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Berg M, Hansson C, Silander E, Bove M, Johansson L, Haugen Cange H, Bosaeus I, Nyman J, Hammerlid E. A randomized study comparing the nutritional effects of radiotherapy with cetuximab versus cisplatin in patients with advanced head and neck cancer. Head Neck 2024; 46:760-771. [PMID: 38192119 DOI: 10.1002/hed.27619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 11/24/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Head and neck cancer (HNC) patients have a high risk of developing malnutrition. This randomized study aimed to compare the effect of weekly cisplatin or cetuximab combined with radiotherapy on weight loss at 3 months after treatment was started. Secondary outcomes were the prevalence of malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria, feeding tube dependence and health related quality of life from a nutritional perspective. METHODS Patients from the ARTSCAN III study with advanced HNC were assessed for weight, body composition, enteral tube dependence and selected quality-of-life scores (EORTC QLQ-C30 and QLQ-H&N35) at diagnosis and 6 weeks 3, 6 and 12 months after treatment initiation. RESULTS Of the 80 patients, 38 and 42 were randomized to receive cetuximab and cisplatin treatment, respectively. There was no significant difference in weight loss at 3 months between the two study groups. However, the cetuximab group had significantly less weight loss, fewer enteral feeding tubes and better physical functioning at the end of treatment but more pain-related problems 3 months after treatment initiation. No differences between the groups were found at 6 and 12 months. The prevalence of malnutrition was not significantly different at any time point. CONCLUSION The hypothesized benefit of concomitant treatment with cetuximab over cisplatin regarding the prevalence of malnutrition was not supported by this study.
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Affiliation(s)
- Malin Berg
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology-Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Camilla Hansson
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology-Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ewa Silander
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology-Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mogens Bove
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, NU-Hospital Group, Trollhättan, Sweden
| | - Leif Johansson
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Skas, Skövde, Sweden
| | - Hedda Haugen Cange
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingvar Bosaeus
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Nyman
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Hammerlid
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology-Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Eyre S, Stenberg J, Wallengren O, Keane D, Avesani CM, Bosaeus I, Clyne N, Heimbürger O, Indurain A, Johansson AC, Lindholm B, Seoane F, Trondsen M. Bioimpedance analysis in patients with chronic kidney disease. J Ren Care 2023; 49:147-157. [PMID: 37497959 DOI: 10.1111/jorc.12474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/29/2023] [Accepted: 06/21/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Sintra Eyre
- Department of Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jenny Stenberg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ola Wallengren
- Department of Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Keane
- Department of Medicine, CÚRAM SFI Research Centre for Medical Devices, HRB-Clinical Research Facility Galway, National University of Ireland Galway, Galway, Ireland
| | - Carla M Avesani
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine and Baxter Novum, Karolinska Institutet, Solna, Sweden
| | - Ingvar Bosaeus
- Department of Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Naomi Clyne
- Department of Nephrology, Clinical Sciences, Skåne University Hospital and Lund University, Lund, Sweden
| | - Olof Heimbürger
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine and Baxter Novum, Karolinska Institutet, Solna, Sweden
| | - Ainhoa Indurain
- Department of Kidney Medicine, University Hospital, Linköping, Sweden
| | | | - Bengt Lindholm
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine and Baxter Novum, Karolinska Institutet, Solna, Sweden
| | - Fernando Seoane
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Technology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Textile Technology, University of Borås, Borås, Sweden
| | - Mia Trondsen
- Department of Nephrology, Skåne University Hospital, Malmö, Sweden
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Wallengren O, Bosaeus I, Frändin K, Lissner L, Falk Erhag H, Wetterberg H, Rydberg Sterner T, Rydén L, Rothenberg E, Skoog I. Comparison of the 2010 and 2019 diagnostic criteria for sarcopenia by the European Working Group on Sarcopenia in Older People (EWGSOP) in two cohorts of Swedish older adults. BMC Geriatr 2021; 21:600. [PMID: 34702174 PMCID: PMC8547086 DOI: 10.1186/s12877-021-02533-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background The operational definition of sarcopenia has been updated (EWGSOP2) and apply different cut-off points compared to previous criteria (EWGSOP1). Therefore, we aim to compare the sarcopenia prevalence and the association with mortality and dependence in activities of daily living using the 2010 (EWGSOP1 and 2019 (EWGSOP2 operational definition, applying cut-offs at two levels using T-scores. Methods Two birth cohorts, 70 and 85-years-old (n = 884 and n = 157, respectively), were assessed cross-sectionally (57% women). Low grip strength, low muscle mass and slow gait speed were defined below − 2.0 and − 2.5 SD from a young reference population (T-score). Muscle mass was defined as appendicular lean soft tissue index by DXA. The EWGSOP1 and EWGSOP2 were applied and compared with McNemar tests and Cohen’s kappa. All-cause mortality was analyzed with the Cox-proportional hazard model. Results Sarcopenia prevalence was 1.4–7.8% in 70-year-olds and 42–62% in 85 years-old’s, depending on diagnostic criteria. Overall, the prevalence of sarcopenia was 0.9–1.0 percentage points lower using the EWGSOP2 compared to EWGSOP1 when applying uniform T-score cut-offs (P < 0.005). The prevalence was doubled (15.0 vs. 7.5%) using the − 2.0 vs. -2.5 T-scores with EWGSOP2 in the whole sample. The increase in prevalence when changing the cut-offs was 5.7% (P < 0.001) in the 70-year-olds and 17.8% (P < 0.001) in the 85-year-olds (EWGSP2). Sarcopenia with cut-offs at − 2.5 T-score was associated with increased mortality (hazard ratio 2.4–2.8, P < 0.05) but not at T-score − 2.0. Conclusions The prevalence of sarcopenia was higher in 85-year-olds compared to 70-year-olds. Overall, the differences between the EWGSOP1 and EWGSOP2 classifications are small. Meaningful differences between EWGSOP1 and 2 in the 85-year-olds could not be ruled out. Prevalence was more dependent on cut-offs than on the operational definition. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02533-y.
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Affiliation(s)
- Ola Wallengren
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Clinical Nutrition Unit, Sahlgrenska University hospital, Gothenburg, Sweden.
| | - Ingvar Bosaeus
- Clinical Nutrition Unit, Sahlgrenska University hospital, Gothenburg, Sweden
| | - Kerstin Frändin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hanna Falk Erhag
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Hanna Wetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Therese Rydberg Sterner
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden
| | - Lina Rydén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
| | | | - Ingmar Skoog
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden
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Eyre S, Bosaeus I, Jensen G, Saeed A. Using Bioimpedance Spectroscopy for Diagnosis of Malnutrition in Chronic Kidney Disease Stage 5-Is It Useful? J Ren Nutr 2021; 32:170-177. [PMID: 33965304 DOI: 10.1053/j.jrn.2021.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/24/2021] [Accepted: 03/14/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Malnutrition is common in chronic kidney disease stage 5 (CKD5) and has negative clinical impacts. The aim of the present study is to evaluate bioimpedance spectroscopy (BIS) in diagnosing malnutrition in CKD5 including hemodialysis and peritoneal dialysis patients (CKD5D) using cutoff values for fat-free mass index (FFMI) according to the Global Leadership Initiative on Malnutrition criteria. Dual-energy X-ray absorptiometry (DXA) was used as a reference method. DESIGN AND METHODS We performed a single-center cross-sectional diagnostic study of 90 patients with CKD5 or CKD5D. RESULTS BIS-derived FFMI estimates were significantly higher compared with those obtained by DXA (18.5 ± 2.6 vs.17.8 ± 2.0, P < .05). The mean difference in FFMI estimates between the methods (DXA-BIS) and Bland-Altman 95% limits of agreements is -0.38 (2.76, -3.52) kg/m2. Overhydration (B = 0.67, P < .001), age (B = 0.02, P = .037), and interactions between overhydration and CKD5 subgroups (P = .034) independently predicted bias in BIS-derived FFMI. BIS-derived FFMI showed poor sensitivity (64%) and positive predictive value (48%) in diagnosing malnutrition in the present study population. CONCLUSION The present study showed a limited agreement between estimates of FFMI derived by BIS and DXA due to a large interindividual variation. Using BIS as a clinical tool for assessing FFMI has limited accuracy and poor sensitivity in diagnosing malnutrition in patients with CKD5 and CKD5D.
