Impaired Nutritional Status Research Articles

Nutritional screening tool for critically ill children: a systematic review.

Nutritional screening tools (NSTs) are used to identify patients who are at risk of nutritional status (NS) deterioration and associated clinical outcomes. Several NSTs have been developed for hospitalized children; however, none of these were specifically developed for Pediatric Intensive Care Unit (PICU) patients. A systematic review of studies describing the development, application, and validation of NSTs in hospitalized children was conducted to critically appraise their role in PICU patients. PubMed, Embase, Web of Science, Scopus, SciELO, LILACS, and Google Scholar were searched from inception to December 11, 2020. The review included 103 studies that applied NSTs at hospital admission. The NST characteristics collected included the aims, clinical setting, variables, and outcomes. The suitability of the NSTs in PICU patients was assessed based on a list of variables deemed relevant for this population. From 19 NSTs identified, 13 aimed to predict NS deterioration. Five NSTs were applied in PICU patients, but none was validated for this population. NSTs did not include clinical, NS, laboratory, or dietary variables that were deemed relevant for the PICU population. None of the available NSTs were found to be suitable for critically ill children, so a new NST should be developed for this population. AQ6. PROSPERO registration no. CRD42020167898.

Blood Neutrophil Counts Define Specific Clusters of Bronchiectasis Patients: A Hint to Differential Clinical Phenotypes.

We sought to investigate differential phenotypic characteristics according to neutrophil counts, using a biostatistics approach in a large-cohort study from the Spanish Online Bronchiectasis Registry (RIBRON). The 1034 patients who met the inclusion criteria were clustered into two groups on the basis of their blood neutrophil levels. Using the Mann–Whitney U test to explore potential differences according to FACED and EFACED scores between the two groups, a neutrophil count of 4990 cells/µL yielded the most balanced cluster sizes: (1) above-threshold (n = 337) and (2) below-threshold (n = 697) groups. Patients above the threshold showed significantly worse lung function parameters and nutritional status, while systemic inflammation levels were higher than in the below-threshold patients. In the latter group, the proportions of patients with mild disease were greater, while a more severe disease was present in the above-threshold patients. According to the blood neutrophil counts using biostatistics analyses, two distinct clinical phenotypes of stable patients with non-CF bronchiectasis were defined. Patients falling into the above-threshold cluster were more severe. Severity was characterized by a significantly impaired lung function parameters and nutritional status, and greater systemic inflammation. Phenotypic profiles of bronchiectasis patients are well defined as a result of the cluster analysis of combined systemic and respiratory variables.

The importance of nutritional status on clinical outcomes among both ICU and Non-ICU patients with COVID-19.

Background and aimsThe current Covid-19 outbreak becomes a tremendous public health concern worldwide. Since a little information is available on nutritional status and its devastating effects on covid-19 complications in Iran, in the present study, we aimed to evaluate nutritional status of covid-19 population and its related factors.MethodsWe performed this observational study by recruiting 400 hospitalized covid-19 subjects. Thereafter, the needed clinical and para clinical data were collected and their nutritional status was then assessed using NRS-2002.ResultsApproximately 36% of the total sample size and 100% of the ICU- admitted cases were at the severe risk of malnutrition. The patients with NRS≥ 5 were significantly older (p < 0.0001). Non-survivals obtained higher scores in terms of both severity of disease (86%) and impaired nutritional status (67%), and this relationship was found to be statistically significant (p < 0.0001). In regard to the obtained prognostic inflammatory scores, 86% of the non-survivals obtained significantly highest scores for GPS (P = 0.015).ConclusionNutritional status has a considerable effect on clinical outcomes of covid-19 patients, which should be evaluated. Thereafter, rapid subsequent nutritional interventions must be implemented in this regard. As well, special attention must be paid to both elderly population and individuals with underlying diseases.

Aggressive Intervention of Pancrelipase After Pancreatectomy Prevents Deterioration of Postoperative Nutritional Status.

