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Yadav S, Ali US, Deshmukh M. Screening for protein energy wasting in children with chronic kidney disease using dual energy x-ray absorptiometry as an additional tool. Pediatr Nephrol 2024; 39:1491-1497. [PMID: 37515740 DOI: 10.1007/s00467-023-06060-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND The current diagnosis of protein energy wasting (PEW) is based on scoring systems that lack precision in measuring muscle deficits. We undertook this cross-sectional study to determine the prevalence of PEW in children with chronic kidney disease (CKD) using a scoring system that included dual energy x-ray absorptiometry (DEXA) for measuring lean body mass (LBM) and to determine the prevalence of selected markers in PEW. METHODS Thirty CKD and 20 healthy children (1-18 years) were evaluated for (1) reduced dietary protein intake (DPI); (2) BMI < fifth centile for height age (BMI/HA); (3) serum albumin < 3.8 g/dl, cholesterol < 100 mg/dl, or CRP > 3 mg/L; (4) LBM < fifth centile for height age [LBMr] on DEXA. PEW was scored as minimal-one parameter positive in 2/4 categories; standard-one parameter positive in 3/4 categories; or modified-standard plus height < 2 SD. RESULTS Twenty children with CKD (66.7%) had PEW, (5/9) 55% in CKD 3, and (15/21) 71% in advanced CKD; minimal 12, standard 1, and modified 7. LBMr was seen in 20 (100%), reduced DPI in 16 (80%), and BMI/HA in 6 (30%) children with PEW. LBMr had 100% sensitivity and BMI/HA 100% specificity. LBMr was seen in 8 who had no other criteria for PEW. None of the parameters were positive in controls (p < 0.01). CONCLUSIONS PEW prevalence in CKD was high. Both prevalence and severity were higher in advanced CKD. LBMr was a highly sensitive marker to detect PEW. LBMr seen in some children with CKD who were negative for other markers could represent subclinical PEW.
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Affiliation(s)
- Sanjay Yadav
- Department of Pediatrics, Lilavati Hospital and Research Centre, A 791, Bandra Reclamation, Gen Arun Kumar Vaidya Nagar, Bandra West, Mumbai, 400050, India
| | - Uma S Ali
- Department of Pediatrics, Lilavati Hospital and Research Centre, A 791, Bandra Reclamation, Gen Arun Kumar Vaidya Nagar, Bandra West, Mumbai, 400050, India.
| | - Manoj Deshmukh
- Department of Radiology, Lilavati Hospital and Research Centre, A 791, Bandra Reclamation, Gen Arun Kumar Vaidya Nagar, Bandra West, Mumbai, 400050, India
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2
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Shen CL, Liebstein D, Fernandez H. Malnutrition and protein energy wasting are associated with severity and progression of pediatric chronic kidney disease. Pediatr Nephrol 2024; 39:243-250. [PMID: 37464056 DOI: 10.1007/s00467-023-06078-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Protein energy wasting (PEW), a state of deficient protein storage, is not well understood in children and adolescents with chronic kidney disease (CKD). We aimed to re-define PEW using pediatric malnutrition guidelines from the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN), and to describe the relationship between PEW, malnutrition, and kidney function. METHODS This was a retrospective review of outpatients ≤ 20 years old with a diagnosis of CKD from January 1, 2013, to August 31, 2018. Malnutrition was diagnosed by a licensed dietitian, and PEW was diagnosed using an updated definition incorporating AND/ASPEN malnutrition guidelines. Logistic regression and linear mixed effects modeling were performed on the relationship of malnutrition and PEW to estimated glomerular filtration rate (eGFR). RESULTS The 142 patients included in this analysis had a median age of 11.1 years and median eGFR of 57 ml/min/1.73 m2 at initial visit. Malnutrition was diagnosed in 50% of patients in at least one visit, and 17.6% met ≥ 2 PEW criteria. Patients with eGFR < 30 ml/min/1.73 m2 had significantly increased risk of malnutrition [OR 2.5, 95% CI 2.0-3.3] (p < 0.001) and PEW [OR 4.9, 95% CI 3.0-8.0] (p < 0.001). A diagnosis of malnutrition or PEW was associated with worse eGFR by logistic regression (p = 0.01 and p = 0.001, respectively) and more rapid eGFR decline by linear mixed effects model (p = 0.002 and p < 0.001, respectively) compared to those without these diagnoses. CONCLUSIONS Malnutrition and PEW are prevalent in pediatric CKD and are associated with significantly lower eGFR and more rapid decline in eGFR, emphasizing the need to address nutritional status. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Carol L Shen
- Division of Pediatric Nephrology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Dana Liebstein
- Department of Pediatrics, New York Presbyterian Morgan Stanley Children's Hospital of New York, New York, USA
| | - Hilda Fernandez
- Division of Nephrology, Columbia University Irving Medical Center, New York, NY, USA
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3
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Huang W, Luo L. Interactive effects of vitamin D and serum uric acid concentration on protein-energy wasting in maintenance hemodialysis patients. Cell Mol Biol (Noisy-le-grand) 2023; 69:108-113. [PMID: 38279479 DOI: 10.14715/cmb/2023.69.15.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Indexed: 01/28/2024]
Abstract
This study aimed to explore the influence of the interaction between vitamin D level and blood uric acid level on protein-energy wasting (PEW) in patients with Maintenance hemodialysis (MHD), in order to provide a solution for disease prevention. For this aim, a total of 150 patients with maintenance hemodialysis aged 30-79 years in a hospital were included in the study. The logistic regression model was used to analyze the relationship between vitamin D level, blood uric acid level and PEW, and the additive interaction was evaluated by calculating the relative excess risk ratio (RERI) attributive ratio (AP) and synergy index (S) of the interaction. Finally, the ROC curve was drawn to evaluate the diagnostic value of vitamin D level and blood uric acid level for PEW. In this study, the detection rate of PEW was 68%, low vitamin D level was 57.33%, and high blood uric acid level was 64.67%. Compared with non-low vitamin D levels, the PEW risk was OR=16.794, 95%CI: 4.973-60.356; Compared with those without high uric acid levels, the PEW risk was OR=7.599, 95%CI: 2.460-23.468. However, there was no multiplicative interaction between the two on PEW risk (OR=0.345, 95%CI: 0.060-1.983, P=0.233). In the additive interaction analysis, the PEW risk OR=43.992,95%CI: 12.795-151.253, higher than those with only high uric acid levels or only low vitamin D levels, the combination of the two had a summative interaction with PEW risk, with a RERI of 20.599 (95%CI: -26.158-67.356) API was 0.468 (-0.159-1.095) and S was 1.920 (0.569-6.483). In conclusion, both vitamin D deficiency and high uric acid levels were associated with an increased risk of PEW in MHD patients, and low vitamin D and high uric acid levels had a summative interaction with protein-energy expenditure risk.
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Affiliation(s)
- Wenbin Huang
- Department of Laboratory Medicine, The People's Hospital of Dujiangyan, Dujiangyan, 611800, China.
| | - Luping Luo
- Intensive Care Unit, Dujiangyan Shoujia Hospital, Dujiangyan, 611800, China.
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Wang W, Meng X, Liu J, Lou X, Zhang P, He P, Chen J, Yuan J. Study on the correlation between bioelectrical impedance analysis index and protein energy consumption in maintenance dialysis patients. Nutr J 2023; 22:56. [PMID: 37940938 PMCID: PMC10633946 DOI: 10.1186/s12937-023-00890-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 11/01/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Protein-energy wasting (PEW) has been reported to be pretty common in maintenance dialysis patients. However, the existing PEW diagnostic standard is limited in clinical use due to the complexity of it. Bioelectrical impedance analysis (BIA), as a non-invasive nutritional assessment method, can objectively and quantitatively analyze the changes of body tissue components under different nutritional states. We aim to explore the association between PEW and BIA and establish a reliable diagnostic model of PEW. METHODS We collected cross-sectional data of 609 maintenance dialysis patients at the First Affiliated Hospital, College of Medicine, Zhejiang University. PEW was diagnosed according to International Society of Renal Nutrition and Metabolism (ISRNM) criteria. Among them, 448 consecutive patients were included in the training set for the establishment of a diagnostic nomogram. 161 consecutive patients were included for internal validation. 52 patients from Zhejiang Hospital were included for external validation of the diagnostic model. Correlation analysis of BIA indexes with other nutritional indicators was performed. Logistic regression was used to examine the association of BIA indexes with PEW. 12 diagnostic models of PEW in maintenance dialysis patients were developed and the performance of them in terms of discrimination and calibration was evaluated using C statistics and Hosmer-Lemeshow-type χ2 statistics. After comparing to existing diagnostic models, and performing both internal and external validation, we finally established a simple but reliable PEW diagnostic model which may have great value of clinical application. RESULTS A total of 609 individuals from First Affiliated Hospital, College of Medicine, Zhejiang University and 52 individuals from Zhejiang Hospital were included. After full adjustment, age, peritoneal dialysis (compared to hemodialysis), subjective global assessment (SGA, compared to non-SGA) and water ratio were independent risk factors, while triglyceride, urea nitrogen, calcium, ferritin, BCM, VFA and phase angle were independent protective factors of PEW. The model incorporated water ratio, VFA, BCM, phase angle and cholesterol revealed best performance. A nomogram was developed according to the results of model performance. The model achieved high C-indexes of 0.843 in the training set, 0.841 and 0.829 in the internal and external validation sets, respectively, and had a well-fitted calibration curve. The net reclassification improvement (NRI) showed 8%, 13%, 2%, 38%, 36% improvement of diagnostic accuracy of our model compared with "PEW score model", "modified PEW score model", "3-index model", "SGA model" and "BIA decision tree model", respectively. CONCLUSIONS BIA can be used as an auxiliary tool to evaluate PEW risk and may have certain clinical application value.
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Affiliation(s)
- Weina Wang
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000, China
| | - Xinxuan Meng
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000, China
- College of Medicine, Zhejiang University, Hangzhou, 310000, China
| | - Jiaojiao Liu
- Hebei ophthalmology hospital, Xingtai, 054000, China
| | - Xiaowei Lou
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000, China
- College of Medicine, Zhejiang University, Hangzhou, 310000, China
| | - Ping Zhang
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000, China
| | - Peipei He
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000, China
| | - Jianghua Chen
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000, China.
| | - Jing Yuan
- Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000, China.
