Diagnosis Of Protein-energy Malnutrition Research Articles

The impact of protein-energy malnutrition on clinical outcomes in hospitalized gastric cancer patients: A population-based analysis.

503 Background: Protein-energy malnutrition (PEM) is considered an adverse prognostic factor in various clinical conditions. Patients with gastric cancer are at an increased risk of malnutrition because of factors such as loss of appetite due to the tumor, difficulty swallowing, malabsorption, and metabolic changes caused by the cancer. However, the implications of protein-energy malnutrition (PEM) in gastric cancer patients are not well studied. Through this study, we wanted to examine how PEM affects clinical outcomes in hospitalized patients with gastric cancer. Methods: We used the National Inpatient Sample (NIS) from 2018 to 2020 to detect patients with a primary diagnosis of gastric cancer and a secondary diagnosis of protein energy malnutrition (PEM). We used the chi-square and student T-test to analyze categorical and continuous variables. Confounders were adjusted using multivariable regression analysis, and the adjusted odds ratio (aOR) was calculated. Results: We detected a total of 1673915 patients with the primary diagnosis of gastric cancer using ICD-10 codes. Of them, 401,739 (24%) of the patients had a secondary diagnosis of PEM. The mean age of the patients was 66 years (p-value <0.01). Of these, 56% of the patients were male, while the remaining 44% were female (p-value <0.001). Based on race, 68% of the patients belonged to the White Race, 12% were African Americans, and 11% were Hispanics (p-value <0.001). It was observed that the presence of PEM was associated with higher mortality (aOR 1.6, p-value <0.001). There was also higher hospitalization cost ($109522 vs. 75725, p-value <0.001) and mean length of stay (LOS) (9.1 days vs. 5.6 days, p-value <0.001). PEM in gastric cancer patients was also associated with higher odds of sepsis (aOR 1.6, p-value <0.001), gastritis (aOR aOR 1.2, p-value <0.001), gastrointestinal (GI) bleeding (aOR 1.1, p-value <0.001) and acute kidney injury (AKI) (aOR 1.7, p-value <0.001). Conclusions: Our study demonstrates that protein-energy malnutrition (PEM) is associated with increased mortality, higher hospitalization costs, and longer stays in hospitalized gastric cancer patients. These findings emphasize the need for regular nutritional assessment and management to improve clinical outcomes in this population. Comparison of outcomes in hospitalized gastric cancer patients with and without protein-energy malnutrition (PEM). Hospital Outcomes Gastric Cancer Patients with PEM Gastric Cancer Patients without PEM Adjusted Odds ratio (aOR) 95% Confidence Interval P-value Mortality 9.1% (n=36999) 5.3% (n=68100) 1.6 1.5-1.7 <0.001 Length of Stay 9.1 5.6 3.0 2.7-3.3 <0.001 Sepsis 10% (n=41915) 6.4% (n= 82035) 1.6 1.5-1.6 <0.001 Gastritis 3.9% (n=16174) 3.3% (n=41879) 1.2 1.1-1.31 <0.001 GI Bleeding 7.1% (n= 28949) 6% (n= 28949) 1.1 1.0-1.2 <0.001 AKI 28% (n=117439) 19% (n=1268134) 1.7 1.7-1.8 <0.001

Impact of protein-energy malnutrition on outcomes among patients with diffuse large B cell lymphoma admitted for inpatient chemotherapy.

