Mid-upper Arm Muscle Circumference Research Articles

Using a generic definition of cachexia in patients with kidney disease receiving haemodialysis: a longitudinal (pilot) study.

Research indicates that cachexia is common among persons with chronic illnesses and is associated with increased morbidity and mortality. However, there continues to be an absence of a uniformed disease-specific definition for cachexia in chronic kidney disease (CKD) patient populations. The primary objective was to identify cachexia in patients receiving haemodialysis (HD) using a generic definition and then follow up on these patients for 12 months. This was a longitudinal study of adult chronic HD patients attending two hospital HD units in the UK. Multiple measures relevant to cachexia, including body mass index (BMI), muscle mass [mid-upper arm muscle circumference (MUAMC)], handgrip strength (HGS), fatigue [Functional Assessment of Chronic Illness Therapy (FACIT)], appetite [Functional Assessment of Anorexia/Cachexia Therapy (FAACT)] and biomarkers [C-reactive protein (CRP), serum albumin, haemoglobin and erythropoietin resistance index (ERI)] were recorded. Baseline analysis included group differences analysed using an independent t-test, dichotomized values using the χ2 test and prevalence were reported using the Statistical Package for the Social Sciences 24 (IBM, Armonk, NY, USA). Longitudinal analysis was conducted using repeated measures analysis. A total of 106 patients (30 females and 76 males) were recruited with a mean age of 67.6 years [standard deviation (SD) 13.18] and dialysis vintage of 4.92 years (SD 6.12). At baseline, 17 patients were identified as cachectic, having had reported weight loss (e.g. >5% for >6 months) or BMI <20 kg/m2 and three or more clinical characteristics of cachexia. Seventy patients were available for analysis at 12 months (11 cachectic versus 59 not cachectic). FAACT and urea reduction ratio statistically distinguished cachectic patients (P = 0.001). However, measures of weight, BMI, MUAMC, HGS, CRP, ERI and FACIT tended to worsen in cachectic patients. Globally, cachexia is a severe but frequently underrecognized problem. This is the first study to apply the defined characteristics of cachexia to a representative sample of patients receiving HD. Further, more extensive studies are required to establish a phenotype of cachexia in advanced CKD.

Assessment of Relationship Between Nutritional Status and Handgrip Strength in Hemodialysis Patients

In hemodialysis patients, the prevalence of malnutrition is high; a decrease in muscle strength is observed.&#x0D; The objective of the research was to evaluate the nutritional status of hemodialysis patients and the relationship between the nutritional status and muscle strength.&#x0D; Materials and Methods. Sixty hemodialysis patients (38 males, 22 females) were chosen from among volunteers. Food consumption, biochemical values, anthropometric measurements, body composition, physical activity status, subjective global assessment, and handgrip strength in individuals were examined.&#x0D; Results. According to subjective global assessment, 73.3% of patients were well-nourished, 26.7% of patients were moderately malnourished. In male patients, a moderate positive correlation was determined between handgrip strength and lean body mass (r=0.359, p&lt;0.05), albumin level (r=0.408, p&lt;0.05), energy intake (r=0.437, p&lt;0.05), protein intake (r=0.345, p&lt;0.05). In female patients, a moderate positive correlation was determined between handgrip strength and body weight (r=0.470, p&lt;0.05), body mass index (r=0.472, p&lt;0.05), triceps skinfold thickness (r=0.530, p&lt;0.05), mid-upper arm circumference (r=0.515, p&lt;0.05), mid-upper arm muscle circumference (r=0.557, p&lt;0.05), lean body mass (r=0.470, p&lt;0.05), body fat content (%) (r=0.588, p&lt;0.05), albumin level (r=0.565, p&lt;0.05).&#x0D; Conclusions. Handgrip strength alongside with more than one method of food consumption, biochemical parameters, subjective global assessment, anthropometric measurements, and body composition should be used for assessing the nutritional status in hemodialysis patients.

