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Perrotta AM, Rotondi S, Mazzaferro S, Bosi L, Letizia C, Muscaritoli M, Gigante A, Salciccia S, Pasculli P, Ciardi MR, Tinti F, Galani A, Errigo F, Menè P, Cianci R, Mitterhofer AP, Mastroianni CM, Palange P, Lai S. COVID-19 and kidney: role of SARS-CoV-2 infection in the induction of renal damage. Eur Rev Med Pharmacol Sci 2023; 27:7861-7867. [PMID: 37667963 DOI: 10.26355/eurrev_202308_33441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE SARS-CoV-2 causes acute respiratory disease, interstitial and alveolar pneumonia, and involves numerous organs and systems such as the kidney, heart, digestive tract, blood, and nervous system. We aimed to evaluate the incidence of renal manifestations in patients diagnosed with COVID-19 infection. PATIENTS AND METHODS We performed a monocentric, cross-sectional, observational study, conducted on 114 patients with SARS-CoV-2. Clinical and laboratory parameters [renal function, serum electrolytes, inflammatory state, blood gas analysis, Interleukin 6 (IL-6) and urinalysis] were evaluated. The same values were checked out after two months (T1), however after negativization. RESULTS We enrolled 114 patients (59 males) with a mean age of 63.8 ± 13.9 years. We found hematuria in 48 patients (55.8%), proteinuria in 33 patients (38.4%), leukocyturia in 61 patients (70.9%), acute kidney injury (AKI) in 28 patients (24.6%), AKI in chronic kidney disease (CKD) in 24 patients (21.1%). Moreover, we found a significant increase of inflammatory indexes as C Reactive Protein (CRP), lactic dehydrogenase (LDH), alpha 1 and alpha 2 globulins with a subsequent reduction at T1 (p = 0.016, p < 0.001, p = 0.005, p = 0.007; respectively). Hemoglobin and erythrocyte values significantly decreased (p < 0.001, p = 0.003, respectively), and we found lymphopenia (p < 0.001). Also, we found elevated levels of the D-Dimer (p < 0.001) and a significant increase in the International Normalized Ratio (INR) (p = 0.038). We also showed a significant improvement after negativization in oxygen partial pressure (p = 0.001) and oxygen saturation (p < 0.001) and a significant increase in pH (p = 0.018) and bicarbonate concentration (p = 0.042). Moreover, we found a significant increase in IL-6 (p = 0.004). Also, we reported mild hyponatremia and hypokalemia with subsequent significant recovery (p < 0.001, p < 0.001, respectively) and mild hypochloremia with a recovery to the limits of statistical significance (p = 0.053). At the entrance, we found an increase in serum glucose with a significant reduction during recovery (p < 0.001). CONCLUSIONS The prevalence of AKI and/or CKD and/or abnormal urinalysis in patients diagnosed with COVID-19 on admission seems to be high and appears as a negative prognostic factor. Urinalysis appears to be very useful in unveiling the potential kidney impairment of COVID-19 patients; therefore, urinalysis could be used to reflect and predict the disease severity. We also recommend a careful evaluation of metabolic alterations, inflammatory states, and electrolytic disorders in COVID-19 patients.
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Affiliation(s)
- A M Perrotta
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy.
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Lai S, Gigante A, Pellicano C, Mariani I, Iannazzo F, Concistrè A, Letizia C, Muscaritoli M. Kidney dysfunction is associated with adverse outcomes in internal medicine COVID-19 hospitalized patients. Eur Rev Med Pharmacol Sci 2023; 27:2706-2714. [PMID: 37013790 DOI: 10.26355/eurrev_202303_31809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
OBJECTIVE In this study, we aimed to evaluate the kidney involvement assessed by estimated glomerular filtration rate (eGFR), the associations with specific clinical disease variables and laboratory findings, and the predictive role of eGFR on clinical outcomes of patients admitted with COVID-19 in Internal Medicine ward in the first wave. PATIENTS AND METHODS Clinical data of 162 consecutive patients hospitalized in the University Hospital Policlinico Umberto I in Rome, Italy, between December 2020 to May 2021 were collected and retrospectively analyzed. RESULTS The median eGFR was significantly lower in patients with worse outcomes than in patients with favorable outcomes [56.64 ml/min/1.73 m2 (IQR 32.27-89.73) vs. 83.39 ml/min/1.73 m2 (IQR 69.59-97.08), p<0.001]. Patients with eGFR < 60 ml/min/1.73 m2 (n=38) were significantly older compared to patients with normal eGFR [82 years (IQR 74-90) vs. 61 years (IQR 53-74), p<0.001] and they had fever less frequently [39.5% vs. 64.2%, p<0.01]. Kaplan-Meier curves demonstrated that overall survival was significantly shorter in patients with eGFR < 60 ml/min/1.73 m2 (p<0.001). In multivariate analysis, only eGFR < 60 ml/min/1.73 m2 [HR=2.915 (95% CI=1.110-7.659), p<0.05] and platelet to lymphocyte ratio [HR=1.004 (95% CI=1.002-1.007), p<0.01] showed a significant predictive value for death or transfer to intensive care unit (ICU). CONCLUSIONS Kidney involvement on admission was an independent predictor for death or transfer to ICU among hospitalized COVID-19 patients. The presence of chronic kidney disease could be regarded as a relevant factor in risk stratification for COVID-19.
