High Nutritional Risk Research Articles

Relationship of Nutritional Status, Inflammation, and Serum Albumin Levels During Acute Illness: A Prospective Study

BackgroundLow serum albumin levels resulting from inflammation-induced capillary leakage or disease-related anorexia during acute illness are associated with poor outcomes. We investigated the relationship of nutritional status and inflammation with low serum albumin levels and 30-day mortality in a large cohort. MethodsWe prospectively enrolled adult patients in the medical emergency department of a Swiss tertiary care center and investigated associations of C-reactive protein (CRP) and Nutritional Risk Screening 2002 as markers of inflammation and poor nutritional status, respectively, with low serum albumin levels and mortality using multivariate regression analyses. ResultsAmong the 2465 patients, 1019 (41%) had low serum albumin levels (<34 g/L), 619 (25.1%) had increased nutritional risk (Nutritional Risk Screening 2002 ≥3), and 1086 (44.1%) had CRP values >20 mg/L. Multivariate analyses adjusted for age, gender, diagnosis, and comorbidities revealed elevated CRP values (adjusted odds ratio [OR] 10.51, 95% confidence interval, 7.51-14.72, P <.001) and increased malnutrition risk (adjusted OR 2.87, 95% confidence interval, 1.98-4.15, P <.001) to be associated with low serum albumin levels, even adjusting for both parameters. Low serum albumin levels, elevated CRP values, and increased nutritional risk independently predicted 30-day mortality, with areas under the curve of 0.77, 0.70, and 0.75, respectively. Combination of these 3 parameters showed an area under the curve of 0.82 to predict mortality. ConclusionsElevated parameters of inflammation and high nutritional risk were independently associated with hypoalbuminemia. All 3 parameters independently predicted mortality. Combining them during initial evaluation of patients in emergency departments facilitates mortality risk stratification.

Malnutrition in older adults: Correlations with social, diet-related, and neuropsychological factors.

The number of older adults is increasing rapidly. Malnutrition is a major problem in this age group, which may adversely affect health and quality of life. Several physiological, socioeconomic, and neuropsychological factors can lead to malnutrition. The aim of this study was to evaluate the nutritional status of community-dwelling older adults, and explore the associations of malnutrition risk with physiological, socioeconomic, and neuropsychological characteristics. This study is part of the Hellenic Longitudinal Investigation of Aging and Diet study, a cross-sectional observational study in Greece, and study participants were 1831 urban-dwelling elderly individuals (mean age: 73.1 ± 5.9 y; 40.8% men). Risk for malnutrition was assessed with the Determine Your Nutritional Health checklist. Data on age, sex, level of education, marital status, depression, cognitive performance, body mass index, total energy intake, and adherence to the Mediterranean diet were recorded. Correlations and multivariate analyses were performed between these variables and risk for malnutrition. The estimated prevalence of moderate and high nutritional risks was 34.8% and 29.4%, respectively. Risk for malnutrition was associated with marital status (unmarried), increased body mass index, male sex, lower level of education, lower cognitive performance, and lower adherence to the Mediterranean diet (P < 0.05). Nutritional screening should be performed frequently in all community-dwelling older adults. Health experts should perform nutritional screening in all community-dwelling older adults as part of secondary prevention, and nutrition counselling and support should be offered in those at risk for malnutrition.

