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Krznarić Ž, Vranešić Bender D, Blaž Kovač M, Cuerda C, van Ginkel-Res A, Hiesmayr M, Marinho A, Mendive J, Monteiro I, Pirlich M, Musić Milanović S, Kozjek NR, Schneider S, Chourdakis M, Barazzoni R. Clinical nutrition in primary care: ESPEN position paper. Clin Nutr 2024:S0261-5614(24)00059-1. [PMID: 38471980 DOI: 10.1016/j.clnu.2024.02.017] [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: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024]
Abstract
Primary care healthcare professionals (PCHPs) are pivotal in managing chronic diseases and present a unique opportunity for nutrition-related disease prevention. However, the active involvement of PCHPs in nutritional care is limited, influenced by factors like insufficient education, lack of resources, and time constraints. In this position paper The European Society for Clinical Nutrition and Metabolism (ESPEN) promotes the active engagement of PCHPs in nutritional care. We emphasize the importance of early detection of malnutrition by screening and diagnosis, particularly in all individuals presenting with risk factors such as older age, chronic disease, post-acute disease conditions and after hospitalization for any cause. ESPEN proposes a strategic roadmap to empower PCHPs in clinical nutrition, focusing on education, tools, and multidisciplinary collaboration. The aim is to integrate nutrition into medical curricula, provide simple screening tools for primary care, and establish referral pathways to address malnutrition systematically. In conclusion, we urge for collaboration with PCHP organizations to raise awareness, enhance nutrition skills, facilitate dietitian accessibility, establish multidisciplinary teams, and promote referral pathways, thereby addressing the underestimated clinical challenge of malnutrition in primary care.
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Affiliation(s)
- Željko Krznarić
- University of Zagreb, Zagreb School of Medicine, University Hospital Centre Zagreb, Department of Gastroenterology, Hepatology and Nutrition, Zagreb, Croatia.
| | - Darija Vranešić Bender
- University of Zagreb, Zagreb School of Medicine, University Hospital Centre Zagreb, Department of Gastroenterology, Hepatology and Nutrition, Zagreb, Croatia.
| | - Milena Blaž Kovač
- Community Health Centre Ljubljana, Ljubljana, Slovenia; Department of Family Medicine, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Annemieke van Ginkel-Res
- European Federation of Associations of Dietitians, Diëtheek The Netherlands, Organization of Primary Care Dietitians, The Netherlands
| | - Michael Hiesmayr
- Center for Medical Data Science, Medical University Vienna, Vienna, Austria
| | - Anibal Marinho
- Department of Intensive Care, Hospital Universitário de Santo António, Porto, Portugal
| | - Juan Mendive
- La Mina Primary Health Care Academic Centre, Catalan Health Institute, University of Barcelona, Barcelona, Spain
| | - Isabel Monteiro
- Department of Sciences, University Institute of Health Sciences, CESPU, Gandra, Portugal; 1H-TOXRUN - One Health Toxicology Research Unit, University Institute of Health Sciences, CESPU, 4585 -116 Gandra, Portugal
| | | | - Sanja Musić Milanović
- University of Zagreb, Zagreb School of Medicine, Division for Health Promotion, Croatian Institute of Public Health, Zagreb, Croatia
| | | | - Stephane Schneider
- Gastroenterology and Clinical Nutrition, Archet University Hospital, Université Côte d'AZUR, Nice, France
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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2
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Jensen GL, Cederholm T, Ballesteros-Pomar MD, Blaauw R, Correia MITD, Cuerda C, Evans DC, Fukushima R, Gautier JBO, Gonzalez MC, van Gossum A, Gramlich L, Hartono J, Heymsfield SB, Jager-Wittenaar H, Jayatissa R, Keller H, Malone A, Manzanares W, McMahon MM, Mendez Y, Mogensen KM, Mori N, Muscaritoli M, Nogales GC, Nyulasi I, Phillips W, Pirlich M, Pisprasert V, Rothenberg E, de van der Schueren M, Shi HP, Steiber A, Winkler MF, Compher C, Barazzoni R. Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach. JPEN J Parenter Enteral Nutr 2024; 48:145-154. [PMID: 38221842 DOI: 10.1002/jpen.2590] [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: 11/11/2023] [Accepted: 12/08/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation, and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation. METHODS A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified Delphi review. A multiround review and revision process served to develop seven guidance statements. RESULTS The final round of review was highly favorable, with 99% overall "agree" or "strongly agree" responses. The presence of acute or chronic disease, infection, or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C-reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (milligrams per deciliter or milligram per liter) for the clinical laboratory that is being used. CONCLUSION Confirmation of inflammation should be guided by clinical judgment based on underlying diagnosis or condition, clinical signs, or CRP.
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Affiliation(s)
- Gordon L Jensen
- Deans Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Tommy Cederholm
- Clinical Nutrition & Metabolism, Uppsala University, Uppsala, Sweden
- Theme Inflammation & Ageing, Karolinska University Hospital, Stockholm, Sweden
| | | | - Renee Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Isabel T D Correia
- Food Science Post Graduation Program; Surgery Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David C Evans
- Trauma, Critical Care, General & Gastrointestinal Surgery, OhioHealth Grant Medical Center, Columbus, Ohio, USA
| | - Ryoji Fukushima
- Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan
| | | | | | - Andre van Gossum
- Department of Gastroenterology and Clinical Nutrition, Hospital Universitaire de Bruxelles, Brussels, Belgium
| | - Leah Gramlich
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Hartono
- Indonesian Central Army Gatot Soebroto Hospital, Jakarta, Indonesia
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Harriët Jager-Wittenaar
- Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Renuka Jayatissa
- Department of Nutrition and Food Science, International Institute of Health Sciences, Colobo, Sri Lanka
| | - Heather Keller
- Department of Kinesiology and Health Sciences, Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Columbus, Ohio, USA
| | - William Manzanares
- Critical Care Medicine, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
| | - M Molly McMahon
- Division of Endocrinology, Metabolism, Diabetes and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Yolanda Mendez
- Internal Medicine, Clinical Nutrition, Colegio Mexicano de Nutrición Clínica y Terapia Nutricional, Mexico City, Mexico
| | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | | | | | - Ibolya Nyulasi
- Department of Medicine, Central Clinical School, Monash University; Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Victoria, Australia
| | | | - Matthias Pirlich
- Departments of Endocrinology, Gastroenterology, and Clinical Nutrition, Imperial Oak Outpatient Clinic, Berlin, Germany
| | - Veeradej Pisprasert
- Division of Clinical Nutrition, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Marian de van der Schueren
- School of Allied Health, HAN University of Applied Sciences; Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Han Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Alison Steiber
- Academy of Nutrition and Dietetics, Cleveland, Ohio, USA
| | - Marion F Winkler
- Surgical Nutrition Service, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing and Clinical Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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3
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Cederholm T, Jensen GL, Ballesteros-Pomar MD, Blaauw R, Correia MITD, Cuerda C, Evans DC, Fukushima R, Ochoa Gautier JB, Gonzalez MC, van Gossum A, Gramlich L, Hartono J, Heymsfield SB, Jager-Wittenaar H, Jayatissa R, Keller H, Malone A, Manzanares W, McMahon MM, Mendez Y, Mogensen KM, Mori N, Muscaritoli M, Nogales GC, Nyulasi I, Phillips W, Pirlich M, Pisprasert V, Rothenberg E, de van der Schueren M, Shi HP, Steiber A, Winkler MF, Barazzoni R, Compher C. Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach. Clin Nutr 2023:S0261-5614(23)00390-4. [PMID: 38238189 DOI: 10.1016/j.clnu.2023.11.026] [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: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND & AIMS The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation in support of the etiologic criterion for inflammation. METHODS A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified-Delphi review. A multi-round review and revision process served to develop seven guidance statements. RESULTS The final round of review was highly favorable with 99 % overall "agree" or "strongly agree" responses. The presence of acute or chronic disease, infection or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C-reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (mg/dL or mg/L) for the clinical laboratory that is being used. CONCLUSION Confirmation of inflammation should be guided by clinical judgement based upon underlying diagnosis or condition, clinical signs, or CRP.
