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Valter R, Paillaud E, Boudou-Rouquette P, Oubaya N, Arégui A, Lorisson E, Brain E, Rochette de Lempdes G, Histe A, Laurent M, Canouï-Poitrine F, Caillet P, Broussier A, Martinez-Tapia C. Comparison of the prognostic value of eight nutrition-related tools in older patients with cancer: A prospective study. J Nutr Health Aging 2024; 28:100188. [PMID: 38350302 DOI: 10.1016/j.jnha.2024.100188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVES The primary objective of the present study was to evaluate and compare the ability of eight nutrition-related tools to predict 1-year mortality in older patients with cancer. DESIGN, SETTING AND PARTICIPANTS We studied older patients with cancer from the ELCAPA cohort and who had been referred for a geriatric assessment at one of 14 participating geriatric oncology clinics in the greater Paris area of France between 2007 and 2018. MEASUREMENTS The studied nutrition-related tools/markers were the body mass index (BMI), weight loss (WL) in the previous 6 months, the Mini Nutritional Assessment, the Geriatric Nutritional Risk Index (GNRI), the Prognostic Nutritional Index, the Glasgow Prognostic Score (GPS), the modified GPS, and the C-reactive protein/albumin ratio. RESULTS A total of 1361 patients (median age: 81; males: 51%; metastatic cancer: 49%) were included in the analysis. Most of the tools showed a progressively increase in the mortality risk as the nutrition-related risk category worsened (overall p-values <0.02 for all) after adjustment for age, outpatient status, functional status, severe comorbidities, cognition, mood, cancer treatment strategy, tumour site, and tumour metastasis. All the models were discriminant, with a C-index ranging from 0.748 (for the BMI) to 0.762 (for the GPS). The concordance probability estimate ranged from 0.764 (WL) to 0.773 (GNRI and GPS)). CONCLUSION After adjustment for relevant prognostic factors, all eight nutrition-related tools/markers were independently associated with 1-year mortality in older patients with cancer. Depending on the time or context of the GA, physicians do not always have the time or means to perform and assess all the tools/markers compared here. However, even when some information is missing, each nutritional tool/marker has prognostic value and can be used in the evaluation.
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Affiliation(s)
- Rémi Valter
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; AP-HP, Paris Cancer Institute CARPEM, hôpital Européen Georges Pompidou, département de gériatrie, F-75015 Paris, France
| | | | - Nadia Oubaya
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; AP-HP, Hopital Henri-Mondor, Service de Santé Publique, F-94010 Creteil, France
| | - Amélie Arégui
- APHP, Hôpital St Louis, UCOG Paris Nord, F-75010 Paris, France
| | | | - Etienne Brain
- Institut Curie, 35 Rue Dailly, F-92210 Saint-Cloud, France
| | | | - Axelle Histe
- AP-HP, Hopital Henri-Mondor, Unité de Recherche Clinique, F-94010 Creteil, France
| | - Marie Laurent
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; AP-HP, Hopital Henri-Mondor, Department of Internal Medicine and Geriatrics, F-94010 Creteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; AP-HP, Hopital Henri-Mondor, Service de Santé Publique, F-94010 Creteil, France
| | - Philippe Caillet
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; AP-HP, Paris Cancer Institute CARPEM, hôpital Européen Georges Pompidou, département de gériatrie, F-75015 Paris, France
| | - Amaury Broussier
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France; AP-HP, Hopitaux Henri-Mondor/Emile Roux, Department of Geriatrics, F-94456 Limeil-Brevannes, France
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Nakamura Y, Kawase M, Kawabata Y, Kanto S, Yamaura T, Kinjo Y, Ogo Y, Kuroda N. Impact of malnutrition on cancer recurrence, colorectal cancer-specific death, and non-colorectal cancer-related death in patients with colorectal cancer who underwent curative surgery. J Surg Oncol 2024; 129:317-330. [PMID: 37846204 DOI: 10.1002/jso.27488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/23/2023] [Accepted: 09/30/2023] [Indexed: 10/18/2023]
Abstract
AIM This study aimed to examine how malnutrition, as reflected by the Geriatric Nutritional Risk Index (GNRI), is associated with colorectal cancer (CRC) recurrence and cause of death. METHODS Consecutive stage I-III CRC patients (n = 601) were divided into two groups using GNRI 98 as the cutoff. The relationship of GNRI with overall survival (OS) and recurrence-free survival (RFS) was evaluated, followed by competing risk analysis to determine prognostic factors of non-CRC-related death, and hazard function analysis to examine changes in the risk of recurrence and death. RESULTS Median body mass index was lower in the low GNRI group than in the high GNRI group (19.8 vs. 23.5; p < 0.001). After adjusting for known prognostic factors, a low GNRI was independently associated with reduced OS/RFS, and was a significant predictor of non-CRC-related death. The risk of recurrence was higher and peaked earlier in the low GNRI group than in the high GNRI group, although after 3 years, both groups had a similar risk. Meanwhile, the low GNRI group had a higher risk of non-CRC-related death over the course of 5 years. CONCLUSION It is important to consider preoperative nutritional status along with the cancer stage when developing strategies to improve outcomes for CRC patients.
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Affiliation(s)
- Yuya Nakamura
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Makoto Kawase
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Yusuke Kawabata
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Satoshi Kanto
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Tadayoshi Yamaura
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Yousuke Kinjo
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Yasumasa Ogo
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
| | - Nobukazu Kuroda
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, 670-8520, Hyogo, Japan
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Alatas H, Serin Y, Arslan N. Nutritional Status and Risk of Sarcopenia among Hospitalized Older Adults Residing in a Rural Region in Turkey. Ann Geriatr Med Res 2023; 27:293-300. [PMID: 37691482 PMCID: PMC10772329 DOI: 10.4235/agmr.23.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/17/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND This study aimed to determine the prevalence of sarcopenia and its associated factors in community-dwelling older adults at risk of malnutrition based on the Mini Nutritional Assessment (MNA), Prognostic Nutritional Index (PNI), and Geriatric Nutritional Risk Index (GNRI). METHODS The study participants were 345 adults aged >65 years who visited Geriatric Internal Medicine outpatient clinics. The study included people without acute illness for whom the risk of malnutrition could be assessed and appropriate measurements taken. At the baseline visit, participants' data and measurements were gathered. The primary data included sociodemographic details, anthropometric measurements, malnutrition screening tests, and functional assessments. RESULTS The participants' mean age was 76.21±5.59 years, and 57.1% were men (n=97). The prevalence rate of sarcopenia was 45.5%. Compared to individuals without sarcopenia, those with it were older; had lower MNA, PNI, and GNRI scores; and had lower muscle mass, muscle strength, and lower leg circumferences (p<0.001). After adjusting for potential confounding factors, we found that sarcopenia, advanced age, male sex, high risk of malnutrition, calf circumference, and a low PNI score were all significantly associated with a low GNRI score (p<0.001). CONCLUSION Sarcopenia was significantly associated with advanced age, male sex, and high risk of malnutrition. Patients' nutritional and functional status should always be assessed for therapeutic interventions and lifestyle changes.
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Affiliation(s)
- Hacer Alatas
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Malatya Turgut Ozal University, Malatya, Turkey
| | - Yeliz Serin
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Cukurova University, Adana, Turkey
| | - Nurgül Arslan
- Department of Nutrition and Dietetics, Ataturk Faculty of Health Sciences, Dicle University, Diyarbakir, Turkey
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Perry E, Walton K, Lambert K. Prevalence of Malnutrition in People with Dementia in Long-Term Care: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:2927. [PMID: 37447253 DOI: 10.3390/nu15132927] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Dementia is a common syndrome in older people. Dementia alters eating behaviors, hunger and thirst cues, swallow function, ability to self-feed, and recognition and interest in food. There is significant variation in the reported prevalence of malnutrition among older people who live in long-term care. The aim was to conduct a systematic literature review and meta-analysis of the prevalence of malnutrition in those with dementia living in long-term care using a validated nutrition assessment tool. Scopus, Web of Science, CINAHL, and Medline were searched. A random effects model was used to determine the prevalence and risk of malnutrition. Data were retrieved from 24 studies. Most of the studies were from Europe or South Asia. The prevalence of malnutrition ranged from 6.8 to 75.6%, and the risk of malnutrition was 36.5-90.4%. The pooled prevalence of malnutrition in those with dementia in long-term care was 26.98% (95% CI 22.0-32.26, p < 0.0001, I2 = 94.12%). The pooled prevalence of the risk of malnutrition in those with dementia was 57.43% (95% CI 49.39-65.28, p < 0.0001, I2 = 97.38%). Malnutrition is widespread in those with dementia living in long-term care. Further research exploring malnutrition in other industrialized countries using validated assessment tools is required.
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Affiliation(s)
- Emma Perry
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Karen Walton
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
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Pradelli L, Zaniolo O, Sanfilippo A, Lezo A, Riso S, Zanetti M. Prevalence and economic cost of malnutrition in Italy: A systematic review and metanalysis from the Italian Society of Artificial Nutrition and Metabolism (SINPE). Nutrition 2023; 108:111943. [PMID: 36669368 DOI: 10.1016/j.nut.2022.111943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Disease-related malnutrition (DRM) is a major public health issue with dramatic consequences on outcomes. However, in Italy a comprehensive and updated overview on national prevalence, in both the adult and pediatric populations, and its burden on the health care environment, is missing. The aim of this systematic literature review and meta-analysis was to identify and summarize the available evidence regarding the prevalence of DRM in Italy from pediatric to adult and older ages, and to project its global costs on the health care system. METHODS We performed a systematic literature search for articles on epidemiology of DRM in Italy published up to June 2021. Studies reporting data on the prevalence of DRM in community-dwelling individuals with chronic diseases, nursing home patients, and hospitalized patients (medical, surgery, and oncology patients), were selected for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria. An epidemiologic meta-analysis to obtain an aggregate estimate of prevalence of DRM was performed and a model for estimating the cost of illness, based on the application of epidemiologic results to official national hospitalization data, and attribution of relevant unit costs in the national context was constructed. RESULTS Sixty-seven studies reporting on the prevalence of DRM in Italian populations were included in the final selection; meta-analytical pooling yields mean prevalence estimates of about 50% and 30% in adult and pediatric hospitalized populations, respectively, with even higher findings for residents of long-term care facilities. Modeled projections of DRM-attributable yearly economic effects on the Italian health care system exceed 10 billion € in base case analysis, with the most optimistic estimate still exceeding 2.5 billion €. CONCLUSION Although comparable in magnitude to data from previous studies in analogous international settings, the diffusion and effects of DRM in the Italian setting is impressive. Increased awareness of these data and proactive fostering of clinical nutrition services are warranted, as prompt identification and treatment of malnutrition have been shown to effectively improve clinical and economic results.
