Nutritional Risk Group Research Articles

The Geriatric Nutritional Risk Index predicts mortality in nonagenarians and centenarians receiving home care.

The increasing prevalence of malnutrition in old people is related to the risk of illness and death. A number of screening tools to detect malnutrition have been used in the elderly to assess nutritional status and predict prognosis. The aim of the present study was to investigate the ability of the Geriatric Nutritional Risk Index (GNRI) to assess nutritional status and predict mortality in very old home-care people by using a cross-sectional study of Chinese older people aged 90-105 years. The present study was based on a 4-year follow-up of mortality data from a previous cross-sectional study. The study was conducted with a very elderly population with a mean age of 93.5±3.2 years (n=716; 230 men and 486 women). In 2005, trained researchers performed face-to-face interviews and physical and geriatric assessments to obtain information on sociodemographic factors, self-reported medical diseases, geriatric-specific conditions, anthropometric factors, biochemical data, and the GNRI score. In 2009, vital status were requested from the local government. After 4 years of follow-up, 371 participants died (125 men and 246 women, 51.8%). The median follow-up time was significantly worse in the nutritional risk group (GNRI <=98) (30.26±15.80 vs 42.27±11.82 months, p<0.001). Activities of daily living (ADL) impairment (hazard ratio [HR]=1.414, 95% CI=1.121-1.783), and GNRI score (HR=0.92, 95% CI=0.908-0.932) were associated with all-cause mortality according to a Cox regression analysis. The GNRI, a nutrition-related risk index, can predict mortality in very old Chinese home-care people.

Planning a health promotion program: Mobile app gamification as a tool to engage adolescents

Over the past decade, the World Health Organization (WHO) has been alerting about the existing overweight prevailing among the adolescents’ group. This group is considered a nutritional risk group mainly because of less correct eating patterns and misbehaviors towards physical activity. To prevent obesity within this risk group, we are working on a mobile application involving gamification techniques. This article presents the preliminary results of a design study for this app, and explores possible design guidelines and processes based on results achieved in preliminary user interface and experience tests.

Factors associated with malnutrition in adolescent and adult patients with cystic fibrosis.

To determine the prevalence of malnutrition in patients attending an adult cystic fibrosis (CF) program and to investigate the associations of malnutrition with the clinical characteristics of those patients. This was a cross-sectional study involving patients with clinically stable CF patients (16 years of age or older). The patients underwent clinical assessment, nutritional assessments, pulmonary function tests, and pancreatic function assessment. They also completed a questionnaire regarding diet compliance. On the basis of their nutritional status, the patients were classified divided into three groups: adequate nutrition; at nutritional risk; and malnutrition. The study has included 73 patients (mean age, 25.6 ± 7.3 years), 40 of whom (54.8%) were female. The mean body mass index was 21.0 ± 3.0 kg/m2 and the mean FEV1 was 59.7 ± 30.6% of predicted. In this sample of patients, 32 (43.8%), 23 (31.5%), and 18 (24.7%) of the patients were allocated to the adequate nutrition, nutritional risk, and malnutrition groups, respectively. The logistic regression analysis identified three independent factors associated with the risk of malnutrition: Shwachman-Kulczycki score, percent predicted FEV1; and age. Malnutrition remains a common complication in adolescents and adults with CF, despite dietary advice. Malnutrition is associated with age, clinical severity, and lung function impairment.

Impact of nutritional risk on short-term clinical outcomes after laparoscope-assisted radical gastrectomy for gastric cancer

