Nutritional Impairment Research Articles

IS MALNUTRITION RISK LINKED TO DECANNULATION IN PATIENTS ATTENDING RESPIRATORY REHABILITATION? PRELIMINARY RESULTS.

Compare malnutrition risk, biochemical nutritional markers and functional impairment at admission and discharge in patients from the Don Gnocchi Foundation Respiratory Rehabilitation Unit. The possible connection between a lower malnutrition risk, a better functional status and decannulation was also investigated. We evaluated 20 patients (30% F), mean age 74±8 years, 55% smokers, at admission and discharge for malnutrition risk using the Malnutrition Universal Screening Tool (MUST)1, for nutritional status with specific blood parameters (albumin, transferrin, total proteins and lymphocyte count) and for functional impairment with the Barthel Index (BI)2. MUST, BI, serum markers concentrations were compared at admission and discharge (Wilcoxon signed-rank test/ paired t-test, p=0.05). All variables, except for total proteins and albumin, showed significantly different values (Table 1). The age adjusted logistic regression models didn't show a significant association between malnutrition risk and functional status (p-value= 0.575) or decannulation (p-value= 0.237). Our preliminary results show a MUST and nutritional status improvement. The study is not yet concluded: when the overall recruitment will be completed, the larger sample might help identifying a possible link between nutritional status, decannulation and functional autonomy.

Efecto del tipo de soporte nutricional especializado sobre la evolución del paciente con esclerosis lateral amiotrófica (ELA). Registro interhospitalario SCLEDyN

IntroductionAmyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease in which specialized nutritional support is essential. The objectives of our study were to describe nutritional support at the beginning of follow-up and its impact on anthropometry and survival. MethodsAn interhospital registry was created for the hospitals of Castilla-León through a web platform designed for this purpose. An anamnesis was carried out on the evolution and nutritional history of the disease; and classical anthropometry was determined. The prescribed nutritional treatment was recorded. The parameters were measured at the beginning, at six and twelve months of nutritional follow-up. ResultsA total of 93 patients [49 (52.7%) spinal; 44 (47.3%) bulbar)] were analyzed. The nutritional support route at the beginning was oral diet in 36 (38.7%) patients; oral nutritional supplementation (SON) in 46 (49.5%) patients; and in 11 (11.8%) patients percutaneous endoscopic gastrostomy (PEG). A decrease in the body mass index (BMI) was observed between the first and second visit [Start: 24.18 (3.29) kg/m2; 6 months: 23.69 (4.12) kg/m2; P<.05]. Less weight loss was observed at 6 months compared to the start of nutritional follow-up [Start: 8.09 (8.72)%; 6 months: 1.4 (6.29)%; P<.01]. 36 (38.7%) patients died but with no differences according to when nutritional support was started. Survival from the onset of symptoms was higher in the group of patients with artificial nutrition, although without reaching statistical significance [Oral: 28 (20.25) months; SON: 30 (16.75-48.25) months; PEG: 39 (27-52) months; P=.90]. ConclusionsPatients with ALS present a severe deterioration in nutritional status before the start of nutritional support. After the nutritional intervention, a slowdown in weight loss and nutritional deterioration was observed.

