Nutritional Parameters In Patients Research Articles

Association of frailty with nutritional parameters in patients with chronic kidney disease

Objectives: Frailty is a significant clinical syndrome characterized by greater susceptibility to stressors due to the dysfunction of multiple organ systems, which increases in prevalence with age. This study was performed to investigate relations between frailty and nutritional parameters in patients with chronic kidney disease (CKD). Methods: This cross-sectional study involved 100 CKD patients aged 50 years or older. Frailty was assessed using the Edmonton Frailty Scale (EFS) and Fried’s Frailty Scale (FFS). The patients nutritional status was assessed using the Mini Nutritional Assessment (MNA) and the routine laboratory tests. Results: The study included 100 patients, consisting of 41 females and 59 males. The mean age of the participants was 65.3±9.3 years. The median glomerular filtration rate (GFR) of the patients was 23 mL/min/1.73 m2) (min: 3-max: 65). According to the MNA, 15 patients had normal nutritional status, 63 were at risk of malnutrition, and 22 were malnourished. According to the EFS score, four patients were categorized as not frail, 11 as vulnerable, 25 with mild frailty, 21 with moderate frailty, and 39 with severe frailty. According to the FFS score, six patients were non-frail, 30 were classified as pre-frail, and 64 were considered frail. Conclusions: Frailty and malnutrition in patients with CKD were independently related to all other factors examined in this study. Screening for malnutrition at the early stages in patients with CKD and the appropriate treatment may prevent the development of frailty.

Variation in nutritional parameters in patients who underwent total pancreatectomy of the remnant pancreas

Variation in nutritional parameters in patients who underwent total pancreatectomy of the remnant pancreas

Deleterious effects of intradialytic meals' suppression during the COVID pandemic

Patients with end-stage renal failure on chronic hemodialysis present an important risk of malnutrition, which is associated with a significant risk of morbidity and mortality. Meals during the dialysis session are important for maintaining the nutritional status of dialysis patients but represent a risk for intradialytic hypotension. During the COVID-19 pandemic, several dialysis centers stopped providing meals during the dialysis session as a protective measure. The aim of this retrospective, multicentric cross-over study was to study the evolution of the nutritional parameters of a cohort of hemodialysis patients for 12 months before, during and after the suspension of meals during dialysis due to the COVID-19 pandemics. We registered the evolution of dry weight, C Reactive Protein (CRP), serum Potassium and Phosphate before the dialysis session, serum albumin and prealbumin levels as well as normalized Protein Catabolic Ratio (nPCR). We studied 168 hemodialysis patients (113M, 55F, mean age at inclusion:68.45±0.45 years). The results ares shown as mean values (±SEM). The supression of the intradialytic meals led to significant reduction of the patients' dry weight (in Kg) from 78.66±0.72 to 76.50±0.49, p=0.013, serum albumin (in g/l) (from 40.72±0.16 to 39.25±0.12, p<0.001) and prealbumin levels (in g/l) (from 33.82±0.31 to 32.73±0.22, p=0.004) as well as the nPCR values (from 1.08±0.08 to 1.05±0.11, p=0.021). Serum CRP as well as predialytic Potassium and Phosphate levels did not change significantly. The reinstitution of the intradialytic meals led to a complete correction of the studied nutritional parameters with Body weight values evolving from 76.50±0.49 to 78.28±1.01, p=0.025, serum albumin from 39.25±0.12 to 40.53±1.04, p<0.001, serum prealbumin levels from 32.73±0.22 to 33.95±0.64, p=0.001 an nPCR from 1.05±0.11 to 1.08±0.08, p=0.021. In conclusion, the suppression of intradialytic meals during the COVID-19 pandemic had deleterious effects on the nutritional parameters of patients on chronic hemodialysis.

Assessment of Nutritional Status by Bioelectrical Impedance in Adult Patients with Celiac Disease: A Prospective Single-Center Study.