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Affiliation(s)
| | | | | | - Antonella Lezo
- Clinical Nutrition Unit, Children's Hospital "Regina Margherita," AOU Città della Salute e della Scienza, Turin, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetic Unit - "Maggiore della Carità" University Hospital, Novara, Italy
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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Moses JS, John S, Monica SJ, Priyadarshini S. Determinants of Malnutrition among Elderly Women Living in Institutional Care. J Midlife Health 2023; 14:139-145. [PMID: 38029033 PMCID: PMC10664058 DOI: 10.4103/jmh.jmh_26_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/09/2023] [Accepted: 06/22/2023] [Indexed: 12/01/2023] Open
Abstract
Background Healthy aging and well-being are largely influenced by nutrition. Objective The objective of the study was to evaluate the risk of malnutrition in elderly women residing in institutional care and its contributing factors. Methodology One hundred institutionalized women aged 60 years and above were screened for malnutrition using Mini Nutritional Assessment (MNA) tool. Details on sociodemographic profile, physical activity, medical conditions, and food habits were gathered through researcher administered survey method. Results The study participants had an average height of 149.70 cm (±7.31), weight of 50.72 kg (±9.11), body mass index of 22.77 kg/m2 (±4.68), body fat percentage of 31.30% (±8.99), mid-arm circumference of 27.36 cm (±7.84), calf circumference of 30.11 cm (±7.51), MNA score of 10.42 (±4.06), and hand grip strength score of 18.69 kg/lbs (±3.80). Upon analyzing the MNA scores, it was found that 9% of elderly women were well nourished, 62% were at risk of malnutrition, and 29% were malnourished. A significant difference was observed in the mean MNA scores (P < 0.05). Age, education level, body fat percentage, appetite, and dental problems were significantly associated with malnutrition (P < 0.05). Conclusion Geriatric residents in old-age homes require adequate nutrition to maintain health. This can be achieved by providing individualized meal planning, reducing barriers to eating, and incorporating nutrient-dense foods.
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Affiliation(s)
- Jessica Subashini Moses
- Department of Home Science, Women’s Christian College (Autonomous), Chennai, Tamil Nadu, India
| | - Sheila John
- Department of Home Science, Women’s Christian College (Autonomous), Chennai, Tamil Nadu, India
| | - Sarah Jane Monica
- Department of Food Science, M.O.P Vaishnav College for Women (Autonomous), Chennai, Tamil Nadu, India
| | - S. Priyadarshini
- Department of Food Science, M.O.P Vaishnav College for Women (Autonomous), Chennai, Tamil Nadu, India
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Zhu L, Xia J, Shao X, Pu X, Chen J, Zhang J, Wu X, Zheng J, Wu D, Chen B. The relationship between the baseline geriatric nutritional risk index (GNRI) and neurological function at the convalescence stage in patients with stroke: a cross-sectional study. BMC Geriatr 2023; 23:173. [PMID: 36973674 PMCID: PMC10045810 DOI: 10.1186/s12877-023-03919-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Malnutrition is a common complication after stroke and may worsen neurological outcomes for patients. There are still no uniform tools for screening nutritional status for the patients with stroke. We aimed to explore the relationship between the baseline geriatric nutritional risk index (GNRI) and neurological function at the convalescence stage for patients with stroke and assessed the predictive value of the GNRI for adverse neurological outcomes. METHODS A total of 311 patients with stroke were enrolled retrospectively. Basic information and laboratory results on admission since onset of stroke were collected. The GNRI on admission was calculated and neurological outcomes evaluated by the Barthel index at 1 month after the onset of stroke. Statistical analyses, including correlation coefficient tests, multivariate regression analyses, and receiver operating characteristic (ROC) analyses, were applied in this study. RESULTS Compared with the good outcome group, the poor outcome group showed a significantly lower GNRI on admission (P < 0.05). GNRI was associated with Barthel index (r = 0.702, P < 0.01). The GNRI was independently correlated with the Barthel index (Standardization β = 0.721, P < 0.01) and poor outcome 0.885 (95% CIs, 0.855-0.917, P < 0.01) after adjusting for covariates. Compared with no nutritional risk grades (Q4), the OR of GNRI to poor neurological outcome increased across increasing nutritional risk grades of GNRI (OR = 2.803, 95% CIs = 1.330-5.909 in Q3, 7.992, 95% CIs = 3.294-19.387 in Q2 and 14.011, 95% CIs = 3.972-49.426 in Q1, respectively, P for trend < 0.001). The area under ROC curves (AUC) of the GNRI was 0.804, which was larger than that of the NIHSS, BMI, or Albumin (P < 0.01), with an optimal cut-off value of 97.69, sensitivity of 69.51% and specificity of 77.27%. Combined GNRI with NIHSS gained the largest AUC among all the variables (all P < 0.05), with an AUC of 0.855, sensitivity of 84.75 and specificity of 72.73%. CONCLUSIONS For patients with stroke, higher nutritional risk grades at baseline indicated worse neurological function at the convalescence stage. Compared with NIHSS, BMI, and Albumin, GNRI was a competitive indicator for the risk of poor neurological outcome. The predictive property of GNRI for adverse neurological outcomes might be more powerful when combined with NIHSS.
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Affiliation(s)
- Lielie Zhu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Jianning Xia
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Xiangzhi Shao
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Xinyu Pu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Jiajun Chen
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Jiacheng Zhang
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Xinming Wu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Jinyihui Zheng
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Dengchong Wu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China
| | - Bing Chen
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang, China.
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Li G, Zhou X, Hou X, Luo Y, Li D, Fan T. Association between serum albumin and mortality in Japan older people with dysphagia. Sci Rep 2022; 12:12089. [PMID: 35840689 DOI: 10.1038/s41598-022-16010-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 07/04/2022] [Indexed: 01/03/2023] Open
Abstract
To determine whether there is a link between serum albumin and mortality among participants in the elderly in Japan. This is a single-center,retrospective cohort study analysis of 253 old patients with dysphagia from Japan, conducted from January 2014 to January 2017. The primary outcome was mortality. We performed Cox regression analysis to compare the mortality between the two groups (divided by serum albumin = 3 g/dl). 253 patients were included in the analysis, of whom the number of serum albumin under 3 g/dl was 93. The log-rank test showed a significant longer mortality in the high group (serum albumin > = 3 g/dl) compared with the low group (median, 382 vs. 176 days, P < 0.0001). Cox regression analysis showed that unadjusted HR for the high group relative to the low group was 0.40 (95% CI: 0.29-0.57; P < 0.001). After adjusting 3 models in multivariable analysis, serum albumin was significantly associated with mortality. The adjusted HRs (95% CI) for total mortality rates were 0.46 (0.33-0.65), 0.66 (0.44-0.99) and 0.64 (0.42-0.97), from model 2 to model 4. There is negative association between serum albumin and mortality in Japanese old people with dysphagia.
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Nakamura Y, Imada A, Fukugaki A, Kanto S, Yamaura T, Kinjo Y, Kuroda N. Association of nutritional risk and systemic inflammation with survival in patients with colorectal cancer who underwent curative surgery. Clin Nutr ESPEN 2022; 49:417-424. [PMID: 35623847 DOI: 10.1016/j.clnesp.2022.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS Malnutrition and inflammation adversely affect the prognosis of patients with cancer. The Geriatric Nutritional Risk Index (GNRI) and systemic inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), lymphocyte-to-C reactive protein ratio (LCR), and C-reactive protein-to-albumin ratio (CAR), predict survival in colorectal cancer (CRC) patients. The present study aimed to examine the association of these two factors with CRC survival. METHODS Subjects were 433 consecutive CRC patients who underwent curative surgery between 2013 and 2018. Patients were stratified by nutritional status, and relationships between overall survival (OS) and systemic inflammation were evaluated. The prognostic impact of combinations of the GNRI and inflammatory markers was assessed. Multivariable analyses were also performed. RESULTS All assessed biomarkers predicted OS in univariable analysis (GNRI:P < 0.001, NLR:P = 0.048, LMR:P = 0.001, LCR:P = 0.010, CAR: P = 0.039). Stratified analysis showed that each inflammatory marker had a prognostic impact on OS in the low GNRI group (NLR:P = 0.028, LMR:P = 0.003, LCR:P = 0.05, CAR:P = 0.009). In contrast, inflammatory markers had no prognostic impact on OS in the high GNRI group. The combination of malnutrition and systemic inflammation had a high prognostic value (all P < 0.016). The multivariable analysis revealed that a low GNRI (hazard ratio: 2.58-2.89) was independently associated with reduced survival, whereas none of the inflammatory markers independently predicted poor prognosis. CONCLUSIONS The GNRI is a useful prognostic biomarker for CRC patients, whereas systemic inflammatory markers can only serve as prognostic factors when patient nutritional status is taken into account. The combination of malnutrition and systemic inflammation may enhance the accuracy of prognostic prediction.
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Affiliation(s)
- Yuya Nakamura
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan.
| | - Ayako Imada
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan
| | - Atsushi Fukugaki
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan
| | - Satoshi Kanto
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan
| | - Tadayoshi Yamaura
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan
| | - Yousuke Kinjo
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan
| | - Nobukazu Kuroda
- Department of Gastroenterological Surgery, Himeji Medical Center, 68 Honmachi, Himeji City, Hyogo, 670-8520, Japan
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Tenpaku Y, Satoh M, Kato K, Fujinaga K, Haruki Y, Nakahashi H, Morikawa K, Imaoka Y, Takemura H, Tatsumi H. Prediction of Postoperative Delirium after Gastrointestinal Surgery Using the Mie Constructional Apraxia Scale. Dement Geriatr Cogn Dis Extra 2021; 11:306-313. [PMID: 35082826 PMCID: PMC8740234 DOI: 10.1159/000520249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 11/19/2022] Open
Abstract
Background Postoperative delirium (POD) is a transient postoperative complication that occurs after surgical procedures. Risk factors reported for POD include dementia and cognitive decline. The purpose of this study was to identify predictors of POD by examining the use of preoperative neuropsychological tests, including the Mie Constructional Apraxia Scale (MCAS), and patient background factors. Method The study was performed as a retrospective cohort study. The subjects were 33 patients (mean age, 75.8 ± 10.9 years; male:female ratio, 26:7) who underwent gastrointestinal surgery at Matsusaka City Hospital between December 2019 and April 2021. Data were collected retrospectively from medical records. The study was started after receiving approval from the institution's ethics committee. The survey items included general patient information, nutritional assessment, surgical information, and neuropsychological tests. Subjects were classified into 2 groups according to the presence or absence of POD. If a significant difference was observed between the 2 groups, the sensitivity, specificity, and area under the curve were calculated using a receiver operating characteristic (ROC) curve. Result There were 10 patients in the POD group (male:female ratio, 6:4) and 23 patients in the non-POD group (20:3). The POD group had a shorter education history (p = 0.047) and significantly higher MCAS scores (p = 0.007) than the non-POD group. The ROC curve showed a sensitivity of 90%, a specificity of 69%, and an area under the curve of 0.798 when the MCAS cutoff value was set at 3 points. Conclusion Preoperative MCAS results were capable of predicting the occurrence of POD after gastrointestinal surgery. In addition, a relatively short education background was also considered a risk factor for POD.
