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von Meijenfeldt GCI, Mogensen KM, van der Laan MJ, Zeebregts CJ, Christopher KB. Nutritional status and out-of-hospital mortality in vascular surgery patients. PLoS One 2022; 17:e0270396. [PMID: 35862384 PMCID: PMC9302752 DOI: 10.1371/journal.pone.0270396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background Malnutrition is often present in vascular surgery patient during hospital admission. The present evidence of the consequence malnutrition has on morbidity and mortality is limited. Aim The purpose of this study was to determine the effect of nutritional status on out-of-hospital mortality in vascular surgery patients. Methods An observational cohort study was performed, studying non-cardiac vascular surgery patients surviving hospital admission 18 years or older treated in Boston, Massachusetts, USA. The exposure of interest was nutritional status categorized as well nourished, at-risk for malnutrition, nonspecific malnutrition or protein-energy malnutrition. The all cause 90-day mortality following hospital discharge was the primary outcome. Adjusted odds ratios were estimated by multivariable logistic regression models. Results This cohort included 4432 patients comprised of 48% women and a mean age 61.7 years. After evaluation by a registered dietitian, 3819 patients were determined to be well nourished, 215 patients were at-risk for malnutrition, 351 had non-specific malnutrition and 47 patients had protein-energy malnutrition. After adjustment for age, sex, ethnicity, medical versus surgical Diagnosis Related Group type, Deyo-Charlson index, length of stay, and vascular Current Procedural Terminology code category, the 90-day post-discharge mortality odds ratio for patients with non-specific malnutrition OR 1.96 (95%CI 1.21, 3.17) and for protein-energy malnutrition OR 3.58 (95%CI 1.59, 8.06), all relative to patients without malnutrition. Discussion Nutritional status is a strong predictor of out-of-hospital mortality. This suggests that patient with vascular disease suffering from malnutrition could benefit from more intensified In-hospital and out-of-hospital dietary guidance and interventions.
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Feng L, Chu Z, Quan X, Zhang Y, Yuan W, Yao Y, Zhao Y, Fu S. Malnutrition is positively associated with cognitive decline in centenarians and oldest-old adults: A cross-sectional study. EClinicalMedicine 2022; 47:101336. [PMID: 35497066 PMCID: PMC9046105 DOI: 10.1016/j.eclinm.2022.101336] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 07/10/2021] [Revised: 01/23/2022] [Accepted: 02/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive decline is a growing public health concern. However, presently, only a few large-scale studies are available on the prevalence of cognitive decline worldwide, and the relationship between nutrition and cognitive decline remains unclear and requires further investigation, especially among Chinese centenarians and oldest-old adults. This study aimed to assess the prevalence of cognitive decline among Chinese centenarians and oldest-old adults, its associated factors, and explore a possible connection with nutrition, to provide new directions for the prevention of cognitive decline in Chinese centenarians and oldest-old adults. METHODS Based on the China Hainan Centenarian Cohort Study (CHCCS), a household survey was conducted among all the centenarians and oldest-old adults residing in 16 cities and counties of Hainan province from June 2014 to June 2016. This study included 946 centenarians and oldest-old adults (412 and 534, respectively). Cognitive function was measured using the mini-mental state examination (MMSE). FINDINGS The total prevalence of cognitive decline was 76·6% (725 participants). Centenarians had a significantly higher prevalence of cognitive decline compared to oldest-old adults [359 centenarians (87·1%) vs. 366 oldest-old adults (68·5%)]. Centenarians and oldest-old adults with cognitive decline had significantly lower prognostic nutritional index (PNI) and mini nutrition assessment-short form (MNA-SF) than those without cognitive decline (P < 0·05). Multivariate logistic regression analyses showed that participants with higher PNI and MNA-SF were less likely to have cognitive decline. Multivariate linear regression analyses showed that PNI and MNA-SF were positively associated with MMSE (P < 0·05). INTERPRETATION Malnutrition was positively associated with cognitive decline among Chinese centenarians and oldest-old adults. It is therefore important for clinicians and community health workers to pay attention to malnutrition in these populations and provide supplemental nutrients to prevent cognitive decline. FUNDING This work was supported by grants from the National Natural Science Foundation of China (81900357, 81903392, 81941021, 81901252, 82001476, 81802804, 81801251), the Military Medical Science and Technology Youth Incubation Program (20QNPY110, 19QNP060), the Excellent Youth Incubation Program of Chinese People's Liberation Army General Hospital (2020-YQPY-007), the Military Medicine Youth Program of Chinese People's Liberation Army General Hospital (QNF19069, QNF19068), the National Key R&D Program of China (2018YFC2000400), the National S&D Resource Sharing Service Platform Project of China (YCZYPT[2018]07), the Innovation Platform for Academinicians of Hainan Province, the Hainan Major Scientific and Technological Cooperation Project (2016KJHZ0039), the China Postdoctoral Science Foundation funded project (2019M650359, 2020M682816, 2021T140298), the Medical Big Data R&D Project of Chinese People's Liberation Army General Hospital (MBD2018030), the National Geriatric Disease Clinical Medicine Research centre Project (NCRCG-PLAGH-2017-014), the Central Health Care Scientific Research Project (W2017BJ12), the Hainan Medical and Health Research Project (16A200057), the Sanya Medical and Health Science and Technology Innovation Project (2016YW21, 2017YW22, 2018YW11), and the Clinical Scientific Research Supporting Fund of Chinese People's Liberation Army General Hospital (2017FC-CXYY-3009).
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Affiliation(s)
- Long Feng
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Zhixiang Chu
- Emergency Department, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Xiaojiao Quan
- Intensive Care Unit, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
| | - Yujie Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Weixiu Yuan
- Department of Anesthesiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
- Corresponding authors at: Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Yao Yao
- China Center for Health Development Studies, Peking University, Beijing, China
- Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China
- Corresponding author at: China Center for Health Development Studies, Peking University, Beijing, China.
| | - Yali Zhao
- Central Laboratory, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
- Corresponding authors at: Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Shihui Fu
- Department of Cardiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
- Corresponding authors at: Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
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Pereira SL, Shoemaker ME, Gawel S, Davis GJ, Luo M, Mustad VA, Cramer JT. Biomarker Changes in Response to a 12-Week Supplementation of an Oral Nutritional Supplement Enriched with Protein, Vitamin D and HMB in Malnourished Community Dwelling Older Adults with Sarcopenia. Nutrients 2022; 14:1196. [PMID: 35334853 PMCID: PMC8953113 DOI: 10.3390/nu14061196] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 02/06/2023] Open
Abstract
Malnutrition and sarcopenia commonly overlap and contribute to adverse health outcomes. Previously, chronic supplementation with two oral nutritional supplements (ONS), control (CONS) and experimental ONS enriched with protein, vitamin D and β-hydroxy β-methylbutyrate (HMB) (EONS), improved muscle strength and quality in malnourished sarcopenic older adults, with EONS demonstrating early strength benefits at 12 weeks. To understand the underlying biological mechanisms contributing to the observed early strength benefits of EONS, we examined serum biomarker changes in response to 12-week supplementation. Serum samples (EONS (n = 90) and CONS (n = 103)) collected at baseline and 12 weeks were analyzed. Biomarkers (n = 243) were measured using multiplexed immunoassay, commercial immunoassays and ELISAs. Sixty markers were excluded with levels below assay detection limits. Sixteen biomarkers significantly changed in response to both interventions including nutritional and metabolic markers. Thirteen biomarkers significantly changed in response to EONS but not CONS. Increases in immunoglobulins, myoglobin, total protein, vitamin E and magnesium were observed with EONS. Inflammation-related ferritin and osteopontin decreased, while soluble receptors for cytokines increased, suggesting decreased inflammation. Sex hormone-binding globulin associated with sarcopenia also decreased with EONS. Biomarkers reflective of multiple biological systems were impacted by nutritional intervention in sarcopenic older adults. Incremental biomarker changes were observed in response to EONS containing HMB that possibly link to improvements in skeletal muscle health.
