Malnourished Patients Research Articles

Malnutrition and sarcopenia worsen short- and long-term outcomes in internal medicine inpatients.

This work aims to describe patients hospitalized in internal medicine wards in terms of nutrition and sarcopenia. It also seeks to evaluate short- and long-term mortality related to malnutrition and sarcopenia. This cross-sectional study collected data on consecutive patients admitted to a single center's internal medicine ward. Patients were recruited in May and October 2021. Malnutrition was determined by the Mini-Nutritional Assessment-Short Form (MNA-SF) and sarcopenia by the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls questionnaire (SARC-F scale) and handgrip strength test. Patients who were hospitalized for >48hours were excluded. The sample included 619 patients with a mean ± SD age of 76.0 ± 14.8 years of which 50.6% were women. Patients were classified into three groups based on malnutrition: group 1 (MNA-SF 12-14 points) (no risk) included 158 patients, group 2 (MNA-SF 8-12 points) (high risk) included 233 patients, and group 3 (MNA-SF 0-7 points) (malnourished) included 228 patients. Malnourished patients had more dysphagia, significantly lower protein and albumin levels, and significantly higher inflammatory marker levels and pressure ulcers. In-hospital mortality was significantly higher in groups 2 and 3 (p < .00001). The worst outcome (mortality and readmissions or mortality) was more common among malnourished patients (p = .0001). Inflammation, comorbidity, and sarcopenia were most closely associated with negative outcomes. Malnutrition upon admission is associated with worse short- and long-term outcomes in internal medicine inpatients. Sarcopenia, multimorbidity, and inflammation-measured by albumin, C-reactive protein, or their ratios-are key risk factors. Early identification of malnutrition and sarcopenia through active screening is important in caring for internal medicine patients.

Hypoalbuminemia and colorectal cancer patients: Any correlation?: A systematic review and meta-analysis.

In malnourished patients with colorectal cancer, hypoalbuminemia is common and was proposed to determine the postoperative outcome of colorectal surgery. Mounting articles published but have not been evaluated. We aim to assess the predictive value of preoperative hypoalbuminemia in patients undergoing colorectal surgery. We performed a literature search from PubMed, Euro PMC, and Cochrane with the terms serum albumin, hypoalbuminemia, prognosis, outcome, colorectal cancer, and neoplasm. We also hand-searched and included any relevant papers. Hypoalbuminemia is defined as plasma albumin level < 3.5 mg/dL. We restricted the included studies to English language and adults undergoing colectomy, laparotomy, laparoscopy, or abdominoperineal resection. Any types of articles were included, except an abstract-only publication and those that did not report the key exposure or outcome of interest. The key exposures were mortality, hospitalization time, and morbid conditions (thrombosis, surgical site infection, sepsis, and wound events). We pooled the odds ratio from each included literature as effect size. The Newcastle Ottawa scale and GRADE were used to determine the quality of each included study. Hereof 7 observational studies (236,480 individuals) were included. Our meta-analysis found that preoperative hypoalbuminemia can predict the postoperative outcome in colorectal cancer patients. Individuals with hypoalbuminemia were not associated with 30-day mortality (risk ratio [RR] 2.05 [0.72, 5.86], P = .18, I2 = 99%) but were associated with morbidity (RR 2.28 [1.78, 2.93], P < .00001, I2 = 87.5%), surgical complication (RR 1.69 [1.34, 2.13], P < .00001, I2 = 98%), and hospitalization (RR 2.21 [1.93, 2.52], P < .00001, I2 = 0%). According to newcastle ottawa scale, the included studies are of moderate to sound quality. The current systematic review and meta-analysis showed that preoperative hypoalbuminemia was significantly associated with morbidity, length of stay, and surgical complication but not mortality.