Risk factors for malnutrition among hospitalized gastroenterological patients

Background/Aim. Risk factors for malnutrition of patients during hospitalization have not been precisely deter-mined. The aim of the study was to determine these factors in hospitalized gastroenterological patients. Methods. Nutritional status (NS) of 650 gastroenterological patients was assessed at the hospital admission and at discharge by the six parameters: unintentional weight loss, lymphocyte count, serum albumin concentration, body mass index, triceps skinfold thickness, and mid-upper arm muscle circumference. The influence on NS at discharge was tested for ten factors: gender, age, affected organ, the nature, severity, and complications of the disease, the length of hospitalization, mobility worsening during hospitalization, Karnofsky score, and NS on admission. Primary and secondary risk factors were defined among the factors significantly influencing malnutrition. Results. Seven factors were found to be the independent predictors for malnutrition in hospitalized gastroenterological patients. NS at admission was considered as a primary risk factor (Forward: Wald multivariate logistic regression analysis, p &lt; 0.001 for five applied assessment parameters). The other six factors, obtained in the evaluation according to 1-3 assessment parameters, were considered as secondary risk factors: severe disease activity, malignancy, the existence of complications, male gender, hospitalization &gt; 14 days, and mobility worsening during the hospitalization (Forward: Wald multivariate logistic regression analysis, p from 0.001 to 0.027). Conclusion. There are seven risk factors for malnutrition among gastroenterological patients during hospitalization. Timely nutritional support in these patients can prevent the development of intrahospital malnutrition and its negative influence on the clinical outcome.

Association Between Anthropometric Indicators of Nutrition Status and Length of Hospital Stay in Hospitalized Patients.

Undernutrition is associated with increased hospital length of stay (LOS). Anthropometrics is required for undernutrition screening and diagnosis. However, the measurements which are more strongly associated with LOS are to be specified. This study aims to measure the independent association of weight, triceps skinfold thickness (TST), mid-upper arm circumference (MUAC), adductor pollicis muscle thickness (APMT), mid-upper arm muscle area (AMA), mid-upper arm muscle circumference (AMC), and body mass index (BMI) with LOS and investigating whether these indicators had similar validity in predicting LOS. Six hundred ninety-five patients participated in a prospective observational study. Participants were dichotomized indicators studied according to the 5th and 25th percentiles described in the literature (for APMT only the 5th percentile was used). Cox regression analysis was used to estimate adjusted hazard ratios (HRs) and corresponding 95% CIs. Patients that presented values <5th percentile for TST (HR, 0.759; 95% CI, 0.579-0.995), MUAC (HR, 0.822; 95% CI, 0.687-0.983), APMT (HR, 0.791; 95% CI, 0.671-0.933), AMA (HR, 0.797, 95% CI, 0.660-0.962), and AMC (HR, 0.746; 95% CI, 0.611-0.911) showed a lower probability of being discharged to usual residence. Patients whose TST values were <25th percentile also presented lower probability of being discharged to usual residence (HR, 0.798; 95% CI, 0.673-0.946). No associations were found between weight and BMI with LOS. Depletion of TST, MUAC, APMT, AMA, and AMC was associated with lower probability of being discharged to usual residence. A thicker TST was independently associated with this outcome and thus TST should be considered for undernutrition screening and diagnosis.

Evaluation of Nutritional Status of Colorectal Cancer Patients from Algerian East Using Anthropometric Measurements and Laboratory Assessment.

Background:Chemotherapy may lead to cancer patient malnutrition, associated with reduced response, and increased complications to anticancer therapy. This study aimed to evaluate the nutritional status of Algerian colorectal cancer patients.Methods:This cross-sectional study was conducted during 2016–2017 at the Oncology departments from the Algerian East included 90 patients with colorectal cancer. For each patient, a questionnaire, anthropometric measurements and biochemical tests have been done.Results:The 50–59 yr and 60–69 age groups represented more than half of the population. Obesity and underweight were significantly higher in female patients according to their actual Body mass index (BMI). Prevalence of underweight increased after cancer diagnosis, while obesity prevalence has decreased significantly. The malnutrition classification based on Mid-upper-arm muscle circumference (MUAMC) and the triceps skinfold thickness (TST) has shown a significant higher prevalence of malnutrition among male patients than females. The classification of Nutrition risk index (NRI) has shown a significant high percentage of male patients having malnutrition. In our study, no significant differences were recorded for biochemical tests. Anemia recorded the higher prevalences for both sex compared to other deficiency. Hypoironemia prevalence’s was higher among male patients than females while hypokalemia and hypoproteinemia prevalence’s were higher in female patients.Conclusion:Malnutrition in CRC patients must be combated by early detection to decrease complications associated to cancer and chemotherapy.

The effect of an arteriovenous fistula and haemodialysis on anthropometric measurements of the upper arm.

