Nutritional Assessment Methods Research Articles

Nutritional Risk Screening and Assessment.

Malnutrition is an independent risk factor that negatively influences patients’ clinical outcomes, quality of life, body function, and autonomy. Early identification of patients at risk of malnutrition or who are malnourished is crucial in order to start a timely and adequate nutritional support. Nutritional risk screening, a simple and rapid first-line tool to detect patients at risk of malnutrition, should be performed systematically in patients at hospital admission. Patients with nutritional risk should subsequently undergo a more detailed nutritional assessment to identify and quantify specific nutritional problems. Such an assessment includes subjective and objective parameters such as medical history, current and past dietary intake (including energy and protein balance), physical examination and anthropometric measurements, functional and mental assessment, quality of life, medications, and laboratory values. Nutritional care plans should be developed in a multidisciplinary approach, and implemented to maintain and improve patients’ nutritional condition. Standardized nutritional management including systematic risk screening and assessment may also contribute to reduced healthcare costs. Adequate and timely implementation of nutritional support has been linked with favorable outcomes such as a decrease in length of hospital stay, reduced mortality, and reductions in the rate of severe complications, as well as improvements in quality of life and functional status. The aim of this review article is to provide a comprehensive overview of nutritional screening and assessment methods that can contribute to an effective and well-structured nutritional management (process cascade) of hospitalized patients.

Relevance of the semi-quantitative short Food Frequency Questionnaire in assessment of calcium consumption by female inhabitants of Zabrze over the age of 55\xa0years (the Silesia Osteo Active Study)

SummaryIn the study, we compare two methods used to assess the effects of nourishment on the bone status. Statistical analysis demonstrated a moderate conformity of both methods. Short Food Frequency Questionnaires can be used as short medical screening tool for calcium intake among women over 55 years of life.IntroductionOsteoporosis is a civilisation disease, the development of which is, among others, controlled and affected by diet. The factors which promote the health of bones include calcium, vitamin D, vitamin K, phosphorus, magnesium, and protein. A number of nutritional epidemiology methods can be applied to assess the effects of nourishment on the bone status, e.g. Food Frequency Questionnaire (FFQ) in its full or short (sFFQ) version or 3-day food record (3DFR). Both methods are known and widely used tools.MethodsIn the reported study, we attempted to compare and assess the sFFQ and 3DFR tools. Both methods were employed to examine 156 women, the majority of whom presented with an overweight-indicating BMI. An analysis of sFFQ data brought an observation that most of the studied patients (33.3%) consumed milk once a day.ResultsBased on 3DFR and sFFQ, we compared the measured volumes of consumed calcium which were 557.8 mg/day and 880.7 mg/day, respectively. The Cohen’s kappa calculator was used for a diagnostic evaluation of both tools; the kappa index was 0.5047, demonstrating a moderate conformity of both methods. In addition, sensitivity and specificity indices were calculated, revealing the values of 97% and 12%, respectively.ConclusionssFFQ can be used as a short medical screening. It is suggested to use both the 3DFR, conducted by the patient, and sFFQ, as a complementary method. It is necessary to continue this type of studies and to standardise the methods of nutritional status assessment with regard to selected groups.

Effective nutritional status screening in orthopaedic oncology patients and post-operative complications.

This study aims to determine the prevalence of malnutrition among orthopaedic oncology patients with malignant tumour during preoperative period. This is a prospective observational study involving patients from the orthopaedic oncology unit who were undergoing surgery. They were assessed with Patient Generated Subjective Global Assessment (PG-SGA), Malnutrition Screening Tool (MST) and 3-minute Nutritional Screening (3MinNS) questionnaires. Anthropometric data such as body mass index, mid upper arm circumference (MUAC) and blood parameters such as serum albumin, total lymphocyte count and haemoglobin were also investigated. Patients were then followed up for 3 months. Post-operative complications were divided into infectious and non-infectious groups. Length of stay and unplanned readmission were also documented. Prevalence of malnutrition ranged from 13.3% to 45.8% under different nutritional assessment methods. Patients who were determined as malnourished were significantly associated with both infectious and non-infectious post-operative complications ( p < 0.001). PG-SGA and 3MinNS values were also significant in univariate and multivariate analysis, respectively. Low serum albumin (<35 g/L) was associated with post-operative infectious complications, especially surgical site infection ( p < 0.001), prolonged hospital stay ( p = 0.009) and unplanned readmission ( p = 0.017). 3MinNS and Charlson Comorbidity Index were predictive of non-infectious complications, whereas serum albumin and the presence of metastasis were predictive of infectious complications. This pilot study of patients with soft tissue and bone sarcoma of upper and lower limbs showed that malnutrition is a significant independent factor related to infectious and non-infectious complications which leads to unplanned readmission and prolonged length of stay. Periodic screening using the PG-SGA or 3MinNS questionnaires, MUAC and evaluation of serum albumin levels is recommended during clinic session and pre-surgery assessment rounds to identify those predisposed to malnutrition and help in reducing incidence of post-operative complications.