Regulation, production and clinical application of Foods for Special Medical Purposes (FSMPs) in China and relevant application of food hydrocolloids in dysphagia therapy

The development and evolution of regulation, production and clinical application of Foods for Special Medical Purposes (FSMPs) in China in recent decades have been reviewed. The FSMPs as dysphagia diet and relevant applications of food hydrocolloids in FSMPs from the viewpoint of rheology were emphasized. Consumer preference, behaviour and perception about FSMPs were also presented. It is a remarkable transition of the legal status of FSMPs from “drugs” to “foods” in China, just as that in USA and EU, which is marked as a milestone by several important national standards and related laws issued in the last decade. The huge market capacity of FSMPs in China has been estimated based on the number of malnourished patients and elderly consumers. However, the supply of FSMPs from both multinational and local producers has not met the strong demand in China market, even though the State Administration for Market Regulation (SAMR) has approved 92 new products by December 2022. Nevertheless, the market prospect is quite optimistic, based on the profound recognition and widespread clinical application of FSMPs in specific diseases, such as dysphagia, cancer, diabetes, chronic kidney disease, etc.

Terapia médico-nutricional en pacientes politraumatizados: una carrera contra el tiempo.

A polytraumatized patient is defined as one who has multiple lesions involving different organs and systems, which are usually serious and lead to life-threatening respiratory or circulatory dysfunction. Traumatic stress in the polytraumatized patient results in many metabolic changes that are evident from the first days, but usually persist for weeks, requiring adequate nutritional support as they influence outcomes. Nutritional treatment should be a priority in the comprehensive treatment of polytraumatized patients since it attenuates the metabolic response to trauma and prevents the deterioration of body reserves. It should be noted that some patients present previous nutritional risk. Nutritional intervention should be considered at the same level as any other therapy that supports organic functions, especially in patients in the intensive care unit. Nutritional intervention in polytraumatized patients is a pillar of treatment that has multiple benefits and can improve prognosis. All efforts must be aimed at the early detection of malnourished patients at nutritional risk and providing timely therapies that improve clinical outcomes.

Malnutrition associated with readmission in elderly patients with chronic obstructive pulmonary disease.

Malnutrition associated with readmission in elderly patients with chronic obstructive pulmonary disease.

Screening and Management of Malnutrition in Total Joint Arthroplasty.

Malnutrition is an increasingly prevalent problem in patients undergoing total joint arthroplasty (TJA). Increased risks associated with TJA in the setting of malnourishment have been well documented. Standardized scoring systems in addition to laboratory parameters such as albumin, prealbumin, transferrin, and total lymphocyte count have been developed to identify and evaluate malnourished patients. Despite an abundance of recent literature, there is no consensus on the best approach for screening TJA patients from a nutritional standpoint. Although there are a variety of treatment options, including nutritional supplements, nonsurgical weight loss therapies, bariatric surgery, and the involvement of dieticians and nutritionists, the effect of these interventions on TJA outcomes has not been well characterized. This overview of the most current literature aims to provide a clinical framework for approaching nutrition status in arthroplasty patients. A comprehensive understanding of the tools available for managing malnourishment will facilitate improved arthroplasty care.

Impact of Nutritional Management on Survival of Critically Ill Malnourished Patients with Refeeding Hypophosphatemia

Early nutritional therapy may aggravate hypophosphatemia in critically ill patients. To investigate the influence of the type nutritional therapy on the survival of critically-ill malnourished patients at refeeding hypophosphatemia risk. Retrospective cohort study including malnourished, critically-ill adults, admitted from June 2014-December 2017 in an intensive care unit (ICU) at a tertiary hospital. Refeeding hypophosphatemia risk was defined as low serum phosphorus levels (<2.5 mg/dL) seen at two timepoints: before the initiation and at day 4 of the nutritional therapy. Patients receiving enteral nutrition (EN) were compared with those receiving supplemental parenteral nutrition (SPN-EN plus parenteral nutrition). Primary outcome was 60 d survival. Secondary endpoint was the incidence of refeeding hypophosphatemia risk. We included 468-321 patients (68.6%) received EN and 147 (31.4%) received SPN. The mortality rate was 36.3% (n=170). Refeeding hypophosphatemia risk was found in 116 (24.8%) patients before and in 177 (37.8%) at day 4 of nutritional therapy. The 60 d mean survival probability was greater for patients receiving SPN both before (42.4 vs. 22.4%, p=0.005) and at day 4 (37.4 vs. 25.8%, p=0.014) vs. patients receiving EN at the same timepoints. Cox regression showed a hazard ratio of 3.3 and 2.4 for patients at refeeding hypophosphatemia risk before and at day 4 of EN, respectively, compared to the SPN group at the same timepoints. Refeeding hypophosphatemia risk was frequent in malnourished ICU patients and the survival for patients receiving SPN seemed associated with better survival than EN only.