FC 080VARIABILITY IN SERUM PHOSPHATE ASSESSED BY DIRECTIONAL CHANGE IS ASSOCIATED WITH INCREASED MORTALITY

Abstract Background and Aims Prior studies showed that there is a wide variability between serial pre-dialysis measurements of serum phosphate (P). Serum P vary can be due to changes in nutritional intake, underlying bone disorders, medication use or inflammation. Various variability markers have been investigated to study the association between P variability and its association with outcomes, however, the directional trends have not been studied in depth. We aimed to study directional changes and investigated its association with outcomes. Method All adult incident HD patients treated in Fresenius Medical Care North America (FMCNA) clinics between 01/2010 and 10/2018 were included in this retrospective cohort study. Serum P levels were averaged from month 1 to 6 after the initiation of dialysis (baseline). Baseline absolute and directional range (DR) of serum P were calculated. DR of P was calculated as: P min/max (t2) – P max/min (t1), with P (t1) and P (t2) represents the timepoint when either the min P value or max P value was measured, whichever comes first, and with t2 happened after t1. It is positive when the minimum antedates the maximum, otherwise negative. All-cause mortality was recorded between months 7 and 18. Cox proportional hazards models with spline terms were applied to explore the association between absolute and DR of P and all-cause mortality. Additionally, tensor product smoothing splines were computed to study the interactions of P with absolute P and DR of P and their joint associations with outcomes, respectably. Results We studied 353,142 patients. The average age was 62.7 years, 58% were male, 64% were diabetic. Baseline P was 4.98 mg/dL, median absolute range was 2.40 mg/dL, median DR was 1.1 mg/dL. Across different levels of P, both higher levels of absolute range and DR of P were associated with higher risk of mortality (Figure 1, Figure 2). The associations even seemed stronger in patients with lower levels of serum P and with negative DR (Figure 1). Conclusion Lower levels of serum P are independently associated with an increased risk of all-cause mortality. Whereas both a positive and negative DR of P are in general associated with increased mortality, the effects of an increase are most predominant in patients with higher levels of serum P, whereas a negative directional range are most predominant in patients with low serum P. This could be explained by the fact that patients with lower levels of P are generally malnourished or inflamed, where a further reduction indicates nutritional deterioration.

Frailty and Sarcopenia in Acute-on-Chronic Liver Failure.

In patients with cirrhosis, sarcopenia is a critical reduction in skeletal muscle mass and frailty represents a status of global physical dysfunction caused by under nutrition, muscle wasting, and functional impairment. Both are prevalent conditions in liver transplant candidates and have shown to be independent predictors of adverse outcome. Evidence supports their incorporation into clinical practice both as a prognostic factor guiding clinical decision making and as a tool to identify candidates for physical and nutritional interventions. The wide heterogeneity of instruments used for sarcopenia and frailty measurement, the absence of a single suitable instrument for sarcopenia and frailty assessment in the outpatient versus inpatient acute‐on‐chronic clinical scenario, and the lack of strong evidence showing a beneficial effect of sarcopenia and frailty improvement on outcomes before and after transplantation are some of the questions that remain unanswered.

Current Nutritional Support in Critical Ill Covid-19 Patients: A Brief Review

Covid-19 is a high prevalence of pneumonia of pathless cause in that started in 2019 in Wuhan, Hubei Province, China. Five to 10% of the coronavirus SARSCoV- 2-infected patients, i.e., with new coronavirus disease 2019 (COVID-19), are presenting with an Acute Respiratory Distress Syndrome (ARDS) requiring urgent respiratory and hemodynamic support in the Intensive Care Unit (ICU). However, nutrition is an important element of care. The nutritional assessment and the early nutritional care management of COVID-19 patients must be integrated into the overall therapeutic strategy. Absence of treatment for this new virus, finding alternative methods to prevent and control the disease is important. Having a well-functioning immune system is essential for the host’s defense against pathogenic organisms. Malnutrition can lead to an impaired immune system during life. Even though the immune system response to infection is itself a factor that could lead to nutritional status impairment. Deficiency of some nutrients can lead to disorders of immune system. Adequate intake of vitamins (A, D, Bs, C and E), minerals (selenium, zinc and iron) and omega-3 fatty acids are among the essential factors in proper immune system function and the international recommendations on nutrition in the ICU should be followed. Some specific issues about the nutrition of the COVID-19 patients in the ICU should be emphasized. We propose a flow chart and ten key issues for optimizing the nutrition management of COVID-19 patients in the ICU.

Evaluation of serum levels of copper and selenium in Helicobacter pylori positive and negative gastritis patients

Helicobacter pylori (H. pylori) infection can result in various complications, included micronutrient variations, nutritional impairment, gastric tissue damages and oxidative stress. The present study aimed to evaluate serum variations of Cu and Se in H. pylori infected individuals. A prospective case-control study was performed on 69 participants with abdominal pains (40 patients with H. pylori gastritis versus 29 control group). Serum levels of Cu and Se were measured using Atomic Absorption Spectrophotometer. Statistical analysis was performed using SPSS software. Comparisons of elements between included groups were done using independent sample t-test. Subgroup analysis between male and female (with or without H. pylori) was performed using one way analysis of variance. Correlation between serum Cu and Se was assessed using Pearson’s correlation test. The p-value levels less than 0.05 were considered as significant. There were no significant differences in serum levels of Cu and Se between H. pylori positive and negative persons. In male with H. pylori, Se levels were 38.4% higher than control male (p-value=0.03). A positive and significant correlation was observed between serum Cu and Se levels (r = 0.51, P-value = 0.024). Although no statistic difference was observed in serum Cu and Se levels, the significant correlation between measured elements represents as good evidence for some discrepancies. Given the importance of well controlled micronutrients in whole body health, especially in high-risk H. pylori patients, more studies are needed to clarify the exact relation of these and other trace elements with H. pylori outcomes.

