Nutritional Risk Screening Research Articles

Global Leadership Initiative on Malnutrition-defined malnutrition coexisting with visceral adiposity predicted worse long-term all-cause mortality among inpatients with decompensated cirrhosis

Background/objectivesMalnutrition coexisting with abdominal adipose tissue accumulation bring a double burden on prognosis. More recently, the Global Leadership Initiative on Malnutrition (GLIM) has reached a novel consensus concerning the diagnostic criteria, that is, a two-step modality combining nutritional risk screening and subsequent phenotypic/etiologic parameters for comprehensive evaluation in hopes of harmonizing the malnutrition diagnosis. We aimed to elucidate their synergistic impact among inpatients with decompensated cirrhosis concerning long-term mortality.Subjects/methodsMalnutrition, visceral obesity, and visceral adiposity were defined by the Global Leadership Initiative on Malnutrition (GLIM), visceral fat area (VFA), and visceral to subcutaneous adipose tissue area ratio (VSR) on computed tomography, respectively. Accordingly, the patients were categorized into different groups given their nutritional status and visceral obesity/adiposity. Multivariate Cox regression was performed to identify independent risk factors associated with 1-year all-cause mortality. Kaplan–Meier curves with log-rank tests were compared among distinct groups.ResultsTotally, 295 patients were recruited. GLIM, VFA, and VSR identified 131 (44.4%), 158 (53.6%), and 59 (20%) patients with malnutrition, visceral obesity and visceral adiposity, respectively. Malnutrition coexisted with visceral obesity in 55 (MO group) relative to visceral adiposity in 40 patients (MA group). Multivariate Cox analysis showed that MA (hazard ratio: 2.48; 95% confidence interval: 1.06, 5.79; P = 0.036) was independently associated with dire outcome rather than MO. Moreover, patients with cirrhosis in the MA group had the worst survival status when compared with other groups (log-rank test: P < 0.001).ConclusionsThe current study indicated that coexisting GLIM-defined malnutrition and VSR-defined visceral adiposity were in relation to worse long-term mortality among inpatients. It is imperative to delicately manage nutritional status and provide personalized treatment in this vulnerable subgroup for achieving better prognosis.

Identifying correlations between nutritional impact symptoms and risk factors for malnutrition in adult cancer patients with solid tumors: a cross-sectional study from a developing country.

Many cancer patients experience malnutrition, which can worsen their health and survival outcomes. However, limited research exists in our region on how common malnutrition is among hospitalized adults with solid tumors and what factors contribute to it. This study aimed to identify these factors and assess the effects of nutritional impact symptoms (NISs) caused by solid tumors on patients' nutritional status. Between July 2022 and February 2023, a cross-sectional study was carried out on the campuses of two major cancer treatment centers located in a national university hospital and a governmental hospital. Twelve NISs were adopted from the Patient-Generated Subjective Global Assessments (PG-SGA). The Nutrition Risk Screening 2002 (NRS-2002) instrument was used to thoroughly assess the risk of malnutrition. Multiple linear regressions were used to conduct a thorough study. A cohort of 294 participants was included. The prevalence of malnutrition risk (NRS score ≥ 3) was 26.9%. Parameters such as age, gender, marital status, educational level, monthly income, type of cancer and treatment modality, and the need for mealtime assistance exhibited statistically significant associations with malnutrition (p < 0.05). The results revealed a substantial inverse correlation between fluid intake and the NRS-2002 score (p < 0.001). Furthermore, symptoms related to solid tumors and their treatment, including chewing difficulties, fatigue, dry mouth, anorexia, constipation, nausea, dizziness, and a sensation of fullness, were also significantly associated with malnutrition (p < 0.05). Additional insights from the regression analysis underscored the independent correlation between the risk of malnutrition in solid malignant malignancies and factors such as anorexia (p < 0.001), colorectal cancer (p = 0.003), gender (p = 0.018), educational attainment (p = 0.049), and the need for mealtime assistance among patients (p < 0.001). Malnutrition is a major issue among adult cancer patients, particularly those with solid tumors. Anorexia, colorectal cancer, gender, educational attainment, and the need for mealtime assistance were identified as factors that led to malnutrition in our research. This study emphasizes the need for a multidisciplinary plan of care to diagnose and treat malnutrition, improve overall therapy, and reduce mortality and morbidity.