This study aimed to investigate the effect of early administration of delayed-release high-titer pancrelipase. The medical records of 120 patients who had undergone pancreatectomy with computed tomography (CT) before and 6 months after surgery were retrospectively reviewed. Delayed-release high-titer pancrelipase were administered daily starting on postoperative day 3, which was defined as the EP group. The postoperative nutritional status and CT attenuation values of the liver were compared between the EP and control groups. Thirty-three patients (28%) were categorized into the EP group. With regard to the postoperative nutritional status 6 months after surgery, the body mass index, total lymphocyte count, and Onodera's prognostic nutritional index were higher, and controlling nutritional status score was lower in the EP group than that in the control group. The CT attenuation values of the liver were not significantly different. After propensity score matching analysis, body mass index (20.7 vs 19.2, P = 0.049) and Onodera's prognostic nutritional index (47.9 vs 44.2, P = 0.045) were significantly higher, and controlling nutritional status score was significantly lower in the EP group than that in the control group (1 vs 3, P = 0.046). The early administration of pancrelipase after pancreatectomy improved nutritional status after pancreatectomy.

Clinical and nutritional characteristics on overall survival impact in patients with gastrointestinal cancer.

Weight loss is present in most cancer patients, being even more frequent in gastrointestinal tract tumors (GIT). Malnourished patients may be at greater toxicity risk during treatment, which may interfere with survival. Tumor-triggered hypercatabolism can lead to impaired nutritional status. In addition, other factors such as the presence of nutritional impact symptoms (NIS) can lead to decrease food consumption, influencing weight loss. The purpose of this study was verify nutritional status and understand which factors are related to survival and weight loss in patients with gastrointestinal tract cancers. This study is a retrospective cross-sectional, with data collected from patient's medical records with the gastrointestinal tract cancers, between the years 2012-2019. Data were classified of tumor location, disease staging, weight change, number of nutritional impact symptoms and diet at the treatment beginning. Survival was calculated using the start of treatment and death dates. A total of 388 medical patient's records were analyzed, most of which presented weight loss (82.5%) with an average weight loss of 9.0kg representing 12.2% of body weight. The main NIS presented by the patients were dry mouth, abdominal pain, constipation and esophagitis. According to predetermined groups, the highest weight loss percentages were for patients with stomach and pancreatic cancer, Stage 4, the presence of 3 or more NIS and enteral diet. The lowest survival and highest death risk were observed at the univariable analysis to patients that have the presence of 3 or more NIS 8.3 months and HR 1.51 (IC95% 1.1-2.1) and to the multivariable analysis, for patients with pancreatic cancer 4.8 months HR 3.13 (IC95% 1.9-5.2), stage IV 9.8 months and HR 4.8 (IC95% 1.7-13.2). Tumor location, cancer stage and the presence of nutritional impact symptoms influenced weight loss and survival of oncologic patients.

Undernutrition is associated with mortality, exacerbation, and poorer quality of life in patients with chronic obstructive pulmonary disease: A systematic review with meta-analysis of observational studies.

Impaired nutrition status is recognized as a risk factor for worse clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to investigate how undernutrition is diagnosed, its prevalence, and whether there is an association between this condition and clinical outcomes in patients with COPD. The search for this systematic review of observational studies (PROSPERO: CRD42020191888) was performed in the PubMed, Embase, and Scopus databases, with no date or language restrictions. The studies had to report data on the diagnosis of undernutrition and its association with mortality, exacerbation, length of hospital stay, or quality of life in adult patients with COPD. A meta-analysis with a random-effects model was performed to combine data. Forty-nine studies were included (20 of them classified as having a low risk of bias), and the most common diagnostic method of undernutrition was body mass index (BMI) (n = 36). The pooled prevalence of undernutrition was equal to 20% (95% CI, 0.15-0.25; I² = 100%), and it was associated with mortality (risk ratio = 1.97; 95% CI, 1.55-2.50; I² = 98%), exacerbation (risk ratio = 1.73; 95% CI, 1.03-2.91; I² = 96%), and poorer quality of life (mean difference = 8.25; 95% CI, 5.40-11.10; I² = 79%). For all outcomes, the certainty of evidence was very low. In conclusion, undernutrition is prevalent and is associated with poorer outcomes in patients with COPD. However, undernutrition is mainly diagnosed by BMI, which underreports its prevalence, and the certainty of the evidence is very low.

The Relation between Vitamin D Level and Lung Clearance Index in Cystic Fibrosis-A Pilot Study.

