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Siems CB, Ji Z, Jedeon Z, Schultz J, Teigen L, Allen T, John R, Estep JD, Masotti M, Alexy T, Kamdar F, Maharaj V, Pritzker M, Garry D, Shaffer A, Cogswell R. Validation of the Minnesota Pectoralis Risk Score to predict mortality in the HeartMate 3 population. J Heart Lung Transplant 2024; 43:539-546. [PMID: 37956881 DOI: 10.1016/j.healun.2023.11.003] [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: 06/09/2023] [Revised: 10/20/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The Minnesota Pectoralis Risk Score (MPRS) utilizes computed tomography-quantified thoracic muscle and clinical variables to predict survival after left ventricular assist device (LVAD) implantation. The model has not been prospectively tested in HeartMate 3 recipients. METHODS A single-center HeartMate 3 cohort from July 2016 to July 2021 (n = 108) was utilized for this analysis. Cohort subjects with complete covariates for MPRS calculation (pectoralis muscle measures, Black race, creatinine, total bilirubin, body mass index, bridge to transplant status, and presence/absence of contrast) implanted after MPRS development were included. MPRS were calculated on each subject. Receiver operating characteristic curves were generated to test model discrimination at 30-day, 90-day, and 1-year mortality post-LVAD. Next, the performance of the 1-year post-LVAD outcome was compared to the HeartMate 3 survival risk score (HM3RS). RESULTS The mean age was 58 (15 years), 80% (86/108) were male, and 26% (28/108) were destination therapy. The area under the curve (AUC) for the MPRS model to predict post-LVAD mortality was 0.73 at 30 days, 0.78 at 90 days, and 0.81 at 1 year. The AUC for the HM3RS for the 1-year outcome was 0.693. Each 1-unit point of the MPRS was associated with a significant increase in the hazard rate of death after LVAD (hazard ratio 2.1, 95% confidence interval 1.5-3.0, p < 0.0001). CONCLUSIONS The MPRS had high performance in this prospective validation, particularly with respect to 90-day and 1-year post-LVAD mortality. Such a tool can provide additional information regarding risk stratification to aid informed decision-making.
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Affiliation(s)
- Chesney B Siems
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
| | - Ziyu Ji
- Department of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Zeina Jedeon
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Jessica Schultz
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Levi Teigen
- Department of Food Science and Nutrition, University of Minnesota, Minneapolis, Minnesota
| | - Tadashi Allen
- Department of Diagnostic Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Ranjit John
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Jerry D Estep
- Department of Cardiology, Cleveland Clinic Florida, Weston, Florida
| | - Maria Masotti
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Tamas Alexy
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Forum Kamdar
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Valmiki Maharaj
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Marc Pritzker
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Garry
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Andrew Shaffer
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Rebecca Cogswell
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Mohamed ME, Saqr A, Staley C, Onyeaghala G, Teigen L, Dorr CR, Remmel RP, Guan W, Oetting WS, Matas AJ, Israni AK, Jacobson PA. Pharmacomicrobiomics: Immunosuppressive Drugs and Microbiome Interactions in Transplantation. Transplantation 2024:00007890-990000000-00663. [PMID: 38361239 DOI: 10.1097/tp.0000000000004926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The human microbiome is associated with human health and disease. Exogenous compounds, including pharmaceutical products, are also known to be affected by the microbiome, and this discovery has led to the field of pharmacomicobiomics. The microbiome can also alter drug pharmacokinetics and pharmacodynamics, possibly resulting in side effects, toxicities, and unanticipated disease response. Microbiome-mediated effects are referred to as drug-microbiome interactions (DMI). Rapid advances in the field of pharmacomicrobiomics have been driven by the availability of efficient bacterial genome sequencing methods and new computational and bioinformatics tools. The success of fecal microbiota transplantation for recurrent Clostridioides difficile has fueled enthusiasm and research in the field. This review focuses on the pharmacomicrobiome in transplantation. Alterations in the microbiome in transplant recipients are well documented, largely because of prophylactic antibiotic use, and the potential for DMI is high. There is evidence that the gut microbiome may alter the pharmacokinetic disposition of tacrolimus and result in microbiome-specific tacrolimus metabolites. The gut microbiome also impacts the enterohepatic recirculation of mycophenolate, resulting in substantial changes in pharmacokinetic disposition and systemic exposure. The mechanisms of these DMI and the specific bacteria or communities of bacteria are under investigation. There are little or no human DMI data for cyclosporine A, corticosteroids, and sirolimus. The available evidence in transplantation is limited and driven by small studies of heterogeneous designs. Larger clinical studies are needed, but the potential for future clinical application of the pharmacomicrobiome in avoiding poor outcomes is high.