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Affiliation(s)
- Yosuke Tenpaku
- Department of Rehabilitation, Matsusaka Municipal Hospital, Matsusaka, Japan
- *Yosuke Tenpaku,
| | - Masayuki Satoh
- Dementia Prevention and Therapeutics, Graduate School of Advanced Institute of Industrial Technology, Shinagawa, Japan
| | - Kenji Kato
- Department of Surgery, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Kazuhisa Fujinaga
- Department of Surgery, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Yuji Haruki
- Department of Surgery, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Hiroki Nakahashi
- Department of Surgery, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Keisuke Morikawa
- Department of Rehabilitation, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Yasunori Imaoka
- Department of Rehabilitation, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Hiroyuki Takemura
- Department of Rehabilitation, Matsusaka Municipal Hospital, Matsusaka, Japan
| | - Hiroshi Tatsumi
- Department of Health Science, Aichi Gakuin University, Nisshin, Japan
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Takahashi F, Hashimoto Y, Kaji A, Sakai R, Kawate Y, Okamura T, Kitagawa N, Okada H, Nakanishi N, Majima S, Senmaru T, Ushigome E, Asano M, Hamaguchi M, Yamazaki M, Fukui M. Association between Geriatric Nutrition Risk Index and The Presence of Sarcopenia in People with Type 2 Diabetes Mellitus: A Cross-Sectional Study. Nutrients 2021; 13:3729. [PMID: 34835985 PMCID: PMC8618310 DOI: 10.3390/nu13113729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of this cross-sectional study was to examine the association between the geriatric nutritional risk index (GNRI) and the prevalence of sarcopenia in people with type 2 diabetes (T2DM). Having both low handgrip strength (<28 kg for men and <18 kg for women) and low skeletal muscle mass index (<7.0 kg/m2 for men and <5.7 kg/m2 for women) was diagnosed as sarcopenia. GNRI was estimated by the formula as below: GNRI = (1.489 × serum albumin level [g/L]) + (41.7 × [current body weight (kg)/ideal body weight (kg)]). Participants were dichotomized on the basis of their GNRI scores (GNRI < 98, low; or GNRI ≥ 98, high). Among 526 people (301 men and 225 women) with T2DM, the proportions of participants with sarcopenia and low GNRI were 12.7% (n = 67/526) and 5.1% (n = 27/526), respectively. The proportion of sarcopenia in participants with low-GNRI was higher than that with high GNRI (44.4% [n = 12/27] vs. 11.0% [n = 55/499], p < 0.001). The GNRI showed positive correlations with handgrip strength (r = 0.232, p < 0.001) and skeletal muscle mass index (r = 0.514, p < 0.001). Moreover, low GNRI was related to the prevalence of sarcopenia (adjusted odds ratio, 4.88 [95% confidence interval: 1.88-12.7], p = 0.001). The GNRI, as a continuous variable, was also related to the prevalence of sarcopenia (adjusted odds ratio, 0.89 [95% confidence interval: 0.86-0.93], p < 0.001). The present study revealed that low GNRI was related to the prevalence of sarcopenia.
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Affiliation(s)
- Fuyuko Takahashi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Ayumi Kaji
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Ryosuke Sakai
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Yuka Kawate
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Takuro Okamura
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Noriyuki Kitagawa
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
- Department of Diabetology, Kameoka Municipal Hospital, 1-1 Noda, Shinochoshino, Kyoto 621-8585, Japan
| | - Hiroshi Okada
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
- Department of Diabetes and Endocrinology, Matsushita Memorial Hospital, 5-55 Sotojimacho, Osaka 570-8540, Japan
| | - Naoko Nakanishi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Saori Majima
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Takafumi Senmaru
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Mai Asano
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.A.); (M.H.); (M.Y.); (M.F.)
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Łukaszyk E, Bień-Barkowska K, Bień B. Identification of Mortality Risks in the Advancement of Old Age: Application of Proportional Hazard Models Based on the Stepwise Variable Selection and the Bayesian Model Averaging Approach. Nutrients 2021; 13:nu13041098. [PMID: 33801694 PMCID: PMC8066062 DOI: 10.3390/nu13041098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023] Open
Abstract
Identifying factors that affect mortality requires a robust statistical approach. This study’s objective is to assess an optimal set of variables that are independently associated with the mortality risk of 433 older comorbid adults that have been discharged from the geriatric ward. We used both the stepwise backward variable selection and the iterative Bayesian model averaging (BMA) approaches to the Cox proportional hazards models. Potential predictors of the mortality rate were based on a broad range of clinical data; functional and laboratory tests, including geriatric nutritional risk index (GNRI); lymphocyte count; vitamin D, and the age-weighted Charlson comorbidity index. The results of the multivariable analysis identified seven explanatory variables that are independently associated with the length of survival. The mortality rate was higher in males than in females; it increased with the comorbidity level and C-reactive proteins plasma level but was negatively affected by a person’s mobility, GNRI and lymphocyte count, as well as the vitamin D plasma level.
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Affiliation(s)
- Ewelina Łukaszyk
- Department of Geriatrics, Medical University of Bialystok, Fabryczna 27, 15-471 Bialystok, Poland;
- Geriatric Ward, Hospital of the Ministry of the Interior and Administration in Bialystok, 15-471 Białystok, Poland
- Correspondence: ; Tel.: +48-47-710-40-23
| | - Katarzyna Bień-Barkowska
- Institute of Econometrics, Warsaw School of Economics, Madalińskiego 6/8, 02-513 Warsaw, Poland;
| | - Barbara Bień
- Department of Geriatrics, Medical University of Bialystok, Fabryczna 27, 15-471 Bialystok, Poland;
- Geriatric Ward, Hospital of the Ministry of the Interior and Administration in Bialystok, 15-471 Białystok, Poland
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Takahara M, Iida O, Soga Y, Azuma N, Nanto S. Clinical Impact of Measures for Frailty Severity in Poor-Risk Patients Undergoing Revascularization for Chronic Limb-Threatening Ischemia. J Atheroscler Thromb 2021; 29:221-228. [PMID: 33518553 PMCID: PMC8803558 DOI: 10.5551/jat.61481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim:
This study aimed to demonstrate the clinical impact of various frailty-related aspects in poor-risk patients undergoing revascularization for chronic limb-threatening ischemia (CLTI).
Methods:
We analyzed a clinical database of a prospective multicenter observational study. A total of 562 CLTI patients who required assistance for their daily lives and were candidates for revascularization were included. We examined various measures of frailty severity, including activities of daily living (ADL)/mobility, physical performance, nutritional status, cognitive function, and cardiac function at baseline (before revascularization). Data on inflammatory markers at baseline and ADL/mobility before CLTI onset were also collected.
Results:
The patients were aged 77±10 years, 65% were non-ambulatory, and 38% were categorized as mild dementia or severer. The correlation coefficients between the frailty measures ranged from 0.00 to 0.91. The random forest analysis for one-year mortality risk showed that these frailty-related measures, as well as age and inflammatory markers, had a relatively high variable importance compared with comorbidities and limb severity.
Conclusion:
The correlations between measures of frailty severity were not always strong but rather widely varied in CLTI patients who required assistance for their daily lives and were candidates for revascularization. Measures of frailty severity, as well as age and inflammatory markers, had a relatively large predictive impact on one-year mortality risk compared with comorbidities and limb severity in the population.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, and Department of Metabolic Medicine, Osaka University Graduate School of Medicine
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Shinsuke Nanto
- Department of Cardiology, Nishinomiya Municipal Central Hospital
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Abstract
BACKGROUND Various factors affect the mortality of older adult residents of long-term care facilities. To provide adequate nursing care for older adults, it is necessary to understand the factors that affect their risk of mortality. PURPOSE This study was designed to (a) evaluate the 24-month survival rate and (b) identify the underlying cause of death in various dimensions, including cognitive, psychological, and physical function; nutritional status; and chronic disease. METHODS A longitudinal study was carried out between 2011 and 2013 at seven long-term care facilities. The participants comprised 276 residents who were all older than 65 years old. Baseline measurements included cognitive function (Mini-Mental State Examination for Dementia Screening), psychological function (Cornell Scale for Depression in Dementia), physical function (Barthel Index), nutritional status (Mini Nutritional Assessment, mid-arm circumference, and calf circumference), and chronic disease status (hypertension, diabetes mellitus, chronic respiratory disease, heart disease, and urinary incontinence). Data analysis included univariate and multivariate logistic regression to identify the main factors affecting mortality. RESULTS In 2011 (baseline), the mean age of the participants was 80.46 years (SD = 7.08) and most were female (73.6%). At the 24-month follow-up, 94 (34.1%) of the participants had died. The major factors affecting mortality were as follows: cognitive dysfunction (OR = 3.12, 95% CI [1.41, 6.90]), mid-arm circumference (< 22.5 cm; OR = 2.32, 95% CI [1.35, 3.96]), and urinary incontinence (OR = 2.04, 95% CI [1.16, 3.61]). CONCLUSIONS According to the findings, special attention is needed at the end of life to improve the quality of life of older adults with cognitive dysfunction, malnutrition (low mid-arm circumference), and urinary incontinence who reside in long-term care facilities.
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Mertes G, Ding L, Chen W, Hallez H, Jia J, Vanrumste B. Measuring and Localizing Individual Bites Using a Sensor Augmented Plate During Unrestricted Eating for the Aging Population. IEEE J Biomed Health Inform 2020; 24:1509-1518. [DOI: 10.1109/jbhi.2019.2932011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hao X, Li D, Zhang N. Geriatric Nutritional Risk Index as a predictor for mortality: a meta-analysis of observational studies. Nutr Res 2019; 71:8-20. [DOI: 10.1016/j.nutres.2019.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022]
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Keller H, Vucea V, Slaughter SE, Jager-Wittenaar H, Lengyel C, Ottery FD, Carrier N. Prevalence of Malnutrition or Risk in Residents in Long Term Care: Comparison of Four Tools. J Nutr Gerontol Geriatr 2019; 38:329-344. [PMID: 31335280 DOI: 10.1080/21551197.2019.1640165] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The ideal tool for determination of malnutrition risk or malnutrition in long term care (LTC) is elusive. This study compares prevalence, association with resident risk factors and sensitivity (SE) and specificity (SP) of malnutrition or risk categorization in 638 residents from 32 LTC homes in Canada using four tools: the Mini-Nutritional Assessment Short Form (MNA-SF); Patient-Generated Subjective Global Assessment (PG-SGA) Global Category Rating and the Pt-Global webtool; and the interRAI Long Term Care Facility undernutrition trigger. Prevalence was most common with MNA-SF (53.7%) and lowest with InterRAI (28.9%), while the PG-SGA Global Category Rating (44%) was higher than the Pt-Global webtool (33.4%). Tools were consistently associated with resident covariates with few exceptions. The PG-SGA Global Category Rating demonstrated the best sensitivity and specificity when compared to all other tools. Further work to determine the predictive validity of this tool in LTC residents is required.
