Nutritional Risk Score Research Articles

Nutritional Status and Risks of Cognitive Decline and Incident Neurocognitive Disorders: Singapore Longitudinal Ageing Studies.

Studies suggest that nutritional interventions using the whole diet approach such as the Mediterranean diet may delay cognitive decline and dementia onset. However, substantial numbers of older adults are non-adherent to any ideally healthy dietary pattern and are at risk of malnutrition. The present study investigated the relationship between global malnutrition risk and onsets of cognitive decline and neurocognitive disorders (NCD), including mild cognitive impairment (MCI) or dementia in community-dwelling older adults. Participants aged ≥ 55 years in the Singapore Longitudinal Ageing Studies (SLAS) were assessed at baseline using the Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA) and followed up 3-5 years subsequently on cognitive decline (MMSE drop ≥ 2) among 3128 dementia-free individuals, and incident neurocognitive disorders (NCD) among 2640 cognitive normal individuals. Individuals at high nutritional risk score (≥ 3) were more likely to develop cognitive decline (OR=1.42, 95%CI=1.01-1.99) and incident MCI-or-dementia (OR=1.64, 95%CI=1.03-2.59), controlling for age, sex, ethnicity, low education, APOE-e4, hearing loss, physical, social, and mental activities, depressive symptoms, smoking, alcohol, central obesity, hypertension, diabetes, low HDL, high triglyceride, cardiac disease, and stroke. Among ENIGMA component indicators, low albumin at baseline was associated with cognitive decline and incident NCD, and 5 or more drugs used, few fruits/vegetables/milk products daily, and low total cholesterol were associated with incident NCD. The ENIGMA measure of global malnutrition risk predicts cognitive decline and incident neurocognitive disorders, suggesting the feasibility of identifying vulnerable subpopulations of older adults for correction of malnutrition risk to prevent neurocognitive disorders.

The impact of oral diseases in cirrhosis on complications and mortality.

Background and AimThe aims of this study were to describe the prevalence of various oral diseases and to examine the association of the oral diseases with complications and mortality of cirrhosis.MethodsA total of 184 cirrhosis patients were enrolled and were followed up for 2 years. They underwent oral clinical and radiographic examination. At study entry, the associations between oral diseases with nutrition, inflammation, and cirrhosis complication status were examined. Then, the associations of oral diseases with all‐cause and cirrhosis‐related mortality were examined using Cox regression to adjust for confounding by age, gender, smoking, alcohol use, alcoholic cirrhosis, cirrhosis complications, comorbidity, Child‐Pugh, and Model of End‐Stage Liver Disease (MELD) score.ResultsAt entry, 26% of the patients had gross caries, 46% periapical lesions, 27% oral mucosal lesions, and 68% periodontitis. Having one or more oral diseases was associated with a higher prevalence of cirrhosis complications (46.7 vs 20.5%), higher C‐reactive protein (28.5 mg/L vs 10.4 mg/L), and higher nutritional risk score (4 vs 3). Two‐thirds of the patients died during follow‐up. The patients with more than one oral disease had an increasingly higher all‐cause mortality (two diseases: hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.02–1.98; three and four diseases: HR 1.75, 95% CI 1.05–3.24) and even higher cirrhosis‐related mortality (two diseases: HR 1.60, 95% CI 1.01–2.40; three and four diseases: HR 2.04, 95% CI 1.05–8.83) compared to those with no oral disease.ConclusionIn cirrhosis, having more than one oral disease was associated with more complications and with higher mortality.

Nutrition risk profile of 62 408 inpatients based on electronic health records in a tertiary children's hospital

