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Pusswald G, Dapić B, Bum C, Schernhammer E, Stögmann E, Lehrner J. Olfactory identification, cognition, depressive symptoms, and 5-year mortality in patients with subjective cognitive decline, mild cognitive impairment, and Alzheimer's disease. Wien Med Wochenschr 2024; 174:95-106. [PMID: 36917318 PMCID: PMC10959832 DOI: 10.1007/s10354-023-01008-6] [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: 11/11/2022] [Accepted: 02/06/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE An association between odor and cognitive impairment has been shown in many studies. The objective of the present hospital-based, single-center retrospective study was to assess the impact of odor impairment on the mortality of patients with Alzheimer's disease (AD), subjective cognitive decline (SCD), and mild cognitive impairment (MCI). METHODS Odor function was measured by Sniffin Sticks (Burghart Messtechnik, Holm, Germany) and the assessment of self-reported olfactory functioning and olfaction-related quality of life (ASOF) test. Cognitive performance was assessed by an extensive neuropsychological test battery, symptoms of depression were diagnosed with the Geriatric Depressive Scale (GDS). The influence of demographic factors such as gender, age, and education were examined. RESULTS Although the univariate analyses and pairwise post hoc comparison showed significant differences for some of the olfactory performance tests/subtests, the multivariate models showed no association between olfactory test performance and mortality among patients with cognitive impairment. "Attention," a domain of the Neuropsychological Test Battery Vienna (NTBV), as well as depressive symptoms, gender, and age, showed a significant influence on the mortality of the patient group. CONCLUSION Lower olfactory performance showed no impact on mortality. However, decreased cognitive function of "Attention" can be considered as an influential predictor for mortality.
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Affiliation(s)
- Gisela Pusswald
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Blaz Dapić
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Carina Bum
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Eva Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Vienna, Austria.
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Withrow DR, Oke J, Friedemann Smith C, Hobbs R, Nicholson BD. Serious disease risk among patients with unexpected weight loss: a matched cohort of over 70 000 primary care presentations. J Cachexia Sarcopenia Muscle 2022; 13:2661-2668. [PMID: 36056750 PMCID: PMC9745555 DOI: 10.1002/jcsm.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/06/2022] [Accepted: 07/05/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Unexpected weight loss (UWL) in patients consulting in primary care presents dilemmas for management because of the broad differential diagnoses associated with UWL. Research on the risks of serious disease among patients with UWL to date has largely taken place in secondary care, limiting generalizability to primary care patients. In this study, we use a large matched cohort study to estimate the risks of 12 serious diseases among patients presenting to primary care with UWL where this was recorded, stratified by age and sex, in order to inform a rational clinical approach to patients presenting with UWL. METHODS This was a retrospective matched cohort study using electronic health records (EHRs) from the UK Clinical Practice Research Datalink (CPRD). Each patient with UWL (ascertained from EHR coding) was matched to five patients without UWL and followed until the earliest of a diagnosis of the serious disease, date of death, exit from the CPRD database, or end of the study. Observed absolute risks of the 12 serious diseases were estimated as probabilities, and hazard ratios (HRs) were estimated with Cox proportional hazards models. RESULTS Between 2000 and 2012, 70 193 patients in CPRD had at least one record of UWL and were matched with 295 579 patients without UWL. Patients with UWL had significantly higher risk of nearly all serious diseases examined compared with patients without. HRs ranged from 1.43 for congestive heart failure [95% confidence interval (CI): 1.27-1.62] to 9.70 for malabsorption (95% CI: 6.81-13.82). The absolute risks of any given serious disease were relatively low (<6% after 1 year). The magnitude and rank order of absolute risks varied by age and sex. Depression was the most common diagnosis among women aged <80 with UWL (3.74% of women aged <60 and 2.46% of women aged 60-79), whereas diabetes was the most common in men <60 with UWL (2.96%) and cancer was the most common in men aged 60 and over with UWL (3.79% of men aged 60-70 and 5.28% of men aged ≥80). CONCLUSIONS This analysis provides new evidence to patients and clinicians about the risks of serious disease among patients presenting with UWL in primary care. Depending on age and sex, the results suggest that workup for UWL should include screening for diabetes, thyroid dysfunction, depression, and dementia. If performed in a timely manner, this workup could be used to triage patients eligible for cancer pathway referral.
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Affiliation(s)
- Diana R Withrow
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Claire Friedemann Smith
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
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Aligué J, Vicente M, Arnau A, Trapé J, Martínez E, Bonet M, Abril A, El Boutrouki O, Ordeig R, Ruiz D, Ordeig J, San José A. Etiologies and 12-month mortality in patients with isolated involuntary weight loss at a rapid diagnostic unit. PLoS One 2021; 16:e0257752. [PMID: 34555091 PMCID: PMC8459999 DOI: 10.1371/journal.pone.0257752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background Numerous studies on involuntary weight loss (IWL) have been published since the 1980s, although most of them have included small samples of patients with specific symptoms. The aim of the present study was to determine the causes, demographic and clinical characteristics and mortality at 12 months in patients attended at a rapid diagnostic unit (RDU) for isolated IWL. Methods A single-center retrospective observational study including all patients presenting to the RDU for isolated IWL between 2005 and 2013. The following data were recorded: demographic and clinical variables, results of complementary tests (blood tests, x-rays, computed tomography scan and digestive endoscopy), main diagnosis and vital status at 12 months. Results Seven hundred and ninety-one patients met the criteria for IWL. Mean age was 67.9 years (SD 4.7), 50.4% were male and mean weight loss was 8.3 kg (SD 4.7). The cause for IWL was malignant disease in 23.6% of patients, non-malignant organic disease in 44.5%, psychiatric disorder in 29.0% and unknown in 3.2%. Overall mortality at 12 months was 18.6% (95%CI: 16.1–21.6). The mortality rate was highest in the group with malignancy (61.1%; 95%CI: 54.2–68.2). Conclusions Almost a quarter of all patients attended at the RDU for IWL were diagnosed with cancer. Mortality at 12 months was higher in this group than in the other three. Malignancy should therefore be ruled out during the first visit for patients attended for IWL.
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Affiliation(s)
- Jordi Aligué
- Central Catalonia Chronicity Research Group (C3RG), Internal Medicine Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
- Faculty of Medicine, University of Vic—Central University of Catalonia (UVIC-UCC), Vic, Spain
- * E-mail:
| | - Mireia Vicente
- Primary Care, Institut Català de la Salut, Barcelona, Spain
| | - Anna Arnau
- Central Catalonia Chronicity Research Group (C3RG), Clinical Research Unit. Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Jaume Trapé
- Faculty of Medicine, University of Vic—Central University of Catalonia (UVIC-UCC), Vic, Spain
- Department of Laboratory Medicine, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Eva Martínez
- Internal Medicine Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Mariona Bonet
- Internal Medicine Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Andrés Abril
- Primary Care, Institut Català de la Salut, Barcelona, Spain
| | - Omar El Boutrouki
- Internal Medicine Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Roser Ordeig
- Primary Care, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Domingo Ruiz
- Faculty of Medicine, University of Vic—Central University of Catalonia (UVIC-UCC), Vic, Spain
- Internal Medicine Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Josep Ordeig
- Internal Medicine Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Antonio San José
- Internal Medicine Service, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Unintentional Weight Loss as a Marker of Malignancy Across Body Weight Categories. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Diagnosing undernutrition children and adults: new French criteria. Why, for what and for whom? A joint statement of the French National Authority for Health and French Federation of Nutrition. Br J Nutr 2021; 127:739-751. [PMID: 33958009 DOI: 10.1017/s0007114521001471] [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: 11/06/2022]
Abstract
The objective was to establish new diagnostic criteria for undernutrition for the French population, concordant for children aged <18 years and adults aged <70 years, easy to use by health professionals and applicable whatever the situation (in and outpatients). A multi-disciplinary working and a reading group were involved. The procedure was divided into four phases: (1) systematic review and synthesis of the literature; (2) writing of the initial version of the guidelines; (3) reading and (4) finalisation. The literature search included international guidelines, meta-analyses, systematic reviews and randomised control trials from January 2007 to 31 July 2018. A two-step approach was selected: diagnosing undernutrition and then grading its severity. For diagnosis at least one phenotypic criterion associated with at least one aetiologic criterion were required for both children and adults. Phenotypic criteria for children were weight loss, Body Mass Index (BMI) < International Obesity Task Force curve 18·5, weight stagnation, reduction of muscle mass/function; for adults: weight loss, BMI < 18·5 and reduction of muscle mass/function. Aetiological criteria for children and adults were reduction in dietary intake, reduced absorption and hypercatabolism. Phenotypic metrics were used in both children and adults for grading severity (moderate or severe). These new French recommendations integrate the proposals of recent international recommendations combining aetiologic with phenotypic criteria, but for the first time, they are concordant for children and adults. The WHO threshold of 18·5 for BMI was kept as phenotypic criteria because epidemiological data show an increased mortality for that threshold.
