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Kananen L, Eriksdotter M, Boström A, Kivipelto M, Annetorp M, Metzner C, Bäck Jerlardtz V, Engström M, Johnson P, Lundberg L, Åkesson E, Sühl Öberg C, Hägg S, Religa D, Jylhävä J, Cederholm T. Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19. Clin Nutr 2022; 41:2973-2979. [PMID: 34389208 PMCID: PMC8318666 DOI: 10.1016/j.clnu.2021.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 05/10/2021] [Revised: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Overweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19. As a reference, the analyses were performed also in patients treated for other diagnoses than COVID-19. METHODS We analyzed up to 10,031 geriatric patients with a median age of 83 years of which 1409 (14%) were hospitalized for COVID-19 and 8622 (86%) for other diagnoses in seven geriatric hospitals in the Stockholm region, Sweden during March 2020-January 2021. Data were available in electronic hospital records. The associations between 1) BMI and 2) nutritional status, assessed using the Mini-Nutritional Assessment - Short Form (MNA-SF) scale, and short-term in-geriatric hospital mortality were analyzed using logistic regression. RESULTS After adjusting for age, sex, comorbidity, polypharmacy, frailty and the wave of the pandemic (first vs. second), underweight defined as BMI<18.5 increased the risk of in-hospital mortality in COVID-19 patients (odds ratio [OR] = 2.30; confidence interval [CI] = 1.17-4.31). Overweight and obesity were not associated with in-hospital mortality. Malnutrition; i.e. MNA-SF 0-7 points, increased the risk of in-hospital mortality in patients treated for COVID-19 (OR = 2.03; CI = 1.16-3.68) and other causes (OR = 6.01; CI = 2.73-15.91). CONCLUSIONS Our results indicate that obesity is not a risk factor for very old patients with COVID-19, but emphasize the role of underweight and malnutrition for in-hospital mortality in geriatric patients with COVID-19.
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Affiliation(s)
- L. Kananen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Faculty of Social Sciences (Health Sciences), Gerontology Research Center, Tampere University, Tampere, Finland,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland,Corresponding author. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M. Eriksdotter
- Division Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - A.M. Boström
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - M. Kivipelto
- Division Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden,Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - M. Annetorp
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - C. Metzner
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - V. Bäck Jerlardtz
- Department of Geriatric Medicine, Jakobsbergsgeriatriken, Stockholm, Sweden
| | - M. Engström
- Department of Geriatric Medicine, Sabbatsbergsgeriatriken, Stockholm, Sweden
| | - P. Johnson
- Department of Geriatric Medicine, Capio Geriatrik Nacka AB, Nacka, Sweden
| | - L.G. Lundberg
- Department of Geriatric Medicine, Dalengeriatriken Aleris Närsjukvård AB, Stockholm, Sweden
| | - E. Åkesson
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - C. Sühl Öberg
- Department of Geriatric Medicine, Handengeriatriken, Aleris Närsjukvård AB, Stockholm, Sweden
| | - S. Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - D. Religa
- Division Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - J. Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Faculty of Social Sciences (Health Sciences), Gerontology Research Center, Tampere University, Tampere, Finland
| | - T. Cederholm
- Division Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Sundberg M, Andersson PH, Åkesson E, Odeberg J, Holmberg L, Inzunza J, Falci S, Öhman J, Suuronen R, Skottman H, Lehtimäki K, Hovatta O, Narkilahti S, Sundström E. Markers of pluripotency and differentiation in human neural precursor cells derived from embryonic stem cells and CNS tissue. Cell Transplant 2010; 20:177-91. [PMID: 20875224 DOI: 10.3727/096368910x527266] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cell transplantation therapies for central nervous system (CNS) deficits such as spinal cord injury (SCI) have been shown to be effective in several animal models. One cell type that has been transplanted is neural precursor cells (NPCs), for which there are several possible sources. We have studied NPCs derived from human embryonic stem cells (hESCs) and human fetal CNS tissue (hfNPCs), cultured as neurospheres, and the expression of pluripotency and neural genes during neural induction and in vitro differentiation. mRNA for the pluripotency markers Nanog, Oct-4, Gdf3, and DNMT3b were downregulated during neural differentiation of hESCs. mRNA for these markers was found in nonpluripotent hfNPC at higher levels compared to hESC-NPCs. However, Oct-4 protein was found in hESC-NPCs after 8 weeks of culture, but not in hfNPCs. Similarly, SSEA-4 and CD326 were only found in hESC-NPCs. NPCs from both sources differentiated as expected to cells with typical features of neurons and astrocytes. The expressions of neuronal markers in hESC-NPCs were affected by the composition of cell culture medium, while this did not affect hfNPCs. Transplantation of hESC-NPC or hfNPC neurospheres into immunodeficient mouse testis or subcutaneous tissue did not result in tumor formation. In contrast, typical teratomas appeared in all animals after transplantation of hESC-NPCs to injured or noninjured spinal cords of immunodeficient rats. Our data show that transplantation to the subcutaneous tissue or the testes of immunodeficient mice is not a reliable method for evaluation of the tumor risk of remaining pluripotent cells in grafts.
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Affiliation(s)
- M Sundberg
- Regea-Institute for Regenerative Medicine, University of Tampere and Tampere University Hospital, Tampere, Finland
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