ObjectivesThis study aimed to evaluate the nutrition risk profile of hospitalized children with electronic health record–based nutrition risk screening. Additionally, this study analyzed the association between high nutrition risk and clinical outcomes. MethodsChildren discharged from Shanghai Children's Medical Center between 2017 and 2018 were enrolled and nutritionally screened. Nutrition risk scores using the Screening Tool for Assessment of Malnutrition in Pediatrics (STAMP), length of stay (LOS), and costs of hospitalization were recorded. Enrolled patients were categorized into two groups: the low and medium nutrition risk (LMNR) group, with scores ranging from 0 to 3, and the high nutrition risk (HNR) group, with scores ≥4. ResultsOut of 62 408 subjects, 17.4% were at HNR. Patients with congenital heart diseases (83.9%), hematology-oncology diseases (26.0%) and gastroenterological diseases (21.4%) were affected most. Infants had the highest HNR rates (35.5%) of any age group. Surgical patients (20.7%) had a higher rate of HNR than non-surgical patients (9.5%). The HNR group had longer LOS (10.0 d versus 3.0 d, P < 0.001), higher total hospital costs (53 680.1 Chinese yuan [CNY] versus 8810.1 CNY, P < 0.001), and higher costs of antibiotics (441.0 CNY versus 0.0 CNY, P < 0.001) compared to the LMNR group. As STAMP score values increased, growing LOS and costs of hospitalization, medications, and antibiotics were observed. ConclusionsA high prevalence of HNR was found in patients of Shanghai Children's Medical Center. Surgeries, specific disease, and infancy were important HNR risk factors. HNR scores using STAMP might predict prolonged LOS and higher medical costs.

A novel nutritional risk score and prognosis of oral cancer patients: A prospective study.

To evaluate the prognostic performance of a novel nutritional risk score based on serum iron, hemoglobin, and body mass index (BMI) in oral cancer patients, and to predict the response to chemotherapy in patients with different nutritional status. X-tile analysis was performed to determine the optimal cutoff values of serum iron, hemoglobin, and BMI. A nutritional risk score was established by using the HR values of serum iron, hemoglobin, and BMI. Kaplan-Meier curve and multivariable Cox proportional hazards models were used to evaluate the prognostic value of the nutritional risk score in overall survival (OS) and oral cancer-specific survival (OCSS). Serum iron, hemoglobin, and body mass index were all inversely related to the prognosis of oral cancer. The adjusted HR of serum iron, hemoglobin, and BMI were 1.562, 1.886, and 1.465 for OS, and 1.653, 1.865, and 1.443 for OCSS. Patients with higher nutritional risk score had a poorer OS and OCSS. Additionally, chemotherapy was only associated with improved OCSS in patients with the lowest nutritional risk score, but not in patients with higher one. Nutritional risk score is of prognostic value in oral cancer patients. Favorable response to chemotherapy may only be observed in well-nourished oral cancer patients with lower nutritional risk score.

Measurement of body mass by bioelectrical impedance analysis and computed tomography in cancer patients with malnutrition - a cross-sectional observational study.

Malnutrition and cachexia affects the majority of cancer patients and significantly worsens their quality of life and prognosis. However, the diagnostic criteria of malnutrition and cachexia remain a topic under constant debate. To overcome this hurdle, diagnostic tools to objectively detect and quantify the loss of muscle and fat mass are needed. Computed tomography (CT)-based measurement is currently considered the golden standard. Bioelectrical impedance analysis (BIA) is an economical, non-invasive tool but it is seen controversial in patients with cancer and malnutrition because of possible estimation errors.BIA and CT-based analysis of body mass compartments were performed 172 times in 118 cancer patients, within the nutrition program of our institution. Prevalence of malnutrition was determined according to the global leadership initiative on malnutrition criteria. Data obtained for muscle and fat mass from both BIA and CT were correlated using Pearson's ρ. All analyses were performed with an explorative significance level of 5%.45.7% of the cohort were classified as “malnourished.” No significant differences were observed between the 2 groups regarding demographic data. Median body mass index, Karnofsky performance status, and nutritional risk score were lower in the malnourished group. Values for muscle and fat mass by BIA and CT were significantly lower in malnourished patients. Correlation of the measured parameters were highly significant between CT-based and BIA measurement. In the overall cohort, correlation of measured muscle mass values by CT and BIA was significant with Pearson's ρ = 0.794 (P < .01). Looking at patients without malnutrition only, Pearson's ρ was 0.754 (P < .01). The correlation of measured fat mass values was equally significant, with Pearson's ρ of 0.748 (P < .01) in the overall cohort and 0.771 (P < .01) in patients with malnutrition.To our knowledge, this is the first study comparing BIA to CT-based body mass analysis in a large cohort of cancer patients with malnutrition. The results suggest that BIA is a valid diagnostic tool for the assessment of muscle and fat mass, even in patients with malnutrition, and could be implemented for the early detection and short-term follow-up of malnutrition and cachexia.

Comparison of Modified NUTRIC, NRS-2002, and MUST Scores in Iranian Critically Ill Patients Admitted to Intensive Care Units: A Prospective Cohort Study.