Background: Life expectancy has increased in cystic fibrosis (CF) patients; however, the rate of mortality is still high, and in a majority of cases, the cause of death is due to respiratory deterioration. Vitamin D plays an important role in immunity and infection prophylaxis, as its deficiency is associated with frequent infections. In CF patients, a deficit of liposoluble vitamins is common, despite daily supplementation. The aim of this study is to evaluate the relation between vitamin D status and lung function expressed by lung clearance index (LCI) in patients with CF. We also assessed the relation of factors such as nutritional status, genotype, and associated comorbidities such as Pseudomonas infection, cystic fibrosis-related diabetes (CFRD), and cystic fibrosis liver disease (CFLD) with vitamin D and LCI. Methods: A cross-sectional study was conducted at the National Cystic Fibrosis Center by analyzing patients with CF who presented in our center between November 2017 and November 2019. We enrolled in the study patients diagnosed with CF, who were followed up in our CF center and who were able to perform lung function tests. Patients in exacerbation were excluded. Results: A strong negative correlation was found between vitamin D and LCI (r = −0.69, p = 0.000). A lower vitamin D storage was found in patients with CFLD and CFRD. Higher LCI values were found among patients with chronic Pseudomonas infection, with BMI under the 25th percentile, or with associated CFLD. Conclusion: In CF patients, vitamin D plays an important role, and its deficit correlates with an impaired LCI. Vitamin D deficit is a risk factor in patients with associated comorbidities such as CFLD and CFRD. Chronic infection with Pseudomonas, the presence of impaired nutritional status, and CFLD are associated with a prolonged LCI.

External Validation of the ACTA-PORT Transfusion Risk Score in Older Cardiac Surgery Patients at Risk of Frailty

Accurate preoperative transfusion risk stratification may serve to better manage older patients undergoing cardiac surgery. Therefore, the aim of the present study was to externally validate the existing Association of Cardiothoracic Anesthetists perioperative risk of blood transfusion (ACTA-PORT) score in a population ≥70 years of age scheduled for cardiac surgery. Furthermore, the study authors investigated the additional prognostic value of individual frailty variables to this transfusion risk score. A retrospective analysis. At a tertiary-care hospital. Five hundred seven patients aged ≥70 years undergoing elective cardiac surgery from July 2015 to August 2017. None. The primary outcome was the administration of a perioperative blood transfusion. Frailty domains were assessed in a preanesthesia geriatric assessment, and a priori selection of biomarkers derived from blood was determined. The original ACTA-PORT score resulted in a c-statistic of 0.78 (95% confidence interval 0.74-0.82), with moderate calibration in predicting perioperative allogeneic transfusion in older patients undergoing cardiac surgery. Model updating, using the closed testing procedure, resulted in model revision with a higher discriminatory performance (c-statistic of 0.83, 95% confidence interval 0.79-0.86) and corrected calibration slope. Iron deficiency, impaired nutritional status, and physical impairment were associated with perioperative transfusions. The addition of individual frailty variables to the updated ACTA-PORT model did not result in improved predictive performance. External validation of the original ACTA-PORT score showed good discrimination and moderate calibration in older patients at risk of frailty undergoing cardiac surgery. Updating the original ACTA-PORT improved the predictive performance. Careful evaluation of additional frailty domains did not add prognostic value to the ACTA-PORT score.

A255 INCREASED ENERGY EXPENDITURE AND REDUCED EXERCISE CAPACITY IN CELIAC DISEASE PATIENTS ON A GLUTEN-FREE DIET

Abstract Background Celiac disease (CeD) patients often exhibit impaired nutritional status due to nutrient malabsorption and altered metabolism. Accurate clinical assessment of malnutrition, muscle function and energy requirements are thus essential to prevent and treat malnutrition. Indirect calorimetry (IC) is the most accurate method to measure energy needs, but it is underutilized in outpatient settings. Aims To assess the use of IC testing in estimating the resting energy expenditure and exercise-related energy utilization in treated CeD patients compared to patients with other gastrointestinal (GI) conditions. Methods Adult patients attending the Celiac and Nutrition Clinic at McMaster University that underwent rest and exercise testing as a part of their nutritional assessment were enrolled. CeD diagnosis was based on positive CeD serology and confirmed by biopsy, and all of them were on a GFD for at least 6 months. Patients with inflammatory bowel disease (IBD), functional gastrointestinal disorders (FGID) and undernutrition due to other causes (UN) were included as controls. Resting energy expenditure was assessed using 3 methods 1) predictive formula (25kcal/kg), 2) Harris Benedict and 3) estimation of VO2 by IC. Exercise capacity and energy expenditure (EE) during exercise was estimated at baseline, moderate and maximum exercise. Statistical analysis was performed using SPSS. ANOVA with Bonferroni corrections and Chi2 test were used to assess differences between continuous and categorical variables, respectively. Results A total of 66 patients (CeD n=24; IBD n=15; FGID n=17; UN n=10) were included in the analysis. The REE of GI patients measured using the HB equation and the predictive formula were significantly underestimated compared to IC [Mean Difference (MD)=229 kcal/day p=0.03 and MD=365 kcal/day p&amp;lt;0.001, respectively]. The EE during exercise increased with intensity of exercise. CeD patients had the highest EE during moderate and strenuous exercise (Mean EE = 286 kcal/h and 494 kcal/h respectively) compared to patients with other GI conditions (Moderate and Strenuous for IBD= 218kcal/h and 373kcal/h; for FGIDs 296kcal/hand 467kcal/h, for UN, Mean EE = 181kcal/h and 294kcal/h). Exercise capacity was reduced in CeD compared to predicted exercise capacity (Mean = 86% predicted work capacity, range 72.5–107%), but was significantly higher than IBD (86% vs 73%; p=0.65) and UN patients (86% vs 46%; p=0.004). Conclusions Increased energy consumption and reduced exercise capacity is suggestive of chronic impaired nutritional status in treated CeD patients. Future studies with larger sample sizes are needed to understand whether incorporating accurate estimations of energy expenditure in nutritional practices can improve CeD outcomes. Funding Agencies CAG

