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Wunderle C, Gomes F, Schuetz P, Stumpf F, Austin P, Ballesteros-Pomar MD, Cederholm T, Fletcher J, Laviano A, Norman K, Poulia KA, Schneider SM, Stanga Z, Bischoff SC. ESPEN practical guideline: Nutritional support for polymorbid medical inpatients. Clin Nutr 2024; 43:674-691. [PMID: 38309229 DOI: 10.1016/j.clnu.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Disease-related malnutrition in polymorbid medical inpatients is a highly prevalent syndrome associated with significantly increased morbidity, disability, short- and long-term mortality, impaired recovery from illness, and healthcare costs. AIM As there are uncertainties in applying disease-specific guidelines to patients with multiple conditions, our aim was to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. METHODS The 2023 update adheres to the standard operating procedures for ESPEN guidelines. We undertook a systematic literature search for 15 clinical questions in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g., published guidelines), until July 12th, 2022. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations (including SIGN grading), which was followed by submission to Delphi voting. Here, the practical version of the guideline is presented which has been shortened and equipped with flow charts for patients care. RESULTS 32 recommendations (7× A, 11× B, 10× O and 4× GPP), which encompass different aspects of nutritional support were included from the scientific guideline including indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Here, the practical version of the guideline is presented which has been shortened and equipped with flow charts for patients care. CONCLUSIONS Recent high-quality trials have provided increasing evidence that nutritional support can reduce morbidity and other complications associated with malnutrition in polymorbid patients. The timely screening of patients for risk of malnutrition at hospital admission followed by individualized nutritional support interventions for at-risk patients should be part of routine clinical care and multimodal treatment in hospitals worldwide. Use of this updated practical guideline offers an evidence-based nutritional approach to polymorbid medical inpatients and may improve their outcomes.
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Affiliation(s)
- Carla Wunderle
- Cantonal Hospital Aarau and University of Basel, Switzerland
| | - Filomena Gomes
- Cantonal Hospital Aarau and University of Basel, Switzerland; NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Philipp Schuetz
- Cantonal Hospital Aarau and University of Basel, Switzerland.
| | - Franziska Stumpf
- Cantonal Hospital Aarau and University of Basel, Switzerland; Institute of Clinical Nutrition, University of Hohenheim, 70599 Stuttgart, Germany
| | - Peter Austin
- Oxford University Hospitals, and University College London, United Kingdom
| | | | - Tommy Cederholm
- Uppsala University, Uppsala and Karolinska University Hospital, Stockholm Sweden
| | - Jane Fletcher
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - Kristina Norman
- Charité University Medicine Berlin and German Institute for Human Nutrition, Germany
| | | | | | - Zeno Stanga
- University Hospital and University of Bern, Switzerland
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
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Carlsson L, Poulia KA, Madden A. Sustainability in dietetics means embracing complexity, contributing and collaborating. J Hum Nutr Diet 2023; 36:2123-2126. [PMID: 37864405 DOI: 10.1111/jhn.13257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Liesel Carlsson
- School of Nutrition and Dietetics, Acadia University, Wolfville, NS, Canada
| | - Kalliopi-Anna Poulia
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Angela Madden
- Nutrition and Dietetics, University of Hertfordshire, Hatfield, UK
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Wunderle C, Gomes F, Schuetz P, Stumpf F, Austin P, Ballesteros-Pomar MD, Cederholm T, Fletcher J, Laviano A, Norman K, Poulia KA, Schneider SM, Stanga Z, Bischoff SC. ESPEN guideline on nutritional support for polymorbid medical inpatients. Clin Nutr 2023; 42:1545-1568. [PMID: 37478809 DOI: 10.1016/j.clnu.2023.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Disease-related malnutrition in polymorbid medical inpatients is a highly prevalent syndrome associated with significantly increased morbidity, disability, short- and long-term mortality, impaired recovery from illness, and cost of care. AIM As there are uncertainties in applying disease-specific guidelines to patients with multiple conditions, our aim was to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. METHODS This update adheres to the standard operating procedures for ESPEN guidelines. We did a systematic literature search for 15 clinical questions in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until July 12th. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations (incl. SIGN grading), which was followed by submission to Delphi voting. RESULTS From a total of 3527 retrieved abstracts, 60 new relevant studies were analyzed and used to generate a guideline draft that proposed 32 recommendations (7x A, 11x B, 10x O and 4x GPP), which encompass different aspects of nutritional support including indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. The results of the first online voting showed a strong consensus (agreement of >90%) on 100% of the recommendations. Therefore, no final consensus conference was needed. CONCLUSIONS Recent high-quality trials have provided increasing evidence that nutritional support can reduce morbidity and other complications associated with malnutrition in polymorbid patients. The timely screening of patients for risk of malnutrition at hospital admission followed by individualized nutritional support interventions for at-risk patients should be part of routine clinical care and multimodal treatment in hospitals worldwide. Use of this updated guideline offers an evidence-based nutritional approach to the polymorbid medical inpatients and may improve their outcomes.
