Nutritional Risk Group Research Articles

AHP SO07 - Dietetic Outpatient Service to Patients undergoing Oesophagogastric (OG) Surgery for Cancer

Abstract Background Nutrition is a modifiable risk factor impacting surgical outcomes in OG cancer. Its key role influencing health related quality of life is emerging with improved survivorship. Guidelines depicting optimal timing and type of dietetic intervention for this patient group are unclear. In order to best direct dietetic care, optimise timing of nutritional interventions and understand demand for service it is important to reflect on current provision. This audit aimed to describe the dietetic outpatient service to patients undergoing OG Surgery for cancer in a national centre for treatment of oesophageal cancer. Method A retrospective review of dietetic records and statistics. Patients who underwent oesophagectomy (O), gastrectomy (G) or subtotal gastrectomy (STG) for cancer between May 2022- May 2023 were included. Results 63 patients were included: 38 O, 17 TG, 8 STG. 11 were seen by the dietitian at first visit to OG Clinic (9 O, 1 TG, 1 STG) – 6 had an elective feeding tube (FT) inserted for neoadjuvant treatment (5 O, 1 STG). 83% attended a surgical pre-assessment dietetic appointment (36 O, 14 TG, 2 STG). 86% were reviewed within 1 month post O or TG, 75% post STG. 258 dietetic interventions occurred in the first year post-op (median 3.5, range 0-14). 64% in the first 3 months(m) post op, 16% at 3-6m, 10% at 6-9m, 10% at 9-12m. Conclusion In this high nutritional risk group only 18% are assessed by a dietitian at first visit to UGI MDT clinic. There is a successful pathway for immediate peri-operative dietetic care in patients post O and TG. The pathway for STG is less well established. Dietetic interventions are concentrated in the first 3 months after surgery. There is no established protocol to support longer term nutritional needs into survivorship. To inform practice a measure of patient experience and needs would be useful, to explore best delivery format and access routes to future services.

Nutritional status of patients with gastrointestinal cancers and analysis of factors for postoperative infections.

Patients with gastrointestinal cancer have a higher risk of malnutrition and postoperative infection. To investigate the nutritional status of patients with gastrointestinal cancers and factors for postoperative infections. Based on the nutritional risk status, 294 patients with gastrointestinal tumours were divided into a nutritional risk group and a non-nutritional risk group, and the differences between the two groups were compared. Among the included patients, 128 were at preoperative nutritional risk (43.54%); there were significant differences between the two groups in terms of age (66.25 ± 11.73 vs. 58.36 ± 10.41 years, P < 0.001), percentage of gastric cancers (39.84% vs. 28.92%, P = 0.049), percentage of stage IV tumours (60.16% vs. 45.18%, P = 0.011), total protein (64.90 ± 6.82 vs. 67.21 ± 7.41g/L, P = 0.007), albumin (38.32 ± 4.74 vs. 41.61 ± 5.10g/L, P < 0.001) and haemoglobin (112.72 ± 22.63 vs. 125.11 ± 22.79g/L, P < 0.001). Multivariate logistic regression analysis showed that risk factors for postoperative infections in patients included age ≥ 60 years (odds ratio [OR] = 2.266 95%CI = 1.357-4.134), Nutrition Risk Screening (NRS)-2002 score ≥ 3 (OR = 2.183, 95%CI = 1.218-4.102), alcohol history (OR = 2.505, 95%CI = 1.370-4.683), comorbid diabetes mellitus (OR = 2.110, 95%CI = 1.381-4.023) and surgical time ≥ 6h (OR = 2.446, 95%CI = 1.359-4.758). Patients with gastrointestinal cancers are at high incidence of preoperative nutritional risk, and those with an NRS-2002 score of > 3, history of alcohol consumption and surgical time of > 6h have a higher risk of postoperative infections.

Poor nutrition doubles post-COVID-19 syndrome risk in cancer patients: insights from a Chinese multicentre study