Restriction of the Family-Centered Care by COVID-19: A Supportive Educational Program for Fathers to Improve the Eating Behavior of Hospitalized Pediatrics

Background: Poor oral nutrition is one of the important outcomes of hospitalization in children with respiratory disease, which may lead to insufficient energy intake. Deterioration of nutritional status during hospitalization affects clinical outcomes seriously. This study aimed to investigate the effect of an educational-supportive program for fathers on the eating behavior of hospitalized pediatrics with pneumonia in the COVID-19 pandemic. Methods: In this clinical trial, 40 children aged 12 to 36 months with pneumonia were selected together with their parents, after which they were randomly assigned to control and intervention groups. The intervention group received an educational supportive program face-to-face and virtually. Then, the father established an online video communication with the child and his mother as the main caregiver, while the control group received routine care. The data collection tools included the demographic questionnaire and the children's eating behavior questionnaire (CEBQ) completed by the mother during admission and 7 days later. Results: The results of the study showed no significant differences between any of the demographic variables of the study (P &gt; 0.05). The mean eating behavior of the two groups before the intervention was 104.25 ± 6.20 and 105 ± 6.20, which were not significantly different (P = 0.70). However, the values of 113.2 ± 6.20 and 96.40 ± 6.20 were obtained after the intervention, indicating statistically significant differences (P &lt;0.001). Conclusions: Planning and maintaining family integrity and educating and reminding parents of their role, including the fathers’ supportive role, can lead to the improvement of a child's eating disorder during hospitalization for pneumonia.

CONUT Score: A New Tool for Predicting Prognosis in Patients with Advanced Thyroid Cancer Treated with TKI.

Simple SummaryMany studies have shown that an impaired nutritional status correlated with a worse prognosis in cancer patients. The aim of our retrospective study was to evaluate the potential role of baseline Controlling Nutritional Status (CONUT score) in predicting prognosis of advanced thyroid cancer treated with tyrosine kinase inhibitors (TKI). We were able to confirm that baseline CONUT score significantly correlated with progression free survival (PFS) and overall survival (OS) and was the only independent prognostic factor for both outcomes. In particular, a CONUT score ≥3 was associated with a worse PFS and OS. The CONUT score represents a relatively new screening tool that is useful in predicting prognosis in thyroid cancer patients before the beginning of anti-tumoral treatment.(1) Background: The Controlling Nutritional Status (CONUT) score is an immuno-nutritional screening tool based on serum albumin, total cholesterol, and lymphocyte count. The aim of the study was to assess the CONUT score as a potential prognostic factor of response to therapy in patients with advanced thyroid cancer treated with tyrosine kinase inhibitors (TKIs). (2) Methods: We retrospectively evaluated 42 metastatic thyroid cancer patients (54.8% female). The median age at the time of TKI treatment was 69 years. Histological diagnosis was differentiated thyroid cancer in 66.7%, poorly differentiated thyroid cancer in 21.4%, and medullary thyroid cancer in 11.9% of patients. CONUT score was assessed before starting TKI therapy. (3) Results: Progression-free survival (PFS) and overall survival (OS) were significantly influenced by baseline CONUT score. The best CONUT cut-off able to predict the response to treatment was 3. Both PFS and OS were better in patients with CONUT score <3 than in those with CONUT score ≥3 (p < 0.0001). CONUT score was the only independent prognostic factor associated with PFS (p = 0.021) and OS (p = 0.007). (4) Conclusions: CONUT score represents a relatively new screening tool, easily applicable in clinical practice and potentially useful in predicting prognosis in thyroid cancer patients treated with TKIs.

