Higher Body Mass Index Scores Research Articles

Role of Nutrition therapy during COVID 19

Nutrition is a vital element of health. More decisively, nutrition is part of the treatment routine for acute and chronic diseases and applies mainly to conditions for which an etiologic treatment has not yet been discovered. Ebola virus outbreak Western Africa in the 2014–2016 proved that immediate supportive care significantly reduces case mortality rates [1]. This may relate as well to the current COVID-19 pandemic that is disturbing the world. Emerging evidence shows that COVID-19 is associated with negative outcomes in older, comorbid, and hypoalbuminemia patients. These features are not specific to the Chinese residents because they have been testified also in North American patients with COVID-19. When measured together, the emerging literature on patients with COVID-19 indirectly highlights the applicability of nutrition in possibly determining their outcomes. Older age and the presence of comorbid conditions are almost consistently associated with impaired nutritional status and sarcopenia, independently of body mass index. Fascinatingly, a high body mass index score appears to be related to a poor prognosis in comorbid patients with COVID-19, which further points to a possible role of sarcopenic obesity in influencing the outcome [2].

Foot arch height affects the effect of BMI on gait and lower-limb joint kinematics

Foot arch structure contributes to walking in adults with obesity. However, little is known about the relationship between arch height and walking in these populations. The purpose of this study was to investigate if arch height affects gait characteristics among adults classified into three groups by body mass index (BMI). In this study, dynamic plantar pressure, spatiotemporal gait parameters, and lower-limb joint kinematics were collected from adults with normal weight (n=21), moderate obesity (n=18), and severe obesity (n=8) during walking at their preferred speed. Digital foot pressure data were used to compute a measure of arch height, the Chippaux-Smirak Index (CSI). Our results revealed that adults with higher BMI scores had lower arches than adults with lower BMI scores (p<0.01). Arch height was related to step width, double-limb support time, knee joint extension angle, and knee joint abduction angle (ps<0.01). Our results have implications for improving gait stability and increasing physical activity for obese populations via intervening in arch height.

A Short Review Article – Role of Nutrition Therapy during COVID – 19

Nutrition is a vital element of health. More decisively, nutrition is part of the treatment routine for acute and chronic diseases and applies mainly to conditions for which an etiologic treatment has not yet been discovered. Ebola virus outbreak Western Africa in the 2014–2016 proved that immediate supportive care significantly reduces case mortality rates [1]. This may relate as well to the current COVID-19 pandemic that is disturbing the world. Emerging evidence shows that COVID-19 is associated with negative outcomes in older, comorbid, and hypoalbuminemia patients. These features are not specific to the Chinese residents because they have been testified also in North American patients with COVID-19. When measured together, the emerging literature on patients with COVID-19 indirectly highlights the applicability of nutrition in possibly determining their outcomes. Older age and the presence of comorbid conditions are almost consistently associated with impaired nutritional status and sarcopenia, independently of body mass index. Fascinatingly, a high body mass index score appears to be related to a poor prognosis in comorbid patients with COVID-19, which further points to a possible role of sarcopenic obesity in influencing the outcome [2].

Which patients improve most after total hip arthroplasty? Influence of patient characteristics on patient-reported outcome measures of 22,357 total hip arthroplasties in the Dutch Arthroplasty Register.

Patient-reported outcome measures (PROMs) after total hip arthroplasty (THA), can be influenced by patient characteristics (case-mix factors). We used the Dutch Arthroplasty Register (LROI) to determine the effect of case-mix on improvement of PROMs after primary THA. We included all primary THAs (n = 22,357) performed in the Netherlands between 2014 and 2018. The Hip disability and Osteoarthritis Outcome Score Physical function short form (HOOS-PS), Oxford Hip Score (OHS), EQ-5D index score and thermometer, and Numeric Rating Scales (NRS) measuring pain during activities and at rest, were recorded. The difference between preoperative and 3- and 12-month postoperative scores was calculated (delta-PROM) and used as primary outcome variable. Multivariable linear regression was used to examine the association between patient characteristics (age, sex, ASA score, body mass index (BMI), Charnley class, smoking, and previous operations to the affected hip) and PROMs. Cohens' d was used to measure effect size. Postoperative improvement (delta-PROM) on HOOS-PS, OHS, EQ-5D, and pain relief were significantly higher in patients <60 years, in patients with female gender, a high ASA score (III-IV), a BMI >30 kg/m2, and patients without a previous operation to the hip. Cohen's d indicated clinically small differences (0.2). Patients benefiting most in terms of postoperative improvement of self-reported physical functioning, pain relief and quality of life after primary THA were young, female, with a high ASA or BMI score, and without previous operations to the hip.