Haemodialysis (HD) patients are at increased risk of sarcopenia. Measurements of triceps skinfold thickness (TSFT) and mid-upper arm circumference (MUAC) are used to estimate muscle mass. An arteriovenous fistula is the preferred vascular access for HD patients, and we wished to determine whether anthropometric measurements were affected by the fistula and HD treatment. One hundred and forty-four HD patients, 90 (62.5%) males, mean age 63.1 ± 15.4 years, had measurements pre- and post-HD. TSFT was similar in the arms, whereas MUAC and corrected mid-upper arm muscle circumference (CMUAMC) were greater in the fistula compared with the non-fistula arm (MUAC pre-HD 30.0 ± 5.2 vs 29.2 ± 4.7 and post-HD 29.6 ± 5.1 vs 28.5 ± 4.7, p < 0.001; MUAMC 23.5 ± 4.0 vs 22.5 ± 4.1, and post-HD 22.9 ± 4.0, and 22.0 ± 3.7 cm p < 0.01). Following HD; TSFT did not change, but MUAC and CMUAMC fell significantly in both arms (p < 0.01). When screening for sarcopenia in HD patients, anthropometric measurements should be taken post-HD in the non-fistula arm.

Estimating the Prevalence of Muscle Wasting, Weakness, and Sarcopenia in Hemodialysis Patients

Haemodialysis (HD) patients suffer from nutritional problems, which include muscle wasting, weakness, and cachexia, and are associated with poor clinical outcomes. The European Working Group for Sarcopenia in Older People (EWGSOP) and Foundations for the National Institute of Health (FNIH) have developed criteria for the assessment of sarcopenia, including the use of non-invasive techniques such as bioelectrical impedance assessment (BIA), anthropometry, and hand grip strength (HGS) dynamometry. This study investigated the prevalence of muscle wasting, weakness, and sarcopenia using the EWGSOP and FNIH criteria. BIA was performed in 24 females (f) and 63 males (m) in the post-dialysis period. Total skeletal muscle mass and appendicular skeletal muscle mass were estimated and index values (i.e., muscle mass divided by height2 [kg/m2]) were calculated (Total Skeletal Muscle Index (TSMI) and Appendicular Skeletal Muscle Index (ASMI)). Mid-arm circumference and triceps skin-fold thickness were measured and mid-upper arm muscle circumference (MUAMC) calculated. HGS was measured using a standard protocol and Jamar dynamometer. Suggested cut-points for low muscle mass and grip strength were utilized using the EWGSOP and FNIH criteria with prevalence estimated, including sarcopenia. The prevalence varied depending on methodology: low TSMI (moderate and severe sarcopenia combined) was 55% for whole group: 21% (f) and 68% (m). Low ASMI was 32% for whole group: 25% (f) and 35% (m). Low MUAMC was 25% for whole group: 0% (f) and 30% (m). ASMI highly correlated with Body Mass Index (r=0.78, P<.001) and MUAMC (r=0.68, P<.001). Muscle weakness was high regardless of cut-points used (50-71% (f); 60-79% (m)). Internationally, this is the first study comparing measures of muscle mass (TSMM and ASMM by BIA and MUAMC) and muscle strength (HGS) using this specific methodology in a hemodialysis population. Future work is required to confirm findings.

Steady Growth in Early Infancy Is Associated with Greater Anthropometry in Indian Children Born Low Birth Weight at Term

ABSTRACTBackgroundPatterns of early growth are associated with later body composition and risk of adult noncommunicable disease but information from low-income countries is limited.ObjectivesThe aim of this study was to investigate early growth trajectories and later anthropometric and bone density outcomes among children born term low birth weight (LBW: 1.8–2.5 kg).MethodsWe used data from 902 children from the Delhi Infant Vitamin D Supplementation study of LBW term infants (which collected monthly anthropometry from birth to 6 mo) and who had height, weight, midupper arm circumference (MUAC), midupper arm muscle circumference (MUAMC), subscapular and triceps skinfold thicknesses, tibia and radius bone density measured at age 4–6 y. We investigated how growth in the first 6 mo of life, modeled using the SuperImposition by Translation and Rotation (SITAR) growth curve model, was related to these outcomes. SITAR summarizes each infant's weight and length trajectory in terms of a population mean curve and child-specific growth parameters: size, timing, and intensity. These were included as explanatory variables in linear regression models for the childhood outcomes.ResultsConsidering the infant weight and length SITAR parameters jointly, childhood weight was strongly associated with infant length timing [estimated regression coefficient β = 0.25 (95% CI: 0.10, 0.39)] and with weight size, timing, and intensity [β = 9.01 (6.75, 11.27), β = −0.25 (−0.43, −0.07), β = 5.03 (3.22, 6.84), respectively]. Childhood height was associated only with the length parameters [β = 0.97 (0.71, 1.23), β = −0.43 (−0.77, −0.09), β = 11.68 (8.60, 14.75), respectively]; childhood MUAC, MUAMC, and skinfolds with all parameters; and bone density with none. Overall, delayed and sustained growth in infant weight and length resulted in higher values of all outcomes except bone density, with the period up to 15 wk of age appearing critical for setting childhood anthropometry in this population.ConclusionsThe explanation for the effects of delayed growth and length of the period in which trajectories are set is unclear; however, sustained and delayed growth in early infancy appears to be beneficial for these LBW children at least in the short-term. The trial was registered at clinicaltrials.gov as BT/PR7489/PID/20/285/2006.