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Affiliation(s)
- Carla Wunderle
- Cantonal Hospital Aarau and University of Basel, Switzerland
| | - Filomena Gomes
- Cantonal Hospital Aarau and University of Basel, Switzerland; NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Philipp Schuetz
- Cantonal Hospital Aarau and University of Basel, Switzerland.
| | - Franziska Stumpf
- Cantonal Hospital Aarau and University of Basel, Switzerland; Institute of Clinical Nutrition, University of Hohenheim, 70599 Stuttgart, Germany
| | - Peter Austin
- Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK, University College London School of Pharmacy, London, United Kingdom
| | | | - Tommy Cederholm
- Uppsala University, Uppsala and Karolinska University Hospital, Stockholm Sweden
| | - Jane Fletcher
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - Kristina Norman
- Charité University Medicine Berlin and German Institute for Human Nutrition, Germany
| | | | | | - Zeno Stanga
- University Hospital and University of Bern, Switzerland
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
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Haidar SA, de Vries N, Poulia KA, Hassan H, Rached M, Karavetian M. Neck Circumference as a Screening Tool for Metabolic Syndrome among Lebanese College Students. Diseases 2022; 10:diseases10020031. [PMID: 35735631 PMCID: PMC9221764 DOI: 10.3390/diseases10020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022] Open
Abstract
Metabolic syndrome (MetS) is a cluster of symptoms that, when present, increase the risk for cardiovascular disease. There is a need for reliable screening tools that are ethnically sensitive. Two hundred and sixty-six college students were assessed anthropometrically. They had a fasting blood sample drawn, and blood pressure measured. They then completed a demographic questionnaire and The International Physical Activity Questionnaire (IPAQ). The prevalence of MetS was found to be 10.1% in males and 4.5% in females. Neck circumference (NC) was positively associated with BMI in males (r = 0.55, p < 0.001) and females (r = 0.53, p < 0.001) and was positively associated with hip circumference in both males (r = 0.47, p < 0.001) and females (r = 0.50, p < 0.001) and with waist circumference in males (r = 0.46, p < 0.001) and females (r = 0.49, p < 0.001.) An area under the curve (AUC) was calculated using receiver operating characteristics (ROC), and NC > 38 cm in males and NC> 36 cm in females were found to be appropriate cut-offs for diagnosing MetS. NC is a reliable and non-invasive screening tool that can be used to screen for MetS in males. NC could also serve as an anthropometric instrument to assess abdominal obesity and could be valuable for college students.
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Affiliation(s)
- Suzan A. Haidar
- Department of Nutrition and Food Sciences, School of Arts and Sciences, Lebanese International University, Beirut P.O. Box 146404, Lebanon;
| | - Nanne de Vries
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 6166200, 6211 LK Maastricht, The Netherlands;
| | - Kalliopi-Anna Poulia
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855 Athens, Greece;
| | - Hussein Hassan
- Nutrition Program, Department of Natural Sciences, Lebanese American University, Beirut P.O. Box 135053, Lebanon;
| | - Mohammad Rached
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Beirut P.O. Box 146404, Lebanon;
| | - Mirey Karavetian
- School of Nutrition, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON M1L2A6, Canada
- Correspondence:
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Papakonstantinou E, Xaidara M, Siopi V, Giannoglou M, Katsaros G, Theodorou G, Maratou E, Poulia KA, Dimitriadis GD, Skandamis PN. Effects of Spaghetti Differing in Soluble Fiber and Protein Content on Glycemic Responses in Humans: A Randomized Clinical Trial in Healthy Subjects. Int J Environ Res Public Health 2022; 19:ijerph19053001. [PMID: 35270698 PMCID: PMC8909947 DOI: 10.3390/ijerph19053001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023]
Abstract
This randomized, single blind, cross-over study investigated the glycemic responses to three spaghetti No 7 types differing in dietary protein and soluble fiber content. Fourteen clinically and metabolically healthy, fasting individuals (25 ± 1 years; ten women; BMI 23 ± 1 kg/m2) received isoglucidic test meals (50 g available carbohydrate) and 50 g glucose reference, in random order. GI was calculated using the FAO/WHO method. Capillary blood glucose and salivary insulin samples were collected at 0, 15, 30, 45, 60, and 120 min. Subjective appetite ratings (hunger, fullness, and desire to eat) were assessed by visual analogue scales (VAS, 100 mm) at baseline and 120 min. All three spaghetti types (regular, whole wheat, and high soluble fiber–low carbohydrates) provided low GI values (33, 38, and 41, respectively, on glucose scale) and lower peak glucose values compared to glucose or white bread. No differences were observed between spaghetti No 7 types for fasting glucose, fasting and post-test-meal insulin concentrations, blood pressure (systolic and diastolic), and subjective appetite. Conclusions: all spaghetti No 7 types, regardless of soluble fiber and/or protein content, attenuated postprandial glycemic response, which may offer advantages to glycemic control.
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Affiliation(s)
- Emilia Papakonstantinou
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (M.X.); (V.S.); (K.-A.P.)
- Correspondence: ; Tel.: +30-2105294967
| | - Marina Xaidara
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (M.X.); (V.S.); (K.-A.P.)
| | - Vassiliki Siopi
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (M.X.); (V.S.); (K.-A.P.)
| | - Marianna Giannoglou
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization “DEMETER”, 14123 Athens, Greece; (M.G.); (G.K.)
| | - George Katsaros
- Institute of Technology of Agricultural Products, Hellenic Agricultural Organization “DEMETER”, 14123 Athens, Greece; (M.G.); (G.K.)
| | - Georgios Theodorou
- Laboratory of Animal Breeding and Husbandry, Department of Animal Science, School of Animal Biosciences, Agricultural University of Athens, 11855 Athens, Greece;
| | - Eirini Maratou
- Department of Clinical Biochemistry, “Attikon” University General Hospital, National and Kapodistrian University of Athens, Haidari, 12462 Athens, Greece;
| | - Kalliopi-Anna Poulia
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece; (M.X.); (V.S.); (K.-A.P.)
