Independent Risk Factor For Malnutrition Research Articles

Analysis of Risk Factors Related to Malnutrition on Length of Stay Hospitalization: A Single-Center Observational Study at Klungkung General Hospital, Indonesia

Background: Malnutrition is a prevalent issue in hospital settings, significantly impacting patient outcomes and healthcare costs. This study aimed to identify and analyze risk factors associated with malnutrition and its influence on the length of stay (LOS) among hospitalized patients at Klungkung General Hospital, Indonesia. Methods: A retrospective observational study was conducted, including adult patients admitted to Klungkung General Hospital between January 1, 2023, and December 31, 2023. Malnutrition was assessed using the Subjective Global Assessment (SGA) tool. Patient demographics, medical history, nutritional status, laboratory parameters, and LOS were collected. Univariate and multivariate analyses were performed to identify risk factors associated with malnutrition and its impact on LOS. Results: A total of 43,949 patients were included in the study, with 1,084 (2.46%) identified as malnutrition. The mean LOS for malnutrition patients was significantly longer than for well-nutrition patients (7.8 days vs. 4.2 days, p < 0.001). Multivariate analysis revealed that age ≥ 60 years (OR 2.31, 95% CI 1.85-2.89), presence of comorbidities (OR 1.75, 95% CI 1.42-2.16), low albumin levels (OR 2.05, 95% CI 1.68-2.50), and inadequate dietary intake (OR 1.98, 95% CI 1.61-2.43) were independent risk factors for malnutrition. Malnutrition was also an independent predictor of prolonged LOS (OR 1.68, 95% CI 1.36-2.07). Conclusion: Malnutrition is a significant problem at Klungkung General Hospital, associated with increased LOS. Early identification of risk factors and implementation of targeted nutritional interventions are crucial to improve patient outcomes and reduce healthcare costs.

Serum growth differentiation factor 15 as a biomarker for malnutrition in patients with acute exacerbation of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that often coexists with malnutrition during acute exacerbation (AECOPD) and significantly affects the prognosis. Previous studies have shown that growth differentiation factor 15 (GDF15) levels promote appetite suppression, weight loss, and muscle weakness, and are markedly high in peripheral blood following inflammatory stimulation. However, it is still unknown whether serum GDF15 levels can be used to predict malnutrition in patients with AECOPD. A total of 142 patients admitted to the Department of Respiratory Medicine at Anshun People's Hospital between December 2022 and August 2023 were selected for this study. The participants were divided into two groups: malnutrition group (n = 44) and non-malnutrition group (n = 98) based on a body mass index (BMI) < 18.5 kg/m2, according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Serum GDF15 levels were measured using the enzyme-linked immunosorbent assay (ELISA) and compared between the two groups. Spearman correlation analysis was used to examine the association between serum GDF15 levels, baseline data, and clinical indicators. Binary logistic regression was used to identify the independent risk factors for AECOPD combined with malnutrition. The predictive value of serum GDF15, albumin (ALB), and a combination of these was evaluated to identify malnutrition in patients with AECOPD using a receiver operating characteristic (ROC) curve. Serum GDF15 levels in patients with malnutrition and AECOPD were significantly higher than those in patients without malnutrition, whereas the serum ALB levels were significantly lower than those in patients without malnutrition (p < 0.001). Moreover, serum GDF15 levels were negatively correlated with BMI (r = -0.562, p < 0.001), mid-arm circumference (r = -0.505, p < 0.001), calf circumference (r = -0.490, p < 0.001), total protein (r = -0.486, p < 0.001), ALB (r = -0.445, p < 0.001), and prognostic nutritional index (r = -0.276, p = 0.001), and positively correlated with C-reactive protein (r = 0.318, p < 0.001), COPD assessment test score (r = 0.286, p = 0.001), modified medical research council classification (r = 0.310, p < 0.001), and global initiative for chronic obstructive pulmonary disease grade (r = 0.177, p = 0.035). Furthermore, serum GDF15 levels were an independent risk factor for malnutrition in patients with AECOPD (OR = 1.010, 95% CI, 1.003∼1.016). The optimal cut-off value of serum GDF15 level was 1,092.885 pg/mL, with a sensitivity of 65.90% and a specificity of 89.80%, while the serum ALB level was 36.15 g/L, with a sensitivity of 86.40% and a specificity of 65.00%, as well as a combined sensitivity of 84.10% and a specificity of 73.90%. Serum GDF15 and serum ALB levels had a good predictive ability (AUC = 0.856, AUC = 0.887), and the ROC revealed a greater combined prediction value for the two (AUC = 0.935). Serum GDF15 levels could be used as a potential biomarker in the prediction of malnutrition in patients with AECOPD, offering a guidance for future clinical evaluation of malnutrition.