ANTHROPOMETRIC AND DIETETIC EVALUATION OF PEOPLE WITH ILEOSTOMIES

The maintenance of nutrition for the person with ileostomy is a major challenge despite to the proper management of stoma eliminations. This study aimed to evaluate the nutritional status of people with ileostomy. This is a cross-sectional study carried out on a population of 17 people with ileostomy enrolled in the Service of Attention to the Health of the Person with Stoma of level II, referring to a health region in Minas Gerais. The anthropometric evaluation consisted of the collection of weight, height, and calculation of body mass index. A 24-hour food recall and the nutritional assessment method Global Subjective Assessment were also evaluated. The data were analyzed by the Dietbox software, where the ingested nutrients were estimated, and by the Statistical Package for the Social Sciences version 22.0. There was a predominance of a population composed of people over 50 years old, female, married and single, with family income between two and three minimum wages, incomplete elementary school and that did not exercise paid activity. The cancer was given as the main diagnosis that originated the stoma and had a surgery time of less than two years. Regarding nutritional status, most of the interviewees presented adequate body mass index, but more than half reported significant weight loss after the ileostomy. The predominant nutritional diagnosis provided by the General Subjective Assessment was "suspected malnutrition/moderate malnutrition". On the other hand, the contribution of energy, carbohydrates, lipids, sodium, potassium, magnesium and vitamin B12 was considered insufficient in almost all the participants. Therefore, it is suggested the periodic evaluation of the nutritional status of this population. Thus, it is expected that preventive, therapeutic and maintenance dietary diagnosis and planning may contribute to the nutritional status of the person with the ileostomy.

Community nutrition support for discharged patients

It is important to find the patients with malnutrition or at risk of malnutrition, so that the appropriate nutrition support would be given in time. The nutritional status of inpatients isexamined by various nutrition assessment methods and laboratory indexes. If necessary, when the patient sare discharged the home enteral nutrition therapy should be given under the supervision of community doctors and nurses following the established nutrition support program. With this program the nutritional status can be further improved, the disease recovery and quality of life can be promoted, as well as the economical burden of patients can be reduced. Key words: Nutritional support; Community health services

Abstracts of the 11th International Conference on Cachexia, Sarcopenia and Muscle Wasting, Maastricht, The Netherlands, 7–9 December 2018 (Part 2)

Abstracts of the 11^th International Conference on Cachexia, Sarcopenia and Muscle Wasting, Maastricht, The Netherlands, 7–9 December 2018 (Part 2)

Skeletal Muscle Index is a useful tool for the nutritional assessment of patients with pancreatic and hepatobiliary cancer

