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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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High Lymphocyte Count as a Significant Risk Factor for Incisional Hernia After Laparoscopic Colorectal Surgery. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2023; 33:69-75. [PMID: 36630645 DOI: 10.1097/sle.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND In the era of laparoscopic surgery, incisional hernia (IH) remains a common complication of colorectal surgery. Various risk factors for IH have been evaluated to reduce the incidence, but the impact of nutrition on IH has not been well discussed. The aim of this study is to evaluate the relationship between nutritional status and the development of IH after laparoscopic colorectal surgery. MATERIALS AND METHODS We retrospectively evaluated 342 colorectal cancer patients undergoing laparoscopic colectomy or proctectomy between January 2012 and December 2018. Postoperative computed tomography was used to diagnose the IH. Patient characteristics, including preoperative albumin and lymphocyte counts, were evaluated for the risk of development of IH. Further investigations were conducted regarding the impact of nutritional status on the development of IH in each patient of body mass index (BMI) under and over 25.0 kg/m 2 . RESULTS IH was observed in 37 patients (10.8%), with a median follow-up period of 48.5 months. Female [odds ratio (OR)=3.43, P <0.01], BMI ≥25 kg/m 2 (OR=2.9, P <0.01), lymphocyte count ≥1798/µL (OR=3.37, P <0.01), and operative time ≥254 minutes (OR=3.90, P <0.01) had statistically significant relationships to IH in multivariate analysis. Low albumin was related to IH in BMI ≥25 kg/m 2 ( P =0.02), but was not in BMI<25 kg/m 2 ( P =0.21). On the other hand, a high lymphocyte count was related to IH regardless of BMI (BMI ≥25 kg/m 2 : P =0.01, BMI<25 kg/m 2 : P =0.04). CONCLUSIONS A high preoperative lymphocyte count is an independent risk factor for IH, whereas a low albumin count is limited regarding predicting IH.
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Trovato CM, Capriati T, Bolasco G, Campana C, Papa V, Mazzoli B, Zanna V, Marchili MR, Basso MS, Maggiore G, Diamanti A. Five-Year Inpatient Management of Teenagers With Anorexia Nervosa: Focus on Nutritional Issues. J Pediatr Gastroenterol Nutr 2022; 74:674-680. [PMID: 35149647 DOI: 10.1097/mpg.0000000000003410] [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: 12/10/2022]
Abstract
OBJECTIVES In patients with Anorexia Nervosa (AN) malnutrition can lead to life-long nutritional treatments. The refeeding process can combine natural feeding (NF) with specific nutritional strategies, including oral nutritional supplements (ONS) and nasogastric feeding (NGF). Aims of the present study were to assess the efficacy of hospital protocol and identify the most effective inpatient nutritional strategies for weight restoration. METHODS All patients hospitalized from April 2015 to April 2020 were enrolled. According to hospital protocol, NF was proposed to all patients; ONS were combined with NF if caloric intake was <70% of the requirements and NGF was added if caloric intake did not reach 30% in the first week from admission. RESULTS Overall, 186 patients [M = 20; median age 14 (interquartile range 1316)] were included. Nutritional issues were the main indication to admission (56.6%). A significant effect of combination treatment, with a shorter duration of hospitalization when using ONS with NGF in addition to NF was found (ß: -20.28 [95% confidence interval -34.92:-5.65], P < 0.001). Only one patient showed a significant but limited increase of liver enzymes. CONCLUSIONS We provide a safe and effective standardized protocol to treat the malnutrition of teenagers with AN in an inpatient setting. Malnutrition was the most important cause of admission, and more than half of the patients admitted were severely malnourished. The combination of NF, ONS, and NGF was the most effective strategy to achieve the weight restoration; however, this result should be validated on larger series of patients treated with NGF and NF.
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Affiliation(s)
| | | | | | | | | | | | - Valeria Zanna
- the Department of Neuroscience, Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry
| | | | - Maria Sole Basso
- the Hepatology Gastroenterology and Nutrition Unit, I.R.C.C.S. Bambino Gesti Children's Hospital, Rome, italy
| | - Giuseppe Maggiore
- Gastroenterology and Nutritional Rehabilitation Unit
- the Hepatology Gastroenterology and Nutrition Unit, I.R.C.C.S. Bambino Gesti Children's Hospital, Rome, italy
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Rogulska J, Osowska S, Kunecki M, Sobocki J, Ładyżyński P, Giebułtowicz J. Antioxidant balance in plasma of patients on home parenteral nutrition: A pilot study comparing three different lipid emulsions. Clin Nutr 2021; 40:3950-3958. [PMID: 34139468 DOI: 10.1016/j.clnu.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/23/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND & AIMS Parenteral nutrition (PN) can supply all essential nutrients to a patient with gastrointestinal insufficiency. However, the sensitivity to lipid peroxidation might increase in those receiving PN, especially home parenteral nutrition (HPN). This study aimed to investigate whether PN affects the antioxidant balance of plasma of HPN patients without comorbidities and whether this balance is influenced by comorbidities and according to the type of lipid emulsion included in the PN. METHODS Adult patients on HPN (n = 86) received one of three types of lipid emulsion (based on 1) soyabean oil, 2) olive and soyabean oil or 3) soyabean, coconut, olive and fish oil) in all-in-one mixtures; in addition healthy controls (n = 66) were studied as comparators. HPN patients were classified to the following subgroups: 1) patients without (n = 58) or with (n = 28) comorbidities 2) patients on Intralipid (GINTRA, n = 53), ClinOleic (GCLIN, n = 17) or SMOFlipid (GSMOFn = 16). The activities of total glutathione peroxidase (GSH-Px), selenium dependent glutathione peroxidase (Se-GSHPx) and glutathione S-transferase (GST) in plasma were determined spectrophotometrically. The antioxidant potential of plasma was determined using oxygen radical absorbance capacity (ORAC). The lipid peroxidation marker malondialdehyde (MDA) was analyzed with high performance liquid chromatography. RESULTS MDA concentration was the highest in GINTRA and the lowest in GSMOF (p < 0.05). GSMOF also had the highest activity of GSH-Px. No differences in Se-GSHPx, GST and ORAC were observed among GINTRA, GCLIN and GSMOF. Comparing with healthy controls, significantly lower GST (p = 0.0293) and ORAC (p < 0.0001) were observed in the HPN patients. Among all measured parameters only the concentration of MDA was significantly higher in patients with comorbidities compared to those without them. Comorbidities did not influence MDA level in GINTRA and GSMOF being still the lowest in GSMOF (p = 0.0033). In contrast, significantly higher MDA level was observed for GCLIN in those with vs. without comorbidities (p = 0.0262). CONCLUSIONS Patients on HPN have lower antioxidant defenses than healthy controls. The type of lipid emulsion used in HPN affects lipid peroxidation (even after taking into account comorbidities which often involve oxidative stress) being the highest in GINTRA and the lowest in GSMOF. Thus, to minimize the risk of oxidative stress, SMOFlipid can be considered in patients in HPN especially for those with comorbidities. ClinOleic can be considered in HPN patients without comorbidities. The observation should be confirmed in larger studies.