NUTRITIONAL RISK IS ASSOCIATED WITH LOW BACK PAIN AMONG OLDER ADULTS: RESULTS FROM THE UAB STUDY OF AGING

Poor nutritional status is associated with adverse health outcomes across the life course, affecting older adults’ ability to maintain overall well-being, limiting physical strength, and affecting mobility. International research has demonstrated associations between nutritional risk and general musculoskeletal pain; however, no research has explored relationships between nutritional risk and low back pain. Using the University of Alabama-Birmingham Study of Aging, we examined this relationship among 1000 community-dwelling older Alabamians (65+years). We used the DETERMINE Checklist, a well-validated nutritional risk assessment and assessed presence and severity of low back pain over the past 4 weeks. We completed univariate and bivariate analysis and multivariate logistic regression, adjusting for factors significant in the bivariate analyses: sex, body mass index, depression, and co-morbidities. More than half of the participants were at nutritional risk (55.2%). In multivariate analyses, one point increases in nutritional risk were associated with a 14% increase in the likelihood of low back pain 95% CI (1.087,1.213); in categorical analyses, moderate nutritional risk and high nutritional risk were associated with an increase in likelihood of low back pain [46% (95% CI 1.07,2.02) and 164% (95% CI 1.80,3.94), respectively]. While this cross-sectional analysis should be interpreted cautiously, it further emphasizes the importance of nutritional health for older adults. Clinicians treating patients with low back pain or nutritional risk may consider assessing for the other condition. When nutritional risk is detected, clinicians should refer to services such as counseling with a registered dietitian or to a social worker for assistance identifying community-based nutritional supports.

FALLS AND NUTRITIONAL RISK AMONG RURAL STATE RESIDENTS

Vermont continues to have one of the nation’s highest fall rates and its rurality may be a contributing factor. The purpose of our study was to compare fall history and nutritional risk (a fall risk factor also associated with rurality) in participants from rural and metropolitan areas. We collected data at statewide community-based fall risk screenings. During the events, nutritional data was collected using the DETERMINE Your Nutritional Health Screening Tool Questionnaire. We used descriptive statistics (chi2) to examine the relationship between fall history, nutritional risk, and rurality. From 123 subjects, 67% were classified as rural residents. There was no relationship between fall history and nutritional risk (p=0.6). Compared to rural residents, a significantly higher percentage of those living in metropolitan areas reported falls (54% versus 35% p=0.05). However, metropolitan residents were not at higher nutritional risk (49% versus 54%, p=0.61). National nutritional risk rates are lacking, but food insecurity is associated with nutritional risk. Our overall reported high nutritional risk (20%) is higher than the prevalence of food insecurity, both nationally (11%) and in Vermont (9%). In conclusion, we did not identify a relationship between fall history and nutritional risk. We did find a higher percentage of metropolitan residents reporting falls. Furthermore, we identified that DETERMINE is a feasible nutritional screening tool to use at fall risk screenings. It can be used to identify community-dwelling older adults at nutritional risk, but it may not have the sensitivity to identify an association between nutritional risk and falls.

ASSESSING NUTRITIONAL RISK IN ADULT DAY SERVICES: UTILITY OF THE DETERMINE CHECKLIST

Older adults attending adult day services (ADS) often possess risk factors for malnutrition, such as chronic disease, physical disability, and cognitive impairment. We explored the utility of administering to ADS participants the DETERMINE Checklist - a measure of nutritional status. Among eleven participants (M age=77.3 years), 82% (n = 9) presented high nutritional risk. The three most common risk factors were: difficulty shopping, cooking, and/or feeding themselves (100%), making health-related dietary changes (63.7%), and taking three or more daily medications (63.7%). Our preliminary findings indicate that ADS participants may be at moderate-high risk of malnutrition; however, the DETERMINE Checklist may require modification for an ADS population. For example, the checklist may be more reliable if completed jointly by a participant and informal caregiver. We present recommendations for adaptions based on our pilot data as well as implications for ADS staff and clinicians.

Depression in middle and older adulthood: the role of immigration, nutrition, and other determinants of health in the Canadian longitudinal study on aging