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Affiliation(s)
- Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo , Waterloo , Canada
- Faculty of Applied Health Sciences, University of Waterloo , Waterloo , ON , Canada
| | - Vanessa Vucea
- Faculty of Applied Health Sciences, University of Waterloo , Waterloo , ON , Canada
| | - Susan E Slaughter
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta , Edmonton , Canada
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences , Groningen , The Netherlands
- Department of Maxillofacial Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Christina Lengyel
- Faculty of Agricultural and Food Sciences, University of Manitoba , Winnipeg , Canada
| | - Faith D Ottery
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences , Groningen , The Netherlands
- Ottery and Associates , Vernon Hills , IL , USA
| | - Natalie Carrier
- École des sciences des aliments, de nutrition et d'études familiales, Faculté des sciences de la santé et des services communautaires, Université de Moncton , Moncton , Canada
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Nishioka S, Omagari K, Nishioka E, Mori N, Taketani Y, Kayashita J. Concurrent and predictive validity of the Mini Nutritional Assessment Short-Form and the Geriatric Nutritional Risk Index in older stroke rehabilitation patients. J Hum Nutr Diet 2019; 33:12-22. [PMID: 31435986 DOI: 10.1111/jhn.12699] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Malnutrition may worsen clinical outcomes in stroke patients. Few malnutrition screening tools have been validated in the rehabilitation setting. The present study aimed to assess the concurrent and predictive validity of two malnutrition screening tools. METHODS We retrospectively collected scores for the Mini Nutritional Assessment Short-Form (MNA-SF) and the Geriatric Nutritional Risk Index (GNRI) in consecutive stroke patients aged ≥65 years in a rehabilitation hospital. Concurrent validity was confirmed against the European Society for Clinical Nutrition and Metabolism diagnostic criteria for malnutrition (ESPEN-DCM). Malnutrition risk within the ESPEN-DCM process was assessed using the Malnutrition Universal Screening Tool. Cut-off values with maximum Youden index, and with sensitivity (Se) >90% and specificity (Sp) >50%, were defined as appropriate for identification and screening of malnutrition, respectively. The Functional Independence Measure and discharge destination were used to explore predictive validity. RESULTS Overall, 420 patients were analysed. Of these, we included 125 patients in the malnutrition group and 295 in the non-malnutrition group based on the ESPEN-DCM. Cut-off values for the identification and screening of malnutrition were 5 (Se: 0.78; Sp: 0.85) and 7 (Se: 0.96; Sp: 0.57) for the MNA-SF; 92 (Se: 0.74; Sp: 0.84) and 98 (Se: 0.93; Sp: 0.50) for the GNRI, respectively. The GNRI predicted discharge to acute care hospital, whereas the MNA-SF did not predict all outcome measures. CONCLUSIONS The MNA-SF and the GNRI have a fair concurrent validity in stroke patients, although lower cut-off values than currently used were required for the MNA-SF. The GNRI exhibits good predictive validity for discharge destination.
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Affiliation(s)
- S Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan.,Graduate School of Human Health Science, University of Nagasaki, Nagasaki, Japan.,Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - K Omagari
- Graduate School of Human Health Science, University of Nagasaki, Nagasaki, Japan
| | - E Nishioka
- Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - N Mori
- Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Y Taketani
- Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - J Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
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Wang Y, Wang L, Fang M, Li J, Song T, Zhan W, Xu H. Prognostic Value of the Geriatric Nutritional Risk Index in Patients Exceeding 70 Years Old with Esophageal Squamous Cell Carcinoma. Nutr Cancer 2019; 72:620-626. [PMID: 31390885 DOI: 10.1080/01635581.2019.1650189] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
To investigate the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in esophageal squamous cell carcinoma (ESCC) patients treated with radiotherapy (RT) or definitive concurrent chemoradiotherapy (dCRT). Fifty-two ESCC patients were included from July 2014 to December 2018. RT was delivered at a dose of 1.8-2.0 Gy per day to a total dose of 50-60 Gy. Tumor response was assessed using the RECIST 1.1 system. Overall survival (OS) and progression-free survival (PFS) were calculated and compared with the Kaplan-Meier method. Multivariate analysis of predictive factors of response and survival was performed using a logistic regression and a Cox model, respectively. In multivariate analysis, GNRI score (HR 0.278, P = 0.036) was the only independent prognostic factor for tumor response. As for survival outcomes, GNRI score (OS: HR 0.505, P = 0.028; PFS: HR 0.583, P = 0.045) and treatment modality (OS: HR 0.356, P = 0.015; PFS: HR 0.392, P = 0.0014) were both independent prognostic factors for better OS and PFS. Additionally, there was no correlation between GNRI score and treatment modality (Spearman's ρ = 0.200; P = 0.154). In conclusion, routine use of the GNRI criteria may help in the risk stratification of elderly patients undergoing RT/dCRT. The dCRT treatment could provide survival benefits for elderly ESCC patients.
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Affiliation(s)
- Ying Wang
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Lei Wang
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Min Fang
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Jianbo Li
- Department of Radiation Oncology, Ningbo Mingzhou Hospital, Ningbo, P.R. China
| | - Tao Song
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Wenming Zhan
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Hong'en Xu
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
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Abd-Elraheem M, Mashav N, Ioffe M, Kremer A, Justo D. Which laboratory malnutrition markers best predict 1-year mortality in hospitalized older adults? Eur Geriatr Med 2019; 10:619-24. [PMID: 34652737 DOI: 10.1007/s41999-019-00204-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/08/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE To study which laboratory malnutrition markers best predict 1-year mortality in the general population of hospitalized older adults as well as among patients at risk for malnutrition. METHODS A historical prospective study. All older adults (age ≥ 65 years) hospitalized in one geriatric department during 9 months were included. Malnutrition Universal Screening Tool (MUST) was used to determine malnutrition risk. Laboratory malnutrition markers included albumin serum levels, transferrin serum levels, total cholesterol serum levels, vitamin D serum levels, and lymphocyte count. A receiver operating characteristic (ROC) curve analysis was used to study which markers best predict 1-year mortality. RESULTS Overall, 437 patients (63.2% women; mean age 84.7 years) were included. Overall, 126 (28.8%) patients died in the year following admission. ROC curve analysis showed that low albumin serum levels best predict 1-year mortality (AUC 0.721, p < 0.001), followed by low transferrin serum levels (AUC 0.661, p < 0.001) and low lymphocyte count (AUC 0.575, p = 0.016). Among 178 (40.7%) patients at risk for malnutrition, 63 (35.4%) patients died in the year following admission. ROC curve analysis showed that albumin serum levels best predict 1-year mortality in patients at risk for malnutrition (AUC 0.720, p < 0.001), followed by transferrin serum levels (AUC 0.659, p = 0.001). Regression analysis showed that low albumin serum levels were also independently associated with 1-year mortality among the whole cohort and among patients at risk for malnutrition (OR 0.2, 95% CI 0.1-0.4, p < 0.001, for both). CONCLUSIONS Low albumin serum levels best predict 1-year mortality in hospitalized older adults, followed by low transferrin serum levels.
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Power L, Mullally D, Gibney ER, Clarke M, Visser M, Volkert D, Bardon L, de van der Schueren MAE, Corish CA. A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study. Clin Nutr ESPEN 2019; 24:1-13. [PMID: 29576345 DOI: 10.1016/j.clnesp.2018.02.005] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Older adults are at increased risk of malnutrition compared to their younger counterparts. Malnutrition screening should be conducted using a valid malnutrition screening tool. An aim of the Healthy Diet for a Healthy Life (HDHL) Joint Programming Initiative (JPI) 'Malnutrition in the Elderly Knowledge Hub' (MaNuEL) was to review the reported validity of existing malnutrition screening tools used in older adults. METHODS A literature search was conducted to identify validation studies of malnutrition screening tools in older populations in community, rehabilitation, residential care and hospital settings. A database of screening tools was created containing information on how each tool was validated. RESULTS Seventy-four articles containing 119 validation studies of 34 malnutrition screening tools used in older adults were identified across the settings. Twenty-three of these tools were designed for older adults. Sensitivity and specificity ranged from 6 to 100% and 12-100% respectively. Seventeen different reference standards were used in criterion validation studies. Acceptable reference standards were used in 68 studies; 38 compared the tool against the Mini Nutritional Assessment-Full Form (MNA-FF), 16 used clinical assessment by a nutrition-trained professional and 14 used the Subjective Global Assessment (SGA). Twenty-five studies used inappropriate reference standards. Predictive validity was measured in 14 studies and was weak across all settings. CONCLUSIONS Validation results differed significantly between tools, and also between studies using the same tool in different settings. Many studies have not been appropriately conducted, leaving the true validity of some tools unclear. Certain tools appear to be more valid for use in specific settings.
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Affiliation(s)
- Lauren Power
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Deirdre Mullally
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Michelle Clarke
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marjolein Visser
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands.
| | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Laura Bardon
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marian A E de van der Schueren
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
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Shoji F, Matsubara T, Kozuma Y, Haratake N, Akamine T, Takamori S, Katsura M, Toyokawa G, Okamoto T, Maehara Y. Preoperative Geriatric Nutritional Risk Index: A predictive and prognostic factor in patients with pathological stage I non-small cell lung cancer. Surg Oncol 2017; 26:483-488. [PMID: 29113668 DOI: 10.1016/j.suronc.2017.09.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/20/2017] [Accepted: 09/24/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Surgical outcomes of early-stage non-small cell lung cancer (NSCLC) are poor. The Geriatric Nutritional Risk Index (GNRI) is a useful parameter for evaluating nutritional status. We aimed to investigate if preoperative GNRI could be a predictive factor for pathological stage I NSCLC patients. PATIENTS AND METHODS We retrospectively selected 141 consecutive pathological stage I NSCLC patients treated from August 2005 to August 2010. We analyzed their preoperative GNRI in univariate and multivariate Cox regression analyses for postoperative recurrence-free survival (RFS). RESULTS A preoperative abnormal GNRI was significantly associated with postoperative recurrence (P = 0.0107). Univariate analyses showed that serum carcinoembryonic antigen (CEA) levels (P = 0.0013), preoperative serum albumin level (P < 0.0001), preoperative GNRI (P = 0.0009), pleural invasion (P < 0.0001) and blood vessel invasion (P = 0.0137) significantly affected RFS. In multivariate analysis, preoperative GNRI (P = 0.0084), CEA level (P = 0.0031), preoperative serum albumin level (P = 0.0041) and pleural invasion (P = 0.0018) were independent prognostic factors. In Kaplan-Meier analysis of RFS, cancer-specific survival (CS), and overall survival (OS) by preoperative GNRI, the abnormal GNRI group had significantly shorter RFS, CS, and OS (5-year RFS, CS, and OS: 52.81% vs. 89.15%; P < 0.0001, 81.73% vs. 94.73%; P = 0.0014 and 50.84% vs. 89.57%; P < 0.0001, log-rank test, respectively). CONCLUSIONS Preoperative GNRI is a novel prognostic factor for pathological stage I NSCLC patients, which can identify high-risk patients for postoperative recurrence and cancer-related death.