| | - George D. Dimitriadis
- Sector of Medicine, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Panagiotis N. Skandamis
- Laboratory of Food Quality Control and Hygiene, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece;
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Karatzi K, Poulia KA, Papakonstantinou E, Zampelas A. The Impact of Nutritional and Lifestyle Changes on Body Weight, Body Composition and Cardiometabolic Risk Factors in Children and Adolescents during the Pandemic of COVID-19: A Systematic Review. Children (Basel) 2021; 8:children8121130. [PMID: 34943326 PMCID: PMC8700559 DOI: 10.3390/children8121130] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 12/29/2022]
Abstract
The coronavirus (COVID-19) pandemic and the measures taken by most countries to curb virus transmission, such as social distancing, distance learning, population, home confinement and disruption of all organized activities, has affected children and adolescents worldwide. The aim of this review was to assess the role of diet and lifestyle changes due to COVID-19 measures on body weight/composition and cardiometabolic risk factors in children and adolescents. An electronic search was conducted in PUBMED, COCHRANE, Google Scholar and SCOPUS databases up to 31 October 2021. 15 eligible studies were identified. According to the studies included in the analysis, COVID-19 measures seem to have had a negative impact on the diets and lifestyles of children and adolescents, with a consequent increase in body weight and central fat accumulation. On the other hand, the parental presence and control resulted in better glycaemic control in children with diabetes mellitus (DM) Type 1, but the effect of the pandemic in the glycaemic control of children with DM2 2 is controversial. Finally, diet and lifestyle changes had a differential impact on children’s hypertension prevalence. These findings point to the need for public policy measures to prevent obesity and its complications, to and improve diet and lifestyle during the continuing and yet unresolved COVID-19 epidemic.
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Katsagoni CN, Cheirakaki O, Hatzoglou A, Zerva O, Koulieri A, Loizou K, Vasileiadi E, Toilou M, Poulia KA, Kontogianni MD. Malnutrition in Hospitalised Children-An Evaluation of the Efficacy of Two Nutritional Screening Tools. Nutrients 2021; 13:nu13041279. [PMID: 33924630 PMCID: PMC8069022 DOI: 10.3390/nu13041279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 01/04/2023] Open
Abstract
Nutritional risk screening (NRS) is not yet established in many clinical settings. This study aimed to evaluate the efficacy of two NRS tools; the Paediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), compared to the global dietitians’ clinical judgment. The goal of this study was also to estimate the prevalence of nutritional risk in Greek paediatric patients. Overall, 1506 children, 1–16 years, from paediatric and surgical wards of two Greek hospitals were included. NRS was performed using PYMS and STAMP based either on World Health Organization (WHOGC) or Hellenic growth charts (HGC). The first 907 children were also referred to dietitians who categorized children in low, medium and high nutritional risk according to their global clinical judgment. PYMS, either based on WHOGC or HGC, showed better agreement with dietitians’ feedback (kPYMS_WHO = 0.47; 95%CI: 0.41–0.52, kPYMS_HGC = 0.48; 95%CI: 0.43–0.53) compared to STAMP (kSTAMP_WHO = 0.28; 95%CI: 0.23–0.33, kSTAMP_HGC = 0.26; 95%CI: 0.21–0.32). PYMS also showed the best diagnostic accuracy compared to STAMP in paediatrics and surgical wards separately. Moreover, the PYMS showed similar sensitivity to the STAMP (WHOGC: 82% vs. 84.4%), but a higher positive predictive value (WHOGC: 58.2 vs. 38.7). Using PYMS, high and medium malnutrition risk was observed at 14.9%, and 13.1% of children, respectively. Almost 28% of hospitalised children were at nutritional risk. Children in hospitals should be screened with effective and feasible NRS tools such as PYMS.
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Affiliation(s)
- Christina N. Katsagoni
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, 70 El. Venizelou str., 176 71 Athens, Greece; (C.N.K.); (O.C.); (A.H.); (E.V.); (M.T.)
- Department of Nutrition and Dietetics, “Agia Sofia” Children’s Hospital, 4 Thivon and Papadiamatopoulou str., 115 27 Athens, Greece
| | - Olga Cheirakaki
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, 70 El. Venizelou str., 176 71 Athens, Greece; (C.N.K.); (O.C.); (A.H.); (E.V.); (M.T.)
| | - Anastasia Hatzoglou
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, 70 El. Venizelou str., 176 71 Athens, Greece; (C.N.K.); (O.C.); (A.H.); (E.V.); (M.T.)
| | - Ourania Zerva
- Department of Nutrition and Dietetics, “P. and A. Kyriakou” Children’s Hospital, Thivon and 13 Livadias str., 115 27 Athens, Greece; (O.Z.); (A.K.); (K.L.)
| | - Alexandra Koulieri
- Department of Nutrition and Dietetics, “P. and A. Kyriakou” Children’s Hospital, Thivon and 13 Livadias str., 115 27 Athens, Greece; (O.Z.); (A.K.); (K.L.)
| | - Konstantina Loizou
- Department of Nutrition and Dietetics, “P. and A. Kyriakou” Children’s Hospital, Thivon and 13 Livadias str., 115 27 Athens, Greece; (O.Z.); (A.K.); (K.L.)
| | - Emmanouela Vasileiadi
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, 70 El. Venizelou str., 176 71 Athens, Greece; (C.N.K.); (O.C.); (A.H.); (E.V.); (M.T.)
| | - Maria Toilou
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, 70 El. Venizelou str., 176 71 Athens, Greece; (C.N.K.); (O.C.); (A.H.); (E.V.); (M.T.)
| | - Kalliopi-Anna Poulia
- Department of Nutrition and Dietetics, “Laiko” General Hospital of Athens, Agiou Thoma 17, 115 27 Athens, Greece;
| | - Meropi D. Kontogianni
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, 70 El. Venizelou str., 176 71 Athens, Greece; (C.N.K.); (O.C.); (A.H.); (E.V.); (M.T.)
