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A simpler screening tool for sarcopenia in surgical patients.
Chaiwat, O, Wongyingsinn, M, Muangpaisan, W, Chalermsri, C, Siriussawakul, A, Pramyothin, P, Thitisakulchai, P, Limpawattana, P, Thanakiattiwibun, C
PloS one. 2021;(9):e0257672
Abstract
BACKGROUND Sarcopenia is defined as decreased skeletal muscle mass and muscle functions (strength and physical performance). Muscle mass is measured by specific methods, such as bioelectrical impedance analysis and dual-energy X-ray absorptiometry. However, the devices used for these methods are costly and are usually not portable. A simple tool to screen for sarcopenia without measuring muscle mass might be practical, especially in developing countries. The aim of this study was to design a simple screening tool and to validate its performance in screening for sarcopenia in older adult cancer patients scheduled for elective surgery. METHODS Cancer surgical patients aged >60 years were enrolled. Their nutritional statuses were evaluated using the Mini Nutrition Assessment-Short Form. Sarcopenia was assessed using Asian Working Group for Sarcopenia (AWGS) criteria. Appendicular skeletal muscle mass was measured by bioelectrical impedance analysis. Four screening formulas with differing combinations of factors (muscle strength, physical performance, and nutritional status) were assessed. The validities of the formulas, compared with the AWGS definition, are presented as sensitivity, specificity, accuracy, and area under a receiver operating characteristic curve. RESULTS Of 251 enrolled surgical patients, 84 (34%) were diagnosed with sarcopenia. Malnutrition (odds ratio [OR]: 2.89, 95% CI: 1.40-5.93); underweight status (OR: 2.80, 95% CI: 1.06-7.43); and age increments of 5 years (OR: 1.78, 95% CI: 1.41-2.24) were independent predictors of preoperative sarcopenia. The combination of low muscle strength and/or abnormal physical performance, plus malnutrition/risk of malnutrition had the highest sensitivity, specificity, and accuracy (81.0%, 78.4%, and 79.3%, respectively). This screening formula estimated the probability of sarcopenia with a positive predictive value of 65.4% and a negative predictive value of 89.1%. CONCLUSION Sarcopenia screening can be performed using a simple tool. The combination of low muscle strength and/or abnormal physical performance, plus malnutrition/risk of malnutrition, has the highest screening performance.
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Under nutrition and associated factors among adolescent girls attending school in the rural and urban districts of Debark, Northwest Ethiopia: A community-based comparative cross-sectional study.
Alemu, TG, Muhye, AB, Ayele, AD
PloS one. 2021;(8):e0254166
Abstract
INTRODUCTION Adolescence is the time of puberty in which a substantial changes in physical, mental, and emotional are observed; Nutritional requirements significantly rise as a result. Even though improving adolescent girls' nutritional status helps to break the intergenerational cycle of malnutrition, many studies in Ethiopia focus on determining the nutritional status of under-five and pregnant women and even they don't show disparities between urban and rural adolescent girls. Thus, this study was aimed at comparing the rural and urban prevalence's of stunting and thinness and their associated factors among adolescent girls attending school in Debark district, Northwest Ethiopia, 2020. METHOD A community-based comparative cross-sectional study was conducted among 792 adolescent girls from February 25th to March 21st 2020. A multi-stage sampling followed by simple random sampling technique was used. Data were collected through a face-to-face interviewer-based questionnaire. Different anthropometric measurements were taken. The collected data were entered to Epi-data and exported into SPSS for analyses. Variables with p-values < 0.25 in the bivariable analysis were exported to multivariable logistic regression model to control confounders and identify the factor. The strength of association and statistical significance was declared using the adjusted odds ratios with its corresponding 95% CI, and p-value ≤ 0.05 respectively. RESULTS A total of 757 adolescent girls with a response rate of 95.6% were participated in the study. The overall prevalence of stunting and thinness were 20.1% and 10.3%, respectively. Stunting among rural adolescent girls was 24.2%; whereas it was 16% among urban residents. Likewise, thinness among rural adolescent girls was 8.5%; whereas it was 12.1% among urban dwellers. No latrine [AOR: 1.95 (95% CI: 1.11, 3.43)], lowest media exposure [AOR: 5.14 (95% CI: 1.16, 22.74)], lower wealth class [AOR:2.58 (95% CI: 1.310, 5.091)], and middle wealth class[AOR: 2.37 (95% CI: 1.230, 4.554)] have risen the likelihood of stunting in rural setting while early adolescent age [AOR:3.17 (95% CI:1.445,6.95)] significantly associated with stunting in urban setting. Food insecurity [AOR: 1.95 (95% CI: 1.01, 3.78)] was associated with stunting in overall adolescent girls. Middle adolescent age groups in rural area have more than three times to experience thinness [AOR: 3.67 (95% CI: 1. 21, 11.149)]. Whereas urban resident girls fall in early adolescent age group developed thinness were eight times [AOR: 8.39 (95% CI: 2.48-28.30)]. CONCLUSION Stunting was higher among rural adolescent girls as compared to urban. However, thinness was higher among urban dwellers. Lower wealth class, food insecurity, lowest media exposure, and age were significantly associated with stunting and thinness. Hence, increasing latrine coverage, boosting the economic status of the community, and increasing media exposure for adolescent girls should get due attention.