Background: We aim to examine the association of skeletal muscle index (SMI) with traditional methods of nutritional assessment, anthropometric measurements and hand grip strength in pancreatic and hepatobiliary cancer patients. Methods: The study sample consisted of 49 patients (24 men, 25 women) with pancreatic and hepatobiliary cancer who were admitted for surgery in the First Department of Surgery, Laikon University Hospital, Athens, Greece between September 2015 and January 2017. The preoperative nutritional assessment was based on albumin and Total Lymphocyte Count (TLC), whereas anthropometric measurements included Body Mass Index(BMI), Waist Circumference(WC), Hip Circumference(HC), Mid Arm Muscle Circumference(MAMC), Corrected Mid Arm Muscle Area(cMAMA) and Calf Circumference (CC). Hand Grip Strength(HS) was measured using dynamometer and SMI was derived from analysis of CT scans. Results: The mean SMI in men was 48,81 cm2/m2 and in women 38,94 cm2/m2 (p < 0,05). SMI was positively correlated with albumin(r = 0,439, p < 0,05), WC(r = 0,590, p < 0,01), HC(r = 0,423, p < 0,05), MAMC(r = 0,436, p < 0,05), cMAMA(r = 0,399,p < 0,05), CC(r = 0,531,p < 0,01), HS dominant hand (r = 0,671,p < 0,01) and HS non dominant hand (r = 0,694,p < 0,01). On the other hand, TLC and BMI showed no significant correlation with SMI. Conclusion: Preoperative SMI measurement seems to be a useful tool in order to detect malnourished/sarcopenic patients with pancreatic and hepatobiliary cancer.

Phase angle as a screening tool for mortality risk among hematopoietic stem cell transplanted adult patients

Mortality among adult patients undergoing hematopoietic stem cell transplantation (HSCT) is high, especially within the first 100 days after the event. Therefore, identifying prognostic factors would be useful as screening tools to protect patients at risk throughout early intervention. In our previous work, the standardized phase angle (SPA) was explored as a useful indicator of survival and nutritional status among children and adolescent within the first 180 days after HSCT. The aim of this study was to evaluate the SPA and the arm muscle area (AMA) as prognostic indicators of mortality and nutritional status among adults in the same population. This study was conducted with 29 adult patients undergoing allogeneic HSCT and 28 controls. Anthropometric assessment as well as body composition and laboratory data were analyzed. The phase angle was standardized according to reference values for healthy population. The correlation of SPA and AMA with other variables was verified and sensibility and specificity were tested by constructing ROC curves considering mortality and nutritional status as outcomes. Kaplan-Meier analysis was applied to calculate survival considering the cut-off points found in ROC curves. Chi-squared test and Kappa coefficient were used for evaluate the agreement among methods of nutritional assessment. SPA presented a predictive value for mortality and nutritional status considering the cut-off point at-0.19. In fact, the mortality incidence was higher among patients with values below the cut-off point for SPA as compared to the ones with SPA above this value up to 90 days after the HSCT. Regarding to AMA, mortality was higher using the values bellow P15 (percentile 15) as reference. The average SPA decreased after the beginning of conditioning and after the HSCT, while the decrease of AMA was observed only 90 days after the transplant. In this study SPA was confirmed as a prognostic tool for adult HSCT patients. In addition, it seems that SPA is more sensitive to detect structural body changes among the transplanted patients as compared to AMA. More studies are needed to confirm it as a tool to screen patients at risk of mortality for early intervention.

Strategies for online personalised nutrition advice employed in the development of the eNutri web app.

The internet has considerable potential to improve health-related food choice at low-cost. Online solutions in this field can be deployed quickly and at very low cost, especially if they are not dependent on bespoke devices or offline processes such as the provision and analysis of biological samples. One key challenge is the automated delivery of personalised dietary advice in a replicable, scalable and inexpensive way, using valid nutrition assessment methods and effective recommendations. We have developed a web-based personalised nutrition system (eNutri) which assesses dietary intake using a validated graphical FFQ and provides personalised food-based dietary advice automatically. Its effectiveness was evaluated during an online randomised controlled trial dietary intervention (EatWellUK study) in which personalised dietary advice was compared with general population recommendations (control) delivered online. The present paper presents a review of literature relevant to this work, and describes the strategies used during the development of the eNutri app. Its design and source code have been made publicly available under a permissive open source license, so that other researchers and organisations can benefit from this work. In a context where personalised diet advice has great potential for health promotion and disease prevention at-scale and yet is not currently being offered in the most popular mobile apps, the strategies and approaches described in the present paper can help to inform and advance the design and development of technologies for personalised nutrition.