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Affiliation(s)
- Moataz E Mohamed
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | - Abdelrahman Saqr
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | | | - Guillaume Onyeaghala
- Hennepin Healthcare Research Institute, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Levi Teigen
- Department of Food Science and Nutrition, University of Minnesota, St Paul, MN
| | - Casey R Dorr
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN
- Hennepin Healthcare Research Institute, Minneapolis, MN
- Department of Medicine, University of Minnesota, Minneapolis, MN
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN
| | - Rory P Remmel
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - William S Oetting
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | - Arthur J Matas
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Ajay K Israni
- Hennepin Healthcare Research Institute, Minneapolis, MN
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Pamala A Jacobson
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN
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Freeman M, Lally L, Teigen L, Graziano E, Shivashankar R, Shmidt E. Hormone Replacement Therapy Is Associated with Disease Activity Improvement among Post-Menopausal Women with Inflammatory Bowel Disease. J Clin Med 2023; 13:88. [PMID: 38202098 PMCID: PMC10779540 DOI: 10.3390/jcm13010088] [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: 11/08/2023] [Revised: 11/25/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: There are limited data available to guide clinical decision-making regarding the effects of hormone replacement therapy (HRT) in post-menopausal women with inflammatory bowel disease (IBD). In this study, we sought to characterize a population of post-menopausal women with IBD and to determine the effects of HRT on their disease activity. (2) Methods: A multicenter, retrospective, case-control cohort study of post-menopausal women with IBD was conducted. The physician global assessment (PGA) score was used to quantify disease activity. To control for the effects of menopause, IBD patients who had not undergone HRT were used as controls. (3) Results: There was a significant reduction in the frequency of PGA scores ≥2 post HRT treatment (p < 0.01). HRT treatment was associated with a 5.6× increase in the odds of post-HRT PGA score improvement compared to controls (OR 5.6; 95% CL 1.6, 19.7) in our univariate logistic regression analysis. (4) Conclusion: Post-menopausal IBD women who underwent HRT therapy showed an improvement in their disease symptoms following HRT compared to post-menopausal women without HRT therapy, who showed no change.
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Affiliation(s)
- Morgan Freeman
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (L.T.); (E.G.)
| | - Lauren Lally
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, USA (R.S.)
| | - Levi Teigen
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (L.T.); (E.G.)
| | - Elliot Graziano
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (L.T.); (E.G.)
| | - Raina Shivashankar
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, USA (R.S.)
| | - Eugenia Shmidt
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (L.T.); (E.G.)
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Moutsoglou DM, Tatah J, Prisco SZ, Prins KW, Staley C, Lopez S, Blake M, Teigen L, Kazmirczak F, Weir EK, Kabage AJ, Guan W, Khoruts A, Thenappan T. Pulmonary Arterial Hypertension Patients Have a Proinflammatory Gut Microbiome and Altered Circulating Microbial Metabolites. Am J Respir Crit Care Med 2023; 207:740-756. [PMID: 36343281 PMCID: PMC10037487 DOI: 10.1164/rccm.202203-0490oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
Rationale: Inflammation drives pulmonary arterial hypertension (PAH). Gut dysbiosis causes immune dysregulation and systemic inflammation by altering circulating microbial metabolites; however, little is known about gut dysbiosis and microbial metabolites in PAH. Objectives: To characterize the gut microbiome and microbial metabolites in patients with PAH. Methods: We performed 16S ribosomal RNA gene and shotgun metagenomics sequencing on stool from patients with PAH, family control subjects, and healthy control subjects. We measured markers of inflammation, gut permeability, and microbial metabolites in plasma from patients with PAH, family control subjects, and healthy control subjects. Measurements and Main Results: The gut microbiome was less diverse in patients with PAH. Shannon diversity index correlated with measures of pulmonary vascular disease but not with right ventricular function. Patients with PAH had a distinct gut microbial signature at the phylogenetic level, with fewer copies of gut microbial genes that produce antiinflammatory short-chain fatty acids (SCFAs) and secondary bile acids and lower relative abundances of species encoding these genes. Consistent with the gut microbial changes, patients with PAH had relatively lower plasma concentrations of SCFAs and secondary bile acids. Patients with PAH also had enrichment of species with the microbial genes that encoded the proinflammatory microbial metabolite trimethylamine. The changes in the gut microbiome and circulating microbial metabolites between patients with PAH and family control subjects were not as substantial as the differences between patients with PAH and healthy control subjects. Conclusions: Patients with PAH have proinflammatory gut dysbiosis, in which lower circulating SCFAs and secondary bile acids may facilitate pulmonary vascular disease. These findings support investigating modulation of the gut microbiome as a potential treatment for PAH.