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Affiliation(s)
- Sintra Eyre
- Department of Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingvar Bosaeus
- Department of Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gert Jensen
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Aso Saeed
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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Axelsson L, Silander E, Bosaeus I, Hammerlid E. Bioelectrical phase angle at diagnosis as a prognostic factor for survival in advanced head and neck cancer. Eur Arch Otorhinolaryngol 2018; 275:2379-2386. [PMID: 30046911 PMCID: PMC6096573 DOI: 10.1007/s00405-018-5069-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 06/06/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022]
Abstract
Objective Bioelectrical impedance analysis (BIA) is used to measure the patient’s body composition, fat-free mass, phase angle (PA), and standardized phase angle (SPA), which are affected by malnutrition. Low values of PA and SPA have been found to be negative prognostic factors for survival in different types of cancer and other severe diseases. The aim of the current study was to investigate whether PA and SPA can be used to predict survival in head and neck (HN) cancer. Methods One hundred twenty-eight patients with advanced HN cancer treated in Western Sweden 2002–2006 were examined with BIA at diagnosis, and PA and SPA were calculated. Patients’ age, gender, tumor site, TNM stage, and performance status were obtained, and weight, height, and BIA were measured. Survival up to 12 years was ascertained. Results The mean PA was 5.85° and the median was 5.91°. Lower PA and SPA values were significantly associated with shorter overall survival in univariate analyses, together with higher age, oral cancer, higher T class, worse performance status, more weight loss before diagnosis, lower: weight, height, BMI, and reactance. Age, performance status, T class, and PA were significant factors for the overall survival in the multivariable analysis. A PA cutoff value at 5.95° provided the best prediction of 5-year survival. Conclusions PA and SPA at diagnosis are significant factors for survival in patients with advanced HN cancer. They are promising prognostic tools to use in treatment planning; further studies are needed.
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Affiliation(s)
- Lars Axelsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Department of Otorhinolaryngology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ewa Silander
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Otorhinolaryngology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingvar Bosaeus
- Department of Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Hammerlid
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Otorhinolaryngology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ellegård L, Petersen P, Öhrn L, Bosaeus I. Longitudinal changes in phase angle by bioimpedance in intensive care patients differ between survivors and non-survivors. Clin Nutr ESPEN 2018; 24:170-172. [DOI: 10.1016/j.clnesp.2018.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 01/06/2023]
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Wallengren O, Bosaeus I. MON-P099: Predicting Energy Expenditure in Cancer: Impact of Body Composition, Tumour Stage and Inflammation. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30984-6] [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: 11/16/2022]
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Seoane F, Abtahi S, Abtahi F, Ellegård L, Johannsson G, Bosaeus I, Ward LC. Slightly superior performance of bioimpedance spectroscopy over single frequency regression equations for assessment of total body water. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:3707-10. [PMID: 26737098 DOI: 10.1109/embc.2015.7319198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Electrical bioimpedance has been used for several decades to assess body fluid distribution and body composition by using single frequency and bioimpedance spectroscopic (BIS) techniques. It remains uncertain whether BIS methods have better performance compare to single frequency regression equations. In this work the performance of two BIS methods and four different 50 kHz single frequency prediction equations was studied in a data set of wrist-to-ankle tetrapolar BIS measurements (5-1000 kHz) together with reference values of total body water obtained by tritium dilution in 92 patients. Data were compared using regression techniques and Bland-Altman plots. The results of this study showed that all methods produced similarly high correlation and concordance coefficients, indicating good accuracy as a method. Limits of agreement analysis indicated that the population level performance of Sun's prediction equations was very similar to the performance of both BIS methods. However, BIS methods in practice have slightly better predictive performance than the single-frequency equations as judged by higher correlation and the limits of agreement from the Bland-Altman analysis. In any case, the authors believe that an accurate evaluation of performance of the methods cannot be done as long as the evaluation is done using Bland-Altman analysis, the commonly accepted technique for this kind of performance comparisons.
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Martin L, Lagergren J, Blomberg J, Johar A, Bosaeus I, Lagergren P. Phase angle as a prognostic marker after percutaneous endoscopic gastrostomy (PEG) in a prospective cohort study. Scand J Gastroenterol 2016; 51:1013-6. [PMID: 27160049 DOI: 10.3109/00365521.2016.1172341] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The phase angle identifies changes in tissue's electrical properties assessed by bioelectrical impedance measurement and it can predict prognosis in some conditions. Percutaneous endoscopic gastrostomy (PEG) is commonly used in patients with severe nutritional problems, but there is a need to improve the clinical decision-making for using PEG. We examined if a decreased phase angle predicts complications, short-term mortality (within 60 days of PEG insertion), or inflammatory markers (high C-reactive protein [CRP] levels or low albumin levels) following PEG insertion. MATERIAL AND METHODS The phase angle was assessed from body resistance and reactance as measured by bioelectrical impedance in 131 patients admitted for PEG. Anthropometrics and clinical biochemical measures were collected at the time of PEG insertion, while complications and mortality were assessed at clinical follow-ups. Multivariable logistic regression analysis provided odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for sex, age, body mass index, and comorbidity. RESULTS A decreased phase angle did not statistically significantly increase the probability of acute complications or short-term mortality, but predicted increased inflammatory markers (CRP ≥10 mg/L [OR 1.63, 95% CI 1.02-2.60], albumin <30 g/L [OR 2.10, 95% CI 1.24-3.57] and a combination of CRP ≥10 mg/L and albumin <30 g/L [OR 3.06, 95% CI 1.51-6.19]). CONCLUSIONS A decreased phase angle did not predict acute complications or short-term mortality after PEG insertion, but predicted increased levels of inflammatory markers.
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Affiliation(s)
- Lena Martin
- a Division of Surgical Care Science, Department of Molecular Medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden ;,b Department of Biosciences and Nutrition , Karolinska Institutet, Karolinska University Hospital , Huddinge , Sweden ;,c Department of Clinical Nutrition and Dietetics , Karolinska University Hospital , Stockholm , Sweden
| | - Jesper Lagergren
- d Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden ;,e Division of Cancer Studies , King's College London , London , UK
| | - John Blomberg
- f Department of Clinical Science, Intervention and Technology (CLINTEC) , Karolinska Institutet, Karolinska University Hospital , Huddinge , Sweden ;,g Center for Digestive Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Asif Johar
- a Division of Surgical Care Science, Department of Molecular Medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
| | - Ingvar Bosaeus
- h Department Clinical Nutrition at Sahlgrenska University Hospital , Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden
| | - Pernilla Lagergren
- a Division of Surgical Care Science, Department of Molecular Medicine and Surgery , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden ;,e Division of Cancer Studies , King's College London , London , UK
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Wichmann H, Unosson M, Rothenberg E, Stene C, Bosaeus I. [Still obvious shortcomings in nutrition therapy in hospitals. Survey study comparing the years 2004 and 2014]. Lakartidningen 2016; 113:DWP3. [PMID: 27115779] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In 2003 the Council of Europe published a resolution on food and nutritional care in hospitals. The resolution suggests screening of nutritional status for all patients and a care plan should be established for malnourished patients or patients at risk of malnutrition. In 2004 a survey amongst Swedish physicians, nurses and dieticians focusing on education, knowledge in clinical nutrition, division of responsibilities and guidelines was made. The results showed that Swedish hospitals did not meet the standards set by the Council. This study is a ten year follow-up of the original study from 2004. Data from 2014 show only minor improvements. Screening of nutritional status was still performed in less than fifty percent of all hospitalisations. The level of knowledge is still seen as a barrier against optimal treatment of malnutrition. Lack of guidelines was mentioned as another barrier, and a majority of physicians and nurses were not aware of the existing guidelines.