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Affiliation(s)
- Joanna Rogulska
- Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.
| | - Sylwia Osowska
- Department of Clinical Pharmacy, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.
| | - Marek Kunecki
- Clinical Nutrition Center, Pirogov Hospital, 191/195 Wólczańska Street, 90-001 Łódź, Poland.
| | - Jacek Sobocki
- Department of Clinical Nutrition and Surgery, Medical Center of Postgraduate Medical Education, Prof. Orłowski Hospital, 231 Czerniakowska Street, 00-416 Warsaw, Poland.
| | - Paweł Ładyżyński
- Interdisciplinary PhD Studies, Polish Academy of Sciences, 5 Jana Kazimierza Street, 01-248 Warsaw, Poland.
| | - Joanna Giebułtowicz
- Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha Street, 02-097 Warsaw, Poland.
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Yang JA, Lee KE, Park JH, Yee J, Kim JY, Gwak HS. Effects of Citrulline Supplementation on Body Weight in Patients With Hepatobiliary Pancreatic Surgery. Nutr Clin Pract 2019; 35:323-330. [PMID: 31606911 DOI: 10.1002/ncp.10395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many health benefits have been proposed for citrulline, but they lack evidence based on human research. This study was to evaluate whether an oral citrulline supplement affects body weight changes and laboratory values in patients with hepatobiliary and pancreatic surgery. METHODS Patients who underwent hepatobiliary and pancreatic surgery during January to June 2015 were screened for analysis. Patients using citrulline during hospital stay and at discharge were classified as the citrulline group, whereas those without any records of citrulline were designated as the control group. The primary efficacy outcome was the change in body weight at discharge and at first outpatient visit. Other outcomes included change in laboratory values. RESULTS A total of 138 patients were included in analysis. Citrulline group and control group did not differ with respect to baseline characteristics except for white blood cell count. Percent in change of body weight and body mass index from discharge to first outpatient visit was significantly different between the 2 groups, showing less weight loss in citrulline group than in controls (-0.8 ± 2.7% vs -2.5 ± 3.8%, P < 0.05). Especially in men, citrulline use significantly affected weight loss from the multivariate analysis (P < 0.05); percent change in weight in citrulline group was predicted to increase by 2.1 units. During hospital stay, significant differences between the 2 groups were found in changes of cholesterol and protein levels. CONCLUSION Citrulline supplement reduced weight loss in surgical patients during recovery.
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Affiliation(s)
- Jin A Yang
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul, Republic of Korea.,Department of Pharmacy, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Kyung Eun Lee
- College of Pharmacy, Chungbuk National University, Cheongju, Republic of Korea
| | - Ji Hyun Park
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea.,College of Pharmacy, Korea University, Sejong-si, Republic of Korea
| | - Jeong Yee
- College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Jae Youn Kim
- Department of Pharmacy, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Hye Sun Gwak
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul, Republic of Korea.,College of Pharmacy & Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
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Yoshitomi R, Nakayama M, Sakoh T, Fukui A, Katafuchi E, Seki M, Tsuda S, Nakano T, Tsuruya K, Kitazono T. High neutrophil/lymphocyte ratio is associated with poor renal outcomes in Japanese patients with chronic kidney disease. Ren Fail 2019; 41:238-243. [PMID: 30942116 PMCID: PMC6450582 DOI: 10.1080/0886022x.2019.1595645] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Several studies have shown that the neutrophil/lymphocyte ratio (NLR) is a marker that reflects the state of systemic inflammation. A high NLR was reported to be associated with cardiovascular events and mortality. However, little is known about the association between NLR and kidney disease progression in patients with chronic kidney disease (CKD). Therefore, the aim of the present study was to determine whether NLR is associated with renal outcomes in CKD patients. Methods: This prospective observational study included 350 consecutive patients with stage 1–4 CKD treated between June 2009 and November 2016. Data were collected until June 2017. The endpoint was the composite of end-stage renal disease requiring dialysis or death. Subjects were divided into two groups according to high and low NLR levels. A Cox proportional hazards model was used to determine the risk factors for composite outcomes. Results: The composite endpoint was observed in 83 patients during the median follow-up period of 31.8 months: 29 in the low NLR group and 54 in the high NLR group. Multivariable analysis showed that the high NLR group had a significant increase in the hazard ratio (HR) for composite outcomes (HR 1.67, 95% confidence interval 1.02–2.77) compared with the low NLR group. Conclusion: The present study demonstrated that a high NLR was associated with poor renal outcomes, suggesting that NLR may be a useful marker for prognostic prediction in patients with CKD.