e19539 Background: Protein-Energy Malnutrition (PEM) is a major factor contributing to morbidity and mortality in cancer patients. Chemotherapy causes anorexia, decreasing the caloric intake and affects the lean body mass which requires significant energy expenditure to surmount. Empiric data does not abound on the effect of PEM and its impact on the outcomes of patients receiving chemotherapy, specifically in diffuse large B cell lymphoma (DLBCL). Methods: A retrospective cohort study was designed using data from 2016 to 2018 combined National Inpatient Sample (NIS) database. Adult patients (age > 18) admitted for chemotherapy with a principal diagnosis of DLBCL were identified using the International Diseases Classification code, 10th revision. They were stratified into two cohorts based on presence of a secondary diagnosis of PEM. Primary outcomes assessed were mortality, length of stay (LOS), and total hospitalization charges. Secondary outcomes included a diagnosis of neutropenia, urinary tract infections (UTI), septic shock, bacteremia, candida sepsis, acute kidney injury (AKI), acute liver failure, and acute respiratory failure (ARF). Multivariate linear and logistic regressions were used to adjust for confounders. Results: There was a total of 76,425 adult hospitalizations for chemotherapy among patients with DLBCL out of which 2.32% had a secondary diagnosis of PEM. PEM was associated with an increased odds of mortality, 3.94% vs 0.37% (AOR :12.69, p < 0.001, 95% CI: 6.34 – 25.38). There was also an increased LOS in patients with PEM, 7.55 days vs 4.96 days (adjusted difference of 2.74 days, p < 0.001, 95% CI: 1.88 – 3.61), as well as an increase in total charge, 97,500.55 USD vs 60,600.12 USD (adjusted difference of 37,109 USD, p < 0.001, 95% CI: 20,139.59 – 54,080.18). Similarly, the presence of PEM was associated with increased odds of several secondary outcomes measured, including neutropenia (AOR : 1.87, p < 0.001, 95% CI: 1.29 – 2.69), candida sepsis (AOR : 12.28, p = 0.033, 95% CI: 1.22 – 123.39), septic shock (AOR : 14.11, p < 0.001, 95%CI: 6.31 – 31.52), bacteremia (AOR : 5.51, p < 0.001, 95% CI: 2.61 – 11. 63), ARF (AOR : 7.83, p < 0.001, 95% CI: 4.75 – 12.92) and an increased odds of AKI (AOR : 1.87, p < 0.001, 95% CI: 1.37 – 2.55) compared to the other cohort. However, there was no difference in the odds of UTI and acute liver failure between the two groups. Conclusions: Clinical outcomes among patients with DLBCL during chemotherapy admissions are worse in patients with PEM and are associated with a 4-fold increased odds of death and attendant increase in LOS and total charge. The odds of secondary adverse clinical outcomes including neutropenia, bacteremia, candida sepsis, septic shock, AKI, and ARF are also increased. Prospective trials to evaluate PEM as an independent prognostic marker of chemotherapy tolerance and adequate nutritional support can improve the clinical outcomes.

In-patient outcomes of patients with diabetic ketoacidosis and concurrent protein energy malnutrition: A national database study from 2016 to 2017

ABSTRACT Introduction: Patients often present to the hospital with a well-known complication of diabetes mellitus, namely diabetic ketoacidosis (DKA). In this study, we assess the clinical outcomes of DKA hospitalizations with and without protein-energy malnutrition (PEM). Methods: This was a population-based, retrospective observational study using data gathered from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. Hospitalizations of adults >/ = 18 years old with a principal diagnosis of DKA were obtained using ICD-10 codes and divided into groups based on a secondary diagnosis of PEM. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), total hospital charges (THC), and system-based complications. Results: Patients with PEM had a statistically significant difference in the adjusted odds for in-hospital mortality compared to patients without PEM (aOR 1.73, 95% CI: 1.20–2.49, p = 0.004). Patients with DKA and PEM had an increased risk of developing sepsis (aOR 2.99, 95% CI: 2.49–3.58, p < 0.001), septic shock (aOR 3.37, 95% CI: 2.31–4.91, p < 0.001), acute kidney failure (aOR 1.27, 95% CI: 1.17–1.37, p < 0.001), acute respiratory failure (aOR 2.23, 95% CI: 1.83–2.73, p < 0.001), deep vein thrombosis (aOR 1.91, 95% CI: 1.43–2.54, p < 0.001), and pulmonary embolism (aOR 2.36, 95% CI: 1.42–3.94, p = 0.001). Patients with DKA and PEM also had an increased mean THC (aOR 19,200, 95% CI 16,000–22,400, p < 0.001) in US dollars and increased LOS (aOR 2.26, 95% CI 1.96–2.57, p < 0.001) in days when compared to patients without PEM. Conclusion: Patients hospitalized for DKA with a secondary diagnosis of PEM within the same admission had a statistically significantly higher in-hospital mortality.

