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Sasson AN, Noelting J, Schwenger K, Armstrong D, Raman M, Duerksen D, Whittaker S, Lu Y, Jurewitsch B, Gramlich L, Ananthakrishnan A, Allard J. A287 HOME PARENTERAL NUTRITION FOR INDIVIDUALS WITH SHORT BOWEL SYNDROME SECONDARY TO CROHN’S DISEASE VERSUS OTHER ETIOLOGIES: A PROSPECTIVE COHORT STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991271 DOI: 10.1093/jcag/gwac036.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Individuals with short bowel syndrome (SBS) have reduced intestinal absorptive capacity and many require home parenteral nutrition (PN) support. One of the common causes of SBS is secondary to intestinal resections in the management of Crohn’s disease (CD). Complication rates and survival in SBS secondary to CD on PN versus other etiologies remains unknown. Purpose To determine whether patients with SBS secondary to CD versus SBS secondary to other etiologies on home PN, have increased risk of hospitalizations and complications including central line associated bloodstream infection (CLABSI) and venous thromboembolism and whether there is a difference in overall survival between groups. Method This is a multicentre prospective cohort study using the Canadian Home Parenteral Nutrition (HPN) Registry on individuals with defined SBS separated into two cohorts: 1) Patients with SBS secondary to Crohn’s disease vs. 2) Patients with SBS secondary to other aetiologies (trauma, surgical complication, vascular event, volvulus, malignancy). Patient characteristics and clinical factors are presented as mean (standard deviation) for continuous variables and as frequency (percentage) for categorical variables. Comparison between groups (SBS CD vs SBS other) were performed using 2-sample t-test for continuous variables and Chi-square or Fisher exact tests when appropriate for categorical variable. Survival probabilities will be estimated using the Kaplan-Meier method. Result(s) The study included a total of 379 patients with short bowel syndrome on home PN. There are 170 (45%) patients with SBS secondary to CD and 209 (55%) patients with SBS from other secondary causes. The average age of those with CD is 52 and 65% female patients. The average age of those with other causes of SBS is 56 with similar percentage of female patients (65%). There were significant differences in baseline medications with higher use of immunosuppressant therapy (39% vs. 7%, p<0.001) in those with CD. There was no significant difference in total number of hospitalizations, hospitalizations related to PN and CLABSI. Image ![]()
Conclusion(s) Individuals with SBS secondary to CD do not appear to be at increased risk of central line infections or hospitalizations compared those with SBS from other causes. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- A N Sasson
- Gastroenterology, University of Toronto, Toronto, Canada
| | - J Noelting
- Gastroenterology, Essentia Health, Duluth, United States
| | - K Schwenger
- Gastroenterology, University of Toronto, Toronto, Canada
| | - D Armstrong
- Gastroenterology, McMaster University, Hamilton
| | - M Raman
- Gastroenterology, University of Calgary, Calgary
| | - D Duerksen
- Gastroenterology, University of Manitoba, Winnipeg
| | - S Whittaker
- Gastroenterology, University of British Columbia, Vancouver
| | - Y Lu
- Gastroenterology, McGill University, Montreal
| | | | - L Gramlich
- Gastroenterology, University of Alberta, Edmonton, Canada
| | - A Ananthakrishnan
- Gastroenterology, Massachusetts General Hospital, Boston, United States
| | - J Allard
- Gastroenterology, University of Toronto, Toronto, Canada
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Veldhuijzen van Zanten D, Gramlich L, Cahill L. A288 PHYSICIAN PERSPECTIVES OF MALNUTRITION CARE IN NOVA SCOTIA: A MORE-2-EAT (M2E) NOVA SCOTIA PHASE 2 QUALITATIVE SUBSTUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991185 DOI: 10.1093/jcag/gwac036.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Malnutrition is a clinical entity that is often underdiagnosed due to a lack of standard nutrition status screening during patient encounters, a lack of malnutrition education throughout medical training, inadequate resources to provide proper nutritional care, and differing perceptions regarding the importance of this condition. Amongst patients whose malnutrition is left untreated, approximately two thirds of them will experience further decline in their nutritional status. It is therefore important that the nutritional status of each patient be evaluated with every healthcare encounter where malnutrition may be relevant. Purpose The purpose of this study is to assess generalist and specialist physician perspectives on patient malnutrition care at various Nova Scotia healthcare sites. The aim is to better understand physician viewpoints and attitudes towards malnutrition and nutrition care, its role in their patient care, and what factors might facilitate or impede its effective use in clinical practice. Method Using the Consolidated Framework of Implementation Research (CFIR) and Theoretical Domains Framework (TDF) approaches and ethics approval from the Nova Scotia Health Authority, individually recorded virtual interviews were conducted with physicians working in Nova Scotia. Standardized questions on malnutrition were asked to a target of 12-24 physicians Responses were transcribed and qualitatively analyzed using NVivo software by a professional data analyst. Result(s) To date, ten interviews have been completed. Preliminary qualitative analysis indicates that while all physicians agreed that malnutrition is an important aspect of a patient’s care, its consistent screening and ongoing management is variable. Key Theoretical Domains identified were Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, Memory Attention and Decisions Processes, and Social Influences. Overall, most physicians had a knowledge deficit related to nutrition care and malnutrition, which led to uncertainty on how to screen or manage it. Standardized malnutrition screening tools were infrequently used. This responsibility was often deferred to the dietitian, thereby minimizing the role that physicians play or believe they have in its management. A lack of time during clinical encounters was also a key contributing factor. Conclusion(s) Strategies to optimize physician involvement in and awareness of nutrition care include increased education to train physicians to recognize and manage malnutrition in patients. The use of health system resources such as standardized malnutrition screening tools when malnutrition may be an issue can help with earlier identification and subsequent management. In addition, a team-based approach consisting of healthcare professionals with knowledge of malnutrition that actively involves the physician may be the most appropriate way for patient malnutrition to be effectively managed and provide education to both the physician and the patient. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest D. Veldhuijzen van Zanten Shareholder of: N/A, Consultant of: N/A, Employee of: N/A, Paid Instructor of: N/A, Speakers bureau of: N/A, L. Gramlich Grant / Research support from: Baxter, research funds, principal investigator; Nestle, education funds, chair; and Fresenius Kabi, research funds, principal investigator., Consultant of: Abbott, honorarium for consultant/advisory board, L. Cahill Grant / Research support from: Canadian Institutes of Health Research (CIHR), Research Nova Scotia, Nova Scotia Health Research Fund, Dalhousie University’s Internal Medicine Research Fund (UIMRF), Nova Scotia Health Research Foundation, Queen Elizabeth II Foundation.