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Affiliation(s)
| | - Jasmine Tatah
- Division of Cardiovascular Medicine, Department of Medicine
| | | | - Kurt W. Prins
- Division of Cardiovascular Medicine, Department of Medicine
| | - Christopher Staley
- Division of Basic and Translational Research, Department of Surgery, and
| | - Sharon Lopez
- Division of Gastroenterology, Hepatology, and Nutrition
| | - Madelyn Blake
- Division of Cardiovascular Medicine, Department of Medicine
| | - Levi Teigen
- Division of Gastroenterology, Hepatology, and Nutrition
| | | | | | | | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Teigen L, Biruete A, Khoruts A. Impact of diet on hydrogen sulfide production: implications for gut health. Curr Opin Clin Nutr Metab Care 2023; 26:55-58. [PMID: 36542535 PMCID: PMC10413438 DOI: 10.1097/mco.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Excessive hydrogen sulfide (H 2 S) production by the gut microbiota may contribute to the pathogenesis of multiple intestinal diseases, including colon cancer and ulcerative colitis. Therefore, understanding of dietary drivers of H 2 S production has potential implications for nutritional strategies to optimize gut health and treat intestinal diseases. RECENT FINDINGS Recent studies support a positive relationship between dietary protein intake and H 2 S production. However, protein rarely exists in isolation in the diet, and dietary fiber intake could reduce H 2 S production in humans and animals, even with ∼30% of calories derived from protein. SUMMARY These findings suggest that increased fiber intake may reduce H 2 S production irrespective of protein intake, enabling the ability to meet the metabolic demands of the illness while supporting gut health. Here we discuss two recent ulcerative colitis diet studies that illustrate this point.
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Affiliation(s)
- Levi Teigen
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alexander Khoruts
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- BioTechnology Institute, University of Minnesota, St. Paul, Minnesota, USA
- Center for Immunology, University of Minnesota, Minneapolis, Minnesota, USA
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Campbell JP, Teigen L, Manski S, Blumhof B, Guglielmo FF, Shivashankar R, Shmidt E. Sarcopenia Is More Prevalent Among Inflammatory Bowel Disease Patients Undergoing Surgery and Predicts Progression to Surgery Among Medically Treated Patients. Inflamm Bowel Dis 2022; 28:1844-1850. [PMID: 35166776 DOI: 10.1093/ibd/izac013] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sarcopenia is common in inflammatory bowel disease (IBD); however, estimates of its prevalence and impact on clinical outcomes are variable. This study sought to compare the prevalence of sarcopenia in IBD patients starting new biologics vs patients undergoing IBD surgeries, and its association with common clinical predictors of nutritional status, adverse events, and clinical outcomes. METHODS This was a multicenter retrospective cohort study of IBD patients who had a computed tomography (CT) scan within 6 months prior to new biologic initiation (medical cohort) or IBD surgery (surgery cohort). The lowest sex-specific quartile of the total psoas area index at the L3 level defined sarcopenia. Prevalence and predictors of sarcopenia, performance of common clinical nutritional markers, and association with adverse events and clinical outcomes at 1 year were determined. RESULTS A total of 156 patients were included (48% medical cohort, 52% surgery cohort). Sarcopenia was more common in the surgery cohort (32% vs 16%; P < .02). In the medical cohort, sarcopenia predicted need for surgery at 1 year (odds ratio, 4.75; 95% confidence interval, 1.10-20.57; P = .04). Low albumin and body mass index (BMI) were associated with the presence of sarcopenia; however, 24% of sarcopenic patients had both normal BMI and albumin. CONCLUSIONS Sarcopenia is more prevalent among IBD patients undergoing surgery and predicts the need for surgery in patients starting new biologic therapy. Low albumin and BMI were similar between cohorts, suggesting a unique role for sarcopenia as a relevant clinical marker of lean muscle mass depletion for surgically and medically treated IBD patients.