Risk factors for malnutrition in patients with diabetic foot ulcer and its association with prolonged length of hospitalization.

The study was designed to investigate the occurrence and risk factors of malnutrition in diabetic foot ulcers (DFU) patients and examine the association between malnutrition and length of stay (LOS). This observational study included DFU hospitalized patients in two campuses of a hospital from January 2021 to June 2023. The diagnosis standard of malnutrition was established by using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Patients were followed up to ascertain the length of hospitalization, and hospital stays longer than 17 days were considered as prolonged LOS. To explore the risk factors of malnutrition and the association between malnutrition and LOS, univariate and multivariate logistic regression analyses were performed. Overall 219 DFU patients were enrolled, malnutrition was identified in 38.36% of patients according to GLIM criteria, and 92 patients (42%) were recognized as prolonged LOS. Logistic regression analyses showed that BMI (P <0.001), Alb (P = 0.002), HbA1c (P <0.001), ulcer infection (P <0.001), LOS (P = 0.010), and ABI (P = 0.024) were independent risk factors for malnutrition. Besides, malnutrition by GLIM criteria was closely related to prolonged LOS and malnourished DFU patients were 2.857 times (95% CI, 1.497-5.450; P = 0.001) likely to present prolonged LOS than that of normal nutrition. Malnutrition was considered to be extremely prevalent in DFU patients and was associated with approximately three times higher likelihood of prolonged LOS. Implementing and disseminating the diagnostic criteria during routine practice is crucial, given the predictive efficacy of GLIM criteria.

Analysis of risk factors and development of predictive model for malnutrition in patients with traumatic brain injury

ABSTRACT Malnutrition is a highly prevalent complication in patients with traumatic brain injury (TBI), and it is closely related to the prognosis of patients. Accurate identification of patients at high risk of malnutrition is essential. Therefore, we analyzed the risk factors of malnutrition in patients with TBI and developed a model to predict the risk of malnutrition. A retrospective collection of 345 patients with TBI, and they were divided into malnutrition and comparison groups according to the occurrence of malnutrition. Univariate correlation and multifactor logistic regression analyses were performed to determine patients’ malnutrition risk factors. We used univariate and logistic regression (forward stepwise method) analyses to identify significant predictors associated with malnutrition in patients with TBI and developed a predictive model for malnutrition prediction. The model's discrimination, calibration, and clinical utility were evaluated using the receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA). A total of 216 patients (62.6%) developed malnutrition. Multifactorial logistic regression analysis showed that pulmonary infection, urinary tract infection, dysphagia, application of NGT, GCS score ≤ 8, and low ADL score were independent risk factors for malnutrition in patients with TBI (P < 0.05). The area under the curve of the model was 0.947. Calibration plots showed good discrimination of model calibration. DCA showed that the column line plot models were all clinically meaningful when nutritional interventions were performed over a considerable range of threshold probabilities (0-0.98). Malnutrition is widespread in patients with TBI, and the nomogram is a good predictor of whether patients develop malnutrition.

Impact of continuity of care based on Triangle theory on nutritional status of patients after pancreatic cancer surgery: a retrospective study.