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Affiliation(s)
| | | | - L Cahill
- Dalhousie University, Halifax, Canada
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Tsang L, Fredriksen M, Jin J, Gramlich L. A249 RETROSPECTIVE CHART REVIEW OF PATIENTS WITH MALNUTRITION REQUIRING ADVANCED NUTRITIONAL SUPPORT POST BARIATRIC SURGERY. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859273 DOI: 10.1093/jcag/gwab049.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Obesity is a global pandemic with a steady increase in global BMI since 1975. Bariatric surgery is an effective treatment for patients with severe obesity in order to sustain long-term weight loss and reduce comorbidity burden and mortality associated with obesity. However, post-bariatric surgery patients face nutritional complications ranging from micronutrient deficiencies to intestinal failure requiring total parenteral nutrition (TPN). From our institution of home TPN patients, 6.4% of patients had bariatric surgery. Intestinal failure is a burdensome diagnosis for patients, and there is a paucity of literature characterizing patients post-bariatric surgery who develop intestinal failure. Aims We aim to identify the patient characteristics, surgical details, and nutritional traits that predisposed patients to developing intestinal failure requiring advanced nutritional support. Methods This is a retrospective chart review of 48 patient admitted to the Royal Alexandra Hospital post-bariatric surgery for nutritional support and followed by the TPN program dieticians and nurses. Results Our results show the mean BMI was 49.94 kg/m2 pre-bariatric surgery. Interestingly, the mean BMI at time of hospitalization for bariatric-surgery related complications was 33.210 kg/m2 which is classified as overweight but most of patients were severely malnourished with SGA C (43.8%), SGA B (29.17%), and 8.3% were SGA A. Patients requiring parenteral nutrition post-bariatric surgery are mostly female, developed barriers to oral intake, 15% engaged in medical tourism, 58.3% had an underlying mental health diagnosis, and only 18.8% were on a multivitamin even though it is standard of post-bariatric surgery care. The time between initial bariatric surgery to hospital admission was 11.2 years, and most required ≥1 revisional surgery. The mean age at bariatric surgery was 33.2-years old and the average age at initial hospitalization was 48.9-years old. Patients requiring ≥2 admissions had vertical band gastroplasty or sleeve gastrectomy (both 36.8%) while 21.1% had Roux-en-Y gastric bypass. Of these patients, 39.6% of patients required ≥2 hospital admissions and the mean total days spent in hospital was 57.15 days. While these complications are uncommon, these patients result in multiple prolonged hospitalizations and can be difficult to manage. Conclusions Overall, the results of our study will allow the multidisciplinary teams that care for post-bariatric surgery patients to identify patients at risk of intestinal failure and potentially intervene with early enrollment into home nutrition program. With increasing awareness, patients at higher risk can be closely monitored in order to prevent micronutrient deficiencies before they progress to intestinal failure and require lifetime parenteral nutrition. Funding Agencies None
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Affiliation(s)
- L Tsang
- Gastroenterology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - M Fredriksen
- Gastroenterology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - J Jin
- Gastroenterology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - L Gramlich
- Gastroenterology, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada
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Daoud D, Cartagena EMS, Somlaw N, Schwenger K, Gramlich L, Armstrong D, Raman M, Duerksen D, Whittaker S, Jurewitsch B, Marliss E, Allard J. A240 HOME PARENTERAL NUTRITION IN OLDER VERSUS YOUNGER PATIENTS: CLINICAL CHARACTERISTICS AND OUTCOMES. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is a demographic shift toward older patients receiving home parenteral nutrition (HPN) but there is little data on their clinical characteristics and outcomes versus younger HPN patients.
Aims
The objective of this study was to determine if there are any differences between older (> 60 years) and younger (18–59 years) HPN patients in regard to HPN indications, prescriptions and outcomes over the first 2 years receiving HPN.
Methods
This was a retrospective analysis of prospectively collected data from HPN adult patients entered in the password protected web-based Canadian HPN Registry. New HPN patients enrolled between 2003 and 2017 and receiving HPN for 2 years were selected from 8 participating programs across Canada. Data included demographics, anthropometrics, PN prescriptions, line sepsis events, survival and quality of life based on the Karnofsky Performance Status (KPS).
Results
402 patients met the inclusion criteria: 184 patients were 60 years old or above (older group) and 219 patients were between 18 and 59 years old (younger group). Around 64% of both groups were female. There were no significant differences in the main indications for HPN, body mass index (BMI), and PN prescriptions at baseline. At 2-years, younger patients received more calories from PN than older patients (27.88 vs 19.56 Kcal/kg respectively, p <0.001) but BMI remained comparable between groups. There were less line sepsis in the older group versus the younger group (20% vs 36%, p=0.0023) but 78% of younger patients remained alive versus 69 % in the older group (p=0.0401). In those alive, the proportion of patients remaining on HPN was comparable (older group: 77%; younger; group 81%, p=0.4709) and the proportion of patients with a reasonable quality of life (KPS > 60) was similar (older group: 58%; younger group: 63%, p=0.2156).