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Ergul F, Sackan F, Koc A, Guney I, Kizilarslanoglu MC. Adherence to the Mediterranean diet in Turkish hospitalized older adults and its association with hospital clinical outcomes. Arch Gerontol Geriatr 2022; 99:104602. [DOI: 10.1016/j.archger.2021.104602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022]
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Rahman KMT, Khalequzzaman M, Khan FA, Rayna SE, Samin S, Hasan M, Islam SS. Factors associated with the nutritional status of the older population in a selected area of Dhaka, Bangladesh. BMC Geriatr 2021; 21:161. [PMID: 33673811 PMCID: PMC7934473 DOI: 10.1186/s12877-021-02068-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 11/07/2020] [Accepted: 01/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background Globally, older population (aged ≥60 years) comprise 11% of the total population, and 23% of them are malnourished. Lack of knowledge and education, adverse dietary habits, depression or psychological disorders, poor oral and dental health, disability, and diseases are the reported factors responsible for malnutrition among them. Geriatric people comprise 7.5% of the total population of Bangladesh, and almost a quarter are malnourished. But there is scarce data on the factors associated with the nutritional status of the older population in Bangladesh. Methods A cross-sectional study was conducted among 125 older individuals (male 59, female 66) living in three villages of Uttarkhan, Dhaka, Bangladesh, to identify the factors associated with their nutritional status. The Mini Nutritional Assessment scale, Geriatric Depression Scale-Short Form, and Geriatric Oral Health Assessment Index were used for assessing the nutritional status, mental health status, and oral health quality of the respondents, respectively. Information on socio-demographic characteristics, comorbidities and dietary factors, and food behaviors were gathered by a pretested semi-structured questionnaire. Ethical approval was obtained from the Institutional Review Board of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Results The participants’ mean age was 67.9 ± 7.1 years. Most of them (53.6%) had no formal education. Among the respondents, 22.0% male and 28.8% female were malnourished. The proportion of malnourished and at risk of malnutrition among the respondents living without a partner were 28.6 and 65.3%, respectively. A significantly (p < 0.05) higher odds of having depression (OR 15.6; 95% CI 3.1–78.1), poor oral health (OR 7.3; 95% CI 1.3–41.8), and no formal education (OR 6.5; 95% CI 1.3–32.1) was observed among the malnourished respondents. Though it was not statistically significant, among the malnourished, 31.3, 25.0 and 25.0% avoided highly oily food, beef/mutton, and sugary food, respectively. Conclusions More than two-thirds of the older population were malnourished or at risk of malnutrition, where the female respondents were more vulnerable. Depression, inadequate oral health, and lack of education were negatively associated with the nutritional status of the older population.
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Affiliation(s)
- K M Thouhidur Rahman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Room # 309, Block # B, Shahbag, Dhaka, 1000, Bangladesh
| | - Md Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Room # 309, Block # B, Shahbag, Dhaka, 1000, Bangladesh.
| | - Fahmida Afroz Khan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Room # 309, Block # B, Shahbag, Dhaka, 1000, Bangladesh
| | - Shahrin Emdad Rayna
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Room # 309, Block # B, Shahbag, Dhaka, 1000, Bangladesh
| | - Sharraf Samin
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Room # 309, Block # B, Shahbag, Dhaka, 1000, Bangladesh
| | - Md Hasan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Room # 309, Block # B, Shahbag, Dhaka, 1000, Bangladesh
| | - Syed Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Room # 309, Block # B, Shahbag, Dhaka, 1000, Bangladesh
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Son DH, Kim KS, Lee HS, Lee JW, Shin CS. Derivation and validation of a new nutritional index for predicting 90 days mortality after ICU admission in a Korean population. J Formos Med Assoc 2020; 119:1283-91. [PMID: 32439248 DOI: 10.1016/j.jfma.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/26/2020] [Accepted: 05/05/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/PURPOSE Predicting the mortality in patients admitted to the ICU is important for determining a treatment strategy and public health policy. Although many scores have been developed to predict the mortality, these scores were based on Caucasian population. We aimed to develop a new prognostic index, the New nutritional index (NNI), to predict 90-days mortality after ICU admission based on Korean population. METHODS Patients (1453) who admitted intensive care unit (ICU) of the Gangnam Severance hospital were analyzed. After exclusion, 984 patients were randomly divided into internal (n = 702) and external validation (n = 282) data set. The new nutritional index (NNI) was developed using univariate and multivariate logistic regression with backward selection of predictors. Receiver operating characteristic (ROC) curve analysis and comparison of the area under the curve (AUC) verified the better predictor of 90 days-mortality after ICU admission. RESULTS The NNI better predicted 90 days-mortality compared to modified NUTRIC score, APACHE II scores, SOFA scores, CRP, glucose, total protein, and albumin level in internal and external data sets, with AUC of 0.862 (SE: 0.017, 95% CI: 0.829-0.895) and 0.858 (SE: 0.015, 95% CI: 0.829-0.887), respectively. The calibration plots using external data set for validation showed a close approximation to the logistic calibration of each nomogram, and p-value of Hosmer and Lemeshow test was 0.1804. CONCLUSION The NNI has advantages as a predictor of 90 days mortality based on nutritional status in the Korean population.
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Abstract
The elderly population is increasing rapidly worldwide, and we are faced with the significant challenge for maintaining or improving physical activity, independence, and quality of life. Sarcopenia, the age-related decline of skeletal muscle mass, is characterized by loss of muscle quantity and quality resulting to a gradual slowing of movement, a decrease in strength and power, elevated risk of fall-related injury, and often frailty. Supplemental, hormonal, and pharmacological approaches have been attempted to attenuate sarcopenia but these have not achieved outstanding results. In this review, we summarize the current knowledge of nutrition-based therapies for counteracting sarcopenia.
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Affiliation(s)
- Behnaz Abiri
- Department of Nutrition, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammadreza Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran. .,Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
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Khatami F, Shafiee G, Kamali K, Ebrahimi M, Azimi M, Ahadi Z, Sharifi F, Tanjani PT, Heshmat R. Correlation between malnutrition and health-related quality of life (HRQOL) in elderly Iranian adults. J Int Med Res 2019; 48:300060519863497. [PMID: 31502490 PMCID: PMC7140194 DOI: 10.1177/0300060519863497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/16/2022] Open
Abstract
Objectives We aimed to evaluate the association of nutritional status and health-related
quality of life (HRQOL) among elderly Iranian residents. Methods We used the 36-item Short Form Health Survey (SF-36) to assess HRQOL among
participants with normal nutrition status, at risk of malnutrition, and
malnourished. Results Mean group scores for the Physical Component Summary (PCS) of the SF-36 were
44, 36.5, and 29.0 for normal, at-risk, and malnourished groups,
respectively; for the Mental Component Summary (MCS), these were 47.1, 40.7,
and 34.8, respectively. The PCS and MCS displayed significant positive
correlation with malnutrition in three models: crude (I); age- and
sex-adjusted (II); and adjusted for age, sex, education, occupation, marital
status, and residence. Standardized beta coefficients of PCS in Models I–III
were 1.35, 1.27, and 1.14, respectively; for MCS, these were 1.11 in all
three models; all results were statistically significant. Estimated results
of logistic regression were −6.023 for malnourished versus well-nourished
and −2.652 for malnourished versus at risk of malnutrition. Conclusion Our analyses revealed the crucial impact of nutritional status on both mental
and physical components of HRQOL.
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Affiliation(s)
- Fatemeh Khatami
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Koorosh Kamali
- Department of Public Health, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehdi Ebrahimi
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zeinab Ahadi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Taheri Tanjani
- Department of Internal Medicine, Ayatollah Taleghani Hospital, Research Development Unit, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Hong H, Budhathoki C, Farley JE. Increased risk of aminoglycoside-induced hearing loss in MDR-TB patients with HIV coinfection. Int J Tuberc Lung Dis 2019; 22:667-674. [PMID: 29862952 DOI: 10.5588/ijtld.17.0830] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING A high proportion of individuals with multidrug-resistant tuberculosis (MDR-TB) develop permanent hearing loss due to ototoxicity caused by injectable aminoglycosides (AGs). The prevalence of AG-induced hearing loss is greatest in tuberculosis (TB) and human immunodeficiency virus (HIV) endemic countries in sub-Saharan Africa. However, whether HIV coinfection is associated with a higher incidence of AG-induced hearing loss during MDR-TB treatment is controversial. OBJECTIVE To evaluate the impact of HIV coinfection on AG-induced hearing loss among individuals with MDR-TB in sub-Saharan Africa. DESIGN This was a meta-analysis of articles published in PubMed, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane Review, and reference lists using search terms 'hearing loss', 'aminoglycoside', and 'sub-Saharan Africa'. RESULTS Eight studies conducted in South Africa, Botswana and Namibia and published between 2012 and 2016 were included. As the included studies were homogeneous (χ2 = 8.84, df = 7), a fixed-effects model was used. Individuals with MDR-TB and HIV coinfection had a 22% higher risk of developing AG-induced hearing loss than non-HIV-infected individuals (pooled relative risk 1.22, 95%CI 1.10-1.36) during MDR-TB treatment. CONCLUSION This finding is critical for TB programs with regard to the expansion of injectable-sparing regimens. Our findings lend credibility to using injectable-sparing regimens and more frequent hearing monitoring, particularly in resource-limited settings for HIV-coinfected individuals.