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Affiliation(s)
- Tommy Cederholm
- Clinical Nutrition & Metabolism, Uppsala University, Sweden; Theme Inflammation & Ageing, Karolinska University Hospital, Stockholm, Sweden.
| | - Gordon L Jensen
- Deans Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
| | | | - Renee Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Isabel T D Correia
- Food Science Post Graduation Program, Surgery Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - David C Evans
- Trauma, Critical Care, General & Gastrointestinal Surgery, OhioHealth Grant Medical Center, Columbus, OH, USA.
| | - Ryoji Fukushima
- Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo Japan.
| | | | | | - Andre van Gossum
- Department of Gastroenterology and Clinical Nutrition, Hospital Universitaire de Bruxelles, Brussels, Belgium.
| | - Leah Gramlich
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Joseph Hartono
- Indonesian Central Army Gatot Soebroto Hospital, Jakarta, Indonesia.
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.
| | - Harriët Jager-Wittenaar
- Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands; Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Renuka Jayatissa
- Department of Nutrition and Food Science, International Institute of Health Sciences, Colobo, Sri Lanka.
| | - Heather Keller
- Schlegel-UW Research Institute for Aging and Department of Kinesiology and Health Sciences, University of Waterloo, Ontario, Canada.
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Columbus, OH, USA.
| | - William Manzanares
- Critical Care Medicine, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay.
| | - M Molly McMahon
- Division of Endocrinology, Metabolism, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA.
| | - Yolanda Mendez
- Internal Medicine, Clinical Nutrition, Colegio Mexicano de Nutrición Clínica y Terapia Nutricional, Mexico.
| | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, MA, USA.
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Japan.
| | | | | | - Ibolya Nyulasi
- Department of Medicine, Central Clinical School, Monash University, Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia.
| | | | - Matthias Pirlich
- Praxis Kaisereiche - Imperial Oak Outpatient Clinic, Berlin Germany; Endocrinology, Gastroenterology, Clinical Nutrition, Berlin, Germany.
| | - Veeradej Pisprasert
- Division of Clinical Nutrition, Department of Medicine, Khon Kaen University, Thailand.
| | | | - Marian de van der Schueren
- HAN University of Applied Sciences, School of Allied Health, Wageningen University, Division of Human Nutrition and Health, the Netherlands.
| | - Han Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, China.
| | | | - Marion F Winkler
- Alpert Medical School of Brown University, Rhode Island Hospital, Surgical Nutrition Service, Providence, RI, USA.
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing, and Clinical Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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Barazzoni R, Pirlich M, Chourdakis M, Cuerda C, Malykh R, Jurgutis A, Jakab M, Krznaric Z, Marinho A, Schneider S, Wickramasinghe K. Brief interventions to prevent NCDs and their nutritional complications in primary care setting. Clin Nutr 2023; 42:1034-1035. [PMID: 37163958 DOI: 10.1016/j.clnu.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023]
Affiliation(s)
- R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - M Pirlich
- Imperial Oak Outpatient Clinic (Kaisereiche), Internal Medicine & Endocrinology, Berlin, Germany
| | - M Chourdakis
- Laboratory of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - C Cuerda
- Department of Medicine, Universidad Complutense. Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Malykh
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, Kazakhstan
| | - A Jurgutis
- WHO European Centre for Primary Health Care, Kazakhstan
| | - M Jakab
- WHO European Centre for Primary Health Care, Kazakhstan
| | - Z Krznaric
- Department of Gastroenterology, Hepatology and Clinical Nutrition, School of Medicine, University of Zagreb, Croatia
| | - A Marinho
- Intensive Care Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - S Schneider
- Gastroenterology and Nutrition Department, Archet University Hospital, Université Côte D'Azur, Nice, France
| | - K Wickramasinghe
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, Kazakhstan
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5
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Ockenga J, Fuhse K, Chatterjee S, Malykh R, Rippin H, Pirlich M, Yedilbayev A, Wickramasinghe K, Barazzoni R. Tuberculosis and malnutrition: The European perspective. Clin Nutr 2023; 42:486-492. [PMID: 36857957 DOI: 10.1016/j.clnu.2023.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/29/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 02/12/2023]
Abstract
Tuberculosis (TB) is a leading infectious cause of death worldwide, despite ongoing efforts to limit its incidence and mortality. Although the European Region has made gains in TB incidence and mortality, it now contends with increasing numbers of multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB). Malnutrition is a major contributor to the burden of TB and may also be directly caused or enhanced by the onset of TB. The presence of malnutrition may worsen TB and MDR/RR-TB related treatment outcomes and contribute to growing TB drug-resistance. Preventing and treating all forms of malnutrition is an important tool to limit the spread of TB worldwide and improve TB outcomes and treatment efficacy. We carried out a scoping review of the existing evidence that addresses malnutrition in the context of TB. Our review found malnutrition increased the risk of developing TB in high-burden settings and increased the likelihood of developing unfavorable treatment outcomes, including treatment failure, loss to follow-up, and death. The potential impact of nutritional care and improved nutritional status on patient prognosis was more difficult to evaluate due to heterogeneity of patient populations, treatment protocols, and treatment durations and goals. High-quality trials that consider malnutrition as a major risk factor and relevant treatment target when designing effective strategies to limit TB spread and mortality are needed to inform evidence-based practice. In TB patients, we suggest that widespread and regular nutritional screening, assessment, and counselling, has the potential to increase effectiveness of TB management strategies and improve patient quality of life, overall outcomes, and survival.
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Affiliation(s)
- J Ockenga
- Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany.
| | - K Fuhse
- Department of Gastroenterology, Endocrinology and Clinical Nutrition, Klinikum Bremen Mitte, Bremen, Germany.
| | - S Chatterjee
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - R Malykh
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - H Rippin
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - M Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany.
| | - A Yedilbayev
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - K Wickramasinghe
- Division of Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - R Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
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6
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Barazzoni R, Breda J, Cuerda C, Schneider S, Deutz NE, Wickramasinghe K, Abbasoglu O, Meijerink JB, Bischoff S, Pelaez RB, Cardenas D, Cederholm T, Cereda E, Chourdakis M, Toulson Davisson Correia MI, Schuren MDVD, Delzenne N, Frias-Toral E, Genton L, Cappellari GG, Cakir BK, Klek S, Krznaric Z, Laviano A, Lobo D, Muscaritoli M, Ockenga J, Pirlich M, Serlie MJM, Shi HP, Singer P, Soop M, Walrand S, Weimann A. COVID-19: Lessons on malnutrition, nutritional care and public health from the ESPEN-WHO Europe call for papers. Clin Nutr 2022; 41:2858-2868. [PMID: 36075815 PMCID: PMC9365508 DOI: 10.1016/j.clnu.2022.07.033] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 01/27/2023]
Abstract
With prolonged pandemic conditions, and emerging evidence but persisting low awareness of the importance of nutritional derangements, ESPEN has promoted in close collaboration with World Health Organization-Europe a call for papers on all aspects relating COVID-19 and nutrition as well as nutritional care, in the Society Journals Clinical Nutrition and Clinical Nutrition ESPEN. Although more COVID-related papers are being submitted and continue to be evaluated, ESPEN and WHO present the current editorial to summarize the many published findings supporting major interactions between nutritional status and COVID-19. These include 1) high risk of developing the disease and high risk of severe disease in the presence of pre-existing undernutrition (malnutrition) including micronutrient deficiencies; 2) high risk of developing malnutrition during the course of COVID-19, with substantial impact on long-term sequelae and risk of long COVID; 3) persons with obesity are also prone to develop or worsen malnutrition and its negative consequences during the course of COVID-19; 4) malnutrition screening and implementation of nutritional care may improve disease outcomes; 5) social and public health determinants contribute to the interaction between nutritional status and COVID-19, including negative impact of lockdown and social limitations on nutrition quality and nutritional status. We believe the evidence supports the need to consider COVID-19 as (also) a case of malnutrition-enhanced disease and disease-related malnutrition, with added risk for persons both with and without obesity. Similarities with many other disease conditions further support recommendations to implement standard nutritional screening and care in COVID-19 patients, and they underscore the relevance of appropriate nutritional and lifestyle prevention policies to limit infection risk and mitigate the negative health impact of acute pandemic bouts.
