Nutritional Risk Research Articles

Sex differences in clinical presentation, treatment response, and side effects of nutritional therapy among patients at nutritional risk: a secondary analysis of the randomized clinical trial EFFORT

BackgroundConsidering sex-specific factors has become an increasingly recognized area for research and practice, in the field of clinical nutrition, there is insufficient evidence regarding differences in clinical presentation, treatment response, and side effects of nutritional therapy among female and male patients. ObjectivesWe hypothesized that the clinical presentation, response to nutritional therapy, and side effects from the intervention would differ in the two sexes. MethodsThis secondary analysis investigated differences among female and male patients at risk for malnutrition regarding initial presentation, clinical outcomes, and treatment response in patients included in the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized controlled trial comparing individualized nutritional support to usual care. ResultsOf 2028 patients included in the trial, 964 were females and 1064 were males. The nutritional history and clinical presentation of female patients was different: they consumed less food and had a greater loss of appetite than the male population. Male patients had higher risk for mortality at 180 d [27% compared with 19%; adjusted hazards ratio (HR): 1.35; 95% CI: 1.12, 1.63] and further adverse clinical outcomes. However, there was no difference in the effect of nutritional support on mortality among female and male patients (HR: 0.76; 95% CI: 0.45, 1.27, compared with HR: 0.81; 95% CI: 0.54, 1.21, respectively; P-interaction = 0.939). ConclusionsResults of this multicenter randomized trial suggest that multimorbid female inpatients have a different clinical presentation and are more prone to loss of appetite and reduced daily dietary intake than male inpatients. Importantly, the favorable response to nutritional interventions was similar in both sexes.This trial was registered at clinicaltrials.gov as NCT02517476.

CN33 G-8 geriatric screening tool and geriatric nutritional risk index

CN33 G-8 geriatric screening tool and geriatric nutritional risk index

A commentary on 'Association of postoperative outcomes with geriatric nutritional risk index after conventional and robotic-assisted total knee arthroplasty: a randomized controlled trial'.

A commentary on 'Association of postoperative outcomes with geriatric nutritional risk index after conventional and robotic-assisted total knee arthroplasty: a randomized controlled trial'.

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

Association between geriatric nutritional risk index and cognitive function in older adults with/without chronic kidney disease.

Cognitive impairment is highly prevalent among patients with chronic kidney disease, who face an increased risk of cognitive decline. The aim of this study was to investigate the relationship between the Geriatric Nutritional Risk Index (GNRI) and cognitive function in older individuals, both with and without chronic kidney disease (CKD). In this study, we analyzed data from 2728 participants in the 2011-2014 National Health and Nutrition Examination Survey (NHANES). Cognitive function was measured using the Consortium to Establish a Registry for the Alzheimer's Disease Word Learning subtest (CERAD W-L), the animal fluency test (AFT), the digit symbol substitution test (DSST), and the global cognitive z-score. The GNRI, representing whole-body nutritional status, was calculated based on serum albumin, body weight, and ideal body weight. We employed weighted multiple linear regression analyses and subgroup analyses to assess the independent association of GNRI with cognitive function in CKD and non-CKD populations. Smoothing techniques were used to fit curves, and interaction tests were used to assess the robustness and specificity of the findings. Our analyses revealed a significant positive association between higher GNRI levels and cognitive function in the older US population (for global z-score: β=0.01; 95% confidence interval [CI]=0.00, 0.01). This association remained consistent across various subgroup analyses, including those for different gender groups, age groups, smoking statuses, diabetes statuses, hypertension statuses, individuals with a BMI below 25, individuals who consumed alcohol, and non-Hispanic white individuals. Smoothed curve-fitting analyses indicated that the GNRI was linearly related to cognitive function. No statistically significant interactions were detected among these variables. Our findings emphasize the positive association between GNRI and cognitive health in individuals with or without CKD, especially when combined with other risk factors. Consequently, enhancing the nutritional status of the elderly may serve as a viable strategy to thwart the onset of cognitive decline.

Association of geriatric nutritional risk index with bone mineral density and osteoporosis in postmenopausal elderly women with T2DM.

