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Cao A, Luo W, Wang L, Wang J, Zhou Y, Huang C, Zhu B. The prognostic value of prognostic nutritional index and renal function indicators for mortality prediction in severe COVID-19 elderly patients: A retrospective study. Medicine (Baltimore) 2024; 103:e38213. [PMID: 38758852 PMCID: PMC11098216 DOI: 10.1097/md.0000000000038213] [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: 10/18/2023] [Accepted: 04/22/2024] [Indexed: 05/19/2024] Open
Abstract
Identifying prognostic factors in elderly patients with severe coronavirus disease 2019 (COVID-19) is crucial for clinical management. Recent evidence suggests malnutrition and renal dysfunction are associated with poor outcome. This study aimed to develop a prognostic model incorporating prognostic nutritional index (PNI), estimated glomerular filtration rate (eGFR), and other parameters to predict mortality risk. This retrospective analysis included 155 elderly patients with severe COVID-19. Clinical data and outcomes were collected. Logistic regression analyzed independent mortality predictors. A joint predictor "L" incorporating PNI, eGFR, D-dimer, and lactate dehydrogenase (LDH) was developed and internally validated using bootstrapping. Decreased PNI (OR = 1.103, 95% CI: 0.78-1.169), decreased eGFR (OR = 0.964, 95% CI: 0.937-0.992), elevated D-dimer (OR = 1.001, 95% CI: 1.000-1.004), and LDH (OR = 1.005, 95% CI: 1.001-1.008) were independent mortality risk factors (all P < .05). The joint predictor "L" showed good discrimination (area under the curve [AUC] = 0.863) and calibration. The bootstrapped area under the curve was 0.858, confirming model stability. A combination of PNI, eGFR, D-dimer, and LDH provides useful prognostic information to identify elderly patients with severe COVID-19 at highest mortality risk for early intervention. Further external validation is warranted.
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Affiliation(s)
- Angyang Cao
- Anesthesiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
- Health Science Center, Ningbo University, Zhejiang, China
| | - Wenjun Luo
- Anesthesiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
- Health Science Center, Ningbo University, Zhejiang, China
| | - Long Wang
- Nephrology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Jianhua Wang
- Radiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Yanling Zhou
- Anesthesiology Department, Kunming Third People’s Hospital, Yunnan, China
| | - Changshun Huang
- Anesthesiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
| | - Binbin Zhu
- Anesthesiology Department, the First Affiliated Hospital of Ningbo University, Zhejiang, China
- Health Science Center, Ningbo University, Zhejiang, China
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Cortés-Aguilar R, Malih N, Abbate M, Fresneda S, Yañez A, Bennasar-Veny M. Validity of nutrition screening tools for risk of malnutrition among hospitalized adult patients: A systematic review and meta-analysis. Clin Nutr 2024; 43:1094-1116. [PMID: 38582013 DOI: 10.1016/j.clnu.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUNDS & AIMS Malnutrition is prevalent among hospitalized patients in developed countries, contributing to negative health outcomes and increased healthcare costs. Timely identification and management of malnutrition are crucial. The lack of a universally accepted definition and standardized diagnostic criteria for malnutrition has led to the development of various screening tools, each with varying validity. This complicates early identification of malnutrition, hindering effective intervention strategies. This systematic review and meta-analysis aimed to identify the most valid and reliable nutritional screening tool for assessing the risk of malnutrition in hospitalized adults. METHODS A systematic literature search was conducted to identify validation studies published from inception to November 2023, in the Pubmed/MEDLINE, Embase, and CINAHL databases. This systematic review was registered in INPLASY (INPLASY202090028). The risk of bias and quality of included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2). Meta-analyses were performed for screening tools accuracy using the symmetric hierarchical summary receiver operative characteristics models. RESULTS Of the 1646 articles retrieved, 60 met the inclusion criteria and were included in the systematic review, and 21 were included in the meta-analysis. A total of 51 malnutrition risk screening tools and 9 reference standards were identified. The meta-analyses assessed four common malnutrition risk screening tools against two reference standards (Subjective Global Assessment [SGA] and European Society for Clinical Nutrition and Metabolism [ESPEN] criteria). The Malnutrition Universal Screening Tool (MUST) vs SGA had a sensitivity (95% Confidence Interval) of 0.84 (0.73-0.91), and specificity of 0.85 (0.75-0.91). The MUST vs ESPEN had a sensitivity of 0.97 (0.53-0.99) and specificity of 0.80 (0.50-0.94). The Malnutrition Screening Tool (MST) vs SGA had a sensitivity of 0.81 (0.67-0.90) and specificity of 0.79 (0.72-0.74). The Mini Nutritional Assessment-Short Form (MNA-SF) vs ESPEN had a sensitivity of 0.99 (0.41-0.99) and specificity of 0.60 (0.45-0.73). The Nutrition Universal Screening Tool-2002 (NRS-2002) vs SGA had a sensitivity of 0.76 (0.58-0.87) and specificity of 0.86 (0.76-0.93). CONCLUSIONS The MUST demonstrated high accuracy in detecting malnutrition risk in hospitalized adults. However, the quality of the studies included varied greatly, possibly introducing bias in the results. Future research should compare tools within a specific patient population using a valid and universal gold standard to ensure improved patient care and outcomes.
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Affiliation(s)
| | - Narges Malih
- Primary Care Research Unit of Mallorca, Balearic Islands Health Service, 07002 Palma, Spain.
| | - Manuela Abbate
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Sergio Fresneda
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Aina Yañez
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain.
| | - Miquel Bennasar-Veny
- Research Group on Global Health and Lifestyles, Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain; Nursing and Physiotherapy Department, University of the Balearic Islands, 07122 Palma, Spain; Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
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Villaverde-Núñez A, Ramírez-López MT, Antón-Rodríguez C, Hammel IC, Pérez Ramos C, Álvarez Villarreal M, Ruíz Fernández S, Arriero López B, Hernández Cordobés G, Manzano Guerrero N, Baena Ruíz L, Guerra-Llamas MI. Vaccination and Nutritional Outcomes of Hemodialysis Patients Infected With SARS-CoV-2. Nurs Res 2024; 73:138-148. [PMID: 38112624 DOI: 10.1097/nnr.0000000000000707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Patients on hemodialysis are particularly vulnerable to COVID-19 and may have a reduced response to vaccination because of a decreased immune response. The nutritional status before or during the infection could also impact on the clinical effectiveness of vaccination. OBJECTIVES We aim to describe the evolution of clinical and nutritional biomarkers of hemodialysis patients infected with SARS-CoV-2 and to assess their association with vaccination status. METHODS An observational, analytic, longitudinal, retrospective multicenter study was carried out in 82 patients on hemodialysis with SARS-CoV-2 infection. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), anthropometry, and biochemical parameters. The association of the vaccine doses with clinical- and nutritional-related variables was also evaluated. RESULTS The percentage of vaccinated patients was similar to that of nonvaccinated patients. Before infection, most of the patients were malnourished. They presented lower albumin, creatinine, and urea levels than the well-nourished patients. Significant deterioration of nutritional status after infection was evidenced considering GNRI score, dry weight, and body mass index. Albumin and creatinine also decreased significantly after infection, whereas C-reactive protein increased in the acute phase. Significant inverse correlation was found between the variation of post-pre GNRI scores and basal albumin and C-reactive protein at 7 days. In addition, we observed the opposite trend between albumin at 30 days and basal cholesterol. A negative value in the GNRI variation was associated with bilateral pneumonia, need for hospitalization, and nutritional support. Vaccinated patients presented substantially less bilateral pneumonia and hospitalization. No significant effects were observed between vaccine doses and the variation in nutritional status, although a positive correlation was detected with the albumin at 7 days and C-reactive protein before infection and the number of vaccine doses received. DISCUSSION COVID-19 is associated with affectations in the nutritional status and biomarkers in hemodialysis patients. In this study, vaccines have shown a protective effect against the clinical consequences of COVID. However, they have shown limitations in preventing the deterioration of nutritional status after infection. The results highlight the importance of promoting the vaccination in these patients as well as incorporating nutritional assessment before, during, and after the infection.
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Flores-López A, Quiroz-Olguin G, González-Garay AG, Serralde-Zúñiga AE. It is not just about prescription. A cohort study of the impact of enteral nutrition on mortality of hospitalized patients with COVID-19. NUTR HOSP 2024; 41:11-18. [PMID: 37929849 DOI: 10.20960/nh.04828] [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: 11/07/2023] Open
Abstract
Introduction Introduction: during COVID-19 pandemic, international societies released guidelines and recommendations for patients requiring nutritional support according to previous similar respiratory diseases. Objectives: the aim of the study was to evaluate the nutritional support provided by enteral nutrition (EN) in patients with COVID-19 infection, identify if the recommendations from international societies were met and their impact on mortality rate. Methods: a cohort study was conducted on adult patients with COVID-19 admitted to a tertiary hospital. Demographic, clinical, biochemical, and nutritional variables were obtained. A random-effect parametric survival-time model was performed to quantify the risk of death for each variable, and the Hausman test was used to confirm the model. Results: two hundred and twenty-nine patients were enrolled. The delivered energy was > 80 % of adequacy in the first two days, as suggested by international guidelines (11.7 ± 4.9 kcal/kg); however, an adequacy rate less than 60 % was achieved on day 14 (25.4 ± 7.4 kcal/kg). The protein adequacy was > 75 % on the first days of infusion (1.3 ± 0.3 g/kg); however, the infusion was < 50 % (1.5 ± 0.4 g/kg) after being extubated. Age, sex, and nutritional risk were related to higher mortality in patients with EN, whereas the infused energy and protein, the percentage of protein adequacy, arginine, and n-3 PUFA were associated with lower mortality. Conclusion: achieving at least 80 % of the energy and protein requirements, as well as n-3 PUFA and arginine supplementation could be associated with lower mortality in COVID-19 patients. More studies are needed to confirm the role of these nutrients on the mortality rate.
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Affiliation(s)
- Adriana Flores-López
- Servicio Nutriología Clínica. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | | | | | - Aurora E Serralde-Zúñiga
- Servicio Nutriología Clínica. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
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Ramos A, Joaquin C, Ros M, Martin M, Cachero M, Sospedra M, Martínez E, Socies G, Pérez-Montes de Oca A, Sendrós MJ, Sánchez-Migallón JM, Alonso N, Puig-Domingo M. Early nutritional risk detection and intervention in COVID-19 hospitalized patients through the implementation of electronic automatized alarms. ENDOCRINOL DIAB NUTR 2024; 71:71-76. [PMID: 38553171 DOI: 10.1016/j.endien.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/31/2023] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Hospitalized COVID-19 patients may present acute malnutrition which could influence morbidity and mortality. In the first wave of the pandemic severe weight loss was observed in many hospitalized patients. This pilot study evaluates the usefulness of an electronic automatized alarm for the early quantification of a low food intake as a predictor of the risk of malnutrition using COVID-19 disease as a model of severe illness. METHODS Observational prospective nutritional screening with a daily automatized warning message to the Endocrinology and Nutrition Service provided by the Information Systems. All adult patients admitted for COVID-19 from November 2020 to February 2021 were included. When diet intake was <50% during consecutive 48h, an automated message was generated identifying the patient as "at nutritional risk (NR)" and additional specialist nutritional evaluation and therapy was performed within the next 24h. RESULTS 205 patients out of 1176 (17.4%) were detected by automatized alarm and were considered as presenting high NR; 100% were concordant by the validated nutritional screening SNAQ. Nutritional support after detection was: 77.6% dietary adaptation+oral supplements; 9.3% enteral nutrition (EN); 1.5% parenteral nutrition (PN); 1% EN+PN and 10.7% no intervention is performed due to an end-of-life situation. Median weight loss during admission was 2.5kg (p25 0.25-p75: 6kg). Global mortality was 6.7% while in those detected by automatized alarm was 31.5%. CONCLUSIONS The implementation of an electronic NR screening tool was feasible and allowed the early nutritional assessment and intervention in COVID-19 hospitalized patients and can be useful in patients hospitalized for other pathologies.