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Unintentional weight loss: what radiologists need to know and what clinicians want to know. Abdom Radiol (NY) 2021; 46:2236-2250. [PMID: 33386448 DOI: 10.1007/s00261-020-02908-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Unintentional weight loss (UWL) is a common presenting symptom with a wide differential diagnosis. Causes may be organic (e.g., malignancy or gastrointestinal disease) or inorganic (e.g., psychosocial). The purpose of this review is to provide a guide for radiologists and other clinicians to understand the imaging modalities and laboratory studies involved in the diagnosis and treatment of UWL and the evidence supporting their routine use. Cases illustrating both common and uncommon causes of UWL are presented to emphasize both the breadth of pathology that may cause UWL as well as the importance of a multi-modality diagnostic approach. Imaging studies are crucial in the diagnosis of unintentional weight loss, particularly with regard to evaluating for the presence of malignancy. It is important for both the radiologist and other clinicians to understand the relative prevalence of the various causes of UWL and the utility of different imaging modalities in diagnosis and management.
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Hue JJ, Sugumar K, Kyasaram RK, Shanahan J, Lyons J, Ocuin LM, Rothermel LD, Hardacre JM, Ammori JB, Rao G, Winter JM, Markt SC. Weight Loss as an Untapped Early Detection Marker in Pancreatic and Periampullary Cancer. Ann Surg Oncol 2021; 28:6283-6292. [PMID: 33835301 DOI: 10.1245/s10434-021-09861-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) has the worst survival of common cancers, partly because there are no reliable early detection tests. Unintentional weight loss (≥ 5% decrease from baseline) has been linked to PDAC, but the frequency and severity of weight loss using objective measures, and its relationship to prognosis, have not been well characterized. METHODS We identified 390 patients with PDAC (all stages) and two or more prediagnosis weights in the electronic medical record. Percentage weight loss in the 365 and 180 days preceding diagnosis was calculated. Results were compared with raw weights of age- and sex-matched non-cancer controls (n = 780). Odds ratios for PDAC were calculated using conditional logistic regression. Cox proportional hazards models were used for survival. RESULTS Within 1 year of diagnosis, more PDAC patients lost ≥ 5% weight relative to controls (74.9% vs. 11.2%; p < 0.001), with a median weight loss of 14.2 versus 2.9 lbs. The odds ratio for PDAC comparing weight loss within 1 year of 5 to < 10% was 10.30 (p < 0.001) and 77.82 for ≥ 10% (p < 0.001), compared with stable weight. Weight loss prior to diagnosis was also associated with early-stage PDAC. PDAC cases with ≥ 10% prediagnosis weight loss had worse survival compared with stable weights (hazard ratio [HR] 1.60; p = 0.01). Greater prediagnosis weight loss was associated with poor survival after pancreatectomy (5 to < 10% vs. < 5%, HR 2.40, p = 0.03; ≥ 10% vs. < 5%, HR 2.59, p = 0.03). CONCLUSIONS Diagnosis of PDAC is preceded by unintentional weight loss in the majority of patients, even at an early stage. Greater prediagnosis weight loss severity is also associated with poor postoperative survival.
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Affiliation(s)
- Jonathan J Hue
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Kavin Sugumar
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ravi K Kyasaram
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John Shanahan
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Joshua Lyons
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lee M Ocuin
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Atrium Health, Charlotte, NC, USA
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffrey M Hardacre
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John B Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Goutham Rao
- Department of Family Medicine, University Hospitals, Cleveland, OH, USA
| | - Jordan M Winter
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah C Markt
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Diagnostic utility of computed tomography in patients presenting to the emergency department with unintended weight loss. Emerg Radiol 2021; 28:771-779. [PMID: 33638740 DOI: 10.1007/s10140-021-01920-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Unintended weight loss (UWL) is a common presenting symptom in the emergency department (ED) with several etiologies. Our study looks to evaluate the diagnostic utility of computed tomography (CT) in the evaluation of UWL in the ED. METHODS We identified all patients who underwent CT of the chest, abdomen, or pelvis in the ED at our institution for the diagnosis of UWL from 2004 to 2020 and retrospectively reviewed their clinical history and imaging. CT findings were organized into 4 types: (1) definite cause for UWL identified, (2) possible findings for UWL, (3) incidental findings unrelated to UWL, and (4) normal scan. Associations between clinical and laboratory findings with positive CT scans were also examined. RESULTS One hundred seventy-three eligible patients were identified; 40 patients were excluded due to history of malignancy or inadequate follow-up. One hundred thirty-three patients were included in the final cohort. Overall, the most common causes of UWL were non-malignant gastrointestinal (GI) conditions (n = 41, 30%) and cancer (n = 30, 23%). True-positive CT findings were identified in 48.8% of patients (65/133). Elevated white blood cell counts (p = <0.0001) and physical exam abnormalities (p = 0.02) were both significantly associated with CT abnormalities. CONCLUSION The use of CT scanning in the evaluation of UWL in the ED yielded a diagnosis in approximately half of all cases, indicating good diagnostic value. The most common causes of UWL were non-malignant GI conditions and cancer in this cohort.
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Abstract
Unintentional weight loss is a common clinical problem with a broad differential diagnosis that is clinically important because of the associated risks of morbidity and mortality. Community-dwelling adults are often diagnosed with malignancy, nonmalignant gastrointestinal disorders, and psychiatric disorders as the cause of unintentional weight loss, whereas institutionalized older adults are diagnosed most often with psychiatric disorders. Up to a quarter of patients do not have a diagnosis after comprehensive workup, and close follow-up is warranted. Treatment involves management of underlying causes.
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Affiliation(s)
- Liyanage Ashanthi Menaka Perera
- Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, 1000 First Drive NW, Austin, Minnesota, 55912, USA
| | - Aparna Chopra
- Institute for Critical Care Medicine, The Mount Sinai Hospital, 1468 Madison Avenue, Guggenheim Pavilion 6 East, Room 378, New York, New York, USA
| | - Amy L Shaw
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68th Street, Box 39, New York, NY 10065, USA.
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Cancer, Cardiovascular Disease, and Body Weight: a Complex Relationship. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00660-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hue JJ, Markt SC, Rao G, Winter JM. Patient-centered Weight Tracking as an Early Cancer Detection Strategy. J Cancer Prev 2020; 25:181-188. [PMID: 33033712 PMCID: PMC7523038 DOI: 10.15430/jcp.2020.25.3.181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 01/05/2023] Open
Abstract
Early detection is a valued strategy to decrease cancer mortality rates; however, new strategies are needed. Unintentional weight loss (UWL) is experienced by patients across the cancer spectrum, but often goes unnoticed. Patient-centered weight tracking may be a useful early detection marker. Fifty patients were enrolled in a prospective patient-centered weight tracking trial. Patients received a scale and monetary compensation to participate. A reminder to measure and record weight was texted to participants for 26 consecutive weeks. Most patients were black (86.0%) and female (68.0%). The median age was 47 years (range: 22-84 years). Many participants had Medicaid (42.0%) and the median household income by home zip code was $31,046. After 26 weeks, 90% of patients had recorded at least one weight. Among all patients, 73.7% of all possible weights were recorded and the median response rate per patient was 92.3% (24 of 26 weights). There was no difference in the response rates during the first and second halves of the study (77.7% vs. 69.7%, P = 0.53). The range of weight change over the study period was 16.1% loss to 25.0% gain, with 56% of patients maintaining stable weight. Seven patients (14.0%) lost more than 5% weight and 11 patients (22.0%) gained over 5%. Of the seven patients with weight loss, two (4.0% of the cohort) were determined to have UWL. Patient-centered weight tracking is feasible and inexpensive, and has potential as an early detector of UWL. Further studies are needed to apply this strategy to detect underlying malignancies.