To evaluate the impact of Triangle theory-based continuity of care on postoperative malnutrition in pancreatic cancer patients. We retrospectively analyzed the data from 184 patients with pancreatic cancer admitted to The Second People's Hospital of Lanzhou City from January 2020 to May 2023. Patients were divided into a control group receiving conventional care (n = 114) and a study group receiving Triangle theory-based care (n = 70). Postoperative nutritional status and prognosis were compared between the two groups. Nutritional indexes included serum total protein (STP), albumin (ALB), and hemoglobin (HB). Self-care ability was assessed using the Exercise of Self-care Agency (ESCA). Quality of life was measured using the Quality-of-Life Questionnaire for Pancreatic Cancer 26 (QLQ-PAN-26), and the incidence of malnutrition was evaluated using the Patient-Generated Subjective Global Assessment (PG-SGA). Multifactorial logistic regression was applied to analyze risk factors for malnutrition. At ten days post-operation, the study group showed significantly better nutritional levels (P < 0.05). After three months, the, study group also exhibited superior self-care ability and quality of life scores (all P < 0.001). The incidence of malnutrition was 42.39%. Independent risk factors for malnutrition included routine care (OR = 3.459), operation time ≥ 90 min (OR = 2.277), intraoperative bleeding ≥ 200 mL (OR = 2.590), postoperative day 1 ALB < 37.5 g/L (OR = 3.975), and HB < 95.5 g/L (OR = 6.068). Triangle theory-based continuity of care significantly improves nutritional status and quality of life in postoperative pancreatic cancer patients, demonstrating its potential for broader clinical use.

Elevation of preoperative serum hs-CRP is an independent risk factor for malnutrition in patients with gastric cancer.

Recent studies have reported hypersensitive C-reactive protein (hs-CRP) linked to clinicopathological characteristics and nutritional status of the tumor, but its clinical significance in GC remains unclear. This study aimed to investigate the relationship between preoperative serum hs-CRP level and clinicopathological features and nutritional status in gastric cancer (GC) patients. The clinical data of 628 GC patients who met the study criteria were analyzed retrospectively. The preoperative serum hs-CRP level was divided into two groups (<1 mg/L and ≥1 mg/L) to evaluate clinical indicators. Nutritional Risk Screening and nutritional assessment of GC patients were performed by the Nutritional Risk Screening 2002 (NRS2002) and the Patient-Generated Subjective Global Assessment (PG-SGA), respectively. The data were subjected to chi-square test, univariate and multivariate logistic regression analyses, respectively. The analysis of 628 GC cases revealed that 338 patients (53.8%) were on malnutrition risk(NRS2002≥3 points), and 526(83.8%) had suspected/moderate to severe malnutrition(PG-SGA≥ 2 points). Preoperative serum hs-CRP level was significantly correlated with age, tumor maximum diameter (TMD), peripheral nerve invasion (PNI), lymph-vascular invasion (LVI), depth of tumor invasion (DTI), lymph node metastasis (LNM), pTNM stage, body weight loss (BWL), body mass index (BMI), NRS2002 score, PG-SGA grade, hemoglobin (HB), total protein (TP), albumin (ALB), prealbumin (PAB) and total lymphocyte count (TLC). Multivariate logistic regression analysis revealed that hs-CRP (OR=1.814, 95%CI=1.174-2.803; P=0.007), age, ALB, BMI, BWL and TMD were independent risk factors for existing malnutritional risk in GC. Similarly, non-malnutrition and suspected/moderate to severe malnutrition groups presented that hs-CRP (OR=3.346, 95%CI=1.833-6.122; P< 0.001), age, HB, ALB, BMI and BWL were independent risk factors for malnutrition in GC. In addition to the generally used nutritional evaluation indicators such as age, ALB, BMI, and BWL, the hs-CRP level may be used as a nutritional screening and evaluation indicator for GC patients.

A novel nomogram for predicting risk of malnutrition in patients with heart failure.

This study aimed to explore the risk factors of malnutrition in patients with heart failure and construct a novel nomogram model. A cross-sectional study based on the STROBE checklist. Patients with heart failure from July 2020 to August 2021 were included. Patients were divided into a malnutrition group and a normal nutrition group based on the Society's recommended AND-ASPEN standard. Logistic regression was used to analyze the independent risk factors for malnutrition. A new prediction model of nomogram was constructed based on the risk factors, and its fit and prediction performance were evaluated. Of 433 patients, 66 (15.2%) had malnutrition and 367 (84.8%) had normal nutrition, Logistic regression analyses showed that the risk factors for malnutrition were total protein, hemoglobin, triglyceride, and glucose levels. The regression model based on the above four variables showed an area under the curve of 0.858. The novel nomogram model had a sensitivity of 78.5% and a specificity of 77.3%. After 2000 bootstrap resampling iterations, AUC was 0.852. The novel nomogram model can predict the odds of malnutrition in patients with heart failure at the early stage of admission, and can provide a reference for nursing staff to optimize nutritional care for inpatient with heart failure and to develop a discharge nutritional care plan.