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Affiliation(s)
- S Lai
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
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Concistrè A, Petramala L, Pugliano CL, Celi M, Vinci F, Assanto E, Barchetta I, Perrone EP, Rella S, Iannazzo F, Angheloni A, Coraggio L, Di Rienzo F, Maggi D, Circosta F, Galardo G, Muscaritoli M, Letizia C. Analysis of prognostic factors in COVID-19 hospitalized patients: an Italian single-center case-control study. Eur Rev Med Pharmacol Sci 2023; 27:1207-1221. [PMID: 36808370 DOI: 10.26355/eurrev_202302_31232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE COVID-19 clinical presentation ranges from asymptomatic infection to an inflammatory cytokine storm with multi-organ failure and fatal outcomes. The identification of high-risk patients for severe disease is crucial to plan an early treatment and intensive follow-up. We aimed to investigate negative prognostic factors in a group of patients hospitalized for COVID-19. PATIENTS AND METHODS 181 patients (90 men and 91 women, mean age 66.56 ± 13.53 years) were enrolled. Each patient received a work-up including medical history, clinical examination, arterial blood gas analysis, laboratory blood tests, feasible ventilatory support required during hospital stay, intensive care setting required, duration of illness and length of hospital stay (>or<25 days). For the assessment of the severity of COVID-19, three main indicators were considered: 1) the intensive care unit (ICU) admission 2) the hospitalization length >25 days; 3) the need of non-invasive ventilation (NIV). RESULTS The independent risk factor associated with the ICU admission were lactic dehydrogenase elevation (p=0.046), C reactive protein elevation (p=0.014) at hospital admission and direct oral anticoagulant home therapy (p=0.048); for hospital length >25 days: early corticosteroid therapy (p=0.035); for NIV treatment: ferritin elevation at hospital admission (p=0.006). CONCLUSIONS The presence of the above factors may be useful to identify patients at high risk of developing a severe COVID-19 that need an early treatment and intensive follow-up.
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Affiliation(s)
- A Concistrè
- Internal Medicine COVID-19 Unit, Policlinico "Umberto I" University Hospital, Rome, Italy.
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Cuerda C, Muscaritoli M, Chourdakis M, Krznaric Z, Archodoulakis A, Gürbüz S, Berk K, Aapro M, Farrand C, Patja K, Schneider S, Barazzoni R. Nutrition education in medical schools (NEMS) project: Promoting clinical nutrition in medical schools - Perspectives from different actors. Clin Nutr 2023; 42:54-59. [PMID: 36473759 DOI: 10.1016/j.clnu.2022.11.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND & AIMS Nutrition education is not adequately represented in the medical curriculum, and this prompted the European Society for Clinical Nutrition and Metabolism (ESPEN) to launch the Nutrition Education in Medical Schools (NEMS) Project in 2017. The aim of this original paper was to describe the perspectives of different actors in the promotion of nutrition education in medical schools. METHODS On 11 November 2021, an online meeting was held on this topic, where nine representatives from different backgrounds participated in the scientific programme. More than 640 participants registered to this webinar. RESULTS The different models of Nutrition Education in Medical Schools were introduced by Prof. Cristina Cuerda (Spain) and Prof. Maurizio Muscaritoli (Italy). The students' perspective was given by Ms. Alexandra Archodoulakis (Germany) and Ms. Sila Gürbüz (Turkey), representing the European Medical Students' Association. The dietitian's perspective was given by Dr. Kirsten Berk (The Netherlands), whereas Dr. Matti Aapro (Switzerland) gave the medical doctor (oncology)'s perspective. Ms. Clare Farrand (Australia) gave the WHO perspective and Dr. Kristiina Patja (Finland) explained the healthy lifestyle teaching to medical students. Lastly, Prof. Michael Chourdakis (Greece) and Prof. Zeljko Krznaric (Croatia) hosted the round-table discussion. CONCLUSIONS There was strong agreement among the representatives from different settings joining this ESPEN initiative that increasing nutritional knowledge and skills of young doctors is now possible and will launch a virtuous cycle that will proactively involve all the other healthcare professionals working in the nutritional field.
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Affiliation(s)
- C Cuerda
- Department of Medicine, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - M Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - M Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Z Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, University of Zagreb, Croatia
| | | | - S Gürbüz
- Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - K Berk
- Department of Internal Medicine, Division of Dietetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - M Aapro
- Oncology Department, Genolier Cancer Center, Clinique de Genolier, Genolier, Switzerland
| | - C Farrand
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), Copenhagen, Denmark
| | - K Patja
- Department of Public Health, Medical Faculty, University of Helsinki, Finland
| | - S Schneider
- Gastroenterology and Nutrition, Centre Hospitalier Universitaire de Nice, Universite Cote d'Azur, Nice, France
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Molfino A, Imbimbo G, Belli R, Carletti R, Andreini M, Amabile M, Nigri G, Muscaritoli M. Modifications in markers of browning in white adipose tissue of patients with cancer cachexia. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Belli R, Molfino A, Ferraro E, Imbimbo G, Carletti R, Possente E, Gasperini-Zacco M, Amabile M, Muscaritoli M. Muscle-related mirnas and its relationship with circulating GDF-15 and FGF-21 levels in patients with cardiac cachexia. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.349] [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: 10/19/2022]
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Concistrè A, Alessandri F, Rosato E, Pugliese F, Muscaritoli M, Letizia C. A case of chronic systemic capillary leak syndrome (SCLS) exacerbated during SARS-CoV2 infection. Eur Rev Med Pharmacol Sci 2021; 25:5922-5927. [PMID: 34661250 DOI: 10.26355/eurrev_202110_26868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Systemic capillary leak syndrome (SCLS) is a very rare and lethal disease characterized by hemoconcentration and hypoalbuminemia caused by reversible plasma extravasation. The underlying cause for SCLS remains largely unknown and acute treatment has remained mainly supportive. Prophylaxis with intravenous immunoglobulin (IVIG) has been shown to successfully prevent further episodes in affected patients. We reported a case of SCLS in a patient who presented to our hospital with COVID-19 and developed profound shock.