Refeeding Syndrome—Diagnostic Challenges and the Potential of Clinical Decision Support Systems.

Refeeding syndrome (RFS) can occur in malnourished patients when normal, enteral, or parenteral feeding is resumed. The syndrome often goes unrecognized and may, in the most severe cases, result in death. The diagnosis of RFS can be crucially facilitated by the use of clinical decision support systems (CDSS). The literature in PubMed was searched for current treatment recommendations, randomized intervention studies, and publications on RFS and CDSS. We also took account of insights gained from the development and implementation of our own CDSS for the diagnosis of RFS. The identification of high-risk patients and the recognition of manifest RFS is clinically challenging due to the syndrome's unspecific symptoms and physicians' lack of awareness of the risk of this condition. The literature shows that compared to patients without RFS, malnourished patients with RFS have significantly greater 6-month mortality (odds ratio 1.54, 95% confidence interval: [1.04; 2.28]) and an elevated risk of admission to intensive care (odds ratio 2.71 [1.01; 7.27]). In a prospective testing program, use of our own CDSS led to correct diagnosis in two thirds of cases. RFS is difficult to detect and represents a high risk to the patients affected. Appropriate CDSS can identify such patients and ensure proper professional care.

Immunonutrition vs standard nutrition for patients with cancer.

The prevailing belief in the value of immunonnutrition has been questioned as different patient populations show variable responses ranging from no benefit or even harm to significant improvements in clinical outcomes. The subject of this invited review is a previously published meta-analysis that showed important benefits from the perioperative use of an immunonutrition formula (defined as nutrition therapy that contains specific immune-modulating agents) in a distinct population: adult patients with cancer undergoing an elective major surgical operation. Findings showed that use of an immunonutrition formula was associated with reduced infectious morbidity, anastomotic leakage, hospital length of stay, and postoperative complications compared with standard formulations. These benefits were seen after adjusting for bias and removal of older publications. Issues, such as dosing, duration of therapy, baseline nutrition status, content of specific immunomodulatory agents, and route of delivery that contributed to the beneficial response, were discussed. Little difference in response was seen between well-nourished and malnourished patients, but geographic differences were seen, with greater outcome benefits seen in studies originating from Europe than from Asia or the United States. The best results were seen when at least three agents (arginine, fish oil, and RNA nucleotides) were given, with the timing of the delivery occurring throughout the perioperative period. A review of this meta-analysis is warranted because it shows a consistent benefit from such therapy over 30 years of clinical research, provides a detailed subset analysis of related issues, and highlights its value in improving outcome in this patient population.

The effects of hypoalbuminemia in obese patients undergoing total joint arthroplasty.

Total joint arthroplasty (TJA) is a highly effective surgery. However, poor nutritional status has been associated with worse outcomes. In orthopedics, nutrition status is commonly evaluated using serum albumin. When albumin levels fall below 3.0g/dL, wound healing ability becomes impaired. Typically, malnutrition is associated with low BMI, but malnourished patients can also be obese. The goals of this study were to investigate the relationship between malnourishment represented through albumin levels of obese patients and likelihood of postoperative complications. A retrospective review of patients undergoing primary TJA from 2016 to 2020 in the American College of Surgeons National Surgical Quality Improvement Program national database was performed. Patients with an albumin of < 3.5g/dL were considered to have hypoalbuminemia and those with ≥ 3.5g/dL were considered normal albumin. Univariate analysis was used to determine demographic and comorbidity differences between those with and without hypoalbuminemia. Outcomes of interest included length of stay, resource utilization, discharge disposition, and unplanned readmissions. Multivariate logistic regression examined albumin as a predictor of increased resource utilization and complications after controlling for possible confounding variables. Of the 79,784 patients, 4.96% of patients had low albumin. Those with hypoalbuminemia were nearly 1.5years older than those with normal albumin, were more likely to be black, female, and had an overall increased comorbidity burden as shown by percent of patients with ASA > 3 (all p < 0.001). After risk adjustment, those with hypoalbuminemia and a BMI of 35 + had greater risk of complications and increased resource utilization. Our results demonstrated the prevalence of malnutrition increases as a patient's BMI increases. Further, hypoalbuminemia was associated with increased resource utilization and increased complication rates in all obese patients. We suggest screening albumin levels in obese patients preoperatively to give surgeons the best opportunity to optimize patient nutrition before undergoing surgery.

