Loss Of Body Cell Mass Research Articles

Optimal Nutritional Support Strategy Based on the Association between Modified NUTRIC Score and 28-Day Mortality in Critically Ill Patients: A Prospective Study.

Malnutrition in critically ill patients is closely linked with clinical outcomes. During acute inflammatory states, nutrition cannot reverse the loss of body cell mass completely. Studies on nutritional screening and strategy considering metabolic changes have not yet been conducted. We aimed to identify nutrition strategies using the modified Nutrition Risk in the Critically ill (mNUTIRC) score. Nutrition support data, laboratory nutrition indicators, and prognosis indices were prospectively collected on the 2nd and 7th day after admission. It was to identify the effect of the changes on the metabolic status and critical target of nutrition intervention. To discriminate the high-risk group of malnutrition, receiver operating characteristic curves were plotted. Risk factors associated with 28 day-mortality were evaluated using multivariable Cox proportional hazards regression. A total of 490 and 266 patients were analyzed on the 2nd and 7th day, respectively. Only the mNUTRIC score showed significant differences in nutritional risk stratification. The use of vasopressors, hypoprotein supply (<1.0 g/kg/day), high mNUTRIC score, and hypoalbuminemia (<2.5 mg/dL) in the recovery phase were strongly associated with a 28-day mortality. The implementation of the mNUTRIC score and protein supply in the post-acute phase is critical to improve 28-day mortality in critically ill patients.

Post-Intensive Care Unit Multidisciplinary Approach in Patients with Severe Bilateral SARS-CoV-2 Pneumonia.

Background: Short and long-term sequelae after admission to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) are to be expected, which makes multidisciplinary care key in the support of physical and cognitive recovery. Objective: To describe, from a multidisciplinary perspective, the sequelae one month after hospital discharge among patients who required ICU admission for severe COVID-19 pneumonia. Design: Prospective cohort study. Environment: Multidisciplinary outpatient clinic. Population: Patients with severe COVID-19 pneumonia, post- ICU admission. Methods: A total of 104 patients completed the study in the multidisciplinary outpatient clinic. The tests performed included spirometry, measurement of respiratory muscle pressure, loss of body cell mass (BCM) and BCM index (BCMI), general joint and muscular mobility, the short physical performance battery (SPPB or Guralnik test), grip strength with hand dynamometer, the six-minute walk test (6-MWT), the functional assessment of chronic illness therapy-fatigue scale (FACIT-F), the European quality of life-5 dimensions (EQ-5D), the Barthel index and the Montreal cognitive assessment test (MoCA). While rehabilitation was not necessary for 23 patients, 38 patients attended group rehabilitation sessions and other 43 patients received home rehabilitation. Endpoints: The main sequelae detected in patients were fatigue (75.96%), dyspnoea (64.42%) and oxygen therapy on discharge (37.5%). The MoCA showed a mean score compatible with mild cognitive decline. The main impairment of joint mobility was limited shoulder (11.54%) and shoulder girdle (2.88%) mobility; whereas for muscle mobility, lower limb limitations (16.35%) were the main dysfunction. Distal neuropathy was present in 23.08% of patients, most frequently located in lower limbs (15.38%). Finally, 50% of patients reported moderate limitation in the EQ-5D, with a mean score of 60.62 points (SD 20.15) in perceived quality of life. Conclusions: Our findings support the need for a multidisciplinary and comprehensive evaluation of patients after ICU admission for COVID-19 because of the wide range of sequelae, which also mean that these patients need a long-term follow-up. Impact on clinical rehabilitation: This study provides data supporting the key role of rehabilitation during the follow-up of severe patients, thus facilitating their reintegration in society and a suitable adaptation to daily living.

Handgrip Strength Index Predicts Nutritional Status as a Complement to Body Mass Index in Crohn's Disease.