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Affiliation(s)
- Analía Ramos
- Endocrinology and Nutrition Service, Germans Trias University Hospital and Research Institute, Badalona, Spain; Autonomous University of Barcelona, Barcelona, Spain.
| | - Clara Joaquin
- Endocrinology and Nutrition Service, Germans Trias University Hospital and Research Institute, Badalona, Spain; University of Vic, Vic, Spain
| | - Mireia Ros
- Endocrinology and Nutrition Service, Germans Trias University Hospital and Research Institute, Badalona, Spain
| | - Mariona Martin
- Endocrinology and Nutrition Service, Germans Trias University Hospital and Research Institute, Badalona, Spain
| | - Montserrat Cachero
- Endocrinology and Nutrition Service, Germans Trias University Hospital and Research Institute, Badalona, Spain
| | - María Sospedra
- Endocrinology and Nutrition Service, Germans Trias University Hospital and Research Institute, Badalona, Spain
| | - Eva Martínez
- Endocrinology and Nutrition Service, Germans Trias University Hospital and Research Institute, Badalona, Spain
| | - Guillem Socies
- Endocrinology and Nutrition Service, Germans Trias University Hospital and Research Institute, Badalona, Spain
| | - Alejandra Pérez-Montes de Oca
- Endocrinology and Nutrition Service, Germans Trias University Hospital and Research Institute, Badalona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Maria José Sendrós
- Endocrinology and Nutrition Service, Germans Trias University Hospital and Research Institute, Badalona, Spain
| | | | - Nuria Alonso
- Endocrinology and Nutrition Service, Germans Trias University Hospital and Research Institute, Badalona, Spain; Autonomous University of Barcelona, Barcelona, Spain
| | - Manel Puig-Domingo
- Endocrinology and Nutrition Service, Germans Trias University Hospital and Research Institute, Badalona, Spain; Autonomous University of Barcelona, Barcelona, Spain
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Shamlan G, Albreiki M, Almasoudi HO, Alshehri LA, Ghaith MM, Alharthi AS, Aleanizy FS. Nutritional status of elderly patients previously ill with COVID-19: Assessment with nutritional risk screening 2002 (NRS-2002) and mini nutritional assessment (MNA-sf). J Infect Public Health 2024; 17:372-377. [PMID: 38217931 DOI: 10.1016/j.jiph.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/19/2023] [Accepted: 11/02/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Long-term effects of COVID-19 showed a wide range of symptoms. Also, it was found that older patients were five times more likely than younger patients to develop long-COVID symptoms (1). This study aimed to investigate the use of Nutrition Risk Screening 2002 (NRS-2002) and the Mini Nutrition Assessment-Short Form (MNA-sf) among COVID-19 in elderly patients in Saudi Arabia. METHODS A total of (n = 159) COVID-19 elderly patients were recruited in the study; the relationship between patients' characteristics, including age, gender, Body Mass Index (BMI), infection history, vaccination and chronic disease were evaluated using NRS-2002 and MNA-sf. Multivariate logistic regression to estimate the Odd Ratio (OR) by comparing the OR of different variables between normal nutritional Status and at-risk and Cohen's kappa (κ) coefficient was assessed to analyse the agreement between both tools. RESULTS MNA-sf showed a positive association between age and malnutrition risk ≥ 66 years old P = 0.035. Both tools showed a negative association between BMI (P < 0.001 and P = 0.046), respectively and vaccination (P = 0.002 and P = 0.01), respectively, with risk for malnutrition. There was no significant association between Diabetes (DM) and malnutrition risk, but elderly Cardiovascular Disease (CVD) were at malnutrition risk using the NRS- 2002 tool P = 0.003. Inversely, people infected six months or more before malnutrition assessment have a lower risk of malnutrition P = 0.05. CONCLUSIONS Both tools were valuable and practical tools for screening elderly people with COVID-19 who are at nutritional risk and those in need of additional nutritional intervention. Further research needed to be applied in the relationship between nutritional status during and post-infectious disease for elderly people using cross-sectional and intervention studies in order to prevent malnutrition complications in Saudi Arabia.
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Affiliation(s)
- Ghalia Shamlan
- Department of Human Nutrition, College of food science and agriculture, King Saud University, Riyadh, Saudi Arabia.
| | - Mohammed Albreiki
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; Biosecurity Affairs Division, Innovation and Development Sector, Abu Dhabi Agriculture and Food Safety Authority, Abu Dhabi, United Arab Emirates.
| | - Hadeel O Almasoudi
- Department of Human Nutrition, College of food science and agriculture, King Saud University, Riyadh, Saudi Arabia
| | - Lina A Alshehri
- Department of Human Nutrition, College of food science and agriculture, King Saud University, Riyadh, Saudi Arabia
| | - Mazen M Ghaith
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 7607, Al Abdeyah, Makkah, Saudi Arabia
| | - Abdulrahman S Alharthi
- Department of Animal Production, College of food science and agriculture, King Saud University, Riyadh, Saudi Arabia
| | - Fadilah S Aleanizy
- Department of Pharmacutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Ma YC, Ju YM, Cao MY, Yang D, Zhang KX, Liang H, Leng JY. Exploring the relationship between malnutrition and the systemic immune-inflammation index in older inpatients: a study based on comprehensive geriatric assessment. BMC Geriatr 2024; 24:19. [PMID: 38178005 PMCID: PMC10768166 DOI: 10.1186/s12877-023-04604-8] [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: 08/18/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Malnutrition is a prevalent and major challenge among senior citizens, possibly due to the continual low-grade inflammatory state of the body. A novel inflammatory parameter, the systemic immune-inflammation index (SII), is highly valuable in evaluating and predicting the prognosis of a wide range of diseases. This study aims to explore the significance of the SII in assessing malnutrition in older inpatients. METHODS This retrospective study included 500 senior hospitalized patients who met the inclusion and exclusion criteria from the Comprehensive Geriatric Assessment database of the First Hospital of Jilin University. The Mini-Nutritional Assessment (MNA) questionnaire was used to evaluate the nutritional status of patients. The SII was calculated using complete blood counts, and we performed natural logarithm transformation of the SII [ln(SII)]. Multivariable logistic regression analysis was used to identify the association between ln(SII) and malnutrition. To ensure the stability of the findings, a sensitivity analysis was conducted. RESULTS The 500 patients had a mean age of 77.29 ± 9.85 years, and 68.6% were male. In accordance with the MNA, 30.4% of the patients were malnourished or at risk of malnutrition, and patients in this group had considerably greater levels of ln(SII) than patients with adequate nutrition (P < 0.001). The optimum ln(SII) cutoff value for patients with malnutrition or at risk of malnutrition was 6.46 (SII = 635.87) with 46.7% sensitivity and 80.2% specificity [95% CI: 0.613-0.721, AUC: 0.667, P < 0.001]. Multivariable logistic regression demonstrated that ln(SII) was an independent risk factor for the risk of malnutrition or malnutrition in older individuals (OR 3.984, 95% CI: 2.426-6.543, P < 0.001). Other metrics from the geriatric comprehensive assessment, including body mass index, calf circumference, fat ratio, activities of daily living and instrumental activities of daily living, and geriatric depression scale scores, were also independently correlated with nutritional status. CONCLUSIONS According to our research, a high SII is an independent predictor of older inpatient malnutrition, and the SII aids in screening for malnutrition and may be a potential target for intervention. Comprehensive geriatric assessment parameters such as BMI, calf circumference, fat ratio, activities of daily living and depression were also linked to malnutrition.
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Affiliation(s)
- Yu-Cen Ma
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China
| | - Yan-Min Ju
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China
| | - Meng-Yu Cao
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China
| | - Di Yang
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China
| | - Ke-Xin Zhang
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China
| | - Hong Liang
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China
| | - Ji-Yan Leng
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, 130021, China.
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De Meester D, Goossens M, Marco E, Claessens M, Gautier J, Annweiler C, Lieten S, Benoit F, Surquin M, Sánchez-Rodríguez D. Evaluation of the Geriatric Nutritional Risk Index in predicting mortality in older patients with COVID-19 in the AgeBru cohort. Clin Nutr ESPEN 2023; 57:65-72. [PMID: 37739719 PMCID: PMC10290730 DOI: 10.1016/j.clnesp.2023.06.025] [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: 01/19/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE To determine whether the Geriatric Nutritional Risk Index (GNRI) on hospital admission was associated to an increased 14-day and 12-month mortality-risk in older inpatients with COVID-19. METHODS Cohort study of consecutive inpatients admitted with COVID-19 in a university hospital (20/03/2020-11/05/2021). INCLUSION CRITERIA age over 65 years and positive polymerase chain reaction test. EXCLUSION CRITERIA missing data for weight, height, and/or albumin, hospital-acquired COVID-19, or patients transferred to other health facilities. OUTCOME all-cause mortality at 14-day and 12-month follow-up. GNRI [1.489 × albumin (g/L)] + [41.7 (weight/ideal body weight)] was assessed at admission; scores ≤98 indicated risk of malnutrition. Cox-proportional hazards models assessed the association between the admission GNRI and 14-day and 12-month mortality-risk, after adjusting by demographic and clinical variables, including inflammation (C-reactive protein). RESULTS Of the 570 eligible patients, 224 (mean age 78 years; 52.2% women) met inclusion criteria and 151 (67.4%) were classified at risk of malnutrition. Twenty patients died during the 14-day and 42 during the 12-month follow-up. The risk of 14-day mortality was nearly 10 times higher in patients with GNRI scores ≤98 (HR = 9.6 [95%CI 1.3-71.6], P = 0.028); this association was marginally significant in the adjusted model (HR = 6.73 [95%CI 0.89-51.11], P = 0.065)]. No association between GNRI and the 12-month mortality-risk was found. CONCLUSIONS The GNRI may play a role in the short-term prognosis of older inpatients with COVID-19. Further studies are required to confirm the short-term predictive validity of the GNRI within this population (Clinicaltrials.gov_NCT05276752).
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Affiliation(s)
- Dorien De Meester
- Department of Geriatrics, Onze Lieve Vrouw Ziekehuis (OLV) Aalst, Aalst, Belgium
| | | | - Ester Marco
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital Del Mar, Hospital de L'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; Faculty of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Marie Claessens
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jennifer Gautier
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France; University of Angers, UPRES EA, 4638, Angers, France; Gérontopôle Autonomie Longévité des Pays de La Loire, F-44000, Nantes, France; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, N6A 5K8, Canada
| | - Siddhartha Lieten
- Department of Geriatrics, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Florence Benoit
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Murielle Surquin
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain; Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium; Geriatrics Department, Parc de Salut Mar (Centre Fòrum-Hospital Del Mar), Barcelona, Catalonia, Spain; WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
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Erfani Z, Alizadeh N, Faraji N, Teymouri A. Vitamin B12 effectiveness in the management of hospitalized COVID-19 and its clinical outcomes and complications: A randomized clinical trial. Health Sci Rep 2023; 6:e1509. [PMID: 37720165 PMCID: PMC10500256 DOI: 10.1002/hsr2.1509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023] Open
Abstract
Background and Aims Since 2019, severe acute respiratory syndrome coronavirus 2, has spread and challenged the health care system for treatment which is mainly limited to supportive care. It is well-established that malnutrition impedes the immunity in human bodies, and makes it vulnerable to microorganisms. Vitamin B12 is one of the agents that has critical roles in body systems. Thus, the following clinical trial was conducted to assess its possible therapeutic value in COVID-19 patients. Method The present randomized clinical trial was carried out in Baharlou Hospital, and patients with confirmed COVID-19 infection within 24 h of admission were included. We used quadruple blocks randomization to divide patients into groups of case and control. The case group received 1000 mg of vitamin B12, daily for 7 day while the patients in control group were administered distilled water as placebo. The studied outcomes were duration of hospitalization, need for intensive care unit (ICU), mechanical ventilation, mortality rate and laboratory findings. The statistical analysis was done via SPSS version 22. Results After implementing inclusion and exclusion criteria, 34 participants were included in the study, 20 of which were male. Serum levels of creatinine, LDH (Lactate dehydrogenase), Ferritin, and CRP (C-reactive protein) had decreased in both groups. The improving changes of CRP, LDH, ferritin and creatinine was higher in case group. The increase of Alanine Transaminase and D-dimer was higher in control group. however there was no statistically significant difference. More patients were admitted to ICU in the control group but the difference was not statistically significant. Duration of hospitalization did not differ statistically between the groups. No in hospital mortality has been recorded. Conclusion Our study suggests that vitamin B12 supplementation seem to have curative effect in COVID-19. Nutritious diet is necessary for proper functioning of the immune system. Since malnutrition is associated with poor prognosis in COVID-19 patients, and limited number of participants in this study, we suggest performing meta-analysis on similar studies to reach reliable result.