- Correspondence: ; Tel.: +30-210-9549359; Fax: +30-210-9549141
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Alexandraki KI, Kandaraki EA, Poulia KA, Piperi C, Papadimitriou E, Papaioannou TG. Assessment of Early Markers of Cardiovascular Risk in Polycystic Ovary Syndrome. touchREV Endocrinol 2021; 17:37-53. [PMID: 35118445 DOI: 10.17925/ee.2021.17.1.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/22/2020] [Indexed: 11/24/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome, with long-term sequelae from birth to senescence. The long-term effects of PCOS are attributed to several metabolic aberrations ensuing the syndrome. In a systematic review of literature regarding the cardiovascular risk factors that accompany PCOS, we found that macrovascular function has been assessed by flow-mediated dilatation (FMD), microvascular function by venous occlusion plethysmography (VOP), and arterial structure by ultrasonographic assessment of intima-media thickness (IMT) usually of the carotid artery. Contradictory results have been reported; however, in most studies, endothelial dysfunction, an early marker of atherosclerosis assessed either by haemodynamic methods such as FMD or by biochemical methods such as endothelin-1 levels, was found to be impaired. VOP is a less-studied method, with few indices altered. IMT was found to be altered in most of the included studies, but the population was more heterogeneous. Inflammatory markers, including C-reactive protein, were also found to be altered in most studies. On the other hand, a number of interventions have been shown beneficial for the markers of cardiovascular risk, in the context of insulin-sensitizers. However, other interventions such as oral contraceptive pills or statins did not consistently show a similar beneficial effect. In summary, the early identification and eventual treatment of cardiovascular clinical and biochemical risk factors may be used in clinical practice to prevent potential 'silent' triggers of cardiovascular disease.
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Affiliation(s)
- Krystallenia I Alexandraki
- Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Eleitho Practice, Athens, Greece
| | - Eleni A Kandaraki
- Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Department of Endocrinology & Diabetes Mellitus, HYGEIA Hospital, Athens, Greece
| | | | - Christina Piperi
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Theodoros G Papaioannou
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Alexandraki KI, Kandaraki EA, Poulia KA, Piperi C, Papadimitriou E, Papaioannou TG. Assessment of Early Markers of Cardiovascular Risk in Polycystic Ovary Syndrome. European Endocrinology 2021. [DOI: 10.17925/ee.2021.1.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Alexandraki KI, Kaltsas G, Grozinsky-Glasberg S, Oleinikov K, Kos-Kudła B, Kogut A, Srirajaskanthan R, Pizanias M, Poulia KA, Ferreira C, Weickert MO, Daskalakis K. The effect of prophylactic surgery in survival and HRQoL in appendiceal NEN. Endocrine 2020; 70:178-186. [PMID: 32524502 PMCID: PMC7524808 DOI: 10.1007/s12020-020-02356-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS Long-term outcomes are understudied in patients with well-differentiated appendiceal neuroendocrine neoplasms (WD-ANENs). We aimed to evaluate the validity of currently applied criteria for completion prophylactic right hemicolectomy (pRHC) and determine its association with patient outcomes, including health-related quality of life (HRQoL). METHODS Eligible patients from five European referral centers were divided between those who underwent appendectomy alone and those who underwent completion pRHC. HRQoL EORTC-QLC-C30 questionnaires and cross-sectional imaging data were prospectively collected. Age- and sex-matched healthy controls were recruited for HRQoL analysis' validation. RESULTS We included 166 patients (119 women [71.2%]: mean age at baseline: 31 ± 16 years). Mean follow-up was 50.9 ± 54 months. Most patients (152 [92%]) had tumors ≤20 mm in size. Fifty-eight patients (34.9%) underwent pRHC that in final analysis was regarded as an overtreatment in 38/58 (65.5%). In multivariable analysis, tumor size >20 mm was the only independent predictor for lymph node (LN) involvement (p = 0.002). No mortality was reported, whereas 2-, 5- and 10-year recurrence-free survival in patients subjected to postoperative cross-sectional imaging (n = 136) was 98.5%, 97.8%, and 97.8%, respectively. Global HRQoL was not significantly impaired in patients with WD-ANEN compared with age- and sex-matched healthy individuals (median scores 0.83[0.08-1] vs 0.83[0.4-1], respectively; p = 0.929). Among patients with WD-ANEN impaired social functioning (p = 0.016), diarrhea (p = 0.003) and financial difficulties (0.024) were more frequently reported in the pRHC group. CONCLUSIONS WD-ANEN is a low-malignant neoplasm with unconfirmed associated mortality, low recurrence rate, and overall preserved HRQoL. pRHC comes at a price of excessive surgery, functional HRQoL issues, and diarrhea. The value per se of a prophylactic surgical approach to patients with WD-ANENs <20 mm is challenged.