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Affiliation(s)
- Ryota Yoshitomi
- a Department of Medicine and Clinical Science, Graduate School of Medical Sciences , Kyushu University , Higashi-ku , Japan.,b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Masaru Nakayama
- b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Teppei Sakoh
- b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Akiko Fukui
- b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Eisuke Katafuchi
- b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Makiko Seki
- b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Susumu Tsuda
- b Division of Nephrology and Clinical Research Institute, Department of Internal Medicine , National Hospital Organization Kyushu Medical Center , Chuo-ku , Japan
| | - Toshiaki Nakano
- a Department of Medicine and Clinical Science, Graduate School of Medical Sciences , Kyushu University , Higashi-ku , Japan
| | - Kazuhiko Tsuruya
- c Division of Nephrology , Nara Medical University , Kashihara , Japan
| | - Takanari Kitazono
- a Department of Medicine and Clinical Science, Graduate School of Medical Sciences , Kyushu University , Higashi-ku , Japan
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Scislo L, Pach R, Nowak A, Walewska E, Gadek M, Brandt P, Puto G, Szczepanik AM, Kulig J. The Impact of Postoperative Enteral Immunonutrition on Postoperative Complications and Survival in Gastric Cancer Patients - Randomized Clinical Trial. Nutr Cancer 2018. [PMID: 29533110 DOI: 10.1080/01635581.2018.1445770] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Immunomodulating enteral nutrition in the perioperative period may reduce postoperative complications in cancer patients. Little is known if this effect translates to the better survival. The aim of study was to assess the impact of postoperative immunomodulating enteral nutrition on postoperative complications and survival of gastric cancer patients. METHODS A group of 98 gastric cancer patients was randomly assigned for postoperative immunomodulating enteral nutrition n = 44 (Reconvan, Fresenius Kabi, Bad Homburg, Germany), or standard enteral nutrition n = 54 (Peptisorb, Nutricia, Schipol, The Netherlands). Postoperative complications, mortality, 6-mo and 1-yr survival were analyzed. RESULTS The overall postoperative morbidity did not differ between the groups. The rate of pulmonary complications (excluding pneumonia) was significantly lower in immunomodulation group (0% vs 9.3%, p = 0.044), as well as 60-day mortality (0% vs. 11.1%, p = 0.037). There was no difference in 6-mo and 1-yr survival between the groups. CONCLUSIONS Postoperative immunomodulating enteral nutrition may reduce respiratory complications and postoperative mortality in comparison to standard enteral nutrition. Despite this effect, it did not improve 6-mo and 1-yr survival in immunomodulation group. Probably the beneficial effect of immunomodulating enteral nutrition is too weak to be significant in such a number of patients.
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Affiliation(s)
- Lucyna Scislo
- a Clinical Nursing Unit, Nursing and Obstetrics Institute, Faculty of Health Sciences, Jagiellonian University Medical College , Krakow , Poland
| | - Radoslaw Pach
- b 1st Department of General, Oncological and Gastrointestinal Surgery , Jagiellonian University Medical College , Krakow , Poland
| | - Anna Nowak
- c 2nd Department of Surgery , Jagiellonian University Medical College , Krakow , Poland
| | - Elzbieta Walewska
- a Clinical Nursing Unit, Nursing and Obstetrics Institute, Faculty of Health Sciences, Jagiellonian University Medical College , Krakow , Poland
| | - Malgorzata Gadek
- b 1st Department of General, Oncological and Gastrointestinal Surgery , Jagiellonian University Medical College , Krakow , Poland
| | - Philip Brandt
- d Baystate Medical Centre , Springfield , Massachusetts , USA
| | - Grazyna Puto
- a Clinical Nursing Unit, Nursing and Obstetrics Institute, Faculty of Health Sciences, Jagiellonian University Medical College , Krakow , Poland
| | - Antoni M Szczepanik
- b 1st Department of General, Oncological and Gastrointestinal Surgery , Jagiellonian University Medical College , Krakow , Poland
| | - Jan Kulig
- b 1st Department of General, Oncological and Gastrointestinal Surgery , Jagiellonian University Medical College , Krakow , Poland
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Wleklik M, Uchmanowicz I, Jankowska-Polańska B, Andreae C, Regulska-Ilow B. The Role of Nutritional Status in Elderly Patients with Heart Failure. J Nutr Health Aging 2018; 22:581-588. [PMID: 29717757 DOI: 10.1007/s12603-017-0985-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Evidence indicates that malnutrition very frequently co-occurs with chronic heart failure (HF) and leads to a range of negative consequences. Studies show associations between malnutrition and wound healing disorders, an increased rate of postoperative complications, and mortality. In addition, considering the increasing age of patients with HF, a specific approach to their treatment is required. Guidelines proposed by the European Society of Cardiology (ESC) for treating acute and chronic HF refer to the need to monitor and prevent malnutrition in HF patients. However, the guidelines feature no strict nutritional recommendations for HF patients, who are at high nutritional risk as a group, nor do they offer any such recommendations for the poor nutritional status subgroup, for which high morbidity and mortality rates have been observed. In the context of multidisciplinary healthcare, recommended by the ESC and proven by research to offer multifaceted benefits, nutritional status should be systematically assessed in HF patients. Malnutrition has become a challenge within healthcare systems and day-to-day clinical practice, especially in developed countries, where it affects the course of disease and patients' prognosis.