Objective To explore the impact of nutritional risk on short-term clinical outcomes after laparoscope-assisted radical gastrectomy for gastric cancer. Methods The retrospective case-control study was conducted. The clinical data of 150 patients who underwent laparoscopic gastrectomy at the First Affiliated Hospital of Wenzhou Medical University between June 2014 and April 2016 were collected. According to nutritional risk screening 2002 (NRS 2002), 42 and 108 patients were respectively divided into the nutritional risk group (NRS 2002 score ≥3) and non-nutritional risk group (NRS 2002 score <3). Laparoscope-assisted radical subtotal gastrectomy or total gastrectomy was performed based on tumor location. Observation indicators: (1) postoperative short-term clinical outcomes: postoperative complications, duration of postoperative hospital stay, hospital expenses, unplanned readmission within 30 days after discharging. Postoperative complications meant total complications within 30 days postoperatively, grade Ⅰ-Ⅴ of Clavien-Dindo grade was complication classification. Grade Ⅱ and above of Clavien-Dindo grade were analyzed in this research. (2) Risk factors analysis affecting occurrence of postoperative complications of patients. Measurement data with normal distribution were represented as ±s and analyzed using the independent-sample t test. Measurement data with skewed distribution were described as M (Qn) and analyzed using the Mann-Whitney U test. Categorical variables were described as number and percentage and analyzed by the chi-square test. Ranked data were analyzed by the Mann-Whitney U test. Univariate analysis was done by the chi-square test. P<0.1 of univariate analysis was used to multivariate analysis. COX regression model in multivariate analysis was built using progressive condition method. Results (1) Postoperative short-term clinical outcomes: number of patients with total complications, number of patients with severe complications, duration of postoperative hospital stay, hospital expenses and number of patients with unplanned readmission within 30 days after discharging were 9, 2, 11 days (9 days, 16 days), 57 825 yuan (51 894 yuan, 66 908 yuan), 2 in the nutritional risk group and 16, 3, 11 days (9 days, 13 days), 55 067 yuan (49 395 yuan, 62 423 yuan), 8 in the non-nutritional risk group, respectively, with no statistically significant difference between the 2 groups (χ2=0.952, 0.010, Z=-1.133, -1.691, χ2=0.048, P>0.05). Results of univariate analysis showed that age was a risk factor affecting incidence of complications after laparoscope-assisted radical gastrectomy for gastric cancer (χ2=4.468, P<0.05). Results of multivariate analysis showed that preoperative hypoproteinemia was an independent risk factor affecting incidence of complications after laparoscope-assisted radical gastrectomy for gastric cancer (OR=2.797, 95% confidence interval: 1.053-7.435, P<0.05). Conclusion There is little poor impact of nutritional risk on short-term outcomes after laparoscope-assisted radical gastrectomy for gastric cancer, preoperative hypoproteinemia is an independent risk factor affecting occurrence of grade Ⅱ and above of postoperative complications. Key words: Gastric neoplasms; Nutritional risk; Postoperative complications; Laparoscopy

Screening for nutritional risk in hospitalized children with liver disease.

Malnutrition is a major contributor to morbidity and mortality from pediatric liver disease. We investigated the prevalence of both malnutrition and high nutritional risk in hospitalized children with liver disease as well as the rate of in-hospital nutritional support. A total of 2,874 hospitalized children and adolescents with liver disease aged 1 to 17 years (inclusive) were enrolled. Malnutrition was screened by anthropometric measures (height-for-age, weight-for-height, weight-for-age, and BMI- for-age z-scores). The Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) was used to evaluate nutritional risk status. Nutrition markers in blood, rate of nutritional support, length of hospital stay, and hospital fees were compared among nutritional risk groups. The overall prevalence of malnutrition was 38.6%. About 20.0% of children had high nutritional risk, and prevalence of malnutrition was markedly greater in the high nutritional risk group compared with the moderate risk group (67.9% vs 31.3%). Serum albumin and prealbumin differed significantly between high and moderate risk groups (p<0.001). Only 8.9% of children with high nutritional risk and 3.5% with moderate nutritional risk received nutrition support during hospitalization. Children with high nutritional risk had longer hospital stays and greater hospital costs (p<0.001). The prevalence of malnutrition is high in children with liver disease. High nutritional risk is also prevalent at admission. Albumin and prealbumin are sensitive markers for distinguishing nutritional risk groups. High nutritional risk prolongs length of stay and increases hospital costs. The nutritional support rate is still low and requires standardization.