Health Disparities and Cardiovascular Disease.

The number one leading cause of death in 2017 for Americans was cardiovascular disease (CVD), and health disparities can exacerbate risks. This study evaluates the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 437,436) to estimate population risks for behavioral, socio-economic, psychological, and biological factors. A general linear model with a quasi-binomial link function indicated higher risks for the following groups: smokers (odds ratio, OR = 0.688), individuals with higher body mass index scores (OR = 1.023), persons unable to work (OR = 2.683), individuals with depression (OR = 1.505), workers who missed more days due to mental issues (OR = 1.12), the elderly, males (OR = 1.954), those in race categories “indigenous Americans, Alaskan non-Hispanics”, “Black Hispanics,” or “other, non-Hispanic,” and individuals with lower income. Surprisingly, increased consumption of alcohol was not found to be a risk factor as in other studies. Additional study of alcohol risk factors is needed. Further, Black non-Hispanics were associated with lower rates of CVD/MI (myocardial infarction), a finding that is supported by recent evidence of more unhealthy behaviors in other races. The results of this study highlight 2018 CVD/MI disparities based on the BRFSS and suggest the need for additional policy interventions including education and providing increased access to health care for the disadvantaged. The principles of beneficence and justice require policy interventions such as these.

Association of obesity measures and multimorbidity in Pakistan: findings from the IMPACT study

ObjectiveObesity is a major factor leading to multimorbidity. However, the relative importance of obesity measures, including body mass index (BMI), body fat percentage (BF%) and visceral fat (VF), in relation to multimorbidity has not been extensively studied in Asia. Therefore, the objective of this study was to examine the relation of these measures of obesity with multimorbidity in a representative community sample in Pakistan. Study designThis is a community-based cross-sectional study. MethodsThis study was conducted among residents of Gulshan town, Karachi, Pakistan. Data on healthy individuals and individuals with chronic conditions were recorded. All self-reported chronic conditions were further assessed by physical examination, medical history of the participants and laboratory findings. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses of BMI, BF% and VF as predictors of obesity were used to examine the association with multimorbidity. ResultsA total of 1500 participants (738 men and 762 women) were recruited, with a median age of 54.5 years. Multivariate logistic regression showed a significant association of BMI (odds ratio [OR] = 1.28, 95% confidence interval [CI] = 1.00–1.81, P-value 0.049) and BF% (OR = 2.28, 95% CI = 1.50–3.45, P-value <0.001) with multimorbidity. However, the ROC analysis for BMI, BF% and VF showed very similar results, even when the analysis was stratified by gender. In this exploratory analysis, increasing age and female gender were significantly associated with multimorbidity compared with their counterparts. ConclusionsAdult populations with high BF% levels carry a higher risk of multimorbidity than those with high BMI scores. In a population with differing metabolic characteristics, BMI might be less precise than direct adiposity measurements. Additional studies are needed to confirm the potential use of measuring the anatomical location and metabolic characteristics of lean and fat mass to identify risk of diseases.

Systemic low-grade inflammation-associated lifestyle, diet, and genetic factors: A population-based cross-sectional study.