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Affiliation(s)
- Henric Wichmann
- Sahlgrenska universitetssjukhuset - Enheten för klinisk nutrition Göteborg, Sweden Enheten för klinisk nutrition - Sahlgrenska universitetssjukhuset Göteborg, Sweden
| | - Mitra Unosson
- Linköpings universitet - Institutionen för samhälls- och välfärdsstudier Linköping, Sweden Institutionen för samhälls- och välfärdsstudier - Linköpings universitet Linköping, Sweden
| | - Elisabet Rothenberg
- Högskolan i Kristianstad - Kristianstad, Sweden Högskolan i Kristianstad - Kristianstad, Sweden
| | - Christina Stene
- Region Skåne - Skånevård Sund Ängelholm, Sweden Region Skåne - Skånevård Sund Ängelholm, Sweden
| | - Ingvar Bosaeus
- Sahlgrenska universitetssjukhuset - Enheten för klinisk nutrition Göteborg, Sweden Sahlgrenska universitetssjukhuset - Enheten för klinisk nutrition Göteborg, Sweden
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Tognon G, Malmros V, Freyer E, Bosaeus I, Mehlig K. Are segmental MF-BIA scales able to reliably assess fat mass and lean soft tissue in an elderly Swedish population? Exp Gerontol 2015; 72:239-43. [PMID: 26456399 DOI: 10.1016/j.exger.2015.10.004] [Citation(s) in RCA: 6] [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: 06/29/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS The assessment of body composition is an important measure to monitor the process of healthy aging and detect early signs of disease. Dual X-ray absorptiometry (DXA) is considered a valid technique for the assessment of body composition but is confined to the clinical environment. Multi-frequency bio-electrical impedance analysis (MF-BIA) might be a versatile alternative to DXA. We aimed to assess whether a segmental MF-BIA scale can be an accurate and reliable tool for the monitoring of body composition in the elderly and whether the presence of metallic prostheses can influence the agreement between the two techniques. SUBJECTS AND METHODS Weight and height were measured in 92 healthy subjects (53 women) aged 80-81 years from the H70 Gerontological and Geriatric study in Gothenburg. Total and segmental fat mass (FM) and lean soft tissue (LST) were estimated by DXA (Lunar Prodigy, Scanex, Sweden) and segmental MF-BIA (MC-180MA, Tanita, Japan). Bland-Altman analyses were performed to assess the agreement between the two techniques. The prediction of DXA-FM by MF-BIA was compared to that of the body mass index (BMI). RESULTS AND DISCUSSION MF-BIA showed a significant underestimation of FM and an overestimation of LST that was larger in men than in women. Smaller but significant deviations were found for appendicular LST and SMM. MF-BIA was not superior to BMI at predicting DXA-FM. The lack of agreement between MF-BIA and DXA was not due to the presence of metal prostheses or diagnoses such as hypertension and edema. The prediction equations applied by the device used in this study should be adapted to the elderly population and details about the reference population(s) should be disclosed.
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Affiliation(s)
- Gianluca Tognon
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Vibeke Malmros
- Department of Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden
| | - Elisa Freyer
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ingvar Bosaeus
- Department of Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden
| | - Kirsten Mehlig
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Buendia R, Seoane F, Lindecrantz K, Bosaeus I, Gil-Pita R, Johannsson G, Ellegård L, Ward LC. Estimation of body fluids with bioimpedance spectroscopy: state of the art methods and proposal of novel methods. Physiol Meas 2015; 36:2171-87. [DOI: 10.1088/0967-3334/36/10/2171] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, Muscaritoli M, Nyulasi I, Ockenga J, Schneider SM, de van der Schueren MAE, Singer P. Diagnostic criteria for malnutrition - An ESPEN Consensus Statement. Clin Nutr 2015; 34:335-40. [PMID: 25799486 DOI: 10.1016/j.clnu.2015.03.001] [Citation(s) in RCA: 1008] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide a consensus-based minimum set of criteria for the diagnosis of malnutrition to be applied independent of clinical setting and aetiology, and to unify international terminology. METHOD The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a group of clinical scientists to perform a modified Delphi process, encompassing e-mail communications, face-to-face meetings, in group questionnaires and ballots, as well as a ballot for the ESPEN membership. RESULT First, ESPEN recommends that subjects at risk of malnutrition are identified by validated screening tools, and should be assessed and treated accordingly. Risk of malnutrition should have its own ICD Code. Second, a unanimous consensus was reached to advocate two options for the diagnosis of malnutrition. Option one requires body mass index (BMI, kg/m(2)) <18.5 to define malnutrition. Option two requires the combined finding of unintentional weight loss (mandatory) and at least one of either reduced BMI or a low fat free mass index (FFMI). Weight loss could be either >10% of habitual weight indefinite of time, or >5% over 3 months. Reduced BMI is <20 or <22 kg/m(2) in subjects younger and older than 70 years, respectively. Low FFMI is <15 and <17 kg/m(2) in females and males, respectively. About 12% of ESPEN members participated in a ballot; >75% agreed; i.e. indicated ≥7 on a 10-graded scale of acceptance, to this definition. CONCLUSION In individuals identified by screening as at risk of malnutrition, the diagnosis of malnutrition should be based on either a low BMI (<18.5 kg/m(2)), or on the combined finding of weight loss together with either reduced BMI (age-specific) or a low FFMI using sex-specific cut-offs.
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Affiliation(s)
- T Cederholm
- Departments of Geriatric Medicine, Uppsala University Hospital and Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
| | - I Bosaeus
- Clinical Nutrition Unit, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - J Bauer
- Department of Geriatric Medicine, Carl von Ossietzky Universität, Oldenburg, Germany
| | - A Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - S Klek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - M Muscaritoli
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - I Nyulasi
- Department of Nutrition and Dietetics and Department of Medicine, Monash University Central Clinical School, Prahran, Australia
| | - J Ockenga
- Department of Gastroenterology, Hepatology, Endocrinology, and Nutrition, Klinikum Bremen Mitte, Bremen, Germany
| | - S M Schneider
- Department of Gastroenterology and Clinical Nutrition, University Hospital and University of Nice Sophia-Antipolis, Nice, France
| | - M A E de van der Schueren
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition, Sports and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - P Singer
- Department of General Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
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Varkey J, Simrén M, Jalanko H, Oltean M, Saalman R, Gudjonsdottir A, Gäbel M, Borg H, Edenholm M, Bentdal O, Husby S, Staun M, Mäkisalo H, Bosaeus I, Olausson M, Pakarinen M, Herlenius G. Fifteen years' experience of intestinal and multivisceral transplantation in the Nordic countries. Scand J Gastroenterol 2015; 50:278-90. [PMID: 25592555 DOI: 10.3109/00365521.2014.999255] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Intestinal and multivisceral transplantation have gained acceptance as treatment modalities for patients with: intestinal failure and life-threatening complications of parenteral nutrition (PN), rare cases of vascular abdominal catastrophes and selected cases of low-grade neoplastic tumors such as neuroendocrine pancreatic tumors and desmoids involving the mesenteric root. The aim was to describe the survival and nutritional outcome in the transplanted Nordic patients and the complications attributed to this procedure. METHOD The authors included all Nordic patients transplanted between January 1998 and December 2013. Information on patients transplanted outside the Nordic region was collected through questionnaires. RESULTS A total of 34 patients received different types of intestinal allografts. Currently, there are two Nordic transplant centers (n = 29) performing these procedures (Gothenburg, Sweden n = 24, Helsinki, Finland n = 5). The remaining five patients were transplanted in the USA (n = 3) and the UK (n = 2). Most patients were transplanted for life-threatening failure of PN (70%) caused primarily by intestinal motility diseases (59%). Allograft rejection was the most common complication and occurred in 79% of the patients followed by post-transplantation lymphoproliferative disorders (21%) and graft-versus-host disease (18%). The 1- and 5-year survival was 79% and 65% respectively for the whole cohort and nutritional autonomy was achieved in 73% of the adults and 57% of the children at 1 year after transplantation. CONCLUSION This collective Nordic experience confirms that intestinal transplantation is a complex procedure with many complications, yet with the possibility to provide long-term survival in selected conditions previously considered untreatable.