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Affiliation(s)
- Rocco Barazzoni
- Corresponding author. Department of Medical, Surgical and Health Sciences, Cattinara University Hospital, Strada di Fiume 447, 34149 Trieste, Italy
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7
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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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Hammermüller C, Hinz A, Dietz A, Wichmann G, Pirlich M, Berger T, Zimmermann K, Neumuth T, Mehnert-Theuerkauf A, Wiegand S, Zebralla V. Depression, anxiety, fatigue, and quality of life in a large sample of patients suffering from head and neck cancer in comparison with the general population. BMC Cancer 2021; 21:94. [PMID: 33482771 PMCID: PMC7825198 DOI: 10.1186/s12885-020-07773-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 09/02/2020] [Accepted: 12/26/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Treatment of head and neck cancer (HNC) often leads to visible and severe functional impairments. In addition, patients often suffer from a variety of psychosocial problems, significantly associated with a decreased quality of life. We aimed to compare depression, anxiety, fatigue and quality of life (QoL) between HNC patients and a large sample of the general population in Germany and to examine the impact of sociodemographic, behavioral and clinical factors on these symptoms. METHODS We assessed data of HNC patients during the aftercare consultation at the Leipzig University Medical Center with a patient reported outcome (PRO) tool named "OncoFunction". Depression, anxiety, fatigue and QoL were assessed using validated outcome measures including the PHQ-9, the GAD-2, and the EORTC QLQ-C30 questionnaire. RESULTS A total of 817 HNC patients were included in our study and compared to a sample of 5018 individuals of the general German population. HNC patients showed significantly higher levels of impairment in all dimensions assessed. Examination of association between depression, anxiety, fatigue and QoL and clinical as well as sociodemographic variables showed significant relationships between occupational status, ECOG-state, body mass index and time since diagnosis. CONCLUSIONS HNC patients suffer significantly from psychological distress. The used questionnaires are suitable for the use in daily routine practice and can be helpful to increase the detection of depression, anxiety and fatigue and therefore can improve HNC aftercare.
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Affiliation(s)
- C Hammermüller
- Clinic of Otolaryngology, Head and Neck Surgery, University of Leipzig, Leipzig, Germany
| | - A Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - A Dietz
- Clinic of Otolaryngology, Head and Neck Surgery, University of Leipzig, Leipzig, Germany
| | - G Wichmann
- Clinic of Otolaryngology, Head and Neck Surgery, University of Leipzig, Leipzig, Germany
| | - M Pirlich
- Clinic of Otolaryngology, Head and Neck Surgery, University of Leipzig, Leipzig, Germany
| | - T Berger
- Clinic of Otolaryngology, Head and Neck Surgery, University of Leipzig, Leipzig, Germany
| | - K Zimmermann
- Clinic of Otolaryngology, Head and Neck Surgery, University of Leipzig, Leipzig, Germany
| | - T Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
| | - A Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - S Wiegand
- Clinic of Otolaryngology, Head and Neck Surgery, University of Leipzig, Leipzig, Germany
| | - V Zebralla
- Clinic of Otolaryngology, Head and Neck Surgery, University of Leipzig, Leipzig, Germany.
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9
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Cederholm T, Krznaric Z, Pirlich M. Diagnosis of malnutrition in patients with gastrointestinal diseases: recent observations from a Global Leadership Initiative on Malnutrition perspective. Curr Opin Clin Nutr Metab Care 2020; 23:361-366. [PMID: 32701522 DOI: 10.1097/mco.0000000000000678] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW To review recent reports on techniques and tools for screening and diagnosis of malnutrition in gastrointestinal disease, in the light of the newly published definition of malnutrition by the Global Leadership Initiative on Malnutrition (GLIM). RECENT FINDINGS In 2019, the GLIM concept of malnutrition was published advocating a two-step procedure; first, screening, and second confirmation of the diagnosis that requires a combination of phenotypic and etiologic criteria. Three studies in patients with gastrointestinal disorders so far published utilize the GLIM criteria. Otherwise, traditional tools, as Nutrition Risk Screening-2002, Malnutrition Universal Screening Tool or Subjective Global Assessment are used, and confirm that malnutrition is observed in a substantial number of patients with inflammatory bowel diseases (IBDs), serious liver disorders and various forms of pancreatitis. Common for these disorders is an extensive loss of muscle mass, which is one of the GLIM phenotypic criteria. Such patients often undergo abdominal computed tomography scans that enable psoas muscle mass at L3 or L4 level to be calculated. SUMMARY The GLIM criteria for the diagnosis of malnutrition are feasible for IBD, liver and pancreas diseases. Pending studies expect to provide data on the clinical relevance to diagnose malnutrition by the GLIM concept.
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Affiliation(s)
- Tommy Cederholm
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala
- Theme Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Croatia
| | - Matthias Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany
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10
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Cuerda C, Muscaritoli M, Donini LM, Baqué P, Barazzoni R, Gaudio E, Jezek D, Krznaric Z, Pirlich M, Schetgen M, Schneider S, Vargas JA, Van Gossum A. Nutrition education in medical schools (NEMS). An ESPEN position paper. Clin Nutr 2020; 39:2938-2939. [PMID: 32690431 DOI: 10.1016/j.clnu.2020.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/25/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine (Formerly Department of Clinical Medicine), Sapienza University of Rome, Rome, Italy
| | - Lorenzo Maria Donini
- Food Science and Human Nutrition Research Unit, Medical Pathophysiology, Food Science and Endocrinology Section, Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Patrick Baqué
- School of Medicine, Université Nice-Sophia Antipolis, Université Côté d'Azur, Nice, France
| | - Rocco Barazzoni
- Internal Medicine, Department of Medical, Surgical, Health Sciences, Cattinara University Hospital, Trieste, Italy
| | | | - Davor Jezek
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zeljko Krznaric
- University Hospital Centre Zagreb, Department of Gastroenterology, Hepatology and Nutrition and Zagreb School of Medicine, Zagreb, Croatia
| | - Matthias Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology & Clinical Nutrition, Berlin, Germany
| | - Marco Schetgen
- School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Stephane Schneider
- Gastroenterology and Nutrition, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Juan A Vargas
- Internal Medicine. Hospital Universitario Puerta de Hierro de Majadahonda. Universidad Autónoma de Madrid, Madrid, Spain
| | - André Van Gossum
- Department of Gastroenterology and Nutritional Support, Hopital Erasme and Institut Bordet, Free University of Brussels, Brussels, Belgium
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11
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Keller H, van der Schueren MAE, Jensen GL, Barazzoni R, Compher C, Correia MITD, Gonzalez MC, Jager‐Wittenaar H, Pirlich M, Steiber A, Waitzberg D, Cederholm T. Global Leadership Initiative on Malnutrition (GLIM): Guidance on Validation of the Operational Criteria for the Diagnosis of Protein‐Energy Malnutrition in Adults. JPEN J Parenter Enteral Nutr 2020; 44:992-1003. [DOI: 10.1002/jpen.1806] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Heather Keller
- Schlegel‐University of Waterloo Research Institute for Aging Waterloo Ontario Canada
- Department of KinesiologyUniversity of Waterloo Waterloo Ontario Canada
| | - Marian A. E. van der Schueren
- Department of Nutrition and HealthSchool of Allied HealthHAN University of Applied Sciences Nijmegen the Netherlands
| | - Gordon L. Jensen
- The Larner College of MedicineUniversity of Vermont Burlington Vermont USA
| | - Rocco Barazzoni
- Department of MedicalSurgical and Health Sciences, University of Trieste Trieste Italy
| | - Charlene Compher
- Biobehavioral Health Sciences DepartmentSchool of NursingUniversity of Pennsylvania Philadelphia Pennsylvania USA
| | | | - M. Cristina Gonzalez
- Post‐Graduate Program in Health and BehaviourCatholic University of Pelotas Pelotas Rio Grande do Sul Brazil
- Post‐Graduate Program in Nutrition and FoodFederal University of Pelotas Pelotas Rio Grande do Sul Brazil
| | - Harriët Jager‐Wittenaar
- Research Group Healthy AgeingAllied Health Care and NursingHanze University of Applied Sciences Groningen the Netherlands
- Department of Maxillofacial SurgeryUniversity of Groningen, University Medical Center Groningen Groningen the Netherlands
| | - Matthias Pirlich
- Endocrinology, Gastroenterology, Clinical NutritionImperial Oak Outpatient Clinic (Kaisereiche) Berlin Germany
| | | | - Dan Waitzberg
- Department of GastroenterologySchool of MedicineUniversity of Sao Paulo Sao Paulo Brazil
| | - Tommy Cederholm
- Clinical Nutrition and MetabolismDepartment of Public Health and Caring SciencesUppsala University Uppsala Sweden
- Theme AgingKarolinska University Hospital Stockholm Sweden
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12
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Krznarić Ž, Bender DV, Laviano A, Cuerda C, Landi F, Monteiro R, Pirlich M, Barazzoni R. A simple remote nutritional screening tool and practical guidance for nutritional care in primary practice during the COVID-19 pandemic. Clin Nutr 2020; 39:1983-1987. [PMID: 32425292 PMCID: PMC7227572 DOI: 10.1016/j.clnu.2020.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/15/2022]
Abstract
Challenging periods like the COVID-19 pandemic require fast and efficient adaptations of the healthcare system. It is vital that every patient has access to nutritional care as a part of primary healthcare services, even if social distancing measures are adopted. Therefore, we propose a simple remote nutritional screening tool and practical guidance for nutritional care in primary practice, and their implementation into telemedicine processes and digital platforms suitable for healthcare providers. The acronym for the tool is R-MAPP, as for Remote – Malnutrition APP, while the tool will be available also as an app. This protocol consists of two simple validated clinical tools for identifying nutritional risk and loss of muscle mass and function –Malnutrition Universal Screening Tool (‘MUST’) and SARC-F (5-item questionnaire: Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) - and additional practical guidance on nutritional interventions for family physicians.