Morbimortality associated to nutritional status and feeding path in children with cerebral palsy

Children and adolescents with cerebral palsy (CP) have a high prevalence of malnutrition associated to poor prognosis. For an adequate nutritional assessment, new growth curves (Brooks, 2011) are available, in which precise cut-off points in Weight/Age index correlate to increased morbidity and mortality rate. To evaluate risk of hospitalization and death in patients with CP, according to nutritional risk (NR). Observational and prospective cohort study of patients with CP in an outpatient referral center. We registered demographic, socioeconomic data and nutritional assessment. During a one-year follow-up, hospitalizations and mortality were recorded. The correspondent committee extended an ethical approval. 81 CP patients were recruit, age 131.6 ± 60.4 months (25-313), 60 % male, 77.5 % without independent mobility. The 23 NR patients (28.4%) had lower muscle and fat mass (p = 0.000). During the follow-up, 29/81 patients required hospitalization (35.8%) and 4/81 died (4.9%). There was not an increased risk of hospitalization and/or mortality in NR group, but both were significantly higher in gastrostomy-fed children (RR: 2,98 CI 95%: 1.32-6.75 combining both variables). In this study, children and adolescents with severe CP and nutritional risk had similar morbidity and mortality during a one-year follow-up, compared to those with acceptable nutritional status. Both risks were higher in gastrostomy-fed than the orally fed children.

Association between Functional Capacity Decline and Nutritional Status Based on the Nutrition Screening Initiative Checklist: A 2-Year Cohort Study of Japanese Community-Dwelling Elderly.

AimTo assess whether nutritional status based on the Nutrition Screening Initiative Checklist is useful for predicting functional capacity decline in community-dwelling Japanese elderly.MethodsThis two-year observational cohort study included 536 community-dwelling Japanese (65 years and older at baseline) who were independent in both activities and instrumental activities of daily living. Demographic attributes, chronic illness, lifestyle-related habits, nutritional status, functional capacity, and anthropometric measurements were assessed, with decline in functional capacity used as the outcome measure.ResultsSubjects were classified into three groups as follows based on the Nutrition Screening Initiative Checklist: low (59.5%), moderate (23.7%), and high (16.8%) nutritional risk. Significant differences were found between nutritional status and the following four baseline variables: age, hypertension, cerebrovascular diseases, and current smoking. However, no significant differences were evident between nutritional status and sex, body mass index, diabetes, drinking habit, or exercise habit. Logistic regression analysis adjusted for age, sex, body mass index, hypertension, cerebrovascular diseases and smoking habit showed that the high nutritional risk group was significantly associated with a decline in both activities of daily living (odds ratio: 4.96; 95% confidence interval (CI): 1.59–15.50) and instrumental activities of daily living (OR: 2.58; 95% CI: 1.31–5.06) compared with the low nutritional risk group.ConclusionsPoor nutritional status based on the Nutrition Screening Initiative Checklist was associated with a decline in functional capacity over a 2-year period in community-dwelling Japanese elderly. These results suggest that the Nutrition Screening Initiative Checklist is a suitable tool for predicting functional capacity decline in community-dwelling elderly.

The Geriatric Nutritional Risk Index Predicts Survival in Elderly Esophageal Squamous Cell Carcinoma Patients with Radiotherapy.