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Affiliation(s)
- Jonathan J Hue
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH, USA
| | - Sarah C Markt
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, OH, USA
| | - Goutham Rao
- Department of Family Medicine, University Hospitals Cleveland Medical Center, OH, USA
| | - Jordan M Winter
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, OH, USA
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Teo AKJ, Prem K, Evdokimov K, Ork C, Eng S, Tuot S, Chry M, Mao TE, Hsu LY, Yi S. Effect of community active case-finding strategies for detection of tuberculosis in Cambodia: study protocol for a pragmatic cluster randomized controlled trial. Trials 2020; 21:220. [PMID: 32093778 PMCID: PMC7041270 DOI: 10.1186/s13063-020-4138-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/04/2020] [Indexed: 11/29/2022] Open
Abstract
Background Cambodia has made notable progress in the fight against tuberculosis (TB). However, these gains are impeded by a significant proportion of undiagnosed cases. To effectively reach people with TB, active case-finding (ACF) strategies have been adopted by countries affected by the epidemic, including Cambodia, alongside passive case finding (PCF). Despite increased efforts to improve case detection, approximately 40% of TB cases in Cambodia remained undiagnosed in 2018. In Cambodia, several community-based TB ACF modalities have been implemented, but their effectiveness has yet to be systematically assessed. Methods This pragmatic cluster randomized controlled trial will be conducted between December 2019 and June 2021. We will randomize eight operational districts (clusters) in seven provinces (Kampong Cham, Kampong Thom, Prey Veng, Thbong Khmum, Kampong Chhnang, Kandal, and Kampong Speu) to either the control group (PCF) or the intervention groups (ACF using a seed-and-recruit model, ACF targeting household and neighborhood contacts, and ACF targeting persons aged ≥ 55 years using mobile screening units). The primary endpoints will be TB case notification rates, additionality, and cumulative yield of TB cases. The secondary endpoints include treatment outcomes, the number needed to screen to find one TB case, and cost-effectiveness outcome measures. We will analyze the primary and secondary endpoints by intention to treat. We will compare cluster and individual-level characteristics using Student’s t test and hierarchical or mixed-effect models to estimate the ratio of these means. The incremental cost-effectiveness ratio per disability-adjusted life year averted will also be considered as a benchmark to determine whether the interventions are cost-effective. Discussion This study will build an evidence base to inform future scale-up, implementation, and sustainability of ACF strategies in Cambodia and other similar settings. Implementation of this study will also complement TB control strategies in Cambodia by conducting ACF in operational districts without active interventions to find TB cases currently. Those who are ill and might have TB will be promptly screened, diagnosed, and linked to care. Early diagnosis and treatment initiation will also benefit their community by interrupting transmission and prevent further infections. The experience gained from this project will inform future attempts in conducting pragmatic trials in low-resource settings. Trial registration ClinicalTrials.gov, NCT04094350. Registered on 18 September 2019.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Konstantin Evdokimov
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chetra Ork
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sothearith Eng
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Monyrath Chry
- Cambodia Anti-Tuberculosis Association, Phnom Penh, Cambodia
| | - Tan Eang Mao
- National Center for Tuberculosis and Leprosy Control Cambodia, Phnom Penh, Cambodia
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore. .,KHANA Center for Population Health Research, Phnom Penh, Cambodia. .,Center for Global Health Research, Touro University California, Vallejo, CA, USA. .,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia.
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Lee AK, Woodward M, Wang D, Ohkuma T, Warren B, Sharrett AR, Williams B, Marre M, Hamet P, Harrap S, Mcevoy JW, Chalmers J, Selvin E. The Risks of Cardiovascular Disease and Mortality Following Weight Change in Adults with Diabetes: Results from ADVANCE. J Clin Endocrinol Metab 2020; 105:5582233. [PMID: 31588504 PMCID: PMC6936964 DOI: 10.1210/clinem/dgz045] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/29/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022]
Abstract
CONTEXT Weight loss is strongly recommended for overweight and obese adults with type 2 diabetes. Unintentional weight loss is associated with increased risk of all-cause mortality, but few studies have examined its association with cardiovascular outcomes in patients with diabetes. OBJECTIVE To evaluate 2-year weight change and subsequent risk of cardiovascular events and mortality in established type 2 diabetes. DESIGN AND SETTING The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation was an international, multisite 2×2 factorial trial of intensive glucose control and blood pressure control. We examined 5 categories of 2-year weight change: >10% loss, 4% to 10% loss, stable (±<4%), 4% to 10% gain, and >10% gain. We used Cox regression with follow-up time starting at 2 years, adjusting for intervention arm, demographics, cardiovascular risk factors, and diabetes medication use from the 2-year visit. RESULTS Among 10 081 participants with valid weight measurements, average age was 66 years. By the 2-year examination, 4.3% had >10% weight loss, 18.4% had 4% to 10% weight loss, and 5.3% had >10% weight gain. Over the following 3 years of the trial, >10% weight loss was strongly associated with major macrovascular events (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.26-2.44), cardiovascular mortality (HR, 2.76; 95% CI, 1.87-4.09), all-cause mortality (HR, 2.79; 95% CI, 2.10-3.71), but not major microvascular events (HR, 0.91; 95% CI, 0.61-1.36), compared with stable weight. There was no evidence of effect modification by baseline body mass index, age, or type of diabetes medication. CONCLUSIONS In the absence of substantial lifestyle changes, weight loss may be a warning sign of poor health meriting further workup in patients with type 2 diabetes.
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Affiliation(s)
- Alexandra K Lee
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mark Woodward
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- The George Institute for Global Health, Sydney, Australia
- The George Institute for Global Health, University of Oxford, Oxford, OX1 2BQ, UK
| | - Dan Wang
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Bethany Warren
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - A Richey Sharrett
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London, London, WC1E 6BT, UK
- National Institute of Health Research UCL Hospitals Biomedical Research Center, London, W1T 7DN, UK
| | - Michel Marre
- Fondation Opthalmologique Adolphe de Rothschild, Université Denis Diderot, Paris, France
- INSERM U 1138, Paris, France
| | - Pavel Hamet
- Center de Rechercher, Center Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec H2X 0A9, Canada
| | - Stephen Harrap
- Department of Physiology, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - John W Mcevoy
- School of Medicine, National University of Ireland, Galway Campus, and National Institute for Preventive Cardiology, Galway, H91 TK33, Ireland
| | - John Chalmers
- The George Institute for Global Health, Sydney, Australia
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Correspondence and Reprint Requests: Elizabeth Selvin, PhD, MPH, Welch Center for Prevention, Epidemiology, and Clinical Research, 2024 E Monument St, Suite 2-600, Baltimore, MD 21205, USA. E-mail:
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The cause of anorexia and proportion of its recovery in older adults without underlying disease: Results of a retrospective study. PLoS One 2019; 14:e0224354. [PMID: 31648285 PMCID: PMC6812872 DOI: 10.1371/journal.pone.0224354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/13/2019] [Indexed: 11/19/2022] Open
Abstract
Aim It is difficult to determine whether or not end-of-life care is necessary for frail older adults complaining of anorexia without underlying disease, such as cancer or organ failure. The main reason for this is the lack of the specification of the anorexia cause and no understanding of the cause-providing factor and the prognostic factor. This study aimed to clarify the cause of anorexia, and the determinant of the cause and recovery from anorexia. Methods Retrospective chart reviews were conducted on patients with anorexia without an underlying disease who were aged ≥65 years and visited the emergency department of a single tertiary care center between 2016 and 2017. Patient characteristics at hospital visit, the cause of anorexia, and diagnostic modalities were summarized. The diagnosis-providing rate, recovery rate, and the association between them were analyzed. Results Eighty-three patients (mean age 82.3 years; 50.6% male) were investigated. In 67 patients (81%), the causes of anorexia were identified, including 18 patients (22%) with infection, 13 (16%) with benign gastrointestinal diseases, and 7 (8%) with cardiovascular diseases. In 16 patients (19%), the causes of anorexia were not identified despite examinations. The modality that most contributed to diagnosis was plain computed tomography followed by blood tests. The value regarding information in history-taking and physical examinations was limited. Sixty-five patients (78%) recovered. Only 73% of patients with a definite cause recovered; all patients with an unknown cause recovered. Conclusions Older adults with anorexia are not always at the end of life, and efforts to identify the cause are crucial. Moreover, it is vital to realize the limitations associated with the treatment of infections and cardiovascular diseases.
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Torné Cachot J, Baucells Azcona JM, Blanch Falp J, García Pont J, Camell Ilari H. Isolated involuntary weight loss: Epidemiology and predictive factors of malignancy. Med Clin (Barc) 2019; 152:384-390. [PMID: 30297253 DOI: 10.1016/j.medcli.2018.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/20/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The aims of the study were to analyse the epidemiology, prognostic and predictive factors of malignant disease on isolated involuntary weight loss (IIWL) and to know the effectiveness of the quick diagnosis unit in the evaluation of the process. MATERIAL AND METHODS Prospective observational study realised from 2006 to 2015 of all patients who were evaluated with IIWL in the quick diagnosis unit. Demographic, clinical, diagnostic and evolutive variables were analysed. Through the analysis of logistic regression, predictive factors of malignant disease and prognostic factors were identified. RESULTS Of the 533 registered patients, 55.1% were≥65 years old. The diagnostics were: non-neoplastic organic disorders in 214 patients (40.2%), psychiatric disorders in 144 (27%), cancer in 81 (15.2%) and unknown cause in 94 (17.6%). In 66.7% of the patients with cancer, there was an increase of serum tumour markers (STM). Being over 60 (OR: 2.57; 95% CI: 1.27-5.77; P=.01) %), male (OR: 3.23; 95% CI: 1.52-6.87; P=0.002), increase of an STM (OR: 2.38; 95% CI: 1.17-4.8; P=0.016) and more than one STM (OR: 6.51; 95% CI: 2.62-16.13; P=0.000) were identified as predictive factors of malignancy. Mortality was 14.2%; the diagnosis of cancer (OR: 47.61; 95% CI: 20.76-109.19; P=0.000) was identified as a prognostic factor. CONCLUSIONS IIWL is a clinical syndrome that requires a study with a sequential protocol and follow-up. STM were identified as predictive factors of malignancy.
