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Rodriguez C, Mota JD, Palmer TB, Heymsfield SB, Tinsley GM. Skeletal muscle estimation: A review of techniques and their applications. Clin Physiol Funct Imaging 2024; 44:261-284. [PMID: 38426639 DOI: 10.1111/cpf.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
Quantifying skeletal muscle size is necessary to identify those at risk for conditions that increase frailty, morbidity, and mortality, as well as decrease quality of life. Although muscle strength, muscle quality, and physical performance have been suggested as important assessments in the screening, prevention, and management of sarcopenic and cachexic individuals, skeletal muscle size is still a critical objective marker. Several techniques exist for estimating skeletal muscle size; however, each technique presents with unique characteristics regarding simplicity/complexity, cost, radiation dose, accessibility, and portability that are important factors for assessors to consider before applying these modalities in practice. This narrative review presents a discussion centred on the theory and applications of current non-invasive techniques for estimating skeletal muscle size in diverse populations. Common instruments for skeletal muscle assessment include imaging techniques such as computed tomography, magnetic resonance imaging, peripheral quantitative computed tomography, dual-energy X-ray absorptiometry, and Brightness-mode ultrasound, and non-imaging techniques like bioelectrical impedance analysis and anthropometry. Skeletal muscle size can be acquired from these methods using whole-body and/or regional assessments, as well as prediction equations. Notable concerns when conducting assessments include the absence of standardised image acquisition/processing protocols and the variation in cut-off thresholds used to define low skeletal muscle size by clinicians and researchers, which could affect the accuracy and prevalence of diagnoses. Given the importance of evaluating skeletal muscle size, it is imperative practitioners are informed of each technique and their respective strengths and weaknesses.
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Affiliation(s)
- Christian Rodriguez
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Jacob D Mota
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Ty B Palmer
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
| | - Steven B Heymsfield
- Metabolism and Body Composition Laboratory, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana, USA
| | - Grant M Tinsley
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
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Varan HD, Ceker E, Cataltepe E, Gungor F, Fadiloglu A, Borazan FY. Predictive value of adductor pollicis muscle thickness for ultrasound-based sarcopenia in older adults. Nutr Clin Pract 2024; 39:619-625. [PMID: 38699806 DOI: 10.1002/ncp.11149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 02/22/2024] [Accepted: 03/03/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The adductor pollicis muscle thickness (APMT) is least affected by subcutaneous adipose tissue and can be measured externally. The aim of this study is to identify the predictive value of APMT for the diagnosis of ultrasonography-based sarcopenia. METHODS A total of 245 outpatients who were aged ≥65 years (49 with sarcopenia and 196 without sarcopenia) were included in this cross-sectional study. Patients with knee or hip replacement, advanced dementia, cerebrovascular disease, neurodegenerative disease, or decompensated heart failure and those using drugs that affect muscle functions, such as steroids, were excluded. Comprehensive geriatric assessments and anthropometric measurements of the patients were performed. APMT was assessed with a skinfold caliper. The diagnosis of sarcopenia was based on a low Sonographic Thigh Adjustment Ratio (STAR) index (anterior thigh muscle thickness by ultrasonography/body mass index [BMI] ratio, cutoff points are <1.4 for men and <1.0 for women) and low handgrip strength. The predictive ability of APMT for ultrasound-based sarcopenia diagnosis was examined. RESULTS There was no significant difference in terms of arm and calf circumference and BMI between the sarcopenic and nonsarcopenic groups. APMT, handgrip strength, anterior thigh muscle thickness, and gait speed were significantly lower in the patients with sarcopenia. The best cutoff points of APMT for sarcopenia were ≤16.5 for women and ≤21.5 for men with areas under the curve of 0.70 and 0.66, respectively, and negative predictive values of 91.2 and 94.3, respectively (P < 0.001). CONCLUSION APMT can be a useful anthropometric marker for ultrasound-based sarcopenia diagnosis.
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Affiliation(s)
- Hacer D Varan
- Division of Geriatric Medicine, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Eda Ceker
- Division of Geriatric Medicine, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Esra Cataltepe
- Division of Geriatric Medicine, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Fatih Gungor
- Division of Geriatric Medicine, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayse Fadiloglu
- Division of Geriatric Medicine, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Funda Y Borazan
- Division of Geriatric Medicine, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
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de Sousa IM, Fayh APT, Gonzalez MC, Silva FM. Prevalence of low calf circumference in hospitalized patients classified by raw or body mass index-adjusted values. Nutr Clin Pract 2024; 39:611-618. [PMID: 38443160 DOI: 10.1002/ncp.11138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/02/2024] [Accepted: 01/20/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Adiposity can influence the estimation of muscle mass using calf circumference (CC) and underestimate the frequency of low CC. An adjustment for CC using body mass index (BMI) was proposed to reduce this effect. We aimed to compare the low CC frequency in hospitalized patients when considering raw and BMI-adjusted values and explore data by sex, age, and race (white and non-white). METHODS Secondary analysis from two cohort studies conducted with adult hospitalized patients using BMI and CC data collected in the first 72 h after hospital admission. We classified low CC by two approaches: (1) raw CC; (2) BMI-adjusted CC for patients with BMI ≥ 25. Cutoff values for low CC were ≤34 cm (men) and ≤33 cm (women). RESULTS Among 1272 patients (54.1 ± 15.3 years old; 51.7% women; 82.1% White race), low CC frequency was 30.6% and low BMI-adjusted CC was 68.9%. For all elevated BMI categories, the low CC frequency was higher when considering BMI-adjusted values (P < 0.001). Low CC was more frequent (P < 0.001) in older adults (38.7% by raw; 79.1% by BMI-adjusted value) than in younger adults (27.6% by raw; 65.2% by BMI-adjusted value) and it was not associated with race. Low CC by raw values was more frequent in men than in women (35.0% versus 26.4%; P = 0.001), but did not differ between sexes when classified by BMI-adjusted values (70.7% versus 67.1%; P = 0.184). CONCLUSION Low CC BMI adjusted was 2.2 times more frequent in comparison with raw CC values, and it was identified in >60% of patients with BMI ≥ 25.
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Affiliation(s)
- Iasmin M de Sousa
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Maria Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Flávia M Silva
- Nutrition Science Postgraduation Program of Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Kennedy F, Ní Cheallaigh C, Romero-Ortuno R, Doyle SL, Broderick J. Outcomes of the LEAP feasibility trial-A low-threshold, exercise programme with protein supplementation to target frailty and poor physical functioning in people experiencing homelessness and addiction issues. PLoS One 2024; 19:e0301926. [PMID: 38820432 PMCID: PMC11142616 DOI: 10.1371/journal.pone.0301926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/25/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND People experiencing homelessness are more likely to experience poor health with physical functioning deficits and frailty commonly reported. It is not well known how strategies to target physical functioning deficits and frailty work in practice in this group. The primary aim of this study was to explore the feasibility of an exercise intervention with protein supplementation to target physical functioning and frailty in people experiencing homelessness evaluated by recruitment and retention rates, adherence to the exercise sessions and protein supplement, adverse effects, programme feedback and characteristics of non-returners, sporadic and frequent attenders. The secondary aim was to evaluate changes in effectiveness outcomes of grip strength, muscle mass, lower extremity physical function, pain, frailty, and risk of malnutrition. METHOD This prospective single-arm study evaluated the feasibility of a 16-week rolling, low-threshold, 'drop-in' once weekly exercise programme with protein supplementation. The main recruitment site was a day-service centre for people who are homeless. Feasibility was assessed by the recruitment and retention rates, adherence to the exercise sessions and protein supplement as well as adverse effects, programme feedback and evaluation of characteristics of non-returners, sporadic (≤50% of available sessions) and frequent attenders (≥50% of available sessions). Effectiveness outcomes included pain (Visual Analogue Scale), physical functioning and performance (hand-grip dynamometry, limb circumference, the Short Physical Performance Battery), frailty (SHARE-FI and Clinical Frailty Scale) and nutritional status (Mini Nutritional Assessment). RESULTS Thirty-one participants were recruited mean (SD) age 45(16) years. There was a recruitment rate of a median (IQR) of 2(1-3) new participants per week. The retention rate was 45% (n = 14) to the main recruitment site. Adherence to the exercise sessions and nutritional intervention was 90% and 100% respectively. Three adverse events were recorded during 74 interventions over the 16-week programme. The acceptability of the programme was highlighted in participant feedback. Characteristics of frequent returners (≥50%) were older age, female, more stably housed and more stable in addiction. The programme did not induce any changes in effectiveness outcomes. CONCLUSION The feasibility of this programme was demonstrated. Overall, the programme was well received with higher retention rates in older participants, females, those more stably housed and those stable in addiction. A higher powered, more intense programme is needed to demonstrate programme effectiveness.
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Affiliation(s)
- Fiona Kennedy
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Clíona Ní Cheallaigh
- St James’s Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Roman Romero-Ortuno
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Suzanne L. Doyle
- School of Biological, Health and Sports Sciences, Technological University Dublin, Dublin, Ireland
| | - Julie Broderick
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Nel S, de Man J, van den Berg L, Wenhold FAM. Statistical assessment of reliability of anthropometric measurements in the multi-site South African National Dietary Intake Survey 2022. Eur J Clin Nutr 2024:10.1038/s41430-024-01449-1. [PMID: 38745053 DOI: 10.1038/s41430-024-01449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Anthropometric data quality in large multicentre nutrition surveys is seldom adequately assessed. In preparation for the South African National Dietary Intake Survey (NDIS-2022), this study assessed site leads' and fieldworkers' intra- and inter-rater reliability for measuring weight, length/height, mid-upper arm circumference (MUAC), waist circumference (WC) and calf circumference (CC). METHODS Standardised training materials and measurement protocols were developed, and new anthropometric equipment was procured. Following two training rounds (12 site lead teams, 46 fieldworker teams), measurement reliability was assessed for both groups, using repeated measurements of volunteers similar to the survey target population. Reliability was statistically assessed using the technical error of measurement (TEM), relative TEM (%TEM), intra-class correlation coefficient (ICC) and coefficient of reliability (R). Agreement was visualised with Bland-Altman analysis. RESULTS By %TEM, the best reliability was achieved for weight (%TEM = 0.260-0.923) and length/height (%TEM = 0.434-0.855), and the poorest for MUAC by fieldworkers (%TEM = 2.592-3.199) and WC (%TEM = 2.353-2.945). Whole-sample ICC and R were excellent ( > 0.90) for all parameters except site leads' CC inter-rater reliability (ICC = 0.896, R = 0.889) and fieldworkers' inter-rater reliability for MUAC in children under two (ICC = 0.851, R = 0.881). Bland-Altman analysis revealed no significant bias except in fieldworkers' intra-rater reliability of length/height measurement in adolescents/adults ( + 0.220 (0.042, 0.400) cm). Reliability was higher for site leads vs. fieldworkers, for intra-rater vs. inter-rater assessment, and for weight and length/height vs. circumference measurements. CONCLUSION NDIS-2022 site leads and fieldworkers displayed acceptable reliability in performing anthropometric measurements, highlighting the importance of intensive training and standardised measurement protocols. Ongoing reliability assessment during data collection is recommended.
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Affiliation(s)
- Sanja Nel
- University of Pretoria, Department of Human Nutrition, Faculty of Health Sciences, Pretoria, South Africa.
- University of Pretoria Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Kalafong Hospital, Atteridgeville, South Africa.
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Kalafong Hospital, Atteridgeville, South Africa.
| | - Jeroen de Man
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Louise van den Berg
- University of the Free State, Department of Nutrition and Dietetics, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Bloemfontein, South Africa
| | - Friedeburg Anna Maria Wenhold
- University of Pretoria, Department of Human Nutrition, Faculty of Health Sciences, Pretoria, South Africa
- University of Pretoria Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Kalafong Hospital, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Kalafong Hospital, Atteridgeville, South Africa
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da Silva Nascimento ML, Alves Bennemann N, de Sousa IM, de Oliveira Bezerra MR, Villaça Chaves G, Moreira Lima Verde SM, Fernandes Maurício S, Barreto Campello Carvalheira J, Santos Mendes MC, Miranda AL, da Costa Pereira JP, Gonzalez MC, Prado CM, Fayh APT. Examining variations in body composition among patients with colorectal cancer according to site and disease stage. Sci Rep 2024; 14:10829. [PMID: 38734789 PMCID: PMC11088614 DOI: 10.1038/s41598-024-61790-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/09/2024] [Indexed: 05/13/2024] Open
Abstract
Patients with colorectal cancer (CRC) often exhibit changes in body composition (BC) which are associated with poorer clinical outcomes. Many studies group colon and rectal cancers together, irrespective of staging, potentially affecting assessment and treatment strategies. Our study aimed to compare BC in patients with CRC focusing on tumor location and metastasis presence. A total of 635 individuals were evaluated, with a mean age of 61.8 ± 12.4 years and 50.2% female. The majority had rectal cancer as the primary cancer site (51.0%), and 23.6% had metastatic disease. The first regression model showed tumor site and metastasis as independent factors influencing skeletal muscle (SM), skeletal muscle index (SMI), and visceral adipose tissue variability (all p values < 0.05). The second model, adjusted for BMI, indicated tumor site as the primary factor affecting SMI variations (adjusted R2 = 0.50 p < 0.001), with colon tumors inversely associated with SM (standardized β - 2.15(- 3.3; - 0.9) p < 0.001). A third model, considering all the confounders from the directed acyclic graphs, was constructed and the found association remained independent. Our findings highlight significant BC variations in patients with CRC, influenced by tumor location and metastases presence, underscoring the need for location-specific assessment in CRC management.
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Affiliation(s)
- Mayra Laryssa da Silva Nascimento
- PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Nithaela Alves Bennemann
- PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Iasmin Matias de Sousa
- Health Sciences Center, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, No 3000, Natal, RN, 59078-970, Brazil
| | - Mara Rubia de Oliveira Bezerra
- Health Sciences Center, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, No 3000, Natal, RN, 59078-970, Brazil
| | | | | | | | - José Barreto Campello Carvalheira
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maria Carolina Santos Mendes
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Ana Lucia Miranda
- Health Sciences Center, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, No 3000, Natal, RN, 59078-970, Brazil
- Liga Norteriograndense Contra o Câncer, Natal, Rio Grande do Norte, Brazil
| | | | | | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Ana Paula Trussardi Fayh
- PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, RN, Brazil.
- Health Sciences Center, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, No 3000, Natal, RN, 59078-970, Brazil.