Systemic low-grade inflammation (SLGI) is an intermediary common condition to the physiopathology of chronic noncommunicable diseases and targeting its determinants could lead to more efficient public health strategies. We aimed to investigate SLGI-independent associations with lifestyle, diet, and genetic factors in a population-based sample of adults using a systemic low-grade inflammation score (SIS). The study sample is composed of 269 participants from the cross-sectional population-based Health Survey of Sao Paulo (2008-2010), ages 20 to 59 y, whose data on socioeconomic variables, lifestyle, health parameters, and blood samples were available. Diet was assessed by two 24-h recalls, and the Brazilian Health Eating Index-Revised (BHEI-R) was scored. From blood samples, 30 single nucleotide polymorphisms on inflammatory genes were genotyped, and plasma eleven inflammatory biomarkers levels that composed the SIS were determined. A multiple, stepwise, linear regression was used to investigate SIS-independent associated factors. Factors independently associated with SIS were BHEI-R score (partial R² = 5.1; β = -0.13; P = 0.003), body mass index (partial R² = 3.4; β = 0.19; P = 0.001), TLR4 rs5030728 GA + AA genotype (partial R² = 3.1; β = -1.37; P = 0.008), age 50 to 59 y (partial R² = 2.5; β = 1.93; P = 0.029) in comparison with the reference category (20 to 29 y), and commuting physical activity >150 min/wk (partial R² = 2.2; β = -1.29; P = 0.043) after adjustment for current smoking status, medication use, and dietary misreporting. Eating a lower quality diet, having a higher body mass index score and age, being GG homozygous for TLR4 rs5030728, and spending <150 min/wk in transportation physical activity are independent determinants of SLGI.

Drive for muscularity and disordered eating behaviors and its relationship with anthropometric indicators and physical activity in Mexican adolescent men.

Adolescent men have been identified as a risk population to develop eating disorders and other psychopathologies as drive for muscularity (DM) recently considered as muscularity-oriented disordered eating. It is important to identify risk factors as precursors of these pathologies. The aim of this study was to determine the risk of developing disordered eating behaviors (DEB) and DM and its relationship with anthropometric indicators and physical activity (PA) in adolescent men (high-schoolstudents, age 15-19) from Hidalgo, Mexico. A cross sectional, descriptive, and correlational field study was carried out in a non-probabilistic sample of 267 Mexican adolescents aged 15-19years. Participants completed measures of DM, DEB, and PA. Each subject was weighted and heighted to calculate body mass index (BMI), body fat percentage, and fat-free mass index (FFMI). Adolescents in the DM risk category (OR 8.28, CI 2.71-25.22) had significantly greater odds of developing DEB, while adolescents with higher BMI scores (OR 1.28, CI 1.14-1.45) tended to be more likely of developing DEB. The results showed that DEB and moderate PA were associated with DM; adolescents who engaged in DEB had an 8.64 times (CI 3.05-24.52) higher risk of developing DM. Participants classified in the category of highest moderate PA (OR 2.66, CI 1.26-5.59) had significantly greater odds of developing DM. Important percentages of the risk of developing DEB and DM were determined in Mexican adolescent men. In agreement with other findings, there were no associations between anthropometric indicators and DM. V, descriptive cross-sectional study.

Assessing Cardiovascular Disease Risk Factors in Parkinson’s Disease by Treatment: Levodopa Alone versus Deep Brain Stimulation with Levodopa (P12-047-19)

ObjectivesCardiovascular disease (CVD) risk factors include obesity, hypertension (HTN), diabetes (DM), dyslipidemia, and hyperhomocysteinemia. They are associated with accelerated cognitive decline in persons with Parkinson’s disease (PwPD). Levodopa is the primary medication to manage PD but can increase homocysteine. However, PwPD taking levodopa have a lower prevalence of DM and HTN than PwPD not taking levodopa. Deep brain stimulation (DBS) is a newer PD treatment. DBS may lower levodopa dose, reducing homocysteine, but PwPD with DBS can experience weight gain. This case study will compare CVD risk factors of PwPD treated with levodopa alone versus DBS with levodopa. MethodsFour male participants with PD (2 taking levodopa (LD1, LD2) and 2 with DBS (DBS1, DBS2) were assessed for CVD risk at ≥7 evaluations within 3y. CVD risk factors assessed: 1) body mass index (BMI) ≥25 kg/m2; 2) diastolic blood pressure (DBP) > 80 mmHg; 3) high density lipoprotein cholesterol (HDL-C) < 40 mg/dL; 4) low density lipoprotein cholesterol (LDL-C) > 100 mg/dL; 5) total cholesterol to HDL-C (TC/HDL-C) ratio > 4; 6) the Dietary Screening Tool (DST); 7) Framingham’s CVD 10y risk score. At baseline LD1 (62 y) was on medication for PD, HTN and dyslipidemia and had a myocardial infarction. He was following a heart healthy diet and overtime reported eating smaller portions. At baseline LD2 (70 y) was on medication for PD and to lower LDL-C. LD2 experienced decreased appetite and food intake. At baseline, DBS1 (62 y) was on medication for PD, HTN and dyslipidemia. He eats a balanced diet but is at nutritional risk. DBS2 (68 y) was taking PD, HTN medication. He self-reported swallowing and chewing issues. ResultsDBS1/2 TC/HDL-C ratios categorized them at risk at all time points, while LD1/2 ratios were ideal. DBS1/2 experienced high LDL-C. HDL-C values were at risk level for DBS1/2, while LD1/2 were not. All were overweight to obese, but DBS1/2 consistently had high BMI scores. DBS1/2 DST scores were at nutritional risk, while LD1/2 DST scores were at possible risk or no risk. LD1/2 had elevated DBP, while DBS1/2 had normal values. ConclusionsWhile all PWPD exhibit CVD risk factors, DBS treated patients may be more likely to have a greater number of risk factors after treatment. Further studies should look into risk factors before and after treatment of DBS. Funding SourcesUniversity of Rhode Island’s Enhancement of Graduate Research Award and SPARK Award.