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Affiliation(s)
- Joaquim Torné Cachot
- Servicio de Medicina Interna, Hospital Sant Camil, Consorci Sanitari del Garraf, San Pere de Ribes, Barcelona, España.
| | - José Manuel Baucells Azcona
- Servicio de Medicina Interna, Hospital Sant Camil, Consorci Sanitari del Garraf, San Pere de Ribes, Barcelona, España
| | - Jesús Blanch Falp
- Servicio de Medicina Interna, Hospital Sant Camil, Consorci Sanitari del Garraf, San Pere de Ribes, Barcelona, España
| | - Javier García Pont
- Servicio de Medicina Interna, Hospital Sant Camil, Consorci Sanitari del Garraf, San Pere de Ribes, Barcelona, España
| | - Helena Camell Ilari
- Servicio de Medicina Interna, Hospital Sant Camil, Consorci Sanitari del Garraf, San Pere de Ribes, Barcelona, España
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Zarbl M, Weckbecker K. [I continue losing weight despite eating and eating]. MMW Fortschr Med 2018; 160:42-44. [PMID: 30478559 DOI: 10.1007/s15006-018-1174-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Maximilian Zarbl
- Institut für Hausarztmedizin der Universität Bonn, Sigmund-Freud-Straße 25, D-53127, Bonn, Deutschland
| | - Klaus Weckbecker
- Institut für Hausarztmedizin der Universität Bonn, Sigmund-Freud-Straße 25, D-53127, Bonn, Deutschland.
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Observational Evidence for Unintentional Weight Loss in All-Cause Mortality and Major Cardiovascular Events: A Systematic Review and Meta-Analysis. Sci Rep 2018; 8:15447. [PMID: 30337578 PMCID: PMC6194006 DOI: 10.1038/s41598-018-33563-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
The obesity paradox has been described in several observational cohorts and meta-analysis. However, evidence of the intentionality of weight loss in all-cause deaths and major cardiovascular events (MACE) in prospective cohorts is unclear. We analysed whether involuntary weight loss is associated with increased cardiovascular events and mortality. In a systematic review, we searched multiple electronic databases for observational studies published up to October 2016. Studies reporting risk estimates for unintentional weight loss compared with stable weight in MACE and mortality were included. Fifteen studies met the selection criteria, with a total of 178,644 participants. For unintentional weight loss, we found adjusted risk ratios (RRs) with confidence intervals (CIs) of 1.38 (95% CI: 1.23, 1.53) and 1.17 (95% CI: 0.98, 1.37) for all-cause mortality and MACE, respectively. Participants with comorbidities, overweight and obese populations, and older adults yielded RRs (95% CI) of 1.49 (1.30, 1.68), 1.11 (1.04, 1.18), and 1.81 (1.59, 2.03), respectively. Unintentional weight loss had a significant impact on all-cause mortality. We found no protective effect of being overweight or obese for unintentional weight loss and MACE.
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Goh Y, Dan YY, Chua W, Jagmohan P, Lee JKT, Thian YL. Diagnostic utility of whole body CT scanning in patients with unexplained weight loss. PLoS One 2018; 13:e0200686. [PMID: 30052642 PMCID: PMC6063413 DOI: 10.1371/journal.pone.0200686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/02/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Unexplained weight loss is a non-specific complaint with myriad potential etiologies. Increasingly, whole body CT studies are being performed in patients with unexplained weight loss to exclude organic etiologies such as malignancy. Our study aims to assess the diagnostic accuracy and yield of whole body CT in these patients. METHODS AND MATERIALS Patients who had a whole body CT scan for investigation of unexplained weight loss as their primary complaint from 2009-2012 were retrospectively reviewed. CT scans were classified into 4 categories: (1) Definite/highly suspicious for underlying organic cause (2) Indeterminate for underlying organic cause (3) No findings accounting for weight loss and only incidental findings and (4) Normal study. Scan findings were correlated with the final diagnosis after all investigations. Univariate logistic regression was performed to determine associations between patient's baseline variables and positive CT scan findings. RESULTS Of 301 eligible patients during the study period, 101 patients were excluded due to known history of malignancy, inadequate follow-up or inadequate scan technique. 200 patients were included in the final analyses. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT for organic pathology were 72.0%, 90.7%, 87.0%, 78.9% and 82.0% respectively. Additional symptoms, abnormal physical examinations, anemia, and raised tumor markers were significantly correlated with positive CT findings. Overall, the diagnostic yield of whole body CT scan for patients with unexplained weight loss was 33.5%. CONCLUSIONS Whole body CT imaging may be a useful investigation for the noninvasive workup of patients with unexplained weight loss, with diagnostic yield of 33.5% and good sensitivity, specificity, positive and negative predictive values for organic etiologies.
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Affiliation(s)
- Yonggeng Goh
- Department of Radiology, National University Hospital, Singapore
| | - Yock Young Dan
- Department of Gastroenterology, National University Hospital, Singapore
| | - Wynne Chua
- Department of Radiology, National University Hospital, Singapore
| | - Pooja Jagmohan
- Department of Radiology, National University Hospital, Singapore
| | | | - Yee Liang Thian
- Department of Radiology, National University Hospital, Singapore
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Weight Loss in Parkinson's Disease: The Relationship with Motor Symptoms and Disease Progression. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9642524. [PMID: 30105269 PMCID: PMC6076942 DOI: 10.1155/2018/9642524] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/20/2018] [Indexed: 01/31/2023]
Abstract
Objectives To determine the prevalence of weight loss (WL) in PD patients, its relationship to the severity of motor manifestations and appetite changes. Methods 144 PD patients and 120 controls were evaluated in a single session. All subjects were asked about changes in body weight and appetite. PD patients were examined with the UPDRS-III and the Hoehn and Yahr (HY) scales. Subscores of tremor, bradykinesia /rigidity, and non-dopaminergic symptoms (NDS) were analyzed individually. Multivariable logistic regression analysis was used to determine an association between WL and PD motor manifestations. Results 48.6 % of PD patients presented WL compared to 20.8 % of controls (p < 0.001). Weight losers were significantly older and had longer disease duration, higher scores in HY stages, UPDRS-III, and NDS-subscore. Multivariable logistic regression analysis demonstrated that WL was associated with NDS-subscore (p= 0.002; OR: 1.33) and older age (p= 0.037; OR: 1.05). Appetite in PD cases losing weight was unchanged (35.7 %), decreased (31.4 %), or even increased (32.9). Conclusions Our results showed that WL occurs in almost half of PD patients and it is largely the consequence of disease progression rather than involuntary movements or a decrease in food intake.
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Motivo de consulta: pérdida de peso. Semergen 2018; 44:257-261. [DOI: 10.1016/j.semerg.2017.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/11/2017] [Accepted: 08/03/2017] [Indexed: 11/19/2022]
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El Hadidi KT, Medhat BM, Abdel Baki NM, Abdel Kafy H, Abdelrahaman W, Yousri AY, Attia DH, Eissa M, El Dessouki D, Elgazzar I, Elgengehy FT, El Ghobashy N, El Hadary H, El Mardenly G, El Naggar H, El Nahas AM, El Refai RM, El Rwiny HA, Elsman RM, Galal M, Ghoniem S, Maged LA, Sally SM, Naji H, Saad S, Shaaban M, Sharaf M, Sobhy N, Soliman RM, El Hadidi TS. Characteristics of systemic lupus erythematosus in a sample of the Egyptian population: a retrospective cohort of 1109 patients from a single center. Lupus 2018; 27:1030-1038. [DOI: 10.1177/0961203317751856] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- K T El Hadidi
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - B M Medhat
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - N M Abdel Baki
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - H Abdel Kafy
- Rheumatology Department, Al Azhar University Faculty of Medicine, Cairo, Egypt
| | - W Abdelrahaman
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - A Y Yousri
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - D H Attia
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M Eissa
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - D El Dessouki
- Rheumatology Department, National Research Centre, Cairo, Egypt
| | - I Elgazzar
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - F T Elgengehy
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - N El Ghobashy
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - H El Hadary
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - G El Mardenly
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - R M El Refai
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - R M Elsman
- Rheumatology Department, Helwan University, Cairo, Egypt
| | - M Galal
- Ministry of Health, Cairo, Egypt
| | - S Ghoniem
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - L A Maged
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - S M Sally
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - H Naji
- Rheumatology and Rehabilitation Department, Military Academy, Agouza Rheumatology and Rehabilitation Centre, Giza, Egypt
| | - S Saad
- Ministry of Health, Cairo, Egypt
| | - M Shaaban
- Rheumatology Department, Helwan University, Cairo, Egypt
| | - M Sharaf
- Ministry of Health, Cairo, Egypt
| | - N Sobhy
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - T S El Hadidi
- Rheumatology and Rehabilitation Department, Military Academy, Agouza Rheumatology and Rehabilitation Centre, Giza, Egypt
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Schaap LA, Quirke T, Wijnhoven HAH, Visser M. Changes in body mass index and mid-upper arm circumference in relation to all-cause mortality in older adults. Clin Nutr 2017; 37:2252-2259. [PMID: 29195733 DOI: 10.1016/j.clnu.2017.11.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND & AIMS The assessment of weight loss as an indicator of poor nutritional status in older persons is currently widely applied to establish risk of mortality. Little is known about the relationship between changes in mid-upper arm circumference (MUAC) and mortality in older individuals. The aim of the present study was to examine the association between 3-year change in MUAC and 20-year mortality in community-dwelling older adults and compare this to the association between body mass index (BMI) change and mortality. METHODS Data on changes in MUAC (cm) and BMI (kg/m2), covariates, and mortality were available for 1307 Dutch older adults (49.7% men) aged 65 years and older in 1995/96 (mean 75.6 years, SD 6.5) from Longitudinal Aging Study Amsterdam (LASA). Anthropometric measurements were performed in 1992/93 with repeated measurements in 1995/96 (baseline), and a mortality follow up until July 2015. BMI and MUAC change were divided into quintiles, with the quintile including zero defined as the reference category. Cox regression analyses were performed to examine the associations of 3-year changes in MUAC and BMI with subsequent 20-year all-cause mortality, adjusted for demographic and health factors. Age, sex and initial measurement of BMI and MUAC (1992/93) were tested for effect modification (P = <0.10). RESULTS Mean baseline BMI was 26.7 kg/m2 (SD 4.2) with a 3-year change of -0.2 (SD 1.5). Mean baseline MUAC was 30.5 cm (SD 3.5) with a 3-year change of -0.8 (SD 1.6). Age, sex, and BMI and MUAC 3 years prior were effect modifiers in the associations between change in anthropometric measurement and mortality. Decrease in MUAC was not associated with mortality in persons with a higher initial MUAC (≥31 cm), while for persons with a lower initial MUAC, a decrease in MUAC of ≤-2.15 was associated with increased mortality risk (HR 1.54; 95% CI: 1.14-2.09), also when further stratified on median age and sex. In stratified analysis of BMI change for median initial BMI (26.5) and additionally stratified for median age and sex, the associations between a BMI decrease of ≤-1.19 and mortality fluctuated, mostly statistically not significant. No associations were found for gain in MUAC or BMI. CONCLUSIONS Given that MUAC loss is more strongly and consistently associated with an increased mortality risk in older individuals with a low initial MUAC compared to BMI loss, this may be a more recommendable measure to use in clinical practice for assessing poor nutritional status, instead of weight loss.