BackgroundLittle is known about depression in middle-aged and older Canadians and how it is affected by health determinants, particularly immigrant status. This study examined depression and socio-economic, health, immigration and nutrition-related factors in older adults.MethodsUsing weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging (n = 27,162) of adults aged 45–85, gender-specific binary logistic regression was conducted with the cross-sectional data using the following variables: 1) Depression (outcome) measured using the Center for Epidemiologic Studies Short Depression (CESD-10) rating scale; 2) Immigration status: native-born, recent and mid-term (< 20 years), and long-term immigrants (≥20 years); and 3) covariates: socioeconomic status, physical health (e.g., multi-morbidity), health behavior (e.g., substance use), over-nutrition (e.g., anthropometrics), under-nutrition (e.g., nutrition risk), and dietary intake.ResultsThe sample respondents were mainly Canadian-born (82.6%), women (50.6%), 56–65 years (58.9%), earning between C$50,000–99,999 (33.2%), and in a relationship (69.4%). When compared to Canadian-born residents, recent, mid-term (< 20 years), and longer-term (≥ 20 years) immigrant women were more likely to report depression and this relationship was robust to adjustments for 32 covariates (adjusted ORs = 1.19, 2.54, respectively, p < 0.001). For women, not completing secondary school (OR = 1.23, p < 0.05), stage 1 hypertension (OR = 1.31, p < 0.001), chronic pain (OR = 1.79, p < 0.001), low fruit/vegetable intakes (OR = 1.33, p < 0.05), and fruit juice (OR = 1.80, p < 0.001), chocolate (ORs = 1.15–1.66, p’s < 0.05), or salty snack (OR = 1.19, p < 0.05) consumption were associated with depression. For all participants, lower grip strength (OR = 1.25, p < 0.001) and high nutritional risk (OR = 2.24, p < 0.001) were associated with depression. For men, being in a relationship (OR = 0.62, p < 0.001), completing post-secondary education (OR = 0.82, p < 0.05), higher fat (ORs = 0.67–83, p’s < 0.05) and omega-3 egg intake (OR = 0.86, p < 0.05) as well as moderate intakes of fruits/vegetables and calcium/high vitamin D sources (ORs = 0.71–0.743, p’s < 0.05) predicted a lower likelihood of depression. For men, chronic conditions (ORs = 1.36–3.65, p’s < 0.001), chronic pain (OR = 1.86, p < 0.001), smoking (OR = 1.17, p < 0.001), or chocolate consumption (ORs = 1.14–1.72, p’s < 0.05) predicted a higher likelihood of depression.ConclusionsThe odds of developing depression were highest among immigrant women. Depression in middle-aged and older adults is also associated with socioeconomic, physical, and nutritional factors and the relationships differ by sex. These results provide insights for mental health interventions specific to adults aged 45–85.

Diversity in Dietetics Matters

The dietetics profession is comprised of practitioners who understand the relationship between food and health. Registered Dietitians (RDs) can work in a variety of fields ranging from acute care hospitals, food service institutions, community settings, and research or marketing arenas. A wide variety of populations are served by RDs, including minority populations. Several minority populations such as African Americans and Hispanics tend to be at higher nutritional risk, and often have higher rates of obesity and chronic diseases, such as diabetes, hypertension, and cardiovascular disease. Despite the fact that these disparities tend to be related to nutrition, the RDs who serve these populations tend to be primarily white and female (96%). This problem has been addressed within the profession for decades and little progress has been made. The success of white RDs treating non-white patients has been questioned and could lead to lower quality of care. The purpose of this study was to investigate the perceptions and experiences of minority dietitians throughout their education. Barriers that prohibit minorities from entering the field were also be explored.&#x0D; To explore this phenomenon, minority female dietitians were interviewed to investigate their perceptions of the field and their higher education experience. This work answers the question: What are the experiences of minority female professional dietitians regarding training, education, and practice? Using Critical Race Theory (CRT) as the lens, results showed that minorities have had disgraceful treatment in their higher education and internship experiences and have had to work harder than their white peers.

What can dietary patterns tell us about the Caribbean nutrition transition?