Anthropometric Measurements and Cognitive Impairment Rather Than Nutrition Status Are Associated With Sarcopenia in Long-Term Care Residents.

Sarcopenia is an important health problem in older adults. The aim was to study the association of anthropometric measurements, functional capacity, cognitive impairment, and nutrition status with sarcopenia in institutionalized older adults. A cross-sectional study was undertaken, determining the calf circumference (CC), mid-upper arm muscle circumference (MUAMC), and body mass index (BMI) and administering the Pfeiffer test and Mini Nutritional Assessment Short Form (MNA-SF). Sarcopenia was diagnosed following criteria of the European Working Group on Sarcopenia in Older People. After bivariate analyses, a multivariate logistic regression model was constructed to determine the association of study variables with sarcopenia. The study group comprised 249 residents (mean age 84.9 ± 6.7years). The prevalence of sarcopenia was 63%. The multivariate analysis with adjusted odds ratios (ORs) indicated that the risk of sarcopenia was significantly increased by being female (OR = 2.8; 95% CI 1.3-6.2), having moderate or severe cognitive impairment (Pfeiffer test score of 5-10) (OR = 2.4; 95% CI 0.9-6.4), and having a BMI < 22kg/m2 (OR = 22.4; 95% CI 6.7-75.0). Moreover, a low CC (OR = 6.5; 95% CI 3.0-14.0) or MUAMC (OR = 3.9; 95% CI 1.7-9.3) also significantly increased the risk of sarcopenia. A negative association was observed between sarcopenia and MNA-SF, although it did not remain statistically significant in the multivariate analysis. The variables identified as risk factors for sarcopenia can assist in detecting individuals at higher risk who require special clinical attention.

Impact of lunch provision on anthropometry, hemoglobin, and micronutrient status of female Cambodian garment workers: exploratory randomized controlled trial

BackgroundLunch provision is expected to improve the nutritional status of Cambodian garment workers. The objective of this study is to evaluate the effects of a model lunch provision through a canteen on anthropometry, hemoglobin, and micronutrient status in female garment workers in Cambodia.MethodsThis exploratory randomized controlled trial was implemented at a garment factory in Phnom Penh, Cambodia. Female workers (nulliparous, non-pregnant) were recruited and randomly allocated into an intervention arm (workday’s lunch provision) and a control arm. Served lunch sets (~ 700 kcal on average) included diverse local dishes. Anthropometry (body mass index, weight, triceps skinfold thickness, and mid-upper arm muscle circumference), as well as hemoglobin, serum ferritin and soluble transferrin receptor, serum retinol binding protein, and serum folate concentrations were assessed at baseline and after 5 months of lunch provision. A general linear model with adjustments for baseline values was used to estimate intervention effects for each outcome variable.ResultsTwo hundred twenty-three women were recruited (n = 112 control and n = 111 intervention). 172 (n = 86 in each arm) completed the study. Baseline prevalence of underweight, anemia, depleted iron stores, and marginal iron stores, were 31, 24, 21, and 50%, respectively. Subjects were not affected by frank vitamin A or folate deficiency, whereas 30% showed a marginal folate status. Overall, mean changes in anthropometric variables, hemoglobin, and retinol binding protein were marginal and not significant among intervention subjects. Mean folate concentration increased insignificantly by + 1.1 ng/mL (− 0.02, 2.2) (p = 0.054). On the other hand, mean ferritin decreased by − 6.6 μg/L (− 11.9, − 1.3) (p = 0.015). Subgroup analysis prompts that effects are differently pronounced according to the baseline status of workers.ConclusionsFindings indicate that model lunch sets provided a beneficial amount of dietary folate, but need to be revisited for iron content and/or iron bioavailability. It is believed that distinct positive effects on anthropometry, hemoglobin, and micronutrient status can solely be expected in malnourished individuals. The authors suggest that similar larger trials, which include sets adapted to the concrete needs of workers affected by underweight, anemia and/or definite micronutrient deficiencies, should be performed.Trial registrationThe trial was registered at the German Clinical Trials Register (9 January 2015, Identifier: DRKS00007666).