Body mass index [BMI] is widely used to measure nutritional status in Crohn's disease [CD] patients, but limitations remain. Measuring handgrip strength index, in addition to BMI, may aid in overcoming limitations. A total of 150 patients with CD and 254 controls were included in this study. All patients and controls underwent BMI, handgrip strength and bioelectrical impedance analysis. Bioelectrical impedance analysis included body cell mass, bone mineral content, skeletal muscle mass and body fat mass. A total of 88 CD patients were age-, sex- and BMI-matched with healthy controls for further analysis. BMI, body cell mass, body cell mass index, handgrip strength and handgrip strength index were all significantly decreased in the group of CD patients compared with controls [p < 0.0001]. When paired by BMI, healthy controls had significantly increased body cell mass index[p = 0.0344] and handgrip strength index [p = 0.0010] compared to patients. In addition, handgrip strength was well correlated with body cell mass [r = 0.8365, p < 0.0001]. BMI is widely used for detecting malnutrition, but it is less sensitive in predicting loss of body cell mass and skeletal muscle mass. Our study shows that handgrip strength index is an effective and convenient parameter to predict the functional nutritional status and muscular health in CD patients.

Promoting Perioperative Metabolic and Nutritional Care.

Surgery represents a major stressor that disrupts homeostasis and can lead to loss of body cell mass. Integrated, multidisciplinary medical strategies, including enhanced recovery programs and perioperative nutrition support, can mitigate the surgically induced metabolic response, promoting optimal patient recovery following major surgery. Clinical therapies should identify those who are poorly nourished before surgery and aim to attenuate catabolism while preserving the processes that promote recovery and immunoprotection after surgery. This review will address the impact of surgery on intermediary metabolism and describe the clinical consequences that ensue. It will also focus on the role of perioperative nutrition, including preoperative nutrition risk, carbohydrate loading, and early initiation of oral feeding (centered on macronutrients) in modulating surgical stress, as well as highlight the contribution of the anesthesiologist to nutritional care. Emerging therapeutic concepts such as preoperative glycemic control and prehabilitation will be discussed.

SP0086 Promotion Exercise: The Evidence

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease, and the most common form of chronic joint inflammation. Inflammation leads to elevation of proinflammatory cytokines such as tumour necrosis factor...

A close association of body cell mass loss with disease activity and disability in Chinese patients with rheumatoid arthritis

OBJECTIVES:To investigate the association of body cell mass loss with disease activity and disability in rheumatoid arthritis patients.INTRODUCTION:Rheumatoid cachexia, defined as the loss of body cell mass, is important but under-recognized and contributes to morbidity and mortality in patients with rheumatoid arthritis.METHODS:One hundred forty-nine rheumatoid arthritis patients and 53 healthy, non-rheumatoid arthritis control subjects underwent anthropometric measurements of body mass index and waist and hip circumferences. Bioelectrical impedance analysis was used to determine the subjects' body compositions, including fat mass, skeletal lean mass, and body cell mass. The disease activity of rheumatoid arthritis was assessed using C-reactive protein serum, the erythrocyte sedimentation rate and the 28-joint disease activity score, while disability was evaluated using a health assessment questionnaire.RESULTS:Rheumatoid arthritis patients had lower waist-to-hip ratio (0.86±0.07 vs. 0.95±0.06; p<0.001) and lower skeletal lean mass indexes (14.44±1.52 vs. 15.18±1.35; p = 0.002) than those in the healthy control group. Compared with rheumatoid arthritis patients with higher body cell masses, those with body cell masses lower than median had higher erythrocyte sedimentation rates (40.10±27.33 vs. 25.09±14.85; p<0.001), higher disease activity scores (5.36±3.79 vs. 4.23±1.21; p = 0.022) and greater disability as measured by health assessment questionnaire scores (1.26±0.79 vs. 0.87±0.79; p = 0.004).CONCLUSIONS:The loss of body cell mass is associated with higher disease activity and greater disability in rheumatoid arthritis patients. Body composition determined by bioelectrical impedance analysis can provide valuable information for a rheumatologist to more rapidly recognize rheumatoid cachexia in rheumatoid arthritis patients.