The Diagnosis of Cystic Fibrosis in Adult Age. Data from the Italian Registry.

Cystic Fibrosis (CF) registries are an essential resource of epidemiological and clinical data. Although the median age at diagnosis is usually reported in the first months of life, a minority of individuals is diagnosed during adulthood. The aim of this study was to describe demographic, genetic, and clinical characteristics of this subgroup of the Italian CF population by using data from the Italian CF Registry (ICFR). Patients ≥18 years at diagnosis were selected and clinical data at diagnosis were analyzed from the 2012–2018 ICFR data (Cohort A). Subjects with diagnosis ≥18 years were selected from 2018 ICFR dataset (Cohort B) to describe their clinical status. In 2012–18 the incidence of late diagnosis was 18.2%, whereas, in 2018, the prevalence of patients diagnosed ≥18 years was 12.54%. The median age of late diagnosis was 36.2 years, ranging from 19.0 to 68.3. The male patients were diagnosed because of infertility in the 45.9% of cases. Median sweat chloride value (SCL) was 69 mmol/L (range 9–150). F508del mutation accounted for 28.3% of alleles. A wide variability in respiratory function was present with a median percent predicted Forced Expiratory Volume in the first second (ppFEV1) of 90.8% (range 20–147%). Low prevalence of pancreatic insufficiency (25%) and of Pseudomonas aeruginosa (Pa) infection (17%) suggest a mild CF phenotype in the majority of patients. The assessment of the clinical status in the 2018 dataset and the comparison between genders showed a greater nutritional and respiratory impairment in females. Further studies are needed to clarify the importance of a true diagnostic delay or of late onset of CF symptoms.

Hospital-acquired malnutrition in paediatric patients: a multicentre trial focusing on prevalence, risk factors, and impact on clinical outcomes.

Alteration of nutrient metabolism during hospital stay may cause a deterioration in patients' nutritional status. The aim of this study was to determine the prevalence and possible risk factors for nutritional deterioration in hospitalized children. A multicentre prospective study was conducted among the patients aged 1 month to 18 years in tertiary-care hospitals, between December 2018 and May 2019. Demographic data, illness, and nutritional assessment on the first and the last day of admission were collected. There were 623 patients enrolled in this study with the median age of 4.3 years. Two thirds of the patients had at least one underlying disease. Eighty-eight percent of the patients were admitted with mild medical conditions including a scheduled cycle of chemotherapy or immunosuppressive drugs, minor infection, and non-invasive procedures. The prevalence of nutritional deterioration (reduction in body mass index ≥ 0.25 Z-score) was 24% and was associated with a significantly higher rate of nosocomial infection (24% vs. 11%, p < 0.001) compared to patients without hospital-acquired malnutrition. Risk factors included moderate to severe medical conditions (AOR 1.90, 95% CI 1.09-3.31, p = 0.024), pneumonia (AOR 1.85, 95% CI 1.05-3.28, p = 0.034), seizure (AOR 2.82, 95% CI 1.28-6.19, p = 0.01), and surgery (AOR 2.98, 95% CI 1.60-5.56, p = 0.001). Nutritional management showed a significant reduction in the incidence of hospital-acquired malnutrition and a trend towards a 60% decrease in infectious complications in patients with moderate to severe medical conditions.Conclusions: Approximately one fourth of paediatric patients developed malnutrition during hospitalization. Nutritional screening, assessment, and treatment should be implemented to improve the outcomes of hospitalized paediatric patients. What is Known: • Malnutrition at admission has a negative impact on outcomes of patients, including prolonged hospitalization, increased costs of care, and a higher rate of nosocomial infection. What is New: • Hospital-acquired malnutrition can occur regardless of prior nutritional status and is predominantly related to illness severity. • Malnourished patients with nutritional intervention experience an improvement in their nutritional status as well as a lower risk of developing hospital morbidity during hospitalization.