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St-Jules DE, Lloyd L, Meade A, Biruete A, Kistler B, Carrero JJ. Deconstructing Disease-Related Malnutrition: A New Assessment Framework for Clinical Practice. J Ren Nutr 2023; 33:707-716. [PMID: 37116625 PMCID: PMC10603213 DOI: 10.1053/j.jrn.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/06/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023] Open
Abstract
Protein-energy wasting (PEW) is a key cause of functional impairment and poor health outcomes in people with chronic kidney disease. While PEW can be mitigated with nutrition therapy, it is a complex myriad of disorders with numerous interacting etiologies and corresponding presentations, which make it difficult to diagnose and manage in practice. A variety of scoring rubrics have been developed to facilitate malnutrition assessment. Although these tools have greatly benefited the recognition and treatment of PEW, the typical format of grading specified PEW indicators has the potential to overlook or overstate highly relevant individual-specific factors. This review presents a simple framework for malnutrition assessment that can be used to complement and evaluate conventional assessment tools. Unlike standard tools, which are designed to identify and rate malnutrition risk and severity, the malnutrition framework is conceptual model that organizes PEW assessment into three distinct, but interacting facets of PEW risk: nutrient balance, nutrition status, and malnutrition risk. The new framework encourages critical thinking about PEW risk that may help clinicians plan and interpret assessments to efficiently and effectively manage this condition.
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Affiliation(s)
- David E St-Jules
- Assistant Professor, Department of Nutrition, University of Nevada, Reno, Nevada.
| | - Lyn Lloyd
- Senior Renal Dietitian, Nutrition and Dietetics, Te Toka Tumai Auckland Hospital, Te Whatu Ora Health New Zealand
| | - Anthony Meade
- Advanced Renal Dietitian, Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Annabel Biruete
- Assistant Professor, Department of Nutrition Science, Purdue University, West Lafayette, and Division of Nephrology, Indiana University School of Medicine, Indianapolis
| | - Brandon Kistler
- Assistant Professor, Department of Nutrition Science, Purdue University, West Lafayette
| | - Juan-Jesus Carrero
- Professor, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, and Division of Nephrology, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Sweden
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Abstract
Protein energy wasting(PEW) is a term that most nephrologists used to define nutritional disorders in patients with acute kidney injury and chronic kidney disease. Although this nomenclature is well implemented in the field of nephrology, the use of other terms such as cachexia or malnutritionin the majority of chronic diseases can induce confusion regarding the definition and interpretation of these terms. There is ample evidence in the literature that the pathways involved in cachexia/malnutrition and PEW are common. However, in kidney diseases, there are pathophysiological conditions such as accumulation of uremic toxins, and the use of dialysis, which may induce a phenotypic specificity justifying the original term PEW. In light of the latest epidemiologic studies, the criteria for PEW used in 2008 probably need to be updated. The objective of this review is to summarize the main mechanisms involved in cachexia/malnutrition and PEW. We discuss the need to modernize and simplify the current definition and diagnostic criteria of PEW. We consider the interest of proposing a specific nomenclature of PEW for children and elderly patients with kidney diseases.
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Affiliation(s)
- Laetitia Koppe
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; University Lyon, Cardiovasculaire, Métabolisme, Diabète et Nutrition Laboratory, Institut National des Sciences Appliquées-Lyon, Institut National de la Santé et de la Recherche Médicale U1060, l'Institut National de Recherche Pour l'agriculture, l'alimentation et l'environnement (INRAE), Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California San Diego, La Jolla, California
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7
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Thomas J, Delaney C, Miller M. The ability of the Global Leadership Initiative on Malnutrition (GLIM) to diagnose protein-energy malnutrition in patients requiring vascular surgery: a validation study. Br J Nutr 2023; 129:49-53. [PMID: 35115059 DOI: 10.1017/s0007114522000344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 02/03/2023]
Abstract
Identifying nutritional deficits and implementing appropriate interventions in patients requiring vascular surgery is challenging due to the paucity of appropriate screening and assessment tools in this group. This retrospective study aimed to determine the validity of the Global Leadership Initiative on Malnutrition (GLIM) in identifying protein-energy malnutrition (PEM) in inpatients admitted to a vascular surgery unit, using the PG-SGA as the comparator. Diagnostic accuracy and consistency were determined between the GLIM and the Patient-Generated Subjective Global Assessment (PG-SGA) global rating. The GLIM determination was made retrospectively using the relevant parameters collected at baseline in the original study. Two hundred and twenty-four (70·1 % male) participants were included. The prevalence of PEM was 28·6 % on GLIM and 17 % via the PG-SGA. Compared with the PG-SGA, the GLIM achieved sensitivity of 73·7 % and specificity of 80·6 %; however positive predictive value was 43·7 % indicating that the GLIM over-diagnosed malnutrition compared with the PG-SGA. Kappa reached 0·427 indicating moderate diagnostic consistency. Due to the absence of an ideal instrument and the complexity of malnutrition often seen in this group which extends beyond PEM to significant micronutrient deficiencies, further work is required to determine the most appropriate instrument in this patient group, and how micronutrient status can also be included in the overall assessment given the critical role of micronutrients in this group.
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Affiliation(s)
- Jolene Thomas
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia
| | - Christopher Delaney
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
- Department of Vascular and Endovascular Surgery, Southern Adelaide Local Health Network, Adelaide, South Australia
| | - Michelle Miller
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia
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Nassar MK, El Kannishy G, Nagy E, Shemies RS, Mansour M, Mofreh M, Gaber TZ, Tharwat S. The Relation of Serum Dehydroepiandrosterone Sulfate Level to Protein Energy Wasting in Hemodialysis Patients. Saudi J Kidney Dis Transpl 2022; 33:639-649. [PMID: 37955456 DOI: 10.4103/1319-2442.389424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Protein-energy wasting (PEW) is a major risk for morbidity and mortality in hemodialysis (HD) patients. The change in the concentration of dehydroepiandrosterone sulfate (DHEA-S) may play a role in PEW. The aim of this work was to study the possible relationship between serum DHEA-S levels and various nutritional and inflammatory parameters in a cohort of HD patients. In total, 78 HD patients (47 males and 31 females) were included in this crosssectional observational study. In addition to taking their history, clinical examinations, and routine laboratory investigations, the nutritional status was assessed, and their serum DHEA-S was measured. Nutritional status was assessed by anthropometric measures, bioelectrical impedance analysis, malnutrition inflammation scores, and subjective global assessments. A diagnosis of malnutrition was made based on the recommendations of the International Society of Renal Nutrition and Metabolism. The relationship between DHEA-S and various nutritional parameters was analyzed. Eighteen patients (23.1%) suffered from PEW. Those with PEW had a longer duration of HD (P = 0.04), and lower serum levels of creatinine (P = 0.003), hemoglobin (P = 0.01), albumin (P <0.0001), cholesterol (P = 0.02), and DHEA-S (P = 0.01). Among the variables, serum DHEA-S levels were significant predictors of PEW in this cohort (odds ratio: 0.976; 95% confidence interval: 0.954-1.0; P = 0.04). PEW is frequently encountered in HD patients. Decreased serum DHEA-S levels were associated with PEW in male HD patients. Further studies are needed to assess the effect of hormone supplementation on this serious disorder in HD patients.
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Affiliation(s)
- Mohammed Kamal Nassar
- Department of Internal Medicine, Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Ghada El Kannishy
- Department of Internal Medicine, Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Eman Nagy
- Department of Internal Medicine, Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Rasha Samir Shemies
- Department of Internal Medicine, Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Mostafa Mansour
- Department of Clinical Pathology, Rheumatology and Immunology Unit, Mansoura University, Mansoura, Egypt
| | - Mohamed Mofreh
- Department of Clinical Pathology, Rheumatology and Immunology Unit, Mansoura University, Mansoura, Egypt
| | - Tamer Zaki Gaber
- Department of Internal Medicine, Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Samar Tharwat
- Department of Internal Medicine, Rheumatology and Immunology Unit, Mansoura University, Mansoura, Egypt
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Sung CC, Liao MT, Chao CT. Independent Determinants of Appetite Impairment among Patients with Stage 3 or Higher Chronic Kidney Disease: A Prospective Study. Nutrients 2021; 13:nu13082863. [PMID: 34445030 PMCID: PMC8401624 DOI: 10.3390/nu13082863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
Abstract
Protein-energy wasting (PEW) is an important complication resulting from chronic kidney disease (CKD). Appetite impairment contributes significantly to PEW in these patients, but risk factors associated with having appetite impairment in patients with CKD remain elusive. Patients with an estimated glomerular filtration rate <60 mL/min/1.73 m2 for ≥2 times at least three months apart were prospectively enrolled during 2017, with their demographic features, comorbidities, anthropometric parameters, physical and performance indices, functional status, frailty, sensory organ integrity, and laboratory data collected. Their appetite status was measured using the Council on Nutrition Appetite Questionnaire (CNAQ). We examined independent determinants of appetite impairment in these CKD patients using multiple regression analyses. Among 78 patients with CKD, 42.3% had CNAQ-identified impaired appetite. Those with an impaired appetite also had poorer physical performance, a higher degree of functional impairment, higher frail severities, lower serum sodium levels, less intact oral cavity, and a trend toward having less intact nasal structures than those without. Multiple regression analyses revealed that a higher frail severity, in the forms of increasing Study of Osteoporotic Fractures (SOF) scores (odds ratio (OR), 2.74; 95% confidence interval (CI), 1.15–6.57) and a less intact nasal structure (OR, 0.96; 95% CI, 0.92–0.995) were associated with a higher probability of having an impaired appetite, while higher serum sodium (OR, 0.76; 95% CI, 0.6–0.97) correlated with a lower probability. Based on our findings, in patients with CKD, the severity of frailty, serum sodium, and nasal structural integrity might modify appetite status. Therapies targeting these factors might be beneficial for appetite restoration in patients with CKD.
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Affiliation(s)
- Chih-Chien Sung
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Min-Tser Liao
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan County 325, Taiwan
- Department of Pediatrics, Taoyuan Armed Forces General Hospital Hsinchu Branch, Hsinchu City 300, Taiwan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: (M.-T.L.); (C.-T.C.)
| | - Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei 10845, Taiwan
- Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
- Correspondence: (M.-T.L.); (C.-T.C.)
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10
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Abstract
Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.