Associations between parameters of nutritional status and disease activity in patients with rheumatoid arthritis

In patients with rheumatoid arthritis (RA), the loss of body cell mass is observed, known as rheumatoid cachexia. Cachexia is associated with increased morbidity and premature mortality of RA patients. The aim of the study was to assess the effect of chronic inflammation and disease activity on nutritional status in RA patients. In 140 patients with RA (111 women, 29 men), RA activity was measured using the Disease Activity Score in 28 joints (DAS28) and using the Modified Health Assessment Questionnaire (M-HAQ). The nutritional status was assessed with the following parameters: serum albumin and total cholesterol (TC), body mass index (BMI), hand-grip strength (HGS), and tricipital skinfold thickness. There was a significant association between the parameters of nutritional status and the markers of inflammatory disease activity (number of swollen and tender joints, C-reactive protein, hemoglobin) and physical disability (M-HAQ). Swollen joint count and M-HAQ were inversely correlated with several nutritional parameters. In patients with high disease activity, significantly lower HGS and serum albumin levels were observed. Advanced stages of the disease (erosive and/or long-standing RA) were associated with lower HGS and higher TC levels. The nutritional status of RA patients is determined by the intensity of chronic inflammatory process observed in the course of the disease and by disease duration.

Aerobic endurance training improves weight loss, body composition, and co-morbidities in patients after laparoscopic Roux-en- Y gastric bypass

Background One of the most effective treatments of patients with morbid obesity is laparoscopic Roux-en- Y gastric bypass (RYGB). Sudden weight loss after RYGB for morbid obesity can result in a concurrent decrease in the lean body mass. However, the long-term results (weight reduction and reduced co-morbidities) depend on the postoperative long-term therapy. Aerobic physical exercise (APE) has been considered conservative treatment of obesity and type 2 diabetes mellitus. The aim of the present study was to assess the efficacy of APE on weight loss, body composition, and co-morbidities in patients after laparoscopic RYGB. The study was performed at a university hospital in Germany. Methods A total of 60 consecutive morbidly obese patients underwent laparoscopic RYGB. The patients were prospectively randomized into a low-exercise group (APE 1 time for 1 hr/wk) or a multiple-exercise group (APE 2 times for 1 hr/wk). The following prospective data were collected: age, gender, length of hospital stay, operative details, co-morbidities, postoperative complications, initial body weight and height, postoperative weight, and body composition. The patients' body composition was assessed every 8 weeks during the 24-month follow-up period. Results The average body mass index (52 kg/m 2) and other baseline characteristics were distributed equally in the 2 groups. No major complications and no significant differences in the minor complications were found postoperatively between the 2 groups. The multiple exercise group had a significantly more rapid reduction of body mass index, excess weight loss, and fat mass compared with the low-exercise group. The initial loss of body cell mass and lean body mass was significantly lower in the multiple exercise group and was regained more rapidly in the low-exercise group. In addition, the multiple exercise group showed significantly earlier resolution or improvement of co-morbidities. Conclusion APE positively influenced weight loss, body composition, and co-morbidity resolution after RYGB for obesity. Additional controlled studies and longer follow-up are needed to confirm these positive findings.

Advances in understanding and assessing malnutrition

To describe the varying views on the pathophysiology of malnutrition in different populations and the definitions that result from these views. To propose an umbrella definition for different malnutrition syndromes and principles of assessment of nutritional state. At present, tacitly or openly inflammatory activity is considered to contribute to the malnourished state. The malnourished state, therefore, arises from a combination of inflammation and a disturbed nutrient balance (undernutrition or overnutrition). The undernourished category of malnutrition leads to loss of body cell mass, which, together with inflammation diminish host response and quality of life. On the basis of these findings, malnutrition may be assessed by estimating nutrient balance but, subsequently, to measure body composition (muscle mass), inflammatory activity (plasma albumin and C-reactive protein) and muscle endurance and force. Changes in muscle function in patients with chronic obstructive pulmonary disease are associated with changes in fiber composition. Few data exist in other malnourished states. There is an increasing acknowledgement of the fact that malnutrition is caused by disturbances in nutrient balance and inflammatory activity. This leads to changes in body composition and diminished function. An umbrella definition has been proposed including the pathogenetic factors, underlying the different malnutrition syndromes and dictating the methods to assess malnutrition.