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Affiliation(s)
- Krystallenia I Alexandraki
- Endocrine Oncology Unit, 1st Department of Propaupedic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Gregory Kaltsas
- Endocrine Oncology Unit, 1st Department of Propaupedic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumour Unit, ENETS CoE, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kira Oleinikov
- Neuroendocrine Tumour Unit, ENETS CoE, Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Neoplasms, Department of Endocrinology and Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - Angelika Kogut
- Department of Endocrinology and Neuroendocrine Neoplasms, Department of Endocrinology and Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - Rajaventhan Srirajaskanthan
- ENETS Centre of Excellence, Neuroendocrine Tumour Unit, King's College Hospital, London, SE5 9RS, UK
- Department of Gastroenterology, King's College Hospital, London, SE5 9RS, UK
| | - Michail Pizanias
- Department of Liver Transplantation, Hepatobiliary Pancreatic Surgery, King's Healthcare Partners, King's College Hospital, NHS FT, Institute of Liver Studies, Denmark Hill, London, UK
| | | | - Clara Ferreira
- Department of Nuclear Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Martin O Weickert
- The ARDEN NET Centre, European Neuroendocrine Tumour Society (ENETS) Centre of Excellence (CoE), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Clinical Sciences Research Laboratories, Warwick Medical School, University of Warwick, University Hospital, Coventry, UK
- Centre of Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | - Kosmas Daskalakis
- Endocrine Oncology Unit, 1st Department of Propaupedic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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11
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Grammatikopoulou MG, Katsouda A, Lekka K, Tsantekidis K, Bouras E, Kasapidou E, Poulia KA, Chourdakis M. Is continuing medical education sufficient? Assessing the clinical nutrition knowledge of medical doctors. Nutrition 2018; 57:69-73. [PMID: 30153582 DOI: 10.1016/j.nut.2018.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/24/2018] [Accepted: 05/13/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Provision of nutritional support (NS) can improve disease outcome and shorten hospital length of stay. NS, often prescribed by medical doctors, requires adequate clinical nutrition (CN) expertise. The aim of this study was to investigate self-perceived and actual CN knowledge among medical doctors in Greece. METHODS Internal medicine physicians and surgical specialties (residents and specialized) were asked to self-evaluate their CN expertise, via a seven-item questionnaire and to complete a 20-question multiple-choice test on CN topics, with the aim of evaluating their actual CN knowledge. Participants were discouraged from accessing literature/information during the completion of either questionnaire. RESULTS Of 182 invited medical doctors, 115 (50.4% surgical specialties) participated in the study (63.2% response rate). The majority of participants (65.2%) demonstrated inadequate CN knowledge, with 30.4% of those scoring low having a high self-perception of their CN expertise. Comparison of perceived and actual CN knowledge revealed that only 56.5% of the participants estimated their knowledge correctly. Those who had participated in CN continuous medical education courses demonstrated increased related expertise (P = 0.002). CONCLUSIONS Medical doctors in Greece demonstrate low knowledge of fundamental CN principles, jeopardizing the provision of high-quality and efficient NS. Most importantly, the majority of participants overestimated their CN knowledge and prescribe artificial nutrition or participate in related decision making. Physicians' CN knowledge should be enhanced accordingly, either by attending CN modules during their studies, by participating in basic and advanced courses or CN-specific continuous medical education, or both.
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Affiliation(s)
- Maria G Grammatikopoulou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Katsouda
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriaki Lekka
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Tsantekidis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Bouras
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Kasapidou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Michael Chourdakis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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12
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Papageorgiou O, Poulia KA, Skalioti CN, Melexopoulou C, Kokkinos A, Perrea D, Boletis IN. Adherence to the Mediterranean diet and metabolic parameters in patients with chronic kidney disease stage 5. Clin Nutr ESPEN 2018. [DOI: 10.1016/j.clnesp.2018.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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13
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Poulia KA, Chourdakis M, Vamvakopoulou V, Karamouzis M. Nutritional assessment in gastrointestinal oncology patients undergoing chemotherapy. Clin Nutr ESPEN 2018. [DOI: 10.1016/j.clnesp.2018.01.055] [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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14
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Stamou A, Liaskas A, Tzanninis IG, Kanioura E, Politis D, Poulia KA, Skarlatou V, Viniou NA, Konstantopoulos K, Diamantopoulos P. A clinical audit of nutritional screening and support of hospitalized patients with hematologic diseases. Clin Nutr ESPEN 2018. [DOI: 10.1016/j.clnesp.2018.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Malisova O, Poulia KA, Kolyzoi K, Lysandropoulos A, Sfendouraki K, Kapsokefalou M. Evaluation of water balance in a population of older adults. A case control study. Clin Nutr ESPEN 2018; 24:95-99. [PMID: 29576371 DOI: 10.1016/j.clnesp.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/07/2017] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
Older adults are at risk for dehydration and its' potentially life-threatening consequences. Unrecognized dehydration can complicate chronic medical problems and increase morbidity. The objective of the study was to estimate water balance, intake and loss in elderly people living in Greece using the Water Balance Questionnaire (WBQ). WBQ was administered in winter to 108 independents (65-81yrs) (Group A), 94 independents (82-92yrs) (Group B) and 51 hospitalized (65-92yrs) (Group C). A database from previous study of 335 adults (18-65yrs) (Control Group) used for comparison. Mean estimates of water balance, intake and loss were, respectively, for Group A -749 ± 1386 mL/day, 2571 ± 739 mL/day and 3320 ± 1216 mL/day, for Group B -38 ± 933 mL/day, 2571 ± 739 mL/day and 3320 ± 1216 mL/day, for Group C 64 ± 1399 mL/day, 2586 ± 1071 mL/day and 2522 ± 1048 mL/day and for Control Group -253 ± 1495 mL/day, 2912 ± 1025 mL/day and 3492 ± 2099 mL/day. Significant differences were detected in water balance, intake and loss (p < 0.01). Water balance and water intake in Group A was the lowest. For Groups A, B, C and Control, contribution of solid foods to water intake was 36%, 29%, 32%, 25%, of drinking water was 32%, 48%, 45%, 47%, of beverages was 32%, 23%, 23% and 28% respectively. Significant differences observed in the contribution of drinking water and beverages (p < 0.01). Group A had lower water balance and water intake. Groups B and C had lower water intake from beverages.