Mini nutritional assessment is a better predictor of mortality than subjective global assessment in heart failure out-patients

There is no consensus on the best method for nutritional screening and assessment in patients with heart failure (HF). This study aimed to determine which nutritional assessment method had the highest prognostic significance for patients with HF treated in outpatient clinics. We also aimed to identify a fast, reliable screening method for detecting malnutrition in these patients. This prospective study included 151 subjects that attended an outpatient HF clinic at a university hospital. All patients completed three nutritional screening tools: the Malnutrition Universal Screening Tool (MUST), the MNA-short form (MNA-SF), and the Malnutrition Screening Tool (MST), and then, two nutritional assessment questionnaires: the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment®(MNA). Patients were followed-up for 2 years. The primary endpoint was all-cause mortality. Malnutrition or nutritional risk was identified in 15.9% of patients with the SGA and in 25.1% of patients with the MNA. Age, New York Heart Association (NYHA) functional class, and MNA were the only independent all-cause death predictors after adjusting for age, gender, NYHA functional class, body mass index, Barthel index, 25-hydroxyvitamin D concentrations, treatment with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, and treatment with beta-blockers. The SGA could not independently predict all-cause mortality in a multivariate analysis that included the same covariates. The MNA-SF had the best sensitivity, specificity, and kappa coefficient for screening malnutrition, based on the MNA and the SGA as references, compared to the other screening methods. In our cohort, malnutrition assessed by MNA, but not by SGA, was an independent predictor of mortality. MNA-SF showed remarkable sensitivity and specificity; thus, it might be a valuable tool for rapidly identifying malnutrition risk in outpatients with HF.

Agreement between Subjective Global Nutritional Assessment and the nutritional assessment of the World Health Organization

ObjectiveTo assess the agreement between the results of the Subjective Global Nutritional Assessment questionnaire, adapted for children and adolescents of the Brazilian population, and the nutritional status assessment method through growth curves and the classification of the World Health Organization in a pediatric hospital service. MethodsThis was an analytical, quantitative, cross‐sectional study. During the data collection period, the nutritional status of all patients from 0 to 12 years of age, admitted to the pediatric unit of a university hospital, was concomitantly assessed according to the Subjective Global Nutritional Assessment and World Health Organization curves. To determine the assessment and agreement between these methods, the Kappa and Kendall coefficients were used, respectively, considering a significance level of 5%. ResultsSixty‐one children participated, with a predominance of males. It was observed that the highest frequency of equivalent results occurred among the group classified as well nourished, and that only the height/age variable showed a close agreement between the methods. Additionally, there was a good correlation only for the weight/height variable between the assessment tools used. ConclusionDue to the low agreement between the methods, the combination of both may be beneficial for the nutritional assessment of pediatric patients, collaborating with the early diagnosis of nutritional alterations and facilitating the use of adequate dietary therapy.

Comparative Analysis between Anthropometry and Subjective Methods in Nutritional Evaluation in Cancer: A Systematic Review

This study aims to evaluate the anthropometric indicators used in cancer patients, comparing them with one another and with the subjective methods of nutritional assessment. Methodology: A search was made in January 2018 in the databases Medline (PubMed), Latin American and Caribbean Literature in Health Sciences (Lilacs) and Scientific Electronic Library Online (Scielo), with the descriptors oncology, cancer, evaluation, anthropometry, adults, elderly and malnutrition. Results: A total of 10 articles were included in this review. All of them used body mass index (BMI) to diagnose malnutrition; however, fewer malnourished individuals were identified by this method. In addition to BMI, the most used anthropometric indicators were arm muscle circumference, tricipital skinfold and arm perimeter, used in most articles, being the most malnourished identified by it. As for subjective methods, fewer malnourished patients were tracked when compared to perimeters and folds. Conclusion: It is concluded that the arm perimeter is the most anthropometric indicator use in tracking of malnutrition in cancer patients, considering the prevalence.