To investigate the relationship between geriatric nutritional risk index (GNRI) and osteoporosis (OP) in postmenopausal elderly women with type 2 diabetes mellitus (T2DM). A total of 141 postmenopausal elderly women with T2DM was divided into OP and normal bone mineral density (BMD) groups, the differences in GRNI levels between the two groups were compared. According to the tertile levels of GRNI, T2DM were divided into three groups (T1, T2, T3 groups), and the differences in OP prevalence and levels of BMD among the three groups were compared. Among postmenopausal elderly women with T2DM, GNRI levels were lower in the OP group compared to the nor-mal BMD group [(103±5.46) vs. (105±5.46), p<0.05)]. With elevated GNRI levels, the BMD levels of femoral, total hip, total body, and lumbar vertebrae (L) were gradually increased, which were higher in the T3 group than in the T1 group (all p< 0.05). GNRI levels were positively correlated with the BMD levels of femoral, spine, total hip, total body, L1, L2, L3, L4, and L1-L4. GNRI was an independent influencing factor for the occurrence of OP (OR=0.887, 95%CI [0.795,0.988]). The ROC curve showed that the GNRI combined with serum ALP and P levels had a high predictive value for OP, with an area under the curve of 0.725 (p<0.01). In postmenopausal elderly women with T2DM, GNRI was independently and positively correlated with BMD levels. GNRI may be a predictor development of OP.

The Geriatric Nutritional Risk Index as a prognostic factor in patients treated with immune checkpoint inhibitors with non-small-cell lung cancer.

Globally, non-small cell lung cancer (NSCLC) is a leading factor in cancer-related mortality. Additionally, the Geriatric Nutritional Risk Index (GNRI) has been assessed as a predictive and prognostic indicator in various types of carcinomas. Our study aims to assess the prognostic importance of GNRI computed at diagnosis in NSCLC patients receiving immune checkpoint inhibitors (ICIs). The study evaluated 148 patients who underwent immunotherapy for NSCLC from January 1, 2018, through December 31, 2021, retrospectively. Patients combined with other malignant tumors or severe comorbidities were excluded from the study. The receiver operating characteristic (ROC) curve was employed in regulating the ideal cutoff worth of GNRI. Survival outcomes were evaluated through Kaplan-Meier analysis. Following this, both univariate and multivariate analyses were conducted utilizing Cox regression analysis to identify any potential factors that may influence the survival outcomes. The cutoff point for GNRI was 108.15 [area under the curve (AUC) =0.575, P=0.048]. Further analysis using the Kaplan-Meier method demonstrated that individuals in the high GNRI group had significantly longer progression-free survival (PFS) and overall survival (OS) compared to those in the low GNRI group (P=0.02, P=0.01). The further stratified study showed that GNRI had greater predictive value in tumor node metastasis (TNM) stage II-III and elderly (age ≥65 years) NSCLC patients undergoing ICI therapy. The multivariate Cox regression analysis indicated that GNRI [hazard ratio (HR): 0.536, P=0.03], obesity (HR: 16.283, P<0.001), and surgical history (HR: 0.305, P<0.001) were associated with poorer survival rates. Among patients undergoing ICI therapy for NSCLC, GNRI is an effective independent prognostic indicator, and a high GNRI at diagnosis is substantially related with longer PFS and OS. The incorporation of GNRI in pre-treatment evaluations within clinical settings is beneficial.

The role of cholesterol-modified prognostic nutritional index in nutritional status assessment and predicting survival after liver resection for hepatocellular carcinoma.

Malnutrition, which is often underestimated in patients with hepatocellular carcinoma (HCC), has a proven adverse effect on survival rates. The purpose of this study was to verify the effectiveness of the cholesterol-modified prognostic nutritional index (CPNI) in determining the nutritional status and predicting overall survival (OS) and recurrence-free survival (RFS) in patients with HCC by comparing it with several other nutritional indicators. This retrospective single-center study enrolled 1450 consecutive HCC patients who underwent curative liver resection from January 2015 to November 2019. We evaluated the prognostic significance of several nutritional indicators, including CPNI, the controlling nutritional status (CONUT), the nutritional risk index (NRI), and the prognostic nutritional index (PNI), by applying time-dependent receiver operating characteristic (ROC) curves, Kaplan-Meier survival analysis, and Cox proportional hazards regression analysis. Among several objective nutrition evaluations (including CPNI, CONUT, NRI, and PNI), CPNI demonstrated the greatest prognostic predictive power for predicting OS. Meanwhile, CPNI demonstrated marginally higher accuracy in predicting RFS compared to PNI, and significantly outperformed CONUT and NRI. Univariate and multivariate analyses suggested that CPNI was an independent risk factor for the OS and RFS of patients with HCC undergoing curative liver resection. In most subgroups, malnutrition as identified by CPNI demonstrates strong stratification ability in predicting both OS and RFS. CPNI serves as an accurate and stable instrument for evaluating nutritional status and forecasting survival outcomes in HCC patients following liver resection, which has the potential to markedly influence clinical decision-making processes and the management of patient care.

