mood and physical functional ability, the research addressing these associations in older individuals is still scarce. In the present study, 162 older community-dwelling individuals (29.53% classified as ID) were enrolled in a cross-sectional analysis and characterized regarding cognition, mood, functional ability, general nutritional intake and iron status. Assessment of iron status was performed using several blood biomarkers. Storage and erythropoiesis dimensions were positively associated with memory, along with an interaction (moderator effect) between iron storage and nutritional status. A more depressed mood was negatively associated with (iron) transport, transport saturation and erythropoiesis dimensions, and functional tiredness was positively associated with the erythropoiesis dimension. These observations indicate that lower iron status is associated with depressive mood, functional tiredness and poorer memory ability, with the latter moderated by nutritional status. These findings suggest that using iron as a continuous variable may be useful in finding associations with iron homeostasis, eventually missed when iron levels are considered within the usual classification groups.
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Affiliation(s)
- Carlos Portugal-Nunes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| | - Teresa Costa Castanho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| | - Liliana Amorim
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Associação Centro de Medicina P5 (ACMP5), 4710-057 Braga, Portugal
| | - Pedro Silva Moreira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| | - José Mariz
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
- Emergency Department, Intermediate Care Unit (EDIMCU), Hospital de Braga, 4710-243 Braga, Portugal
| | - Fernanda Marques
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
| | - Nadine Correia Santos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Associação Centro de Medicina P5 (ACMP5), 4710-057 Braga, Portugal
| | - Joana Almeida Palha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (C.P.-N.); (T.C.C.); (L.A.); (P.S.M.); (J.M.); (F.M.); (N.S.); (N.C.S.)
- ICVS/3B′s, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center—Braga, 4710-243 Braga, Portugal
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Zhang M, Ye S, Huang X, Sun L, Liu Z, Liao C, Feng R, Chen H, Wu Y, Cai Z, Lin Q, Zhou X, Zhu B. Comparing the prognostic significance of nutritional screening tools and ESPEN-DCM on 3-month and 12-month outcomes in stroke patients. Clin Nutr 2020; 40:3346-3353. [PMID: 33221053 DOI: 10.1016/j.clnu.2020.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/27/2020] [Accepted: 11/01/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Malnutrition is prevalent among individuals with acute ischaemic stroke (AIS) and may worsen clinical outcomes. There is no consensus on the best tool for nutritional screening in this population. The present study compared four screening tools and one diagnostic tool in terms of their prognostic significance in predicting short-term and long-term outcomes in AIS patients. METHODS We included patients admitted to five major hospitals in Wenzhou and diagnosed with a primary diagnosis of AIS from October 1 to December 31, 2018. The Controlling Nutritional Status (CONUT) score, the Geriatric Nutritional Risk Index (GNRI), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Screening Tool 2002 (NRS-2002) and the European Society for Clinical Nutrition and Metabolism diagnostic criteria for malnutrition (ESPEN-DCM) were assessed at admission. The clinical outcomes were evaluated by the modified Rankin Scale (mRS) and mortality at 3 months and 12 months after discharge. RESULTS Five hundred and ninety-three patients were included in our prospective study. The mean age was 67.3 ± 12.0 years. Based on the mRS score, 125 patients exhibited poor functional recovery (an mRS ≥3) at 3 months after discharge. Seventeen patients died during the 3-month follow-up period, and the other 25 did not survive 12 months. Multivariate binary logistic regression revealed that inadequate nutritional status at admission, as determined by the CONUT, GNRI, MUST, NRS-2002 and ESPEN-DCM, were independently associated with poor outcomes in AIS patients 3 months after discharge. Both MUST ≥2 and NRS-2002 ≥ 3 showed significant associations with poor outcomes at 12-month post-discharge. Further analysis with the receiver operator characteristic (ROC) curve showed similar results, where all the tools predicted the poor outcomes at 3 months while only the NRS-2002 and MUST scores were significantly associated with the mRS at 12 months post-discharge. Moreover, the area under the curve (AUC) of MUST and NRS-2002 were significantly larger than those for the other tools. The optimal cut-off values of the MUST and NRS-2002 to predict poor outcomes were scores of ≥2 and ≥ 3 points, respectively. CONCLUSIONS Our data supported a deleterious effect of inadequate nutrition, as evidenced by the nutrition screening tools or ESPEN-DCM, on clinical outcomes during and beyond the acute phase of AIS. We recommended the use of the MUST and NRS-2002 in guiding nutritional support in AIS patients, as they have higher predictive power and can predict both short-term and long-term outcomes.
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Affiliation(s)
- Manman Zhang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shenglie Ye
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xuerong Huang
- Department of Neurology, Ruian People's Hospital, Wenzhou, Zhejiang, China
| | - Leqiu Sun
- Department of Neurology, Yueqing People's Hospital, Wenzhou, Zhejiang, China
| | - Zhipeng Liu
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chengwei Liao
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Renqian Feng
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haoman Chen
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yanzhi Wu
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhongmin Cai
- The First Clinical School, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qunli Lin
- Department of Neurology, Yongjia County People's Hospital, Wenzhou, Zhejiang, China
| | - Xudong Zhou
- Department of Neurology, The People's Hospital of Pingyang, Wenzhou, Zhejiang, China
| | - Beilei Zhu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Xu YC, Vincent JI. Clinical measurement properties of malnutrition assessment tools for use with patients in hospitals: a systematic review. Nutr J 2020; 19:106. [PMID: 32957989 PMCID: PMC7507822 DOI: 10.1186/s12937-020-00613-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/25/2020] [Indexed: 12/24/2022] Open
Abstract
Background The use of malnutrition outcome measures (OM) by registered dietitians (RD) with inpatients in hospitals has increased promoting the achievement of nutritional care goals and supporting decision-making for the allocation of nutritional care resources in hospitals. There are 3 commonly used OMs: Subjective Global Assessment (SGA), Patient Generated-Subjective Global Assessment (PG-SGA) and Mini Nutritional Assessment (MNA). The purpose of this current study was to systematically review the evidence of the clinical measurement properties of malnutrition assessment tools for use with patients admitted in hospitals. Methods MEDLINE, Cinahl, EMBASE, and PubMed were searched for articles published between 2000 and 2019. Research articles were selected if they established reliability, validity, and responsiveness to change properties of the SGA, PG-SGA and MNA tools, were written in English, and used any of these OMs as an outcome measure. Abstracts were not considered. The risk of bias within studies was assessed using the Quality Appraisal for Clinical Measurement Study (QA-CMS). Results Five hundred five studies were identified, of which 34 articles were included in the final review: SGA (n = 8), PG-SGA (n = 13), and MNA (n = 13). Of the 34 studies, 8 had a quality score greater than 75%; 23 had a quality score of 40–75% and 3 studies had a quality score of less than 40%. PG-SGA was found to have excellentdiagnostic accuracy (ROC: 0.92–0.975; Sensitivity: 88.6–98%; Specificity: 82–100%), sufficient internal consistency (Cronbach’s alpha: 0.722–0.73), and strong test-retest reliability (r = 0.866). There was insufficient evidence to suggest adequate diagnostic accuracy and good inter-rater reliability for SGA. Only one study examined the minimum detectable change of MNA (MDC = 2.1). Conclusions The evidence of validity for the existing malnutrition assessment tools supports the use of these tools, but more studies with sound methodological quality are needed to assess the responsiveness of these OMs to detect the change in nutritional status.