Preoperative low absolute and relative handgrip strength as predictors of postoperative short-term outcomes: a prospective study based on patients aged 60years and older with gastric cancer.

This study aimed to determine the association of absolute and relative HGS indicators with postoperative short-term outcomes in older patients with gastric cancer. The prospective, single-center, observational study involved 230 patients (age ≥ 60years) who underwent radical gastrectomy. Absolute HGS was directly obtained from results measured by a hand dynamometer, while relative HGS was calculated as the value of absolute HGS divided by body mass index (BMI), appendicular skeletal muscle mass index (ASMI) and age, respectively. Low absolute HGS was defined according to the criterion in AWGS 2019 consensus and the first gender-specific quartile. Low relative handgrip strength was defined if it was below the first gender-specific quartile of the distribution. Postoperative outcomes included total complications, malnutrition and length of hospital stay. Univariate and multivariate regression models were performed to investigate and compare the predictive values of different HGS indicators. For the five HGS indicators, multivariate analyses showed that low absolute HGS (AWGS consensus), low HGS/BMI and HGS/age were independent risk factors for both postoperative total complications (absolute HGS(AWGS consensus): OR 2.03, 95%CI:1.05-3.93; HGS/BMI: OR 2.12, 95%CI 1.05-4.28; HGS/age: OR 2.79, 95%CI 1.40-5.54) and malnutrition (absolute HGS(AWGS consensus): OR 2.01, 95%CI 1.10-3.67; HGS/BMI: OR 2.28, 95%CI 1.20-4.33; HGS/age: OR 2.70, 95%CI 1.42-5.14). Low absolute HGS (quartile) was an independent risk factor for malnutrition (OR 1.96, 95%CI 1.04-3.71). Moreover, Low HGS/age was associated with lengthened postoperative hospital stay (OR 2.07, 95%CI 1.12-3.85). Except HGS/ASMI, both absolute and relative HGS indicators were associated with postoperative short-term outcomes. Particularly, HGS/age revealed relatively better predictive value for the studied outcomes.

Nutritional Intake, Hospital Readmissions and Length of Stay in Hospitalised Oncology Patients.

Poor food intake is an independent risk factor for malnutrition in oncology patients, and achieving adequate nutrition is essential for optimal clinical and health outcomes. This study investigated interrelationships between nutritional intake and clinical outcomes in hospitalised adult oncology patients. Estimated nutrition intake data were obtained from patients admitted to a 117-bed tertiary cancer centre during May-July 2022. Clinical healthcare data, including length of stay (LOS) and 30-day hospital readmissions, were obtained from patient medical records. Statistical analysis, including multivariable regression analysis, assessed whether poor nutritional intake was predictive of LOS and readmissions. No relationships between nutritional intake and clinical outcomes were evident. Patients at risk of malnutrition had lower mean daily energy (-898.9 kJ, p = 0.001) and protein (-10.34 g, p = 0.015) intakes. Increased malnutrition risk at admission prolonged LOS (1.33 days, p = 0.008). Hospital readmission rates were 20.2%, and associated with age (r = -0.133, p = 0.015), presence of metastases (r = 0.125, p = 0.02) and longer LOS (1.34 days, r = 0.145, p = 0.02). Sarcoma (43.5%), gynaecological (36.8%) and lung (40.0%) cancers had the highest readmission rates. Despite research showing the benefits of nutritional intake during hospitalisation, evidence continues to emerge on the relationship between nutritional intake and LOS and readmissions that may be confounded by malnutrition risk and cancer diagnosis.

Earlier anti-TNF therapy reduces the risk of malnutrition associated with alterations in body composition in patients with Crohn's disease.