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Affiliation(s)
- Željko Krznarić
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre, University of Zagreb, Croatia.
| | - Darija Vranešić Bender
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre, University of Zagreb, Croatia
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francesco Landi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Catholic University, Rome, Italy
| | - Rosario Monteiro
- Department of Biomedicine, Biochemistry Unit, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, Portugal
| | - Matthias Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology & Clinical Nutrition, Berlin, Germany
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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13
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Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, Pirlich M, Singer P. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr 2020; 39:1631-1638. [PMID: 32305181 PMCID: PMC7138149 DOI: 10.1016/j.clnu.2020.03.022] [Citation(s) in RCA: 465] [Impact Index Per Article: 116.3] [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: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemics is posing unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Patients with worst outcomes and higher mortality are reported to include immunocompromised subjects, namely older adults and polymorbid individuals and malnourished people in general. ICU stay, polymorbidity and older age are all commonly associated with high risk for malnutrition, representing per se a relevant risk factor for higher morbidity and mortality in chronic and acute disease. Also importantly, prolonged ICU stays are reported to be required for COVID-19 patients stabilization, and longer ICU stay may per se directly worsen or cause malnutrition, with severe loss of skeletal muscle mass and function which may lead to disability, poor quality of life and additional morbidity. Prevention, diagnosis and treatment of malnutrition should therefore be routinely included in the management of COVID-19 patients. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing concise guidance for nutritional management of COVID-19 patients by proposing 10 practical recommendations. The practical guidance is focused to those in the ICU setting or in the presence of older age and polymorbidity, which are independently associated with malnutrition and its negative impact on patient survival.
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Affiliation(s)
- Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
| | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Joao Breda
- WHO European Office for Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Kremlin Wickramasinghe
- WHO European Office for Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, University of Zagreb, Croatia
| | - Dorit Nitzan
- Health Emergencies and Operation Management, World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Matthias Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology & Clinical Nutrition, Berlin, Germany
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Cuerda C, Muscaritoli M, Donini LM, Baqué P, Barazzoni R, Gaudio E, Jezek D, Krznaric Z, Pirlich M, Schetgen M, Schneider S, Vargas JA, Van Gossum A. Nutrition education in medical schools (NEMS). An ESPEN position paper. Clin Nutr 2019; 38:969-974. [DOI: 10.1016/j.clnu.2019.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/01/2019] [Indexed: 01/25/2023]
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15
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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: 418] [Impact Index Per Article: 83.6] [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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16
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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: 1171] [Impact Index Per Article: 195.2] [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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Jensen GL, Cederholm T, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, de Baptista GA, Barazzoni R, Blaauw R, Coats AJS, 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 M, Siltharm S, Singer P, Tappenden KA, Velasco N, Waitzberg DL, Yamwong P, Yu J, Compher C, Van Gossum A. GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community. JPEN J Parenter Enteral Nutr 2018; 43:32-40. [PMID: 30175461 DOI: 10.1002/jpen.1440] [Citation(s) in RCA: 301] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND This initiative aims to build a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. METHODS The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. RESULTS A 2-step approach for the malnutrition diagnosis was selected, that is, 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 GLIM participants that selected 3 phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and 2 etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least 1 phenotypic criterion and 1 etiologic criterion should be present. Phenotypic metrics for grading severity 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. CONCLUSIONS A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The construct should be re-considered every 3-5 years.
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Affiliation(s)
- Gordon L Jensen
- Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | | | - M Christina Gonzalez
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, RS, Brazil
| | - Ryoji Fukushima
- Department of Medicine, Department of Surgery, Tokyo University School of Medicine, Tokyo
| | - Takashi Higashiguchi
- Department of Surgery and Palliative Medicine, Fujita Health University School of Medicine, Dengakugakubo, Kutsukake, Toyoake-City, Aichi, Japan
| | - Gertrudis Adrianza de Baptista
- Medicine Faculty Central University of Venezuela, University Hospital of Caracas, Chief Nutritional Support Unit Hospital Universitary/Academic of Caracas, University Central of Venezuela
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Renée Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andrew J S Coats
- Monash University Australia and University of Warwick, Warwick, UK; Member Board of Directors Society on Sarcopenia, Cachexia and Wasting Disorders
| | - Adriana Crivelli
- Nutritional Support Unit, San Martín Hospital, La Plata, Argentina
| | - David C Evans
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | | | | | - Heather Keller
- Schlegel-UW Research Institute for Aging and Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - Luisito Llido
- Clinical Nutrition Service, St. Luke's Medical Center-Quezon City, Metro-Manila, Phillippines, Quezon City, Philippines
| | - Ainsley Malone
- The American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, and Mt. Carmel West Hospital, Columbus, Ohio, USA
| | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John E Morley
- Division of Geriatrics, Saint Louis University Hospital, St. Louis, Missouri, U.S.A. Member Board of Directors Society on Sarcopenia, Cachexia and Wasting Disorders
| | | | - Ibolya 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
| | - Matthias Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany
| | - Veeradej Pisprasert
- Department of Medicine, Khon Kaen University College of Medicine, Khon Kaen, Thailand
| | - Marian 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
| | | | - Pierre Singer
- Department of General Intensive Care, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Israel
| | - Kelly A Tappenden
- Department of Kinesiology and Nutrition, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Nicolas Velasco
- Department of Nutrition, Diabetes and Metabolismo. School of Medicine, Pontificia Universidad Catolica de Chile
| | - Dan L Waitzberg
- Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Jianchun Yu
- GI Surgery and Nutrition Metabolic Division, Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Charlene Compher
- Biobehavioral Health Sciences Department and Nutrition Programs, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Andre Van Gossum
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