Formulation of the Best Practice Evidence-Based Nutrition Management Protocol for Nasopharyngeal Carcinoma Patients Undergoing Chemoradiotherapy

To formulate a nutrition management protocol and processes for nasopharyngeal carcinoma patients undergoing chemoradiotherapy. A nutrition management protocol and the process for nasopharyngeal carcinoma patients undergoing chemoradiotherapy were formulated on the basis of literature review and the Delphi expert consensus method. Literature analysis and two rounds of Delphi expert consultations via correspondence were conducted. The final protocol subsequently derived included 7 first-level items and 36 second-level items. The first-level items included the establishment of a nutrition management team, nutritional risk screening and nutritional status assessment, health education, the timing and method of nutritional treatment, energy and nutrient supply, nutritional monitoring, and follow-up after discharge. After summarizing the best evidence for the nutritional management protocol and classifying the evidence by different grades, the construction process of the nutrition management team and the nutrition management processes for the pre-cancer treatment period, the tumor treatment period, and the post-discharge follow-up period were formulated. The nutritional management protocol and the relevant processes for nasopharyngeal carcinoma patients undergoing chemoradiotherapy formulated in this study demonstrate a certain level of scientific validity and reliability and can be further tested and applied in clinical practice.

To explore the postoperative nutritional status and factors influencing prognosis in patients with chronic constipation complicated by malnutrition.

Many patients with constipation also suffer from varying degrees of malnutrition, and the relationship between the two conditions is a vicious cycle. Surgery is the final step in the treatment of constipation, with a success rate of up to 95%. This study aims to investigate the effects of surgical treatment on the nutritional status of patients with chronic constipation and malnutrition. A total of 60 patients with chronic constipation and various degrees of malnutrition who underwent surgery in our department from January 2020 to March 2023 were included in this study. Biochemical tests including BMI, albumin, total protein, hemoglobin, cholesterol and lymphocyte count were conducted, as well as measurements of inflammatory markers such as Interleukin-6 (IL-6), Interleukin-8 (IL-8), and C-reactive protein (CRP). Additionally, multiple nutritional risk screening scales (NRS2002, MUST, NRI, and MNA) and the prognostic nutritional index (PNI) were used to assess the nutritional status of patients before surgery, as well as at 1 month, 3 months, and 6 months post-surgery. Finally, we analyzed the factors influencing postoperative recovery outcomes in patients. Compared to pre-operation, the BMI of patients significantly increased at 1 month, 3 months, and 6 months after the operation, with statistically significant differences (p < 0.001). Multiple nutritional risk assessment tools (NRS2002, MUST, NRI, and MNA), as well as the prognostic nutritional index (NPI), indicated a reduction in nutritional risk and improvement in nutritional status at 1, 3, and 6 months post-surgery, compared to pre-surgery levels (p < 0.001). The levels of albumin, total protein, and hemoglobin in patients at 1, 3, and 6 months after the surgery were significantly higher than those before the surgery (p < 0.001). However, there was no significant change in the number of lymphocytes. Inflammatory markers such as IL-6, IL-8, and CRP exhibited a significant decrease after the surgery, reaching normal levels at 6 months post-surgery (p < 0.001). Low BMI, low PNI, and low cholesterol levels are independent risk factors for patient prognosis (p < 0.05). Surgical treatment can enhance the nutritional status of constipation patients with malnutrition, which in turn promotes the restoration of intestinal motility. The patient's nutritional status will impact the postoperative recovery outcomes.

CN40 Nutritional risk screening (NRS 2002), Prognostic nutritional index (PNI) and Controlling nutritional status (CONUT) in patients with digestive cancer: An observational study

CN40 Nutritional risk screening (NRS 2002), Prognostic nutritional index (PNI) and Controlling nutritional status (CONUT) in patients with digestive cancer: An observational study

Investigation of situation for development of infection, nutritional and length of hospital stay in elderly hospitalized in a palliative clinic

Aim: In our study, we aimed to evaluate patients' nutritional status, compare frequently used nutritional scales with each other and with the duration of hospitalization, and measure the effect of nutritional status on infection and mortality who are in the elderly. Materials and Methods: Nutritional Risk Screening-2002, Mini Nutritional Assessment, and Geriatric Nutritional Risk Index were used. Patients were monitored for infection and mortality throughout the hospitalization period. Results: The prevalence of malnutrition was found 98.6% with Mini Nutritional Assessment, 97.3% with Nutritional Risk Screening-2002, and 87.1% with Geriatric Nutritional Risk Index. A high correlation was found between the Geriatric Nutritional Risk Index and albumin, body mass index, arm, and calf circumference. Conclusion: The malnutrition rate is quite high in patients who need palliative care. The Geriatric Nutritional Risk Index, compared to Nutritional Risk Screening-2002 and Mini Nutritional Assessment, is an effective and user-friendly scale that contains objective variables in bed-dependent patients for nutrition.