Association of Nutrition Status at Dialysis Start With Long-Term Survival: A 10-Year Retrospective Study

The objectives of the study are to explore the association between nutritional status at the initiation of dialysis and the improvement or worsening of nutrition status during first 3months of dialysis and first 5years of survival on dialysis. Two hundred ninety-seven patients who started dialysis between March 2009 and March 2019 were enrolled in the study. The nutritional status of the patients at dialysis commencement was evaluated by the method of The Integrative Clinical Nutrition Dialysis Score (ICNDS). Improvement or worsening of nutrition status was monitored by calculating the ICNDS slope for each patient enrolled in the study from 3 ICNDS values from the first 3months on dialysis. The baseline ICNDS and the slope of 3 subsequent monthly ICNDS values were tested for correlation with the odds of all-cause mortality for each of the first 5years on dialysis. There was a significant difference between the survival odds of patients who started dialysis with an ICNDS at 75 and those who started dialysis with an ICNDS <75 (hazard ratio [HR] 2.505, confidence interval [Cl] 1.235-5.079, P=.011 after 1year on dialysis;, HR 1.543, Cl 1.083-2.198, P=.016 after 5years). Deterioration of nutritional status (a negative ICNDS slope) during the first 3months of dialysis was associated with increased mortality during 1-3years after dialysis start, compared to a positive ICNDS slope indicating a stable or improved nutritional status (HR 1.732, Cl 1.151-2.607, P=.008 after 3years on dialysis). Nutritional status at initiation of dialysis is associated with long-term (5years) survival. Deterioration of nutritional status during the first 3months on dialysis significantly increases the risk of death during the first 3years on dialysis.

P454 Evaluation of the nutritional care status in italian centers managing patients affected by inflammatory bowel disease

Abstract Background Patients affected by IBD are at risk for malnutrition. An impaired nutritional status is associated with several negative outcomes (increased risk of flares, poor response to therapy, hospitalizations, surgical interventions, and post-surgical complications). Nutritional care is defined as “the form of nutrition, nutrient delivery and the system of education that is required for meal service or to treat any nutrition-related condition in both preventive nutrition and clinical nutrition”. The aim of this study was to assess the current status of the nutritional care in the Italian Centers managing IBD patients. Methods A dedicated web-based questionnaire developed by the Italian Society of Artificial Nutrition and Metabolism (SINPE) was sent to all the 120 IBD Centers referring to IG-IBD. The relevance of the nutritional care was assessed using a Visual Analogue Scale from 0 (the less) to 100 mm (the most) and expressed as mean ± SD. Results 63.3 (%) questionnaires were returned. The presence of an IBD-dedicated nutritionist is present in 27/120 (35.5%) Centers, while in 25/120 (32.9%) the evaluation of the nutritional status is considered hard to obtain. In 52 (68.4%) of Centers is present an IBD multidisciplinary team, in 22 of these (42.3%) a nutritionist is included. In the outpatient setting, the malnutrition risk is evaluated at each visit in 28 (36.8%) Centers, in case of active or complicated disease in 29 (38.2%) and only when the presence of malnutrition is suspected in 34 (44.7%). The nutritional status is evaluated at each visit in 28 (36.8%) Centers, in case of active or complicated disease in 38 (50.0%), while only when the presence of malnutrition is suspected in 31 (40.8%). In 67 (88.2%) Centers the evaluation of nutritional parameters is directly assessed by the gastroenterologist, by means of blood chemistry (98.7%), antropometric indices (82.9%) and impedenziometry (14.5%). For hospitalized IBD patients, the malnutrition risk and the nutritional status are evaluated at each admission in 37 (48.7%) and 42 (56.0%) Centers and only when the presence of malnutrition is suspected in 39 (51.3%) and in 37 (48.7%). The relevance of nutritional assistance in clinical management of IBD patients and in the institutional diagnostic and therapeutic paths were considered high by physicians: 86.5 ± 12.2 mm and 86.7 ± 13.1 mm, respectively. Conclusion Nutritional care for IBD patients appears quite far from being satisfactory in the Italian reality and at the same time highly wanted. Educational and logistic interventions are needed to improve the assessment and the treatment of malnutrition in the everyday clinic practice.