Efficacy and tolerability of a specific blend of amino acids in patients with anorexia nervosa treated in a hospital setting: study protocol for a randomized controlled trial

BackgroundSpecific blends of essential amino acids (EAA) containing a high percentage of branched-chain amino acids preserves mitochondrial metabolism and higher physical resistance in elderly mice, increasing their survival and improving physical performance and cognitive functions in malnourished elderly patients. However, no study has been yet done on patients with anorexia nervosa (AN) who regain weight with specialized intensive treatment. The present study aims to evaluate the efficacy of supplementation with EAA on the change in lean body mass (LBM) and other physical and psychological outcomes in patients with AN who are undergoing specialist treatment for eating disorders.MethodsThis is a 13-week randomized, double-blind, placebo-controlled study. Patients will be randomized to either a mixture of a complex blend of EAA and intermediates of the tricarboxylic acid (TCA) cycle (citrate, malate, succinate) supplementation (or placebo) upon admission at the intensive residential and day-hospital treatment for eating disorders. Ninety-two participants with AN aged 16–50 years will be recruited from a specialized intensive treatment of eating disorders. Double-blind assessment will be conducted at baseline (T0) and the end of the 13 weeks of treatment (T1). The study’s primary aim is to evaluate the efficacy of supplementation with EAA and TCA intermediates on the change in lean body mass (LBM) with weight restoration in patients with AN who are undergoing specialist treatment for eating disorders. The secondary aims of the study are to assess the effect of dietary supplementation on physical fitness, weight restoration, modification of AN and general psychopathology, and psychosocial impairment.DiscussionThe study’s results will inform researchers and clinicians on whether supplementing a mixture of EAA and TCA cycle intermediates will improve the increase of LBM and other important physical and psychological outcomes in patients with AN who regain weight with specialized intensive treatment.Trial registrationNCT, NCT05290285. Registered on 22 March 2022.

Survey of food offered to United Kingdom haemodialysis patients attending for dialysis sessions in main dialysis centres and satellite units and international comparison

BackgroundHaemodialysis (HD) patients are at increased risk of frailty, sarcopenia and protein energy wasting, all associated with increased mortality. Most of the dialysis day is taken up with travelling to and from dialysis centres and dialysis treatment. The International Society of Nutrition and Metabolism (ISNM) recommend that meals or supplements should be part of standard clinical practice when patients attending for dialysis.ResultsWe surveyed adult UK centres to determine the provision of food to dialysis patients in the United Kingdom (UK). A hot meal was provided by six (8.7%) of the 69 UK adult units, although 16 (23.2%) main centres would potentially provide meals to a restricted number of malnourished patients. Forty-seven (68.1%) centres provided sandwiches, although this was restricted in eight main centres, and 26.2% of units did not provide sandwiches to patients in their satellite dialysis centres. Biscuits were the only nutrition routinely offered in 15 (21.7%) of the main dialysis units, 41.3% of satellite units. Meals were more likely to be offered in Northern Ireland and Scotland compared to England, and 38% of the main dialysis units in England, and 58% of their satellite centres did not routinely offer patients a sandwich compared to none or one centre in Wales, Scotland and Northern Ireland.ConclusionsDespite an increasing older, more frail dialysis population in the UK, food provision for dialysis patients has reduced, particularly in England, with < 10% of centres routinely offering hot food, and > 50% of dialysis units now only offering biscuits to their satellite dialysis patients.

Association between Cognitive Impairment and Malnutrition in Hemodialysis Patients: Two Sides of the Same Coin.