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Affiliation(s)
- M Wleklik
- Izabella Uchmanowicz, Wroclaw Medical University, Wroclaw, Lower Silesia Poland,
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Doundoulakis I, Poulia KA, Antza C, Bouras E, Kasapidou E, Klek S, Chourdakis M. Screening for Malnutrition Among People Accessing Health Services at Greek Public Hospitals: Results From an Observational Multicenter Study. JPEN J Parenter Enteral Nutr 2017; 42:709-718. [DOI: 10.1177/0148607117722748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/30/2017] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Christina Antza
- Third Department of Internal Medicine, Aristotle University, Papageorgiou Hospital, Thessaloniki, Greece
| | - Emmanouil Bouras
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Kasapidou
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stanislaw Klek
- General and Oncology Surgery Unit, Stanley Dudrick’s Memorial Hospital, Skawina, Poland
| | - Michael Chourdakis
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Luma HN, Eloumou SAFB, Mboligong FN, Temfack E, Donfack OT, Doualla MS. Malnutrition in patients admitted to the medical wards of the Douala General Hospital: a cross-sectional study. BMC Res Notes 2017; 10:238. [PMID: 28673364 PMCID: PMC5496176 DOI: 10.1186/s13104-017-2592-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/30/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Malnutrition is common in acutely ill patients occurring in 30-50% of hospitalized patients. Awareness and screening for malnutrition is lacking in most health institutions in sub-Saharan Africa. This study aimed at screening for malnutrition using anthropometric and laboratory indices in patients admitted to the internal medicine wards. METHODS A cross-sectional study. We screened for malnutrition in 251 consecutive patients admitted from January to March 2013 in the internal medicine wards. Malnutrition defined as body mass index (BMI) less than 18.5 kg/m2 and/or mid upper arm circumference (MUAC) less than 22 cm in women and 23 cm in men. Weight loss greater than 10% in the last 6 months prior to admission, relevant laboratory data, diagnosis at discharge and length of hospital stay (LOS) were also recorded. RESULTS Mean age was 47 (SD 16) years. 52.6% were male. Mean BMI was 24.44 (SD 5.79) kg/m2 and MUAC was 27.8 (SD 5.0) cm. Median LOS was 7 (IQR 5-12) days. 42.4% of patients reported weight loss greater than 10% in the 6 months before hospitalization. MUAC and BMI correlated significantly (r = 0.78; p < 0.0001) and malnutrition by the two methods showed moderate agreement (κ = 0.56; p < 0.0001). Using the two methods in combination, the prevalence of malnutrition was 19.34% (35/251). Blood albumin and hemoglobin were significantly lower in malnourished patients. Malnourished patients had a significantly longer LOS (p = 0.019) when compared to those with no malnutrition. Malnutrition was most common amongst patients with malignancy. CONCLUSION Malnutrition is common in patients admitted to the medical wards of the Douala General Hospital. Nutritional screening and assessment should be integrated in the care package of all admitted patients.
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Affiliation(s)
- Henry Namme Luma
- Douala General Hospital, P.O. Box 4856 Douala, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | - Elvis Temfack
- Douala General Hospital, P.O. Box 4856 Douala, Cameroon
| | | | - Marie-Solange Doualla
- Douala General Hospital, P.O. Box 4856 Douala, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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Fujino M, Takahama H, Hamasaki T, Sekiguchi K, Kusano K, Anzai T, Noguchi T, Goto Y, Kitakaze M, Yokoyama H, Ogawa H, Yasuda S. Risk stratification based on nutritional screening on admission: Three-year clinical outcomes in hospitalized patients with acute heart failure syndrome. J Cardiol 2016; 68:392-398. [PMID: 27283339 DOI: 10.1016/j.jjcc.2016.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/17/2016] [Accepted: 05/07/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several blood tests are commonly used to assess nutritional status, including serum albumin levels (SAL) and lymphocyte counts (LC). The aim of this study is to investigate whether nutritional screening on admission can be used to determine risk levels for adverse clinical events in acute heart failure syndrome (AHFS) patients. METHODS In 432 consecutive AHFS patients, we measured SAL and LC and prospectively followed the patients for their combined clinical events (all-cause death and re-hospitalization for heart failure) for three years from admission. The classification and regression tree (CART) tool identified the cut-off criteria for SAL and LC to differentiate among patients with different risks of clinical events as 3.5g/dl and 963/mm3, respectively. RESULTS The CART tool classified 15.5% patients as high risk, 15.7% as intermediate risk, and 68.8% as low risk. The CART for nutritional status (CART-NS) values were strongly correlated with combined clinical events [hazard ratio of 2.13 (low vs high risk), 95% confidence interval of 1.42-3.16, p<0.001], even after adjusting for plasma brain natriuretic peptide levels. The CART-NS analysis improved the specificity (89.5%) of predictions of clinical outcomes with the comparable sensitivity (36.3%) compared with the use of a single criterion (SAL <3.5g/dl: 70.2, 42.4% or LC <963/mm3: 73.4, 41.7%, respectively). CONCLUSION A substantial proportion of AHFS patients are at risk of malnutrition, and this risk is associated with poor clinical outcomes. We demonstrate that this algorithm for nutritional screening, even in emergency clinical settings, can determine risk levels for further adverse events in AHFS patients.
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Affiliation(s)
- Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Toshimitsu Hamasaki
- Office of Biostatistics and Data Management, Department of Advanced Medical Technology Development, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichi Sekiguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoichi Goto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Kitakaze
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Yokoyama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Division of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Abstract
INTRODUCTION Since Canada began fortifying grain products with folic acid in 1998, the rate of folate deficiency in outpatients has decreased substantially. Limited data exist on the prevalence of folate deficiency in Canadian hospital inpatients. METHODS The electronic patient record at a large urban academic institution was reviewed for all red blood cell folate and vitamin B12 level tests performed on inpatients between January 1 and December 31, 2010. Chart reviews were performed on patients found to have folate deficiency to determine the indication for folate testing and the etiology of deficiency. RESULTS There were 2563 red blood cell folate and 3154 vitamin B12 level tests performed in 2010. Of these, only 4 (0.16%) red blood cell folate levels were in the deficient range (<254 nmol/L), compared with 98 (3.1%) and 426 (13.5%) vitamin B12 levels that were in the deficient (<138 pmol/L) and intermediate (138-221 pmol/L) range, respectively. Of the 4 patients with folate deficiency, the etiology appeared to be alcohol abuse in one, a malabsorption syndrome in the second, decreased oral intake due to schizophrenia in the third, with the final low folate level appearing to be spurious. At a cost of $12.54 per test, $32,140 could be saved each year at this institution if red blood cell folate testing on inpatients was restricted. CONCLUSION Folate deficiency in inpatients is nearly nonexistent, while an appreciable number of patients have low/intermediate vitamin B12 levels. Significant savings could be achieved by eliminating folate testing on inpatients.