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Affiliation(s)
- A Concistrè
- Department of Translational and Precision Medicine, University "Sapienza", Rome, Italy.
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Lai S, Bagordo D, Perrotta AM, Gigante A, Gasperini ML, Muscaritoli M, Mazzaferro S, Cianci R. Autonomic dysfunction in kidney diseases. Eur Rev Med Pharmacol Sci 2021; 24:8458-8468. [PMID: 32894552 DOI: 10.26355/eurrev_202008_22643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Kidney diseases are associated with many cardiovascular risk factors, such as anaemia, inflammation and chronic volume overload. Changes in the sympathovagal balance are common findings in patients with end-stage renal disease (ESRD). In particular, sympathetic hyperactivity is linked with an increase in resting heart rate leading to myocardial hypertrophy and fibrosis. The latter increases the risk of sudden cardiac death from fatal arrythmias and therefore assessment of both sympathetic and parasympathetic tones could be clinically relevant in ESRD patients. Heart rate variability and other indices are currently used to evaluate the functionality of the autonomic nervous system. Some of these have emerged as potential diagnostic tools that can support clinical decision-making processes and therapeutic strategies in patients with renal disease, including those who are on dialysis replacement therapy. In this review, we summarize the impact and the relationships between sympathovagal disturbances and kidney diseases, replacement therapies and transplantation.
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Affiliation(s)
- S Lai
- Department of Translational and Precision Medicine, Nephrology Unit, Sapienza University of Rome, Rome, Italy.
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Cuerda C, Muscaritoli M, Krznaric Z, Pirlich M, Van Gossum A, Schneider S, Ellegard L, Fukushima R, Chourdakis M, Della Rocca C, Milovanovic D, Lember M, Arias-Diaz J, Stylianidis E, Anastasiadis K, Alunni V, Mars T, Hellerman MI, Kujundžić-Tiljak M, Irtun O, Abbasoglu O, Barazzoni R. Nutrition education in medical schools (NEMS) project: Joining ESPEN and university point of view. Clin Nutr 2021; 40:2754-2761. [PMID: 33933741 DOI: 10.1016/j.clnu.2021.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/07/2021] [Accepted: 03/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS Nutrition education is not well represented in the medical curriculum. The aim of this original paper was to describe the Nutrition Education in Medical Schools (NEMS) Project of the European Society for Clinical Nutrition and Metabolism (ESPEN). METHODS On 19 January 2020, a meeting was held on this topic that was attended by 51 delegates (27 council members) from 34 countries, and 13 European University representatives. RESULTS This article includes the contents of the meeting that concluded with the signing of the Manifesto for the Implementation of Nutrition Education in the Undergraduate Medical Curriculum. CONCLUSION The meeting represented a significant step forward, moved towards implementation of nutrition education in medical education in general and in clinical practice in particular, in compliance with the aims of the ESPEN Nutrition Education Study Group (NESG).
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Affiliation(s)
- C Cuerda
- Nutrition Unit. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - M Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Z Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, University of Zagreb, Croatia
| | - M Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology & Clinical Nutrition, Berlin, Germany
| | - A Van Gossum
- Department of Gastroenterology and Nutritional Support, Hopital Erasme and Institut Bordet, Free University of Brussels, Brussels, Belgium
| | - S Schneider
- Department of Gastroenterology and Nutrition, CHU de Nice, Université Côte D'Azur, Nice, France
| | - L Ellegard
- Sahlgrenska Academy at the University of Gothenborg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - R Fukushima
- Department of Surgery, Teikyo University School of Medicine, Japan
| | - M Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - C Della Rocca
- Dean of the Faculty of Pharmacy and Medicine, Sapienza University of Rome, Italy
| | - D Milovanovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences University of Kragujevac, Kragujevac, Serbia
| | - M Lember
- Dean of the Faculty of Medicine, University of Tartu, Estonia
| | - J Arias-Diaz
- Dean of the Faculty of Medicine, Complutense University, Madrid, Spain
| | - E Stylianidis
- Vice Rector for Research and Lifelong Education, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Anastasiadis
- Dean of the School of Medicine, Aristotle University of Thessaloniki, Greece
| | - V Alunni
- Vice Dean of the Faculty of Medicine for Education, Université Côte D'Azur, Nice, France
| | - T Mars
- Vice Dean Erasmus LLP Coordinator, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - M I Hellerman
- Department of General Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva 49100, Israel
| | - M Kujundžić-Tiljak
- Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Croatia
| | - O Irtun
- Gastrosurgical Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - O Abbasoglu
- Department of Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Gigante A, Rosato E, Muscaritoli M. Body composition and microvascular damage in systemic sclerosis patients. J Endocrinol Invest 2021; 44:205-206. [PMID: 32683616 DOI: 10.1007/s40618-020-01364-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Affiliation(s)
- A Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy.