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Affiliation(s)
- Fumihiro Shoji
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan.
| | - Taichi Matsubara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Yuka Kozuma
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Naoki Haratake
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Takaki Akamine
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Shinkichi Takamori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Masakazu Katsura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Gouji Toyokawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Tatsuro Okamoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Japan
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Abstract
OBJECTIVES The aim of this study was to elucidate the impact of nutritional status on survival per Controlling Nutritional Status (CONUT) score and Geriatric Nutritional Risk Index (GNRI) in patients with hypertension over 80 years of age. DESIGN Prospective follow-up study. PARTICIPANTS A total of 336 hypertensive patients over 80 years old were included in this study. OUTCOME MEASURES All-cause deaths were recorded as Kaplan-Meier curves to evaluate the association between CONUT and all-cause mortality at follow-up. Cox regression models were used to investigate the prognostic value of CONUT and GNRI for all-cause mortality in the 90-day period after admission. RESULTS Hypertensive patients with higher CONUT scores exhibited higher mortality within 90 days after admission (1.49%, 6.74%, 15.38%, respectively, χ2=30.92, p=0.000). Surviving patients had higher body mass index (24.25±3.05 vs 24.25±3.05, p=0.012), haemoglobin (123.78±17.05 vs 115.07±20.42, p=0.040) and albumin levels, as well as lower fasting blood glucose (6.90±2.48 vs 8.24±3.51, p=0.010). Higher GRNI score (99.42±6.55 vs 95.69±7.77, p=0.002) and lower CONUT (3.13±1.98 vs 5.14±2.32) both indicated better nutritional status. Kaplan-Meier curves indicated that survival rates were significantly worse in the high-CONUT group compared with the low-CONUT group (χ1 =13.372, p=0.001). Cox regression indicated an increase in HR with increasing CONUT risk (from normal to moderate to severe). HRs (95% CI) for 3-month mortality was 1.458 (95% CI 1.102 to 1.911). In both respiratory tract infection and 'other reason' groups, only CONUT was a sufficiently predictor for all-cause mortality (HR=1.284, 95% CI 1.013 to 1.740, p=0.020 and HR=1.841, 95% CI 1.117 to 4.518, p=0.011). Receiver operating characteristic showed that CONUT higher than 3.0 was found to predict all-cause mortality with a sensitivity of 77.8% and a specificity of 64.7% (area under the curve=0.778, p<0.001). CONCLUSION Nutritional status assessed via CONUT is an accurate predictor of all-cause mortality 90 days postadmission. Evaluation of nutritional status may provide additional prognostic information in hypertensive patients.
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Affiliation(s)
- Xiaonan Sun
- Department of Geriatric Cardiolog, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Leiming Luo
- Department of Geriatric Cardiolog, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiaoqian Zhao
- Department of Cardiology, Chinese People’s Liberation Army 305 Hospital, Beijing, China
| | - Ping Ye
- Department of Geriatric Cardiolog, Chinese People’s Liberation Army General Hospital, Beijing, China
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24
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Salinero-Fort MA, San Andrés-Rebollo FJ, Gómez-Campelo P, de Burgos-Lunar C, Cárdenas-Valladolid J, Abánades-Herranz JC, Otero-Puime A, Jiménez-García R, López-de-Andrés A, de Miguel-Yanes JM. Body mass index and all-cause mortality among type 2 diabetes mellitus patients: Findings from the 5-year follow-up of the MADIABETES cohort. Eur J Intern Med 2017; 43:46-52. [PMID: 28679485 DOI: 10.1016/j.ejim.2017.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 06/18/2017] [Accepted: 06/21/2017] [Indexed: 10/24/2022]
Abstract
PURPOSE To analyse the association between body mass index (BMI) and all-cause mortality in a 5-year follow-up study with Spanish type 2 diabetes mellitus (T2DM) patients, seeking gender differences. METHODS 3443 T2DM outpatients were studied. At baseline and annually, patients were subjected to anamnesis, a physical examination, and biochemical tests. Data about demographic and clinical characteristics was also recorded, as was the treatment each patient had been prescribed. Mortality records were obtained from the Spanish National Institute of Statistics. Survival curves for BMI categories (Gehan-Wilcoxon test) and a multivariate Cox proportional hazard analysis were performed to identify adjusted Hazard Ratios (HRs) of mortality. RESULTS Mortality rate was 26.38 cases per 1000patient-years (95% CI, 23.92-29.01), with higher rates in men (28.43 per 1000patient-years; 95% CI, 24.87-32.36) than in women (24.31 per 1000patient-years; 95% CI, 21.02-27.98) (p=0.079). Mortality rates according to BMI categories were: 56.7 (95% CI, 40.8-76.6), 28.4 (95% CI, 22.9-34.9), 24.8 (95% CI, 21.5-28.5), 21 (95% CI, 16.3-26.6) and 23.7 (95% CI, 14.3-37) per 1000person-years for participants with a BMI of <23, 23-26.8, 26.9-33.1, 33.2-39.4, and >39.4kg/m2, respectively. The BMI values associated with the highest all-cause mortality were <23kg/m2, but only in males [HR: 2.78 (95% CI, 1.72-4.49; p<0.001)], since in females this association was not significant [HR: 1.14 (95% CI, 0.64-2.04; p=0.666)] (reference category for BMI: 23.0-26.8kg/m2). Higher BMIs were not associated with higher mortality rates. CONCLUSIONS In an outpatient T2DM Mediterranean population sample, low BMI predicted all-cause mortality only in males.
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Affiliation(s)
- M A Salinero-Fort
- Subdirección General de Investigación Sanitaria, Consejería de Sanidad, Madrid, Spain; MADIABETES Research Group, Spain; Aging and Fragility in the Elderly Group-IdiPAZ, Madrid, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
| | | | - P Gómez-Campelo
- MADIABETES Research Group, Spain; Aging and Fragility in the Elderly Group-IdiPAZ, Madrid, Spain; Plataforma de Apoyo al Investigador Novel (PAIN Platform), Hospital La Paz Institute for Health Research (IdiPAZ), Servicio Madrileño de Salud, Madrid, Spain
| | - C de Burgos-Lunar
- MADIABETES Research Group, Spain; Aging and Fragility in the Elderly Group-IdiPAZ, Madrid, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain; Dirección General de Salud Pública, Subdirección de Promoción, Prevención y Educación de la Salud, Consejería de Sanidad, Madrid, Spain
| | - J Cárdenas-Valladolid
- MADIABETES Research Group, Spain; Aging and Fragility in the Elderly Group-IdiPAZ, Madrid, Spain; Dirección Técnica Sistemas de Información, Gerencia Asistencial de Atención Primaria, Madrid, Spain
| | - J C Abánades-Herranz
- MADIABETES Research Group, Spain; Aging and Fragility in the Elderly Group-IdiPAZ, Madrid, Spain; Centro de Salud Monóvar, Servicio Madrileño de Salud, Madrid, Spain
| | - A Otero-Puime
- Departamento de Medicina y Salud Pública, Facultad de Medicina, Universidad Autónoma, Madrid, Spain
| | - R Jiménez-García
- MADIABETES Research Group, Spain; Departamento de Medicina Preventiva y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (Campus de Alcorcón), Madrid, Spain
| | - A López-de-Andrés
- MADIABETES Research Group, Spain; Departamento de Medicina Preventiva y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (Campus de Alcorcón), Madrid, Spain
| | - J M de Miguel-Yanes
- MADIABETES Research Group, Spain; Hospital Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
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Zhang Z, Pereira SL, Luo M, Matheson EM. Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis. Nutrients 2017; 9:E829. [PMID: 28771192 PMCID: PMC5579622 DOI: 10.3390/nu9080829] [Citation(s) in RCA: 254] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/22/2017] [Accepted: 07/31/2017] [Indexed: 01/04/2023] Open
Abstract
Malnutrition is a common yet under-recognized problem in hospitalized patients. The aim of this paper was to systematically review and evaluate malnutrition biomarkers among order adults. Eligible studies were identified through Cochrane, PubMed and the ProQuest Dialog. A meta-regression was performed on concentrations of biomarkers according to malnutrition risks classified by validated nutrition assessment tools. A total of 111 studies were included, representing 52,911 participants (55% female, 72 ± 17 years old) from various clinical settings (hospital, community, care homes). The estimated BMI (p < 0.001) and concentrations of albumin (p < 0.001), hemoglobin (p < 0.001), total cholesterol (p < 0.001), prealbumin (p < 0.001) and total protein (p < 0.05) among subjects at high malnutrition risk by MNA were significantly lower than those without a risk. Similar results were observed for malnutrition identified by SGA and NRS-2002. A sensitivity analysis by including patients with acute illness showed that albumin and prealbumin concentrations were dramatically reduced, indicating that they must be carefully interpreted in acute care settings. This review showed that BMI, hemoglobin, and total cholesterol are useful biomarkers of malnutrition in older adults. The reference ranges and cut-offs may need to be updated to avoid underdiagnosis of malnutrition.
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Affiliation(s)
- Zhiying Zhang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA.
- Abbott Nutrition Research and Development Asia-Pacific Center, 138668 Singapore, Singapore.
| | | | - Menghua Luo
- Abbott Nutrition Research and Development, Columbus, OH 43219, USA.
| | - Eric M Matheson
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29412, USA.
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Söderström L, Rosenblad A, Thors Adolfsson E, Bergkvist L. Malnutrition is associated with increased mortality in older adults regardless of the cause of death. Br J Nutr 2017; 117:532-40. [DOI: 10.1017/s0007114517000435] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AbstractMalnutrition predicts preterm death, but whether this is valid irrespective of the cause of death is unknown. The aim of the present study was to determine whether malnutrition is associated with cause-specific mortality in older adults. This cohort study was conducted in Sweden and included 1767 individuals aged ≥65 years admitted to hospital in 2008–2009. On the basis of the Mini Nutritional Assessment instrument, nutritional risk was assessed as well nourished (score 24–30), at risk of malnutrition (score 17–23·5) or malnourished (score <17). Cause of death was classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, into twenty different causes of death. Data were analysed using Cox proportional hazards regression models. At baseline, 55·1 % were at risk of malnutrition, and 9·4 % of the participants were malnourished. During a median follow-up of 5·1 years, 839 participants (47·5 %) died. The multiple Cox regression model identified significant associations (hazard ratio (HR)) between malnutrition and risk of malnutrition, respectively, and death due to neoplasms (HR 2·43 and 1·32); mental or behavioural disorders (HR 5·73 and 5·44); diseases of the nervous (HR 4·39 and 2·08), circulatory (HR 1·95 and 1·57) or respiratory system (HR 2·19 and 1·49); and symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (HR 2·23 and 1·43). Malnutrition and risk of malnutrition are associated with increased mortality regardless of the cause of death, which emphasises the need for nutritional screening to identify older adults who may require nutritional support in order to avoid preterm death.
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Ferrah N, Ibrahim JE, Kipsaina C, Bugeja L. Death Following Recent Admission Into Nursing Home From Community Living: A Systematic Review Into the Transition Process. J Aging Health 2017; 30:584-604. [PMID: 28553803 DOI: 10.1177/0898264316686575] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study examines the impact of the transition process on the mortality of elderly individuals following their first admission to nursing home from the community at 1, 3, and 6 months postadmission, and causes and risk factors for death. Method: A systematic review of relevant studies published between 2000 and 2015 was conducted using key search terms: first admission, death, and nursing homes. Results: Eleven cohort studies met the inclusion criteria. Mortality within the first 6 month postadmission varied from 0% to 34% (median = 20.2). Causes of deaths were not reported. Heightened mortality was not wholly explained by intrinsic resident factors. Only two studies investigated the influence of facility factors, and found an increased risk in facilities with high antipsychotics use. Discussion: Mortality in the immediate period following admission may not simply be due to an individual’s health status. Transition processes and facility characteristics are potentially independent and modifiable risk factors.