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Affiliation(s)
- Johanna T Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, 02111, USA
- Department of Medicine and Community Health, School of Medicine and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
| | - Jaime J Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
| | - Mary Weiler
- Abbott Nutrition Division of Abbott, Columbus, OH, 43219, USA
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Aniort J, Freist M, Piraud A, Philipponnet C, Hadj Abdelkader M, Garrouste C, Gentes E, Pereira B, Heng AE. Circulating 20S proteasome for assessing protein energy wasting syndrome in hemodialysis patients. PLoS One 2020; 15:e0236948. [PMID: 32735636 PMCID: PMC7394422 DOI: 10.1371/journal.pone.0236948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/16/2020] [Indexed: 12/02/2022] Open
Abstract
Protein energy wasting (PEW) including muscle atrophy is a common complication in chronic hemodialysis patients. The ubiquitin proteasome system (UPS) is the main proteolytic system causing muscle atrophy in chronic kidney disease and proteasome 20S is the catalytic component of the UPS. Circulating proteasome 20S (c20S proteasome) is present in the blood and its level is related to disease severity and prognosis in several disorders. We hypothesized that c20S proteasome could be related with muscle mass, other PEW criteria and their evolution in hemodialysis patients. Stable hemodialysis patients treated at our center for more than 3 months were followed over 2 years. C20S proteasome assay was performed at baseline. Biological and clinical data were collected, muscle mass was assessed by multi-frequency bio-impedancemetry, and nutritional scores were calculated at baseline, 1 year and 2 years. Hospitalizations and mortality data were collected over the 2 years. Forty-nine patients were included. At baseline, the c20S proteasome level was 0.40[0.26–0.55] μg/ml. Low muscle mass as defined by a lean tissue index (LTI) < 10th in accordance with the International Society of Renal Nutrition and Metabolism guidelines was observed in 36% and PEW in 62%. Increased c20S proteasome levels were related with LTI at baseline (R = 0.43, p = 0.004) and with its 2 year-variation (R = -0.56, p = 0.003). Two-year survival rate was not different between higher and lower c20S proteasome values (78.9 vs 78.4%, p = 0.98 log-rank test). C20S proteasome is not a good marker for assessing nutritional status in hemodialysis patients and predicting patient outcomes.
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Affiliation(s)
- Julien Aniort
- Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, Clermont-Ferrand, France
- INRA, UMR 1019, Human Nutrition Unit (UNH), St Genès Champanelle, France
- * E-mail:
| | - Marine Freist
- Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, Clermont-Ferrand, France
- Nephrology and Dialysis Department, Emile Roux Hospital, Le Puy en Velay, France
| | - Aurélien Piraud
- Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Carole Philipponnet
- Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Mohamed Hadj Abdelkader
- Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Cyril Garrouste
- Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Elodie Gentes
- Clinical Nutrition Department, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Bruno Pereira
- University Hospital of Clermont-Ferrand, Biostatistics unit (DRCI), Clermont-Ferrand, France
| | - Anne-Elisabeth Heng
- Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, Clermont-Ferrand, France
- INRA, UMR 1019, Human Nutrition Unit (UNH), St Genès Champanelle, France
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12
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Kumada Y, Ishii H, Oshima S, Ito R, Umemoto N, Takahashi H, Murohara T. Association of protein-energy wasting and inflammation status with mortality after coronary revascularisation in patients on haemodialysis. Open Heart 2020; 7:e001276. [PMID: 32709700 PMCID: PMC7380732 DOI: 10.1136/openhrt-2020-001276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Protein-energy wasting is associated with chronic inflammation and advanced atherosclerosis in haemodialysis (HD) patients. We investigated association of geriatric nutritional risk index (GNRI), C reactive protein (CRP) with prediction of mortality after coronary revascularisation in chronic HD patients. METHODS We enrolled 721 HD patients electively undergoing coronary revascularisation. They were divided into tertiles according to preprocedural GNRI levels (tertile 1 (T1):<91.5, T2: 91.5-98.1 and T3:>98.1) and CRP levels (T1:≤1.4 mg/L, T2: 1.5-7.0 mg/L and T3:≥7.1 mg/L). RESULTS Kaplan-Meier 10 years survival rates were 32.3%, 44.8% and 72.5% in T1, T2 and T3 of GNRI and 60.9%, 49.2% and 23.5% in T1, T2 and T3 of CRP, respectively (p<0.0001 in both). Declined GNRI (HR 2.40, 95% CI 1.58 to 3.74, p<0.0001 for T1 vs T3) and elevated CRP (HR 2.31, 95% CI 1.58 to 3.43, p<0.0001 for T3 vs T1) were identified as independent predictors of mortality. In combined setting of both variables, risk of mortality was 5.55 times higher (95% CI 2.64 to 13.6, p<0.0001) in T1 of GNRI with T3 of CRP than in T3 of GNRI with T1 of CRP. Addition of GNRI and CRP in a model with established risk factors improved C-statistics (0.648 to 0.724, p<0.0001) greater than that of each alone. CONCLUSION Preprocedural declined GNRI and elevated CRP were closely associated with mortality after coronary revascularisation in chronic HD patients. Furthermore, combination of both variables not only stratified risk of mortality but also improved the predictability.
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Affiliation(s)
- Yoshitaka Kumada
- Cardiovascular Surgery, Matsunami General Hospital, Hashima-gun, Gifu, Japan
| | - Hideki Ishii
- Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Satoru Oshima
- Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Ryuta Ito
- Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Norio Umemoto
- Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | | | - Toyoaki Murohara
- Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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González-Ortiz A, Correa-Rotter R, Vázquez-Rangel A, Vega-Vega O, Espinosa-Cuevas Á. Relationship between protein-energy wasting in adults with chronic hemodialysis and the response to treatment with erythropoietin. BMC Nephrol 2019; 20:316. [PMID: 31412807 PMCID: PMC6694582 DOI: 10.1186/s12882-019-1457-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 07/08/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND It is known that one of the leading causes of morbidity in chronic kidney disease (CKD) is the anemic syndrome. Although the pathogenic mechanisms of anemia are multiple, erythropoietin deficiency appears as the dominant factor. Patients in hemodialysis (HD) have a high prevalence of protein energy wasting (PEW) that may explains the poor response to Erythropoietin (EPO). METHODS Retrospective cohort study of patients on HD from January to December 2014. The participants were classified according to a diagnostic of PEW using the "Malnutrition Inflammation Score" (MIS) and bioimpedance analysis (BIA) measurement of body composition at the start of erythropoietin therapy and after 3 months of follow up. We performed descriptive statistics and analyzed the differences between groups with and without PEW considering their responsiveness. In addition, we calculated the relative risk of EPO resistance, considering p value < 0.05 as statistically significant. RESULTS Sixty-one patients ended the follow up. Both groups were similar in basal hemoglobin, hematocrit and other hematopoiesis markers (p = NS). Patients without PEW have a decrease risk for poor response to treatment with EPO (RR = 0.562 [95% CI, 0.329-0.961-]) than those with PEW. Finally, hemoglobin concentrations were evaluated at baseline and every four weeks until week 12, finding a statistically significant improvement only in patients without PEW according MIS (p < 0.05). CONCLUSIONS PEW is an incremental predictor of poor responsiveness to EPO in HD patients, thus, it is important to consider correcting malnutrition or wasting for a favorable response to treatment with EPO.
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Affiliation(s)
- Ailema González-Ortiz
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Belisario Dominguez Sección XVI, Deleg. Tlalpan, 14080 Mexico City, CP Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Ave. Universidad No. 3000, Col. Ciudad Universitaria, Deleg, Coyoacán, 04510 México City, CP Mexico
| | - Ricardo Correa-Rotter
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Belisario Dominguez Sección XVI, Deleg. Tlalpan, 14080 Mexico City, CP Mexico
| | - Armando Vázquez-Rangel
- Nephrology Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1, Colonia Belisario Dominguez Sección XVI, Deleg. Tlalpan, 14080 Mexico City, CP Mexico
| | - Olynka Vega-Vega
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Belisario Dominguez Sección XVI, Deleg. Tlalpan, 14080 Mexico City, CP Mexico
| | - Ángeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Belisario Dominguez Sección XVI, Deleg. Tlalpan, 14080 Mexico City, CP Mexico
- Health Care Department, Universidad Autónoma Metropolitana-Xochimilco, Calz. Del Hueso No. 1100, Col. Villa Quietud, Deleg. Coyoacán, 04960 Mexico City, CP Mexico
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Mahjoub F, Mizouri R, Ben Amor N, Bacha MM, Khedher A, Lahmar I, Jamoussi H. Prevalence of malnutrition for elderly hemodialysis patients. Tunis Med 2019; 97:588-594. [PMID: 31729710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The prevalence of the terminal chronic renal failure treated by hemodialysis is rising steadily especially for the elderly. Its evolution is fraught with complications including protein-energy malnutrition. The aim of this study was to evaluate the predominance of protein-energy malnutrition among elderly hemodialysis patients. METHODS This cross-sectional descriptive study included 40 elderly hemodialysis patients recruited at the M8 nephrology department of Charles Nicolle Hospital in Tunis. All patients went through a clinical examination, a biological assessment, a dietary survey based on food registration for 3 consecutive days and the calculation of nutritional risk scores (MNA and GNRI). RESULTS The Average of hemodialysis was of 7 ± 3.8 years. The average energy intake of the patients was 25.3 ± 12.3 kcal / kg of ideal weight per day. The weight evolution during the last 6 months preceding the study was marked by a weight loss exceeding the 10 % in 12 % of the cases. A BMI less than 21 kg / m² was noted in 73.7 % of the women and 47.6 % of the men. The brachial circumference was less than 22 cm in 36.8 % of the women and 23.6 % of the men. One-third (32.5 %) of the study population had a calf circumference that is less than 31 cm. Most patients (67.5 %) had hypoalbuminaemia. The predominance of malnutrition according to the 2007 HAS criteria was 71% among hemodialysis patients. The majority of women (78.9 %) and 57.1 % of men had GNRI less than or equal to 98. CONCLUSION Protein-energy malnutrition is a common and serious pathological situation in elderly hemodialysis patients which can be life-threatening.
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Marin S, Serra-Prat M, Ortega O, Clavé P. Cost of oropharyngeal dysphagia after stroke: protocol for a systematic review. BMJ Open 2018; 8:e022775. [PMID: 30552255 PMCID: PMC6303570 DOI: 10.1136/bmjopen-2018-022775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/18/2018] [Accepted: 10/26/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Oropharyngeal dysphagia (OD) is a major disorder following stroke. OD can produce alterations in both the efficacy and safety of deglutition and may result in malnutrition, dehydration, frailty, respiratory infections and pneumonia. These complications can be avoided by early detection and treatment of OD in poststroke patients, and hospital stays, medication and mortality rates can be reduced. In addition to acute in-hospital costs from OD complications, there are other costs related to poststroke OD such as direct non-healthcare costs or indirect costs. The objective of this systematic review is to assess and summarise literature on the costs related to OD in poststroke patients. METHODS AND ANALYSIS A systematic review of studies on the cost of OD and its complications (aspiration, malnutrition, dehydration, aspiration pneumonia and death) in patients who had a stroke will be performed from the perspectives of the hospital, the healthcare system and/or the society. The main outcomes of interest are the costs related to poststroke OD. We will search MEDLINE, Embase and the National Health Service Economic Evaluation Database. Studies will be included if they are partial economic evaluation studies, studies that provide information on costs in adult (>17 years) poststroke patients with OD and/or its complications (malnutrition, dehydration, frailty, respiratory infections and pneumonia) or economic evaluation studies in which the cost of this condition has been estimated. Studies will be excluded if they refer to oesophageal dysphagia or OD caused by causes other than stroke. Main study information will be presented and summarised in tables, separately for studies that provide incremental costs attributable to OD or its complications and studies that report the effect of OD or its complications on total costs of stroke, and according to the perspective from which costs were measured. ETHICS AND DISSEMINATION The results of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018099977.