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Anticona C, San Sebastian M. Anemia and malnutrition in indigenous children and adolescents of the Peruvian Amazon in a context of lead exposure: a cross-sectional study. Glob Health Action 2014; 7:22888. [PMID: 24560254 PMCID: PMC3925814 DOI: 10.3402/gha.v7.22888] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/13/2014] [Accepted: 01/15/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Indigenous children and adolescents of the Peruvian Amazon live in precarious conditions that could increase the risk of malnutrition. A particular problem in the Corrientes river communities is the high exposure to lead among children and adolescents. OBJECTIVE This study aimed to determine the nutritional status of children and adolescents in indigenous communities in the Corrientes river basin and examine risk factors for anemia, stunting, underweight, and wasting. DESIGN This was a cross-sectional assessment in children and adolescents aged 0-17 years from six communities (n=330). Data collection included measurement of hemoglobin levels, anthropometrics, blood lead levels (BLLs); a parental questionnaire including demographic and dwelling information; parents' occupation; and the child's duration of breastfeeding and food consumption. Analysis included univariate, bivariate, and logistic regression. RESULTS Overall, anemia prevalence was 51.0%, stunting (proxy for chronic malnutrition) 50.0%, and underweight 20.0%. Bivariate analysis showed that anemia and underweight prevalence was higher in the 0-4 years group (p<0.05). No association was found between anemia, stunting, or underweight with gender, community exposure to oil activity, or consumption of river water. Stunting prevalence was higher in the group whose BLLs were >5 µg/dL (p<0.05). In the logistic regression analysis, no variable was associated with anemia or underweight. The group 5-11 years and >12 years had 1.9 and 3.1 times higher risk of stunting than the group under five years, respectively. Children and adolescents with BLLs >5 µg/dL had twice the risk of stunting compared to those with lower BLLs. CONCLUSIONS Half of the study population was found with anemia and stunting. Anemia was more prevalent in the 0- to 5-year age group and stunting in the 12- to 17-year group. The association between stunting and BLLs might be attributed to a direct effect of lead on human growth. Also, poor nutrition and other socioeconomic-related factors may contribute to the simultaneous existence of stunting and elevated BLLs.
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Affiliation(s)
- Cynthia Anticona
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Fundación Cayetano Heredia, Casa Honorio Delgado, Lima, Perú;
| | - Miguel San Sebastian
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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14
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Abstract
PURPOSE The presence of gastrointestinal (GI) cancer and its treatment might aggravate patient nutritional status. Malnutrition is one of the major factors affecting the postoperative course. We evaluated changes in perioperative nutritional status and risk factors of postoperative severe malnutrition in the GI cancer patients. MATERIALS AND METHODS Nutritional status was prospectively evaluated using patient-generated subjective global assessment (PG-SGA) perioperatively between May and September 2011. RESULTS A total of 435 patients were enrolled. Among them, 279 patients had been diagnosed with gastric cancer and 156 with colorectal cancer. Minimal invasive surgery was performed in 225 patients. PG-SGA score increased from 4.5 preoperatively to 10.6 postoperatively (p<0.001). Ten patients (2.3%) were severely malnourished preoperatively, increasing to 115 patients (26.3%) postoperatively. In gastric cancer patients, postoperative severe malnourishment increased significantly (p<0.006). In univariate analysis, old age (>60, p<0.001), male sex (p=0.020), preoperative weight loss (p=0.008), gastric cancer (p<0.001), and open surgery (p<0.001) were indicated as risk factors of postoperative severe malnutrition. In multivariate analysis, old age, preoperative weight loss, gastric cancer, and open surgery remained significant as risk factors of severe malnutrition. CONCLUSION The prevalence of severe malnutrition among GI cancer patients in this study increased from 2.3% preoperatively to 26.3% after an operation. Old age, preoperative weight loss, gastric cancer, and open surgery were shown to be risk factors of postoperative severe malnutrition. In patients at high risk of postoperative severe malnutrition, adequate nutritional support should be considered.
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Affiliation(s)
- Hongjin Shim
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital Nutritional Support Team, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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15
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Boban M, Persic V, Miletic B, Kovacicek K, Madzar Z. Heart surgery stems increased nutritional risk, expressed during the course of stationary rehabilitation. ANNALS OF NUTRITION AND METABOLISM 2013; 63:17-24. [PMID: 23867581 DOI: 10.1159/000350044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/20/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cardiovascular diseases are a vast global health burden. Despite common prevalence, current knowledge and investigations concerning nutritional aspects are limited. Characteristics and dynamics of nutritional risk are not entirely known for most of the entities, disease stages or treatment-induced fluctuations. This study assessed the effects of heart surgery on unintentional weight loss and nutritional risk using the NRS-2002. METHODS A noninterventional study that included patients scheduled for rehabilitation 1-6 months after heart surgery was performed. Evaluation included routine cardiovascular diagnostics and review of medical histories. Documented baseline weight was available for >85% of the patients. Nutritional risk screening was performed with the standardized NRS-2002 questionnaire. RESULTS A total of 145 patients were involved, with a mean age of 65.3 ± 11.5 years in a range of 23-84 years. The male to female ratio was 121:24 (83.4%:16.6%), respectively. Coronary artery bypass graft surgery (CABG) was performed in 89 patients (61.4%), valvular surgery (VS) in 34 (23.4%) and combined operations (CABG + VS) in 22 (15.2%). Percentage weight loss history was 11.1 ± 3.4% in a range of 0-20.1%, while NRS-2002 was 4.77 ± 1.05 in a range of 1-6. Increased nutritional risk (NRS-2002 ≥3) was found in nearly all patients. Combined ischemic and valvular etiology displayed the highest values of NRS-2002 (5.0 ± 1.2). Patient age and creatinine showed significant correlations with NRS-2002 (Rho = 0.521, p < 0.001 and Rho = 0.335, p < 0.001, respectively). CONCLUSION Increased nutritional risk was found to be frequently prevalent in patients scheduled for rehabilitation after heart surgery. Risk was found to be in relation with underlying coronary artery disease as well as with the age of patients and parameters of renal function. Routine application of nutritional risk screening appears to be a valuable clinical tool for detecting this relevant comorbidity, particularly since no connection was found with traditional anthropometrics.