BackgroundSince 2019, approximately 760 million SARS-CoV-2 cases have been reported globally, with post-COVID-19 syndrome posing significant challenges for cancer patients due to their immunosuppressed status and poor nutritional conditions. The role of nutritional status in influencing their infection risk and post-COVID-19 outcomes remains unclear, underscoring the need for targeted research and strategies.ObjectiveTo investigate the impact of baseline nutritional status on SARS-CoV-2 infection and the risk of post-COVID-19 syndrome in cancer patients.MethodsA multicenter cross-sectional study was conducted from December 2022 to June 2023 in four tertiary hospitals across China. Cancer inpatients aged 18 years and older were enrolled and classified into two groups based on their Nutritional Risk Screening (NRS) scores. The correlation between SARS-CoV-2 infection, post-COVID-19 syndrome and nutritional status were analyzed using multivariable logistic regression.ResultsAmong 834 eligible cancer patients, 10.8% were in the high nutritional risk group (NRS ≥ 3). The prevalence of SARS-CoV-2 infection was 58.8% (95% confidence interval, CI: 56.8–60.8%), and post-COVID-19 syndrome was 21.0% (95% CI: 10.4–14.4%). After adjusting for confounding factors, the high nutritional risk group had a significantly higher prevalence of post-COVID-19 syndrome compared to the low nutritional risk group (32.7% vs. 19.5%, AOR: 2.37, 95% CI: 1.23–4.54, p = 0.010). However, no significant difference in SARS-CoV-2 infection rates was found between the two groups (61.1% vs. 58.5%, AOR: 1.12, 95% CI: 0.70–1.80; p = 0.634).InterpretationPoor baseline nutritional status in cancer patients is associated with a higher prevalence of post-COVID-19 syndrome, providing preliminary information on post-COVID-19 syndrome in this population. These findings underscore the importance of adequate nutritional management in cancer patients, particularly during pandemic recurrences.

Efficiency of a technology-assisted nutritional screening system: A retrospective analysis of 11,722 admissions in a tertiary hospital

Background and AimNutritional screening is essential for addressing malnutrition and its consequences. However, routine implementation in large hospitals faces several challenges. To overcome these obstacles, the Clinical Nutrition Service of a tertiary hospital developed a technology-assisted nutritional screening system. This study evaluates the system's efficiency in detecting and assessing patients at nutritional risk upon hospital admission. It also examines the association between nutritional risk, clinical outcomes, and sociodemographic characteristics. MethodsThis retrospective, analytical, observational study examined 11,722 hospital admissions of adult patients in 2019, each with a minimum hospital stay of 48 hours in a tertiary hospital. Rates and timing for the detection, referral, and assessment of patients at nutritional risk were calculated. Participants were divided into low (Malnutrition Screening Tool [MST] < 2 points) and moderate/high (MST ≥ 2) nutritional risk groups to evaluate the relationship between nutritional risk and clinical and demographic variables. ResultsWe found that 91% of patients underwent nutritional screening within the first hours of admission, with a median time of 9 hours from admission to screening (interquartile range [IQR] 3-19). The prevalence of nutritional risk (MST ≥ 2) was 21%. All patients identified as being at nutritional risk were immediately referred for a nutritional assessment once identified, with a median referral time of 0 hours (IQR 0-0). This assessment was carried out by a nutritionist for 98% of these patients, with a median time of 19 hours from referral to assessment (IQR 6-24). Compared to the low-risk group, patients with nutritional risk were older, had higher rates of mortality and admission to the intensive care unit (ICU), longer hospital stays, and a higher proportion of men and cancer diagnoses (p=0.00 for all comparisons). After adjusting for age and sex, nutritional risk was significantly associated with a higher probability of ICU admission (Odds Ratio [OR] 1.13; 95% CI 1.02-1.24) and in-hospital mortality (OR 2.32; 95% CI 1.97-2.73). ConclusionThe integration of technology into nutritional screening was highly efficient for early detection and assessment of at-risk patients upon hospital admission. Features of this system could guide other hospitals. The association found between nutritional risk and clinical outcomes emphasizes the importance of prompt and appropriate nutritional interventions.

The geriatric nutritional risk index is related to adverse hospitalization outcomes in individuals undergoing cardiac surgery

Malnutrition is linked to adverse outcomes in post-cardiac surgery patients. This study investigates the correlation between the Geriatric Nutritional Risk Index (GNRI) and adverse hospital outcomes in patients following cardiac surgery. This retrospective study included elderly patients with heart disease who were admitted to the Department of Cardiology, Fujian Medical University Union Hospital from January 2020 to December 2022. Patients were divided into two groups based on the cut-off value (98 g/dL). Data from 407 patients were assessed, with 278 (68.3%) classified as having nutritional risk and 129 (31.7%) as having no nutritional risk. Notable distinctions were observed in body weight, BMI, and left ventricular ejection fraction (P < 0.05). Laboratory indicators indicated lower levels of serum albumin, lymphocytes, red blood cells, hemoglobin, admission blood glucose, and admission triglyceride in the nutritional risk group (P < 0.05). Neutrophils and serum creatinine were higher in the nutritional risk group (P < 0.05). Poor prognosis was prevalent in the nutrition risk group (64.7%), with higher incidences of adverse outcomes (P < 0.05). Univariate and multivariate studies showed that GNRI < 98 g/dL was an independent predictor of postoperative cardiac surgery. Nutritional risk was an important predictor of adverse hospital outcomes after the surgery.

Nutritional Indices Predict All Cause Mortality in Patients with Multi-/Rifampicin-Drug Resistant Tuberculosis.

Multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) with high mortality remains a public health crisis and health security threat. This study aimed to explore the predictive value of nutritional indices for all-cause mortality (ACM) in MDR/RR-TB patients. We retrospectively recruited MDR/RR-TB patients between January 2015 and December 2021, randomly assigning them to training and validation cohorts. Patients were divided into high nutritional risk groups (HNRGs) and low nutritional risk groups (LNRGs) based on the optimal cut-off value obtained from receiver operating characteristic (ROC) analyses of the hemoglobin-albumin-lymphocyte-platelet (HALP) score, prognostic nutritional index (PNI), and controlling nutritional status (CONUT) score. In the training cohort, Kaplan-Meier survival curves and Log rank tests were used to compare overall survival (OS) between the groups. Cox risk proportion regression analyses were used to explore the risk factors of ACM in patients with MDR/RR-TB. The predictive performance of ACM was assessed using area under the curve (AUC), sensitivity and specificity of ROC analyses. A total of 524 MDR/RR-TB patients, with 255 in the training cohort and 269 in the validation cohort, were included. Survival analyses in the training cohort revealed significantly lower OS in the HNRGs compared to the LNRGs. After adjusting for covariates, multivariate analysis identified low HALP score, low PNI and high CONUT score were independent risk factors for ACM in MDR/RR-TB patients. ROC analyses demonstrated good predictive performance for ACM with AUCs of 0.765, 0.783, 0.807, and 0.811 for HALP score, PNI, CONUT score, and their combination, respectively. Similar results were observed in the validation set. HALP score, PNI, and CONUT scores could effectively predict ACM in patients with MDR/RR-TB. Hence, routine screening for malnutrition should be given more attention in clinical practice to identify MDR/RR-TB patients at higher risk of mortality and provide them with nutritional support to reduce mortality.

USE OF NUTRIENT RISK IN CRITICALLY ILL SCORE TO ASSESS NUTRITIONAL RISK IN MECHANICALLY VENTILATED PATIENTS

Ensuring proper nutritional support is crucial for critically ill patients. This nutritional deficit is closely associated with heightened susceptibility to nosocomial infections, delayed wound healing, and an escalated risk of mortality. Objective: The objective of this study is to evaluate the effectiveness of the Nutrient Risk in Critically Ill (NUTRIC) score in assessing the nutritional risk of mechanically ventilated patients. Method: It is a cross-sectional study. It is conducted at the Department of Critical Care Medicine, Shifa International Hospital, Islamabad from 1st Jan 2024 to 30 May 2024. The calculated sample size was 381 selected by non-probability consecutive sampling. The study utilized the modified Nutritional Risk in the Critically Ill (mNUTRIC) score to assess nutritional risk in mechanically ventilated (MV) patients. Data will be analyzed using SPSS 24.0. A P value of ≤ 5 will be significant Result: The study included a total of 381 participants, with a mean age of 55.7 ± 17.5 years and, a BMI was 23.7 ± 3.5. 219 (57.48%) had low nutritional risk (NUTRIC score ≤4), while 162 (42.51%) had high nutritional risk (NUTRIC score ≥5). Patients in the high nutritional risk group had a longer stay in the intensive care unit (ICU), had fewer ventilator-free days and had higher mortality rates compared to those in the low nutritional risk group (8.5 ± 4.1 days vs. 5.2 ± 3.9 days, p-value &lt; 0.01). Conclusion: The study highlights the significance of the NUTRIC score as a valuable tool for the estimation of nutritional risk among mechanically ventilated patients in the ICU setting

Nutritional risk factors in patients with nasopharyngeal carcinoma: a cross-sectional study.

Patients with nasopharyngeal carcinoma are notably susceptible to high nutritional risks. If not addressed, this susceptibility can lead to malnutrition, resulting in numerous adverse clinical outcomes. Despite the significance of this issue, there is limited comprehensive research on the topic. The objective of our study was to identify nutritional risk factors in patients with nasopharyngeal carcinoma. For this cross-sectional study, we recruited a total of 377 patients with nasopharyngeal carcinoma. The Nutritional Risk Screening 2002 tool was used to assess their nutritional risk. These patients were divided into a well-nourished group (n = 222) and a nutritional risk group (n = 155). Potential risk factors were screened out using univariate analysis (p < 0.1). These factors were subsequently analyzed with multivariate logistic regression analysis (p < 0.05) to identify the nutritional risk factors for these patients. Our findings indicated that increasing age (OR = 1.085, 95%CI: 1.053-1.117, p < 0.001), high number of radiation treatments (OR = 1.103, 95%CI: 1.074-1.132, p < 0.001), low BMI (OR = 0.700, 95%CI: 0.618-0.793, p < 0.001), and low albumin levels (OR = 0.852, 95%CI: 0.789-0.921, p < 0.001) are significant nutritional risk factors in patients with nasopharyngeal carcinoma. Increasing age, high number of radiation treatments, low BMI, and low albumin levels are significant nutritional risk factors in patients with nasopharyngeal carcinoma.