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Affiliation(s)
- Sergio Marin
- Pharmacy Department, Consorci Sanitari del Maresme. Hospital de Mataró., Mataro, Spain
| | - Mateu Serra-Prat
- Research Unit, Consorci Sanitari del Maresme, Barcelona, Spain
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - Omar Ortega
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
- Gastrointestinal Physiology Laboratory, Consorci Sanitari del Maresme, Universitat Autónoma de Barcelona, Catalunya, Spain
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
- Gastrointestinal Physiology Laboratory, Consorci Sanitari del Maresme, Universitat Autónoma de Barcelona, Catalunya, Spain
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Affiliation(s)
- Menaka Sarav
- Division of Nephrology and Hypertension, NorthShore University HealthSystem, Evanston, Illinois
| | - Csaba Pal Kovesdy
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee; and
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
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Han BG, Lee JY, Kim JS, Yang JW. Clinical Significance of Phase Angle in Non-Dialysis CKD Stage 5 and Peritoneal Dialysis Patients. Nutrients 2018; 10:nu10091331. [PMID: 30235860 PMCID: PMC6165137 DOI: 10.3390/nu10091331] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 01/07/2023] Open
Abstract
Background: Fluid overload and protein-energy wasting (PEW) are common in patients with end-stage renal disease (ESRD) and lead to a poor prognosis. We aimed to evaluate the volume and nutritional status of ESRD patients and to determine the clinical significance of phase angle (PhA). Methods: This study was a cross-sectional comparison of bioimpedance spectroscopy (BIS) findings in patients with non-dialysis chronic kidney disease (CKD) stage 5 (CKD5-ND, N = 80) and age/sex-matched peritoneal dialysis patients (PD, N = 80). PEW was defined as a PhA less than 4.5°. Results: The PhA was found to be positively associated with a geriatric nutritional risk index (GNRI, r = 0.561, p < 0.001), lean tissue index (LTI, r = 0.473, p < 0.001), and albumin (r = 0.565, p < 0.001) while OH/ECW (r = −0.824, p < 0.001) showed an inverse correlation. The CKD5-ND group had more overhydration (p = 0.027). The PD group had significantly higher PhA (p = 0.023), GNRI (p = 0.005), hemoglobin (p < 0.001), and albumin (p = 0.003) than the CKD5-ND group. The cut-off values predicting PEW were found to be 3.55 g/dL for albumin, 94.9 for GNRI, and 12.95 kg/m2 for LTI in PD patients. Conclusions: This study demonstrated that PhA could be used as a marker to reflect nutritional status in patients with ESRD. Since BIS can inform both volume and nutritional status, regular monitoring will provide the basis for active correction of fluid overload and nutritional supplementation, which may improve outcomes in patients with ESRD.
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Affiliation(s)
- Byoung-Geun Han
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won 26426, Korea.
| | - Jun Young Lee
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won 26426, Korea.
| | - Jae-Seok Kim
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won 26426, Korea.
| | - Jae-Won Yang
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Kang-won 26426, Korea.
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Valdés-Sosa PA, Galler JR, Bryce CP, Rabinowitz AG, Bringas-Vega ML, Hernández-Mesa N, Taboada-Crispi A. Seeking Biomarkers of Early Childhood Malnutrition's Long-term Effects. MEDICC Rev 2018; 20:43-48. [PMID: 29773777 PMCID: PMC6310420 DOI: 10.37757/mr2018.v20.n2.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 10/06/2023]
Abstract
Protein-energy malnutrition affects one in nine people worldwide and is most prevalent among children aged less than five years in low-income countries. Early childhood malnutrition can have damaging neurodevelopmental effects, with significant increases in cognitive, neurological and mental health problems over the lifespan, outcomes which can also extend to the next generation. This article describes a research collaboration involving scientists from five centers in Barbados, China, Cuba and the USA. It builds on longer-term joint work between the Barbados Nutrition Study (which, over a 45-year span, has extensively documented nutritional, health, behavioral, social and economic outcomes of individuals who experienced protein-energy malnutrition in the first year of life and healthy controls from the same classrooms and neighborhoods) and the Cuban Neuroscience Center (which has developed low-cost brain imaging methods that can be readily used in low income settings to identify biomarkers for early detection and treatment of adverse consequences of childhood malnutrition). This collaboration, which involved Barbadian, Cuban and US scientists began in the 1970s, when quantitative EEG techniques were applied to EEG data collected in 1977-78, at which time study participants were aged 5-11 years. These EEG records were never fully analyzed but were stored in New York and made available to this project in 2016. These data have now been processed and analyzed, comparing EEG findings in previously malnourished and control children, and have led to the identification of early biomarkers of long-term effects of early childhood protein-energy malnutrition. The next stage of the project will involve extending earlier work by collecting EEG recordings in the same individuals at ages 45-51 years, 40 years later, and comparing findings to earlier data and to these individuals' behavioral and cognitive outcomes. Quantitative EEG biomarkers of the effects of protein-energy malnutrition may help identify children at greatest risk for early malnutrition's adverse neurodevelopmental effects and inform development of targeted interventions to mitigate the long-term adverse effects of protein-energy malnutrition in developing countries. KEYWORDS Protein-energy malnutrition, electroencephalography, EEG, biomarkers, neurosciences, Barbados, Cuba, USA.
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Maraj M, Kuśnierz-Cabala B, Dumnicka P, Gala-Błądzińska A, Gawlik K, Pawlica-Gosiewska D, Ząbek-Adamska A, Mazur-Laskowska M, Ceranowicz P, Kuźniewski M. Malnutrition, Inflammation, Atherosclerosis Syndrome (MIA) and Diet Recommendations among End-Stage Renal Disease Patients Treated with Maintenance Hemodialysis. Nutrients 2018; 10:E69. [PMID: 29324682 PMCID: PMC5793297 DOI: 10.3390/nu10010069] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 12/23/2022] Open
Abstract
Malnutrition-inflammation-atherosclerosis syndrome is one of the causes of increased mortality in chronic kidney disease (CKD). The aim of the study was to assess the inflammation and nutritional status of patients in end-stage kidney disease treated with maintenance hemodialysis. The study included a group of 98 hemodialyzed patients with stage 5 CKD (38 women and 60 men). Albumin, prealbumin (PRE), and C-reactive protein (CRP) were measured in serum samples collected before mid-week dialysis. Fruit and vegetables frequency intakes were assessed with a questionnaire. CRP was above the reference limit of 5 mg/L in 53% of patients. Moreover, the Glasgow Prognostic Score (GPS) indicated the co-occurrence of inflammation and protein calorie malnutrition in 11% of patients, and the presence of either inflammation or malnutrition in 25%. The questionnaire revealed that hemodialyzed patients frequently exclude fruit and vegetables from their diets. Nearly 43% of the interviewed patients declared frequently eating vegetables, and 35% declared frequently eating fruit, a few times per week or less. The most frequently selected fruit and vegetables had a low antioxidant capacity. The strict dietary restrictions in CKD are difficult to fulfill, and if strictly followed, may lead to protein-calorie malnutrition.
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Affiliation(s)
- Małgorzata Maraj
- Faculty of Medicine, Dietetics, Jagiellonian University Medical College, Anny St. 12, 31-008 Kraków, Poland;
| | - Beata Kuśnierz-Cabala
- Department of Diagnostics, Jagiellonian University Medical College, Kopernika 15A St., 31-501 Kraków, Poland; (B.K.-C.); (K.G.); (D.P.-G.)
| | - Paulina Dumnicka
- Department of Medical Diagnostics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 St., 30-688 Kraków, Poland;
| | - Agnieszka Gala-Błądzińska
- Dialysis Therapy Centre, St’ Queen Jadwiga Clinical District Hospital No. 2, Lwowska St. 60, 35-301 Rzeszów, Poland;
- Faculty of Medicine, University of Rzeszów, Kopisto Ave. 2a, 35-310 Rzeszów, Poland
| | - Katarzyna Gawlik
- Department of Diagnostics, Jagiellonian University Medical College, Kopernika 15A St., 31-501 Kraków, Poland; (B.K.-C.); (K.G.); (D.P.-G.)
| | - Dorota Pawlica-Gosiewska
- Department of Diagnostics, Jagiellonian University Medical College, Kopernika 15A St., 31-501 Kraków, Poland; (B.K.-C.); (K.G.); (D.P.-G.)
| | - Anna Ząbek-Adamska
- Diagnostic Department, University Hospital in Krakow, Kopernika 15B St., 31-501 Kraków, Poland; (A.Z.-A.); (M.M.-L.)
| | - Małgorzata Mazur-Laskowska
- Diagnostic Department, University Hospital in Krakow, Kopernika 15B St., 31-501 Kraków, Poland; (A.Z.-A.); (M.M.-L.)
| | - Piotr Ceranowicz
- Department of Physiology, Jagiellonian University Medical College, Grzegórzecka 16 St., 31-531 Kraków, Poland
| | - Marek Kuźniewski
- Department of Nephrology, Jagiellonian University Medical College, Kopernika 15C, 31-501 Kraków, Poland;
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Zhou SJ, Han QF, Zhang AH, Tang W, Sun LH. Irisin and Volume Overload are Associated with Protein Energy Wasting in Peritoneal Dialysis Patients. Kidney Blood Press Res 2017; 42:1216-1224. [PMID: 29248911 DOI: 10.1159/000485925] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Protein energy wasting (PEW) is a common medical phenomenon that is observed in maintenance dialysis patients. PEW also increases morbidity and mortality of these patients. Its pathogenesis is unclear. We hypothesize that serum irisin levels and volume overload may induce PEW in peritoneal dialysis (PD) patients. The aim of this study is to measure serum irisin levels, evaluate volume status of PD patients, and study their correlations with PEW in PD patients. METHODS This study is a cross-sectional study with 160 PD patients from the PD center of Peking University Third Hospital and 35 healthy control subjects. PD patients were divided into PEW group and non-PEW group according to PEW diagnosis criteria. Serum irisin concentrations were measured by ELISA. Volume overload status (volume overload is defined as overhydration value ≥2 liters) of PD patients was analyzed by bioelectrical impedance. RESULTS The serum irisin levels were significantly lower in PD patients compared with those of the controls (113.2±11.8 ng/ml vs. 464.2±37.4 ng/ml, P<0.01). The serum irisin levels were lower in PD patients with PEW than those of the patients without PEW (106.5±15.2 ng/ml vs. 117.4±17.6 ng/ml, P<0.01). PEW is more prevalent in patients with volume overload than patients without volume overload (62.5% vs. 43.1%, x2=5.756, P=0.016); however, no direct relationship was found between irisin levels and volume overload status. The independent influencing factors of PEW were serum irisin, serum albumin, and volume overload. CONCLUSION Our results are the first to provide clinical evidence of the association between serum irisin, volume overload, and PEW in PD patients. PEW may inhibit the release or synthesis of irisin from skeletal muscles, and volume overload may aggravate PEW in PD patients.