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Affiliation(s)
- H Hong
- Department of Community-Public Health
| | | | - J E Farley
- Department of Community-Public Health, REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Knappe-Drzikova B, Maasberg S, Vonderbeck D, Krafft TA, Knüppel S, Sturm A, Müller-Nordhorn J, Wiedenmann B, Pape UF. Malnutrition predicts long-term survival in hospitalized patients with gastroenterological and hepatological diseases. Clin Nutr ESPEN 2019; 30:26-34. [PMID: 30904226 DOI: 10.1016/j.clnesp.2019.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS Malnutrition is a common problem in hospitalized patients, influencing treatment outcomes, length of hospital stay, quality of life and overall survival. However, the association of nutritional status parameters with long-term mortality has not yet been studied systematically in gastroenterological-hepatological patients. The present study aimed to assess the association between nutritional status parameters as characterized by Nutritional Risk Screening (NRS), anthropometry, serum transferrin, bioelectrical impedance analysis (BIA) and long-term overall survival in hospitalized gastroenterological-hepatological patients. METHODS Nutritional status was assessed in 644 gastroenterological-hepatological patients by NRS score. In addition, body mass index (BMI) and serum transferrin were determined and BIA was performed. Mid-upper arm circumference (MUAC) and triceps skinfold thickness (TST) were measured. Patients were followed for a mean period of 67 months (mean 54.8, range 0-107 months). RESULTS During malnutrition screening, 475 (73.8%) patients were diagnosed as sufficiently nourished by NRS (NRS 0-2), while an increased risk of malnutrition was found in 169 (26.2%) patients (NRS≤3). Malnutrition was significantly associated with less favourable results for BMI (p < 0.001), serum transferrin (p < 0.001), BIA (p < 0.001), MUAC (p < 0.001) and TST (p < 0.05). Overall 5-year survival rates (YSR) were much shorter in malnourished patients whether with (5-YSR: 43.9%) or without (73.6%) malignancy. Overall 5-year survival rates (YSR) were much shorter in malnourished patients whether with (5-YSR: 43.9%) or without (73.6%) malignancy. By the multivariable analysis the NRS ≥3 and, phase angle (PhA) over the 5th percentile or over the mean of the cohort were found to be associated with long-term survival. CONCLUSIONS Malnutrition is highly prevalent in hospitalized gastroenterological-hepatological patients and is associated with distinct clinical diagnoses. In the present study we demonstrated that malnutrition characterized by the NRS, anthropometry, serum transferrin and BIA, not only predicts short-term but also significantly poor long-term outcome in these patients.
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Affiliation(s)
- Barbora Knappe-Drzikova
- Department of Hepatology and Gastroenterology, Charité Campus Mitte and Campus Virchow Clinic, Charité University Medicine, Berlin, Germany.
| | - Sebastian Maasberg
- Department of Hepatology and Gastroenterology, Charité Campus Mitte and Campus Virchow Clinic, Charité University Medicine, Berlin, Germany
| | - Dorothée Vonderbeck
- Department of Hepatology and Gastroenterology, Charité Campus Mitte and Campus Virchow Clinic, Charité University Medicine, Berlin, Germany
| | - Thomas A Krafft
- Department of Hepatology and Gastroenterology, Charité Campus Mitte and Campus Virchow Clinic, Charité University Medicine, Berlin, Germany
| | - Sven Knüppel
- Department of Nutrition and Gerontology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
| | - Andreas Sturm
- Department of Hepatology and Gastroenterology, Charité Campus Mitte and Campus Virchow Clinic, Charité University Medicine, Berlin, Germany; Department of Gastroenterology, DRK-Kliniken Westend, Berlin, Germany
| | | | - Bertram Wiedenmann
- Department of Hepatology and Gastroenterology, Charité Campus Mitte and Campus Virchow Clinic, Charité University Medicine, Berlin, Germany
| | - Ulrich-Frank Pape
- Department of Hepatology and Gastroenterology, Charité Campus Mitte and Campus Virchow Clinic, Charité University Medicine, Berlin, Germany; Department of Internal Medicine and Gastroenterology, Asklepios Klinik St. Georg, Hamburg, Germany
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Vest MT, Papas MA, Shapero M, McGraw P, Capizzi A, Jurkovitz C. Characteristics and Outcomes of Adult Inpatients With Malnutrition. JPEN J Parenter Enteral Nutr 2017; 42:1009-1016. [PMID: 29360158 DOI: 10.1002/jpen.1042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/22/2017] [Accepted: 10/23/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The diagnosis of malnutrition remains controversial. Furthermore, it is unknown if physician diagnosis of malnutrition impacts outcomes. We sought to compare outcomes of patients with physician diagnosed malnutrition to patients recognized as malnourished by registered dietitians (RDs), but not physicians, and to describe the impact of each of 6 criteria on the diagnosis of malnutrition. METHODS We conducted a retrospective cohort study of adult patients identified as meeting criteria for malnutrition. Pediatric, psychiatric, maternity, and rehabilitation patients were excluded. Patient demographics, clinical data, malnutrition type and criteria, nutrition interventions, and outcomes were abstracted from the electronic medical record. RESULTS RDs identified malnutrition for 291 admissions during our study period. This represents 4.1% of hospital discharges. Physicians only diagnosed malnutrition on 93 (32%) of these cases. Physicians diagnosed malnutrition in 43% of patients with a body mass index <18.5 but only 26% of patients with body mass index higher than 18.5. Patients with a physician diagnosis had a longer length of stay (mean 14.9 days vs 7.1 days) and were more likely to receive parenteral nutrition (PN) (20.4% vs 4.6%). Of the patients, 62% had malnutrition due to chronic illness. Of the 6 criteria used to identify malnourished patients, weight loss and reduced energy intake were the most common. CONCLUSIONS Malnutrition is underrecognized by physicians. However, further research is needed to determine if physician recognition and treatment of malnutrition can improve outcomes. The most important criteria for identifying malnourished patients in our cohort were weight loss and reduced energy intake.
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Affiliation(s)
- Michael T Vest
- Critical Care Medicine, Department of Medicine, Christiana Care Healthcare System, Christiana Care Value Institute, Sidney Kimmel Medical College, Newark, Delaware
| | - Mia A Papas
- Christiana Care Value Institute, Newark, Delaware
| | - Mary Shapero
- Department of Food and Nutrition Services, Christiana Care Healthcare System, Newark, Delaware
| | - Patty McGraw
- Department of Medicine Research Christiana Care Healthcare System, Newark, Delaware
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Orlandoni P, Venturini C, Jukic Peladic N, Costantini A, Di Rosa M, Cola C, Giorgini N, Basile R, Fagnani D, Sparvoli D, David S. Malnutrition upon Hospital Admission in Geriatric Patients: Why Assess It? Front Nutr 2017; 4:50. [PMID: 29164125 PMCID: PMC5670098 DOI: 10.3389/fnut.2017.00050] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 09/26/2016] [Accepted: 10/05/2017] [Indexed: 01/04/2023] Open
Abstract
Objective To assess the prevalence of malnutrition according to the new ESPEN definition in a population of geriatric hospital patients and to determine how malnutrition affects the length of hospital stay (LOS) and hospital mortality. Design A retrospective analysis of data gathered during nutritional screening surveys carried out three consecutive years, from 2012 to 2014, in an Italian geriatric research hospital (INRCA, Ancona) was performed. On the day of the study, demographic data, data on clinical conditions and the nutritional status of newly admitted patients were collected. Patients were screened for malnutrition risk using the Malnutrition Universal Screening Tool (MUST). Subsequently, malnutrition was diagnosed, for subjects at high risk, following the criteria suggested by the European Association for Clinical Nutrition and Metabolism [body mass index (BMI) < 18.5 kg/m2 or different combinations of unintentional weight loss over time and BMI values]. Sensitivity, specificity, positive and negative predictive value of MUST compared to ESPEN criteria were assessed. The characteristics of patients with a diagnosis of malnutrition were compared to those of non-malnourished patients. The impact of malnutrition on LOS and hospital mortality was investigated through logistic and linear regression models. Setting The study was performed in an Italian geriatric research hospital (INRCA, Ancona). Subjects Two hundred eighty-four newly hospitalized geriatric patients from acute care wards (mean age 82.8 ± 8.7 years), who gave their written consent to participate in the study, were enrolled. Results According to the MUST, high risk of malnutrition at hospitalization was found in 28.2% of patients. Malnutrition was diagnosed in 24.6% of subjects. The malnutrition was an independent predictor of both the LOS and hospital mortality. The multivariate analyses—linear and logistic regression—were performed considering different potential confounders contemporarily. The results showed that the malnutrition is an independent predictor of LOS and hospital mortality. Malnourished subjects were hospitalized almost 3 days longer compared to non-malnourished patients (p = 0.047; CI 0.04–5.80). The risk of death during hospitalization was 55% higher for malnourished patients (p = 0.037; CI 0.21–0.95). Conclusion A new ESPEN consensus of malnutrition was easily applicable in a population of geriatric hospital patients. Given that the nutritional status of geriatric patients was strongly correlated with the LOS and hospital mortality, the use of this simple and non-time consuming tool is highly recommended in clinical practice.