Comparison of longterm exocrine and endocrine function following duct to mucosa versus dunking pancreaticojejunostomy in pancreaticoduodenectomy

Aim: Though survival following Pancreaticoduodenectomy (PD) has improved, long term impairment of exocrine and endocrine function remains problematic. This study aims at evaluating any difference in long term pancreatic function between those who underwent Duct to Mucosa Vs. Dunking PJ (pancreaticojejunostomy) following PD. Methodology: Patients who underwent PD between the year 2010-18 and were disease free on follow up were evaluated. Patients with chronic pancreatitis were excluded. All survivors beyond 18 months were evaluated for their pancreatic exocrine (Fecal Elastase-1) and endocrine (FBS/PPBS; HbA1c) function as per the Departmental protocol. The risk of developing nutritional impairment was assessed using the Mini Nutritional Assessment (MNA®) tool and by Serum albumin and Hemoglobin. Results: 136 patients satisfied the inclusion criteria. 30 day mortality was 5, 26 had expired and 53 were lost to follow up. Of the remaining 52 who were evaluated, 32 had dunking PJ, 20 had duct to mucosa PJ. Exocrine insufficiency was present in 29/32(90.6%) of dunking PJ and 17/20(85%) of duct to mucosa PJ (P = 0.24). 11(34.4%) & 4 (20%) had endocrine insufficiency in dunking and duct to mucosa groups respectively (P=0.21). Endocrine insufficiency was significantly higher in adjuvant chemoradiotherapy group (P=0.04). The relative risk of developing nutritional impairment in presence of severe pancreatic exocrine insufficiency was 2.68. Conclusion: Exocrine and Endocrine dysfunction post PD can occur irrespective of the type of pancreatic anastomosis and is comparable between the two groups. There appears to be a significant risk of nutritional impairment post PD.

3P Association between inflammation index and nutritional status and the effectiveness of immunotherapy in NSCLC treatment

Immunotherapy is an important therapeutic strategy for NSCLC, but only about 20% of patients had benefit. To identify predictive markers is crucial for a proper patient selection. Few trials assessed the correlation between nutritional/inflammation status and the effectiveness of immunotherapy. A retrospective trial included patients (pts) with metastatic lung adenocarcinoma treated with immunotherapy from June 2017 to October 2019. We evaluated the following parameters: body mass index, weight loss, body composition by BIVA and computed tomography (CT) at L3-L4, C-reactive protein (CRP), albumin, hemoglobin, absolute lymphocytes count, patient performance status (PS), anorexia and quality of life (by miniCASCO questionnaire). Clinical response (CR) according iRECIST criteria, overall survival and progression-free survival (PFS) were assessed. All pts were evaluated every 4-6 months. We included 18 patients. CR significantly correlated with CRP (r = 0.4943; CI95% 0.05164-0.7746; p=0.0315) and muscle mass index (MMI) calculated by CT at baseline (r = 0.4955; CI95% 0.05328- 0.7752; p=0.031). We also found a significant correlation between PFS and CRP (r = -0.7304; CI95% -0, 8928 to -0.3999; p = 0.0006), MMI (r = 0.8229; CI95% 0.2119-0.6623; p = 0.0255) and PS at baseline ( r = -0.5101; CI95% -0.7890 to -0.05667; p = 0.0306). OS correlated significantly with baseline CRP (r = -0.6637; CI95% -0.8631 to -0.2851; p = 0.0027) and MMI at CT (r = 0.584; CI95% -0.2370-0.6472; p = 0.0304). At multivariate analysis CRP was an independent predictive factor of CR (p = 0.0213), PFS (p = 0.0006) and OS (p = 0.0027). The miniCASCO correlated positively with PS (r = 0.567; p = 0.036) and negatively with CR (r = -0.438; p = 0.010). Moreover, pts with partial response and stable disease had a significant decrease of CRP and a significant increase of MMI and hemoglobin compared to pts with progressive disease. Our results showed, even in a limited sample size, the negative correlation of inflammation and poor nutritional status with CR in NSCLC pts treated with immunotherapy. Blocking inflammation and the related nutritional impairment may be crucial in improving efficacy of immunotherapy in advanced lung cancer pts.