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Affiliation(s)
- M Boban
- Department of Cardiology, University Hospital 'Thalassotherapia Opatija', Opatija, Croatia
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16
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Malnutrition-sarcopenia syndrome: is this the future of nutrition screening and assessment for older adults? J Aging Res 2012. [PMID: 23024863 DOI: 10.1155/2012/651570.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Malnutrition is common across varying patient populations, particularly older adults, and sarcopenia prevalence increases with advancing age. Both malnutrition and sarcopenia are associated with substantial adverse outcomes affecting both the patient and the healthcare system, including increased morbidity, mortality, rehospitalization rates, and healthcare costs. Healthcare practitioners may assess patients for either malnutrition or sarcopenia; however, many patients clinically present with both conditions, resulting in the syndrome, Malnutrition-Sarcopenia Syndrome, which is the clinical presentation of both malnutrition and accelerated age-associated loss of lean body mass, strength, and/or functionality. Clinicians are urged to screen, assess, and treat these conditions currently so as to adequately address the full spectrum of patients' nutritional issues. By examining aspects of both conditions, clinicians can more fully assess their patients' clinical and nutritional status and can tailor targeted therapies to meet their needs and improve outcomes. This proposed syndrome embodies the inherent association of malnutrition and sarcopenia, highlighting their combined impact on clinical outcomes. The objective of this review paper is to characterize Malnutrition-Sarcopenia Syndrome to advance clinical practice, by providing clinicians with the necessary background information to integrate nutritional assessment along with loss of muscle mass and functionality in their everyday clinical practice.
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17
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Malnutrition-sarcopenia syndrome: is this the future of nutrition screening and assessment for older adults? J Aging Res 2012; 2012:651570. [PMID: 23024863 PMCID: PMC3449123 DOI: 10.1155/2012/651570] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 07/11/2012] [Indexed: 12/18/2022] Open
Abstract
Malnutrition is common across varying patient populations, particularly older adults, and sarcopenia prevalence increases with advancing age. Both malnutrition and sarcopenia are associated with substantial adverse outcomes affecting both the patient and the healthcare system, including increased morbidity, mortality, rehospitalization rates, and healthcare costs. Healthcare practitioners may assess patients for either malnutrition or sarcopenia; however, many patients clinically present with both conditions, resulting in the syndrome, Malnutrition-Sarcopenia Syndrome, which is the clinical presentation of both malnutrition and accelerated age-associated loss of lean body mass, strength, and/or functionality. Clinicians are urged to screen, assess, and treat these conditions currently so as to adequately address the full spectrum of patients' nutritional issues. By examining aspects of both conditions, clinicians can more fully assess their patients' clinical and nutritional status and can tailor targeted therapies to meet their needs and improve outcomes. This proposed syndrome embodies the inherent association of malnutrition and sarcopenia, highlighting their combined impact on clinical outcomes. The objective of this review paper is to characterize Malnutrition-Sarcopenia Syndrome to advance clinical practice, by providing clinicians with the necessary background information to integrate nutritional assessment along with loss of muscle mass and functionality in their everyday clinical practice.
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18
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Adult malnutrition screening, prevalence in four Iranian hospitals: cross-sectional study. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2012. [DOI: 10.1007/s12349-011-0063-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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19
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Predictive factors for platelet count after laparoscopic splenectomy in cirrhotic patients. Hepatol Int 2011; 6:657-61. [PMID: 21959984 DOI: 10.1007/s12072-011-9315-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 09/15/2011] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of our study was to investigate predictive factors for platelet count at 1 month after splenectomy in patients with liver cirrhosis. METHODS A total of 60 patients with liver cirrhosis who were treated with splenectomy from January 2005 to December 2006 were enrolled in the study (hepatitis C, n = 50; hepatitis B, n = 6; alcoholism, n = 2; others, n = 2). Various preoperative clinical characteristics, including spleen weight, were analyzed by simple and multiple linear regressions to study the relationship between platelet count before and after splenectomy. RESULTS Platelet count increased significantly after splenectomy. After simple linear regression, spleen weight, preoperative platelet count, lymphocyte count, and total bilirubin were significantly correlated with platelet count after splenectomy. Spleen weight, preoperative platelet count, and lymphocyte count also had a significant correlation after multiple linear regression analysis. CONCLUSIONS Platelet count after splenectomy in cirrhotic patients can be predicted on the basis of preoperative clinical characteristics. When selecting patients for splenectomy, spleen weight, preoperative platelet count, and lymphocyte count should be taken into consideration.
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20
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O'Leary F, Flood VM, Petocz P, Allman-Farinelli M, Samman S. B vitamin status, dietary intake and length of stay in a sample of elderly rehabilitation patients. J Nutr Health Aging 2011; 15:485-9. [PMID: 21623471 DOI: 10.1007/s12603-010-0330-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the relationships between previous diet, biomarkers of selected B vitamins, nutritional status and length of stay. DESIGN Cross sectional study. SETTING Geriatric rehabilitation patients, Sydney, Australia. PARTICIPANTS Fifty two consenting patients with normal serum creatinine levels and no dementia. MEASUREMENTS Serum vitamin B12, plasma vitamin B6, serum and erythrocyte folate, homocysteine and methylmalonic acid (MMA) concentrations; dietary intake using a validated semi-quantitative food frequency questionnaire and nutritional assessment using the Mini Nutritional Assessment (MNA). Length of stay data were collected from medical records after discharge. RESULTS The age was 80 ± 8 year (mean ± SD), BMI 26.4 ± 6.8 kg/m2 and MNA score 22 ± 3 indicating some risk of malnutrition. Deficiencies of vitamins B6, B12 and folate were found in 30, 22 and 5 subjects respectively. Length of stay was positively correlated with age and MMA (Spearman's correlation 0.4, p<0.01 and 0.28, p<0.05 respectively) and negatively correlated with albumin, vitamin B6 and MNA score (Spearman's correlation -0.35, -0.33 and -0.29, p<0.05). After adjustment for age and sex, ln vitamin B6 and ln MMA concentrations were significant in predicting ln LOS (p=0.006 and p=0.014 respectively). CONCLUSION The study indicates a high risk of vitamin B deficiencies in the elderly and suggests that deficiencies of vitamins B6 and B12 are associated with length of stay. This is concerning as B vitamin status is rarely fully assessed.