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Miller LJ, Halliday V, Snowden JA, Aithal GP, Lee J, Greenfield DM. Health professional attitudes and perceptions of prehabilitation and nutrition before haematopoietic cell transplantation. J Hum Nutr Diet 2024. [PMID: 38696512 DOI: 10.1111/jhn.13315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/20/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Nutritional prehabilitation may improve haematopoietic cell transplantation (HCT) outcomes, although little evidence exists. The present study aimed to understand healthcare professional (HCP) perceptions of prehabilitation and nutritional care pre-HCT in UK centres. METHODS An anonymous online survey (developed and refined via content experts and piloting) was administered via email to multidisciplinary HCPs in 39 UK adult centres, between July 2021 and June 2022. Data are presented as proportions of responses. Routine provision denotes that care was provided >70% of time. RESULTS Seventy-seven percent (n = 66) of HCPs, representing 61.5% (n = 24) of UK adult HCT centres, responded. All HCPs supported prehabilitation, proposing feasible implementation between induction chemotherapy (60.4%; n = 40) and first HCT clinic (83.3%; n = 55). Only 12.5% (n = 3) of centres had a dedicated prehabilitation service. Nutrition (87.9%; n = 58), emotional wellbeing (92.4%; n = 61) and exercise (81.8%; n = 54) were considered very important constituents. HCPs within half of the HCT centres (n = 12 centres) reported routine use of nutrition screening pre-HCT with a validated tool; 66.7% of HCPs (n = 36) reported using the malnutrition universal screening tool (MUST). Sixty-two percent (n = 41) of HCPs reported those at risk, received nutritional assessments, predominantly by dietitians (91.6%; n = 22) using the dietetic care process (58.3%; n = 14). Body mass index (BMI) was the most frequently reported body composition measure used by HCPs (70.2%, n = 33). Of 59 respondents, non-dietitians most routinely provided dietary advice pre-HCT (82.4%; n = 28 vs. 68%; n = 17, p = 0.2); including high-energy/protein/fat and neutropenic diet advice. Prophylactic enteral feeding pre-HCT was rare, indicated by low BMI and significant unintentional weight loss. Just under half (n = 25 of 59, 42.4%) HCPs reported exercise advice was given routinely pre-HCT. CONCLUSIONS Nutrition and prehabilitation pre-HCT are considered important and deliverable by HCPs, but current provision in UK centres is limited and inconsistent.
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Affiliation(s)
- Laura J Miller
- Department of Dietetics and Nutrition, Nottingham University Hospitals NHS Trust, Nottingham, UK
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Vanessa Halliday
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - John A Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- British Society of Blood and Marrow Transplantation & Cellular Therapy (BSBMTCT), London, UK
| | - Guruprasad P Aithal
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Julia Lee
- British Society of Blood and Marrow Transplantation & Cellular Therapy (BSBMTCT), London, UK
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Prado CM, Batsis JA, Donini LM, Gonzalez MC, Siervo M. Sarcopenic obesity in older adults: a clinical overview. Nat Rev Endocrinol 2024; 20:261-277. [PMID: 38321142 DOI: 10.1038/s41574-023-00943-z] [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] [Accepted: 12/15/2023] [Indexed: 02/08/2024]
Abstract
Sarcopenic obesity is characterized by a concurrent decline in muscle mass and function, along with increased adipose tissue. Sarcopenic obesity is a growing concern in older adults owing to significant health consequences, including implications for mortality, comorbidities and risk of developing geriatric syndromes. A 2022 consensus statement established a new definition and diagnostic criteria for sarcopenic obesity. The pathophysiology of this condition involves a complex interplay between muscle, adipose tissue, hormonal changes, inflammation, oxidative stress and lifestyle factors, among others. Sarcopenic obesity is treated with a range of management approaches, such as lifestyle interventions, exercise, nutrition and medical therapies. Emerging therapies that were developed for treating other conditions may be relevant to sarcopenic obesity, including novel pharmacological agents and personalized approaches such as precision medicine. In this Review, we synthesize the current knowledge of the clinical importance of sarcopenic obesity, its assessment and diagnosis, along with current and emerging management strategies.
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Affiliation(s)
- Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
| | - John A Batsis
- Division of Geriatric Medicine, School of Medicine, and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lorenzo M Donini
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - M Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Pelotas, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Mario Siervo
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Curtin Dementia Centre of Excellence, enAble Institute, Curtin University, Perth, Western Australia, Australia
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Coca-Martinez M, Carli F. Prehabilitation: Who can benefit? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106979. [PMID: 37451924 DOI: 10.1016/j.ejso.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 05/29/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Prehabilitation is an intervention that occurs between cancer diagnosis and the start of an acute treatment. It involves physical, nutritional, and psychological assessments to establish a baseline functional level and provide targeted interventions to improve a person's health and prevent future impairments. Prehabilitation has been applied to surgical oncology and has shown positive results at improving functional capacity, reducing hospital stay, decreasing complications, and enhancing health-related quality of life. The importance of collaboration between various healthcare professionals and the implementation of multimodal interventions, including exercise training, nutrition optimization, and emotional support is discussed in this manuscript. The need for screening and assessment of conditions such as sarcopenia, frailty, or low functional status in order to identify patients who would benefit the most from prehabilitation is vital and should be a part of all prehabilitation programs. Exercise and nutrition play complementary roles in prehabilitation, enhancing anabolism and performance. However, in the presence of malnutrition and sarcopenia, exercise-related energy expenditure without sufficient protein intake can lead to muscle wasting and further deterioration of functional capacity, thus special emphasis on nutrition and protein intake should be made in these cases. Finally, the challenges and the need for a paradigm shift in perioperative care are discussed to effectively implement personalized prehabilitation programs.
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Affiliation(s)
- Miquel Coca-Martinez
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada; Department of Anesthesia and Intensive Care, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Franco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada.
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do Nascimento MK, Costa Pereira JPD, de Araújo JO, Gonzalez MC, Fayh APT. Exploring the role of body mass index-adjusted calf circumference within the SARC-CalF screening tool among older patients with cancer. J Nutr Health Aging 2024; 28:100251. [PMID: 38677077 DOI: 10.1016/j.jnha.2024.100251] [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: 02/19/2024] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES This study aimed to assess and compare the frequency of positive scores using unadjusted SARC-CalF with the scores derived from SARC-CalF after adjusting calf circumference (CC) for body mass index (BMI). The secondary aim was to assess the prognostic value of SARC-CalF after BMI adjustment, for length of hospital stay (LOS) and mortality. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of a prospective cohort study, included both outpatients and inpatients of an oncology unit hospital in Brazil. MEASUREMENTS BMI and CC were measured. Patients with excess weight had their CC adjusted for BMI by subtracting 3 cm, 7 cm, and 12 cm from the unadjusted CC values for respective BMI categories. SARC-CalF was used to screen for sarcopenia. Scores ≥11 were indicative of sarcopenia, considering both unadjusted and BMI-adjusted CC values. Clinical outcomes included prolonged LOS and both short- and long-term mortality. RESULTS Our study included 206 subjects, with a median age of 69 years, and the majority were males (52.1%). The prevalence of low CC increased from 65% to 84% after BMI adjustment. Positive unadjusted SARC-CalF scores (≥11) were observed in 51% of the population and this prevalence increased to 65% using BMI-adjusted SARC-CalF criteria (≥11). Higher scores on BMI-adjusted SARC-CalF but not unadjusted SARC-CalF were independently associated with prolonged LOS [adjusted HR: 1.26 (1.03-1.53)], and 6-month mortality [adjusted HR: 1.42 (1.07-1.87)]. Both unadjusted and BMI-adjusted SARC-CalF were independently associated with 12-month mortality. CONCLUSION BMI-adjusted SARC-CalF may be a promising strategy to enhance the detection of older patients with cancer and excess weight at risk of sarcopenia, and it may serve a dual role as a prognostic tool, as it was independently associated with prolonged LOS and mortality.
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Affiliation(s)
- Maria Karolainy do Nascimento
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Jarson Pedro da Costa Pereira
- Postgraduate Program in Nutrition and Public Health, Department of Nutrition, Federal University of Pernambuco, Recife, PE, Brazil
| | - Janaína Oliveira de Araújo
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - M Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil; PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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Hsu BG, Wang CH, Lai YH, Kuo CH, Lin YL. Association of endothelial dysfunction and peripheral arterial disease with sarcopenia in chronic kidney disease. J Cachexia Sarcopenia Muscle 2024. [PMID: 38644163 DOI: 10.1002/jcsm.13471] [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: 05/14/2023] [Revised: 12/21/2023] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Endothelial dysfunction and peripheral arterial disease (PAD), which disturb skeletal muscle microperfusion, are highly prevalent in patients with chronic kidney disease (CKD). We evaluated the association of endothelial dysfunction and PAD with sarcopenia in patients with non-dialysis CKD. METHODS This cross-sectional study included 420 patients with stages 3-5 non-dialysis CKD aged 69.0 ± 11.8 years. Skeletal muscle index (skeletal muscle mass/height2), handgrip strength, 6-m gait speed and strength of hip flexion and knee extension were measured. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019. Endothelial dysfunction and PAD were assessed using the vascular reactivity index (VRI) and ankle-brachial index (ABI), respectively. A VRI < 1.0 was classified as poor endothelial function, and an ABI < 0.9 was defined as PAD. Additionally, endothelial and inflammatory biomarkers, including intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), asymmetric dimethylarginine, endothelin-1 (ET-1) and interleukin-6, were measured in a subgroup of 262 patients. RESULTS Among the participants, 103 (24.5%) were classified as having sarcopenia. Compared with patients without sarcopenia, those with sarcopenia had significantly lower ABI (1.04 ± 0.16 vs. 1.08 ± 0.15, P = 0.028 for the right ABI; 1.01 ± 0.16 vs. 1.06 ± 0.16, P = 0.002 for the left ABI) and VRI (0.83 ± 0.57 vs. 1.08 ± 0.56, P < 0.001) and had higher serum levels of ICAM-1 (P < 0.001), VCAM-1 (P = 0.003) and ET-1 (P = 0.037). Multivariate logistic regression revealed that, beyond age and body mass index, the average ABI (odds ratio [OR]: 0.81/0.1 increase; 95% confidence interval [CI]: 0.67-0.98; P = 0.032) and VRI (OR: 0.93/0.1 increase; 95% CI: 0.88-0.98; P = 0.010) were independently associated with sarcopenia. Among the endothelial biomarkers measured, ICAM-1 (OR: 2.47/1-SD increase; 95% CI: 1.62-3.75) and VCAM-1 (OR: 1.91/1-SD increase; 95% CI: 1.27-2.87) were independent predictors of sarcopenia. Group stratification based on the cut-offs of VRI and ABI showed that those with both poor VRI and ABI had the greatest risk for sarcopenia (OR: 4.22; 95% CI: 1.69-10.49), compared with those with normal VRI and ABI. CONCLUSIONS Endothelial dysfunction and PAD are independently associated with sarcopenia in patients with stages 3-5 CKD, suggesting the dominant role of vascular dysfunction in sarcopenia.
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Affiliation(s)
- Bang-Gee Hsu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chih-Hsien Wang
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Hsien Lai
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chiu-Huang Kuo
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Post-baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Li Lin
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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12
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Chen Y, Wu J. Aging-Related Sarcopenia: Metabolic Characteristics and Therapeutic Strategies. Aging Dis 2024:AD.2024.0407. [PMID: 38739945 DOI: 10.14336/ad.2024.0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/07/2024] [Indexed: 05/16/2024] Open
Abstract
The proportion of the elderly population is gradually increasing as a result of medical care advances, leading to a subsequent surge in geriatric diseases that significantly impact quality of life and pose a substantial healthcare burden. Sarcopenia, characterized by age-related decline in skeletal muscle mass and quality, affects a considerable portion of older adults, particularly the elderly, and can result in adverse outcomes such as frailty, fractures, bedridden, hospitalization, and even mortality. Skeletal muscle aging is accompanied by underlying metabolic changes. Therefore, elucidating these metabolic profiles and specific mechanisms holds promise for informing prevention and treatment strategies for sarcopenia. This review provides a comprehensive overview of the key metabolites identified in current clinical studies on sarcopenia and their potential pathophysiological alterations in metabolic activity. Besides, we examine potential therapeutic strategies for sarcopenia from a perspective focused on metabolic regulation.
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Mwala NN, Borkent JW, van der Meij BS, de van der Schueren MAE. Challenges in identifying malnutrition in obesity; An overview of the state of the art and directions for future research. Nutr Res Rev 2024:1-10. [PMID: 38576127 DOI: 10.1017/s095442242400012x] [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: 04/06/2024]
Abstract
(Protein-energy) malnutrition in individuals living with obesity presents complex diagnostic challenges due to the distinctive physiological characteristics of obesity. This narrative review critically examines the identification of malnutrition within the population with obesity, distinguishing malnutrition in obesity from related conditions such as sarcopenic obesity. While noting some shared features, the review highlights key differences between these conditions. The review also highlights the limitations of current malnutrition screening tools, which are not designed for individuals living with obesity. These tools primarily rely on anthropometric measurements, neglecting (among others) nutrient intake assessment, which hinders accurate malnutrition detection. Additionally, this review discusses limitations in existing diagnostic criteria, including the Global Leadership Initiative on Malnutrition (GLIM) criteria, when applied to individuals living with obesity. Challenges include the identification of appropriate cut-off values for phenotypic criteria (unintentional weight loss, low body mass index and muscle mass) and aetiological criteria such as reduced food intake and inflammation for the population with obesity. Overall, this review emphasises the need for modified screening tools and diagnostic criteria to recognise and assess malnutrition in obesity, leading to improved clinical outcomes and overall wellbeing.
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Affiliation(s)
- Natasha Nalucha Mwala
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Jos W Borkent
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Barbara S van der Meij
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
- Bond University Nutrition and Dietetics Research Group, Bond University, Gold Coast, Australia
| | - Marian A E de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
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Mat Nawi NF, Simok AA, Hanafi MH, Mohd Ismail ZI. Improvements of mid-thigh circumferences following robotic rehabilitation in hemiparetic stroke patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2091. [PMID: 38642068 DOI: 10.1002/pri.2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/22/2023] [Accepted: 03/31/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Stroke has emerged as the leading cause of disability globally. The provision of long-term rehabilitation to stroke survivors poses a health care burden to many countries. Robotic devices have created a major turning point in stroke rehabilitation program. Currently, the anthropometric evidence to support the benefit of robotic rehabilitation (RR) among stroke patients is scarce. Therefore, the aim of this study was to evaluate the impact of RR on the mid-thigh circumferences of the paretic limbs in stroke patients. METHODS Twenty stroke patients from conventional rehabilitation (CR) (n = 10) and RR (n = 10) groups were recruited through a purposive sampling method. Patients in the CR group received a two-hour session of a five-day-a-week home-based CR program for 4 weeks. Patients in the RR group received a five-day-a-week of an hour combined physiotherapy and occupational therapy session and a one-hour robotic therapy session using the HAL® Cyberdyne lower-limb, for 4 weeks. The mid-thigh circumferences of both limbs were measured on day 1 (baseline), week 2 and week 4 of rehabilitation program. RESULTS The results revealed no statistically significant difference in the mid-thigh circumferences between the paretic (F1.05,9.44 = 1.96, p = 0.20), and the normal (F1.05,9.44 = 1.96, p = 0.20) sides in the CR group (n = 10). For the comparison between the paretic and normal sides in the RR group (n = 10), the paretic mid-thigh circumferences revealed significant time effect results (F2,18 = 11.91, p = 0.001), which were due to changes between baseline and week 2, and baseline and week 4 measurements. Interestingly, the normal mid-thigh circumferences also revealed a significant time effect (F2,18 = 6.56, p = 0.007), which is due to changes between baseline and week 4. One-way analysis of variance was employed to compare the mean average between groups due to the difference in the baseline measurements of the mid-thigh circumferences between the paretic side of the CR and the RR groups. With this adjustment, the average means mid-thigh circumferences after 4 weeks of therapy were shown to be significantly different between the CR and RR groups (F1,18 = 12.49, p = 0.02). CONCLUSION Significant increments in the mid-thigh circumferences following RR were seen in the paretic limbs of stroke patients. Hence, this study may provide some insights into further potential research related to the benefits of RR in stroke patients.