Conclusions
Older HPN patients have similar clinical characteristics as younger patients but with reduced line sepsis events and higher 2-year mortality.
Funding Agencies
Ontario Medical Supply, Takeda, Fresenius Kabi and Baxter Inc
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Affiliation(s)
- D Daoud
- Centre Hospitalier de l’Université de Montréal - CHUM, Montréal, QC, Canada
| | | | - N Somlaw
- Chulalongkorn University, Bangkok, Bangkok, Thailand
| | | | - L Gramlich
- Community Services Centre, Edmonton, AB, Canada
| | | | - M Raman
- University of Calgary, Calgary, AB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
| | - S Whittaker
- The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | | | - E Marliss
- McGill University Faculty of Medicine, Montreal, QC, Canada
| | - J Allard
- Toronto General Hospital, Toronto, ON, Canada
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Lorbergs A, Prorok J, Holroyd-Leduc J, Bouchard D, Giguere A, Gramlich L, Keller H, Tang A, Racey M, Ali M, Fitzpatrick-Lewis D, Sherifali D, Kim P, Muscedere J. Nutrition and Physical Activity Clinical Practice Guidelines for Older Adults Living with Frailty. J Frailty Aging 2021; 11:3-11. [DOI: 10.14283/jfa.2021.51] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: We developed clinical practice guidelines to provide health care providers with evidence-based recommendations for decisions related to the effective management of frailty and pre-frailty using nutrition and physical activity interventions. Methods: We based the recommendations on two systematic reviews with meta-analyses. Nutrition, physical activity, and combined nutrition and physical activity interventions for adults ≥65y were considered if study populations were identified as frail using a frailty tool or assessment. Risk of bias and certainty of evidence were evaluated. We included physical outcomes, mobility, frailty, cognitive function, activities of daily living, falls, quality of life, diet quality, energy/fatigue levels, health services use, and caregiver outcomes. Results: Overall, mobility improvements were moderate with nutritional strategies that optimize dietary intake, various types of physical activity interventions, and interventions that combine nutrition and physical activity. Physical outcomes, such as body mass and muscle strength, improved moderately with nutritional strategies and interventions that combined nutrition with physical activity. Frailty status improved with multi-component physical activity interventions. Strong recommendations include optimizing dietary intake, performing physical activity, and adopting interventions that combine nutrition and physical activity. We strongly recommend various types of physical activity including muscle strengthening activities, mobilization or rehabilitation exercises, and multi-component physical activity interventions. Interpretation: Tailored nutrition and physical activity interventions based on individual goals and health status are associated with improved clinical and physical outcomes. While the recommendations facilitate shared decision-making, we identified sparse application of validated frailty assessments and lack of standardized research outcomes as critical gaps in knowledge.
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7
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Gramlich L, Dhaliwal R, Laviano A, de van der Schueren M, Bauer J, Findlay M, Martin L, Widaman A. Nutrition practices around surgery for head & neck and esophageal cancer: results from the international nutrition audit in foregut tumors (inform). Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.461] [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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8
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Laviano A, Martin L, Dhaliwal R, Gramlich L. SUN-LB664: Screening for Nutrition Risk: Results from the International Nutrition Audit in Foregut Tumors (INFORM) Study. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32630-5] [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: 11/24/2022]
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9
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Cederholm T, Jensen G, Correia M, Gonzalez M, Fukushima R, Higashiguchi T, Baptista G, Barazzoni R, Blaauw R, Coats A, Crivelli A, Evans D, Gramlich L, Fuchs‐Tarlovsky V, Keller H, Llido L, Malone A, Mogensen K, Morley J, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, de van der Schueren M, Siltharm S, Singer P, Tappenden K, Velasco N, Waitzberg D, Yamwong P, Yu J, Van Gossum A, Compher C. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle 2019; 10:207-217. [PMID: 30920778 PMCID: PMC6438340 DOI: 10.1002/jcsm.12383] [Citation(s) in RCA: 428] [Impact Index Per Article: 85.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. METHODS In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. RESULTS A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify "at risk" status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. CONCLUSION A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re-considered every 3-5 years.