The impact of nutritional status on survival among elderly esophageal squamous cell carcinoma (ESCC) patients undergoing radiotherapy is unclear. In this study, we aimed at validating the performance of the geriatric nutritional risk index (GNRI) in predicting overall survival time in elderly ESCC patients with radiotherapy. A retrospective cohort study was conducted on 239 ESCC patients aged 60 and over admitted consecutively from January 2008 to November 2014 in the Department of Radiotherapy, Henan Tumor Hospital (Affiliated Tumor Hospital of Zhengzhou University), Zhengzhou, Henan, China. All patients were subjected to nutritional screening using GNRI, and were followed for the occurrence of lymphatic node metastasis, radiation complication and mortality. The Kaplan–Meier method with Log-rank test was used to estimate survival curves. Univariable Cox regression analysis was used to identify variables associated with overall survival time. Among the 239 patients, 184 patients (76.9%) took no nutritional risk, 32 patients (13.4%) took moderate risk of malnutrition, and 23 patients (9.7%) took a high risk of malnutrition. Univariable Cox regression showed that both high nutritional risk group and moderate nutritional risk group were significantly less likely to survive than no nutritional risk patients (hazard ratio (HR) = 1.688, 95% confidence interval (CI) = 1.019–2.798 for moderate risk group, and HR = 2.699, 95% CI = 1.512–4.819 for high risk group, respectively). The GNRI is an independent prognostic factor for overall survival time in elderly ESCC patients with radiotherapy. A GNRI ≤98 can be suggested as an indicator of surviving less.

The effect of nutritional risk and Acute Physiology and Chronic Health Evaluation II on the prognosis of critically ill patients

Objective To explore the effect of nutritional risk and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) on the prognosis of critically ill patients. Methods From January 2014 to November 2015, 138 critically ill patients were screened using Nutritional Risk Screening 2002 (NRS-2002) in intensive care unit (ICU) of our hospital. APACHEⅡ and nutritional status of the patients were measured at the same time. Patients were divided into the survival group and death group according to the prognosis, the NRS-2002, nutritional status and APACHEⅡ scores were compared between the two groups.The effect of NRS-2002 and APACHE Ⅱ on the prognosis of critically ill patients was analyzed. Results Of 138 critically ill patients, 131 cases were found nutritional risk and 82 patients survived (62.60%) ,7 cases were found without nutritional risk and 5 patients survived, There were no significant differences in survival rate of both groups(P=0.714). The APACHE Ⅱ scores in the nutritional risk group were (22.14±6.86) points, which were obviously higher than those of non-nutritional risk group (5.80±1.90)points. There were significant differences (t'=17.47,P 0.05).Logistic regression analysis showed APACHE Ⅱ, nutritional risks, RBC,HGB,ALB and CRP were all the risk factors for the prognosis of critically ill patients(P <0.01), while APACHE Ⅱ, RBC, nutritional risks and ALB were the leading influencing factors. Conclusions There exists higher nutritional risks among the critically ill patients. APACHE Ⅱ, RBC, nutritional risks and ALB should be given more attention when they are admitted in the ICU. Patients' nutritional status should be comprehensively evaluated and the prognosis of the patients should be predicted. Key words: Prognosis; Critically illness; Nutritional risk; Acute Physiology and Chronic Health EvaluationⅡ; Nutrition index

Malnutrition risk in hospitalized children: use of 3 screening tools in a large European population1–3

Several malnutrition screening tools have been advocated for use in pediatric inpatients. We evaluated how 3 popular pediatric nutrition screening tools [i.e., the Pediatric Yorkhill Malnutrition Score (PYMS), the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and the Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGKIDS)] compared with and were related to anthropometric measures, body composition, and clinical variables in patients who were admitted to tertiary hospitals across Europe. The 3 screening tools were applied in 2567 inpatients at 14 hospitals across 12 European countries. The classification of patients into different nutritional risk groups was compared between tools and related to anthropometric measures and clinical variables [e.g., length of hospital stay (LOS) and infection rates]. A similar rate of completion of the screening tools for each tool was achieved (PYMS: 86%; STAMP: 84%; and STRONGKIDS: 81%). Risk classification differed markedly by tool, with an overall agreement of 41% between tools. Children categorized as high risk (PYMS: 25%; STAMP: 23%; and STRONGKIDS: 10%) had a longer LOS than that of children at low risk (1.4, 1.4, and 1.8 d longer, respectively; P < 0.001). In high-risk patients identified with the PYMS, 22% of them had low (<-2) body mass index (BMI) SD-scores (SDSs), and 8% of them had low height-for-age SDSs. For the STAMP, the percentages were 19% and 14%, respectively, and for the STRONGKIDS, the percentages were 23% and 19%, respectively. The identification and classification of malnutrition risk varied across the pediatric tools used. A considerable portion of children with subnormal anthropometric measures were not identified with all of the tools. The data obtained do not allow recommending the use of any of these screening tools for clinical practice. This study was registered at clinicaltrials.gov as NCT01132742.