The gluten-free diet [GFD] has been linked to an increased risk of weight gain and the development of metabolic disorders. Most of the studies have focused on the effect of GFD on the Body Mass Index [BMI]. We aimed to evaluate the nutritional status using specific nutritional parameters in patients with celiac disease [CeD] at diagnosis and on a GFD compared to healthy controls. We recruited subjects at our outpatient clinic at the University of Padua. We collected demographic and clinical data and values obtained with bioelectrical impedance analysis. A total of 24 CeD patients and 28 healthy controls were enrolled. CeD patients at diagnosis had a lower body cell mass index [BCMI, p = 0.006], fat-free mass index [FFMI, p = 0.02], appendicular skeletal muscle index [ASMI, p = 0.02], and phase angle [PA] [p < 0.001] compared to controls. Their percentage of extracellular water [ECW] was also higher [p < 0.001]. Considering CeD patients after GFD, nutritional status significantly improved after 6 months of GFD. We did not observe differences in BMI among groups [p = ns]. CeD patients at diagnosis were found to have a poorer nutritional status than healthy controls, with a positive effect of the GFD on their nutritional status, underlining the inefficacy of evaluating this aspect through only BMI evaluation.

Correlation of Serum Asprosin Levels With Normalized Protein Catabolic Rate in Patients Receiving Peritoneal Dialysis Treatment.

Background Peritoneal dialysis patients are malnourished due to loss of protein in the dialysate and inadequate dialysis, although they take additional calories every day during treatment. Many parameters are used to assess nutritional status, with normalized protein catabolic rate (nPCR) being one of the most common. Asprosin, a novel adipokine secreted by adipose tissue, peaks during fasting and induces hepatic glucose release through the activation of the G-protein-cAMP-PKA pathway, which has been indicated to have a curative effect on chronic inflammation. In this study, we aimed to investigate the relationship between asprosin levels and nutritional parameters in patients receiving peritoneal dialysis treatment as well as to investigate the applicability of more practical tests. Methodology A total of 70 peritoneal dialysis patients, 35 female (59%) and 24 male (41%), were included in the study. The mean age of the patients was 53 ± 14 years (range = 18-80 years), and the median peritoneal dialysis duration was 31.5 months (range = 20-56.2 months). The most common etiologic cause was hypertension(37%). Patients over 18 years of age who had been receiving peritoneal dialysis treatment for at least 24 months were included in the study. The correlation between patients' nPCR levels and serum asprosin, body mass index, and lipids was evaluated. Results The correlation between the level of nPCR and the serum asprosin level, body mass index, and lipids was evaluated. Patients with nPCR <0.815 were considered malnourished, and factors affecting malnutrition were determined by univariate analysis. Among the factors affecting malnutrition according to univariate analysis, those with p-value <0.05 were analyzed by multivariate analysis. Low asprosin level was one of the independent factors affecting malnutrition in patients (Exp(B) = 0.944, 95% confidence interval (CI) = 0.896-0.994). Other independent factors affecting malnutrition were Kt/V (Exp(B) = 0.018, 95% CI = 0.001-0.550) and residual renal function (Exp(B) = -0.004, 95% CI = 0.993-0.999). Conclusions There is a need for more accessible tests and reliable parameters to evaluate dialysis and nutritional deficiency in peritoneal dialysis patients. One possible hormone that could serve as a guide is asprosin.

Associations between insulin-like growth factor-1 standard deviation score and overall nutritional parameters in patients with maintenance hemodialysis: a cross-sectional study.