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Affiliation(s)
- Yue Camille Xu
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada. .,Clinical Dietitian at Bruyere Continuing Care, Ottawa, Canada.
| | - Joshua I Vincent
- School of Rehabilitation Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
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Groenendijk I, Kramer CS, den Boeft LM, Hobbelen HS, van der Putten GJ, de Groot LC. Hip Fracture Patients in Geriatric Rehabilitation Show Poor Nutritional Status, Dietary Intake and Muscle Health. Nutrients 2020; 12:nu12092528. [PMID: 32825439 PMCID: PMC7551784 DOI: 10.3390/nu12092528] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 01/10/2023] Open
Abstract
The aim of this study was to gain insight into the nutritional status, dietary intake and muscle health of older Dutch hip fracture patients to prevent recurrent fractures and to underpin rehabilitation programs. This cross-sectional study enrolled 40 hip fracture patients (mean ± SD age 82 ± 8.0 years) from geriatric rehabilitation wards of two nursing homes in the Netherlands. Assessments included nutritional status (Mini Nutritional Assessment), dietary intake on three non-consecutive days which were compared with Dietary Reference Intake values, and handgrip strength. Muscle mass was measured using Bioelectrical Impedance Analysis and ultrasound scans of the rectus femoris. Malnutrition or risk of malnutrition was present in 73% of participants. Mean energy, protein, fibre and polyunsaturated fat intakes were significantly below the recommendations, while saturated fat was significantly above the UL. Protein intake was <0.8 in 46% and <1.2 g/(kg·day) in 92%. Regarding micronutrients, mean intakes of calcium, vitamin D, potassium, magnesium and selenium were significantly below the recommendations. The prevalence of low muscle mass, low handgrip strength and sarcopenia were 35, 27 and 10%, respectively. In conclusion, a poor nutritional status, dietary intake and muscle health are common in older hip fracture patients in geriatric rehabilitation wards.
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Affiliation(s)
- Inge Groenendijk
- Division of Human Nutrition and Health, Wageningen University & Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (C.S.K.); (L.C.P.G.M.d.G.)
- Correspondence:
| | - Charlotte S. Kramer
- Division of Human Nutrition and Health, Wageningen University & Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (C.S.K.); (L.C.P.G.M.d.G.)
| | | | - Hans S.M. Hobbelen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, 9747 AS Groningen, The Netherlands
| | - Gert-Jan van der Putten
- Department of Oral Function and Prosthetic Dentistry, Radboud Medical Centre, 6525 GA Nijmegen, The Netherlands;
- Orpea, Dagelijks Leven, 7327 AA Apeldoorn, The Netherlands
| | - Lisette C.P.G.M. de Groot
- Division of Human Nutrition and Health, Wageningen University & Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (C.S.K.); (L.C.P.G.M.d.G.)
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24
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Yao SM, Zheng PP, Liang YD, Wan YH, Sun N, Luo Y, Yang JF, Wang H. Predicting non-elective hospital readmission or death using a composite assessment of cognitive and physical frailty in elderly inpatients with cardiovascular disease. BMC Geriatr 2020; 20:218. [PMID: 32571237 PMCID: PMC7309999 DOI: 10.1186/s12877-020-01606-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/08/2020] [Indexed: 11/15/2022] Open
Abstract
Background We aimed to assess the utility of the combination of the mini-mental state examination (MMSE) + clock drawing test (CDT) and the Fried phenotype for predicting non-elective hospital readmission or death within 6 months in elderly inpatients with cardiovascular disease (CVD). Methods A single-center prospective cohort was conducted from September 2018 to February 2019. Inpatients ≥65 years old were recruited. Predictive validity was tested using a Cox proportional hazards regression model analysis, and the discriminative ability was evaluated by the receiver operating characteristic (ROC) curve. Results A total of 542 patients were included. Overall, 12% (64/542) screened positive for cognitive impairment, 16% (86/542) were physically frail and 8% (44/542) had cognitive impairment combined with physical frailty, showing an older age (P < 0.001) and a lower education level (P < 0.001) than physically frail patients. A total of 113 patients (20.9%) died or were readmitted at 6 months. Frail participants with a normal (hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.06–2.82, P = 0.028) or impaired cognition (HR: 2.50, 95% CI: 1.27–4.91, P = 0.008) had a higher risk of non-elective hospital readmission or death than robust patients after adjusting for the age, sex, education level, marital status, the presence of diabetes mellitus, heart failure, and history of stroke. The area under the ROC curve (AUC) showed that the discriminative ability in relation to 6 months readmission and death for the MMSE + CDT + Fried phenotype was 0.65 (95% CI: 0.60–0.71), and the AUC for men was 0.71 (95% CI: 0.63–0.78), while that for women was 0.60 (95% CI: 0.51–0.69). Conclusions Accounting for cognitive impairment in the frailty phenotype may allow for the better prediction of non-elective hospital readmission or death in elderly inpatients with CVD in the short term. Trial registration ChiCTR1800017204; date of registration: 07/18/2018.
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Affiliation(s)
- Si-Min Yao
- Peking University Fifth School of Clinical Medicine, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Pei-Pei Zheng
- Peking University Fifth School of Clinical Medicine, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Yao-Dan Liang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Yu-Hao Wan
- Peking University Fifth School of Clinical Medicine, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Ning Sun
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Yao Luo
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Jie-Fu Yang
- Peking University Fifth School of Clinical Medicine, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China. .,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
| | - Hua Wang
- Peking University Fifth School of Clinical Medicine, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China. .,Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P. R. China. No. 1, DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.