Locomotion and muscle mass measures in a murine model of collagen-induced arthritis

BackgroundRheumatoid arthritis (RA) is characterized by chronic poly-arthritis, synovial hyperplasia, erosive synovitis, progressive cartilage and bone destruction accompanied by a loss of body cell mass. This loss of cell mass, known as rheumatoid cachexia, predominates in the skeletal muscle and can in part be explained by a decreased physical activity. The murine collagen induced arthritis (CIA) model has been proven to be a useful model in RA research since it shares many immunological and pathological features with human RA. The present study explored the interactions between arthritis development, locomotion and muscle mass in the CIA model.MethodsCIA was induced in male DBA/1 mice. Locomotion was registered at different time points by a camera and evaluated by a computerized tracing system. Arthritis severity was detected by the traditionally used semi-quantitative clinical scores. The muscle mass of the hind-legs was detected at the end of the study by weighing. A methotrexate (MTX) intervention group was included to study the applicability of the locomotion and muscle mass for testing effectiveness of interventions in more detail.ResultsThere is a strong correlation between clinical arthritis and locomotion. The correlations between muscle mass and locomotion or clinical arthritis were less pronounced. MTX intervention resulted in an improvement of disease severity accompanied by an increase in locomotion and muscle mass.ConclusionThe present data demonstrate that registration of locomotion followed by a computerized evaluation of the movements is a simple non invasive quantitative method to define disease severity and evaluate effectiveness of therapeutic agents in the CIA model.

Sarcopenia da caquexia reumatoide: conceituação, mecanismos, consequências clínicas e tratamentos possíveis

A caquexia relacionada à artrite reumatoide é conceituada como perda involuntária de massa magra, predominantemente de músculo esquelético, que também ocorre em vísceras e sistema imune, com massa gorda estável ou um pouco elevada e com pequena ou nenhuma perda de peso. A causa é multifatorial, incluindo a produção acentuada de citocinas, principalmente TNF± e IL-1², diminuição da ação periférica da insulina e pouca atividade física. A caquexia se faz presente em doentes com AR ativa ou mesmo inativa. Neste artigo discutem-se aspectos relacionados à patogenia, implicações clínicas e possíveis opções terapêuticas.

Malnutrition and impaired muscle strength in patients with Crohn's disease and ulcerative colitis in remission

Objective This prospective, controlled, and multicentric study evaluated nutritional status, body composition, muscle strength, and quality of life in patients with inflammatory bowel disease in clinical remission. In addition, possible effects of gender, malnutrition, inflammation, and previous prednisolone therapy were investigated. Methods Nutritional status (subjective global assessment [SGA], body mass index, albumin, trace elements), body composition (bioelectrical impedance analysis, anthropometry), handgrip strength, and quality of life were assessed in 94 patients with Crohn's disease (CD; 61 female and 33 male, Crohn's Disease Activity Index 71 ± 47), 50 patients with ulcerative colitis (UC; 33 female and 17 male, Ulcerative Colitis Activity Index 3.1 ± 1.5), and 61 healthy control subjects (41 female and 20 male) from centers in Berlin, Vienna, and Bari. For further analysis of body composition, 47 well-nourished patients with inflammatory bowel disease were pair-matched by body mass index, sex, and age to healthy controls. Data are presented as median (25th–75th percentile). Results Most patients with inflammatory bowel disease (74%) were well nourished according to the SGA, body mass index, and serum albumin. However, body composition analysis demonstrated a decrease in body cell mass (BCM) in patients with CD (23.1 kg, 20.8–28.7, P = 0.021) and UC (22.6 kg, 21.0–28.0, P = 0.041) compared with controls (25.0 kg, 22.0–32.5). Handgrip strength correlated with BCM ( r = 0.703, P = 0.001) and was decreased in patients with CD (32.8 kg, 26.0–41.1, P = 0.005) and UC (31.0 kg, 27.3–37.8, P = 0.001) compared with controls (36.0 kg, 31.0–52.0). The alterations were seen even in patients classified as well nourished. BCM was lower in patients with moderately increased serum C-reactive protein levels compared with patients with normal levels. Conclusion In CD and UC, selected micronutrient deficits and loss of BCM and muscle strength are frequent in remission and cannot be detected by standard malnutrition screening.