This study investigated the association between insulin-like growth factor-1 and nutritional status indicators in patients undergoing maintenance hemodialysis (MHD). Patients undergoing MHD for > 3months were included in this single-center cross-sectional study in March 2021. Clinical, demographic, and body mass data and blood samples were collected before the hemodialysis sessions. Serum insulin-like growth factor-1 (IGF-1) levels were measured using a radioimmunoassay, and serum IGF-1 standard deviation score (SDS) was calculated for MHD patients according to age and sex. The nutritional status of patients was assessed using serum albumin, serum prealbumin, handgrip strength, pinching strength, upper arm muscle circumference, lean body mass, phase angle, seven-point subjective global assessment (SGA) score, and geriatric nutritional risk index (GNRI). The patients were divided into groups according to tertiles of serum IGF-1 SDS levels. Spearman correlation analyses and univariate and multivariate binary logistic regression analyses were used to determine the association between serum IGF-1 SDS and nutritional status parameters. A total of 155 MHD patients (male: female = 90:65) were enrolled in the study, witha median dialysis vintage of 28.0 (11.0, 55.0)months, and an average age of66 (65.5 ± 13.0)years. The median of IGF-1 SDS was - 0.1 (- 0.6 to 0.6). Compared to patients with higher IGF-1 SDSs, patients with lower IGF-1 SDSs had lower levels of serum ceruloplasmin (341.0 [287.5, 416.0] vs 395.0 [327.0, 451.0] vs 409.0 [349.5, 507.5], p = 0.002), serum albumin (34.7 ± 3.0 vs 37.0 ± 3.1 vs 37.8 ± 2.6, p < 0.001), serum prealbumin (270.3 [233.7, 327.8] vs 326.0 [279.3, 355.6] vs 363.0 [324.2, 398.2], p < 0.001), handgrip strength (13.8 [10.0, 20.7] vs 17.7 [10.7, 22.5] vs 23.3 [16.6, 27.8], p < 0.001), pinch strength (4.6 [3.9, 6.0] vs 4.9 (3.9, 6.9) vs 6.5 [4.7, 8.7], p = 0.002), phase angle (3.3 [3.0, 3.8] vs 3.9 [3.4, 4.7] vs 4.3 [3.6, 5.2, p < 0.001), modified Creatinine Index (83.1 ± 19.7 vs 93.1 ± 23.4 vs 113.9 ± 24.3, p < 0.001), intracellular water (14.5 ± 4.4 vs 16.1 ± 4.9 vs 16.9 ± 4.4, p = 0.031), higher extracellular water (26.9 ± 5.8 vs 25.7 ± 5.5 vs 25.1 ± 3.1, p = 0.042), and higher malnutrition risk as defined by GNRI (49.0% vs 15.7% vs 11.5%, p < 0.001) and SGA (53.9% vs 23.5% vs 7.7%, p < 0.001). Lower IGF-1 SDSs are independently associated with higher malnutrition risk in patients with MHD.

Testosterone Deficiency and Nutritional Parameters as Predictors of All-Cause Mortality among Male Dialysis Patients.

Chronic kidney disease (CKD) is associated with an accelerated risk of cardiovascular mortality. Hormonal and metabolic disorders in CKD may constitute novel risk factors. Our objective was to characterize and evaluate prognostic implications of circulating sex steroids and selected nutritional parameters in patients at different stages of CKD. Studied groups were composed of 78 men: 31 on hemodialysis (HD), 17 on peritoneal dialysis (PD), 30 with CKD stage G3-G4. Total testosterone (TT), dehydroepiandrosterone sulphate (DHEA-S), androstenedione, luteinizing hormone (LH), prolactin (PRL), and biochemical parameters were measured; Free testosterone (FT) was calculated. The lowest TT and FT were observed in HD, the highest- in CKD (p = 0.006 for TT, p = 0.005 for FT). TT positively correlated with total cholesterol in HD (p = 0.012), FT negatively correlated with BMI in CKD (p = 0.023). During the 12 months, 9 patients died (5 in the HD, 4 in the PD group). The deceased group had significantly lower concentrations of albumin (p = 0.006) and prealbumin (p = 0.001), and a significantly higher concentration of androstenedione (p = 0.019) than the surviving group. In the group of men on dialysis, a serum TT concentration &lt;2.55 ng/mL (Q1-first quartile) was associated with a 3.7-fold higher risk of death, although statistical significance was not achieved (p = 0.198). After analysis of the ROC curves, the FT level was the best prognostic marker in HD (AUC = 0.788; 95% CI: 0.581-0.996; p = 0.006) Conclusions: Total and free testosterone levels were lower in the HD group than in the CKD group. The nutritional status undoubtedly affects the survival of dialysis patients but also the concentrations of testosterone significantly contributes to further worsening the prognosis.

Impact of Preoperative Muscle Mass Maintenance and Perioperative Muscle Mass Loss Prevention After Pancreatectomy: Association Between Perioperative Muscle Mass and Postoperative Nutritional Status.

