The influence of patients' nutritional risk, nutritional status, and energy density in MEDPass versus conventional administration of oral nutritional supplements - A secondary analysis of a randomized controlled trial

OBJECTIVES

The clinical influence of nutritional risk, nutritional status, and energy density of oral nutritional supplements (ONS) in MEDPass versus conventional administration of ONS is currently unknown. The aim of this analysis was to examine whether these variables have an impact on clinical outcomes.

METHODS

Secondary analysis of the intention to treat dataset of the randomized controlled MEDPass Trial in geriatric and medical inpatients. Patients in the intervention group received 4 × 50 ml ONS during the medication rounds (MEDPass mode), while those in the control group received ONS in a non-standardized manner. The examined endpoints included energy and protein coverage, ONS intake, handgrip strength (HGS), weight, appetite nausea and 30-day mortality. Three subgroup analyses for NRS 2002 total score (3, 4 or 5-7 points), NRS 2002 impaired nutritional status score (0, 1, 2 or 3 points) and energy density of the ONS (1.5 kcal/mL or 2 kcal/mL) were performed using linear and logistic regression with interaction and mixed effect models.

RESULTS

The data of 202 patients (103 women and 99 men) at nutritional risk (NRS total 2002 score ≥3), mean (SD) age 82.2 (6.5) years were included. There was no significant difference between the groups in the primary endpoint energy coverage in all three subgroup analyses. There were also no significant differences between the groups in the secondary endpoints of protein coverage, ONS intake, HGS, weight, appetite, nausea, and 30-day mortality.

CONCLUSION

The MEDPass mode of ONS administration was not superior to the conventional mode of administration in this study. ONS with high energy density (≥2 kcal/mL) should be offered since current evidence shows a tendency towards improved appetite, increased ONS and increased energy intake.

Application value of NRS2002 and PG-SGA in nutritional assessment for patients with cervical cancer surgery

OBJECTIVE

This study explored and analyzed the application value of nutritional risk screening 2002 (NRS2002) and patient-generated subjective nutrition assessment (PG-SGA) in nutritional assessment for patients with cervical cancer surgery.

METHODS

A total of 165 cervical cancer patients that received elective cervical cancer surgery from February 2017 to December 2019 were chosen as the research subjects. NRS 2002 and PG-SGA were employed to evaluate the nutritional status of patients, and detect their nutrition-related laboratory examination indexes. By using albumin (ALB)≤30 g/L as the criterion of malnutrition, the accuracy of NRS2002 and PG-SGA in evaluating the nutritional status of patients was analyzed.

RESULTS

The differences between scores of NRS2002 and PG-SGA in age, BMI, tumor stage, pelvic lymph node metastasis were statistically significant (P<0.05); while the difference between scores of NRS2002 and PG-SGA in different education degree, pathological type and growth type of patients was statistically insignificant (P>0.05). By using ALB≤30 g/L as the gold standard to determine malnutrition, 64 malnourished patients were detected, with a detection rate of 38.79%. Compared with this gold standard, the judgment of NRS 2002 and PG-SGA have high consistency with the gold standard, and the Youden indexes were 0.550 and 0.795 respectively. In addition, the nutritional or malnutrition risk of cervical cancer patients was assessed by NRS2002 and PG-SGA, respectively. Among them, 33 patients received co-diagnosis, the results had remarkably correlation (P<0.05) with contingency coefficient r of 0.523.

CONCLUSION

Both NRS2002 and PG-SGA are suitable for preoperative nutritional risk screening of patients with cervical cancer surgery. PG-SGA has a higher positive rate but poor time requirement than that of RS2002. Therefore, clinicians can choose the appropriate tool on the basis of an individual patient's situation for nutritional assessment.

Malnutrition is not related with emergence delirium in older patients after noncardiac surgery

Background

Delirium is one of the most common complications in older surgical patients. Although previous studies reported that preoperative malnutrition was related with postoperative delirium (POD), there was lack of evidence to illustrate the relationship between malnutrition and emergency delirium (ED). The objective of this study was to investigate the relationship between preoperative malnutrition and ED in older patients undergoing noncardiac surgery.

Methods

The study was carried out in accordance with STROBE guidelines. This was a secondary analysis of a prospective cohort study. Older patients (65–90 years) who underwent noncardiac surgery under general anesthesia were enrolled in Peking University First Hospital.

Results

915 patients were enrolled. The incidence of malnutrition was 53.6 % (490/915). The incidence of emergency delirium was 41.8 % (205/490) in malnutrition group and 31.5 % (134/425) in control group, P < 0.001. After adjusting confounding factors (i.e., age, cognitive impairment, American Society of Anesthesiologists classification (ASA), duration of surgery, pain score, low body temperature and allogeneic blood transfusion), malnutrition was not associated with increased risk of emergency delirium (OR = 1.055, 95 % CI 0.767–1.452, P = 0.742).