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.

Changes in nutritional status, risk factors and food intake in stroke subjects: cohort study analysis of non-communicable disease risk factors

Background: Stroke is a major cause of death and disability worldwide, affecting 15 million people annually. In Indonesia, the prevalence is 10.9%. Major risk factors include high blood pressure, obesity, inactivity, poor diet, and smoking. Objective: This study aims to analyze long-term trends in risk factors, nutritional status, and food intake among stroke patients from 2011-2021, assessing their impact on stroke incidence. Methods: Data from a longitudinal cohort study of 5,329 subjects, including 215 stroke patients, were analyzed using Microsoft Excel 2019 and SAS software. ANOVA was used to assess annual changes in risk factors, nutritional status, and food intake. Survival analysis was conducted with SAS PROC LIFETEST and PROC LIFEREG. Results: The cohort was primarily female (62.8%), aged 60 or older (57.2%), senior high school education (25.6%), civil servants (30.7%), and low income (57.2%). Significant changes were noted in BMI (p=0.037), fasting blood glucose (FBG) (p=0.001), HDL (p=0.049), abdominal circumference, smoking habits, physical activity (p&lt;0.001), protein intake (p=0.026), and intake of energy, fat, carbohydrates, and sodium (p&lt;0.001). Factors significantly associated with stroke included age, FBG, postprandial glucose, smoking (p&lt;0.0001), LDL (p=0.0380), HDL (p=0.0126), physical activity (p=0.0455), energy intake (p=0.0002), fat intake (p=0.0007), and sodium intake (p=0.0012). Conclusions: The study highlights significant changes in nutritional status, glucose levels, HDL cholesterol, physical activity, and smoking habits. These factors, along with age, cholesterol levels, and dietary intake, impact stroke incidence, underscoring the need for comprehensive stroke prevention strategies.

A scoring system based on inflammatory and nutritional indicators to predict the long-term survival of patients with non-metastatic nasopharyngeal carcinoma

To develop a simple scoring system based on baseline inflammatory and nutritional markers to predict the long-term prognosis of patients with nasopharyngeal carcinoma (NPC). Conducted a retrospective analysis of clinical data from 1024 newly diagnosed non-metastatic NPC patients. A total of 15 pre-treatment inflammatory and nutritional markers were collected as candidate variables. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff points for each parameter. Survival analysis was performed using Kaplan–Meier method and Cox regression analysis. Besides, the Inflammation Nutrition Risk Score (INRS) was calculated for each patient by assigning each independent prognostic factor a score of 1. Multivariate Cox regression analysis showed that serum albumin (ALB), systemic immune-inflammation index, and monocyte count (M) were independent prognostic factors for OS (P < 0.05). Survival analysis showed that higher INRS was associated with a worsened prognosis. Patients in the high-risk group had shorter OS than in the low-risk group. In the training group, the 3-, 5-, and 8-years OS rates for the low-risk group versus high-risk group were 92.5% versus 87.8%, 87.4% versus 75.1%, and 84.6% versus 62.2%, respectively (P < 0.05). In the validation group, the 3-, 5-, and 8-years OS rates for the low-risk group vs. high-risk group were 95.0% versus 86.4%, 92.1% versus 82.2%, and 89.5% versus 74.3%, respectively (P < 0.05). Further subgroup analysis showed a significant difference in the OS between the high-risk group and low-risk group in patients with locally advanced disease (P < 0.05). The ROC curve demonstrated that INRS had a similar predictive value for long-term survival in NPC patients compared to TNM staging and serum EBV-DNA levels. Pretreatment ALB, M, and SIRI are independent prognostic factors for long-term survival in patients with NPC. INRS constructed based on these three factors can serve as a long-term prognostic indicator for NPC.

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.