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Affiliation(s)
- Suparna Ghosh-Jerath
- Public Health Foundation of India, Indian Institute of Public Health-Delhi, Gurgaon, Haryana 122002, India
| | - Archna Singh
- Biochemistry Department, All India Institute of Medical Sciences, New Delhi, India
| | - Nameet Jerath
- Indraprastha Apollo Hospital, Pediatrics, New Delhi, India
| | - Suruchi Gupta
- Public Health Foundation of India, Indian Institute of Public Health-Delhi, Gurgaon, Haryana 122002, India
| | - Elizabeth F Racine
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte NC, USA
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Rytter MJ, Michaelsen KF, Friis H, Christensen VB. [Acute malnutrition in children]. Ugeskr Laeger 2017; 179:V03170193. [PMID: 28504629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The prevalence of malnutrition has declined significantly over the last 30 years. Despite this, malnutrition remains a major cause of illness and death among children worldwide, particularly in low- and medium-income countries. Marasmus and kwashiorkor are the most life-threatening forms of malnutrition. Treatment protocols enable effective treatment, but only a minority of malnourished children have access to treatment. Furthermore, treating children with complicated malnutrition requiring hospitalization remains a clinical challenge.
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Kamimura MA, Majchrzak KM, Cuppari L, Pupim LB. Protein and Energy Depletion in Chronic Hemodialysis Patients: Clinical Applicability of Diagnostic Tools. Nutr Clin Pract 2017; 20:162-75. [PMID: 16207654 DOI: 10.1177/0115426505020002162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 12/18/2022] Open
Abstract
Protein and energy depletion states are common and associated with increased morbidity and mortality in chronic hemodialysis (CHD) patients. Therefore, proper use of diagnostic tools to assess depleted states in CHD patients is critical. Assessment of protein and energy status can be done by an array of methodologies that include simple estimates of the visceral and somatic pools of protein to more refined techniques to measure protein and energy balance. The nutritional and metabolic derangements in the CHD population are highly complex and can be confounded by multiple comorbidities and fluid shifts between body compartments. Therefore, assessment of protein and energy status in CHD patients requires a wide range of methodologies that not only identify depleted states but also monitor nutrition therapy and predict clinical outcome. Most important, these methods require cautious and individualized interpretation in order to minimize the interference of comorbid conditions frequently observed in the CHD population. Currently, there is not a single method that can be considered the gold standard for assessment of protein and energy status in CHD patients. Therefore, a combination of methods is recommended. In this review, we describe available methods to assess protein and energy status, with special considerations pertaining to CHD patients.
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Affiliation(s)
- M A Kamimura
- Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
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Abstract
Within the context of Levine’s conceptual framework, this study evaluated fatigue and protein calorie malnutrition affecting adult, long-term ventilated patients during the weaning process. Levine’s principles of energy and structural integrity provided the basis for an evaluation of the fatigue and prealbumin levels for 11 patients. During the weaning process (1 to 4 weeks), fatigue data were collected at multiple points while prealbumin levels were collected weekly. Statistically significant findings revealed that long-term ventilated patients had distinctive fatigue trends in addition to trends associated with low prealbumin levels, which can affect the patient’s weaning ability.
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Röhrig G, Rücker Y, Becker I, Schulz RJ, Lenzen-Großimlinghaus R, Willschrei P, Gebauer S, Modreker M, Jäger M, Wirth R. Association of anemia with functional and nutritional status in the German multicenter study "GeriAnaemie2013". Z Gerontol Geriatr 2016; 50:532-537. [PMID: 27364876 DOI: 10.1007/s00391-016-1092-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 12/04/2015] [Revised: 02/25/2016] [Accepted: 05/19/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Anemia and malnutrition are risk factors for frailty in older people but data from multicenter studies among German geriatric inpatients are lacking. This analysis evaluated data from the multicenter study "GerAnaemie2013" commissioned by the German Geriatric Society. PATIENTS AND METHODS The study involved an analysis of the 579 geriatric inpatients recruited in the context of the German multicenter study "GeriAnaemie2013". Study parameters: Barthel index (BI), handgrip strength, nutritional data (e.g. loss of appetite, loss of weight and decreased food intake). INCLUSION CRITERIA in-patient age ≥70 years, exclusion criteria: current cancer disease or cancer-associated treatment. Anemia was defined according to the World Health Organization (WHO) criteria. RESULTS The mean age of patients was 81.9 years, overall prevalence of anemia 55.1 %, mean hemoglobin (Hb) level 11.9 g/dl, average BI 50.8 points and 30.3 % of all patients were at risk of malnutrition. While univariate analysis revealed a significantly lower BI in anemic patients, this association was no longer seen in multivariate analysis. Regression analysis revealed that a drug intake of > 5 drugs/day doubles the chance of suffering from anemia with an adjusted odds ratio (OR) of 2.17 (confidence interval (CI) 1.28-3.68, p = 0.004) as well as a serum albumin level below 3.5 g/dl with an adjusted OR of 2.11 (range 1.40-3.19, p < 0.001). CONCLUSION Polymedication and low serum albumin were independent risk factors for anemia in geriatric patients, probably reflecting disease severity.
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Affiliation(s)
- Gabriele Röhrig
- Ageing Clinical Research, Department II of Internal Medicine, University Hospital Cologne, Herderstrasse 52, 50937, Cologne, Germany.
- Department of Geriatrics, St. Marien-Hospital, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Ymkje Rücker
- Ageing Clinical Research, Department II of Internal Medicine, University Hospital Cologne, Herderstrasse 52, 50937, Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics, Informatics and Epidemiology, Cologne, Germany
| | | | | | - Peter Willschrei
- Clinic for Geriatric Medicine, Kliniken Essen Mitte, Essen, Germany
| | | | - Mirja Modreker
- Clinic for Geriatric Medicine and Geriatric Rehabilitation, Helios Kliniken Schwerin, Schwerin, Germany
| | - Martin Jäger
- Clinic for Geriatric Medicine, St. Vinzenz-Hospital Dinslaken, Dinslaken, Germany
| | - Rainer Wirth
- St. Marien-Hospital Borken, Department for Geriatric Medicine, Borken, Germany
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
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St-Jules DE, Woolf K, Pompeii ML, Sevick MA. Exploring Problems in Following the Hemodialysis Diet and Their Relation to Energy and Nutrient Intakes: The BalanceWise Study. J Ren Nutr 2016; 26:118-24. [PMID: 26586249 PMCID: PMC4762735 DOI: 10.1053/j.jrn.2015.10.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/08/2015] [Accepted: 10/06/2015] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To identify the problems experienced by hemodialysis (HD) patients in attempting to follow the HD diet and their relation to energy and nutrient intakes. DESIGN Cross-sectional analysis of baseline data from the BalanceWise Study. SUBJECTS Participants included community-dwelling adults recruited from outpatient HD centers. After excluding participants with incomplete dietary analyses (n = 50), 140 African American and white (40/60%) men and women (52/48%) on chronic intermittent HD for at least 3 months (median 3 years) were included. INTERVENTION Participant responses, on a 5-point Likert scale ranging from "not at all a problem" to "a very important problem for me," to 34 questions pertaining to potential barriers to following the HD diet in the previous 2 months were classified as either a problem (1) or not a problem (2-5). MAIN OUTCOME MEASURE Energy and nutrient intakes determined using the Nutrition Data System for Research® based on 3, non-consecutive, unscheduled, 2-pass 24-hour dietary recalls collected on 1 dialysis and 1 non-dialysis weekday, and 1 non-dialysis weekend day. RESULTS More than half of participants reported having problems related to specific behavioral factors (e.g., feeling deprived), technical difficulties (e.g., tracking nutrients), and physical condition (e.g., appetite), but issues of time and food preparation and behavioral factors tended to be most deterministic of reported dietary intakes. Longer duration of HD was associated with lower intakes of protein, potassium, and phosphorus (P < .05). CONCLUSION Registered dietitian nutritionists should consider issues of time and food preparation, and behavioral factors in their nutrition assessment of HD patients and should continually monitor HD patients for changes in protein intake that may occur over time.
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Affiliation(s)
- David E St-Jules
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York.
| | - Kathleen Woolf
- Department of Nutrition, Food Studies, and Public Health, New York University Steinhardt, New York, New York
| | - Mary Lou Pompeii
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Mary Ann Sevick
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
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Nishikawa H, Yoh K, Enomoto H, Iwata Y, Kishino K, Shimono Y, Hasegawa K, Nakano C, Takata R, Nishimura T, Aizawa N, Sakai Y, Ikeda N, Takashima T, Ishii A, Iijima H, Nishiguchi S. Factors Associated With Protein-energy Malnutrition in Chronic Liver Disease: Analysis Using Indirect Calorimetry. Medicine (Baltimore) 2016; 95:e2442. [PMID: 26765430 PMCID: PMC4718256 DOI: 10.1097/md.0000000000002442] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We aimed to elucidate the incidence of protein-energy malnutrition (PEM) in patients with chronic liver disease and to identify factors linked to the presence of PEM.A total of 432 patients with chronic liver disease were analyzed in the current analysis. We defined patients with serum albumin level of ≤3.5 g/dL and nonprotein respiratory quotient (npRQ) value using indirect calorimetry less than 0.85 as those with PEM. We compared between patients with PEM and those without PEM in baseline characteristics and examined factors linked to the presence of PEM using univariate and multivariate analyses.There are 216 patients with chronic hepatitis, 123 with Child-Pugh A, 80 with Child-Pugh B, and 13 with Child-Pugh C. Six patients (2.8%) had PEM in patients with chronic hepatitis, 17 (13.8%) in patients with Child-Pugh A, 42 (52.5%) in patients with Child-Pugh B, and 10 (76.9%) in patients with Child-Pugh C (P < 0.001). Multivariate analysis revealed that Child-Pugh classification (P < 0.001), age ≥64 years (P = 0.0428), aspartate aminotransferase (AST) ≥40 IU/L (P = 0.0023), and branched-chain amino acid to tyrosine ratio (BTR) ≤5.2 (P = 0.0328) were independent predictors linked to the presence of PEM. On the basis of numbers of above risk factors (age, AST, and BTR), the proportions of patients with PEM were well stratified especially in patients with early chronic hepatitis or Child-Pugh A (n = 339, P < 0.0001), while the proportions of patients with PEM tended to be well stratified in patients with Child-Pugh B or C (n = 93, P = 0.0673).Age, AST, and BTR can be useful markers for identifying PEM especially in patients with early stage of chronic liver disease.