Amino Acid Requirements in Critically Ill Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy

Acute kidney injury in critically ill patients is often a complication of an underlying condition such as organ failure, sepsis, or drug therapy. In these patients, stress-induced hypercatabolism results in loss of body cell mass. Unless nutrition support is provided, malnutrition and negative nitrogen balance may ensue. Because of metabolic, fluid, and electrolyte abnormalities, optimization of nutrition to patients with acute kidney injury presents a challenge to the clinician. In patients treated with conventional intermittent hemodialysis, achieving adequate amino acid intake can be limited by azotemia and fluid restriction. With the use of continuous renal replacement therapy (CRRT), however, better control of azotemia and liberalization of fluid intake allow amino acid intake to be maximized to support the patient's metabolic needs. High amino acid doses up to 2.5 g/kg/day in patients treated with CRRT improved nitrogen balance. However, to our knowledge, no studies have correlated increased amino acid intake with improved outcomes in critically ill patients with acute kidney injury. Data from large, prospective, randomized, controlled trials are needed to optimize the dosing of amino acids in critically ill patients with acute kidney injury who are treated with CRRT and to study the safety of high doses and their effects on patient morbidity and survival.

Nutritional Status of Persons with HIV Infection, Persons with HIV Infection and Tuberculosis, and HIV-Negative Individuals from Southern India

We compared the nutritional status of individuals with human immunodeficiency virus (HIV) infection alone, individuals with HIV infection and tuberculosis (after completion of antituberculosis treatment), and HIV-negative individuals and found that malnutrition, anemia, and hypoalbuminemia were most pronounced among HIV-positive patients with tuberculosis. Weight loss was associated with loss of fat in female patients and with loss of body cell mass in male patients.

ESPEN Guidelines on Enteral Nutrition: Wasting in HIV and other chronic infectious diseases

Undernutrition (wasting) is still frequent in patients infected with the human immunodeficiency virus (HIV), despite recent decreases in the prevalence of undernutrition in western countries (as opposed to developing countries) due to the use of highly active antiretroviral treatment. Undernutrition has been shown to have a negative prognostic effect independently of immunodeficiency and viral load. These guidelines are intended to give evidence-based recommendations for the use of enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) in HIV-infected patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. Nutritional therapy is indicated when significant weight loss (>5% in 3 months) or a significant loss of body cell mass (>5% in 3 months) has occurred, and should be considered when the body mass index (BMI) is <18.5 kg/m(2). If normal food intake including nutritional counselling and optimal use of ONS cannot achieve an adequate nutrient intake, TF with standard formulae is indicated. Due to conflicting results from studies investigating the impact of immune-modulating formulae, these are not generally recommended. The results obtained in HIV patients may be extrapolated to other chronic infectious diseases, in the absence of available data.

Therapeutic effects of artificial nutrition in intensive care patients: New insights

Summary Nutritional support has become a routine part of the care of critically ill patients and it is now widely accepted for the treatment and prevention of malnutrition and related complications. Most positive effects of artificial nutrition on the outcome of the critically ill patient result from controlling complex physiologic changes that lead to catabolism and loss of body cell mass. The knowledge of metabolic requirements is essential to define an appropriate artificial nutritional regimen, according to guideline recommendations. There is a general agreement that enteral nutrition (EN) is better than parenteral since it is safer, preserves gut function and is more cost effective. Most comparative studies of EN and PN, however, show that outcomes are comparable with either route. Evidence supports early initiation of nutrition support and debate is ongoing over whether gastric feedings or small-bowel feedings are best. Immunonutrition refers to the potential to modulate the activity of the immune system by interventions with specific nutrients (arginine, glutamine, n-3 fatty acids, antioxidants agents) and thereby to attempt to further improve the clinical outcome of selected critically ill patients. The emerging discipline of nutrigenomics (speculative branch of genes-nutrition interaction) has tremendous potential to change the future of our knowledge and intervention strategies on artificial nutrition.