The malnutrition screening tool STRONGKIDS performed better than other screening tools for children hospitalised in Egypt.

To compare the accuracy of three different screening tools, namely, the Paediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), and Screening Tool for Risk on Nutritional Status and Growth (STRONGKIDS), in assessing malnutrition risk in hospitalised children. A cross-sectional study was conducted on 300 children aged 6 months to 15 years at Alexandria University Children's Hospital, Egypt. The sensitivity and specificity of each tool were calculated to detect acute and chronic malnutrition, and an agreement test was conducted between the nutritional screening tools. The patients were classified into different nutritional risk groups, and their classification was compared with anthropometric measures and clinical variables, such as the length of hospital stay (LOS). The prevalence of stunting and wasting on admission was found to be 3% and 6.6%, respectively. Children categorised as high-risk on admission had a longer LOS than those at low risk. The agreement test between the STAMP score and STRONGKIDS score on admission showed the most significant agreement, and STRONGKIDS had the best accuracy in detecting acute and chronic malnutrition. The comparison of the three screening tools revealed that STRONGKIDS exhibited the best accuracy in detecting acute and chronic malnutrition.

Nutritional Risk, Depression, and Physical Function in Older People Living Alone.

This study investigated depression and physical function as factors associated with nutritional risk in older adults living alone. The study included 2896 people 65 years or older who lived alone. Data were collected in South Korea between September and November 2020. Descriptive statistics, a chi-squared test, independent samples t-test, weighted multiple regression analysis, and binary logistic regression analysis were performed using IBM SPSS for Windows ver. 23.0. In this study, 44.8% of participants were in the nutritional risk group. Furthermore, 60.9% of those at risk for depression, 75.1% of those with instrumental activities of daily living (IADLs) dependency, and 59.1% of those with chewing limitations were at nutritional risk. The factors that increased nutritional risk in the weighted multiple regression analysis were depression (β = 0.27, p < 0.001), chewing limitations (β = 0.12, p < 0.001), IADL dependency (β = 0.09, p < 0.001), and basic physical movement (β = 0.04, p = 0.020). Binary logistic regression analysis showed that those with IADL dependency had a 2.59 times higher nutritional risk than those with IADL non-dependency (p < 0.001). The nutritional risk group had a higher risk of depression (2.01 times higher [p < 0.001]), chewing limitations (1.76 times higher [p < 0.001]), and basic physical movement limitations (1.35 times higher [p = 0.009]) than the good nutritional group. Therefore, nutritional screening is required of older individuals living alone. To mitigate nutritional risks, it is necessary to assess depression and physical function, including IADL dependency.

Impact of sarcopenia and malnutrition on swallowing function utilizing ultrasonography in patients with acute heart failure: A retrospective cohort study

This study aimed to determine the impact of sarcopenia and nutritional risk on swallowing-related muscles by ultrasonography and dysphagia occurrence in older patients with acute heart failure (AHF) during hospitalization. Patients with AHF aged ≥65 years without dysphagia (Food Intake LEVEL Scale [FILS] score ≥9) before admission were classified into four groups at admission: robust group, sarcopenia group (Asian Working Group for Sarcopenia 2019), nutritional risk group (geriatric nutritional risk index <92), and complicated group (with both sarcopenia and nutritional risk). Swallowing function (maximal hyoid displacement, geniohyoid muscle area and brightness, and maximal tongue pressure) and FILS were investigated from the medical records. In total, 131 patients with AHF (mean age 82.8±7.1 years, 71 males) were enrolled during the study period; 33, 58, 5, and 35 were classified into the robust, sarcopenia, nutritional risk, and complicated groups, respectively. In the covariance analysis adjusted for age, sex, comorbidities, and cardiac function, the complicated group had significantly worse swallowing function than the sarcopenia and robust groups (P<0.05). In the Cox proportional hazards model, in which event occurrence was defined as the first-time FILS score of ≥9 obtained during hospitalization, the sarcopenia group (hazard ratio [HR]: 0.83, 95% confidence interval [CI]: 0.51-1.34, P=0.438) and nutritional risk group (HR: 0.77, 95% CI:0.25-2.32, P=0.637) were not significantly different, but the complicated group (HR: 0.54, 95% CI: 0.31-0.95, P=0.033) had significantly lower cumulative event rates with the robust group as the reference. Sarcopenia and nutritional risk in older patients with AHF are risk factors for decreased swallowing function.