Nutritional Support

Nutritional optimization of the surgical patient remains a cornerstone of perioperative care. Significant effort and scrutiny are routinely directed to the field as it has the potential to improve outcomes, limit infectious complications, and decrease hospital length of stay and mortality. As such, previously identified cornerstones of care have been called into question. The timing, route, and intensity of nutritional supplementation remain the subject of controversy in an ever-evolving field. Previous methods of nutritional assessment, such as albumin and transthyretin, have proved unreliable, and their use is no longer recommended. In their place, new scoring systems are available to risk assess patients for malnutrition. We review the most pressing changes and assess the landscape of the field today. Key words: critical illness, enteral, glutamine, malnutrition, nutrition, outcomes, parenteral, protein

Prediction of prognosis in chronic obstructive pulmonary disease patients with respiratory failure: A comparison of three nutritional assessment methods

ObjectivesDue to their increased energy expenditure, chronic obstructive pulmonary disease (COPD) patients with respiratory failure are susceptible to malnutrition. This study aimed to compare the predictive values of the following three widely used nutritional assessment methods for the clinical prognosis of COPD patients with respiratory failure: body mass index (BMI), Nutritional Risk Screening 2002 (NRS 2002), and serum albumin (ALB) level. MethodsCOPD patients with respiratory failure treated in our center from June 2013 to June 2016 were retrospectively included. Patient BMI, NRS 2002 and ALB values were measured to assess their nutritional status. A multivariable analysis was conducted, and receiver operating characteristic (ROC) curves were generated to explore the predictive factors for clinical prognoses. ResultsA total of 438 qualified patients were enrolled in our study. Multivariable analysis revealed that the BMI and ALB values independently predicted in-hospital mortality, the BMI and NRS 2002 predicted 1-year mortality, and all three methods (BMI, NRS 2002, and ALB) predicted 30-day readmission after discharge (P < 0.05). Regarding the results of the AUROC analysis, the optimal cutoff values that maximized the ability to predict the prognosis were an ALB level of 30.5 g/L for in-hospital mortality, an NRS 2002 score of 3 points for 1-year mortality, and an ALB level of 30.1 g/L for readmission within 30 days following discharge. ConclusionsFor COPD patients with respiratory failure, ALB level was superior for predicting in-hospital mortality and 30-day readmission after discharge, and NRS 2002 was superior for long-term prognosis of 1-year mortality.

Socio-demographic characteristics, dietary habits and physical activity influence on nutritional status of the diabetics: a cross sectional study

Diabetes mellitus, a chronic, debilitating disease, is associated with a range of severe complications which include cardiovascular disease, renal disease and blindness. Demographic and epidemiological evidences suggest that the incidence of diabetes is increasing worldwide. Diabetes mellitus in people of all ages is reaching epidemic proportions in Bangladesh. The main objective of this cross sectional study was carried out to evaluate that nutritional status of the diabetic patients influence by socio-economic level, dietary habits and physical activity.A total of 282 diabetic outpatients were recruited using Simple Random Sampling technique from three referral diabetic centers namely-Kushtia Diabetic Shomity, Bheramara Diabetic Shomity and Diabetic Shomity Kumarkhali, Kushtia, Bangladesh. The nutritional status of each participant was screened. Direct method of nutritional assessment including anthropometric measurement, biochemical measurement, clinical assessment and dietary method was carried out. Socio economic data were also collected. Data were analyzed using the computer program Statistical Package for Social Sciences (SPSS) version 22.The result reveals that51.1% (n=144) of the total participants were male and 48.9% (n=138) were female. About 28.4% population studied were between 51-60 years, 94.7% married, 44.7% were unemployed and 50.4% were resided in urban area. Based on Body Mass Index (BMI), mean BMI of male was 23.32 ± 3.47 and that of female was 25.83 ± 4.46, half of the respondents (48.9%) had an acceptable nutritional status with a BMI between 18.5-24.9 (62.3% male; 37.7% female) whilst 4.6% of the respondents were underweight with BIMs below 18.5. The female who were observed were 22 (88.0%) and the male were 3 (12.0%) showing a very great prevalence of obesity (BMI more than 30.0). Study showed that 98 (34.7%) respondents bear diabetes from their family and 147 (52.1%) respondents have family history of hypertension The mean blood hemoglobin level was 12.49±1.47g/dl, in which male hemoglobin level was 12.85±1.48g/dl and of female was 12.11±1.36g/dl. The result shows that about 29.8% (n=84) patients had no formal education; among them more were female 65.5% (n=55). More of the patient (50.7%) had family member of 4-6. About 33.0% of the studied patients were low-income level (25.9% were from upper-lower and 7.1% were from lower socio-economic status). Among 37.6% (n=106) overweight (BMI 25.0-29.9) diabetic patients more were female 56.6% (n=60) and 55.7% (n=59) were unemployed. So, female sex, lower educational status, more family member, low monthly family income group and unemployment are associated with malnutrition. Unemployed housewives represented to have both extremes of nutritional status- under nutrition and over nutrition. In the study, most of the patient 126 (44.7%) were unemployed, among them almost all the patient 124 (98.4%) were female. Diabetic care seeking by rural people and female appeared encouraging emphasizing the need of decentralization of diabetic care center to periphery.Asian J. Med. Biol. Res. March 2018, 4(1): 123-134