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25
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Rosendahl-Riise H, Dierkes J, Ådnanes S, Skodvin VA, Strand E, Ranhoff AH. Weight changes and mobility in the early phase after hip fracture in community-dwelling older persons. Eur Geriatr Med 2020; 11:545-553. [PMID: 32557251 PMCID: PMC7438288 DOI: 10.1007/s41999-020-00342-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/02/2020] [Indexed: 11/26/2022]
Abstract
Aim To investigate body weight changes and their effect on mobility during the first two months following a hip fracture. Findings The loss of body weight was observed in three out of four patients in the early phase after hip fracture and was associated with decreased mobility measured by the NMS. Message Bodyweight loss is common and may further reduce mobility in hip fracture patients, but these findings need more research. Purpose Hip fractures in older persons are associated with reduced mobility and loss of independence. Few studies address the nutritional status and mobility in the early phase after hip fracture. The objective of the present study was, therefore, to investigate weight changes and their effect on mobility during the first two months following hip fracture in community-dwelling older persons without dementia. Methods Patients (> 60 years) admitted for a first hip fracture were recruited from two tertiary referral hospitals in Bergen, Norway. The patients' weights and dietary intakes were determined in the hospital and at home after two months. Mobility was assessed based on the New Mobility Score (NMS) (scale 0–9, with values > 5 regarded as sufficient mobility). Results We included 64 patients (median age 80 years, 48 women, 16 men) with information on weight collected in the hospital. Follow-up measurements were available for 32 patients, corresponding to an attrition rate of 50%. The patients had a median weight loss of 1.8 kg (IQR = − 3.7, 0 kg). Most of them had reduced mobility at two months after the surgery [median NMS = 5 (IQR = 3–6)]. Both age and the weight change after surgery were predictors of the NMS at follow-up. Conclusion Bodyweight loss was observed in three out of four patients in the early phase after hip fracture and was associated with decreased mobility measured by the NMS. The results should be interpreted with caution as half of the patients dropped out of the study and did not participate in the follow-up visit.
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Affiliation(s)
- Hanne Rosendahl-Riise
- Mohn Nutrition Research Laboratory, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jutta Dierkes
- Center for Nutrition, Mohn Nutrition Research Laboratory, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Laboratory Medicine and Pathology, Haukeland University Hospital, Bergen, Norway
| | - Svanhild Ådnanes
- Center for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Vilde Aabel Skodvin
- Center for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Elin Strand
- Department of Clinical Science, University of Bergen, Bergen, Norway
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26
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Abstract
Despite evidence that malnutrition is associated with significant complications in orthopedic surgery1, unrecognized malnutrition continues to be a "silent epidemic", effecting up to 50% of hospitalized patients. Specifically, pre-surgical malnutrition is associated with increased risk for surgical site infections, increased length of hospital stay, and increased health care costs in patients following total joint arthroplasty. Serologic markers (i.e. serum albumin and total lymphocyte count), anthropometric measurements, (i.e. calf muscle circumference and triceps skin fold) and assessment and screening tools (i.e. The Rainey-MacDonald Nutritional Index, the Mini Nutrition Assessment Short Form, the Malnutrition Universal Screening Tool and the Nutrition Risk Screening 2002) have all been used to aid in the diagnosis of malnutrition in orthopedic patients, yet there is no universal gold standard for screening or assessing nutritional risk and no accepted guideline for perioperative nutritional optimization in this patient population. Recently, the Perioperative Nutrition Screen (PONS) was introduced2 as an easy and efficient way to preoperatively identify and risk stratify patients for malnutrition in order to guide perioperative nutrition optimization. Given malnutrition is associated with increased risk of surgical site infections and increased length of hospital stay, adequate assessment of perioperative risk for malnutrition and preoperative nutrition optimization, including structured weight loss in the obese population, consumption of high protein oral nutritional supplements, immunonutrition oral supplements and adequate glucose control, may improve perioperative outcomes. The presence of a Registered Dietician (RD) should be a standard of care in all pre-operative clinics to improve nutrition care and surgical outcomes.
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27
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Sayeed Z, Anoushiravani AA, Simha S, Padela MT, Schafer P, Awad ME, Darwiche HF, Saleh KJ. Markers for Malnutrition and BMI Status in Total Joint Arthroplasty and Pharmaconutrient Therapy. JBJS Rev 2019; 7:e3. [PMID: 31094890 DOI: 10.2106/jbjs.rvw.18.00056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Zain Sayeed
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan.,Resident Research Partnership, Detroit, Michigan.,Department of Orthopaedic Surgery, Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois.,Fajr Scientific, Detroit, Michigan
| | | | | | - Muhammad Talha Padela
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan.,Resident Research Partnership, Detroit, Michigan.,Department of Orthopaedic Surgery, Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois.,Fajr Scientific, Detroit, Michigan.,Michigan State University College of Medicine, Detroit, Michigan.,John D. Dingell Veteran Affairs Medical Center, Detroit, Michigan
| | - Patrick Schafer
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan
| | - Mohamed E Awad
- Resident Research Partnership, Detroit, Michigan.,Fajr Scientific, Detroit, Michigan.,Michigan State University College of Medicine, Detroit, Michigan.,John D. Dingell Veteran Affairs Medical Center, Detroit, Michigan
| | - Hussein F Darwiche
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan.,Resident Research Partnership, Detroit, Michigan
| | - Khaled J Saleh
- Fajr Scientific, Detroit, Michigan.,Michigan State University College of Medicine, Detroit, Michigan.,John D. Dingell Veteran Affairs Medical Center, Detroit, Michigan
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28
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Gu A, Malahias MA, Strigelli V, Nocon AA, Sculco TP, Sculco PK. Preoperative Malnutrition Negatively Correlates With Postoperative Wound Complications and Infection After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2019; 34:1013-1024. [PMID: 30745081 DOI: 10.1016/j.arth.2019.01.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Malnutrition continues to be prevalent in the general population. A variety of studies have correlated poor nutritional status with reduced perioperative outcomes. However, the correlation between serologic malnutrition and arthroplasty outcomes has not been systematically evaluated. The purpose of this study was to determine if serologic malnutrition has a correlation with postoperative wound infection, as well as other complications, after total joint arthroplasty. METHODS A systematic review of the literature was performed to identify studies that reported on outcomes for patients who were malnourished and had undergone a total hip or knee arthroplasty. RESULTS Twenty studies were included for review. Based on the quality of the evidence of the different studies, the balance between desirable/undesirable outcomes and the values of patients, there was a strong recommendation that preoperative serologic markers of malnutrition are significantly associated with inferior postoperative outcomes. All 20 studies analyzed albumin as a marker for malnutrition. Eleven (55%) studies used the total lymphocyte count, and 6 (30%) studies reported transferrin as a marker for malnutrition. Among 20 studies, 18 (90%) studies reported a correlation with at least one serological marker and poor postoperative outcomes. Finally, patients with an albumin level <3.5 dg/L were more likely to develop a postoperative wound complication (odds ratio: 2.176; 95% confidence interval: 1.916-2.471). CONCLUSIONS There is strong evidence that serologic malnutrition was associated with increased risk of poor postoperative outcome across all total joint replacement interventions.
