Malnutrition Group Research Articles

GLIM-Defined Malnutrition in Patients with Head and Neck Cancer during the Qualification Visit for Home Enteral Nutrition.

Patients with head and neck cancer (HNC) present multiple symptoms that increase the risk of malnutrition. Nutritional care, including enteral nutrition (EN), plays a crucial role in the management of this group of patients. The aim of the study was to determine the Global Leadership Initiative on Malnutrition (GLIM)-based stages of malnutrition and the relationship with selected biochemical parameters during the home enteral nutrition (HEN) qualification visit of patients with HNC. The retrospective analysis involved 224 patients with HNC referred for HEN. The following parameters were evaluated: body mass index (BMI), percent weight loss, and laboratory tests (serum albumin, total serum protein, C-reactive protein (CRP), and total lymphocyte count (TLC)). Malnutrition was defined using GLIM-based criteria. The prevalence of malnutrition based on GLIM criteria was 93.75% (15.18% moderately malnourished, 78.57% severely malnourished). There was a positive correlation between malnutrition based on GLIM criteria, serum albumin, and CRP. In the model assessing the odds of severe malnutrition according to the criteria of GLIM, TLC and CRP had a statistically significant effect on the chance in the probability of qualifying a patient to the severe malnutrition group, but the strength of the results was weak. The prevalence of malnutrition in HNC patients enrolled to HEN is high and most of them are severely malnourished. This suggests that it is important to identify more efficiently patients with risk of malnutrition at an earlier stage. GLIM criteria for malnutrition can be easily applied in this group of patients, but the definition of inflammation criteria should be clarified.

Assessment of dietary nutrient intake and its relationship to the nutritional status of children with congenital heart disease in Guangdong province of China.

Congenital heart disease (CHD) is the common congenital malformations in children and cause malnutrition. We determine the association between dietary nutrient intake and nutritional status of children with CHD. 428 children of age 1-10 years with CHD admitted. The dietary nutrient intake was recorded after 3 days of 24-h recall. The growth and nutritional status of children were evaluated using anthropometric measurements and z-scores. The prevalence of malnutrition was 37.6% in CHD. 57.8%, 12.6%, 43.8%, and 40.6% of children did not meet their requirements for energy, protein, fat, and carbohydrate, respectively. The prevalence of insufficient intake was 88.3% for calcium, 35.9% for magnesium, 21.9% for iron, and 12.5% for zinc. 15%-86% of children did not meet vitamin requirements. 85.2% and 53.9% of children did not meet their requirements for vitamin A and vitamin C. The prevalence of insufficient intake was 39.1% for thiamin, 24.2% for riboflavin, 15.6% for niacin and 28.1% for vitamin E. Compared with the normal nutrition group, malnutrition group had a relatively lower intake of proteins, iron, zinc and vitamin E. An obvious deficiency of dietary nutrient intake was found among children with CHD, especially CHD with malnutrition. Dietary intake related to the nutritional status of children with CHD. The gap between actual consumption and recommendation indicates a need for improved nutritional counseling and monitoring. Early interventions targeting the dietary intakes of children with CHD may be a benefit for long-term effects associated with nutritional status.

Malnutrition predicts poor outcomes in diabetic COVID-19 patients in Huangshi, Hubei.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread throughout the world, which becomes a global public health emergency. Undernourishment prolongs its convalescence and has an adverse effect on its prognosis, especially in diabetic patients. The purpose of this study was to evaluate the prevalence and characteristics of undernourishment and to determine how it is related to the prognostic outcomes in the diabetic patients with coronavirus disease 2019 (COVID-19). A retrospective, multicenter study was conducted in 85 diabetic COVID-19 patients from three hospitals in Hubei Province. All patients were assessed using the European Nutritional Risk Screening 2002 (NRS-2002) and other nutritional assessments when admitted. Of them, 35 (41.18%) were at risk of malnutrition (NRS score ≥3). Severe COVID-19 patients had a significantly lower level of serum albumin and prealbumin and higher NRS score than non-severe patients. Multivariate logistic regression analysis showed that serum prealbumin and NRS score increased the likelihood of progression into severe status (P<0.05). Meanwhile, single factor and multivariate analysis determined that grade of illness severity was an independent predictor for malnutrition. Furthermore, prealbumin and NRS score could well predict severe status for COVID-19 patients. The malnutrition group (NRS score ≥3) had more severe illness than the normal nutritional (NRS score <3) group (P<0.001), and had a longer length of in-hospital stay and higher mortality. Malnutrition is highly prevalent among COVID-19 patients with diabetes. It is associated with severely ill status and poor prognosis. Evaluation of nutritional status should be strengthened, especially the indicators of NRS-2002 and the level of serum prealbumin.