Validation (in Spanish) of the Mini Nutritional Assessment survey to assess the nutritional status of patients over 65 years of age.

To validate the Mini Nutritional Assessment (MNA) in a Spanish population over 65 years of age with varying degrees of independence. This cross-sectional validation study used the Chang nutritional assessment method as a reference test. 248 subjects (72.2% female), with a mean age of 81.3, completed the study. They were classified into three groups: (i) autonomous patients who were able to take part in activities outside their home; (ii) patients who require help with daily self-care; (iii) patients living in a residential health care facility. Three health centres and three residential care homes situated in Cordoba (Spain). The kappa values for intra-observer and inter-observer agreement were 0.870 and 0.784, respectively. The intra-class correlation coefficient intra-observer was 0.874 and the inter-observer was 0.789. The sensitivity and specificity readings for the diagnostic accuracy of MNA were 63.2% and 72.9% in the total sample, respectively. The area under the curve was 0.726. For patients in the Group A, B and C, the sensitivity was 89.3%, 60.7% and 18.8%, and the specificity was 23.3%, 56.8% and 94.1%, respectively. The results for the reliability of the survey were excellent, and its internal consistency was acceptable. The diagnostic accuracy, as measured by the sensitivity and specificity readings, was lower than that obtained with the original survey. It can therefore be considered more suitable for a population with limited autonomy, and less appropriate for independent patients. The results may not be relevant to patients outside of the Cordova region in Spain.

Realization of the right to adequate food and the nutritional status of land evictees: a case for mothers/caregivers and their children in rural Central Uganda

BackgroundIn developing countries like Uganda, the human right to adequate food (RtAF) is inextricably linked to access to land for households to feed themselves directly through production or means for its procurement. Whether RtAF is enjoyed among Ugandan land evictees, is unknown. We therefore explored this among land evictees (rights-holders) in Wakiso and Mpigi districts in rural Central Uganda. We assessed food accessibility and related coping strategies, diet quality and nutritional status of children 6–59 months old, and their caregivers. Effectiveness of the complaint and redress mechanisms in addressing RtAF violations was also explored.MethodsIn this cross-sectional study, quantitative data was collected using a structured questionnaire, with food security and nutritional assessment methods from a total of 215 land evictees including 187 children aged 6–59 months. Qualitative data was collected by reviewing selected national and international documents on the RtAF and key informant interviews with 15 purposively sampled duty-bearers. These included individuals or representatives of the Uganda Human Rights Commission, Resident District Commissioner, Sub-county Chiefs, and local Council leaders.ResultsWe found that 78% of land evictees had insufficient access to food while 69.4% had consumed a less diversified diet. A majority of evictees (85.2%) relied on borrowing food or help from others to cope with food shortages. Of the 187 children assessed, 9.6% were wasted, 18.2% were underweight and 34.2% were stunted. Small, but significant associations, were found between food accessibility, diet quality, food insecurity coping strategies; and the nutritional status of evictees. We observed that administrative, quasi-judicial and judicial mechanisms to provide adequate legal remedies regarding violations of the RtAF among evictees in Uganda are in place, but not effective in doing so.ConclusionLand eviction without adequate legal remedies is a contributor to food insecurity and undernutrition in rural Central Uganda. It is essential that the Government strengthens and enforces the policy and legal environment to ensure adequate and timely compensation of evictees in order to reduce their vulnerability to food insecurity.