Evaluation of nutritional status (Nutritional Risk Screening-2002) of hospitalized inpatients and comparison with various variables

Aim: This study aimed to evaluate the nutritional status of hospitalized patients according to Nutritional Risk Screening-2002 (NRS-2002) and to examine the effects of various variables on nutritional status. Methods: The sample of the cross-sectional study consisted of 469 inpatients reached by simple random sampling method. Data was collected from hospitalized patients with a survey form using face-to-face interview method between January and March 2024. Personal information and hospital stay characteristics form, NRS-2002 form was used in the survey used to collect data. Results: The average age of the patients included in the study was found to be 59.8±18.1 years. Of the patients, 51.4% were male and 48.6% were female. According to the total NRS-2002 score result, 410 (87.3%) of the patients were classified as no risk of malnutrition and 59 (12.6%) were classified as risk of malnutrition. No statistically significant difference was found between patients’ malnutrition risk and gender, education level, hospital diets, hospital clinics (p&amp;gt;0.05). However, a statistically significant difference was found between the malnutrition risk of the patients and their age, body mass index (BMI) and length of hospital stay (p&amp;lt;0.05). Conclusion: Nutrition screening tools should be applied more frequently to these patients, especially since the risk of malnutrition is higher in patients who are elderly, have a long hospital stay, and have a low BMI.

GLIM-defined malnutrition in patients with acute abdomen associated with poor prognosis and increased economic burden: A cross-sectional study.

The Global Leadership Initiative on Malnutrition (GLIM) criteria have rapidly developed into a principal methodological framework for nutrition diagnosis. However, the applicability of the GLIM criteria in patients with acute abdomen has not been validated. This is a cross-sectional study conducted on patients diagnosed with acute abdomen and admitted to a tertiary hospital in southwest China. Nutrition risk screening was conducted using the Nutrition Risk Screening 2002, and patients identified with nutrition risk were assessed for malnutrition based on the GLIM criteria. We enrolled a total of 440 patients with acute abdomen. The top three diagnoses of acute abdomen were intestinal obstruction (47.2%), acute appendicitis (23.1%), and digestive system perforation (8.8%). The prevalence of nutrition risk was 46.5%, with a malnutrition rate of 32.5% based on the GLIM. Patients with malnutrition according to the GLIM showed significantly higher rates of intensive care unit (ICU) admission (13.28% vs 7.07%; P = 0.003), increased hospitalization costs (median: 3315USD [interquartile range (IQR): 978-7852] vs 1641 [IQR: 816-3523] USD; P < 0.001), and longer length of hospital stay (LOS) (median: 8 [IQR: 5-13] vs 6 [IQR: 4-8] days; P < 0.001) compared with patients without malnutrition. Multivariate analysis indicated that GLIM-defined malnutrition was an independent predictor of hospitalization costs, and severe malnutrition was an independent predictor of ICU admission. GLIM criteria are applicable for diagnosing malnutrition in patients with acute abdomen. The prevalence of malnutrition was high in patients with acute abdomen. Malnutrition was associated with increased ICU admission and LOS, along with higher economic burden.