Evaluation of malnutrition and screening tools in hospitalized children

Detecting malnutrition and its related risk factors are crucial, in hospitalized children. Anthropometric z scores are used to assess malnutrition. Screening tools also aim to detect the presence of malnutrition and the developing risk of malnutrition in hospitalized children to determine who may benefit from nutritional support. Therefore, the aims of the study are to detect malnutrition and its related demographic and clinical risk factors in hospitalized children and determining the sensitivity of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) and Pediatric Yorkhill Malnutrition Score (PYMS) screening tools. A total of 130 hospitalized children aged between 0 and 18 years were included in to study. A survey including demographic and clinical characteristics, STAMP and PYMS were applied to parents of the children. Patients were classified into nutritional risk groups through screening tools. Anthropometric measurements (body weight, length/height, and middle upper arm circumference (MUAC) of the children were taken. Body mass index-for-age and height-for-age z scores were calculated to assess acute and chronic malnutrition prevalence. MUAC-for-age z scores were calculated as well. To detect independent risk factors for acute and chronic malnutrition multivariable logistic regression models were constructed. A total of 14.6% of hospitalized children had acute malnutrition, 21.5% of children had chronic malnutrition and 27.7% of them had low MUAC standard deviation score (SDS) (less than-2). The independent risk factors for acute malnutrition were younger maternal age at birth and long length of stay (p<0.05). The independent risk factors for chronic malnutrition were being female, younger maternal age at birth, longer illness duration and having urological or allergy and immunological diseases (p<0.05). However, MUAC for age SDS groups were not related to any demographic and clinical factors, in children of all ages (p>0.05). Regarding the screening tools, PYMS displayed 100% sensitivity against acute malnutrition. While PYMS displayed better sensitivity to identify acute malnutrition than STAMP, STAMP was more sensitive than PYMS to detect chronic malnutrition and low MUAC SDS. Low MUAC for age SDS was not related to any demographic and clinical factors, in hospitalized children of all ages, unlike acute and chronic malnutrition, in this study. Pediatric screening tools mainly PYMS did not have high sensitivity to detect chronic malnutrition and low MUAC SDS, in hospitalized children. Therefore, the tools have to be used along with z scores of anthropometric parameters.

Current status of nutritional provision and effects of nutritional support on the clinical outcomes of acute kidney injury requiring continuous renal replacement therapy in the surgical intensive care unit.

Patients with acute kidney injury requiring continuous renal replacement therapy are at high risk of malnutrition. Nutritional support is an important part of treatment for patients with critical illness admitted to the intensive care unit. We aimed to investigate the status of nutritional provision and the effects of nutritional support on clinical outcomes. Our institution's medical records (from January 1, 2020, to December 31, 2021) were analyzed in this retrospective cohort study. We included 43 patients aged >18 years who received continuous renal replacement therapy for acute kidney injury in the surgical intensive care unit. The demographic characteristics were similar between the survivor and non-survivor groups. The protein supply per body weight (0.88 ± 0.37 g/kg vs. 0.47 ± 0.53 g/kg, p = 0.029) and the proportion of patients who met the target protein level (58.9 ± 24.9% vs. 30.8 ± 34.9%, p = 0.022) were significantly higher in the survivor group. Approximately 79.1% of the patients had a high malnutrition risk with a modified Nutrition Risk in the Critically Ill score of ≥5. The lengths of hospital and intensive care unit stays were longer in the high nutritional risk group compared with that in the low nutritional risk group, but the result was not significant. The nutritional amount provided in patients with critical illness is significantly lesser than the recommended amount. Ensuring proper nutritional support can improve the clinical outcomes.

Computer Tomography (CT)-based Screening of Hospitalized Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease Complicated by Bronchiectasis Phenotype During Acute Exacerbation: A Clinical Analysis.

In the past, many experts considered chronic obstructive pulmonary disease (COPD) and bronchiectasis to be separate, chronic respiratory diseases. Nonetheless, the widespread use of high-resolution lung computed tomography (CT) has led to the discovery that these diseases can occur alone or together. The current study aimed to compare the effects of nutritional status on the clinical outcomes in moderate to severe COPD patients with bronchiectasis. This study identifies the nutritional risk in hospitalized patients with moderate to severe COPD complicated by bronchiectasis phenotype during acute exacerbation screened using computer tomography (CT). Also, determines its correlation with disease progression. NRS 2002 (Nutrition Risk Screening Evaluation Tool) was used to determine and evaluate the nutritional risk status in 182 hospitalized patients with moderate to severe COPD complicated by bronchiectasis phenotype during an acute exacerbation. Selected patients were divided into the nutritional risk (NR) group and the non-nutritional risk (NNR) group according to their nutritional status determined by NRS 2002. The body mass index (BMI), serum albumin (ALB), pre albumin (PAB), lymphocyte count (TLC), FEV1/FVC, FEV1% predicted, PEF% predicted, blood gas analysis, number of acute exacerbations in the past year, number of respiratory failure cases, number of anti-infection days, and length of hospitalization of the two groups were observed. The hospitalized patients in acute exacerbation of moderate to severe COPD complicated by bronchiectasis phenotype had a nutritional risk of 62.64%. BMI, ALB, PAB, TLC, FEV1% predicted, FEV1/FVC, PEF% predicted, blood gas analysis, number of acute exacerbations in the past year, number of respiratory failure cases, number of anti-infection days, and length of hospitalization were statistically significantly different between the NR group and NNR group (P<0.05). Hospitalized patients with moderate to severe COPD complicated by bronchiectasis phenotype during acute exacerbation are often associated with nutritional risk. An increase in nutritional risk reduces the level of pulmonary function of the patient and elevates the risk for repeated acute exacerbations, which predispose the patient to respiratory failure, thereby increasing the length of hospitalization. Therefore, the nutritional risk status of COPD patients with bronchiectasis was closely related to the occurrence, development, and prognosis of the disease.