Simposio 15: Diabetes en la fibrosis quística

Simposio 15: Otras afecciones y diabetesDiabetes en la fibrosis quísticaLa fibrosis quística es un desorden autosómico recesivo muy frecuente caracterizada por la función severamente alterada o ausente del CFTR (canal regulador transmembrana de transporte de cloro y bicarbonato). Con los avances en el cuidado nutricional y pulmonar, y la prolongación de la supervivencia hasta la adultez, la CFRD ha emergido como una comorbilidad común principalmente en los sujetos con insuficiencia pancreática. La CFRD es el estadio final de un espectro lento y progresivo de alteraciones en el metabolismo hidrocarbonado que se caracteriza por una insulinopenia temprana, que produce un deterioro nutricional y declinación pulmonar.Durante décadas los equipos de atención de pacientes con fibrosis quística hemos diagnosticado CFRD a través de la PTOG con puntos de corte para complicaciones microvasculares (como en DM1 y DM2). Por ser el pulmón el órgano principalmente en riesgo en CF, tal vez debería definirse la CFRD por el nivel de glucemia en el que se desarrolla la pulmonopatía. Es probable que la insulinopenia con el catabolismo consecuente juegue un rol fundamental en el deterioro pulmonar y que la hiperglucemia postprandial temprana (altos niveles glucémicos en puntos intermedios pero normales a las 2 h) pueda usarse como indicador de la necesidad de indicar insulinoterapia de precisión.

Rodeando al enemigo: Colectomía derecha laparoscópica por enfermedad de Crohn estenosante y fistulizante.

Nicolás Avellaneda (1) (ORCID 0000-0002-6802-7125), Augusto Carrie (1) (ORCID 0000-0003-4226-7240), Federico Veracierto (1) (ORCID 0000-0003-3363-8935).&#x0D; &#x0D; Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC). Galván 4102, C1431 CABA, Argentina.&#x0D; &#x0D; &#x0D; &#x0D; Introducción.&#x0D; &#x0D; &#x0D; La enfermedad de Crohn presenta una incidencia aumenta en los últimos años en los países industrializados, y la afectación ileocecal es la mas frecuente en esta patología.&#x0D; En una primera instancia los pacientes puede recibir tratamiento médico, pero un porcentaje significativo de estos pueden evolucionar hacia complicaciones de la enfermedad como estenosis o fístulas. Cuando estas se presentan, deben ser tratadas quirúrgicamente, representando un desafío para el equipo quirúrgico porque se trata de pacientes en mal estado general y con gran compromiso inflamatorio a nivel abdominal que dificulta la correcta identificación de los planos anatómicos.&#x0D; &#x0D; 2) Descripción.&#x0D; Se presenta el caso de un paciente de 84 años que ingresa por guardia en nuestra institución por presentar diagnóstico de enfermedad de Crohn de 10 años de evolución, mal estado general y deterioro nutricional severo. Al examen físico se palpa tumor a nivel de flanco derecho y fosa ilíaca derecha.&#x0D; Entero-RMN: Ileon terminal con fístula hacia colon derecho y transverso y cavidad intermedia con colección de 3 cm.&#x0D; Laboratorio: Glóbulos blancos: 12.000x10-9/L, Albúmina: 1,3 gr/dl.&#x0D; Se decide internar al paciente, se instaura tratamiento antibiótico, medidas de sostén y nutrición parenteral total.&#x0D; A las 3 semanas, el paciente presenta mejora en los parámetros nutricionales y en el estado general, por lo cual se programa tratamiento quirúrgico de la patología.&#x0D; Se realiza una laparoscopía exploradora donde se evidencia gran tumor inflamatorio que involucra ileon terminal, colon derecho y transverso. Se logra logra la movilización completa de las estructuras mencionadas, las cuales se exteriorizan por una mini laparotomía mediana supraumbilical, y se hace la resección en bloc del tumor inflamatorio, confeccionando una ileostomía terminal y abocando el colon transverso en tejido celular subcutáneo.&#x0D; Paciente presenta buena evolución postoperatoria, recibiendo el alta senatorial al séptimo día postoperatorio sin complicaciones.&#x0D; &#x0D; 3) Conclusiones.&#x0D; &#x0D; El tratamiento quirúrgico de la enfermedad de Crohn representa un desafío para el cirujano. Realizado por vía laparoscópica y luego de optimizar al paciente desde el punto de vista clínico y nutricional, se pueden obtener buenos resultados postoperatorios.