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Affiliation(s)
- Zahra Erfani
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Nafiseh Alizadeh
- Baharlou Hospital Research CenterTehran University of Medical SciencesTehranIran
- Pharmaceutical Care Department Baharlou HospitalTehran University of Medical SciencesTehranIran
| | - Neda Faraji
- School of MedicineTehran University of Medical SciencesTehranIran
- Baharlou Hospital Research CenterTehran University of Medical SciencesTehranIran
| | - Alireza Teymouri
- School of MedicineTehran University of Medical SciencesTehranIran
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Jiang H, Ye L, Zhang S, Jin M, Wang J, Tang M, Chen K. The association between nutritional status and sleep quality of Chinese community-dwelling older adults. Aging Clin Exp Res 2023; 35:1945-1954. [PMID: 37382809 DOI: 10.1007/s40520-023-02479-8] [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: 05/02/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Sleep disorders are a common syndrome and could affect the life quality of the older adults. AIMS This study aimed to investigate the association between nutritional status and sleep quality in the Chinese community-dwelling older adults. METHODS A total of 2,878 participants ≥ 65 years old from the Yiwu Elderly Cohort were included in the study. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF). Participants were categorized as subjects with malnutrition, at risk of malnutrition or well-nourished based on their MNA-SF score. Pittsburgh Sleep Quality Index (PSQI) was used to identify sleep disorders. PSQI score ≥ 6 was categorized as poor sleep quality. RESULTS Among the 2,878 participants (mean age 72.71 ± 5.79 years, 50.3% men), 31.5% (n = 906) were classified as having sleep disorders, and 25.5% were identified as malnutrition or at risk of malnutrition. We found a significantly relationship between nutritional status and sleep quality in older adults, and the results showed well-nourished decreased the risk of sleep disorders (OR = 0.32, 95% CI = 0.13, 0.75). And well-nourished status was significantly associated with less daytime dysfunction, adequate sleep duration, and good subjective sleep quality (all P < 0.05). CONCLUSION There was a close association of nutritional status and sleep quality in older adults. We should pay more attention to the nutritional status of older people with sleep problems, as well as the sleep quality of older adults with malnutrition.
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Affiliation(s)
- Haiyan Jiang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Lifang Ye
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Simei Zhang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Mingjuan Jin
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Jianbing Wang
- Department of Public Health, National Clinical Research Center for Child Health of Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Mengling Tang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
| | - Kun Chen
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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Wang X, Deng W, Zhao J, Guo Y, Lai H, Hu Y, Kang W, Li Y, Zuo J. Improving Nutritional Status Was Associated with Decreasing Disease Severity and Shortening of Negative Conversion Time of PCR Test in Non-ICU Patients with COVID-19. Infect Drug Resist 2023; 16:4443-4452. [PMID: 37435236 PMCID: PMC10332416 DOI: 10.2147/idr.s409615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/14/2023] [Indexed: 07/13/2023] Open
Abstract
Background Nutrition is an important prevention in old patients with COVID-19. However, in China, there are few studies on the correlation between nutrition and COVID-19. Methods A total of 148 hospitalized COVID-19 (65.7 ± 16.0 [range: from 21 to 101] years old) patients were enrolled in this study. The information of demographic, biochemical results, vaccination doses, types of COVID-19, PCR test negative conversion time, and scores of Mini Nutritional Assessment Short Form (MNA-SF) for evaluating nutritional status were recorded. We first explored the relationships between MNA-SF performance and the severities of COVID-19 in the groups with non-vaccinated, vaccinated, and all the patients using multivariable ordinal logistic regression. Further, we explored the relationships between performance of MNA-SF and the time of negative conversion of PCR in the groups with non-vaccinated, vaccinated, and all the patients using COX proportional hazards survival regression. Results Group of patients with malnutrition or at risk of malnutrition group was associated with older of the age, those who had not been vaccinated, in fewer people who were asymptomatic type and in more people who showed longer of the negative conversion time of PCR, lower of the BMI, and the lower of the hemoglobin level. Each additional increase of one point of MNA-SF was associated with a 17% decrease in the odds of a worse type of COVID-19 in all patients, and the significant result exists in non-vaccinated patients. One point increase of MNA-SF was associated with increased 11% of hazard ratios of turning negative of PCR and well-nourished group was associated with increased 46% of hazard ratio of turning negative of PCR. Conclusion Higher nutrition is associated with less severity of COVID-19, especially in the non-vaccinated group. Higher nutrition is also associated with shorter time of turning negative of PCR in non-ICU COVID-19 patients.
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Affiliation(s)
- Xiaodan Wang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Weiping Deng
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Jiehui Zhao
- Department of General Practice, Daning Community Health Service Center, Shanghai, 200072, People’s Republic of China
| | - Yongchao Guo
- Department of Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Haifang Lai
- Department of Rehabilitation Medicine Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Yueliang Hu
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Wenyan Kang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Yong Li
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
- Institute of Respiratory Disease, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Disease, Shanghai, People’s Republic of China
| | - Junli Zuo
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
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Chen B, Yang Y, Cai F, Zhu C, Lin S, Huang P, Zhang L. Nutritional status as a predictor of the incidence of pressure injury in adults: A systematic review and meta-analysis. J Tissue Viability 2023:S0965-206X(23)00043-8. [PMID: 37117126 DOI: 10.1016/j.jtv.2023.04.005] [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: 11/25/2022] [Revised: 03/12/2023] [Accepted: 04/15/2023] [Indexed: 04/30/2023]
Abstract
AIM Pressure injuries are a significant health care problem worldwide, and many factors influence their occurrence and development. The purpose of this systematic review and meta-analysis was to investigate the role of nutritional status in the development rate of pressure injuries as a potentially modifiable risk factor. METHODS Study designs included cohort (prospective and retrospective), case-control, and RCTs if the association between nutrition status and pressure injuries was reported. Databases searched included: PubMed, CINAHL, Embase, Scopus, Web of Science, and Cochrane Library on April 20th, 2022. The data were analyzed using OR and random effect model in Revman5.3 and STATA 15 Software. Report this systematic review and meta-analysis according to the PRISMA 2020 statement. RESULTS A total of 22 separate studies were retained in this systematic review. Of these, 16 articles were included in the meta-analysis. Three studies were assessed as low risk and sixteen as a moderate risk of bias. All RCTs were B quality. The odds ratio of the incidence of pressure injuries in malnourished and non-malnourished patients was 3.66(95% CI: 2.77-4.83). In the three RCTs studies(n = 870), the odds ratio of the incidence of pressure ulcers in patients with standard nutrition to those with specific nutritional interventions was 1.35(95%CI:1.02-1.78). CONCLUSIONS This systematic review and meta-analysis showed that nutritional status is significantly associated with pressure injuries. Malnutrition can increase the incidence of pressure injuries, and specific nutritional interventions can reduce the incidence of pressure injuries compared to standard nutrition.
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Affiliation(s)
- Bei Chen
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.
| | - Yufan Yang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Fuman Cai
- College of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Chunjing Zhu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shaoqin Lin
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Pan Huang
- College of Nursing, Wenzhou Medical University, Wenzhou, China.
| | - Liping Zhang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
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Elliott A, Gibson S. Exploring stakeholder experiences of dietetic service and care delivery: A systematic qualitative review. J Hum Nutr Diet 2023; 36:288-310. [PMID: 35833488 PMCID: PMC10087390 DOI: 10.1111/jhn.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is limited understanding of patients' and healthcare professionals' perceptions and experiences of receiving and delivering dietetic care, respectively. This systematic review of the literature used qualitative synthesis to explore the perceptions and experiences of multiple stakeholders involved in the delivery of nutrition care and dietetic service. METHODS MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, ISI Web of Science, PsycINFO and ProQuest were systematically searched. Study characteristics and perceptions of stakeholders regarding nutrition care services were extracted. Qualitative synthesis was employed and thematic analysis conducted. RESULTS Five themes were identified from 44 studies related to stakeholders' perceptions of dietetic services. Studies included quantitative, qualitative and mixed methods involving patients, families, dietitians and other healthcare professionals. The themes were (1) patients desiring a personalised approach to nutrition care; (2) accessing dietetic service; (3) perceived impact of nutrition care on the patient; (4) relationships between stakeholders; and (5) beliefs about nutrition expertise. Two themes were specific to patients; these were the desire for individualised care and the impact of nutrition care. Within each theme perceptions varied with patients' views often contrasting with those of dietetic service providers. CONCLUSIONS Experiences of dietetic service do not always meet stakeholder expectations which impacts on patient engagement. Seeking stakeholder input is imperative to design dietetic services that engage patients in positive and supportive clinical partnerships.
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Affiliation(s)
- Andrea Elliott
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Simone Gibson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, Victoria, Australia
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14
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Oliveira LCD, Rosa KSDC, Pedrosa AP, Silva NFD, Santos LAD, Maria EV. Cancer patients with COVID-19: does prior nutritional risk associated with cancer indicate a poor prognosis for COVID-19? EINSTEIN-SAO PAULO 2023; 21:eAO0172. [PMID: 36946825 PMCID: PMC10010257 DOI: 10.31744/einstein_journal/2023ao0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/30/2022] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To verify whether the presence of related nutritional risk indicators prior to COVID-19 diagnosis is associated with poor survival in patients with cancer. METHODS We retrospectively analyzed the data of hospitalized cancer patients who tested positive for COVID-19 between March 2020 and February 2021. Nutritional risk was defined as the presence of one of the following characteristics: body mass index <20kg/m 2 , scored Patient-generated Subjective Global Assessment ≥9 points or classification B, albumin level <3.5g/dL, and C-reactive protein level ≥10mg/L, evaluated between 7 and 60 days prior to the date of patient inclusion. The endpoint measure was all-cause mortality within 30 days of COVID-19 diagnosis. RESULTS A total of 253 patients were included, most of whom were elderly (62.4%) and female (63.6%). Overall, 45.4% of the patients were at nutritional risk. Survival was significantly lower in patients at nutritional risk (8 days; interquartile range [IQR]: 3-29) than in patients not at nutritional risk (16 days; IQR: 6-30) (p<0.001). The presence of prior nutritional risk was associated with increased 30-day mortality (HR: 1.42; 95%CI: 1.03-1.94), regardless of age, gender, tumor site or stage, and other risk factors, and the model had good discrimination accuracy (concordance statistic: 0.744). CONCLUSION The presence of prior nutritional risk indicators is related to poor prognosis in patients with cancer and COVID-19, emphasizing the importance of nutritional care, notably during this pandemic.
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15
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Zhou Y, Chen Y, Zhang X, Zhao B, Gao F, Yuan X, Zhu Y, Liu D. Nutritional risk and a high NRS2002 score are closely related to disease progression and poor prognosis in patients with COVID-19. Front Nutr 2023; 10:1089972. [PMID: 37125047 PMCID: PMC10130536 DOI: 10.3389/fnut.2023.1089972] [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: 11/04/2022] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Background Organism can lead to excessive nutrient consumption in the infected state and increase nutritional risk, which is detrimental to the control of the infection and can further aggravate the disease. Objectives To investigate the impact of nutritional risk and the NRS2002 score on disease progression and prognosis in patients with COVID-19. Methods This was a retrospective cohort study including 1,228 COVID-19 patients, who were divided into a with-nutritional risk group (patients with NRS2002 score ≥ 3) and a without-nutritional risk group (patients with NRS2002 score < 3) according to the NRS2002 score at admission. The differences in clinical and outcome data between the two groups were compared, and the relationship between the NRS2002 score and the disease progression and prognosis of COVID-19 patients was assessed. Results Of 1,228 COVID-19 patients, including 44 critical illness patients and 1,184 non-critical illness patients, the rate of harboring nutritional risk was 7.90%. Compared with those in the without-nutritional risk group, patients in the with-nutritional risk group had a significantly longer coronavirus negative conversion time, significantly lower serum albumin (ALB), total serum protein (TP) and hemoglobin (HGB) at admission, discharge or 2 weeks, a significantly greater proportion with 3 or more comorbidities, and a significantly higher rate of critical illness and mortality (all p < 0.001). Multiple regression analysis showed that nutritional risk, NRS2002 score and ALB at admission were risk factors for disease severity. In addition, nutritional risk, NRS2002 score and TP at admission were risk factors for prognosis. The NRS2002 score showed the best utility for predicting critical illness and death in COVID-19 patients. Conclusion Nutritional risk and a high NRS2002 score are closely related to disease progression and poor prognosis in COVID-19 patients. For patients with NRS2002 score > 0.5, early intervention of malnutrition is needed to reduce the occurrence of critical disease. Additionally, for patients with NRS2002 score > 5.5, continuous nutritional support therapy is needs to reduce mortality and improve prognosis.Clinical Trial registration: [https://www.chictr.org.cn/historyversionpub.aspx?regno=ChiCTR2000034563], identifier [Chinese Clinical Trial Register ChiCTR2000034563].