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Sulz I, Hiesmayr M, Moick S, Pirlich M, de van der Schueren M, Singer P, Volkert D, Laviano A. Weight loss rather than BMI is associated with systemic infections in cancer patients: Data from nutritionday (nD) oncology 2012–2016. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1108] [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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Sulz I, Hiesmayr M, Moick S, Pirlich M, de van der Schueren M, Singer P, Volkert D, Laviano A. Oral nutritional supplements (ONS) and metabolically active nutrients are neglected in cancer patients receiving treatment: Data from nutritionday (nD) oncology 2012–2016. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1109] [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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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: 626] [Impact Index Per Article: 89.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [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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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: 1154] [Impact Index Per Article: 144.3] [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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Ockenga J, Pirlich M, Plauth M, Schmidt H, Tilg H, Trauner M. [Obituary for Prof. Dr. Herbert Lochs (1946-2015) ]. Z Gastroenterol 2015; 53:246-247. [PMID: 25945372 DOI: 10.1055/s-0034-1397611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Pirlich M, Fischer M, Mozet C, Horn IS, Monecke A, Dietz A. [A 4-year-old boy with an unknown tumor in the nasopharyngeal space]. Laryngorhinootologie 2014; 94:102-4. [PMID: 25429638 DOI: 10.1055/s-0034-1394393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M Pirlich
- Universitätsklinikum Leipzig AöR - Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde
| | - M Fischer
- Universitätsklinikum Leipzig AöR - Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde
| | - C Mozet
- Universitätsklinikum Leipzig AöR - Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde
| | - I-S Horn
- Universitätsklinikum Leipzig AöR - Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde
| | - A Monecke
- Universitätsklinikum Leipzig - Pathologie
| | - A Dietz
- Universitätsklinikum Leipzig AöR - Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde
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Valentini L, Volkert D, Schütz T, Ockenga J, Pirlich M, Druml W, Schindler K, Ballmer PE, Bischoff SC, Weimann A, Lochs H. Suggestions for terminology in clinical nutrition. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.clnme.2013.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Plauth M, Schütz T, Pirlich M, Canbay A. S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE und der DGVS. Aktuel Ernahrungsmed 2014. [DOI: 10.1055/s-0033-1360016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M. Plauth
- Städtisches Klinikum Dessau, Klinik für Innere Medizin, Dessau-Roßlau
| | - T. Schütz
- Universitätsmedizin Leipzig, IFB Adipositas-Erkrankungen, Forschungsbereich Bariatrische Chirurgie, Leipzig
| | - M. Pirlich
- Evangelische Elisabeth Klinik, Abteilung für Innere Medizin, Berlin
| | - A. Canbay
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen
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Valentini L, Volkert D, Schütz T, Ockenga J, Pirlich M, Druml W, Schindler K, Ballmer P, Bischoff S, Weimann A, Lochs H. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM). Aktuel Ernahrungsmed 2013. [DOI: 10.1055/s-0032-1332980] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- L. Valentini
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Gastroenterologie und Hepatologie, Sektion Ernährungsmedizin, Berlin, Deutschland
| | - D. Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für Biomedizin des Alterns, Nürnberg, Deutschland
| | - T. Schütz
- Universitätsmedizin Leipzig, IFB AdipositasErkankungen, Leipzig, Deutschland
| | - J. Ockenga
- Klinikum Bremen Mitte, Medizinische Klinik für Gastroenterologie, Hepatologie, Endokrinologie und Ernährung, Bremen, Deutschland
| | - M. Pirlich
- Evangelische Elisabeth Klinik, Abteilung für Innere Medizin, Berlin, Deutschland
| | - W. Druml
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III/Nephrologie, Wien, Österreich
| | - K. Schindler
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Abteilung für Endokrinologie und Stoffwechsel, Wien, Österreich
| | - P. Ballmer
- Kantonsspital Winterthur, Departement Medizin, Winterthur, Schweiz
| | - S. Bischoff
- Universität Hohenheim, Institut für Ernährungsmedizin, Stuttgart, Deutschland
| | - A. Weimann
- Klinikum St. Georg gGmbH, Med. Klinik für Allgemein- und Visceralchirurgie, Leipzig, Deutschland
| | - H. Lochs
- Medizinische Universität Innsbruck, Rektorat, Innsbruck, Österreich
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Norman K, Pirlich M, Schulzke JD, Smoliner C, Lochs H, Valentini L, Bühner S. Increased intestinal permeability in malnourished patients with liver cirrhosis. Eur J Clin Nutr 2012; 66:1116-9. [PMID: 22872031 DOI: 10.1038/ejcn.2012.104] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVE Malnutrition is a prominent feature in liver cirrhosis, with deleterious impact on clinical outcome. The objective of this study is to investigate whether malnutrition is associated with increased gastrointestinal permeability in liver cirrhosis reflected by altered urinary excretion of non-metabolizable sugar probes. SUBJECTS/METHODS Patients with advanced liver cirrhosis (Child Pugh Score B or C) were recruited. Nutritional status was determined according to the Subjective Global Assessment. Intestinal permeability was assessed by measuring the urinary excretion of orally administered, non-metabolized sugar probe molecules. The lactulose/mannitol ratio served as marker for intestinal permeability and reflects non-carrier-mediated transcellular and paracellular transport of the small intestine during the first 5 h. Sucrose recovery in urine within the first 5 h reflects gastroduodenal permeability; sucralose recovery in urine 5-26 h after consumption reflects colonic permeability. RESULTS Sixty-four patients (56.7±10.8 years; 33% female) were included in the study. Twenty-one patients were considered well nourished according to the Subjective Global Assessment, 23 moderately nourished and 20 patients severely malnourished; 74% had alcoholic liver disease and 67% had cirrhosis stage Child C. Gastroduodenal and colonic permeability was significantly increased in patients with liver cirrhosis compared with 63 healthy controls (0.23±0.22 and 1.37±1.42% vs 0.14±0.10 and 0.41±0.72% in controls), but not different between well and malnourished subjects. Small intestinal permeability (lactulose/mannitol ratio) was increased in all patients (0.069±0.055%) and further increased in malnourished patients (0.048±0.031% vs 0.084±0.061%, P=0.004) due to decreased mannitol recovery only. CONCLUSIONS Gastric, small intestinal and even colonic permeability was altogether increased in liver cirrhosis, and malnutrition was associated with further increased small intestinal permeability indicative of villous atrophy.
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Affiliation(s)
- K Norman
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie-Einschl. Arbeitsbereich Ernährungsmedizin, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
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Norman K, Stobäus N, Reiß J, Schulzke J, Valentini L, Pirlich M. Effect of sexual dimorphism on muscle strength in cachexia. J Cachexia Sarcopenia Muscle 2012; 3:111-6. [PMID: 22476918 PMCID: PMC3374022 DOI: 10.1007/s13539-012-0060-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 02/15/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Reduced muscle strength is a cardinal feature in cachexia. We investigated whether weight loss is associated differently with muscle strength in men and women in a large cohort of hospitalized patients. METHODS One thousand five hundred hospitalized patients (whereof 718 men, mean age 57.6 ± 16.0 years, mean body mass index (BMI) 24.6 ± 4.8 kg/m²) were included in the study. Non-edematous involuntary weight loss was determined with Subjective Global Assessment; isometric maximal muscle strength was evaluated by hand grip strength. Mid-upper arm circumference and triceps skinfold were used to calculate arm muscle area. Interrelationship between sex and weight loss was evaluated by regression analysis performed with the general linear model (GLM) allowing adjustment for continuous and categorical variables and corrected for age, arm muscle area (AMA), BMI, and diagnosis category (benign/malignant disease) as potentially confounding covariates. RESULTS Both men and women exhibited a significant stepwise decrease of hand grip strength with increasing weight loss. Age, sex, moderate and severe weight loss, BMI, and AMA were significant predictors of hand grip strength. The GLM moreover revealed a significant sex × weight loss effect, since grip strength was similarly decreased in moderate weight loss in men and women when compared to control patients without weight loss (8.5% in men and 10.5% in women, not significant (n.s.)), but the further reduction of grip strength in severe weight loss was significantly different between men and women (10.6% vs. 4.1%, P = 0.033). CONCLUSIONS Our findings indicate sex-specific differences in muscle strength response to weight loss.