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Affiliation(s)
- Alex Gu
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | | | - Vanni Strigelli
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Allina A Nocon
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Thomas P Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
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29
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Acute phase nutritional screening tool associated with functional outcomes of hip fracture patients: A longitudinal study to compare MNA-SF, MUST, NRS-2002 and GNRI. Clin Nutr 2019; 38:220-226. [DOI: 10.1016/j.clnu.2018.01.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/11/2018] [Accepted: 01/23/2018] [Indexed: 11/19/2022]
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30
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Cizmic Z, Feng JE, Huang R, Iorio R, Komnos G, Kunutsor SK, Metwaly RG, Saleh UH, Sheth N, Sloan M. Hip and Knee Section, Prevention, Host Related: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S255-S270. [PMID: 30348549 DOI: 10.1016/j.arth.2018.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Mahran DG, Farouk O, Ismail MA, Alaa MM, Eisa A, Ragab II. Effectiveness of home based intervention program in reducing mortality of hip fracture patients: A non-randomized controlled trial. Arch Gerontol Geriatr 2018; 81:8-17. [PMID: 30471472 DOI: 10.1016/j.archger.2018.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 11/08/2018] [Accepted: 11/12/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE The study was done to investigate whether a postoperative intervention program is effective in reducing mortality and improving mobility in two comparative hip fracture patients over one year postoperatively. METHODS A non-randomized controlled trial study with an intervention group of hip fracture patients and historical control group with 12 months follow up. One hundred twenty four admitted hip fracture patients to the Trauma Unit of Assiut University Hospitals, aged 50 years and older were included from 1st July to 31st December 2014. They were divided into 64 and 60 patients as intervention and control groups respectively. Weight, height and bone mineral density were measured and baseline characteristics were taken. The intervention was a postoperative care program in the form of education sessions with an explanatory leaflet on discharge for nutrition and physical exercise program at home. Follow up phone calls were done at 3 months, 6 months and one year postoperatively by one assessor. Physical mobility was assessed by 24 items Western Ontario And McMaster Universities Osteoarthritis Index (WOMAC). RESULTS Mortality was significantly higher in the control group, WOMAC score was significantly better among intervention group through follow up. By multivariate Cox survival analysis, advancing age, no intervention, osteoporosis, postoperative complications, chest infections and heart attacks were significant predictors for mortality. CONCLUSION A significant improvement in mobility and reduction of mortality was achieved by application of a postoperative care program that could be incorporated into the hip fracture patients' care pathway.
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Affiliation(s)
- Dalia G Mahran
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Osama Farouk
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
| | - Mervat A Ismail
- Adult Nursing Department, Faculty of Nursing, Assiut University, Assiut, Egypt
| | - Mohamed M Alaa
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
| | - Amr Eisa
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
| | - Islam I Ragab
- Adult Medical Surgical Nursing Department, Faculty of Nursing, South Valley University, Qena, Egypt
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32
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Nutritional Status and Nutritional Treatment Are Related to Outcomes and Mortality in Older Adults with Hip Fracture. Nutrients 2018; 10:nu10050555. [PMID: 29710860 PMCID: PMC5986435 DOI: 10.3390/nu10050555] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/09/2018] [Accepted: 04/25/2018] [Indexed: 01/16/2023] Open
Abstract
Malnutrition is very prevalent in geriatric patients with hip fracture. Nevertheless, its importance is not fully recognized. The objective of this paper is to review the impact of malnutrition and of nutritional treatment upon outcomes and mortality in older people with hip fracture. We searched the PubMed database for studies evaluating nutritional aspects in people aged 70 years and over with hip fracture. The total number of studies included in the review was 44, which analyzed 26,281 subjects (73.5% women, 83.6 ± 7.2 years old). Older people with hip fracture presented an inadequate nutrient intake for their requirements, which caused deterioration in their already compromised nutritional status. The prevalence of malnutrition was approximately 18.7% using the Mini-Nutritional Assessment (MNA) (large or short form) as a diagnostic tool, but the prevalence was greater (45.7%) if different criteria were used (such as Body Mass Index (BMI), weight loss, or albumin concentration). Low scores in anthropometric indices were associated with a higher prevalence of complications during hospitalization and with a worse functional recovery. Despite improvements in the treatment of geriatric patients with hip fracture, mortality was still unacceptably high (30% within 1 year and up to 40% within 3 years). Malnutrition was associated with an increase in mortality. Nutritional intervention was cost effective and was associated with an improvement in nutritional status and a greater functional recovery. To conclude, in older people, the prevention of malnutrition and an early nutritional intervention can improve recovery following a hip fracture.
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Pre-fracture nutritional status is predictive of functional status at discharge during the acute phase with hip fracture patients: A multicenter prospective cohort study. Clin Nutr 2017; 36:1320-1325. [DOI: 10.1016/j.clnu.2016.08.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 08/04/2016] [Accepted: 08/21/2016] [Indexed: 11/20/2022]
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34
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Zhang Z, Pereira SL, Luo M, Matheson EM. Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis. Nutrients 2017; 9:E829. [PMID: 28771192 PMCID: PMC5579622 DOI: 10.3390/nu9080829] [Citation(s) in RCA: 265] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/22/2017] [Accepted: 07/31/2017] [Indexed: 01/04/2023] Open
Abstract
Malnutrition is a common yet under-recognized problem in hospitalized patients. The aim of this paper was to systematically review and evaluate malnutrition biomarkers among order adults. Eligible studies were identified through Cochrane, PubMed and the ProQuest Dialog. A meta-regression was performed on concentrations of biomarkers according to malnutrition risks classified by validated nutrition assessment tools. A total of 111 studies were included, representing 52,911 participants (55% female, 72 ± 17 years old) from various clinical settings (hospital, community, care homes). The estimated BMI (p < 0.001) and concentrations of albumin (p < 0.001), hemoglobin (p < 0.001), total cholesterol (p < 0.001), prealbumin (p < 0.001) and total protein (p < 0.05) among subjects at high malnutrition risk by MNA were significantly lower than those without a risk. Similar results were observed for malnutrition identified by SGA and NRS-2002. A sensitivity analysis by including patients with acute illness showed that albumin and prealbumin concentrations were dramatically reduced, indicating that they must be carefully interpreted in acute care settings. This review showed that BMI, hemoglobin, and total cholesterol are useful biomarkers of malnutrition in older adults. The reference ranges and cut-offs may need to be updated to avoid underdiagnosis of malnutrition.
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Affiliation(s)
- Zhiying Zhang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA.
- Abbott Nutrition Research and Development Asia-Pacific Center, 138668 Singapore, Singapore.
| | | | - Menghua Luo
- Abbott Nutrition Research and Development, Columbus, OH 43219, USA.
| | - Eric M Matheson
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29412, USA.