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Prediction of Hypoglycemia During Admission of Non-Critically Ill Patients: Results from the MENU Study.
Khanimov, I, Ditch, M, Adler, H, Giryes, S, Felner Burg, N, Boaz, M, Leibovitz, E
Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme. 2020;(9):660-668
Abstract
The objective of the work was to study admission parameters associated with an increased incidence of hypoglycemia during hospitalization of non-critically ill patients. Included in this cross-sectional study were patients admitted to internal medicine units. The Nutritional Risk Screening 2002 (NRS2002) was used for nutritional screening. Data recorded included admission serum albumin (ASA) and all glucose measurements obtained by the institutional blood glucose monitoring system. Neither of these are included in the NRS2002 metrics. Hypoalbuminemia was defined as ASA<3.5 g/dl. Patients were categorized as hypoglycemic if they had at least one documented glucose≤70 mg/dl during the hospitalization period. Included were 1342 patients [median age 75 years (IQR 61-84), 51.3% male, 52.5% with diabetes mellitus, (DM)], who were screened during three distinct periods of time from 2011-2018. The incidence of hypoglycemia was 10.8% with higher rates among DM patients (14.6 vs. 6.6%, p<0.001). Hypoglycemia incidence was negatively associated with ASA regardless of DM status. Multivariable regression showed that ASA (OR 0.550 per g/dl, 95% CI 0.387-0.781, p=0.001) and positive NRS2002 (OR 1.625, 95% CI 1.072-2.465, p=0.022) were significantly associated with hypoglycemia. The addition of hypoalbuminemia status to the NRS2002 tool improved the overall sensitivity from 0.55 to 0.71, but reduced specificity from 0.63 to 0.46. The negative predictive value was 0.93. Our data suggest that the combination of positive malnutrition screen and hypoalbuminemia upon admission are independently associated with the incidence of hypoglycemia among non-critically ill patients, regardless of diabetes mellitus status.
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Nutritional Assessment and Status of Hospitalized Infants.
Matsuyama, M, Bell, K, White, M, Lawson, K, David, M, Doolan, A, Todd, A
Journal of pediatric gastroenterology and nutrition. 2017;(3):338-342
Abstract
OBJECTIVES Malnutrition during infancy has long-term adverse consequences for both physical and psychological development. Early detection of malnutrition among hospitalized infants is essential to provide optimal nutrition support. The primary aim of the present study was to investigate the nutritional status of hospitalized infants using 2 methods: the Subjective Global Nutritional Assessment (SGNA) and anthropometric measurement. We also investigated diagnostic category associated with nutritional status, the mean anthropometric z scores, and explored the association between malnutrition and nutrition focused variables. METHODS Nutritional status of 110 hospitalized infants ages 31 days to 12 months was investigated using the SGNA and anthropometric measurements converted to z scores. RESULTS Utilizing the SGNA, 78 (70.9%) infants were classified as having normal nutritional status, 30 (27.3%) were moderately malnourished, and 2 (1.8%) were severely malnourished. The proportion of infants with acute malnutrition (weight-for-length z score <-2) was 16.4%, and chronic malnutrition (length-for-age z score <-2) was 3.6%. The mean anthropometric z scores of infants were significantly lower in infants identified as moderately and severely malnourished using the SGNA. Decrease in serial weight (odds ratio [OR] 44.4; 95% confidence interval [CI]: 4.3-451.5), having prolonged gastrointestinal symptoms (OR 18.8; 95% CI: 1.5-234.7), and reduced nutrition-related functional capacity (OR 27.6; 95% CI 2.5-301.7) were associated with malnutrition after adjusting for sex, age, and length of hospital stay. CONCLUSIONS Regardless of the method applied, cases of malnutrition amongst hospitalized infants were identified. The SGNA is a comprehensive approach to identifying malnutrition in hospitalized infants.
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Correlates of Physical Activity among Young Children with Moderate Acute Malnutrition.