There are no data on the validity of the modified Nutrition Risk in the Critically Ill (m-NUTRIC)-score and Nutritional Risk Screening 2002 (NRS-2002)-score in Iranian intensive care unit (ICU) patients. The Malnutrition Universal Screening Tool (MUST) is still used in most Iranian ICUs. Our goal was to test the validity of these tools in the Iranian ICU population. The association between nutrition risk scores and outcomes (longer length of stay [LOS], prolonged mechanical ventilation [MV], and 28-day mortality) was assessed using the multivariable logistic regression. The performance of nutrition risk tools to predict 28-day mortality was assessed using the receiver operating characteristic curve. A logistic regression model was used to test the interaction between nutrition risk category, energy adequacy, and 28-day mortality. Four hundred forty patients were included. Both the m-NUTRIC and NRS-2002 scores were significantly associated with all 3 outcomes (all P < .001). However, no significant association was identified between the MUST and all 3 outcomes (P > .05). The area under the curve for predicting 28-day mortality was 0.806 (95% CI, 0.756-0.851), 0.695 (95% CI, 0.632-0.752), and 0.551 (95% CI, 0.483-0.612) for m-NUTRIC, NRS-2002, and MUST, respectively. Greater energy adequacy was associated with a lower 28-day mortality rate in patients with high m-NUTRIC but not in those with low m-NUTRIC score (P interaction = .015). In the Iranian ICU population, the m-NUTRIC score may be a valid tool for identifying patients who would benefit from more aggressive nutrition therapy.

Influence of nutritional status on the hospital length of stay in patients with type 2 diabetes

IntroductionIn the hospitalized patient, Diabetes mellitus type 2 (DM2) may result in a worse nutritional status due to its pathophysiology and dietary treatment. ObjectivesThe aim of this study was to know if a hospitalized diabetic patient has a worse nutritional status, and to establish the influence of DM2 on the hospital length of stay in patients with malnutrition. Material and methodsThis was a transveral study from January 2014 to October 2016; 1017 patients were included who were assessed by the Endocrinology and Nutrition Department. The data collected included anthropometry, plasma albumin, delay in performing the nutrition interconsultation and hospital length of stay. Nutritional status was evaluated using the Mini Nutritional Assesment (MNA) questionnaire and the nutritional risk score (NRS). Results24.4% of the patients were diabetic and 75.6% were not. Diabetic patients had a higher body mass index (BMI) [23.18 (20.78–25.99) kg/m2 vs. 22.31 (19.79–25.30) kg/m2, p<0.01], a lower total score in the MNA questionnaire [16.5(13.12–19) points vs. 17(14–20) points, p<0.01], and a lower NRS score [83.09(77.72–91.12) points vs. 85.78(79.27–92.83) points, p=0.03]. According to the MNA and the NRS, diabetic patients had an increased risk of malnutrition (<17.5 points) [OR=1.39, IC95%(1.04–1.86), p=0.02]; and NRS (<85 points) [OR=1.65, IC 95% (1.07–2.54) p=0.02], respectively. When adjusted for age these significant results disappeared. Diabetes combined with malnutrition showed that diabetic patients with malnutrition (MNA<17.5) spent longer in hospital [21(12–36) days vs. 17(9–30) days, p=0.01]. ConclusionsDiabetic patients have a worse nutritional status than non-diabetic patients. Diabetic patients with a poor nutritional status spend a longer period in hospital.

Full Versus Trophic Feeds in Critically Ill Adults with High and Low Nutritional Risk Scores: A Randomized Controlled Trial.

Although energy intake might be associated with clinical outcomes in critically ill patients, it remains unclear whether full or trophic feeding is suitable for critically ill patients with high or low nutrition risk. We conducted a prospective study to determine which feeding energy intakes were associated with clinical outcomes in critically ill patients with high or low nutrition risk. This was an investigator-initiated, single center, single blind, randomized controlled trial. Critically ill patients were allocated to either high or low nutrition risk based on their Nutrition Risk in the Critically Ill score, and then randomized to receive either the full or the trophic feeding. The feeding procedure was administered for six days. No significant differences were observed in hospital, 14-day and 28-day mortalities, the length of ventilator dependency, or ICU and hospital stay among the four groups. There were no associations between energy and protein intakes and hospital, 14-day and 28-day mortalities in any of the four groups. However, protein intake was positively associated with the length of hospital stay and ventilator dependency in patients with low nutrition risk receiving trophic feeding. Full or trophic feeding in critically ill patients showed no associations with clinical outcomes, regardless of nutrition risk.