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Affiliation(s)
- Laura A Schaap
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands.
| | - Tara Quirke
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands; Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Hajek A, Bock JO, König HH. Psychosocial correlates of unintentional weight loss in the second half of life in the German general population. PLoS One 2017; 12:e0185749. [PMID: 28968437 PMCID: PMC5624619 DOI: 10.1371/journal.pone.0185749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022] Open
Abstract
Background Unintentional weight loss (UWL) is common in older age and associated with adverse outcomes including mortality. The aim of the present study was to determine psychosocial correlates of UWL. Methods Data were derived from a large, nationally representative study of community-dwelling individuals in the second half of life (40 years and over) in Germany in 2014 (n = 7,933). Data on UWL were assessed in face-to-face interviews as unintentional loss of more than 5kg (11 pounds) in weight in the past 12 months, and data on psychosocial factors were recorded in self-administered questionnaires. Results Multiple logistic regressions revealed that UWL was positively associated with depressive symptoms and positive affect, whereas it was negatively associated with self-esteem. Individuals with UWL were more likely to feel lonely and perceive themselves as socially excluded. Conclusion The findings of important psychosocial correlates of UWL may help to identify individuals at risk for UWL in older age. This is in particular important since interventions to treat this phenomenon in older age are available that reduce adverse consequences resulting from UWL.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
AIM The aim of this study was to assess the yield of endoscopic evaluation in isolated unintentional weight loss (UWL) patients compared with patients with weight loss and additional symptoms or signs. PATIENTS AND METHODS A retrospective review of all patients who underwent an endoscopic evaluation for the investigation of UWL at Soroka University Medical Center between 2006 and 2012. Data on clinical indication, endoscopic, and laboratory finding were retrieved. Severe inflammation, ulcers, achalasia, and neoplasias were considered clinically significant endoscopic findings (CSEF) that could explain weight loss. Detection rates of CSEF were compared between endoscopic studies for which UWL was the sole indication (group 1) and those performed for UWL and at least one other indication (group 2). RESULTS During the study period, 1843 patients with UWL were evaluated with 2098 endoscopic procedures. Of these, 1540 underwent esophagogastroduodenoscopy (EGD) and 558 underwent colonoscopy. EGD was performed in 229 (14.8%) patients in group 1 (mean age: 60.9±16.4, 43.3% men), and in 1311 (85.2%) patients in group 2 (mean age: 60.5±18.5, 45% men). Pathological endoscopic findings were identified in 712 (46%) EGDs. Of these, 155 (10%) studies detected significant outcomes: six (3.9%) in group 1 and 149 (96.1%) in group 2. Of the 558 colonoscopies performed, 105 (18.8%) were performed in group 1 (mean age: 61.7±17.5, 43% men) and 453 (82.2%) in group 2 patients (mean age: 62.9±14.6, 49% men). Abnormal findings were found in 190 (33.8%) of the procedures. CSEF were found in 34 (6%) patients: two in group 1 and 32 in group 2. CONCLUSION The diagnostic yield of endoscopy for investigation of patients with UWL is non-negligible, and should be considered as part of its baseline evaluation, especially in older individuals and those who present with other gastrointestinal manifestations.
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Bosch X, Monclús E, Escoda O, Guerra-García M, Moreno P, Guasch N, López-Soto A. Unintentional weight loss: Clinical characteristics and outcomes in a prospective cohort of 2677 patients. PLoS One 2017; 12:e0175125. [PMID: 28388637 PMCID: PMC5384681 DOI: 10.1371/journal.pone.0175125] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/21/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Whereas there are numerous studies on unintentional weight loss (UWL), these have been limited by small sample sizes, short or variable follow-up, and focus on older patients. Although some case series have revealed that malignancies escaping early detection and uncovered subsequently are exceptional, reported follow-ups have been too short or unspecified and necropsies seldom made. Our objective was to examine the etiologies, characteristics, and long-term outcome of UWL in a large cohort of outpatients. METHODS We prospectively enrolled patients referred to an outpatient diagnosis unit for evaluation of UWL as a dominant or isolated feature of disease. Eligible patients underwent a standard baseline evaluation with laboratory tests and chest X-ray. Patients without identifiable causes 6 months after presentation underwent a systematic follow-up lasting for 60 further months. Subjects aged ≥65 years without initially recognizable causes underwent an oral cavity examination, a videofluoroscopy or swallowing study, and a depression and cognitive assessment. RESULTS Overall, 2677 patients (mean age, 64.4 [14.7] years; 51% males) were included. Predominant etiologies were digestive organic disorders (nonmalignant in 17% and malignant in 16%). Psychosocial disorders explained 16% of cases. Oral disorders were second to nonhematologic malignancies as cause of UWL in patients aged ≥65 years. Although 375 (14%) patients were initially diagnosed with unexplained UWL, malignancies were detected in only 19 (5%) within the first 28 months after referral. Diagnosis was established at autopsy in 14 cases. CONCLUSION This investigation provides new information on the relevance of follow-up in the long-term clinical outcome of patients with unexplained UWL and on the role of age on this entity. Although unexplained UWL seldom constitutes a short-term medical alert, malignancies may be undetectable until death. Therefore, these patients should be followed up regularly (eg yearly visits) for longer than reported periods, and autopsies pursued when facing unsolved deaths.
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Affiliation(s)
- Xavier Bosch
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Esther Monclús
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ona Escoda
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Mar Guerra-García
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Neus Guasch
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alfons López-Soto
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Physical impairment and body weight history in postmenopausal women: the Women's Health Initiative. Public Health Nutr 2016; 19:3169-3177. [PMID: 27269298 DOI: 10.1017/s1368980016001415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine whether weight history and weight transitions over adult lifespan contribute to physical impairment among postmenopausal women. DESIGN BMI categories were calculated among postmenopausal women who reported their weight and height at age 18 years. Multiple-variable logistic regression was used to determine the association between BMI at age 18 years and BMI transitions over adulthood on severe physical impairment (SPI), defined as scoring <60 on the Physical Functioning subscale of the Rand thirty-six-item Short-Form Health Survey. SETTING Participants were part of the Women's Health Initiative Observational Study (WHI OS), where participants' health was followed over time via questionnaires and clinical assessments. SUBJECTS Postmenopausal women (n 76 016; mean age 63·5 (sd 7·3) years). RESULTS Women with overweight (BMI=25·0-29·9 kg/m2) or obesity (BMI≥30·0 kg/m2) at 18 years had greater odds (OR (95 % CI)) of SPI (1·51 (1·35, 1·69) and 2·14 (1·72, 2·65), respectively) than normal-weight (BMI=18·5-24·9 kg/m2) counterparts. Transitions from normal weight to overweight/obese or to underweight (BMI<18·5 kg/m2) were associated with greater odds of SPI (1·97 (1·84, 2·11) and 1·35 (1·06, 1·71), respectively) compared with weight stability. Shifting from underweight to overweight/obese also had increased odds of SPI (1·52 (1·11, 2·09)). Overweight/obese to normal BMI transitions resulted in a reduced SPI odds (0·52 (0·39, 0·71)). CONCLUSIONS Higher weight history and transitions into higher weight classes were associated with higher likelihood of SPI, while transitioning into lower weight classes for those with overweight/obesity was protective among postmenopausal women.