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35
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Helminen H, Luukkaala T, Saarnio J, Nuotio M. Comparison of the Mini-Nutritional Assessment short and long form and serum albumin as prognostic indicators of hip fracture outcomes. Injury 2017; 48:903-908. [PMID: 28249678 DOI: 10.1016/j.injury.2017.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/10/2017] [Accepted: 02/16/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Malnutrition is common among older hip fracture patients and associated with adverse outcomes. We examined Mini Nutritional Assessment short (MNA-SF) and long form (MNA-LF) and serum albumin as prognostic indicators of mobility, living arrangements and mortality after hip fracture. METHODS Population-based prospective data were collected on 594 hip fracture patients aged 65 and over. MNA-SF, MNA-LF and serum albumin were assessed on admission. Outcomes were poorer mobility; transfer to more assisted living accommodation and mortality one month, four months and one year post fracture. Logistic regression analyses for mobility and living arrangements with odds ratios (OR) and Cox proportional hazards model for mortality with hazard ratios (HR) and 95% confidence intervals (CI) were used, adjusted for age, gender, ASA grade and fracture type. RESULTS All measures predicted mortality at all time-points. Risk of malnutrition and malnutrition measured by MNA-LF predicted mobility and living arrangements within four months of hip fracture. At one year, risk of malnutrition predicted mobility and malnutrition predicted living arrangements, when measured by MNA-LF. Malnutrition, but not risk thereof, measured by MNA-SF predicted living arrangements at all time-points. None of the measures predicted one-month mobility. CONCLUSIONS All measures were strong indicators of short- and long-term mortality after hip fracture. MNA-LF was superior in predicting mobility and living arrangements, particularly at four months. All measures were relatively poor in predicting short-term outcomes of mobility and living arrangements.
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Affiliation(s)
- Heli Helminen
- Department of Surgical, Seinäjoki Central Hospital, Seinäjoki, Finland.
| | - Tiina Luukkaala
- Science Center Pirkanmaa Hospital District, Tampere Finland and School of Health Sciences, University of Tampere, Finland
| | - Juha Saarnio
- Department of Surgical, Oulu University Hospital, Oulu, Finland
| | - Maria Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Impaired nutritional status in geriatric trauma patients. Eur J Clin Nutr 2017; 71:602-606. [DOI: 10.1038/ejcn.2017.25] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/23/2017] [Accepted: 02/09/2017] [Indexed: 02/01/2023]
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Nutritional assessment of community-dwelling older adults in rural Nepal. PLoS One 2017; 12:e0172052. [PMID: 28196115 PMCID: PMC5308814 DOI: 10.1371/journal.pone.0172052] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 01/30/2017] [Indexed: 11/19/2022] Open
Abstract
Background Demographic transition in Nepal, like in many developing countries, has resulted in a burgeoning elderly population whose health status is not currently monitored. One pillar of health is adequate nutrition. Yet, little is known about the nutritional health status of the elderly in Nepal. The financial, material, and personnel limitations in Nepal’s health delivery services necessitate health screening instruments that require minimal clinical staff and resources. To our knowledge, no such nutritional assessment tool has been validated in Nepal. Therefore, our aims are two-fold: To assess the nutritional status of the elderly population in one typical Nepali village, Okharpauwa, in Nuwakot District, Nepal; and concurrently, to validate the Mini Nutritional Assessment (MNA) tool. Methods A cross-sectional field study was conducted with a sample of 242 elderly people in Okharpauwa, Nepal to obtain prevalence of malnutrition. Differences in demographic and lifestyle factors between these who were malnourished, those at risk of malnourishment, and those who had adequate nutritional status were analyzed. The MNA tool was evaluated using receiver operating characteristic (ROC) curve analysis; sensitivity, specificity, and diagnostic accuracy were calculated. Results 111 males and 131 females, with a mean age of 69.8±7.4 years, participated in this study. The mean BMI of the participants was 21.4±3.9 kg/m2; the mean MNA score was 19.3±4.2. BMI was significantly correlated with the total MNA score (r = 0.58; p<0.001). The diagnostic accuracy, sensitivity and specificity of MNA were 81%, 86% and 67% respectively. Of the 242 elderly sampled, 24% were malnourished and 65% were at risk of malnutrition. Malnutrition was more prevalent among females (29%) than males (18%), and most prevalent among the marginalized Dalit ethnic group (40%). Elderly persons who were married and literate had better nutritional health than their counterparts. Conclusions The MNA appears to be a valid and sensitive tool for rapid nutritional screening of the elderly in Nepal. The prevalence of malnutrition was high among Nepalese elderly in the Okharpauwa VDC, which requires urgent health monitoring and management attention.
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Risk Factors for In-Hospital Complications of Fall-Related Fractures among Older Chinese: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8612143. [PMID: 28105435 PMCID: PMC5220428 DOI: 10.1155/2016/8612143] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/07/2016] [Indexed: 11/26/2022]
Abstract
Purpose. The aim of this study was to investigate the risk factors and the efficacy of the preventive measurements for the in-hospital complications of fall-related fractures. Methods. The data on older Chinese patients with fall-related fractures were collected, including information on the patients, diseases, and preventive measurements. The potential risk factors for the in-hospital complications included health status on admission, comorbidity, fractures, preventive measures of the complications, and drugs use for the comorbidity. After univariate analyses, multivariate logistic regression analyses were applied to investigate the impact of the potential risk factors on the number of the complications and each individual complication, respectively, and the efficacy of the preventive measurements. Results. A total of 525 male and 1367 female were included in this study. After univariate analyses, multiple logistic regression showed that dementia, pneumonia, antidepressant, postural hypotension, and cerebral infarction could increase the incidence and number of comorbidities. Meanwhile, dementia has shown the strongest association with each individual complication. Conclusions. Different combinations of comorbidity, medication use, and preventive measurements were related to the in-hospital complications of fall-related fractures. Dementia emerged as the most important risk factor for these complications, while most of the preventive measurements could not reduce their incidences.