We investigated how preoperative sarcopenia and perioperative muscle mass changes affect postoperative nutritional parameters in patients undergoing pancreatectomy. This study included 164 patients undergoing pancreatectomy between January 2011 and October 2018. Skeletal muscle area was measured by computed tomography before and 6 months after surgery. Sarcopenia was defined as the lowest sex-specific quartile, and patients with muscle mass ratios less than -10% were classified into the high-reduction group. We examined the relationship between perioperative muscle mass and postoperative nutritional parameters 6 months after pancreatectomy. There were no significant differences in nutritional parameters between the sarcopenia and nonsarcopenia groups at 6 months after surgery. In contrast, albumin (P < 0.001), cholinesterase (P < 0.001), and prognostic nutritional index (P < 0.001) were lower in the high-reduction group. According to each surgical procedure, albumin (P < 0.001), cholinesterase (P = 0.007), and prognostic nutritional index (P < 0.001) were lower in the high-reduction group of pancreaticoduodenectomy. In distal pancreatectomy cases, only cholinesterase (P = 0.005) was lower. Postoperative nutritional parameters were correlated with muscle mass ratios but not with preoperative sarcopenia in patients undergoing pancreatectomy. Improvement and maintenance of perioperative muscle mass are important to maintain good nutritional parameters.

MA14.03 Effect of Mirtazapine on Energy Intake in Patients with Anorexia Associated with NSCLC

Anorexia (lack of appetite), is a phenomenon which promotes malnutrition from insufficient food consumption; anorexia represents a widespread issue in patients with lung cancer, driving negative outcomes and hampering survival. Currently there is no standard therapy to improve cancer-related anorexia. This study sought to evaluate the effect of mirtazapine vs. placebo on nutritional parameters in patients with NSCLC diagnosed with anorexia.

Analysis of Selected Nutritional Parameters in Patients with HPV-Related and Non-HPV-Related Oropharyngeal Cancer before and after Radiotherapy Alone or Combined with Chemotherapy.

Simple SummaryThe aim of this study was to assess and compare the nutritional status (NS) of patients with HPV-related (HPV+) and non-HPV-related (HPV-) oropharyngeal cancer (OPC) before and after radiotherapy (RT) or chemoradiotherapy (CRT). The analysis included 127 patients with OPC who underwent radiotherapy (RT) alone, or in combination with chemotherapy (CRT). In both groups, a significant decrease in all analyzed nutritional parameters was noted after RT/CRT. Overall survival (OS) and disease-free survival (DFS) were significantly better in patients with a higher BMI in the HPV- group; DFS was significantly better in patients with total lymphocyte count (TLC) >1.28/mm3 in the HPV+ group. Higher NRS 2002 was an independent adverse prognostic factor for OS and DFS in HPV-, but not in the HPV+ group. Regardless of HPV status, patients with OPC can develop malnutrition during RT/CRT. Therefore, nutritional support during RT/CRT is required in patients with HPV- and HPV+ OPC.Background: Radiotherapy plays an essential role in the treatment of oropharyngeal carcinoma (OPC). The aim of this study was to assess and compare the nutritional status (NS) of patients with HPV-related (HPV+) and non-HPV-related (HPV-) OPC before and after radiotherapy (RT) or chemoradiotherapy (CRT). Methods: The analysis included 127 patients with OPC who underwent radiotherapy (RT) alone, or in combination with chemotherapy (CRT), in the I Radiation and Clinical Oncology Department of Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland. Patients were divided according to HPV status. Confirmation of HPV etiology was obtained from FFPE (formalin-fixed, paraffin-embedded) tissue material and/or extracellular circulating HPV DNA. Basic anthropometric and biochemical parameters before and after RT/CRT were compared between the HPV- and HPV+ groups. The effect of NS on survival was also analyzed. Results: In both groups, a significant decrease in all analyzed nutritional parameters was noted after RT/CRT (p < 0.01). CRT caused significant weight loss and decreases in BMI, albumin, total lymphocyte count (TLC), and hemoglobin concentration, as well as an increase in the Nutritional Risk Score (NRS) 2002, in HPV- and HPV+ patients. A significant decrease in prealbumin levels after CRT was noted only in HPV+ patients. RT caused a significant decrease in hemoglobin concentration and TLC in HPV- patients. There were no significant differences regarding other nutritional parameters after RT in either group. RT did not have negative impact on body mass index (BMI), weight, NRS, CRP, Alb, Prealb, or PNI. Overall survival (OS) and disease-free survival (DFS) were significantly better in patients with a higher BMI in the HPV- group (OS, p = 0.011; DFS, p = 0.028); DFS was significantly better in patients with C-reactive protein (CRP) < 3.5 g/dL in the HPV- (p = 0.021) and HPV+ (p = 0.018) groups, and with total lymphocyte count (TLC) >1.28/mm3 in the HPV+ group (p = 0.014). Higher NRS 2002 was an independent adverse prognostic factor for OS and DFS in HPV-, but not in the HPV+ group. Kaplan–Meier analysis showed that both OS and DFS were significantly better in HPV- patients with lower NRS 2002 scores. However, this relationship was not observed in the HPV+ group. Conclusions: Regardless of HPV status, patients with OPC can develop malnutrition during RT/CRT. Therefore, nutritional support during RT/CRT is required in patients with HPV- and HPV+ OPC.