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Affiliation(s)
- T. Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and MetabolismUppsala UniversityUppsalaSweden
- Theme AgingKarolinska University HospitalStockholmSweden
| | - G.L. Jensen
- Dean's Office and Department of Medicine, Larner College of MedicineUniversity of VermontBurlingtonVTUSA
| | - M.I.T.D. Correia
- Department of SurgeryUniversidade Federal de Minas GeraisBelo HorizanteBrazil
| | - M.C. Gonzalez
- Post‐graduate Program in Health and BehaviorCatholic University of PelotasRSBrazil
| | - R. Fukushima
- Department of Medicine, Department of SurgeryTokyo University School of MedicineTokyoJapan
| | - T. Higashiguchi
- Department of Surgery and Palliative MedicineFujita Health University School of MedicineDengakugakubo, KutsukakeToyoake‐CityAichiJapan
| | - G. Baptista
- Medicine Faculty Central University of VenezuelaUniversitary Hospital of Caracas, Chief Nutritional Support Unit Hospital Universitary/Academic of Caracas, University Central of VenezuelaVenezuela
| | - R. Barazzoni
- Department of Medical, Technological and Translational SciencesUniversity of Trieste, Ospedale di CattinaraTriesteItaly
| | - R. Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - A.J.S. Coats
- Monash UniversityAustralia
- University of WarwickWarwickUK
| | - A.N. Crivelli
- Unit of Nutrition Support and Malabsorptive DiseasesHospital HIGA San MartínBuenos AiresArgentina
| | - D.C. Evans
- Department of SurgeryThe Ohio State UniversityColumbusOHUSA
| | | | - V. Fuchs‐Tarlovsky
- Clinical Nutrition DepartmentHospital General de MéxicoMexico CityMexico
| | - H. Keller
- Schlegel‐UW Research Institute for Aging and Department of KinesiologyUniversity of WaterlooOntarioCanada
| | - L. Llido
- Clinical Nutrition ServiceSt. Luke's Medical Center‐Quezon CityMetro‐Manila, Quezon CityPhilippines
| | - A. Malone
- The American Society for Parenteral and Enteral NutritionSilver SpringMDUSA
- Mt. Carmel West HospitalColumbusOHUSA
| | - K.M. Mogensen
- Department of NutritionBrigham and Women's HospitalBostonMAUSA
| | - J.E. Morley
- Division of GeriatricsSaint Louis University HospitalSt. LouisMOUSA
| | - M. Muscaritoli
- Department of Clinical MedicineSapienza University of RomeItaly
| | - I. Nyulasi
- Department of Nutrition, Alfred Health and Professor of Dietetic Practice, Department of Rehabilitation, Nutrition and Sport, Latrobe University; Department of Medicine, Central Clinical SchoolMonash UniversityAustralia
| | - M. Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical NutritionBerlinGermany
| | - V. Pisprasert
- Department of MedicineKhon Kaen University College of MedicineKhon KaenThailand
| | - M.A.E. de van der Schueren
- Department of Nutrition and DieteticsAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamthe Netherlands
- Faculty of Health and Social Studies, Department of Nutrition and DieteticsHAN University of Applied SciencesNijmegenthe Netherlands
| | - S. Siltharm
- Ministry of Science and TechnologyBangkokThailand
| | - P. Singer
- Department of General Intensive CareRabin Medical CenterPetah TikvaIsrael
- Sackler School of MedicineTel Aviv UniversityIsrael
| | - K. Tappenden
- Department of Kinesiology and NutritionUniversity of Illinois‐ChicagoChicagoILUSA
| | - N. Velasco
- Department of Nutrition, Diabetes and Metabolismo, School of MedicinePontificia Universidad Catolica de ChileChile
| | - D. Waitzberg
- Department of Gastroenterology, School of MedicineUniversity of São PauloSão PauloBrazil
| | - P. Yamwong
- Department of MedicineSiriaj HospitalBangkokThailand
| | - J. Yu
- GI Surgery and Nutrition Metabolic Division, Department of General SurgeryPeking Union Medical College HospitalBeijingChina
| | - A. Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional SupportHopital Erasme, Free University of BrusselsBrusselsBelgium
| | - C. Compher
- Biobehavioral Health Sciences Department and Nutrition ProgramsUniversity of Pennsylvania School of NursingPhiladelphiaPAUSA
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Bisch S, Wells T, Gramlich L, Faris P, Wang X, Tran D, Thanh N, Glaze S, Chu P, Ghatage P, Nation J, Capstick V, Steed H, Sabourin J, Nelson G. Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes. Gynecol Oncol 2018; 151:117-123. [DOI: 10.1016/j.ygyno.2018.08.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/28/2018] [Accepted: 08/04/2018] [Indexed: 01/21/2023]
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11
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Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, Baptista G, Barazzoni R, Blaauw R, Coats A, Crivelli A, Evans DC, Gramlich L, Fuchs-Tarlovsky V, Keller H, Llido L, Malone A, Mogensen KM, Morley JE, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, de van der Schueren MAE, Siltharm S, Singer P, Tappenden K, Velasco N, Waitzberg D, Yamwong P, Yu J, Van Gossum A, Compher C, Cederholm T, Van Gossum A, Correia MIT, Gonzalez MC, Fukushima R, Higashiguchi T, Baptista G, Barazzoni R, Blaauw R, Coats A, Crivelli A, Evans D, Gramlich L, Fuchs V, Keller H, Llido L, Malone A, Mogensen K, Morley J, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, de van der Schueren M, Siltharm S, Singer P, Tappenden K, Velasco N, Waitzberg D, Yamwong P, Yu J. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clin Nutr 2018; 38:1-9. [PMID: 30181091 DOI: 10.1016/j.clnu.2018.08.002] [Citation(s) in RCA: 1191] [Impact Index Per Article: 198.5] [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: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 12/12/2022]
Abstract
RATIONALE This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. METHODS In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. RESULTS A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify "at risk" status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. CONCLUSION A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re-considered every 3-5 years.