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Affiliation(s)
- Kristina Norman
- Department of Gastroenterology, Infectiology and Rheumatology, Charité-University Medicine Berlin, Berlin, Germany,
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Braumann C, Guenther N, Menenakos C, Muenzberg H, Pirlich M, Lochs H, Mueller JM. Clinical experiences derived from implementation of an easy to use concept for treatment of wound healing by secondary intention and guidance in selection of appropriate dressings. Int Wound J 2011; 8:253-60. [PMID: 21401884 DOI: 10.1111/j.1742-481x.2011.00777.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The main objective of this case-cohort-type observational study conducted at different Surgical Departments of the Charité-Universitätsmedizin in Berlin was to evaluate the sequential use concept first described by Systagenix Wound Management in 2007. Fifty-two patients with different wound healing by secondary intention were treated for 7 weeks at the Charité-Universitätsmedizin in Berlin. A multidisciplinary team worked together to reach consensus in wound assessment; in classification of infection status according to the criteria described by European Wound Management Association (EWMA); in treatment protocol and on dressings to be used to 'cover' wounds. Before dressing application, all wounds were cleaned from debris. Following the sequential use concept, wounds classified as stages 2 and 3 were dressed with SILVERCEL(®) and TIELLE(®) or TIELLE PLUS(®) to 'clean' the wounds. After 2-3 weeks, treatment was changed to PROMOGRAN PRISMA(®) and TIELLE(®) to 'close and cover' wounds, thus providing optimal wound healing. Wounds classified as non infected were dressed with PROMOGRAN PRISMA(®) and TIELLE(®) during the complete treatment period. Patients were asked to evaluate the treatment using a simplified questionnaire developed at the Charité-Universitätsmedizin in Berlin. Wounds comprised 37 surgical procedures, 8 chronic mixed ulcer, 4 pressure sores, 1 diabetic foot ulcer, 1 venous leg ulcer, and 1 mixed arterial/venous ulcer. At baseline, 12 wounds were classified as stage 3, 38 wounds as stage 2 and 2 wounds as stage 1. After 7 weeks of treatment, all patients showed a positive clinical response to the sequential use treatment. Results of wound size showed a high significant progression of wound healing expressed with a profound reduction of wound area (P in all measurements <0·001, chi-square test) and improved granulation. This study summarises the clinical experiences derived from the evaluation of the sequential use concept in the daily clinical practice of wound treatment. On the basis of the wound healing results, patients' evaluation of treatment and the clinicians' and staff experiences, this concept was implemented at different Surgical Departments of the Charité-Universitätsmedizin in Berlin.
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Affiliation(s)
- Chris Braumann
- Department of General and Visceral Surgery, Campus Mitte, Charite-Universitaetsmedizin Berlin, Berlin, Germany.
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Norman K, Schulzke JD, Pirlich M. [Positive impact of breakfast on cognitive function in liver cirrhosis]. Z Gastroenterol 2010; 48:1317-8. [PMID: 21043011 DOI: 10.1055/s-0029-1245666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K Norman
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, Berlin.
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Norman K, Stobäus N, Gonzalez MC, Schulzke JD, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr 2010; 30:135-42. [PMID: 21035927 DOI: 10.1016/j.clnu.2010.09.010] [Citation(s) in RCA: 576] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/10/2010] [Accepted: 09/23/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Among all muscle function tests, measurement of hand grip strength has gained attention as a simple, non-invasive marker of muscle strength of upper extremities, well suitable for clinical use. This review outlines the prognostic relevance of grip strength in various clinical and epidemiologic settings and investigates its suitability as marker of nutritional status in cross-sectional as well as intervention studies. METHODS Studies investigating grip strength as prognostic marker or nutritional parameter in cross-sectional or intervention studies were summarized. RESULTS AND CONCLUSIONS Numerous clinical and epidemiological studies have shown the predictive potential of hand grip strength regarding short and long-term mortality and morbidity. In patients, impaired grip strength is an indicator of increased postoperative complications, increased length of hospitalization, higher rehospitalisation rate and decreased physical status. In elderly in particular, loss of grip strength implies loss of independence. Epidemiological studies have moreover demonstrated that low grip strength in healthy adults predicts increased risk of functional limitations and disability in higher age as well as all-cause mortality. As muscle function reacts early to nutritional deprivation, hand grip strength has also become a popular marker of nutritional status and is increasingly being employed as outcome variable in nutritional intervention studies.
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Affiliation(s)
- Kristina Norman
- Department of Gastroenterology, Hepatology and Endocrinology, Charité-University Medicine Berlin, Berlin, Germany.
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Norman K, Stobäus N, Smoliner C, Zocher D, Scheufele R, Valentini L, Lochs H, Pirlich M. Determinants of hand grip strength, knee extension strength and functional status in cancer patients. Clin Nutr 2010; 29:586-91. [DOI: 10.1016/j.clnu.2010.02.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 02/15/2010] [Accepted: 02/17/2010] [Indexed: 01/25/2023]
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Norman K, Stobäus N, Zocher D, Bosy-Westphal A, Szramek A, Scheufele R, Smoliner C, Pirlich M. Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life, and mortality in patients with cancer. Am J Clin Nutr 2010; 92:612-9. [PMID: 20631202 DOI: 10.3945/ajcn.2010.29215] [Citation(s) in RCA: 237] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The bioelectrical phase angle has shown predictive potential in various diseases, but general cutoffs are lacking in the clinical setting. OBJECTIVES This study evaluated the prognostic value of the fifth percentile of sex-, age-, and body mass index-stratified phase angle reference values in patients with cancer with respect to nutritional and functional status, quality of life, and 6-mo mortality. In a second step, we also studied the effect of the standardized phase angle (with a z score to determine individual deviations from the population average) on these variables. DESIGN A total of 399 patients with cancer were studied. Phase angle was obtained with bioelectrical impedance analysis; muscle function was assessed by handgrip strength and peak expiratory flow. Quality of life was determined by the European Organization for Research and Treatment of Cancer questionnaire. Nutritional status was assessed by using Subjective Global Assessment. Survival of patients was documented after 6 mo. RESULTS Patients with a phase angle of less than the fifth reference percentile had significantly lower nutritional and functional status, impaired quality of life (P lt 0.0001), and increased mortality (P lt 0.001). The standardized phase angle emerged as a significant predictor for malnutrition and impaired functional status in generalized linear model regression analyses. It was also a stronger indicator of 6-mo survival than were malnutrition and disease severity in the Cox regression model (P lt 0.0001) and according to the receiver operating characteristic curve. CONCLUSIONS The standardized phase angle is an independent predictor for impaired nutritional and functional status and survival. The fifth phase angle reference percentile is a simple and prognostically relevant cutoff for detection of patients with cancer at risk for these factors.
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Affiliation(s)
- Kristina Norman
- Department of Gastroenterology, Charité-Universitätsmedizin Berlin, Germany.
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Norman K, Valentini L, Lochs H, Pirlich M. [Protein catabolism and malnutrition in liver cirrhosis - impact of oral nutritional therapy]. Z Gastroenterol 2010; 48:763-70. [PMID: 20607635 DOI: 10.1055/s-0029-1245388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Malnutrition with loss of muscle is common in patients with liver cirrhosis and has negative impact on morbidity and mortality. The aetiology of malnutrition is multifactorial and includes inflammation, early onset of gluconeogenesis due to impaired glycogen storage and sometimes hypermetabolism. Reduced nutritional intake, however, plays the most important role in the pathogenesis of malnutrition. There is, however, ample evidence that nutritional intake and therapy are inadequate in liver cirrhosis although studies have clearly shown that dietary counselling and nutritional therapy with oral supplements improve intake in these patients. Protein requirement is considered to be increased in liver cirrhosis and high protein intake has been shown to be well tolerated and associated with an improvement of liver function and nutritional status. Protein intolerance on the other hand is uncommon and hepatic encephalopathy can thus rarely be attributed to high protein consumption. Recommendations for general protein restriction must therefore be considered obsolete and rather a risk factor for an impaired clinical outcome. Furthermore, the administration of late evening meals is highly beneficial in patients with liver disease since the rapid onset of the overnight catabolic state is counteracted. The serum concentration of branched-chain amino acids (BCAA) is decreased in patients with liver cirrhosis and long-term supplementation of BCAA has been shown to improve nutritional status and prolong event-free survival and quality of life.
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Affiliation(s)
- K Norman
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Charité - Universitätsmedizin Berlin
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Elbelt U, Schuetz T, Hoffmann I, Pirlich M, Strasburger CJ, Lochs H. Differences of energy expenditure and physical activity patterns in subjects with various degrees of obesity. Clin Nutr 2010; 29:766-72. [PMID: 20627487 DOI: 10.1016/j.clnu.2010.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 03/21/2010] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND & AIMS An imbalance of energy intake and energy expenditure leads to obesity. However, little detailed information of energy expenditure and physical activity patterns in obese subjects is available. Therefore, we assessed total energy expenditure (TEE) with its components resting energy expenditure (REE) and activity thermogenesis (AT) and the patterns of physical activity in non-obese and in subjects with different degrees of obesity. METHODS TEE and activity pattern were assessed with the SenseWear™ armband in 78 subjects (46 ± 12 years; 28 with normal weight/overweight, 13 each with obesity I° and II°, and 24 with obesity III°). In addition, REE was measured by indirect calorimetry and AT was calculated. RESULTS Although TEE (and REE) increased with increasing weight category from 2567 (1437) kcal/d in non-obese subjects to 3033 (1931) kcal/d in subjects with obesity III° (p=0.016, p<0.001, respectively) body weight adjusted TEE decreased from 33.1 to 22.1 kcal/kg/d (p<0.001). This was mainly due to decreased body weight adjusted AT (11.3-5.8 kcal/kg/d, p<0.001). AT consisted almost completely of non-exercise AT. In particular, for obese subjects exercise-related AT was negligible. CONCLUSIONS Higher degrees of obesity are associated with decreased body weight adjusted AT. These differences have to be considered for therapeutic strategies.