Association between the Controlling Nutritional Status score and long-term outcome in patients with acute heart failure

Objective: To evaluate the nutritional status by the Controlling Nutritional Status (CONUT) score and its association with the long-term prognosis in patients with acute heart failure (AHF). Methods: This prospective monocentric study consecutively enrolled patients admitted to our hospital for AHF from April 2012 to May 2016. Patients were divided into 3 groups based on the CONUT score at admission: normal (0-1), mild malnutrition (2-4) and moderate-severe malnutrition (5-12) groups. Baseline information was obtained and recorded within 24 hours after admission. All patients were followed up every 3 months by outpatient visit or telephone call until March 2019. The primary endpoint was all-cause mortality. The Kaplan-Meier survival curves and log-rank test were used to compare all-cause mortality between groups. Variables showing statistical significance in the univariate analysis were incorporated into multivariate Cox regression model to analyze the independent risk factors for all-cause mortality after discharge. Results: A total of 396 patients were enrolled in this study, including 114 patients with normal nutritional status, 200 patients with mild malnutrition and 82 patients with moderate-severe malnutrition. One hundred and fifty-eight patients died during a median follow-up of 34 (18, 46) months. The mortality was 32.4% (37/114), 39% (78/200) and 52.4% (43/82) in normal, mild malnutrition and moderate-severe malnutrition groups, respectively. The mortality was significantly higher in the moderate-severe malnutrition group than in normal nutrition group (P<0.05). However, there was no significant difference in mortality between normal and mild malnutrition group as well as between mild and moderate-severe malnutrition group (both P>0.05). Kaplan-Meier curves indicated that patients with high CONUT score group was at higher risk of all-cause mortality compared with those with low CONUT score (P=0.002). Cox proportional hazard analyses showed that the risk of all-cause mortality of moderate-severe malnutrition group was significantly higher than that of normal nutrition group (HR =1.648, 95%CI 1.021-2.660, P=0.041). Conclusions: The CONUT score of patients with AHF at admission is associated with the long-term prognosis. High CONUT score is an independent risk factor for all-cause mortality in AHF patients after discharge.

The Prevalence of Malnutrition and its Impact on Children with Congenital Heart Disease in Post Cardiac Surgery

Background: Children with congenital heart disease (CHD) require adequate nutrition for growth and development. Children with CHD are often malnourished and with dyspnea, leading to failure to thrive. Children with CHD have a high basal metabolic rate leading to high caloric requirement. Objective: To evaluate the prevalence ofmalnutrition and its impact on children with congenital heart disease in post cardiac surgery. Method: This cross-sectional study was carried out at Bangladesh Shishu Hospital and Institute, Bangladesh. Data were collected from January 2019 to January 2020. A total of 40 pediatric patients with CHD admitted for cardiac surgery were included in the study. Sample were collected through purposive sampling as per inclusion criteria. Results: During the study, most of the children belonged to 1 year to 5 years of age group and 60% were male. The nutritional status of the patients before surgery was defined as normal 55%, malnutrition 45%. In malnutrition group heart defect cases was higher than that of normal group. Mean z score for A/W(SEM) was -1.05 in normal group and -3.06 in malnutrition group. Malnourished patients clearly showed a tendency (P=0.005) to have a longer length of intubation, i.e., mean 35.67 hours when compared with those with a normal nutritional status who have mean intubation time of 27.51 hours. The other morbidity factor measured was the length of ICU stay, which also showed a significant result. Conclusion: In Bangladesh, malnutrition is frequent among children with congenital cardiac defects which increases risk of morbidity related with prolonged mechanical ventilation and ICU stays. To minimize potentially harmful effects, the health care system should be able to screen and identify these individuals early on.