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Affiliation(s)
- Yuanyuan Zhou
- Department of Internal Medicine, Public Health and Clinical Center of Chengdu, Chengdu, China
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Yi Chen
- Department of Internal Medicine, Public Health and Clinical Center of Chengdu, Chengdu, China
| | - Xinyi Zhang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Bennan Zhao
- Department of Internal Medicine, Public Health and Clinical Center of Chengdu, Chengdu, China
| | - Fengjiao Gao
- Department of Internal Medicine, Public Health and Clinical Center of Chengdu, Chengdu, China
| | - Xiaoyan Yuan
- Department of Internal Medicine, Public Health and Clinical Center of Chengdu, Chengdu, China
| | - Yanfeng Zhu
- School of Public Health, Chengdu Medical College, Chengdu, China
- *Correspondence: Yanfeng Zhu,
| | - Dafeng Liu
- Department of Internal Medicine, Public Health and Clinical Center of Chengdu, Chengdu, China
- Dafeng Liu,
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Mozota M, Castro I, Gómez-Torres N, Arroyo R, Gutiérrez-Díaz I, Delgado S, Rodríguez JM, Alba C. Administration of Ligilactobacillus salivarius CECT 30632 to elderly during the COVID-19 pandemic: Nasal and fecal metataxonomic analysis and fatty acid profiling. Front Microbiol 2022; 13:1052675. [PMID: 36590434 PMCID: PMC9800801 DOI: 10.3389/fmicb.2022.1052675] [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: 09/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Elderly was the most affected population during the first COVID-19 and those living in nursing homes represented the most vulnerable group, with high mortality rates, until vaccines became available. In a previous article, we presented an open-label trial showing the beneficial effect of the strain Ligilactobacillus salivarius CECT 30632 (previously known as L. salivarius MP101) on the functional and nutritional status, and on the nasal and fecal inflammatory profiles of elderly residing in a nursing home highly affected by the pandemic. The objective of this post-hoc analysis was to elucidate if there were changes in the nasal and fecal bacteriomes of a subset of these patients as a result of the administration of the strain for 4 months and, also, its impact on their fecal fatty acids profiles. Culture-based methods showed that, while L. salivarius (species level) could not be detected in any of the fecal samples at day 0, L. salivarius CECT 30632 (strain level) was present in all the recruited people at day 120. Paradoxically, the increase in the L. salivarius counts was not reflected in changes in the metataxonomic analysis of the nasal and fecal samples or in changes in the fatty acid profiles in the fecal samples of the recruited people. Overall, our results indicate that L. salivarius CECT 30632 colonized, at least temporarily, the intestinal tract of the recruited elderly and may have contributed to improvements in their functional, nutritional, and immunological status, without changing the general structure of their nasal and fecal bacteriomes when assessed at the genus level. They also suggest the ability of low abundance bacteria to train immunity.
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Affiliation(s)
- Marta Mozota
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
| | - Irma Castro
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
| | - Natalia Gómez-Torres
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
| | - Rebeca Arroyo
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
| | - Isabel Gutiérrez-Díaz
- Department of Microbiology and Biochemistry, Dairy Research Institute of Asturias (IPLA-CSIC), Villaviciosa, Spain
| | - Susana Delgado
- Department of Microbiology and Biochemistry, Dairy Research Institute of Asturias (IPLA-CSIC), Villaviciosa, Spain
| | - Juan Miguel Rodríguez
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain,*Correspondence: Juan Miguel Rodríguez,
| | - Claudio Alba
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain,Claudio Alba,
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A modified nutrition risk screening 2002 predicts the risk of death among hospitalized patients with COVID-19. Clin Nutr ESPEN 2022; 52:365-370. [PMID: 36513477 PMCID: PMC9482444 DOI: 10.1016/j.clnesp.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the ability of a modified Nutrition Risk Screening 2002 (modified NRS) compared with other nutrition screening tools such as NRS 2002, Mini Nutrition Assessment Short Form (MNA-SF), and Malnutrition Universal Screening Tool (MUST) on predicting the risk of death in patients with coronavirus disease 2019 (COVID-19). METHODS We retrospectively collected data of patients who were admitted to the West campus of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 25th, 2020 to April 24th, 2020. The nutritional status of the patients was assessed by modified NRS, NRS 2002, MNA-SF, and MUST. According to the score of modified NRS, patients were divided into malnutrition risk group (score ≥3) and normal nutrition group (score <3). Clinical characteristics were compared between the two groups. Kaplan meier survival curve was used to analyze the difference of compositing survival rate between the two groups. The predictive efficacy of different nutritional scales on the outcome of death was detected by Receiver operating characteristic (ROC) analysis. RESULTS The modified NRS, NRS 2002, MNA-SF, and MUST identified malnutrition risk in 71.4%, 57.9%, 73.9%, and 43.4% of the patients, respectively. The patients were divided into malnutrition risk group and normal nutrition group by modified NRS score. Patients in the malnutrition risk group were older (65 y vs. 56 y) and with more severe and critical cases (42.30% vs. 5.20%) and diabetes cases (21.50% vs. 9.80%), worse prognosis (death of 13.80% vs. 0.50%), longer hospital stay (29 days vs. 23 days), lower albumin (31.85 g/L vs. 38.55 g/L) and prealbumin (201.95 mg/L vs. 280.25 mg/L) compared with the normal nutrition group (P were <0.001, respectively). There were more patients with chronic respiratory disease in malnutrition risk group (9.70 vs. 2.10%, P = 0.001). BMI was lower in malnutrition risk group (23.45 kg/m2vs. 24.15 kg/m2, P = 0.017). Kaplan meier survival curve demonstrated that the survival of malnutrition risk group was significantly lower than normal nutrition group (P < 0.001). The area under the ROC curve (AUC) of the modified NRS scale (0.895) outperformed NRS 2002 (0.758), MNA-SF (0.688), and MUST (0.485). The former three scales could predict the risk of death (P were < 0.001), while MUST could not (P = 0.690). CONCLUSIONS Patients with COVID-19 at risk of malnutrition have a worse prognosis than those with normal nutrition. The modified NRS scale could effectively predict the risk of death among patients with COVID-19.
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Alkhatib B, Al Hourani HM, Al-Shami I. Using inflammatory indices for assessing malnutrition among COVID-19 patients: A single-center retrospective study. J Infect Public Health 2022; 15:1472-1476. [PMID: 36403404 PMCID: PMC9650260 DOI: 10.1016/j.jiph.2022.11.006] [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: 08/30/2022] [Revised: 10/14/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) causes malnutrition in infected patients. This study aimed to investigate the use of systemic immune-inflammatory index (SII), platelet-to-lymphocyte ratio (PLR), the Glasgow Prognostic Score (GPS), and neutrophil-to-lymphocyte ratio (NLR) for malnutrition assessment among COVID-19 inpatients. METHODS This is a single-center retrospective study on 108 hospitalized COVID-19 patients; 14 were admitted to the intensive care unit (ICU). Data were collected from patients' profiles while NLR, PLR, GPS, and SII were calculated. Inflammatory indices' predictive power was analyzed using the receiver operating characteristic curve (ROC). A P-value of < 0.05 was considered statistically significant. RESULTS Hospitalization days, neutrophils count, C-reactive protein (CRP), and serum urea levels were significantly higher in ICU patients. None of SII, PLR, and NLR were significantly different between ICU and non-ICU groups. Also, albumin and GPS showed a higher sensitivity level (100.0), followed by PLR and SII (78.57 and 71.34, respectively). Regarding ROC curves, even though NLR, PLR, and SII provided the largest area under the curve (AUC) (0.687, 0.682, 0.645; respectively), they have shown a poor discrimination ability, while GPS and albumin were ineffective in predicting malnutrition in COVID-19 patients. CONCLUSION NLR, SII, and PLR showed poor predicting ability for malnutrition among COVID-19 inpatients. Additional consideration should be taken for using inflammatory parameters (SII, PLR, GPS, and NLR) to predict malnutrition in COVID-19 inpatients.
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Caccialanza R, Formisano E, Klersy C, Ferretti V, Ferrari A, Demontis S, Mascheroni A, Masi S, Crotti S, Lobascio F, Cerutti N, Orlandoni P, Dalla Costa C, Redaelli E, Fabbri A, Malesci A, Corrao S, Bordandini L, Cereda E. Nutritional parameters associated with prognosis in non-critically ill hospitalized COVID-19 patients: The NUTRI-COVID19 study. Clin Nutr 2022; 41:2980-2987. [PMID: 34353669 PMCID: PMC8233046 DOI: 10.1016/j.clnu.2021.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS To investigate the association between the parameters used in nutritional screening assessment (body mass index [BMI], unintentional weight loss [WL] and reduced food intake) and clinical outcomes in non-critically ill, hospitalized coronavirus disease 2019 (COVID-19) patients. METHODS This was a prospective multicenter real-life study carried out during the first pandemic wave in 11 Italian Hospitals. In total, 1391 patients were included. The primary end-point was a composite of in-hospital mortality or admission to ICU, whichever came first. The key secondary end-point was in-hospital mortality. RESULTS Multivariable models were based on 1183 patients with complete data. Reduced self-reported food intake before hospitalization and/or expected by physicians in the next days since admission was found to have a negative prognostic impact for both the primary and secondary end-point (P < .001 for both). No association with BMI and WL was observed. Other predictors of outcomes were age and presence of multiple comorbidities. A significant interaction between obesity and multi-morbidity (≥2) was detected. Obesity was found to be a risk factor for composite end-point (HR = 1.36 [95%CI, 1.03-1.80]; P = .031) and a protective factor against in-hospital mortality (HR = 0.32 [95%CI, 0.20-0.51]; P < .001) in patients with and without multiple comorbidities, respectively. Secondary analysis (patients, N = 829), further adjusted for high C-reactive protein (>21 mg/dL) and LDH (>430 mU/mL) levels yielded consistent findings. CONCLUSIONS Reduced self-reported food intake before hospitalization and/or expected by physicians in the next days since admission was associated with negative clinical outcomes in non-critically ill, hospitalized COVID-19 patients. This simple and easily obtainable parameter may be useful to identify patients at highest risk of poor prognosis, who may benefit from prompt nutritional support. The presence of comorbidities could be the key factor, which may determine the protective or harmful role of a high body mass index in COVID-19.
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Affiliation(s)
- Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy,Corresponding author. Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy. Fax: +39 0382 502801
| | - Elena Formisano
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Virginia Ferretti
- Biometry and Clinical Epidemiology Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Ferrari
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Annalisa Mascheroni
- Clinical Nutrition and Dietetics Unit - ASST Melegnano e Martesana, Melegnano (Milano), Italy
| | - Sara Masi
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Crotti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Lobascio
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nadia Cerutti
- Medicine and Dietetics Unit, ASST Pavia, Pavia, Italy
| | | | - Cloè Dalla Costa
- Clinical Nutrition Unit, Michele e Pietro Ferrero Hospital, Verduno (Cuneo), Italy
| | - Elena Redaelli
- UOSD Endocrinology and Clinical Nutrition ASST Lecco, Lecco Hospital, Lecco, Italy
| | - Alessandra Fabbri
- Artificial Nutrition Interprofessional Group, Local Health Unit-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Malesci
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Salvatore Corrao
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy,COVID Unit, Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Lorella Bordandini
- Clinical Nutrition and Dietetic Unit, Department of Internal Medicine, AUSL Della Romagna, S.Maria Delle Croci Hospital, Ravenna, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - NUTRI-COVID19 Collaborative Working Group1CaccialanzaRiccardooFormisanoElenaoKlersyCatherineoFerrettiVirginiaoFerrariAlessandraoMasiSaraoCrottiSilviaoLobascioFedericaoCeredaEmanueleoBrunoRaffaeleoMontecuccoCarlo MauriziooCorsicoAngelo GuidooBelliatoMirkooDi SabatinoAntoniooLudovisiSerenaoBoglioloLauraoMarianiFrancescaoMuggiaChiaraoCroceGabrieleoBarteselliChiaraoMambellaJacopooDi TerlizziFrancescooCostaCloè DallaPLentaElenaPNigroEmanuelaPMascheroniAnnalisaqMerelliElisaqMisottiAlessandro Mariaqde MonteAndreaqRedaelliElenarLauraLaura IoriorRossiPaolarCeruttiNadiasFavaretoFlaviasPisocriElisasCimorelliManuelasOrlandoniPaolotVenturiniClaudiatFabbriAlessandrauVaccaroSalvatoreuBodecchiSimonauMonzaliElisauMalesciAlbertovCraviottoVincenzovOmodeiPaolo DariovPreatoniPaolettavPastoreManuelavDa RioLeonardovDemontisStefaniawIvaldiCeciliawSferrazzoElsawArietaLorenzinawNattaErikawCorraoSalvatorexBocchioRaffaella MollacixBordandiniLorellayPalmeseFrancescoyGrazianiAlessandroyFondazione IRCCS Policlinico San Matteo, Pavia, ItalyMichele e Pietro Ferrero Hospital, Verduno (Cuneo), ItalyASST Melegnano-Martesana, Melegnano (MI), ItalyASST Lecco, Lecco Hospital, Lecco, ItalyASST Pavia, Pavia, ItalyIRCCS-INRCA, Ancona, ItalyLocal Health Unit-IRCCS of Reggio Emilia, Reggio Emilia, ItalyHumanitas Research Hospital and Humanitas University, Rozzano, Milano, ItalyGiovanni Borea Civil Hospital, Sanremo, ItalyNational Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, ItalyAUSL della Romagna, S.Maria delle Croci Hospital, Ravenna, Italy
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20
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The Effects of COVID-19 on Skeletal Muscles, Muscle Fatigue and Rehabilitation Programs Outcomes. Medicina (B Aires) 2022; 58:medicina58091199. [PMID: 36143878 PMCID: PMC9500689 DOI: 10.3390/medicina58091199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: Consequences due to infection with SARS-CoV-2 virus can have a direct impact on skeletal muscle, due to the fact that both cardiac and skeletal muscle tissue show robust ACE2(angiotensin-converting enzyme 2) expression, suggesting a potential susceptibility to SARS-CoV-2 infection in both types of tissues. From the articles analyzed we concluded that the musculoskeletal damage is firstly produced by the inflammatory effects, cytokine storm and muscle catabolism. However, myopathy, polyneuropathy and therapies such as corticoids were also considered important factors in muscle fatigue and functional incapacity. Pulmonary rehabilitation programs and early mobilization had a highly contribution during the acute phase and post-illness recovery process and helped patients to reduce dyspnea, increase the capacity of physical effort, overcome psychological disorders and improved the quality of their life. Materials and Methods: We have included in this review 33 articles that contain data on muscle damage following SARS-CoV-2 infection. We used the following keywords to search for articles: SARS-CoV-2, COVID-19, muscle weakness, muscle disease, muscle fatigue, neurological disorders. As a search strategy we used PubMed, Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects and Health Technology Assessment Database to collect the information. We also have chosen the most recent articles published in the last 5 years. Conclusions: Muscular damage, as well as the decrease in the quality of life, are often a consequence of severe SARS-CoV-2 infection through: systemic inflammation, corticotherapy, prolonged bed rest and other unknown factors. Pulmonary rehabilitation programs and early mobilization had a highly contribution during the acute phase and post-illness recovery process and helped patients to reduce dyspnea, increase the capacity of physical effort, overcome psychological disorders and improve the quality of their life.