Equal efficacy of gastric and jejunal tube feeding in liver cirrhosis and/or alcoholic hepatitis: a randomised controlled study

Malnutrition and muscle mass loss are complications in liver cirrhosis and alcoholic hepatitis (AH). Hospitalised patients who do not meet nutritional requirements are recommended to be fed enterally or parenterally, but no guidelines recommend a specific type of tube. This study aimed to compare the efficacy of jejunal versus gastric feeding. 40 inpatients with liver cirrhosis and/or AH, a nutritional risk score more than 2 and a reduced daily energy intake were included. Half were randomised to nasogastric (NG) and half to nasojejunal (NJ) tube feeding. All received Peptamen AF as a supplement to oral intake. Participants were followed up until discharge or death. The study evaluated the data for 33 patients for 7 days after tube insertion. Mean daily energy intake for 7 days was 6509 kJ (NG) vs 6605kJ (NJ) (P=0.90). Tubes accidently removed by patients: once (n=16); twice (n=9); three times (n=6), with no differences between NG and NJ. There were no significant differences in total nutritional intake between early NG feeding and early NJ feeding 7 days after tube insertion. The number of tube replacements was similar in both groups. Choice of tubes for patients with severe liver disease will depend on individual patient characteristics and needs and local facilities.

Nutritional support in children with pneumonia on mechanical ventilation by short-peptide enteral nutrition formula

Objective To observe the incidence of malnutrition and nutritional risk in children with pneumonia on mechanical ventilation in the pediatric intensive care unit (PICU), and to explore the nutritional support effect of short-peptide enteral nutrition formula. Methods A total of 68 children with severe pneumonia who were hospitalized in the PICU from October 2017 to October 2018 and required mechanical ventilation were enrolled for a prospective randomized controlled study. The children were randomly divided into a control group and an experimental group. Through the nasogastric feeding tube, the experimental group received the short-peptide enteral nutrition formula, and the control group received the intact-protein enteral nutrition formula. The weight-for-age Z score, STRONGkids nutritional risk score, and pediatric critical illness score of the two groups were evaluated. The serum levels of total protein, albumin, and prealbumin (PA) on admission and before discharge were measured. The gastrointestinal tolerance and clinical outcome indicators of the two groups were observed. Results Among the 68 mechanically ventilated children, 26 (38%) had malnutrition, including moderate malnutrition (10 cases, 15%) and severe malnutrition (16 cases, 24%); 10 cases (15%) had malnutrition at discharge. Sixty-three children (93%) had nutritional risk, including moderate nutritional risk in 21 cases and high nutritional risk in 42 cases. The moderate and high nutritional risk rates of the critical and extreme critical groups were significantly higher than those of the non-critical group (P 0.05). Conclusions The detection rates of malnutrition and nutritional risk in children with pneumonia on mechanical ventilation are relatively high. Short-peptide enteral nutrition formula can help improve their treatment outcome and are more suitable for nutritional support in critically ill children on mechanical ventilation.

The role of body muscle mass as an indicator of activity in inflammatory bowel disease patients