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Affiliation(s)
- Paolo Orlandoni
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Claudia Venturini
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Nikolina Jukic Peladic
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Annarita Costantini
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Mirko Di Rosa
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Claudia Cola
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Natascia Giorgini
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Redenta Basile
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Donata Fagnani
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Debora Sparvoli
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Serenella David
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
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Isono N, Imamura Y, Ohmura K, Ueda N, Kawabata S, Furuse M, Kuroiwa T. Transthyretin Concentrations in Acute Stroke Patients Predict Convalescent Rehabilitation. J Stroke Cerebrovasc Dis 2017; 26:1375-1382. [PMID: 28314625 DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.020] [Citation(s) in RCA: 5] [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: 11/08/2016] [Revised: 02/06/2017] [Accepted: 02/15/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE For stroke patients, intensive nutritional management is an important and effective component of inpatient rehabilitation. Accordingly, acute care hospitals must detect and prevent malnutrition at an early stage. Blood transthyretin levels are widely used as a nutritional monitoring index in critically ill patients. Here, we had analyzed the relationship between the transthyretin levels during the acute phase and Functional Independence Measure in stroke patients undergoing convalescent rehabilitation. METHODS We investigated 117 patients who were admitted to our hospital with acute ischemic or hemorrhagic stroke from February 2013 to October 2015 and subsequently transferred to convalescent hospitals after receiving acute treatment. Transthyretin concentrations were evaluated at 3 time points as follows: at admission, and 5 and 10 days after admission. After categorizing patients into 3 groups according to the minimum transthyretin level, we analyzed the association between transthyretin and Functional Independence Measure. RESULTS In our patients, transthyretin levels decreased during the first 5 days after admission and recovered slightly during the subsequent 5 days. Notably, Functional Independence Measure efficiency was significantly associated with the decrease in transthyretin levels during the 5 days after admission. Patients with lower transthyretin levels had poorer Functional Independence Measure outcomes and tended not to be discharged to their own homes. DISCUSSION A minimal transthyretin concentration (<10 mg/dL) is predictive of a poor outcome in stroke patients undergoing convalescent rehabilitation. In particular, an early decrease in transthyretin levels suggests restricted rehabilitation efficiency. Accordingly, transthyretin levels should be monitored in acute stroke patients to indicate mid-term rehabilitation prospects.
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Affiliation(s)
- Naofumi Isono
- Department of Neurosurgery, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan.
| | - Yuki Imamura
- Clinical Nutrition and Food Service, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan
| | - Keiko Ohmura
- Clinical Nutrition and Food Service, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan
| | - Norihide Ueda
- Clinical Nutrition and Food Service, Higashi-Sumiyoshi Morimoto Hospital, Osaka, Japan; Clinical Nutrition and Food Service, Kokuho Central Hospital, Shiki, Japan
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan
| | - Motomasa Furuse
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan
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Abstract
BACKGROUND We assessed the nutrition status of patients on admission and monitored changes during hospitalization at Shariatri Educational Hospital, Tehran, Iran. METHODS One hundred fifty-six randomly selected patients from 9 different wards were assessed. Body mass index (BMI) and body composition (based on bioelectrical impedance) were measured on admission and discharge. A questionnaire was also completed to evaluate general physical, psychological, and living status of the patients. Medical records were audited to identify when nutrition consultation, nutrition support, and nutrition-related laboratory factors (serum levels of total lymphocyte count [TLC] and albumin) were ordered. Frequency and paired t-test were used to analyze data. RESULTS Undernutrition (BMI <18.5 kg/m(2)) was present in 5.7% of the patients on admission, and severe undernutrition (BMI <16 kg/m(2)) existed in 0.6%. When discharged, 11% of patients were undernourished, and the prevalence of severe undernutrition increased to 1.3%. Average body weight and BMI decreased significantly during hospitalization (p < .001). Body composition analysis showed a significant reduction in body protein mass (p < .001). During hospitalization, body water percentile decreased and body fat percentile increased but not significantly. Only 1 patient was supported with parenteral nutrition (PN) and 1 with enteral nutrition. Orders for nutrition consultation were present in 1.9%, TLC levels in 10.8%, and serum albumin levels in 7% of the patient medical records surveyed. CONCLUSIONS Undernutrition increased in patients during hospitalization. According to the low rate of nutrition-related orders, one potential cause of worsening nutrition status may be inadequate medical staff awareness about the importance of nutrition in hospitalized patients.
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Affiliation(s)
- Saeed Hosseini
- Nutrition and Biochemistry Department, Tehran University of Medical Sciences, Endocrinology and Metabolism Research Centre of the Tehran University of Medical Sciences, Shariati Hospital, North Kargar St., Tehran 14114, Iran.
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Havens JM, Columbus AB, Seshadri AJ, Olufajo OA, Mogensen KM, Rawn JD, Salim A, Christopher KB. Malnutrition at Intensive Care Unit Admission Predicts Mortality in Emergency General Surgery Patients. JPEN J Parenter Enteral Nutr 2016; 42:156-163. [DOI: 10.1177/0148607116676592] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/27/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Joaquim M. Havens
- Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Alexandra B. Columbus
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Olubode A. Olufajo
- Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Kris M. Mogensen
- Department of Nutrition, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - James D. Rawn
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ali Salim
- Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Kenneth B. Christopher
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Cramer JT, Cruz-Jentoft AJ, Landi F, Hickson M, Zamboni M, Pereira SL, Hustead DS, Mustad VA. Impacts of High-Protein Oral Nutritional Supplements Among Malnourished Men and Women with Sarcopenia: A Multicenter, Randomized, Double-Blinded, Controlled Trial. J Am Med Dir Assoc 2016; 17:1044-1055. [DOI: 10.1016/j.jamda.2016.08.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 08/22/2016] [Indexed: 12/24/2022]
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Sola M, Ramm CJ, Kolarczyk LM, Teeter EG, Yeung M, Caranasos TG, Vavalle JP. Application of a Multidisciplinary Enhanced Recovery After Surgery Pathway to Improve Patient Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 2016; 118:418-23. [PMID: 27344271 DOI: 10.1016/j.amjcard.2016.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 12/18/2022]
Abstract
Enhanced recovery after surgery (ERAS) protocols have proven effective in a variety of surgical specialties. Published reports on these pathways within cardiac surgery and interventional cardiology are limited. Invasive aortic valve replacement procedures are increasingly being performed by hybrid groups of interventional cardiologists and surgeons through transcatheter aortic valve implantation (TAVI). The TAVI patient population is at a higher surgical risk compared with those undergoing surgical aortic valve replacement since they are older, frailer, and have significant co-morbidities which result in an increased risk of perioperative complications. ERAS protocols have the potential to help these patients undergoing TAVI procedures. In conclusion, we propose a TAVI ERAS protocol with a call-to-action for other centers to implement an ERAS protocol to improve hospital and cardiac outcomes.
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Menon S, Rossi R, Nshimyumukiza L, Wusiman A, Zdraveska N, Eldin MS. Convergence of a diabetes mellitus, protein energy malnutrition, and TB epidemic: the neglected elderly population. BMC Infect Dis 2016; 16:361. [PMID: 27456231 PMCID: PMC4960905 DOI: 10.1186/s12879-016-1718-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 07/15/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND On a global scale, nearly two billion persons are infected with Mycobacterium tuberculosis. From this vast reservoir of latent tuberculosis (TB) infection, a substantial number will develop active TB during their lifetime, with some being able to transmit TB or Multi-drug- resistant (MDR) TB to others. There is clinical evidence pointing to a higher prevalence of infectious diseases including TB among individuals with Diabetes Mellitus (DM). Furthermore, ageing and diabetes mellitus may further aggravate protein-energy malnutrition (PEM), which in turn impairs T-lymphocyte mediated immunologic defenses, thereby increasing the risk of developing active TB and compromising TB treatment. This article aims to a) highlight synergistic mechanisms associated with immunosenescence, DM and PEM in relation to the development of active TB and b) identify nutritional, clinical and epidemiological research gaps. METHODS To explore the synergistic relationship between ageing, DM, tuberculosis and PEM, a comprehensive review was undertaken. The MEDLINE and the Google Scholar databases were searched for articles published from 1990 to March 2015, using different MESH keywords in various combinations. RESULTS Ageing and DM act synergistically to reduce levels of interferon gamma (IFN- γ), thereby increasing susceptibility to TB, for which cell mediated immunity (CMI) plays an instrumental role. These processes can set in motion a vicious nutritional cycle which can predispose to PEM, further impairing the CMI and consequently limiting host defenses. This ultimately transforms the latent TB infection into active disease. A clinical diagnostic algorithm and clinical guidelines need to be established for this population. CONCLUSION Given the increase in ageing population with DM and PEM, especially in resource-poor settings, these synergistic tripartite interactions must be examined if a burgeoning TB epidemic is to be averted. Implementation of a comprehensive, all-encompassing approach to curb transmission is clearly indicated. To this end, clinical, nutritional and epidemiological research gaps must be addressed without a delay.