Spotlight on Mammalian Cell-Derived Somatropin in HIV-Associated Wasting1

HIV-associated wasting, characterized by progressive loss of lean body mass and bodyweight, remains a significant problem in the era of highly active antiretroviral therapy. Loss of body cell mass, a component of lean body mass, is associated with decreased survival. Somatropin (recombinant human growth hormone) derived from mammalian cells (Serostim) is the only US FDA-approved treatment indicated to increase lean body mass, bodyweight, and physical endurance in HIV-associated wasting. Somatropin 0.1 mg/kg/day administered subcutaneously for 12 weeks effectively increased work output, bodyweight, and lean body mass, and improved health-related quality of life, compared with placebo, and had a generally manageable tolerability profile in a large randomized study in patients with HIV-associated wasting. Potential areas for further research include determination of longer-term efficacy and tolerability, the cost effectiveness of treatment, the optimal somatropin dosage, management of patients after 12 weeks' therapy, and whether maintenance strategies might exist to maintain accrued lean body mass with lower doses of somatropin. Nevertheless, indications to date are that somatropin is likely to have an important role in the treatment of patients with HIV-associated wasting.

Mammalian Cell-Derived Somatropin

HIV-associated wasting, characterised by progressive loss of lean body mass and bodyweight, remains a significant problem in the era of highly active antiretroviral therapy (HAART). Loss of body cell mass, a component of lean body mass, is associated with decreased survival. Somatropin (recombinant human growth hormone) derived from mammalian cells (Serostim) is the only US FDA-approved treatment indicated to increase lean body mass, bodyweight and physical endurance in HIV-associated wasting. Somatropin 0.1 mg/kg/day administered subcutaneously for 12 weeks effectively increased work output, bodyweight and lean body mass and improved health-related quality of life (HR-QOL), compared with placebo, and had a generally manageable tolerability profile in a large randomised study in patients with HIV-associated wasting. Potential areas for further research include determination of longer-term efficacy and tolerability, the cost effectiveness of treatment, the optimal somatropin dosage, management of patients after 12 weeks' therapy and whether maintenance strategies might exist to maintain accrued lean body mass with lower doses of somatropin. Nevertheless, indications to date are that somatropin is likely to have an important role in the treatment of patients with HIV-associated wasting.

Rheumatoid Cachexia: causes, significance and possible interventions

Rheumatoid arthritis is a chronic autoimmune disease characterised by joint pain and stiffness but also systemic mutli-organ involvement. Several features are due to excessive production of inflammatory cytokines, particularly tumour necrosis factor alpha, interleukin-1 and interleukin-6. These are implicated in both local synovial inflammation, which causes joint destruction, but also systemic inflammation, which can cause loss of body cell mass, amongst other phenomena. Body cell mass breakdown in rheumatoid arthritis leads to the classical, but largely ignored, metabolic abnormality known as rheumatoid cachexia. Cachexia is a very strong predictor of adverse functional outcome and death in many disease states. In this review we highlight the mechanisms linked with rheumatoid cachexia and discuss possible interventions that may limit this in patients with rheumatoid arthritis.

Relationship between weight loss, reduction of body cell mass and inflammatory response in patients with cancer.

Reduced food intake is a major cause of continuing weight loss in patients with cancer. Previous work has suggested that an ongoing inflammatory response may also contribute to weight loss and alter the nature of body tissue loss. To examine this, body cell mass was estimated using measurements of total body potassium (TBK) in 31 patients with gastrointestinal cancer and weight loss with or without an inflammatory response (C-reactive protein level above 5 mg/l). Albumin levels, total body water and 24-h urinary creatinine clearance were also measured. When measured TBK was expressed as a percentage of predicted normal values there was a significant reduction in TBK for patients with an inflammatory response compared with that of those without (P = 0.04). However, when a different prediction equation for TBK was used this difference was not significant (P = 0.29). Therefore, it remains uncertain whether an ongoing inflammatory response in patients with cancer and weight loss contributes to loss of body cell mass.