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Affiliation(s)
- Jonas Varkey
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
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Cederholm T, Bosaeus I, Brummer R, Ellegård L, Irving GF, Larsson J, Thorell A, Rothenberg E. [SBU report "misses" persuasive evidence. Dietary supplements extends the life of malnourished elderly]. Lakartidningen 2014; 111:2299-2300. [PMID: 25584567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Tommy Cederholm
- Uppsala universitet - Institutionen för folkhälso- och vårdvetenskap, klinisk nutrition och metabolism Uppsala, Sweden Uppsala universitet - Institutionen för folkhälso- och vårdvetenskap, klinisk nutrition och metabolism Uppsala, Sweden
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Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, Strasser F, Thoresen L, Jagoe RT, Chasen M, Lundholm K, Bosaeus I, Fearon KH, Baracos VE. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol 2014; 33:90-9. [PMID: 25422490 DOI: 10.1200/jco.2014.56.1894] [Citation(s) in RCA: 450] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Existing definitions of clinically important weight loss (WL) in patients with cancer are unclear and heterogeneous and do not consider current trends toward obesity. METHODS Canadian and European patients with cancer (n = 8,160) formed a population-based data set. Body mass index (BMI) and percent WL (%WL) were recorded, and patients were observed prospectively until death. Data were entered into a multivariable analysis controlling for age, sex, cancer site, stage, and performance status. Relationships for BMI and %WL to overall survival were examined to develop a grading system. RESULTS Mean overall %WL was -9.7% ± 8.4% and BMI was 24.4 ± 5.1 kg/m(2), and both %WL and BMI independently predicted survival (P < .01). Differences in survival were observed across five categories of BMI (< 20.0, 20.0 to 21.9, 22.0 to 24.9, 25.0 to 27.9, and ≥ 28.0 kg/m(2); P < .001) and five categories of %WL (-2.5% to -5.9%, -6.0% to -10.9%, -11.0% to -14.9%, ≥ -15.0%, and weight stable (± 2.4%); P < .001). A 5 × 5 matrix representing the five %WL categories within each of the five BMI categories was graded based on median survival and prognostic significance. Weight-stable patients with BMI ≥ 25.0 kg/m(2) (grade 0) had the longest survival (20.9 months; 95% CI, 17.9 to 23.9 months), and %WL values associated with lowered categories of BMI were related to shorter survival (P < .001), as follows: grade 1, 14.6 months (95% CI, 12.9 to 16.2 months); grade 2, 10.8 months (95% CI, 9.7 to 11.9 months); grade 3, 7.6 months (95% CI, 7.0 to 8.2 months); and grade 4, 4.3 months (95% CI, 4.1 to 4.6 months). Survival discrimination by grade was observed within specific cancers, stages, ages, and performance status and in an independent validation sample (n = 2,963). CONCLUSION A robust grading system incorporating the independent prognostic significance of both BMI and %WL was developed.
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Affiliation(s)
- Lisa Martin
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pierre Senesse
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ioannis Gioulbasanis
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sami Antoun
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Federico Bozzetti
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Chris Deans
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Florian Strasser
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lene Thoresen
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - R Thomas Jagoe
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Chasen
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kent Lundholm
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingvar Bosaeus
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kenneth H Fearon
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Vickie E Baracos
- Lisa Martin and Vickie E. Baracos, University of Alberta, Edmonton, Alberta; R. Thomas Jagoe, McGill Cancer Nutrition Rehabilitation Clinic, Jewish General Hospital, Montreal, Quebec; Martin Chasen, University of Ottawa, Ottawa, Ontario, Canada; Pierre Senesse, Institut Régional du Cancer de Montpellier, Montpellier; Sami Antoun, Institut Gustave Roussy, Villejuif, France; Ioannis Gioulbasanis, Larissa General Clinic, Larissa, Thessaly, Greece; Federico Bozzetti, University of Milan, Milan, Italy; Chris Deans and Kenneth H. Fearon, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, United Kingdom; Florian Strasser, Cantonal Hospital, St Gallen, Switzerland; Lene Thoresen, St Olavs University Hospital, Trondheim, Norway; Kent Lundholm, Institute of Clinical Sciences, Gothenburg University; and Ingvar Bosaeus, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Subramoney S, Björkelund C, Guo X, Skoog I, Bosaeus I, Lissner L. Age-related differences in recommended anthropometric cut-off point validity to identify cardiovascular risk factors in ostensibly healthy women. Scand J Public Health 2014; 42:827-33. [PMID: 25294689 PMCID: PMC4257998 DOI: 10.1177/1403494814550178] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aim: To investigate validity of widely recommended anthropometric and total fat percentage cut-off points in screening for cardiovascular risk factors in women of different ages. Methods: A population-based sample of 1002 Swedish women aged 38, 50, 75 (younger, middle-aged and elderly, respectively) underwent anthropometry, health examinations and blood tests. Total fat was estimated (bioimpedance) in 670 women. Sensitivity, specificity of body mass index (BMI; ≥25 and ≥30), waist circumference (WC; ≥80 cm and ≥88 cm) and total fat percentage (TF; ≥35%) cut-off points for cardiovascular risk factors (dyslipidaemias, hypertension and hyperglycaemia) were calculated for each age. Cut-off points yielding high sensitivity together with modest specificity were considered valid. Women reporting hospital admission for cardiovascular disease were excluded. Results: The sensitivity of WC ≥80 cm for one or more risk factors was ~60% in younger and middle-aged women, and 80% in elderly women. The specificity of WC ≥80 cm for one or more risk factors was 69%, 57% and 40% at the three ages (p < .05 for age trends). WC ≥80 cm yielded ~80% sensitivity for two or more risk factors across all ages. However, specificity decreased with increasing age (p < .0001), being 33% in elderly. WC ≥88 cm provided better specificity in elderly women. BMI and TF % cut-off points were not better than WC. Conclusions:Validity of recommended anthropometric cut-off points in screening asymptomatic women varies with age. In younger and middle-age, WC ≥80 cm yielded high sensitivity and modest specificity for two or more risk factors, however, sensitivity for one or more risk factor was less than optimal. WC ≥88 cm showed better validity than WC ≥80 cm in elderly. Our results support age-specific screening cut-off points for women.
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Affiliation(s)
- Sreevidya Subramoney
- Nordic School of Public Health, Gothenburg, Sweden Department of Public Health and Community Medicine; Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | | | | | | | - Lauren Lissner
- Department of Public Health and Community Medicine; Sahlgrenska Academy, University of Gothenburg, Sweden
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Bosaeus I, Wilcox G, Rothenberg E, Strauss B. Reply to Thibault & Genton:. Clin Nutr 2014; 33:1158-9. [PMID: 25175756 DOI: 10.1016/j.clnu.2014.08.008] [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: 08/04/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Ingvar Bosaeus
- Clinical Nutrition Unit, Sahlgrenska University Hospital, Per Dubbsgatan 14, S-413 45 Gothenburg, Sweden.
| | - Gisela Wilcox
- Dept. of Medicine, Southern Clinical School, Monash University, Clayton, Victoria, Australia
| | - Elisabet Rothenberg
- Dept. of Food and Meal Science, Kristianstad University, SE-291 88 Kristianstad, Sweden
| | - Boyd Strauss
- Dept. of Medicine, Southern Clinical School, Monash University, Clayton, Victoria, Australia
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Nordén J, Grönberg A, Bosaeus I, Bertéus Forslund H, Hulthén L, Rothenberg E, Karlsson J, Wallengren O, Slinde F. PP168-SUN: Nutrition Impact Symptoms and Body Composition in Patients with COPD. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50210-5] [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: 11/28/2022]
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Ellegard L, Petersen P, Öhrn L, Bosaeus I. PP037-SUN: Phase Angle by Bis is Low in ICU Patients and Decreases in Non-Survivors. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50079-9] [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: 11/30/2022]
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Barbosa EJL, Glad CAM, Nilsson AG, Bosaeus N, Nyström HF, Svensson PA, Bengtsson BÅ, Nilsson S, Bosaeus I, Boguszewski CL, Johannsson G. Extracellular water and blood pressure in adults with growth hormone (GH) deficiency: a genotype-phenotype association study. PLoS One 2014; 9:e105754. [PMID: 25157616 PMCID: PMC4144955 DOI: 10.1371/journal.pone.0105754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 07/28/2014] [Indexed: 12/18/2022] Open
Abstract
Objectives Growth hormone deficiency (GHD) in adults is associated with decreased extracellular water volume (ECW). In response to GH replacement therapy (GHRT), ECW increases and blood pressure (BP) reduces or remains unchanged. Our primary aim was to study the association between polymorphisms in genes related to renal tubular function with ECW and BP before and 1 year after GHRT. The ECW measures using bioimpedance analysis (BIA) and bioimpedance spectroscopy (BIS) were validated against a reference method, the sodium bromide dilution method (Br−). Design and Methods Using a candidate gene approach, fifteen single-nucleotide polymorphisms (SNPs) in nine genes with known impact on renal tubular function (AGT, SCNN1A, SCNN1G, SLC12A1, SLC12A3, KCNJ1, STK39, WNK1 and CASR) were genotyped and analyzed for associations with ECW and BP at baseline and with their changes after 1 year of GHRT in 311 adult GHD patients. ECW was measured with the Br−, BIA, and BIS. Results Both BIA and BIS measurements demonstrated similar ECW results as the reference method. At baseline, after adjustment for sex and BMI, SNP rs2291340 in the SLC12A1 gene was associated with ECW volume in GHD patients (p = 0.039). None of the SNPs influenced the ECW response to GHRT. One SNP in the SLC12A3 gene (rs11643718; p = 0.024) and three SNPs in the SCNN1G gene [rs5723 (p = 0.02), rs5729 (p = 0.016) and rs13331086 (p = 0.035)] were associated with the inter-individual differences in BP levels at baseline. A polymorphism in the calcium-sensing receptor (CASR) gene (rs1965357) was associated with changes in systolic BP after GHRT (p = 0.036). None of these associations remained statistically significant when corrected for multiple testing. Conclusion The BIA and BIS are as accurate as Br− to measure ECW in GHD adults before and during GHRT. Our study provides the first evidence that individual polymorphisms may have clinically relevant effects on ECW and BP in GHD adults.