Conclusions

Malnutrition was common in older patients undergoing non-cardiac surgery, but it’s not related with emergence delirium after adjusted for confounders.

Trial registration

Chinese Clinical Trial Registry (http://www.chictr.org.cn) (ChiCTR-OOC-17,012,734).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02270-2.

[Changes in nutritional status of patients with different diseases during hospitalization]

Objective: To evaluate changes in nutritional status of hospitalized patients with different diseases by subjective global assessment (SGA) and nutritional risk screening (NRS-2002). Methods: A prospective and parallel research done by multi-center collaboration from 34 hospitals in China from June to September 2014. Hospitalized patients with the following diseases were investigated: malignant tumor (2 487 cases), benign disease of the digestive system (1 358 cases), benign disease of the nervous system (1 043 cases), benign bone disease (451 cases), benign disease of the respiratory system(395 cases), cardiovascular disease (227 cases), benign thyroid and breast disease (179 cases), and endocrine disease (149 cases). Patients above the age of 18 and hospitalization time between 7-30 days were included. Physical indexes were measured, the NRS-2002 and SGA scores were recorded, the nutritional support were recorded during hospitalization and 24 hours after discharge from hospital. Measurement data between groups were analyzed using t test or Wilcoxon rank sum test, enumeration data and ranked data between groups were analyzed using chi-square test or Fisher exact test. Results: There were 6 638 cases of hospitalized patients, 3 861 cases were males and 2 777 were females, the male/female ratio was 1.4∶1.0; the median age was 60 years; the median height was 1.66 m; the median weight was 62 kg; the median body mass index (BMI)was 22.89 kg/m(2). At discharge, compared with that of admission, the body weight, BMI, grip strength, upper arm and calf circumferences of patients with malignant tumor were significantly decreased (t=20.15-259.67, all P<0.01); the body weight and calf circumference were significantly decreased (t=35.27, 60.40, P<0.01)of patients with digestive benign disease; the body weight of patients with benign bone diseases was decreased (t=2.12, P=0.033); the body weight, grip strength and upper arm circumference were decreased in patients with benign thyroid and breast disease (t=2.79-10.18, all P<0.01); nutritional risk incidence rate (from NRS-2002) of patients with malignant tumor was significantly higher(χ(2)=21.275, P=0.000); moderate malnutrition (from SGA) incidence rate was significantly higher(χ(2)=62.318, P=0.000; χ(2)=11.312, P<0.01) in patients with malignant tumor and with orthopedics diseases. Compared with that of admission, records of the patients with other diseases had no statistically difference at discharge, no more than 50% of the patients under risk of nutritional deficiency(except those with digestive benign diseases )received nutritional support, while the proportion of non-parenteral nutrition application was higher. Conclusion: The patients with malignant tumor have higher incidence rate of malnutrition on admission and at discharge. Doctors should pay more attention to the nutritional status(screening and evaluation) of patients before discharge and use appropriate and adequate nutrition support in order to prevent the weight loss and improve the life quality of patients.

Screening of nutritional risk and nutritional support in general surgery patients: a survey from Shanghai, China

To determine the prevalence of nutritional risk in surgical departments and to evaluate the impact of nutritional support on clinical outcomes. The nutritional risk in different surgical diseases and the different way of nutritional support on clinical outcomes in patients at nutritional risk remain unclear. Hospitalized patients from general surgical departments were screened using the Nutritional Risk Screening (NRS) 2002 questionnaire on admission. Data were collected on nutritional risk, complications, and length of stay (LOS). Overall, 5034 patients were recruited; the overall prevalence of nutritional risk on admission were 19.2%. The highest prevalence was found among patients with gastric cancer. At-risk patients had more complications and longer LOS than nonrisk patients. Of the at-risk patients, the complication rate was significantly lower and LOS was significantly shorter in the nutritional-support group than in the no-support group (20.9 versus 30.0%, P < 0.05). Subgroup analysis showed reduced complication rates and LOS only in patients with gastric cancer, colorectal cancer, and hepato-pancreato-biliary (HPB) cancer. Significantly lower complication rates relative to nonsupported patients were found among patients who received enteral nutrition or who received support for 5 to 7 days, or daily support entailing 16 to 25 kcal/kg of nonprotein energy. Different surgical diseases have different levels of nutritional risk. The provision of nutritional support was associated with a lower complication rate and a shorter LOS for gastric, colorectal, and HPB cancer patients at nutritional risk. The improper use of nutritional support may not improve outcomes for at-risk patients.