Comparison of prognosis of elderly patients with gastric and colorectal tumors receiving different nutritional support treatments

Objective: To compare the prognosis of elderly patients with gastric and colorectal cancer treated with different nutritional support methods. Methods: Elderly patients with gastrointestinal tumors who received surgical treatment in Beijing Hospital from January 2019 to June 2020 were retrospectively included and divided into malnourished group and non-malnourished group according to the Global Leadership Initiative on Malnutrition (GLIM). The patients were divided into parenteral nutrition (PN) group, enteral nutrition (EN) group and enteral+parenteral nutrition (EN+PN) group according to the nutritional support. The prognosis of patients with different nutritional support treatment was compared. Results: A total of 426 elderly patients with gastric and colorectal tumors underwent surgical treatment were included, including 287 males and 139 females, aged 65-91 (72±6) years. There were 186 cases in malnourished group and 240 cases in non-malnourished group. A total of 257 patients received nutritional support therapy, including 108 cases in PN group, 48 cases in EN group and 101 cases in EN+PN group. The body mass index (BMI) of malnutrition group was lower than that of non-malnutrition group [(20.5±3.4) vs (23.7±2.8) kg/m2, P<0.001], and the score of nutritional risk screening 2002 (NRS 2002) [M (Q1, Q3)] was higher than that of non-malnutrition group [4 (4, 5) vs 2 (2, 3) points, P<0.001]. The total hospitalization time of patients in EN group was shorter than that in PN group and EN+PN group [(11.9±4.0) vs (16.5±6.5) and (19.2±7.1) d, all P<0.001]. The total hospitalization time in PN group was shorter than that in EN+PN group [(16.5±6.5) vs (19.2±7.1) d, P=0.005]. The total incidence of complications in EN group was lower than that in PN group [0 vs 9.3% (10/108), P=0.030] and EN+PN group [0 vs 19.8% (20/101), P<0.001]. The incidence of total complications in PN group was lower than that in EN+PN group [9.3% (10/108) vs 19.8% (20/101), P=0.030]. Conclusion: Among the three nutritional supportive treatment modalities: EN, PN, and EN+PN, patients receiving EN support treatment have a shorter total hospitalization time and a lower complication rate.

Malnutrition Risk Factors and Clinical Outcomes in Gynecology and Obstetric Patients

Aim: Nutrition was a prerequisite for a healthy life, a basic human need, and a fundamental human right. The aim of this descriptive study is to examine the risk factors for malnutrition in obstetrics and gynecology patients and the relationship between malnutrition and clinical outcomes. Subjects and Method: The research was carried out in a Gynecology and Obstetrics Branch Hospital between 30.10.2018 and 01.06.2022. The research sample consisted of patients who were assessed for malnutrition risk using the Nutritional Risk Screening-2002 (NRS-2002) form during the specified dates and had severe risk of malnutrition in all of the patients (risk score of ≥3, case group, n=82). An equal number of patients with mild/moderate malnutrition risk (score=1 and 2) and patients without risk were randomly selected using a computerized randomization process. General health, obstetric, admission characteristics, and laboratory findings were compared between the groups. A statistical significance level of p&lt;0.05 was accepted. Results: According to NRS-2002, the mean malnutrition risk score scores were 0.64±0.8 in the mild/moderate malnutrition risk group and 3.71±0.90 in the severe malnutrition risk group. The median age and body mass index of the group with a severe risk were higher and lower, respectively (p&lt;0.05). The median length of hospital stay, weight loss, occurrence of surgical procedures, presence of infection, and presence of an oncological diagnosis were significantly higher in the group with a severe risk of malnutrition group compared to the other groups (p&lt;0.05). Conclusion: When evaluating women for malnutrition, care should be taken in case of age, length of hospital stay, weight loss, surgical procedure, presence of infection and oncological diagnosis. In case of impaired laboratory findings and normal body mass index value, it is important not to ignore the evaluation and to perform a comprehensive evaluation.

Updated systematic review and meta‑analysis for risk predictors of 30‑day unplanned readmission following gastric cancer surgery.

Readmission to hospital is a common occurrence due to adverse post-operative events. The primary objective of the present study was to examine the possible risk predictors for 30-day unplanned readmissions after the surgical treatment of gastric cancer. The secondary aim was to determine the clinical characteristics that are associated with readmission. Studies that reported the risk factors and clinical characteristics of patients with gastric cancer who had an unplanned 30-day post-operative readmission were identified systematically from PubMed, Cochrane Central Register of Controlled Trials, Web of Science and Embase databases, with a final search date of March 30, 2024. A systematic review and meta-analysis were then performed to estimate the risk predictors and relevant clinical characteristics for readmission. A total of 16,154 patients from 12 studies were included in the present study, with 1,736 patients who were readmitted and 14,418 patients who were not readmitted. A higher proportion of patients with an age ≥70 years, cardiovascular comorbidity, Nutritional Risk Screening (NRS) 2002 score ≥3, respiratory diseases, male sex, American Society of Anesthesiologists score ≥3, combined multi-organ resection, greater depth of invasion (T3-4/T1-2), discharge to home with provision of care services, neoadjuvant therapy, post-operative complications or a blood transfusion were found in the readmission group compared with that in the non-readmission group. A meta-analysis was also performed to calculate risk predictors using the results of multivariate regression analyses from the original literature. This identified cardiovascular comorbidity, NRS 2002 score ≥3, pancreatectomy and post-operative complications as risk predictors for 30-day unplanned readmission following surgery for gastric cancer. Therefore, it is recommended that extra attention and support should be given to patients with these high-risk predictors during the perioperative period.