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Affiliation(s)
- Sonia Menon
- International Centre for Reproductive health, Ghent University, LSHTM Alumni, Ghent, Belgium
- CDC Foundation, Atlanta, USA
| | | | - Leon Nshimyumukiza
- Department of Social and Preventive Medicine, Laval University-Faculty of Medicine, Quebec, Canada
| | - Aibibula Wusiman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Natasha Zdraveska
- Department of Clinical Pharmacy, Saints Cyril and Methodius University of Skopje (Alumni), Skopje, Republic of Macedonia
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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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Gelinas JP, Walley KR. Beyond the Golden Hours. Clin Chest Med 2016; 37:347-65. [DOI: 10.1016/j.ccm.2016.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wischmeyer P. Malnutrition in the acutely ill patient: is it more than just protein and energy? South African Journal of Clinical Nutrition 2016. [DOI: 10.1080/16070658.2011.11734372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Klu YAK, Phillips RD, Chen J. Development of a Drinkable, Peanut-Based Dietary Supplement and Comparison of Its Nutritional and Microbiological Qualities with Commercial Products. J Food Sci 2016; 81:H1309-12. [DOI: 10.1111/1750-3841.13298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/28/2016] [Accepted: 03/14/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Yaa Asantewaa Kafui Klu
- Dept. of Food Science and Technology; The Univ. of Georgia; 1109 Experiment St. Griffin Ga 30223-1797 U.S.A
| | - Robert D. Phillips
- Dept. of Food Science and Technology; The Univ. of Georgia; 1109 Experiment St. Griffin Ga 30223-1797 U.S.A
| | - Jinru Chen
- Dept. of Food Science and Technology; The Univ. of Georgia; 1109 Experiment St. Griffin Ga 30223-1797 U.S.A
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Costa LDO, Souza DÚF, Fonseca WM, Gonçalves BCC, Gomes GB, Cruz LARD, Reis Júnior NNA, Leite JOM. Evidências para o uso da avaliação nutricional subjetiva global nos pacientes com doença arterial periférica. J Vasc Bras 2016. [DOI: 10.1590/1677-5449.001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo A desnutrição é uma doença extremamente prevalente em pacientes internados, chegando a acometer 50% deles, 47% dos pacientes cirúrgicos e entre 39 e 73% dos portadores de doença arterial periférica, com grande impacto na morbimortalidade desses pacientes. A desnutrição possui grande relevância no desfecho clínico desses pacientes durante a internação, estando associada a maior incidência de infecções, demora na cicatrização das feridas, diminuição do status de deambulação, maior tempo de internação e mortalidade. Entretanto, o diagnóstico de desnutrição ou risco nutricional desses pacientes tem sido um desafio. A avaliação nutricional subjetiva global revelou-se, até o momento, o padrão ouro como método de triagem de pacientes cirúrgicos internados devido à sua praticidade e acurácia. O objetivo deste trabalho é revisar métodos utilizados na avaliação do estado nutricional e da triagem nutricional de pacientes internados e caracterizar a importância dessa avaliação nos desfechos clínicos dos pacientes com arteriopatias.
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Mogensen KM, Robinson MK, Casey JD, Gunasekera NS, Moromizato T, Rawn JD, Christopher KB. Nutritional Status and Mortality in the Critically Ill. Crit Care Med 2015; 43:2605-15. [PMID: 26427592 DOI: 10.1097/CCM.0000000000001306] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The association between nutritional status and mortality in critically ill patients is unclear based on the current literature. To clarify this relation, we analyzed the association between nutrition and mortality in a large population of critically ill patients and hypothesized that mortality would be impacted by nutritional status. DESIGN Retrospective observational study. SETTING Single academic medical center. PATIENTS Six thousand five hundred eighteen adults treated in medical and surgical ICUs between 2004 and 2011. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All cohort patients received a formal, in-person, standardized evaluation by a registered dietitian. The exposure of interest, malnutrition, was categorized as nonspecific malnutrition, protein-energy malnutrition, or well nourished and determined by data related to anthropometric measurements, biochemical indicators, clinical signs of malnutrition, malnutrition risk factors, and metabolic stress. The primary outcome was all-cause 30-day mortality determined by the Social Security Death Master File. Associations between nutrition groups and mortality were estimated by bivariable and multivariable logistic regression models. Adjusted odds ratios were estimated with inclusion of covariate terms thought to plausibly interact with both nutrition status and mortality. We used propensity score matching on baseline characteristics to reduce residual confounding of the nutrition status category assignment. In the cohort, nonspecific malnutrition was present in 56%, protein-energy malnutrition was present in 12%, and 32% were well nourished. The 30-day and 90-day mortality rates for the cohort were 19.1% and 26.6%, respectively. Nutritional status is a significant predictor of 30-day mortality following adjustment for age, gender, race, medical versus surgical patient type, Deyo-Charlson index, acute organ failure, vasopressor use, and sepsis: nonspecific malnutrition 30-day mortality odds ratio, 1.17 (95% CI, 1.01-1.37); protein-energy malnutrition 30-day mortality odds ratio, 2.10 (95% CI, 1.70-2.59), all relative to patients without malnutrition. In the matched cohort, the adjusted odds of 30-day mortality in the group of propensity score-matched patients with protein-energy malnutrition was two-fold greater than that of patients without malnutrition. CONCLUSION In a large population of critically ill adults, an association exists between nutrition status and mortality.
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Khrykov GN, Khalikov AD, Pasechnik IN. [Enhanced recovery protocol in gerontological colon cancer patients]. Khirurgiia (Mosk) 2016:37-41. [PMID: 28091455 DOI: 10.17116/hirurgia20161237-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/06/2023]
Abstract
To develop enhanced recovery protocol for elderly and old patients in elective colon cancer surgery. In Russia as in the most world countries the biggest frequency of colon cancer are among elderly and old people. At the same time surgery treatment of elderly patients compared with young patients accompanied with increased frequency of complications, length of stay in hospital and mortality. Based on own and literature trials authors proposed enhanced recovery protocol for gerontological colon cancer patients. Protocol established on multidisciplinary approach to elderly and old patients treatment and include all stages of perioperative period.
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Affiliation(s)
- G N Khrykov
- Kirov Military Medical Academy, St. Petersburg
| | - A D Khalikov
- City Clinical Oncology Dispensary, Saint-Petersburg
| | - I N Pasechnik
- Central State Medical Academy of President Administration, Moscow
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Shi R, Duan J, Deng Y, Tu Q, Cao Y, Zhang M, Zhu Q, Lü Y. Nutritional status of an elderly population in Southwest China: a cross-sectional study based on comprehensive geriatric assessment. J Nutr Health Aging 2015; 19:26-32. [PMID: 25560813 DOI: 10.1007/s12603-014-0471-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 12/20/2022]
Abstract
OBJECTIVE Few data is available on the nutritional status of old Chinese. The present study aimed to describe the nutritional status and clinical correlates for malnutrition risk in the older people. DESIGN Cross-sectional study. SETTING Hospital- and community-based older people were recruited in the region of Chongqing, China. PARTICIPANTS 558 individuals aged 60 years old or over between April 2011 and October 2012. MEASUREMENTS Comprehensive geriatric assessment was performed and nutritional status was assessed by the Mini Nutritional Assessment Short Form (MNA-SF). Nutrition-associated factors were analyzed, including health status (chronic diseases, depression, cognition, function impaired), social factors (education status, marital status, the type of work before 60 years old) and life style factors (smoking, drinking, diet). RESULTS The mean age was 73.1±8.0 years and 43.9% were men. Prevalence of malnutrition and risk for malnutrition were 3.2% and 19.3 %, respectively. Several factors increased poor nutrition independently including self-rated health, comorbidity, chronic obstructive pulmonary disease, gastrointestinal disease and cognitive impairment. Fish decreased the risk of poor nutrition. CONCLUSIONS The prevalence was relatively low in older people of Chongqing, Southwest China. Poor nutrition was found to be increased due to the common health problems. Thus the patients with these problems should pay more attention on nutritional status. The older people should often have fish because of their nutritional benefit.
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Affiliation(s)
- R Shi
- Yang Lü, Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China, Tel: 86-23-89011632, Fax: 86-23-68811487, E-mail:
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Mastronuzzi T, Paci C, Portincasa P, Montanaro N, Grattagliano I. Assessing the nutritional status of older individuals in family practice: Evaluation and implications for management. Clin Nutr 2014; 34:1184-8. [PMID: 25547985 DOI: 10.1016/j.clnu.2014.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 01/15/2014] [Revised: 08/18/2014] [Accepted: 12/11/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS Malnutrition is emerging as a multidimensional concern of ageing with a high prevalence among nursing home residents. This study investigated the extent of malnutrition among old subjects in family practice and its relationship with major complications. METHODS Over 75 years old subjects (n = 274) filled the Mini Nutritional Assessment questionnaire. Appearance of major events in the following 6 months were registered. RESULTS MNA scored were 11.5 ± 3.1, with 175 (64%) subjects showing no malnutrition, 69 (25%) resulted at risk, and 30 (11%) malnourished. Within at risk group, 1.4% was resident, 7% bed rested, 8% had a history of major bone fracture, 33% was demented and 24.6% hospitalized at least once in the last year. Among malnourished patients, 10% was resident, ten bed rested with 70% showing multiple bedsores, 20% have had bone fractures, 60% were demented and 13% hospital admitted in the previous year. In over 90% of them, malnutrition had neither diagnosed nor considered before. During follow-up, a significantly higher number of major events including death occurred in the malnourished group. By multivariate logistic regression, n = 56 (20.4%) patients resulted at risk of major complications. The sensitivity of the questionnaire in identifying these patients was 84% with the cut-off value of 7 associated with the highest prediction (positive predictive value, 0.92; negative predictive value, 0.71) yielding a specificity of 92%. CONCLUSIONS The prevalence of malnutrition is high among older subjects in the setting of family practice. The Mini Nutritional Assessment allows to identify malnourished subjects better than BMI and effectively predicts the risk of major events.