The Impact of Preoperative Nutritional Status on the Survival of Patients With Esophageal Squamous Cell Carcinoma.

Background: The goal of this study was to investigate the impact of different nutritional parameters in patients with esophageal squamous cell carcinoma (ESCC) who underwent surgical resection.Methods: A total of 620 patients with ESCC who underwent esophagectomy were analyzed. A receiver operating characteristic curve was constructed to set the appropriate cutoff points for five nutritional parameters: serum albumin (SA), body mass index (BMI), geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and a new modified nutritional risk index (mNRI). Survival analyses were performed to calculate overall survival and investigate the independent prognostic factors.Results: The median preoperative BMI, SA, GNRI, PNI, and mNRI values were 20.90, 42.75, 102.95, 51.90, and 63.90, respectively. The corresponding optimal cutoff points were 18.75 for BMI, 43.05 for SA, 98.5 for GNRI, 51.45 for PNI, and 61.45 for mNRI. All nutritional parameters were significantly correlated with tumor length and pT category. Decreased nutritional parameters were significantly correlated with poor survival in univariate analysis; however, only the mNRI was an independent prognostic factor in multivariate analysis (P = 0.041).Conclusions: Nutritional parameters are convenient and valuable prognostic factors in ESCC patients who undergo surgical resection. The new mNRI parameter may be superior to the other nutritional parameters.

Pressure injuries during the SARS-CoV-2 pandemic: A retrospective, case-control study

Aim of studyThe main objective of this study was to ascertain whether severe alterations in hypoxemic, inflammatory, and nutritional parameters in patients diagnosed with SARS-CoV-2 infection were associated with the occurrence and severity of developed dependency-related injuries. The secondary objective was to determine whether there were prognostic factors associated with the occurrence and severity of developed dependency-related injuries during the SARS-CoV-2 pandemic. Material and methodsA retrospective, single-centre, case-control study was conducted to compare SARS-CoV-2 patients who developed dependency-related injuries after the first 48 h after admission with a control group made up of SARS-CoV-2 patients without dependency-related injuries. The cases of the 1987 patients diagnosed with SARS-CoV-2 infection during the study period were reviewed. Data from 94 patients who developed dependency-related injuries and from 190 patients who did not develop them during hospital admission were analysed. ResultsHigh baseline dependency levels, prolonged hospital stays, and low oxygen saturation levels on arrival in emergency department triage were associated with the occurrence of dependency-related injuries among patients diagnosed with SARS-CoV-2 infection. ConclusionsSARS-CoV-2 infection can lead to complications such as dependency-related injuries. Although there are several non-modifiable variables associated with the occurrence of dependency-related injuries in these patients, it is essential to conduct further research and introduce consensus guidelines to reduce their incidence and prevalence.

The relation between malnutrition screening tool (NUTRIC) score and serum pro- and anti-inflammatory cytokines levels and some nutritional parameters in patients with traumatic head injury in Sulaimani