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Malnutrition Predicts Infectious and Wound Complications Following Posterior Lumbar Spinal Fusion. Spine (Phila Pa 1976) 2016; 41:1693-1699. [PMID: 27035584 DOI: 10.1097/brs.0000000000001591] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of data collected prospectively by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). OBJECTIVE The aim of this study was to investigate the association between preoperative hypoalbuminemia, a marker for malnutrition, and complications during the 30 days following posterior lumbar fusion surgery. SUMMARY OF BACKGROUND DATA Malnutrition is a potentially modifiable risk factor that may contribute to complications following spinal surgery. Although prior studies have identified associations between malnutrition, delayed wound healing, and surgical site infection (SSI), the evidence for such a relationship within spine surgery is mixed. METHODS Patients who underwent posterior lumbar spinal fusion of one to three levels as part of the ACS-NSQIP were identified. Patients without preoperative serum albumin concentration were excluded. Outcomes were compared between patients with and without hypoalbuminemia (defined as serum albumin concentration <3.5 g/dL). All comparisons were adjusted for baseline differences between populations. RESULTS Four thousand three hundred ten patients were included. The prevalence of hypoalbuminemia was 4.8%. In comparison to patients with normal albumin concentration, patients with hypoalbuminemia had a higher risk for occurrence of wound dehiscence [1.5% vs. 0.2%, adjusted relative risk (RR) = 5.8, P = 0.006], SSI (5.4% vs. 1.7%, adjusted RR = 2.3, P = 0.010), and urinary tract infection (5.4% vs. 1.5%, adjusted RR = 2.5, P = 0.005). Similarly, patients with hypoalbuminemia had a higher risk for unplanned hospital readmission within 30 days of surgery (11.7% vs. 5.4%, RR = 1.8, P < 0.001). Finally, patients with hypoalbuminemia had a longer mean inpatient stay (5.2 vs. 3.7 days, RR = 1.2, P < 0.001). CONCLUSION The present study suggests that malnutrition is an independent risk factor for infectious and wound complications following posterior lumbar fusion. Malnutrition was also associated with an increased length of stay and readmission. Future studies should evaluate methods of correcting malnutrition before lumbar spinal surgery. Such efforts have the potential to meaningfully decrease the rates of adverse events following this procedure. LEVEL OF EVIDENCE 3.
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Koren-Hakim T, Weiss A, Hershkovitz A, Otzrateni I, Anbar R, Gross Nevo RF, Schlesinger A, Frishman S, Salai M, Beloosesky Y. Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients. Clin Nutr 2016; 35:1053-8. [DOI: 10.1016/j.clnu.2015.07.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 04/30/2015] [Accepted: 07/15/2015] [Indexed: 11/28/2022]
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Sayeed Z, Anoushiravani AA, Chambers MC, Gilbert TJ, Scaife SL, El-Othmani MM, Saleh KJ. Comparing In-Hospital Total Joint Arthroplasty Outcomes and Resource Consumption Among Underweight and Morbidly Obese Patients. J Arthroplasty 2016; 31:2085-90. [PMID: 27080111 DOI: 10.1016/j.arth.2016.03.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/24/2016] [Accepted: 03/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND As orthopedic surgeons search for objective measures that predict total joint arthroplasty (TJA) outcomes, body mass index may aid in risk stratification. The purpose of this study was to compare in-hospital TJA outcomes and resource consumption amongst underweight (body mass index ≤19 kg/m(2)) and morbidly obese patients (≥40 kg/m(2)). METHODS Discharge data from 2006 to 2012 National Inpatient Sample were used for this study. A total of 1503 total hip arthroplasty (THA) and 956 total knee arthroplasty (TKA) patients were divided into 2 cohorts, underweight (≤19 kg/m(2)) and morbidly obese (≥40 kg/m(2)). Patients were matched by gender and 27 comorbidities by use of Elixhauser Comorbidity Index. Patients were compared for 13 in-hospital postoperative complications, length of stay, total hospital charge, and disposition. Multivariate analyses were generated by SAS software. Significance was assigned at P value <.05. RESULTS Underweight patients undergoing primary TJA had higher risk for developing postoperative anemia compared with morbidly obese patients (TKA: odds ratio [OR], 3.1; 95% CI, 2.3-4.1; THA: OR, 1.8; 95% CI, 1.5-2.3). Underweight THA candidates displayed greater risk for deep venous thrombosis (75.36% vs 24.64%; OR, 3.1; 95% CI, 1.1-8.4). Underweight TJA patients were charged more (TKA: USD 51,368.90 vs USD 40,128.80, P = .001, THA: USD 57,451.8 vs USD 42,776.9, P < .001) compared to the morbidly obese patients. Length of stay was significantly longer for underweight THA patients (4.6 days vs 3.5 days, P = .008) compared to morbidly obese counterparts. CONCLUSION Our results indicate underweight, compared to morbidly obese, TJA patients are at a greater risk for postoperative anemia and consume more resources.
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Affiliation(s)
- Zain Sayeed
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
| | - Afshin A Anoushiravani
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Theodore J Gilbert
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Steven L Scaife
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Mouhanad M El-Othmani
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
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Özbilgin Ş, Hancı V, Ömür D, Özbilgin M, Tosun M, Yurtlu S, Küçükgüçlü S, Arkan A. Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit. Medicine (Baltimore) 2016; 95:e5038. [PMID: 27749567 PMCID: PMC5059069 DOI: 10.1097/md.0000000000005038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 12/21/2022] Open
Abstract
The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality.At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count. Patients were monitored for postoperative complications until death or discharge. Correlation of complications with these parameters was also analyzed.A total of 152 patients were included in the study. In this study a positive correlation was determined between mortality and NRS-2002, SGA, CCI, Acute Physiology and Chronic Health Evaluation , Sepsis-related Organ Failure Assessment, and NUTRIC score, whereas a negative correlation was determined between mortality and NRI. There was a correlation between NUTRIC score and pneumonia, development of atrial fibrillation, delirium, renal failure, inotrope use, and duration of mechanical ventilation. In our study group of postoperative patients, MNA had no predictive properties for any complication, whereas SGA had no predictive properties for any complications other than duration of hospital stay and mortality.The NUTRIC score is an important indicator of mortality and morbidity in postoperative surgical patients. NRI correlated with many postoperative complications, and though SGA and NRS were correlated with mortality, they were not correlated with the majority of complications. MNA was determined not to have any correlation with any complication, mortality, and duration of hospital stay in our patient group.