Applicability of Global Leadership Initiative on Malnutrition (GLIM) criteria in nutrition risk screening for patients over 60 years old with digestive system tumors – A retrospective study

ObjectiveThis study aimed to identify the most effective nutritional risk screening tool for elderly patients with digestive system tumors. MethodsNutritional risk screening was performed using Nutritional Risk Screening 2002 (NRS2002), prognostic nutritional index (PNI) and Geriatric Nutritional Risk Index (GNRI) for elderly patients who underwent surgical resection of digestive tumor. Comparative analysis of each nutritional screening tool was conducted through Kappa test and ROC curve. ResultsMalnourished individuals diagnosed by the Global Leadership Initiative on Malnutrition (GLIM) criteria had lower levels of hematological parameters (serum albumin, pre-albumin, total protein and hemoglobin) and poorer body composition parameters (body mass index, body fat percentage, edema index, upper arm muscle circumference, skeletal muscle index, and phase angle; P<0.05). NRS2002 demonstrated a sensitivity of 75.56% and specificity of 38.16% under the GLIM criteria, showing moderate agreement (Kappa=0.346, P<0.001). PNI had an average sensitivity of 71.11% and the highest specificity at 87.23%, but exhibited no consistency with GLIM (Kappa=0.152, P=0.062). GNRI showed the highest sensitivity at 91.11% and general specificity at 37.14%, aligning closely with GLIM criteria (Kappa=0.711, P<0.001). GNRI had the highest predictive value (AUC=0.870, 95% CI: 0.801–0.939), followed by NRS2002 (AUC=0.687, 95% CI: 0.589–0.785). Patients diagnosed with malnutrition via GNRI-GLIM exhibited higher rates of surgical site infection (χ2=15.534, P<0.001) and 3-month readmission (χ2=4.499, P=0.034). ConclusionGNRI and NRS2002 demonstrate good performance as GLIM criteria for nutritional screening in elderly patients with digestive tumors, with GNRI being potentially more suitable. Moreover, GNRI-GLIM can predict short-term prognosis in these patients.

Determination of the effectiveness of the three-minute nutrition screening (3-MinNS) tool in adult patients hospitalized in a cardiology clinic.

To determine the efficacy of the 3-Minute Nutrition Screening (3-MinNS) tool in adults hospitalized for cardiovascular diseases. In this descriptive cross-sectional study of 759 cardiovascular disease patients in Erciyes University Cardiology Clinic, anthropometric measurements and some routine biochemical parameters were recorded, and nutrition screening tools were used to determine malnutrition status. The power of 3-MinNS to detect malnutrition in cardiovascular diseases patients was calculated. There was a strong positive correlation between 3-MinNS and Nutrition Risk Screening-2002 (NRS-2002) (r=0.719, p<0.001). A moderate agreement was found between 3-MinNS and NRS-2002 (κ=0.496, p<0.001). The sensitivity, specificity, and AUC of 3-MinNS were 79.1%, 75.0%, and 0.851, respectively, and it was determined to be a moderately effective nutrition screening tool that can be used to identify malnutrition in patients with cardiovascular diseases. The 3-MinNS is a moderately effective nutrition screening tool that can be administered within the first 24 hours of hospitalization in patients with cardiovascular diseases.

Validation of the Global Leadership Initiative on Malnutrition Criteria for Predicting Adverse Outcomes in Acute Pancreatitis.