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Affiliation(s)
| | | | | | - Lyndal Bugeja
- Monash University, Victoria, Australia
- Coroners Court of Victoria, Australia
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28
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Martucci RB, Barbosa MV, D'Almeida CA, Rodrigues VD, Bergmann A, de Pinho NB, Thuler LCS. Undernutrition as independent predictor of early mortality in elderly cancer patients. Nutrition 2017; 34:65-70. [DOI: 10.1016/j.nut.2016.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
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Cereda E, Pedrolli C, Klersy C, Bonardi C, Quarleri L, Cappello S, Turri A, Rondanelli M, Caccialanza R. Nutritional status in older persons according to healthcare setting: A systematic review and meta-analysis of prevalence data using MNA ®. Clin Nutr 2016; 35:1282-1290. [DOI: 10.1016/j.clnu.2016.03.008] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 02/12/2016] [Accepted: 03/14/2016] [Indexed: 01/26/2023]
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Donini LM, Poggiogalle E, Molfino A, Rosano A, Lenzi A, Rossi Fanelli F, Muscaritoli M. Mini-Nutritional Assessment, Malnutrition Universal Screening Tool, and Nutrition Risk Screening Tool for the Nutritional Evaluation of Older Nursing Home Residents. J Am Med Dir Assoc 2016; 17:959.e11-8. [DOI: 10.1016/j.jamda.2016.06.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 12/15/2022]
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Harding KM, Dyo M, Goebel JR, Gorman N, Levine J. Early malnutrition screening and low cost protein supplementation in elderly patients admitted to a skilled nursing facility. Appl Nurs Res 2016; 31:29-33. [DOI: 10.1016/j.apnr.2015.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 11/30/2015] [Accepted: 12/02/2015] [Indexed: 01/04/2023]
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32
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Gärtner S, Kraft M, Krüger J, Vogt LJ, Fiene M, Mayerle J, Aghdassi AA, Steveling A, Völzke H, Baumeister SE, Lerch MM, Simon P. Geriatric nutritional risk index correlates with length of hospital stay and inflammatory markers in older inpatients. Clin Nutr 2016; 36:1048-1053. [PMID: 27426416 DOI: 10.1016/j.clnu.2016.06.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 03/31/2016] [Accepted: 06/27/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS Malnutrition is a prevalent condition in older inpatients and has been shown to increase morbidity and direct medical costs. A number of established tools to assess malnutrition are available but malnourished patients rarely receive adequate nutritional assessment and treatment. The medical and economic consequences of malnutrition in hospitalized patients are therefore often underestimated. This study investigates whether the Geriatric Nutritional Risk Index (GNRI) predicts hospital mortality, correlates with length of hospital stay (LOS) and inflammatory markers in older inpatients. METHODS We conducted a prospective monocentric study in 500 hospital patients over 65 years of age (female: 248; male: 252; age: 76.3 ± 0.31 years). GNRI was correlated to C-reactive protein (CRP), lymphocyte count, LOS and all-cause mortality, adjusted for potential confounders. RESULTS The median body mass index was 24.1 (25th percentile: 21.1; 75th percentile: 27.8) kg/m2 and the mean GNRI 82.2 ± 0.56. A higher risk GNRI was associated with increased CRP levels (p < 0.05) and low lymphocyte counts (p < 0.05) after multivariable adjustment. Moreover, we found positive correlation between a higher risk GNRI and length of hospital stay, whereas, the association with in-hospital mortality was not significant. CONCLUSIONS The GNRI correlates well with indicators of inflammation and the length of hospital stay. The routine implementation of the GNRI for the nutritional assessment of older patients could have a significant medical and socio-economic impact.
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Affiliation(s)
- Simone Gärtner
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Matthias Kraft
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Janine Krüger
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Lena J Vogt
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Michael Fiene
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Julia Mayerle
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Ali A Aghdassi
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Antje Steveling
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Henry Völzke
- Institute for Community Medicine, Walter-Rathenau-Str. 48, 17475, Greifswald, Germany.
| | | | - Markus M Lerch
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Peter Simon
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
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Bo Y, Wang K, Liu Y, You J, Cui H, Zhu Y, Lu Q, Yuan L. The Geriatric Nutritional Risk Index Predicts Survival in Elderly Esophageal Squamous Cell Carcinoma Patients with Radiotherapy. PLoS One 2016; 11:e0155903. [PMID: 27196126 PMCID: PMC4873221 DOI: 10.1371/journal.pone.0155903] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/05/2016] [Indexed: 11/19/2022] Open
Abstract
The impact of nutritional status on survival among elderly esophageal squamous cell carcinoma (ESCC) patients undergoing radiotherapy is unclear. In this study, we aimed at validating the performance of the geriatric nutritional risk index (GNRI) in predicting overall survival time in elderly ESCC patients with radiotherapy. A retrospective cohort study was conducted on 239 ESCC patients aged 60 and over admitted consecutively from January 2008 to November 2014 in the Department of Radiotherapy, Henan Tumor Hospital (Affiliated Tumor Hospital of Zhengzhou University), Zhengzhou, Henan, China. All patients were subjected to nutritional screening using GNRI, and were followed for the occurrence of lymphatic node metastasis, radiation complication and mortality. The Kaplan-Meier method with Log-rank test was used to estimate survival curves. Univariable Cox regression analysis was used to identify variables associated with overall survival time. Among the 239 patients, 184 patients (76.9%) took no nutritional risk, 32 patients (13.4%) took moderate risk of malnutrition, and 23 patients (9.7%) took a high risk of malnutrition. Univariable Cox regression showed that both high nutritional risk group and moderate nutritional risk group were significantly less likely to survive than no nutritional risk patients (hazard ratio (HR) = 1.688, 95% confidence interval (CI) = 1.019-2.798 for moderate risk group, and HR = 2.699, 95% CI = 1.512-4.819 for high risk group, respectively). The GNRI is an independent prognostic factor for overall survival time in elderly ESCC patients with radiotherapy. A GNRI ≤98 can be suggested as an indicator of surviving less.
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Affiliation(s)
- Yacong Bo
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of radiotherapy, Henan Tumor Hospital, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Kunlun Wang
- Department of radiotherapy, Henan Tumor Hospital, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Liu
- Department of radiotherapy, Henan Tumor Hospital, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie You
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Han Cui
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yiwei Zhu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Quanjun Lu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, China
- * E-mail: (QJL); (LY)
| | - Ling Yuan
- Department of radiotherapy, Henan Tumor Hospital, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
- * E-mail: (QJL); (LY)
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Yim GW, Eoh KJ, Kim SW, Nam EJ, Kim YT. Malnutrition Identified by the Nutritional Risk Index and Poor Prognosis in Advanced Epithelial Ovarian Carcinoma. Nutr Cancer 2016; 68:772-9. [PMID: 27044606 DOI: 10.1080/01635581.2016.1159702] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ovarian cancer is a chronic disease with a risk of malnutrition. Nutritional Risk Index (NRI) has been reported as a simple and accurate tool to assess the nutritional status. We sought to explore the prevalence of malnutrition and its association with survival in ovarian cancer. A retrospective study was conducted in 213 advanced ovarian cancer patients. NRI was calculated before and at the end of treatment using patients' body weight and serum albumin level. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier method, and associations were assessed using a Cox proportional hazards analysis adjusted for known prognostic variables. Moderate to severely malnourished patients had lower 5-yr OS (45.3%) compared to normal to mild group (64.0%), respectively (P = 0.024). Adjusted for covariates, the relative risk of death was 5.8 times higher in moderate/severely malnourished group identified at the last course of chemotherapy (HR = 5.896, 95% CI = 2.723-12.764, P < 0.001). Similarly, this cohort had shorter PFS compared with normal to mild risk group (median 15 vs. 28 months, P = 0.011). Malnutrition is prevalent among ovarian cancer patients and is found to be a significant predictor for mortality.
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Affiliation(s)
- Ga Won Yim
- a Institute of Women's Life Medical Science, Division of Gynecologic Oncology , Department of Obstetrics and Gynecology, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Kyung Jin Eoh
- a Institute of Women's Life Medical Science, Division of Gynecologic Oncology , Department of Obstetrics and Gynecology, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Sang Wun Kim
- a Institute of Women's Life Medical Science, Division of Gynecologic Oncology , Department of Obstetrics and Gynecology, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Eun Ji Nam
- a Institute of Women's Life Medical Science, Division of Gynecologic Oncology , Department of Obstetrics and Gynecology, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Young Tae Kim
- a Institute of Women's Life Medical Science, Division of Gynecologic Oncology , Department of Obstetrics and Gynecology, Yonsei University College of Medicine , Seoul , Republic of Korea
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Pezzana A, Cereda E, Avagnina P, Malfi G, Paiola E, Frighi Z, Capizzi I, Sgnaolin E, Amerio ML. Nutritional Care Needs in Elderly Residents of Long-Term Care Institutions: Potential Implications for Policies. J Nutr Health Aging 2015; 19:947-54. [PMID: 26482698 DOI: 10.1007/s12603-015-0537-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To collect information on actual nutritional intervention requirements in long-term care institutions and on the role of institutional factors in nutritional care. DESIGN A cross-sectional analysis of baseline data (collected between September 2011 and September 2013) within the context of a multicenter prospective cohort study. SETTING Nineteen long-term care institutions. PARTICIPANTS Thirteen hundred and ninety-four resident elderly (age ≥60 years). MEASUREMENTS The prevalence of nutritional derangements (MNA-Short Form) and the need to introduce nutritional interventions on the residents. RESULTS Prevalence of malnutrition and risk of malnutrition were 35.2% [95%CI, 32.8-37.8] and 52.6% [95%CI, 50.0-55.2], respectively. Malnutrition was more frequent upon admission and in larger institutions (≥50 beds). Overall, 50% of the residents requiring an individualized nutritional care plan (any type) were not receiving it. Oral diet, the use of fluid thickeners and oral nutritional supplements had to be introduced in 306 (22.5%), 201 (15%) and 175 (13%) residents, respectively. The need to implement the oral diet was mainly due to inadequacy of texture according to chewing and swallowing capabilities. In gender and age-adjusted multivariable logistic regression models, nutritional interventions were associated with worse nutritional status (P<0.001 for all). Moreover, while the duration of stay was unrelated to the need for nutritional interventions, we observed that residents living in larger long-term care institutions (≥50 beds) were more likely to require improvement in nutrition care. CONCLUSIONS In long-term care elderly residents nutritional derangements are very common, underdiagnosed and undertreated. Nutritional screening should be part of routine care. However, also the systematic involvement of a nutritional care specialist appears to be an urgent need, particularly in larger institutions where the standards of care are likely to be lower.