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Affiliation(s)
- Edna J. L. Barbosa
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- SEMPR, Servico de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Camilla A. M. Glad
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Center for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna G. Nilsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Bosaeus
- Department of Clinical Nutrition Unit, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helena Filipsson Nyström
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per-Arne Svensson
- Sahlgrenska Center for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt-Åke Bengtsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Staffan Nilsson
- Institute of Mathematical Sciences, Department of Mathematical Statistics, Chalmers University of Technology, Chalmers, Gothenburg, Sweden
| | - Ingvar Bosaeus
- Department of Clinical Nutrition Unit, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cesar Luiz Boguszewski
- SEMPR, Servico de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Gudmundur Johannsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
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Wallengren O, Iresjö BM, Lundholm K, Bosaeus I. Loss of muscle mass in the end of life in patients with advanced cancer. Support Care Cancer 2014; 23:79-86. [PMID: 24975045 DOI: 10.1007/s00520-014-2332-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/22/2014] [Indexed: 01/06/2023]
Abstract
PURPOSE Muscle mass depletion is associated with adverse outcomes in cancer patients. There is limited information on the impact of age, sex, tumor type, and inflammation on muscle loss in the end of life of cancer patients. METHODS Muscle depletion and loss of muscle in the last 2 years of life was estimated in 471 cancer patients from 779 dual-energy X-ray absorptiometry scans. A linear mixed model was used to estimate the impact of age, sex, tumor type, and inflammation. RESULTS Patients above median age (>71 years) had less muscle mass (-1.1 ± 0.3 kg, P < 0.001). Prevalence of muscle depletion was higher in men than women (59 vs. 28%, P < 0.001). Men lost muscle mass over time (mean, 1.4 ± 0.3 kg/year, P < 0.001) contrary to women (0.3 ± 0.4 kg/year, P = 0.5). Patients with pancreatic cancer had less muscle mass than patients with biliary tract and colorectal cancers (P < 0.02). There were no differences in muscle loss over time in patients grouped by median age or tumor type. The prevalence of elevated C-reactive protein was 61 to 70% during the study. Patients with C-reactive protein >10 mg/L had less muscle mass (0.6 ± 0.2 kg, P < 0.001) and lost muscle mass at an accelerated pace during the disease trajectory (0.7 ± 0.3 kg/year, P = 0.03). CONCLUSIONS Muscle loss in advanced cancer is related to age, sex, tumor type, and inflammation. The mechanism(s) behind the apparent sexual dimorphism warrants further study.
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Affiliation(s)
- Ola Wallengren
- Department of Endocrinology, Diabetology and Metabolism, Sahlgrenska University Hospital, Dietistmotagningen, Per Dubbsgatan 14, 413 45, Gothenburg, Sweden,
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Buendia R, Seoane F, Bosaeus I, Gil-Pita R, Johannsson G, Ellegård L, Lindecrantz K. Robustness study of the different immittance spectra and frequency ranges in bioimpedance spectroscopy analysis for assessment of total body composition. Physiol Meas 2014; 35:1373-95. [DOI: 10.1088/0967-3334/35/7/1373] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Brekke HK, Bertz F, Rasmussen KM, Bosaeus I, Ellegård L, Winkvist A. Diet and exercise interventions among overweight and obese lactating women: randomized trial of effects on cardiovascular risk factors. PLoS One 2014; 9:e88250. [PMID: 24516621 PMCID: PMC3917884 DOI: 10.1371/journal.pone.0088250] [Citation(s) in RCA: 23] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/03/2014] [Indexed: 12/15/2022] Open
Abstract
Objective To examine the effects of Diet (D) and Exercise (E) interventions on cardiovascular fitness, waist circumference, blood lipids, glucose metabolism, inflammation markers, insulin-like growth factor 1 (IGF-1) and blood pressure in overweight and obese lactating women. Methods At 10–14 wk postpartum, 68 Swedish women with a self-reported pre-pregnancy BMI of 25–35 kg/m2 were randomized to a 12-wk behavior modification treatment with D, E, both or control using a 2×2 factorial design. The goal of D treatment was to reduce body weight by 0.5 kg/wk, accomplished by decreasing energy intake by 500 kcal/d and monitoring weight loss through self-weighing. The goal of E treatment was to perform 4 45-min walks per wk at 60–70% of max heart-rate using a heart-rate monitor. Effects were measured 12 wk and 1 y after randomization. General Linear Modeling was used to study main and interaction effects adjusted for baseline values of dependent variable. Results There was a significant main effect of the D treatment, decreasing waist circumference (P = 0.001), total cholesterol (P = 0.007), LDL-cholesterol (P = 0.003) and fasting insulin (P = 0.042), at the end of the 12-wk treatment. The decreased waist circumference (P<0.001) and insulin (P = 0.024) was sustained and HDL-cholesterol increased (P = 0.005) at the 1-y follow-up. No effects from the E treatment or any interaction effects were observed. Conclusions Dietary behavior modification that produced sustained weight loss among overweight and obese lactating women also improved risk factors for cardiovascular disease and type 2 diabetes. This intervention may not only reduce weight-related risks with future pregnancies but also long-term risk for metabolic disease. Trial registration ClinicalTrials.gov NCT01343238
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Affiliation(s)
- Hilde K. Brekke
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Fredrik Bertz
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kathleen M. Rasmussen
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United State of America
| | - Ingvar Bosaeus
- Department of Clinical Nutrition, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Ellegård
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Ellegård L, Kurlberg G, Bosaeus I. High prevalence of vitamin D deficiency and osteoporosis in out-patients with intestinal failure. Clin Nutr 2013; 32:983-7. [DOI: 10.1016/j.clnu.2013.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 01/14/2013] [Accepted: 02/12/2013] [Indexed: 01/04/2023]
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Decker R, Andersson B, Nierop AFM, Bosaeus I, Dahlgren J, Albertsson-Wikland K, Hellgren G. Protein markers predict body composition during growth hormone treatment in short prepubertal children. Clin Endocrinol (Oxf) 2013; 79:675-82. [PMID: 23469944 DOI: 10.1111/cen.12196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 11/06/2012] [Accepted: 03/04/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A high-throughput pharmaco-proteomic approach has previously been successfully used to identify lipoprotein biomarkers related to changes in longitudinal growth and bone mass in response to growth hormone (GH) treatment. The aim of this study was to identify protein markers involved in the diverse anabolic and lipolytic remodelling of body composition during GH treatment. DESIGN, PATIENTS AND MEASUREMENTS The study population consisted of 128 prepubertal children receiving GH treatment. Thirty-nine were short as a result of GH deficiency, and 89 had idiopathic short stature (ISS). Serum protein expression profiles at study start and after 1 year of GH treatment were analysed using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS). Body composition was analysed by dual-energy X-ray absorptiometry (DXA), reliably estimating muscle mass from appendicular (arms and legs) lean soft tissue mass (LST). DXA was also used to estimate appendicular bone mineral content (BMC) and fat mass for the total body. RESULTS Specific protein expression patterns associated with GH response in different body compartments were identified. Among identified proteins, different isoforms of nutrition markers such as apolipoproteins (Apo) were recognized: Apo C-I, Apo A-II, serum amyloid A4 (SAA4) and transthyretin (TTR). In addition, unidentified peaks were associated with GH effects on specific body compartments. CONCLUSIONS Our results suggest that unique protein markers are associated with remodelling of different body compartments during GH treatment, which in the future might be useful to optimize GH treatment not only with regard to longitudinal growth.