Serum albumin and total protein level as plausible marker for diagnosis of protein energy malnutrition in children under age 5 years

Background: The circulating concentration of transport protein, traditionally albumin, has been used to define protein deficiency. However, few studies have been conducted to see if there is any correlation between serum total protein and albumin levels in children with PEM. Hence the study was planned to estimate serum total protein, serum albumin levels in children with PEM and healthy controls.Methods: All the children were divided in two groups. Case Group A consist of 250 children with protein energy malnutrition and control Group B consist of healthy 250 children. Venous blood of amount 3 ml was collected with full aseptic precautions. The blood was collected in the EDTA vacutainer and test tube. Serum total protein was estimated by Biuret method, serum albumin was estimated by Bromocresol green dye method (BCG dye).Results: When the mean serum levels of albumin levels and the total protein levels were measured in the controls as well as case groups, there was decrease in levels in case group as compared to control group. This difference of decrease when evaluated statistically it was found to be statistically significant. When the albumin/globulin ratio was calculated in both the groups, it was found to be statistically lower in case group as compared to control group. PEM children have low serum total protein and albumin levels as compared to healthy controls (p&lt;0.001), this is probably due to decreased intake of proteins and reduced biosynthesis. PEM children have lower hemoglobin levels as compared to healthy controls; this is probably due to deficiency of iron and other micronutrients, which is often found in a child with malnutrition.Conclusions: Early diagnosis and prompt management of PEM and its complications can prevent development of permanent physical and mental retardation.

Phenotypic expression of the 3120+1G&gt;A mutation in non-Caucasian children with cystic fibrosis in South Africa

Cystic fibrosis (CF) is the most common genetic disorder in Caucasians. Presentation of CF in non-Caucasians is less well studied. This audit was undertaken to determine the phenotypic expression of the 3120+1G>A mutation in black and mixed race children in South Africa. A multi-centre retrospective chart review of clinical, laboratory and spirometry data of non-Caucasian CF patients in four CF centres in South Africa was collected. Data was collected at diagnosis and after a five-year follow-up period. Ethical approval was granted for the study. A total of 30 participants were enrolled of whom 14 (47%) were homozygous and 16 (53%) heterozygous for the 3120+1G>A mutation. The mean age of diagnosis was 13 months. Twenty-four (80%) patients had malnutrition (mean weight z-score -3.6) or failure to thrive (77%) at presentation. Twenty (67%) presented with non-specific abdominal symptoms, whilst fifteen (50%) had recurrent respiratory tract infections. Pseudomonas aeruginosa was detected at a mean age of 21 months. The mean FEV1 was 73% predicted (95% CI 54.0-91.1) at study entry and 68% predicted (95% CI 49.74-87.06) at follow-up. Failure to thrive and a diagnosis of protein energy malnutrition (kwashiorkor) are the common presenting features of CF in children with the 3120+1G>A mutation. Meconium ileus is a rare presenting feature of CF in black and mixed race children with this deletion in South Africa.

Serum concentrations of sex hormone binding globulin are elevated in kwashiorkor and anorexia nervosa but not in marasmus , ,