| | - E Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
| | - M Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
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Rosato E, Gigante A, Villa A, Iannazzo F, Muscaritoli M. Gastrointestinal involvement and low muscularity in systemic sclerosis. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.385] [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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Pradelli L, Mayer K, Klek S, Omar Alsaleh A, Rosenthal M, Heller A, Muscaritoli M. SUN-LB640: Omega-3 Fatty-Acid Enriched Parenteral Nutrition Regimens in Hospitalized Patients in EU5 Countries: A Pharmacoeconomic Analysis. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32606-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Molfino A, Gasperini M, Gigante A, Rosato E, Muscaritoli M. SUN-PO183: Correlation Between Left Ventricular Mass and Fat Free Mass Index in Patients with Systemic Sclerosis without Cardiovascular Disease. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32815-8] [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: 11/30/2022]
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Gigante A, Gasperini M, Iacolare A, Molfino A, Proietti L, Margiotta D, Navarini L, Afeltra A, Rosato E, Muscaritoli M. MON-PO498: Phase Angle as a Marker of Microvascular Damage in Systemic Sclerosis. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32331-3] [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: 10/26/2022]
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Gigante A, Gasperini M, Iacolare A, Molfino A, Proietti L, Rosato E, Muscaritoli M. GM01: Comparison of ESPEN 2015 and GLIM Criteria for Assessing Malnutrition in Systemic Sclerosis. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32124-7] [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: 10/26/2022]
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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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Roberto M, Sarfati E, Di Girolamo M, Schipilliti F, Crimini E, Botticelli A, Marchetti L, Muscaritoli M, Marchetti P, Mazzuca F. Clinical impact of whey protein and nutritional counseling in gastrointestinal cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy300.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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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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Molfino A, Muscaritoli M, Amabile M, Mitterhofer A, Lai S. Older adults with chronic kidney disease (CKD): Role of the multidimensional prognostic index (MPI) in patients on conservative and replacement therapy. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1135] [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: 10/28/2022]
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Molfino A, Lai S, Amabile M, Mitterhofer A, Muscaritoli M. Sarcopenia and markers of atherosclerosis and endothelial dysfunction: Preliminary results from an italian cohort of ckd patients. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1342] [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: 10/28/2022]
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21
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Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, Erickson N, Laviano A, Lisanti MP, Lobo DN, McMillan DC, Muscaritoli M, Ockenga J, Pirlich M, Strasser F, de van der Schueren M, Van Gossum A, Vaupel P, Weimann A. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr 2017; 36:1187-1196. [PMID: 28689670 DOI: 10.1016/j.clnu.2017.06.017] [Citation(s) in RCA: 637] [Impact Index Per Article: 91.0] [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: 06/15/2017] [Accepted: 06/15/2017] [Indexed: 12/13/2022]
Abstract
Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatments threaten their nutritional status. Yet cancer-related nutritional risk is sometimes overlooked or under-treated by clinicians, patients, and their families. The European Society for Clinical Nutrition and Metabolism (ESPEN) recently published evidence-based guidelines for nutritional care in patients with cancer. In further support of these guidelines, an ESPEN oncology expert group met for a Cancer and Nutrition Workshop in Berlin on October 24 and 25, 2016. The group examined the causes and consequences of cancer-related malnutrition, reviewed treatment approaches currently available, and built the rationale and impetus for clinicians involved with care of patients with cancer to take actions that facilitate nutrition support in practice. The content of this position paper is based on presentations and discussions at the Berlin meeting. The expert group emphasized 3 key steps to update nutritional care for people with cancer: (1) screen all patients with cancer for nutritional risk early in the course of their care, regardless of body mass index and weight history; (2) expand nutrition-related assessment practices to include measures of anorexia, body composition, inflammatory biomarkers, resting energy expenditure, and physical function; (3) use multimodal nutritional interventions with individualized plans, including care focused on increasing nutritional intake, lessening inflammation and hypermetabolic stress, and increasing physical activity.
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Affiliation(s)
- J Arends
- Department of Medicine I, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - V Baracos
- Department of Oncology, University of Alberta, Edmonton, Canada
| | - H Bertz
- Department of Medicine I, Medical Center - University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - F Bozzetti
- Faculty of Medicine, University of Milan, Milan, Italy
| | - P C Calder
- Faculty of Medicine, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - N E P Deutz
- Center for Translational Research in Aging & Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - N Erickson
- Comprehensive Cancer Center, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - A Laviano
- Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - M P Lisanti
- Department of Translational Medicine, University of Salford, Salford, UK
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - D C McMillan
- Department of Surgical Science, University of Glasgow, Glasgow, UK
| | - M Muscaritoli
- Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - J Ockenga
- Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany
| | - M Pirlich
- Department of Internal Medicine, Elisabeth Protestant Hospital, Berlin, Germany
| | - F Strasser
- Department Internal Medicine and Palliative Care Centre, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - M de van der Schueren
- Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - A Van Gossum
- Gastroenterology Service, Hôpital Erasme, University Hospitals of Brussels, Brussels, Belgium
| | - P Vaupel
- Department of Radiation Oncology and Radiotherapy, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - A Weimann
- Department of General, Visceral, and Oncological Surgery, Hospital St Georg, Leipzig, Germany
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Molfino A, Amabile M, Altieri S, Mastroluca D, Lai C, Aceto P, Crudo M, Rossi Fanelli F, Muscaritoli M, Lai S. SUN-P115: Older Adults with Reduced Renal Function: Evaluation of the Effects of Underlying Renal Disease on Nutritional and Metabolic Profile. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30512-5] [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: 10/18/2022]