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Affiliation(s)
- Ralph Decker
- Göteborg Pediatric Growth Research Center (GP-GRC), The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Lindblad A, Dahlin-Ivanoff S, Bosaeus I, Rothenberg E. PP022-MON BODY COMPOSITION AND PHYSICAL FUNCTION IN HEALTHY COMMUNITY-DWELLING OLDER ADULTS IN SWEDEN, A CROSS-SECTIONAL STUDY. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60334-9] [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: 11/26/2022]
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Bosaeus I, Wilcox G, Rothenberg E, Strauss BJ. Skeletal muscle mass in hospitalized elderly patients: comparison of measurements by single-frequency BIA and DXA. Clin Nutr 2013; 33:426-31. [PMID: 23827183 DOI: 10.1016/j.clnu.2013.06.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/30/2013] [Accepted: 06/04/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS There is increasing interest in estimating skeletal muscle mass (SMM) in clinical practice. We aimed to validate a bioelectrical impedance analysis (BIA) prediction equation for SMM, developed in a different healthy elderly population, in a population of hospital patients aged 70 and over, by comparison with dual-energy X-ray absorptiometry (DXA) SMM estimates. Comparison was also made with two other previously published BIA muscle prediction equations. METHODS Muscle measurements by BIA and DXA were compared in 117 patients with a range of clinical conditions (45 female, 72 male, mean age 75 years). RESULTS The BIA equation used yielded an accurate estimate of DXA-derived SMM. Mean (SD) difference was 0.26(1.79) kg (ns). The two other BIA equations over-estimated SMM compared to DXA (both p < 0.001), but all equations were highly correlated. CONCLUSIONS The BIA equation used, developed in a different healthy elderly population, gave an accurate estimate of DXA-derived SMM in a population with various clinical disorders. BIA appears potentially capable to estimate SMM in clinical disorders, but the optimal approach to its use for this purpose requires further investigation.
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Affiliation(s)
- Ingvar Bosaeus
- Clinical Nutrition Unit, Sahlgrenska University Hospital, Bruna stråket 11 plan 4, S-413 45 Gothenburg, Sweden.
| | - Gisela Wilcox
- Dept. of Medicine, Southern Clinical School, Monash University, Clayton, Victoria, Australia.
| | - Elisabet Rothenberg
- Clinical Nutrition Unit, Sahlgrenska University Hospital, Bruna stråket 11 plan 4, S-413 45 Gothenburg, Sweden.
| | - Boyd J Strauss
- Dept. of Medicine, Southern Clinical School, Monash University, Clayton, Victoria, Australia.
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Varkey J, Simrén M, Bosaeus I, Krantz M, Gäbel M, Herlenius G. Survival of patients evaluated for intestinal and multivisceral transplantation - the Scandinavian experience. Scand J Gastroenterol 2013; 48:702-11. [PMID: 23544434 DOI: 10.3109/00365521.2013.775327] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The current treatment of choice for patients with intestinal failure is parenteral nutrition, whereas medical therapy or resection is preferred for patients with neuroendocrine pancreatic tumors (NEPT) along with liver metastasis. As the survival of patients undergoing intestinal and multivisceral transplantation is improving, the discussion for expansion of treatment options has become a subject of debate. The aim was to investigate the outcome for patients referred for intestinal and multivisceral transplantation and to determine which patient group are the ones most likely to benefit the most from transplantation. METHODS The authors included all patients evaluated for intestinal and multivisceral transplantation at the Sahlgrenska University Hospital and The Queen Silvia Children's Hospital center between February 1998 and November 2009. Patients were classified according to proposed treatment strategy, and the outcome was evaluated. RESULTS A total of 43 adults and 19 children with either intestinal failure or NEPT with liver metastases were evaluated for transplantation. Of these patients, 15 adults and 5 children were transplanted. Transplantation was lifesaving for most children - all the children survived after transplantation, but 70% (4/6) died while awaiting transplantation. Among the adult patients with intestinal failure, the survival rate for patients considered to be stable on parenteral nutrition was higher than the transplanted adult patients. The survival rate of patients with NEPT was similar to the results seen among patients transplanted for intestinal failure. CONCLUSION The results confirm the poor prognosis of patients with intestinal failure awaiting transplantation and indicate that different transplantation criteria may be applied for adults and children, especially when early transplantation is the preferred treatment. The role of multivisceral transplantation in patients with NEPT remains uncertain.
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Affiliation(s)
- Jonas Varkey
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Winkvist A, Bertz F, Ellegård L, Bosaeus I, Brekke HK. Metabolic risk profile among overweight and obese lactating women in Sweden. PLoS One 2013; 8:e63629. [PMID: 23667649 PMCID: PMC3646790 DOI: 10.1371/journal.pone.0063629] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/01/2013] [Indexed: 11/20/2022] Open
Abstract
Background Obesity and cardiovascular diseases are increasing globally and any association between reproduction and these conditions is of concern. Unfortunately, little is known about normal levels of metabolic risk factors in women of different body mass index throughout the reproductive cycle. This study is one of the first to describe the metabolic risk profile of lactating overweight or obese women at 8–12 weeks postpartum. Methods During 2007–2009, 66 overweight or obese Swedish lactating women without known diseases underwent detailed measurements of their metabolic profiles, dietary intake and general health before entering a lifestyle intervention trial. Baseline measurements took place between 8–12 wk postpartum. Almost all women were exclusively breastfeeding their term infants. Results The women were regarded as healthy, as reflected in the absence of diagnosed diseases, their own perceptions and in normal hemoglobin, albumin and fasting plasma glucose values. Four women were diagnosed with metabolic syndrome. In these cases, underlying conditions included large waist circumference, low HDL cholesterol values, high triglyceride values and relatively high blood pressure. The metabolic profile differed between overweight and obese women; obese women had significantly higher levels of fasting insulin (p = 0.017), borderline higher HOMA values (p = 0.057) and significantly higher triglyceride values (p = 0.029), as well as larger waist and hip circumferences (p<0.001 and p<0.001). However, no significant differences between overweight and obese women were detected for LDL or total cholesterol levels. Overweight and obese women reported similar total energy and macronutrient intakes, but obese women tended to be less physically active (p = 0.081). Conclusions Among generally healthy lactating women, obesity as compared to overweight is associated with increased metabolic risk. This cut-off is thus important also in the early postpartum period, and obesity among these women should warrant proper health investigation. Macronutrient intake did not differ between the groups and, hence, cannot explain these differences. Trial registration ClinicalTrials.gov Identifier: NCT01343238
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Affiliation(s)
- Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Brekke HK, Bertz F, Rasmussen KM, Bosaeus I, Ellegård L, Winkvist A. Dietary Behavior Modification, With or Without Exercise, Improves Risk Factors for CVD over One Year in Overweight and Obese Lactating Women. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.225.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hilde Kristin Brekke
- Internal Medicine and Clinical NutritionSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Fredrik Bertz
- Internal Medicine and Clinical NutritionSahlgrenska Academy at University of GothenburgGothenburgSweden
| | | | - Ingvar Bosaeus
- Internal Medicine and Clinical NutritionSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Lars Ellegård
- Internal Medicine and Clinical NutritionSahlgrenska Academy at University of GothenburgGothenburgSweden
| | - Anna Winkvist
- Internal Medicine and Clinical NutritionSahlgrenska Academy at University of GothenburgGothenburgSweden
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Wallengren O, Bosaeus I, Lundholm K. Dietary energy density, inflammation and energy balance in palliative care cancer patients. Clin Nutr 2013; 32:88-92. [DOI: 10.1016/j.clnu.2012.05.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/29/2012] [Accepted: 05/31/2012] [Indexed: 11/28/2022]
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Laurenius A, Larsson I, Bosaeus I, Melanson KJ, Lönroth H, Olbers T. P-13 Dietary energy density decreases after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2011. [DOI: 10.1016/j.soard.2011.04.014] [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: 11/29/2022]
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Andersson B, Decker R, Nierop AF, Bosaeus I, Albertsson-Wikland K, Hellgren G. Protein profiling identified dissociations between growth hormone-mediated longitudinal growth and bone mineralization in short prepubertal children. J Proteomics 2011; 74:89-100. [DOI: 10.1016/j.jprot.2010.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 08/24/2010] [Accepted: 08/25/2010] [Indexed: 10/19/2022]
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Decker R, Albertsson-Wikland K, Kriström B, Nierop AFM, Gustafsson J, Bosaeus I, Fors H, Hochberg Z, Dahlgren J. Metabolic outcome of GH treatment in prepubertal short children with and without classical GH deficiency. Clin Endocrinol (Oxf) 2010; 73:346-54. [PMID: 20455890 DOI: 10.1111/j.1365-2265.2010.03812.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
CONTEXT Few studies have evaluated the metabolic outcomes of growth hormone (GH) treatment in idiopathic short stature (ISS). Moreover, children with ISS appear to need higher GH doses than children with GH deficiency (GHD) to achieve the same amount of growth and may therefore be at increased risk of adverse events during treatment. The individualized approach using prediction models for estimation of GH responsiveness, on the other hand, has the advantage of narrowing the range of growth response, avoiding too low or high GH doses. DESIGN Short prepubertal children with either isolated GHD (39) or ISS (89) participated in a 2-year randomized trial of either individualized GH treatment with six different GH doses (range, 17-100 microg/kg/day) or a standard dose (43 microg/kg/day). OBJECTIVE To evaluate if individualized GH treatment reduced the variance of the metabolic measures as shown for growth response and to compare changes in metabolic variables in children with ISS and GHD. HYPOTHESIS Individualized GH dose reduces the range of metabolic outcomes, and metabolic outcomes are similar in children with ISS and GHD. RESULTS We observed a narrower variation for fasting insulin (-34.2%) and for homoeostasis model assessment (HOMA) (-38.9%) after 2 years of individualized GH treatment in comparison with standard GH dose treatment. Similar metabolic changes were seen in ISS and GHD. Delta (Delta) height SDS correlated with Deltainsulin-like growth factor I (IGF-I), Deltaleptin and Deltabody composition. Principal component analysis identified an anabolic and a lipolytic component. Anabolic variables [Deltalean body mass (LBM) SDS and DeltaIGF-I SDS] clustered together and correlated strongly with Deltaheight SDS and GH dose, whereas lipolytic variables [Deltafat mass (FM) SDS and Deltaleptin] were clustered separately from anabolic variables. Regression analysis showed GH dose dependency in ISS, and to a lesser degree in GHD, for DeltaLBM SDS and Deltaheight SDS, but not for changes in FM. CONCLUSIONS Individualized GH dosing during catch-up growth reduces the variance in insulin and HOMA and results in equal metabolic responses irrespective of the diagnosis of GHD or ISS.