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Affiliation(s)
- F O'Leary
- Discipline of Nutrition and Metabolism, School of Molecular Bioscience, University of Sydney, NSW 2006, Australia
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21
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Feldblum I, German L, Castel H, Harman-Boehm I, Shahar DR. Individualized Nutritional Intervention During and After Hospitalization: The Nutrition Intervention Study Clinical Trial. J Am Geriatr Soc 2010; 59:10-7. [DOI: 10.1111/j.1532-5415.2010.03174.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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23
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Heersink JT, Brown CJ, Dimaria-Ghalili RA, Locher JL. Undernutrition in hospitalized older adults: patterns and correlates, outcomes, and opportunities for intervention with a focus on processes of care. ACTA ACUST UNITED AC 2010; 29:4-41. [PMID: 20391041 DOI: 10.1080/01639360903574585] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Undernutrition in hospitalized older adults is increasingly being recognized as a serious problem with implications for both patient care and outcomes and health service utilization and costs. This article presents an overview of research that has been conducted examining undernutrition in hospitalized older adults. First, findings from observational studies examining patterns and predictors of undernutrition in hospitalized older adults will be described, with a focus on methodological challenges. Second, clinical outcomes and costs associated with undernutrition in hospitalized older adults will be presented, both while in the hospital and subsequent to discharge. Third, a description of interventions that have already been implemented in hospitalized older adults will be described. Finally, future areas of inquiry and opportunities for evidence-based nutritional interventions targeted at older adults during and following hospitalization will be suggested. The emphasis of the discussion on interventions will focus on processes of care and the hospital environment.
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Affiliation(s)
- Juanita Titrud Heersink
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-2041, USA
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24
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Nishida T, Sakakibara H. Association Between Underweight and Low Lymphocyte Count as an Indicator of Malnutrition in Japanese Women. J Womens Health (Larchmt) 2010; 19:1377-83. [DOI: 10.1089/jwh.2009.1857] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Tomoko Nishida
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hisataka Sakakibara
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
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25
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Calton JB. Prevalence of micronutrient deficiency in popular diet plans. J Int Soc Sports Nutr 2010; 7:24. [PMID: 20537171 PMCID: PMC2905334 DOI: 10.1186/1550-2783-7-24] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 06/10/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has shown micronutrient deficiency to be scientifically linked to a higher risk of overweight/obesity and other dangerous and debilitating diseases. With more than two-thirds of the U.S. population overweight or obese, and research showing that one-third are on a diet at any given time, a need existed to determine whether current popular diet plans could protect followers from micronutrient deficiency by providing the minimum levels of 27 micronutrients, as determined by the U.S. Food and Drug Administrations (FDA) Reference Daily Intake (RDI) guidelines. METHODS Suggested daily menus from four popular diet plans (Atkins for Life diet, The South Beach Diet, the DASH diet, the DASH diet) were evaluated. Calorie and micronutrient content of each ingredient, in each meal, were determined by using food composition data from the U.S. Department of Agriculture Nutrient Database for Standard Reference. The results were evaluated for sufficiency and total calories and deficient micronutrients were identified. The diet plans that did not meet 100% sufficiency by RDI guidelines for each of the 27 micronutrients were re-analyzed; (1) to identify a micronutrient sufficient calorie intake for all 27 micronutrients, and (2) to identify a second micronutrient sufficient calorie intake when consistently low or nonexistent micronutrients were removed from the sufficiency requirement. RESULTS Analysis determined that each of the four popular diet plans failed to provide minimum RDI sufficiency for all 27 micronutrients analyzed. The four diet plans, on average, were found to be RDI sufficient in (11.75 +/- 2.02; mean +/- SEM) of the analyzed 27 micronutrients and contain (1748.25 +/- 209.57) kcal. Further analysis of the four diets found that an average calorie intake of (27,575 +/- 4660.72) would be required to achieve sufficiency in all 27 micronutrients. Six micronutrients (vitamin B7, vitamin D, vitamin E, chromium, iodine and molybdenum) were identified as consistently low or nonexistent in all four diet plans. These six micronutrients were removed from the sufficiency requirement and additional analysis of the four diets was conducted. It was determined that an average calorie content of (3,475 +/- 543.81) would be required to reach 100% sufficiency in the remaining 21 micronutrients. CONCLUSION These findings are significant and indicate that an individual following a popular diet plan as suggested, with food alone, has a high likelihood of becoming micronutrient deficient; a state shown to be scientifically linked to an increased risk for many dangerous and debilitating health conditions and diseases.
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Affiliation(s)
- Jayson B Calton
- Department of Nutritional Research and Education, Calton Nutrition, North Venice, FL, USA.