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da Silva Fink J, Daniel de Mello P, Daniel de Mello E. Subjective global assessment of nutritional status – A systematic review of the literature. Clin Nutr 2015; 34:785-92. [DOI: 10.1016/j.clnu.2014.12.014] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 11/24/2014] [Accepted: 12/18/2014] [Indexed: 12/14/2022]
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Messinger-Rapport BJ, Gammack JK, Thomas DR, Morley JE. Clinical update on nursing home medicine: 2013. J Am Med Dir Assoc 2014; 14:860-76. [PMID: 24286710 DOI: 10.1016/j.jamda.2013.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/18/2013] [Indexed: 12/18/2022]
Abstract
This is the seventh article in the series of Clinical Updates on Nursing Home Care. The topics covered are antiresorptive drugs, hip fracture, hypertension, orthostatic hypotension, depression, undernutrition, anorexia, cachexia, sarcopenia, exercise, pain, and behavioral and psychological symptoms of dementia.
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Abstract
Involuntary weight loss remains an important and challenging clinical problem, with a high degree of morbidity and mortality. Because of the frequency of finding a serious underlying diagnosis, clinicians must be thorough in assessment, keeping in mind a broad range of possible causes. Although prediction scores exist, they have not been broadly validated; therefore, clinical judgment remains ever essential.
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Affiliation(s)
- Christopher J Wong
- Division of General Internal Medicine, Department of Medicine, University of Washington, 4245 Roosevelt Way Northeast, Box 354760, Seattle, WA 98105, USA.
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Baicus C, Rimbas M, Baicus A, Caraiola S. Cancer and involuntary weight loss: failure to validate a prediction score. PLoS One 2014; 9:e95286. [PMID: 24762986 PMCID: PMC3999093 DOI: 10.1371/journal.pone.0095286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 03/25/2014] [Indexed: 12/02/2022] Open
Abstract
Background Many patients who have involuntary weight loss have cancer. The Hernandez prediction rule includes 5 variables (elevated levels of alkaline phosphatase and lactate dehydrogenase, low albumin, high white blood cell count, and age >80 years). The purpose of this study was to evaluate the validity of the prediction rule. Methods We prospectively evaluated 290 consecutive inpatients and outpatients who had involuntary weight loss. Clinical, hematologic, and biochemical parameters were determined. There were 259 patients who had follow-up at 6 months to determine the cause of involuntary weight loss, and 31 other patients were lost to follow-up. The 5 variables were introduced into a regression logistic model with cancer as a dependent variable. Results Cancer was diagnosed in 72 of the 290 patients (25%) who had involuntary weight loss. Bivariate analysis showed that serum albumin, C-reactive protein, erythrocyte sedimentation rate, alkaline phosphatase, iron, lactate dehydrogenase, white blood cell count, hemoglobin, and ferritin levels were associated with cancer (range of area under the receiver operating characteristic curve, 0.589 to 0.688). Multivariate analysis showed that albumin, erythrocyte sedimentation rate, iron, white blood cell count, and lactate dehydrogenase levels were associated with cancer. When dichotomized, only low albumin (odds ratio, 2.6, CI [1.3–5.2]) and high alkaline phosphatase (odds ratio, 2.3, CI [1.7–4.7]) were associated with cancer. The area under the receiver operating characteristic curve of the 5-variable prediction rule was only 0.70 (95% confidence interval, 0.61–0.78). The negative predictive value of this model with 3 variables (age >60 y, alkaline phosphatase, and albumin level) increased from 85% to 95% when all tests were negative. Conclusions In patients who had involuntary weight loss, those who have cancer are likely to have ≥1 abnormal laboratory test. The 5-variable prediction rule had a significantly lower accuracy than originally reported. Further evaluation of the 3-variable modification of the prediction rule may be useful.
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Affiliation(s)
- Cristian Baicus
- Colentina University Hospital, Departments of Internal Medicine and Gastroenterology, Bucharest, Romania
- Clinical Research Unit, Réseau d' Epidémiologie Clinique International Francophone, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- * E-mail:
| | - Mihai Rimbas
- Colentina University Hospital, Departments of Internal Medicine and Gastroenterology, Bucharest, Romania
- Clinical Research Unit, Réseau d' Epidémiologie Clinique International Francophone, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Anda Baicus
- Clinical Research Unit, Réseau d' Epidémiologie Clinique International Francophone, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- I. Cantacuzino National Institute of Research and Development in Microbiology-Immunology, Bucharest, Romania
| | - Simona Caraiola
- Colentina University Hospital, Departments of Internal Medicine and Gastroenterology, Bucharest, Romania
- Clinical Research Unit, Réseau d' Epidémiologie Clinique International Francophone, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Studnicki J, Ekezue BF, Tsulukidze M, Honoré P, Moonesinghe R, Fisher J. Classification tree analysis of race-specific subgroups at risk for a central venous catheter-related bloodstream infection. Jt Comm J Qual Patient Saf 2014; 40:134-43. [PMID: 24730209 DOI: 10.1016/s1553-7250(14)40017-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Studies of racial disparities in patient safety events often do not use race-specific risk adjustment and do not account for reciprocal covariate interactions. These limitations were addressed by using classification tree analysis separately for black patients and white patients to identify characteristics that segment patients who have increased risks for a venous catheter-related bloodstream infection. METHODS A retrospective, cross-sectional analysis of 5,236,045 discharges from 103 Florida acute hospitals in 2005-2009 was conducted. Hospitals were rank ordered on the basis of the black/white Patient Safety Indicator (PSI) 7 rate ratio as follows: Group 1 (white rate higher), Group 2, (equivalent rates), Group 3, (black rate higher), and Group 4, (black rate highest). Predictor variables included 26 comorbidities (Elixhauser Comorbidity Index) and demographic characteristics. Four separate classification tree analyses were completed for each race/hospital group. RESULTS Individual characteristics and groups of characteristics associated with increased PSI 7 risk differed for black and white patients. The average age for both races was different across the hospital groups (p < .01). Weight loss was the strongest single delineator and common to both races. The black subgroups with the highest PSI 7 risk were Medicare beneficiaries who were either < or = 25.5 years without hypertension or < or = 39.5 years without hypertension but with an emergency or trauma admission. The white subgroup with the highest PSI 7 risk consisted of patients < or = 45.5 years who had congestive heart failure but did not have either hypertension or weight loss. DISCUSSION Identifying subgroups of patients at risk for a rare safety event such as PSI 7 should aid effective clinical decisions and efficient use of resources and help to guide patient safety interventions.
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Studnicki J, Ekezue BF, Tsulukidze M, Honoré P, Moonesinghe R, Fisher J. Disparity in race-specific comorbidities associated with central venous catheter-related bloodstream infection (AHRQ-PSI7). Am J Med Qual 2013; 28:525-32. [PMID: 23526359 DOI: 10.1177/1062860613480826] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Studies of racial disparities in hospital-level patient safety outcomes typically apply a race-common approach to risk adjustment. Risk factors specific to a minority population may not be identified in a race-common analysis if they represent only a small percentage of total cases. This study identified patient comorbidities and characteristics associated with the likelihood of a venous catheter-related bloodstream infection (Agency for Healthcare Research and Quality Patient Safety Indicator 7 [PSI7]) separately for blacks and whites using race-specific logistic regression models. Hospitals were ranked by the racial disparity in PSI7 and segmented into 4 groups. The analysis identified both black- and white-specific risk factors associated with PSI7. Age showed race-specific reverse association, with younger blacks and older whites more likely to have a PSI7 event. These findings suggest the need for race-specific covariate adjustments in patient outcomes and provide a new context for examining racial disparities.
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Abstract
BACKGROUND/OBJECTIVE Information on weight loss is used in screening and assessment tools. It is essential that the data are correct. Anamnestic data of weight changes were compared with records for hospitalized patients and outpatients. SUBJECTS/METHODS For hospitalized patients, anamnestic and recorded weight data were obtained. For outpatients, data of weight changes since last visit were obtained. RESULTS Of 34 hospitalized patients, 21 stated change of weight (15 lost, 6 gained). Weight loss in 9 and weight gain in 12 patients were recorded. Ten patients stated no change of weight. Weight loss in 4 and weight gain in 3 patients were recorded. Of 15 patients who stated weight loss, it was correct for 9 patients. Six of 21 patients stated weight changes opposite the records. Of 43 patients, 14 stated weight changes before admission; only 9 could indicate the time span. Ten patients stated 'Do not know' to the question of weight changes. For 156 outpatients, 86 stated change of weight (39 lost, 47 gained). Weight loss in 42 and weight gain in 47 patients were recorded. Fifty-eight patients stated no change of weight. Weight loss in 26 and weight gain in 29 patients were recorded. Of 38 patients who stated weight loss, it was correct for 31. Seventeen of 85 patients stated weight changes opposite the records. CONCLUSIONS Recollection of weight changes is poor for a large percentage of patients. In patients who stated weight loss it was only correct for 75%, and for patients who stated unchanged weight 25% have lost more than 1 kg. Thus, incorrect weight loss data can cause over- and underestimation of nutritional risk.