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Affiliation(s)
- Ulf Elbelt
- Department of Medicine, Gastroenterology, Hepatology and Endocrinology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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Krause L, Becker MO, Brueckner CS, Bellinghausen CJ, Becker C, Schneider U, Haeupl T, Hanke K, Hensel-Wiegel K, Ebert H, Ziemer S, Ladner UM, Pirlich M, Burmester GR, Riemekasten G. Nutritional status as marker for disease activity and severity predicting mortality in patients with systemic sclerosis. Ann Rheum Dis 2010; 69:1951-7. [PMID: 20511612 DOI: 10.1136/ard.2009.123273] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess and analyse nutritional status in patients with systemic sclerosis (SSc) and identify possible associations with clinical symptoms and its prognostic value. METHODS Body mass index (BMI) and parameters of bioelectrical impedance analysis (BIA) were assessed in 124 patients with SSc and 295 healthy donors and matched for sex, age and BMI for comparisons. In patients with SSc, BMI and BIA values were compared with clinical symptoms in a cross-sectional study. In a prospective open analysis, survival and changes in the nutritional status and energy uptake induced by nutritional treatment were evaluated. RESULTS Patients with SSc had reduced phase angle (PhA) values, body cell mass (BCM), percentages of cells, increased extracellular mass (ECM) and ECM/BCM values compared with healthy donors. Malnutrition was best reflected by the PhA values. Of the patients with SSc, 69 (55.7%) had malnutrition that was associated with severe disease and activity. As assessed by multivariate analysis, low predicted forced vital capacity and high N-terminal(NT)-proBNP values discriminated best between good and bad nutritional status. Among different clinical parameters, low PhA values were the best predictors for SSc-related mortality. BMI values were not related to disease symptoms or mortality. Fifty per cent of patients with SSc had a lower energy uptake related to their energy requirement, 19.8% related to their basal metabolism. Nutritional treatment improved the patients' nutritional status. CONCLUSIONS In patients with SSc, malnutrition is common and not identified by BMI. BIA parameters reflect disease severity and provide best predictors for patient survival. Therefore, an assessment of nutritional status should be performed in patients with SSc.
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Affiliation(s)
- Lijana Krause
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Germany
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Valentini L, Eggers J, Ockenga J, Haas VK, Bühner S, Winklhofer-Roob BM, Hengstermann S, Sinn B, Weigel A, Norman K, Pirlich M, Lochs H. Association between intestinal tight junction permeability and whole-body electrical resistance in healthy individuals: A hypothesis. Nutrition 2009; 25:706-14. [DOI: 10.1016/j.nut.2008.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 11/26/2008] [Accepted: 11/30/2008] [Indexed: 01/05/2023]
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Konopelska S, Kienitz T, Hughes B, Pirlich M, Bauditz J, Lochs H, Strasburger CJ, Stewart PM, Quinkler M. Hepatic 11beta-HSD1 mRNA expression in fatty liver and nonalcoholic steatohepatitis. Clin Endocrinol (Oxf) 2009; 70:554-60. [PMID: 18665910 DOI: 10.1111/j.1365-2265.2008.03358.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Nonalcoholic fatty liver disease represents the hepatic manifestation of the metabolic syndrome. Nonalcoholic steatohepatitis (NASH) is the progressive form of liver injury. The pathophysiology that leads to NASH is not well understood. OBJECTIVE We hypothesize that an altered cortisol metabolism in the liver may be a pathogenetic factor. DESIGN AND PATIENTS 75 patients (28 men, 47 women) underwent liver biopsy for elevation in liver enzymes. Histological diagnosis identified normal liver in eight, fatty liver in 20, NASH grade 1 in 22, grade 2 in nine, grade 3 in three patients, and other forms of hepatitis or cirrhosis in 13 patients. We quantified hepatic 11beta-hydroxysteroid dehydrogenase type1 (11beta-HSD1) and hexose-6-phosphate-dehydrogenase (H6PDH) mRNA expression by real-time PCR. In addition, analysis of 24 h urinary excretion of cortisol metabolites using GCMS was performed and compared with healthy controls. RESULTS 11beta-HSD1 mRNA expression correlated significantly (R2= 0.809; P < 0.001) with H6PDH mRNA expression, negatively with waist-to-hip ratio in women (R2= 0.394; P= 0.005), but not with urinary (THF + 5alpha-THF)/THE ratio, total cortisol metabolite excretion, age, BMI, degree of fatty liver or NASH stages. Total cortisol metabolite excretion was increased in patients with fatty liver or NASH compared with healthy controls. CONCLUSIONS Our data suggest that expression of hepatic 11beta-HSD1 and H6PDH are closely interlinked. 11beta-HSD1 gene expression does not seem to be involved in the pathogenesis of fatty liver or NASH. However, those patients showed an increased 5alpha- and 5beta-reduction of cortisol leading to an increased cortisol turnover rate and an activation of the HPA axis.
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Affiliation(s)
- Sarah Konopelska
- Internal Medicine, Center for Gastroenterology, Hepatology, and Endocrinology, Charité Campus Mitte, Charité University Medicine Berlin, Berlin, Germany
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Smoliner C, Norman K, Pirlich M. [No benefit of omega-3 free fatty acids for the maintenance of remission in Crohn's disease]. Z Gastroenterol 2009; 47:381-382. [PMID: 19358066 DOI: 10.1055/s-0028-1109119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- C Smoliner
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin
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Norman K, Smoliner C, Pirlich M. [Benefits of a nocturnal nutritional supplementation in liver cirrhosis]. Z Gastroenterol 2008; 46:1331-2. [PMID: 19012204 DOI: 10.1055/s-2008-1027860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Smoliner C, Norman K, Scheufele R, Hartig W, Pirlich M, Lochs H. Effects of food fortification on nutritional and functional status in frail elderly nursing home residents at risk of malnutrition. Nutrition 2008; 24:1139-44. [PMID: 18789649 DOI: 10.1016/j.nut.2008.06.024] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 06/16/2008] [Accepted: 06/17/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Malnutrition is a frequent problem in the elderly and is associated with an impaired functional status and higher morbidity and mortality. In this study we evaluated the effect of a 12-wk nutritional intervention with fortified food on nutritional and functional status in nursing home residents at risk of malnutrition. METHODS Nutritional status was assessed with the Mini Nutritional Assessment. Body composition was measured with bioelectrical impedance analysis. Functional status was assessed with handgrip strength, peak flow, the Barthel Index, and the Physical Functioning component of the Short Form 36 questionnaire. The residents were assigned to a group receiving the standard food of the nursing home or a group with a protein- and energy-enriched diet and snacks. RESULTS Sixty-five nursing home residents were included; 62 were at nutritional risk and 3 were severely malnourished according to the Mini Nutritional Assessment. Protein intake was significantly higher in the group on the enriched diet, whereas energy intake did not differ from the group on the standard diet. Both groups significantly improved most nutritional and body composition parameters during the intervention period. We did not observe convincing improvements in muscle function. Furthermore, the Barthel Index and the Physical Functioning component of the Short Form 36 questionnaire declined in all participants. CONCLUSION Standard food in this nursing home provided sufficient energy and macronutrients. Provision of snacks was not effective in increasing energy intake. Although nutritional status improved, functional status did not increase as a consequence. Functional frailty in this study population seems to be influenced more by age-related morbidity and immobilization than by nutritional intake.