Rodeando al enemigo: colectomía derecha laparoscópica por enfermedad de Crohn estenosante y fistulizante

1) Introduction. Crohn's disease has an increasing incidence in recent years in industrialized countries, and ileocecal involvement is the most frequent in this pathology. Firstly, patients can receive medical treatment, but many of them can present complications of the disease such as stenosis or fistulas. When these appear, they must be treated surgically, representing a challenge for the surgical team because this are patients in poor general condition and with a large abdominal inflammatory compromise that makes it difficult to correctly identify the anatomical planes. 2) Description. We present the case of an 84-year-old patient who is admitted to our institution in Emergency Service for presenting a diagnosis of Crohn's disease of 10 years of evolution, poor general condition and severe nutritional deterioration. Physical examination revealed a palpable tumor at the level of the right flank and right iliac fossa. Entero-MRI: Terminal ileum with fistula towards the right and transverse colon and intermediate cavity with a 3 cm collection. Laboratory: White blood cells: 12,000x10-9 / L, Albumin: 1.3 gr / dl. Decission is made to admit the patient, antibiotic treatment, support measures and total parenteral nutrition were instituted. At 3 weeks, the patient shows improvement in nutritional parameters and general condition, for which surgical treatment of the pathology is scheduled. An exploratory laparoscopy is performed where a large inflammatory tumor involving the terminal ileum, right and transverse colon is evidenced. Complete mobilization of the aforementioned structures is achieved, which are externalized by a supraumbilical median mini laparotomy, and enbloc resection of the inflammatory tumor is made, performing a terminal ileostomy and leaving the transverse colon in subcutaneous cellular tissue. Patient presented good postoperative evolution, receiving sanatorial discharge on the seventh postoperative day without complications. 3) Conclusions. Surgical treatment of Crohn's disease represents a challenge for the surgeon. Performed laparoscopically and after optimizing the patient from a clinical and nutritional point of view, good postoperative results can be obtained.

Infections and nutritional status of internationally adopted children in France.

In the context of global changes in the epidemiology of internationally adopted children (IACs), the prevalence of infectious diseases and nutritional impairment has not been recently reviewed. Moreover, in France, these characteristics of the children according to their continents of origin and preadoption special needs (SN) status have been incompletely explored. Demographic, infectious data and anthropometric of all the newly arrived IACs seen in a specialised clinic for international adoptees in Paris, France, between 2013 and 2016 were retrospectively reviewed. Three hundred and fifty IACs [mean age: 3.4years (±2.7), 204 male] from 39 countries were included; 55% had SN. Ninety-nine patients had at least one infection, 42% being classified as 'serious' (chronic viral infection, tuberculosis or malaria). Chronic viral infection was diagnosed in 26 (7%) patients (HIV: 16 cases, HBV: 5, HCV: 4) and affected especially Asian children (P<.001). The prevalence of stunting, underweight, wasting and microcephaly was, respectively, 25%, 22%, 15% and 8%. Stunting was more frequent in children from Eastern Europe (P=.02), while SN children were more often microcephalic or underweight (respectively P=.03 and .02). The prevalence of serious infections and nutritional impairment remains high in IACs and requires early detection and careful follow-up.

Body Fat in Children with Chronic Kidney Disease - A Comparative Study of Bio-impedance Analysis with Dual Energy X-ray Absorptiometry.