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Affiliation(s)
- James P Campbell
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Levi Teigen
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Scott Manski
- Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian Blumhof
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Raina Shivashankar
- Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eugenia Shmidt
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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7
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Teigen L, Mathai PP, Lopez S, Matson M, Elkin B, Kozysa D, Kabage AJ, Hamilton M, Vaughn BP, Sadowsky MJ, Khoruts A. Differential hydrogen sulfide production by a human cohort in response to animal- and plant-based diet interventions. Clin Nutr 2022; 41:1153-1162. [PMID: 35500315 DOI: 10.1016/j.clnu.2022.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hydrogen sulfide (H2S) is a toxic end-product of microbial fermentation produced in the colon that may play a role in the pathogenesis of several diseases, including ulcerative colitis and colon cancer. However, the effect of diet interventions on intestinal burden of H2S gas exposure remains poorly understood. OBJECTIVE Determine the effect of short-term (1-week) plant- and animal-based eating patterns on ex vivo fecal H2S production in healthy human volunteers. METHODS The study design was an open-label, cross-over diet study and diets were self-administered. Each participant consumed two interventional diets: 1) an animal-based, low fiber (i.e. western) diet and 2) a plant-based, high fiber diet, separated by a two-week washout period. Participants collected full stool samples at the end of each week, which were processed within 2 h of collection to capture H2S production. Microfluidic qPCR (MFQPCR) was used to simultaneously quantify multiple taxonomic and functional groups involved in sulfate reduction and the fecal microbiota was characterized through high-throughput DNA sequencing. RESULTS Median H2S production was higher following the animal-based diet compared to the plant-based diet (p = 0.02; median difference 29 ppm/g, 95% CI 16-97). However, there was substantial individual variability and 2 of 11 individuals (18%) produced more H2S on the plant-based diet. Using the top and bottom quartiles of H2S percent change between animal- and plant-based diet weeks to define responders and non-responders, significant taxonomic differences were observed between the responder and non-responder cohorts. CONCLUSIONS Here we report that substrate changes associated with a 1-week plant-based diet intervention resulted in lower ex vivo H2S production compared to a 1-week animal-based diet intervention in most healthy individuals. However, H2S responsiveness to diet was not uniform across the entire cohort, and potential H2S production enterotypes were characterized that may predict individualized H2S responsiveness to diet.
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Affiliation(s)
- Levi Teigen
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Prince P Mathai
- BioTechnology Institute, University of Minnesota, St. Paul, MN, USA
| | - Sharon Lopez
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Michael Matson
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Baila Elkin
- Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Daria Kozysa
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Amanda J Kabage
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Matthew Hamilton
- BioTechnology Institute, University of Minnesota, St. Paul, MN, USA
| | - Byron P Vaughn
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Michael J Sadowsky
- BioTechnology Institute, University of Minnesota, St. Paul, MN, USA; Department of Soil, Water, and Climate, USA; Department of Plant and Microbial Biology, USA
| | - Alexander Khoruts
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; BioTechnology Institute, University of Minnesota, St. Paul, MN, USA; Center for Immunology, University of Minnesota, Minneapolis, MN, USA.
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Jedeon Z, Agdamag A, Rafei AE, Schultz J, Masotti M, Vest A, Alexy T, Teigen L, Martin C, Klajda M, Cogswell R. The Sarcopenia Index Correlates with Computed Tomography Quantified Muscle Measures in Patients with Advanced Heart Failure. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.036] [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: 10/18/2022] Open
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Schultz J, Hoeg A, Masotti M, Teigen L, John R, Shaffer A, Martin C, Alexy T, Cogswell R. Trends in Body Mass Index before and after Left Ventricular Assist Device and Association with Pectoralis Muscle Measures: Evidence for Progressive Sarcopenia Prior to LVAD Implantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1223] [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] Open
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Feemster J, Steele T, Tao Y, Rivera S, Gossard T, Teigen L, Timm P, McCarter S, St. Louis E. 0817 Abnormal REM Sleep Atonia Control In Patients With Chronic Post-traumatic Stress Disorder. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Post-traumatic stress disorder (PTSD) is characterized by persistent mental and emotional stress following one or more significant physical or psychological traumatic incidents earlier in life. Vivid recall of the events, including traumatic nightmares, and prominent sleep disturbance are usual in PTSD. Previous studies have suggested that PTSD may share some clinical features with idiopathic REM sleep behavior disorder (iRBD) including altered REM sleep without atonia (RSWA) levels. Our group has previously found evidence for altered RSWA control in patients with psychiatric disease, including a pilot sample of PTSD patients with iRBD. We aimed to comparatively analyze RSWA levels between patients with PTSD, PTSD and RBD (PTSD+RBD), iRBD, and controls.
Methods
We selected 18 PTSD, 18 PTSD+RBD, 15 iRBD, and 51 healthy control patients matched for age and sex from the Mayo Clinic Center for Sleep Medicine’s polysomnography database for RSWA quantification. RSWA amounts in the submentalis (SM) and anterior tibialis (AT) were quantitatively analyzed as a percentage of REM sleep duration, in accordance with previously published methods. Non-parametric analyses were performed to compare RSWA, patient demographics, and PSG data across groups. Significance was set at p < 0.016.
Results
Patients with PTSD had significantly higher RSWA than controls in all RSWA density measures (p < 0.016 for all). All measures of RSWA, excluding average SM duration, were significantly greater in PTSD+RBD patients compared with controls (p < 0.016 for all). Within the PTSD group, patients on antidepressants did not have significantly higher RSWA in any of the measures. PTSD+RBD patients had significantly higher SM Phasic, AT Any, SM+AT Any, and Tonic RSWA measures than PTSD patients (p < 0.016 for all).