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Affiliation(s)
| | - Claudio Paci
- Italian College of General Practitioners, Bari, Italy
| | - Piero Portincasa
- Department of Biosciences and Human Oncology (DIMO), Clinica Medica 'A. Murri', University of Bari Medical School, Policlinico Hospital, Bari, Italy
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Boban M, Laviano A, Persic V, Rotim A, Jovanovic Z, Vcev A. Characteristics of NRS-2002 Nutritional Risk Screening in patients hospitalized for secondary cardiovascular prevention and rehabilitation. J Am Coll Nutr 2014; 33:466-73. [PMID: 25387165 DOI: 10.1080/07315724.2013.876902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/31/2022]
Abstract
OBJECTIVE The aim of our study was to assess the prevalence and characteristics of nutritional risk in patients scheduled for cardiovascular rehabilitation. BACKGROUND Knowledge concerning nutritional aspects of cardiovascular diseases is contemporary limited. METHODS Nutritional risk screening using a standardized Nutritional Risk Screening-2002 (NRS-2002) questionnaire was performed on a cohort of consecutive patients scheduled for rehabilitation 1-6 months after treatment for ischemic, valvular, or combined causes of heart diseases. Baseline weight was available for more than 80% of patients. RESULTS The study population consisted of 317 patients, aged 23-85 years, with a mean age of 62.5 ± 11.3 years. Male to female share was 253 (79.8%) and 64 (20.2%), respectively. Twenty-eight (8.8%) were treated for myocardial infarction conservatively, 151 (47.6%) by percutaneous coronary interventions, and 145 (45.7%) by surgery. NRS-2002 was 3.56 ± 1.54 in range 0-6. A high correlation was found between the NRS-2002 and percentage weight loss history (rho = 0.813; p <0.001). Significant differences according to increased nutritional risk (NRS-2002 ≥ 3) were found within age groups (p < 0.001), disease etiology (p = 0.002), cardiovascular treatments (p < 0.001), and grades of renal function (p < 0.001). Odds for developing increased nutritional risk (NRS-2002 ≥ 3) were significant for cardiovascular treatments (odds ratio [OR] = 4.35, 95% confidence interval [CI], 2.28-8.30, p < 0.001), age (OR = 3.19, 95% CI, 2.00-5.09, p < 0.001), grade of renal function (OR = 1.91, 95% CI, 1.17-3.09, p = 0.009), diabetes mellitus (OR = 2.37, 95% CI, 1.09-5.16, p = 0.029), and any psychological disturbance (OR = 2.04, 95% CI, 1.06-3.90, p = 0.032). CONCLUSIONS Pronounced nutritional risk frequently existed among patients at stationary cardiovascular rehabilitation. Nutritional risk was connected with preceding cardiovascular treatments, patient age, and renal function. Further studies concerning nutritional risk and its connections with clinical outcomes might serve as a resourceful perspective to improve outcomes or quality of care for the entities from the cardiovascular diseases continuum.
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Hervé C, Obin B, Ferrand C. Nutrition and Decision Making in the Elderly People: A Preliminary Study. Psychol Stud 2014; 59:231-235. [DOI: 10.1007/s12646-014-0274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Tangvik RJ, Tell GS, Eisman JA, Guttormsen AB, Henriksen A, Nilsen RM, Øyen J, Ranhoff AH. The nutritional strategy: Four questions predict morbidity, mortality and health care costs. Clin Nutr 2014; 33:634-41. [PMID: 24094814 DOI: 10.1016/j.clnu.2013.09.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 09/06/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
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Thomakos N, Zacharakis D, Rodolakis A, Zagouri F, Papadimitriou CA, Bamias A, Dimopoulos MA, Haidopoulos D, Vlahos G, Antsaklis A. Gynecologic oncology patients in the surgical high dependency unit: an analysis of indications. Arch Gynecol Obstet 2014; 290:335-9. [PMID: 24639289 DOI: 10.1007/s00404-014-3180-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The establishment of high dependency units (HDUs) has been an undoubted advance in the management of patients undergoing major oncological procedures. The aim of this study was to examine the impact of various preoperative and perioperative patients' characteristics on the prolonged HDU stay. METHODS We conducted a retrospective study including all gynecologic oncology patients who underwent surgical management and were admitted postoperatively to our hospitals' HDU from 2006 to 2010. RESULTS A total of 1,014 patients were transferred to the HDU and divided into two groups according to the length of HDU stay. Group A consisted of 840 (82.8 %) patients who stayed in the HDU for ≤24 h and Group B included 174 (17.2 %) patients who remained in the HDU under close observation for >24 h. Older age was the only preoperative characteristic that remained significantly associated with HDU prolonged stay. In addition, three intraoperative factors such as use of invasive hemodynamic monitoring, bowel resection and estimated blood loss were proved to be independently associated with prolonged HDU stay. CONCLUSION Certain characteristics could identify those patients who are more likely to benefit most from HDU admission.
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Affiliation(s)
- Nikolaos Thomakos
- Department of Obstetrics and Gynaecology, Alexandra Hospital, Medical School, University of Athens, Athens, Greece
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Soenen S, Chapman IM. Body Weight, Anorexia, and Undernutrition in Older People. J Am Med Dir Assoc 2013; 14:642-8. [DOI: 10.1016/j.jamda.2013.02.004] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 02/06/2013] [Indexed: 11/28/2022]
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Sonnek FC, Muilekom EV. Metastatic castration-resistant prostate cancer. Part 2: helping patients make informed choices and managing treatment side effects. Eur J Oncol Nurs 2013; 17 Suppl 1:S7-12. [DOI: 10.1016/s1462-3889(14)70003-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Diekmann R, Winning K, Uter W, Kaiser MJ, Sieber CC, Volkert D, Bauer JM. Screening for malnutrition among nursing home residents - a comparative analysis of the mini nutritional assessment, the nutritional risk screening, and the malnutrition universal screening tool. J Nutr Health Aging 2013; 17:326-31. [PMID: 23538654 DOI: 10.1007/s12603-012-0396-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [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: 12/15/2022]
Abstract
BACKGROUND The European Society for Clinical Nutrition and Metabolism (ESPEN) has recommended the Mini Nutritional Assessment (MNA®), the Nutritional Risk Screening 2002 (NRS), and the Malnutrition Universal Screening Tool (MUST) for nutritional screening in various settings and age groups. While in recent years all three tools have been applied to nursing home residents, there is still no consensus on the most appropriate screening tool in this specific setting. AIM The present study aims at comparing the MNA, the NRS, and the MUST with regard to applicability, categorization of nutritional status, and predictive value in the nursing home setting. METHOD MNA, NRS, and MUST were performed on 200 residents from two municipal nursing homes in Nuremberg, Germany. Follow-up data on infection, hospitalization, and mortality were collected after six and again after twelve months. RESULTS Among 200 residents (mean age 85.5 ± 7.8 years) the MNA could be completed in 188 (94.0%) and the NRS and MUST in 198 (99.0%) residents. The prevalence of 'malnutrition' according to the MNA was 15.4%. The prevalence of 'risk of malnutrition' (NRS) and 'high risk of malnutrition' (MUST), respectively, was 8.6% for both tools. The individual categorization of nutritional status showed poor agreement between NRS and MUST on the one hand and MNA on the other. For all tools a significant association between nutritional status and mortality was demonstrated during follow-up as classification in 'malnourished', respectively 'high risk of malnutrition' or 'nutritional risk', was significantly associated with increased hazard ratios. However, the MNA showed the best predictive value for survival among well-nourished residents. CONCLUSION The evaluation of nutritional status in nursing home residents by MNA, NRS, and MUST shows significant differences. This observation may be of clinical relevance as nutritional intervention is usually based on screening results. As the items of the MNA reflect particularities of the nursing home population, this tool currently appears to be the most suitable one in this setting.
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Affiliation(s)
- R Diekmann
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Heimerichstr. 58, D-40419 Nürnberg, Germany
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Abstract
BACKGROUND OBJECTIVE The study aimed to determine the prevalence of malnutrition risk in a population of older people (aged 75 years and over) attending a community general practice and identify characteristics of those classified as malnourished or at risk of malnutrition. DESIGN Cross-sectional study of nutritional risk screen conducted over a six month period. PARTICIPANTS AND SETTING Patients attending a general practice clinic in Victoria, Australia, who attended for the "75 plus" health assessment check. MEASUREMENTS The Mini Nutritional Assessment Short Form (MNA®-SF) was included as part of the health assessment. Information was collected on living situation, co-morbidities, independence with meal preparation and eating, number of medications. Height and weight was measured and MNA®-SF score recorded. RESULTS Two hundred and twenty five patients attending a general practice for a health assessment with a mean age of 81.3(4.3)(SD) years, 52% female and 34% living alone. Only one patient was categorised by the MNA®-SF as malnourished, with an additional 16% classified as at risk of malnutrition. The mean Body Mass Index (BMI) of the at-risk group was significantly lower than the well-nourished group (23.6 ± 0.8 (SEM) vs 27.4 ± 0.3; p=0.0001). However, 34% of the at-risk group had a BMI of 25 or more with only 13% in the underweight category. CONCLUSION In this population of older adults attending their general practitioner for an annual health assessment, one in six were identified as being at nutritional risk which is an additional risk factor for a severe health issue. Importantly, one third of the at-risk group had a BMI in the overweight or obese category, highlighting that older people can be at nutritional risk although they may be overweight or obese.