The clinical study of Nutric score system and nutritional assessment in neurological critical ill patients

Objective To investigate the clinical utility of critical nutrients nutrition risk assessment(Nutric score) in neurological critical ill patients, laying the foundation for clinical nutrition support. Methods From July 2016 to March 2017, 59 ICU patients with neurological critical ill in the First Affiliated Hospital of Anhui Medical University were divided into low score group(Nutric score 0-4) and high score group(Nutric score 5-9) according to Nutric score system.On the first and seventh day after ICU admission, the body mass index(BMI), triceps skinfold thickness (TSF), mid-upper arm circumference (MAC) and mid-upper arm muscle circumference (MAMC) were measured.The serum albumin(ALB), prealbumin(PA), hemoglobin(Hb) and lymphocyte(LY) were detected as nutritional indicators.And at the same time, recorded the 28-day outcomes, and made the SGA evaluation. Results At the first day admission in ICU, there were no statistically significant differences between the two groups in TSF, MAC and MAMC (all P>0.05). But at the seventh day, the TSF, MAC, MAMC of the high score group were (0.943±0.484)cm, (24.143±3.203)cm, (21.187±2.625)cm, respectively, which were significantly lower than those of the low score group[(1.185±0.403)cm, (26.981±2.731)cm, (23.265±2.327)cm], there were statistically significant differences between the two groups(t=2.090, 3.672, 3.223, all P<0.05). At the first day after admission, the serum levels of ALB and Hb in the high score group were (34.5±7.3)g/L, (103.68±13.5)g/L, which of the low score group were (39.0±6.9)g/L, (122.29±20.4)g/L, respectively, and there were statistically significant differences between the two groups(t=2.466, 4.168, all P<0.05). And at the seventh day after admission, the serum levels of ALB, PA, Hb and Ly in the high score group were (30.6±5.1)g/L, (146.0±77.0)mg/L, (83.9±11.9)g/L, (1.123±0.535)×109/L, respectively, which were significantly lower than those in the low score group[(35.8±5.5)g/L, (209.9±105.1)mg/L, (105.8±19.2)g/L, (1.709±1.377)×109/L]. Compared with the first day after admission, the ALB, Hb levels in the two groups at the seventh day after admission were significantly decreased (t=2.29, 2.042, 5.817, 3.286, all P<0.05); the PA level in the low score group had no statistically significant difference at the seventh day after admission, but the PA level in the high score group was decreased significantly (t=2.024, P<0.05). The incidence rate of malnutrition, mortality of the high score group were 32.1%, 32.1%, respectively, which were significantly higher than those in the low score group (9.7%, 6.5%) (χ2=4.583, 6.402, all P<0.05). Conclusion The Nutric score system can be used in the purpose of early nutrition assessment in neurological critical ill patients, and it is benefit for clinical early nutritional support. Key words: Nutric score system; Neurological; Critical illness

Establishing a clinical phenotype for cachexia in end stage kidney disease \u2013 study protocol

BackgroundSurveys using traditional measures of nutritional status indicate that muscle wasting is common among persons with end-stage kidney disease (ESKD). Up to 75% of adults undergoing maintenance dialysis show some evidence of muscle wasting. ESKD is associated with an increase in inflammatory cytokines and can result in cachexia, with the loss of muscle and fat stores. At present, only limited data are available on the classification of wasting experienced by persons with ESKD. Individuals with ESKD often exhibit symptoms of anorexia, loss of lean muscle mass and altered energy expenditure. These symptoms are consistent with the syndrome of cachexia observed in other chronic diseases, such as cancer, heart failure, and acquired immune deficiency syndrome. While definitions of cachexia have been developed for some diseases, such as cardiac failure and cancer, no specific cachexia definition has been established for chronic kidney disease. The importance of developing a definition of cachexia in a population with ESKD is underscored by the negative impact that symptoms of cachexia have on quality of life and the association of cachexia with a substantially increased risk of premature mortality. The aim of this study is to determine the clinical phenotype of cachexia specific to individuals with ESKD.MethodsA longitudinal study which will recruit adult patients with ESKD receiving haemodialysis attending a Regional Nephrology Unit within the United Kingdom. Patients will be followed 2 monthly over 12 months and measurements of weight; lean muscle mass (bioelectrical impedance, mid upper arm muscle circumference and tricep skin fold thickness); muscle strength (hand held dynamometer), fatigue, anorexia and quality of life collected. We will determine if they experience (and to what degree) the known characteristics associated with cachexia.DiscussionCachexia is a debilitating condition associated with an extremely poor outcome. Definitions of cachexia in chronic illnesses are required to reflect specific nuances associated with each disease. These discrete cachexia definitions help with the precision of research and the subsequent clinical interventions to improve outcomes for patients suffering from cachexia. The absence of a definition for cachexia in an ESKD population makes it particularly difficult to study the incidence of cachexia or potential treatments, as there are no standardised inclusion criteria for patients with ESKD who have cachexia. Outcomes from this study will provide much needed data to inform development and testing of potential treatment modalities, aimed at enhancing current clinical practice, policy and education.