Prevalence and correlates of low self-reported physical health status among prisoners in New South Wales, Australia

The purpose of this paper is to examine the prevalence and predictors of low self-reported physical health status among NSW prison inmates. Cross-sectional random sample of 1,098 adult male and female prisoners, interviewed as part of the 2015 Justice Health and Forensic Mental Health Network Patient Health Survey. Almost a quarter of participants had "low self-reported physical health status". Independent predictors of "low health status" were having been in out of home care before the age of 16 years, being illiterate, smoking 20 or more cigarettes a day, not eating more than one serve of fruit a day, not being physically active in the 12 months before incarceration, higher body mass index score and low self-reported mental health status. Many of these predictors are modifiable risk factors for chronic disease, which could be targeted during incarceration. This paper demonstrates the utility of a using a single item measure of self-reported physical health status among Australian prisoners, and helps to characterise those prisoners in greatest need of intervention for issues relating to their health.

The Prevalence and Social Determinants of Fruit and Vegetable Consumption and Its Associations With Noncommunicable Diseases Risk Factors Among Adults in Laos.

The study aimed to assess the prevalence and correlates of fruit and vegetable (FAV) consumption and its associations with noncommunicable diseases risk factors among adults in Laos. In a national cross-sectional survey in 2013, 2527 individuals (18-64 years old) responded to a questionnaire, and anthropometric and blood pressure measurements, and biochemistry tests were conducted. On average, participants had 0.99 servings of fruits a day and 1.33 servings of vegetables a day, a combined total of 2.32 servings of FAVs per day. Almost 1 in 5 respondents (18.9%) had 2 or more servings of fruit a day, 8.7% had 3 or more servings of vegetables a day, and 94.7% had less than 5 servings of FAV a day. In adjusted logistic analysis, being a Lao-Tai increased the odds of consuming 2 or more servings of fruits daily. Past month binge drinking decreased the odds of having 3 or more servings of vegetables daily. Higher education and urban residence decreased the odds of inadequate (<5 servings) FAV consumption. In adjusted linear regression analysis, increased FAV consumption was associated with higher body mass index scores. A high prevalence of inadequate FAV consumption was found. Interventions targeting identified modifiable risk factors, including lower education, general obesity, and binge drinking, may potentially increase FAV consumption in Laos.

The impacts of oral health symptoms, hygiene, and diet on the development and severity of psoriasis

Numerous studies have suggested a correlation between oral health, the oral microbiome, and various dermatologic conditions, particularly psoriasis. In this study, we utilize a specially designed questionnaire administered to 265 patients at The Ohio State University's dermatology clinics to explore the relationship between psoriasis and a combination of factors that included dietary habits, oral health, and oral hygiene practices. Age, family history of psoriasis, previous diagnosis of strep throat or rheumatoid arthritis, and oral pain or discomfort experienced within the last 12 months were all found to be significant predictors of psoriasis. Additionally, higher body mass index scores, poor gum health, and speech difficulties related to dental problems were all correlated with more severe psoriasis symptoms. Conversely, patients who reported consuming fresh fruit at least once a day experienced milder symptoms. Our goal is to develop a better understanding of how and why psoriasis incidence is correlated with some of the oral health factors under review.