P023 Prevalence of malnutrition, risk of malnutrition and quality of life among patients with Inflammatory Bowel Disease

Abstract Background The relapsing and remitting course of inflammatory bowel disease (IBD) with inflammation and gut symptoms may result in an elevated risk of malnutrition and impaired quality of life. Patients with pro-longed active IBD are at the highest risk of developing impaired nutritional status. The aim of this study was to determine the prevalence of malnutrition and risk of malnutrition in outpatients with inflammatory bowel disease. Furthermore, to study their body composition, identify factors associated with malnutrition and investigate the association between malnutrition and quality of life. Methods A total of 328 IBD outpatients, (154 [47 %] with Crohn’s disease (CD) and 174 [53%] with ulcerative colitis (UC)) at Linköping University hospital were included in this population-based cross-sectional study. Patients underwent malnutrition assessment using the recently published Global Leadership Initiative on Malnutrition (GLIM) criteria. Data about body mass index, weight loss and dietary problems were collected and used to evaluate risk of malnutrition. The Short Health Scale (SHS) was used to measure quality of life. Results Malnutrition was detected in 33 patients (10,1 %) and 162 patients (55,0 %) had an increased risk of malnutrition. Malnutrition was associated with lower quality of life in the entire patient cohort and there was no difference between diagnoses. The prevalence of malnutrition was significantly higher among women (73% vs 27 %). Malnourished patients and those at risk of impaired nutritional status were more likely to have had active disease during the preceding 12 months compared to patients without malnutrition or at risk of malnutrition (27 % vs 12% [p=0.015] and 15 % vs 7% [p=0.037] respectively). Surprisingly, a higher calprotectin value was detected among patients without risk of malnutrition when compared to those who were at risk (median 46 [IQR 17 – 106] vs 59 [IQR 25 – 288] respectively, p=0,009). Women with IBD had significantly lower fat-free mass index (FFMI) compared to men. Patients with CD had reduced quality of life compared to patients with UC. Conclusion The prevalence of malnutrition in IBD-outpatients was 10% and more than half of the participants were at risk of malnutrition. Malnutrition was associated with poor quality of life. Malnutrition screening might be important in this population as ongoing inflammation and active disease seem to be apparent even among patients without clear nutrition difficulties or weight problems, but might influence nutritional status and quality of life negatively in the long term. Patients with IBD should therefore be screened for malnutrition and risk of malnutrition on a regular basis.

Progressive Skeletal Muscle Loss After Surgery and Adjuvant Radiotherapy Impact Survival Outcomes in Patients With Early Stage Cervical Cancer.

The effect of skeletal muscle loss associated with surgery and adjuvant radiotherapy on survival outcomes in patients with early-stage cervical cancer remains unclear. We analyzed the data of 133 patients with early-stage cervical cancer who underwent surgery and adjuvant radiotherapy between 2013 and 2018 at two tertiary centers. Skeletal muscle changes were measured using computed tomography scans at baseline, at simulation for radiotherapy, and at 3 months post-treatment. A decrease of ≥5% in the skeletal muscle was defined as “muscle loss.” The Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) was used to assess gastrointestinal toxicity. The Patient-Generated Subjective Global Assessment (PG-SGA) was used for nutritional assessment. Predictors of overall survival were identified using the Cox regression models. The median follow-up period was 3.7 years. After treatment, 32 patients (24.1%) experienced muscle loss. The rate of muscle loss was higher in patients with PRO-CTCAE score ≥3 or PG-SGA score ≥4 at the end of radiotherapy than in patients with PRO-CTCAE score ≤2 or PG-SGA score 0–3 (75.0 vs. 10.5%, p < 0.001; 71.4 vs. 2.2%, p < 0.001). The 3-year overall survival was significantly lower in patients with muscle loss than in those with muscle preserved (65.6 vs. 93.9%, p < 0.001). Multivariate analysis showed that muscle loss was independently associated with poor overall survival (hazard ratio, 4.55; 95% confidence interval: 1.63–12.72; p < 0.001). Muscle loss after surgery and adjuvant radiotherapy was associated with poor overall survival in patients with early-stage cervical cancer. Muscle loss is associated with patient-reported gastrointestinal toxicity and deterioration in nutritional status.