Determinants for Low Birth Weight in Mothers Giving Birth during the Covid-19 Pandemic

Background: Low birth weight (LBW) remains a significant global health issue, leading to higher rates of infant and child morbidity and mortality. In 2022, Indonesia had a 12.58% rate, while in Kutai Kartanegara Regency, East Kalimantan, the rate was higher at 16.30%. The Covid-19 pandemic, which severely impacted East Kalimantan also influenced LBW rates. Objectives: Analyzed the determinants of LBW incidence during the Covid-19 pandemic in Kutai Kartanegara. Methods: This population of 1265 mothers delivered in four public health centers with the highest cases of BBLR. This study used a case control design for 240 mothers, including 120 mothers who gave birth to babies with low birth weight and 120 mothers who gave birth to babies with LBW. Data were obtained from e-cohort data according to specific inclusion and exclusion criteria. Data collection occurred from August until October 2022 through interviews with structured questionnaires and maternal child handbooks. Data analysis was performed with logistic regression. Results: Determinant factors LBW were maternal nutritional risk (upper arm circumference &lt;23.5 cm) (OR=2.800, 95% CI=1.237-6.340), history of anemia (OR=3.156, 95% CI=1.716-5.804), history of Covid-19 (OR=4.357, 95% CI=2.355-8.063), living with a smoker (OR=2.505, 95% CI=1.716-2.804), and not having health insurance (OR=2.744, 95% CI=1.435-5.247). Conclusions: Internal factors such as age, under arm circumference, anemia, Covid-19, birth spacing, and parity and external factors (such as living with smokers, not having insurance) were interconnected in contributing to the risk of LBW, the pandemic further influenced these determinant factors.

Preoperative Nutrition Impacts Retear Rate After Arthroscopic Rotator Cuff Repair.

A rotator cuff retear following arthroscopic rotator cuff repair (ARCR) is a concern in older patients. However, only a few of its risk factors are amenable to preoperative intervention. We aimed to elucidate the relationship between preoperative nutritional status and rotator cuff retears after ARCR. This single-center retrospective study included patients aged ≥65 years with rotator cuff tears who underwent ARCR. The Geriatric Nutritional Risk Index (GNRI) was used to assess preoperative nutritional status. Data collection encompassed patient demographics, clinical assessments, and surgical specifics. Patients were divided into healed and retear groups based on 2-year post-ARCR magnetic resonance imaging results. Logistic regression analysis was conducted to adjust for confounding factors and detect independent risk factors for retears. The GNRI cutoff value for retear prediction was determined by a stratum-specific likelihood ratio; clinical outcomes were compared based on the cutoff values obtained. Overall, 143 patients were included. The retear rate was 20.3%. The albumin level, GNRI, postoperative shoulder strength of abduction and external rotation, and postoperative Japanese Orthopaedic Association and Constant scores in the retear group were significantly lower than those in the healed group. The logistic regression analysis showed that low risk of morbidity and mortality (compared with no risk) based on the GNRI (odds ratio [OR], 3.39) and medial-lateral tear size per mm (OR = 1.10) were independent risk factors for a retear 2 years after ARCR. Stratum-specific likelihood ratio analysis identified data-driven strata as GNRI < 103, 103 ≤ GNRI < 109, and GNRI ≥ 109. Univariate analysis showed that patients with GNRI < 103 had a significantly higher retear risk than those with 103 ≤ GNRI < 109 and those with GNRI ≥ 109. Logistic regression analysis showed that GNRI < 103 compared with 103 ≤ GNRI < 109 (OR = 3.88) and GNRI < 103 compared with GNRI ≥ 109 (OR = 5.62), along with the medial-lateral tear size per mm (OR = 1.10), were independent risk factors for a retear at 2 years after ARCR. When assessing the risk of a retear after ARCR, GNRI ≥ 103 may indicate good preoperative nutritional status. However, more data are essential to ascertain the importance of this finding. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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.

Nutritional support clinical efficacy in tuberculosis: quasi-experimental study

ObjectiveThis study aimed to investigate the impact of nutritional support on the clinical efficacy in hospitalised tuberculosis patients with nutritional risk.MethodsWe selected a total of 266 eligible patients with tuberculosis...

Prediction model establishment and validation for enteral nutrition aspiration during hospitalization in patients with acute pancreatitis.