The Global Leadership Initiative on Malnutrition (GLIM) has proposed criteria for the diagnosis of malnutrition. No studies validated the GLIM criteria in acute pancreatitis (AP). The present study aimed to validate the predictive capacity of GLIM criteria for adverse outcomes in AP patients. Clinical data of 269 patients with AP were analyzed retrospectively. The Nutritional Risk Screening 2002 (NRS2002) was chosen as the screening tool. Multivariate logistic regression analyses evaluated the adverse clinical outcomes in malnourished patients. Overall, 160 patients (59.5%) were at nutritional risk and 38 (14.1%) were malnourished. Reduced muscle mass/ low bodymassindex + inflammation combinations contributed most to malnutrition overall and in each subgroup. The malnourished group had lower hemoglobin, neutrophils, albumin, total cholesterol, and triglycerides than the well-nourished group. The malnourished group had higher hospitalization costs (CNY, 11319.34 vs 9258.22, p <0.001) and more local complications (34.2% vs 14.7%, p =0.009) than the well-nourished group. There was an interaction between malnutrition and overweight/obesity on local complications (p for interaction = 0.023). Multivariate logistic regression showed malnutrition was significantly associated with local complications (OR 12.2, 95% CI: 2.51-59.37), infectious complications (OR 9.95, 95% CI: 1.25-79.44) and composite adverse outcome (OR 4.78, 95% CI: 1.05-21.73) in the overweight/obesity subgroup. There was no association between malnutrition and the rate of various adverse outcomes in the non-overweight/obesity subgroup. Additionally, we observed an association between malnutrition and composite adverse outcome (OR 6.75, 95% CI: 1.49-30.68) in patients <70 years only in females. Malnourished AP patients were more likely to have adverse outcomes than well-nourished patients. Malnutrition was associated with various adverse outcomes only in the overweight/obesity subgroups.

GLIM criteria validation and reliability in critically ill patients with cancer: A prospective study.

The present study aims to assess the interrater reliability of the Global Leadership Initiative on Malnutrition (GLIM) criteria, a framework to provide a consensus diagnosis of malnutrition. We also aimed to investigate its concurrent and predictive validity in the context of patients with cancer admitted to the intensive care unit (ICU). Individuals aged ≥19 years with cancer who were admitted to the ICU within 48 h of their initial hospital admission were included. Nutrition status was assessed with the Nutritional Risk Screening 2002, the Subjective Global Assessment (SGA), and the GLIM criteria. Interrater reliability was assessed by the kappa test (>0.80). The SGA served as the established benchmark for assessing concurrent validity. To evaluate predictive validity, the occurrence of mortality within 30 days was the outcome, and Cox regression models were applied. A total of 212 patients were included: 66.9% were at nutrition risk, and 45.8% were malnourished according to the SGA. According to the GLIM criteria, 68.4% and 66% were identified as malnourished by evaluators 1 and 2, respectively (κ = 0.947; P < 0.001). The GLIM combination incorporating weight loss and the presence of inflammation exhibited sensitivity (82.4%) and specificity (92%). In the multivariate Cox regression models, most GLIM combinations emerged as independent predictors of complications. The GLIM criteria demonstrated satisfactory interrater reliability, and the combination involving weight loss and the presence of inflammation exhibited noteworthy sensitivity and specificity. Most GLIM combinations emerged as independent predictors of 30-day mortality.

Summary of the best evidence for nutritional support programs in nasopharyngeal carcinoma patients undergoing radiotherapy.

To evaluate and summarize the best evidence for nutritional support in patients receiving radiotherapy for nasopharyngeal carcinoma and to offer guidance for clinical practice. Patients with nasopharyngeal carcinoma undergoing radiotherapy often experience a high prevalence of malnutrition, and there is a lack of compiled guideline recommendations, which complicates the provision of a reference for clinical nursing. A systematic literature search revealed the best evidence of nutritional support for nasopharyngeal carcinoma patients undergoing radiotherapy. Included in the review were various types of literature, such as clinical guidelines, expert consensus, systematic evaluations, meta-analyses, evidence summaries, and original studies. The evidence was graded according to the Australian Joanna Briggs Institute Centre for Evidence-Based Health Care Evidence Pre-Grading System (2016 version). Data were gathered from a range of sources, including BMJ Best Practice, the Scottish Intercollegiate Guidelines Network, the Cochrane Library, Embase, PubMed, Web of Science, CINAL, CNKI, the WanFang database, SinoMed, the Yi Maitong Guidelines Network, Dingxiangyuan, the Chinese Nutrition Society, the European Society for Clinical Nutrition and Metabolism website, and the American Society for Parenteral and Enteral Nutrition website. The search spanned from January 2013 to 2023. A comprehensive review identified a total of 3,207 articles, comprising six guidelines, eight expert consensus articles, four systematic evaluations, five randomized controlled trials, two cohort trials, and two observational studies. From these articles, we synthesized 63 pieces of evidence spanning six domains: nutritional risk screening and assessment, nutrient requirements, nutritional support, management of nutritional symptoms, functional exercise, and nutritional monitoring and follow-up. A total of lines of evidence supporting nutritional support for nasopharyngeal carcinoma patients receiving radiotherapy were summarized. However, the evidence should be combined with the actual clinical situation, and it should be validated in the future by combining large-sample and multicenter studies to provide a more scientific and beneficial nutritional support program for nasopharyngeal carcinoma patients receiving radiotherapy.