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Affiliation(s)
- Olga Malisova
- Unit of Human Nutrition, Department of Food Science and Technology, Agricultural University of Athens, Athens, Greece
| | | | - Kleoniki Kolyzoi
- Unit of Human Nutrition, Department of Food Science and Technology, Agricultural University of Athens, Athens, Greece
| | - Athanasios Lysandropoulos
- Unit of Human Nutrition, Department of Food Science and Technology, Agricultural University of Athens, Athens, Greece
| | - Kalliopi Sfendouraki
- Unit of Human Nutrition, Department of Food Science and Technology, Agricultural University of Athens, Athens, Greece
| | - Maria Kapsokefalou
- Unit of Human Nutrition, Department of Food Science and Technology, Agricultural University of Athens, Athens, Greece.
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16
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Poulia KA, Klek S, Doundoulakis I, Bouras E, Karayiannis D, Baschali A, Passakiotou M, Chourdakis M. The two most popular malnutrition screening tools in the light of the new ESPEN consensus definition of the diagnostic criteria for malnutrition. Clin Nutr 2017; 36:1130-1135. [DOI: 10.1016/j.clnu.2016.07.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 07/14/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022]
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17
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Gomes F, Schuetz P, Bounoure L, Austin P, Ballesteros-Pomar M, Cederholm T, Fletcher J, Laviano A, Norman K, Poulia KA, Ravasco P, Schneider SM, Stanga Z, Weekes CE, Bischoff SC. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clin Nutr 2017; 37:336-353. [PMID: 28802519 DOI: 10.1016/j.clnu.2017.06.025] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Polymorbidity (also known as multimorbidity) - defined as the co-occurrence of at least two chronic health conditions - is highly prevalent, particularly in the hospitalized population. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid patients hospitalized in medical wards. METHODS The methodology used for the development of the current project follows the standard operating procedures for ESPEN guidelines. It started with an initial meeting of the Working Group in January 2015, where twelve key clinical questions were developed that encompassed different aspects of nutritional support: indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Systematic literature searches were conducted in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until April 2016. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations, which were followed by submission to Delphi voting rounds. RESULTS From a total of 4532 retrieved abstracts, 38 relevant studies were analyzed and used to generate a guideline draft that proposed 22 recommendations and four statements. The results of the first online voting showed a strong consensus (agreement of >90%) in 68% of recommendations and 75% of statements, and consensus (agreement of >75-90%) in 32% of recommendations and 25% of statements. At the final consensus conference, a consensus greater than 89% was reached for all of the recommendations. CONCLUSIONS Despite the methodological difficulties in creating non-disease specific guidelines, the evidence behind several important aspects of nutritional support for polymorbid medical inpatients was reviewed and summarized into practical clinical recommendations. Use of these guidelines offer an evidence-based nutritional approach to the polymorbid medical inpatient and may improve their outcomes.
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Affiliation(s)
- Filomena Gomes
- Cantonal Hospital Aarau, Switzerland; Medical Faculty, University of Basel, Switzerland
| | - Philipp Schuetz
- Cantonal Hospital Aarau, Switzerland; Medical Faculty, University of Basel, Switzerland.
| | - Lisa Bounoure
- Cantonal Hospital Aarau, Switzerland; Medical Faculty, University of Basel, Switzerland
| | - Peter Austin
- Oxford and Southampton University Hospitals, United Kingdom
| | | | | | - Jane Fletcher
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | | | | | | | | | - Zeno Stanga
- University Hospital and University of Bern, Switzerland
| | - C Elizabeth Weekes
- Guy's & St. Thomas' NHS Foundation Trust and King's College London, United Kingdom
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
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18
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de Barbieri I, Baumann J, Casal MC, Gurevich A, Pancirova J, Poulia KA, Riemann A. AN OVERVIEW OF NURSES' MANAGEMENT OF SECONDARY HYPERPARATHYROIDISM: HOW IS EUROPE DOING? J Ren Care 2015; 41:202-10. [PMID: 25899821 DOI: 10.1111/jorc.12120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nurses have an important role to play in the management of secondary hyperparathyroidism (SHPT). An online survey conducted by the European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) in conjunction with Amgen (Europe) GmbH surveyed nephrology nurses' knowledge of secondary hyperparathyroidism, treatment targets, current treatments, patient adherence and nephrology nurse training education needs. The survey's aim was to establish common practices being used by nurses in the management of secondary hyperparathyroidism and to identify nephrology nurses' training and educational needs in order to improve patient care. METHODS DESIGN Descriptive study. MEASUREMENTS An online survey of multiple choice and closed questions. PARTICIPANTS A sample of nephrology nurses from Spain, Italy, France and the Netherlands. RESULTS A total of 111 nurses completed the questionnaire (98% response rate, 82% of which were fully completed). Collected data revealed that there were specific aspects of SHPT patient management where nurses lacked confidence, despite the majority of respondents having 15 years nephrology nursing experience. These aspects included explaining the disorder and therapies to patients, managing side effects of drugs and appreciating the significance of controlling biochemical targets. Over 40% of the respondents felt they did not have sufficient training to support patients who were non-compliant. CONCLUSION Nursing skills are integral to SHPT patient management as part of the multidisciplinary approach. The nurse's role is particularly important in patient assessment and monitoring, and in the provision of patient education and support, particularly with treatment adherence. Nephrology nurses who are better informed about SHPT and who receive training on practical patient care may improve the care of patients.