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Molfino A, Alessandri F, Farcomeni A, Dell’utri D, Mosillo P, Amabile M, Muscaritoli M, Laviano A. SUN-P012: The Association Between Phosphatase and Tensin Homologue (PTEN) Expression, Glucose Control and Calories Supplemented in Critically Ill Patients. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30614-3] [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]
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Muscaritoli M, Molfino A, Scala F, De Lorenzo F, Christoforidi K, Manneh-Vangramberen I. European survey of 907 people with cancer about the importance of nutrition. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx385.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Barazzoni R, Deutz N, Biolo G, Bischoff S, Boirie Y, Cederholm T, Cuerda C, Delzenne N, Leon Sanz M, Ljungqvist O, Muscaritoli M, Pichard C, Preiser J, Sbraccia P, Singer P, Tappy L, Thorens B, Van Gossum A, Vettor R, Calder P. Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group. Clin Nutr 2017; 36:355-363. [DOI: 10.1016/j.clnu.2016.09.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 12/17/2022]
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Muscaritoli M, Rossi Fanelli F, Molfino A. Perspectives of health care professionals on cancer cachexia: results from three global surveys. Ann Oncol 2016; 27:2230-2236. [PMID: 28007753 PMCID: PMC5178142 DOI: 10.1093/annonc/mdw420] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/15/2016] [Accepted: 08/26/2016] [Indexed: 12/19/2022] Open
Abstract
Cachexia has a high prevalence in cancer patients, leading to reduced tolerance/response to treatment and decreased quality of life. Results from three global surveys presented herein demonstrate a definite need for increased awareness and educational initiatives to improve the knowledge and understanding of cancer cachexia among physicians in order to optimize patient outcomes. Background Cachexia has a high prevalence in cancer patients and negatively impacts prognosis, quality of life (QOL), and tolerance/response to treatments. This study reports the results of three surveys designed to gain insights into cancer cachexia (CC) awareness, understanding, and treatment practices among health care professionals (HCPs). Methods Surveys were conducted globally among HCPs involved in CC management. Topics evaluated included definitions and synonyms of CC, diagnosis and treatment practices, and goals and desired improvements of CC treatment. Results In total, 742 HCPs from 14 different countries participated in the surveys. The majority (97%) of participants were medical oncologists or hematologists. CC was most frequently defined as weight loss (86%) and loss of appetite (46%). The terms loss of weight and decreased appetite (51% and 34%, respectively) were often provided as synonyms of CC. Almost half (46%) of the participants reported diagnosing CC and beginning treatment if a patient experienced a weight loss of 10%. However, 48% of the participants would wait until weight loss was ≥15% to diagnose CC and start treatment. HCPs also reported that 61%–77% of cancer patients do not receive any prescription medication for CC before Stage IV of disease is reached. Ability to promote weight gain was rated as the most important factor for selecting CC treatment. Key goals of treatment included ensuring that patients can cope with the cancer and treatment and have a QOL benefit. HCPs expressed desire for treatments with a more CC-specific mode of action and therapies that enhance QOL. Conclusions These surveys underscore the need for increased awareness among HCPs of CC and its management.
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Affiliation(s)
- M Muscaritoli
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - F Rossi Fanelli
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - A Molfino
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
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Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, Compher C, Correia I, Higashiguchi T, Holst M, Jensen GL, Malone A, Muscaritoli M, Nyulasi I, Pirlich M, Rothenberg E, Schindler K, Schneider SM, de van der Schueren MAE, Sieber C, Valentini L, Yu JC, Van Gossum A, Singer P. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2016; 36:49-64. [PMID: 27642056 DOI: 10.1016/j.clnu.2016.09.004] [Citation(s) in RCA: 1161] [Impact Index Per Article: 145.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 09/09/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research. OBJECTIVE This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures. METHODS The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round. RESULTS Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery. CONCLUSION An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.
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Affiliation(s)
- T Cederholm
- Departments of Geriatric Medicine, Uppsala University Hospital and Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - P Austin
- Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, United Kingdom; Pharmacy Department, University Hospital Southampton NHS Foundation Trust, United Kingdom.
| | - P Ballmer
- Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland.
| | - G Biolo
- Institute of Clinical Medicine, University of Trieste, Trieste, Italy.
| | - S C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - C Compher
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
| | - I Correia
- Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | - T Higashiguchi
- Department of Surgery and Palliative Medicine, Fujita Health University, School of Medicine, Toyoake, Japan.
| | - M Holst
- Center for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark.
| | - G L Jensen
- The Dean's Office and Department of Medicine, The University of Vermont College of Medicine, Burlington, VT, USA.
| | - A Malone
- Pharmacy Department, Mount Carmel West Hospital, Columbus, OH, USA.
| | - M Muscaritoli
- Department of Clinical Medicine, Sapienza University of Rome, Italy.
| | - I Nyulasi
- Nutrition and Dietetics, Alfred Health, Melbourne, Australia.
| | - M Pirlich
- Department of Internal Medicine, Elisabeth Protestant Hospital, Berlin, Germany.
| | - E Rothenberg
- Department of Food and Meal Science, Kristianstad University, Kristianstad, Sweden.
| | - K Schindler
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University Vienna, Vienna, Austria.
| | - S M Schneider
- Department of Gastroenterology and Clinical Nutrition, Archet Hospital, University of Nice Sophia Antipolis, Nice, France.
| | - M A E de van der Schueren
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition, Sports and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - C Sieber
- Institute for Biomedicine of Ageing, Friedrich-Alexander University Erlangen-Nürnberg, Hospital St. John of Lord, Regensburg, Germany.
| | - L Valentini
- Department of Agriculture and Food Sciences, Section of Dietetics, University of Applied Sciences, Neubrandenburg, Germany.
| | - J C Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - A Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium.
| | - P Singer
- Department of Critical Care, Institute for Nutrition Research, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 49100 Israel.