Acute pancreatitis (AP) is a disease caused by abnormal activation of pancreatic enzymes and can lead to self-digestion of pancreatic tissues and dysfunction of other organs. Enteral nutrition plays a vital role in the treatment of AP because it can meet the nutritional needs of patients, promote the recovery of intestinal function, and maintain the barrier and immune functions of the intestine. However, the risk of aspiration during enteral nutrition is high; once aspiration occurs, it may cause serious complications, such as aspiration pneumonia, and suffocation, posing a threat to the patient's life. This study aims to establish and validate a prediction model for enteral nutrition aspiration during hospitalization in patients with AP. To establish and validate a predictive model for enteral nutrition aspiration during hospitalization in patients with AP. A retrospective review was conducted on 200 patients with AP admitted to Chengdu Shangjin Nanfu Hospital, West China Hospital of Sichuan University from January 2020 to February 2024. Clinical data were collected from the electronic medical record system. Patients were randomly divided into a validation group (n = 40) and a modeling group (n = 160) in a 1:4 ratio, matched with 200 patients from the same time period. The modeling group was further categorized into an aspiration group (n = 25) and a non-aspiration group (n = 175) based on the occurrence of enteral nutrition aspiration during hospitalization. Univariate and multivariate logistic regression analyses were performed to identify factors influencing enteral nutrition aspiration in patients with AP during hospitalization. A prediction model for enteral nutrition aspiration during hospitalization was constructed, and calibration curves were used for validation. Receiver operating characteristic curve analysis was conducted to evaluate the predictive value of the model. There was no statistically significant difference in general data between the validation and modeling groups (P > 0.05). The comparison of age, gender, body mass index, smoking history, hypertension history, and diabetes history showed no statistically significant difference between the two groups (P > 0.05). However, patient position, consciousness status, nutritional risk, Acute Physiology and Chronic Health Evaluation (APACHE-II) score, and length of nasogastric tube placement showed statistically significant differences (P < 0.05) between the two groups. Multivariate logistic regression analysis showed that patient position, consciousness status, nutritional risk, APACHE-II score, and length of nasogastric tube placement were independent factors influencing enteral nutrition aspiration in patients with AP during hospitalization (P < 0.05). These factors were incorporated into the prediction model, which showed good consistency between the predicted and actual risks, as indicated by calibration curves with slopes close to 1 in the training and validation sets. Receiver operating characteristic analysis revealed an area under the curve (AUC) of 0.926 (95%CI: 0.8889-0.9675) in the training set. The optimal cutoff value is 0.73, with a sensitivity of 88.4 and specificity of 85.2. In the validation set, the AUC of the model for predicting enteral nutrition aspiration in patients with AP patients during hospitalization was 0.902, with a standard error of 0.040 (95%CI: 0.8284-0.9858), and the best cutoff value was 0.73, with a sensitivity of 91.9 and specificity of 81.8. A prediction model for enteral nutrition aspiration during hospitalization in patients with AP was established and demonstrated high predictive value. Further clinical application of the model is warranted.

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.

A novel nomogram based on inflammatory-nutritional biomarkers for gallbladder cancer after surgical resection

PurposeSystemic inflammation and nutrition are vital for tumor progression. This study aimed to identify prognostic inflammation nutrition markers and develop a predictive nomogram for gallbladder cancer (GBC).MethodsA total of 123 patients with GBC who underwent surgical resection at the First Affiliated Hospital of Soochow University and Suzhou Kowloon Hospital were included in our study. The final prognostic variables were identified using univariate and multivariate analyses. A nomogram model was then established, and the consistency index (C-index), calibration curves, and Kaplan–Meier analysis were performed to evaluate the accuracy and discrimination of the nomogram. The area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) suggested that our nomogram had better predictive ability and clinical feasibility than a published model.ResultsThe cox regression analysis showed that carcinoembryonic antigen (CEA) > 4.580, albumin-bilirubin (ALBI) > –2.091, geriatric nutritional risk index (GNRI) < 90.83, T3–T4, and N2 are independent prognostic factors. A predictive nomogram was constructed with a C-index of 0.793. In the calibration curves, the nomogram-predicted 1-, 3-, and 5-year survival matched well with the actual survival. Kaplan–Meier analysis showed that the high-risk group had worse survival than the low-risk group (P < 0.001). Finally, our nomogram achieved better 1-, 3- and 5-year AUCs than an established model (0.871, 0.844, and 0.781 vs. 0.753, 0.750, and 0.693). DCA also confirmed that our model outperformed the established model.ConclusionsIn conclusion, our study revealed that CEA > 4.580, GNRI < 90.83, ALBI > –2.091, T3–T4 stage, and N2 were related to clinical outcomes of patients with GBC after surgical resection. The constructed nomogram has superior predictive ability and clinical practicality.

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.