Cognitive impairment and malnutrition are prevalent in patients on hemodialysis (HD), and they negatively affect the outcomes of HD patients. Evidence suggests that cognitive impairment and malnutrition may be associated, but clinical studies to assess this association in HD patients are lacking. The aim of this study was to evaluate the association between cognitive impairment evaluated by the Montreal Cognitive Assessment (MoCA) score and nutritional status evaluated by the malnutrition inflammation score (MIS) in HD patients. We enrolled 84 HD patients (44 males and 40 females; age: 75.8 years (63.5-82.7); HD vintage: 46.0 months (22.1-66.9)). The MISs identified 34 patients (40%) as malnourished; the MoCa scores identified 67 patients (80%) with mild cognitive impairment (MCI). Malnourished patients had a higher prevalence of MCI compared to well-nourished patients (85% vs. 70%; p = 0.014). MoCa score and MIS were negatively correlated (rho:-0.317; p < 0.01). Our data showed a high prevalence of MCI and malnutrition in HD patients. Low MoCA scores characterized patients with high MISs, and malnutrition was a risk factor for MCI. In conclusion, it is plausible that MCI and malnutrition are linked by common sociodemographic, clinical, and biochemical risk factors rather than by a pathophysiological mechanism.

Effect on nutritional status and biomarkers of inflammation and oxidation of an oral nutritional supplement (with or without probiotics) in malnourished hemodialysis patients. A multicenter randomized clinical trial "Renacare Trial".

Malnutrition in patients undergoing hemodialysis is frequent and associated with a reduction in muscular mass and strength, with an increment in biomarkers of inflammation and oxidation. Randomized, multicenter, parallel-group trial in malnourished hemodialysis patients with three groups [(1) control (C) individualized diet, (2) oral nutritional supplement-ONS- + placebo-SU- PL-, and (3) ONS + probiotics-SU-PR]; the trial was open regarding the intake of ONS or individualized diet recommendations, but double-blind for the intake of probiotics. We obtained, at baseline and after 3 and 6 months, anthropometric measurements, handgrip strength, bioelectrical impedance analysis (BIA), dietary records, and routine biochemical parameters. Inflammation and oxidation were determined using ELISA techniques (Versamax and ProcartaPlex multiplex Immunoassay). Results were analyzed by intention to treat. A total of 31 patients (11 corresponding to group C, 10 to SU-PL, and 10 to SU-PR) completed the 6-months trial. The two groups that took supplements significantly increased their protein calorie, fat (total and n-3), and fiber intake. Weight and fat-free mass (FFM) also increased significantly in the groups on supplements, both at 3 and 6 months, and dynamometry did so in the SU-PL group. At month 3, prealbumin and vitamin D were significantly increased in the SU-TOT (SU-PL + SU-PR) group. No changes were observed regarding levels of phosphorus and potassium in any of the groups. Urea increased significantly at 6 months in the SU-PL group. There were significant changes in some inflammation biomarkers in the groups on supplements during the intervention (brain-derived neurotrophic factor, bone morphogenetic protein-2, MCP-1, IL-1-beta, IL-10, IL-4, and IL-8). The total antioxidant capacity (TAC) increased significantly in the supplemented patients, with no significant changes observed in isoprostanes. The specific ONS improved protein-calorie intake, nutritional status (mainly FFM), and some biomarkers of inflammation/oxidation. The addition of probiotics could have a synergistic effect with ONS in such biomarkers. https://clinicaltrials.gov/ct2/show/, identifier NCT03924089.

Development and validation of an inflammatory bowel disease nutrition self-screening tool (IBD-NST) for digital use.