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Lucia S, Emerenziani S, Imperatori M, Rescio M, Tonini G, Santini D, Fanelli FR, Muscaritoli M. MON-P082: Nutritional Status in Naïve Cancer Patients Affects Long-Term Outcome. A Compelling Need for Early Intervention. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30716-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Molfino A, Amabile M, Farcomeni A, Ammann T, Simmaco M, Lionetto L, Lai S, Chiappini M, Fanelli FR, Laviano A, Muscaritoli M. SUN-P123: Beta-Aminoisobutyric Acid in Physical Inactivity Among Hemodialysis Patients. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30466-6] [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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Molfino A, Muscaritoli M. SUN-LB277: What are the Health Care Professionals’ Perspectives on Cancer Cachexia? Results from Three Global Surveys. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30633-1] [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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Molfino A, Amabile M, Ramaccini C, Farcomeni A, Monti M, Biolo G, Mazzucco S, Fanelli FR, Muscaritoli M. SUN-P068: Effect of Oral Docosahexaenoic Acid (DHA) Supplementation on Plasma DHA Levels and Omega-3 Index in Breast Cancer (BC) Patients. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30411-3] [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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Molfino A, Emerenziani S, Valeri S, Guarino M, Cocca S, Rescio M, Trillo L, Lucia S, Cicala M, Fanelli FR, Coppola R, Muscaritoli M. MON-P232: Weight Loss and Surgical Outcomes in Patients Undergoing Pancreaticoduodenectomy (PD) for Pancreatic Cancer. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30866-4] [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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Fearon K, Argiles JM, Baracos VE, Bernabei R, Coats A, Crawford J, Deutz NE, Doehner W, Evans WJ, Ferrucci L, Garcia JM, Gralla RJ, Jatoi A, Kalantar-Zadeh K, Lainscak M, Morley JE, Muscaritoli M, Polkey MI, Rosano G, Rossi-Fanelli F, Schols AM, Strasser F, Vellas B, von Haehling S, Anker SD. Request for regulatory guidance for cancer cachexia intervention trials. J Cachexia Sarcopenia Muscle 2015; 6:272-4. [PMID: 26675232 PMCID: PMC4670733 DOI: 10.1002/jcsm.12083] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/25/2015] [Indexed: 12/27/2022] Open
Affiliation(s)
- Kch Fearon
- Clinical and Surgical Sciences, School of Clinical Sciences and Community Health, Royal Infirmary, University of Edinburgh Edinburgh, UK
| | - J M Argiles
- Biochemistry and Molecular Biology of Cancer, Faculty of Biology, University of Barcelona Barcelona, Spain
| | - V E Baracos
- Department of Oncology, University of Alberta Edmonton, Alberta, Canada
| | - R Bernabei
- Department of Geriatrics, Neurosciences, and Orthopedics, Catholic University of the Sacred Heart Roma, Italy
| | - Ajs Coats
- Monash University Australia ; University of Warwick UK
| | | | - N E Deutz
- Center for Translational Research in Aging and Longevity, Department of Health and Kinesiology, Texas A&M University College Station, TX, 77843, USA
| | - W Doehner
- Center for Stroke Research CSB, Charité - Universitätsmedizin Berlin Germany
| | - W J Evans
- KineMed, Inc. Emeryville, CA, 94608, USA ; Division of Geriatrics, Duke Medical Center Durham, NC, 27710, USA
| | - L Ferrucci
- Intramural Research Program, National Institute on Aging, NIH Baltimore, MD, 20892, USA
| | - J M Garcia
- Division of Endocrinology, Diabetes and Metabolism, Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, and Baylor College of Medicine Houston, TX, 77030, USA
| | - R J Gralla
- Albert Einstein College of Medicine, Jacobi Medical Center Bronx, NY, 10461, USA
| | - A Jatoi
- Department of Oncology, Mayo Clinic Rochester, MN, 55905, USA
| | - K Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine Medical Center Orange, CA, 92868, USA
| | - M Lainscak
- Department of Cardiology and Department of Research and Education, General Hospital Celje Celje, Slovenia
| | - J E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine St Louis, MO, 63103, USA
| | - M Muscaritoli
- Department of Clinical Medicine, Sapienza University Rome, Italy
| | - M I Polkey
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and NHS Foundation Trust and Imperial College London, UK
| | - G Rosano
- Department of Medical Sciences, IRCCS San Raffaele Roma. Nutramed Consortium Italy
| | - F Rossi-Fanelli
- Department of Clinical Medicine, Sapienza University Rome, Italy
| | - A M Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Respiratory Medicine, Maastricht University Medical Centre Maastricht, The Netherlands
| | - F Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department Internal Medicine and Palliative Centre, Cantonal Hospital St.Gallen Switzerland
| | - B Vellas
- Department of Geriatrics, CHU Toulouse Toulouse, France
| | - S von Haehling
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG) Göttingen, Germany
| | - S D Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG) Göttingen, Germany
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Molfino A, Iannace A, Colaiacomo M, Farcomeni A, Seminara P, Emiliani A, Gioia G, Gualdi G, Muscaritoli M, Rossi Fanelli F, Laviano A. OR018: Cancer Anorexia: Assessment of Hypothalamic Dysfunction by Functional Magnetic Resonance Imaging (FMRI) and Its Association with Inflammation, Ghrelin, and Leptin in Lung Cancer Patients. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30115-1] [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: 10/23/2022]
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Lai S, Molfino A, Coppola B, De Leo S, Tommasi V, Galani A, Migliaccio S, Greco EA, Gnerre Musto T, Muscaritoli M. Effect of personalized dietary intervention on nutritional, metabolic and vascular indices in patients with chronic kidney disease. Eur Rev Med Pharmacol Sci 2015; 19:3351-3359. [PMID: 26439028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Patients with chronic kidney disease (CKD) present a markedly increased cardiovascular (CV) morbidity and mortality since the early stages of the disease and a high prevalence of malnutrition, inflammation, and accelerated atherosclerosis. Personalized nutritional intervention, with of a low-protein diet (LPD), since the early stages of CKD should be able to achieve significant metabolic improvements. In our study we have verified the effects of a personalized dietary intervention in patients in the CKD stages 3/4 KDOQI on nutritional, metabolic and vascular indices. PATIENTS AND METHODS We have evaluated renal function, lipid profile, mineral metabolism, inflammatory indices, and acid-base balance of 16 patients with CKD (stages 3/4 KDOQI). Assessment of nutritional status, body composition, bone mineral density and muscle mass, using body mass index (BMI), handgrip strength, bioelectrical impedance analysis (BIA), and dual energy X-ray absorptiometry (DEXA) was performed. Vascular indices and endothelial dysfunction such as carotid intima-media thickness (cIMT) and the brachial artery flow-mediated dilation (baFMD) were also analyzed. RESULTS After dietary interventions, we observed a significant increase in plasma bicarbonate (p = 0.004) and vitamin D levels (p = 0.03) and a concomitant significant reduction of phosphorus concentration (p = 0.001) and C-reactive protein (CRP) (p = 0.01). CONCLUSIONS Nutritional intervention potentially plays a major role in reducing the progression of CKD and systemic complications of predialysis patients. A low-protein diet (LPD) ensuring vegetable protein intake and a reduced amount of specific micronutrients should be recommended to stage 3/4 CKD patients in order to ameliorate metabolic profile, renal outcome, and reduce cardiovascular risk factors.