Nutritional Risk Screening 2002 used for preoperative nutritional assessment of patients with pancreatic cancer

Objective To investigate the value of the Nutritional Risk Screening 2002 (NRS2002) for preoperative nutritional assessment of patients with pancreatic cancer. Methods Ninety-one patients who had undergone surgery in the Department of General Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School from March 2012 to December 2014 were included into this study. These patients had all underwent preoperative nutritional assessment using NRS2002. According to the results of the NRS2002 evaluation, all these patients were divided into two groups, the nutritional risk group (51 patients) with a score of NRS2002≥3 and the non-nutritional risk group (40 patients) with a score of NRS2002<3. The preoperative and postoperative nutritional indicators, postoperative complications, physical state and quality of life, length of postoperative hospital stay, and medical costs were compared between the two groups. Results The anthropometric measurements in the risk group were significantly lower than that of the no risk group. These included the body mass index (22.4±1.8 vs 24.5±1.6), triceps skinfold thickness (14.6±3.7 vs 16.5±4.0)mm, mid-arm circumference (26.1±3.7 vs 28.2±4.1)cm, and midarm muscle circumference (21.5±2.5 vs 23.0±2.9)(P<0.05). Similarly, in the risk group, the preoperative and postoperative prealbumin, albumin on postoperative day 1, and transferrin on postoperative day 4 and day 7 were significantly lower than that of the no risk group. In addition, there were significant differences between the two groups in postoperative complication rates (25/51 vs 8/40), surgical site complications (22/51 vs 7/40), non-surgical site complications (11/51 vs 2/40), Karnofsky Performance Status, Zubrod-ECOG-WHO, Quality of Life, dosage of albumin, length of postoperative hospital stay, medical cost and Glasgow prognostic score. Conclusions The nutritional status of patients with pancreatic cancer would influence rehabilitation after surgery. NRS2002 effectively assessed the preoperative nutritional status of the patients with pancreatic cancer, and predicted postoperative nutritional risks. Therefore, NRS2002 is recommended as a preoperative nutritional assessment method for patients with pancreatic cancer. Key words: Nutrition Risk Screening 2002; Pancreatic cancer; Nutrition risk; Preoperative assessment

Nutritional Risk Screening 2002 as a Predictor of Postoperative Outcomes in Patients Undergoing Abdominal Surgery: A Systematic Review and Meta-Analysis of Prospective Cohort Studies.

BackgroundThe nutritional risk screening (NRS 2002) has been applied increasingly in patients who underwent abdominal surgery for nutritional risk assessment. However, the usefulness of the NRS 2002 for predicting is controversial. This meta-analysis was to examine whether a preoperative evaluation of nutritional risk by NRS 2002 provided prediction of postoperative outcomes in patients undergoing abdominal surgery.MethodsA systematic literature search for published papers was conducted using the following online databases: MEDLINE, EMBASE, the Cochrane library, EBSCO, CRD databases, Cinahl, PsycInfo and BIOSIS previews. The pooled odds ratio (OR) or weight mean difference (WMD) was calculated using a random-effect model or a fix-effect model.ResultsEleven studies with a total of 3527 patients included in this study. Postoperative overall complications were more frequent in nutritional risk patients versus patients without nutritional risk (the pooled OR 3.13 [2.51, 3.90] p<0.00001). The pooled OR of mortality for the nutritional risk group and non-nutritional risk group was 3.61 [1.38, 9.47] (p = 0.009). Furthermore, the postoperative hospital stay was significant longer in the preoperative nutritional risk group than in the nutritional normal group (WMD 5.58 [4.21, 6.95] p<0.00001).ConclusionsThe present study has demonstrated that patients at preoperative nutritional risk have increased complication rates, high mortality and prolonged hospital stay after surgery. However, NRS 2002 needs to be validated in larger samples of patients undergoing abdominal surgery by better reference method.