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Affiliation(s)
- J Eriksen
- Medical Department, Regional Hospital West Jutland, Herning, Denmark.
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Wu JM, Lin MH, Peng LN, Chen LK, Hwang SJ. Evaluating diagnostic strategy of older patients with unexplained unintentional body weight loss: A hospital-based study. Arch Gerontol Geriatr 2011; 53:e51-4. [DOI: 10.1016/j.archger.2010.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 10/12/2010] [Accepted: 10/14/2010] [Indexed: 11/26/2022]
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Herselman M, Esau N, Kruger JM, Labadarios D, Moosa MR. Relationship Between Body Mass Index and Mortality in Adults on Maintenance Hemodialysis: A Systematic Review. J Ren Nutr 2010; 20:281-292, 7 p following 292. [PMID: 20580250 DOI: 10.1053/j.jrn.2010.03.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Indexed: 11/11/2022] Open
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Bamia C, Halkjaer J, Lagiou P, Trichopoulos D, Tjønneland A, Berentzen TL, Overvad K, Clavel-Chapelon F, Boutron-Ruault MC, Rohrmann S, Linseisen J, Steffen A, Boeing H, May AM, Peeters PH, Bas Bueno-de-Mesquita H, van den Berg SW, Dorronsoro M, Barricarte A, Rodriguez Suarez L, Navarro C, González CA, Boffetta P, Pala V, Hallmans G, Trichopoulou A. Weight change in later life and risk of death amongst the elderly: the European Prospective Investigation into Cancer and Nutrition-Elderly Network on Ageing and Health study. J Intern Med 2010; 268:133-44. [PMID: 20210842 DOI: 10.1111/j.1365-2796.2010.02219.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Later life weight change and mortality amongst elders. DESIGN Nested case-control study. SETTING Six countries from the European Investigation into Cancer and nutrition-Elderly, Network on Ageing and Health. SUBJECTS A total of 1712 deceased (cases) and 4942 alive (controls) were selected from 34,239 participants, > or = 60 years at enrolment (1992-2000) who were followed-up until March 2007. Annual weight change was estimated as the weight difference from recruitment to the most distant from-date-of-death re-assessment, divided by the respective time. OUTCOME MEASURES Mortality in relation to weight change was examined using conditional logistic regression. RESULTS Weight loss > 1 kg year(-1) was associated with statistically significant increased death risk (OR = 1.65; 95% CI: 1.41-1.92) compared to minimal weight change (+/-1 kg year(-1)). Weight gain > 1 kg year(-1) was also associated with increased risk of death (OR = 1.15; 95% CI: 0.98-1.37), but this was evident and statistically significant only amongst overweight/obese (OR = 1.55; 95% CI: 1.17-2.05). In analyses by time interval since weight re-assessment, the association of mortality with weight loss was stronger for the interval proximal (< 1 year) to death (OR = 3.10; 95% CI: 2.03-4.72). The association of mortality with weight gain was stronger at the interval of more than 3 years and statistically significant only amongst overweight/obese (OR = 1.58; 95% CI: 1.07-2.33). Similar patterns were observed regarding death from circulatory diseases and cancer. CONCLUSIONS In elderly, stable body weight is a predictor of lower subsequent mortality. Weight loss is associated with increased mortality, particularly short-term, probably reflecting underlying nosology. Weight gain, especially amongst overweight/obese elders, is also associated with increased mortality, particularly longer term.
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Affiliation(s)
- C Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece.
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Evaluating probability of cancer among older people with unexplained, unintentional weight loss. Arch Gerontol Geriatr 2010; 50 Suppl 1:S27-9. [PMID: 20171452 DOI: 10.1016/s0167-4943(10)70008-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Unexplained, unintentional weight loss (UUWL) in older people is usually multi-factorial and poses a diagnostic challenge, with cancer being the major concern. The main purpose of this study was to evaluate the effectiveness of a cancer scoring system for predicting cancer in elderly UUWL patients. From 2006 to 2007, 50 patients (mean age, 78.8+/-4.7 years, 82% male) who lost > 5% of usual body weight were enrolled. The subjects' mean body weight loss was 14.1%+/-6.6% (8.7+/-4.6 kg). After evaluation, the common diagnoses were non-malignant organic disorder (22/50, 44%), neuropsychiatric disorder (17/50, 34%), unknown (8/50, 16%), and cancer (3/50, 6%). The most rapid weight loss occurred with cancer (6.5% per month), followed by non-malignant organic disorders (5.6% per month), neuropsychiatric disorders (2.8% per month), and unknown causes (2.4% per month); the difference among the groups was significant (p = 0.023). Using a previously proposed scoring system, 42 patients (84%) had a low probability of cancer; all three cancer patients were in this category. In conclusion, the annual incidence of cancer among elderly UUWL patients was 6%, and the previously developed cancer scoring system did not effectively predict cancer occurrence. Further study is needed to develop an effective instrument to predict cancer in elderly UUWL patients.
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Salzman BE, Lamb K, Olszewski RF, Tully A, Studdiford J. Diagnosing cancer in the symptomatic patient. Prim Care 2010; 36:651-70; table of contents. [PMID: 19913180 DOI: 10.1016/j.pop.2009.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Finding cancer at its earliest, most treatable stage gives patients the greatest chance of survival. For a number of cancers, screening tests allow for early detection and treatment, and thereby, reduce cancer-related mortality. However, many cancers are discovered by symptomatic presentation rather than screening. This article addresses several symptoms commonly reported in the primary care setting, including rectal bleeding, a breast lump, cough, lymphadenopathy, and weight loss, and offers an evidence-based approach to the consideration and possibly the diagnosis of cancer.
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Affiliation(s)
- Brooke E Salzman
- Division of Geriatric Medicine, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Gurevitz SL, Costakis T, Leiter J. Do Atypical Antipsychotics Cause Weight Gain in Nursing Home Dementia Residents? ACTA ACUST UNITED AC 2009; 19:809-12. [PMID: 16553497 DOI: 10.4140/tcp.n.2004.809] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the effects of atypical antipsychotics on weight gain in the elderly resident with dementia or Alzheimer's disease, complicated with agitation and/or psychosis. DESIGN Retrospective chart review. SETTING Twenty-seven long-term care facilities in Indiana. PATIENTS/PARTICIPANTS Residents of long-term care facilities with a diagnosis of dementia or Alzheimer's disease, complicated by agitation and/or psychosis, and receiving atypical antipsychotics for a minimum of four weeks. INTERVENTION None. MAIN OUTCOME MEASURE Changes in weight after initiation of atypical antipsychotic therapy. RESULTS Ninety residents were evaluated. Mean age was 83.4 years; 71% were female. Forty-nine percent of the residents gained weight. The residents who received risperidone, olanzapine, or quetiapine gained an average of 5.6 pounds, 8.2 pounds, and 6.1 pounds, respectively. Seven residents had a significant weight gain, and seven residents had a significant weight loss. CONCLUSION In our population we did not observe any significant weight change in individuals receiving risperidone, olanzapine, or quetiapine. Further prospective studies are needed to determine if there is a difference in potential weight gain among the various atypical antipsychotics in residents with dementia or Alzheimer's disease.
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Böttiger LE, Hällén J. Do we overlook malignant tumors? ACTA MEDICA SCANDINAVICA 2009; 213:321-2. [PMID: 6880853 DOI: 10.1111/j.0954-6820.1983.tb03744.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Raynaud-Simon A. Virtual Clinical Nutrition University: Malnutrition in the elderly, Epidemiology and consequences. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.eclnm.2008.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Jenkins KR, Kabeto MU, Langa KM. Does caring for your spouse harm one's health? Evidence from a United States nationally-representative sample of older adults. AGEING & SOCIETY 2009; 29:277-293. [PMID: 24567660 PMCID: PMC3932049 DOI: 10.1017/s0144686x08007824] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this article is to investigate the relationship between spousal care-giving and declines in functioning and self-rated health among older care-givers. The authors used data from the 2000 and 2002 waves of the United States Health and Retirement Study, a biennial longitudinal survey of a nationally representative cohort of adults aged 50 or more years. Two outcomes were examined, declines in functioning and declines in self-rated health. Care-givers were classified into three groups: no care-giving, less than 14 hours of care-giving per week, and 14 or more hours care-giving per week. To assess declines in functioning, two summary scores were created of limitations in basic and instrumental Activities of Daily Living. To assess declines in self-rated health, we compared responses from 2000 and 2002. In the fully adjusted models, care-giving hours did not have an independent effect on declines in functioning or self-rated health. The relationship between care-giving hours and declines in functioning and self-rated health is probably attributable to socio-demographic characteristics, mainly age. The findings suggest that spousal care-giving does not of itself harm functional health or perceived health among older adult care-givers. Understanding the differential effects of these socio-economic characteristics with care-giving hours on health will be useful in promoting the health of older adult care-givers and treating their disorders.