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Affiliation(s)
- Nur Fasihah Mat Nawi
- Department of Anatomy, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Anna Alicia Simok
- Department of Anatomy, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Muhammad Hafiz Hanafi
- Department of Neuroscience, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
- Rehabilitation Medicine Unit, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Zul Izhar Mohd Ismail
- Department of Anatomy, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
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Bernardes S, Stello BB, Milanez DSJ, Razzera EL, Silva FM. Absence of association between low calf circumference, adjusted or not for adiposity, and ICU mortality in critically ill adults: A secondary analysis of a cohort study. JPEN J Parenter Enteral Nutr 2024; 48:291-299. [PMID: 38142302 DOI: 10.1002/jpen.2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/08/2023] [Accepted: 12/15/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Despite its correlation with skeletal muscle mass and its predictive value for adverse outcomes in clinical settings, calf circumference is a metric underexplored in intensive care. We aimed to determine whether adjusting low calf circumference for adiposity provides prognostic value superior to its unadjusted measurement for intensive care unit (ICU) mortality and other clinical outcomes in critically ill patients. METHODS In a secondary analysis of a cohort study across five ICUs, we assessed critically ill patients within 24 h of ICU admission. We adjusted calf circumference for body mass index (BMI) (25-29.9, 30-39.9, and ≥40) by subtracting 3, 7, or 12 cm from it, respectively. Values ≤34 cm for men and ≤33 cm for women identified low calf circumference. RESULTS We analyzed 325 patients. In the primary risk-adjusted analysis, the ICU death risk was similar between the low and preserved calf circumference (BMI-adjusted) groups (hazard ratio, 0.90; 95% CI, 0.47-1.73). Low calf circumference (unadjusted) increased the odds of ICU readmission 2.91 times (95% CI, 1.40-6.05). Every 1-cm increase in calf circumference as a continuous variable reduced ICU readmission odds by 12%. Calf circumference showed no significant association with other clinical outcomes. CONCLUSION BMI-adjusted calf circumference did not exhibit independent associations with ICU and in-hospital death, nor with ICU and in-hospital length of stay, compared with its unadjusted measurement. However, low calf circumference (unadjusted and BMI-adjusted) was independently associated with ICU readmission, mainly when analyzed as a continuous variable.
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Affiliation(s)
- Simone Bernardes
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Bruna Barbosa Stello
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | | | - Elisa Loch Razzera
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Flávia Moraes Silva
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Enge M, Peelen FO, Nielsen RL, Beck AM, Olin AÖ, Cederholm T, Boström AM, Paur I. Malnutrition prevalence according to GLIM and its feasibility in geriatric patients: a prospective cross-sectional study. Eur J Nutr 2024; 63:927-938. [PMID: 38240774 PMCID: PMC10948466 DOI: 10.1007/s00394-023-03323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/29/2023] [Indexed: 03/19/2024]
Abstract
PURPOSE In 2019, the Global Leadership Initiative on Malnutrition (GLIM) suggested a 2-step diagnostic format for malnutrition including screening and diagnosis. Prospective validation and feasibility studies, using the complete set of the five GLIM criteria, are needed. The aims of this study were to determine the prevalence of malnutrition, and investigate how the prevalence varied with mode of screening. Furthermore, we assessed the feasibility of GLIM in geriatric patients. METHODS Consecutive patients from two acute geriatric wards were included. For screening risk of malnutrition, the Mini Nutritional Assessment-Short Form (MNA-SF) or Malnutrition Screening Tool (MST) were used. In accordance with GLIM, a combination of phenotypic and etiologic criteria were required for the diagnosis of malnutrition. Feasibility was determined based on % data completeness, and above 80% completeness was considered feasible. RESULTS One hundred patients (mean age 82 years, 58% women) were included. After screening with MNA-SF malnutrition was confirmed by GLIM in 51%, as compared with 35% after screening with MST (p = 0.039). Corresponding prevalence was 58% with no prior screening. Using hand grip strength as a supportive measure for reduced muscle mass, 69% of the patients were malnourished. Feasibility varied between 70 and 100% for the different GLIM criteria, with calf circumference as a proxy for reduced muscle mass having the lowest feasibility. CONCLUSION In acute geriatric patients, the prevalence of malnutrition according to GLIM varied depending on the screening tool used. In this setting, GLIM appears feasible, besides for the criterion of reduced muscle mass.
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Affiliation(s)
- Maria Enge
- Department of Geriatric Medicine, Jakobsbergsgeriatriken, Stockholm, Sweden
| | - Frida Ostonen Peelen
- Theme Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Rikke Lundsgaard Nielsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit EATEN, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Ann Ödlund Olin
- Department of Quality and Patient Safety, Karolinska University Hospital Stockholm, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Tommy Cederholm
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Huddinge, Sweden
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anne-Marie Boström
- Theme Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, Huddinge, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Stockholms Sjukhem, Research and Development Unit, Stockholm, Sweden
| | - Ingvild Paur
- Norwegian Advisory Unit On Disease-Related Undernutrition, Oslo, Norway.
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Nydalen, Postbox 4950, 0424, Oslo, Norway.
- Institute for Clinical Medicine, Clinical Nutrition Research Group, UiT the Arctic University of Norway, Tromsø, Norway.
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17
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Dos Santos ALS, Santos BC, Frazão LN, Miranda AL, Fayh APT, Silva FM, Gonzalez MC, Correia MITD, Souza NC, Anastácio LR, Maurício SF. Validity of the GLIM criteria for the diagnosis of malnutrition in patients with colorectal cancer: A multicenter study on the diagnostic performance of different indicators of reduced muscle mass and disease severity. Nutrition 2024; 119:112324. [PMID: 38215671 DOI: 10.1016/j.nut.2023.112324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVES To assess the concurrent and predictive validity of different combinations of Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with colorectal cancer considering different indicators of reduced muscle mass (MM) and the effects of the disease. METHODS A secondary analysis with patients with colorectal cancer. The reduced MM was assessed by arm muscle area, arm muscle circumference, calf circumference, fat-free mass index, skeletal muscle index (SMI) and skeletal muscle. Cancer diagnosis or disease staging (TNM) was considered for the etiologic criterion referred to as the effect of the disease. The other phenotypic and etiologic criteria were also evaluated, and we analyzed 13 GLIM combinations. Concurrent validity between GLIM criteria and Patient-Generated Subjective Global Assessment was evaluated. Logistic and Cox regression were used in the predictive validation. RESULTS For concurrent validity (n = 208), most GLIM combinations (n = 6; 54.5%) presented a moderate agreement with Patient-Generated Subjective Global Assessment and none showed satisfactory sensitivity and specificity (>80%). Reduced MM evaluated by SMI and SMI were present in the GLIM combinations associated with postoperative complications (odds ratio, ≥2.0), independent of other phenotypic and etiologic criteria. The combinations with reduced MM considering any method and fixed phenotypic criteria and TNM were associated with mortality (hazard ratio, ≥2.0). CONCLUSIONS Satisfactory concurrent validity was not verified. The GLIM diagnosis of malnutrition was associated with postoperative complications and mortality.
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Affiliation(s)
| | - Bárbara Chaves Santos
- Universidade Federal de Minas Gerais, Postgraduate Program in Food Science, Belo Horizonte, Brazil
| | | | - Ana Lúcia Miranda
- Universidade Federal do Rio Grande do Norte, Postgraduate Program in Health Sciences, Health Sciences Center, Natal, Brazil
| | - Ana Paula Trussardi Fayh
- Universidade Federal do Rio Grande do Norte, Postgraduate Program in Health Sciences, Health Sciences Center, Natal, Brazil
| | - Flávia Moraes Silva
- Universidade Federal de Ciências da Saúde de Porto Alegre, Department of Nutrition, Porto Alegre, Brazil
| | - Maria Cristina Gonzalez
- Postgraduate Program in Food and Nutrition, Federal University of Pelotas, Rio Grande do Sul, Pelotas, Brazil
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Sun Y, Yin T, Li M, Wang F, Qi J, Zhang H, Wang L, Zhao J, Zhang Y. Development and Validation of Estimation Equations for Appendicular Skeletal Muscle Mass in Chinese Community-Dwelling Older Adults. Clin Interv Aging 2024; 19:265-276. [PMID: 38384404 PMCID: PMC10880553 DOI: 10.2147/cia.s440967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024] Open
Abstract
Purpose This study aimed to establish equations for estimating muscle mass through anthropometric parameters or together with physical function parameters in the community-dwelling older adults, providing a simple way of muscle mass assessment. Methods In this cross-sectional descriptive study, a total of 1537 older adults were recruited from the community and accepted the measurements of height, weight, upper arm and calf circumferences, grip strength, and walking speed. Body composition including appendicular skeletal muscle mass (ASM) was measured using bioelectrical impedance analysis (BIA). Participants were randomly divided into the development or validation group. Stepwise multiple linear regression was applied to develop equations in the development group. Thereafter, Pearson correlation coefficients, Bland-Altman plots, paired t-test, intraclass correlation coefficient (ICC) and paired-samples t-tests were used to assess the validity of the equations. Results All parameters were significantly correlated with ASM (r = 0.195~0.795, P < 0.001) except for the age in the validation group (P = 0.746). The most optimal anthropometric equation was: [adjusted R2 = 0.911, standard error of the estimate (SEE) = 1.311, P < 0.001]. Comparatively speaking, this equation showed high correlation coefficient (r = 0.951, P < 0.001) and ICC (ICC = 0.950, P < 0.001). No significant differences were found between BIA-measured ASM and the estimated ASM. The Bland-Altman plot showed that the mean difference between the estimated ASM and BIA-measured ASM was 0 kg and the limits of agreement of ASM was -2.70~2.60 kg. Furthermore, inclusion of physical function did not significantly improve the adjusted R2 and SEE. Conclusion The anthropometric equation offers a practical alternative simple and dependable method for estimating ASM in community-dwelling older adults.
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Affiliation(s)
- Yun Sun
- Department of Oncology, Suzhou BenQ Medical Center, Suzhou, Jiangsu, People’s Republic of China
| | - Tongtong Yin
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Mengli Li
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- School of Nursing, Hong Kong Polytechnic University, Hongkong, People’s Republic of China
| | - Fangfang Wang
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jiaying Qi
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hui Zhang
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- School of Nursing, Vocational Health College, Suzhou, Jiangsu, People’s Republic of China
| | - Li Wang
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jiehua Zhao
- Department of Nursing, Suzhou BenQ Medical Center, Suzhou, Jiangsu, People’s Republic of China
| | - Yu Zhang
- Department of Nursing, Suzhou BenQ Medical Center, Suzhou, Jiangsu, People’s Republic of China
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Lew CCH, Lee ZY, Day AG, Jiang X, Bear D, Jensen GL, Ng PY, Tweel L, Parillo A, Heyland DK, Compher C. The Association Between Malnutrition and High Protein Treatment on Outcomes in Critically Ill Patients: A Post Hoc Analysis of the EFFORT Protein Randomized Trial. Chest 2024:S0012-3692(24)00154-5. [PMID: 38354904 DOI: 10.1016/j.chest.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Preexisting malnutrition in critically ill patients is associated with adverse clinical outcomes. Malnutrition can be diagnosed with the Global Leadership Initiative on Malnutrition using parameters such as weight loss, muscle wasting, and BMI. International critical care nutrition guidelines recommend high protein treatment to improve clinical outcomes in critically ill patients diagnosed with preexisting malnutrition. However, this recommendation is based on expert opinion. RESEARCH QUESTION In critically ill patients, what is the association between preexisting malnutrition and time to discharge alive (TTDA), and does high protein treatment modify this association? STUDY DESIGN AND METHODS This multicenter randomized controlled trial involving 16 countries was designed to investigate the effects of high vs usual protein treatment in 1,301 critically ill patients. The primary outcome was TTDA. Multivariable regression was used to identify if preexisting malnutrition was associated with TTDA and if protein delivery modified their association. RESULTS The prevalence of preexisting malnutrition was 43.8%, and the cumulative incidence of live hospital discharge by day 60 was 41.2% vs 52.9% in the groups with and without preexisting malnutrition, respectively. The average protein delivery in the high vs usual treatment groups was 1.6 g/kg per day vs 0.9 g/kg per day. Preexisting malnutrition was independently associated with slower TTDA (adjusted hazard ratio, 0.81; 95% CI, 0.67-0.98). However, high protein treatment in patients with and without preexisting malnutrition was not associated with TTDA (adjusted hazard ratios of 0.84 [95% CI, 0.63-1.11] and 0.97 [95% CI, 0.77-1.21]). Furthermore, no effect modification was observed (ratio of adjusted hazard ratio, 0.84; 95% CI, 0.58-1.20). INTERPRETATION Malnutrition was associated with slower TTDA, but high protein treatment did not modify the association. These findings challenge current international critical care nutrition guidelines. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT03160547; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Charles Chin Han Lew
- Department of Dietetics & Nutrition, Ng Teng Fong General Hospital, Singapore, Singapore; Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore
| | - Zheng-Yii Lee
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Cardiac Anesthesiology & Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Andrew G Day
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Xuran Jiang
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Danielle Bear
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gordon L Jensen
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Pauline Y Ng
- Critical Care Medicine Unit, School of Clinical Medicine, The University of Hong Kong, Adult Intensive Care Unit, Queen Mary Hospital, Hong Kong
| | - Lauren Tweel
- Clinical and Preventive Nutrition Sciences, Rutgers University, School of Health Professions, New Brunswick, NJ; Foothills Medical Centre, Calgary, AB, Canada
| | - Angela Parillo
- Department of Clinical Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania, School of Nursing, Philadelphia, PA.