The correlation between skeletal muscle index of the L3 vertebral body and malnutrition in patients with advanced lung cancer

BackgroundStudies have shown that the skeletal muscle index at the third lumbar vertebra (L3 SMI) had reasonable specificity and sensitivity in nutritional assessment and prognostic prediction in digestive system cancers, but its performance in lung cancer needs further investigation.MethodsA retrospective study was performed on 110 patients with advanced lung cancer. The L3 SMI, the Patient-Generated Subjective Global Assessment score (PG-SGA score), body mass index (BMI), and serological indicators were analyzed. According to PG-SGA scores, patients were divided into severe malnutrition (≥9 points), mild to moderate malnutrition (≥3 points and ≤ 8 points), and no malnutrition (≤2 points) groups. Pearson correlation and logistic regression analysis were adopted to find factors related to malnutrition, and a forest plot was drawn. The receiver operating characteristic (ROC) curve was performed to compare the diagnostic values of malnutrition among factors, which were expressed by the area under curve (AUC).Results1. The age of patients in the severe malnutrition group, the mild to moderate malnutrition group, and the no malnutrition group significantly differed, with mean ages of 63.46 ± 10.01 years, 60.42 ± 8.76 years, and 55.03 ± 10.40 years, respectively (OR = 1.062, 95%CI: 1.008 ~ 1.118, P = 0.024; OR = 1.100, 95%CI: 1.034 ~ 1.170, P = 0.002). Furthermore, the neutrophil to lymphocyte ratio (NLR) of the severe malnutrition group was significantly higher than that of the no malnutrition group, with statistical significance. The difference between the mild to moderate malnutrition group and the no malnutrition group were not statistically significant, with NLR of 4.07 ± 3.34 and 2.47 ± 0.92, respectively (OR = 1.657,95%CI: 1.036 ~ 2.649, P = 0.035). The L3 SMI of patients in the severe malnutrition and mild to moderate malnutrition groups were significantly lower than that of the patients in the no malnutrition group, with statistical significance. The L3 SMI of patients in the severe malnutrition group, mild to moderate malnutrition group, and no malnutrition group were 27.40 ± 4.25 cm2/m2, 38.19 ± 6.17 cm2/m2, and 47.96 ± 5.02 cm2/m2, respectively (OR = 0.600, 95%CI: 0.462 ~ 0.777, P < 0.001; OR = 0.431, 95%CI: 0.320 ~ 0.581, P < 0.001).2. The Pearson correlation analysis showed that the PG-SGA score positively correlated with age (r = 0.296, P < 0.05) but negatively correlated with L3 SMI (r = − 0.857, P < 0.05). The L3 SMI was also negatively correlated with age (r = − 0.240, P < 0.05).3. The multivariate analysis showed that the L3 SMI was an independent risk factor for malnutrition (OR = 0.446, 95%CI: 0.258 ~ 0.773, P = 0.004; OR = 0.289, 95%CI: 0.159 ~ 0.524, P < 0.001).Conclusion1. The differences in the L3 SMI was statistically significant among advanced lung cancer patients with different nutritional statuses.2. In the nutritional assessment of patients with lung cancer, the L3 SMI was consistent with the PG-SGA.3. The L3 SMI is an independent predictor of malnutrition in patients with advanced lung cancer.

Nutrition and frailty status of patients undergoing cardiovascular surgery and its association with postoperative outcomes

Abstract Background Malnutrition is a component of Frailty Syndrome characterized by weakness, poor nutritional status and reduced cognitive function. Frailty has been recognized to adversely affect post Cardiovascular Surgery outcomes in the elderly. In developing countries, Frailty can occur in younger patients from Rheumatic Heart Disease and earlier onset of Atherosclerotic Cardiovascular Disease. There is limited data on frailty in the young. Methods Malnutrition and Frailty were assessed preoperatively in 111 adult patients undergoing Cardiovascular Surgery from October 2020 to February 2021. Nutrition Risk Screening Tool (NRS) and Clinical Frailty Scale (CFS) were used for assessment respectively. Their in-hospital postoperative outcomes was then observed. Results There were 57 patients (51%) diagnosed with malnutrition, 26 (23%) of which were also Frail. Advanced age, Rheumatic Heart Disease, Heart Failure and Chronic Kidney Disease was significantly higher in malnutrition and frail group. After multivariate analysis, mortality rate (odds ratio [OR] 7.8; 95% confidence interval [CI]: 1.45 - 41.91; P=.017), prolonged hospitalization (OR: 5.96; 95% CI: 2.14–16.53; P=.001), mechanical ventilation (OR: 7.56; 95% CI: 1.81–31.62; P=.006) and nosocomial infections (OR: 13.57; 95% CI: 4.41–41.76; P≤.001) were found higher in patients with malnutrition and frailty. Conclusion Evaluation of nutrition and frailty status using NRS and CFS was helpful in predicting postoperative outcomes. With a significant number of this population having Malnutrition and Frailty, there is a need to strengthen clinical pathways on perioperative nutrition and rehabilitation with the possibility of improving Cardiovascular Surgery outcomes. Funding Acknowledgement Type of funding sources: None.