Conclusion
PTSD patients have significantly higher RSWA than controls, with PTSD+RBD patients having higher RSWA levels than PTSD patients. These data provide the first evidence for abnormal RSWA control in patients with chronic PTSD. This provides evidence of a unique biology in PTSD that could imply a future risk for neurodegenerative disease in PTSD similar to RBD patients. Further prospective studying will need to be performed on patients with PTSD to understand the unique biology.
Support
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Affiliation(s)
| | | | - Y Tao
- Mayo Clinic, Rochester, MN
| | | | | | | | - P Timm
- Mayo Clinic, Rochester, MN
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Nagel E, Hickey M, Teigen L, Kuchnia A, Holm T, Earthman C, Demerath E, Ramel S. Can Ultrasound Measures of Muscle and Adipose Tissue Thickness Predict Body Composition of Premature Infants in the Neonatal Intensive Care Unit? JPEN J Parenter Enteral Nutr 2020; 45:323-330. [DOI: 10.1002/jpen.1829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/03/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Emily Nagel
- Department of Food Science and Nutrition University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Marie Hickey
- Department of Pediatrics University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Levi Teigen
- Department of Gastroenterology University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Adam Kuchnia
- Department of Nutritional Sciences University of Wisconsin–Madison Madison Wisconsin USA
| | - Tara Holm
- Department of Radiology University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Carrie Earthman
- Department of Behavioral Health and Nutrition University of Delaware Newark Delaware USA
| | - Ellen Demerath
- School of Public Health University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Sara Ramel
- Department of Pediatrics University of Minnesota–Twin Cities Minneapolis Minnesota USA
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Maharaj V, Masotti M, Schultz J, Murray T, Teigen L, Shah H, Shaffer A, Alexy T, John R, Cogswell R. Worsening Creatinine Trend in the Year Prior to LVAD Implantation is Associated with Lower Pectoralis Muscle Measures and Increased Post LVAD Mortality. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.223] [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] Open
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13
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Araujo-Gutierrez R, Potter L, Teigen L, Schultz J, Estep J, John R, Martin C, Cogswell R, Trachtenberg B. Pre-Operative Pectoralis Muscle Quantity and Attenuation by Computed Tomography are Predictive of Recurrent Gastrointestinal Bleeding on Left Ventricular Assist Device Support: A Multicenter Analysis. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Cogswell R, Murray T, Araujo R, Teigen L, Trachtenberg B, Schultz J, John R, Martin C, Estep J. External Validation of the Minnesota Pectoralis Muscle Risk Score to Predict Mortality after Ventricular Assist Device Implantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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15
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Mulasi U, Vock DM, Jager-Wittenaar H, Teigen L, Kuchnia AJ, Jha G, Fujioka N, Rudrapatna V, Patel MR, Earthman CP. Nutrition Status and Health-Related Quality of Life Among Outpatients With Advanced Head and Neck Cancer. Nutr Clin Pract 2020; 35:1129-1137. [PMID: 32141121 DOI: 10.1002/ncp.10476] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This pilot study evaluated nutrition status and health-related quality of life (HRQOL) outcomes among outpatients with head and neck cancer (HNC). Data were collected from 19 patients (18 males, 1 female) during 3 time points: once before chemoradiotherapy (CRT) initiation and 1 and 3 months after CRT. Nutrition status was evaluated using the Scored Patient-Generated Subjective Global Assessment (PG-SGA). Malnutrition was defined as PG-SGA stage B (moderate/suspected malnutrition) or stage C (severely malnourished). HRQOL was assessed through the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its HNC-specific module (QLQ-H&N35). We found that well-nourished patients reported having fewer issues with pain, fatigue, appetite loss, chewing, sticky saliva, coughing, and social eating than those categorized as malnourished (P < .05). The association between the global quality-of-life score and PG-SGA score was statistically significant but weak in strength (r = -0.37, P = .012). Although PG-SGA identified 70% as either moderately or severely malnourished before treatment initiation, the mean body mass index was in the overweight category (29 ± 5 kg/m2 ). Compared with pretreatment, patients reported more severe problems with chewing, swallowing, sticky saliva, dry mouth, speech, social eating, and taste and smell sensations at 1-month follow-up, although issues with dry mouth persisted 3 months post treatment (P = .003). In conclusion, malnourished patients reported having worse HRQOL symptoms compared with well-nourished patients. Routine nutrition and psychosocial assessment through PG-SGA and EORTC tools might help identify patients in need of nutrition and psychosocial care.