Malnutrition is an objective disease activity parameter for patients with inflammatory bowel disease (IBD), particularly Crohn's Disease (CD), and is an indicator of lesion expansion or inflammatory activity. Active disease is correlated with the systemic response of the body's immune system, activating a hypermetabolic state and protein degradation (Argiles JM, 2015). These conditions lead to malnutrition, which significantly increases the risk of impaired clinical outcomes, such as delayed recovery or increased mortality (Landi F, 2019). Our aim was to identify malnutrition parameters associated with more pronounced metabolic status changes in IBD patients (i.e., classified as by low and high clinical activity) as an indicator of disease activity. This prospective pilot study included hospitalised patients aged ≥18 years, with an established diagnosis of IBD, with no medical history of surgical interventions. IBD patients were divided into those with low clinical activity indexes (CD activity index [CDAI] <150 for CD and Mayo <4 for ulcerative colitis [UC]) and those with high clinical activity indexes (CDAI >150 for CD and Mayo >4 for UC). Patients were assessed twice using the Nutritional Risk Score (NRS2002) and Malnutrition Universal Screening Tool (MUST) and 48 body bioelectrical impedance analysis (BIA) measurements were taken. A control group consisting of heathy age- and sex-matched individuals was used for comparison. Fifty hospitalised patients (median age, 36.5 IQR: 28.5-51.5 years) were enrolled, of which 44% (n=21) were female and 56% (n=27) were male. Of these, 48% (n=23) patients were diagnosed with CD and 52% (n=25) with UC. The median CDAI was 128 (IQR=6.0-207.0) and Mayo score was >4 (IQR=1.0-8.0). The study group comprised 48% (n=23) patients with low IBD activity and 52% (n=25) of patients with high IBD activity. According to the NRS2002, 31% (n=15) patients were nutritionally at risk and in need of nutritional support and an additional 24% (n=12) had low-risk requiring observation, without necessity for additional nutritional care. According to the MUST score, 40% (n=19) of patients had a high-risk of malnutrition requiring a nutritional care plan and 19% (n=9) were of low-risk. Overall, 31% (n=17) of patients received enteral oral feeding and 10% (n=4) required additional parenteral feeding. The group with low IBD activity showed a considerably lower score on both screening tools (NRS2002 p=0.007; MUST p<0.001). Comparing BIA results between IBD patients and the control group, the median BMI was lower for the CD (21.10 [IQR=19.2-23.3]) than for the control group (23.4 [IQR=21.5-25.8]) (p=0.014). In addition, visceral fat mass was lower in CD (-4,00 [IQR=-12.1 to 5.6]) than in the control group (7.85 [IQR=-0.9-18.2]) (p=0.003). In terms of deviation from standard weight, 39% (n=9) of CD patients showed reduced %body fat, while this was observed in only 19% (n=5) of UC patients. Reduced muscle mass was observed in 48% (n=11) of CD patients and in 19% (n=4) of UC patients, while only 13% (n=6) of all IBD patients had reduced BMI. IBD patients with high disease activity indices had a noticeably increased risk for malnutrition (according to NRS2002 scores), taking into consideration not only IBD activity, but also increased weight loss and loss of appetite. Most CD patients in both the low and high disease activity groups had reduction in muscle mass, which was not evaluated in UC patients. Identification of the reduction in soft lean muscle mass in CD patients can be used as an anticipatory indicator of disease activity.

Influencia del estado nutricional sobre la estancia media hospitalaria en el paciente con diabetes mellitus tipo 2

IntroductionIn the hospitalized patient, Diabetes mellitus type 2 (DM2) may result in a worse nutritional status due to its pathophysiology and dietary treatment. ObjectivesThe aim of this study was to know if a hospitalized diabetic patient has a worse nutritional status, and to establish the influence of DM2 on the hospital length of stay in patients with malnutrition. Material and methodsThis was a transveral study from January 2014 to October 2016; 1017 patients were included who were assessed by the Endocrinology and Nutrition Department. The data collected included anthropometry, plasma albumin, delay in performing the nutrition interconsultation and hospital length of stay. Nutritional status was evaluated using the Mini Nutritional Assesment (MNA) questionnaire and the nutritional risk score (NRS). Results24.4% of the patients were diabetic and 75.6% were not. Diabetic patients had a higher body mass index (BMI) [23.18 (20.78-25.99) kg/m2 vs. 22.31 (19.79-25.30) kg/m2, P˂.01], a lower total score in the MNA questionnaire [16.5(13.12-19) points vs. 17(14-20) points, P˂.01], and a lower NRS score [83.09(77.72-91.12) points vs. 85.78(79.27-92.83) points, p=0.03]. According to the MNA and the NRS, diabetic patients had an increased risk of malnutrition (<17.5 points) [OR=1.39, IC95%(1.04-1.86), p=0.02]; and NRS (<85 points) [OR=1.65, IC 95% (1.07-2.54) p=0.02], respectively. When adjusted for age these significant results disappeared. Diabetes combined with malnutrition showed that diabetic patients with malnutrition (MNA˂17.5) spent longer in hospital [21(12-36) days vs. 17(9-30) days, P=.01]. ConclusionsDiabetic patients have a worse nutritional status than non-diabetic patients. Diabetic patients with a poor nutritional status spend a longer period in hospital.