The application of different nutritional assessment methods in patients with gastrointestinal tumors

Objective To study the effect of different nutritional assessment methods for patients nursing with gastrointestinal cancer. Methods From January 2016 to December 2016, 96 patients with gastrointestinal cancer in our hospital were selected, all patients were randomly divided into two groups, 48 cases of each group.One group of patients were treated with mini nutritional assessment(MNA) as MNA group.Another group of patients were treated with subjective global assessment(SGA) as SGA group.The hospitalization time and complication rate were compared between the two groups. Results In MNA group, the complication rate of innutrition patients(73.50%) were significantly higher than patients of normal nutrition(7.10%), with statistically significant(P 0.05). Conclusion The nutritional assessment MNA and SGA can effective evaluate patients with gastrointestinal cancer.According to the results of the evaluation of patients with continuous nutrition care can effectively reduce the incidence of complications and help patients recover.There was no significant difference between the two methods in patient care. Key words: Gastrointestinal tumor; Mini nutritional assessment; Subjective global assessment; Complications

Zinc Content of Cereals and Pulses in Delhi

Severe zinc deficiency is rare in India but mild to moderate deficiency could be widespread. There is little data on zinc intakes based on nutritional assessment methods, mainly because the Indian Food Composition Tables that were available until recently gave incomplete zinc content values in foods. A pilot study was, therefore, undertaken to assess the zinc content of cereals and pulses consumed in Delhi and to compare the values with those given in the latest Indian Food Composition Tables. Four hundred and twenty six samples of twenty three varieties of cereals / cereal products and fifteen varieties of pulses, collected from wholesale suppliers in the north, south, east and west zones of Delhi, were analyzed for zinc using atomic absorption spectrophotometer. The concentration of zinc in a given cereal or pulse varied widely between the different zones. Cereals like pearl millet, Italian millet, dry maize, whole wheat and its flour and pulses like roasted Bengal gram and dry peas, Bengal gram dhal and lentil dhal were identified as rich sources of zinc. The mean zinc content in most of the foods analysed in the laboratory showed significant differences when compared with the mean values for cereals and pulses reported in the Indian Food Composition Tables given by the National Institute of Nutrition - Indian Council of Medical Research in 2017. A region specific food composition database is urgently needed as there seem to be huge differences in the zinc values of cereals and pulses consumed in Delhi as compared to the average values representative of all states given in the latest food composition database.

Variation in Exhaled Acetone and Other Ketones in Patients Undergoing Bariatric Surgery: a Prospective Cross-sectional Study

BackgroundDietary restriction together with alteration of the gastrointestinal tract results in major metabolic changes and significant weight loss in patients undergoing bariatric surgery. Current methods of measuring these changes are often inaccurate and lack a molecular basis. The objective of this study was to determine the role of exhaled ketones as non-invasive markers of nutritional status in patients undergoing surgical treatment of obesity.MethodsPatients at different stages of treatment for obesity were recruited to this single-centre cross-sectional study. The sample time points were as follows: (i) at the time of initial attendance prior to dietary or surgical interventions, (ii) on the day of surgery following a low carbohydrate diet, and (iii) > 3 months after either Roux-en-Y gastric bypass or sleeve gastrectomy. The concentrations of ketones within breath samples were analysed by selected ion flow tube mass spectrometry.ResultsForty patients were recruited into each of the three study groups. Exhaled acetone concentrations increased significantly following pre-operative diet (1396 ppb) and bariatric surgery (1693 ppb) compared to the start of treatment (410 ppb, P < 0.0001). In comparison, concentrations of heptanone (6.5 vs. 4.1 vs. 1.4 ppb, P = 0.021) and octanone (3.0 vs. 1.4 vs. 0.7 ppb, P = 0.021) decreased significantly after dieting and surgical intervention. Exhaled acetone (ρ − 0.264, P = 0.005) and octanone (ρ 0.215, P = 0.022) concentrations were observed to correlate with excess body weight at the time of sampling. Acetone and octanone also correlated with neutrophil and triglyceride levels (P < 0.05).ConclusionFindings confirm breath ketones, particularly acetone, to be a potentially clinically useful method of non-invasive nutritional assessment in obese patients.