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Affiliation(s)
- T Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden; Theme Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - G L Jensen
- Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - M I T D Correia
- Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizante, Brazil
| | - M C Gonzalez
- Post-graduate Program in Health and Behavior, Catholic University of Pelotas, RS, Brazil
| | - R Fukushima
- Department of Medicine, Department of Surgery, Tokyo University School of Medicine, Tokyo, Japan
| | - T Higashiguchi
- Department of Surgery and Palliative Medicine, Fujita Health University School of Medicine, Dengakugakubo, Kutsukake, Toyoake-City, Aichi, Japan
| | - G Baptista
- Medicine Faculty Central University of Venezuela, Universitary Hospital of Caracas, Chief Nutritional Support Unit Hospital Universitary/Academic of Caracas, University Central of Venezuela, Venezuela
| | - R Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - R Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Coats
- Monash University, Australia; University of Warwick, Warwick, UK
| | - A Crivelli
- Hospital HIGA San Martín, Unit of Nutrition Support and Malabsorptive Diseases, Buenos Aires, Argentina
| | - D C Evans
- Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - L Gramlich
- University of Alberta, Edmonton, Alberta, Canada
| | - V Fuchs-Tarlovsky
- Clinical Nutrition Department, Hospital General de México, Mexico City, Mexico
| | - H Keller
- Schlegel-UW Research Institute for Aging and Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - L Llido
- Clinical Nutrition Service, St. Luke's Medical Center-Quezon City, Metro-Manila, Quezon City, Philippines
| | - A Malone
- The American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA; Mt. Carmel West Hospital, Columbus, OH, USA
| | - K M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, MA, USA
| | - J E Morley
- Division of Geriatrics, Saint Louis University Hospital, St. Louis, MO, USA
| | - M Muscaritoli
- Department of Clinical Medicine, Sapienza University of Rome, Italy
| | - I Nyulasi
- Department of Nutrition, Alfred Health and Professor of Dietetic Practice, Department of Rehabilitation, Nutrition and Sport, Latrobe University; Department of Medicine, Central Clinical School, Monash University, Australia
| | - M Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany
| | - V Pisprasert
- Department of Medicine, Khon Kaen University College of Medicine, Khon Kaen, Thailand
| | - M A E de van der Schueren
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Nutrition and Dietetics, Amsterdam, the Netherlands; HAN University of Applied Sciences, Faculty of Health and Social Studies, Department of Nutrition and Dietetics, Nijmegen, the Netherlands
| | - S Siltharm
- Ministry of Science and Technology, Bangkok, Thailand
| | - P Singer
- Department of General Intensive Care, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - K Tappenden
- Department of Kinesiology and Nutrition, University of Illinois-Chicago, Chicago, IL, USA
| | - N Velasco
- Department of Nutrition, Diabetes and Metabolismo, School of Medicine, Pontificia Universidad Catolica de Chile, Chile
| | - D Waitzberg
- Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - P Yamwong
- Department of Medicine, Siriaj Hospital, Bangkok, Thailand
| | - J Yu
- GI Surgery and Nutrition Metabolic Division, Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - A Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - C Compher
- Biobehavioral Health Sciences Department and Nutrition Programs, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Gramlich L, Dhaliwal R. International nutrition audit in foregut tumors (inform): An exploration of nutrition care processes in cancer care settings. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.2079] [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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13
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PONTA ML, Somlaw N, Saqui O, Stevenson D, Boudreault M, Marliss E, Raman M, Duerksen D, Whittaker S, Armstrong D, Jurewitsch B, Jeejeebhoy KN, Gramlich L, Allard J. A321 CANADIAN HOME TOTAL PARENTERAL NUTRITION REGISTRY: 10 YEARS OF DATA ENTRY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.321] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M L PONTA
- Medicine, University Health Network, Toronto, ON, Canada
| | - N Somlaw
- Medicine, University Health Network, Toronto, ON, Canada
| | - O Saqui
- University Health Network, Toronto, ON, Canada
| | - D Stevenson
- Regina Qu’Appelle Health Region, Regina, SK, Canada
| | | | - E Marliss
- McGill University Health Centre, Montreal, QC, Canada
| | - M Raman
- University of Calgary, Calgary, AB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
| | - S Whittaker
- Providence Health Care, Vancouver, BC, Canada
| | | | | | | | - L Gramlich
- Community Services Centre, Edmonton, AB, Canada
| | - J Allard
- Medicine, University Health Network, Toronto, ON, Canada
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Tran V, Bielawska B, teterina A, Raman M, Whittaker S, Armstrong D, Gramlich L, Allard J. A316 CANADIAN CANCER PATIENTS ON HOME TOTAL PARENTERAL NUTRITION (HTPN): A 10-YEAR ASSESSMENT. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.316] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V Tran
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - B Bielawska
- University Health Network, Toronto, ON, Canada
| | - A teterina
- University Health Network, Toronto, ON, Canada
| | - M Raman
- University of Calgary, Calgary, AB, Canada
| | - S Whittaker
- Providence Health Care, Vancouver, BC, Canada
| | | | - L Gramlich
- Community Services Centre, Edmonton, AB, Canada
| | - J Allard
- University Health Network, Toronto, ON, Canada
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Noelting J, Jurewitsch B, Gramlich L, Duerksen D, Raman M, Armstrong D, Ponta ML, Saqui O, Arca-Juico CK, Kim P, Stewart B, Allard J. A312 POST MARKET USE OF TEDUGLUTIDE IN CANADA IN PATIENTS WITH SHORT BOWEL SYNDROME ON HOME PARENTERAL NUTRITION: THE REAL WORLD SETTING. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.312] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Noelting
- Gastroenterology, University Health Network, Toronto, ON, Canada
| | | | - L Gramlich
- Alberta Health Sciences, Edmonton, AB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
| | - M Raman
- University of Calgary, Calgary, AB, Canada
| | | | - M L Ponta
- Gastroenterology, University Health Network, Toronto, ON, Canada
| | - O Saqui
- Gastroenterology, University Health Network, Toronto, ON, Canada