Effects of enteral nutrition intervention on immune and nutritional indexes of patients with gastric malignant cancer during postoperative chemotherapy

Abstract Objective The aim of this study was to investigate changes in nutritional status and related indexes in patients with Nutritional Risk Score (NRS) ≥ 3 gastric cancer after nutritional support treatment. Methods A total of 50 patients with gastric cancer were divided into two groups according to the different nutritional support treatment they received during postoperative chemotherapy: immune-enhanced enteral nutrition group (n = 25) and conventional enteral nutrition group (n = 25). Changes in patient’ body mass index (BMI), hemoglobin (HB), serum total protein (TP), serum albumin (ALB), and immune indexes (CD3+, CD4+/CD8+, CD3+/CD8+) were monitored before and after chemotherapy. At the same time, the incidence and classification of gastrointestinal adverse reactions after chemotherapy were assessed. Results Compared with the conventional enteral nutrition group, the nutritional and immune indexes in the immune-enhanced enteral nutrition group were significantly improved. After chemotherapy, the incidence of adverse reactions in the digestive tract was relatively lower and the grade was reduced. Conclusion Immune-enhanced enteral nutrition support can significantly improve the nutritional status of patients, improve immune function, increase the susceptibility of cancer patients to chemotherapy, reduce toxicity and adverse effects, and improve the quality of life of tumor patients compared with conventional enteral nutrition support.

Greater Nutritional Risk Scores in 2-Year-Old Children Exposed to Gestational Diabetes Mellitus In Utero and Their Relationship to Homeostasis Model Assessment for Insulin Resistance at Age 5 Years

ObjectivesExposure to gestational diabetes mellitus (GDM) in utero may impact nutritional intake and lifestyle habits in early childhood. However, it is unclear whether nutritional status predicts greater risk for metabolic disturbances, such as insulin resistance (IR). The primary objectives were: 1) to determine parent-reported nutritional risk scores in 2-year-old children born to women with and without GDM and 2) to assess whether these scores predict IR in 5-year-old children. MethodsChildren exposed (n=34) and unexposed (n=46) to GDM were screened at 2 years of age using the Toddler version of the Nutrition Screening Tool for Every Preschooler (NutriSTEP). At a 5-year follow up, IR was assessed using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). ResultsTotal NutriSTEP scores ranged from 6 to 33, with higher scores indicating greater risk. After controlling for infant birthweight, sex of the child, child ethnicity, maternal age at time of pregnancy, breastfeeding status and maternal prepregnancy body mass index, average NutriSTEP scores were higher in children exposed to GDM compared with those unexposed (13.8±1.1 vs 11.2±1.1, p=0.03). NutriSTEP scores at 2 years emerged as a positive independent predictor of HOMA-IR at 5 years. For each unit increase in NutriSTEP score, suggesting greater nutritional risk, we saw a 0.48 (95% confidence interval, 0.17 to 0.80; p=0.003) increase in score on the HOMA-IR. ConclusionsParent-reported nutritional risk is greater in GDM-exposed children, and these nutritional behaviours developed during the first years of life may predispose to metabolic disturbance in early childhood.

Relationship With Calcium, Nutrition Risk, QTc Interval, Tp-e Interval, and Tp-e/QTc Ratio of Critical Care Patients.

To our knowledge, there are studies related to QTc interval in critical care patients whose nutrition scores are evaluated but no studies evaluating T-wave peak and end interval (Tp-e interval), Tp-e/QT ratio, and Tp-e/QTc ratio, used to evaluate cardiac arrhythmia risk and ventricular repolarization change rates. Therefore, we aimed to investigate whether there is a change in Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients whose nutrition scores are evaluated. This study was planned as a retrospective cross-sectional study. Forty-four patients with a risk score of ≤3 were defined as low-risk group, and 45 patients with a score of ≥4 were defined as high-risk group. Forty-five healthy patients of similar age and gender were included in the control group. All patients underwent 12-lead electrocardiography (ECG). The Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio were measured on ECG. The study data were grouped as patients with high Nutritional Risk Screening 2002 (NRS-2002) risk score, low NRS-2002 risk score, and healthy control. QTc interval, Tp-e interval, and Tp-e/QTc ratios were significantly higher in patients with high nutrition risk. In a correlation analysis, Tp-e interval and Tp-e/QTc ratio were found to be independently associated with calcium, corrected calcium, and serum albumin level. QTc interval, Tp-e interval, and Tp-e/QTc ratios are significantly increased in patients with high nutrition risk score compared with healthy people and are independently associated with calcium and serum albumin levels; thus, they can be used more effectively in the follow-up of cardiac fatal arrhythmias.