Anti-TNF therapy has been found to exert an influence on long-term nutritional status and even reverse malnutrition in patients with Crohn's disease. to observe the effect of anti-TNF therapy on nutritional status in patients with Crohn's disease, investigate the correlation between the timing of anti-TNF therapy and the human body composition and examine independent body composition factors for predicting malnutrition in these patients. This was a retrospective study of 115 patients with Crohn's disease. Body composition parameters were assessed by bioelectrical impedance analysis. The nutritional status of the patients was determined by NRS2002 and MNA. The BMI, BFMI, FFMI, BCMI, SMI, BMC, intracellular water, protein and BMR were significantly lower in patients without any biologic agents (p < 0.05). Negative correlations were found between BMC, intracellular water, extracellular water, protein and BMR and the interval between the first symptom and first dose by Spearman's correlation analysis (r < 0, p < 0.05). Low BMI (OR 0.602, 95% CI 0.434-0.836, p = 0.002), low FFMI (OR 0.678, 95% CI 0.507-0.906, p = 0.009), and low BCMI (OR 0.564, 95% CI 0.367-0.868, p = 0.009) were independent risk factors for malnutrition in Crohn's disease patients. Anti-TNF therapy tended to reduce the malnutrition probability as assessed by Cox regression analysis (OR: 0.217, 95% CI 0.057-0.821, p = 0.024). Body composition analysis is predictive of malnutrition in patients with Crohn's disease. Early application of anti-TNF therapy significantly affected skeletal muscle mass, fat mass and bone mineral content, supporting their long-term nutritional status and reducing their probability of malnutrition.

Interrelationships between Dietary Outcomes, Readmission Rates and Length of Stay in Hospitalised Oncology Patients: A Scoping Review.

Poor food intake is an independent risk factor for malnutrition in oncology patients, and achieving adequate nutrition is essential for optimal clinical and health outcomes. This review investigated the interrelationships between dietary intakes, hospital readmissions and length of stay in hospitalised adult oncology patients. Three databases, MEDLINE, Web of Science and PubMed were searched for relevant publications from January 2000 to the end of August 2022. Eleven studies investigating the effects of dietary intakes on length of stay (LOS) and hospital readmissions in cohorts of hospitalised patients that included oncology patients were identified. Heterogenous study design, nutritional interventions and study populations limited comparisons; however, a meta-analysis of two randomised controlled trials comparing dietary interventions in mixed patient cohorts including oncology patients showed no effect on LOS: mean difference -0.08 (95% confidence interval -0.64-0.49) days (p = 0.79). Despite research showing the benefits of nutritional intake during hospitalisation, evidence is emerging that the relationship between intakes, LOS and hospital readmissions may be confounded by nutritional status and cancer diagnosis.

Risk Investigation and Analysis of Risk Factors for Malnutrition in Patients with Advanced Kidney Cancer: A Single-Centre Retrospective Study.

To investigate the nutritional status of patients with advanced kidney cancer and analyse the risk factors for malnutrition in such patients. The study selected the clinical data of 103 patients with advanced kidney cancer who were admitted to Qingdao Jiaozhou Central Hospital from February 2020 to February 2022 for a retrospective analysis. The Subjective Global Assessment of Nutrition scale was used to evaluate the nutritional status of all research subjects. Patients' baseline data, such as gender, age and clinical classifications, and laboratory indicators, such as albumin and C-reactive protein (CRP), were collected, and multivariate logistic regression was used to screen the independent risk factors for malnutrition in patients with advanced kidney cancer. A total of 78 (76.00%) individuals among the 103 patients with advanced kidney cancer had malnutrition. The results of univariate analysis showed marked differences in the age, body mass index (BMI), albumin, haemoglobin, CRP, diabetes, anorexia and family monthly income of patients of the good nutrition and malnutrition groups (p < 0.05). The results of logistic regression showed that age ≥65 years old (odds ratio (OR) = 29.187), albumin <40 g/L (OR = 0.025), haemoglobin <110 g/L (OR = 0.049), the presence of diabetes (OR = 28.138), the presence of anorexia (OR = 98.739), BMI <18.5 kg/m2 (OR = 0.024) and CRP <3 mg/L (OR = 24.819) were independent influencing factors of malnutrition in the patients with advanced kidney cancer (all p < 0.05). The incidence of malnutrition in patients with advanced kidney cancer is relatively high. Therefore, the understanding of malnutrition in such patients in clinical work must be fortified, and attention should be paid to screening the above risk factors and implementing active measures in nutrition therapy to reduce the risk of malnutrition in patients with advanced kidney cancer and prolong their survival time.