| | - C K Arca-Juico
- Gastroenterology, University Health Network, Toronto, ON, Canada
| | - P Kim
- Gastroenterology, University Health Network, Toronto, ON, Canada
| | - B Stewart
- Gastroenterology, University Health Network, Toronto, ON, Canada
| | - J Allard
- Toronto General Hospital, Toronto, ON, Canada
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16
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Gramlich L, Dhaliwal R. MON-P083: International Nutrition Audit in Foregut Tumors (Inform): A Look at Canadian Patient Experiences. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)31000-2] [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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17
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Keller H, Payette H, Laporte M, Bernier P, Allard J, Duerksen D, Gramlich L, Jeejeebhoy K. Patient-reported dietetic care post hospital for free-living patients: a Canadian Malnutrition Task Force Study. J Hum Nutr Diet 2017; 31:33-40. [DOI: 10.1111/jhn.12484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H. Keller
- Department of Kinesiology; Schelgel-University of Waterloo Research Institute for Aging; University of Waterloo; Waterloo Ontario Canada
| | - H. Payette
- Research Centre on Aging; CIUSSS de l'Estrie-CHUS and Faculty of Medicine and Health Sciences; University of Sherbrooke; Sherbrooke Québec Canada
| | - M. Laporte
- Réseau de santé Vitalité Health Network; Campbellton Regional Hospital; Campbellton New Brunswick Canada
| | - P. Bernier
- Jewish General Hospital; Montreal Québec Canada
| | - J. Allard
- Department of Medicine; Toronto General Hospital; University of Toronto; Toronto Ontario Canada
| | - D. Duerksen
- Department of Medicine; Faculty of Health Sciences; University of Manitoba; Winnipeg Manitoba Canada
| | - L. Gramlich
- Department of Medicine & Dentistry; Royal Alexandra Hospital; University of Alberta; Edmonton Alberta Canada
| | - K. Jeejeebhoy
- Department of Medicine; University of Toronto ( emeritus ); Toronto Ontario Canada
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Keller H, Allard J, Duerksen D, Jeejeebhoy K, Gramlich L, Laporte M, Bernier P, Payette H. SUN-P164: Predictors of Post-Hospital Discharge Weight Change: A Study of the Canadian Malnutrition Task Force. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30507-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Keller H, McCullough J, Davidson B, Allard J, Duerksen D, Jeejeebhoy K, Gramlich L, Laporte M, Bernier P. SUN-P165: Development of the Integrated Nutrition Pathway for Acute Care (INPAC). Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Avdagovska M, Bistritz L, Kovacs Burns K, Olson K, Gramlich L. Diffusion of an innovative online education intervention: experiences and lessons learned. Public Health 2016; 140:23-26. [PMID: 27475449 DOI: 10.1016/j.puhe.2016.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/31/2016] [Accepted: 06/10/2016] [Indexed: 11/26/2022]
Affiliation(s)
- M Avdagovska
- Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - L Bistritz
- Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - K Kovacs Burns
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - K Olson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - L Gramlich
- Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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21
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Keller H, Allard J, Vesnaver E, Laporte M, Gramlich L, Bernier P, Davidson B, Duerksen D, Jeejeebhoy K, Payette H. Barriers to food intake in acute care hospitals: a report of the Canadian Malnutrition Task Force. J Hum Nutr Diet 2015; 28:546-57. [DOI: 10.1111/jhn.12314] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- H. Keller
- Schlegel-UW Research Institute for Aging; University of Waterloo; Waterloo ON Canada
| | - J. Allard
- Department of Medicine; University Hospital Network; University of Toronto; Toronto ON Canada
| | | | - M. Laporte
- Réseau de Santé Vitalité Health Network; Cambellton NB Canada
| | - L. Gramlich
- Department of Medicine; University of Alberta; Alberta Health Services; Edmonton AB Canada
| | - P. Bernier
- Jewish General Hospital; Montréal QC Canada
| | - B. Davidson
- Canadian Malnutrition Task Force; Canadian Nutrition Society; Toronto ON Canada
| | - D. Duerksen
- Department of Medicine St-Boniface Hospital; University of Manitoba; Winnipeg MB Canada
| | - K. Jeejeebhoy
- Department of Medicine St-Michael Hospital; University of Toronto; Toronto ON Canada
| | - H. Payette
- Centre de recherche sur le vieillissement; CSSS-IUGS; Faculté de Médecine et des Sciences de la Santé; Université de Sherbrooke; Sherbrooke QC Canada
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Laporte M, Keller HH, Payette H, Allard JP, Duerksen DR, Bernier P, Jeejeebhoy K, Gramlich L, Davidson B, Vesnaver E, Teterina A. Validity and reliability of the new Canadian Nutrition Screening Tool in the ‘real-world’ hospital setting. Eur J Clin Nutr 2014; 69:558-64. [DOI: 10.1038/ejcn.2014.270] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/24/2014] [Accepted: 11/14/2014] [Indexed: 01/04/2023]
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23
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Wichansawakun S, Meddings L, Martin L, Visuthranukul C, Alberda C, Mulesa L, Robbins S, Gramlich L. LB004-SUN: Comparison of Predictive Equations and Measured Energy Expenditure in Patients with BMI Less than 20 kg/m2. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50630-9] [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: 11/15/2022]
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24
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Bozzetti F, Santarpia L, Pironi L, Thul P, Klek S, Gavazzi C, Tinivella M, Joly F, Jonkers C, Baxter J, Gramlich L, Chicharro L, Staun M, Van Gossum A, Lo Vullo S, Mariani L. The prognosis of incurable cachectic cancer patients on home parenteral nutrition: a multi-centre observational study with prospective follow-up of 414 patients. Ann Oncol 2014; 25:487-93. [DOI: 10.1093/annonc/mdt549] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Keller HH, Vesnaver E, Davidson B, Allard J, Laporte M, Bernier P, Payette H, Jeejeebhoy K, Duerksen D, Gramlich L. Providing quality nutrition care in acute care hospitals: perspectives of nutrition care personnel. J Hum Nutr Diet 2013; 27:192-202. [DOI: 10.1111/jhn.12170] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - B. Davidson
- Canadian Nutrition Society; Toronto ON Canada
| | - J. Allard
- University Health Network; Toronto ON Canada
| | - M. Laporte