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Affiliation(s)
- Urvashi Mulasi
- Department of Family & Consumer Sciences (Nutrition and Food/Dietetics), California State University, Sacramento, California, USA
| | - David M Vock
- School of Public Health, Division of Biostatistics, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands.,Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Levi Teigen
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Adam J Kuchnia
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Gautam Jha
- Division of Hematology, Oncology and Transplantation, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Naomi Fujioka
- Division of Hematology, Oncology and Transplantation, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | | | - Manish R Patel
- Division of Hematology, Oncology and Transplantation, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Carrie P Earthman
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
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16
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Nagel E, Hickey M, Teigen L, Kuchnia A, Curran K, Soumekh L, Earthman C, Demerath E, Ramel S. Clinical Application of Body Composition Methods in Premature Infants. JPEN J Parenter Enteral Nutr 2020; 44:785-795. [DOI: 10.1002/jpen.1803] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/08/2020] [Accepted: 01/15/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Emily Nagel
- Department of Food Science and NutritionUniversity of Minnesota‐Twin Cities Minneapolis MN USA
| | - Marie Hickey
- Department of PediatricsUniversity of Minnesota‐Twin Cities Minneapolis MN USA
| | - Levi Teigen
- Department of GastroenterologyUniversity of Minnesota‐Twin Cities Minneapolis MN USA
| | - Adam Kuchnia
- Department of Nutritional SciencesUniversity of Wisconsin‐Madison Madison WI USA
| | - Kent Curran
- Department of PediatricsAlbany Medical Center Albany NY USA
| | - Lisa Soumekh
- School of MedicineUniversity of Minnesota‐Twin Cities Minneapolis MN USA
| | | | - Ellen Demerath
- School of Public HealthUniversity of Minnesota‐Twin Cities Minneapolis MN USA
| | - Sara Ramel
- Department of PediatricsUniversity of Minnesota‐Twin Cities Minneapolis MN USA
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17
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Feemster J, Timm P, Gossard T, Teigen L, Imlach C, Westerland S, McCarter S, St. Louis E. Decreased thalamo-cortical activation during sleep in patients with Parkinsonism. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.303] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Cogswell R, Teigen L, Allen T, Estep J, Araujo R, Schultz J, John R, Martin C, Trachtenberg B. Measurement of Pectoralis Muscle Quantity and Attenuation by Computed Tomography Using Routinely Available Software is Feasible and Predicts Mortality after LVAD Implantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1134] [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] Open
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19
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Cogswell R, Estep J, Araujo R, Teigen L, Schultz J, John R, Martin C, Trachtenberg B. Heart Failure Severity Stratification beyond INTERMACS Profiles: A Step towards Identification of Optimal LVAD Implantation Timing. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.253] [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: 10/27/2022] Open
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20
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Teigen L. Response to “Is the definition of malnutrition a Sisyphean task?”. Clin Nutr ESPEN 2019; 29:245. [DOI: 10.1016/j.clnesp.2018.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
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21
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Cogswell R, Teigen L, Schultz J, Thenappan T, Lin L, Kealhofer J, Martin C, John R. Pre-Operative Pectoralis Muscle Measures by Computed Tomography Predict Early Right Heart Failure Deaths After Left Ventricular Assist Device. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1215] [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] Open
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22
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Mulasi U, Vock DM, Kuchnia AJ, Jha G, Fujioka N, Rudrapatna V, Patel MR, Teigen L, Earthman CP. Malnutrition Identified by the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Consensus Criteria and Other Bedside Tools Is Highly Prevalent in a Sample of Individuals Undergoing Treatment for Head and Neck Cancer. JPEN J Parenter Enteral Nutr 2018. [PMID: 29505143 DOI: 10.1177/0148607116672264.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Using the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (Academy/ASPEN) Consensus malnutrition definition, we estimated malnutrition prevalence in a sample of individuals with head and neck cancer (HNC) and compared it with the Patient-Generated Subjective Global Assessment (PG-SGA). We also investigated the utility of the 50-kHz phase angle (PA) and 200-kHz/5-kHz impedance ratio (IR) to identify malnutrition. MATERIALS AND METHODS Nineteen individuals (18 males, 1 female) scheduled to undergo chemoradiotherapy were seen at 5 time points during and up to 3 months after treatment completion. Multiple-frequency bioelectrical impedance analysis, PG-SGA, nutrition-focused physical examination, anthropometry, dietary intake, and handgrip strength data were collected. RESULTS Using the Consensus, 67% were found to be malnourished before treatment initiation; these criteria diagnosed malnutrition with overall good sensitivity (94%) and moderate specificity (43%) compared with PG-SGA. Over all pooled observations, "malnourished" (by Consensus but not PG-SGA category) had a lower mean PA (5.2 vs 5.9; P = .03) and higher IR (0.82 vs 0.79; P = .03) than "well-nourished" categorizations, although the clinical relevance of these findings is unclear. PA and IR were correlated with higher PG-SGA score (r = -0.35, r = 0.36; P < .01) and handgrip strength (r = 0.48, r = -0.47; P < .01). CONCLUSION The Academy/ASPEN Consensus and the PG-SGA were in good agreement. It is unclear whether PA and IR can be used as surrogate markers of nutrition status or muscle loss.