Association of Circulating Trimethylamine-N Oxide With Malnutrition and the Risk of Coronary Artery Disease in Patients With Maintenance Hemodialysis

Malnutrition is a serious complication frequently observed in dialysis patients. Therefore, nutrition status evaluation and the early identification of malnutrition are clinically important. Trimethylamine N-oxide (TMAO) is reportedly associated with deteriorating metabolic profiles and cardiovascular diseases. The aim of our study was to investigate correlations between circulating TMAO levels and malnutrition and the risk of major adverse cardiovascular events in patients on maintenance hemodialysis. This retrospective observational study involved 228 subjects. Fasting plasma TMAO levels were detected using liquid chromatography-tandem mass spectrometry. TMAO levels were significantly elevated in patients with malnutrition (8728.78±704.12ng/mL) when compared with those without (6532.1±570.41ng/mL, P<.01). TMAO levels were positively correlated with Subjective Global Assessment scores (ρ=0.56, P=.02) and were independent risk factors for malnutrition after adjustment for multiple traditional risk factors (odds ratio=2.07, 95% confidence interval: 1.41-3.62, P<.01). Furthermore, TMAO levels were good predictors of major adverse cardiovascular events in a 2-year follow-up period (area under the curve=0.68, P<.01) and accuracy was increased to 74% when TMAO levels were combined with Subjective Global Assessment scores (area under the curve=0.74, P=.02). Elevated TMAO levels were independently associated with a risk of malnutrition and cardiovascular disease, and could be a useful predictive biomarker for risk stratification and cardiovascular disease management for patients on dialysis.

Analysis on the Risk Factors of Malnutrition in Type 2 Diabetes Mellitus Patients with Pulmonary Tuberculosis.

To explore the risk factors of malnutrition in type 2 diabetes mellitus combined with pulmonary tuberculosis (PTB-T2DM) patients and further to provide a clinical research basis for the identification and prevention of malnutrition. From January 2020 to February 2022, 307 adult patients diagnosed with PTB-T2DM were enrolled in this retrospective study. According to whether malnutrition occurred after 6 months of treatment, patients were divided into malnutrition group (n = 123) and non-malnutrition group (n = 184). The nutritional status of patients was evaluated according to the Micro-Nutrition Assessment Scale (MNA). Evaluation of indicators was performed, including general information, disease characteristics of PTB-T2DM and laboratory indicators. Univariate logistic regression analysis showed that drinking, divorced, BMI <18.5kg/m2, weight <45kg, waist circumference <79cm, hip circumference <88cm, waist-to-hip ratio <69.99, calf circumference <26kg, grip strength <28kg, NRS score ≥3, Hb <106g/L, Alb <29.00g/L, PA <48.00μmol/L, GHB <3.40%, serum transferrin <1.37 mmol/L, serum potassium <3.18mmol/L, serum sodium <142.95 mmol/L, FEV1 ≥67.90% and RV <2.89% were risk factors for malnutrition in PTB-T2DM patients (all P < 0.05). The results of multivariate logistic regression analysis showed that drinking, divorced, weight <45kg, BMI <18.5kg/m2, NRS score ≥3, Hb <106g/L, Alb <29.00g/L, PA <48.00μmol/L, serum transferrin <1.37mmol/L, FEV1 ≥67.90% and RV <2.89% were independent risk factors for malnutrition in PTB-T2DM patients (all P < 0.05). Drinking, divorced, weight <45kg, BMI <18.5kg/m2, NRS score ≥3, Hb <106g/L, Alb <29.00g/L, PA <48.00μmol/L, serum transferrin <1.37mmol/L, FEV1 ≥67.90% and RV <2.89% may be independent risk factors for malnutrition in PTB-T2DM patients, and timely identification of high-risk groups could improve the prognosis of PTB-T2DM patients.

S930 Identifying Risk Factors and Predictors of Malnutrition in Patients With Inflammatory Bowel Disease at a Tertiary Care Center