Prognostic importance of the Controlling Nutritional Status (CONUT) score in patients undergoing cardiac resynchronisation therapy

AimsMalnutrition is common and associated with worse clinical outcomes in patients with heart failure (HF). The Controlling Nutritional Status (CONUT) score is an integrated index for evaluating diverse aspects of...

Malnutrition Is an Independent Risk Factor for Low Health-Related Quality of Life Among Centenarians.

Background: To explore the association and understand gender disparities between nutritional status and quality of life among centenarians.Methods: It was a full-sample survey of centenarians conducted in Hainan that included a total of 1,002 eligible centenarians whose age had been verified. The Mini Nutritional Assessment – Short Form (MNA-SF) questionnaire and the EuroQol five dimensions visual analog scale (EQ-5D-VAS) were used to measure participants' nutritional status and quality of life, respectively.Findings: In the 1002 centenarians (822 women and 180 men), 797 (79.5%) (79.5%) reported multimorbidity. The adjusted standardized β estimate association between the MNA-SF and EQ-5D scores was 0.508 in the complete sample. With reference to the normal nutrition group, the standardized β estimate of the association between EQ-5D score and nutritional status were −0.179 and −0.583 for the at risk of malnutrition and malnutrition groups, respectively (both P <0.001). Nutritional status significantly affected the five dimensions of quality of life, particularly mobility and self-care. Compared with the normal nutrition group, the malnutrition group had greater odds of low mobility [Odds ratio (OR)=23.15; 95% CI: 9.81–54.64] and low self-care (OR=24.58; 95% CI: 12.62–47.89). Among males, nutritional status was significantly associated with the usual activities and anxiety/depression dimensions after adjustment. Female participants had results similar to the general population.Interpretation: Malnutrition and being at risk of malnutrition is prevalent among centenarians. Maintaining normal nutritional status is an important protective factor and should receive more attention to improve centenarians' quality of life.

Impact of malnutrition on in-hospital outcomes in takotsubo cardiomyopathy

ObjectiveThis study assesses the effect of malnutrition on the in-hospital outcomes of patients with takotsubo cardiomyopathy (TCM). MethodsWe performed a retrospective cohort analysis using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for a primary diagnosis of TCM from the National Inpatient Sample database (2016–2018). A concurrent diagnosis of malnutrition was then identified, and these patients were divided into the malnutrition group and non-malnutrition group. To adjust for underlying risk factors, a multivariable logistic regression model was employed followed by a propensity score matching analysis for the malnutrition and the non-malnutrition group. We then compared the in-hospital outcomes between these two groups. ResultsAmong 4733 patients with a primary diagnosis of TCM, 221 (4.7%) patients with TCM were found to be malnourished. After propensity score matching, patients with TCM with malnutrition were found to have a higher mortality rate (8.3% versus 2.0%, P < 0.001), a higher rate of complications including cardiogenic shock (16.1% versus 7.0%, P < 0.001), ventricular arrhythmia (8.8% versus 3.9%, P = 0.01), acute kidney injury (24.9% versus 10.6%, P < 0.001), and acute respiratory failure (32.7% versus 17.8%, P < 0.001). There was no statistically significant difference in the incidence of cardiac arrest between the two groups. Malnutrition of severe degree was associated with a sevenfold (odds ratio 6.8, 95% confidence interval, 3.2–13.4) increased risk of in-hospital mortality compared with those without malnutrition. ConclusionPatients with malnutrition who were admitted with TCM were associated with higher rates of in-hospital mortality and complications compared with those without malnutrition.