Customary blood protein markers for malnutrition are of limited value in the diagnosis of protein-energy malnutrition or anorexia nervosa in children and in the follow-up to refeeding in such children. For these diseases, we compared the diagnostic value of sex hormone binding globulin (SHBG) with that of albumin, transferrin, transthyretin, and retinal binding protein and determined the relations between concentrations of insulin, insulin-like growth factor I, and SHBG. SHBG was assayed in children with protein-energy malnutrition (29 children with kwashiorkor and 28 with marasmus), in 29 anorectic girls (before and after refeeding), and in age- and sex-matched control subjects. Mean (+/-SE) serum SHBG concentrations were higher in the children with kwashiorkor (0.18 +/- 0.07 micromol/L) than in the children with marasmus (0.11 +/- 0.05 micromol/L, P < 0.0001) or the control subjects (0.11 +/- 0.03 micromol/L, P < 0.0005). In the children with anorexia nervosa before weight gain, serum SHBG concentrations were significantly higher (0.10 +/- 0.04 micromol/L) than in the age-matched control subjects (0.06 +/- 0.03 micromol/L, P < 0.001) and decreased significantly after 30 d of refeeding (0.04 +/- 0.01 micromol/L, P < 0.0001). This decrease was negatively correlated with insulin-like growth factor I but not with insulin. Mean serum SHBG concentrations were influenced neither by inflammation, as indicated when C-reactive protein was used as a marker (0.27 +/- 0.27, 0.34 +/- 0.42, and <0.04 micromol/L in the children with marasmus, kwashiorkor, and anorexia nervosa, respectively), nor by glomerular filtration, as indicated when cystatin-C was used as a marker (68.46 +/- 23.08, 66.90 +/- 43.08, and 49.23 +/- 7.69 micromol/L, respectively). The high SHBG concentration observed in anorexia nervosa and kwashiorkor seems to be of multifactorial origin. For these 2 diseases, SHBG is a reliable marker of nutritional status, is unrelated to either C-reactive protein or cystatin-C, and may be helpful in distinguishing kwashiorkor from marasmus and as a follow-up marker after refeeding.

Low levels of plasma proteins: malnutrition or inflammation?

Levels of several plasma proteins, including albumin, transferrin, and transthyretin (prealbumin), have been proposed as markers for protein energy malnutrition. However, many other factors, especially inflammatory disease and drug or hormone therapy, affect levels of these proteins. These factors probably account for the majority of low levels of transthyretin. Levels of albumin and other proteins may be helpful in determining increased risk of morbidity and mortality, but better markers are needed for diagnosis of protein energy malnutrition per se.

Body impedance analysis (BIA) in the diagnosis of protein-energy malnutrition (PEM) in liver cirrhosis (LC)

Body impedance analysis (BIA) in the diagnosis of protein-energy malnutrition (PEM) in liver cirrhosis (LC)

Serum free amino acids of healthy males and pregnant women from Ethiopia.

Several clinical, anthropometric and biochemical parameters have been used for the evaluation of the nutritional status and diagnosis of protein-energy malnutrition [1]. Analysis of the complete serum amino-acid spectrum by ion-exchange chromatography provides valuable information on the adequacy of protein intake and on the metabolic response to protein depletion in undernourished subjects. However, the serum aminogram is quite differently affected by acute or chronic starvation or the great variety of starchy but low-protein foods and further toxic factors (e.g. mycotoxins) leading to kwashiorkor. Thus, very complex alterations of the serum amino-acid spectrum had to be expected [5, 9] and stimulated the present investigation for reference purposes. We report the results of amino acid determinations in apparently healthy adult males and pregnant women taking the traditional Ethiopian diet. For want of a better evaluation of the specific nutritional influence, we also collected data on serum amino acids of healthy Ethiopians consuming an average European diet.

A prospective study of the effects of clinically severe protein-energy malnutrition on growth.

The effects of severe protein-energy malnutrition (PEM) upon the growth of children was studied in a 13-month cohort. The serial records of 19 PEM children from the cohort were compared to those of cohort children with the same growth history (either failing or non-failing growth), but without severe PEM. When the comparison was made on the basis of age, no differences in growth were found except for arm muscle circumference at one age. Using Z-scores, comparisons were also made according to months before or after the diagnosis of PEM. When compared to children with the same growth history, PEM children showed short-term differences in weight and arm muscle circumference and a mild retardation in growth in length which was not significant. Any growth effects following the episode of severe PEM were accounted for by growth status preceding its onset.