The association between sociodemographic factors, frailty, and health-related quality of life in older inpatients: a cross-sectional study.

This cross-sectional study aims to explore the association between frailty and domains of quality of life (QOL) among hospitalized patients in older age under consideration of the sociodemographic characteristics. Older inpatients in a comprehensive tertiary hospital in China were involved. Data including sociodemographic, clinical diagnosis, frailty status, and QOL were collected through questionnaires and physical assessments. Frailty was measured using the frailty phenotype defined by Fried. QOL was determined by completion of version 2 of the 12-item Short Form Survey (SF-12v2). Multivariable linear regression and structural equation modeling were applied to estimate associations between frailty and QOL. 260 older inpatients were enrolled and classified as frail (31.92%), pre-frail (39.62%), and robust (28.46%). Patients with frailty were older and were more likely to have severe comorbidity, higher nutritional risk score and lower body mass index, activities of daily living score (P<0.05). As the extent of frailty increased, the patients in old age experienced poor QOL in most of dimensions. Five multiple linear regression models indicated that the estimated differences in the physical component summary of QOL were lower for the frail and pre-frail groups versus the robust group. After adjusting all covariates, the coefficients were -7.72 (-11.04, -4.41) and -16.48 (-20.37, -12.58) for pre-frail and frail, respectively. Structural equation modeling results showed that sociodemographic characteristics directly affected QOL, while others played an indirect role in reducing their QOL by causing frailty. Frailty is prevalent in hospitalized patients having older age. Patients with frailty would experience poor QOL, especially in the dimension of physical health. To promote healthy aging, further studies into how frailty influences the QOL is warranted.

What do screening tools measure? Lessons learned from SCREEN II and SNAQ65.

Over the last decade, different screening tools for malnutrition have been developed. Within these tools, a distinction can be made between tools that assess nutritional risk and tools that assess protein energy malnutrition. Insights in differences in characteristics of participants at risk and in differences in prevalence rates will aid in deciding which tool(s) to use in daily practice. Dutch community-dwelling older adults (n=200, 78.2±6.9 years), not known to have specific nutrition problems, were recruited to participate in this cross-sectional study. SNAQ65+ (low risk vs moderate/high risk) was used to assess risk of protein energy malnutrition and SCREEN II was used to assess nutrition risk (score <54 out of 64). Chi-square tests were used to test associations between demographic, health, physical and social factors and outcome of SNAQ65+ and SCREEN II. Of all participants 69.0% were at nutrition risk (SCREEN II), while 13.5% were at risk of protein energy malnutrition (SNAQ65+). Agreement between the two tools was poor (kappa<0.20). Gender, BMI, living status, income, activity level and protein/energy intake were associated with SCREEN II; age, BMI, comorbidities, medication use, help at home, activity level and low basic mobility were associated with SNAQ65+. SCREEN II and SNAQ65+ measure different concepts of malnutrition and therefore identify different persons at risk. SCREEN II is more inclusive and comprises both undernutrition and overnutrition as well as different determinants that can impact on food intake, while SNAQ65+ is solely focused on protein-energy malnutrition.

Preconceptional Maternal Vegetable Intake and Paternal Smoking Are Associated with Pre-implantation Embryo Quality

Inadequate nutrition and lifestyle behaviors, particularly during the periconception period, are associated with a negative impact on embryonic and subsequent fetal development. We investigated the associations between parental nutritional and lifestyle factors and pre-implantation embryo development. A total of 113 women and 41 partners, with a corresponding 490 embryos, who underwent intracytoplasmic sperm injection (ICSI) treatment subscribed to the mHealth coaching platform “Smarter Pregnancy.” At baseline, nutrition and lifestyle behaviors (intake of fruits, vegetables, folic acid, and smoking and alcohol use) were identified and risk scores were calculated. A lower risk score represents healthier behavior. As outcome measure, a time-lapse morphokinetic selection algorithm (KIDScore) was used to rank pre-implantation embryo quality on a scale from 1 (poor) to 5 (good) after being cultured in the Embryoscope™ time-lapse incubator until embryonic day 3. To study the association between the nutritional and lifestyle risk scores and the KIDScore in men and women, we used a proportional odds model. In women, the dietary risk score (DRS), a combination of the risk score of fruits, vegetables, and folic acid, was negatively associated with the KIDScore (OR 0.86 (95% CI 0.76 to 0.98), p = 0.02). This could mainly be attributed to an inadequate vegetable intake (OR 0.76 (95% CI 0.59 to 0.96), p = 0.02). In men, smoking was negatively associated with the KIDscore (OR 0.53 (95% CI 0.33 to 0.85), p < 0.01). We conclude that inadequate periconceptional maternal vegetable intake and paternal smoking significantly reduce the implantation potential of embryos after ICSI treatment. Identifying modifiable lifestyle risk factors can contribute to directed, personalized, and individual recommendations that can potentially increase the chance of a healthy pregnancy.