Background: Research has provided evidence that malnutrition screening tool (NUTRIC) score has a relation with interleukin-6 but not with other cytokines. In addition, the relation between malnutrition screening tool (NUTRIC) score and some nutritional parameters has not yet been studied in traumatic head injured patients. Therefore, the aim of the current study is examining the relation between malnutrition screening tool (NUTRIC) score and serum pro- and anti-inflammatory cytokines levels and some nutritional parameters in patients with traumatic head injury in the intensive care unit (ICU) of General Teaching Hospital in Sulaimani, the Kurdistan Region of Iraq in 2016-17. Methods: Using appropriate methods and tools, the patients’ (NUTRIC) score, mid-upper arm circumference (MUAC), disease severity and organ dysfunction, concentration level of serum cytokines (IL-6) were assessed within 24 hours after admission. All of the mentioned measurements except the serum interleukin were also assessed on days 6 and 13 of staying in ICU. Afterwards, in order to examine the relationship between the study’s variables, the collected data were analyzed using Mann-Whitney U test through SPSS 22.0. Results: The results of data analysis using Mann-Whitney U and independent samples T-tests revealed that there was a significant relation between malnutrition screening tool (NUTRIC) score and the studied interleukin (IL-6) within 24 hours after ICU admission. Other studied variables that had a significant association with the patients’ (NUTRIC) score within 24 hours after ICU admission were APACHE II score, SOFA score, and MUAC, this significant association has been seen on days 6 and 13 after ICU admission between malnutrition screening tool (NUTRIC) score and serum cytokines (IL-6) APACHE II, and SOFA scores. Conclusion: The results of the present study revealed that pro-inflammatory cytokines (IL-6) along with other factors such as APACHE II and SOFA had significantly higher among patients with risk of malnutrition. Keywords: pro-inflammatory cytokines, traumatic head injury (THI), nutritional score

The relation between malnutrition screening tool (NUTRIC) score and serum pro- and anti-inflammatory cytokines levels and some nutritional parameters in patients with traumatic head injury in Sulaimani

Background: Research has provided evidence that malnutrition screening tool (NUTRIC) score has a relation with interleukin-6 but not with other cytokines. In addition, the relation between malnutrition screening tool (NUTRIC) score and some nutritional parameters has not yet been studied in traumatic head injured patients. Therefore, the aim of the current study is examining the relation between malnutrition screening tool (NUTRIC) score and serum pro- and anti-inflammatory cytokines levels and some nutritional parameters in patients with traumatic head injury in the intensive care unit (ICU) of General Teaching Hospital in Sulaimani, the Kurdistan Region of Iraq in 2016-17. Methods: Using appropriate methods and tools, the patients’ (NUTRIC) score, mid-upper arm circumference (MUAC), disease severity and organ dysfunction, concentration level of serum cytokines (IL-6) were assessed within 24 hours after admission. All of the mentioned measurements except the serum interleukin were also assessed on days 6 and 13 of staying in ICU. Afterwards, in order to examine the relationship between the study’s variables, the collected data were analyzed using Mann-Whitney U test through SPSS 22.0. Results: The results of data analysis using Mann-Whitney U and independent samples T-tests revealed that there was a significant relation between malnutrition screening tool (NUTRIC) score and the studied interleukin (IL-6) within 24 hours after ICU admission. Other studied variables that had a significant association with the patients’ (NUTRIC) score within 24 hours after ICU admission were APACHE II score, SOFA score, and MUAC, this significant association has been seen on days 6 and 13 after ICU admission between malnutrition screening tool (NUTRIC) score and serum cytokines (IL-6) APACHE II, and SOFA scores. Conclusion: The results of the present study revealed that pro-inflammatory cytokines (IL-6) along with other factors such as APACHE II and SOFA had significantly higher among patients with risk of malnutrition. Keywords: pro-inflammatory cytokines, traumatic head injury (THI), nutritional score

Evaluation of a Post-Operative Rehabilitation Program in Patients Undergoing Laparoscopic Colorectal Cancer Surgery: A Pilot Study.

This pilot study explores the effects of a post-operative physical exercise program on the quality of life (QoL) and functional and nutritional parameters of patients that underwent laparoscopic colorectal cancer surgery, compared to usual care alone. The intervention group (IG) attended a 2-month-long supervised and combined exercise–training program during the post-operative period. Both IG and control group (CG) participated in the QoL, functional, and nutritional assessments before exercise training (T0), 2 months after the beginning of the exercise (end of treatment) (T1), and 2 (T2) and 4 (T3) months from the end of treatment. Eleven patients with colorectal cancer that underwent laparoscopic surgery were enrolled (six intervention; five control). The IG showed significant improvements compared to the CG in “Physical functioning” (PF2) (p = 0.030), “Cognitive functioning” (CF) (p = 0.018), and “Fatigue” (FA) (p = 0.017) of the European Organization for Research and Treatment of Cancer Quality of Life-C30 Questionnaire (EORTC QLQ-C30) at T1; in SMWT (p = 0.022) at T1; in PF2 (p = 0.018) and FA (p = 0.045) of EORTC QLQ-C30 at T2, in phase angle (PhA) of bioelectrical impedance analysis (p = 0.022) at T3. This pilot study shows that a post-operative, combined, and supervised physical exercise program may have positive effects in improving the QoL, functional capacity, and nutritional status in patients that undergo laparoscopic colorectal cancer surgery.