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Affiliation(s)
- Hiroki Nishikawa
- From the Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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Leonhard N, Aeberhard C, Birrenbach T, Stanga Z. [An Uncommon Diagnosis]. Praxis (Bern 1994) 2015; 104:1151-1156. [PMID: 26463907 DOI: 10.1024/1661-8157/a002163] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report on a 61-year-old patient who suffered from severe protein-energy malnutrition due to an inadequately treated exocrine pancreatic insufficiency. In this context, a thiamine deficiency was not recognized and there were clinical manifestations of beriberi disease with decompensated biventricular heart failure. In the course of time, a manifest niacin deficiency (pellagra) with dermatitis, diarrhea and persistent delirium occurred, which was recognized and could be treated. We highlight differential diagnostic considerations about the consequences and the treatment of malnutrition, with special focus on the classical deficiency diseases beriberi and pellagra.
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Affiliation(s)
- Nicole Leonhard
- 1 Universitätsklinik für Endokrinologie, Diabetologie und Klinische Ernährung, Inselspital Bern
| | - Carla Aeberhard
- 2 Universitätsklinik für Allgemeine Innere Medizin, Universitätsspital, Inselspital Bern
| | - Tanja Birrenbach
- 2 Universitätsklinik für Allgemeine Innere Medizin, Universitätsspital, Inselspital Bern
| | - Zeno Stanga
- 1 Universitätsklinik für Endokrinologie, Diabetologie und Klinische Ernährung, Inselspital Bern
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Berthélemy P, Bouisson M, Vellas B, Moreau J, Nicole-Vaysse, Albarede JL, Ribet A. Postprandial Cholecystokinin Secretion in Elderly with Protein-Energy Undernutrition. J Am Geriatr Soc 2015; 40:365-9. [PMID: 1372922 DOI: 10.1111/j.1532-5415.1992.tb02136.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 11/30/2022]
Abstract
OBJECTIVE Malnutrition is currently observed in aged people, and cholecystokinin is an important peripheral satiety signal. The aim of this study was to examine the effect of aging and protein-energy malnutrition on postprandial cholecystokinin (CCK) release. DESIGN Non-randomized, cross-sectional comparison by age group. SETTING Gastroenterology section of a teaching hospital. PARTICIPANTS Twenty-one human volunteers divided into three groups: young healthy subjects (Group 1: mean 29 years, n = 7), aged healthy subjects (Group 2, mean 80 years, n = 7), and aged subjects with an important degree of malnutrition (Group 3, mean 84.6 years, n = 7). INTERVENTION Each subject ingested a standardized liquid meal after an overnight fast. MAIN OUTCOME MEASURES Plasma cholecystokinin was measured using a sensitive bioassay before and after the ingestion of the liquid meal. RESULTS Basal cholecystokinin levels were similar (0.9 to 1 pM equivalent CCK-8) in the three groups. Postprandial levels were significantly increased over basal (P less than 0.05). The maximal cholecystokinin value was lower in Group 1 (3.5 +/- 0.8 pM equivalent CCK-8) and Group 2 (3.3 +/- 0.77 pM equivalent CCK-8) than in Group 3 (8.3 +/- 2 pM equivalent CCK-8) (P less than 0.05). Integrated plasma cholecystokinin was also similar in Group 1 (171 +/- 38 pM.60 min), (P less than 0.05). CONCLUSION The increase of postprandial maximal levels of cholecystokinin is more related to malnutrition than to aging.
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Affiliation(s)
- P Berthélemy
- Service des Maladies d l'Appareil Digestif, CHU Rangueil, Toulouse, France
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Bhattacharyya AK. Protein-energy malnutrition (Kwashiorkor-Marasmus syndrome): terminology, classification and evolution. World Rev Nutr Diet 2015; 47:80-133. [PMID: 3088855 DOI: 10.1159/000412332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Pouyssegur V, Brocker P, Schneider SM, Philip JL, Barat P, Reichert E, Breugnon F, Brunet D, Civalleri B, Solere JP, Bensussan L, Lupi-Pegurier L. An innovative solid oral nutritional supplement to fight weight loss and anorexia: open, randomised controlled trial of efficacy in institutionalised, malnourished older adults. Age Ageing 2015; 44:245-51. [PMID: 25324332 DOI: 10.1093/ageing/afu150] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults>70 years with protein-energy malnutrition. The innovation of these high-protein and high-energy cookies was the texture adapted to edentulous patients (Protibis®, Solidages, France). DESIGN An open, multicentre, randomised controlled trial. SETTING Seven nursing homes. PARTICIPANTS One hundred and seventy-five malnourished older adults, aged 86±8 years. INTERVENTION All participants received the standard institutional diet. In addition, Intervention group participants received eight cookies daily (11.5 g protein; 244 kcal) for 6 weeks (w0-w6). MEASUREMENTS Five visits (w-4, w0, w6, w10 and w18). MAIN OUTCOME Percentage of weight gain from w0 to w6 (body mass in kg). SECONDARY OUTCOMES Appetite, rated using a numerical scale (0: no appetite to 10: extremely good appetite); current episodes of pressure ulcers and diarrhea. RESULTS Average weight increased in Intervention group (n=88) compared with Control group (n=87) without cookies supplementation (+1.6 versus -0.7%, P=0.038). Weight gain persisted 1 month (+3.0 versus -0.2%, P=0.025) and 3 months after the end of cookies consumption (+3.9 versus -0.9%, P=0.003), with diarrhea reduction (P=0.027). There was a synergistic effect with liquid/creamy dietary supplements. Subgroup analysis confirmed the positive impact of cookies supplementation alone on weight increase (P=0.024), appetite increase (P=0.009) and pressure ulcers reduction (P=0.031). CONCLUSION The trial suggested that, to fight against anorexia, the stimulation of touch (finger food; chewing, even on edentulous gums) and hearing (intra-oral sounds) could be valuable alternatives to sight, smell and taste alterations.
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Affiliation(s)
- Valerie Pouyssegur
- MICORALIS Laboratory, School of Dentistry, University Nice Sophia Antipolis, Nice, France Department of Dentistry, Nice University Hospital, Nice, France
| | - Patrice Brocker
- Department of Geriatrics, Nice University Hospital, Nice, France
| | | | | | | | | | | | | | | | | | | | - Laurence Lupi-Pegurier
- MICORALIS Laboratory, School of Dentistry, University Nice Sophia Antipolis, Nice, France Department of Dentistry, Nice University Hospital, Nice, France
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Bašić-Jukić N, Radić J, Klarić D, Jakić M, Vujičić B, Gulin M, Krznarić Z, Pavić E, Kes P, Jelaković B, Rački S. [Croatian guidelines for screening, prevention and treatment of protein-energy wasting in chronic kidney disease patients]. Lijec Vjesn 2015; 137:1-8. [PMID: 25906541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There is a high incidence of cardiovascular morbidity and mortality among patients with chronic kidney disease (CKD) and malnutrition is a powerful predictor of cardiovascular morbidity and mortality in this population of patients. A multitude of factors related to CKD and renal replacement therapy can affect the nutritional status of CKD patients and lead to the development of malnutrition. In patients with CKD, protein energy wasting (PEW) is a condition that is distinct from undernutrition and is associated with inflammation, increased resting energy expenditure, low serum levels of albumin and prealbumin, sarcopenia, weight loss and poor clinical outcomes. Nutritional and metabolic derangements are implicated for the development of PEW in CKD and leading to the development of chronic catabolic state with muscle and fat loss. Prevention is the best way in treating PEW. Appropriate management of CKD patients at risk for PEW requires a comprehensive combination of strategies to diminish protein and energy depletion, and to institute therapies that will avoid further losses. The mainstay of nutritional treatment in MHD patients is nutritional counselling and provision of an adequate amount of protein and energy, using oral supplementation as needed. Intradialytic parenteral nutrition and total enteral nutrition should be attempted in CKD patients who cannot use the gastrointestinal tract efficiently. Other strategies such as anemia correction, treatment of secondary hyperparathyroidism and acidosis, delivering adequate dialysis dose can be considered as complementary therapies in CKD patients. Multidisciplinary work of nephrologists, gastroenterologist and dietician is needed to achieve best therapeutic goals in treating CKD patients with PEW.
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Keller H, Allard JP, Laporte M, Davidson B, Payette H, Bernier P, Jeejeebhoy K, Duerksen DR, Gramlich L. Predictors of dietitian consult on medical and surgical wards. Clin Nutr 2014; 34:1141-5. [PMID: 25510874 DOI: 10.1016/j.clnu.2014.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 08/18/2014] [Revised: 11/04/2014] [Accepted: 11/14/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIM Guidelines promote dietitian consult (DC) for nutrition support. In Canada, dietitians are involved in the assessment of malnutrition and provide specialized dietary counseling. It is unknown however, what leads to a DC for patients fed orally. This study identifies independent predictors for a DC and determines what is the proportion of malnourished patients seeing a dietitian. METHODS The Canadian Malnutrition Task Force conducted a prospective cohort study in medical and surgical wards of 18 Canadian hospitals. 947 patients who did not receive enteral or parenteral nutrition were analyzed. At admission, subjective global assessment (SGA), body mass index, patient demography were collected. During hospitalization clinical data, including dietary intake and presence of a DC were obtained. Multivariate logistic regression was completed with dietitian consult ≤ 3 days and 4 + days as the outcome variables. RESULTS The prevalence of malnutrition (SGA B + C) was 45%. Dietitians were consulted for 23% of patients, and of these consults 44% were well nourished (SGA-A), 37% were mildly/moderately malnourished (SGA-B), and 19% were severely malnourished (SGA-C). DC missed 75% of the SGA-B and 60% of SGA-C patients. Predictors of consultation within 3 days of hospitalization were: renal diet (OR 5.75) modified texture diet (OR 5.38), metabolic diagnosis (3.91), ONS use pre-admission (OR 2.33), severe malnutrition (SGA-C, OR 1.88) and age (OR 0.98). Predictors for 4 + days were: dysphagia (OR 11.4), a new medical diagnosis (OR 2.3), severe malnutrition (OR 2.17), constipation (OR 2.16), more than one diagnosis (OR 1.8), antibiotic use (OR 1.6), and male gender (OR 1.6). Consuming < 50% of food in the first week was not a predictor as only 19% of those with low intake had a DC at 4 + days. CONCLUSIONS Overall predictors of DC were appropriate but SGA B and C patients and those eating <50% were missed. Screening at admission with algorithms of care that include referral to the dietitian are needed to improve the process of nutrition care.