Correlation between nutritional status and expression of intestinal dipeptide transporter 1 protein in gastric cancer patients

Objective To study the expression of intestinal dipeptide transporter 1(PEPT1) protein in gastric cancer patients at different nutritional status, and to explore the possible regulatory mechanism. Methods According to Nutritional Risk Screening 2002 (NRS 2002) score, a total of 60 gastric cancer patients were divided into nutritional risk group (NRS 2002 score ≥ 3, n=18) and non-nutritional risk group (NRS 2002 score <3, n=42). With specimens of the small intestinal mucosa taken during operation, the expression of intestinal PEPT1 protein was detected using Western blot. The serum concentration of tumor necrosis factor (TNF-α) were measured using enzyme-linked immunosorbent assay. The expression of PEPT1 in Caco-2 cells treated with different concentrations of TNF-α (20, 50, 100 μg/L) were detected using Western blot at different time points (24, 48, 72 hours). Results The expression of intestinal PEPT1 (0.63 vs. 0.23, P=0.000) and serum TNF-α concentration (0.23 μg/L vs. 0.17 μg/L, P=0.001) in the nutritional risk group were significantly higher than those in the non-nutritional risk group. In Caco-2 cells, those treated with different concentrations of TNF-α (20, 50, 100 μg/L) for 24 hours had significantly higher PEPT1 expression than the blank group did (0.68 vs. 0.54, P=0.005; 0.72 vs. 0.54, P=0.001; 0.78 vs. 0.54, P=0.000). The Caco-2 cells treated with 50 μg/L TNF-α for 24, 48, and 72 hours had significantly higher PEPT1 expression compared with the cells in the blank group (0.57 vs. 0.52, P=0.004; 0.75 vs. 0.52, P=0.000; 0.77 vs. 0.52, P=0.000). Conclusion The expression of intestinal PEPT1 protein was increased in gastric cancer patients with nutritional risk, which was probably attributed to the regulation of TNF-α. Key words: Dipeptide transporter 1; Tumor necrosis factor; Gastric cancer; Nutritional Risk Screening 2002

Nutrition-Related Factors Predicted Pressure Ulcers in Intensive Care Unit Patients*

Purpose: The purpose of this study was to identify the nutrition-related factors influencing the prevalence of pressure ulcers among patients admitted to an intensive care unit. Methods: Research participants were 112 patients who were admitted to the ICU of a university hospital. Data were collected through questionnaires which included general characteristics, diet-related characteristics, nutritional status, and pressure ulcer status. Multivariate logistic regression was used to identify independent factors association with prevalence of pressure ulcer. Results: The prevalence of pressure ulcers was 58 patients (51.8%) at 10th day after ICU admission. In multivariate analysis, prevalence of pressure ulcers at 10th day in ICU was significantly higher in the nutritional risk group (OR=6.43), malnutrition group (OR=88.02), and deceased serum albumin group (OR=28.83). Conclusion: The results of this research indicate that scores on MNA (Mini Nutritional Assessment) and serum albumin were significant predictors of pressure ulcer prevalence in ICU patients. Therefore, regular MNA-SF and albumin checkups are needed to identify risk for pressure ulcer for ICU patients. In the case of decreased MNA-SF scores and serum albumin levels, more intensive pressure ulcer care is needed for ICU patients. 주요어: 중환자, 영양, 욕창 Key words: Intensive care unit, Nutrition, Pressure ulcer