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Affiliation(s)
- Şule Özbilgin
- Dokuz Eylul University, School of Medicine, Department of Anesthesiology and Reanimation
| | - Volkan Hancı
- Dokuz Eylul University, School of Medicine, Department of Anesthesiology and Reanimation
| | - Dilek Ömür
- Dokuz Eylul University, School of Medicine, Department of Anesthesiology and Reanimation
| | - Mücahit Özbilgin
- Dokuz Eylul University, School of Medicine, Department of General Surgery
| | - Mine Tosun
- Dokuz Eylül University, Faculty of Medicine, Postoperatif Care Unit, Izmir, Turkey
| | - Serhan Yurtlu
- Dokuz Eylul University, School of Medicine, Department of Anesthesiology and Reanimation
| | - Semih Küçükgüçlü
- Dokuz Eylul University, School of Medicine, Department of Anesthesiology and Reanimation
| | - Atalay Arkan
- Dokuz Eylul University, School of Medicine, Department of Anesthesiology and Reanimation
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Eschbach D, Kirchbichler T, Wiesmann T, Oberkircher L, Bliemel C, Ruchholtz S, Buecking B. Nutritional intervention in cognitively impaired geriatric trauma patients: a feasibility study. Clin Interv Aging 2016; 11:1239-1246. [PMID: 27672318 PMCID: PMC5026212 DOI: 10.2147/cia.s109281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Most studies focusing on improving the nutritional status of geriatric trauma patients exclude patients with cognitive impairment. These patients are especially at risk of malnutrition at admission and of worsening during the perioperative fasting period. This study was planned as a feasibility study to identify the difficulties involved in including this high-risk collective of cognitively impaired geriatric trauma patients. Patients and methods This prospective intervention study included cognitively impaired geriatric patients (Mini–Mental State Examination <25, age >65 years) with hip-related fractures. We assessed Mini Nutritional Assessment (MNA), Nutritional Risk Screening (NRS 2002), body mass index, calf circumference, American Society of Anesthesiologists’ classification, and Braden Scale. All patients received parenteral nutritional supplementation of 800 kcal/d for the 96-hour perioperative period. Serum albumin and pseudocholinesterase were monitored. Information related to the study design and any complications in the clinical course were documented. Results A total of 96 patients were screened, among whom eleven women (median age: 87 years; age range: 74–91 years) and nine men (median age: 82 years; age range: 73–89 years) were included. The Mini–Mental State Examination score was 9.5 (0–24). All patients were manifestly undernourished or at risk according to MNA and NRS 2002. The body mass index was 23 kg/m2 (13–30 kg/m2), the calf circumference was 29.5 cm (18–34 cm), and the mean American Society of Anesthesiologists’ classification status was 3 (2–4). Braden Scale showed 18 patients at high risk of developing pressure ulcers. In all, 12 patients had nonsurgical complications with 10% mortality. Albumin as well as pseudocholinesterase dropped significantly from admission to discharge. The study design proved to be feasible. Conclusion The testing of MNA and NRS 2002 was feasible. Cognitively impaired trauma patients proved to be especially at risk of malnutrition. Since 96 hours of parenteral nutrition as a crisis intervention was insufficient, additional supplementation could be considered. Laboratory and functional outcome parameters for measuring successive supplementation certainly need further evaluations involving randomized controlled trials.
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Affiliation(s)
- D Eschbach
- Center for Orthopedics and Trauma Surgery
| | | | - T Wiesmann
- Department of Anaesthesiology and Critical Care, University of Marburg, Marburg, Germany
| | | | - C Bliemel
- Center for Orthopedics and Trauma Surgery
| | | | - B Buecking
- Center for Orthopedics and Trauma Surgery
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Eschbach D, Kirchbichler T, Oberkircher L, Knobe M, Juenemann M, Ruchholtz S, Buecking B. Management of malnutrition in geriatric trauma patients: results of a nationwide survey. Eur J Trauma Emerg Surg 2016; 42:553-558. [DOI: 10.1007/s00068-016-0698-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
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Enhanced interdisciplinary care improves self-care ability and decreases emergency department visits for older Taiwanese patients over 2 years after hip-fracture surgery: A randomised controlled trial. Int J Nurs Stud 2016; 56:54-62. [DOI: 10.1016/j.ijnurstu.2015.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 11/03/2015] [Accepted: 12/14/2015] [Indexed: 12/29/2022]
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Martín A, Ruiz E, Sanz A, García JM, Gómez-Candela C, Burgos R, Matía P, Ramalle-Gomera E. Accuracy of Different Mini Nutritional Assessment Reduced Forms to Evaluate the Nutritional Status of Elderly Hospitalised Diabetic Patients. J Nutr Health Aging 2016; 20:370-5. [PMID: 26999235 DOI: 10.1007/s12603-015-0618-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Disease-associated malnutrition (DAM) is a health problem involving all sanitary levels, especially hospitalised elderly patients. Different MNA (Mini Nutritional Assessment)-based forms have been validated in different settings, but it remains unclear if they are appropriate to evaluate the nutritional status of geriatric hospitalised patients with diabetes. OBJECTIVE The aim of this work was to analyse the accuracy of several MNA reduced forms to detect malnutrition in hospitalised elderly diabetic patients. METHODS A multicentre observational study was carried out in diabetic patients, who were over the age of 65, from 35 Spanish hospitals. Principal component analysis (PCA) selected the minimal components to elaborate the newly-proposed reduced new version of the MNA (r-MNA). Cohen's Kappa index (KI), with its 95% confidence interval (CI), was used to measure the agreement between the different reduced forms (r-MNA, MNA-SF-BMI, MNA-SF-CC, m-MNA) with the original MNA. RESULTS Five hundred and ninety-one elderly diabetic patients were included in the study. ROC analysis determined the following cut-off points for the newly proposed r MNA: 0-<10 "malnourished", 10-12 "at risk" and >12-15 "well-nourished". The upper cut-off point demonstrated a sensitivity of 87.7%, a specificity of 78.3% and an area under the curve of 0.93. The lower cut-off point showed a sensitivity of 95.9%, a specificity of 78.3% and an area under the curve of 0.95. The best agreement with the original MNA was observed for the MNA-SF-BMI (Κ index 80.7; 95% CI: 77.4-84) and the worst for the r-MNA (Κ index 72; 95% CI: 68.2-75.4). CONCLUSIONS This study found that MNA-SF-BMI is the most accurate screening tool for determining the nutritional status of hospitalised diabetic elderly patients. This is an easy-to-use, fast screening tool with a low risk of misclassification.
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Affiliation(s)
- A Martín
- Angela Martín MD, Unidad de Nutrición Clínica. Servicio de Endocrinología, Hospital de San Pedro. C/Piqueras 98. Logroño, Spain, Phone: 0034941298000,
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Tseng MY, Liang J, Shyu YIL, Wu CC, Cheng HS, Chen CY, Yang SF. Effects of interventions on trajectories of health-related quality of life among older patients with hip fracture: a prospective randomized controlled trial. BMC Musculoskelet Disord 2016; 17:114. [PMID: 26936194 PMCID: PMC4776406 DOI: 10.1186/s12891-016-0958-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/19/2016] [Indexed: 11/30/2022] Open
Abstract
Background Health-related quality of life (HRQoL) has been used to assess subjects’ prognosis and recovery following hip fracture. However, evidence is mixed regarding the effectiveness of interventions to improve HRQoL of elders with hip fracture. The purposes of this study were to identify distinct HRQoL trajectories and to evaluate the effects of two care models on these trajectories over 12 months following hip-fracture surgery. Methods For this secondary analysis, data came from a randomized controlled trial of subjects with hip fracture receiving three treatment care models: interdisciplinary care (n = 97), comprehensive care (n = 91), and usual care (n = 93). Interdisciplinary care consisted of geriatric consultation, discharge planning, and 4 months of in-home rehabilitation. Comprehensive care consisted of interdisciplinary care plus management of malnutrition and depressive symptoms, fall prevention, and 12 months of in-home rehabilitation. Usual care included only in-hospital rehabilitation and occasional discharge planning, without geriatric consultation and in-home rehabilitation. Mental and physical HRQoL were measured at 1, 3, 6, and 12 months after discharge by the physical component summary scale (PCS) and mental component summary scale (MCS), respectively, of the Medical Outcomes Study Short Form 36, Taiwan version. Latent class growth modeling was used to identify PCS and MCS trajectories and to evaluate how they were affected by the interdisciplinary and comprehensive care models. Results We identified three quadratic PCS trajectories: poor PCS (n = 103, 36.6 %), moderate PCS (n = 96, 34.2 %), and good PCS (n = 82, 29.2 %). In contrast, we found three linear MCS trajectories: poor MCS (n = 39, 13.9 %), moderate MCS (n = 84, 29.9 %), and good MCS (n = 158, 56.2 %). Subjects in the comprehensive care and interdisciplinary care groups were more likely to experience a good PCS trajectory (b = 0.99, odds ratio [OR] = 2.69, confidence interval [CI] = 7.24–1.00, p = 0.049, and b = 1.32, OR = 3.75, CI = 10.53–1.33, p = 0.012, respectively) than those who received usual care. However, neither care model improved MCS. Conclusions The interdisciplinary and comprehensive care models improved recovery from hip fracture by increasing subjects’ odds for following a trajectory of good physical functioning after hospitalization. Trial registration ClinicalTrials.gov (NCT01350557)
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Affiliation(s)
- Ming-Yueh Tseng
- Department of Nursing, Meiho University, 23 Pingguang Road, Neipu, Pingtung, 91202, Taiwan.