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Affiliation(s)
- Heather Keller
- Schlegel-UW Research Institute for Aging, University of Waterloo, 200 University Avenue, West Waterloo, ON, N2L 3G1, Canada.
| | - Johane P Allard
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, 585 University Avenue, 9N-973, Toronto, ON, M5G 2C4 Canada
| | - Manon Laporte
- Reseau de sante Vitalite Health Network, Campbellton Regional Hospitals, 189 Lily Lake Road, PO Box 880, Campbellton, NB, E3N 3H3, Canada
| | | | - Helénè Payette
- Université de Sherbrooke, Research Center on Aging, CSSS-IUGS, 1036, Belvedere Street, Sherbrooke, QC, J1H 4C4, Canada
| | - Paule Bernier
- Jewish General Hospital, 3755 ch Cote Ste-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Khursheed Jeejeebhoy
- Department of Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Donald R Duerksen
- Department of Medicine, Division of Gastroenterology, C5120 409 Tache Avenue, St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada
| | - Leah Gramlich
- University of Alberta, Division of Gastroenterology, Room 214, Community Services Centre, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada
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Zhang L, Li Z, Luo B, Li Z, Jing Y. [Effects of different intakes of protein on nutritional status in severe stroke patients]. Wei Sheng Yan Jiu 2014; 43:929-932. [PMID: 25603601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the effects of different intake of protein on nutritional indicators in severe stroke patients. METHODS 89 patients with severe stroke and NRS-2002 scores not less than 3 were enrolled. The patients were divided into group A, group B and group C by random, and 28 cases were in group A with protein intake at 0.9 g/kg, 30 cases were in group B with protein intake at 1.2 g/kg and 31 cases were in group C with protein intake at 1.6 g/kg, all patients were given the same calories support (25 kcal/kg). On the day of pre-intervention, the 7th and 14th day of post-intervention, fasting blood samples were collected from every subjects. The total protein (TP), albumin (ALB), hemoglobin (Hb), creatinine (Cr), blood urea nitrogen (BUN), midarm circumference (MAC) and calf circumference (CC) were recorded. RESULTS (1) The MAC and CC of health side body decreased on the 14th day post-intervention in group A and group B, the differences were significant compared with pre-intervention and on the 7th day post-intervention (P < 0.05), but there were no statistical differences between group A and group B. The index of group C had no significant changes from pre-intervention to the 14th day post-intervention. The differences among the three groups were statistically significant on the 14th day post-intervention (P < 0.05). (2) TP, ALB and Hb in group A were decreased from pre-intervention to the 14th day post-intervention, the differences were statistically significant. The levels of TP and Hb decreased in group B during the observation period, the differences were statistically significant. ALB in group B was decreased on the 7th day post-intervention, but it was increased on the 14th day post-intervention, there was no statistical difference compared with pre-intervention. The levels of TP, ALB and Hb in group C had no significant differences on the 7th day post-intervention, but they all increased on the 14th day post-intervention. The differences of ALB and Hb in group C were statistically significant on the 14th day post-intervention compared with pre-intervention and on the 7th day post-intervention. The differences of TP, ALB and Hb among the three groups were statistically significant on the 14th day post-intervention. (3) Cr in the three groups did not have significant differences during the observation period. BUN of group A and group B were both increased post-interventinon, the differences were statistically significant compared with pre-intervention and there were statistically significant differences between group A and group B (P < 0.05). BUN in group C did not have significant changes during the observation period. On the 14th day post-intervention, the differences of BUN were statistically significant among the three groups (P < 0.05). CONCLUSION The nutritional effect of protein intake at 1.6 g/kg is better than 0.9 g/kg and 1.2 g/kg on improving the nutritional status in severe stroke patients.
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Affiliation(s)
- Li Zhang
- The 3rd Hospital of Hebei Medical University, Shijiazhuang 050051, China.
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Toshikuni N, Arisawa T, Tsutsumi M. Nutrition and exercise in the management of liver cirrhosis. World J Gastroenterol 2014; 20:7286-7297. [PMID: 24966599 PMCID: PMC4064074 DOI: 10.3748/wjg.v20.i23.7286] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/22/2014] [Accepted: 05/05/2014] [Indexed: 02/07/2023] Open
Abstract
Liver cirrhosis (LC) patients often have protein-energy malnutrition (PEM) and decreased physical activity. These conditions often lead to sarcopenia, which is the loss of skeletal muscle volume and increased muscle weakness. Recent studies have demonstrated that PEM and sarcopenia are predictors for poor survival in LC patients. Nutrition and exercise management can improve PEM and sarcopenia in those patients. Nutrition management includes sufficient dietary intake and improved nutrient metabolism. With the current high prevalence of obesity, the number of obese LC patients has increased, and restriction of excessive caloric intake without the exacerbation of impaired nutrient metabolism is required for such patients. Branched chain amino acids are good candidates for supplemental nutrients for both obese and non-obese LC patients. Exercise management can increase skeletal muscle volume and strength and improve insulin resistance; however, nutritional status and LC complications should be assessed before an exercise management regimen is implemented in LC patients. The establishment of optimal exercise regimens for LC patients is currently required. In this review, we describe nutritional status and its clinical impact on the outcomes of LC patients and discuss general nutrition and exercise management in LC patients.
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Khrykov GN, Manikhas GM, Strukov EI, Khanevich MD, Fridman MK. [Influence of nutritive support on surgery outcomes in elderly patients with colon cancer]. Vestn Khir Im I I Grek 2014; 173:77-81. [PMID: 25306641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The article presents the results of surgery outcomes in 127 elderly patients with colon cancer. The patients were divided into two groups: the main group (prospective, n = 52) and control group (retrospective, n = 75). The combined preoperative nutritive status assessment by BMI and a prognostic hypotrophy index were used. It included the optimization of nutritive support on all stages and an early tube removal, an enteral feeding during postoperative period. It was stated, that it significantly reduced the level of complications, period of intensive care unit stay on 2 days and a hospital stay on 4 days in main group. All the patients of the main group improved the quality of life during 7 days (EORTC QIQ CR29). Proposed nutritive support program allowed improvement of the quality of life and positive treatment outcomes in elderly patients with colon cancer.
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Landendörfer P, Karsch-Völk M, Schneider A. [Eating and drinking in old age]. MMW Fortschr Med 2013; 155:38-41. [PMID: 24475668 DOI: 10.1007/s15006-013-2330-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Peter Landendörfer
- Allgemeinmedizin und Klinischer Geriater Institut für Aligemeinmedizin, Klinikum rechts der Isar Technische Universität München.
| | - Marlies Karsch-Völk
- Institut für Aligemeinmedizin, Klinikum rechts der Isar Technische Universität München
| | - Antonius Schneider
- Institut für Aligemeinmedizin, Klinikum rechts der Isar Technische Universität München
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Zeeh J. [Care of the frail elderly by primary physicians]. MMW Fortschr Med 2013; 155:37. [PMID: 24475667 DOI: 10.1007/s15006-013-2329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Ekramzadeh M, Sohrabi Z, Salehi M, Ayatollahi M, Hassanzadeh J, Geramizadeh B, Sagheb MM. Adiponectin as a novel indicator of malnutrition and inflammation in hemodialysis patients. Iran J Kidney Dis 2013; 7:304-308. [PMID: 23880808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 12/09/2012] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Protein-energy malnutrition and inflammation are common and overlapping conditions in hemodialysis patients, which are associated with increased risk of morbidity and mortality. Adiponectin is an adipocytokine exclusively produced by adipose tissue. The aim of this study was to further elucidate the association between serum adiponectin levels and the nutritional status of hemodialysis patients. MATERIALS AND METHODS Seventy-three patients on hemodialysis for at least 3 months, three times weekly, without any acute illness, were divided into 2 groups of well-nourished (n = 25) and malnourished (n = 48) based on their nutritional status, measured by the subjective global assessment. Serum levels of adiponectin, albumin, blood urea nitrogen, and creatinine; body mass index; and the malnutrition-inflammation score were measured in all patients. These values were compared between well-nourished and malnourished patients. The correlations of nutritional variables with serum levels of adiponectin were determined, as well. RESULTS Except for the malnutrition-inflammation score, which was significantly higher in the malnourished patients compared to the well-nourished ones (11.1 +/- 3.6 versus 4.2 +/- 2.0, P < .001), no other significant differences were found between the two groups. A weak but significant positive correlation was found between the serum levels of adiponectin and subjective global assessment scores (r = 0.25, P = .03). CONCLUSIONS The results of our study point to potential utility of serum adiponectin level as an indicator of nutritional status in hemodialysis patients. Further studies are needed to clarify the role of adiponectin in the pathogenesis of malnutrition in hemodialysis patients.
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Affiliation(s)
- Maryam Ekramzadeh
- Department of Nutrition, Shiraz School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran.
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Jariyapitaksakul C, Tannirandorn Y. The occurrence of small for gestational age infants and perinatal and maternal outcomes in normal and poor maternal weight gain singleton pregnancies. J Med Assoc Thai 2013; 96:259-265. [PMID: 23539926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess the occurrence of small for gestational age (SGA) infants and perinatal and maternal outcomes in singleton pregnancies with normal and poor maternal weight gain. MATERIAL AND METHOD Pregnant women with normal pre-pregnancy body mass index (BMI) and attending the antenatal clinic at King Chulalongkorn Memorial Hospital (KCMH) between 2006 and 2010 were eligible for the present study. The Thai population guidelines recommend a total weight gain of 10 to 16 kg or > or = 0.27 kg/week during pregnancy. In contrast, in 2009 the Institute of Medicine (IOM) guidelines recommended a total weight gain of 11.5 to 16 kg or > or = 0.31 kg/week. Our patients were analyzed using both sets of guidelines based on a normal pre-pregnancy BMI (18.5-24.9 kg/m2). SGA infants, perinatal outcomes, and maternal outcomes were compared between women whose weight gain met or exceeded the recommendations (normal weight gain) and women who did not meet these recommendations (poor weight gain). RESULTS A case-control of 1,152 singleton pregnancies was used for the analyses. Women with poor weight gain by the recommendation of the Thai population guidelines were significantly associated with SGA infants (1% in normal weight gain group and 2.6% in poor weight gain group adjusted odd ratio (aOR) 2.77, 95% confidence interval (CI) 1.06 to 7.28), preterm births (aOR 2.20, 95% CI 1.43 to 3.38), and low birth weight (LBW) infants (aOR 2.57, 95% CI 1.60 to 4.13). Women with poor weight gain by the recommendation in the 2009 IOM guidelines were significantly associated with preterm births (aOR 2.04, 95% CI 1.31 to 3.17), LBW infants (aOR 2.75, 95% CI 1.66 to 4.55), but not SGA infants (aOR 1.97, 95% CI 0.74 to 5.20). Maternal weight gain < 0.27 kg/week (Thai guidelines) was more likely to associate with SGA infants than maternal weight gain < 0.31 kg/week (2009 IOM guidelines). Women with normal weight gain by both recommendations were more likely to have pregnancy-induced hypertension and less likely to have gestational diabetes compared with women with poor weight gain. CONCLUSION Poor maternal weight gain during pregnancy was associated with SGA infants, preterm births, and LBW infants. The Thai guidelines were a better predictor of SGA infants. The 2009 IOM guidelines should be used with caution in Thai patients.