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Kiss CM, Bertschi D, Beerli N, Berres M, Kressig RW, Fischer AM. Calf circumference as a surrogate indicator for detecting low muscle mass in hospitalized geriatric patients. Aging Clin Exp Res 2024; 36:25. [PMID: 38321234 PMCID: PMC10847205 DOI: 10.1007/s40520-024-02694-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Sarcopenia is characterized by low muscle strength, decreased muscle mass, and decline in physical performance. While the measurements of muscle strength and physical performance are easy to perform, an accurate evaluation of muscle mass is technically more demanding. We therefore evaluated the suitability of calf circumference (CC) as a clinical indicator for muscle mass. METHODS In a cross-sectional single-centre study, geriatric inpatients were assessed for sarcopenia according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) consensus. Calf circumference was tested for correlation with appendicular skeletal muscle mass index (ASMI). Receiver operating characteristic curves (ROC) were used to calculate the discriminatory value of the CC cut-off values to differentiate patients above and below ASMI cut-offs for sarcopenia. RESULTS In this study population (n = 305, age 83.5 ± 7.0 years, BMI 25.7 kg/m2, 65.6% female), the prevalence of sarcopenia was 22.6%. In subjects with low ASMI, mean CC was 29.5 ± 3.4 cm for females and 32.0 ± 3.4 cm for males. A positive relationship between CC and ASMI was found. The optimized cut-off value for CC to identify patients with low ASMI was <31.5 cm for females (sensitivity 78%, specificity 79%), and <33.5 cm for males (sensitivity 71%, specificity 62%). CONCLUSION In clinical settings where imaging technology for muscle mass quantification is not available, simple calf circumference measurement may be used as a dependable indicator for low muscle mass in older adults.
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Affiliation(s)
- Caroline M Kiss
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Dominic Bertschi
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nadine Beerli
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- Institute of Nursing Science, Basel, Switzerland
| | - Manfred Berres
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Koblenz, Germany
| | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Andreas M Fischer
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
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21
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Hegazi R, Miller A, Sauer A. Evolution of the diagnosis of malnutrition in adults: a primer for clinicians. Front Nutr 2024; 11:1169538. [PMID: 38379550 PMCID: PMC10876842 DOI: 10.3389/fnut.2024.1169538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 01/19/2024] [Indexed: 02/22/2024] Open
Abstract
During the last two decades, the definition, diagnosis, and management of malnutrition have significantly evolved. Malnutrition is generally defined as deficiencies, excesses, or imbalances in a person's intake of energy and/or nutrients. While malnutrition is associated with a significantly increased risk of morbidity, mortality, and healthcare cost, it is often underdiagnosed both in healthcare and community settings. One contributing factor is the lack of a consensus on its definition and appropriate diagnostic indicators. In the current article, we review the evolution of frameworks for the diagnosis of malnutrition. Recently published consensuses by prominent clinical nutrition societies have established a trajectory for the uniform global diagnosis of malnutrition. Limiting the use of body mass index (BMI) as a diagnostic criterion while emphasizing the use of muscle mass enables a more consistent and accurate diagnosis of malnutrition in the clinical setting. Guidance for the unified methodology and terminology for diagnosing malnutrition, such as the one proposed in the current article will enable policy makers to systematically address the two faces of malnutrition, starvation- and disease-related malnutrition applicable to both pediatric and adult populations. Policies and programs that could address issues of food insecurity and scarcity as well as early diagnosis and management of disease-related malnutrition will empower better care of community nutrition.
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Affiliation(s)
- Refaat Hegazi
- Department of Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, United States
| | - Anthony Miller
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Abby Sauer
- Department of Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, United States
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22
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de Luis Román D, Gómez JC, García-Almeida JM, Vallo FG, Rolo GG, Gómez JJL, Tarazona-Santabalbina FJ, Sanz-Paris A. Diabetic Sarcopenia. A proposed muscle screening protocol in people with diabetes : Expert document. Rev Endocr Metab Disord 2024:10.1007/s11154-023-09871-9. [PMID: 38315411 DOI: 10.1007/s11154-023-09871-9] [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] [Accepted: 12/28/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To propose the grounds for "diabetic sarcopenia" as a new comorbidity of diabetes, and to establish a muscle screening algorithm proposal to facilitate its diagnosis and staging in clinical practice. METHOD A qualitative expert opinion study was carried out using the nominal technique. A literature search was performed with the terms "screening" or "diagnostic criteria" and "muscle loss" or "sarcopenia" and "diabetes" that was sent to a multidisciplinary group of 7 experts who, in a face-to-face meeting, discussed various aspects of the screening algorithm. RESULTS The hallmark of diabetic sarcopenia (DS) is muscle mass atrophy characteristic of people with diabetes mellitus (DM) in contrast to the histological and physiological normality of muscle mass. The target population to be screened was defined as patients with DM with a SARC-F questionnaire > 4, glycosylated haemoglobin (HbA1C) ≥ 8.0%, more than 5 years since onset of DM, taking sulfonylureas, glinides and sodium/glucose cotransporter inhibitors (SGLT2), as well as presence of chronic complications of diabetes or clinical suspicion of sarcopenia. Diagnosis was based on the presence of criteria of low muscle strength (probable sarcopenia) and low muscle mass (confirmed sarcopenia) using methods available in any clinical consultation room, such as dynamometry, the chair stand test, and Body Mass Index (BMI)-adjusted calf circumference. DS was classified into 4 stages: Stage I corresponds to sarcopenic patients with no other diabetes complication, and Stage II corresponds to patients with some type of involvement. Within Stage II are three sublevels (a, b and c). Stage IIa refers to individuals with sarcopenic diabetes and some diabetes-specific impairment, IIb to sarcopenia with functional impairment, and IIc to sarcopenia with diabetes complications and changes in function measured using standard tests Conclusion: Diabetic sarcopenia has a significant impact on function and quality of life in people with type 2 diabetes mellitus (T2DM), and it is important to give it the same attention as all other traditionally described complications of T2DM. This document aims to establish the foundation for protocolising the screening and diagnosis of diabetic sarcopenia in a manner that is simple and accessible for all levels of healthcare.
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Affiliation(s)
- Daniel de Luis Román
- Center Investigación of Endocrinology and Nutrition, University of Valladolid, Valladolid, Spain.
| | | | - José Manuel García-Almeida
- Clinical Management Unit of Endocrinology and Nutrition, Virgen de la Victoria Clinical Hospital, Málaga, Spain
| | | | | | - Juan José López Gómez
- Endocrinology and Nutrition Department, University Clinical Hospital of Valladolid, Valladolid, Spain
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Hansen SS, Munk T, Knudsen AW, Beck AM. Concordance between changes in calf circumference and muscle mass exists: A narrative literature review. Clin Nutr ESPEN 2024; 59:171-175. [PMID: 38220372 DOI: 10.1016/j.clnesp.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/09/2023] [Accepted: 11/30/2023] [Indexed: 01/16/2024]
Abstract
Technological methods such as BIA or DXA are not always accessible in clinical practice, thus GLIM supports the use of calf circumference measurements to examine muscle mass. However, it has not been described if measurements of calf circumference can detect a change in muscle mass to the same degree as the technological methods. The aim of this study was to assess, whether changes in calf circumference can be used as a valid proxy for changes in muscle mass. 10 studies including measurements of muscle mass by calf circumference and technological methods at baseline and follow-up were identified through a narrative literature review. Results were used to determine concordance between measurements. Predominantly concordance between changes in calf circumference and muscle mass assessed by BIA or DXA was reviled. However, the results were not uniform for hospitalized patients or older adults as groups. Thus, uncertainty whether changes in calf circumference can be used as a valid proxy for changes in muscle mass in these groups still exist.
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Affiliation(s)
- Signe Skovgaard Hansen
- The Unit for Dieticians and Nutrition Research, EATEN, Herlev and Gentofte Hospital, Borgmester Ib Juuls vej 1, Denmark.
| | - Tina Munk
- The Unit for Dieticians and Nutrition Research, EATEN, Herlev and Gentofte Hospital, Borgmester Ib Juuls vej 1, Denmark.
| | - Anne Wilkens Knudsen
- The Unit for Dieticians and Nutrition Research, EATEN, Herlev and Gentofte Hospital, Borgmester Ib Juuls vej 1, Denmark.
| | - Anne Marie Beck
- The Unit for Dieticians and Nutrition Research, EATEN, Herlev and Gentofte Hospital, Borgmester Ib Juuls vej 1, Denmark.
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Martone AM, Ciciarello F, Galluzzo V, Calvani R, Zazzara MB, Tosato M, Coelho‐Junior HJ, Marzetti E, Landi F. A simple medical device development according to normative values of calf circumference across ages: results from the Italian Longevity Check-up 7+ (Lookup 7+) project. J Cachexia Sarcopenia Muscle 2024; 15:36-44. [PMID: 38053516 PMCID: PMC10834319 DOI: 10.1002/jcsm.13286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Wide consensus exists on the notion that low muscle mass is a predictor of negative health-related events, such as disability, morbidity, and mortality. Indeed, the European Working Group on Sarcopenia in Older People 2 had identified muscle mass as the key component to confirm the diagnosis of sarcopenia. However, the lack of normative values for muscle mass across ages hampers the practical assessment of this important parameter. The aim of the present study was to produce cross-sectional centile and normative values for calf circumference (a surrogate estimation of muscle mass) across a wide spectrum of ages using a large and unselected sample of community-dwellers enrolled in the Longevity Check-up 7+ (Lookup 7+) project. METHODS This is a cross-sectional study using the data of Lookup 7+ project, an ongoing study started in June 2015 and conducted in unconventional settings (i.e., exhibitions, malls, and health promotion campaigns). Candidate participants were considered eligible for enrolment if they were at least 45 years of age and provided written informed consent. Calf circumference was measured using an inextensible but flexible plastic tape in a sitting position with the knee and ankle at a right angle and the feet resting on the floor. Normative values for calf circumference from ages 45 to 80 + years were generated. RESULTS A total of 11 814 participants were enrolled from 1 June 2015 to 30 September 2022. The mean age of participants included in the analyses was 61.8 years (standard deviation; 10.2 years; range: 45-98 years), and 6686 (57%) were women. Normative values for calf circumference were obtained for men and women, stratified by age groups. Accordingly, a calf circumference tape, with colour bands that demarcate the centiles range into which the patient falls, was created and validated. CONCLUSIONS Our study established age- and gender-specific centile reference values for calf circumference. The calf circumference tape can be used to easily interpret the assessment in every-day practice for the early detection of individuals with or at risk of sarcopenia and malnutrition.
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Affiliation(s)
- Anna Maria Martone
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCSRomeItaly
- Department of Geriatrics, Orthopedics and RheumatologyUniversità Cattolica del Sacro CuoreRomeItaly
| | | | - Vincenzo Galluzzo
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCSRomeItaly
| | - Riccardo Calvani
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCSRomeItaly
- Department of Geriatrics, Orthopedics and RheumatologyUniversità Cattolica del Sacro CuoreRomeItaly
| | | | - Matteo Tosato
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCSRomeItaly
| | - Hélio José Coelho‐Junior
- Department of Geriatrics, Orthopedics and RheumatologyUniversità Cattolica del Sacro CuoreRomeItaly
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCSRomeItaly
- Department of Geriatrics, Orthopedics and RheumatologyUniversità Cattolica del Sacro CuoreRomeItaly
| | - Francesco Landi
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCSRomeItaly
- Department of Geriatrics, Orthopedics and RheumatologyUniversità Cattolica del Sacro CuoreRomeItaly
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25
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Alves VA, Fayh APT, Queiroz SA, Gonzalez MC, de Sousa IM. Muscle mass evaluation in hospitalized patients: Comparison between doubly indirect methods. Clin Nutr ESPEN 2024; 59:188-193. [PMID: 38220375 DOI: 10.1016/j.clnesp.2023.11.022] [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: 04/18/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Loss of muscle mass (MM) in hospitalized patients has been associated with negative outcomes, thus, evaluating this biomarker is important to stratify risk. Although studies have been showing that calf circumference (CC) and bioelectrical impedance analysis (BIA) are valid for estimating MM in hospitalized patients, we do not know if they are associated. The aim of this study was to evaluate the associations between CC and BIA in hospitalized patients. METHODS A cross-sectional study, in hospitalized patients' post-acute cardiac event. We collected sociodemographic, clinical, and anthropometric data. CC measurement was adjusted according to the BMI. Spearman's correlations and associations between the methods were performed for the total sample, according to sex and stage of life (older adults or not). RESULTS We included 177 patients, mean age of 60.5 ± 12.4 years old, the majority males (75 %). Median BMI was 26.2 kg/m2 (23.8-29.2 kg/m2), most of them overweight (41.8 %). The median of CC was lower in females and older adults, and majority of the patients had low CC (87.6 %). Higher values of fat-free mass (FFM) by BIA were observed in males and younger adults, and 5.6 % presented low FFMI. We found a positive and moderate correlation between fat-free mass index (FFMI) and CC (rho = 0.532). Males had higher correlations (rho = 0.481). An increase of 1 kg in the FFM represented an increase of 1.16 cm (crude analysis) to 1.59 cm (adjusted analysis) in CC (p < 0.001). FFM explained 37 % in the variability of CC, and together with BMI, sex and age, explained 60 % in the variability. CONCLUSIONS Raw values of FFM obtained by BIA and CC presented a weak to moderate correlation in cardiac patients. Changes in one measure impact on the other one.
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Affiliation(s)
- Viviane Andrade Alves
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
| | - Sandra Azevedo Queiroz
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | | | - Iasmin Matias de Sousa
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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26
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Houmøller CP, Hellerup SH, Nøhr NK, Winther G, Mikkelsen S, Geisler L, Holst M. Measured versus estimated energy requirement in hospitalized patients. Clin Nutr ESPEN 2024; 59:312-319. [PMID: 38220392 DOI: 10.1016/j.clnesp.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/21/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIM Failure to identify a patient's energy requirement has a variety of consequences both physiological and economical. Previous studies have shown that predictive formulas, including the Harris Benedict equation (HB), both over- and underestimates energy requirement in severely ill patients and healthy younger adults, compared to the golden standard, indirect calorimetry (IC). The comparison between measured and estimated energy requirements in hospitalized patients in regular wards is underreported. The aim of this study was to assess the agreement between measured energy requirements and requirements estimated by HB in the individual hospitalized patients, and to investigate whether those findings were associated with other specific patient characteristics. METHODS IC (n = 86) was used to measure resting energy expenditure (REE) and bioimpedance analysis (BIA) (n = 67) was used for body composition in patients admitted to Aalborg University Hospital. Furthermore, height, weight, body mass index, calf circumference, while information regarding hospital ward, vital values, dieticians estimated energy requirements and blood samples were collected in the patients' electronic medical records. Bland-Altman plots, multiple linear regression analysis, and Chi2 tests were performed. RESULTS On average a difference between IC compared with the HB (6.2%), dietitians' estimation (7.8%) and BIA (4.50%) was observed (p < 0.05). Association between REE and skeletal muscle mass (SMM) (R2 = 0.58, β = 149.0 kJ), body fat mass (BFM) (R2 = 0.51, β = 59.1 kJ), and weight (R2 = 0.62, β = 45.6 kJ) were found (p < 0.05). A positive association between measured REE and HB were found in the following variables (p < 0.05): CRP, age, surgical patients, and respiratory rate. CONCLUSION This study found a general underestimation of estimated energy expenditure compared to measured REE. A positive correlation between measured REE and SMM, BRM and weight was found. Lastly, the study found a greater association between CRP, age, surgical patients, and respiratory rate and a general greater than ±10% difference between measured and estimation of energy requirements.