Comparison of three different nutrition screening tools for pediatric inpatients

Early detection of children at risk of developing malnutrition during hospitalization prevents the development of complications. This study aims to determine the malnutrition risk of pediatric inpatients by using three different nutrition screening tools and to evaluate the reliability/sensitivity of the screening tools. This cross-sectional study included 176 children who were 1-16 years of age and were admitted to the pediatrics service of a second-line hospital. Body weight and height were used to evaluate the nutrition status of children. Age- and sex-specific z-score values for height for age (HFA), weight for age (WFA), and body mass index for age (BFA) were indicators of malnutrition. The Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), Pediatric Yorkhill Malnutrition Score (PYMS), and Pediatric Nutrition Screening Tool (PNST) were used under the responsibility of pediatricians and dietitians to evaluate the risk of malnutrition in children. At admission, according to the HFA, BFA, and WFA SD scores (SDSs), the incidence of malnutrition in children was 8.5%, 14.8%, and 6.3%, respectively. Three screening tools determined that WFA SDSs were significantly higher in children without malnutrition risk than in those at risk of malnutrition (P<0.05). PYMS revealed a relatively higher sensitivity of 90.9% and 84.6% for WFA and BFA, respectively, and PNST revealed a relatively higher sensitivity of 88.9% for HFA. PYMS and PNST are suitable for use in malnutrition risk assessment in pediatric inpatients because of the screening tools' high sensitivity.

Assessment of nutritional status and characteristics of dietary patterns in a group of pediatric patients

Impaired nutritional status as well as imbalance between dietary requirements and intake may negatively influence child’s growth, development and treatment’s response. This observational study was conducted between July 2021 and March 2022 on 63 pediatric patients, aged 5-18 years old, hospitalized in Târgu-Mureş. The aim of the stu­dy was to evaluate the impact of dietary patterns on nu­tri­tio­nal status. Body composition was assessed by using bioelectrical impedance analysis. Aspects of die­tary pat­terns and patient history were evaluated by a structured ques­tion­naire. The patients were divided into two groups ac­cording to their Body Mass Index: obese/over­weight children – Group 1, and patients with normal weight – Group 2. As for dietary patterns, there were several sta­tis­ti­cally significant differences between the groups. Normal weight children had a higher intake of whole grains, fruits and vegetables, while overweight patients consumed fats, red meat and sweetened beverages more frequently. The in­take of fish, legumes, whole grains, nuts and seeds was the lowest. The majority of children mentioned that their pre­ferred snacks were fruits but also sweets, while nuts and seeds were consumed mainly by normal weight children. Signs that could suggest emotional eating were more frequent among overweight patients. The results suggest that complex nutritional assessment could be a useful tool in patient’s management by improving the nutritional status of pediatric patients.

Malnutrition, Sarcopenia, and Malnutrition-Sarcopenia Syndrome in Older Adults with COPD.

Purpose: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world population. In addition to airflow obstruction, COPD is associated with multiple systemic manifestations, including impaired nutritional status or malnutrition and changes in body composition (low muscle mass, LMM). Poor nutritional status and sarcopenia in subjects with COPD leads to a worse prognosis and increases health-related costs. Data from previous studies indicate that 30–60% of subjects with COPD are malnourished, 20–40% have low muscle mass, and 15–21.6% have sarcopenia. This study aimed to assess the prevalence of malnutrition, sarcopenia, and malnutrition-sarcopenia syndrome in elderly subjects with COPD and investigate the relationship between COPD severity and these conditions.Patients and methods: A cross-sectional study involving 124 patients with stable COPD, aged ≥60, participating in a stationary pulmonary rehabilitation program. Nutritional status was assessed following the Global Leadership Initiative on Malnutrition (GLIM) criteria and sarcopenia with the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. The results of pulmonary function tests and exercise capacity were obtained from the hospital database. Results: 22.6% of participants had malnutrition according to the GLIM criteria. Subjects with malnutrition had lower gait speed (p = 0.0112) and worse results of the Six Minute Walk Test. Sixteen participants (12.9%) had sarcopenia; 12 subjects with sarcopenia had concomitant malnutrition. The prevalence of severe and very severe obstruction (GOLD3/GOLD4) was 91.7%. It was significantly higher in patients with malnutrition-sarcopenia syndrome. Conclusions: Malnutrition was found in nearly one out of four subjects with COPD, while sarcopenia was one out of seven patients. About 10% of our study sample had malnutrition-sarcopenia syndrome. The prevalence of severe and very severe obstruction was significantly higher in patients with malnutrition-sarcopenia syndrome.