Abstract Background Given the public health urgency facing the increasing rates of obesity and chronic diseases in the Caribbean, characterization of the nutrition transition and population groups at higher nutritional risk is needed. We identified dietary patterns in the French West Indies (FWI) and their association with individual characteristics. Methods This cross-sectional analysis included 1,144 Guadeloupeans and Martinicans from a representative survey. To identify dietary patterns, principal component analysis was performed using 25 food groups, followed by a clustering procedure classifying subjects in independent clusters. Their associations with health status, Diet Quality Index-International (DQI-I), food supply behaviors, sociodemographic and economic characteristics were studied using multivariable models. Results Four dietary patterns were identified, representing 25%, 24%, 31% and 20% of the sample: (1) a “healthy” cluster characterised by a high DQI-I, composed of high educated individuals; (2) a “traditional” cluster with a high DQI-I and high intakes of traditional dishes, formed mostly by women and older persons, with a high obesity prevalence (26%); (3) a “western” cluster with a low DQI-I, high intakes of sweetened beverages, snacks and fast foods, composed mainly of young subjects, buying their fruits, vegetables and tubers only or mainly in supermarkets; and (4) a “transitional” cluster with high intakes of bread, processed meat, sauces, alcoholic and sweetened beverages but conversely high intakes of tubers, legumes, fish and low intakes of biscuits and cakes, formed mainly by middle age men, self-employed or manual workers, and 35% had metabolic syndrome. Conclusions The dietary patterns identified reflect different steps of dietary change as described by Popkin, suggesting an ongoing nutrition transition in the FWI. This characterization provides useful information for public health actions regarding population groups at higher nutritional risk. Key messages Four diversified dietary patterns were identified suggesting an ongoing nutrition transition in the French West Indies. Demographic and socioeconomic characteristics associated with dietary patterns, especially age, reflecting a generational contrast, provided needed information to guide future public health measures.

Feasibility of using the “modified NUTrition Risk In the Critically ill” nutritional risk screening tool to identify nutritionally at-risk patients in an Australian intensive care unit

BackgroundThe modified NUTrition Risk In the Critically ill (mNUTRIC) score has been demonstrated to accurately quantify the risk of negative patient outcomes and discriminate which patients will benefit the most from nutrition intervention in an intensive care unit (ICU) setting. Calculation of an mNUTRIC score, however, may be time-intensive and unable to be performed within available resources. This may prevent high-risk patients from being identified and reviewed by a dietitian. ObjectivesThe purpose of this study was to assess the feasibility of using the mNUTRIC tool to screen for patients at increased nutrition risk and to determine the proportion of those high-risk patients who were reviewed by a dietitian. Subjects/methodsA retrospective observational study of 260 critically ill patients was conducted between 01/01/2017 and 30/05/2017 in a 20-bed Australian tertiary ICU. Participants included all adults admitted to the ICU for more than 72 h. Feasible implementation was defined as calculating an mNUTRIC score in <5 min per patient where all data were available for >90% of patients. ResultsA median time of 4 min and 54 s (interquartile range: 4.3–5.6 min) was required to calculate each mNUTRIC score, with 96% of scores calculated in <10 min. Data were available to calculate mNUTRIC scores for 93% (241/260) of patients. The mNUTRIC tool identified 81 patients at high nutrition risk, 44% (36/81) of whom were not reviewed by a dietitian. There were 21 high-risk patients who were purposefully excluded from dietetic review for various clinical reasons, leaving 15 high-risk patients (19%) who were not reviewed by a dietitian. ConclusionsImplementation of the mNUTRIC tool was not feasible in our ICU, given the set dietetic resources (0.6 full-time equivalent). Shared responsibility of nutrition screening or automating the calculation may be possible solutions to increase feasibility of mNUTRIC screening.

Nutritional assessment of children with non-Hodgkinundefineds lymphoma during induced chemotherapy