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Affiliation(s)
- S Lai
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
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Klek S, Chourdakis M, Bischoff S, Dubrov S, Forbes A, Galas A, Genton L, Gundogdu H, Irtun O, Jagmane I, Jirka A, Jakobson-Forbes T, Kennedy N, Klimasauskas A, Khoroshilov I, Leon-Sanz M, Muscaritoli M, Panisic-Sekeljic M, Poulia K, Schneider S, Siljamäki-Ojansuu U, Uyar M, Wanten G, Krznaric Z. SUN-PP013: Reimbursement Affects Prescription of Enteral and Parenteral Nutrition? Results from European Multicenter Survey. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Molfino A, Muscaritoli M, Bargagli M, Gnerre Musto T, Testorio M, Lai C, Aceto P, D’Angelo A, Amabile M, Laviano A, Rossi Fanelli F, Lai S. SUN-PP147: Peritoneal Dialysis in Older Adults: Evaluation of Clinical, Nutritional, and Metabolic Outcomes. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30297-1] [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: 10/23/2022]
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Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, Muscaritoli M, Nyulasi I, Ockenga J, Schneider SM, de van der Schueren MAE, Singer P. Diagnostic criteria for malnutrition - An ESPEN Consensus Statement. Clin Nutr 2015; 34:335-40. [PMID: 25799486 DOI: 10.1016/j.clnu.2015.03.001] [Citation(s) in RCA: 1008] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide a consensus-based minimum set of criteria for the diagnosis of malnutrition to be applied independent of clinical setting and aetiology, and to unify international terminology. METHOD The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a group of clinical scientists to perform a modified Delphi process, encompassing e-mail communications, face-to-face meetings, in group questionnaires and ballots, as well as a ballot for the ESPEN membership. RESULT First, ESPEN recommends that subjects at risk of malnutrition are identified by validated screening tools, and should be assessed and treated accordingly. Risk of malnutrition should have its own ICD Code. Second, a unanimous consensus was reached to advocate two options for the diagnosis of malnutrition. Option one requires body mass index (BMI, kg/m(2)) <18.5 to define malnutrition. Option two requires the combined finding of unintentional weight loss (mandatory) and at least one of either reduced BMI or a low fat free mass index (FFMI). Weight loss could be either >10% of habitual weight indefinite of time, or >5% over 3 months. Reduced BMI is <20 or <22 kg/m(2) in subjects younger and older than 70 years, respectively. Low FFMI is <15 and <17 kg/m(2) in females and males, respectively. About 12% of ESPEN members participated in a ballot; >75% agreed; i.e. indicated ≥7 on a 10-graded scale of acceptance, to this definition. CONCLUSION In individuals identified by screening as at risk of malnutrition, the diagnosis of malnutrition should be based on either a low BMI (<18.5 kg/m(2)), or on the combined finding of weight loss together with either reduced BMI (age-specific) or a low FFMI using sex-specific cut-offs.