Nutritional Status Impairment Due to Neoadjuvant Chemotherapy Predicts Post-Radical Cystectomy Complications.

Background: Radical cystectomy (RC) is the standard treatment for muscle invasive bladder cancer (MIBC). Neoadjuvant chemotherapy (NAC) is associated with improved patient survival. The impact of NAC on nutritional status is understudied, while the association between malnutrition and poor surgical outcomes is well known. This study aims to examine the association between NAC, nutritional status impairment, and post-operative morbidity. Materials and Methods: We included MIBC patients who underwent RC and received NAC from multiple academic centers in Israel. Cross-sectional imaging was used to measure the psoas muscle area and normalized it by height (smooth muscle index, SMI). Pre- and post-NAC SMI difference was calculated (represents nutritional status change). The primary outcomes were post-RC ileus, infection, and a composite outcome of any complication. Logistic regression models were fit to identify independent predictors of the outcomes. Results: Ninety-one patients were included in the study. The median SMI change was −0.71 (−1.58, −0.06) cm2/m2. SMI decline was significantly higher in patients with post-RC complications (−18 vs. −203, p < 0.001). SMI change was an independent predictor of all complications, ileus, infection, and other complications. The accuracy of SMI change for predicting all complications, ileus, infection, and other complications was 0.85, 0.87, 0.75, and 0.86, respectively. Conclusions: NAC-related nutritional deterioration is associated with increased risk of complications after RC. Our results hint towards the need for nutritional intervention during NAC prior to RC.

315 Cardiac surgery in the elderly: the underestimate role of frailty in the decision making

Abstract Aims Elders represent the most common population with indication to cardiac surgery, also presenting the highest mortality/disability after interventions. Both for valve and coronary artery surgery the estimation of the surgical risk, including the frailty assessment, is recommended to guide the decision making. However, frailty results not exhaustively assessed by the commonly used surgical risk scores such as EuroSCORE I-II and score of the Society of Thoracic Surgeons and is mostly used the Kat’s Index (included in the latest European guidelines). This study aims at establishing the feasibility and the value of a Comprehensive Geriatric Assessment (CGA) in elderly undergoing cardiac surgery. Methods From June 2021we consecutively enrolled 50 elderly patients undergoing cardiac surgery (age &amp;gt; 65 years old). All patients underwent CGA with an expert geriatrician and the demographic, biometrics, clinical and echocardiographic data were collected. We evaluated frailty and disability (Kats index, Barthel Index and Frailty Index FI), cognitive status (Montreal Cognitive Assessment MOCA, Mini Mental State Examination MMSE and Geriatric Depression Scale), physical status (Tinetti test, Short Performance Physical Battery SPPB, Physical Activity Scale for the Elderly PASE and 6-min Walking test), delirium condition, sarcopenia and nutritional status (Mini-Nutritional Assessment MNA). A clinical, echocardiographic, and geriatric 3-month follow-up is planned. In particular, we are evaluating the impact of frailty, assessed by CGA, on peri-surgical outcome and the potential additive value of a CGA on the commonly used surgical risk-scores and Kat’s Index. Furthermore, we are assessing the impact of cardiac surgery of frail elderly at GCA. Results The CGA was feasible in all patients and lasted 1 h/patient. In our baseline data, only 23% of the enrolled patients resulted ‘frail’ according to Kat’s Index. However, in the remaining 77% of the study population, the CGA have identified 30% of patients with increased frailty index and 30% with disability, assessed by Barthel Index and physical function indexes (PASE and SPPB). In these patient, frailty and disability were associated to impaired nutritional status, assessed at MNA. Furthermore, 40% of the patients of this group resulted sarcopenic at the hand grip test. The cognitive valuation has shown a cognitive impairment in the 20% of patients at the MMSE and the 70 % at the MOCA. Of note, the 40% of the patients resulted to suffer of depression, not diagnosed before the GCA. At mid-November 2021 the follow-up will be completed. Conclusions The preliminary results of the presents study suggest that in patients undergoing cardiac surgery frailty is currently underdiagnosed. The follow-up analysis will establish if a CGA has an additive value on common surgical risk estimators. This study has a potential impact on the risk stratification of elderly patients undergoing invasive procedures and defines the need of a geriatrician in the heart team.