Malnutrition and Sarcopenia Combined Increases the Risk for Mortality in Older Adults on Hemodialysis.

Aim: Sarcopenia and malnutrition are highly prevalent in older adults undergoing hemodialysis (HD) and are associated with negative outcomes. This study aimed to evaluate the role of sarcopenia and malnutrition combined on the nutritional markers, quality of life, and survival in a cohort of older adults on chronic HD.Methods: This was an observational, longitudinal, and multicenter study including 170 patients on HD aged >60 years. Nutritional status was assessed by 7-point-subjective global assessment (7p-SGA), body composition (anthropometry and bioelectrical impedance), and appendicular skeletal muscle mass (Baumgartner's prediction equation). Quality of life was assessed by KDQoL-SF. The cutoffs for low muscle mass and low muscle strength established by the 2019 European Working group on sarcopenia for Older People (EWGSOP) were used for the diagnosis of sarcopenia. Individuals with a 7p-SGA score ≤5 were considered malnourished, individuals with low strength or low muscle mass were pre-sarcopenic, and those with low muscle mass and low muscle strength combined as sarcopenic. The sample was divided into four groups: sarcopenia and malnutrition; sarcopenia and no-malnutrition; no-sarcopenia with malnutrition; and no-sarcopenia and no-malnutrition. Follow-up for survival lasted 23.5 (12.2; 34.4) months.Results: Pre-sarcopenia, sarcopenia, and malnutrition were present in 35.3, 14.1, and 58.8% of the patients, respectively. The frequency of malnutrition in the group of patients with sarcopenia was not significantly higher than in the patients without sarcopenia (66.7 vs. 51.2%; p = 0.12). When comparing groups according to the occurrence of sarcopenia and malnutrition, the sarcopenia and malnutrition group were older and presented significantly lower BMI, calf circumference, body fat, phase angle, body cell mass, and mid-arm muscle circumference. In the survival analysis, the group with sarcopenia and malnutrition showed a higher hazard ratio 2.99 (95% CI: 1.23: 7.25) for mortality when compared to a group with no-sarcopenia and no-malnutrition.Conclusion: Older adults on HD with sarcopenia and malnutrition combined showed worse nutritional parameters, quality of life, and higher mortality risk. In addition, malnutrition can be present even in patients without sarcopenia. These findings highlight the importance of complete nutritional assessment in patients on dialysis.

Prognostic prediction by hypermetabolism varies depending on the nutritional status in early amyotrophic lateral sclerosis

To examine whether hypermetabolism could predict the prognosis of early amyotrophic lateral sclerosis (ALS) patients with differing nutritional profiles. This single-center, retrospective study examined the prognosis of ALS patients with hypermetabolism in relation to their nutritional status at hospitalization. The metabolic state was estimated by the ratio of measured resting energy expenditure (mREE) to lean soft tissue mass (LSTM) (mREE/LSTM), wherein patients with ratios ≥ 38 were defined as hypermetabolic. Malnutrition was defined as %ideal body weight < 0.9. Forty-eight patients were enrolled in this study. The hypermetabolic group had shorter survival in the normal-weight group but more prolonged survival in the malnutrition group. Multiplication of nutritional and metabolic factors, such as [(body mass index (BMI) − 19.8) × (mREE/LSTM − 38)], designated as BMI-muscle metabolism index (BMM index), successfully predicted the prognosis in the group with a high BMM index (≥ 1), which showed shorter survival and a faster rate of weight loss and functional decline. Multivariate analysis using the Cox model showed high BMM index was an independent poor prognostic factor (hazard ratio: 4.05; p = 0.025). Prognostic prediction by hypermetabolism varies depending on the nutritional status in ALS, and the BMM index is a consistent prognostic factor.