The identification of, and timely intervention for, patients with impaired nutritional status may reduce inflammatory bowel disease (IBD) complications. This study aimed to develop and validate an IBD-specific nutrition self-screening tool (IBD-NST) that identifies patients at nutrition risk. An expert IBD panel was consulted to support development of an IBD-NST. The tool was assessed in different cohorts of patients attending IBD outpatient clinics for face, content and convergent validity and repeat reliability. The tool was compared with (i) the malnutrition universal screening tool to assess face validity and (ii) subjective global assessment (SGA), hand-grip strength (HGS) and mid-arm muscle circumference to assess convergent validity. Tool content was informed by agreement between assessment tools, sensitivity analysis and chi-squared tests. The IBD-NST was completed electronically twice, 1 week apart to assess repeat reliability using observed agreement and kappa statistic. Statistical significance assumed at p < 0.05. In total, 282 IBD patients (175 with Crohn's disease) were recruited to validate the IBD-NST. The final validated IBD-NST includes body mass index (BMI), weight loss and IBD-specific nutrition-focussed questions which were acceptable to patients. It identified patients at risk of malnutrition, moderately or severely malnourished patients and patients at nutritional risk. The IBD-NST identified 54/179 (30%) patients at moderate or high nutrition risk and had excellent repeat reliability in 85 patients [r = 0.77 (95% CI 0.669 to 0.746)]. The IBD-NST is a self-screening tool, validated for use as either a paper or e-health version, that identifies patients at nutrition risk who are likely to benefit from dietetic assessment and intervention. Furthermore, patients with IBD symptoms who are concerned about their dietary intake can potentially access dietetic care more easily therefore encouraging greater self-management of IBD-related symptoms. The routine use of the IBD-NST as a self-screening tool would enable patient-led care in the outpatient setting and may facilitate timely access to dietetic care.

Low Preoperative Albumin Associated With Increased Risk of Superficial Surgical Site Infection Following Midfoot, Hindfoot, and Ankle Fusion.

This study investigates the effect of malnutrition, defined by hypoalbuminemia, on rates of complication, readmission, reoperation, and mortality following midfoot, hindfoot, or ankle fusion. The National Surgical Quality Improvement Program (NSQIP) database was queried from 2005 to 2019 to identify 500 patients who underwent midfoot (n = 233), hindfoot (n = 261), or ankle (n = 117) fusion. Patients were stratified into normal (n = 452) or low (n = 48) albumin group, which was defined by preoperative serum albumin level <3.5 g/dL. Demographics, medical comorbidities, hospital length of stay (LOS), and 30-day complication, readmission, and reoperation rates were compared between groups. The mean age of the cohort was 58.7 (range, 21-89) years. Hypoalbuminemia patients were significantly more likely to have diabetes (P < .001), be on dialysis (P < .001), and be functionally dependent (P < .001). The LOS was significantly greater among the low albumin group (P < .001). The hypoalbuminemia cohort also exhibited a significantly increased likelihood of superficial infection (P = .048). Readmission (P = .389) and reoperation (P = .611) rates did not differ between the groups. This study shows that malnourished patients have an increased risk of superficial infection following foot and ankle fusions but are not at an increased risk of readmission or reoperation, suggesting that low albumin confers an elevated risk of surgical site infection. Level III, Retrospective cohort study.

Comparison of laparoscopic and open radical gastrectomy for gastric cancer patients with GLIM-defined malnutrition.

Malnutrition is common in the patients with gastric cancer. Radical gastrectomy remained the primary strategy of curable treatment for gastric cancer. This study is performed to explore the effect of laparoscopic radical gastrectomy on clinical outcomes in gastric cancer patients with malnutrition. Gastric cancer patients with GLIM-defined malnutrition between 2014 and 2019at our center were enrolled. The patients were divided into two groups according to the different type of surgery. Propensity score match analysis was used to balance the clinicopathologic characteristics of two groups. Postoperative outcomes and survival were compared. Multivariate analysis was used to independent risk factors of complication, overall survival (OS), and disease-free survival (DFS). Compared with patients underwent open radical gastrectomy, patients who underwent laparoscopic radical gastrectomy had lower rate of total, surgical and severe complications. They also had shorter postoperative hospital stay with better OS and DFS. Hypoalbuminemia (P=0.003) was the independent risk factor of complications. Old age (≥75, P=0.035) and TNM stage (III: P<0.001, II: P=0.015) were the independent risk factors of OS. Combined resection (P=0.003) and TNM stage (III: P<0.001, II: P=0.001) posed independent risk factors of lacking DFS. Laparoscopic surgery proved to be the independent protective factor of complications (P=0.014), OS (P<0.001) and DFS (P<0.001). Laparoscopic radical gastrectomy was relative safe and showed favorable outcomes in malnourished gastric cancer patients.