Physical performance and protein-energy wasting in patients treated with nocturnal haemodialysis compared to conventional haemodialysis: protocol of the DiapriFIT study

BackgroundPoor physical performance and protein-energy wasting (PEW) are health issues of major concern in haemodialysis patients. The conventional haemodialysis (CHD) regime, three times per week 3–5 h, is subject of discussion because of high morbidity and mortality rates. When patients switch from CHD to longer dialysis sessions, i.e. nocturnal haemodialysis (NHD), improvement in protein intake and increase in body weight is seen. However, it is unclear whether physical performance and more important aspects of PEW, such as body composition, improve as well. Therefore, the aim of this study is to investigate whether physical performance improves and PEW decreases, when patients switch from CHD to NHD. A second aim is to assess the influence of NHD on the biomarkers fibroblast growth factor-23 and sclerostin which are thought to be associated with malnutrition and mortality in patients on haemodialysis.MethodsThis study is a prospective multicentre cohort study with an inclusion aim of 50 patients: 25 patients in a control group (three times per week, 3–5 h CHD) and 25 patients in a nocturnal group (three times per week, 7–9 h NHD). Primary outcome is change in physical performance, measured by the Short Physical Performance Battery. Additional measurements are a 6-min walk test, handgrip strength, a physical activity questionnaire and physical activity monitoring. The secondary outcome of the study is PEW, which will be evaluated by body weight, dual-energy X-ray absorptiometry, bio-electrical impedance spectroscopy, mid-upper arm muscle circumference, subjective global assessment, visual analogue scale for appetite and dietary records. Laboratory measurements including fibroblast growth factor-23 and sclerostin, and quality of life assessed with the Kidney Disease Quality of Life-Short Form are also studied. In every patient, four repeated measurements will be performed during one year of follow-up.DiscussionThis study will investigate whether physical performance improves and PEW decreases when patients switch from CHD to NHD, compared to a control group who continue treatment with CHD. Strengths of this study are the comparison with a conventional haemodialysis cohort, and the broad variety of objective measurements combined with patient-reported outcomes of physical performance and PEW.Trial registrationNTR4715, Netherlands Trial Register. Registered 30 July 2014.

THE RELATIONSHIP BETWEEN MARKERS OF MALNUTRITION AND MUSCLE WASTING WITH FRAILTY AND PHYSICAL FUNCTION IN OLDER CARE HOME RESIDENTS

Background: Older care homes residents may suffer from malnutrition and muscle wasting within a background of varying degrees of frailty, comorbidity and disability. Hence, malnutrition is complicated by co-presence of sarcopenia, cachexia and inactivity-induced muscle atrophy. Objectives: (1) to assess the prevalence of malnutrition in care home residents using different methodologies. (2) To examine the relationship between measurements of nutritional status and muscle mass with frailty and physical function; Design: initial pilot study. Setting: care homes for older people. Participants: 73 participants, 46 female and 27 male; Intervention: observational study. Measurements: height (m), weight (kg), body mass index (BMI) (kg), bioelectrical impedance assessment (BIA) of fat free mass index (FFMI) (kg/m2), mid upper arm muscle circumference (MUAMC) (cm), Edmonton Frailty Scale (EFS) and Barthel Index (BI). Results: There was a relatively high prevalence of malnutrition depending on measure used. MNA-SF 0-7 score was 30% for females and 28% males. Low MUAMC was found in 41% females and 53% males; low BIA FFMI in 37% females and 52% males. Good correlation (P&lt;0.001) was found for most measures including against EFS and BI for MNA-SF and MUAMC. Conclusions: Malnutrition prevalence was relatively high. MNA-SF and MUAMC correlated well with functional status and frailty EFS measures. FFMI by BIA correlated well with MNA-SF and MUAMC. This range of practical techniques should be explored further for determining malnutrition risk and muscle wasting in relation to functionality and frailty in care home residents.

Anthropometric Parameters of Nutritional Status in Children with Cerebral Palsy.