Are Nutritional Screening Scores Associated with the Serum Albumin Levels and the Presence of Bedsores in Bedridden and Chairbound Home Care Patients?

Based on the fact that immobile bedridden patients have a high risk of developing bedsores and infection, we evaluated whether the presence of bedsores and low serum albumin levels significantly alter the scores of long and short forms of Mini Nutritional Assessment and body mass index. From January to July 2016, 143 bedridden/chairbound home care patients were visited with the Karaman State Hospital home healthcare team. The Mini Nutritional Assessment and Mini Nutritional Assessment-short form were used for nutritional evaluation. The retrospective serum albumin levels that had been analysed in the last 30 days, were recorded from the patients’ files. Also, the skin integrity was evaluated by the home care physician to detect the presence of bedsores. The mean Mini Nutritional Assessment and Mini Nutritional Assessment-short form scores of the patients were 13.2±7.0 and 6.4±3.8, respectively. The mean serum albumin level was 3.2±0.6 g/dL, and 33 patients had bedsores. The Mini Nutritional Assessment and Mini Nutritional Assessment-short form scores, and body mass index values in patients with normal serum albumin levels were significantly higher than those in patients with low serum albumin levels. Moreover, these nutritional parameters in patients with bedsores were significantly lower than those in patients without bedsores. Lastly, the serum albumin levels were found to be significantly positively correlated with all these nutritional parameters. (r=0.477 for Mini Nutritional Assessment; r=0.456 for Mini Nutritional Assessment-short form; r=0.451 for body mass index). Low Mini Nutritional Assessment and Mini Nutritional Assessment-short form scores were significantly related to the presence of bedsores, providing strong evidence that malnutrition may be a major risk factor for bedsore formation. An effective, comprehensive, and holistic treatment protocol and care plan, including nutritional intervention, is important and necessary for immobile home care patients.

Comparative analysis of the prognostic utility of preoperative nutritional parameters in patients with resectable esophageal carcinoma.

Although surgical resection is a mainstay in the management of esophageal carcinoma (EC), its postoperative outcomes remain unsatisfactory. To optimize surgical strategies for EC, a simple method of stratifying patients according to risk factors is desired. Controlling nutritional status (CONUT), the prognostic nutritional index (PNI), transthyretin and transferrin are nutritional parameters used to predict the long-term outcomes of EC patients. We aimed to comparatively evaluate the prognostic significance of these four markers, measured preoperatively, in patients with operable EC. In total, 224 patients undergoing surgical resection for EC were retrospectively reviewed. Overall/cancer-specific survivals (OS/CSS) were estimated applying the Cox proportional hazard model to univariate and multivariate analyses. PNI, transthyretin and transferrin levels were treated as continuous variables in these analyses. Preoperative CONUT had significant associations with tumor location, depth and preoperative irradiation. The other three markers all showed significant relationships with age and tumor depth. On univariate Cox regression analysis, preoperative CONUT, PNI, transthyretin and transferrin all correlated significantly with OS and CSS. On multivariate Cox regression analysis, the preoperative transthyretin level was identified as an independent predictor of OS (HR 0.51 per 10mg/dL increase, 95% CI 0.29-0.88, p = 0.017) and CSS (HR 0.50, 95% CI 0.27-0.91, p = 0.027) as well as tumor depth, nodal metastasis and preoperative irradiation, while the other three parameters were not. Preoperative transthyretin, as a continuous variable, independently predicted both OS and CSS in resectable EC patients, appearing to be the best prognosticator among conventional nutrition-related parameters.

Nutritional evaluation and management in patients with Covid-19 following hospitalization in intensive care units

Rationale: Among hospitalized patients with COVID 19 pneumonia, up to 32% may require admission in intensive care units (ICU). The aim of this prospective cohort study is to assess nutritional parameters in patients with COVID 19 following ICU.