Geriatric nutrition risk index in the prediction of all-cause and cardiovascular mortality in elderly hypertensive population: NHANES 1999-2016.

Hypertension is a major risk factor for the global burden of disease, and nutrition is associated with an increased risk of mortality from multiple diseases. Few studies have explored the association of nutritional risk with all-cause mortality and cardiovascular mortality in hypertension, and our study aims to fill this knowledge gap. We included data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016 on a total of 10,037 elderly patients with hypertension. The nutritional status was evaluated using the Geriatric Nutrition Risk Index (GNRI). Kaplan-Meier survival analysis was performed to analyze the survival rates of different nutritional risk groups. COX proportional risk regression models were used to analyze the predictive effect of GNRI on all-cause mortality and cardiovascular mortality in hypertensive patients. Restricted cubic splines (RCS) were used to explore the nonlinear relationship between GNRI and mortality. The mean age of the hypertensive patients was 70.7 years. A total of 4255 (42.3%) all-cause mortality and 1207 (17.2%) cardiovascular mortality occurred during a median follow-up period of 106 months. Kaplan-Meier showed a more significant reduction in survival for the moderate to severe malnutrition risk of GNRI. The adjusted COX proportional hazards model showed that the hazard ratios for all-cause mortality and cardiovascular mortality in the moderate to severe malnutrition risk group for GNRI were 2.112 (95% CI, 1.377,3.240) and 2.604 (95% CI, 1.603,4.229), respectively. The RCS showed that increased GNRI was associated with a reduced risk of all-cause mortality and cardiovascular mortality risk reduction. Malnutrition exposure assessed by GNRI effectively predicts the risk of all-cause mortality and cardiovascular mortality in the elderly with hypertension.

The impact of sarcopenia on nutritional status in elderly patients with gastrointestinal tumors

This study aimed to analyze the impact of sarcopenia on nutritional status in elderly patients with gastrointestinal tumors. We conducted a study of 146 elderly patients with gastrointestinal tumors in our hospital from January 2020 to June 2022. Patients enrolled were divided into normal nutritional status group (80 patients) and high nutritional risk group (66 patients) according to their nutritional status. The clinical information and nutritional status of the two groups were compared and analyzed. Multivariate logistic regression was done to analyze the risk factors of nutritional status in elderly patients with gastrointestinal tumors; and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of sarcopenia on nutritional status in elderly patients with gastrointestinal tumors. Malnutrition was present in 66 (45.21%) of 146 elderly patients with gastrointestinal cancer. There was no significant difference in gender, age, and tumor location between the two groups (P > 0.05). However, statistically significant difference was observed between the two groups in terms of BMI, tumor staging, calf circumference, the third lumbar vertebra skeletal muscle index (L3-SMI), muscle strength, 6 m walking speed, short physical performance battery (SPPB) score, PG-SGA score, and sarcopenia (p < 0.05). The independent variables were set as BMI (≤ 21.27 kg/cm2), tumor staging (stage II to III), calf circumference (male: ≤ 30.01 cm, female: ≤ 29.37 cm), L3-SMI (male: ≤ 41.29 cm2/m2, female: ≤ 34.29 cm2/m2), muscle strength (male: ≤ 22.32 kg, female: ≤ 16.39 kg), 6 m walking speed (≤ 0.89 m/s), SPPB score (≤ 8.67 points), PG-SGA score (> 3 points), and sarcopenia. The dependent variable was malnutrition in elderly patients with gastrointestinal tumors. A univariate logistic regression analysis was conducted, showing that the influencing factors for malnutrition in elderly patients with gastrointestinal tumors were L3-SMI (male: ≤ 41.29 cm2/m2; female: ≤ 34.29 cm2/m2), muscle strength (male: ≤ 22.32 kg; female: ≤ 16.39 kg), BMI (≤ 21.27 kg/cm2), SPPB score (≤ 8.67 points), PG-SGA score (> 3 points) and sarcopenia. Moreover, the independent variables were set as L3-SMI (male: ≤ 41.29 cm2/m2; female: ≤ 34.29 cm2/m2), muscle strength (male: ≤ 22.32 kg; female: ≤ 16.39 kg), BMI (≤ 21.27 kg/cm2), SPPB score (≤ 8.67 points), PG-SGA score (> 3 points), and sarcopenia. The dependent variable was malnutrition in elderly patients with gastrointestinal tumors. The multivariate logistic regression analysis revealed that the influencing factors of malnutrition in elderly patients with gastrointestinal tumors were BMI (≤ 21.27 kg/cm2) and sarcopenia. The ROC curve of BMI (≤ 21.27 kg/cm2) and sarcopenia, and the area under the curve (AUC) of BMI (≤ 21.27 kg/cm2) and sarcopenia predicting malnutrition in elderly gastrointestinal cancer patients were 0.681 and 0.881, respectively. The influencing factors of malnutrition in elderly patients with gastrointestinal tumors were BMI (≤ 21.27 kg/cm2) and sarcopenia, and the two factors may exert predictive value in terms of the occurrence of malnutrition in such patients.