Introduction:Nutritional impairment in patients with chronic kidney disease (CKD) is due to decreased body stores of both protein and fat. We need a tool that can be used in clinics to determine and monitor fat composition with a special focus on normalizing fat measurements to height in these children. Bio-impedance analysis (BIA), a portable and simple tool, has been used to estimate body fat in children with CKD but needs validation against the reference tool dual energy X-ray absorptiometry (DXA). The purpose of the cross-sectional study was to estimate the prevalence of low body fat in children with stages 2-5 CKD (non-dialysis) and CKD 5D (dialysis), and to compare fat measures from two different methods namely BIA and DXA.Method:Children in stages 2–5 CKD (n = 19) and in CKD 5D (n = 14) were recruited for assessment of fat mass (FM, Kg) by BIA and DXA, from which percent body fat (BF %) and fat mass index (FMI, Kg/M2) were obtained. Low body fat was defined as <5th age and gender centile for BF% or FMI by DXA and BF% by BIA.Results:Low body fat was detected equally using BF% and FMI in 18% of children by DXA while only 12% were detected using BF% by BIA. In children with CKD2–5, a good degree of reliability was found with FMI measurements (ICC 0.76 CI [0.48,0.9]) and poor reliability in children with CKD 5D (ICC 0.58 CI [0.1,0.84]). BF% had poor to fair reliability in the children with CKD 2-5 and CKD 5D (ICC 0.64 [0.28,0.84] and 0.53 [0.02,0.82]), respectively. Comparing BF% and FMI obtained by BIA and DEXA, BIA overestimated BF% by 3.5% in comparison to DXA.Conclusion: In children with CKD, body fat is preserved in the majority. Among the two measures of fat, BF% estimated by BIA did not compare well with DXA while FMI measure was comparable with a lower bias. However, due to lack of reference values in Indian children for FMI obtained by BIA, BIA cannot be used to measure fat in this population.

Effects of supplementary feeding level on digestion and energy utilization by sheep and goats grazing arid-area rangelands

An experiment was implemented to examine differences between sheep and goats in the utilization of open arid-area rangelands when provided with different concentrate supplement levels. Fifty-two non-lactating females (Abu-duleik sheep, n = 26 and Balady goats, n = 26) were employed in a 90-day experimental period. Animals of each species were allocated randomly into two treatments, according to a 2 × 2 factorial arrangement, with animal species (goats and sheep) and concentrate level (low and high) as main factors. They were grazing widely over the arid-area rangelands with a limited amount of a concentrate supplement, low (1 % BW) or high (2 % BW) (DM basis). Total energy expenditure was estimated by heart rate (HR) monitors for 48 h after its calibration by oxygen consumption with a face mask open-circuit respiratory system. However, the significant interaction between animal species and concentrate levels of supplement indicated that increasing the concentrate level had a negative effect (P < 0.05) on forage intake (22.8 vs. 17.0 ± 1.58 g/ kg BW, for goats supplemented with low or high concentrate level, respectively) and digestibility by grazing goats. The reduction in goat’s digestibility was mainly attributed to the reduction (P < 0.01) in fiber fraction digestibility (546 vs. 441 ± 24.0 g/ kg dry matter intake, respectively). The contrary was observed in sheep in which the greatest forage consumption and digestibility were observed in grazing sheep supplemented with a high concentrate level, including the fiber fraction digestibility. Total energy expenditure was similar between sheep and goats when supplemented with a low concentrate level (600 and 574 ± 24.6 kJ/ kgBW0.75, respectively), while it was significantly (P < 0.01) greater for sheep than for goats when supplemented with a high level (776 vs. 577 ± 24.6 kJ/ kg BW0.75, respectively). This was reflected in the energy balance (EB) that was negative and similar in sheep and goats at a low supplementation level (−55.2 and −64.3 ± 14.27 kJ/ kg BW0.75, respectively, while sheep reported positive (P < 0.05) and greater EB than that of goats with a high level (71.5 vs. 2.7 ± 14.27 kJ/ kg BW0.75, respectively). In conclusion, concentrate supplement is necessary to maintain animals without nutritional deterioration while grazing in the open arid-area rangelands, however, its effects on the ability to utilize a low quality forage differed between sheep and goats at a high supplementation level.

Early versus conventional nutritional intervention in head and neck cancer patients before radiotherapy: benefits of a fast-track circuit.

Radiotherapy (RT) is a component of therapy for head and neck cancer (HNC) with a negative nutritional impact. Our aim was to compare an early versus a conventional nutritional intervention. Retrospective study of HNC patients undergoing RT. Evolution before and after the establishment of a fast-track circuit was evaluated. A conventional group (CG) made up of patients submitted to the nutrition unit during RT after nutritional deterioration, was compared to an early group (EG) represented by patients included in a fast-track circuit, starting nutritional follow-up before the beginning of RT. Only patients with preserved oral intake were involved. Demographic, nutritional and clinical variables were analyzed. Data of hospitalizations and deaths were collected up to three months after RT. 135 subjects constituted the EG and 39 the CG. At baseline, the prevalence of malnutrition was lower in the EG (31.9% vs 69.5%, p = 0.0001), as was the need for nutritional supplements (40% vs 79.5%, p = 0.0001) or nasogastric tube (0% vs 12.8%, p = 0.0001) in comparison to the CG. Three months after RT, there were less patients with oral nutritional support in the EG (79.1% vs 96.9%, p = 0.018), and the number of emergency visits (0.75 vs 1.1 episodes per patient, p = 0.021) and hospitalizations was also lower in this group (29% vs 59%, p = 0.044). The fast-track approach made early intervention possible. Therefore, patients maintained a better nutritional status, needed less nutritional support and their evolution improved, with a significant decrease in hospitalizations.