Yaméogo, CW, Cichon, B, Fabiansen, C, Iuel-Brockdorf, AS, Shepherd, S, Filteau, S, Traoré, AS, Christensen, VB, Michaelsen, KF, Brage, S, et al
The Journal of pediatrics. 2017;:235-241
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Abstract
OBJECTIVE To assess the levels of physical activity among young children with moderate acute malnutrition and to identify clinical, biochemical, anthropometric, and sociodemographic correlates of physical activity. STUDY DESIGN In a cross-sectional study, 1609 children aged 6-23 months wore a triaxial accelerometer (ActiGraph GT3x+; ActiGraph, Pensacola, Florida) for 6 consecutive days, from which total physical activity were determined. Data on morbidity were collected based by history and physical examination, and serum C-reactive protein and α1-acid glycoprotein were measured. RESULTS A total of 1544 (96%) children had physical activity measured, of whom 1498 (97%) completed 6 consecutive days of physical activity recording with a daily median wear time of 24 hours. The mean (±SD) total physical activity was 707 (±180) vector magnitude counts per minute (cpm). Age was negatively correlated with physical activity; compared with children below 12 months of age, those 12-17 months of age, and 18-23 months of age had 51 (95% CI, 26; 75) and 106 (95% CI, 71; 141) cpm lower physical activity, respectively. Fever and malaria were associated with 49 (95% CI, 27; 70) and 44 (95% CI, 27; 61) cpm lower activity, respectively. Elevated serum C-reactive protein and α1-acid glycoprotein were both negative correlates of physical activity, and hemoglobin was a positive correlate. CONCLUSIONS Physical activity declines with age in children with moderate acute malnutrition and is also inversely related to infection and inflammatory status. Future studies are needed to ascertain cause and effect of these associations. TRIAL REGISTRATION Controlled-Trials.com: ISRCTN42569496.
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Moderately high-protein enteral formula improved retinol-binding protein in tube-fed patients: A multicentre open study.
Pisprasert, V, Shantavasinkul, PC, Rattanachaiwong, S, Lepananon, T, Komindr, S
Nutrition and health. 2017;(3):203-209
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BACKGROUND Long-term inadequate dietary consumption may increase the possibility of malnutrition, morbidity and mortality. Enteral nutrition (EN) is a beneficial support that could help to maintain nutritional status and gut function. AIM: Our aim was to evaluate the effect of moderately high-protein enteral formula containing fibre on nutritional status, and its safety. METHOD A total of 23 tube-feeding-dependent adult patients were included in this multicentre, open-label study. The patients were fed with the study formula for 7-12 days or equal to the required nutritional support period, during which we performed physical examinations and assessed nutritional status. The primary endpoint was the statistical difference in nutritional status after the treatment, and the secondary outcome was the desirable safety profile. RESULTS A significant improvement in cumulative energy balance after intervention was observed ( p = 0.008). However, the differences in nutritional status, weight and BMI before and after the intervention do not reach statistical significance. Retinol-binding protein (RBP), a marker for nutritional status, increased from baseline levels. Few cases of diarrhoea and constipation had been reported during the study as a safety concern. CONCLUSIONS This study investigated the efficacy and safety of an enteral feed formulation containing fibre. The patients were nourished with the studied formulation via tube feeding for a short period without serious adverse events. After the intervention, the significant increase in cumulative energy balance was observed. However, an extended period of the intervention may be required to attain the significance in other indicators for nutritional status.
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Malnutrition in patients with chronic GVHD.
Bassim, CW, Fassil, H, Dobbin, M, Steinberg, SM, Baird, K, Cole, K, Joe, G, Comis, LE, Mitchell, SA, Grkovic, L, et al
Bone marrow transplantation. 2014;(10):1300-6
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Malnutrition is a known complication of chronic GVHD (cGVHD), but has not been well described in the context of organ-specific manifestations and the recent National Institutes of Health (NIH) criteria. Here, 210 cGVHD patients were analyzed, in a cross-sectional study design, for demographics, transplant-related history, clinical assessments, symptoms, function, quality-of-life, laboratory values and survival in order to determine their associations with nutritional status. Most patients had long-standing, moderate or severe cGVHD and had failed many lines of therapy. Twenty-nine percent (60/210) of subjects were malnourished, using the subjective Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and evaluation. No demographic or transplant characteristics were associated with malnutrition; cGVHD of the lungs, gastrointestinal (GI) tract and mouth, NIH global score, cGVHD symptoms, worse functioning, low albumin, poorer survival and low BMI were associated with malnutrition. A predictive model was developed from all variables of significance: cGVHD of the lungs, GI tract, mouth and BMI accurately predicted 84.2% of malnourished patients as well as 87.2% of well-nourished patients. The PG-SGA questionnaire may be a useful tool in diagnosing nutritional deficits in cGVHD patients undergoing one-time evaluations. Longitudinal prospective studies should assess the utility of nutritional support interventions in cGVHD.