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Affiliation(s)
- J Winter
- Centre for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Abstract
Critical care is a very recent advance in the history of human evolution. Prior to the existence of ICU care, when the saber-tooth tiger attacked you had but a few critical hours to recover or you died. Mother Nature, and her survival of the fittest mentality, would never have favored the survival of the modern ICU patient. We now support ICU patients for weeks, or even months. During this period, patients appear to undergo phases of critical illness. A simplification of this concept would include an acute phase, a chronic phase, and a recovery phase. Given this, our nutrition care should probably be different in each phase, and targeted to address the evolution of the metabolic response to injury. For example, as insulin resistance is maximal in the acute phase of critical illness, perhaps we have evolved to benefit from a more hypocaloric, high-protein intervention to minimize muscle catabolism. In the chronic phase, and especially in the recovery phase, more aggressive calorie delivery and perhaps proanabolic therapy may be needed. As the body has evolved limited stores of some key nutrients, adequate nutrition may hinge on more than just how many calories we provide. The provision of adequate protein and other key nutrients at the right time may also be vital. This review will attempt to utilize the fundamentals of our evolution as humans and the rapidly growing body of new clinical research to answer questions about how to administer the right nutrients, in the right amounts, at the right time.
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Affiliation(s)
- Paul E Wischmeyer
- Department of Anesthesiology, University of Colorado School of Medicine, 12700 E, 19th Avenue, Box 8602, RC2 P15-7120, Aurora, CO 80045, USA.
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Holst M, Yifter-Lindgren E, Surowiak M, Nielsen K, Mowe M, Carlsson M, Jacobsen B, Cederholm T, Fenger-Groen M, Rasmussen H. Nutritional screening and risk factors in elderly hospitalized patients: association to clinical outcome? Scand J Caring Sci 2012. [DOI: 10.1111/scs.12010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mette Holst
- Centre for Nutrition and Bowel Disease; Department of Gastroenterology; Aalborg University Hospital; Aalborg Denmark
| | | | | | - Kari Nielsen
- Department of Gastroenterology; Queen Alexandrine Hospital; Tórshavn Faroe Islands
| | | | | | - Bent Jacobsen
- Department of Gastroenterology; Aalborg University Hospital; Aalborg Denmark
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
- Department of Geriatrics; Uppsala University Hospital; Uppsala Sweden
| | - Morten Fenger-Groen
- Department of Public Health; Institute of Biostatistics; Aarhus Univsersity; Aarhus Denmark
| | - Henrik Rasmussen
- Centre for Nutrition and Bowel Disease; Department of Gastroenterology; Aalborg University Hospital
- Department of Health Sciences; Aalborg University; Aalborg Denmark
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McGill NK, Vyas J, Shimauchi T, Tokura Y, Piguet V. HTLV-1-associated infective dermatitis: updates on the pathogenesis. Exp Dermatol 2012; 21:815-21. [DOI: 10.1111/exd.12007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2012] [Indexed: 12/12/2022]
Affiliation(s)
- Neilia-Kay McGill
- Department of Dermatology and Wound Healing; Institute of Infection and Immunity; Cardiff University; Cardiff, UK
| | - Jui Vyas
- Department of Dermatology and Wound Healing; Institute of Infection and Immunity; Cardiff University; Cardiff, UK
| | - Takatoshi Shimauchi
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu; Japan
| | - Yoshiki Tokura
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu; Japan
| | - Vincent Piguet
- Department of Dermatology and Wound Healing; Institute of Infection and Immunity; Cardiff University; Cardiff, UK
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Vandewoude MF, Alish CJ, Sauer AC, Hegazi RA. Malnutrition-sarcopenia syndrome: is this the future of nutrition screening and assessment for older adults? J Aging Res 2012; 2012:651570. [PMID: 23024863 DOI: 10.1155/2012/651570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Malnutrition is common across varying patient populations, particularly older adults, and sarcopenia prevalence increases with advancing age. Both malnutrition and sarcopenia are associated with substantial adverse outcomes affecting both the patient and the healthcare system, including increased morbidity, mortality, rehospitalization rates, and healthcare costs. Healthcare practitioners may assess patients for either malnutrition or sarcopenia; however, many patients clinically present with both conditions, resulting in the syndrome, Malnutrition-Sarcopenia Syndrome, which is the clinical presentation of both malnutrition and accelerated age-associated loss of lean body mass, strength, and/or functionality. Clinicians are urged to screen, assess, and treat these conditions currently so as to adequately address the full spectrum of patients' nutritional issues. By examining aspects of both conditions, clinicians can more fully assess their patients' clinical and nutritional status and can tailor targeted therapies to meet their needs and improve outcomes. This proposed syndrome embodies the inherent association of malnutrition and sarcopenia, highlighting their combined impact on clinical outcomes. The objective of this review paper is to characterize Malnutrition-Sarcopenia Syndrome to advance clinical practice, by providing clinicians with the necessary background information to integrate nutritional assessment along with loss of muscle mass and functionality in their everyday clinical practice.
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Vandewoude MF, Alish CJ, Sauer AC, Hegazi RA. Malnutrition-sarcopenia syndrome: Is this the future of nutrition screening and assessment for older adults? J Aging Res. 2012;2012:651570. [PMID: 23024863 PMCID: PMC3449123 DOI: 10.1155/2012/651570] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 07/11/2012] [Indexed: 12/18/2022] Open
Abstract
Malnutrition is common across varying patient populations, particularly older adults, and sarcopenia prevalence increases with advancing age. Both malnutrition and sarcopenia are associated with substantial adverse outcomes affecting both the patient and the healthcare system, including increased morbidity, mortality, rehospitalization rates, and healthcare costs. Healthcare practitioners may assess patients for either malnutrition or sarcopenia; however, many patients clinically present with both conditions, resulting in the syndrome, Malnutrition-Sarcopenia Syndrome, which is the clinical presentation of both malnutrition and accelerated age-associated loss of lean body mass, strength, and/or functionality. Clinicians are urged to screen, assess, and treat these conditions currently so as to adequately address the full spectrum of patients' nutritional issues. By examining aspects of both conditions, clinicians can more fully assess their patients' clinical and nutritional status and can tailor targeted therapies to meet their needs and improve outcomes. This proposed syndrome embodies the inherent association of malnutrition and sarcopenia, highlighting their combined impact on clinical outcomes. The objective of this review paper is to characterize Malnutrition-Sarcopenia Syndrome to advance clinical practice, by providing clinicians with the necessary background information to integrate nutritional assessment along with loss of muscle mass and functionality in their everyday clinical practice.
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Scognamiglio U, Salvia A, Paolucci S, Garbagnati F, Caltagirone C, Musicco M. Validity of a questionnaire for the semi-quantitative evaluation of dietary intake of hospitalised patients compared to weighed records. J Hum Nutr Diet 2012; 25:526-33. [PMID: 22906426 DOI: 10.1111/j.1365-277x.2012.01285.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Malnutrition in hospitalised patients is often underestimated. The present study aimed to evaluate the validity of a questionnaire for the semi-quantitative evaluation of food intake compared to weighed records in patients who were hospitalised for the rehabilitation of neurological disorders. METHODS Food intake at breakfast, lunch and dinner was evaluated in 319 in-patients, by weighing the meals and the residuals, and using a semi-quantitative questionnaire, during five consecutive days. The questionnaire represented, for each offered food, the pictures of the nonconsumed quantities. The consumption of each food was determined by weighing foods that were served and the residuals after the meal. As a measure of validity of the questionnaire, the agreement over chance (kappa statistic) between the questionnaire and the weight was calculated. Considering the weight as the gold standard, the sensitivity and specificity of the questionnaire in detecting patients who consumed <50% or 75% of the meals was calculated. RESULTS The agreement between the two measures was satisfactory (κ ≥ 0.70) or almost satisfactory (0.60 < κ < 0.70) for most of the foods, with the exception of fruit and the first course at dinner. The sensitivity and specificity of the questionnaire in detecting consumers of <50% or 75% of the offered foods were always >80%, except for bread and first course, as well as fruit at dinner. CONCLUSIONS The present study shows that this semi-quantitative questionnaire on food consumption reproduces with sufficient precision the measures obtained by weighing. The questionnaire appears also to be a valid and suitable instrument for the identification of patients with poor food intake in a neurorehabilitation hospital.
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Affiliation(s)
- U Scognamiglio
- Centre of Research on Nutrition and Rehabilitation (CeSAR), IRCCS Santa Lucia Foundation, Rome, Italy.
