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Liu J, Pan M, Sun M, Shi H, Feng R. Nutritional Status and Physical Exercise Are Associated with Cognitive Function in Chinese Community-Dwelling Older Adults: The Role of Happiness. Nutrients 2024; 16:203. [PMID: 38257095 PMCID: PMC10819784 DOI: 10.3390/nu16020203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
We aim to assess the relationship between nutrition status, physical exercise, and cognitive function and particularly examine how happiness modifies and mediates the relationship, among 699 seniors aged 60 and above in Shanghai, China. Linear regression models were used to validate the effects of nutrition and exercise on cognitive function and to test their interaction effects with happiness. When the interactions were significant, stratified analyses in sub-groups were conducted. Mediation effects of happiness were examined using two-step causal mediation models. We confirmed that better nutrition (p < 0.001) and exercise (p = 0.009) were significantly associated with less cognitive decline. Furthermore, the effects of nutrition and exercise on cognitive decline were significant in the unhappy (happiness < 20) (p < 0.001) and younger (age < 74) sub-groups (p = 0.015). Happiness partially mediated 11.5% of the negative association of cognitive decline with nutrition (p = 0.015) and 23.0% of that with exercise (p = 0.017). This study suggests that happiness moderates and partially mediates the effects of exercise and nutrition on cognitive status. The beneficial effects of exercise and nutrition were stronger in less happy or younger seniors. Future intervention studies are required to confirm this path relationship.
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Affiliation(s)
- Jianghong Liu
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.P.); (H.S.)
| | - Michael Pan
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.P.); (H.S.)
- School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - McKenna Sun
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.P.); (H.S.)
- College of Arts & Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Haoer Shi
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.P.); (H.S.)
- School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rui Feng
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
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Shang J, Dong W, Huang P, Sun Y, He Y, Li H, Liao S, Li M. Development of a nutritional screening and assessment indicator system for patients with esophageal cancer in China: Findings from the Delphi method. Cancer Med 2023; 12:21240-21255. [PMID: 37990781 PMCID: PMC10726821 DOI: 10.1002/cam4.6703] [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: 06/21/2023] [Revised: 10/14/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND In China, individuals diagnosed with esophageal cancer are confronted with an elevated risk of nutritional inadequacy or malnutrition throughout the course of their disease, a condition that contributes to various adverse clinical outcomes. A vast corpus of data are burgeoning at an unprecedented rate, primarily due to the revolutionary growth of digitalization technologies and artificial intelligence, notably within the domains of health care and medicine. The purpose of this investigation is to initiate the development of a nutritional screening and assessment indicator framework for patients with esophageal cancer within the Chinese context. We seek to furnish an instrumental reference to facilitate preparations for the forthcoming era of advanced, "deep," evidence-based medicine. METHODS An integrative methodology was employed to forge the preliminary draft of the nutritional screening and assessment indicator system for preoperative patients with esophageal cancer. This encompassed a rigorous literature survey, in-depth clinical practice investigation, and the facilitation of expert panel discussions. Thereafter, two iterative consultation phases were conducted using the Delphi method in China. The analytic hierarchy process was deployed to ascertain the weighting of each index within the definitive evaluation indicator system. RESULTS The effective response rates for the dual rounds of expert consultation were 91.7% and 86.4%, with commensurate authority coefficients of 0.97 and 0.91. The Kendall harmony coefficients were ascertained to be 0.19 and 0.14 (p < 0.01), respectively. The culminating nutritional screening and assessment indicator system for patients with esophageal cancer comprised 5 primary-level indicators and 38 secondary-level indicators. CONCLUSIONS The nutritional screening and assessment indicator system contrived for patients with esophageal cancer is underpinned by cogent theoretical principles, leverages an astute research methodology, and manifests dependable outcomes. This system may be appositely utilized as a meaningful reference for the nutritional screening and assessment process in patients afflicted with esophageal cancer.