Assessing Diet Quality of People with Parkinson’s Disease: Dietary Screening Tool Versus HEI-2015

Abstract Objectives To assess the diet quality of people with Parkinson's Disease (PwPD) using two assessment tools: Healthy Eating Index (HEI)-2015 and the Dietary Screening Tool (DST). HEI-2015 and DST scores were compared for alignment to explore associations between HEI-2015 and DST total scores and sub-scores. Methods This secondary data analysis utilized a total of 28 participants from two studies examining PwPD and their informal caregivers. Dietary data was collected with two 24-hour recalls using the multiple pass method and entered into the Nutrition Data System for Research (NDSR). SAS Version 9.4 was used to compute HEI-2015 scores to assess diet quality. The HEI-2015 score is a total of 100 points and is based on the Dietary Guidelines for Americans for 2015–2020. Total HEI-2015 scores and 13 component scores were interpreted using the graded approach (grades A-F). Radar graphs provide a visual representation. Participants also completed the DST. The DST is a 25-item questionnaire used to identify dietary patterns and assess nutritional risk. Total scores were categorized into at risk &amp;lt;60, possibly risk 60–75, and not at risk &amp;gt;75. Sub-scores were calculated with point classifications for specific food categories. These sub-scores were divided into tertials of recommended intakes less than 50%, 50–80% and 80–100%, and compared for alignment between DST sub-scores and HEI-2015 sub-scores by assessing total number of pairs per category. Results The mean total score was 59.4 ± 28.6 for DST and 58.7 ± 22.2 for HEI-2015. HEI-2015 scores fell into grades of A (n = 0) B (n = 3) C (n = 3) D (n = 7) F (n = 14). PwPD who were categorized at risk from the DST scores (n = 18) received an HEI grade of D/F. PwPD who were at possible risk (n = 7) received a grade of B/C/D. PwPD who were not at risk (n = 3) received a grade of B/C/D for sub-scores, vegetable intake had a 50% alignment in scores, fat/sugar 43% alignment, whole grains and dairy 46% alignment and fruit 39% alignment. Conclusions There appeared to be partial alignment between the total HEI-2015 scores and DST nutritional risk scores. Sub-scores differ 50% of the time. Due to differences between the assessment tools, more research is needed to validate the DST in PwPD as this can be a less taxing assessment compared with 24-hour recalls. Funding Sources There was no external funding for this study.

Validity and reliability analysis of the Turkish version of pediatric nutritional risk score scale.

We aimed to perform the validity and reliability analysis of the Turkish version of the Pediatric Nutritional Risk Score (PNRS). The study group consisted of 149 patients aged between 1 month and 18 years who were admitted to the hospital for at least 48 h. The patients' age, gender, anthropometric measurements, length of stay, admission diagnosis, daily body weights, food consumption, and pain status were recorded. Backward and forward translations into Turkish were done. PNRS was performed by two different physicians. The consistency of the PNRS results was evaluated to determine the validity of PNRS. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Of all patients, 69 (46.3%) were female and 80 (53.7%) were male. The mean length of the stay was 7.3±4.0 days. The mean age of the patients was 51.9±63.6 months. The Kappa coefficient between the two physicians was 0.66. Weight loss was observed in 65.2% of the patients in the high-risk group and 25.4% in the low-risk group. The hospital malnutrition rate was 31.5%. A higher risk was identified in those with <50% food intake and more severe disease. The specificity, sensitivity, NPV, and PPV of PNRS were 82.1%, 77.8%, 92.0%, and 58.3%, respectively. A good consistency suggests that the Turkish validation was achieved successfully. The power of PNRS to discriminate the patients with moderate-low risk of developing malnutrition is higher than the patients with high risk. PNRS is considered a valid and reliable tool to establish the risk of malnutrition in the hospitalized patients.