Routine addition of zinc to the parenteral fluid formula is not able to prevent zinc deficiency in all patients receiving parenteral nutrition

Abstract Background Zinc deficiency is associated with poor wound healing, skin lesions, alopecia, etc. It is common in malnourished patients. Although parenteral nutrition (PN) has anabolic effect; however, lack of zinc supplement for a long period might result in zinc deficiency. The aim of the study is to calculate the incidence of zinc deficiency and the correlation to multiple nutritional parameters. Methods This is a retrospective analysis of patients who received PN and were under care of nutrition support service of Mackay Memorial Hospital from 1995 to 2020. Zinc serum level less than 800 μg/L were considered zinc deficiency. All patients had evaluation of nutrition status by assessing of albumin, total lymphocyte count (TLC), and midarm circumference (MAC). Results Data were analyzed by analysis of variance. A P value less than 0.05 was considered significant. A total of 3854 patients received PN during this period, 18 of them had zinc level less than 800 μg/L. In those 18 patients, 12 of them had clinical symptoms and signs of zinc deficiency. The average day of receiving PN for patients was 74.4 ± 62.5 (14–204) days. The average day of appearance of symptoms was 11 ± 12.3 (1–43) days. Eleven patients received blood or plasma transfusion during this period. It was found that serum zinc level did not correlate with serum albumin, TLC, and MAC. Conclusions Zinc deficiency could occur in patients with PN and adequate supply of calorie. It also occurs in patients with extra loss such as discharges from enterocutaneous fistula even in patients with supply of daily requirement of zinc. Zinc deficiency does not correlate with serum albumin, TLC, MAC, or age.

Preoperative Malnutrition-Associated Spinal Malalignment with Patient-Reported Outcome Measures in Adult Spinal Deformity Surgery: A 2-Year Follow-Up Study.

Malnutrition could lead to additional medical complications, and the prognostic nutrition index (PNI) is evaluated to assess the nutritional status of patients. However, the midterm postoperative outcomes of malnutrition in patients with adult spinal deformity (ASD) are unclear. This study aims to investigate postoperative midterm spinal alignment and patients' reported outcome measures (PROMs) in malnourished patients with ASD. This study recruited 303 ASD patients who underwent surgery. Adult patients ≥50 years old were categorized into the PNI <50 (L group) and the PNI ≥50 (H group) groups. Demographic data, medical complications, mechanical complications, radiographic parameters, Oswestry Disability Index (ODI), and Scoliosis Research Society-22 (SRS-22) were analyzed. In this study, 303 patients participated, with 132 and 171 patients in the L and H groups, respectively. Significant differences were noted between the L and H groups in body mass index (22.5 vs. 23.6 kg/m2, p=0.011), autoimmune disease (9.8% vs. 2.3%, p=0.005), and total number of medical complications (47.7% vs. 33.3%, p=0.011). The T1 slope was significantly higher in the L group than in the H group preoperatively (36.5 vs. 32.8°, p=0.042). However, no significant differences were noted in mechanical complications, ODI, SRS-22 scores, or radiographic parameters 2 years postoperatively between the L and H groups, except for the sagittal vertical axis (73.1 vs. 55.7 mm, p=0.014). No significant difference was noted in the incidence of mechanical complications and PROMs 2 years postoperatively. Malnourished status was related to medical complications and global malalignment. However, good surgical outcomes can be expected even for malnourished patients.

Perioperative Nutritional Considerations in Colon and Rectal Surgery.

Malnutrition is common in surgical patients and is associated with substantially increased morbidity and mortality. Dedicated assessment of nutritional status is advised by major nutrition and surgical societies. Assessment may utilize comprehensive and validated nutritional assessment tools or targeted history, physical examination with accompanying serologic markers to identify nutritional risk preoperatively. Emergent surgery in malnourished patients should proceed as the clinical situation dictates with consideration of ostomy or primary anastomosis with proximal fecal diversion to mitigate postoperative infectious complications. Nonemergent surgery should be delayed to facilitate nutritional optimization via oral nutritional supplementation preferably and total parenteral nutrition if necessary for at least 7 to 14 days. Exclusive enteral nutrition may be considered to optimize nutritional status and inflammation in patients with Crohn's disease. Immunonutrition use in the preoperative setting is not supported by evidence. Perioperative and postoperative immunonutrition may be of benefit but requires dedicated study in the contemporary era. Close attention to preoperative nutritional status and optimization represents a critical opportunity to improve outcomes in patients undergoing colorectal surgery.