Objective To evaluate the nutritional status of children with non-Hodgkin lymphoma (NHL) during induction chemotherapy, and to understand the incidence of malnutrition, so as to give nutrition intervention in time. Methods From January 2017 to December 2018, 257 children with NHL were selected from the Center for Hematological Oncology, Peking Children′s Hospital Affiliated to Capital Medical University.Nutritional status and growth risk screening tools were used to assess the nutritional risk of the children, and the malnutrition was classified according to the height and body weight.The body mass, height and other anthropometric indexes, hemoglobin, prealbumin, albumin and other laboratory indexes were measured at the end of initial diagnosis and induction chemotherapy. Results There were 223 cases of moderate nutritional risk (86.8%) and 34 cases of high nutritional risk (13.2%). After treatment, the nutritional status of the children decreased: 13 cases of mild malnutrition, 1 case of moderate malnutrition, 4 cases of overweight and 3 cases of obesity before treatment; 32 cases of mild malnutrition, 9 cases of moderate malnutrition, 5 cases of severe malnutrition, 3 cases of overweight and 2 cases of obesity after treatment.Ninety-six patients received nutritional support (37.4%), including 15 cases of parenteral nutrition and 81 cases of enteral nutrition.The body weight ((29.50±15.13) kg before and after chemotherapy (27.60±14.30) kg) and body mass index ((17.2±3.28) kg/m2 before and (16.1±3.13) kg/m2 after chemotherapy) decreased significantly (t=12.404, 13.949, all P<0.01). Laboratory indicators except prealbumin were lower in hemoglobin ((109.00±15.78) g/L), albumin ((37.40±4.38) g/L), total lymphocyte ((1.58±1.26)×109/L) than before treatment (hemoglobin(117.90±21.06) g/L), (albumin (39.60±6.70) g/L), (total lymphocyte (2.98±2.87)×109/L)) (t=6.514, 4.834, 7.420, all P<0.01). Conclusion There is a high incidence of malnutrition in NHL children after initial treatment.Early screening of nutritional risk and optimizing nutritional treatment are one of the ways to improve the clinical efficacy of NHL children. Key words: Non-hodgkin′slymphoma; Nutritional assessment; Malnutrition; Pediatrics

Effects of perioperative nutritional risk scores on postoperative clinical outcomes in patients with glioblastoma multiforme

Objective To analyze the effects of perioperative nutritional risk scores on postoperative clinical outcomes in patients with glioblastoma multiforme (GBM) . Methods Totally 72 patients with GBM treated in Beijing Tiantan Hospital, Capital Medical University between December 2018 and July 2019 were selected. Their clinical data were retrospectively analyzed. The subjects were divided into high-risk (>5 points, n=34) and low-risk (≤5 points, n=38) groups according to the scores of Nutritional Risk Screening (NRS 2002) . Chi-square test was used to analyze the relationship between nutritional risk and patients' clinical pathological characteristics. Univariate and multivariate Cox regression analyzes were used to analyze the risk factors affecting patients' prognosis. Kaplan-Meier survival analysis and Log-rank test were employed to the difference in survival time between high-risk and low-risk groups. Results Chi-square test revealed that there was statistically significant difference in nutritional risks between patients with methylated an unmethylated MGMT promotor, with and without radiotherapy, and with and without chemotherapy (P 5) was shorter than that of the low-risk group (NRS 2002 score≤5) (P<0.05) . Univariate and multivariate Cox regression analyzes showed that high nutritional risk scores were the risk factor to the prognosis of patients with GBM (P<0.05) . Conclusions Perioperative nutritional risk scores in patients with GBM may serve as a useful indicator for predicting the postoperative clinical outcome of these patients. Key words: Perioperative period; Glioblastoma multiforme; Nutritional status; Nutritional risk; Clinical outcome

Risk Factors of Progression to Frailty: Findings from the Singapore Longitudinal Ageing Study.