A More Supportive Social Environment May Protect Against Nutritional Risk: A Cross-Sectional Analysis Using Data From the Canadian Longitudinal Study on Aging

BackgroundNutritional risk has been linked to individual social factors, but the relationship with the overall social environment has not been assessed. ObjectivesTo evaluate associations between different support profiles of the social environment and nutritional risk using cross-sectional data from the Canadian Longitudinal Study on Aging (n = 20,206). Subgroup analyses were performed among middle-aged (range, 45–64 y; n = 12,726) and older-aged (≥65 y, n = 7480) adults. Consumption of major food groups [whole grains, proteins, dairy products, and fruits and vegetables (FV)] by social environment profile was a secondary outcome. MethodsLatent structure analysis (LSA) classified participants into social environment profiles according to data on network size, social participation, social support, social cohesion, and social isolation. Nutritional risk and food group consumption were assessed with the SCREEN-II-AB and Short Dietary questionnaires, respectively. ANCOVA was conducted to compare SCREEN-II-AB mean scores by social environment profile, adjusted for sociodemographic and lifestyle factors. Models were repeated to compare mean food group consumption (times/day) by social environment profile. ResultsLSA identified 3 social environment profiles classified as low, medium, and high support (17%, 40%, and 42% of the sample, respectively). Adjusted mean SCREEN-II-AB scores significantly increased with increasing social environment support, with the low support score indicating high nutritional risk status [low, medium, high support, respectively: 37.1 (99% CI: 36.9, 37.4), 39.3 (39.2, 39.5), 40.3 (40.2, 40.5), all comparisons P < 0.0001]. Results were consistent among age subgroups. The low support social environment profile had lower consumption of protein [low, medium, high support, respectively (mean ± SD): 2.17 ± 0.09, 2.21 ± 0.07, 2.23 ± 0.08, P = 0.004], dairy (2.32 ± 0.23, 2.40 ± 0.20, 2.38 ± 0.21, P = 0.009), and FV (3.65 ± 0.23, 3.94 ± 0.20, 4.08 ± 0.21, P < 0.0001), with some variation among age subgroups. ConclusionsThe low support social environment profile had the poorest nutritional outcomes. Therefore, a more supportive social environment may protect against nutritional risk among middle- and older-aged adults.

An analysis of nutritional risk factors in older adults with gastrointestinal tumours

IntroductionThe aim of this study was to investigate risk factors for nutritional risk in older adults with gastrointestinal tumours. Materials and MethodsA total of 170 eligible hospitalised older adults with gastrointestinal tumours were included. Their clinical characteristics were collected, their nutritional risk was screened by NRS 2002, and then patients were divided into a nutritional risk group and a non-nutritional risk group. The observation indicators included body mass index (BMI), muscle mass, muscle strength, and calf circumference. The third lumbar skeletal muscle index (L3 SMI) was calculated using abdominal computed tomography (CT) scan results, and grip strength/muscle strength, 6-m walking speed and calf circumference were measured. Sarcopenia was diagnosed according to the criteria of the Asian Sarcopenia Working Group (AWGS). Finally, we analysed the relationship between nutritional risk and sarcopenia and other related factors (BMI, calf circumference, L3 SMI, grip strength/muscle strength, 6-m walking speed) in older adults with gastrointestinal tumours by multivariate logistic regression analysis. ResultsOlder adults with gastrointestinal tumours who were at nutritional risk accounted for 51.8% of patients in this study. The differences between sex, tumour stage, age, BMI, calf circumference, L3 SMI, grip strength/muscle strength, 6-m walking speed, and prevalence of sarcopenia were statistically significant in two groups (all P < 0.05). Multivariate logistic regression analysis showed that age, BMI, grip strength/muscle strength, and sarcopenia were risk factors of nutritional risk in older adults with gastrointestinal tumours (all P < 0.05). DiscussionOlder adults with gastrointestinal cancer had a higher proportion of nutritional risk, and L3 SMI, grip strength/muscle strength were independent risk factors for nutritional risk. In clinical practice, attention to nutritional risk screening and sarcopenia development in older adults with gastrointestinal cancer is warranted.