| | - Jersey Liang
- School of Public Health, University of Michigan, 1415 Washington Heights, M3007 SPH II, Ann Arbor, MI, 48109, USA. .,Institute of Gerontology, University of Michigan, 1415 Washington Heights, M3007 SPH II, Ann Arbor, MI, 48109, USA.
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan, 33302, Taiwan. .,Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan, 33302, Taiwan.
| | - Chi-Chuan Wu
- Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan District, Taoyuan, 33305, Taiwan.
| | - Huey-Shinn Cheng
- Department of Internal Medicine, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan District, Taoyuan, 33305, Taiwan.
| | - Ching-Yen Chen
- Section of General Psychiatry, Department of Psychiatry, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Guishan District, Taoyuan, 33305, Taiwan.
| | - Shu-Fang Yang
- School of Nursing, College of Medicine, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan, 33302, Taiwan.
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Chu CS, Liang CK, Chou MY, Lin YT, Hsu CJ, Chou PH, Chu CL. Short-Form Mini Nutritional Assessment as a useful method of predicting the development of postoperative delirium in elderly patients undergoing orthopedic surgery. Gen Hosp Psychiatry 2016; 38:15-20. [PMID: 26412147 DOI: 10.1016/j.genhosppsych.2015.08.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/25/2015] [Accepted: 08/26/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Postoperative delirium (POD) is a major cause for concern among elderly patients undergoing surgery, often resulting in poor outcome. It is therefore important to predict and prevent POD. The aim of this study was to evaluate the Mini Nutritional Assessment Short-Form (MNA-SF) as a predictor of POD after orthopedic surgery. METHODS Elderly patients undergoing orthopedic surgery between April 2011 and March 2013 were included in the study (n=544; mean age, 74.24 ± 7.92 years). The MNA-SF was used to evaluate preoperative nutritional status. Delirium was assessed daily after surgery using the confusion assessment method. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria were used to confirm delirium diagnosis. Univariate and multivariate logistic regression analyses were performed to identify key factors associated with POD. RESULTS POD occurred in 52 patients (9.6%). According to the MNA-SF, 17.5% of subjects were at risk of undernutrition. Adjusting for all potential factors in the final model, age, male gender and lower Mini-Mental State Examination and higher Charlson Comorbidity Index scores were associated with significantly increased likelihood of POD. Subjects who were identified preoperatively as at risk of undernutrition were 2.85 times more likely to develop POD compared to normally nourished subjects (odds ratio: 2.85, 95% confidence interval: 1.19-6.87). CONCLUSIONS These results suggest that the MNA-SF is a simple and effective tool that can be used to predict incident delirium in elderly patients after orthopedic surgery.
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Affiliation(s)
- Che-Sheng Chu
- Department of Psychiatry, Puli Branch, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chien-Jen Hsu
- Department of Medical Education, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Po-Han Chou
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung City, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Chin-Liang Chu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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Machado RSP, Coelho MASC, Veras RP. Validity of the portuguese version of the mini nutritional assessment in brazilian elderly. BMC Geriatr 2015; 15:132. [PMID: 26493313 PMCID: PMC4619212 DOI: 10.1186/s12877-015-0129-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 10/12/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Malnutrition is common and affects negatively the health of the older adult. The Mini Nutritional Assessment (MNA), a nutritional assessment tool allows to identify elders malnourished and at risk of malnutrition. The aim of this study is to validate the Portuguese version of the MNA. METHODS Cross-sectional study with 344 Brazilian elderly. The full version of the MNA was performed, also calf circumference (CC), mid arm circumference (MAC) and body fat (BF). Psychometric evaluation was carried out and correlation, diagnostic accuracy and ROC curves were generated. RESULTS Construct validity was supported, all four questionnaire dimensions were evidenced in the Principal Component Analysis and also significant Spearman correlation (P < 0.001) were demonstrated. Criterion validity was also evidenced with relevant sensitivity (MAC = 82.8; CI95% = 64.2-94.2) and specificity (CC = 80.0; CI95% = 74.0-85.1). In the ROC curve AUC was excellent (MAC = 0.832; CI95% =0.785-0.873). CONCLUSIONS The full MNA demonstrated significant results and sufficient exploratory psychometric properties that supported its validity. It seems to be valid tool to access nutritional status of Brazilian elderly.
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Affiliation(s)
- Renata Santos Pereira Machado
- Instituto de Nutrição Josué de Castro - INJC, Universidade Federal do Rio de Janeiro - UFRJ, Av. Carlos Chagas Filho, 373 - Ed. do Centro de Ciências da Saúde, Bloco J / 2° andar. Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brasil.
| | - Maria Auxiliadora Santa Cruz Coelho
- Instituto de Nutrição Josué de Castro - INJC, Universidade Federal do Rio de Janeiro - UFRJ, Av. Carlos Chagas Filho, 373 - Ed. do Centro de Ciências da Saúde, Bloco J / 2° andar. Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brasil.
| | - Renato Peixoto Veras
- Universidade Aberta da Terceira Idade - UnATI, Universidade Estadual do Rio de Janeiro - UERJ, Rio de Janeiro, Brasil.
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Nuotio M, Tuominen P, Luukkaala T. Association of nutritional status as measured by the Mini-Nutritional Assessment Short Form with changes in mobility, institutionalization and death after hip fracture. Eur J Clin Nutr 2015; 70:393-8. [DOI: 10.1038/ejcn.2015.174] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 01/10/2023]
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