Introduction: Malnutrition is highly prevalent in patients with inflammatory bowel disease (IBD). Nutritional assessment tools have been created to identify malnourished individuals and facilitate prompt nutritional intervention. The Malnutrition Universal Screening Tool (MUST) is a validated tool recommended for patients across all healthcare settings. In the present study, we implemented the MUST among patients with IBD at outpatient clinics in an academic health system. The aim of this study was to examine the relationship between patient and clinical characteristics, and laboratory markers of nutrition with the MUST nutritional risk score in patients with IBD. Methods: This was a multi-center retrospective study conducted in outpatient clinics throughout the MedStar Healthcare System. 199 patients with IBD were screened using the MUST between February 10, 2022, and May 31, 2022. Low, medium, and high nutritional risk scores were defined as a score of 0, 1, or ≥ 2, respectively. We examined the association between the MUST scores and patient demographic data, markers of nutrition, and markers of disease activity. Univariate and multivariate logistic regression was used to examine associations between independent risk factors with nutritional risk score. Results: Among the 199 patients screened, 87% were classified as low risk for malnutrition, 9% as moderate risk, and 4% as high risk. There was no statistically significant association between nutritional risk score and sex, IBD diagnosis, or age. In univariate analysis, IBD-related hospitalizations within one year of screening (p = 0.022), recent steroid use (p < .001), and elevated C-reactive protein (CRP) (p = 0.027) were associated with moderate-to-high risk of malnutrition as compared to low risk (Table). Decreased albumin (OR: 0.10; 95% CI: 0.02-0.57) and decreased hemoglobin (OR: 0.58; 95% CI: 0.40-0.84) were also significant predictors of malnutrition. In multivariate analysis, recent steroid use remained an independent risk factor for malnutrition. Conclusion: In this study, we demonstrate that MUST screening correlates to markers of disease activity, inflammation, and nutrition in patients with IBD. Univariate analysis identified IBD-related hospitalizations, recent steroid use, elevated CRP, decreased albumin, and decreased hemoglobin as risk factors. Only recent steroid use was identified as an independent risk factor. Further study on nutritional risk screening and disease markers in larger populations is warranted. Table 1. - Univariate analysis of risk factors associated with moderate-high risk nutritional risk score Characteristic Odds Ratio 95% Confidence Interval P-Value Lower Limit Upper Limit Steroid Use 7.314 2.346 22.805 < .001 IBD-related Hospitalization 4.632 1.247 17.213 0.022 CRP (mg/L) 1.129 1.014 1.257 0.027 Fecal Calprotectin (mcg/gm) 1.001 1.000 1.002 0.062 Albumin (gm/dL) 0.101 0.018 0.570 0.009 Hemoglobin (gm/dL) 0.580 0.403 0.835 0.003

Prevalence of Malnutrition, Its Risk Factors, and the Use of Nutrition Support in Patients with Inflammatory Bowel Disease.

Malnutrition is prevalent among patients with inflammatory bowel disease (IBD). Nutritional profiles among Asian patients with IBD have seldom been investigated. We assessed the prevalence of and risk factors for malnutrition, use of nutrition support, and sociopsychological status associated with malnutrition among patients with IBD in China. Patients with ulcerative colitis and Crohn's disease (CD) recruited from 43 tertiary referral hospitals were screened for malnutrition and nutrient deficiencies in this cross-sectional study. The use of nutrition support was recorded. The sociopsychological status was assessed by subjective questionnaires. Factors associated with malnutrition were analyzed, and multivariate regression was used to determine independent predictors for malnutrition. We recruited 1013 patients with a median age of 35.0 years, 58.5% of them had CD, and 61.4% of all patients were male. Overall, 49.5% (n = 501) of patients were diagnosed with malnutrition, including 57.0% of patients with CD, 38.8% of patients with ulcerative colitis, and 44.1% of patients with quiescent or mildly active disease. Nutrient deficiencies were prevalent despite the absence of malnutrition. Malnutrition was associated with adverse sociopsychological status, including decreased social support, higher perceived stress, and impaired quality of life. Moderate to severe disease activity and extensive disease were 2 independent risk factors for malnutrition. In total, 41.6% of patients received nutrition support, and patients with risk factors were more likely to receive nutrition support. Malnutrition was highly prevalent and associated with adverse consequences in Chinese patients with IBD. Malnutrition screening and early initiation of nutrition support are essential components in IBD care.

Risk factors for inpatient malnutrition and length of stay assessed by 'NutritionDay' in China.