Prognostic value of nutritional impairment on treatment-related toxicity and survival in patients with nasopharyngeal carcinoma taking normal nutrition before radiotherapy.

To investigate nutritional impairment during intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC) taking normal nutrition before IMRT and its effect on treatment-related toxicities (TRTs) and survival. Modified nutrition index (m-NI) of 187 patients with NPC, comprised eight indicators (body mass index, circumference of upper arm muscles, total lymphocyte count, red blood cell count, levels of albumin, pre-albumin, transferrin, and hemoglobin), were evaluated before/after IMRT. Patient characteristics, m-NI, and the follow-up data for survival and TRTs were analyzed. The m-NI scores of patients with NPC decreased significantly after IMRT. Severe nutritional impairment (SNI; decrease in m-NI score ≥50%) was an independent prognostic factor for overall survival (OS) and an independent risk factor for grade ≥2 oral mucositis. Classification T4 disease and smoking were SNI risk factors. SNI during IMRT is a risk factor for oral mucositis and a prognostic factor for worse OS in patients with NPC.

Weight Loss as a Nutritional Indicator in Head and Neck Cancer Patients Undergoing Chemoradiotherapy: Contributing Factors and Its Impact on Disease Outcome

This is a retrospective study carried out at a tertiary care cancer center to assess weight loss in patients of head and neck cancers (HNCs) during treatment with chemoradiotherapy (CRT) and study various factors affecting it. Treatment and follow-up records of 77 patients of HNCs were studied and assessed for demographic, disease-specific variables, treatment parameters, weight loss during CRT, as well as survival at 2 years after treatment completion. A statistical analysis was conducted to assess the association of study variables with weight loss. It was also assessed if a correlation existed between weight loss during treatment and patient survival at 2 years. Of the study patients, 62.3% (48) suffered 5% or more weight loss during CRT while 23.4% (18) suffered a weight loss of 10% or more. No particular factor was identified having a statistically significant association with weight loss. Nutritional impairment is an important factor affecting the morbidity and possibly the mortality of patients of HNCs undergoing CRT. More robust studies are required to identify which factors affect weight loss during treatment and whether weight loss can be used as a parameter to prognosticate patients.

Prevalence of nutritional disorders in Saudi children with inflammatory bowel disease based on the national growth reference

Background and study aimThe prevalence of nutritional disorders in Saudi children with inflammatory bowel diseases (IBDs) has been reported using the World Health Organization (WHO) reference. Our aim was to provide more accurate definition of the prevalence of nutritional impairment in Saudi children with IBDs based on the national growth reference and to demonstrate the effect of using a reference from other populations on the prevalence rates. Patients and MethodsWeight, height, and body mass index data, from the multicenter study of IBDs in Saudi children and adolescents, were plotted on the new Saudi national growth reference. Statistical analyses included frequency calculations and z-test for proportions to investigate the significance of the difference in prevalence. A p-value of < 0.05 was considered significant. ResultsAmong a total of 374 patients, 119 (32%) had ulcerative colitis (UC) and 255 (68%) had Crohn’s disease (CD). Compared with the WHO reference, the Saudi national reference produced a significantly lower prevalence of thinness in patients with UC (24% vs. 8%, p = 0.001), CD (35% vs. 20%, p = 0.002), and of short stature in patients with CD (28% vs. 11%, p < 0.001). The difference in the prevalence of overweight was not significant. ConclusionsWe provide more accurate prevalence estimate of nutritional disorders in Saudi children with IBDs based on national reference. The use of the WHO reference overestimated the prevalence of thinness and short stature in Saudi children. Prevalence estimates based on references from other populations should be interpreted with caution.