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21
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Evaluation of the Relationship between Nutritional Status of COVID-19 Patients Admitted to the ICU and Patients' Prognosis: A Cohort Study. J Nutr Metab 2022; 2022:5016649. [PMID: 35865866 PMCID: PMC9295016 DOI: 10.1155/2022/5016649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 01/18/2023] Open
Abstract
Background Malnutrition in COVID-19 critically ill patients can lead to poor prognosis. This study aimed to evaluate the association between nutritional status (or risk) and the prognosis of critically ill COVID-19 patients. In this study, prognosis is the primary outcome of "hospital mortality" patients. The second outcome is defined as "need for mechanical ventilation." Methods and Materials In this single-center prospective cohort study, 110 patients admitted to the Intensive Care Unit of Imam Khomeini Hospital Complex (Tehran, Iran) between April and September 2021 were enrolled. Participants formed a consecutive sample. MNA-SF, NRS-2002, mNUTRIC, and PNI scores were used to evaluate nutritional assessment. Patients' lab results and pulse oximetric saturation SpO2/FiO2 (SF) ratio at the time of intensive care unit (ICU) admission were collected. Patients were screened for nutritional status and categorized into two groups, patients at nutritional risk and nonrisk. Results Sixty-five (59.1%) of all patients were men. The overall range of age was 52 ± 15. Thirty-six (32.7%) of patients were obese (BMI ≥ 30). The hospital mortality rate was 59.1% (n = 65). According to the different criteria, malnutrition rate was 67.3% (n = 74) (NRS), 28.2% (n = 31) (MNA), 34.5% (n = 38) (mNUTRIC), and 58.2% (n = 64) (PNI). There was a statistically significant association between chronic kidney disease (CKD) and mNUTRIC risk (OR = 13.5, 95% CI (1.89-16.05), P=0.002), diabetes mellitus (DM) and MNA risk (OR = 2.82, 95% CI (1.01-7.83), P=0.041), hypertension (HTN) and MNA risk (OR = 5.63, 95% CI (2.26-14.05), P < 0.001), and malignancy and mNUTRIC risk (P=0.048). The nutritional risk (all tools) significantly increased the odds of in-hospital death and need for mechanical ventilation. The length of stay was not significantly different in malnourished patients. Conclusion In the critical care setting of COVID-19 patients, malnutrition is prevalent. Malnutrition (nutritional risk) is associated with an increased risk of need for mechanical ventilation and in-hospital mortality. Patients with a history of HTN, CKD, DM, and cancer are more likely to be at nutritional risk at the time of ICU admission.
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22
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Chen L, Arai H, Assantachai P, Akishita M, Chew ST, Dumlao LC, Duque G, Woo J. Roles of nutrition in muscle health of community-dwelling older adults: evidence-based expert consensus from Asian Working Group for Sarcopenia. J Cachexia Sarcopenia Muscle 2022; 13:1653-1672. [PMID: 35307982 PMCID: PMC9178363 DOI: 10.1002/jcsm.12981] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 12/29/2022] Open
Abstract
General muscle health declines with age, and in particular, sarcopenia-defined as progressive loss of muscle mass and strength/physical performance-is a growing issue in Asia with a rising population of community-dwelling older adults. Several guidelines have addressed early identification of sarcopenia and management, and although nutrition is central to treatment of sarcopenia, there are currently few guidelines that have examined this specifically in the Asian population. Therefore, the Asian Working Group for Sarcopenia established a special interest group (SIG) comprising seven experts across Asia and one from Australia, to develop an evidence-based expert consensus. A systematic literature search was conducted using MEDLINE on the topic of muscle health, from 2016 (inclusive) to July 2021, in Asia or with relevance to healthy, Asian community-dwelling older adults (≥60 years old). Several key topics were identified: (1) nutritional status: malnutrition and screening; (2) diet and dietary factors; (3) nutritional supplementation; (4) lifestyle interventions plus nutrition; and (5) outcomes and assessment. Clinical questions were developed around these topics, leading to 14 consensus statements. Consensus was achieved using the modified Delphi method with two rounds of voting. Moreover, the consensus addressed the impacts of COVID-19 on nutrition, muscle health, and sarcopenia in Asia. These statements encompass clinical expertise and knowledge across Asia and are aligned with findings in the current literature, to provide a practical framework for addressing muscle health in the community, with the overall aim to encourage and facilitate broader access to equitable care for this target population.
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Affiliation(s)
- Liang‐Kung Chen
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Center for Geriatrics and GerontologyTaipei Veterans General HospitalTaipeiTaiwan
- Taipei Municipal Gan‐Dau HospitalTaipeiTaiwan
| | - Hidenori Arai
- National Center for Geriatrics and GerontologyObuJapan
| | | | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Samuel T.H. Chew
- Department of Geriatric MedicineChangi General Hospital, SingHealthSingapore
| | | | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS)The University of Melbourne and Western HealthMelbourneVictoriaAustralia
| | - Jean Woo
- Chinese University of Hong KongHong Kong
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23
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Can B, Senturk Durmus N, Olgun Yıldızeli S, Kocakaya D, Ilhan B, Tufan A. Nutrition risk assessed by Nutritional Risk Screening 2002 is associated with in-hospital mortality in older patients with COVID-19. Nutr Clin Pract 2022; 37:605-614. [PMID: 35488891 PMCID: PMC9347896 DOI: 10.1002/ncp.10860] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/19/2022] [Accepted: 04/02/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although numerous studies have been performed to determine predictors of coronavirus disease 2019 (COVID-19) mortality, studies that address the geriatric age group are limited. The aim of this study was to investigate the utility of the Nutritional Risk Screening 2002 (NRS-2002) and the Geriatric 8 (G8) screening tools in predicting clinical outcomes in older adults hospitalized with COVID-19. METHODS Patients aged ≥60 years who were hospitalized with COVID-19 in the second wave of the pandemic were included in the study. COVID-19 infection was demonstrated by a positive real-time reverse transcriptase-polymerase chain reaction on nasopharyngeal swab or positive radiological findings. Disease severity was determined as defined by the National Institutes of Health. Patient demographics, laboratory values on admission, comorbidities, and medications were recorded. The NRS-2002 and the G8 screening tools were performed for all patients by the same geriatrician. Primary outcome was in-hospital mortality. RESULTS A total of 121 patients were included. Mean age was 75 ± 9 years, and 51% were female. Mean body mass index was 27 ± 4.5 kg/m2 . Sixty-nine percent of the patients had nutrition risk according to the NRS-2002. Eighty-nine percent of the patients had a G8 score ≤14. In-hospital mortality occurred in 26 (22%) patients. Older age and having nutrition risk as determined by the NRS-2002 were independently associated with a higher risk of in-hospital mortality in older patients with COVID-19. CONCLUSION The NRS-2002 tool provides rapid assessment for risk stratification in hospitalized older patients with COVID-19.
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Affiliation(s)
- Busra Can
- Department of Internal Medicine, Division of Geriatrics, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nurdan Senturk Durmus
- Department of Internal Medicine, Division of Geriatrics, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Sehnaz Olgun Yıldızeli
- Department of Pulmonary Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Derya Kocakaya
- Department of Pulmonary Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Birkan Ilhan
- Department of Internal Medicine, Division of Geriatrics, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Asli Tufan
- Department of Internal Medicine, Division of Geriatrics, Faculty of Medicine, Marmara University, Istanbul, Turkey
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24
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shabanpur M, Pourmahmoudi A, Nicolau J, Veronese N, Roustaei N, Jahromi AJ, Hosseinikia M. The importance of nutritional status on clinical outcomes among both ICU and Non-ICU patients with COVID-19. Clin Nutr ESPEN 2022; 49:225-231. [PMID: 35623817 PMCID: PMC9021035 DOI: 10.1016/j.clnesp.2022.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/22/2022] [Accepted: 04/15/2022] [Indexed: 12/19/2022]
Abstract
Background and aims Methods Results Conclusion
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25
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Hinkelmann JV, de Oliveira NA, Marcato DF, Costa ARRO, Ferreira AM, Tomaz M, Rodrigues TJ, Mendes AP. Nutritional Support Protocol for patients with COVID-19. Clin Nutr ESPEN 2022; 49:544-550. [PMID: 35623865 PMCID: PMC8915452 DOI: 10.1016/j.clnesp.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
Background & aims COVID-19 is a hypercatabolic disease with possible pulmonary and gastrointestinal symptoms, and consequent deterioration of the nutritional status and the worst clinical prognosis. This study presents a protocol to guide the nutritional care of adult and elderly people non-critically and critically ill with COVID-19. Methods A critical review of the literature was carried out in the databases PubMed, Scielo, Bireme, and Science Direct, in search of articles and guidelines that presented assessment criteria and nutritional conduct for COVID-19 and Severe Acute Respiratory Syndrome (SARS), as well as guidelines for managing the symptoms presented by patients. Results The results are recommendations based on the literature and the professional experience of nutritionists who provide nutritional assistance to individuals hospitalized with COVID-19 since the beginning of the pandemic in Brazil. We present tools and suggestions for assessing the nutritional status, calculating nutritional needs, initiating nutritional therapy and monitoring tolerance to it, nutritional monitoring during hospitalization, and guidelines for hospital discharge. Conclusion Patients with COVID-19 are at nutritional risk. A complete nutritional assessment (anthropometric, dietary, and laboratory assessment) enables the establishment of an individualized nutritional approach in order to contribute to better clinical and nutritional prognoses.
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Affiliation(s)
| | | | | | | | | | - Marcilene Tomaz
- Santa Casa de Misericórdia de Juiz de Fora, Minas Gerais, Brazil
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26
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Ahmadi S, Firoozi D, Dehghani M, Zare M, Mehrabi Z, Ghaseminasab-Parizi M, Masoumi SJ. Evaluation of Nutritional Status of Intensive Care Unit COVID-19 Patients Based on the Nutritional Risk Screening 2002 Score. Int J Clin Pract 2022; 2022:2448161. [PMID: 36320896 PMCID: PMC9592191 DOI: 10.1155/2022/2448161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patients with COVID-19 are susceptible to malnutrition, which is particularly concerning among critically ill patients. We evaluated the Nutritional Risk Screening 2002 (NRS-2002) score in such patients and determined its relationship with the hospitalization outcome. METHODS This cross-sectional study involved COVID-19 patients admitted to the intensive care units (ICUs) of Shahid Faghihi Hospital, Shiraz, Iran, between February and March 2021. We assessed the nutritional status using NRS-2002 and determined disease severity with the APACHE II index. Demographic information, weight, height, clinical signs, previous illness, medications, biochemical test results, and history of anorexia and weight loss were recorded. Data were analyzed using SPSS version 18. RESULTS The mean age of 100 patients was 55.36 ± 18.86 years. According to NRS-2002, 30%, 29%, and 41% of patients were at low risk, moderate risk, and high risk of malnutrition, respectively. Age and BUN increased significantly with NRS-2002, while albumin and hematocrit followed the opposite trend (P < 0.001). Patients who died had lower albumin and hematocrit levels but higher age, NRS-2002 scores, and BUN/creatinine levels than those who recovered. Multivariable logistic regression revealed that for every unit increase in the NRS-2002 score, the odds of mortality increased by 354% (OR: 4.54, CI: 1.48, 13.95, P=0.008). CONCLUSION NRS-2002 is a valuable prognostic tool for critically ill COVID-19 patients, with each unit's rise in the score being associated with a 354% rise in the odds of mortality. Increased malnutrition risk was linked with higher age and BUN and lower albumin and hematocrit levels.