- Vitalité Health Network; Campbellton NB Canada
| | - P. Bernier
- Jewish General Hospital; Montreal QC Canada
| | - H. Payette
- University of Sherbrooke; Sherbrooke QC Canada
| | | | - D. Duerksen
- St Boniface General Hospital; Winnipeg MB Canada
| | - L. Gramlich
- Royal Alexandra Hospital; Edmonton AB Canada
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26
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Ney M, Vandermeer B, Ma MM, Gramlich L, Tandon P. Commentary: oral or enteral nutritional supplementation in cirrhosis--authors' reply. Aliment Pharmacol Ther 2013; 37:1023. [PMID: 23590541 DOI: 10.1111/apt.12309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 03/21/2013] [Indexed: 12/08/2022]
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27
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Ney M, Vandermeer B, van Zanten SJV, Ma MM, Gramlich L, Tandon P. Meta-analysis: oral or enteral nutritional supplementation in cirrhosis. Aliment Pharmacol Ther 2013; 37:672-9. [PMID: 23421379 DOI: 10.1111/apt.12252] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [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] [Received: 12/01/2012] [Revised: 01/03/2013] [Accepted: 01/28/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Malnutrition is a common and clinically significant problem in patients with cirrhosis. The impact of nutritional therapy remains unclear. AIM To provide an up-to-date systematic review and meta-analysis of RCTs of oral or enteral nutritional supplementation (ONS or ENS) on nutritional and clinical outcomes in adult patients with cirrhosis. METHODS The primary outcome measure was survival. Included: full-text English language RCTs investigating ONS or ENS vs. a standard nonsupplemented diet in patients with cirrhosis. Excluded: parenteral or branched chain amino acids intervention; treatment duration ≤7 days, exclusive evaluation of posttransplant, postsurgical or quality of life outcomes. RESULTS Six trials (4 ONS/2 ENS) and 470 patients were included with 71% males and median age 53 years. When all studies were combined, there was no reduction in mortality [Relative risk (RR): 0.75 (0.42, 1.32), P = 0.31]. Subgroup analysis of 3 of the 4 ONS studies did demonstrate a mortality reduction [RR: 0.40 (0.18, 0.90), P = 0.03]. Of the 2 ENS studies, one included the sickest patients in the meta-analysis (82% Child Pugh C) and the other had the shortest mean intervention duration (8.6 days), possibly impacting the potential for benefit. Study quality was suboptimal (median Jadad = 2). CONCLUSIONS Although there is insufficient evidence to definitively state that oro-enteral nutritional supplementation impacts clinical outcomes, on the basis of this analysis, one can be cautiously optimistic that there is the potential for benefit without an increase in adverse events. Adequately powered, Child Pugh stratified studies of at least 1 month in duration are needed to clarify the impact on relevant clinical outcomes.
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Affiliation(s)
- M Ney
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Abdalian R, Fernandes G, Duerksen D, Jeejeebhoy KN, Whittaker S, Gramlich L, Allard JP. Prescription of Trace Elements in Adults on Home Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2012; 37:410-5. [DOI: 10.1177/0148607112463074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R. Abdalian
- North York General Hospital, Toronto, Ontario, Canada
| | - G. Fernandes
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - D. Duerksen
- St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - S. Whittaker
- University of British Columbia, Vancouver, British Columbia, Canada
| | - L. Gramlich
- University of Alberta, Edmonton, Alberta, Canada
| | - J. P. Allard
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Fernandes G, Kaila B, Jeejeebhoy KN, Gramlich L, Armstrong D, Allard JP. Canadian Home Parenteral Nutrition (HPN) Registry. JPEN J Parenter Enteral Nutr 2012; 36:407-14. [DOI: 10.1177/0148607111434599] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- G. Fernandes
- University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - B. Kaila
- University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - L. Gramlich
- Alberta Health Services, Edmonton, Alberta, Canada
| | - D. Armstrong
- Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - J. P. Allard
- University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
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Gramlich L. Health organizations and the food industry. CMAJ 2011; 183:934; discussion 934. [DOI: 10.1503/cmaj.111-2048] [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: 11/01/2022] Open
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31
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Waugh AWG, Garg S, Matic K, Gramlich L, Wong C, Sadowski DC, Millan M, Bailey R, Todoruk D, Cherry R, Teshima CW, Dieleman L, Fedorak RN. Maintenance of clinical benefit in Crohn's disease patients after discontinuation of infliximab: long-term follow-up of a single centre cohort. Aliment Pharmacol Ther 2010; 32:1129-34. [PMID: 20807218 DOI: 10.1111/j.1365-2036.2010.04446.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [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: 12/13/2022]
Abstract
BACKGROUND Tumour necrosis factor-blockade with infliximab has advanced the treatment of Crohn's disease. While infliximab is efficacious, it remains to be determined whether patients who enter clinical remission with an anti-tumour necrosis factor therapy can have their treatment stopped and retain the state of remission. AIM To assess in patients with Crohn's disease who obtained infliximab-induced remission, the proportion who relapsed after infliximab discontinuation. METHODS This longitudinal cohort study examined patients from a University-based IBD referral centre. Forty eight patients with Crohn's disease in full clinical remission and who then discontinued infliximab were followed up for up to 7 years. Crohn's disease relapse was defined as an intervention with Crohn's disease medication or surgery. RESULTS Kaplan-Meier analysis of the proportion of patients with sustained clinical benefit demonstrated that 50% relapsed within 477 days after infliximab discontinuance. In contrast, 35% of patients remained well, and without clinical relapse, up to the end of the nearly 7-year follow-up. CONCLUSIONS In patients with Crohn's disease with an infliximab-induced remission, stopping infliximab results in a predictable relapse in a majority of patients. Nevertheless, a small percentage of patients sustain a long-term remission.