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Affiliation(s)
| | | | - Niels K Nøhr
- Department of Health, Science and Technology, Aalborg University, Denmark.
| | - Gustav Winther
- Department of Health, Science and Technology, Aalborg University, Denmark.
| | - Sabina Mikkelsen
- Centre for Nutrition and Intestinal Failure, Aalborg University Hospital, Denmark.
| | - Lea Geisler
- Centre for Nutrition and Intestinal Failure, Aalborg University Hospital, Denmark.
| | - Mette Holst
- Centre for Nutrition and Intestinal Failure, Department of Gastroenterology, Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Denmark.
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Beretta MV, de Paula TP, da Costa Rodrigues T, Steemburgo T. Prolonged hospitalization and 1-year mortality are associated with sarcopenia and malnutrition in older patients with type 2 diabetes: A prospective cohort study. Diabetes Res Clin Pract 2024; 207:111063. [PMID: 38110120 DOI: 10.1016/j.diabres.2023.111063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 12/20/2023]
Abstract
AIM To assess the relationship of the presence of sarcopenia and malnutrition with unfavorable clinical outcomes: prolonged length of hospital stay (LOS), readmission, and one-year mortality in older patients with type 2 diabetes (T2D). METHODS Were included 319 patients with ≥ 60 years of age with T2D hospitalized at a university hospital in Southern Brazil. Sarcopenia was diagnosed according to handgrip strength (HGS), calf circumference (CC), and the timed up and go (TUG) walking test, and malnutrition according to the subjective global assessment (SGA) and the mini nutritional assessment long form (MNA-LF). Multivariate analyses, adjusted for confounders, were performed to assess the association of sarcopenia and malnutrition with clinical outcomes. One-year survival was compared using Kaplan-Meier analysis. RESULTS The association between sarcopenia and malnutrition increased by 2.42 times (95 %CI 1.35-4.36) the probability of LOS ≥ 14 days and by 2.01 times (95 %CI 1.09-3.72) the risk of one-year mortality. Older patients with malnutrition and sarcopenia have a higher risk of one-year mortality (log-rank p < 0.05) compared with well-nourished patients without sarcopenia. CONCLUSION In older patients with type 2 diabetes, those with sarcopenia, and malnutrition have higher odds of prolonged hospitalization and risk of mortality within one year after hospital discharge.
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Affiliation(s)
- Mileni Vanti Beretta
- Graduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Tatiana Pedroso de Paula
- Graduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Ticiana da Costa Rodrigues
- Graduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Thais Steemburgo
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Graduate Program in Food, Nutrition and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Lee S, Lee S, Jo S, Kim KA, Yang YJ, Lee JJ, Kim E, Park Y, Kyong T, Kim JH. Calf Circumference as an Indicator for Cystatin C Testing in Hospitalized Elderly Male Patients for Detecting Hidden Renal Impairment. J Clin Med 2023; 12:6899. [PMID: 37959364 PMCID: PMC10647781 DOI: 10.3390/jcm12216899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Serum creatinine is used to measure the estimated glomerular filtration rate (eGFR); however, it is influenced by muscle mass and may therefore overestimate renal function in patients with sarcopenia. We examined calf circumference (CC) as a convenient muscle mass evaluation tool that can potentially indicate the need to test for cystatin C instead of creatinine in elderly inpatients. We retrospectively reviewed the electronic health record of 271 inpatients aged 65 or over. CC was determined by measuring the thickest part of the nondominant calf. eGFRcys and eGFRcr were calculated using cystatin C and creatinine levels, respectively. We evaluated optimum CC cutoff values using the eGFRcys/eGFRcr ratio for detecting hidden renal impairment (HRI, defined as eGFRcr ≥ 60 mL/min/1.73 m2 but eGFRcys < 60 mL/min/1.73 m2). CC showed a significant positive correlation with the eGFRcys/eGFRcr ratio in both sexes. The areas under the receiver operating characteristic curve were 0.725 and 0.681 for males and females, respectively. CC cutoffs with a sensitivity or specificity of 90% or 95% might be used to detect HRI in males. In conclusion, utilizing the optimum cutoff, CC could be a cost-effective screening tool for detecting HRI in elderly male patients using cystatin C as an add-on test.
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Affiliation(s)
- Sunghwan Lee
- Department of Laboratory Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Gyeonggi-do, Republic of Korea; (S.L.); (K.-A.K.)
| | - Seul Lee
- Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Gyeonggi-do, Republic of Korea; (S.L.); (S.J.)
| | - Sunhee Jo
- Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Gyeonggi-do, Republic of Korea; (S.L.); (S.J.)
| | - Kyung-Ah Kim
- Department of Laboratory Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Gyeonggi-do, Republic of Korea; (S.L.); (K.-A.K.)
| | - Yu Jin Yang
- Department of Nutrition, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Gyeonggi-do, Republic of Korea; (Y.J.Y.); (J.J.L.)
| | - Jung Joo Lee
- Department of Nutrition, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Gyeonggi-do, Republic of Korea; (Y.J.Y.); (J.J.L.)
| | - Eunsung Kim
- Department of Inpatient Nursing, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Gyeonggi-do, Republic of Korea;
| | - Yongjung Park
- Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-gu, Seoul 06273, Republic of Korea;
| | - Taeyoung Kyong
- Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Gyeonggi-do, Republic of Korea; (S.L.); (S.J.)
| | - Jeong-Ho Kim
- Department of Laboratory Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Gyeonggi-do, Republic of Korea; (S.L.); (K.-A.K.)
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29
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Deng Y, Li N, Wang Y, Xiong C, Zou X. Risk Factors and Prediction Nomogram of Cognitive Frailty with Diabetes in the Elderly. Diabetes Metab Syndr Obes 2023; 16:3175-3185. [PMID: 37867632 PMCID: PMC10588717 DOI: 10.2147/dmso.s426315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/02/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose Diabetes is a well-recognized risk factor for cognitive frailty. This study aimed to investigate the influencing factors of cognitive frailty in elderly patients with diabetes and develop a nomogram for its assessment. Methods We collected the clinical data of diabetic patients aged 60 years or older and the patients were divided into training and validation cohorts at a ratio of 7:3. In the training cohort, logistic regression was used to screen out the influencing factors of cognitive frailty in elderly diabetic patients, and a risk prediction model and nomogram were constructed and verified in the validation cohort. The performance of the model was evaluated using various measures, including the area under the receiver operating characteristic curve, calibration curve, Hosmer-Lemeshow test and decision curve analysis. Results A total of 315 elderly diabetic patients were included, of which 87 (27.6%) patients had cognitive frailty. Age, albumin levels, calf circumference, duration of diabetes, intellectual activity, and depressive state were identified as independent risk factors for cognitive frailty in older patients with diabetes (P < 0.05). The training cohort and validation cohort demonstrated area under curve (AUC) values of 0.866 and 0.821, respectively. Conclusion Older patients with diabetes have a higher prevalence of cognitive frailty. The nomogram model exhibited satisfactory calibration and identification, providing a reliable tool for assessing the risk of cognitive frailty in individuals with diabetes.
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Affiliation(s)
- Yinhui Deng
- Department of Nursing, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Na Li
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Yaru Wang
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Chen Xiong
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Xiaofang Zou
- Department of Nursing, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
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Ren SS, Zhang KW, Chen BW, Yang C, Xiao R, Li PG, Zhu MW. Machine Learning-Based Prediction of Complications and Prolonged Hospitalization with the GLIM Criteria Combinations Containing Calf Circumference in Elderly Asian Patients. Nutrients 2023; 15:4146. [PMID: 37836430 PMCID: PMC10574169 DOI: 10.3390/nu15194146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND AIMS Malnutrition is widely present and influences the prognosis of elderly inpatients, so it is helpful to be able to identify it with a convenient method. However, in the widely accepted criteria for malnutrition, the Global Leadership Initiative on Malnutrition (GLIM), a lot of metrics can be used to define the phenotypic and etiological criteria. To identify muscle mass reduction, anthropometric parameters such as calf circumference (CC) and hand grip strength (HGS) are preferable to other expensive methods in many situations because they are easy and inexpensive to measure, but their applicability needs to be verified in specific clinical scenarios. This study aims to verify the value of CC- and HGS-identified muscle loss in diagnosing malnutrition and predicting in-hospital complications (IHC) and prolonged length of hospital stay (PLOS) in elderly inpatients using machine learning methods. METHODS A sample of 7122 elderly inpatients who were enrolled in a previous multicenter cohort study in China were screened for eligibility for the current study and were then retrospectively diagnosed for malnutrition using 33 GLIM criteria that differ in their combinations of phenotypic and etiological criteria, in which CC or CC+HGS were used to identify muscle mass reduction. The diagnostic consistency with the subjective global assessment (SGA) criteria at admission was evaluated according to Kappa coefficients. The association and the predictive value of the GLIM-defined malnutrition with 30-day IHC and PLOS were evaluated with logistic regression and randomized forest models. RESULTS In total, 2526 inpatients (average age 74.63 ± 7.12 years) were enrolled in the current study. The prevalence of malnutrition identified by the 33 criteria combinations ranged from 3.3% to 27.2%. The main IHCs was infectious complications (2.5%). The Kappa coefficients ranged from 0.130 to 0.866. Logistic regression revealed that malnutrition was identified by 31 GLIM criteria combinations that were significantly associated with 30-day IHC, and 22 were significantly associated with PLOS. Random forest prediction revealed that GLIM 15 (unconscious weight loss + muscle mass reduction, combined with disease burden/inflammation) performs best in predicting IHC; GLIM 30 (unconscious weight loss + muscle mass reduction + BMI reduction, combined with disease burden/inflammation) performs best in predicting PLOS. Importantly, CC alone performs better than CC+HGS in the criteria combinations for predicting adverse clinical outcomes. CONCLUSION Muscle mass reduction defined by a reduced CC performs well in the GLIM criteria combinations for diagnosing malnutrition and predicting IHC and PLOS in elderly Asian inpatients. The applicability of other anthropometric parameters in these applications needs to be further explored.
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Affiliation(s)
- Shan-Shan Ren
- Department of Clinical Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China;
- The Key Laboratory of Geriatrics, National Center of Gerontology, National Health Commission, Beijing Hospital, Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Kai-Wen Zhang
- School of Public Health, Capital Medical University, Beijing 100069, China; (K.-W.Z.); (C.Y.)
- Beijing Key Laboratory of Environmental Toxicology, Beijing 100069, China
- Beijing Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Bo-Wen Chen
- Sir Run Run Shaw Hospital, Hangzhou 310016, China;
| | - Chun Yang
- School of Public Health, Capital Medical University, Beijing 100069, China; (K.-W.Z.); (C.Y.)
- Beijing Key Laboratory of Environmental Toxicology, Beijing 100069, China
- Beijing Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Rong Xiao
- School of Public Health, Capital Medical University, Beijing 100069, China; (K.-W.Z.); (C.Y.)
- Beijing Key Laboratory of Environmental Toxicology, Beijing 100069, China
- Beijing Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Peng-Gao Li
- School of Public Health, Capital Medical University, Beijing 100069, China; (K.-W.Z.); (C.Y.)
- Beijing Key Laboratory of Environmental Toxicology, Beijing 100069, China
- Beijing Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Ming-Wei Zhu
- Department of Clinical Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China;
- The Key Laboratory of Geriatrics, National Center of Gerontology, National Health Commission, Beijing Hospital, Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
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Fontane L, Reig MH, Garcia-Ribera S, Herranz M, Miracle M, Chillaron JJ, Estepa A, Toro S, Ballesta S, Navarro H, Llaurado G, Pedro-Botet J, Benaiges D. Validity and Applicability of the Global Leadership Initiative on Malnutrition (GLIM) Criteria in Patients Hospitalized for Acute Medical Conditions. Nutrients 2023; 15:4012. [PMID: 37764796 PMCID: PMC10535463 DOI: 10.3390/nu15184012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: The objectives of this study were to evaluate the concurrent and predictive validity and the applicability of the global leadership initiative on malnutrition (GLIM) criteria in patients hospitalized for acute medical conditions. (2) Methods: prospective cohort study with patients hospitalized for acute medical conditions. For validation, the methodology proposed by the GLIM group of experts was used. Sensitivity and specificity values greater than 80% with respect to those for the subjective global assessment (SGA) were necessary for concurrent validation. The time necessary to complete each nutritional assessment test was determined. (3) Results: A total of 119 patients were evaluated. The SGA was applied to the entire cohort, but the GLIM criteria could not be applied to 3.4% of the patients. The sensitivity and specificity of the GLIM criteria with respect to those for the SGA to detect malnutrition were 78.0 and 86.2%, respectively. The GLIM predictive validity criterion was fulfilled because patients with malnutrition more frequently had a hospital stay >10 days (odds ratio of 2.98 (1.21-7.60)). The GLIM criteria required significantly more time for completion than did the SGA (p = 0.006). (4) Conclusion: The results of this study do not support the use of the GLIM criteria over the SGA for the diagnosis of malnutrition in patients hospitalized for acute medical conditions.
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Affiliation(s)
- Laia Fontane
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
| | - Maria Helena Reig
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
| | - Sonika Garcia-Ribera
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
| | - Miriam Herranz
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
| | - Mar Miracle
- Facultat de Farmàcia i Ciències de l’Alimentació, Universitat de Barcelona, Joan XXIII, 08028 Barcelona, Spain;
| | - Juan Jose Chillaron
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, 08002 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, 08003 Barcelona, Spain
| | - Araceli Estepa
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
| | - Silvia Toro
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
| | - Silvia Ballesta
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, 08003 Barcelona, Spain
| | - Humberto Navarro
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
- Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar., Dr. Aiguader, 80, 08003 Barcelona, Spain
| | - Gemma Llaurado
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, 08002 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, 08003 Barcelona, Spain
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, 08003 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar., Dr. Aiguader, 80, 08003 Barcelona, Spain
| | - David Benaiges
- Department of Endocrinology and Nutrition, Consorci Sanitari Alt Penedès-Garraf, Espirall, 61, 08720 Vilafranca del Penedès, Spain; (L.F.); (M.H.R.); (S.G.-R.); (M.H.); (J.J.C.); (A.E.); (S.T.); (S.B.); (H.N.)
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain; (G.L.); (J.P.-B.)