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Affiliation(s)
- Chutima Jariyapitaksakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Lialiukova EA. [Functional diseases of the digestive organs in patients with the connective tissue dysplasia]. Eksp Klin Gastroenterol 2013:14-17. [PMID: 24772869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Research objective was studying of features of functional diseases of digestive organs at patients with a dysplasia of a connecting tissue. In the conditions of the specialized Center of a dysplasia of a connecting tissue the assessment of a functional condition of digestive organs at 121 patients with signs of a dysplasia of a connecting tissue is carried out. High frequency of functional disorders of digestive organs at patients with a dysplasia of a connecting tissue (74-75%) is registered. Overlapping of syndromes of functional diseases (functional dyspepsia and syndrome of the angry intestine) it is registered at 73 +/- 3.9% of patients with DST, in group of comparison - at 9 +/- 2.3% (p &It; 0.001). Syndromes demonstrated against a wide range of changes of the digestive organs associated with a dysplasia of a connecting tissue. Existence of a dysplasia of a connecting tissue defines variety and features of a course of functional diseases of digestive organs, development of a syndrome of a maldigestiya and advance of an protein-energy malnutrition at this category of patients.
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Kouassi KC, Lamboni C. [Protein-calorie nutritional state in elderly patients hospitalized in Lomé Campus university hospital: pilot study about 33 patients versus 30 reference cases registered in three care units]. Med Sante Trop 2013; 23:39-48. [PMID: 23693091 DOI: 10.1684/mst.2013.0155] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Objective. The aim of this study was to determine the protein-calorie nutritional status of elderly hospitalized patients admitted to the hepato-gastroenterology, cardiology and internal medicine departments of the Lomé Campus University Hospital and identify the endogenous and mixed undernutrition to provide patients with better nutrition and assistance. Methodology. This cross-sectional study conducted between April 1 and July 31, 2009, included 33 hospitalized case patients aged at least 55 years and 30 age-matched outpatient control subjects. Patients were evaluated according to body mass index (BMI), the Mini Nutritional Assessment (MNA), and their serum albumin, serum prealbumin and orosomucoid levels. Results. Among the hospitalized case patients, 37% had protein-calorie undernutrition (low serum albumin), and 73% were at risk of this undernutrition (low serum prealbumin). Five patients (16%) were endogenously undernourished and 17 (57%) exogenously undernourished. Six to 13% of the oupatient controls were undernourished and 33% at risk of undernutrition according to the MNA scale. A significant difference existed between the mean albumin values of case patients and controls (38 ± 9 g/L vs 46 ± 7 g/L, p = 0.002). Conclusion. Our results confirm that the elderly inpatients were regularly malnourished. Knowledge of their nutritional profile has allowed us to launch an improved nutritional assistance program and to supervise it properly.
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Affiliation(s)
- K C Kouassi
- École doctorale de biochimie, faculté des sciences, université de Lomé, unité de biochimie du CHU Campus de Lomé, BP 7544, Lomé, Togo.
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Seiler WO. [Chronic wounds: supplementation for better healing of ulcers]. MMW Fortschr Med 2012; 154 Spec No 3:99-103. [PMID: 23724727 DOI: 10.1007/s15006-012-1303-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Tsagari A, Toulis KA, Makras P, Skagias K, Galanos A, Lyritis G. Performance of the mini nutritional assessment score in the detection of vitamin D status in an elderly Greek population. Horm Metab Res 2012; 44:896-9. [PMID: 22692927 DOI: 10.1055/s-0032-1314856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 10/28/2022]
Abstract
The primary aim of the study was to explore the potential relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and Mini Nutritional Assessment (MNA) score, a surrogate for protein energy undernutrition, in elderly (≥65 years old) subjects with and without a hip fracture. A secondary aim of the study was to provide estimates of the MNA discriminatory performance in the detection of subjects with low levels of 25(OH)D (<20 ng/ml). The study population consisted of 101 patients with a hip fracture, recruited from a single urban Hospital in Athens, Greece, and 85 community dwelling subjects with no history of hip fracture. Serum 25(OH)D was measured, nutritional status was determined by the MNA questionnaire in all subjects, and linear correlation between variables was investigated. Receiver operator characteristic (ROC) curve analysis was performed and discriminatory performance was further assessed by calculating positive and negative likelihood ratios (LR). MNA scores were significantly correlated with 25(OH)D levels (rho=0.685, p<0.001) and this finding was robust in both groups and unaffected by gender. ROC curve analysis demonstrated an area under the curve (AUC) of 0.860 [standard error (SE): 0.026, 95% confidence interval (CI): 0.810-0.910], which provided a significantly better estimation of 25(OH)D status than simple guess (p<0.001). The lowest cutoff value in MNA score, providing a sensitivity over 90% was 25.25, which was associated with a sensitivity of 90.9% and a specificity of 53.6%. The same analysis revealed acceptable results only within hip fracture patients. MNA score might be a satisfactory surrogate marker for 25(OH)D levels with which it is linearly correlated. However, it appears that its discriminatory performance, as a diagnostic tool for 25(OH)D insufficiency, is rather suboptimal.
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Affiliation(s)
- A Tsagari
- Department of Nutrition, KAT General Hospital, Athens, Greece
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[Geriatrician: malnutrition in the elderly is underestimated. 6 simple questions shed light on the nutritional status of patients]. Pflege Z 2012; 65:583. [PMID: 23098023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
PURPOSE OF REVIEW Malnutrition, fatigue, frailty, vulnerability, sarcopenia and cachexia all phenotypically present with the same features because they are subject to the operation of similar mechanistic factors. However, the conditions referred to above differ by which mechanism dominates the cause of the clinical condition. This review discusses the overlap and differences, which distinguish as well as unite these different conditions and allow a rationale for treatment. RECENT FINDINGS In the continuum of malnutrition, cachexia, sarcopenia and frailty the recent activities focus on two areas. The first is a better understanding of the mechanisms of cachexia and sarcopenia and frailty. In particular, the differential effects of cytokines on muscle and on the hypothalamic system. The effects of inactivity promoting the loss of body mass in cachexia and sarcopenia as well as the positive effects of exercise. The second is the development of a synthesis of available literature to develop consensus documents about the definition, causes, diagnosis and treatment of cachexia, sarcopenia and frailty. SUMMARY Loss of body tissues resulting in wasting is a common phenotype for several different conditions which can be caused by a combination of reduced food intake, excessive requirements, altered metabolism, sepsis, trauma, ageing and inactivity. They have been referred to loosely as malnutrition but in not all will respond to simply providing nutrients. In this review the common features and the differences as they relate to cause and response to treatment are discussed.
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Abstract
Protein-energy-malnutrition is a growing problem in industrialised countries. Many studies have found malnourishment in 20-60% of hospitalized medical or surgical patients, as well as out-patients. Malnutrition negatively influences patients' prognosis, immune system, muscle strength, and quality of life. As it is a largely treatable co-morbidity, systematic screening for malnutrition and effective management will improve patient outcomes and reduce healthcare costs. Early diagnosis and assessment depends on a simple and standardised screening tool that identifies at-risk patients, allowing the medical team in charge to solve patients' nutritional problems with an interdisciplinary approach.
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Affiliation(s)
- M S Leuenberger
- Poliklinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Bern
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Abstract
The Wernicke Encephalopathy (WE) as a result of a (sub)acute thiamine deficiency remains, unfortunately, still under-diagnosed, especially among non-alcoholics. It should be considered in each occurrence of delirium as well as in any ocular motor disorder and ataxia, in particular if there is a history of weight loss with or without gastrointestinal symptoms. In cases with suspected WE an immediate intravenous substitution of 3×200 mg/d is recommended.
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Affiliation(s)
- O Felix
- Luzerner Psychiatrie, Klinik Luzern
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Weibel M, Ossola N. [To start eating again could be dangerous]. Praxis (Bern 1994) 2012; 101:55-58. [PMID: 22219076 DOI: 10.1024/1661-8157/a000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 36-year-old woman with anorexia nervosa and resulting malnutrition decided to change her life and eat properly. One day after the refeeding start, instead of feeling better she felt much worse: fatigue, nausea and leg swelling occurred. She consulted our emergency department. A «refeeding syndrome» has been diagnosed. In this case report we discuss causes, clinical presentation and treatment of this illness. The aim is to make practitians aware about the existing of this disease even with oral refeeding. Warning signs have to be interpreted correctly in order to avoid dramatic consequences.
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Affiliation(s)
- M Weibel
- Abteilung Innere Medizin, Ospedale Regionale Beata Vergine, Mendrisio
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Dashti N, Einollahi N, Nabatchian F, Moradi Sarabi M, Zarebavani M. Significance of albumin and C-reactive protein variations in 300 end stage renal disease patients in Tehran University of Medical Sciences Hospitals during year 2010. Acta Med Iran 2012; 50:197-202. [PMID: 22418989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Protein- energy malnutrition, wasting and inflammation are frequent complication among patients with end-stage renal disease (ESRD). Malnutrition is associated with cardiac co-morbidity, inflammation and poor survival in ESRD patients. Serum albumin is a well-known marker of nutrition in ESRD patients. Serum albumin is still the most commonly used nutritional marker in ESRD patients. C-reactive protein (CRP), the major acute phase response (APR) protein is elevated in these patients. High CRP levels are linked to the degree of atherosclerosis in coronary, peripheral, and extracranial brain arteries. The aim of the present study was to investigate nutritional factor (albumin) and CRP levels in ESRD patients. In this cross- sectional study a total of 300 patients who had ESRD and had been on hemodialysis treatment for at least 6 months were selected. The laboratory tests consisted of measurement of CRP and albumin using high sensitive ELISA kits. The study patients included 157 males (52.3%) and 143 females (47.7%) with average age of 41.5 ± 14.3 years. Mean CRP level was 7.96 mg/ dl (±1.52), mean serum albumin was 4.07 g/dl (±0.19).Of 300 patients, 21 died (7%). These were patients with serum albumin <4 g/dl and CRP>9.5 mg/dl. This study showed that low albumin and high CRP levels are the main predictors for death. There was a significant difference between CRP and albumin levels in ESRD patients (P<0.0001). Measuring CRP as a marker of inflammation can be helpful in managing these patients.
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Affiliation(s)
- Nasrin Dashti
- Department of Clinical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Iran
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