P1587EFFECT OF INTERMITTENT FASTING IN RAMADAN ON BODY COMPOSITION AND NUTRITIONAL PARAMETERS IN PATIENTS ON MAINTENANCE HEMODIALYSIS

Abstract Background and Aims Intermittent fasting has been demonstrated to have many potential health-promoting effects. Intermittent fasting regimens were proven to influence metabolic regulation and chronic inflammation. Fasting during the month of Ramadan can be considered as a model of intermittent fasting among Muslims. In general, there is a shortage of studies in the context of the effect of Ramadan fasting in patients on maintenance hemodialysis (HD). The present study aimed to assess the effects of fasting in Ramadan on body composition as well as nutritional and inflammation parameters in patients on chronic HD. Method This prospective observational study included 68 patients on maintenance HD for more than six months in Mansoura Nephrology and Dialysis Unit (MNDU). The study was performed in Ramadan 1440 Hijri when the fasting hours ranged from 15 to 16 hours. Patients’ nutritional status was assessed by malnutrition inflammation score (MIS). Anthropometric measurements, including body weight, height, mid arm circumference (MAC) and triceps skin fold thickness (TSF), were measured. Body composition was assessed by bioelectrical impedance. All of the aforementioned methods were performed before start of Ramadan and repeated three weeks after the end of the holy month in patients who fasted. Results Forty–five patients (66%) fasted more than 18 days during the month of Ramadan. The mean age of patients who fasted was 47.33±14.86 years with a median duration of HD of 35 months (IQR 14.5-74.5). After Ramadan, weight gain was observed in patients who fasted. However, the increase in body mass index (BMI) was statistically insignificant (28.7±6.06 vs 29.04±6.09kg/m? p=0.073). On the other hand, visceral fat was significantly reduced after Ramadan (p&amp;lt;0.0001). MIS score improved with lower score estimated after Ramadan; however, the difference was insignificant (p=0.059). Conclusion Fasting in Ramadan in HD patients was associated improvement of the metabolic profile evident by decrease in visceral fat. The effect of intermittent fasting on inflammation and nutritional parameters in patients on maintenance hemodialysis needs further investigations.

Low body cell mass index in hemodialysis patients: Association with clinical parameters and survival.

Body cell mass (BCM) is a useful nutritional marker and is not affected by changes in the hydration status that commonly occur in hemodialysis (HD) patients. This study aimed to examine the association between body cell mass index (BCMI) and nutritional parameters, as well as its relationship with long-term survival in these patients. This longitudinal prospective multicenter study followed a cohort of patients in HD for 24 months. The clinical parameters of 2527 patients (mean age 70.3 ± 14.6 years, 55.8% male and mean HD vintage 58 (IQR:33-95) months) were measured and their body composition parameters were assessed by a body composition monitor before the HD session. BCM was converted to BCMI (BCM/height2 ) and, taking into account the mean value (6.4 ± 2.1 kg/m2 ), we split our study population into 2 groups: G1 (BCMI <6.4 kg/m2 ; n = 1366) and G2 (BCMI ≥ 6.4 kg/m2 ; n = 1161). All statistical tests were performed using SPSS 20.0 software. A P value lower than 0.05 was considered statistically significant. Patients with a BCMI <6.4 kg/m2 displayed higher age (P < 0.001), dialysis adequacy (Kt/V) (P < 0.001), total cholesterol (TC) (P = 0.033), high-density lipoprotein cholesterol (HDL-C) (P < 0.001), relative overhydration (overhydration/extracellular water [OH/ECW]) (P < 0.001), CRP (P < 0.001), fat tissue index (FTI) (P < 0.001) and lower normalized protein equivalent of nitrogen appearance (nPNA) (P < 0.001), albumin (P < 0.001), serum creatinine (P < 0.001), creatinine index (P < 0.001), potassium (P < 0.001), phosphorus (P < 0.001), calcium/phosphorus product (Ca X P) (P < 0.001), lean tissue index (LTI) (P < 0.001) and body mass index (BMI) (P = 0.046). The Kaplan-Meier survival curve showed a significantly better survival in female and male patients with BCMI ≥6.4 kg/m2 (P = 0.001 and P < 0.001, respectively). In the cox regression analysis, a significantly higher mortality risk was observed in G1 patients (P = 0.001). Our study showed that a low BCMI was a mortality predictor and was associated with worse nutritional parameters in patients undergoing HD.