To investigate risk factors of incident physical frailty. A population-based observational longitudinal study. Community-dwelling elderly with age 55 years and above recruited from 2009 through 2011 in the second wave Singapore Longitudinal Ageing Study-2 (SLAS-2) were followed up 3-5 years later. A total of 1297 participants, mean age of 65.6 ±0.19, who were free of physical frailty. Incident frailty defined by three or more criteria of the physical phenotype used in the Cardiovascular Health Study was determined at follow-up. Potential risk factors assessed at baseline included demographic, socioeconomic, medical, psychological factors, and biochemical markers. A total of 204 (15.7%) participants, including 81 (10.87%) of the robust and 123 (22.28%) of the prefrail transited to frailty at follow-up. Age, no education, MMSE score, diabetes, prediabetes and diabetes, arthritis, ≥5 medications, fair and poor self-rated health, moderate to high nutritional risk (NSI ≥3), Hb (g/dL), CRP (mg/L), low B12, low folate, albumin (g/L), low total cholesterol, adjusted for sex, age and education, were significantly associated (p<0.05) with incident frailty. In stepwise selection models, age (year) (OR=1.07, 95%CI=1.03-1.10, p<0.001), albumin (g/L) (OR=0.85, 95%CI=0.77-0.94, p=0.002), MMSE score (OR=0.88, 95%CI=0.78-0.98, p=0.02), low folate (OR=3.72, 95%CI=1.17-11.86, p=0.03, and previous hospitalization (OR=2.26, 95%CI=1.01-5.04,p=0.05) were significantly associated with incident frailty. The study revealed multiple modifiable risk factors, especially related to poor nutrition, for which preventive measures and early management could potentially halt or delay the development of frailty.

Prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer: Influence on nutritional status, utilisation rate and complications.

Patients with head and neck cancer (HNC) are at high risk for malnutrition because of tumour localisation and therapy. Prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement is common practice to prevent malnutrition. To investigate the benefits of prophylactic PEG tube placement for HNC patients in terms of the influence on patients' nutritional status, utilisation rate, complications and to identify the predictors of PEG tube utilisation. All consecutive HNC patients who underwent prophylactic PEG tube insertion between 1 January 2011 and 31 December 2012 prior to therapy were enrolled. The PEG tube utilisation rate, complications, the patients' nutritional status and tumour therapy were evaluated with the help of electronic patient charts and telephone interviews. A total of 181 patients (48 female, median 67.5years) were included. The PEG utilisation rate in the entire cohort was 91.7%. One hundred and forty-nine patients (82.3%) used the PEG tube for total enteral nutrition, 17 patients (9.4%) for supplemental nutrition and 15 patients (8.3%) made no use of the PEG tube. Peristomal wound infections were the most common complications (40.3%) in this study. A high Nutritional Risk Screening (NRS) score prior to tube insertion was found to be independently associated with PEG utilisation. No significant weight changes were observed across the three patient subgroups. The overall PEG tube utilisation rate was high in this study. However, given the high rate of infections, diligent patient selection is crucial in order to determine which patients benefit most from prophylactic PEG tube insertion.

Nutrition Risk Assessment Using the Modified NUTRIC Score in Cirrhotic Patients with Acute Gastroesophageal Variceal Bleeding: Prevalence of High Nutrition Risk and its Independent Prognostic Value.

Malnutrition is associated with adverse outcomes in patients with liver cirrhosis. Relevant data about nutrition risk in critically ill cirrhotic patients are lacking. The modified Nutrition Risk in Critically Ill (mNUTRIC) score is a novel nutrition risk assessment tool specific for intensive care unit (ICU) patients. This retrospective study was conducted to evaluate the prevalence and prognostic significance of nutrition risk in cirrhotic patients with acute gastroesophageal variceal bleeding (GEVB) using mNUTRIC scores computed on admission to the intensive care unit. The major outcome was 6-week mortality. One-hundred-and-thirty-one admissions in 120 patients were analyzed. Thirty-eight percent of cirrhotic patients with acute GEVB were categorized as being at high nutrition risk (a mNUTRIC score of ≥5). There was a significantly progressive increase in mortality associated with the mNUTRIC score (χ2 for trend, p < 0.001). By using the area under a receiver operating characteristic (ROC) curve, the mNUTRIC demonstrated good discriminative power to predict 6-week mortality (AUROC 0.859). In multivariate analysis, the mNUTRIC score was an independent factor associated with 6-week mortality. In conclusion, the mNUTRIC score can serve as a tool to assess nutrition risk in cirrhotic patients with acute GEVB.