Introduction:Patients with cerebral palsy (CP), besides the basic neurological damage, are also often undernourished. Adequate nutrition for children is very important during the period of intensive growth and development, which is of particular importance in patients with CP.Goal:To evaluate the nutritional status of patients with CP who are treated at the Pediatric Clinic, Clinical Centre of Sarajevo University and causes of malnutrition in these patients.Materials and Methods:Eighty patients with CP underwent anthropometric assessment (body weight, body height, body mass index, head circumference, subscapular skinfold thickness, triceps skinfold thickness and mid upper arm muscle circumference). Severity of CP was classified based on the Gross Motor Function Classification System (GMFCS). We compared the anthropometric parameters of our patients with normal values of healthy children, as well as with degree of motor impairment, oromotor dysfunction, feeding assistance, length of meals and daily feeding time.Results:There were significant differences in all monitored parameters in relation to normal values, with 38 (47.5%) malnourished patients in the total group, out of which 29 (63.0%) with severe motor impairment and with 9 (11.3%) obese patients in the total group. The presence of oromotor dysfunction and other monitored parameters had a significant impact on the nutritional status of these patients.Conclusion:In severely disabled patients with CP there is a risk of profound malnutrition. Early identification and treatment of these patients is very important for their growth, development and health.

Cross-sectional associations of objectively measured physical activity and sedentary time with sarcopenia and sarcopenic obesity in older men

This study investigated associations between objectively measured physical activity (PA) with sarcopenia and sarcopenic obesity in older British men. Participants were men aged 70–92years (n=1286) recruited from UK Primary Care Centres. Outcomes included (i) sarcopenia, defined as low muscle mass (lowest two fifths of the mid-upper arm muscle circumference distribution) accompanied by low muscular strength (hand grip strength <30kg) or low physical performance (gait speed≤0.8m/s); (ii) severe sarcopenia, required all three conditions; (iii) sarcopenic obesity defined as sarcopenia or severe sarcopenia and a waist circumference of >102cm. Independent variables included time spent in PA intensities measured by GT3x accelerometers, worn during one week in 2010–12. Multinomial regression models were used for cross-sectional analyses relating PA and sarcopenia. In total, 14.2% (n=183) of men had sarcopenia and a further 5.4% (n=70) had severe sarcopenia. 25.3% of sarcopenic or severely sarcopenic men were obese. Each extra 30min per day of moderate-to-vigorous PA (MVPA) was associated with a reduced risk of severe sarcopenia (relative risk [RR] 0.53, 95% confidence interval [CI] 0.30, 0.93) and sarcopenic obesity (RR 0.47 [95% CI 0.27, 0.84]). Light PA (LPA) and sedentary breaks were marginally associated with a reduced risk of sarcopenic obesity. Sedentary time was marginally associated with an increased risk of sarcopenic obesity independent of MVPA (RR 1.18 [95% CI 0.99, 1.40]). MVPA may reduce the risk of severe sarcopenia and sarcopenic obesity among older men. Reducing sedentary time and increasing LPA and sedentary breaks may also protect against sarcopenic obesity.

Assessment of Malnutrition in Cirrhotic Patients

Malnutrition is a common but frequently overlooked problem among patients with cirrhosis of liver. Malnourished cirrhotic patients have a higher rate of complications and an overall increased mortality. Identifying these patients is of great clinical importance. This study was carried out to assess nutritional status of cirrhotic patients to identify those who are malnourished and to see the relationship between severity of liver disease and malnutrition. 105 patients were selected by purposive type sampling. Nutritional status was assessed by 3 anthropometric assessment tools- body mass index (BMI), mid upper arm muscle circumference (MAMC) and triceps skin fold thickness (TST). Severity of liver disease was assessed by Child-Pugh (CP) score. Severe malnutrition was defined as MAMC and TST &lt;5th percentile, calculated from standard tables, and as BMI &lt;16. Among 105 patients 18, 49 and 38 were of Child-Pugh group (CP group) A, B and C respectively. Anthropometric assessment revealed that, when assessed by MAMC 63% of the study population were severely malnourished. Based on MAMC, severe malnutrition was present in 39%, 63% and 73% patients in CP group A, B and C, respectively (P&lt;0.05). So, percentage of severely malnourished patient increased with the increase in severity of liver disease. Based on TST, 28%, 34% and 50% patients were severely malnourished in CP-A, CP-B and in CP-C (p&gt;0.05) respectively which showed a trend similar to that by MAMC. Whereas, based on BMI, 0%, 8% and 2% patients were severely malnourished respectively (p&gt;0.05). It showed a decrease in the percentage of severely malnourished patient in CP group C than in CP group B. In this study, nutritional assessment by TST and MAMC revealed that severe malnutrition was common in our study population and assessment by MAMC showed a statistically significant association of severity of liver disease with severe malnutrition.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.189-194

Nutritional Status Deteriorates Postoperatively Despite Preoperative Nutritional Support