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Affiliation(s)
- Sedigheh Ahmadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Donya Firoozi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Dehghani
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Zare
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zeinab Mehrabi
- Department of Internal Disaease, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Ghaseminasab-Parizi
- Department of Health Education and Health Promotion, School of Health, Occupational Environment Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Seyed Jalil Masoumi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Center for Cohort Study of SUMS Employees' Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Use of mNUTRIC-Score for Nutrition Risk Assessment and Prognosis Prediction in Critically Ill Patients with COVID-19: A Retrospective Observational Study. Crit Care Res Pract 2021; 2021:5866468. [PMID: 34956677 PMCID: PMC8694949 DOI: 10.1155/2021/5866468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/05/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nutritional assessment in the critically ill population are scarce. This study was conducted to evaluate the modified Nutrition Risk in the Critically Ill (mNUTRIC)-Score as a mortality risk factor in mechanically ventilated patients with COVID-19. Methods We conducted this retrospective observational study in critically ill patients with COVID-19. Patients' characteristics and clinical information were obtained from electronic medical records. The nutritional risk for each patient was assessed at the time of mechanical ventilation using the mNUTRIC-Score. The major outcome was 28-day mortality. Results Ninety-eight patients were analyzed (mean age, 57.22 ± 13.66 years, 68.4% male); 46.9% of critically ill COVID-19 patients were categorized as being at high nutrition risk (mNUTRIC-Score of ≥5). A multivariate logistic regression model indicated that high nutritional risk has higher 28-day hospital mortality (OR = 4.206, 95% CI: 1.147-15.425, p=0.030). A multivariate Cox regression analysis showed that high-risk mNUTRIC-Score had a significantly increased full-length mortality risk during hospitalization (OR = 1.991, 95% CI: 1.219-3.252, p=0.006). Conclusion The mNUTRIC-Score is an independent mortality risk factor during hospitalization in critically ill COVID-19 patients.
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28
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[Nutrition therapy in critically ill patients with SARS-CoV-2: where to focus now?]. NUTR HOSP 2021; 38:1117-1118. [PMID: 34743524 DOI: 10.20960/nh.03941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction
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29
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Alikiaii B, Heidari Z, Fazeli A, Rahimi Varposhti M, Moradi Farsani D, Fattahpour S, Rafiee S, Bagherniya M. Evaluation of the effectiveness of the Nutritional Risk Screening System 2002 (NRS-2002) in COVID-19 patients admitted to the intensive care unit. Int J Clin Pract 2021; 75:e14934. [PMID: 34606153 PMCID: PMC8646661 DOI: 10.1111/ijcp.14934] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/21/2021] [Accepted: 10/01/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nutritional status of patients with COVID-19 can affect the recovery process of patients; however, no nutritional scale was introduced to evaluate the nutritional status of the patients. Thus, the main objective of this study was to examine the usefulness of Nutritional status-2002 (NRS-2002) among COVID-19 patients admitted to the intensive care unit (ICU). MATERIAL AND METHODS In this cross-sectional study, 73 patients with definitive corona diagnosis admitted to the ICUs of Al-Zahra hospital, Isfahan, Iran in October 2020 to January 2021 were recruited. Dietary intake, NRS-2002, demographic, anthropometric and biochemical indices of patients were recorded. RESULTS The majority of patients were at risk for moderate (69.9%) to severe (12.3%) malnutrition. Daily calorie intake (P = .001) and albumin (P = .001) levels in deceased patients were significantly lower than the recovered group. A direct correlation between NRS-2002 and age (P < .001) and an inverse correlation with daily calorie intake (P = .002), albumin (P = .05) and PaO2 (P = .034) was found. Moreover, there is a strong correlation between NRS-2002 score and chance of death among COVID-19 patients (OR=34.5, 95%CI:(5.2 - 228.93), P-value<0.001). Likewise, the levels of bilirubin direct (OR=8, 95%CI:(1.30 - 49.38), P-value=0.025) and creatine-phosphokinase (OR=0.9, 95%CI:(0.99 - 1.00), P-value=0.035) have a significant direct association with chance of death. CONCLUSION Results showed patients with COVID-19 admitted to the ICU did not have appropriate nutritional status and mortality was higher among patients with lower amounts of the serum albumin and daily calorie intakes. Furthermore, there is a strong association between the NRS-2002 index and the chance of mortality in these patients.
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Affiliation(s)
- Babak Alikiaii
- Anesthesia and Critical Care Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Zahra Heidari
- Department of Biostatistics and EpidemiologySchool of HealthIsfahan University of Medical SciencesIsfahanIran
- Isfahan Cardiac Rehabilitation Research CenterCardiovascular Research InstituteIsfahan University of Medical SciencesIsfahanIran
| | - Afshar Fazeli
- Anesthesia and Critical Care Research CenterIsfahan University of Medical SciencesIsfahanIran
| | | | - Darioush Moradi Farsani
- Anesthesia and Critical Care Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Shirin Fattahpour
- Craniofacial and Cleft Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Sahar Rafiee
- Food Security Research CenterIsfahan University of Medical SciencesIsfahanIran
- Department of Community NutritionSchool of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | - Mohammad Bagherniya
- Anesthesia and Critical Care Research CenterIsfahan University of Medical SciencesIsfahanIran
- Food Security Research CenterIsfahan University of Medical SciencesIsfahanIran
- Department of Community NutritionSchool of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
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Malnutrition and nutrition support in COVID-19: The results of a nutrition support protocol. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2021; 68:621-627. [PMID: 34906342 PMCID: PMC8665355 DOI: 10.1016/j.endien.2021.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
Abstract
Introduction COVID-19 is characterized by various clinical manifestations, mainly respiratory involvement. Disease-related malnutrition is associated with impaired respiratory function and increased all-cause morbidity and mortality. Patients with COVID-19 infection carry a high nutritional risk. After designing a specific nutritional support protocol for this disease, we carried out a retrospective study on malnutrition and on the use of nutritional support in patients with COVID-19. Methods We performed a retrospective study to determine whether nutritional support positively affected hospital stay, clinical complications, and mortality in patients with COVID-19. We compared the results with those of standard nutritional management. Our secondary objectives were to determine the prevalence of malnutrition in patients with COVID-19 and the value of nutritional support in the hospital where the study was performed. Results At least 60% of patients with COVID-19 experience malnutrition (up to 78.66% presented at least 1 of the parameters studied). The specialized nutritional support protocol was indicated in only 21 patients (28%) and was started early in only 12 patients (16%). Hospital stay was significantly shorter in patients managed with the early protocol (5.09 days, 95% CI, 1.338–8.853, p < 0.01). Similarly, in this group, respiratory distress was less severe and less frequent (41% vs 82.5%, p < 0.007), and statistically significantly fewer complications were recorded (9/12 vs 91/63; p < 0.001). Conclusions COVID-19 is associated with high rates of disease-related malnutrition. Early implementation of a specialized nutritional support plan can improve the prognosis of these patients by reducing hospital stay, the possibility of more severe respiratory distress, and complications in general.
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Riesgo H, Castro A, Del Amo S, San Ceferino MJ, Izaola O, Primo D, Gómez Hoyos E, López Gómez JJ, de Luis DA. Prevalence of Risk of Malnutrition and Risk of Sarcopenia in a Reference Hospital for COVID-19: Relationship with Mortality. ANNALS OF NUTRITION AND METABOLISM 2021; 77:324-329. [PMID: 34673644 DOI: 10.1159/000519485] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Many elderly patients with COVID-19 are at risk of malnutrition. The aim of our study was to evaluate the risk of malnutrition and sarcopenia in elderly COVID-19 patients with the R-MAPP (Remote-Malnutrition APP). MATERIALS AND METHODS A cross-sectional study of 337 consecutive outpatients ≥65 years who attended the Central Emergency COVID-19 Hospital of Castilla y Leon was conducted. In all patients, the protocol of R-MAPP (Malnutrition Universal Screening Tool [MUST] and Simple Questionnaire to Rapidly Diagnose Sarcopenia [SARC-F]) was realized. RESULTS The mean age was 86.1 ± 8.7 years, with a sex distribution of 167 males (49.5%) and 170 females (51.5%). According to the MUST test, patients with 0 points have a low nutritional risk (n = 50, 14.8%), 1 point a medium nutritional risk (n = 19, 5.6%), and 2 or more points a high nutritional risk (n = 268, 79.6%). The SARC-F questionnaire generates patients with 4 or more points as predictive of sarcopenia (n = 304, 80.2%) and <4 points without prediction of sarcopenia (n = 33, 9.8%). Global mortality was 24.03% (n = 81). The mortality rate was related to the pathological SARC-F score ≥4 (27.1% vs. 3.1%; p = 0.01) and MUST score ≥2 (26.7% vs. 16.4%; p = 0.04). In the logistic regression analysis, only the SARC-F score ≥4 remained as an independent variable related to mortality; odds ratio was 8.34 (95% CI: 1.1-63.8; p = 0.04), adjusted for age, sex, albumin levels, and MUST test. CONCLUSIONS During COVID-19 infection, hospitalized patients at risk of sarcopenia have a high risk of mortality and have a poor nutritional status.
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Affiliation(s)
- Henar Riesgo
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - Angeles Castro
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - Sofía Del Amo
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - Maria Jesus San Ceferino
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - Olatz Izaola
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - David Primo
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - Emilia Gómez Hoyos
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - Juan Jose López Gómez
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - Daniel A de Luis
- Center of Investigation of Endocrinology and Nutrition, Medicine School, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
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Mancin S, Bertone A, Cattani D, Morenghi E, Passadori L, Donizzetti D, Sökeland F, Azzolini E, Mazzoleni B. Malnutrition risk as a negative prognostic factor in COVID-19 patients. Clin Nutr ESPEN 2021; 45:369-373. [PMID: 34620342 PMCID: PMC8327593 DOI: 10.1016/j.clnesp.2021.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND/OBJECTIVE SARS CoV-2 infection is a disease, whose prevalence has drastically risen in the past year. The aim of this study is to examine a possible association between the risk of malnutrition, clinical outcomes following hospitalisation and morbidity at discharge. METHODS This study has analysed the medical records of 652 patients hospitalised at Humanitas Research Hospital (Milan, Italy) between 01/03 and 30/04/2020. The risk of malnutrition was identified with the Malnutrition Universal Screening Tool (MUST). RESULTS The cohort was composed of 515 patients. The MUST scale is significantly associated to malnutrition evaluating the morbidity at discharge (discharged 0.27 ± 0.68, discharged with problems 0.40 ± 0.93, deceased 0.64 ± 0.93, p < 0.001), and the clinical outcome following hospitalisation (HR 1.25, 95% CI 1.04-1.51, p = 0.019) is maintained even after correction for age, treated hypertension, admission to an intensive care unit and oxygen therapy). A subgroup analysis addressing patients with a BMI ≥30 shows a significant association between comorbidities such as: arterial hypertension (HR 4.95, 95% CI 1.10-22.22, p = 0.037), diabetes (HR 3.37, 95% CI 1.04-10.89, p = 0.043) and renal failure (HR 3.94, 95% CI 1.36-11.36, p = 0.011). CONCLUSIONS The results of this study suggest that the risk of malnutrition is a noteworthy indicator that impacts both the clinical outcomes and morbidity at discharge.
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Affiliation(s)
- Stefano Mancin
- IRCCS Humanitas Research Hospital Rozzano, Milan, Italy.
| | | | | | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital Rozzano, Milan, Italy; Humanitas University Pieve Emanuele, Milan, Italy
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Mozota M, Castro I, Gómez-Torres N, Arroyo R, Lailla Y, Somada M, Alba C, Rodríguez JM. Administration of Ligilactobacillus salivarius MP101 in an Elderly Nursing Home during the COVID-19 Pandemic: Immunological and Nutritional Impact. Foods 2021; 10:2149. [PMID: 34574259 PMCID: PMC8470390 DOI: 10.3390/foods10092149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/05/2021] [Accepted: 09/09/2021] [Indexed: 12/26/2022] Open
Abstract
The elderly population living in nursing homes is particularly vulnerable to COVID-19 although individual susceptibility to SARS-CoV-2 infection may be related to the host microbiota. The objective of this work was to investigate the effect of Ligilactobacillus salivarius MP101 on the functional (Barthel index), cognitive (GDS/FAST), and nutritional (MNA) status as well as on the nasal and fecal inflammatory profiles of elderly residents living in a nursing home that is highly affected by COVID-19. A total of 25 residents participated in the trial, which involved the daily ingestion of a dairy product (L. salivarius MP101: 9.3 log10 CFU per unit) for 4 months. Nasal and fecal samples were analyzed for 37 immune factors at recruitment and at the end of the study. After the trial, no change in the GDS/FAST scores were found but, in contrast, the values for the Barthel index and the MNA score improved significantly. The concentrations of some immune factors changed significantly after the trial, including a decrease in the concentrations of BAFF/TNFSF13B, APRIL/TNFSF13, IL8, IL31, osteopontin, sTNF-R1, and sTNF-R2, and an increase in chitinase 3-like 1, IL19, IL35, and pentraxin 3 was also observed. In conclusion, L. salivarius MP101 seems to be a promising strain for improving or maintaining health in this highly vulnerable population.