Application of STRONGkids to screen infants with lower respiratory tract infection and its possible influence on clinical outcome

Objective To investigate the incidence of nutritional risk in infants with lower respiratory tract infection, and to compare the effects of different nutritional risks on clinical outcomes, and to provide evidence for clinical nutritional management of infantile lower respiratory tract infection. Methods Infants and young children with lower respiratory tract infection who were hospitalized in our hospital from January 2013 to March 2016 were selected as subjects. Nutritional risk screening was performed using the Nutritional Status and Growth Risk Screening Tool (STRONGkids). Results A total of 957 infants with lower respiratory tract infections were included in the study. The incidence of high nutrition risk and low and medium nutritional risk were 17.6% and 82.4%, respectively. The clinical cure rate was 68.5% and 71.4% respectively. The children with pneumonia and bronchitis had high nutritional risk. The incidence rates were 20.60% and 4.87%, respectively, and the difference was statistically significant (χ2=25.52, P=0.000). Time-effect single factor analysis (Kaplan-Meier method): The hospitalization time for infants with low nutritional risk and high nutritional risk was 9.3(0.3) d and 13.3(1.0) d, respectively. The difference between the two groups was statistically significant. (χ2=28.33, P=0.000), the total hospitalization expenses were 5 653.5(224.8) yuan and 10 079.5(1 755.8) yuan respectively. The difference between the two groups was statistically significant (χ2=4.47, P=0.034). Multivariate COX regression analysis: High nutritional risk was a risk factor for hospitalization of hospitalized infants with lower respiratory tract infection (RR=1.57, P=0.024). Conclusion There is a high incidence of high nutritional risk in infants with lower respiratory tract infection. Compared with children with low and moderate nutritional risk, the hospitalization time is longer, the hospitalization cost is increased, and the clinical cure rate is lower, which is the risk of clinical outcome. factor. Therefore, it is necessary to conduct nutrition risk screening for infants with lower respiratory tract infections, and provide a theoretical basis for clinical nutrition evaluation and nutritional intervention. Key words: Respiratory infections; Infants; Nutritional status and growth risk screening tools

Parameters of Bioelectrical Impedance Are Good Predictors of Nutrition Risk, Length of Stay, and Mortality in Critically Ill Patients: A Prospective Cohort Study.

Assessment of nutrition risk in the intensive care unit (ICU) is limited by characteristics of critically ill patients, and new methods have been investigated for their applicability and predictive validity. The aim of the present study was to evaluate the validity of bioelectrical impedance analysis (BIA) parameters as predictors of nutrition risk and clinical outcomes in critically ill patients. This was a prospective cohort study of patients admitted to an ICU. The modified Nutrition Risk in the Critically Ill score was used for assessment of nutrition risk, and BIA was performed in the first 72 hours of admission. Phase angle (PA) measurements were obtained, and bioelectrical impedance vector analysis (BIVA) was used to classify patients by hydration status (BIVA >70%). Patients were followed until hospital discharge and evaluated for hospital mortality, ICU length of stay, length of hospitalization, and duration of mechanical ventilation. Eighty-nine patients were included (62.5±14.1years, 50.6% female). A PA <5.5o showed an accuracy of 79% (95% CI 0.59-0.83) in identifying patients at high nutrition risk and was associated with nearly 2 times greater risk for an ICU length of stay longer than 5days (relative risk=2.18 [95% CI 1.39-3.40]). Hyperhydration was a significant predictor of mortality (hazard ratio=2.24 [95% CI 1.07-4.68]). Higher resistance and reactance values, adjusted for height, were found in survivors compared with nonsurvivors. The predictive validity of BIA was satisfactory for the assessment of nutrition risk, ICU length of stay, and mortality in critically ill patients.

Relationship between Nutrition Intake and 28-Day Mortality Using Modified NUTRIC Score in Patients with Sepsis.