Background/Aims: The aim of the current study was to assess the postoperative evolution of nutritional status and to relate it with postoperative outcomes. Methods: Demographic, surgical and nutritional parameters were assessed 10 days preoperatively (d-10) and 30 days postoperatively (d30) in 146 patients. Risk factors responsible for perioperative (>5% between d-10 and d30) weight loss were identified. Overall, severe (Clavien 3-5) and infectious complications were compared in patients with and without perioperative weight loss (>5%). Results: Nutritional status worsened beyond the postoperative period as reflected by decreasing weight (67 ± 13 kg at d-10 vs. 63 ± 13 kg at d30, p < 0.001), body mass index (23.4 ± 4 vs. 22.2 ± 4 kg/m², p < 0.001) and mid upper-arm muscle circumference (MAMC, 241 ± 32 vs. 232 ± 30 mm, p < 0.001). Fifty-two patients (46%) lost >5% of their body weight between d-10 and d30. Patients who presented overall (63 vs. 36%, p = 0.004) and major (27 vs. 10%, p = 0.016) postoperative complications were at significantly higher risk to deteriorate postoperative nutritional status. Multivariate analysis identified low preoperative lean body mass (OR 3.2; 95% CI 1.2-8.9, p = 0.023) and low preoperative MAMC (OR 2.5; 95% CI 0.9-6.8, p = 0.066) as independent risk factors for perioperative weight loss. Conclusions: These data suggest continuing nutritional follow-up after the index hospitalization.

Association between nutritional indicators and risk of hospitalization among hemodialysis patients

ABSTRACT Objective To verify the ability of nutritional indicators to predict risk of hospitalization in hemodialysis patients. Methods This prospective cohort study was conducted in two hemodialysis units in Southern Brazil. The following nutritional indicators were evaluated: subjective global assessment, malnutrition-inflammation score, nutritional risk screening 2002, percentage of body fat, mid-upper arm muscle circumference, hand grip strength, phase angle, and serum albumin. The association between nutritional indicators and risk of hospitalization over a period of two years was analyzed. Results One hundred thirty-eight patients (55.4±15.2 years, 61.6% men) were evaluated. The cumulative incidence of hospitalization during the study was 48.0% (95%CI=37.9-58.0). Patients hospitalized during the study period had higher body mass index and lower serum albumin than those who were not hospitalized. Based on the other indicators, malnourished patients did not have a significant risk of hospitalization (p&gt;0.05). Serum albumin was the only predictor of hospitalization. Patients with levels &lt;3.8 g/dL had a density ratio for incidence of hospitalization 2.47 times greater than those with higher levels (p=0.003). Gender was a modifier of the effect (p interaction=0.042), with an effect in women of 7.31 (95%CI=2.34-22.9; p=0.001) and in men of 1.37 (95%CI=0.60-3.12; p=0.448). Conclusion Serum albumin was able to predict the risk of hospitalization over a period of two years in female patients undergoing hemodialysis.

Malnutrition and sarcopenia are associated with increased mortality rate in nursing home residents: A prospective study

Background and aimsThe aim of this study was to determine the prevalence of malnutrition risk and sarcopenia in our elderly (≥65 years) nursing home residents and find out their association with mortality. Material and methodThis prospective observational study with a follow-up of 12 months was done in 402 subjects (65 years old or older) living in a nursing home. Nutritional status was determined with Mini Nutritional Assessment (MNA). Sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People (EWGSOP) with the measurements of muscle mass, muscle strength and physical performance using mid upper arm muscle circumference (MUAC, cm), calf circumference (CC), a standardized handheld dynamometer and gait speed. Nutritional status and sarcopenia were compared with the 1-year mortality rate. ResultsAccording to MNA, 56.5% of the individuals were normal, 24.8% had malnutrition risk (MR) and 18.7% had malnutrition (MN). Sarcopenia was diagnosed in 73.3% of the residents. Reduced muscle strength was found in 94.5% of the population. MN/MR were found associated with sarcopenia (P<0.0001). After 12 months of follow-up, total mortality rate was 16.2%. MN, sarcopenia, BMI and MUAC were found well correlated with mortality (normal nutrition status: 10.6%, MR: 20.0% and MN: 28.0%, P<0.001; sarcopenic: 19.3% and non-sarcopenic: 7.5%, P=0.012). Malnutrition and sarcopenia were found related with mortality independent from other factors. ConclusionMalnutrition and sarcopenia are prevalent in nursing home residents. It is important to diagnose and treat malnutrition and sarcopenia in elderly nursing home residents for both can increase mortality independently.