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Dusingize JC, Hoover DR, Shi Q, Mutimura E, Kiefer E, Cohen M, Anastos K. Association of serum albumin with markers of nutritional status among HIV-infected and uninfected Rwandan women. PLoS One 2012; 7:e35079. [PMID: 22532840 PMCID: PMC3331977 DOI: 10.1371/journal.pone.0035079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 07/19/2011] [Accepted: 03/11/2012] [Indexed: 12/19/2022] Open
Abstract
Introduction The objectives of this study are to address if and how albumin can be used as an indication of malnutrition in HIV infected and uninfected Africans. Methods In 2005, 710 HIV-infected and 226 HIV-uninfected women enrolled in a cohort study. Clinical/demographic parameters, CD4 count, albumin, liver transaminases; anthropometric measurements and Bioelectrical Impedance Analysis (BIA) were performed. Malnutrition outcomes were defined as body mass index (BMI), Fat-free mass index (FFMI) and Fat mass index (FMI). Separate linear predictive models including albumin were fit to these outcomes in HIV negative and HIV positive women by CD4 strata (CD4>350,200–350 and <200 cells/µl). Results In unadjusted models for each outcome in HIV-negative and HIV positive women with CD4>350 cells/µl, serum albumin was not significantly associated with BMI, FFMI or FMI. Albumin was significantly associated with all three outcomes (p<0.05) in HIV+ women with CD4 200–350 cells/µl, and highly significant in HIV+ women with CD4<200 cells/µl (P<0.001). In multivariable linear regression, albumin remained associated with FFMI in women with CD4 count<200 cells/µl (p<0.01) but not in HIV+ women with CD4>200. Discussion While serum albumin is widely used to indicate nutritional status it did not consistently predict malnutrition outcomes in HIV- women or HIV+ women with higher CD4. This result suggests that albumin may measure end stage disease as well as malnutrition and should not be used as a proxy for nutritional status without further study of its association with validated measures.
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Kagawa Y, Maeda T, Kato Y, Ueda I, Kudo T, Watanabe N, Kimura M, Minami S, Sakamoto T, Yamada H, Takagi M. Influence of the slow infusion of a soybean oil emulsion on plasma cytokines and ex vivo T cell proliferation after an esophagectomy. JPEN J Parenter Enteral Nutr 2012; 37:123-8. [PMID: 22457418 DOI: 10.1177/0148607112442216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
BACKGROUND Lipid emulsions have been suggested to reduce immune responses, particularly in severely stressed patients. The authors investigated the influence of the slow intravenous infusion of a soybean oil-based lipid emulsion on some immune parameters in patients who had undergone an esophagectomy for esophageal cancer. METHODS Thirty-two patients who had undergone an esophagectomy were randomly divided into a lipid emulsion (LPD)-treated group and a control group. All patients received parenteral feeding with a glucose-based solution. Patients in the LPD group received 100 mL of a 20% soybean oil emulsion for 7 days after the esophagectomy in addition to the glucose-based feeding. A slow infusion rate (0.09-0.12 g/kg/h) was adopted to take account of the intrinsic degradation of infused lipids. Immune responses were measured based on lymphocyte proliferation and serum concentrations of monocyte chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). The authors also measured levels of rapid turnover proteins (ie, transferrin, prealbumin, and retinol-binding protein). RESULTS Phytohemagglutinin- and concanavalin A-stimulated lymphocyte proliferation significantly decreased after the esophagectomy, but no significant difference was seen between the LPD and control groups. No significant difference in changes in plasma concentrations of MCP-1, IL-6 and TNF-α occurred between the 2 groups either. Plasma concentrations of rapid turnover proteins did not differ between the groups. CONCLUSIONS These results indicate that the lipid emulsion did not affect the immune parameters measured in patients who had undergone an esophagectomy when administered at a slow rate.
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Affiliation(s)
- Yoshiyuki Kagawa
- Department of Clinical Pharmaceutics, University of Shizuoka, Shizuoka, Japan.
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Kozakova R, Jarosova D, Zelenikova R. Comparison of three screening tools for nutritional status assessment of the elderly in their homes. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2011; 156:371-6. [PMID: 22660206 DOI: 10.5507/bp.2011.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/21/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The prevailing recommendation for the elderly is to live in their own homes as long as conditions allow. With this emphasis on the natural living environment, it is imperative to closely monitor both the general health and nutritional needs of the elderly in community settings. AIM The aim of the study was to compare three nutritional status screening and evaluation tools of the elderly in their homes. METHODS Testing of measuring instruments, MNA, SGA, and MUST took place in the homes of 120 seniors in selected areas of the Czech and Slovak Republics. The study included 120 seniors. For testing of the relationships and dependencies, Pearson's correlation coefficient, t and Fisher tests were used. The level of statistical significance was α = 0.05. RESULTS All tests were to a large degree correlated (p(MNA) = 0.0049; p(MUST) = -0.537; p(SGA) = -0.578) with the body mass index of the seniors. Simultaneously, it was confirmed that the tools for assessing nutritional status in the study showed significant differences regarding the classification of patients at risk of malnutrition and/or malnourished patients. CONCLUSIONS Based on the findings, we conclude that MNA appeared to be a more appropriate tool for nutritional assessment of the elderly living in their homes. SGA and MUST provided rather subjective evaluation of the nutritional status and did not furnish an in-depth categorization of malnutrition.
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Affiliation(s)
- Radka Kozakova
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Czech Republic.
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Abstract
PURPOSE OF REVIEW This review highlights the rapidly evolving field of 'pharmaconutrition' by discussing the mechanistic and clinical data for calorie delivery and nutrients shown to improve outcome in surgical and ICU care. RECENT FINDINGS International survey data reveals patients in acute care settings receive approximately 50% of calories/protein they are prescribed. This is, in part, due to the archaic practice of patients remaining nil per os postoperatively until return of bowel sounds. We also know certain nutrients serve as pharmacologic agents and improve clinically relevant outcomes. Thus, larger therapeutic doses of specific nutrients may be required to replace acute deficiencies brought on by specific injury states. Specifically, arginine can reduce postsurgical infection 40% as shown in over 30 trials of more than 3200 patients. Glutamine and fish oil have been shown to reduce mortality in general critical care and acute respiratory distress syndrome patients, respectively. SUMMARY We believe the future of surgical and ICU nutrition will involve administering specific pharmaconutrients as separate components, much like drugs are given. The current use of clinical pharmacology, molecular biology, and clinical research principles in the study of pharmaconutrients should yield answers on how to administer the right nutrients, in the right doses, at the right time in sick patients.
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Bernabeu-Wittel M, Barón-Franco B, Murcia-Zaragoza J, Fuertes-Martín A, Ramos-Cantos C, Fernández-Moyano A, Galindo F, Ollero-Baturone M. A multi-institutional, hospital-based assessment of clinical, functional, sociofamilial and health-care characteristics of polypathological patients (PP). Arch Gerontol Geriatr 2011; 53:284-91. [DOI: 10.1016/j.archger.2010.12.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 12/04/2010] [Accepted: 12/05/2010] [Indexed: 01/23/2023]
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Donini LM, De Felice MR, Savina C, Coletti C, Paolini M, Laviano A, Scavone L, Neri B, Cannella C. Predicting the outcome of long-term care by clinical and functional indices: the role of nutritional status. J Nutr Health Aging 2011; 15:586-92. [PMID: 21808937 DOI: 10.1007/s12603-011-0030-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [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: 01/15/2023]
Abstract
UNLABELLED In elderly subjects, past researches have already underlined the role of nutritional status as a basic factor able to influence the prognosis either in acute wards or in rehabilitation and long-term care settings. Aim of the study is that of retrospectively verify, through a multivariate analysis, the factors able to condition mortality in long-term care, paying particular attention to the nutritional status. METHODS The survey included 513 patients aged more than 65 years admitted to a long-term care unit during a three years period. Exitus within the first three months of hospitalization was considered the outcome variable, while baseline functional, cognitive, clinical and nutritional status were considered the independent variables eventually related to mortality. RESULTS The univariate analysis found that some variables were significantly correlated with the outcome: comorbidity, ADL, cognitive status, pressure sores, albumin, transferrin, CRP, mucoprotein, cholesterol, cholinesterase, MAMC and MNA. The predictive value of the block model of the logistic regression analysis was 77.9% (specificity = 85.3%, sensitivity = 63.9%). With the forward stepwise analysis only MNA, cholinesterase, CRP and mucoprotein were considered in the final model. In this case the predictive value of the model was 79.3% (specificity = 84.6%, sensitivity = 69.46%).
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Affiliation(s)
- L M Donini
- Department of Medical Physiopathology (Food Science Section) - “Sapienza” University of Rome, Italy.
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50
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Abstract
Weight loss is common in older people. It is associated with increased morbidity and mortality, particularly when unintentional, excessive (>5% body weight), or associated with low body weight (body mass index <22 kg/m(2)). It is often unrecognized, the associated adverse effects not appreciated, and underlying causes not addressed. Intentional weight loss by overweight older people is probably appropriate only when functional problems have resulted from the excess weight. It is important to include, wherever possible, exercise in weight-loss measures to preserve skeletal muscle mass.
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Affiliation(s)
- Ian M Chapman
- Division of Medicine, Royal Adelaide Hospital, University of Adelaide, Level 6, Eleanor Harrald Building, North Terrace, Adelaide 5000, Australia.
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