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Affiliation(s)
- A Pezzana
- Emanuele Cereda M.D., Ph.D. Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. Tel.: +39 0382 501615 ; Fax: + 39 0382 502801, E-mail:
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Gu W, Zhang G, Sun L, Ma Q, Cheng Y, Zhang H, Shi G, Zhu Y, Ye D. Nutritional screening is strongly associated with overall survival in patients treated with targeted agents for metastatic renal cell carcinoma. J Cachexia Sarcopenia Muscle 2015; 6:222-30. [PMID: 26401468 PMCID: PMC4575553 DOI: 10.1002/jcsm.12025] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 12/22/2014] [Accepted: 02/23/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although commonly observed, malnutrition is poorly characterized and frequently underdiagnosed in patients with metastatic renal cell carcinoma (RCC). The ability of nutritional screening tools to predict overall survival (OS) in patients with RCC has not been adequately validated. The objective of this study was to investigate the performance of nutritional screening tools and their additional prognostic value in patients with metastatic RCC treated with targeted therapies. METHODS Patients were prospectively recruited from three tertiary hospitals between 2009 and 2013. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI) and the Mini Nutritional Assessment-Short Form (MNA-SF). Their OS and early grade 3/4 adverse events were recorded as outcomes of interest, and their associations with nutritional status were assessed using Cox regression and logistic regression, respectively. The incremental value in prognostication was evaluated using concordance index and decision curve analyses. RESULTS Of the 300 enrolled patients, 95 (31.7%) and 64 (21.3%) were classified as being at risk of malnutrition according to the GNRI and MNA-SF, respectively. Both GNRI and MNA-SF were independent predictors of OS in multivariate analyses and provided significant added benefit to Heng risk classification. Compared with the MNA-SF, the GNRI contributed a higher increment to the concordance index (0.041 vs. 0.016). Nutritional screening, however, was not associated with early grade 3/4 adverse events in multivariate analyses. Further investigations are needed using more comprehensive and accurate assessment tools. CONCLUSIONS This prospective study confirmed the importance of nutritional screening tools in survival prognostication in patients with metastatic RCC. The standardized and objective measurements would allow clinicians to identify metastatic RCC patients at risk of poor survival outcomes. Individualized nutritional assessment and intervention strategies may be included in the multidisciplinary treatment.
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Affiliation(s)
- Weijie Gu
- Department of Urology, Shanghai Cancer Center, Fudan University Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, 200032, China
| | - Guiming Zhang
- Department of Urology, Shanghai Cancer Center, Fudan University Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, 200032, China
| | - Lijiang Sun
- Department of Urology, The Affiliated Hospital of Qingdao University Qingdao, 266003, China
| | - Qi Ma
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University Ningbo, 315010, China
| | - Yue Cheng
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University Ningbo, 315010, China
| | - Hailiang Zhang
- Department of Urology, Shanghai Cancer Center, Fudan University Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, 200032, China
| | - Guohai Shi
- Department of Urology, Shanghai Cancer Center, Fudan University Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, 200032, China
| | - Yao Zhu
- Department of Urology, Shanghai Cancer Center, Fudan University Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, 200032, China
| | - Dingwei Ye
- Department of Urology, Shanghai Cancer Center, Fudan University Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, 200032, China
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Pizzato S, Sergi G, Bolzetta F, De Rui M, De Ronch I, Carraro S, Berton L, Orr E, Imoscopi A, Perissinotto E, Coin A, Manzato E, Veronese N. Effect of weight loss on mortality in overweight and obese nursing home residents during a 5-year follow-up. Eur J Clin Nutr 2015; 69:1113-8. [PMID: 25758838 DOI: 10.1038/ejcn.2015.19] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND/OBJECTIVES The objective of this study was to ascertain the effect of weight loss over the course of 1 year on 5-year mortality in old nursing home (NH) residents in different classes of body mass index (BMI). SUBJECTS/METHODS A longitudinal study was conducted on 161 NH residents aged ⩾ 70 years at the Istituto di Riposo per Anziani, Padova, Italy. Data were collected using a comprehensive geriatric assessment at baseline and at a 1-year follow-up visit. Mortality was recorded over a 5-year follow-up. We divided our sample into four groups using as cutoffs a BMI of 25 and a weight gain or loss of 5% at 1 year (BMI ⩾ 25 and weight stable/gain, BMI ⩾ 25 and weight loss, BMI<25 and weight stable/gain and BMI <25 and weight loss). RESULTS People with a BMI ⩾ 25 and weight loss suffered the worst decline in activities of daily living, whereas those with a BMI <25 and weight loss had the most significant decline in nutritional status, which coincided with the worst decline in the Multidimensional Prognostic Index among the groups whose weight changed. Compared with those with a BMI ⩾ 25 and weight stable/gain (reference group), those with a BMI <25 were at the highest risk of dying (in association with weight loss: hazard ratio HR=3.60, P=0.005; in association with weight stable/gain: HR=2.45, P=0.01), and the mortality risk was also increased in people with a BMI ⩾ 25 and weight loss (HR=1.74, P=0.03). CONCLUSIONS In conclusion, weight loss increases the mortality risk in frail, disabled NH residents, even if they are overweight or obese.
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Affiliation(s)
- S Pizzato
- Department of Medicine-DIMED, Geriatrics Division, University of Padova, Padova, Italy
| | - G Sergi
- Department of Medicine-DIMED, Geriatrics Division, University of Padova, Padova, Italy
| | - F Bolzetta
- Department of Medicine-DIMED, Geriatrics Division, University of Padova, Padova, Italy
| | - M De Rui
- Department of Medicine-DIMED, Geriatrics Division, University of Padova, Padova, Italy
| | - I De Ronch
- Department of Medicine-DIMED, Geriatrics Division, University of Padova, Padova, Italy
| | - S Carraro
- Department of Medicine-DIMED, Geriatrics Division, University of Padova, Padova, Italy
| | - L Berton
- Department of Medicine-DIMED, Geriatrics Division, University of Padova, Padova, Italy
| | - E Orr
- Department of Medicine-DIMED, Geriatrics Division, University of Padova, Padova, Italy
| | - A Imoscopi
- Istituto di Riposo per Anziani, Padova, Italy
| | - E Perissinotto
- Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology and Public Health Unit, University of Padova, Padova, Italy
| | - A Coin
- Department of Medicine-DIMED, Geriatrics Division, University of Padova, Padova, Italy
| | - E Manzato
- Department of Medicine-DIMED, Geriatrics Division, University of Padova, Padova, Italy
| | - N Veronese
- Department of Medicine-DIMED, Geriatrics Division, University of Padova, Padova, Italy
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Tapia MJ, Ocón J, Cabrejas-Gómez C, Ballesteros-Pomar MD, Vidal-Casariego A, Arraiza-Irigoyen C, Olivares J, Conde-García MC, García-Manzanares Á, Botella-Romero F, Quílez-Toboso RP, Cabrerizo L, Rubio MA, Chicharro L, Burgos R, Pujante P, Ferrer M, Zugasti A, Petrina E, Manjón L, Diéguez M, Carrera MJ, Vila-Bundo A, Urgelés JR, Aragón-Valera C, Sánchez-Vilar O, Bretón I, García-Peris P, Muñoz-Garach A, Márquez E, del Olmo D, Pereira JL, Tous MC, Olveira G. Nutrition-related risk indexes and long-term mortality in noncritically ill inpatients who receive total parenteral nutrition (prospective multicenter study). Clin Nutr 2014; 34:962-7. [PMID: 25466952 DOI: 10.1016/j.clnu.2014.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 10/15/2014] [Accepted: 10/24/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malnutrition in hospitalized patients is associated with an increased risk of death, in both the short and the long term. AIMS The purpose of this study was to determine which nutrition-related risk index predicts long-term mortality better (three years) in patients who receive total parenteral nutrition (TPN). METHODS This prospective, multicenter study involved noncritically ill patients who were prescribed TPN during hospitalization. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), body mass index, albumin and prealbumin, as well as long-term mortality. RESULTS Over the 1- and 3-year follow-up periods, 174 and 244 study subjects (28.8% and 40.3%) respectively, died. Based on the Cox proportional hazards survival model, the nutrition-related risk indexes most strongly associated with mortality were SGA and albumin (<2.5 g/dL) (after adjustment for age, gender, C-reactive protein levels, prior comorbidity, mean capillary blood glucose during TPN infusion, diabetes status prior to TPN, diagnosis, and infectious complications during hospitalization). CONCLUSIONS The SGA and very low albumin levels are simple tools that predict the risk of long-term mortality better than other tools in noncritically ill patients who receive TPN during hospitalization.
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Affiliation(s)
| | - María José Tapia
- UGC Endocrinología y Nutrición, IBIMA, Hospital Regional Universitario de Málaga/ Universidad de Málaga, Malaga, Spain
| | - Julia Ocón
- Endocrinology and Nutrition Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Carmen Cabrejas-Gómez
- Endocrinology and Nutrition Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | | | - Josefina Olivares
- Endocrinology and Nutrition, Hospital Son Llàtzer (Palma de Mallorca), Spain
| | - Ma Carmen Conde-García
- Endocrinology and Nutrition Service, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad-Real, Spain
| | - Álvaro García-Manzanares
- Endocrinology and Nutrition Service, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad-Real, Spain
| | | | - Rosa P Quílez-Toboso
- Endocrinology and Nutrition Service, Complejo Hospitalario Universitario de Albacete, Spain
| | - Lucio Cabrerizo
- Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel A Rubio
- Endocrinology and Nutrition Service, Hospital Clínico San Carlos, Madrid, Spain
| | - Luisa Chicharro
- Clinical Nutrition Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Rosa Burgos
- Clinical Nutrition Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Pedro Pujante
- Endocrinology and Nutrition Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mercedes Ferrer
- Endocrinology and Nutrition Service, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ana Zugasti
- Clinical Nutrition Unit, Complejo Hospitalario de Navarra, Spain
| | - Estrella Petrina
- Clinical Nutrition Unit, Complejo Hospitalario de Navarra, Spain
| | - Laura Manjón
- Endocrinology and Nutrition Service, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Marta Diéguez
- Endocrinology and Nutrition Service, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Ma José Carrera
- Endocrinology and Nutrition Service, Hospital del Mar, Barcelona, Spain
| | - Anna Vila-Bundo
- Endocrinology and Nutrition Service, Hospital del Mar, Barcelona, Spain
| | - Juan Ramón Urgelés
- Endocrinology and Nutrition Service, Hospital Universitario Son Dureta, Palma de Mallorca, Spain
| | | | - Olga Sánchez-Vilar
- Endocrinology and Nutrition Service, Fundación Jiménez Díaz, Madrid, Spain
| | - Irene Bretón
- Endocrinology and Nutrition Service, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar García-Peris
- Endocrinology and Nutrition Service, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Araceli Muñoz-Garach
- Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Efren Márquez
- Endocrinology and Nutrition Service, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Dolores del Olmo
- Endocrinology and Nutrition Service, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - José Luis Pereira
- Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - María C Tous
- Endocrinology and Nutrition Service, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Gabriel Olveira
- UGC Endocrinología y Nutrición, IBIMA, Hospital Regional Universitario de Málaga/ Universidad de Málaga, Malaga, Spain; CIBERDEM, CIBER of Diabetes and Associated Metabolic Diseases (CB07/08/0019), Instituto de Salud Carlos III, Spain.