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Affiliation(s)
- Marta Mozota
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain; (M.M.); (I.C.); (N.G.-T.); (R.A.); (C.A.)
| | - Irma Castro
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain; (M.M.); (I.C.); (N.G.-T.); (R.A.); (C.A.)
| | - Natalia Gómez-Torres
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain; (M.M.); (I.C.); (N.G.-T.); (R.A.); (C.A.)
| | - Rebeca Arroyo
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain; (M.M.); (I.C.); (N.G.-T.); (R.A.); (C.A.)
| | - Yolanda Lailla
- Villa Villera, 22142 Sieso de Huesca, Spain; (Y.L.); (M.S.)
| | - Mario Somada
- Villa Villera, 22142 Sieso de Huesca, Spain; (Y.L.); (M.S.)
| | - Claudio Alba
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain; (M.M.); (I.C.); (N.G.-T.); (R.A.); (C.A.)
| | - Juan Miguel Rodríguez
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain; (M.M.); (I.C.); (N.G.-T.); (R.A.); (C.A.)
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Nutrition risk prevalence and nutrition care recommendations for hospitalized and critically-ill patients with COVID-19. Clin Nutr ESPEN 2021; 44:38-49. [PMID: 34330494 PMCID: PMC8184874 DOI: 10.1016/j.clnesp.2021.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 12/12/2022]
Abstract
Nutritional status is an often-overlooked component in infectious disease severity. Hospitalized or critically ill patients are at higher risk of malnutrition, and rapid assessment and treatment of poor nutritional status can impact clinical outcomes. As it relates to the COVID-19 pandemic, an estimated 5% of these patients require admission to an ICU. Per clinical practice guidelines, nutrition therapy should be a core component of treatment regimens. On account of the urgent need for information relating to the nutritional support of these patients, clinical practice guidance was published based on current critical care guidelines. However, a growing body of literature is now available that may provide further direction for the nutritional status and support in COVID-19 patients. This review, intended for the health care community, provides a heretofore lacking in-depth discussion and summary of the current data on nutrition risk and assessment and clinical practice guidelines for medical nutrition therapy for hospitalized and critically ill patients with COVID-19.
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Abate SM, Chekole YA, Estifanos MB, Abate KH, Kabthymer RH. Prevalence and outcomes of malnutrition among hospitalized COVID-19 patients: A systematic review and meta-analysis. Clin Nutr ESPEN 2021; 43:174-183. [PMID: 34024511 PMCID: PMC7968150 DOI: 10.1016/j.clnesp.2021.03.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Malnutrition is inevitable in patients with Coronavirus Disease 2019 (COVID-19) due to its effect on the gastrointestinal system, immune system, and high metabolic activity. However, the prevalence of malnutrition and its outcomes is uncertain. This study aimed to investigate the prevalence and outcome of malnutrition among patients with COVID-19. METHOD A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019 to September, 2020 without language restriction. All observational studies reporting the prevalence of malnutrition were included while case reports and reviews were excluded. The data were extracted with two independent authors with a customized format and the disagreements were resolved by the other authors. The methodological quality of included studies was evaluated using a standardized critical appraisal tool. RESULTS A total of 511 articles were identified from different databases and 27 articles were selected for evaluation after the successive screening. Fourteen articles with 4187 participants were included. The pooled prevalence of malnutrition among hospitalized patients with COVID-19 was 49.11% (95% CI: 31.67 to 66.54). The odd of mortality among patients COVID-19 with malnutrition was 10 times more likely as compared to those who were well-nourished. CONCLUSION The prevalence of malnutrition and mortality associated with malnutrition among COVID-19 hospitalized patients was very high which entails a mitigating strategy by different stakeholders to prevent and manage malnutrition and its outcomes. REGISTRATION This systematic review was registered in Prospero's international prospective register of systematic reviews (CRD42020215396).
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Affiliation(s)
- Semagn Mekonnen Abate
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Ethiopia.
| | - Yigrem Ali Chekole
- Department of Psychiatry, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Mahlet Birhane Estifanos
- Department of Nutrition, School of Public Health, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Kalkidan Hassen Abate
- Department of Nutrition and Dietetics, College of Public Health and Medical Sciences, Jimma University, Ethiopia
| | - Robel Hussen Kabthymer
- Department of Nutrition, School of Public Health, College of Health Sciences and Medicine, Dilla University, Ethiopia
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Ali AM, Kunugi H. Screening for Sarcopenia (Physical Frailty) in the COVID-19 Era. Int J Endocrinol 2021; 2021:5563960. [PMID: 34113379 PMCID: PMC8152925 DOI: 10.1155/2021/5563960] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/22/2021] [Accepted: 04/30/2021] [Indexed: 01/08/2023] Open
Abstract
Although the numbers of aged populations have risen considerably in the last few decades, the current coronavirus disease 2019 (COVID-19) has revealed an extensive vulnerability among these populations. Sarcopenia is an age-related disorder that increases hospitalization, dependencies, and mortality in older adults. It starts to develop in midlife or even earlier as a result of unbalanced diet/poor nutrition and low levels of physical activity, in addition to chronic disorders such as obesity and diabetes mellitus. Given that social isolation is adopted as the most protective measure against COVID-19, the level of physical activity and the intake of adequate diet have considerably declined, especially among older adults-denoting an increased possibility for developing sarcopenia. Research also shows a higher vulnerability of sarcopenic people to COVID-19 as well as the development of wasting disorders such as sarcopenia and cachexia in a considerable proportion of symptomatic and recovering COVID-19 patients. Muscular wasting in COVID-19 is associated with poor prognosis. Accordingly, early detection and proper management of sarcopenia and wasting conditions in older adults and COVID-19 patients may minimize morbidity and mortality during the current COVID-19 crisis. This review explored different aspects of screening for sarcopenia, stressing their relevance to the detection of altered muscular structure and performance in patients with COVID-19. Current guidelines recommend prior evaluation of muscle strength by simple measures such as grip strength to identify individuals with proven weakness who then would be screened for muscle mass loss. The latter is best measured by MRI and CT. However, due to the high cost and radiation risk entailed by these techniques, other simpler and cheaper techniques such as DXA and ultrasound are given preference. Muscle loss in COVID-19 patients was measured during the acute phase by CT scanning of the pectoralis muscle simultaneously during a routine check for lung fibrosis, which seems to be an efficient evaluation of sarcopenia among those patients with no additional cost. In recovering patients, muscle strength and physical performance have been evaluated by electromyography and traditional tests such as the six-minute walk test. Effective preventive and therapeutic interventions are necessary in order to prevent muscle loss and associated physical decline in COVID-19 patients.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW This manuscript reviews evidence collected during COVID-19 pandemic and provides information on the impact of body composition on severity and outcomes of the disease, analysing methods used for body composition assessment. Malnutrition-screening tools will also be discussed to screen and diagnose the patients at higher risk of COVID-19 severity and related worse outcomes. RECENT FINDINGS COVID-19 can occur in a wide range of presentation, from asymptomatic to severe forms. Among the major risk factors for worse severity, overnutrition, undernutrition and body composition play a role in the ability to respond to SARS-CoV-2 infection. Excess fat accumulation (i.e. obesity) or lean mass loss and functionality (i.e. sarcopenia) or a combination of both (i.e. sarcopenic obesity) can affect whole-body functioning. These body composition alterations in the short-term can influence susceptibility and immunological responses to the virus, inflammatory reaction, metabolic and respiratory distress, while in the long-term can modulate disease outcomes, namely length of stay, time required for recovery, risk of ICU-acquired weakness and long-term disabilities, and potentially increase the risk of death. SUMMARY Individuals with malnutrition, sarcopenia, obesity, sarcopenic obesity and older adults with abnormal body composition or malnutrition risk may require tailored medical nutrition therapy to improve short and long-term COVID-19 outcomes.
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Affiliation(s)
- Edda Cava
- Unit of Dietetic and Clinical Nutrition, University Hospital "Maggiore della Carità", Novara, Italy
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States of America; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
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Rothenberg E. Coronavirus Disease 19 from the Perspective of Ageing with Focus on Nutritional Status and Nutrition Management-A Narrative Review. Nutrients 2021; 13:nu13041294. [PMID: 33919840 PMCID: PMC8070771 DOI: 10.3390/nu13041294] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/04/2021] [Accepted: 04/11/2021] [Indexed: 12/18/2022] Open
Abstract
The novel severe acute respiratory syndrome coronavirus (COVID-19) has hit older adults harder due to a combination of age-related immunological and metabolic alterations. The aim of this review was to analyze the COVID-19 literature with respect to nutritional status and nutrition management in older adults. No studies only on people aged 65+ years were found, and documentation on those 80+ was rare. Age was found to be strongly associated with worse outcomes, and with poor nutritional status. Prevalence of malnutrition was high among severely and critically ill patients. The studies found a need for nutrition screening and management, and for nutrition support as part of follow-up after a hospital stay. Most tested screening tools showed high sensitivity in identifying nutritional risk, but none were recognized as best for screening older adults with COVID-19. For diagnosing malnutrition, the Global Leadership Initiative on Malnutrition (GLIM) criteria are recommended but were not used in the studies found. Documentation of olfactory and gustatory dysfunction in relation to nutritional status is missing in older adults. Other COVID-19-associated factors with a possible impact on nutritional status are poor appetite and gastrointestinal symptoms. Vitamin D is the nutrient that has attracted the most interest. However, evidence for supplementation of COVID-19 patients is still limited and inconclusive.
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Affiliation(s)
- Elisabet Rothenberg
- Faculty of Health Science, Kristianstad University, 291 88 Kristianstad, Sweden
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Morán-López JM. Malnutrition and nutrition support in COVID-19: The results of a nutrition support protocol. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00083-5. [PMID: 33858814 PMCID: PMC8008341 DOI: 10.1016/j.endinu.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/15/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION COVID-19 is characterized by various clinical manifestations, mainly respiratory involvement. Disease-related malnutrition is associated with impaired respiratory function and increased all-cause morbidity and mortality. Patients with COVID-19 infection carry a high nutritional risk. After designing a specific nutritional support protocol for this disease, we carried out a retrospective study on malnutrition and on the use of nutritional support in patients with COVID-19. METHODS We performed a retrospective study to determine whether nutritional support positively affected hospital stay, clinical complications, and mortality in patients with COVID-19. We compared the results with those of standard nutritional management. Our secondary objectives were to determine the prevalence of malnutrition in patients with COVID-19 and the value of nutritional support in the hospital where the study was performed. RESULTS At least 60% of patients with COVID-19 experience malnutrition (up to 78.66% presented at least 1 of the parameters studied). The specialized nutritional support protocol was indicated in only 21 patients (28%) and was started early in only 12 patients (16%). Hospital stay was significantly shorter in patients managed with the early protocol (5.09 days, 95% CI, 1.338-8.853, p<0.01). Similarly, in this group, respiratory distress was less severe and less frequent (41% vs 82.5%, p<0.007), and statistically significantly fewer complications were recorded (9/12 vs 91/63; p<0.001). CONCLUSIONS COVID-19 is associated with high rates of disease-related malnutrition. Early implementation of a specialized nutritional support plan can improve the prognosis of these patients by reducing hospital stay, the possibility of more severe respiratory distress, and complications in general.
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Affiliation(s)
- Jesús Manuel Morán-López
- Endocrinology and Nutrition, Hospital Virgen del Puerto (Plasencia), Sociedad Extemeña de Diabetes, Endocrinología y Nutrición, Spain.