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Affiliation(s)
- A W G Waugh
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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Heyland DK, Cahill NE, Wang M, Kutsogiannis J, Alberda C, Gramlich L. Benefit of supplemental parenteral nutrition in the critically ill patient? Results of a multicenter observational study. Crit Care 2010. [PMCID: PMC2934250 DOI: 10.1186/cc8789] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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33
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Van Aerde JE, Duerksen DR, Gramlich L, Meddings JB, Chan G, Thomson AB, Clandinin MT. Intravenous fish oil emulsion attenuates total parenteral nutrition-induced cholestasis in newborn piglets. Pediatr Res 1999; 45:202-8. [PMID: 10022591 DOI: 10.1203/00006450-199902000-00008] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.4] [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: 01/27/2023]
Abstract
Total parenteral nutrition (TPN) causes intrahepatic cholestasis and membrane phospholipid changes. Fatty acid (FA) composition of bile and hepatocyte phospholipid is influenced by dietary FA composition. We hypothesized that altering FA composition of i.v. lipid emulsions modifies 1) severity of TPN-induced cholestasis; 2) hepatocyte membrane composition and function; 3) bile flow and composition. Newborn piglets received either sow's milk, TPN with i.v. soybean oil or TPN with i.v. fish oil (FO). After 3 wk, basal and stimulated bile flow were measured after bolus injections of 20, 50, and 100 micromol/kg of taurocholate (TCA). Bile was analyzed for bile acids, cholesterol, phospholipids, and phospholipid-FA. Sinusoidal and canalicular membrane PL-FA, fluidity, and Na+/K+-ATPase were measured. Although the soybean oil-fed animals developed cholestasis, the FO and milk group had similar liver and serum bilirubin. Basal and stimulated bile flow rates were impaired in the soybean oil but not in the FO group. Hepatocyte membrane FA composition reflected dietary FA. Changes in sinusoidal and canalicular membrane fluidity and sinusoidal Na+/K+-ATPase activity did not explain the effect of FO on TPN-induced cholestasis. Intravenous FO reduces TPN-induced cholestasis by unknown mechanisms.
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Affiliation(s)
- J E Van Aerde
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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Abstract
Malnutrition frequently occurs in patients with chronic liver disease, and may influence both short and long term clinical outcome in these patients. Therefore, nutritional intervention may play an important role in the management of chronic liver disease patients. Recent progress in nutritional assessment, principles of nutrition management and the impact of malnutrition upon the clinical outcome of chronic liver disease are reviewed and summarized. Recommendations on how to manage/prevent malnutrition in these patients will be presented.
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Duerksen DR, Van Aerde JE, Gramlich L, Meddings JB, Chan G, Thomson AB, Clandinin MT. Intravenous ursodeoxycholic acid reduces cholestasis in parenterally fed newborn piglets. Gastroenterology 1996; 111:1111-7. [PMID: 8831607 DOI: 10.1016/s0016-5085(96)70080-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [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: 02/02/2023]
Abstract
BACKGROUND & AIMS Cholestasis complicates total parenteral nutrition (TPN) in preterm infants. Ursodeoxycholic acid (UDCA) is used for several cholestatic problems. The hypothesis of this study was that intravenous UDCA prevents TPN-induced cholestasis by (1) maintaining normal basal and stimulated bile flow, (2) altering bile composition, and (3) changing hepatocyte membrane composition and Na+,K(+)-adenosine triphosphatase (ATPase) activity. METHODS Three groups of piglets were studied: group 1 received sow's milk, groups 2 and 3 received TPN, and group 3 also received 100 mumol.kg-1.day-1 UDCA intravenously. After 3 weeks, basal and stimulated bile flow were measured. Cholesterol, bile acids, phospholipids, and phospholipid fatty acids were analyzed in bile, and fluidity, phospholipid fatty acid composition, and Na+,K(+)-ATPase were analyzed in hepatocyte membranes. RESULTS Bile acid secretion and basal and stimulated bile flow were similar in control and UDCA-treated animals but reduced to < 50% in the TPN group. Bile acid-dependent and -independent bile flow were lower in the TPN group. UDCA did not normalize abnormalities in TPN-induced bile composition. Sinusoidal but not canalicular membrane fluidity was different in TPN than in control and UDCA-treated animals. UDCA also increased Na+,K(+)-ATPase activity. Bile and membrane phospholipid fatty acids reflected dietary fatty acids. CONCLUSIONS Intravenous UDCA improves bile flow and reduces bilirubin levels in the serum and liver in piglets with TPN-induced cholestasis.
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Affiliation(s)
- D R Duerksen
- Department of Medicine, University of Alberta, Edmonton, Canada
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36
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Kovithavongs T, Gramlich L, Dossetor JB. Human T cell subset ratio quantitation by 51Cr release: assessment of a new technique. CLIN INVEST MED 1987; 10:78-85. [PMID: 3495381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A method for T cell subset ratio quantitation is described. This technique makes use of monoclonal antibodies 66.1 (OKT4 equivalent) and 51.1 (OKT8 equivalent) in complement-dependent cytotoxicity. The percentages of 51Cr release with these 2 reagents from peripheral blood lymphocyte targets were used to calculate the ratio. It is simple, inexpensive, and can be used for large numbers of samples, but is less accurate when compared with the microscopic technique in immunofluorescence. It may serve as a screening test in certain clinical situations where there is need to determine the T4/T8 ratio.
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