Fit for duty: The health status of New South Wales Paramedics

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Introduction&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Paramedics are mobile health care workers who respond to trauma and medical emergencies. Worldwide, paramedics exhibit disturbingly high rates of injury and illness with increased markers of poor health, such as obesity and hypertension, being common. The primary aim of this study was to explore the self-reported health status of paramedics in New South Wales, Australia, by gender and geographic rostering pattern and to compare it with that of the Australian general population. A secondary aim was to examine paramedics’ attitudes towards exercise.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Methods&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;In 2015, paramedics employed by NSW Ambulance were invited to complete a web-based survey which composed of the Medical Outcomes Survey Short Form 36 (SF-36), and measures of attitudes towards exercise. Demographic information and participants’ height and weight (for calculating Body Mass Index (BMI)) were also collected. Normative comparator data for the Australian general population (BMI and SF-36 scores) were sourced from the Household Income Labour Dynamics in Australia 2015 survey.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Of the approximately 3,300 paramedics invited to participate, 747 completed the survey (507 male, 240 female). Mean age and mean years of service were 41.5 ±9.5 (SD) and 13.6 ±9.0 respectively. There were no differences in SF-36 scores except for the Vitality domain where males scored higher than females (p&amp;lt;0.001), and regional paramedics had a higher General Health domain score than metropolitan paramedics (p&amp;lt;0.05). Regional male paramedics had higher BMIs than their metropolitan counterparts (28.04 kg/m&lt;sup&gt;2&lt;/sup&gt; ± 3.99 vs. 26.81 kg/m&lt;sup&gt;2&lt;/sup&gt; ± 4.67, p = 0.001). Compared to the Australian population, paramedics scored higher in the Physical Function domain (p&amp;lt;0.001) but lower in summary scores for mental and physical health (p&amp;lt;0.001). Paramedics’ BMIs were slightly higher than the general population (27.10 ± 4.30 kg/m&lt;sup&gt;2 &lt;/sup&gt;vs.26.47 ±5.42, p&amp;lt;0.001). Paramedics reported lack of time, family, lack of motivation and in regional postings: distance to fitness facilities and shift patterns as barriers to exercise.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusions&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Paramedics scored lower on the SF-36 than the general population, which can indicate a lower health-related quality of life. High BMI and low SF-36 scores may be related to a perceived inability to engage in regular exercise and the effects of shift work, especially in regional areas. Increasing BMI can be associated with the development of markers of poor health. Attention is needed to ensure that these essential health care providers are “fit for duty”. This survey should be repeated longitudinally to examine trends in the health status of paramedics. Nationally and internationally, ambulance management can and should foster innovative health promotion programs and paramedics themselves need to recognise and value good health.&lt;/p&gt;

Does loneliness ‘get under the skin’? Associations of loneliness with subsequent change in inflammatory and metabolic markers

Objectives: To expand existing knowledge about the associations of late-life loneliness with subsequent change in inflammation as well as with metabolic dysregulation, using national representative longitudinal data. The current analysis also explores age, gender, and race differences in these pre-disease pathways.Method: The analysis is based on data from the 2005–06 and 2010–11 waves of the National Social Life, Health, and Aging Project (NSHAP)–a longitudinal survey conducted among a representative sample of community-dwelling Americans aged 57–85. Adjusted logistic regression models were used to examine associations of loneliness with changes in C-reactive protein (CRP), Glycated hemoglobin (HbA1c), Body Mass Index (BMI), Waist Circumference (WC), and metabolic burden.Results: Loneliness was found to be associated with a change for the worse in most of the metabolic bio-markers. Specifically, lonely older adults had 39%–71% higher odds of developing prospective risk levels in three out of the four metabolic bio-markers that were measured: HbA1c, BMI, and metabolic burden. Salient differences by race were found in this regard. Whereas loneliness was not significantly associated with HbA1c risk levels and BMI among the Whites, the prospective risk of high HbA1c was more than five times greater and the risk of high BMI scores was three times greater among Hispanics who experienced loneliness than among the not-lonely Hispanic group.Conclusions: The robust impact of loneliness on prospective changes for the worse in levels of various metabolic bio-markers that are closely associated with morbidity highlights the need for prevention, coping with, and reducing loneliness.