A Novel Machine-Learning Algorithm to Predict the Early Termination of Nutrition Support Team Follow-Up in Hospitalized Adults: A Retrospective Cohort Study.

For hospitalized adults, it is important to initiate the early reintroduction of oral food in accordance with nutrition support team guidelines. The aim of this study was to develop and validate a machine learning-based algorithm that predicts the early termination of medical nutritional therapy (the transition to oral feeding). This retrospective cohort study included consecutive adult patients admitted to the Hacettepe hospital (from 1 January 2018 to 31 December 2022). The outcome of the study was the prediction of an early transition to adequate oral feeding before discharge. The dataset was randomly (70/30) divided into training and test datasets. We used six ML algorithms with multiple features to construct prediction models. ML model performance was measured according to the accuracy, area under the receiver operating characteristic curve, and F1 score. We used the Boruta Method to determine the important features and interpret the selected features. A total of 2298 adult inpatients who were followed by a nutrition support team for medical nutritional therapy were included. Patients received parenteral nutrition (1471/2298, 64.01%), enteral nutrition (717/2298, 31.2%), or supplemental parenteral nutrition (110/2298, 4.79%). The median (interquartile range) Nutritional Risk Screening (NRS-2002) score was 5 (1). Six prediction algorithms were used, and the artificial neural network and elastic net models achieved the greatest area under the ROC in all outcomes (AUC = 0.770). Ranked by z-value, the 10 most important features in predicting an early transition to oral feeding in the artificial neural network and elastic net algorithms were parenteral nutrition, surgical wards, surgical outcomes, enteral nutrition, age, supplemental parenteral nutrition, digestive system diseases, gastrointestinal complications, NRS-2002, and impaired consciousness. We developed machine learning models for the prediction of an early transition to oral feeding before discharge. Overall, there was no discernible superiority among the models. Nevertheless, the artificial neural network and elastic net methods provided the highest AUC values. Since the machine learning model is interpretable, it can enable clinicians to better comprehend the features underlying the outcomes. Our study could support personalized treatment and nutritional follow-up strategies in clinical decision making for the prediction of an early transition to oral feeding in hospitalized adult patients.

Jejunostomy feeding plus oral feeding versus intravenous nutrition plus oral feeding after esophageal cancer resection: a comparative retrospective cohort study.

There are multiple choices for the nutritional management mode after esophageal cancer surgery. Currently, there is still controversy regarding which nutritional management mode has an impact on the postoperative recovery and overall survival (OS) of patients. This study aims to compare the differences between two commonly used clinical nutritional management modes: jejunostomy feeding plus oral intake (JF plus OI) and intravenous nutrition plus oral intake (IN plus OI), in terms of short-term efficacy and 3-year OS, in order to further explore the optimal mode of enteral nutrition management after esophageal cancer surgery. We evaluated esophageal cancer patients who underwent radical surgery at Union Hospital of Fujian Medical University between January 1, 2010 and January 1, 2020. The purpose of this analysis was to compare the perioperative complications, Nutritional Risk Screening 2002 (NRS2002) nutritional scores at 1 week, 2 weeks, 1 month, and 3 months after surgery, as well as the 3-year OS rates, between two different nutritional management approaches: JF plus OI and IN plus OI following esophageal cancer surgery. Among the 822 patients included, 668 and 154 patients belonged to JF plus OI and IN plus OI groups, respectively. After propensity score matching, 149 patients per group were evaluated. The amount of gastric drainage fluid was higher in the IN plus OI group (P<0.05), and the incidence of postoperative gastrointestinal emptying disorder and intestinal obstruction was significantly higher in the JF plus OI group (P<0.05). The IN plus OI group had a higher incidence of perioperative hypoproteinemia (P<0.05), and a higher risk of malnutrition in 2 weeks after surgery (P<0.05). The 3-year OS was not significantly different (P>0.05). JF plus OI may be the preferable nutritional management approach after esophageal cancer resection as it can potentially reduce perioperative nutritional deficiency. However, attention should be paid to the risk of gastrointestinal emptying and intestinal obstruction associated with JF.