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Affiliation(s)
| | | | | | | | | | | | - Aase Riemann
- Independent Renal Nurse Consultant, Amsterdam, the Netherlands
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19
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Tsirigoti L, Kontogianni MD, Darema M, Iatridi V, Altanis N, Poulia KA, Zavos G, Boletis J. Exploring associations between anthropometric indices and graft function in patients receiving renal transplant. J Hum Nutr Diet 2014; 29:52-8. [PMID: 25522813 DOI: 10.1111/jhn.12289] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the present study was to identify indicators of malnutrition, as obtained by anthropometric measurements, that might be potential predictors of transplant outcomes. METHODS One hundred and three patients receiving a graft from a living or a deceased donor were included in this prospective study. Body mass index (BMI) based on pretransplant dry body weight, triceps skinfold, mid-arm muscle circumference and corrected mid-arm muscle area were measured. Post-transplant data on delayed graft function (DGF) and glomerular filtration rate (GFR) at discharge were collected until patient discharge. RESULTS Delayed graft function developed in 36.9% of the patients. BMI was the only anthropometric variable associated with a higher likelihood of DGF (odds ratio = 1.25, 95% confidence interval = 1.07-1.47) after adjusting for age, gender, donor group, donor age and years of dialysis before transplantation. Obesity was associated with a higher frequency of DGF (83.3% versus 31.1%, P = 0.001) compared to normal weight. GFR at discharge was negatively associated with BMI [β = -0.014 (0.005), P = 0.004], being overweight [β = -0.151 (0.041), P < 0.001] and obesity [β = -0.188 (0.053), P = 0.001], after adjusting for age, gender, donor group, donor age and years of dialysis, but was not associated with indices of muscle reserves. CONCLUSIONS The likelihood of DGF was higher among obese patients, whereas GFR at discharge was negatively associated with being overweight and obesity.
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Affiliation(s)
- L Tsirigoti
- Department of Nutrition & Dietetics, Harokopio University, Athens, Greece
| | - M D Kontogianni
- Department of Nutrition & Dietetics, Harokopio University, Athens, Greece
| | - M Darema
- Department of Nephrology & Transplantation Unit, Laiko Hospital, Athens, Greece
| | - V Iatridi
- Department of Nutrition & Dietetics, Harokopio University, Athens, Greece
| | - N Altanis
- Department of Nephrology & Transplantation Unit, Laiko Hospital, Athens, Greece
| | - K A Poulia
- Department of Nutrition & Dietetics, Laiko Hospital, Athens, Greece
| | - G Zavos
- Transplantation Unit, Laiko Hospital, Athens, Greece
| | - J Boletis
- Department of Nephrology & Transplantation Unit, Laiko Hospital, Athens, Greece
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20
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Makrilakis K, Grammatikou S, Liatis S, Kontogianni M, Perrea D, Dimosthenopoulos C, Poulia KA, Katsilambros N. The effect of a non-intensive community-based lifestyle intervention on the prevalence of metabolic syndrome. The DEPLAN study in Greece. Hormones (Athens) 2012; 11:316-24. [PMID: 22908064 DOI: 10.14310/horm.2002.1360] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 11/20/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effectiveness of a non-intensive, community-based, lifestyle intervention program on the prevalence of metabolic syndrome (MS), in individuals at high risk for development of type 2 diabetes (T2D). DESIGN In accordance with the FINDRISC score, 191 high-risk persons for T2D, 56.3±10.8 years old, participated in a one-year lifestyle intervention program consisting of six bi-monthly sessions with a dietician. MS prevalence was assessed at baseline and one year later. RESULTS The intervention was completed by 125 participants. They lost on average 1.0±4.8 kg (p=0.025) (mean±SD) and registered favourable dietary changes. The baseline prevalence of MS was similar among age groups and genders and decreased after one year (from 63.4±48.4% to 54.8±50.0%, p<0.001). In a multiple logistic regression model, younger age (p=0.009), male gender (p=0.004), improvement of the dietary score after one year (p=0.022), a lower FINDRISC score (p=0.033), a lower triglyceride level (p=0.010) and a higher baseline HDL-C level (p=0.003) were significantly and independently associated with improvement in MS status. CONCLUSIONS A non-intensive lifestyle intervention program to prevent T2D is effective in decreasing the prevalence of MS in individuals at high risk for T2D development, possibly conferring multiple cardiovascular health benefits.
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Affiliation(s)
- Konstantinos Makrilakis
- First Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece.
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21
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Poulia KA, Yannakoulia M, Karageorgou D, Gamaletsou M, Panagiotakos DB, Sipsas NV, Zampelas A. Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Clin Nutr 2011; 31:378-85. [PMID: 22182948 DOI: 10.1016/j.clnu.2011.11.017] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 10/20/2011] [Accepted: 11/26/2011] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Malnutrition in the elderly is a multifactorial problem, more prevalent in hospitals and care homes. The absence of a gold standard in evaluating nutritional risk led us to evaluate the efficacy of six nutritional screening tools used in the elderly. METHODS Two hundred forty eight elderly patients (129 men, 119 female women, aged 75.2 ± 8.5 years) were examined. Nutritional screening was performed on admission using the following tools: Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), Subjective Global Assessment (SGA), Mini Nutritional Assessment - Screening Form (MNA-SF), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002). A combined index for malnutrition was also calculated. RESULTS Nutritional risk and/or malnutrition varied greatly, ranging from 47.2 to 97.6%, depending on the nutritional screening tool used. MUST was the most valid screening tool (validity coefficient = 0.766, CI 95%: 0.690-0.841), while SGA was in better agreement with the combined index (κ = 0.707, p = 0.000). NRS 2002 although was the highest in sensitivity (99.4%), it was the lowest in specificity (6.1%) and positive predictive value (68.2%). CONCLUSIONS MUST seem to be the most valid in the evaluation of the risk for malnutrition in the elderly upon admission to the hospital. NRS 2002 was found to overestimate nutritional risk in the elderly.