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Łukaszyk E, Bień-Barkowska K, Bień B. Identification of Mortality Risks in the Advancement of Old Age: Application of Proportional Hazard Models Based on the Stepwise Variable Selection and the Bayesian Model Averaging Approach. Nutrients 2021; 13:nu13041098. [PMID: 33801694 PMCID: PMC8066062 DOI: 10.3390/nu13041098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023] Open
Abstract
Identifying factors that affect mortality requires a robust statistical approach. This study’s objective is to assess an optimal set of variables that are independently associated with the mortality risk of 433 older comorbid adults that have been discharged from the geriatric ward. We used both the stepwise backward variable selection and the iterative Bayesian model averaging (BMA) approaches to the Cox proportional hazards models. Potential predictors of the mortality rate were based on a broad range of clinical data; functional and laboratory tests, including geriatric nutritional risk index (GNRI); lymphocyte count; vitamin D, and the age-weighted Charlson comorbidity index. The results of the multivariable analysis identified seven explanatory variables that are independently associated with the length of survival. The mortality rate was higher in males than in females; it increased with the comorbidity level and C-reactive proteins plasma level but was negatively affected by a person’s mobility, GNRI and lymphocyte count, as well as the vitamin D plasma level.
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Affiliation(s)
- Ewelina Łukaszyk
- Department of Geriatrics, Medical University of Bialystok, Fabryczna 27, 15-471 Bialystok, Poland;
- Geriatric Ward, Hospital of the Ministry of the Interior and Administration in Bialystok, 15-471 Białystok, Poland
- Correspondence: ; Tel.: +48-47-710-40-23
| | - Katarzyna Bień-Barkowska
- Institute of Econometrics, Warsaw School of Economics, Madalińskiego 6/8, 02-513 Warsaw, Poland;
| | - Barbara Bień
- Department of Geriatrics, Medical University of Bialystok, Fabryczna 27, 15-471 Bialystok, Poland;
- Geriatric Ward, Hospital of the Ministry of the Interior and Administration in Bialystok, 15-471 Białystok, Poland
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Ali AM, Kunugi H. Approaches to Nutritional Screening in Patients with Coronavirus Disease 2019 (COVID-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2772. [PMID: 33803339 PMCID: PMC7967488 DOI: 10.3390/ijerph18052772] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
Malnutrition is common among severe patients with coronavirus disease 2019 (COVID-19), mainly elderly adults and patients with comorbidities. It is also associated with atypical presentation of the disease. Despite the possible contribution of malnutrition to the acquisition and severity of COVID-19, it is not clear which nutritional screening measures may best diagnose malnutrition in these patients at early stages. This is of crucial importance given the urgency and rapid progression of the disease in vulnerable groups. Accordingly, this review examines the available literature for different nutritional screening approaches implemented among COVID-19 patients, with a special focus on elderly adults. After a literature search, we selected and scrutinized 14 studies assessing malnutrition among COVID-19 patients. The Nutrition Risk Screening 2002 (NRS-2002) has demonstrated superior sensitivity to other traditional screening measures. The controlling nutritional status (CONUT) score, which comprises serum albumin level, cholesterol level, and lymphocytes count, as well as a combined CONUT-lactate dehydrogenase-C-reactive protein score expressed a predictive capacity even superior to that of NRS-2002 (0.81% and 0.92% vs. 0.79%) in midlife and elder COVID-19 patients. Therefore, simple measures based on routinely conducted laboratory investigations such as the CONUT score may be timely, cheap, and valuable alternatives for identifying COVID-19 patients with high nutritional risk. Mini Nutritional Assessment (MNA) was the only measure used to detect residual malnutrition and high malnutrition risk in remitting patients-MNA scores correlated with hypoalbuminemia, hypercytokinemia, and weight loss. Older males with severe inflammation, gastrointestinal symptoms, and pre-existing comorbidities (diabetes, obesity, or hypertension) are more prone to malnutrition and subsequently poor COVID-19 prognosis both during the acute phase and during convalescence. Thus, they are in need of frequent nutritional monitoring and support while detecting and treating malnutrition in the general public might be necessary to increase resilience against COVID-19.
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Affiliation(s)
- Amira Mohammed Ali
- National Center of Neurology and Psychiatry, Department of Mental Disorder Research, National Institute of Neuroscience, Tokyo 187-0031, Japan;
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 21527, Egypt
| | - Hiroshi Kunugi
- National Center of Neurology and Psychiatry, Department of Mental Disorder Research, National Institute of Neuroscience, Tokyo 187-0031, Japan;
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo 173-8605, Japan
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Wirth R, Becker C, Djukic M, Drebenstedt C, Heppner HJ, Jacobs AH, Meisel M, Michels G, Nau R, Pantel J, Bauer JM. [COVID-19 in old age-The geriatric perspective]. Z Gerontol Geriatr 2021; 54:152-160. [PMID: 33595696 PMCID: PMC7887547 DOI: 10.1007/s00391-021-01864-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/02/2021] [Indexed: 01/16/2023]
Abstract
Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons.
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Affiliation(s)
- R Wirth
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland.
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
| | - C Becker
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Deutschland
| | - M Djukic
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Deutschland
- Abteilung für Neuropathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - C Drebenstedt
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Innere Medizin und Geriatrie, St.-Marien-Hospital Friesoythe, Friesoythe, Deutschland
| | - H J Heppner
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie, Helios Klinikum Schwelm, Lehrstuhl für Geriatrie, Universität Witten-Herdecke, Schwelm, Deutschland
| | - A H Jacobs
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Geriatrie mit Neurologie, Johanniter Krankenhaus Bonn, Bonn, Deutschland
- CIO, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
- EIMI, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - M Meisel
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Klinik für Innere Medizin und Geriatrie, Diakonissenkrankenhaus Dessau, Dessau, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH Eschweiler, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - R Nau
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Deutschland
- Abteilung für Neuropathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - J Pantel
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Institut für Allgemeinmedizin, Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - J M Bauer
- Deutsche Gesellschaft für Geriatrie (DGG), Berlin, Deutschland
- Geriatrisches Zentrum und Netzwerk Altersmedizin, Agaplesion Bethanien Krankenhaus Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
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Association of Lower Nutritional Status and Education Level with the Severity of Depression Symptoms in Older Adults-A Cross Sectional Survey. Nutrients 2021; 13:nu13020515. [PMID: 33557348 PMCID: PMC7914802 DOI: 10.3390/nu13020515] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022] Open
Abstract
The study analyzes the relationship between nutritional status and depression symptoms severity in the older population. A total of 1975 older outpatients (1457 women and 518 men, median age 75) were included in the study. Depression symptoms severity was assessed using the Geriatric Depression Scale (GDS). Participants were divided into two subgroups according to GDS score. Group A: 0–5 points—without depression symptoms (1237, W:898, M:339), and group B: 6–15 points—with depression symptoms (738, W:559, M:179). The nutritional status of the patients was assessed with Mini Nutritional Assessment (MNA) and basic anthropometric variables (waist, hips, calf circumferences, body mass index (BMI), waist to hip ratio (WHR), and waist to height ratio (WHtR)). Education years and chronic diseases were also noted. Women with higher depression symptoms severity had significantly lower MNA scores [A: 26.5 (24–28) (median (25%−75% quartiles)) vs. B:23 (20.5–26)], shorter education time [A:12 (8–16) vs. B:7 (7–12)], smaller calf circumference [A:36 (33–38) vs. B: 34 (32–37)], and higher WHtR score [A:57.4 (52.3–62.9) vs. B:58.8 (52.1–65.6)]. Men with depression symptoms had lower MNA scores [A:26.5 (24.5–28) vs. B:24 (20.5–26.5)], shorter education [A:12 (9.5–16), B:10 (7–12)], and smaller calf circumference [A:37 (34–39), B:36 (33–38)]. In the model of stepwise multiple regression including age, years of education, anthropometric variables, MNA and concomitant diseases nutritional assessment, and education years were the only independent variables predicting severity of depression symptoms both in women and men. Additionally, in the female group, odds were higher with higher WHtR. Results obtained in the study indicate a strong relationship between proper nutritional status and education level with depression symptoms severity in older women and men.
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The Aging Bowel Dysfunction and Elderly Vulnerability towards COVID-19 Infection. Life (Basel) 2021; 11:life11020097. [PMID: 33525368 PMCID: PMC7912227 DOI: 10.3390/life11020097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 12/16/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2, primarily a respiratory tract virus, also affects the enteric organs. The most affected sector of the community are the retirement and nursing home elderly residents. Along their life the senescent gastrointestinal functions are deteriorating and failing to fully execute their digestive, absorptive, mucosal barriers, and immune protective duties. Adding the decreased motility, increased intestinal permeability, dysbiosis, morbid chronic disease background, the consumed polypharmacy enteric adverse effects to the presence of the SARS-CoV-2 host receptor along the intestinal tracts put the basis for the current hypothesis. It is hypothesized that the disadvantages and failures of the aging enteric tract contribute to the elderly morbidity and mortality during the current new coronavirus pandemic. In a more optimistic look, several nutraceuticals can prevent or restore the dysfunctional intestinal barrier functions, mainly in the elderly and potentially in those who are SARS-CoV-2 infected.
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Comparison of Nutrition Risk Screening 2002 and Subjective Global Assessment Form as Short Nutrition Assessment Tools in Older Hospitalized Adults. Nutrients 2021; 13:nu13010225. [PMID: 33466724 PMCID: PMC7828813 DOI: 10.3390/nu13010225] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to compare two widely recommended short nutrition assessment tools—Nutrition Risk Screening 2002 (NRS-2002) and Subjective Global Assessment Form (SGA)—with other Comprehensive Geriatric Assessment (CGA) measurements. The study included 622 consecutively hospitalized older subjects, aged 81.7 ± 7.8 years. The criteria to participate were the ability to communicate and given consent. Both NRS-2002 and SGA were inversely related to anthropometric measurements, functional assessment tests, Mini-Mental State Examination (MMSE) and positively associated with the Vulnerable Elders Survey-13 (VES-13) score. Results of SGA and NRS-2002 were not related to sex and 15-item Geriatric Depression Scale (GDS) score. Comparison of well-nourished subjects and patients with suggested problems with nutrition according to NRS-2002 (0–2 vs. 3–7) and SGA (A vs. B + C) gave comparable results. Both nutritional scales at given cut-off points similarly discriminated anthropometric data and other CGA tools in the populations of well-nourished vs. malnourished hospitalized older subjects. In conclusion, we can recommend using both NRS-2002 and SGA to detect malnutrition or risk of malnutrition in a routine clinical practice of the geriatric department ward.
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Affiliation(s)
- Juergen M. Bauer
- Center for Geriatric Medicine and Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - John E. Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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Del Giorno R, Quarenghi M, Stefanelli K, Capelli S, Giagulli A, Quarleri L, Stehrenberger D, Ossola N, Monotti R, Gabutti L. Nutritional Risk Screening and Body Composition in COVID-19 Patients Hospitalized in an Internal Medicine Ward. Int J Gen Med 2020; 13:1643-1651. [PMID: 33380822 PMCID: PMC7767704 DOI: 10.2147/ijgm.s286484] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Malnutrition in patients hospitalized in internal medicine wards is highly prevalent and represents a prognostic factor of worse outcomes. Previous evidence suggested the prognostic role of the nutritional status in patients affected by the coronavirus disease 2019 (COVID-19). We aim to investigate the nutritional risk in patients with COVID-19 hospitalized in an internal medicine ward and their clinical outcomes using the Nutritional Risk Screening 2002 (NRS-2002) and parameters derived from bioelectrical impedance analysis (BIA). METHODS Retrospective analysis of patients with COVID-19 aimed at exploring: 1) the prevalence of nutritional risk with NRS-2002 and BIA; 2) the relationship between NRS-2002, BIA parameters and selected outcomes: length of hospital stay (LOS); death and need of intensive care unit (ICU); prolonged LOS; and loss of appetite. RESULTS Data of 90 patients were analyzed. Patients at nutritional risk were 92% with NRS-2002, with BIA-derived parameters: 88% by phase angle; 86% by body cell mass; 84% by fat-free mass and 84% by fat mass (p-value ≤0.001). In ROC analysis, NRS had the maximum sensitivity in predicting the risk of death and need of ICU and a prolonged hospitalization showing moderate-low specificity; phase angle showed a good predictive power in terms of AUC. NRS-2002 was significantly associated with LOS (β 12.62, SE 5.79). In a multivariate analysis, blood glucose level and the early warning score are independent predictors of death and need of ICU (OR 2.79, p ≤0.001; 1.59, p-0.029, respectively). CONCLUSION Present findings confirm the clinical utility of NRS-2002 to assess nutritional risk in patients with COVID-19 at hospital admission and in predicting LOS, and that bioimpedance does not seem to add further predictive value. An early detection of nutritional risk has to be systematically included in the management of COVID-19 patients hospitalized in internal medicine wards.
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Affiliation(s)
- Rosaria Del Giorno
- Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
| | - Massimo Quarenghi
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Kevyn Stefanelli
- Department of Social Sciences and Economics, Sapienza University of Rome, Rome, Italy
| | - Silvia Capelli
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Antonella Giagulli
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Lara Quarleri
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Daniela Stehrenberger
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Nicola Ossola
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland
| | - Rita Monotti
- Department of Internal Medicine, Ospedale La Carità, Locarno, Switzerland
| | - Luca Gabutti
- Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
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