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The impact of the nutritional state of patients on the results of the surgical treatment of ulcerative colitis.
Skowrońska-Piekarska, U, Matysiak, K, Sowińska, A
Polski przeglad chirurgiczny. 2013;(8):424-32
Abstract
UNLABELLED A variety of mechanisms have been proposed to explain the malnutrition and body mass loss in UC patients. The aim of the study trial was a nutritional state assessment of 347 UC patients, admitted for surgical treatment, and the evaluation of the impact of this state on the postoperative course in this group of patients. MATERIAL AND METHODS We referred the results of nutritional state assessment to the length of time of postoperative hospitalization of patients. RESULTS Through application of the Kruskal-Wallis test we found statistically significant, but weakly expressed, differences between the values of nutritional state parameters and period of hospitalization of patients. The applied U Mann-Whitney test, with statistically significant results with p <0.05, showed statistically significant differences between cured and dead subgroups in: 1) loss of body mass in 6 months before hospitalization (p = 0.000033), 2) hemoglobin level (p = 0.006676), 3) total lymphocyte count (TLC) (p = 0.025242), 4) total serum protein level (p = 0.003485), 5) serum albumin level (p =0.00165). Differences in BMI values were statistically negligible (p = 0.969397). CONCLUSIONS The body mass loss in 6 months before admission, total lymphocyte count and serum albumin level are the reference parameters of the nutritional state of UC patients on admission to surgery.
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Resting energy expenditure in malnourished older patients at hospital admission and three months after discharge: predictive equations versus measurements.
Neelemaat, F, van Bokhorst-de van der Schueren, MA, Thijs, A, Seidell, JC, Weijs, PJ
Clinical nutrition (Edinburgh, Scotland). 2012;(6):958-66
Abstract
BACKGROUND Predicting resting energy expenditure (REE) in malnourished hospitalized older patients is important for establishing optimal goals for nutritional intake. Measuring REE by indirect calorimetry is hardly feasible in most clinical settings. OBJECTIVE To study the most accurate and precise REE predictive equation for malnourished older patients at hospital admission and again three months after discharge. DESIGN Twenty-three equations based on weight, height, gender, age, fat free mass (FFM) and/or fat mass (FM) and eleven fixed factors of kcal/kg were compared to measured REE. REE was measured by indirect calorimetry. Accuracy of REE equations was evaluated by the percentage patients predicted within 10% of REE measured, the mean percentage difference between predicted and measured values (bias) and the Root Mean Squared prediction Error (RMSE). RESULTS REE was measured in 194 patients at hospital admission (mean 1473 kcal/d) and again three months after hospital discharge in 107 patients (mean 1448 kcal/d). The best equations predicted 40% accuracy at hospital admission (Lazzer, FAO/WHO-wh and Owen) and 63% three months after discharge (FAO/WHO-wh). Equations combined with FFM, height or illness factor predicted slightly better. Fixed factors produce large RMSE's. All predictive equations showed proportional bias, with overestimation of low REE values and underestimation of high REE values. Correction by regression analysis did not improve results. CONCLUSIONS The REE predictive equations are not adequate to predict REE in malnourished hospitalized older patients. There is an urgent need for either a new accurate REE predictive equation, or accurate easy-to-use equipment to measure REE in clinical practice.
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Comparable increases in energy, protein and fat intakes following the addition of seasonings and sauces to an older person's meal.
Best, RL, Appleton, KM
Appetite. 2011;(1):179-82
Abstract
Under-nutrition in older individuals is a serious and growing problem, as a result, amongst other factors, of decreased intake. Research has shown some support for the use of flavour enhancers or flavoursome foods as a tool for increasing nutritional intake in older individuals. In this study, seasonings and sauces were added to an older person's meal to investigate and compare effects on food consumption. Participants' were 18 free-living older individuals from Belfast. They consumed three meals on three separate occasions: one with seasoning, one with sauce, and one without seasoning or sauce, and intakes of energy, protein, carbohydrate and fat were compared. Other measures included pre and post-meal hunger and desire to eat, and pleasantness, familiarity, and flavour intensity of the meal. Significantly greater amounts of energy, protein and fat were consumed in the meals with seasoning and meals with sauce compared to meals served plain (smallest t(17)=2.11, p=0.05), with no differences between seasoning and sauce conditions (largest t=0.51, p=0.62). Flavour intensity ratings were also significantly higher for meals with sauce and meals with seasoning compared to meals served plain (smallest t(17)=2.78, p=0.01). These findings suggest that the addition of both seasoning and sauce to an older person's meal can result in comparable increases in energy, protein and fat intake. Effects support a role for flavour in increasing food intake in older individuals. These effects, however, need to be demonstrated repeatedly over a longer time period before their true value can be established.