Sedentary behaviour and health at work: an investigation of industrial sector, job role, gender and geographical differences

This article presents baseline data from 1120 employees across 10 worksites enrolled in a workplace physical activity intervention. The study provides new data on physical activity, sedentary behaviour, and health and highlights gender, geographical, job type and industrial sector differences. Sitting at work accounted for more than 60% of participants’ total daily sitting time on work days. Weekly and monthly hours worked, body mass index (BMI) and waist circumference were significantly higher for workers in the private sector compared to the public sector. Employees in sales and customer services had significantly higher BMI scores and significantly lower scores for workability index (WAI), job satisfaction, organisational commitment and job motivation, compared to other groups. This study provides further evidence that work is a major contributor to sedentary behaviour and supports the pressing need for interventions particularly targeting private sector industries and sales and customer service sectors.Practitioner Summary: Work accounts for more than 60% of the daily sitting time. Private sector employees had higher BMIs than those in the public sector and employees in sales and customer services had higher BMIs and poorer health compared to other occupations, suggesting that these groups should be targeted in workplace interventions.

Social work students’ perceptions of obesity

ABSTRACTResearch indicates that mental health and medical professionals often hold negative views of overweight or obese people. Little is known about weight prejudice among social work students. In order to address this gap in the literature, this study examines the attitudes of Bachelor of social work and Master of social work students (n = 250) toward persons who are overweight and/or obese. Consistent with the literature, findings indicate generally those with higher body mass index scores are more likely to believe that obesity is beyond their control. Further, although age was correlated with Beliefs About Obese People scores, it was not a significant predictor. Implications for social work social justice and cultural competency curriculum are discussed.

Does the presence of endometriosis cause a challenge for transvaginal oocyte retrieval? A comparison between patients with and without endometriosis

Objective:The aim of the study was to compare patients with and without endometriosis regarding performance rates, difficulties, and complications associated with transvaginal oocyte retrieval (TVOR) procedures.Material and Methods:A prospective cohort study was conducted at the In Vitro Fertilization Unit of the Division of Reproductive Endocrinology and Infertility Department of a university hospital. Fifty-eight patients with endometriosis and 61 patients without endometriosis underwent TVOR procedures consecutively. Primary outcome measures were; number of needle entries per patient and performance rating defined as the total number of oocytes retrieved per vaginal needle entry. The requirement for manual compression of the abdominal wall (assistance) to reach the ovaries, procedure-related pain, and procedural complications were also evaluated.Results:The median number of needle entries through the vaginal wall per patient was comparable between the two groups (p=0.45). Performance rates were higher in the control group (p=0.001). Performance rates and total number of the needle entries through the vaginal wall were not significantly correlated with ovarian endometrioma (OMA) diameter (r=0.28; p=0.68; r=0.275, p=0.068, respectively) in the endometriosis group. Body mass index (BMI) scores were found to be correlated with the number of the needle entries and higher BMI scores were associated with higher numbers of vaginal wall punctures (p<0.001). The requirement for manual compression of the abdominal wall was significantly higher in the control group (57.4% vs 27.6%, p=0.001). A similar proportion of women needed analgesic medications after the TVOR procedure in both groups (10.3% vs 16.4%, p=0.33). Hospital readmissions for any symptoms were also comparable between the two groups (p=0.22). Three women were treated for pelvic infection, all of whom were in the endometriosis group.Conclusion:Endometriosis seems to cause a challenge for TVOR that may have reflection on individual surgeon’s performance rates for the procedure, independently from the diameter of a pre-existing OMA or ovarian adhesions. Obesity is another factor that may present a challenge for the procedure.