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26
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Lee JS, Cho MR, Lee GJ. Validation of the Developed Nutritional Screening Tool for Hospital Patients. ACTA ACUST UNITED AC 2010. [DOI: 10.4163/kjn.2010.43.2.189] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Jeong Sook Lee
- Nutrition Health Management Center, Kyunghee University East-West Neo Medical Center, Seoul 139-727, Korea
| | - Mi Ran Cho
- Nutrition Health Management Center, Kyunghee University East-West Neo Medical Center, Seoul 139-727, Korea
| | - Geum Ju Lee
- Nutrition Health Management Center, Kyunghee University East-West Neo Medical Center, Seoul 139-727, Korea
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27
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Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care. Nutr Diet 2009. [DOI: 10.1111/j.1747-0080.2009.01383.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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28
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Low lymphocyte count in underweight Japanese women. Environ Health Prev Med 2008; 13:345-8. [PMID: 19568895 DOI: 10.1007/s12199-008-0047-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Young women being underweight is a public health problem in Japan. The aim of this study was to investigate this problem by measuring lymphocyte count as an indicator of nutritional status. METHODS The subjects were 114 women aged 20-39 who participated in an annual health checkup for residents in a city in Aichi, Japan. Data from a questionnaire, physical examination, and blood tests were analyzed in relation to women who were severely underweight [body mass index (BMI) </= 17.5 kg/m(2)], slightly underweight (17.5 < BMI < 18.5 kg/m(2)), of normal weight (18.5 </= BMI < 25 kg/m(2)), and obese (BMI >/= 25 kg/m(2)). RESULTS Lymphocyte count tended to be lower with a decrease in BMI. The prevalence of low lymphocyte count of <1,500/mm(3) increased in underweight women. In women who had restricted food intake for weight loss, leukocyte count, and total serum protein, and lymphocyte count were lower. A multivariate logistic regression analysis showed the association of low lymphocyte count to being severely underweight [odds ratio (OR): 1.95; 95% confidence interval (CI): 1.07-3.56] and to restricted food intake for weight loss (OR: 3.73; 95% CI: 0.91-15.30). CONCLUSION This study suggests that being severely underweight and on restricted food intake for weight loss in adult women can be risk factors for low lymphocyte count, an indicator of malnutrition. It is important for young women to maintain BMI >17.5 kg/m(2) and not to restrict food intake when of normal weight or underweight in order to prevent malnutrition.
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Factores de riesgo de desnutrición al ingreso hospitalario. ACTA ACUST UNITED AC 2008; 55:259-62. [DOI: 10.1016/s1575-0922(08)70680-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 04/21/2008] [Indexed: 11/19/2022]
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30
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Lelovics Z, Bozó-Kegyes R, Bonyár-Müller K, Figler M. Results of nutritional risk screening of patients admitted to hospital. ACTA ACUST UNITED AC 2008; 95:107-18. [DOI: 10.1556/aphysiol.95.2008.1.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dziedzic T, Pera J, Slowik A, Gryz-Kurek EA, Szczudlik A. Hypoalbuminemia in acute ischemic stroke patients: frequency and correlates. Eur J Clin Nutr 2007; 61:1318-22. [PMID: 17251921 DOI: 10.1038/sj.ejcn.1602643] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Hypoalbuminemia in acute stroke patients is associated with increased mortality and morbidity. The aim of our study was to determine the frequency and correlates of hypoalbuminemia in unselected cohort of patients with acute cerebral infarction. DESIGN Prospective study. SETTING University hospital. SUBJECTS Seven hundred and five consecutive ischemic stroke patients. METHODS Albumin and other serum protein fractions were measured within 36 h after stroke using electrophoresis. RESULTS Hypoalbuminemia defined as serum albumin level <35 g/l was found in 45.5% of patients. Serum albumin level correlates significantly with age (r=-0.13, P<0.01), Scandinavian Stroke Scale score (r=0.14, P<0.01), body temperature on admission (r=0.14, P<0.01), leukocyte count (r=-0.17, P<0.01), fasting glucose (r=-0.16, P<0.01), total cholesterol (r=0.14, P<0.01), alpha1-globulin (r=-0.48, P<0.01), alpha2-globulin (r=-0.49, P<0.01), beta-globulin (r=-0.26, P<0.01) and gamma-globulin (r=-0.35, P<0.01). CONCLUSIONS Hypoalbuminemia is a frequent finding in acute stroke patients and it is associated with more severe stroke and pro-inflammatory pattern of serum protein electrophoresis.
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Affiliation(s)
- T Dziedzic
- Department of Neurology, Collegium Medicum, Jagiellonian University, Krakow, Poland.
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32
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National Program of Malnutrition Assessment in Patients with Cancer of the Gastrointestinal and Respiratory Tract in Poland. POLISH JOURNAL OF SURGERY 2007. [DOI: 10.2478/v10035-007-0029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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John U, Hanke M, Grothues J, Thyrian JR. Validity of overweight and obesity in a nation based on self-report versus measurement device data. Eur J Clin Nutr 2005; 60:372-7. [PMID: 16278688 DOI: 10.1038/sj.ejcn.1602325] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To analyze overweight and obesity in a nation by self-report (SR) data and by data about the target person provided via other household members compared to measurement devices (MD). The magnitude of hypothesized under-reporting by the SR data should be estimated with adjustment for age, gender, and education. DESIGN Two cross-sectional studies, nationally representative health examination surveys (response rates: 61.4 and 73.2%, respectively). SETTING Adult general population of Germany aged 20-79 years. SUBJECTS Sample 1 included 6806 residents. Samples 2 (n=98 673) and 3 (n=34 960) included residents in the second survey. MEASUREMENTS In sample 1 MD data were collected, in sample 2 SR data were collected, and in sample 3 body weight and height information was provided from another household member living together with the target person. RESULTS MD data revealed higher proportions of overweight and obesity compared to SR. Among women with body mass index (BMI) 35.00 or higher, the odds ratio (OR) was 3.9 (95% confidence interval, CI, 3.2-4.7), and among men 2.8 (CI, 2.2-3.6) for MD versus SR. Data from other household members also revealed higher proportions of overweight and obesity than SR (OR for BMI 35.00 or higher 2.1, CI, 1.7-2.5, for data from other household members versus SR in women and OR 1.3, CI, 1.1-1.5, in men). CONCLUSIONS MD data should be used when providing proportions of overweight and obesity in a nation such as Germany.
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Affiliation(s)
- U John
- Institute of Epidemiology and Social Medicine, University of Greifswald, Greifswald, Germany.
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