B-PO05-185 CLINICAL SIGNIFICANCE OF THE CONTROLLING NUTRITIONAL STATUS (CONUT) SCORE IN PATIENTS UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY

The Controlling Nutritional Status (CONUT) score is an index of nutritional status. Malnutrition has recently been reported to be a common condition that is associated with adverse prognosis in patients with heart failure (HF). However, the relationship between nutritional status and clinical outcomes in patients with HF undergoing cardiac resynchronization therapy (CRT) is unclear. We investigated the prognostic value of the CONUT score in CRT recipients. Clinical records were retrospectively evaluated for 263 patients who underwent CRT implantation between March 2003 and August 2020. Blood samples were collected before CRT implantation. Nutritional status was assessed using the CONUT score. Patients were divided into three groups by CONUT score: normal group (CONUT score 0-1, n=56), mild malnutrition group (CONUT score 2-4, n=132), and moderate or severe malnutrition group (CONUT score ≥5, n=75). The primary endpoint was all-cause mortality. The moderate or severe malnutrition group had significantly advanced NYHA functional class, higher N-terminal pro-brain natriuretic peptide (NT pro-BNP) levels, and higher Clinical Frailty Scale scores (all p<0.05). During a median follow-up of 31 months (interquartile range, 10-67), 103 patients (39.1%) died. Kaplan-Meier analysis revealed that mortality was significantly higher in the moderate or severe malnutrition group (log-rank p<0.001). Even after adjustment for a conventional risk score (VALID-CRT risk score), CONUT score (as a continuous variable) remained associated with mortality (p<0.05). Nutritional status as assessed by the CONUT score is significantly associated with the severity of HF and frailty, and subsequent mortality in patients with HF undergoing CRT.

Malnutrition and the risk for contrast-induced acute kidney injury in patients with coronary artery disease.

Malnutrition is a common comorbidity of coronary artery disease (CAD) and is often associated with adverse events. The malnutrition often means lower cholesterol, albumin and high lymphocyte, as risk factors of Contrast-Induced Acute Kidney Injury (CI-AKI). We aim to evaluate the association between malnutrition and CI-AKI following coronary angiography (CAG) in CAD patients. We analyzed 3170 CAD patients with variables of nutritional status (Controlling Nutritional Status score (CONUT)) from the prospective multicenter study, REICIN (NCT01402232) including 4,271 consecutive patients undergoing CAG from January 2013 to February 2016. Patients were divided into the normal group (CONUT score 0-1) and malnutrition group (CONUT score > 1). The association of malnutrition and the risk of CI-AKI was examined in all CAD patients using multivariable logistics regression analysis. Among the 3170 patients (mean age: 63.1 ± 10.7years), 1865 (58.8%) suffered from malnutrition, 111 (3.5%) developed CI-AKI, including 23 (1.76%) in normal group and 88 (4.72%) in malnutrition group (p < 0.01). The malnourished patients were older, and likely had anemia and worse cardiorenal function. After adjustment for confounders, the risk of CI-AKI was 1.04 times higher in the malnutrition group than in the normal group (adjusted OR: 2.04, 95% CI 1.28-3.38, p < 0.01). Among CAD patients undergoing CAG, malnutrition is extremely common and associated with a double risk of CI-AKI. Further studies are needed to investigate the potential renal protection of intervening malnutrition in CAD patients.

Nutritional Status Might Be Related to Physical Performance and Functionality in Older Adults

It was aimed to investigate the effect of malnutrition with and the risk of malnutrition in elderly individuals with regards to other geriatric syndromes and comprehensive geriatric assessment (CGA) parameters. Patients who applied to the geriatric outpatient clinic between January 2019 and June 2020 were included in the study. 460 patients were examined. The patients were divided into three groups according to malnutrition, malnutrition-risk, and normal nutritional status. These three groups were compared in terms of geriatric syndromes and CGA parameters. The well-nourished group and the risk of malnutrition and malnutrition group were compared in terms of geriatric syndromes and CGA parameters adjusted for age and gender. Of 460 patients, 64.5% of these patients were female, and the mean age was 77.75±8.12, 65 had malnutrition, and 141 had malnutrition-risk. When the well-nourished group was compared with the malnutrition and malnutrition-risk group, age, education year, frequency of cerebrovascular disease were statistically different. The frequency of falls, dementia, sleep disturbance, urinary incontinence, orthostatic hypotension, polypharmacy, sarcopenia, and frailty was higher in groups with malnutrition and malnutrition-risk than in the normal group (p<0.05). Also, activities of daily living (ADLs) and gait and balance scores were lower in the group with malnutrition and malnutrition risk (p<0.05). In the regression analysis adjusted for age and gender, geriatric depression, urinary incontinence, dementia, orthostatic hypotension, sarcopenia, and frailty were increased in the group with malnutrition and malnutrition risk compared to the normal group (p<0.05). Malnutrition and risk of malnutrition is associated with other geriatric syndromes and deterioration in ADLs. Therefore, nutritional evaluation must be included in the assessment of older adults, and necessary interventions should be made to optimize the nutritional status.