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, 08002 Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición, Monforte de Lemos Avenue, 3-5, Pavilion 11, Floor 0, 28029 Madrid, Spain
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Stefani GP, Crestani MS, Scott LM, Soares CH, Steemburgo T. Complementarity of nutritional assessment tools to predict prolonged hospital stay and readmission in older patients with solid tumors: A secondary analysis of a cohort study. Nutrition 2023; 113:112089. [PMID: 37354653 DOI: 10.1016/j.nut.2023.112089] [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: 03/10/2023] [Revised: 04/06/2023] [Accepted: 05/19/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the complementarity of five nutritional risk screening tools (Nutritional Risk Screening 2002 [NRS-2002], Malnutrition Screening Tool [MST], Malnutrition Universal Screening Tool [MUST], Mini-Nutritional Assessment-Short Form [MNA-SF], and Patient-Generated Subjective Global Assessment SF [PG-SGA SF]) combined with three malnutrition diagnostic tools (SGA, PG-SGA, and Global Leadership Initiative on Malnutrition [GLIM]) and their ability to predict poor clinical outcomes in older patients with cancer. METHODS Using data collected within 48 h of hospital admission, we conducted a prospective cohort study on nutritional risk (NRS-2002, MST, MUST, MNA-SF, and PG-SGA SF) and the presence of malnutrition (SGA, PG-SGA, and GLIM). Patients were grouped according to their nutritional risk and malnutrition status. Accuracy tests and logistic regression analysis were used to evaluate the ability of the combined tools to predict hospital length of stay and readmission. We evaluated 248 older patients (69.7 ± 7.2 y of age, 59.7% men; 27.4% with gastrointestinal tumors). The median length of stay was 4 d (3-9 d), and 65.3% of patients remained hospitalized for ≥ 4 d. RESULTS The NRS-2002 combined with SGA and MST combined with SGA and GLIM had the highest specificity (> 80%) for predicting hospitalization. Nutritional risk assessed by MNA-SF and malnutrition assessed by PG-SGA were associated with 2.48- and 6.04-fold increased likelihood of hospitalization (≥ 4 d) and readmission (60 d), respectively. CONCLUSION Concomitant application of MNA-SF (specific for older patients) with PG-SGA (specific for patients with cancer) might enhance the ability to predict length of stay and readmission in hospitalized older patients with solid tumors.
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Affiliation(s)
- Giovanna Potrick Stefani
- Postgraduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto, Alegre, Brazil
| | - Mariana Scortegagna Crestani
- Postgraduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto, Alegre, Brazil
| | - Laura Machado Scott
- Hospital de Clínicas de Porto Alegre, Porto, Alegre, Brazil; Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Camilla Horn Soares
- Hospital de Clínicas de Porto Alegre, Porto, Alegre, Brazil; Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Thais Steemburgo
- Postgraduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto, Alegre, Brazil; Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Kiss N, Prado CM, Daly RM, Denehy L, Edbrooke L, Baguley BJ, Fraser SF, Khosravi A, Abbott G. Low muscle mass, malnutrition, sarcopenia, and associations with survival in adults with cancer in the UK Biobank cohort. J Cachexia Sarcopenia Muscle 2023; 14:1775-1788. [PMID: 37212184 PMCID: PMC10401543 DOI: 10.1002/jcsm.13256] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/23/2023] [Accepted: 04/15/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Low muscle mass (MM) is a common component of cancer-related malnutrition and sarcopenia, conditions that are all independently associated with an increased risk of mortality. This study aimed to (1) compare the prevalence of low MM, malnutrition, and sarcopenia and their association with survival in adults with cancer from the UK Biobank and (2) explore the influence of different allometric scaling (height [m2 ] or body mass index [BMI]) on low MM estimates. METHODS Participants in the UK Biobank with a cancer diagnosis within 2 years of the baseline assessment were identified. Low MM was estimated by appendicular lean soft tissue (ALST) from bioelectrical impedance analysis derived fat-free mass. Malnutrition was determined using the Global Leadership in Malnutrition criteria. Sarcopenia was defined using the European Working Group on Sarcopenia in Older People criteria (version 2). All-cause mortality was determined from linked national mortality records. Cox-proportional hazards models were fitted to estimate the effect of low MM, malnutrition, and sarcopenia on all-cause mortality. RESULTS In total, 4122 adults with cancer (59.8 ± 7.1 years; 49.2% male) were included. Prevalence of low MM (8.0% vs. 1.7%), malnutrition (11.2% vs. 6.2%), and sarcopenia (1.4% vs. 0.2%) was higher when MM was adjusted using ALST/BMI compared with ALST/height2 , respectively. Low MM using ALST/BMI identified more cases in participants with obesity (low MM 56.3% vs. 0%; malnutrition 50% vs. 18.5%; sarcopenia 50% vs. 0%). During a median 11.2 (interquartile range: 10.2, 12.0) years of follow up, 901 (21.7%) of the 4122 participants died, and of these, 744 (82.6%) deaths were cancer-specific All conditions were associated with a higher hazard of mortality using either method of MM adjustment: low MM (ALST/height2 : HR 1.9 [95% CI 1.3, 2.8], P = 0.001; ALST/BMI: HR 1.3 [95% CI 1.1, 1.7], P = 0.005; malnutrition (ALST/height2 : HR 2.5 [95% CI 1.1, 1.7], P = 0.005; ALST/BMI: HR 1.3 [95% CI 1.1, 1.7], P = 0.005; sarcopenia (ALST/height2 : HR 2.9 [95% CI 1.3, 6.5], P = 0.013; ALST/BMI: HR 1.6 [95% CI 1.0, 2.4], P = 0.037). CONCLUSIONS In adults with cancer, malnutrition was more common than low MM or sarcopenia, although all conditions were associated with a higher mortality risk, regardless of the method of adjusting for MM. In contrast, adjustment of low MM for BMI identified more cases of low MM, malnutrition, and sarcopenia overall and in participants with obesity compared with height adjustment, suggesting it is the preferred adjustment.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
- Department of Health Services ResearchPeter MacCallum Cancer CentreMelbourneAustralia
| | - Carla M. Prado
- Department of Agricultural, Food and Nutrition ScienceUniversity of AlbertaEdmontonCanada
| | - Robin M. Daly
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
| | - Linda Denehy
- Department of Health Services ResearchPeter MacCallum Cancer CentreMelbourneAustralia
- Melbourne School of Health SciencesUniversity of MelbourneParkvilleAustralia
| | - Lara Edbrooke
- Department of Health Services ResearchPeter MacCallum Cancer CentreMelbourneAustralia
- Department of PhysiotherapyUniversity of MelbourneParkvilleAustralia
| | - Brenton J. Baguley
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
| | - Steve F. Fraser
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
| | - Abbas Khosravi
- Institute for Intelligent Systems Research and InnovationDeakin UniversityGeelongAustralia
| | - Gavin Abbott
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
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Nguyen AL, Burns M, Herath M, Lambell K, Holt D, Fitzpatrick J, Milat F, Ebeling PR, Gibson PR, Moore GT. Accuracy of ultrasound, bioelectrical impedance analysis and anthropometry as point-of-care measurements of skeletal muscle mass in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2023; 58:309-321. [PMID: 37305984 PMCID: PMC10947251 DOI: 10.1111/apt.17607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/11/2023] [Accepted: 05/27/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Disturbance of skeletal muscle mass has clinically important implications in patients with inflammatory bowel disease (IBD), but accurate quantification requires radiation-intense techniques. AIMS We aimed to compare point-of-care muscle assessments and their change with therapy with those using reference-standard whole-body dual energy X-ray absorptiometry (DXA). METHODS Adult patients with IBD and healthy controls underwent prospective assessment of muscularity by ultrasound of the dominant arm and both thighs, bioelectrical impedance analysis (BIA), anthropometric measurements, and DXA. Patients with active IBD were assessed again ≥13 weeks after initiating biologic induction therapy. RESULTS In 54 patients with IBD and 30 controls, all muscle assessments correlated significantly with DXA-derived skeletal muscle index (SMI). In IBD, ultrasound of the arm and legs had the best agreement with DXA-derived SMI (mean difference 0 kg/m2 , 95% limits of agreement -1.3 to 1.3), while BIA overestimated DXA-derived SMI by 1.07 (-0.16 to +2.30) kg/m2 . In 17 patients who underwent biologic therapy, the percentage change in DXA-derived SMI correlated significantly with the percentage change in all other muscle assessment techniques. Responders (n = 9) increased SMI from baseline to follow-up when derived from DXA (mean 7.8-8.5 kg/m2 , p = 0.004), ultrasound of the arm and legs (300-343 cm2 , p = 0.021) and BIA (9.2-9.6 kg/m2 , p = 0.011). CONCLUSIONS Ultrasound of the arm and legs out-performed other point-of-care methods in its accuracy of measuring muscle mass. All methods, except mid-arm circumference, were responsive to therapy-induced change. Ultrasound is the preferred non-invasive test for measuring muscle mass in patients with IBD.
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Affiliation(s)
- Anke L. Nguyen
- Gastroenterology DepartmentMonash HealthVictoriaMelbourneAustralia
- Department of GastroenterologyCentral Clinical School, Monash University and Alfred HealthVictoriaMelbourneAustralia
| | - Megan Burns
- Gastroenterology DepartmentMonash HealthVictoriaMelbourneAustralia
| | - Madhuni Herath
- Endocrinology DepartmentMonash HealthVictoriaMelbourneAustralia
- Department of Medicine, School of Clinical SciencesMonash UniversityVictoriaMelbourneAustralia
| | - Kate Lambell
- Nutrition DepartmentAlfred HealthVictoriaMelbourneAustralia
| | - Darcy Holt
- Gastroenterology DepartmentMonash HealthVictoriaMelbourneAustralia
- Department of Medicine, School of Clinical SciencesMonash UniversityVictoriaMelbourneAustralia
| | - Jessica Fitzpatrick
- Department of GastroenterologyCentral Clinical School, Monash University and Alfred HealthVictoriaMelbourneAustralia
- Nutrition DepartmentAlfred HealthVictoriaMelbourneAustralia
| | - Frances Milat
- Department of Medicine, School of Clinical SciencesMonash UniversityVictoriaMelbourneAustralia
- Centre for Endocrinology & MetabolismHudson Institute of Medical ResearchVictoriaMelbourneAustralia
| | - Peter R. Ebeling
- Endocrinology DepartmentMonash HealthVictoriaMelbourneAustralia
- Department of Medicine, School of Clinical SciencesMonash UniversityVictoriaMelbourneAustralia
| | - Peter R. Gibson
- Department of GastroenterologyCentral Clinical School, Monash University and Alfred HealthVictoriaMelbourneAustralia
| | - Gregory T. Moore
- Gastroenterology DepartmentMonash HealthVictoriaMelbourneAustralia
- Department of Medicine, School of Clinical SciencesMonash UniversityVictoriaMelbourneAustralia
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Beretta MV, Rodrigues TDC, Steemburgo T. Validity of the Global Leadership Initiative on Malnutrition criteria using calf circumference in the prediction of in-hospital mortality in older surgical patients: A secondary analysis of a cohort study. JPEN J Parenter Enteral Nutr 2023; 47:773-782. [PMID: 37246959 DOI: 10.1002/jpen.2526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Malnutrition is a prevalent condition among older patients and is associated with worse clinical outcomes. Methods such as the Subjective Global Assessment (SGA), the Mini Nutritional Assessment Long Form (MNA-LF), and the Global Leadership Initiative on Malnutrition (GLIM) diagnose malnutrition early. This study aimed to evaluate the performance and validity of these instruments to predict the length of hospital stay (LOS) and in-hospital mortality in older surgical patients. METHODS This prospective cohort study was performed in hospitalized older surgical patients. In the first 48 h of admission, general data were collected, and patients were evaluated by SGA, MNA-LF, and GLIM using calf circumference (CC) and mid-upper arm circumference (MUAC) as phenotypic criteria for nutrition diagnoses. Accuracy tests and regression analysis adjusted for sex, type of surgery, and the Charlson Comorbidity Index adjusted for age were performed to assess the criterion validity of instruments to predict LOS and mortality. RESULTS A total of 214 patients (age 75.4 ± 6.6 years, 57.3% men, and 71.1% admitted to elective surgery) were evaluated. Malnutrition was diagnosed in 39.7% (SGA), 63% (MNA-LF), 41.6% (GLIMCC ), and 32.1% (GLIMMUAC ) of patients. GLIMCC had the best accuracy (AUC = 0.70; 95% CI, 0.63-0.79) and sensitivity (95.8%) to predict in-hospital mortality. In the adjusted analysis, malnutrition, according to SGA, MNA-LF, and GLIMCC , increased the risk of in-hospital mortality by 3.12 (95% CI, 1.08-11.34), 4.51 (95% CI, 1.29-17.61), and 4.83 (95% CI, 1.52-15.22), respectively. CONCLUSION GLIMCC had the best performance and satisfactory criterion validity to predict in-hospital mortality in older surgical patients.
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Affiliation(s)
- Mileni V Beretta
- Graduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, R Rio Grande do Sul, Brazil
| | - Ticiana D C Rodrigues
- Graduate Program in Medical Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, R Rio Grande do Sul, Brazil
| | - Thais Steemburgo
- Hospital de Clínicas de Porto Alegre, Porto Alegre, R Rio Grande do Sul, Brazil
- Graduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, R Rio Grande do Sul, Brazil
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Milanez DSJ, Razzera EL, Lima J, Silva FM. Feasibility and criterion validity of the GLIM criteria in the critically ill: A prospective cohort study. JPEN J Parenter Enteral Nutr 2023; 47:754-765. [PMID: 37329138 DOI: 10.1002/jpen.2536] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND This study aimed to evaluate the feasibility and validity of the Global Leadership Initiative on Malnutrition (GLIM) criteria in the intensive care unit (ICU). METHODS This was a cohort study involving critically ill patients. Diagnoses of malnutrition by the Subjective Global Assessment (SGA) and GLIM criteria within 24 h after ICU admission were prospectively performed. Patients were followed up until hospital discharge to assess the hospital/ICU length of stay (LOS), mechanical ventilation duration, ICU readmission, and hospital/ICU mortality. Three months after discharge, the patients were contacted to record outcomes (readmission and death). Agreement and accuracy tests and regression analyses were performed. RESULTS GLIM criteria could be applied to 377 (83.7%) of 450 patients (64 [54-71] years old, 52.2% men). Malnutrition prevalence was 47.8% (n = 180) by SGA and 65.5% (n = 247) by GLIM criteria, presenting an area under the curve equal to 0.835 (95% confidence interval [CI], 0.790-0.880), sensitivity of 96.6%, and specificity of 70.3%. Malnutrition by GLIM criteria increased the odds of prolonged ICU LOS by 1.75 times (95% CI, 1.08-2.82) and ICU readmission by 2.66 times (95% CI, 1.15-6.14). Malnutrition by SGA also increased the odds of ICU readmission and the risk of ICU and hospital death more than twice. CONCLUSION The GLIM criteria were highly feasible and presented high sensitivity, moderate specificity, and substantial agreement with the SGA in critically ill patients. It was an independent predictor of prolonged ICU LOS and ICU readmission, but it was not associated with death such as malnutrition diagnosed by SGA.