Weak association between urea-creatinine ratio and c-reactive protein with nutritional risk in hospitalized patients with COVID-19: A cross-sectional study

BackgroundCOVID-19 is a systemic infection with a significant impact on nutrition risk and the hematopoietic system. The neutrophil-lymphocyte ratio (NLR) may have prognostic value in determining severe cases of COVID-19 and the urea-creatinine ratio (UCR) is currently being studied as a potential biomarker of catabolism associated with critical illness. The aim was to assess the association between the NLR, UCR and C-reactive protein (CRP) with nutritional risk in hospitalized patients with COVID-19. MethodsThis is a retrospective cross-sectional study that assessed 589 hospitalized patients with COVID-19, 18 years of age or older, of both sexes. Nutritional risk was assessed by Nutritional Risk Screening (NRS, 2002) and NLR by neutrophils divided by lymphocyte count. The UCR was calculated by the ratio between urea and creatinine and quantified by the calorimetric biochemical method and CRP by the immunoturbidimetric method. Differences between groups were applied by the Mann-Whitney U test and the automated binary regression test. ResultsOf the 589 patients, 87.4% were at nutritional risk. When evaluating patients admitted to the ICU, 91.9% were at nutritional risk. Patients with NRS ≥3 are older, with lower body mass and BMI, higher NLR and UCR and lower CRP values. However, 73% of patients admitted to the ward were at nutritional risk, and only age differed between groups, being higher in patients with NRS ≥3. Logistic regression showed a weak association between nutritional risk in NRS and UCR (Model 1) (OR=0.96, p=0.003) and NRS with CRP (Model 1) (OR=1.01, p<0.001) in patients in the ICU. On the other hand, the logistic regression in ward patients found association only for CRP in both models (Model 1, OR=1.01, p=0.041) and (Model 2, OR=1.01, p=0.031). ConclusionWe found a low association between nutritional risk and UCR and CRP in patients admitted to the ICU, while in the ward patients the nutritional risk also had weak association with CRP.

Malnutrition independently predicts mortality at 18 months in patients hospitalised for severe acute respiratory syndrome corona virus 2 (SARS-coV-2)

RationaleTo investigate the association between malnutrition and patient outcome following hospitalisation for Corona Virus Disease 2019 (COVID-19). MethodsIn April 2020, 268 adult patients (235 included in the follow-up) hospitalised for COVID-19 infection were evaluated for malnutrition risk and diagnosis using modified Nutritional Risk Screening 2002 and modified Global Leadership Initiative on Malnutrition criteria (GLIM), respectively. An 18-month follow-up was carried out to assess the incidence and the associated risk factors for death and re-hospitalization. ResultsThe outcome was unknown for 33patients. Death occurred in 39% of the 235 patients included in the follow-up. The risk of death was independently associated with malnutrition risk or diagnosis of malnutrition, whereas the male sex showed a protective association. The Kaplan–Meier survival curves showed that patients with diagnosis of malnutrition had lower survival rate. The re-hospitalization rate was 31% and was negatively associated with BMI≥25, and positively associated with length of hospitalisation for COVID-19 and with cancer comorbidity. ConclusionsIn hospitalized patients for SARS-CoV-2 disease, both malnutrition risk (p =0.050) and diagnosis of malnutrition (p=0.047 with modified GLIM and C-reactive protein > 0.5 mg/dL ; p=0.024 with modified GLIM and C-reactive protein > 5 mg/dL) were predictive risk factors for mortality, whereas male sex was associated with lower risk of death. Overweight at time of hospitalization and the length of hospitalisation were respectively protective and risk factor for re-hospitalization after discharge.