Nutritional risk screening in patients at the gastroenterology department

Objective To study the incidence of risk of malnutrition , nutritional support rate , and the relationship between nutrition risk scores and nutrition indicators .Methods A total of 139 patients were investigated by nutrition risk screening 2002 （ NRS2002 ） .The relationships between NRS 2002 scores and nutrition indicators were analyzed .Results The incidence of risk of malnutrition （ NRS≥3 ） and nutritional support rate were 48%.37.5%patients had nutritional support .The pre-albumin was （142.56 ±68.23） mg/L in nutritional risk group, that was less than the risk-free group with （208.45 ±59.65）mg/L, the difference was statistically significant （t=23.95,P〈0.05）.The results of nutritional risk assessment and the pre-albumin, albumin, hemoglobin was negatively correlated （r=-0.882, -0.713,-0.689, respectively;P〈0.05）. Conclusions Screening for new patients is helpful to learn the nutritional status of the patients .The method is easy to operate.NRS2002 has many advantages and should be widely used to predict the nutrition risks of digestive patients . Key words: Nutritional support; Nutritional risk screening; Gastroenterology department

Novel simple and practical nutritional screening tool for cancer inpatients: a pilot study

There is lack of consensus on how nutritional screening and intervention should be provided to cancer patients. Nutritional screening and support of cancer patients are not well established in the Middle East. We report our systematic and practical experience led by a qualified specialist dietician in a cancer inpatient setting, using a novel nutritional screening tool. Ninety-seven consecutive inpatients underwent nutritional screening and categorised into three nutritional risk groups based on oral intake, gastrointestinal symptoms, body mass index (BMI) and weight loss. Nutritional support was introduced accordingly. Statistical tests used included ANOVA, Bonferroni post hoc, chi-square and log rank tests. Median age was 48 (19-87)years. Patients were categorised into three nutritional risk groups: 55 % low, 37 % intermediate and 8 % high. Nutritional intervention was introduced for 36 % of these patients. Individually, weight, BMI, oral intake, serum albumin on admission and weight loss significantly affected nutritional risk and nutritional intervention (all significant P values). Eighty-seven, 60 and 55 % of patients admitted for chemotherapy, febrile neutropenia and other reasons, respectively, did not require specific nutritional intervention. There was a statistically significant relationship between nutritional risk and nutritional intervention (P=0.005). Significantly more patients were alive at 3 months in low (91 %) than intermediate (75 %) than high (37 %)-risk groups. About a third of cancer inpatients require nutritional intervention. The adopted nutritional risk assessment tool is simple and practical. The validity of this tool is supported by its significant relation with known individual nutritional risk factors. This should be confirmed in larger prospective study and comparing this new tool with other established ones.

Early Detection of Coagulation Abnormalities in Patients at Nutritional Risk: The Novel Role of Thromboelastography

It is believed that malnutrition is common among hospitalized patients and associated with increased risk of morbidity and mortality. It is unclear if it is more likely to cause coagulation disorders in patients with malnutrition. We, therefore, investigate the feasibility of using thromboelastography (TEG) in early detection of coagulation abnormalities in patients at nutritional risk. Fifty successive adult patients with gastrointestinal disease were prospectively divided into one of two groups according to nutritional risk score (less than 3 and 3 or greater). Blood samples were collected at admission for analysis of standard biochemical parameters, routine coagulation tests, and TEG parameters. A total of 62 per cent of patients (n = 31) were at nutritional risk. Serum concentrations of prealbumin, transferrin, total protein, low-density lipoprotein, high-density lipoprotein, and cholesterol were much lower in the nutritional risk group than in the no-risk group (P ≤ 0.05). There was no significant difference in routine coagulation tests, whereas most of the TEG parameters showed significant differences between the two groups. The overall coagulation function was worse in patients at nutritional risk than in patients with good nutritional status (P ≤ 0.01). TEG appears to be more sensitive for the detection of coagulation abnormalities compared with routine coagulation tests in patients at nutritional risk. The phenomenon described in this article should be useful in further studies of patients with malnutrition.