Impact of malnutrition diagnosed using Global Leadership Initiative on Malnutrition criteria on clinical outcomes of patients with gastric cancer.

Our objective is to validate the effectiveness of the Global Leadership Initiative on Malnutrition (GLIM) criteria in malnutrition diagnosis compared with Patient-Generated Subjective Global Assessment (PG-SGA) and assess the impact of malnutrition diagnosed using GLIM criteria on the clinical outcomes of patients with GC. We retrospectively analyzed the data of 895 patients who underwent radical gastrectomy at the First Affiliated Hospital of Wenzhou Medical University. Nutrition assessment was performed on all patients according to the GLIM criteria and PG-SGA. The κ statistic was used to evaluate the agreement between two methods. Multivariate logistic regression and Cox regression based on single-factor analysis were used to predict postoperative complications and overall survival rates. Based on the GLIM criteria, 38.3% of the patients were diagnosed as malnourished, including 21.7% Stage I (moderate malnutrition) and 16.6% Stage II (severe malnutrition). GLIM criteria had a moderate agreement with PG-SGA (κ = 0.548). Patients in the Stage II malnutrition group had a higher incidence of complications, a longer postoperative length of stay, and higher hospitalization costs. Logistic regression showed that Stage II malnutrition was an independent risk predictor of postoperative complications (odds ratio, 3.28; 95% confidence interval [CI], 2.18-4.94). Furthermore, Cox regression analysis showed that both Stage I (hazard ratio [HR], 1.52; 95% CI, 1.11-2.07; P = .009) and Stage II (HR, 1.85; 95% CI, 1.34-2.53; P < .001) malnutrition were independent risk predictors of overall survival. Diagnosis of malnutrition according to the GLIM criteria is useful in predicting the adverse postoperative clinical outcomes of patients with gastric cancer.

Confounding influences of malnutrition and Plasmodium falciparum and Schistosoma haematobium infections on haematological parameters in school children in Muyuka, Cameroon

BackgroundSchool-aged children (SAC) are a high-risk demographic group for infectious diseases and malnutrition. The objective of this study was to assess the burden and the effect of Plasmodium falciparum and Schistosoma haematobium infections on the haematological indices in SAC and the confounding influence of malnutrition on the outcomes.MethodsThis cross-sectional study was conducted in SAC 4–14 years old living in Ikata, Bafia and Mile 14-Likoko in Muyuka, Cameroon. Anthropometric measures of malnutrition were obtained and blood samples collected were used for detection of malaria parasites by Giemsa-stained blood films using light microscopy and complete blood count analysis using an automated haematology analyser. Urine samples collected were used to detect micro haematuria with the aid of reagent strips and the eggs of S. haematobium by urine filtration technique. Multiple linear regression model was used to examine influence of independent variables on haematological parameters.ResultsOut of the 606 SAC examined, the prevalence of single infections with Plasmodium or S. haematobium and co-infection with both parasites was 16.2, 16.3 and 8.3%, respectively. Overall, malaria parasite (MP), urogenital schistosomiasis, malnutrition, anaemia, haematuria, microcytosis and thrombocytopenia was prevalent in 24.4, 24.6, 25.9, 74.4, 12.2, 45.4 and 11.1% of SAC, respectively. A significant linear decline (P = 0.023) in prevalence of P. falciparum infection with the severity of stunting was observed. Factors that significantly influenced haematological parameters included haemoglobin: age, stunting and MP; haematocrit: age and MP; white blood cell count: age; red blood cell count; age and MP; lymphocyte counts: stunting; mean cell volume: age; mean cell haemoglobin: age and stunting; mean cell haemoglobin concentration: sex, stunting and red cell distribution width-coefficient of variation: sex, age and stunting.ConclusionsMalnutrition, Plasmodium and S. haematobium infections are common while anaemia is a severe public health problem in Muyuka, Cameroon. The interaction between haematological parameters with malaria parasites as well as linear growth index was negative and other interactions indicate systemic inflammation. While findings provide contextual intervention targets to ensure the judicious use of the limited resources, there is need for regular monitoring and proper treatment to improve the health of the underserved population.