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Affiliation(s)
- Jingjing Shang
- Department of Thoracic SurgerySouthern Medical University Nanfang HospitalGuangzhouChina
- School of NursingSouthern Medical UniversityGuangzhouChina
| | - Wen Dong
- Department of Thoracic SurgerySouthern Medical University Nanfang HospitalGuangzhouChina
| | - Peipei Huang
- Department of Thoracic SurgerySouthern Medical University Nanfang HospitalGuangzhouChina
- School of NursingSouthern Medical UniversityGuangzhouChina
| | - Yidan Sun
- Department of Thoracic SurgerySouthern Medical University Nanfang HospitalGuangzhouChina
- School of NursingSouthern Medical UniversityGuangzhouChina
| | - Yuxin He
- Department of Thoracic SurgerySouthern Medical University Nanfang HospitalGuangzhouChina
- School of NursingSouthern Medical UniversityGuangzhouChina
| | - Hui Li
- Department of Thoracic SurgerySouthern Medical University Nanfang HospitalGuangzhouChina
- School of NursingSouthern Medical UniversityGuangzhouChina
| | - Shengwu Liao
- Department of Health ManagementSouthern Medical University Nanfang HospitalGuangzhouChina
| | - Mei Li
- Department of Thoracic SurgerySouthern Medical University Nanfang HospitalGuangzhouChina
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The association between MNA and PG-SGA malnutrition assessment and the quality of life among hemodialysis patients. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Zheng X, Yeo MEJ, Lew CCH. The association between pre-operative malnutrition and post-amputation clinical outcomes: A systematic review. PROCEEDINGS OF SINGAPORE HEALTHCARE 2022. [DOI: 10.1177/20101058221094864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: In patients who underwent lower limb amputation (LLA), the prevalence of malnutrition and its association with clinical outcomes are unclear. Objectives: This systematic review aims to identify literature and summarise existing information on (1) the prevalence of malnutrition in the patients with LLA and (2) the association between pre-operative nutritional status and post-surgery clinical outcomes in patients who require amputation. Methods: A search was conducted in four electronic databases (Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, CINAHL and Scopus) to identify eligible studies. The search strategy was based on keywords – amputation, malnutrition and undernutrition. Article were included regardless of the study design; and if they were written in English; included adult patients with lower limb or foot amputation; and performed pre-amputation nutrition assessments. Results: Seven articles met the eligibility criteria. Malnutrition was assessed by biochemistry and/or anthropometry – none of which are validated nutrition assessment tools. Nevertheless, abnormal biochemistry and/or anthropometry results were associated with delayed wound healing, complications and failed amputation compared to normal ranges. The association between abnormal biochemistry and/or anthropometry parameters and mortality was less consistent. Only one study used a validated nutrition screen tool and found half of the population with LLA were at risk of malnutrition, but no association was reported. Conclusions: The association between malnutrition and clinical outcomes in patients who underwent LLA remains unclear as all the eligible studies that investigated association used unvalidated nutrition assessment tools. There is an urgent need to address this knowledge gap in future research.
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Affiliation(s)
- Xiaomei Zheng
- Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Singapore
| | - Mei En Joy Yeo
- Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Singapore
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Lee DU, Hastie DJ, Fan GH, Addonizio EA, Lee KJ, Han J, Karagozian R. Effect of malnutrition on the postoperative outcomes of patients undergoing pancreatectomy for pancreatic cancer: Propensity score-matched analysis of 2011-2017 US hospitals. Nutr Clin Pract 2022; 37:117-129. [PMID: 34994482 DOI: 10.1002/ncp.10816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with pancreatic cancer suffer from metabolic dysregulation, which can manifest in clinical malnutrition. Because a portion of these patients require cancer-resective surgery, we evaluate the impact of malnutrition in patients undergoing pancreatic resection using a national database. METHODS The 2011-2017 National Inpatient Sample was used to isolate cases of pancreatic resection (partial/total pancreatectomy and radical pancreaticoduodenectomy), which were stratified using malnutrition. A 1:1 nearest-neighbor propensity-score matching was applied to match the controls to the malnutrition cohort. End points include mortality, length of stay (LOS), hospitalization costs, and postoperative complications. RESULTS Following the match, there were 2108 with malnutrition and an equal number without; from this, those with malnutrition had higher mortality (4.7% vs 3.04%; P = 0.007; odds ratio [OR], 1.57; 95% CI, 1.14-2.17), longer LOS, and higher costs. Regarding complications, malnourished patients had higher bleeding (5.41% vs 2.99%; P < 0.001; OR, 1.86; 95% CI, 1.36-2.54), wound complications (3.75% vs 1.57%; P < 0.001; OR, 2.45; 95% CI, 1.62-3.69), infection (7.83% vs 3.13%; P < 0.001; OR, 2.63; 95% CI, 1.96-3.52), and respiratory failure (7.45% vs 3.56%; P < 0.001; OR, 2.18; 95% CI, 1.65-2.89). In multivariate analyses, those with malnutrition had higher mortality (P = 0.008; adjust OR, 1.55; 95% CI, 1.12-2.14). CONCLUSION Those with malnutrition had higher mortality and complications following pancreatic resection; given these findings, it is important that preoperative nutrition therapy is provided to minimize the surgical risks.