Effect of preoperative nutritional risk to postoperative nutritional status of elderly rectal cancer patients

Objective To investigate the effect of nutritional risk to nutritional status of peroperative elderly rectal cancer patients.Methods 85 elderly patients with rectal cancer were screened for preoperative nutritional status by NRS-2002 and divided into nutritional risk group and non-nutritional risk group.ALB,PALB,TLC and TFN of two groups were measured 1day before operation,1day and 7 days after operation.The values were compared between two groups.Results Before operation,25 patients out of 85 were at nutritional risk with NRS-2002≥3 and incidence of nutritional risk of 29.4％.The PALB value of the nutritional risk group was significantly lower than that of the non-nutritional risk group 1day after operation [(12.4±37)mg/L vs ( 14.3 ± 3.9 ) mg/L ;t =2.026,P＜0.05].After 7 days,the average levels of all indexes of the nutritional risk group were lower than those of the non-nutritional risk group.Among those,differences of ALB and TFN values between two groups were significant ( t =2.412,2.153,respectively; P ＜ 0.05 ).Conclusions Perioperative nutritional status of elderly rectal cancer patients at nutritional risk changes conspicuously and should be given relevant nutritional guidance by nurses. Key words: Elderly patients; Rectal cancer; Nutritional risk screening; Nutritional status

A clinical audit of the nutritional status and need for nutrition support amongst head and neck cancer patients treated with radiotherapy.

Radiotherapy is an effective treatment for head and neck cancers but patients often experience side effects which lead to weight loss. Nutrition intervention in the form of counselling or oral nutrition support (ONS) is frequently needed for these patients. For some patients, tube feeding is required to minimise weight loss during treatment. Data was collected on 48 patients who received radiotherapy to the head and neck region over a nine-month period (June 2009-March 2010). Retrospective data collection was commenced in July 2010. Each patient's Diet Therapy Department record was reviewed. Main outcome measures were: 1) type of nutrition support; 2) percentage weight change during treatment; and 3) Patient-Generated Subjective Global Assessment Global (PG-SGA) rating. On initial assessment 28 (77.8%) patients were classified as well nourished using the PG-SGA. Mean weight loss during radiotherapy was 5.74%. Risk factors for the need for ONS and enteral nutrition support (ENS) were older age, presence of nutrition impact symptoms, high-risk tumour sites, advanced disease and chemotherapy. No significant difference was shown in weight loss between ONS and ENS groups. This study identified the need for early dietetic intervention for high nutritional risk groups of head and neck cancer patients to prevent significant weight loss. Pre-treatment nutritional status did not influence weight loss during treatment. ONS alone cannot prevent significant weight loss in patients with multiple nutrition impact symptoms. Early enteral feeding should be considered in this group of patients.

Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS 2002 and its relationship with postoperative results

To evaluate the nutritional risk of patients with gastric carcinoma using the methodologies of European Nutritional Risk Screening 2002 (NRS 2002) and its relationship with postoperative results. We prospectively evaluated the nutritional risk of 314 cases of gastric carcinoma patients in one center from 2004 to 2007 with NRS 2002, in accordance with China's normal body mass index (BMI), and observed its relationship with postoperative complications, mortality and length of hospital stay. Of 337 cases, 314 (93.1%) were suitable for assessment by NRS 2002.The number of patients with a score > or = 3 was 125 before operation, comprising 39.8% of patients with gastric carcinoma. The rate of complications (26.2%) of the preoperative nutritional risk group (NRS 2002 score > or = 3) was higher than those in the preoperative nutritional normal group (NRS 2002 score < 3) (P < 0.05). Assessed by multivariate logistics regression analysis, the odds ratio of developing complications was 2.366 (P < 0.05) and 2.277 (P < 0.05) by NRS 2002 score and clinicopathological stage, respectively. The correlation between length of hospital stay and nutritional risk was also assessed by Pearson correlation analysis. The Pearson coefficient was 0.177 (P = 0.002). Preoperative nutrition score (NRS 2002) > or = 3 predicted more postoperative complications and longer length of hospital stay. It indicated that preoperative nutritional support was necessary in patients with a preoperative nutritional score (NRS 2002) > or = 3.