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Affiliation(s)
- Kristi Rahrig Jenkins
- Institute of Social Research, University of Michigan, USA ; Addiction Research Center, University of Michigan, USA
| | | | - Kenneth M Langa
- Division of General Medicine, University of Michigan, USA ; Center for Practice Management and Outcomes Research, Department of Veterans Affairs, University of Michigan, USA ; Institute of Social Research, University of Michigan, USA
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Xue QL, Bandeen-Roche K, Varadhan R, Zhou J, Fried LP. Initial manifestations of frailty criteria and the development of frailty phenotype in the Women's Health and Aging Study II. J Gerontol A Biol Sci Med Sci 2008; 63:984-90. [PMID: 18840805 DOI: 10.1093/gerona/63.9.984] [Citation(s) in RCA: 309] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Understanding points of onset of the frailty syndrome is vital to early identification of at-risk individuals and to targeting intervention efforts to those components that are first affected, when reversal may be most possible. This study aims to characterize natural history by which commonly used frailty criteria manifest and to assess whether the rate of progression to frailty depends on initial manifestations. METHODS The investigation was based on a 7.5-year observational study of 420 community-dwelling women aged 70-79 years who were not frail at baseline, with frailty defined as meeting>or=3 of 5 criteria: weight loss, slow walking speed, weakness, exhaustion, and low physical activity level. RESULTS The 7.5-year incidence of frailty was 9% among women who were nonfrail at baseline. Despite significant heterogeneity, weakness was the most common first manifestation, and occurrence of weakness, slowness, and low physical activity preceded exhaustion and weight loss in 76% of the women who were nonfrail at baseline. Women with exhaustion or weight loss as initial presenting symptoms were 3-5 times more likely to become frail than were women without any criterion (p<.05). CONCLUSIONS Our findings suggest that weakness may serve as a warning sign of increasing vulnerability in early frailty development, and weight loss and exhaustion may help to identify women most at risk for rapid adverse progression.
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Affiliation(s)
- Qian-Li Xue
- Department of Medicine, School of Medicine, Johns Hopkins University,2024 E. Monument Street, Suite 2-700, Baltimore, MD 21205, USA.
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Marshall WJ. Nutritional assessment: its role in the provision of nutritional support. J Clin Pathol 2008; 61:1083-8. [PMID: 18818263 DOI: 10.1136/jcp.2007.051813] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Generalised undernutrition is common in hospital patients and in the community. It is frequently unrecognised and is associated with a range of adverse consequences that contribute to increased morbidity and mortality. The National Institute for Health and Clinical Excellence recommends that all individuals engaging with healthcare or admitted to residential homes in the community should be screened for undernutrition. Laboratory investigations have little place in the diagnosis of undernutrition: this is primarily a clinical process. In particular, the measurement of serum albumin concentration, though widely promulgated in the past as an index of nutritional status, is worthless for this purpose. Laboratory investigations are, however, of importance: to diagnose specific nutritional deficiencies (eg, of trace elements) and to monitor the provision of nutritional support, to detect metabolic complications and to assess its adequacy (for which the measurement of serum prealbumin concentrations, particularly in conjunction with measurements of C-reactive protein, may be of value).
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Affiliation(s)
- W J Marshall
- The London Clinic, 20 Devonshire Place, London W1G 6BW, UK.
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Metalidis C, Knockaert DC, Bobbaers H, Vanderschueren S. Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance? Eur J Intern Med 2008; 19:345-9. [PMID: 18549937 DOI: 10.1016/j.ejim.2007.09.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 09/26/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Involuntary weight loss frequently poses a diagnostic challenge. Patient and physician alike want to exclude malignant and other major organic illness. The present study aimed to evaluate whether a negative baseline evaluation (consisting of clinical examination, standard laboratory examination, chest X-ray, and abdominal ultrasound) lowers the probability of evolving organic illness in patients with significant unexplained weight loss. METHODS Prospective observational study of 101 consecutive patients presenting to a general internal medicine department of a university hospital with an unexplained unintentional weight loss of at least 5% within 6-12 months. Laboratory tests of interest included C-reactive protein, albumin, haemoglobin, and liver function tests. RESULTS Weight loss of the 101 patients [age (mean, interquartile range): 64 (51-71) years, 46% male] averaged 10 (7-15) kg. Organic causes were found in 57 patients (56%), including malignancy in 22 (22%). In 44 patients without obvious organic cause for the weight loss (44%), a psychiatric disorder was implicated in 16 (16%) and no cause was established in 28 (28%), despite vigorous effort and follow-up of at least 6 months. Baseline evaluation was entirely normal in none of the 22 patients (0%) with malignancy, in 2 of the 35 (5.7%) with non-malignant organic disease, and in 23 of the 44 (52%) without physical diagnosis. Additional testing, oftentimes extensive, after a normal baseline evaluation led to one additional physical diagnosis (lactose intolerance). CONCLUSION In patients presenting with substantial unintentional weight loss, major organic and especially malignant diseases seem highly unlikely when a baseline evaluation is completely normal. In this setting, a watchful waiting approach may be preferable to undirected and invasive testing.
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Affiliation(s)
- Christoph Metalidis
- Department of General Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium
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Bailey RL, Mitchell DC, Miller C, Smiciklas-Wright H. Assessing the effect of underreporting energy intake on dietary patterns and weight status. ACTA ACUST UNITED AC 2007; 107:64-71. [PMID: 17197273 DOI: 10.1016/j.jada.2006.10.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To identify misreporting among older rural adults using a prediction algorithm and to compare dietary patterns of underreporters and plausible reporters. DESIGN In this cross-sectional study, diet information was assessed by five 24-hour recalls collected over 10 months. All foods were classified into 24 food subgroups. Demographic, health, and anthropometric data were collected via home visit. SETTING Rural Pennsylvania. SUBJECTS One hundred seventy-nine community-dwelling adults, aged 66 to 87 years. STATISTICAL ANALYSIS Cluster analysis. RESULTS Underreporters (n=43) were more likely than plausible reporters (n=133) to be overweight and less educated but did not differ by sex. Underreporters consumed fewer servings across the majority of food groups. Two dietary patterns were determined for all and plausible reporters, in both cases one of higher and one of lower nutrient density. Using only plausible reporters to determine dietary patterns was very similar to using all reporters. The correlation between energy intake and weight status was improved for plausible-reporting women, but not men. CONCLUSIONS Dietary patterns of plausible reporters were generally similar to that of all reporters; however, correlations with energy intake and weight status improved for women using only plausible reporters. Individuals may not accurately report dietary intake. Those obtaining diet reports should be aware of reporting errors before making decisions about dietary adequacy.
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Affiliation(s)
- Regan L Bailey
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16801, USA.
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Jenkins KR, Johnson NE, Ofstedal MB. Patterns and Associations of Body Weight Among Older Adults in Two Asian Societies. J Cross Cult Gerontol 2007; 22:83-99. [PMID: 17225191 DOI: 10.1007/s10823-006-9031-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Body weight has important health implications across the lifespan. Most recent attention has focused on the obesity epidemic that is occurring in many parts of the world. However, underweight is also a concern, particularly in less developed countries. For most health outcomes there is a curvilinear association with body weight, with underweight and overweight (compared to normal weight) being associated with a higher prevalence of chronic debilitating and life-threatening conditions and ultimately mortality. This paper uses data from two nationally-representative surveys of older adults (aged 60 and older) in the Philippines (1996) and Taiwan (1999) to assess the prevalence of underweight and overweight and examine associations between body weight and demographic, socioeconomic, and health characteristics in these populations. Older Filipinos have a modest prevalence of underweight (29.9%) and low prevalence of overweight (12.2%), whereas the reverse is observed in Taiwan (6.4 and 29.3%, respectively). Results show generally expected associations between body weight and demographic characteristics, health conditions and behaviors. We find little evidence of socioeconomic differences in body weight, except in the Philippines where higher SES is associated with a lower risk of being underweight. Implications of the results are discussed in terms of healthy weight maintenance among critical subgroups to potentially reduce the prevalence of disease and improve quality of life.
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Affiliation(s)
- Kristi Rahrig Jenkins
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
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Rolland Y, Kim MJ, Gammack JK, Wilson MMG, Thomas DR, Morley JE. Office management of weight loss in older persons. Am J Med 2006; 119:1019-26. [PMID: 17145241 DOI: 10.1016/j.amjmed.2006.02.039] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 02/18/2006] [Indexed: 11/17/2022]
Abstract
Weight loss in older persons is associated with a variety of deleterious effects, including hip fracture, pressure ulcers, decreasing immune function, decreased functional status, and death. There are 4 major causes of weight loss: anorexia, sarcopenia, cachexia, and dehydration. Many of the reasons for the development of these conditions are treatable. For example, depression is the most common cause of weight loss in the elderly. Early screening for anorexia can be undertaken in the physician's office utilizing the Simplified Nutritional Assessment Questionnaire. An algorithmic approach to the office management of weight loss is provided.
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Affiliation(s)
- Yves Rolland
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, Mo 63104, USA
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