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Affiliation(s)
- Ralph Decker
- Department of Pediatrics, Gothenburg Pediatric Growth Research Center, University of Gothenburg, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
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Lundholm K, Gunnebo L, Körner U, Iresjö BM, Engström C, Hyltander A, Smedh U, Bosaeus I. Effects by daily long term provision of ghrelin to unselected weight-losing cancer patients: a randomized double-blind study. Cancer 2010; 116:2044-52. [PMID: 20186829 DOI: 10.1002/cncr.24917] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The short-term provision of ghrelin to patients with cancer indicates that there may be benefits from long-term provision of ghrelin for the palliative treatment of weight-losing cancer patients. This hypothesis was evaluated in a randomized, double-blind, phase 2 study. METHODS Weight-losing cancer patients with solid gastrointestinal tumors were randomized to receive either high-dose ghrelin treatment (13 microg/kg daily; n = 17 patients) or low-dose ghrelin treatment (0.7 microg/kg daily; n = 14 patients) for 8 weeks as a once-daily, subcutaneous injections. Appetite was scored on a visual analog scale; and food intake, resting energy expenditure, and body composition (dual x-ray absorpitometry) were measured before the start of treatment and during follow-up. Serum levels of ghrelin, insulin, insulin-like growth factor 1, growth hormone (GH), triglycerides, free fatty acids, and glucose were measured. Health-related quality of life, anxiety, and depression were assessed by using standardized methods (the 36-item Short Form Health Survey and the Hospital Anxiety and Depression Scale). Physical activity, rest, and sleep were measured by using a multisensor body monitor. RESULTS Treatment groups were comparable at inclusion. Appetite scores were increased significantly by high-dose ghrelin analyzed both on an intent-to-treat basis and according to the protocol. High-dose ghrelin reduced the loss of whole body fat (P < .04) and serum GH (P < .05). There was a trend for high-dose ghrelin to improve energy balance (P < .07; per protocol). Otherwise, no statistically significant differences in outcome variables were observed between the high-dose and low-dose groups. Adverse effects were not observed by high-dose ghrelin, such as serum levels of tumor markers (cancer antigen 125 [CA 125], carcinoembryonic antigen, and CA 19-9). CONCLUSIONS The current results suggested that daily, long-term provision of ghrelin to weight-losing cancer patients with solid tumors supports host metabolism, improves appetite, and attenuates catabolism.
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Affiliation(s)
- Kent Lundholm
- Department of Surgery, Surgical Metabolic Research Laboratory at Lundberg Laboratory for Cancer Research, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden.
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Trimpou P, Bosaeus I, Bengtsson BÅ, Landin-Wilhelmsen K. High correlation between quantitative ultrasound and DXA during 7 years of follow-up. Eur J Radiol 2010; 73:360-4. [DOI: 10.1016/j.ejrad.2008.11.024] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 11/14/2008] [Accepted: 11/26/2008] [Indexed: 11/28/2022]
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Muscaritoli M, Anker SD, Argilés J, Aversa Z, Bauer JM, Biolo G, Boirie Y, Bosaeus I, Cederholm T, Costelli P, Fearon KC, Laviano A, Maggio M, Rossi Fanelli F, Schneider SM, Schols A, Sieber CC. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) "cachexia-anorexia in chronic wasting diseases" and "nutrition in geriatrics". Clin Nutr 2010; 29:154-9. [PMID: 20060626 DOI: 10.1016/j.clnu.2009.12.004] [Citation(s) in RCA: 1074] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 10/22/2009] [Accepted: 12/09/2009] [Indexed: 12/13/2022]
Abstract
Chronic diseases as well as aging are frequently associated with deterioration of nutritional status, loss muscle mass and function (i.e. sarcopenia), impaired quality of life and increased risk for morbidity and mortality. Although simple and effective tools for the accurate screening, diagnosis and treatment of malnutrition have been developed during the recent years, its prevalence still remains disappointingly high and its impact on morbidity, mortality and quality of life clinically significant. Based on these premises, the Special Interest Group (SIG) on cachexia-anorexia in chronic wasting diseases was created within ESPEN with the aim of developing and spreading the knowledge on the basic and clinical aspects of cachexia and anorexia as well as of increasing the awareness of cachexia among health professionals and care givers. The definition, the assessment and the staging of cachexia, were identified as a priority by the SIG. This consensus paper reports the definition of cachexia, pre-cachexia and sarcopenia as well as the criteria for the differentiation between cachexia and other conditions associated with sarcopenia, which have been developed in cooperation with the ESPEN SIG on nutrition in geriatrics.
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Affiliation(s)
- M Muscaritoli
- Department of Clinical Medicine, La Sapienza, University of Rome, Viale dell'Universita, 37, Rome 00185, Italy.
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Ellegard L, Tengvall M, Groot H, Carlsson E, Wichmann H, Axelsson AS, Malmros V, Kurlberg G, Bosaeus I. PP056 HIGH PREVALENCE OF SARCOPENIA IN OUT-PATIENTS WITH INTESTINAL FAILURE. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1744-1161(10)70133-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Tengvall M, Ellegård L, Bosaeus N, Isaksson M, Johannsson G, Bosaeus I. Bioelectrical impedance spectroscopy in growth hormone-deficient adults. Physiol Meas 2009; 31:59-75. [DOI: 10.1088/0967-3334/31/1/005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Johansson UM, Bosaeus I, Larsson J, Rothenberg E, Stene C, Unosson M. [Nutritional therapy in elderly care--a forgotten perspective. A questionnaire study shows clear shortages in the care of the elderly]. Lakartidningen 2009; 106:2538-2542. [PMID: 19908624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Ulla M Johansson
- Hudiksvalls sjukhus, centrum för klinisk forskning, Uppsala universitet, Gävle.
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Dey DK, Bosaeus I, Lissner L, Steen B. Changes in body composition and its relation to muscle strength in 75-year-old men and women: a 5-year prospective follow-up study of the NORA cohort in Göteborg, Sweden. Nutrition 2009; 25:613-9. [PMID: 19211225 DOI: 10.1016/j.nut.2008.11.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Revised: 11/07/2008] [Accepted: 11/17/2008] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the association between body composition in the elderly and subsequent changes in muscle strength during aging. METHODS This was a longitudinal study with a 5-y follow-up. Eighty-seven men (n = 38) and women (n = 49) from a random sample of 75-y-old subjects in the Göteborg part of the Nordic Research on Aging study who were investigated at ages 75 and 80 y and were free from any major diseases at baseline were included. Body composition was estimated from bioelectrical impedance. The maximal isometric strengths of handgrip, arm flexion, and knee extension were measured on the side of the dominant hand while a subject was in a sitting position in an adjustable dynamometer chair. RESULTS Fat-free mass decreased significantly (P < 0.001) in both sexes, but more in men. Percentage of body fat increased only in men (P < 0.05). Body height decreased in both sexes, but more in women (P < 0.001). Declines in muscle strengths were evident for all muscle groups in both sexes but more prominent in men. It was observed that body composition status at baseline, measured as fat-free mass and fat-free mass index, was a statistically significant predictor for decline in muscle strength, particularly in the extremities. CONCLUSION Fat-free mass at age 75 y was associated with lower 5-y decline in muscle strength. This finding underscores the potential importance of fat-free mass for maintaining functional ability during aging.