In critically ill patients, malnutrition is known to increase morbidity and mortality. We investigated the relationship between nutritional support and 28-day mortality using the modified NUTrition RIsk in the Critically ill (NUTRIC) score in patients with sepsis. This retrospective cohort study included patients with sepsis admitted to the medical intensive care unit (ICU) between January 2011 and June 2017. Nutritional support for energy and protein intakes at day 7 of ICU admission were categorized into <20, 20 to <25, and ≥25 kcal/kg and <1.0, 1.0 to <1.2, and ≥1.2 g/kg, respectively. NUTRIC scores ≥4 were considered to indicate high nutritional risk. Among patients with low nutritional risk, higher intakes of energy (≥25 kcal/kg) and protein (≥1.2 g/kg) were not significantly associated with lower 28-day mortality. In patients with high nutritional risk, higher energy intakes of ≥25 kcal/kg were significantly associated with lower 28-day mortality compared to intakes of <20 kcal/kg (adjusted hazard ratio (aHR): 0.569, 95% confidence interval (CI): 0.339–0.962, p = 0.035). Higher protein intakes of ≥1.2 g/kg were also significantly associated with lower 28-day mortality compared to intakes of <1.0 g/kg (aHR: 0.502, 95% CI: 0.280–0.900, p = 0.021). Appropriate energy (≥25 kcal/kg) and protein (≥1.2 g/kg) intakes during the first week may improve outcomes in patients with sepsis having high nutritional risk.

Racial Disparities in Nutritional Risk among Community-Dwelling Older Adults in Adult Day Health Care

Information regarding nutritional risk among users of American adult day health centers (ADHCs), 60% of whom are racial minorities, is scant. This study examined nutritional risk and associated factors in a diverse sample ADHC users aged 50+ using secondary cross-sectional analysis of data collected between 2013 and 2017. Risk was assessed using the DETERMINE checklist, and results were stratified by race. The majority of the sample (N = 188) was at moderate (45.2%) or high (38.5%) nutritional risk, with statistically significant racial differences. Blacks were at greater risk than any other group: 65% had high nutritional risk; 76.5% ate <5 servings of fruits, vegetables, or milk daily; 21% ate <2 meals daily, 48.5% reported involuntary weight loss/gain, and 41.2% had tooth loss/mouth pain. Older adults in ADHCs are at elevated risk of malnutrition, disproportionately so amongst blacks. Both routine nutrition screening and population-specific approaches are needed to attenuate risk.

Prognostic impact of malnutrition assessed using geriatric nutritional risk index in patients aged ⩾80 years with heart failure.

Malnutrition in elderly patients is one of the important issues in an aging society. We aimed to investigate the prevalence and prognostic impact of malnutrition assessed using the geriatric nutritional risk index in very elderly patients hospitalized owing to heart failure. We enrolled 213 consecutive patients aged ⩾80 years who were hospitalized with heart failure. The mean age was 87.2 ± 4.9 years, and 43.7% of them were male. The nutritional status on admission was evaluated using the geriatric nutritional risk index, which was calculated as follows: 14.89 × serum albumin (g/dL) + 41.7 × body mass index/22. The patients were divided into two groups, a low geriatric nutritional risk index group (<92) with malnutrition risk and a high geriatric nutritional risk index group (⩾92) without malnutrition risk. The mean geriatric nutritional risk index of all patients was 90.7 ± 10.6, and 108 patients (50.7%) had low geriatric nutritional risk index. During the 540-day follow-up, the all-cause mortality was significantly higher in the low geriatric nutritional risk index group than in the high geriatric nutritional risk index group (35.7% vs. 12.9%, p < 0.001). The Cox proportional-hazards regression analysis revealed that low geriatric nutritional risk index was an independent predictor of mortality (hazard ratio, 2.28; 95% confidence interval, 1.15-4.49; p = 0.02). Low geriatric nutritional risk index on admission was common and was associated with poor prognosis in patients aged ⩾80 years who were hospitalized owing to heart failure.

The role of maximum compressed thickness of the quadriceps femoris muscle measured by ultrasonography in assessing nutritional risk in critically-ill patients with different volume statuses.

In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status. 55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected. There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04). Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.