Factors affecting the caloric and protein intake over time in critically ill trauma patients

BackgroundMajor trauma leads to increased nutritional requirements. However, little is known about the actual amount of calories and protein administered and the factors affecting the intake over time in critically ill trauma patients. MethodsProspective study including 100 trauma patients admitted to the Los Angeles County + University of Southern California Medical Center intensive care unit between March 2014 and October 2014. Inclusion criteria were age > 16 y, surgery at admission, and no oral nutrition. The caloric and protein intake was recorded, and requirements were calculated daily for 28 d. The nutritional intake and the impact of clinical factors on the intake over time were assessed using mixed model analysis. ResultsThe caloric and protein intake significantly increased over time, but the median intake did not meet the median calculated requirements at any time. Multivariable analysis revealed a smaller increase of the nutritional intake over time in patients with an injury severity score > 45, whereas penetrating injury and laparotomy were associated with a higher increase of the intake. Body mass index scores ≥ 30 kg/m2, traumatic brain injury, and gastrointestinal tract injuries were associated with a smaller increase of the caloric intake over time. ConclusionsThe median nutritional intake did not meet the median calculated requirements over time. A smaller increase of the nutritional intake over time was found in patients with a higher injury burden, whereas penetrating injury and laparotomy were associated with a higher increase of the intake. Higher body mass index scores, traumatic brain injury, and gastrointestinal tract injuries were associated with a smaller increase of the caloric intake over time. These clinical factors can help to adjust the nutritional support in critically ill trauma patients.

Manifestations of Sasang Typology according to Common Chronic Diseases in Koreans

Sasang typology is a traditional Korean medical classification scheme that combines medical management with general medicine and can be applied to chronic diseases. We aimed to analyze differences in Sasang Personality Questionnaire (SPQ) and Sasang Digestive Function Inventory (SDFI) results in patients with diabetes mellitus (DM), hypertension, functional dyspepsia, major depressive disorder (MDD), and adenomyosis. In this cross‐sectional study, data were collected at a medical college hospital in South Korea. A total of 248 patients were included: 52 with DM, 47 with hypertension, 36 with functional dyspepsia, 26 with MDD, and 87 with adenomyosis. The subjects took both the SPQ and the SDFI. The outcome measures in this study were body mass index (BMI), SPQ score, and SDFI score. The DM and hypertension groups, which were expected to demonstrate many Taeeum‐type traits, exhibited high BMI, high SPQ‐Behavior and SDFI‐Appetite scores, and low SPQ‐Emotionality and SDFI‐Digestion scores. The functional dyspepsia group showed low BMI and high scores for SPQ‐Behavior, SPQ‐Emotionality, SDFI‐Digestion, and SDFI‐Appetite. The MDD group demonstrated high SPQ‐Emotionality and SDFI‐Digestion scores, low BMI, and low SPQ‐Behavior and SDFI‐Appetite scores. The adenomyosis group demonstrated high scores for SPQ‐Behavior, SDFI‐Digestion, and SDFI‐Appetite, low BMI, and low SPQ‐Emotionality scores. Different characteristics distinguishing Sasang traits according to chronic diseases were ascertained, especially for Taeeum and Soeum types.

Predictors of Functional and Quality of Life Outcomes following Deep Brain Stimulation Surgery in Parkinson's Disease Patients: Disease, Patient, and Surgical Factors.

Objective The primary objective was to evaluate predictors of quality of life (QOL) and functional outcomes following deep brain stimulation (DBS) in Parkinson's disease (PD) patients. The secondary objective was to identify predictors of global improvement. Methods PD patients who underwent DBS at our Center from 2006 to 2011 were evaluated by chart review and email/phone survey. Postoperative UPDRS II and EQ-5D were analyzed using simple linear regression adjusting for preoperative score. For global outcomes, we utilized the Patient Global Impression of Change Scale (PGIS) and the Clinician Global Impression of Change Scale (CGIS). Results There were 130 patients in the dataset. Preoperative and postoperative UPDRS II and EQ-5D were available for 45 patients, PGIS for 67 patients, and CGIS for 116 patients. Patients with falls/postural instability had 6-month functional scores and 1-year QOL scores that were significantly worse than patients without falls/postural instability. For every 1-point increase in preoperative UPDRS III and for every 1-unit increase in body mass index (BMI), the 6-month functional scores significantly worsened. Patients with tremors, without dyskinesia, and without gait-freezing were more likely to have “much” or “very much” improved CGIS. Conclusions Presence of postural instability, high BMI, and worse baseline motor scores were the greatest predictors of poorer functional and QOL outcomes after DBS.