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Affiliation(s)
- T Cederholm
- Departments of Geriatric Medicine, Uppsala University Hospital and Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
| | - I Bosaeus
- Clinical Nutrition Unit, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - J Bauer
- Department of Geriatric Medicine, Carl von Ossietzky Universität, Oldenburg, Germany
| | - A Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - S Klek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - M Muscaritoli
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - I Nyulasi
- Department of Nutrition and Dietetics and Department of Medicine, Monash University Central Clinical School, Prahran, Australia
| | - J Ockenga
- Department of Gastroenterology, Hepatology, Endocrinology, and Nutrition, Klinikum Bremen Mitte, Bremen, Germany
| | - S M Schneider
- Department of Gastroenterology and Clinical Nutrition, University Hospital and University of Nice Sophia-Antipolis, Nice, France
| | - M A E de van der Schueren
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition, Sports and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - P Singer
- Department of General Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 49100, Israel
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Pradelli L, Povero M, Muscaritoli M, Eandi M. Updated cost-effectiveness analysis of supplemental glutamine for parenteral nutrition of intensive-care patients. Eur J Clin Nutr 2014; 69:546-51. [PMID: 25469466 PMCID: PMC4424803 DOI: 10.1038/ejcn.2014.255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 10/10/2014] [Accepted: 10/18/2014] [Indexed: 01/21/2023]
Abstract
Background/Objectives: Intravenous (i.v.) glutamine supplementation of parenteral nutrition (PN) can improve clinical outcomes, reduce mortality and infection rates and shorten the length of hospital and/or intensive care unit (ICU) stays compared with standard PN. This study is a pharmacoeconomic analysis to determine whether i.v. glutamine supplementation of PN remains both a highly favourable and cost-effective option for Italian ICU patients. Subjects/Methods: A previously published discrete event simulation model was updated by incorporating the most up-to-date and clinically relevant efficacy data (a clinically realistic subgroup analysis from a published meta-analysis), recent cost data from the Italian health-care system and the latest epidemiology data from a large Italian ICU database (covering 230 Italian ICUs and more than 77 000 patients). Sensitivity analyses were performed to test the robustness of the results. Results: Parenteral glutamine supplementation can significantly improve ICU efficiency in Italy, as the additional cost of supplemented treatment is more than completely offset by cost savings in hospital care. Supplementation was more cost-effective (cost-effectiveness ratio (CER)=€35 165 per patient discharged alive) than standard, non-supplemented PN (CER=€40 156 per patient discharged alive), and it resulted in mean cost savings of €4991 per patient discharged alive or €1047 per patient admitted to the hospital. Sensitivity analyses confirmed the robustness of these results. Conclusions: Alanyl-glutamine supplementation of PN is a clinically and economically attractive strategy for ICU patients in Italy and may be applicable to selected ICU patient populations in other countries.
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Affiliation(s)
- L Pradelli
- AdRes Health Economics and Outcomes Research, Turin, Italy
| | - M Povero
- AdRes Health Economics and Outcomes Research, Turin, Italy
| | - M Muscaritoli
- Department of Internal Medicine, Università La Sapienza, Rome, Italy
| | - M Eandi
- Department of Pharmacology, Università degli Studi di Torino, Torino, Italy
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Molfino A, Colaiacomo C, Gualdi G, Ianance A, Seminara P, Muscaritoli M, Laviano A, Rossi Fanelli F. PP088-SUN: Evaluation of Hypothalamic Activity in Cancer Anorexia by Functional Magnetic Resonance. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50130-6] [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: 10/24/2022]
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Affiliation(s)
- A Molfino
- Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
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Muscaritoli M, Molfino A, Rossi Fanelli F. Cancer Cachexia: Perspectives of Health Care Professionals. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu356.56] [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: 11/14/2022] Open
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Poggiogalle E, Formiconi A, Donini L, Molfino A, Rossi Fanelli F, Muscaritoli M. PP041-MON: Functional Status is Reduced in Nursing Home Residents at Nutritional Risk. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50376-7] [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]
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Aversa Z, Pin F, Lucia S, Penna F, Verzaro R, Vuolo G, Rossi Fanelli F, Costelli P, Muscaritoli M. OP007: Autophagy is Induced in the Skeletal Muscle in Human Cancer Cachexia. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lucia S, Marchetti P, Rossi Fanelli F, Muscaritoli M. PP099-SUN: The Prevalence of Malnutrition in Oncology (The Premio Project). Preliminary Results. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50141-0] [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]
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Molfino A, Muscaritoli M. Sarcopenia and its therapeutic strategies in ICU. Minerva Anestesiol 2014; 80:749-750. [PMID: 24430009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- A Molfino
- Department of Clinical Medicine, Sapienza University of Rome, Italy -
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Pradelli L, Zaniolo O, Muscaritoli M, Eandi M. LB017-MON UPDATE ON PHARMACOECONOMICS IN NUTRITION: PARENTERAL GLUTAMINE SUPPLEMENT IN INTENSIVE CARE UNIT PATIENTS. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60619-6] [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: 10/26/2022]
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Donini L, Muscaritoli M, Poggiogalle P, Molfino A, Di Lazzaro L, Rossi Fanelli F. PP039-SUN AGREEMENT BETWEEN MNA, MUST AND NRS IN THE EVALUATION OF NUTRITIONAL RISK IN ELDERLY INSTITUTIONALISED SUBJECTS. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60084-9] [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: 11/16/2022]
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Lucia S, Stronati M, Gori C, Di Lazzaro Giraldi G, Cascino A, Amoroso A, Muscaritoli M, Rossi Fanelli F, Laviano A. PP171-MON COMPARISON OF THE PERFORMANCE OF DIFFERENT SCREENING TOOLS IN IDENTIFYING MALNUTRITION AND FUNCTIONAL IMPAIRMENT IN HOSPITALIZED PATIENTS. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60482-3] [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: 10/26/2022]
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Muscaritoli M, Lucia S, Molfino A. Sarcopenia in critically ill patients: the new pandemia. Minerva Anestesiol 2013; 79:771-777. [PMID: 23370125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Alteration of muscle mass and function is often observed in critically ill patients and its etiology is multifactorial. Besides the effects of acute disease on muscle metabolism, intensive care stay may per se contribute to muscle derangements. Recently, the concept of sarcopenia has been completely revisited, and indicates the loss of muscle mass and function. Although sarcopenia is generally observed and diagnosed in older adults it may be present in different clinical settings, including critical illness. Sarcopenia in the intensive care unit (ICU) negatively impacts on patients' outcomes and may determine a negative long-term impact on ICU survivors. Additionally, sarcopenia may promote functional disability in the long-term after hospital discharge. Limited data are available on the prevalence of sarcopenia at ICU admission. Considering the growing population of older adults with multiple comorbidities, modern intensive care medicine should pay attention to the prevention of ICU-related sarcopenia and also to the routine screening for sarcopenia at ICU admission.
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Affiliation(s)
- M Muscaritoli
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
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