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Poulia KA, Panagiotakos DB, Tourlede E, Rezou A, Stamatiadis D, Boletis J, Zampelas A. Omega-3 fatty acids supplementation does not affect serum lipids in chronic hemodialysis patients. J Ren Nutr 2011; 21:479-84. [PMID: 21439849 DOI: 10.1053/j.jrn.2011.01.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 01/16/2011] [Accepted: 01/18/2011] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The aim of this study was to test the hypothesis that omega-3 fatty acids have an effect on serum lipids and inflammation markers in chronic hemodialysis (HD) patients. DESIGN The study followed a single-blind, randomized, crossover design. SETTING The study was conducted at the Hemodialysis Unit of the Laikon General Hospital in Athens, Greece. PATIENTS A total of 25 chronic HD patients were included in the study (16 men, 9 women, age: 51 ± 15 years). INTERVENTION Patients were randomly assigned to one of the following 2 intervention groups: omega-3 fatty acids plus α-tocopherol (920 mg eicosapentaenoic Acid (EPA), 760 mg docosahexaenoic acid (DHA), 8 mg α-tocopherol in total per day) or α-tocopherol supplement (100 mg/week resulting in 14.2 mg/day) alone for 4 weeks. After a washout period of 4 weeks, the 2 groups were crossed. MAIN OUTCOME MEASURES Medical history data were collected and anthropometric and nutritional intake evaluation was performed at the beginning and at the end of both interventions. Hematological and biochemical parameters as well as C-reactive protein levels were measured. RESULTS No statistically significant results were recorded in the lipidemic profiles of the participants between baseline and the 2 interventions. C-reactive protein levels also did not change significantly between the 2 interventions (5.54 ± 3.33 to 6.70 ± 5.01 mg/L [P = .19] with vitamin E vs. 7.13 ± 5.04 to 6.87 ± 5.24 [P = .78] with omega-3, P overall = .53). CONCLUSION The results of this study do not provide support for the positive effects of omega-3 fatty acid supplementation in HD patients.
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Tsiodras S, Poulia KA, Yannakoulia M, Chimienti SN, Wadhwa S, Karchmer AW, Mantzoros CS. Adherence to Mediterranean diet is favorably associated with metabolic parameters in HIV-positive patients with the highly active antiretroviral therapy-induced metabolic syndrome and lipodystrophy. Metabolism 2009; 58:854-9. [PMID: 19375132 PMCID: PMC2829239 DOI: 10.1016/j.metabol.2009.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 02/09/2009] [Indexed: 10/20/2022]
Abstract
The objective of the study was to investigate whether closer adherence to a Mediterranean dietary pattern is associated with metabolic aspects of the highly active antiretroviral therapy (HAART)-induced metabolic syndrome (fat redistribution [FR], insulin resistance, dyslipidemia) in HIV-positive patients. This was a cross-sectional study. Two hundred twenty-seven HIV-infected patients were evaluated during a single outpatient visit to the General Clinical Research Center of Beth Israel Deaconess Medical Center. Usual dietary intake and physical activity habits were evaluated; the Mediterranean Diet Score (MedDietScore) was calculated. Dual-energy x-ray absorptiometry, computed tomographic findings, anthropometrics, and data from the study interviews and questionnaires were used for the assessment of body composition using specific criteria. A complete metabolic profile was available for all subjects. In the entire study sample, a weak inverse association was found between insulin resistance, estimated using the homeostasis model assessment, and MedDietScore (standardized beta = -0.15, P = .03). Interaction models revealed that this was largely driven by an inverse association in patients with FR (standardized beta = -0.13, P = .02). Moreover, MedDietScore was positively correlated with high-density lipoprotein cholesterol (standardized beta = 0.15, P = .01) and marginally negatively associated with circulating triglyceride levels (standardized beta = -0.16, P = .13) in this group of patients. Adherence to a Mediterranean dietary pattern was favorably related to cardiovascular risk factors in HIV-positive patients with FR. Further clinical studies are needed to confirm our data in different populations and to explore the underlying mechanisms.
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Affiliation(s)
- Sotiris Tsiodras
- Division of Infectious Diseases, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Yannakoulia M, Poulia KA, Mylona E, Kontogianni MD. Effectiveness of an intensive nutritional intervention in patients with type 2 diabetes mellitus: results from a pilot study. Rev Diabet Stud 2008; 4:226-30. [PMID: 18338075 DOI: 10.1900/rds.2007.4.226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The aim of this pilot study was to compare the effects of an intensive nutritional intervention with usual care conditions on dropout rate, body weight, lifestyle changes and glycemic control in patients with type 2 diabetes mellitus (T2DM). Thirty outpatients with T2DM but without insulin treatment (mean age: 57 +/- 9 yr) were randomly assigned to one of the two intervention groups: intensive care (IC) or usual care (UC). Patients in the UC group were given advice about dietary and physical activity goals in one consultation session at baseline, while patients in the IC group attended five goal-oriented consultation sessions held approximately every two weeks from baseline onwards. Changes in body weight, T2DM knowledge, dietary intake, physical activity, HbA1c, and percentage of dropouts were evaluated at 1-year follow-up post-intervention. Fifty percent of patients quitted the program and were classified as "dropouts". Program completers were older and included a lower percentage of newly diagnosed T2DM compared with dropouts. A tendency to a negative association between attendance of the IC group and the likelihood of dropping out was found (p = 0.08). No difference was detected between UC and IC groups regarding changes in body weight, HbA1c or other outcome measures, at post-intervention or 1-year follow-up. This pilot study did not confirm advantages of intensive nutritional intervention in T2DM patients in terms of glycemic control, body weight, diet and physical activity. However, the high dropout rate may have hampered its effectiveness.
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Affiliation(s)
- Mary Yannakoulia
- Department of Nutrition and Dietetics Harokopio University, 70 El. Venizelou St, 17671, Athens, Greece
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