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Affiliation(s)
- Danielle Silla Jobim Milanez
- Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Elisa Loch Razzera
- Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Júlia Lima
- Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Flávia Moraes Silva
- Nutrition Science Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Curtis AR, Livingstone KM, Daly RM, Brayner B, Abbott G, Kiss N. Dietary patterns, malnutrition, muscle loss and sarcopenia in cancer survivors: findings from the UK Biobank. J Cancer Surviv 2023:10.1007/s11764-023-01428-8. [PMID: 37468793 DOI: 10.1007/s11764-023-01428-8] [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: 04/27/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE To identify dietary patterns derived from protein, polyunsaturated fatty acids (PUFA) and vitamin D and examine associations with malnutrition, low muscle mass and sarcopenia in cancer survivors. METHODS This cross-sectional study included cancer survivors (n = 2415) from the UK Biobank (age [mean ± SD] 59.7 ± 7.1 years; 60.7% female). The Oxford WebQ 24-h dietary assessment estimated food and nutrient intakes. Reduced rank regression derived dietary patterns (response variables: protein [g/kg/day], PUFA [g/day] and vitamin D [μg/day]). Adjusted logistic regression analysis examined associations between dietary patterns and malnutrition, low muscle mass and sarcopenia. RESULTS Three dietary patterns were identified: (i) 'high oily fish and nuts', characterised by higher oily fish and nuts and seeds intake; (ii) 'low oily fish', characterised by lower oily fish intake and higher potato intake; and (iii) 'meat and dairy', characterised by higher intake of meat, poultry and dairy. Eighteen percent of participants were malnourished, 5% had low muscle mass and 6.5% had sarcopenia. Odds of being malnourished were significantly lower with adherence to a 'high oily fish and nuts' pattern (OR: 0.57; 95% CI: 0.50, 0.65) and 'low oily fish' pattern (OR: 0.81; 95% CI: 0.73, 0.90). The 'meat and dairy' pattern was not associated with malnutrition. No dietary patterns were associated with low muscle mass or sarcopenia. CONCLUSIONS Energy-rich dietary patterns were associated with lower odds of malnutrition in cancer survivors but did not influence muscle mass or sarcopenia risk. IMPLICATIONS FOR CANCER SURVIVORS Better understanding of dietary patterns may improve cancer-related outcomes for cancer survivors.
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Affiliation(s)
- Annie R Curtis
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.
| | | | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Barbara Brayner
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
- Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Australia
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Barazzoni R, Cederholm T, Zanetti M, Gortan Cappellari G. Defining and diagnosing sarcopenia: Is the glass now half full? Metabolism 2023; 143:155558. [PMID: 37031950 DOI: 10.1016/j.metabol.2023.155558] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023]
Abstract
Low muscle mass and function exert a substantial negative impact on quality of life, health and ultimately survival, but their definition, identification and combination to define sarcopenia have suffered from lack of universal consensus. Methodological issues have also contributed to incomplete agreement, as different approaches, techniques and potential surrogate measures inevitably lead to partly different conclusions. As a consequence: 1) awareness of sarcopenia and implementation of diagnostic procedures in clinical practice have been limited; 2) patient identification and evaluation of therapeutic strategies is largely incomplete. Significant progress has however recently occurred after major diagnostic algorithms have been developed, with common features and promising perspectives for growing consensus. At the same time, the need for further refinement of the sarcopenia concept has emerged, to address its increasingly recognized clinical heterogeneity. This includes potential differential underlying mechanisms and clinical features for age- and disease-driven sarcopenia, and the emerging challenge of sarcopenia in persons with obesity. Here, we will review existing algorithms to diagnose sarcopenia, and major open methodological issues to assess skeletal muscle mass and function under different clinical conditions, in order to highlight similarities and differences. Potential for consensus on sarcopenia diagnosis as well as emerging new challenges will be discussed.
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Affiliation(s)
- Rocco Barazzoni
- Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy.
| | - Tommy Cederholm
- Uppsala University and Karolinska University Hospital, Stockholm, Sweden
| | - Michela Zanetti
- Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Gianluca Gortan Cappellari
- Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
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Gortan Cappellari G, Guillet C, Poggiogalle E, Ballesteros Pomar MD, Batsis JA, Boirie Y, Breton I, Frara S, Genton L, Gepner Y, Gonzalez MC, Heymsfield SB, Kiesswetter E, Laviano A, Prado CM, Santini F, Serlie MJ, Siervo M, Villareal DT, Volkert D, Voortman T, Weijs PJ, Zamboni M, Bischoff SC, Busetto L, Cederholm T, Barazzoni R, Donini LM. Sarcopenic obesity research perspectives outlined by the sarcopenic obesity global leadership initiative (SOGLI) - Proceedings from the SOGLI consortium meeting in rome November 2022. Clin Nutr 2023; 42:687-699. [PMID: 36947988 DOI: 10.1016/j.clnu.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 02/26/2023]
Abstract
The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched the Sarcopenic Obesity Global Leadership Initiative (SOGLI) to reach expert consensus on a definition and diagnostic criteria for Sarcopenic Obesity (SO). The present paper describes the proceeding of the Sarcopenic Obesity Global Leadership Initiative (SOGLI) meeting that was held on November 25th and 26th, 2022 in Rome, Italy. This consortium involved the participation of 50 researchers from different geographic regions and countries. The document outlines an agenda advocated by the SOGLI expert panel regarding the pathophysiology, screening, diagnosis, staging and treatment of SO that needs to be prioritized for future research in the field.
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Affiliation(s)
| | - Christelle Guillet
- University of Clermont Auvergne, INRA, CRNH, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - John A Batsis
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yves Boirie
- University of Clermont Auvergne, INRA, CRNH, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Irene Breton
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Stefano Frara
- Università Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | | | | | - Eva Kiesswetter
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | | | | | | | | | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Trudy Voortman
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter Jm Weijs
- Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | | | | | | | - Tommy Cederholm
- Uppsala University and Karolinska University Hospital, Stockholm, Sweden
| | - Rocco Barazzoni
- Department of Medical Sciences, University of Trieste, Trieste, Italy
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McCarthy C, Tinsley GM, Yang S, Irving BA, Wong MC, Bennett JP, Shepherd JA, Heymsfield SB. Smartphone prediction of skeletal muscle mass: model development and validation in adults. Am J Clin Nutr 2023; 117:794-801. [PMID: 36822238 PMCID: PMC10315403 DOI: 10.1016/j.ajcnut.2023.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/18/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Skeletal muscle is a large and clinically relevant body component that has been difficult and impractical to quantify outside of specialized facilities. Advances in smartphone technology now provide the opportunity to quantify multiple body surface dimensions such as circumferences, lengths, surface areas, and volumes. OBJECTIVES This study aimed to test the hypothesis that anthropometric body measurements acquired with a smartphone application can be used to accurately estimate an adult's level of muscularity. METHODS Appendicular lean mass (ALM) measured by DXA served as the reference for muscularity in a sample of 322 adults. Participants also had digital anthropometric dimensions (circumferences, lengths, and regional and total body surface areas and volumes) quantified with a 20-camera 3D imaging system. Least absolute shrinkage and selection operator (LASSO) regression procedures were used to develop the ALM prediction equations in a portion of the sample, and these models were tested in the remainder of the sample. Then, the accuracy of the prediction models was cross-validated in a second independent sample of 53 adults who underwent ALM estimation by DXA and the same digital anthropometric estimates acquired with a smartphone application. RESULTS LASSO models included multiple significant demographic and 3D digital anthropometric predictor variables. Evaluation of the models in the testing sample indicated respective RMSEs in women and men of 1.56 kg and 1.53 kg and R2's of 0.74 and 0.90, respectively. Cross-validation of the LASSO models in the smartphone application group yielded RMSEs in women and men of 1.78 kg and 1.50 kg and R2's of 0.79 and 0.95; no significant differences or bias between measured and predicted ALM values were observed. CONCLUSIONS Smartphone image capture capabilities combined with device software applications can now provide accurate renditions of the adult muscularity phenotype outside of specialized laboratory facilities. Am J Clin Nutr 2023;x:xx. This trial was registered at clinicaltrials.gov as NCT03637855 (https://clinicaltrials.gov/ct2/show/NCT03637855), NCT05217524 (https://clinicaltrials.gov/ct2/show/NCT05217524), and NCT03771417 (https://clinicaltrials.gov/ct2/show/NCT03771417).
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Affiliation(s)
- Cassidy McCarthy
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States
| | - Grant M Tinsley
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, United States
| | - Shengping Yang
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States
| | - Brian A Irving
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, United States
| | - Michael C Wong
- University of Hawaii Cancer Center, Honolulu, HI, United States
| | | | - John A Shepherd
- University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States.
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Wong HJ, Harith S, Lua PL, Ibrahim KA. Comparison of concurrent validity of different malnutrition screening tools with the Global Leadership Initiative on Malnutrition (GLIM) among stroke survivors in Malaysia. Sci Rep 2023; 13:5189. [PMID: 36997594 PMCID: PMC10063687 DOI: 10.1038/s41598-023-31006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/06/2023] [Indexed: 04/01/2023] Open
Abstract
Individuals with stroke are at high malnutrition risk in both the acute and chronic phases. This study aimed to assess the validity of different malnutrition screening tools for stroke patients in rehabilitation phase. Participants in this study were 304 stroke patients from three hospitals in the East-Coast region of Peninsular Malaysia from May-August 2019. The concurrent validity of the Malnutrition Risk Screening Tool-Hospital (MRST-H), Mini Nutritional Assessment-Short Form (MNA-SF), Malnutrition Screening Tool (MST), Malnutrition Universal Screening (MUST) and Nutritional Risk Screening (NRS-2002) was assessed with the diagnostic criteria for malnutrition proposed by the Global Leadership Initiative on Malnutrition (GLIM-DCM). Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the curve were computed. MUST and MRST-H demonstrated good validity regardless of different age groups (> 80% sensitivity and specificity); meanwhile, MST and MNA-SF had fair validity, yet NRS-2002 had poor to fair validity with GLIM-DCM. Only MRST-H and NRS-2002 were significantly correlated with all anthropometric indices, dietary energy intake, and health-related quality of life in both age groups. In conclusion, MRST-H and MUST showed good concurrent validity with GLIM-DCM and can be considered as appropriate malnutrition screening tool in discriminating malnutrition among stroke individuals attending rehabilitation centre in Malaysia regardless of their age groups.
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Affiliation(s)
- Hui Jie Wong
- Faculty of Health Sciences, School of Nutrition and Dietetics, Universiti Sultan Zainal Abidin, Gong Badak Campus, 21300, Kuala Nerus, Terengganu, Malaysia
- Dietetic Unit, Karak Health Clinic, Ministry of Health Malaysia, Jalan Besar Karak, 28600, Bentong, Pahang, Malaysia
| | - Sakinah Harith
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, 21300, Kuala Nerus, Terengganu, Malaysia.
| | - Pei Lin Lua
- Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut Campus, 22200, Besut, Terengganu, Malaysia
| | - Khairul Azmi Ibrahim
- Neurology Unit, Department of Medicine, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Jalan Sultan Mahmud, 20400, Kuala Nerus, Terengganu, Malaysia
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Li L, Chen F, Li X, Gao Y, Zhu S, Diao X, Wang N, Xu T. Association between calf circumference and incontinence in Chinese elderly. BMC Public Health 2023; 23:471. [PMID: 36899309 PMCID: PMC10007784 DOI: 10.1186/s12889-023-15324-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The objective of this study was to analyze the association between calf circumference and incontinence in Chinese elderly, and to find out the maximal cut-off point by gender for the use of calf circumference in screening for incontinence. METHODS In this study, participants were from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The maximal calf circumference cut-off point and other incontinence-related risk factors were explored using receiver operating characteristic (ROC) curves and logistic regression analysis. RESULTS The study included 14,989 elderly people (6,516 males and 8,473 females) over 60. The prevalence of incontinence in elderly males was 5.23% (341/6,516), significantly lower than females, which was 8.31% (704/8,473) (p < 0.001). There was no correlation between calf circumference < 34 cm in males and < 33 cm in females and incontinence after adjusting the confounders. We further stratified by gender to predict incontinence in elderly based on the Youden index of ROC curves. We found the association between calf circumference and incontinence was the strongest when the cut-off points were < 28.5 cm for males and < 26.5 cm for females, with an odds rate (OR) value of 1.620 (male, 95%CI: 1.197-2.288) and 1.292 (female, 95%CI: 1.044-1.600) after adjusting the covariates, respectively. CONCLUSIONS Our study suggests that calf circumference < 28.5 cm in males and < 26.5 cm in females is a risk factor for incontinence in the Chinese elderly population. Calf circumference should be measured in routine physical examination, and timely interventions should be made to reduce the risk of incontinence in subjects with calf circumference less than the threshold.
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Affiliation(s)
- Lin Li
- Clinical Medical Center, National Research Institute for Family Planning, Beijing, China
| | - Feilong Chen
- Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xiaoyan Li
- Center for Health Quality, National Research Institute for Family Planning, Beijing, China
| | - Yiyuan Gao
- Center for Health Quality, National Research Institute for Family Planning, Beijing, China
| | - Silin Zhu
- Department of Statistics, Central China Normal University, Hubei, China
| | - Xiyezi Diao
- Department of Statistics, Central China Normal University, Hubei, China
| | - Ning Wang
- Center for Health Quality, National Research Institute for Family Planning, Beijing, China.
| | - Tao Xu
- Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China.
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Crestani MS, Stefani GP, Scott LM, Steemburgo T. Accuracy of the GLIM Criteria and SGA Compared to PG-SGA for the Diagnosis of Malnutrition and Its Impact on Prolonged Hospitalization: A Prospective Study in Patients with Cancer. Nutr Cancer 2023; 75:1177-1188. [PMID: 36892543 DOI: 10.1080/01635581.2023.2184748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
BACKGROUND Early assessment of malnutrition in cancer patients is essential. This study analyzed the accuracy of the Global Leadership Initiative on Malnutrition (GLIM) and the Subjective Global Assessment (SGA), in diagnosing malnutrition, considering the Patient Generated-SGA (PG-SGA) as a reference, and the impact of malnutrition on hospital days. METHODS We conducted a prospective cohort study in 183 patients with gastrointestinal, head and neck, and lung cancer. Malnutrition was assessed within 48 h, of hospital admission according to the SGA, PG-SGA, and GLIM. Accuracy tests and regression analysis were performed to assess the criterion validity of the GLIM and SGA for diagnosing malnutrition. RESULTS Malnutrition was diagnosed in 57.3% (SGA), 86.3% (PG-SGA), and 74.9% (GLIM) of the inpatients. The median of hospitalization was 6 (3-11) days, with 47% hospitalized > 6 day. The SGA presented the best accuracy (AUC = 0.832) than the GLIM (AUC = 0.632) compared to PG-SGA. Patients diagnosed with malnutrition by SGA, GLIM, and PG-SGA remained hospitalized for 2.13, 3.19, and 4.56 day more than well-nourished patients, respectively. CONCLUSION Compared to PG-SGA, the SGA presents good accuracy and adequate specificity (>80%). Malnutrition evaluated by SGA, PG-SGA, and GLIM was associated with more days of hospitalization.