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

BackgroundDelirium 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.MethodsThe 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.Results915 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).ConclusionsMalnutrition was common in older patients undergoing non-cardiac surgery, but it’s not related with emergence delirium after adjusted for confounders.Trial registrationChinese Clinical Trial Registry (http://www.chictr.org.cn) (ChiCTR-OOC-17,012,734).

Relationship of the preoperative NRS 2002 score, PG-SGA score, and serum indices with postoperative complications in patients with gastric cancer

Objective To examine the utility of the Nutrition Risk Screening 2002 (NRS 2002), Patient-Generated Subjective Global Assessment (PG-SGA) and serum factors for the preoperative evaluation of gastric cancer patients. Methods We examined 181 gastric cancer patients treated at the First Afliated Hospital of Guangxi Medical University from January 2015 to January 2018. Nutritional assessments were administered within 48 h of admission. The body mass index (BMI) and serum factors were measured, and information on preoperative nutritional support and postoperative complications was recorded. Results Both the NRS 2002 and PG-SGA had positive correlations with age (P &lt; 0.05), and negative correlations with albumin, prealbumin, transferrin, hemoglobin, BMI, and bodyweight (P &lt; 0.05). The NRS 2002 and PG-SGA scores were positively correlated with each other (r = 0.683, P &lt; 0.01), but had poor consistency (κ = 0.357, P &lt; 0.01). During the preoperative period, 33.2% of patients received nutritional support, mainly enteral nutrition. The nutritional risk group (NRS 2002 ≥ 3) received more support than the group without nutritional risk (NRS 2002 &lt; 3; P &lt; 0.05). Patients with nutritional risk or malnutrition who received preoperative nutritional support had fewer postoperative complications than unsupported patients. The overall rate of complications was 12.2%, and the rate of severe complications (grade Ⅲ or above) was 5.5%. The malnutrition and nutritional risk groups had higher rates of severe complications. Conclusions The combined application of the NRS 2002, PG-SGA, BMI, and serum nutritional indices was useful for the nutritional screening and assessment of preoperative gastric cancer patients. The NRS 2002 and PG-SGA provided guidance on the need for nutritional support during the preoperative period.

Nutritional status and risk of contrast-associated acute kidney injury in elderly patients undergoing percutaneous coronary intervention

BackgroundThis study aimed to investigate the connection between malnutrition evaluated by the Controlling Nutritional Status (CONUT) score and the risk of contrast-associated acute kidney injury (CA-AKI) in elderly patients who underwent percutaneous coronary intervention (PCI).MethodsA total of 1308 patients aged over 75 years undergoing PCI was included. Based on the CONUT score, patients were assigned to normal (0–1), mild malnutrition (2–4), moderate-severe malnutrition group (≥ 5). The primary outcome was CA-AKI (an absolute increase in ≥ 0.3 mg/dL or ≥ 50% relative serum creatinine increase 48 h after contrast medium exposure).ResultsOverall, the incidence of CA-AKI in normal, mild, moderate-severe malnutrition group was 10.8%, 11.0%, and 27.2%, respectively (p < 0.01). Compared with moderate-severe malnutrition group, the normal group and the mild malnutrition group showed significant lower risk of CA-AKI in models adjusting for risk factors for CA-AKI and variables in univariate analysis (odds ratio [OR] = 0.48, 95% confidence interval [CI]: 0.26–0.89, p = 0.02; OR = 0.46, 95%CI: 0.26–0.82, p = 0.009, respectively). Furthermore, the relationship were consistent across the subgroups classified by risk factors for CA-AKI except anemia. The risk of CA-AKI related with CONUT score was stronger in patients with anemia. (overall interaction p by CONUT score = 0.012).ConclusionModerate-severe malnutrition is associated with higher risk of CA-AKI in elderly patients undergoing PCI.