Influence factors of debilitating and nutritional risk on complications of primary hip replacement

To analyze relationship of debilitating and nutritional risk on complications of primary hip replacement, and risk factors of influence of complications of primary hip replacement. Totally 100 patients who underwent hip replacement from January 2019 to January 2021 were retrospectively analyzed, including 36 males and 64 females, aged from 18 to 85 years old with an average of (73.82±4.04) years old. Postoperative frailty status was evaluated by modified frailty index, and nutritional status was evaluated by clinical biochemical indexes and NRS2002 nutritional risk assessment scale. One hundred patients were divided into frailty group and non-frailty group according to modified frailty index, 100 patients were divided into normal nutrition group and nutritional risk group according to nutritional status, and relationship between frailty, nutritional risk and complications after primary hip replacement was analyzed. There were significant differences in age, body mass index (BMI), complications and ASA grade between frailty group and non-frailty group(P<0.05). There were statistically significant differences in age, BMI, complications and ASA grade between normal nutrition group and nutritional risk group (P<0.05). Thirty-five patients occurred at least one postoperative complications, and the incidence of pulmonary infection was the highest, accounting for 34.29% (12/35). The second was urinary infection, accounting for 22.86%(8/35). Univariate Logistic regression analysis showed that age, BMI, ASA grade, complications, frailty and nutritional risk were the risk factors for postoperative complications. Multivariate Logistic regression analysis showed that complications, frailty and nutritional risk were independent factors affecting postoperative complications. Patients with comorbidities, frailty and nutritional risk could increase the incidence of complications. Timely assessment and identification of these patients in time, and formulation of targeted intervention measures have great clinical significance.

Relationship between geriatric nutritional risk index and osteoporosis in type 2 diabetes in Northern China

Osteoporosis is a very common bone disease in the elderly population and can lead to fractures and disability. Malnutrition can lead to osteoporosis. The geriatric nutritional risk index (GNRI) is a tool used to assess the risk of malnutrition and complications associated with nutritional status in older patients and is a crucial predictor of many diseases. Hence, this study investigated the association between the GNRI and the presence of osteoporosis and assessed the value of this index for predicting osteoporosis in patients with type 2 diabetes mellitus (T2DM). This cross-sectional study enrolled 610 elderly patients with T2DM. General and laboratory data of the patients were collected, along with their measurements of bone mineral density (BMD). The GNRI was calculated based on ideal body weight and serum albumin (ABL) levels. Correlation analysis was performed to determine the relationship between the GNRI and BMD and bone metabolism indices. The GNRI predictive value for osteoporosis development was analyzed through logistic regression analysis and by creating a receiver operating characteristic curve (ROC), calculating the area under the curve (AUC). All patients were divided into the no-nutritional risk and nutritional risk groups. Compared with the no-nutritional risk group, the nutritional risk group had a longer diabetes course, older age, higher HbA1c levels, higher prevalence of osteoporosis; lower BMI, ABL,triglyceride (TG),Calcium (Ca),25-hydroxy-vitamin-D(25(OH)D),and parathyroid hormone(PTH) and lower femoral neck BMD,total hip BMD (P < 0.05). All patients were also assigned to the non-osteoporosis and osteoporosis groups. The non-osteoporosis group had higher GNRI values than the osteoporosis group (P < 0.05). Correlation analysis revealed a positive correlation between the GNRI and lumbar BMD, femoral neck BMD, and total hip BMD (P < 0.05). After the adjustment for confounding factors, Spearman's correlation analysis revealed that the GNRI was positively correlated with Ca, 25(OH)D, and PTH and negatively correlated with alkaline phosphatase (ALP) and procollagen of type-1 N-propeptide (P1NP). Regression analysis exhibited that the GNRI was significantly associated with osteoporosis. The ROC curve analysis was performed using the GNRI as the test variable and the presence of osteoporosis as the status variable. This analysis yielded an AUC for the GNRI of 0.695 and was statistically significant (P < 0.05). A lower GNRI among T2DM patients in northern China is associated with a higher prevalence of osteoporosis.