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Affiliation(s)
- Mariana Scortegagna Crestani
- Graduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Giovanna Potrick Stefani
- Graduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Machado Scott
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Thais Steemburgo
- Graduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Wang X, Ying Y, Pei M, Ma X, Sun Y, Wang Y, Li N. Calf circumference change and all-cause mortality among community-dwelling Chinese older people. Clin Nutr 2023; 42:277-281. [PMID: 36724725 DOI: 10.1016/j.clnu.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Previous studies have described an association between single time point calf circumference (CC) and mortality. Evidence of associations between CC change and mortality is lacking. We aimed to determine the relationship between the CC change over time and all-cause mortality. METHODS We conducted a retrospective cohort study of 906 participants in the 2014-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Restricted cubic splines were used to analyze associations between the relative CC change (exposure) and all-cause mortality (primary outcome). When there was evidence of non-linearity, a piecewise Cox regression model was next fitted, adjusting for sociodemographic characteristics, health behaviours, health status and baseline CC. RESULTS The mean (SD) age was 83.8 (12.2) years old, and 50.2% (455/906) of participants were male. We observed a U-shaped association between the relative CC change (%) and all-cause mortality (P for non-linearity <0.001). Participants with stable CC over time had the lowest risk of death. After adjusting for covariates, when CC decreased over time, the hazard ratio per 10% higher in CC change was 1.32 (1.01-1.69). When CC increased over time, the hazard ratio per 10% higher in CC change was 1.35 (1.10-1.66). CONCLUSION Stable CC over time was associated with the lowest mortality risk. Our findings indicate the practical significance of monitoring CC change in older adult.
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Affiliation(s)
- Xiaoxiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China.
| | - Youyou Ying
- Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China; School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China.
| | - Minyue Pei
- Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China.
| | - Xinjie Ma
- The Third Clinical Medical College, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China.
| | - Yuehao Sun
- The Third Clinical Medical College, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China.
| | - Yupeng Wang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China.
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China.
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Rodrigues RG, Dalboni MA, Correia MDA, Dos Reis LM, Moyses RMA, Elias RM. Calf Circumference Predicts Falls in Older Adults on Hemodialysis. J Ren Nutr 2023; 33:363-367. [PMID: 36155086 DOI: 10.1053/j.jrn.2022.08.003] [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: 02/15/2022] [Revised: 07/06/2022] [Accepted: 08/21/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Older patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis are at a higher risk of falling. However, there is no standard method to screen patients at higher risk. We have evaluated whether calf circumference (CC) measurement would be able to predict falls in this population. METHODS This is a prospective study that enrolled patients aged ≥65 years on conventional hemodialysis, followed for 6 months. The presence of falls was associated with demographical, clinical, and biochemical data. Reduced CC was set at <34 cm for men and <33 cm for women. We evaluated physical status using Duke activity status index (DASI) and hand grip strength (HGS). RESULTS Ninety-one patients were included (age 73.7 ± 5.4 years, 69.2% men, 56% with diabetes). Mean CC was 32.6 ± 3.7 cm, with a high prevalence of reduced CC (61.5%). During the follow-up, 13 falls were identified (1 had a fracture and died). These patients were older and heavier (P = .017 and P = .025, respectively). Most falls occurred in patients with sarcopenic obesity (BMI >27 kg/m2 plus reduced HGS or reduced CC). In a logistic regression model, reduced CC (hazard ratio (HR) 7.81, confidence interval (CI): 1.13-53.86, P = .037), higher age (HR 1.19, CI: 1.04-1.36, P = .011), and higher body weight (relative risk (RR) 1.13, CI: 1.04-1.22, P = .003) were independently associated with falls in a fully adjusted model. CONCLUSION CC measurement, an easy and nonexpensive tool, was able to predict falls in older patients on HD. Further studies should test the inclusion of CC in a fall risk assessment in older patients on hemodialysis.
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Affiliation(s)
| | | | | | - Luciene M Dos Reis
- LIM-16, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Rosa M A Moyses
- LIM-16, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Rosilene M Elias
- Post Graduation, Universidade Nove de Julho (UNINOVE), Brazil; LIM-16, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Brazil.
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Sousa IM, Fayh APT, Lima J, Gonzalez MC, Prado CM, Silva FM. Low calf circumference adjusted for body mass index is associated with prolonged hospital stay. Am J Clin Nutr 2023; 117:402-407. [PMID: 36863830 DOI: 10.1016/j.ajcnut.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/07/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Calf circumference (CC) is of emerging importance because of its practicality, high correlation with skeletal muscle, and potential predictive value for adverse outcomes. However, the accuracy of CC is influenced by adiposity. CC adjusted for BMI (BMI-adjusted CC) has been proposed to counteract this problem. However, its accuracy to predict outcomes is unknown. OBJECTIVES To evaluate the predictive validity of BMI-adjusted CC in hospital settings. METHODS A secondary analysis of a prospective cohort study in hospitalized adult patients was conducted. The CC was adjusted for BMI by reducing 3, 7, or 12 cm for BMI (in kg/m2) of 25-29.9, 30-39.9, and ≥40, respectively. Low CC was defined as ≤34 cm for males and ≤33 cm for females. Primary outcomes included length of hospital stay (LOS) and in-hospital death, and secondary outcomes were hospital readmissions and mortality within 6 mo after discharge. RESULTS We included 554 patients (55.2 ± 14.9 y, 52.9% men). Among them, 25.3% presented with low CC, whereas 60.6% had BMI-adjusted low CC. In-hospital death occurred in 13 patients (2.3%), and median LOS was 10.0 (5.0-18.0) d. Within 6 mo from discharge, 43 patients (8.2%) died, and 178 (34.0%) were readmitted to the hospital. BMI-adjusted low CC was an independent predictor of LOS ≥ 10 d (odds ratio = 1.70; 95% confidence interval: 1.18, 2.43], but it was not associated with the other outcomes. CONCLUSIONS BMI-adjusted low CC was identified in more than 60% of hospitalized patients and was an independent predictor of longer LOS.
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Affiliation(s)
- Iasmin M Sousa
- Graduate Program in Nutrition and Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; Graduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ana Paula T Fayh
- Graduate Program in Nutrition and Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; Graduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Júlia Lima
- Nutrition Science Graduate Program of Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Cristina Gonzalez
- Graduate Program in Health and Behavior, Catholic University of Pelotas, Rio Grande do Sul, Brazil
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Flávia M Silva
- Nutrition Science Graduate Program of Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Department of Nutrition, Nutrition Science Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
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Prado CM, Ford KL, Gonzalez MC, Murnane LC, Gillis C, Wischmeyer PE, Morrison CA, Lobo DN. Nascent to novel methods to evaluate malnutrition and frailty in the surgical patient. JPEN J Parenter Enteral Nutr 2023; 47 Suppl 1:S54-S68. [PMID: 36468288 PMCID: PMC9905223 DOI: 10.1002/jpen.2420] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 12/11/2022]
Abstract
Preoperative nutrition status is an important determinant of surgical outcomes, yet malnutrition assessment is not integrated into all surgical pathways. Given its importance and the high prevalence of malnutrition in patients undergoing surgical procedures, preoperative nutrition screening, assessment, and intervention are needed to improve postoperative outcomes. This narrative review discusses novel methods to assess malnutrition and frailty in the surgical patient. The Global Leadership Initiative for Malnutrition (GLIM) criteria are increasingly used in surgical settings although further spread and implementation are strongly encouraged to help standardize the diagnosis of malnutrition. The use of body composition (ie, reduced muscle mass) as a phenotypic criterion in GLIM may lead to a greater number of patients identified as having malnutrition, which may otherwise be undetected if screened by other diagnostic tools. Skeletal muscle loss is a defining criterion of malnutrition and frailty. Novel direct and indirect approaches to assess muscle mass in clinical settings may facilitate the identification of patients with or at risk for malnutrition. Selected imaging techniques have the additional advantage of identifying myosteatosis (an independent predictor of morbidity and mortality for surgical patients). Feasible pathways for screening and assessing frailty exist and may determine the cost/benefit of surgery, long-term independence and productivity, and the value of undertaking targeted interventions. Finally, the evaluation of nutrition risk and status is essential to predict and mitigate surgical outcomes. Nascent to novel approaches are the future of objectively identifying patients at perioperative nutrition risk and guiding therapy toward optimal perioperative standards of care.
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Affiliation(s)
- Carla M. Prado
- Department of Agricultural, Food & Nutritional ScienceUniversity of AlbertaEdmontonAlbertaCanada
| | - Katherine L. Ford
- Department of Agricultural, Food & Nutritional ScienceUniversity of AlbertaEdmontonAlbertaCanada
| | - M. Cristina Gonzalez
- Postgraduate Program in Health and BehaviorCatholic University of PelotasPelotasBrazil
| | - Lisa C. Murnane
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
- Department of Nutrition and DieteticsAlfred HealthMelbourneVictoriaAustralia
| | - Chelsia Gillis
- School of Human NutritionMcGill UniversityMontrealQuebecCanada
| | - Paul E. Wischmeyer
- Departments of Anesthesiology and SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Chet A. Morrison
- Department of SurgeryCentral Michigan UniversitySaginawMichiganUSA
| | - Dileep N. Lobo
- Gastrointestinal SurgeryNottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical CentreNottinghamUK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life SciencesUniversity of Nottingham, Queen's Medical CentreNottinghamUK
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Epidemiological, mechanistic, and practical bases for assessment of cardiorespiratory fitness and muscle status in adults in healthcare settings. Eur J Appl Physiol 2023; 123:945-964. [PMID: 36683091 PMCID: PMC10119074 DOI: 10.1007/s00421-022-05114-y] [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: 07/26/2022] [Accepted: 12/08/2022] [Indexed: 01/24/2023]
Abstract
Given their importance in predicting clinical outcomes, cardiorespiratory fitness (CRF) and muscle status can be considered new vital signs. However, they are not routinely evaluated in healthcare settings. Here, we present a comprehensive review of the epidemiological, mechanistic, and practical bases of the evaluation of CRF and muscle status in adults in primary healthcare settings. We highlight the importance of CRF and muscle status as predictors of morbidity and mortality, focusing on their association with cardiovascular and metabolic outcomes. Notably, adults in the best quartile of CRF and muscle status have as low as one-fourth the risk of developing some of the most common chronic metabolic and cardiovascular diseases than those in the poorest quartile. The physiological mechanisms that underlie these epidemiological associations are addressed. These mechanisms include the fact that both CRF and muscle status reflect an integrative response to the body function. Indeed, muscle plays an active role in the development of many diseases by regulating the body's metabolic rate and releasing myokines, which modulate metabolic and cardiovascular functions. We also go over the most relevant techniques for assessing peak oxygen uptake as a surrogate of CRF and muscle strength, mass, and quality as surrogates of muscle status in adults. Finally, a clinical case of a middle-aged adult is discussed to integrate and summarize the practical aspects of the information presented throughout. Their clinical importance, the ease with which we can assess CRF and muscle status using affordable techniques, and the availability of reference values, justify their routine evaluation in adults across primary healthcare settings.
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Rectus Femoris Muscle and Phase Angle as Prognostic Factor for 12-Month Mortality in a Longitudinal Cohort of Patients with Cancer (AnyVida Trial). Nutrients 2023; 15:nu15030522. [PMID: 36771229 PMCID: PMC9919732 DOI: 10.3390/nu15030522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cancer-related malnutrition is still unrecognized and undertreated in clinical practice. The morphofunctional assessment of disease-related malnutrition (DRM) is a new approach that focuses on evaluating changes in body composition and function. The aim of this study is to evaluate the prognostic value of classic and emerging assessment of malnutrition at 12-months survival in cancer patients. METHODS We conducted a prospective study on cancer outpatients. Bioelectrical impedance with phase angle (PhA), nutritional ultrasound by rectus femoris cross-sectional area (RFCSA), hand grip strength, and "Timed Up and Go Test" (TUG) were evaluated as predictors of mortality. RESULTS Fifty-seven patients were included. The non-survivors had lower PhA values than the survivors (4.7° vs. 5.4°; p < 0.001), and we had the same results with RFCSA 2.98 cm2/m2 vs. 4.27 cm2/m2 (p = 0.03). Cut-off points were identified using the ROC (receiver operating characteristic) curves for PhA (≤5.6° cancer patients, ≤5.9° men, ≤5.3° women), RFCSA (≤4.47 cm2/m2 cancer patients, ≤4.47° men, ≤2.73° women) and rectus femoris-Y-axis (RF-Y-axis; ≤1.3 cm cancer patients, ≤1.06 men, ≤1 women). In multivariate logistic regression analysis, we found that high PhA was significantly associated with a lower mortality hazard ratio (HR: 0.42 95% CI: 0.21-0.84, p = 0.014). Likewise, high RFCSA was associated with a decrease in mortality risk in the crude model (HR: 0.61 95% CI: 0.39-0.96, p = 0.031). This trend was also maintained in the adjusted models by the confounding variables. CONCLUSIONS Low PhA and RFCSA values are significant independent predictors of mortality in cancer patients. These cut-off points are clinical data that can be used for nutritional assessment and the prediction of clinical outcomes.
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Ballesteros-Pomar MD, Blay Cortés G, Botella Romero F, Fernández García JM, Pita Gutiérrez F, Ramírez Arroyo V, Bretón Lesmes I. Continuity of care in disease-related malnutrition and nutritional medical treatment. ENDOCRINOL DIAB NUTR 2022; 69:897-909. [PMID: 36443194 DOI: 10.1016/j.endien.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Disease-related malnutrition (DRM) continues to be a very significant healthcare problem, both in our hospitals and in the community. It is often not properly diagnosed or treated, despite a growing body of evidence highlighting its clinical and economic consequences. The transition between clinical care in the hospital and community services (Primary Care (PC) and Nursing Homes) is a key element in the prevention, detection and treatment of DRM. In October 2020, the Spanish Society of Endocrinology and Nutrition (SEEN) and the main societies of PC physicians in our country (SEMERGEN, SEMFYC and SEMG) met for the first time within the virtual NutriSEEN forum. From that moment on, a joint working group was created for this issue. This document tries to establish joint lines of work between the Clinical Nutrition and Dietetic Units (UNCyD) and the Primary Care teams to improve the detection and treatment of DRM. The clinical consequences and costs associated with DRE, nutritional risk screening, assessment and medical nutritional treatment are considered in a coordinated way between the PC teams and the UNCyD, as well as future proposals to improve the management of DRM.
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Affiliation(s)
- María D Ballesteros-Pomar
- Area de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain; Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, Spain.
| | - Guadalupe Blay Cortés
- Grupo de Endocrinología, Metabolismo y Nutrición, Sociedad Española de Médicos Generales y de Familia (SEMG), Spain
| | - Francisco Botella Romero
- Area de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain; Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - José Manuel Fernández García
- Grupo de trabajo de Nutrición, Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Centro de Salud de Valga, Pontevedra, Spain
| | - Francisco Pita Gutiérrez
- Area de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain; Endocrinología y Nutrición, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Violeta Ramírez Arroyo
- Grupo de Trabajo de Alimentación y Nutrición, Sociedad Española de Medicina de Familia y Comunitaria (SEMFYC), Hospital Comarcal de Inca de las Islas Baleares, Mallorca, Spain
| | - Irene Bretón Lesmes
- Area de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN), Spain; Fundación de la Sociedad Española de Endocrinología y Nutrición (SEEN), Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IsSGM), Madrid, Spain
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