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Mayasari M, . S, Lestariana W. Simple Nutritional Screening Tool (SNST) Has Good Validity to Identify Risk of Malnutrition on Hospitalized Elderly Patients. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/pjn.2014.573.578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Camina Martín MA, de Mateo Silleras B, Barrera Ortega S, Domínguez Rodríguez L, Redondo del Río MP. Specific bioelectrical impedance vector analysis (BIVA) is more accurate than classic BIVA to detect changes in body composition and in nutritional status in institutionalised elderly with dementia. Exp Gerontol 2014; 57:264-71. [DOI: 10.1016/j.exger.2014.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/20/2014] [Accepted: 06/21/2014] [Indexed: 11/25/2022]
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Takahashi H, Ito Y, Ishii H, Aoyama T, Kamoi D, Kasuga H, Yasuda K, Maruyama S, Matsuo S, Murohara T, Yuzawa Y. Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients. J Cardiol 2014; 64:32-6. [DOI: 10.1016/j.jjcc.2013.10.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/21/2013] [Accepted: 10/29/2013] [Indexed: 11/29/2022]
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Cereda E, Klersy C, Pedrolli C, Cameletti B, Bonardi C, Quarleri L, Cappello S, Bonoldi A, Bonadeo E, Caccialanza R. The Geriatric Nutritional Risk Index predicts hospital length of stay and in-hospital weight loss in elderly patients. Clin Nutr 2015; 34:74-8. [PMID: 24508351 DOI: 10.1016/j.clnu.2014.01.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 01/17/2014] [Accepted: 01/20/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND & AIMS Nutritional derangements are common in elderly patients, but how nutritional risk affects outcome in this subset of hospital inpatients deserves further investigation. We evaluated the impact of nutritional risk on length of stay (LOS) and in-hospital weight loss (WL) in elderly patients (>65 yrs). METHODS Nutritional risk was assessed by the Geriatric Nutritional Risk Index (GNRI) in a prospective multicentre hospital-based cohort study. The outcomes were LOS and in-hospital WL. RESULTS In the whole sample (N = 667), the prevalence of high (GNRI < 92) and mild (GNRI: 92-98) nutritional risk were 33% and 25%, respectively. Patients with a high nutritional risk were more likely (OR = 1.89; 95%CI: 1.22-2.92) to stay longer in hospital (fourth quartile, LOS ≥ 20 days) compared to those without. Other factors associated with prolonged LOS were cancer diagnosis (OR = 2.52; 95%CI: 1.69-3.75), the presence of comorbidities (OR = 1.24; 95%CI: 1.11-1.40) and surgical setting (OR = 1.65; 95%CI: 1.10-2.47). In-hospital WL ≥ 5% was recorded in 75 ambulant patients from a representative subgroup (N = 583). It was independently associated with prolonged LOS (OR = 1.80; 95%CI: 1.03-3.06) and was more frequent among cancer patients (OR = 1.88; 95%CI: 1.09-3.24), in patients with a high nutritional risk (OR = 2.23; 95%CI: 1.20-4.14) or those admitted to surgical units (OR = 1.77; 95%CI: 1.02-3.05). CONCLUSIONS Nutritional risk assessed by the GNRI on admission, predicts LOS and in-hospital WL in elderly patients.
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Dent E, Chapman I, Piantadosi C, Visvanathan R. Nutritional screening tools and anthropometric measures associate with hospital discharge outcomes in older people. Australas J Ageing 2014; 34:E1-6. [PMID: 24444126 DOI: 10.1111/ajag.12130] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To examine the association of nutritional screening tools (NSTs) and anthropometric measures with hospital outcomes in older people. METHODS In 172 patients aged ≥70 years admitted to a Geriatric Evaluation Management Unit (GEMU), nutritional status was measured using the Mini-Nutritional Assessment (MNA), MNA-short form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), Simplified Nutritional Appetite Questionnaire, calf circumference (CC), mid-arm circumference (MAC) and BMI. RESULTS Malnutrition according to the MNA occurred in 53 (31%) patients. Functional change was associated with GNRI (Beta coefficient (β), 95% CI = 0.17, 0.001-0.33) and CC (β, 95% CI = 0.17, 0.01-0.33); GEMU length of stay was associated with MNA-SF-BMI (β, 95% CI = -0.02, -0.003 to -0.004) and MNA-SF-CC (β, 95% CI = -0.02, -0.003 to -0.001). MAC was associated with discharge to higher level of care (OR, 95% CI = 0.88, 0.81-0.96). CONCLUSION In hospitalised older people, admission NSTs and anthropometric measures associate with discharge outcomes.
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Affiliation(s)
- Elsa Dent
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Horie N, Yamaguchi T, Chida S, Kato T, Kaneko T, Shimoyama T. The associations between functional and nutritional factors for oral opportunistic infections in a long-term hospital. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 2013. [DOI: 10.1016/j.ajoms.2013.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Miyata S, Tanaka M, Ihaku D. Full Mini Nutritional Assessment and Prognosis in Elderly Patients with Pulmonary Tuberculosis. J Am Coll Nutr 2013; 32:307-11. [DOI: 10.1080/07315724.2013.826114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Olveira G, Tapia MJ, Ocón J, Cabrejas-Gómez C, Ballesteros-Pomar MD, Vidal-Casariego A, Arraiza-Irigoyen C, Olivares J, Conde-García MC, García-Manzanares Á, Botella-Romero F, Quílez-Toboso RP, Cabrerizo L, Rubio MA, Chicharro L, Burgos R, Pujante P, Ferrer M, Zugasti A, Manjón L, Diéguez M, Carrera MJ, Vila-Bundo A, Urgelés JR, Aragón-Valera C, Rovira A, Bretón I, García-Peris P, Muñoz-Garach A, Márquez E, Del Olmo D, Pereira JL, Tous MC. The Subjective Global Assessment Predicts In-Hospital Mortality Better than Other Nutrition-Related Risk Indexes in Noncritically Ill Inpatients Who Receive Total Parenteral Nutrition in Spain (Prospective Multicenter Study). J Acad Nutr Diet 2013; 113:1209-18. [DOI: 10.1016/j.jand.2013.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/23/2013] [Indexed: 01/04/2023]
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Serrano-Urrea R, Garcia-Meseguer MJ. Malnutrition in an elderly population without cognitive impairment living in nursing homes in Spain: study of prevalence using the Mini Nutritional Assessment test. Gerontology 2013; 59:490-8. [PMID: 23949114 DOI: 10.1159/000351763] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 04/30/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of malnutrition in institutionalized elderly people is generally high. A good nutritional status is related to a decrease in mortality and costs of morbidity treatments. Therefore, it is essential to know the nutritional status in order to establish action policies. However, there are not enough studies about malnutrition in institutionalized elderly in Spain. OBJECTIVES The objectives of this survey were to assess the prevalence of malnutrition and risk of malnutrition in elderly people living in nursing homes in the province of Albacete (Spain) using the Mini Nutritional Assessment (MNA®) test, to analyze their distribution according to age, gender and different nursing home features, and to identify the MNA items that best predict the MNA total score. METHODS A cross-sectional study was conducted with data collected from 895 elders living in 34 nursing homes all over the province of Albacete, including facilities located in the main city, towns and villages. Prevalence of malnutrition and risk of malnutrition were assessed using the MNA full form test. Groups of malnutrition were compared by using mean MNA scores. Stepwise linear regression analyses were used to identify the items in the MNA which best predicted the MNA total scores. RESULTS According to the MNA, the prevalence of malnutrition among elderly people staying in Albacete province nursing homes was 2.8%, and the prevalence of being at risk of malnutrition was 37.3%. MNA total score was significantly higher in men (24.3 ± 2.9) than in women (23.7 ± 3.3) and significantly higher in residents living in nursing homes located in towns and villages (24.2 ± 2.8) than in those who were living in institutions placed in the main city (23.7 ± 3.4). The MNA score was found to decrease with increasing age, except for individuals aged 90 years or older. CONCLUSIONS The prevalence of malnutrition and risk of malnutrition was 40.1%. Female gender and living in institutions located in the main city were identified as malnutrition risk factors. In general, an increase in malnutrition with age was detected, except for people in the last years of their lives. The MNA questions that best predicted the nutritional status were the ones relating to the anthropometrical and self-assessments.
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Affiliation(s)
- R Serrano-Urrea
- Department of Mathematics, Faculty of Computer Science Engineering, University of Castilla-La Mancha, Albacete, Spain
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Wang SY, Shamliyan TA, Talley KM, Ramakrishnan R, Kane RL. Not just specific diseases: Systematic review of the association of geriatric syndromes with hospitalization or nursing home admission. Arch Gerontol Geriatr 2013; 57:16-26. [DOI: 10.1016/j.archger.2013.03.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/11/2013] [Accepted: 03/14/2013] [Indexed: 12/01/2022]
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Söderström L, Rosenblad A, Adolfsson ET, Saletti A, Bergkvist L. Nutritional status predicts preterm death in older people: a prospective cohort study. Clin Nutr 2014; 33:354-9. [PMID: 23810625 DOI: 10.1016/j.clnu.2013.06.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/04/2013] [Accepted: 06/06/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND & AIMS There is an association between malnutrition and mortality. However, it is uncertain whether this association is independent of confounders. The aim of the present study was to examine whether nutritional status, defined according to the three categories in the full Mini Nutritional Assessment (MNA) instrument, is an independent predictor of preterm death in people 65 years and older. METHODS This prospective cohort study included individuals aged ≥65 years who were admitted to hospital between March 2008 and May 2009 and followed-up after 50 months (n = 1767). Nutritional status was assessed with the MNA, and possible risk factors associated with malnutrition were recorded during participants hospital stay. Main outcome measure was overall survival. RESULTS Based on the MNA definitions, 628 (35.5%) were well-nourished, 973 (55.1%) were at risk of malnutrition, and 166 (9.4%) of the participants were malnourished at baseline. During the follow-up period 655 (37.1%) participants died. At follow-up, the survival rates were 75.2% for well-nourished participants, 60.0% for those at risk of malnutrition, and 33.7% for malnourished participants (p < 0.001). After adjusting for confounders the hazard ratios (95% CI) for all-cause mortality were 1.56 (1.18-2.07) in the group at risk of malnutrition and 3.71 (2.28-6.04) in the malnourished group. CONCLUSIONS Nutritional status defined according to the three categories in the full MNA independently predicts preterm death in people aged 65 years and older. These findings are clinically important and emphasise the usefulness of the MNA for screening of nutritional status.
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Papparotto C, Bidoli E, Palese A. Risk factors associated with malnutrition in older adults living in Italian nursing homes: a cross-sectional study. Res Gerontol Nurs 2013; 6:187-97. [PMID: 23739882 DOI: 10.3928/19404921-20130528-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/13/2013] [Indexed: 01/08/2023]
Abstract
Malnutrition is a significant problem among older adults living in nursing homes: Malnourished residents are at increased risk of hospitalization and mortality. Multiple factors determine malnutrition, and the extant literature has focused attention on individual factors such as aging, sex, and dependence in activities of daily living. However, little evidence is available on factors influenced by nursing care. Exploring the relationship between the nutritional status of nursing home residents and certain individual factors, including those potentially influenced by nursing care, was the aim of this cross-sectional study. A total of 186 nursing home residents was enrolled in the study; in addition, 18 nurses were involved in the data collection process. Twenty-one percent of the residents had an adequate nutritional status, 43% were at risk of malnutrition, and 36% were malnourished. Multivariate analysis revealed that those independent factors associated with malnutrition, once adjusted for age, sex, and dependence in activities of daily living, were: having had a stroke, being dependent in activities of daily living, eating half or less of food provided at mealtimes, and having their weight checked only every 3 months or longer. Nursing care projects may be effective in reducing the risk of malnutrition among nursing home residents. However, further research is needed to develop knowledge of the factors associated with malnutrition and those influenced by care delivered in nursing homes.
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