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Affiliation(s)
- David Uihwan Lee
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA
| | - David Jeffrey Hastie
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gregory Hongyuan Fan
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Elyse Ann Addonizio
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ki Jung Lee
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - John Han
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Raffi Karagozian
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts, USA
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SOUZA FGD, MARIN FA, SILVA WRD, SPEXOTO MCB. Accuracy of the Global Leadership Initiative on Malnutrition to identify malnutrition in hospitalized patients. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e220048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT Objective: The Global Leadership Initiative on Malnutrition, introduced as a useful method in the diagnosis of malnutrition, is supported by little evidence in hospitalized individuals. Therefore, we reviewed this method with two objectives: 1) to compare the diagnostic accuracy of the Global Leadership Initiative on Malnutrition criteria with the Patient-Generated Subjective Global Assessment; 2) to determine the prevalence of malnutrition and its associated factors. Methods: Cross-sectional study, conducted with individuals hospitalized between April 2019 and July 2021. Sociodemographic, clinical and anthropometric information was investigated. Global Leadership Initiative on Malnutrition was the index test and Patient-Generated Subjective Global Assessment the standard reference to assess malnutrition. For diagnostic accuracy, measurements of sensitivity, specificity, area under the curve and kappa agreement were considered. Results: A total of 105 individuals participated (age 65.9±9.9 years). The prevalence of malnutrition in the total sample was 48.6% and 67.6% according to the Global Leadership Initiative on Malnutrition and Patient-Generated Subjective Global Assessment criteria, respectively. An association was observed between malnutrition and the variables that stand behind hospitalization, metabolic stress and anthropometric indicators (p<0.05). The comparison showed sensitivity and specificity values for the Global Leadership Initiative on Malnutrition criteria of 67.6% (95% CI: 56.1-77.3) and 91.2% (95% CI: 77.0-96.9) (total sample) and 71.7% (95% CI: 58.4-82.0) and 95.5% (95% CI: 78.2-99.2) (elderly), respectively. An agreement of 49% was observed, raising to 55% when the elderly were assessed separately. Conclusion: The Global Leadership Initiative on Malnutrition criteria presented adequate sensitivity conditions and specificity to diagnose malnutrition, moderate agreement with the reference standard and good applicability in hospitalized patients’ clinical practice. Prevalence of malnutrition was high, regardless of the method used, and was associated with the reason for hospitalization, metabolic stress and anthropometric indicators.
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Han CY, Sharma Y, Yaxley A, Baldwin C, Miller M. Use of the Patient-Generated Subjective Global Assessment to Identify Pre-Frailty and Frailty in Hospitalized Older Adults. J Nutr Health Aging 2021; 25:1229-1234. [PMID: 34866150 DOI: 10.1007/s12603-021-1704-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and Edmonton Frail Scale (EFS) are widely used in acute care settings to assess nutritional and frailty status, respectively. We aimed to determine whether the scored PG-SGA can identify pre-frailty and frailty status, to simultaneously evaluate malnutrition and frailty in clinical practice. DESIGN Cross-sectional study. SETTINGS AND PARTICIPANTS A convenience sample of 329 consecutive patients admitted to an acute medical unit in South Australia. MEASUREMENTS Nutritional and frailty status were ascertained with scored PG-SGA and EFS, respectively. Optimal cut-off scores to identify pre-frailty and frailty were determined by calculating the Scored PG-SGA's sensitivity, specificity, positive and negative predictive values, Youden Index (YI), Liu index, Receiver Operator Curves (ROC) and Area Under Curve (AUC). Nutritional status and patient characteristics were analysed according to frailty categories. RESULTS The optimal cut-off PG-SGA score as determined by the highest YI, to identify both pre-frailty and frailty was >3, with a sensitivity of 0.711 and specificity of 0.746. The AUC was 0.782 (95% CI 0.731-0.833). In this cohort, 64% of the patients were well-nourished, 26% were moderately malnourished and 10% were severely malnourished. Forty-three percent, 24% and 33% of the patients were classified as robust, pre-frail and frail, respectively. Bivariate analysis showed that those robust were significantly younger than those who were pre-frail (-2.8, 95% CI -5.5 to -0.1, p=0.036) or frail (-3.4, 95% CI -5.9 to -1.0, p=0.002). Robust patients had significantly lower Scored PG-SGA than those who were pre-frail (-2.5, 95%CI -3.8 to -1.1, p<0.001) or frail (-4.9, 95% CI -6.1 to -3.7, p<0.001). CONCLUSION The Scored PG-SGA is moderately sensitive in identifying pre-frailty/frailty in older hospitalized adults and can be useful in identifying both conditions concurrently.
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Affiliation(s)
- C Y Han
- Chad Yixian Han, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, SA5042, Australia, E-mail address:
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