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Affiliation(s)
- Urvashi Mulasi
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - David M Vock
- School of Public Health, Division of Biostatistics, University of Minnesota, Twin Cities, Minnesota, USA
| | - Adam J Kuchnia
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - Gautam Jha
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Twin Cities, Minnesota, USA
| | - Naomi Fujioka
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Twin Cities, Minnesota, USA
| | | | - Manish R Patel
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Twin Cities, Minnesota, USA
| | - Levi Teigen
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - Carrie P Earthman
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
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23
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Kuchnia AJ, Teigen L, Nagel E, Ligthart-Melis G, Mulasi U, Weijs P, Earthman CP. Protein in the Hospital: Gaining Perspective and Moving Forward. JPEN J Parenter Enteral Nutr 2018; 42:270-278. [PMID: 29356030 DOI: 10.1002/jpen.1068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/14/2017] [Indexed: 12/15/2022]
Abstract
Provision of adequate protein is crucial for optimizing outcomes in hospitalized patients. However, the methodologies upon which current recommendations are based have limitations, and little is known about true requirements in any clinical population. In this tutorial, we aim to give clinicians an understanding of how current protein recommendations were developed, an appreciation for the limitations of these recommendations, and an overview of more sophisticated approaches that can be applied to better define protein requirements. A broader perspective of the challenges and opportunities in determining clinical protein requirements can help clinicians think critically about the individualized nutrition care they provide to their patients with the goal of administering adequate protein to optimize outcomes.
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Affiliation(s)
- Adam J Kuchnia
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Levi Teigen
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Emily Nagel
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Gerdien Ligthart-Melis
- Center for Translational Research in Aging & Longevity, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Urvashi Mulasi
- Department of Family and Consumer Sciences, California State University, Sacramento, California, USA
| | - Peter Weijs
- Department of Nutrition and Dietetics, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Carrie P Earthman
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
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24
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Mulasi U, Vock DM, Kuchnia AJ, Jha G, Fujioka N, Rudrapatna V, Patel MR, Teigen L, Earthman CP. Malnutrition Identified by the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Consensus Criteria and Other Bedside Tools Is Highly Prevalent in a Sample of Individuals Undergoing Treatment for Head and Neck Cancer. JPEN J Parenter Enteral Nutr 2018; 42:139-147. [PMID: 29505143 DOI: 10.1177/0148607116672264] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 03/31/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Using the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition (Academy/ASPEN) Consensus malnutrition definition, we estimated malnutrition prevalence in a sample of individuals with head and neck cancer (HNC) and compared it with the Patient-Generated Subjective Global Assessment (PG-SGA). We also investigated the utility of the 50-kHz phase angle (PA) and 200-kHz/5-kHz impedance ratio (IR) to identify malnutrition. MATERIALS AND METHODS Nineteen individuals (18 males, 1 female) scheduled to undergo chemoradiotherapy were seen at 5 time points during and up to 3 months after treatment completion. Multiple-frequency bioelectrical impedance analysis, PG-SGA, nutrition-focused physical examination, anthropometry, dietary intake, and handgrip strength data were collected. RESULTS Using the Consensus, 67% were found to be malnourished before treatment initiation; these criteria diagnosed malnutrition with overall good sensitivity (94%) and moderate specificity (43%) compared with PG-SGA. Over all pooled observations, "malnourished" (by Consensus but not PG-SGA category) had a lower mean PA (5.2 vs 5.9; P = .03) and higher IR (0.82 vs 0.79; P = .03) than "well-nourished" categorizations, although the clinical relevance of these findings is unclear. PA and IR were correlated with higher PG-SGA score (r = -0.35, r = 0.36; P < .01) and handgrip strength (r = 0.48, r = -0.47; P < .01). CONCLUSION The Academy/ASPEN Consensus and the PG-SGA were in good agreement. It is unclear whether PA and IR can be used as surrogate markers of nutrition status or muscle loss.