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Affiliation(s)
- Debashish K Dey
- Department of Geriatric Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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Tengvall M, Ellegård L, Malmros V, Bosaeus N, Lissner L, Bosaeus I. Body composition in the elderly: Reference values and bioelectrical impedance spectroscopy to predict total body skeletal muscle mass. Clin Nutr 2009; 28:52-8. [DOI: 10.1016/j.clnu.2008.10.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 08/12/2008] [Accepted: 10/06/2008] [Indexed: 01/10/2023]
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Tengvall M, Ellegård L, Malmros V, Bosaeus N, Lissner L, Bosaeus I. Body composition in the elderly: reference values and bioelectrical impedance spectroscopy to predict total body skeletal muscle mass. Clin Nutr 2008. [PMID: 19010572 DOI: 10.1016/j.clnu.2008.10005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND & AIMS To validate the bioelectrical impedance spectroscopy (BIS) model against dual-energy X-ray absorptiometry (DXA), to develop and compare BIS estimates of skeletal muscle mass (SMM) to other prediction equations, and to report BIS reference values of body composition in a population-based sample of 75-year-old Swedes. METHODS Body composition was measured by BIS in 574 subjects, and by DXA and BIS in a subset of 98 subjects. Data from the latter group was used to develop BIS prediction equations for total body skeletal muscle mass (TBSMM). RESULTS Average fat free mass (FFM) measured by DXA and BIS was comparable. FFM(BIS) for women and men was 40.6 kg and 55.8 kg, respectively. Average fat free mass index (FFMI) and body fat index (BFI) for women were 15.6 and 11.0. Average FFMI and BFI for men were 18.3 and 8.6. Existing bioelectrical impedance analysis equations to predict SMM were not valid in this cohort. A TBSMM prediction equation developed from this sample had an R(2)(pred) of 0.91, indicating that the equation would explain 91% of the variability in future observations. CONCLUSIONS BIS correctly estimated average FFM in healthy elderly Swedes. For prediction of TBSMM, a population specific equation was required.
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Affiliation(s)
- Marja Tengvall
- Department of Clinical Nutrition, Sahlgrenska University Hospital, Sahlgrenska Academy at University of Gothenburg, Goteborg, Sweden
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Abstract
OBJECTIVE Patients with short-bowel syndrome (SBS) have impaired health-related quality of life (QoL). However, comparisons of QoL data with the data on other chronic gastrointestinal diseases are not available. The aim of this study was to assess QoL in SBS patients compared with that in the general population and with patients with inflammatory bowel disease (IBD). The potential relation between fatigue and gastrointestinal symptoms and impaired QoL in these patients was also investigated. MATERIAL AND METHODS Four validated questionnaires were used to measure aspects of QoL (SF-36), psychological distress (hospital anxiety and depression scale, HAD), fatigue (fatigue impact scale, FIS), and gastrointestinal symptoms (gastrointestinal symptom rating scale, GSRS) in 26/28 patients (93%) attending a SBS clinic (median age 62 years, 15 F/11 M) at a tertiary referral center. Persons from the general population (n=286) as well as patients with IBD (n=41) of similar age and gender distribution as the SBS group acted as controls. RESULTS SBS patients had significantly lower SF-36 physical and mental component summaries than those in the general population as well as significantly lower SF-36 physical (p<0.05) but not mental (p>0.05) component summaries compared with those of IBD patients. Fatigue and gastrointestinal symptoms were more severe in SBS patients than in IBD patients (p>0.05). The SF-36 physical component summary was independently related to the physical FIS dimension (beta=-0.4, p=0.004), the GSRS eating dysfunction dimension (beta=-0.31, p=0.025), and opiate use (beta=-0.28, p=0.031), regardless of diagnosis (SBS or IBD). CONCLUSIONS Patients with SBS show poor QoL compared with that in the general population and also impairment of mainly physical health compared with that in patients with IBD. Fatigue and gastrointestinal symptoms are more severe in patients with SBS, which has an impact on QoL.
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Affiliation(s)
- Evangelos Kalaitzakis
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Andersson H, Bosaeus I, Ellegard L, Hallgren B, Hultén L, Magnusson O. Comparison of an elemental and two polymeric diets in colectomized patients with or without intestinal resection. Clin Nutr 2008; 3:183-9. [PMID: 16829458 DOI: 10.1016/s0261-5614(84)80042-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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
The absorption of nutrients and minerals from the small bowel on enteral diets of different composition has been studied in seven ileostomy patients without or with only minor (< 100 cm) distal small bowel resection (group A) and in nine patients with major (> 100 cm) resections, i.e. jejunostomies (group B). In group A, a moderate-fat polymeric diet (MF) was compared to a peptide-based low-fat elemental diet (PD). Nitrogen and potassium absorption was higher on the MF, while the absorption of other nutrients and minerals studied did not differ. In group B a low-fat polymeric diet (LF) was also tested. Jejunostomy volumes were higher on the PD diet compared to the polymeric diets, as were losses of sodium and potassium. Nitrogen absorption was lower on the PD diet. Comparison of the MF and LF polymeric diets showed equal energy losses, while jejunostomy volumes and sodium losses were higher on the MF diet. Calcium absorption was higher and balance better on the LF diet. We conclude, that (a) elemental diets offer no nutritional advantages in enteral feeding of patients with intact or impaired small bowel function, and (b) we suggest that a low-fat polymeric diet could replace elemental diets in patients with malabsorption.
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Affiliation(s)
- H Andersson
- Department of Clinical Nutrition, Sahlgrenska sjukhuset, Gothenburg University, S-413 45 Gothenburg, Sweden
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Cederholm T, Marcus C, Rössner S, Hellénius ML, Björck I, Bosaeus I, Forsum E, Hallmans G, Hernell O, Hulthén L, Johansson I, Larsson J, Lissner L, Nilsson A, Nyman M, Palmblad J, Sandberg AS, Aman P. [The researcher, the society and partiality]. Lakartidningen 2008; 105:1206-1207. [PMID: 18522263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Mowe M, Bosaeus I, Rasmussen HH, Kondrup J, Unosson M, Rothenberg E, Irtun Ø. Insufficient nutritional knowledge among health care workers? Clin Nutr 2008; 27:196-202. [PMID: 18295936 DOI: 10.1016/j.clnu.2007.10.014] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Revised: 09/21/2007] [Accepted: 10/17/2007] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Though a great interest and willingness to nutrition therapy, there is an insufficient practice compared to the proposed ESPEN guidelines for nutrition therapy. The aim of this questionnaire was to study doctors and nurses' self-reported knowledge in nutritional practice, with focus on ESPEN's guidelines in nutritional screening, assessment and treatment. METHODS A questionnaire about different aspects of nutritional practice was answered by 4512 doctors and nurses in Denmark, Sweden and Norway. RESULTS The most common cause for insufficient nutritional practice was lack of nutritional knowledge. Twenty-five percent found it difficult to identify patient in need of nutritional therapy, 39% lacked techniques for identifying malnourished patients, and 53% found it difficult to calculate the patients' energy requirement and 66% lacked national guidelines for clinical nutrition. Twenty-eight percent answered that insufficient nutrition practice could lead to complications and prolonged hospital stay. Those that answered that their nutritional knowledge was good had also a better nutritional practice. CONCLUSION The self-reported nutritional knowledge was inadequate among Scandinavian doctors and nurses. Increased nutritional knowledge seems to improve the nutritional practice. A combination of an integrated nutrition curriculum during the education, together with post-graduated education for both physicians and nurses should be established.
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Affiliation(s)
- Morten Mowe
- Department of Geriatric Medicine, Aker University Hospital, Trondheimsveien 155, 0514 Oslo, Norway.
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Bosaeus I. Nutritional support in multimodal therapy for cancer cachexia. Support Care Cancer 2008; 16:447-51. [DOI: 10.1007/s00520-007-0388-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 12/05/2007] [Indexed: 01/10/2023]
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Fouladiun M, Körner U, Gunnebo L, Sixt-Ammilon P, Bosaeus I, Lundholm K. Daily Physical-Rest Activities in Relation to Nutritional State, Metabolism, and Quality of Life in Cancer Patients with Progressive Cachexia. Clin Cancer Res 2007; 13:6379-85. [DOI: 10.1158/1078-0432.ccr-07-1147] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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