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Affiliation(s)
- Christine Smoliner
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Hepatologie und Endokrinologie, Charité Universitätsmedizin Berlin, Berlin, Germany
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Abstract
PURPOSE OF REVIEW This article gives an overview of the several morphological and functional alterations in the gastrointestinal tract that occur in liver disease and their systemic impact. RECENT FINDINGS Recent endoscopic studies have revealed similar mucosal alterations in the upper gastrointestinal as well as the colon that include inflammatory-like changes and vascular lesions. Gut-barrier integrity is consequently impaired. There is an evidence that bacterial translocation with subsequent endotoxaemia provokes an inflammatory response that might trigger the cachexia syndrome in liver disease. Novel therapeutic approaches that address gut-barrier function such as supplementation with insulin-like growth factor or synbiotics have shown promising results. SUMMARY There are various alterations of the gastrointestinal tract in liver disease and portal hypertension, which might be less clinically overt than the cardinal potentially life-threatening features, ascites and oesophageal varices. However, these alterations, for example gut-barrier dysfunction and alterations of gut flora (microbiota) have immense impact on the portal enteropathy, as they both contribute to the systemic inflammation in liver cirrhosis, which is considered a risk factor for infections as well as the development of cachexia.
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Affiliation(s)
- Kristina Norman
- Medizinische Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Charité Universitätsmedizin Berlin, CCM, Charitéplatz 1, Berlin, Germany
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Valentini L, Schaper L, Buning C, Hengstermann S, Koernicke T, Tillinger W, Guglielmi FW, Norman K, Buhner S, Ockenga J, Pirlich M, Lochs H. Malnutrition and impaired muscle strength in patients with Crohn's disease and ulcerative colitis in remission. Nutrition 2008; 24:694-702. [PMID: 18499398 DOI: 10.1016/j.nut.2008.03.018] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 03/22/2008] [Accepted: 03/22/2008] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This prospective, controlled, and multicentric study evaluated nutritional status, body composition, muscle strength, and quality of life in patients with inflammatory bowel disease in clinical remission. In addition, possible effects of gender, malnutrition, inflammation, and previous prednisolone therapy were investigated. METHODS Nutritional status (subjective global assessment [SGA], body mass index, albumin, trace elements), body composition (bioelectrical impedance analysis, anthropometry), handgrip strength, and quality of life were assessed in 94 patients with Crohn's disease (CD; 61 female and 33 male, Crohn's Disease Activity Index 71 +/- 47), 50 patients with ulcerative colitis (UC; 33 female and 17 male, Ulcerative Colitis Activity Index 3.1 +/- 1.5), and 61 healthy control subjects (41 female and 20 male) from centers in Berlin, Vienna, and Bari. For further analysis of body composition, 47 well-nourished patients with inflammatory bowel disease were pair-matched by body mass index, sex, and age to healthy controls. Data are presented as median (25th-75th percentile). RESULTS Most patients with inflammatory bowel disease (74%) were well nourished according to the SGA, body mass index, and serum albumin. However, body composition analysis demonstrated a decrease in body cell mass (BCM) in patients with CD (23.1 kg, 20.8-28.7, P = 0.021) and UC (22.6 kg, 21.0-28.0, P = 0.041) compared with controls (25.0 kg, 22.0-32.5). Handgrip strength correlated with BCM (r = 0.703, P = 0.001) and was decreased in patients with CD (32.8 kg, 26.0-41.1, P = 0.005) and UC (31.0 kg, 27.3-37.8, P = 0.001) compared with controls (36.0 kg, 31.0-52.0). The alterations were seen even in patients classified as well nourished. BCM was lower in patients with moderately increased serum C-reactive protein levels compared with patients with normal levels. CONCLUSION In CD and UC, selected micronutrient deficits and loss of BCM and muscle strength are frequent in remission and cannot be detected by standard malnutrition screening.
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Affiliation(s)
- Luzia Valentini
- Department of Gastroenterology, Hepatology and Endocrinology, CCM, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Wieskotten S, Heinke S, Wabel P, Moissl U, Becker J, Pirlich M, Keymling M, Isermann R. Bioimpedance-based identification of malnutrition using fuzzy logic. Physiol Meas 2008; 29:639-54. [PMID: 18460765 DOI: 10.1088/0967-3334/29/5/009] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Protein-energy malnutrition reduces the quality of life, lengthens the time in hospital and dramatically increases mortality. Currently there is no simple and objective method available for assessing nutritional status and identifying malnutrition. The aim of this work is to develop a novel assistance system that supports the physician in the assessment of the nutritional status. Therefore, three subject groups were investigated: the first group consisted of 688 healthy subjects. Two additional groups consisted of 707 patients: 94 patients with primary diseases that are known to cause malnutrition, and 613 patients from a hospital admission screening. In all subjects bioimpedance spectroscopy measurements were performed, and the body composition was calculated. Additionally, in all patients the nutritional status was assessed by the subjective global assessment score. These data are used for the development and validation of the assistance system. The basic idea of the system is that nutritional status is reflected by body composition. Hence, features of the nutritional status, based on the body composition, are determined and compared with reference ranges, derived from healthy subjects' data. The differences are evaluated by a fuzzy logic system or a decision tree in order to identify malnourished patients. The novel assistance system allows the identification of malnourished patients, and it can be applied for screening and monitoring of the nutritional status of hospital patients.
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Affiliation(s)
- S Wieskotten
- Technische Universität Darmstadt, Institute of Automatic Control, Darmstadt, Germany.
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Norman K, Kirchner H, Freudenreich M, Ockenga J, Lochs H, Pirlich M. Three month intervention with protein and energy rich supplements improve muscle function and quality of life in malnourished patients with non-neoplastic gastrointestinal disease—A randomized controlled trial. Clin Nutr 2008; 27:48-56. [DOI: 10.1016/j.clnu.2007.08.011] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Revised: 08/08/2007] [Accepted: 08/18/2007] [Indexed: 10/22/2022]
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Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008; 27:5-15. [PMID: 18061312 DOI: 10.1016/j.clnu.2007.10.007] [Citation(s) in RCA: 854] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 06/21/2007] [Accepted: 10/12/2007] [Indexed: 12/15/2022]
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Smoliner C, Norman K, Pirlich M. [Prevention of colorectal cancer: novel aspects regarding dietary fibre intake]. Z Gastroenterol 2008; 46:223-224. [PMID: 18253903 DOI: 10.1055/s-2007-963625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- C Smoliner
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin
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Abstract
Sorbitol intake should be considered in patients with bowel problems, chronic diarrhoea, and weight loss
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Affiliation(s)
- Juergen Bauditz
- Department of Gastroenterology, Hepatology, and Endocrinology, Charité Universitätsmedizin, 10117 Berlin, Germany.
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Norman K, Smoliner C, Valentini L, Lochs H, Pirlich M. Is bioelectrical impedance vector analysis of value in the elderly with malnutrition and impaired functionality? Nutrition 2007; 23:564-9. [PMID: 17616343 DOI: 10.1016/j.nut.2007.05.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Revised: 05/22/2007] [Accepted: 05/22/2007] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The calculation of body composition using bioelectrical impedance analysis is difficult in the elderly because most equations have been found to be inadequate, especially in the malnourished elderly. We therefore evaluated the use of bioelectrical impedance vector analysis in elderly nursing home residents. METHODS One hundred twelve nursing home residents were included in the study (34 men, 78 women, age 85.1 y, age range 79.1-91.4 y). Nutritional status was determined by the Mini Nutritional Assessment (MNA), functional status was assessed by handgrip strength, knee extension strength, and Barthel's index, and bioelectrical impedance analysis was performed using Nutriguard M (Data Input, Darmstadt, Germany). RESULTS Twenty-two nursing home residents were classified as well nourished (MNA I), 80 were considered to be at nutritional risk (MNA II), and 10 were classified as malnourished (MNA III). Handgrip strength, knee extension strength, and Barthel's index were lower in MNA II and MNA III than in MNA I. Phase angle also decreased significantly with the MNA (4.0, 3.8-4.7 degrees; 3.7, 3.3-4.3 degrees; and 2.9, 2.6-3.5 degrees). There was a significant displacement of the mean vector in MNA II and MNA III compared with MNA I. CONCLUSION The bioelectrical impedance vector analysis resistance/reactance graph could represent a valuable tool to assess changes in body cell mass and hydration status in elderly nursing home residents.
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Affiliation(s)
- Kristina Norman
- Medizinische Klinik mit Schwerpunkt Gastroenterologie, Hepatologie und Endokrinologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
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