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Affiliation(s)
- Urvashi Mulasi
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - David M Vock
- School of Public Health, Division of Biostatistics, University of Minnesota, Twin Cities, Minnesota, USA
| | - Adam J Kuchnia
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - Gautam Jha
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Twin Cities, Minnesota, USA
| | - Naomi Fujioka
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Twin Cities, Minnesota, USA
| | | | - Manish R Patel
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Twin Cities, Minnesota, USA
| | - Levi Teigen
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
| | - Carrie P Earthman
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, Minnesota, USA
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25
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Kuchnia A, Earthman C, Teigen L, Cole A, Mourtzakis M, Paris M, Looijaard W, Weijs P, Oudemans-van Straaten H, Beilman G, Day A, Leung R, Compher C, Dhaliwal R, Peterson S, Roosevelt H, Heyland DK. Evaluation of Bioelectrical Impedance Analysis in Critically Ill Patients: Results of a Multicenter Prospective Study. JPEN J Parenter Enteral Nutr 2016; 41:1131-1138. [PMID: 27221673 DOI: 10.1177/0148607116651063] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 12/31/2022]
Abstract
BACKGROUND In critically ill patients, muscle loss is associated with adverse outcomes. Raw bioelectrical impedance analysis (BIA) parameters (eg, phase angle [PA] and impedance ratio [IR]) have received attention as potential markers of muscularity, nutrition status, and clinical outcomes. Our objective was to test whether PA and IR could be used to assess low muscularity and predict clinical outcomes. METHODS Patients (≥18 years) having an abdominal computed tomography (CT) scan and admitted to intensive care underwent multifrequency BIA within 72 hours of scan. CT scans were landmarked at the third lumbar vertebra and analyzed for skeletal muscle cross-sectional area (CSA). CSA ≤170 cm2 for males and ≤110 cm2 for females defined low muscularity. The relationship between PA (and IR) and CT muscle CSA was evaluated using multivariate regression and included adjustments for age, sex, body mass index, Charlson Comorbidity Index, and admission type. PA and IR were also evaluated for predicting discharge status using dual-energy x-ray absorptiometry-derived cut-points for low fat-free mass index. RESULTS Of 171 potentially eligible patients, 71 had BIA and CT scans within 72 hours. Area under the receiver operating characteristic (c-index) curve to predict CT-defined low muscularity was 0.67 ( P ≤ .05) for both PA and IR. With covariates added to logistic regression models, PA and IR c-indexes were 0.78 and 0.76 ( P < .05), respectively. Low PA and high IR predicted time to live ICU discharge. CONCLUSION Our study highlights the potential utility of PA and IR as markers to identify patients with low muscularity who may benefit from early and rigorous intervention.
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Affiliation(s)
- Adam Kuchnia
- 1 Food Science and Nutrition, University of Minnesota-Twin Cities, Minnesota, USA
| | - Carrie Earthman
- 1 Food Science and Nutrition, University of Minnesota-Twin Cities, Minnesota, USA
| | - Levi Teigen
- 1 Food Science and Nutrition, University of Minnesota-Twin Cities, Minnesota, USA
| | - Abigail Cole
- 1 Food Science and Nutrition, University of Minnesota-Twin Cities, Minnesota, USA
| | | | - Michael Paris
- 2 Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Willem Looijaard
- 3 Department of Intensive Care Medicine, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Peter Weijs
- 3 Department of Intensive Care Medicine, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | | | - Gregory Beilman
- 4 Division of Critical Care/Acute Care Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Andrew Day
- 5 Clinical Evaluation Research Unit, Kingston General Hospital and Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Roger Leung
- 5 Clinical Evaluation Research Unit, Kingston General Hospital and Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Charlene Compher
- 6 School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rupinder Dhaliwal
- 5 Clinical Evaluation Research Unit, Kingston General Hospital and Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sarah Peterson
- 7 Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Hannah Roosevelt
- 7 Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Daren K Heyland
- 5 Clinical Evaluation Research Unit, Kingston General Hospital and Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
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26
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Teigen L, Boes CJ. An evidence-based review of oral magnesium supplementation in the preventive treatment of migraine. Cephalalgia 2014; 35:912-22. [DOI: 10.1177/0333102414564891] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/10/2014] [Indexed: 12/22/2022]
Abstract
Background Migraine is an incompletely understood, debilitating disorder that lacks a universally effective treatment. Magnesium participates in a variety of biochemical processes related to migraine pathophysiology, and a deficiency could contribute to migraine development. Methods A review of the literature from 1990 to the present on magnesium and migraine was conducted. Review The authors identified 16 studies aimed at magnesium status assessment in migraine, and four intervention trials assessing the efficacy of oral magnesium supplementation, independent of other therapies, in the prevention of migraine. Conclusion The strength of evidence supporting oral magnesium supplementation is limited at this time. With such limited evidence, a more advantageous alternative to magnesium supplementation, in patients willing to make lifestyle changes, may be to focus on increasing dietary magnesium intake.
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Affiliation(s)
- Levi Teigen
- Mayo Clinic College of Medicine, USA
- Mayo Clinic Department of Clinical Dietetics, USA
| | - Christopher J Boes
- Mayo Clinic College of Medicine, USA
- Mayo Clinic Department of Neurology, USA
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27
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Teigen L. [Consumers taken seriously. Interview by Bjørn Arild Ostby]. J Sykepleien 1990; 78:9-10. [PMID: 2114915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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