NutritionDay is a yearly global point-prevalence study of malnutrition or nutritional risk in hospitals. We aimed to provide a comprehensive nutritional survey of hospitalized patients and analyze the risk factors of malnutrition and prolonged hospitalization in Chinese inpatients. The international daylong cross-sectional survey was performed on November 07th, 2019. Ten hospitals were invited to participate in this NutritionDay survey. Nutritional risk was identified by nutritional risk screening 2002, and malnutrition was identified by the ESPEN criteria. We measured the incidence of malnutrition and nutritional risk. And we analysed risk factors for malnutrition and length of stay in Chinese hospitalized patients. 875 hospitalized patients from 6 departments were included in the analysis. The malnutrition rate was 11.6% and the incidence of nutritional risk was 17.8%. It was analyzed that tumor load, end-stage disease, motility, self-rated health, types of oral medicine, and food intake during the past week were independent risk factors for malnutrition or nutritional risk. 56.2% (118/210) of patients at nutritional risk or malnutrition received extra nutritional support, whereas 22.5% (88/391) well-nourished patients did. Moreover, nutrition status, ever stayed in ICU and self-rated health were associated with prolonged length of stay. In a word, the prevalence of malnutrition or nutritional risk was about 29.4%. Patients with malnutrition or nutritional risk had a higher transfer rate, lower rehabilitation rate and longer hospital stays. The attention to malnutrition patients needs to be further strengthened.

A multi-centre survey on hospital malnutrition: result of PNSI study

BackgroundDisease-related malnutrition is associated with adverse outcomes such as increased rates of morbidity and mortality, prolonged hospital stay, and extra costs of health care. This study was conducted to assess nutritional status among patients and to determine the risk factors for malnutrition in Iran university f.MethodsPersian Nutritional Survey In Hospitals (PNSI) was a cross-sectional study that conducted in 20 university hospitals across Iran. All the patients with age range of 18 to 65 years, who were admitted or discharged, were assessed by subjective global assessment (SGA).ResultsIn total, 2109 patients were evaluated for malnutrition. Mean values of age and body mass index were 44.68 ± 14.65 years and 25.44 ± 6.25 kg/m2, respectively. Malnutrition (SGA-B & C) was identified in 23.92% of the patients, 26.23 and 21% of whom were among the admitted and discharged patients, respectively. The highest prevalence of malnutrition was in burns (77.70%) and heart surgery (57.84%) patients. Multivariate analysis presented male gender (OR = 1.02, P < 0.00), malignant disease (OR = 1.40, P < 0.00), length of hospital stay (OR = 1.20, P < 0.00), and polypharmacy (OR = 1.06, P < 0.00) as independent risk factors for malnutrition. Malnutrition was not associated with age (P = 0.10).ConclusionThis study provides an overall and comprehensive illustration of hospital malnutrition in Iran university hospitals, finding that one out of four patients were malnourished; thus, appropriate consideration and measures should be taken to this issue.

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.

Nutritional status and morbidity patterns of the elderly in a Northwestern Nigerian hospital: A cross-sectional study.

Nutrition is a significant factor in determining the health of older people because it affects almost all organs and systems, which could lead to varieties of diseases and premature death. To determine the nutritional status and its association with the morbidity patterns of elderly patients. A cross-sectional hospital-based descriptive study involving 348 patients aged 60 years and above who presented at the Family Medicine Clinic. Data of the socio-demographic profile, anthropometric measurements and clinical diagnosis were collected. The co-morbidities were classified based on the number, duration and affected organ or system. The nutritional status was assessed with the Mini-Nutritional Assessment tool. Chi-square test and logistic regression analysis were used to determine associations between nutritional status and morbidity patterns of the elderly. The level of significance was set at a P ≤ 0.05. A total of 348 respondents were recruited with 60.9% of females and mean age of 67.83 (standard deviation ± 7.53) years. The prevalence of malnutrition was 25.3% and of risk of malnutrition 56.6%. Furthermore, the prevalence of multi-morbidity was 74.4%. Advanced age (odd ratio = 8.911, confidence interval [CI] = 1.992-39.872, P = 0.004), underweight (OR = 1.167, CI = 0.291-37.846, P < 0.001), lack of formal education, (OR = 1.569, CI = 0.357-0.908, P = 0.018), low monthly income (OR = 1.975, CI = 1.376-2.836, P < 0.001), chronic respiratory diseases (OR = 4.250, CI = 4.025-4.492, P < 0.001) and physical inactivity (OR = 2.466, CI = 1.063-5.722, P = 0.036) were the predictors of malnutrition. Furthermore, the duration of chronic disease for more than 10 years (OR = 1.632, CI = 0.408-0.979, P = 0.040) was significantly associated with at-risk of malnutrition. The study revealed advanced age, underweight, low educational status, chronic respiratory diseases and physical inactivity as independent risk factors for malnutrition among the elderly.